Publications of Ulysse GASPARD
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See detail"Je ne suis pas enceinte !" A propos du déni de grossesse...
Grobet, Marie ULiege; CAPELLE, Xavier ULiege; Willems, T et al

in Revue Médicale de Liège (2020), 75

The term «denial of pregnancy», although used in current medical practice since 1970, does not yet have a universal definition. The literature allows to define it as «the non-recognition of a pregnancy ... [more ▼]

The term «denial of pregnancy», although used in current medical practice since 1970, does not yet have a universal definition. The literature allows to define it as «the non-recognition of a pregnancy beyond the first trimester, which can last until delivery and cover it». The changes related to pregnancy are biologically reduced or incorrectly perceived or even ignored. Although often wrongly consi- dered as a rare phenomenon, the literature describes it as having a prevalence of 2 to 3 cases per 1.000 viable deliveries. This case report associated with a short review of the literature aims to optimise the clinician awareness, leading to the diagnosis as well as the potential perinatal consequences linked to this phenomenon. [less ▲]

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See detailAsymmetric facial skin viscoelasticity during climacteric aging.
Pierard, Gérald ULiege; Hermanns-Lê, Trinh ULiege; Gaspard, Ulysse ULiege et al

in Clinical, Cosmetic and Investigational Dermatology (2014), 7

BACKGROUND: Climacteric skin aging affects certain biophysical characteristics of facial skin. The purpose of the present study was to assess the symmetric involvement of the cheeks in this stage of the ... [more ▼]

BACKGROUND: Climacteric skin aging affects certain biophysical characteristics of facial skin. The purpose of the present study was to assess the symmetric involvement of the cheeks in this stage of the aging process. METHODS: Skin viscoelasticity was compared on both cheeks in premenopausal and post-menopausal women with indoor occupational activities somewhat limiting the influence of chronic sun exposure. Eighty-four healthy women comprising 36 premenopausal women and 48 early post-menopausal women off hormone replacement therapy were enrolled in two groups. The tensile characteristics of both cheeks were tested and compared in each group. A computerized suction device equipped with a 2 mm diameter hollow probe was used to derive viscoelasticity parameters during a five-cycle procedure of 2 seconds each. Skin unfolding, intrinsic distensibility, biological elasticity, and creep extension were measured. RESULTS: Both biological elasticity and creep extension were asymmetric on the cheeks of the post-menopausal women. In contrast, these differences were more discrete in the premenopausal women. CONCLUSION: Facial skin viscoelasticity appeared to be asymmetric following menopause. The possibility of asymmetry should be taken into account in future studies of the effects of hormone replacement therapy and any antiaging procedure on the face in menopausal women. [less ▲]

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See detailRevisiting the cutaneous impact of oral hormone replacement therapy.
PIERARD, Gérald ULiege; Humbert, Philippe; Berardesca, Enzo et al

in BioMed Research International (2013), 2013(971760),

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See detailLe médicament du mois. Zoely®, une association monophasique d’estradiol et d’acétate de nomégestrol
PINTIAUX, Axelle ULiege; Gaspard, Ulysse ULiege; Nisolle, Michelle ULiege

in Revue Médicale de Liège (2012), 67(3), 152-6

SUMMARY : A new combined oral contraceptive called Zoely® has just been marketed in Belgium. It contains nomegestrol acetate, a progestin known for its high contraceptive reliability based on its ... [more ▼]

SUMMARY : A new combined oral contraceptive called Zoely® has just been marketed in Belgium. It contains nomegestrol acetate, a progestin known for its high contraceptive reliability based on its antigonadotropic power and long half-life. This progestin is associated with estradiol and Zoely® is devoid of ethinyl estradiol, which is the usual component of the majority of combined oral contraceptives and is primarily responsible for thrombotic side effects of the pill. The compositon and type of regimen of this new oral contraceptive contribute to its efficacy and excellent clinical tolerance. [less ▲]

