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1.
Acta Paediatr ; 107(12): 2152-2157, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29791055

RESUMO

AIM: This study investigated whether a high birth weight was associated with increased risk factors for cardiovascular disease when Swedish adults reached 34-40. METHODS: We studied 27 subjects born at Uppsala University Hospital in 1975-1979, weighing at least 4500 g, and compared them with 27 controls selected by the Swedish National Board of Welfare with birth weights within ±1 standard deviations scores and similar ages and gender. The study included body mass index (BMI), blood pressure, lipid profile, haemoglobin A1c (HbA1c), C-reactive protein (CRP) and high-frequency ultrasound measurements of intima-media thickness, intima thickness (IT) and intima:media ratio of the carotid and radial arteries. RESULTS: Subjects with a high birth weight did not differ from controls with regard to BMI, blood pressure, lipid profile, high-sensitivity CRP, HbA1c or carotid artery wall dimensions. However, their radial artery intima thickness was 37% greater than the control group and their intima:media ratio was 44% higher. CONCLUSION: Our findings indicate that a high birth weight was associated with increased radial artery intima thickness, but not with other investigated cardiovascular risk factors, at 34-40 years of age. The clinical implications of these findings should be investigated further, especially in subjects born with a very high birth weight.


Assuntos
Peso ao Nascer , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , Artéria Radial/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Fatores de Risco
2.
Ultrasound Obstet Gynecol ; 50(1): 93-99, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27256927

RESUMO

OBJECTIVE: Pre-eclampsia (PE) is associated with an increased risk of cardiovascular disease later in life. In cases with PE there is a substantial increase in levels of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) and decreased levels of the proangiogenic factor placental growth factor (PlGF). Elevated levels of sFlt-1 are also found in individuals with cardiovascular disease. The aims of this study were to assess levels of sFlt-1, PlGF and the sFlt-1/PlGF ratio and their correlation with signs of arterial aging by measuring the common carotid artery (CCA) intima and media thicknesses and their ratio (I/M ratio) in women with and without PE. METHODS: Serum sFlt-1 and PlGF levels were measured using commercially available enzyme-linked immunosorbent assay kits, and CCA intima and media thicknesses were estimated using high-frequency (22-MHz) ultrasonography in 55 women at PE diagnosis and in 64 women with normal pregnancy at a similar gestational age, with reassessment at 1 year postpartum. RESULTS: During pregnancy, higher levels of sFlt-1, lower levels of PlGF, a thicker intima, a thinner media and a higher I/M ratio of the CCA were found in women with PE vs controls (all P < 0.0001). Further, sFlt-1 and the sFlt-1/PlGF ratio were positively correlated with intima thickness and I/M ratio (all P < 0.0001). At 1 year postpartum, levels of sFlt-1 and the sFlt-1/PlGF ratio had decreased in both groups; however, their levels in the PE group were still higher than in the controls (P = 0.001 and < 0.0001, respectively). Levels of sFlt-1 and the sFlt-1/PlGF ratio remained positively correlated with intima thickness and I/M ratio at 1 year postpartum. CONCLUSIONS: Higher sFlt-1 levels and sFlt-1/PlGF ratio in women with PE were positively associated with signs of arterial aging during pregnancy. At 1 year postpartum, sFlt-1 levels and the sFlt-1/PlGF ratio were still higher in the PE group and were associated with the degree of arterial aging. © 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.


Assuntos
Biomarcadores/sangue , Artéria Carótida Primitiva/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Envelhecimento , Artéria Carótida Primitiva/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/fisiopatologia , Gravidez , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue
3.
Ultrasound Obstet Gynecol ; 43(6): 675-80, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24375803

