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Objective. – To study the impact of an original education program on compliance to hormone replacement therapy (HRT) in post-menopausal women.Methods. – Data were obtained from 1,192 post-menopausal women (age: 53 ± 5 years) included in the study with an onset less than six months: E2 gel (n = 791) or patch (n = 401) + progestins, and randomized in either educational program (Ep = 600) or regular verbal counselling (VC = 592). A patient is considered bad compliant with HRT when she prematurely stopped the study, whatever the reason of the cessation. The groups EP and VC are homogeneous for the age distribution, the HRT regimen, the date of onset and the climateric symptoms scores.Results. – There is a significant difference between EP and VC groups in compliance, respectively 86 and 81% (p < 0.027). This difference is partially explained by the significant improvement in the patch subgroups (EP: 86% versus VC: 77%, p = 0.028). The trend observed in the gel group is not significant (EP: 85% and VC: 82%) due to the high level of compliance usually noticed in women treated with the gel and the verbal counselling. The significative difference in the compliance observed during the verbal counselling between the continuous (76%) and the sequential (86%, p = 0.001) HRT regimen disappears with the educational program (continuous: 84% and sequential: 87%, NS).Conclusion. – This first large study on the HRT compliance in France, using a patient educational material, validates its efficacy to reach a better compliance than with regular verbal counselling. Even though in the daily practice, about 40% of the patients discontinue the treatment during the first year, 81% of the women followed in this study continue to receive the HRT after nine months of use. The original educational program of the COMET study improves significatively this high compliance (+ 5% from the verbal counselling). Thus, the combination of the doctor verbal counselling and an educational material is desirable to obtain a good compliance with HRT. [Copyright &y& Elsevier]

Wide inter-individual variation of expression of compound metabolic enzymes is determined by polymorphism and may predispose the development of diseases provoked by environmental factors. The combined analysis of phase II detoxification system genes: arylamine N-acetyltransferase 2 (NAT2), and glutathione S-transferases (GST) M1 and T1 was carried out in patients with minimal/mild (group I; n = 36) and moderate/severe endometriosis (group II; n = 29) and controls (n = 72) of French origin, using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The results show a significant difference between patients and controls with regard to NAT2 gene polymorphism (P < 0.05). This is mainly due to the high percentage of slow acetylator genotypes (SA) in patients compared with controls (60.0 versus 38.9%; P < 0.02) with a distinct preponderance in subjects with minimal/mild endometriosis (69.4%, P < 0.005) where there is a significantly elevated frequency of slow allele S1 (NAT2*5) (P = 0.05). Significantly increased proportions of GSTM1-deficient genotypes were found in both groups of patients, in comparison with the controls (75.0 and 79.3% versus 45.8%; P < 0.0001). A preponderance of GSTT1-negative subjects among patients was also detected, but did not appear significant. We suggest the involvement of both NAT2 and GSTM1 detoxification system genes in the pathogenesis of endometriosis and the possible impact of NAT2 gene polymorphism in the development of different forms of this disease. [ABSTRACT FROM AUTHOR]

Adequate management of endometriosis by laparoscopy included 3 steps: a laparoscopic diagnosis with peritoneal fluid sampling for cytologic examination and biopsies of implants and of peritoneum to assure a correct diagnosis, a laparoscopic evaluation of extension with the American Fertility Society (AFS) 85 scoring system in order to classify the severity of the disease, and a laparoscopic treatment with the following strategy: drainage of the ovarian endometrioma and careful peritoneal washing, treatment of peritoneal implants, ovariolysis, treatment of the ovarian cysts, hemostasis and peritoneal lavage. Treatment of peritoneal implants is very easily performed by CO2 laser vaporization using a suprapubic puncture. Ovarian endometriomas are treated by laparoscopic cystectomy using a transparietal cystectomy or an intraperitoneal cystectomy. Laser vaporization is used only in case of small ovarian cysts or after an incomplete resection of a large cyst. Results of laparoscopic treatment of endometriosis compare favorably with those obtained with surgical procedures performed by laparotomy with the well known advantage of a laparoscopic approach. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor of the "British Medical Journal" as of March 13, 2004. Comparison of laparoscopic hysterectomy with abdominal hysterectomy.