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See detailLe medicament du mois. Femoston Low (0,5 mg d'estradiol plus 2,5 mg de dydrogesterone) comme traitement hormonal de substitution a la menopause.
SCHEEN, André ULiege; Gaspard, Ulysse ULiege

in Revue Médicale de Liège (2011), 66(4), 209-14

Femoston Low is a hormone replacement therapy that combines low dosages of steroids, i.e. 0.5 mg of estradiol and 2.5 mg of dydrogesterone. This oral preparation should be taken continuously to treat ... [more ▼]

Femoston Low is a hormone replacement therapy that combines low dosages of steroids, i.e. 0.5 mg of estradiol and 2.5 mg of dydrogesterone. This oral preparation should be taken continuously to treat climacteric symptoms in menopausal women. Femoston Low is in agreement with the recent recommendations for menopausal hormone replacement therapy, which give the preference to low dosage therapy whenever possible. The goals are to potentially minimize the risk of breast cancer, the danger of venous or arterial thrombosis and the glucose and lipid metabolic disturbances. Nevertheless, the preparation should efficaciously oppose to endometrial hyperplasia and yield a high degree of amenorrhea. [less ▲]

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See detailLe cancer du sein en Belgique: pourquoi sommes-nous les premiers en Europe?
DESREUX, Joëlle ULiege; Gaspard, Ulysse ULiege; BLERET, Valerie ULiege et al

in Revue Médicale de Liège (2011), 66(5-6), 231-7

Breast cancer incidence in Belgium is on the top of European countries, with 9.697 new cases in 2008 and 106/100.000 women/year. The explanation of this high incidence in our country is probably the ... [more ▼]

Breast cancer incidence in Belgium is on the top of European countries, with 9.697 new cases in 2008 and 106/100.000 women/year. The explanation of this high incidence in our country is probably the accumulation of risk factors (many of them are linked to lifestyle), and the impact of screening and registration of cases. The relative impact of each of theses factors is less clear because we don't have powerful statistical studies. Belgium is slightly above the European mean for breast cancer mortality, with 19,4/100.000 women/year and an all stages 15-year survival of 75%. Breast cancers are responsible for around 3% of all-cause mortality in Belgian women. This article discusses the causes of this high Belgian incidence and of current decrease of incidence in western countries, and reviews known and less known risk factors of breast cancers, with a special focus on menopause hormonal treatments. [less ▲]

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See detailLe medicament du mois. Ulipristal acetate: une contraception d'urgence etendue a 5 jours par progesterone receptor modulator (Ellaone).
Gaspard, Ulysse ULiege; Kridelka, Frédéric ULiege

in Revue Médicale de Liège (2010), 65(12), 700-5

Emergency contraception is a second chance for prevention of pregnancy after unprotected intercourse. Hormonal emergency contraception with levonorgestrel 1.5 mg, only provides an effective contraception ... [more ▼]

Emergency contraception is a second chance for prevention of pregnancy after unprotected intercourse. Hormonal emergency contraception with levonorgestrel 1.5 mg, only provides an effective contraception from 0 to 72 hours after intercourse with decreasing effectiveness as time elapses. It was accordingly mandatory to develop an alternative approach with a stable contraceptive efficacy and good tolerance for 5 days, knowing additionally that the estimated lifespan of sperm in the female genital tract is about 5 days. In comparative studies bearing on more than 3000 young women, the progesterone receptor modulator (PRM) ulipristal acetate, a progesterone antagonist (taken in a single dose of 30 mg), or levonorgestrel (1.5 mg) were administered. Results indicated that the PRM was as effective as levonorgestrel, or even more, kept a stable efficacy for 120 hours after an unprotected intercourse, and was well tolerated. This establishes ulipristal acetate as the new standard for hormonal emergency contraception. [less ▲]

