Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses. Although testosterone has a role in erections, its importance in erectile dysfunction (ED) has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate, but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of 178 men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Sexual function improved in 75%, with no change in 25%, while significant increases in luteinizing hormone (Po0.001) and free testosterone (Po0.001) occurred in all patients. Multivariable analysis showed that responses decreased significantly with aging (Po0.05). Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use. Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.

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Las pacientes con cáncer ginecológico viven diferentes situaciones de angustia desde el inicio de la enfermedad hasta el final de la vida. Los cuidados paliativos se han definido como un enfoque integral que mejora la calidad de vida de las pacientes y sus familiares, mediante la prevención y el alivio del sufrimiento, cuando se dispone de identificación temprana, evaluación y tratamiento oportuno. Aunque los cánceres ginecológicos surgen de órganos anatómicamente adyacentes, presentan síntomas y patrones de progresión diferentes, siendo necesaria la adopción de estrategias paliativas individualizadas para cada uno de ellos.

La obstrucción intestinal maligna (OIM) asociada a cáncer ginecológico, es un cuadro clínico que acarrea gran morbilidad y mortalidad. El tratamiento conservador es la piedra angular en la OIM cuando no se sospechan signos clínicos de perforación o isquemia. La terapia multimodal es la base del tratamiento y consiste en la administración de forma combinada de glucocorticoides, opioides, antieméticos e inclusive fármacos antisecretores, que logran un control de los síntomas.