[Use of nomegestrol acetate in the treatment of menstruation disorders. Our experience in 56 cases]

OBJECTIVE

To investigate tolerability and efficacy of nomegestrol acetate, a new 19-nor-progesterone derivative, in the treatment of oligomenorrhea and amenorrhea; to compare this drug with didrogesteron, a widely-used spatial isomer of progesterone.

METHODS

56 women, aged 22 to 50, affected by menstrual disorders or premenstrual syndrome, entered the study. They were divided in two homogeneous groups by randomization. In the first group nomegestrol acetate was administered 5 mg daily per os; in the second group patients were treated by the usual didrogesteron dose, that is 10 mg twice a day per os; both treatments were administered for 10 days from day 16, during three consecutive menstrual cycles. Efficacy, compliance and biological tolerance were evaluated.

RESULTS

24 patients in the group treated by nomegestrol acetate and 22 in the group treated by didrogesteron completed the study. After the first cycle of therapy, nomegestrol acetate showed a higher efficacy in reducing menstrual loss; results are statistically homogeneous in the two groups at the end of the study. There were no reports of pain in both the groups. Evaluation of biological and clinical parameters at the end of the study did not show significant modifications in any subject.

CONCLUSIONS

Nomegestrol acetate is an innovative and efficient molecule in the treatment of menstrual disorders. A good response to the drug is evident in a short time and with very low doses; its good compliance, if compared with other progesteron-derivatives, indicates nomegestrol acetate as a first-line therapy for polymenorrhea, olygomenorrhea and premenstrual syndrome.

[Preliminary experience with a new tumor marker in obstetrics and gynecology: UGP (Urinary Gonadotropin Protein)]

AIM

To evaluate the use of UGP (urinary gonadotropin protein) as a tumor marker in gynaecologic and obstetric malignant diseases.

MATERIALS AND METHODS

The study was carried out in the division of Gynaecology and Obstetrics of the Ospedali Riuniti in Bergamo. 63 patients, with obstetric or gynaecologic benign or malignant diseases, entered the study. 66 healthy volunteers were examined as a group-control. In both the groups UGP levels were determined in morning urine, using an immunoenzymatic commercial kit.

RESULTS

Results, expressed in fmol UGP/ml of urin, show that UGP is produced by several neoplasms, but the false-positive percentage is still high; a higher precision can be obtained with an accurate choice of the cut-off value and with a standardization of the analytical technics. Besides, the contemporary determination of UGP and CA 125 levels reduces the possibility of false-positive and false-negative results.

CONCLUSIONS

More studies must be carried out to confirm the value of UGP as a tumor marker in obstetrics and gynaecology. Anyway, this recently purified protein can already be useful, in combination with the usual tumor markers, in the prompt diagnosis and management of primary neoplasms or recurrences, with a higher sensibility in comparison with traditional clinical and radiological examinations.

[Pelvic exenteration in gynecologic oncologic surgery]

Six cases of pelvic exenteration, performed between 1 January 1987 and 30 June 1989 in the Obstetric-Gynecological Division of the Ospedali Riuniti of Bergamo are reported. Indications, surgical methods and complications are analysed in comparison to published data. From an analysis of our data it may also be concluded that pelvic exenteration has a role in the treatment of persistent and recurrent gynecological tumors, provided that patients are carefully selected.

[Stage IB (FIGO) cervical carcinoma. Treatment and prognosis]

Twenty-six cases of stage IB (FIGO) cancer of the uterine cervix seen at the 1st Obstetric-Gynaecological Division of the United Hospitals of Bergamo in 1987-88 have been analysed. The therapeutic approach is discussed with special regard to the indications for radical surgery, which is the treatment of choice in 84% of cases. In addition, among the various risk factors, the presence of lymph node metastases is considered with particular attention as this reduces survival by 50%.