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See detailLe médicament du mois. Nouvelle contraception orale combinée au valerate d'estradiol et au dienogest (Qlaira).
Gaspard, Ulysse ULiege; PINTIAUX, Axelle ULiege; Kridelka, Frédéric ULiege

in Revue Médicale de Liège (2010), 65(12), 706-13

In combined oral contraception (OC), a drastic reduction of both ethinylestradiol and androgenic progestins mostly derived from 19 NOR testosterone, allowed to moderately reduce the adverse impact of ... [more ▼]

In combined oral contraception (OC), a drastic reduction of both ethinylestradiol and androgenic progestins mostly derived from 19 NOR testosterone, allowed to moderately reduce the adverse impact of classical combined pills on metabolism and circulation (both arterial and venous). However, the marked hepatic action of ethinylestradiol, even in small dosages, lessens the expected risk reduction. For the first time, an OC has been developed, which contains estradiol valerate (with reduced hepatic action because of lack of a 17alpha ethinyl group) with dienogest, a 19 NOR testosterone-derived nonandrogenic progestin, which powerfully inhibits endometrial proliferation. Thanks to a dynamic modulation of estrogen and progestin doses (26 active days + 2 placebo days), an adequate contraceptive effectiveness, a good cycle control and drug tolerance are achieved, similar to those obtained with a classical low-dose OC. Recent data indicate that this new combination reduces the usually observed metabolic impact. An adequate cycle control (with 20% amenorrhea) is achieved for the first time with estradiol valerate + progestin,, in opposition with prior catastrophic results with other formulations containing 17beta-estradiol. A second combination containing estradiol + nomegestrol acetate (monophasic, 24 active days + 4 placebo days) is under study and seems also to yield promising results. Of course, in-depth study of metabolic and vascular effects of these new combinations is mandatory - and ongoing. [less ▲]

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See detailPeut-on sortir de l'embrouillamini relatif aux contraceptifs oraux et aux cancers cutanés?
Pierard, Gérald ULiege; Pierard, Claudine ULiege; Quatresooz, Pascale ULiege et al

in Revue Médicale de Liège (2007), 62(5-6), 463-6

Skin contains various hormonal receptors, particularly those for estrogens, progesterone and androgens. Steroid hormones of oral contraceptives affect the skin, in particular the control of the cell cycle ... [more ▼]

Skin contains various hormonal receptors, particularly those for estrogens, progesterone and androgens. Steroid hormones of oral contraceptives affect the skin, in particular the control of the cell cycle, DNA replication, apoptosis and other cellular functions. Some estrogen-responsive pathways have the potential to promote tumor development. The question of whether oral contraceptives increase the risk for the development of skin cancer, particularly melanoma, remains an area of concern. There is some evidence that steroid hormones present in oral contraceptives do not significantly increase the risk of developing skin cancer when estrogen exposure is not excessive. [less ▲]

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See detailActualites therapeutiques en gynecologie: pathologies organiques
HERMAN, Philippe ULiege; Lifrange, Eric ULiege; Nisolle, Michelle ULiege et al

in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 414-22

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause ... [more ▼]

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause of gynaecological consultation and the intrauterine progestin delivery system as well as new hysteroscopic procedures have optimized the therapeutic approach to this problem. Introduction of magnetic resonance imaging and interventional procedures have improved breast disease diagnosis and management; likewise sentinel node localization, introduction of aromatase and growth factors inhibitors, new radiotherapy procedures and pharmacogenomics, have helped to ameliorate breast cancer treatment. Pelvic surgery has been switching more and more towards laparoscopic procedures not only in the field of benign lesions (eg endometriosis), of surgery of prolapse and incontinence with new prosthetic materials, but also for an improved management of gynaecological cancers. [less ▲]

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See detailLa peau et le temps de la menopause.
Thirion, Laurence; Franchimont, Claudine ULiege; Arrese Estrada, Jorge ULiege et al

in Revue Médicale de Liège (2006), 61(3), 159-62

The estrogen deficit occurring at menopause manifests itself under various modalities in the diverse organs and their functions. Skin does not escape this global involutive process. In addition to the ... [more ▼]