RESUMO

OBJECTIVE: To assess whether thicknesses of the intima and media in the common carotid artery (CCA) and the intima/media ratio (I/M) indicate an increased cardiovascular risk in non-pregnant women with a history of previous severe pre-eclampsia. METHODS: Thicknesses of the CCA intima and media layers were measured using non-invasive high-frequency (22 MHz) ultrasound in 42 women with a history of severe pre-eclampsia and 44 women with previous normal pregnancy. RESULTS: Women with a history of severe pre-eclampsia had a thicker CCA intima and a higher I/M than had women with previous normal pregnancy, also after adjustment for mean arterial pressure, body mass index and CCA intima-media thickness (IMT) (all P < 0.0001). CCA-IMT did not differ significantly between groups. In receiver-operating characteristics curve analysis, intima thickness and I/M clearly discriminated between women with and those without previous pre-eclampsia (area under the receiver-operating characteristics curve (AUC), 0.98 and 0.93), whereas CCA-IMT did not (AUC, 0.52). CONCLUSIONS: CCA individual intima and media thicknesses as well as I/M, but not CCA-IMT, reflect the known increased long-term cardiovascular risk of pre-eclampsia. Estimation of individual CCA layers using high-frequency ultrasound appears preferable to measuring CCA-IMT for investigating arterial effects and the increased cardiovascular risk in women with a history of severe pre-eclampsia.


Assuntos
Doenças das Artérias Carótidas/patologia , Artéria Carótida Primitiva/patologia , Pré-Eclâmpsia/patologia , Complicações Cardiovasculares na Gravidez/patologia , Adulto , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Pré-Eclâmpsia/diagnóstico por imagem , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Curva ROC , Fatores de Risco , Túnica Íntima/patologia , Túnica Média/patologia
4.
Scand J Rheumatol ; 40(4): 279-82, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21469940

RESUMO

OBJECTIVE: To determine whether high-frequency ultrasound (US) yielding separate assessments of intima and media thickness gives additional information about the vascular morphology compared with the total common carotid artery intima-media thickness (CCA-IMT). METHODS: Using a 22 MHz US instrument, we determined the near-wall CCA-IMT, the intima and media layers, and the intima/media (I/M) ratio in 47 premenopausal women with systemic lupus erythematosus (SLE), 20 healthy women, and 17 postmenopausal women (mean ages 37, 40, and 69 years, respectively). RESULTS: In SLE, the carotid intima was thicker (0.19 ± 0.04 vs. 0.12 ± 0.02 mm), the media thinner (0.45 ± 0.12 vs. 0.68 ± 0.24 mm), the I/M ratio higher (0.45 ± 0.17 vs. 0.20 ± 0.07) (all p < 0.0001), and the CCA-IMT lower (0.64 ± 0.13 vs. 0.80 ± 0.25 mm, p < 0.01) compared to age-matched controls. The SLE patients had a thicker carotid intima compared to the postmenopausal women (0.19 ± 0.04 vs. 0.14 ± 0.03 mm, p < 0.0001) and a similar I/M ratio. CONCLUSION: Separate assessment of carotid artery wall layers demonstrated a thicker intima, thinner media, and a higher I/M ratio in women with SLE compared to healthy controls and indicated an artery wall status in SLE comparable to 30-years-older healthy women. Separate estimates of carotid intima and media layers may be preferable to CCA-IMT in SLE patients.


Assuntos
Artérias Carótidas/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Pré-Menopausa , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Índice de Gravidade de Doença , Ultrassonografia/métodos
5.
Climacteric ; 13(3): 228-37, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20423243

RESUMO

OBJECTIVE: The objective of the study was to evaluate the endometrial safety of a 10 microg estradiol vaginal tablet in the treatment of vaginal atrophy in postmenopausal women. METHODS: A total of 336 healthy, non-hysterectomized, postmenopausal women (age 59.5 +/- 6.16 years, 9.4 +/- 5.9 years from last menses) were treated with a 10 microg estradiol vaginal tablet for 12 months (once daily for 2 weeks and then twice weekly for 50 weeks). Endometrial histology was analyzed at baseline and at the end of the trial. RESULTS: Of the 336 enrolled subjects, 292 (86.9%) completed the 52-week study. All 336 subjects received an endometrial biopsy at baseline, and 283 had biopsy results at week 52, when 258 out of the 283 biopsy samples were classified as 'atrophic' or 'inactive' endometrium. There were 21 with 'no tissue' despite a repeat biopsy attempt to obtain endometrial tissue, one had insufficient tissue with endometrial thickness >4 mm, one was 'weakly proliferative' and two revealed polyps. No cases of endometrial hyperplasia or endometrial cancer were reported. The mean endometrial thickness decreased from 2.04 mm (n = 334) from study start to 1.94 mm (n = 293) after 52 weeks, and the estradiol levels remained at the low postmenopausal level. CONCLUSIONS: After 12 months of treatment with the 10 microg estradiol vaginal tablet, there was no suggestion of endometrial stimulation and no cases of endometrial hyperplasia or cancer reported. This study provides reassuring data on the endometrial safety of treatment with the 10 microg estradiol vaginal tablet for 1 year in a large group of postmenopausal, non-hysterectomized women with vaginal atrophy.


