The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
J J Walker - One of the best experts on this subject based on the ideXlab platform.
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Uterine ultrasonographic changes with gonadotropin-releasing Hormone Agonists.
American journal of obstetrics and gynecology, 1999Co-Authors: A D Weeks, S R Duffy, J J WalkerAbstract:Our purpose was to assess the changes in uterine volume and uterine artery pulsatility index in response to gonadotropin-releasing Hormone agonist treatment in women undergoing hysterectomy for nonfibroid-related uterine bleeding. A double-blind, placebo-controlled randomized trial of 51 women awaiting hysterectomy in a gynecology outpatient clinic was conducted. The women were treated for 8 weeks with either leuprolide acetate depot or placebo. Vaginal ultrasonographic examinations were performed before and after treatment. The paired t test was used for statistical analysis. In those allocated to therapy with gonadotropin-releasing Hormone agonist the mean uterine volume decreased by 34% and the uterine artery pulsatility index increased from 2.25 to 2.7. No significant changes were seen in the placebo group. The intersonographer variability was low and there was a high correlation between uterine size as measured by ultrasonography before hysterectomy and that measured postoperatively. Treatment with gonadotropin-releasing Hormone Agonists leads to uterine shrinkage and an increase in the uterine artery pulsatility index even in the absence of uterine fibroids.
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Uterine ultrasonographic changes with gonadotropin-releasing Hormone Agonists.
American Journal of Obstetrics and Gynecology, 1999Co-Authors: Andrew Weeks, Sean Duffy, J J WalkerAbstract:Abstract Objectives: Our purpose was to assess the changes in uterine volume and uterine artery pulsatility index in response to gonadotropin-releasing Hormone agonist treatment in women undergoing hysterectomy for nonfibroid-related uterine bleeding. Study Design: A double-blind, placebo-controlled randomized trial of 51 women awaiting hysterectomy in a gynecology outpatient clinic was conducted. The women were treated for 8 weeks with either leuprolide acetate depot or placebo. Vaginal ultrasonographic examinations were performed before and after treatment. The paired t test was used for statistical analysis. Results: In those allocated to therapy with gonadotropin-releasing Hormone agonist the mean uterine volume decreased by 34% and the uterine artery pulsatility index increased from 2.25 to 2.7. No significant changes were seen in the placebo group. The intersonographer variability was low and there was a high correlation between uterine size as measured by ultrasonography before hysterectomy and that measured postoperatively. Conclusions: Treatment with gonadotropin-releasing Hormone Agonists leads to uterine shrinkage and an increase in the uterine artery pulsatility index even in the absence of uterine fibroids. (Am J Obstet Gynecol 1999;180:8-13.)
Alaa Mosbah - One of the best experts on this subject based on the ideXlab platform.
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Aromatase inhibitors or gonadotropin-releasing Hormone Agonists for the management of uterine adenomyosis: a randomized controlled trial.
Acta obstetricia et gynecologica Scandinavica, 2012Co-Authors: Ahmed Badawy, Aboubakr Elnashar, Alaa MosbahAbstract:OBJECTIVE To compare the efficacy of aromatase inhibitor vs. gonadotrophin-releasing Hormone Agonists in treating premenopausal women with uterine adenomyosis. DESIGN A prospective randomized controlled study. SETTING A university hospital and a private practice setting. POPULATION Thirty-two patients with uterine adenomyosis. METHODS Patients were randomly allocated to receive oral letrozole (2.5 mg/day) or a subcutaneous gonadotropin-releasing Hormone agonist (goserelin, 3.6 mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks. OUTCOME MEASURES Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated. RESULTS No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0 cm(3) vs. 21.7, 15.1 and 11.7 cm(3) , at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment. CONCLUSIONS Aromatase inhibitors are as effective as gonadotropin-releasing Hormone Agonists in reducing adenomyoma volume and improving symptoms.
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Aromatase inhibitors or gonadotropin-releasing Hormone Agonists for the management of uterine adenomyosis: a randomized controlled trial.