The estrogen deficit occurring at menopause manifests itself under various modalities in the diverse organs and their functions. Skin does not escape this global involutive process. In addition to the effects of chronological ageing, sunlight exposure and other environmental and endogenous stimuli, the climacteric appears to exert some dramatic consequences on skin biology and aspect. The epidermis, its adnexae and the dermis are altered by this process. The epidermis may become xerotic and exhibits altered functions. The dermis thins out and its elasticity decreases in concert with the decline in bone mass. The skin microcirculation is impaired. These aspects are some of the better-worked out skin climacteric changes of which in turn seem to be stabilized or in part reversible with hormone replacement therapy (HRT). [less ▲]

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See detailLe cas clinique du mois. Remplacement de l'aorte ascendante et conservation de la valve aortique: operation de David
RADERMECKER, Marc ULiege; Pierard, Luc ULiege; GASPARD, Ulysse ULiege et al

in Revue Médicale de Liège (2005), 60(3), 141-3

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic ... [more ▼]

We report the case of an ascending aortic aneurysm involving the aortic root, with a functionally competent bicuspid aortic valve, treated by the David's operation. This operation allows to fix the aortic root pathology, whilst preserving the native aortic valve. The technical aspects, surgical indications, and potential benefits of this operation are reviewed. [less ▲]

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See detailEnvironmental dichlorodiphenyltrichlorethane or hexachlorobenzene exposure and breast cancer: is there a risk?
Charlier, Corinne ULiege; Foidart, Jean-Michel ULiege; Pitance, François ULiege et al

in Clinical Chemistry and Laboratory Medicine (2004), 42(2), 222-227

The carcinogenic potential of environmental xenoestrogens (i.e., organochlorines) is a matter of controversy. Their pathogenic role as promoters in breast cancer has been previously suggested. In Europe ... [more ▼]

The carcinogenic potential of environmental xenoestrogens (i.e., organochlorines) is a matter of controversy. Their pathogenic role as promoters in breast cancer has been previously suggested. In Europe, despite their prohibition since the '70s, residues persist in soil and rivers resulting in a widespread contamination of the general population. In this study, we have compared the serum levels of p,p'-1,1-dichloro-2, 2-bis (4-chlorophenyl) ethylene (DDE) and hexachlorobenzene (HCB) in 231 women at the time of breast cancer discovery and in 290 agematched healthy controls. p,p'-DDE was found in 76.2% of cases and in 71.1% of controls but HCB was present only in 12.6% of cases (29 from 231) and in 8.9% of controls (26 from 290). Even if taking all undetectable results (recorded as "0") into consideration, mean values were significantly different in cases when compared to controls. The serum level of p,p'-DDE was 3.46+/-3.48 ppb (0.58+/-0.58 mug/g lipid) in patients and 1.85+/-2.09 ppb (0.31+/-0.35 mug/g lipid) in controls (p<0.0001). The HCB serum level was 0.66+/-1.25 ppb (0.11+/-0.21 mug/g lipid) in patients and 0.20+/-1.02 ppb (0.03+/-0.17 mug/g lipid) in controls (p<0.0001). When considering p,p'-DDE and HCB as binary variables (1 if higher than the limit of quantification, 0 if lower), the presence of both residues was significantly associated with an increased risk of breast cancer development (OR 2.21, 95% CI 1.41-3.48 for p,p'-DDE and OR 4.99, 95% CI 2.95-8.43 for HCB). No excess was observed among parous women or when familial history of breast cancer was considered. In the cancer group, no differences in serum levels of p,p'-DDE or HCB were found in relation with estrogenreceptor (ER) status, Bloom stage or lymph node metastasis, but the HCB level was moderately correlated with tumor size (p=0.026). [less ▲]