Assuntos
Endométrio/diagnóstico por imagem , Endométrio/patologia , Estradiol/administração & dosagem , Estrogênios/administração & dosagem , Vagina/patologia , Administração Intravaginal , Atrofia , Biópsia , Estradiol/efeitos adversos , Estradiol/sangue , Estrogênios/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa , Ultrassonografia
6.
Placenta ; 26(5): 410-8, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15850646

RESUMO

Impaired placentation and oxidative stress are proposed to play major roles in the pathogenesis of placental dysfunction and pre-eclampsia. This study was carried out to evaluate if inhibited angiogenesis by Suramin injections in early pregnancy may cause a condition resembling pre-eclampsia in rats. Rats of two different Sprague-Dawley strains, U and H, were given intraperitoneal injections of Suramin or saline in early pregnancy. The outcome of pregnancy was evaluated on gestational day 20. Suramin injections caused increased blood pressure and decreased renal blood flow in the U rats. In both rat strains Suramin decreased the placental blood flow and caused fetal growth retardation. In both strains the placental concentration of the isoprostane 8-epi-PGF2alpha was increased, indicating oxidative stress. The serum concentration of Endothelin-1 was increased in the U rats. The U strain had a lower basal placental blood flow, and the effects of Suramin were more pronounced in this strain. We conclude, that Suramin injections to pregnant rats cause a state of placental insufficiency, which partly resembles human pre-eclampsia. The induction of this condition is at least partly mediated by oxidative stress, and is subject to varied genetic susceptibility.


Assuntos
Inibidores da Angiogênese/toxicidade , Placenta/efeitos dos fármacos , Placenta/fisiopatologia , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/fisiopatologia , Suramina/toxicidade , Animais , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Eletrólitos/sangue , Endotelina-1/sangue , Feminino , Humanos , Isoprostanos/metabolismo , Lipídeos/sangue , Nitritos/sangue , Placenta/irrigação sanguínea , Gravidez , Resultado da Gravidez , Proteinúria/etiologia , Ratos , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional/efeitos dos fármacos , Circulação Renal/efeitos dos fármacos , Aumento de Peso/efeitos dos fármacos
7.
J Clin Endocrinol Metab ; 86(6): 2757-62, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11397883

RESUMO

To determine whether ultra-low doses of estradiol (E(2)) affect the serum lipid profile in elderly women, we analyzed changes in serum lipids and lipoproteins in 70 healthy women, 60 yr and older, randomly assigned to parenteral E(2) (7.5 microg per 24 h) delivered by a vaginal ring (Estring; Pharmacia-Upjohn, Malmö, Sweden) or no treatment for 12 months. Baseline serum estrone sulfate (E1S), but not E(2) or serum FSH, was negatively associated with serum total cholesterol (P = 0.026), low-density lipoprotein (LDL) cholesterol (P = 0.053), and apolipoprotein B levels (P = 0.023). Compared with no treatment, Estring treatment yielded nonsignificant increases within the normal postmenopausal range in serum E1S (+16%) and E(2) (+13%), but significantly reduced serum LDL cholesterol by 7.6% (-0.32 mmol/L; 95% confidence interval, -0.58, -0.07; P = 0.014) and LDL to high-density lipoprotein (HDL) ratio by 7.3% (-0.19 mmol/L; 95% confidence interval, -0.44, -0.06; P = 0.030). In Estring users values were significantly reduced in total cholesterol (by 4%), LDL cholesterol (by 7%), LDL to HDL ratio (by 7%), and apolipoprotein B (by 4%), and significantly increased in serum HDL triglyceride (by 25%) but not triglycerides. No significant changes were found in the untreated group. There was a significant interaction between age and both baseline serum E(2)/sex hormone-binding globulin (P = 0.006) and sex hormone-binding globulin (P = 0.009) and a marginal interaction between age and E1S (P = 0.083) with regard to effects on changes in LDL cholesterol levels during Estring treatment. We conclude that ultra-low doses of E(2), which previously were considered to have only local effects, may improve serum lipid profile in elderly women with a pattern and magnitude similar to that reported after conventional estrogen doses or first-generation lipid-lowering agents. The reduction in LDL cholesterol tended to be greater with a combination of high age and low baseline levels of biologically active estrogens.


