Gonadotrophin-releasing hormone agonist therapy for hirsutism is as effective as high dose cyproterone acetate but results in a longer remission

Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone agonist (GnRHa) have been shown to be effective for the treatment of hirsutism. We wished to compare the effectiveness of CPA in two standard doses with GnRHa and add-back therapy and to compare the length of remission after these treatments. A total of 60 hirsute hyperandrogenic women was assigned to the following treatment groups: CPA 2 mg with 35 microg of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg, days 5-15, and ethinylestradiol 50 microg, days 5-25, each month (CPA group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate 10 mg, days 12-21 (GnRHa group). Hirsutism was graded by the Ferriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters and serum luteinizing hormone (LH) and testosterone were assessed before and every 3 months during and after treatment. All women were treated for 1 year with 1 year follow-up. At baseline hirsutism and endocrine patterns were similar in all groups. After one year of treatment, hirsutism decreased in all groups but the changes were greater (P <0.05) in the CPA and GnRHa groups than in the Diane group. Serum LH and testosterone were lowest in the GnRHa group. After withdrawal, hirsutism increased rapidly in the Diane and CPA groups and after 6 months, FGL scores and hair shaft diameters were similar to pretreatment values. In the GnRHa group, hirsutism increased more gradually and after 1 year of withdrawal, FGL scores and hair diameters were significantly (P <0.05) less than pretreatment values. Serum LH and testosterone increased rapidly in all three groups reaching pretreatment values by 6 months. These data suggest equal efficacy of the GnRHa and the high dose CPA regimen for the treatment of hirsutism in hyperandrogenic women. GnRHa with add-back treatment appears to result in a longer remission of hirsutism in comparison with CPA.      

Cancer of the hypopharynx — A clinical study of 290 cases

Between 1986–1990, 290 patients with squamouscell carcinoma of the hypopharynx were assessed at the S. S. K. M. Hospital Calcutta, out of the total of 1460 number of Head Neck cancer, (19.8%). The most frequent initial symptom was a foreign body sensation in the throat (70%), and males were affected more than females (9.8 : 1.2). The peak age incidence was found between 40 and 50 years (24%). Most of the patients came in advanced stages with cervical lymph node metastases (60%). One interesting fact that came out from the present study is the Right pyriform fassa was more commonly affected than the left in righthanded persons (56.9%). Though the reason is not clear it could be due to right — sided swallow, as one side may be predominant in funtion.     

Declining age of menarche in West Bengal

A steady fall in menarcheal age has been observed in many countries during this century. A study on 894 school girls of different parts of West Bengal was carried out by recollection method to verify whether the decline in menarcheal age is existing in West Bengal or not. Evidence of steady fall of menarcheal age has been confirmed in the present study.