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See detailPlace du traitement substitutif de la menopause 1 an apres la publication des resultats de l'etude WHI (Women's Health Initiative)
Pintiaux, Axelle ULiege; Van den Brule, F.; Foidart, Jean-Michel ULiege et al

in Revue Médicale de Liège (2003), 58(9), 572-5

The currently reported data concerning the large WHI randomized controlled trial compare the impact of continuous combined conjugated estrogens + medroxyprogesterone acetate vs placebo in postmenopausal ... [more ▼]

The currently reported data concerning the large WHI randomized controlled trial compare the impact of continuous combined conjugated estrogens + medroxyprogesterone acetate vs placebo in postmenopausal women. These results appear largely pessimistic. After 5.2 years of hormone replacement, an excess of coronary heart disease, cerebrovascular disease, venous thromboembolism, breast cancer incidence and extension, mild cognitive impairment and dementia is recorded. By contrast, osteoporotic fracture risk and colorectal cancer are decreased during hormone replacement. Accordingly, this hormonal treatment can no longer be recommended on a long term basis, except after extensive risk-benefit balance evaluation. It should no longer be prescribed for prevention of chronic diseases. It remains indicated during 4-5 years for relief of vasomotor symptoms, genital atrophy and, potentially, for some aspects of quality of life. HRT should probably be prescribed in minimal-effective dosages; new regimens, routes of administration, new compounds and associations should be envisaged in order to avoid cardiovascular or breast problems. However these new approaches ask for thorough validation studies. [less ▲]

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See detailBreast cancer and serum organochlorine residues
Charlier, Corinne ULiege; Albert, Adelin ULiege; Herman, Philippe ULiege et al

in Occupational and Environmental Medicine (2003), 60(5), 348-351

Background: Controversy still exists about the breast carcinogenic properties in humans of environmental xenoestrogens (organochlorines), justifying new investigations. Aims: To compare the blood levels ... [more ▼]

Background: Controversy still exists about the breast carcinogenic properties in humans of environmental xenoestrogens (organochlorines), justifying new investigations. Aims: To compare the blood levels of total dichlorodiphenyltrichloroethane (DDT) and hexachlorobenzene (HCB) in samples collected at the time of breast cancer discovery, in order to avoid the potential consequences of body weight change ( after chemotherapy or radiotherapy) on the pesticide residue levels. Methods: Blood levels of HCB and total DDT (we calculated total DDT concentrations by adding all DDT and DDE isomers) were compared in 159 women with breast cancer and 250 presumably healthy controls. Risk of breast cancer associated with organochlorine concentration was evaluated. Results: Mean levels of total DDT and HCB were significantly higher for breast cancer patients than for controls. No differences in serum levels of total DDT or HCB were found between oestrogen receptor positive and oestrogen receptor negative patients with breast cancer. Conclusions: These results add to the growing evidence that certain persistent pollutants may occur in higher concentrations in blood samples from breast cancer patients than controls. [less ▲]

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See detailInteret et limites du depistage de masse du cancer du sein par mammographie seule (mammotest)
Lifrange, Eric ULiege; Bleret, Valerie ULiege; Desreux, Joëlle ULiege et al

in Revue Médicale de Liège (2003), 58(5), 331-7

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of ... [more ▼]

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of mammography screening, if any, is modest and the balance between beneficial (potentially, a 20% relative reduction in breast cancer mortality with no significant benefit on all-cause mortality) and harmful (physical and psychological morbidity related to the 15-40% missed cancers and the 80-90% false-positive diagnoses) effects is still delicate. The mammogram alone is a modest weapon. Concurrent clinical breast examination is mandatory. Women that are concerned about breast cancer should be fully informed of the potential benefits and risks of screening mammography. These women should benefit from mammography with concurrent clinical breast examination, and possible whole-breast ultrasound in heterogeneously dense and extremely dense breast patterns. [less ▲]