Assuntos
Estradiol/administração & dosagem , Lipídeos/sangue , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Relação Dose-Resposta a Droga , Estradiol/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Valores de Referência , Globulina de Ligação a Hormônio Sexual/análise , Triglicerídeos/sangue
8.
J Clin Epidemiol ; 53(8): 832-7, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10942866

RESUMO

To determine the risk of developing a first myocardial infarction after a hysterectomy and/or oophorectomy. Case-cohort analysis performed among 17,126 women in the Uppsala Health Care Region of Sweden, who had undergone a hysterectomy and/or oophorectomy in 1965 to 1983. Record linkage was used for follow-up and medical records to ascertain the actual history of oophorectomy. Risk estimates were calculated by relating the observed number of cases in the cohort to that expected on the basis of incidence rates in the population. Overall, 214 cases of myocardial infarction were observed. In premenopausal women a bilateral oophorectomy alone tended to increase the relative risk 1.6; 95% CI 0.8-3.1, but this operation combined with hysterectomy increased the risk only among those aged 50 and over at surgery. Hysterectomy at premenopausal age or unilateral oophorectomy did not alter the risk of myocardial infarction. In naturally menopausal women, hysterectomy-mainly for uterine myoma-was associated with a four-fold increase in relative risk (3.8; 95% CI 1.9-7.8). Hysterectomy for treatment of myoma performed after a natural menopause is linked to an excess risk for myocardial infarction. Bilateral oophorectomy before menopause may increase the risk of myocardial infarction.


Assuntos
Histerectomia/efeitos adversos , Infarto do Miocárdio/epidemiologia , Ovariectomia/efeitos adversos , Adulto , Estudos de Coortes , Feminino , Humanos , Leiomioma/cirurgia , Masculino , Menopausa , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Neoplasias Uterinas/cirurgia , Saúde da Mulher
9.
Int J Epidemiol ; 21(4): 636-42, 1992 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1521965

RESUMO

The effect of excessive endogenous oestrogens on the risk of hip fracture was investigated in a population-based cohort of 2111 women with endometrial carcinoma who were followed up from age 50 years regarding the occurrence of a first hip fracture. Overall, 77 cases of hip fracture were observed, as against 120.8 expected, which meant a significantly reduced relative risk, standardized incidence ratio (SIR) = 0.6, 95% confidence interval (CI): 0.5-0.8. This possible protective effect was significant for cervical fractures, SIR = 0.6 (95% CI: 0.4-0.8), but not for trochanteric, SIR = 0.8 (95% CI: 0.5-1.1). Age at endometrial cancer diagnosis was not a determinant of the risk of hip fracture. A lowered relative risk was present regardless of age at diagnosis and persisted during the entire follow-up period and into advanced ages. A case-control analysis within the cohort, and based on medical record data, indicated that a higher weight might be associated with a greater protective effect, as compared with a lower weight. Exposure to exogenous oestrogens was infrequent and could not have explained the present results. We conclude that persistent influence of oestrogens, notably of endogenous origin, can reduce the risk of hip fractures, and that this protective effect may be long-lasting and extend to advanced ages.


Assuntos
Neoplasias do Endométrio/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco
10.
Psychopharmacology (Berl) ; 155(3): 292-8, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11432692

RESUMO

RATIONALE: It is well established that serotonin reuptake inhibitors (SRIs) are effective for the treatment of premenstrual dysphoria (PMD), but the receptor subtype(s) mediating this effect of serotonin have yet not been identified. OBJECTIVE: In this trial, the possible efficacy of buspirone, a partial 5HT1A receptor agonist, and nefazodone, a combined SRI and 5HT2 receptor antagonist, was evaluated in women with PMD. METHODS: After a three-menstrual-cycle screening phase, patients were randomised to buspirone (n=19), nefazodone (n=22) or placebo (n=22). During the first two treatment cycles, patients were taking the drug during the luteal phase only (mean +/- SD daily dose of buspirone: 21 +/- 6 mg; nefazodone: 228 +/- 54 mg). During the subsequent two cycles, the medication was taken each day of the menstrual cycle (mean daily dose of buspirone: 27 +/- 10 mg; nefazodone: 304 +/- 95 mg). RESULTS: With respect to self-rated global improvement, buspirone (P<0.001) but not nefazodone was significantly superior to placebo. While buspirone appeared to reduce self-rated irritability (visual analogue scale) more effectively than placebo, other self-rated symptoms did not differ markedly between the groups. The side-effects were mild, and sexual dysfunction was not significantly more common in patients given buspirone or nefazodone than in those given placebo. CONCLUSION: It is suggested that buspirone is mildly effective for premenstrual irritability. In patients experiencing sexual dysfunction when treated with an SRI, buspirone may be a useful alternative.


