Objective: The clinical and histological efficacy of gestrinone in the treatment of endometriosis was evaluated. Methods: A prospective study was performed with longitudinal follow-up of 4 years duration (minimum) for each patient. Twenty-five cases of endometriosis were treated with gestrinone (as a drug of choice or associated with other local surgical treatment) during 6 months. Results: The total or partial response to pain was induced with treatment in 19 of the 20 cases (95%), and posttreatment pregnancies were induced in 3 of the 9 cases of infertility (33.3%). The global clinical efficacy was as follows: none (n = 5,20%), poor (n = 2, 8%), moderate (n = 2, 8%), good (n = 3, 12%) and excellent (n = 13, 52%). The pretreatment American Fertility Society score was 23.1 ± 3.8 points (2–58) and that after treatment (re-examination) 7.8 ± 3.7 points (0–52), p < 0.01. Global histological efficacy (n = 17) results were as follows: none (23.6%), poor (0%), moderate (5.8%), good (35.3%) and excellent (35.3%). Conclusions: Gestrinone is presented as a drug with an efficacy comparable to other pharmacological agents currently available in the medical treatment of endometriosis. Adequate posology and acceptable effectiveness were also observed.
Introdução: A síndroma do túnel cárpico (STC) é causada pela compressão do nervo mediano no seu trajeto através do túnel cárpico e é a neuropatia mais frequente do membro superior. Objetivo: Rever e analisar a evidência atual sobre a eficácia dos corticoides orais no alívio dos sintomas em pacientes com síndroma do túnel cárpico. Material e métodos: Pesquisa de guidelines (GL), ensaios clínicos aleatorizados e controlados (ECA), revisões sistemáticas (RS) e meta-análises (MA), publicadas entre 2009 e 2019, nas bases de dados e sítios de medicina baseada na evidência da PubMed, da Cochrane Library, DARE, Bandolier, TRIP Database, BMJ Evidence-Based Medicine, National Guideline Clearinghouse, NICE, Canadian Medical Association Practice Guidelines Infobase e Primary Care Clinical Practice Guidelines, utilizando-se os descritores MeSH: ‘carpal tunnel syndrome’ e ‘corticosteroids’. Foi aplicada a escala Strength of Recommendation Taxonomy (SORT), da American Academy of Family Physicians, para atribuição dos níveis de evidência (NE) e das forças de recomendação (FR). Resultados: Dos 172 artigos devolvidos da pesquisa efetuada foram selecionados seis: um ECA, quatro RS e uma norma de orientação clínica (NOC). A eficácia dos corticoides orais a curto-médio prazo no alívio sintomático da STC é evidenciada por vários ECA e RS metodologicamente bem concebidos. Na maioria dos estudos a administração oral de 20mg de prednisolona por duas semanas conduz ao alívio temporário dos sintomas. Conclusões: A corticoterapia oral pode ser usada no alívio temporário dos sintomas do STC a curto prazo, num regime de 20mg diários de prednisolona durante duas semanas (SORT A). O seu uso no tratamento a médio e a longo prazo apresenta um nível de evidência mais baixo (SORT B).
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