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See detailHormonosubstitution postmenopausique et risque de cancer mammaire: une mise a jour
van den Brule, F.; Lifrange, Eric ULiege; Pintiaux, Axelle ULiege et al

in Revue Médicale de Liège (2003), 58(4), 254-60

Numerous studies have examined the risk of breast cancer in patients with postmenopausal hormone substitution. Most of these studies are retrospective, and a few recent studies are prospective. The ... [more ▼]

Numerous studies have examined the risk of breast cancer in patients with postmenopausal hormone substitution. Most of these studies are retrospective, and a few recent studies are prospective. The observed results present with weak variations from baseline and major heterogeneity. Some studies highlight a slightly increased relative risk of breast cancer. A reanalysis of 51 studies demonstrates a relative risk of 1.35 for developing breast cancer during hormone substitution, with a 2.3% increased risk per year of use. Recently, the results of the WHI study have shown a slight increase of some risks of disease, including breast cancer (relative risk, 1.26). These results have induced the interruption of one of the 3 arms of the study (that of the patients treated with an estrogen-progestin combination), and have provoked a new discussion about the benefits and risks associated with hormone substitution. These facts have been largely related and commented in the general press. In this article, we review the important studies concerning this topic. [less ▲]

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See detailA randomized study over 13 cycles to assess the influence of oral contraceptives containing ethinylestradiol combined with drospirenone or desogestrel on carbohydrate metabolism.
Gaspard, Ulysse ULiege; Scheen, André ULiege; Endrikat, J. et al

in Contraception (2003), 67(6), 423-9

In this open-label, randomized study we compared the influence of a new oral contraceptive containing 30 microg ethinylestradiol and 3 mg drospirenone (Yasmin) with a reference preparation containing 30 ... [more ▼]

In this open-label, randomized study we compared the influence of a new oral contraceptive containing 30 microg ethinylestradiol and 3 mg drospirenone (Yasmin) with a reference preparation containing 30 microg ethinylestradiol and 150 microg desogestrel (Marvelon) on variables of carbohydrate metabolism by means of oral glucose tolerance tests at baseline and in the 6th and 13th treatment cycle. The mean levels of fasting glucose and insulin were similar at baseline and after 13 treatment cycles, whereas C-peptide and free fatty acid levels decreased slightly in both groups. All blood glucose and insulin values measured in the oral glucose tolerance tests were within normal ranges, despite a slight increase in the mean areas under the curves of 0-3 h [AUCs (0-3 h)] of both variables from baseline to treatment cycle 13. Differences between both treatments were not statistically significant. The mean AUCs (0-3 h) for C-peptide were not markedly changed in any treatment group. Free fatty acid levels decreased by 42% in the drospirenone group and increased by 48.9% in the desogestrel group, in terms of means of individual changes. Both preparations were well tolerated and equally efficacious regarding contraception and cycle control. The mean body weight was slightly decreased in most cycles during treatment with the drospirenone combination, as compared to baseline, while it was slightly increased versus baseline in all cycles during treatment with the desogestrel combination. The combination with drospirenone had less impact on blood pressure than the combination with desogestrel. In conclusion, Yasmin, a combined low-dose oral contraceptive with 30 microg ethinylestradiol and 3 mg of the novel progestogen drospirenone, as well as the reference Marvelon, containing 30 microg ethinylestradiol and 150 microg desogestrel had little impact on carbohydrate metabolism when used for 1 year. The observed changes were small and not suggestive of a clinically relevant deterioration of carbohydrate metabolism. [less ▲]

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See detailL'etude clinique du mois. Balance benefice/risque du traitement oestroprogestatif postmenopausique en peril dans l'etude Women's Health Initiative: attitude pratique du clinicien
Gaspard, Ulysse ULiege; van den Brule, F.; PINTIAUX, Axelle ULiege et al

in Revue Médicale de Liège (2002), 57(8), 556-62

The Women's Health Initiative (WHI) is sponsored by the NIH. The study focuses on risk and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colon cancer, and ... [more ▼]