Assuntos
Buspirona/uso terapêutico , Síndrome Pré-Menstrual/tratamento farmacológico , Receptores de Serotonina/efeitos dos fármacos , Agonistas do Receptor de Serotonina/uso terapêutico , Triazóis/uso terapêutico , Adulto , Buspirona/administração & dosagem , Buspirona/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Piperazinas , Síndrome Pré-Menstrual/psicologia , Escalas de Graduação Psiquiátrica , Agonistas do Receptor de Serotonina/administração & dosagem , Agonistas do Receptor de Serotonina/efeitos adversos , Resultado do Tratamento , Triazóis/administração & dosagem , Triazóis/efeitos adversos
11.
Obstet Gynecol ; 97(3): 327-32, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11239631

RESUMO

OBJECTIVE: To compare carotid vascular resistance in long-term estrogen users with that of age-matched nonusers. METHODS: Pairwise comparisons between 18 long-term users of 17beta-estradiol (E2) implants (mean age 67.8 years, mean duration of treatment 18.8 years, range 5.8-33.9 years) and 18 age-matched (+/- 2 years) nonusers. We used color Doppler ultrasound to assess pulsatility index (PI) and resistance index (RI) in common, external, and internal carotid arteries. RESULTS: Estrogen users compared with age-matched nonusers had significantly lower mean values for common carotid RI, -4%; -0.04 (95% confidence interval [CI] -0.07, -0.03, P =.036) and marginally significant for PI, -12%; -0.25 (95% CI -0.54, 0.04, P =.087). Differences in external and internal carotids were smaller and insignificant. Age was a determinant of internal carotid vascular resistance in estrogen users and nonusers. Increasing pairwise differences in external carotid vascular resistance with advancing age (r = 0.55; P =.02), with magnitudes of mean group differences indicate a modest but true effect of long-term estrogen therapy on vascular resistance in common carotids, less in external, and negligible in internal carotid arteries. The study had an 80% power to detect a 10% mean difference (0.08 units) in common carotid RI at the 5% level. The standard deviation was considerably lower for estimates of RI than for PI. CONCLUSION: Long-term estrogen therapy was associated with minor reduction of vascular resistance in common carotid, less in external, and negligible in internal carotid arteries. Effects on carotid vascular resistance do not seem to be a major mechanism in the long-term protective effect of estrogen therapy on cardiovascular risk.


Assuntos
Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/fisiologia , Estradiol/farmacologia , Terapia de Reposição de Estrogênios , Resistência Vascular , Idoso , Doenças Cardiovasculares/prevenção & controle , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Estradiol/sangue , Feminino , Humanos , Fluxo Pulsátil , Ultrassonografia Doppler em Cores
12.
Steroids ; 64(4): 266-72, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10399883

RESUMO

An in vitro method for measuring aromatase cytochrome P450 enzyme (P450AROM) in human granulosa cells (GC) has been developed, based on binding of the 11C-labeled aromatase inhibitor vorozole. GC were obtained following superstimulation during in vitro fertilisation. The method revealed a binding affinity (Kd) of 0.4 nM and a maximum binding (Bmax) at 11 fmol/4000 cells which is equal to 1.6 million binding sites per cell. Linear Scatchard plots indicated a single type of binding site. P450AROM concentrations measured by [11C]vorozole binding correlated positively with aromatisation of [1beta-3H]androst-4-ene-3,17-dione measured as [3H]water release, and a positive association was also found with the ovarian in vivo response to follicle-stimulating hormone (FSH) stimulation expressed as 1000 times the ratio of the number of oocytes recovered from a patient and the total dose of recombinant FSH administered. Frozen cells could be used for P450AROM quantitation, provided the correct freezing procedure was used. Quantitation of P450AROM, based on binding of [11C]vorozole is an accurate and sensitive in vitro method, which might be extended to the measurement of aromatase expression by a noninvasive technique in the intact ovary in vivo using positron emission tomography.