Acta obstetricia et gynecologica Scandinavica, 2012Co-Authors: Ahmed Badawy, Aboubakr Elnashar, Alaa MosbahAbstract:To compare the efficacy of aromatase inhibitor vs. gonadotrophin-releasing Hormone Agonists in treating premenopausal women with uterine adenomyosis. A prospective randomized controlled study. A university hospital and a private practice setting. Thirty-two patients with uterine adenomyosis. Patients were randomly allocated to receive oral letrozole (2.5 mg/day) or a subcutaneous gonadotropin-releasing Hormone agonist (goserelin, 3.6 mg) for 12 weeks. Uterine and adenomyoma volumes were determined at baseline and during treatment at four, eight and 12 weeks. Measurements were performed at baseline and during treatment at four, eight 8 and 12 weeks, and mean values were calculated. Symptoms at the start and after 12 weeks were evaluated. No significant differences in the total uterine size between the post treatment uterine volumes in the two groups (20.1, 15.4 and 13.0 cm(3) vs. 21.7, 15.1 and 11.7 cm(3) , at four, eight and 12 weeks, respectively). Total adenomyoma volume decreased by 8.6, 29.7 and 40.9% vs. 5.7, 34.6 and 49.1% after four, eight and 12 weeks of treatment, in group A and B, respectively. Two patients became pregnant in group A during treatment. Aromatase inhibitors are as effective as gonadotropin-releasing Hormone Agonists in reducing adenomyoma volume and improving symptoms. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
G. David Adamson - One of the best experts on this subject based on the ideXlab platform.
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Treatment of uterine fibroids: Current findings withgonadotropin-releasing Hormone Agonists
American journal of obstetrics and gynecology, 1992Co-Authors: G. David AdamsonAbstract:The gonadotropin-releasing Hormone Agonists have potential benefit as presurgical adjuncts in the management of uterine leiomyomas or fibroids. Uterine fibroids contain estrogen receptors and are responsive to therapeutic hormonal manipulation; gonadotropin-releasing Hormone Agonists are effective by inducing a state of hypoestrogenism. Clinical trials with gonadotropin-releasing Hormone Agonists consistently have demonstrated efficacy for decreasing both myoma size and uterine volume. The advantages of the preoperative use of gonadotropin-releasing Hormone Agonists include a reduction in uterine and myoma size and vascularity and potentially improved operative technique and uterine cavity integrity. Ongoing clinical trials will be needed to confirm the role of gonadotropin-releasing Hormone Agonists in the treatment of uterine fibroids.
Peer Briken - One of the best experts on this subject based on the ideXlab platform.
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treatment of paraphilic disorders in sexual offenders or men with a risk of sexual offending with luteinizing Hormone releasing Hormone Agonists an updated systematic review
The Journal of Sexual Medicine, 2018Co-Authors: Daniel Turner, Peer BrikenAbstract:Abstract Background Different pharmacologic agents are used in the treatment of paraphilic disorders in sexual offenders or men with a risk of sexual offending, with luteinizing Hormone-releasing Hormone (LHRH) Agonists being the agents introduced more recently to treatment regimens. Aim To summarize the relevant literature concerning LHRH agonist treatment of paraphilic disorders in sexual offenders and update the previously published systematic review by Briken et al (J Clin Psychiatry 2003;64:890–897). Methods The PubMed and Google Scholar databases were searched for literature published from January 2003 through October 2017 using the following key words: LHRH Agonists, GnRH Agonists, antiandrogens AND paraphilia, pedophilia, sex offenders. Outcomes Evaluation of the effectiveness and side effects of LHRH agonist treatment of paraphilic disorders in sexual offenders. Results After screening for duplicates and applying specific selection criteria, the search yielded 24 eligible studies reporting on a sample of 256 patients. There is increasing evidence that LHRH Agonists are more effective than steroidal antiandrogens in lowering paraphilic sexual thoughts and behaviors. Current research also is based on methods that might be less susceptible to faking (eg, eye-tracking, brain imaging, and viewing-time measures). Side effects occurring most frequently are fatigue, hot flashes, depressive mood, weight gain, high blood pressure, diabetes, gynecomastia, loss of erectile function, and loss of bone mineral density. Clinical Implications Although LHRH Agonists seem to be the most effective drugs in the treatment of paraphilic fantasies and behaviors, they should be reserved for patients with a paraphilic disorder and the highest risk of sexual offending because of their extensive side effects. Strengths and Limitations This systematic review considers all types of research on LHRH agonist treatment in patients with paraphilic disorders, thereby providing a complete overview of the current state of research. However, most studies are case reports or observational studies and randomized controlled clinical trials have not been conducted or published. Conclusions LHRH Agonists are a useful treatment when combined with psychotherapy in patients with a paraphilic disorder and the highest risk of sexual offending. However, throughout treatment, close monitoring of side effects is needed and ethical concerns must always be kept in mind. Turner D, Briken P. Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review. J Sex Med 2018;15:77–93.