The Women's Health Initiative (WHI) is sponsored by the NIH. The study focuses on risk and benefits of strategies that could potentially reduce the incidence of heart disease, breast and colon cancer, and fractures in postmenopausal women. One arm of the study, a double-blind, placebo-controlled trial, looking at the effects of continuous combined estrogen-progestin regimen was stopped prematurely based on health risks which exceeded health benefits. The main reason for this decision was the increase in risk of invasive breast cancer, as well as a slight increase in the rate of myocardial infarction and stroke. In this paper, we inform our colleagues of the detailed results of the study. We comment on its limitation and discuss the new original observations. Finally, we integrate the others to previous world literature data that are confirmed by the WHI study. It is important for the individual prescribing practitioner to issue practical conclusions and therapeutic recommendations. The department of Obstetrics and Gynaecologic of the University of Liege, in agreement with the European Menopause Society and the International Menopause Society, is convinced that there is no alternative to the hormone replacement therapy for menopausal symptoms. We should stick to the traditional indications for hormones, namely vasomotor symptoms and osteoporosis. We should continue to recommend hormones for symptomatic women. One should realize that the risk for breast cancer appears only after several years of use, and the risk for cardiovascular events below age 60 is very small (the age of the patients was 63 at inclusion in the WHI study). We should encourage women to take the necessary measures for routine, periodic breast examinations (both manual, echographic and radiographic). Women who use HRT for more than 5 years should discuss the latest data of the WHI study with their physician, in order to consider their individual benefit-risk equation. Those who feel good on hormones and are fully satisfied with this treatment should learn of possible harm after long-term use. It is important to take into account the importance of quality of life. We should leave to the patient the final decision whether or not to continue the treatment. It is presently impossible to decide whether other estroprogestin associations, other administration routes and other molecules such as estradiol, natural progesterone or other progestins, SERMS and Tibolone could have an impact very different from that of the estroprogestin combination used in the WHI study. It is the duty of every physician to decide, from the complex epidemiological data obtained in the aged women (63-68 years) with a high cardiovascular risk in the WHI study, if it is possible or not in each individual case to recommend the initiation or pursue of an hormone replacement therapy. [less ▲]

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See detailRandomized controlled study of the influence of two low estrogen dose oral contraceptives containing gestodene or desogestrel on carbohydrate metabolism.
Ludicke, Frank; Gaspard, Ulysse ULiege; Demeyer, Fabienne ULiege et al

in Contraception (2002), 66(6), 411-5

This study compared the impact on carbohydrate metabolism of two combinedoral contraceptives (COCs). This open-label, single-center trial enrolled participants for a total of 15 cycles. Thirty-six women ... [more ▼]

This study compared the impact on carbohydrate metabolism of two combinedoral contraceptives (COCs). This open-label, single-center trial enrolled participants for a total of 15 cycles. Thirty-six women were randomized to receive either 20 microg ethinyl estradiol (EE) and 75 microg gestodene (GSD) or 20 microg ethinyl estradiol and 150 microg desogestrel (DSG) daily for 21 days out of 28. A glucose tolerance test was performed at baseline and cycles 6 and 13. The area under the curve (AUC) for glucose increased in both study groups. The change was statistically significant (p = 0.036) for the 20 EE/75 GSD group at cycle 6 versus baseline. Fasting blood glucose at cycle 13 was significantly (p < 0.01) higher for both treatment groups compared to baseline. No changes were found for fasting insulin and fasting C-peptide levels or for the AUCs of insulin or C-peptide. Both regimens were well tolerated. Gestodene and desogestrel in combination with 20-microg ethinyl estradiol induce similar changes in carbohydrate metabolism which are smaller than those described earlier for COCs containing higher estrogen doses or more androgenic progestins such as levonorgestrel. [less ▲]

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