Assuntos
Aromatase/análise , Inibidores Enzimáticos/metabolismo , Células da Granulosa/enzimologia , Triazóis/metabolismo , Aromatase/metabolismo , Inibidores da Aromatase , Radioisótopos de Carbono , Feminino , Humanos
13.
Contraception ; 52(1): 35-9, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8521712

RESUMO

The question of differential effects on bone density by two different types of progestogen-only methods for contraception in premenopausal women was addressed. Data from a prospective randomized clinical trial among 22 premenopausal women, age 32.6 (range 20-45 years), who were randomly assigned to either of two treatments with continuous progestogens for contraception were analyzed; depot-medroxyprogesterone acetate (DMPA) or continuous levonorgestrel treatment with subdermal implants (Norplant), respectively. Forearm bone density (BMDprox) increased with 2.94% (p = 0.006) in women who were prescribed levonorgestrel, which was in contrast to stable values in those prescribed depot-medroxy-progesterone acetate; group difference at 6 months for BMDprox 3.4% (95% CI 1.3, 5.5; p = 0.025) and BMDdist 4.1% (95% CI - 1.3, 9.6; p = 0.077). The changes in bone density were consistent with the changes in biochemical indices for bone metabolism; DMPA users showed signs of increased bone turnover and users of levonorgestrel showed increased bone formation with increased levels of both alkaline phosphatase (p = 0.004) and osteocalcin (p = 0.007). The findings suggest an increase in bone density during treatment with levonorgestrel and stable values during short-term administration of DMPA, in standard clinical doses for contraception.


PIP: Researchers randomly allocated 22 premenopausal women aged 20-45 to treatment with either Depo-Provera (150 mg depot-medroxyprogesterone acetate [DMPA] injected intramuscularly every 3 months) or Norplant (30-60 g levonorgestrel/day during 1st year of use) to determine the differences in the short-term effects (at 6 months) on bone mass and bone metabolism. The women, clients of the Family Planning Unit of the University Hospital in Uppsala, Sweden, gave their informed consent to try either of the types of continuous progestogen contraception. The researchers examined biochemical indices for bone metabolism. Alkaline phosphatase and osteocalcin increased significantly in the levonorgestrel group (1.88-2.26 mckat/l [p = 0.004] and 1.22-3.05 mcg/l [p = 0.007], respectively). DMPA increased bone turnover (serum calcium: 2.33-2.38 [p = 0.038]; urine hydroxyproline/creatinine ratio: 12.1-24) and bone formation (serum osteocalcin: 1.2-1.61). Women treated with levonorgestrel experienced a 2.94% increase in forearm bone mineral density (BMDprox) (p = 0.006), while women treated with DMPA experienced an insignificant 0.41% decrease in BMDprox. These changes in BMDprox corresponded with the changes in the biochemical indices for bone metabolism. These findings reveal that treatment with levonorgestrel at standard clinical doses for contraception increases bone density, while treatment with DMPA at standard clinical doses for contraception does not affect bone density.


Assuntos
Densidade Óssea/efeitos dos fármacos , Anticoncepcionais Orais/farmacologia , Pré-Menopausa/fisiologia , Progestinas/farmacologia , Adulto , Fosfatase Alcalina/metabolismo , Densidade Óssea/fisiologia , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/metabolismo , Osso e Ossos/fisiologia , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/farmacologia , Preparações de Ação Retardada , Implantes de Medicamento , Feminino , Antebraço , Humanos , Levanogestrel/administração & dosagem , Levanogestrel/farmacologia , Medroxiprogesterona/administração & dosagem , Medroxiprogesterona/farmacologia , Pessoa de Meia-Idade , Osteocalcina/metabolismo , Progestinas/administração & dosagem , Estudos Prospectivos , Fatores de Tempo
14.
Ultrasound Med Biol ; 27(6): 751-6, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11516534

RESUMO

To validate estimates of the arterial wall thickness and its separate layers, 19 superficial (7 femoral and 12 cutaneous) arteries were transcutaneously sonographed in 13 anaesthetized pigs with a high-resolution equipment fitted with a 25 MHz frequency probe. Means of ultrasonographic estimates of each wall layer were compared with those obtained from microscopy of the respective arterial specimens taken after the pigs were sacrificed. For all vessels combined, Spearman-rank correlation tests between ultrasonography and histology estimates were significant for total arterial wall thickness (r(s) = 0.78; p =.0001) but not for the separate layers. For the cutaneous arteries, a significant correlation was found for total arterial wall thickness (r(s) = 0.69; p =.01) and media layer (r(s) = 0.76; p =.004). The method seems to give valid estimates of both total arterial wall and media thickness in superficial arteries, but to be less accurate for estimate the adventitia and intima layers.