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treatment of paraphilia with luteinizing Hormone releasing Hormone Agonists
Journal of Sex & Marital Therapy, 2001Co-Authors: Peer Briken, Evangelia Nika, Wolfgang BernerAbstract:Up to now there have been no published results of therapy of paraphilia (for example, pedophilia or sadism) and sexual aggressive impulsiveness with luteinizing Hormone-releasing Hormone (LHRH) Agonists in the German-speaking countries. After a short intoduction about physiologic features and the present state of investigations in treatment of paraphilia with LHRH Agonists we describe 11 patients who were treated with the LHRH agonist Leuprolide Acetate over a period of 12 months. The patients showed no tendency toward sexually aggressive behavior and reported an evident reduction of penile erection, ejaculation, masturbation, sexually deviant impulsiveness, and fantasies. One patient died from suicide. In combination with other treatments, LHRH Agonists seem to be a very promising alternative to cyproterone acetate and its possible carcinogene effects.
Joerg J Meerpohl - One of the best experts on this subject based on the ideXlab platform.
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non steroidal antiandrogen monotherapy compared with luteinizing Hormone releasing Hormone Agonists or surgical castration monotherapy for advanced prostate cancer a cochrane systematic review
BJUI, 2015Co-Authors: Frank Kunath, Henrik R Grobe, Gerta Rucker, Edith Motschall, Gerd Antes, Philipp Dahm, Bernd Wullich, Joerg J MeerpohlAbstract:To assess the effects of non-steroidal antiandrogen monotherapy compared with luteinizing Hormone-releasing Hormone Agonists or surgical castration monotherapy for treating advanced Hormone-sensitive stages of prostate cancer. We searched the Cochrane Prostatic Diseases and Urologic Cancers Group Specialized Register (PROSTATE), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science with Conference Proceedings, three trial registries and abstracts from three major conferences to 23 December 2013, together with reference lists, and contacted selected experts in the field and manufacturers. We included randomized controlled trials comparing non-steroidal antiandrogen monotherapy with medical or surgical castration monotherapy for men in advanced Hormone-sensitive stages of prostate cancer. Two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, extracted data and assessed risk of bias as well as quality of evidence according to the GRADE working group guidelines. We used Review Manager 5.2 for data synthesis and the fixed-effect model as primary analysis (when heterogeneity was low with I(2) < 50%); we used a random-effects model when confronted with substantial or considerable heterogeneity (when I(2) ≥50%). A total of 11 studies involving 3060 randomly assigned participants were included in the present review. Use of non-steroidal antiandrogens resulted in lower overall survival times (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.05-1.48, six studies, 2712 participants) and greater clinical progression (1 year: risk ratio [RR] 1.25, 95% CI 1.08-1.45, five studies, 2067 participants; 70 weeks: RR 1.26, 95% CI 1.08-1.45, six studies, 2373 participants; 2 years: RR 1.14, 95% CI 1.04-1.25, three studies, 1336 participants), as well as treatment failure (1 year: RR 1.19, 95% CI 1.02-1.38, four studies, 1539 participants; 70 weeks: RR 1.27, 95% CI 1.05-1.52, five studies, 1845 participants; 2 years: RR 1.14, 95% CI 1.05-1.24, two studies, 808 participants), compared with medical or surgical castration. The quality of evidence for overall survival, clinical progression and treatment failure was rated as moderate according to GRADE. Use of non-steroidal antiandrogens increased the risk for treatment discontinuation as a result of adverse events (RR 1.82, 95% CI 1.13-2.94, eight studies, 1559 participants), including events such as breast pain (RR 22.97, 95% CI 14.79- 35.67, eight studies, 2670 participants) and gynaecomastia (RR 8.43, 95% CI 3.19-22.28, nine studies, 2774 participants) The risk of other adverse events, such as hot flushes (RR 0.23, 95% CI 0.19-0.27, nine studies, 2774 participants) was decreased when non-steroidal antiandrogens were used. The quality of evidence for breast pain, gynaecomastia and hot flushes was rated as moderate according to GRADE. The effects of non-steroidal antiandrogens on cancer-specific survival and biochemical progression remained unclear. Non-steroidal antiandrogen monotherapy compared with medical or surgical castration monotherapy for advanced prostate cancer is less effective in terms of overall survival, clinical progression, treatment failure and treatment discontinuation resulting from adverse events. Evidence quality was rated as moderate according to GRADE; therefore, further research is likely to have an important impact on results for patients with advanced but non-metastatic prostate cancer treated with non-steroidal antiandrogen monotherapy.