Assuntos
Artérias/diagnóstico por imagem , Animais , Artérias/anatomia & histologia , Artéria Femoral/anatomia & histologia , Artéria Femoral/diagnóstico por imagem , Pele/irrigação sanguínea , Suínos , Túnica Íntima/anatomia & histologia , Túnica Íntima/diagnóstico por imagem , Túnica Média/anatomia & histologia , Túnica Média/diagnóstico por imagem , Ultrassonografia
15.
Physiother Res Int ; 4(1): 43-54, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10368838

RESUMO

BACKGROUND AND PURPOSE: Recent studies have indicated that oestrogens might have an effect on postural control. The purpose of this study was to investigate the short-term effect of hormone replacement therapy (HRT) on postural control in menopausal women and to analyse the correlation between sway velocity measures and results of functional balance tests. SUBJECTS: 100 menopausal women who were randomized to receive either HRT or placebo for three months were included in the study. METHOD: The balance function was measured with nine different static and dynamic functional balance tests. The sway velocities were measured on a computerized force platform. RESULTS: No significant differences were found between the two groups in the results of the functional balance tests after the three-month placebo-controlled period or in the changes over time. However, some significant improvements occurred within both groups over this three-month period. The correlations between different sway velocities and the results of the functional balance tests were all very low (r < 0.35). CONCLUSION: It can not be concluded that HRT had a positive effect on the performance in the functional balance tests, as some improvement occurred in both groups. The low correlations indicate that the sway velocity and functional balance tests measure different aspects of balance function.


Assuntos
Terapia de Reposição de Estrogênios , Estrogênios/farmacologia , Equilíbrio Postural/efeitos dos fármacos , Análise de Variância , Método Duplo-Cego , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Postura , Caminhada/fisiologia
16.
Clin Endocrinol (Oxf) ; 40(6): 783-9, 1994 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8033370

RESUMO

OBJECTIVE: When the gonadotrophin levels increase at midcycle, more basic isoforms of FSH and LH appear in the circulation. However, when these gonadotrophins increase at menopause more acidic forms appear. The present study was done to see whether chronic 17 beta-oestradiol (E2) administration to post-menopausal women could counteract the formation of the more acidic isoforms after the menopause. DESIGN: Serum samples were obtained from 16 post-menopausal women, mean age 70 years (range 63-84 years), 46-169 days after the subcutaneous insertion of a 20-mg E2-implant. FSH, LH and E2 in the sera were measured with fluoroimmunoassays. The median charge and the degree of charge heterogeneity of the FSH and LH isoforms were determined for each serum by electrophoresis in 0.1% agarose suspension. Sera from an age-matched control group were analysed in parallel. RESULTS: The E2 levels in the E2-treated women were 230-570 pmol/l, within the range expected during the mid-luteal phase of the normal menstrual cycle. The mean serum FSH and LH levels were similar to normal follicular phase FSH and LH levels (8.6 and 20.8% respectively of the control group). It was estimated that individual serum specimens from both groups contained 20-30 different isoforms for both FSH and LH. The median charges of the isoforms of FSH and LH were more basic in all the E2-treated subjects than in their corresponding untreated controls. The mean median charge for FSH was close to the values for the follicular and luteal phases and that for LH close to that for the luteal phase. In some E2-treated women the isoforms were even more basic with a charge similar to that at the midcycle peak. The degree of charge heterogeneity for the E2-treated group was significantly (P < 0.001) larger than for the controls and similar to that during the normal menstrual cycle. CONCLUSION: Chronic E2 administration to post-menopausal women counteracted the formation of more acidic isoforms of both FSH and LH after the menopause.