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non steroidal antiandrogen monotherapy compared with luteinising Hormone releasing Hormone Agonists or surgical castration monotherapy for advanced prostate cancer
Cochrane Database of Systematic Reviews, 2014Co-Authors: Frank Kunath, Henrik R Grobe, Gerta Rucker, Edith Motschall, Gerd Antes, Philipp Dahm, Bernd Wullich, Joerg J MeerpohlAbstract:Background Non-steroidal antiandrogens and castration are the main therapy options for advanced stages of prostate cancer. However, debate regarding the value of these treatment options continues. Objectives To assess the effects of non-steroidal antiandrogen monotherapy compared with luteinising Hormone–releasing Hormone Agonists or surgical castration monotherapy for treating advanced stages of prostate cancer. Search methods We searched the Cochrane Prostatic Diseases and Urologic Cancers Group Specialized Register (PROSTATE), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science with Conference Proceedings, three trial registries and abstracts from three major conferences to 23 December 2013, together with reference lists, and contacted selected experts in the field and manufacturers. Selection criteria We included randomised controlled trials comparing non-steroidal antiandrogen monotherapy with medical or surgical castration monotherapy for men in advanced stages of prostate cancer. Data collection and analysis One review author screened all titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Then, two review authors independently examined full-text reports, identified relevant studies, assessed the eligibility of studies for inclusion, assessed trial quality and extracted data. We contacted the study authors to request additional information. We used Review Manager 5 for data synthesis and used the fixed-effect model for heterogeneity less than 50%; we used the random-effects model for substantial or considerable heterogeneity. Main results Eleven studies involving 3060 randomly assigned participants were included in this review. The quality of evidence is hampered by risk of bias. Use of non-steroidal antiandrogens decreased overall survival (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.05 to 1.48, six studies, 2712 participants) and increased clinical progression (one year: risk ratio (RR) 1.25, 95% CI 1.08 to 1.45, five studies, 2067 participants; 70 weeks: RR 1.26, 95% CI 1.08 to 1.45, six studies, 2373 participants; two years: RR 1.14, 95% CI 1.04 to 1.25, three studies, 1336 participants), as well as treatment failure (one year: RR 1.19, 95% CI 1.02 to 1.38, four studies, 1539 participants; 70 weeks: RR 1.27, 95% CI 1.05 to 1.52, five studies, 1845 participants; two years: RR 1.14, 95% CI 1.05 to 1.24, two studies, 808 participants), compared with medical or surgical castration. The quality of evidence for overall survival, clinical progression and treatment failure was rated as moderate according to GRADE. Predefined subgroup analyses showed that use of non-steroidal antiandrogens, compared with castration, was less favourable for overall survival, clinical progression (at one year, 70 weeks, two years) and treatment failure (at one year, 70 weeks, two years) in men with metastatic disease. Use of non-steroidal antiandrogens also increased the risk for treatment discontinuation due to adverse events (RR 1.82, 95% CI 1.13 to 2.94, eight studies, 1559 participants), including events such as breast pain (RR 22.97, 95% CI 14.79 to 35.67, eight studies, 2670 participants), gynaecomastia (RR 8.43, 95% CI 3.19 to 22.28, nine studies, 2774 participants) and asthenia (RR 1.77, 95% CI 1.36 to 2.31, five studies, 2073 participants). The risk of other adverse events, such as hot flashes (RR 0.23, 95% CI 0.19 to 0.27, nine studies, 2774 participants), haemorrhage (RR 0.07, 95% CI 0.01 to 0.54, two studies, 546 participants), nocturia (RR 0.38, 95% CI 0.20 to 0.69, one study, 480 participants), fatigue (RR 0.52, 95% CI 0.31 to 0.88, one study, 51 participants), loss of sexual interest (RR 0.50, 95% CI 0.30 to 0.83, one study, 51 participants) and urinary frequency (RR 0.22, 95% CI 0.11 to 0.47, one study, 480 participants) was decreased when non-steroidal antiandrogens were used. The quality of evidence for breast pain, gynaecomastia and hot flashes was rated as moderate according to GRADE. The effects of non-steroidal antiandrogens on cancer-specific survival and biochemical progression remained unclear. Authors' conclusions Currently available evidence suggests that use of non-steroidal antiandrogen monotherapy compared with medical or surgical castration monotherapy for advanced prostate cancer is less effective in terms of overall survival, clinical progression, treatment failure and treatment discontinuation due to adverse events. Evidence quality was rated as moderate according to GRADE. Further research is likely to have an important impact on results for patients with advanced but non-metastatic prostate cancer treated with non-steroidal antiandrogen monotherapy. However, we believe that research is likely not necessary on non-steroidal antiandrogen monotherapy for men with metastatic prostate cancer. Only high-quality, randomised controlled trials with long-term follow-up should be conducted. If further research is planned to investigate biochemical progression, studies with standardised follow-up schedules using measurements of prostate-specific antigen based on current guidelines should be conducted.