Assuntos
Estradiol/uso terapêutico , Terapia de Reposição de Estrogênios , Gonadotropinas Hipofisárias/sangue , Menopausa/sangue , Idoso , Idoso de 80 Anos ou mais , Implantes de Medicamento , Eletroforese em Gel de Ágar , Estradiol/sangue , Feminino , Fluorimunoensaio , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Pessoa de Meia-Idade , Valores de Referência
17.
Acta Orthop Scand ; 63(5): 552-4, 1992 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-1441956

RESUMO

In a prospective population-based investigation, we measured bone mineral density (BMD) of the forearm using single-photon absorptiometry at both a distal and a more proximal site in 74 Colles'-fracture patients who were compared with controls matched for age, sex, and years after menopause. For both groups there was a marked inverse relationship between age and bone mass. However, over the entire age range, the probands had 11 percent reduced BMD when compared with the controls. Our findings confirm that patients with fracture of the distal forearm have reduced BMD. They constitute an appropriate group for studies aimed at prevention of fracture in the elderly.


Assuntos
Densidade Óssea , Fratura de Colles/etiologia , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton , Fatores Etários , Idoso , Fratura de Colles/epidemiologia , Fratura de Colles/prevenção & controle , Feminino , Humanos , Masculino , Osteoporose/complicações , Osteoporose/patologia , Vigilância da População , Estudos Prospectivos , Cintilografia , Análise de Regressão , Fatores de Risco , Suécia/epidemiologia
18.
Osteoporos Int ; 5(3): 205-10, 1995 May.
Artigo em Inglês | MEDLINE | ID: mdl-7655182

RESUMO

To compare heel ultrasound values with bone densities at different measurement sites as determined by single photon absorptiometry (SPA) and dual-energy X-ray absorptiometry (DXA) in long-term users of estrogen replacement therapy (ERT), we analyzed data from 30 users of estradiol implants (mean duration of treatment 16 years) and 32 non-users, comprising 28 complete age-matched pairs. The precision errors in vivo of ultrasound measurements were 0.18%, 1.3% and 1.5% for speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index, respectively. In the controls, ultrasound parameters correlated well with values from SPA and DXA measurements (r = 0.51-0.63, p < 0.004). In long-term users of ERT, however, measurements with ultrasound did not correlate with DXA in the spine and hip (r = 0.01-0.31, NS) but correlated well with SPA in the forearm (r = 0.47-0.66, p < 0.009). Implant users, compared with non-users, had small and just significantly different values when measured by ultrasound (at most 12%, p = 0.03-0.04) but significantly higher bone mineral densities (18%-25%, p = 0.0001-0.01) in the forearm, spine and hip when measured by SPA or DXA. Data indicated that a substantial proportion of long-term users of estrogen may be non-responders concerning the effect of estrogen on bone qualities expressed in heel ultrasound values. In a multivariate regression analysis the effect of increasing age and increasing treatment duration were both negative for the ultrasound parameters.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Terapia de Reposição de Estrogênios , Absorciometria de Fóton , Idoso , Densidade Óssea/efeitos dos fármacos , Implantes de Medicamento , Estradiol/administração & dosagem , Estradiol/uso terapêutico , Estudos de Avaliação como Assunto , Feminino , Antebraço , Quadril , Humanos , Coluna Vertebral , Fatores de Tempo , Ultrassonografia
19.
Am J Obstet Gynecol ; 177(1): 115-9, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9240593

RESUMO

OBJECTIVES: Our purpose was to assess whether an ultralow dose of parental estradiol, aimed for treatment of vaginal atrophy, affects bone metabolism and bone density. STUDY DESIGN: Thirty healthy women > or = 60 years old were randomly assigned to a 6-month treatment with either an ultralow dose of parenteral estradiol (7.5 microg/24 hours) delivered by vaginal rings or no treatment in the proportion 2:1. RESULTS: Forearm bone density increased in estradiol users by 2.1% (95% confidence interval 0.4 to 3.8, p = 0.008), contrasting to a decrease in nonusers of -2.7% (95% confidence interval -5.9 to 0.4, p = 0.077). In analysis of variance the changes in the two study groups differed significantly (p = 0.0004). Consistently, serum alkaline phosphatases, bone-specific alkaline phosphatases, and osteocalcin concentrations decreased in the treatment group (8%, p = 0.019; 14%, p = 0.0006; and 9%, p = 0.02, respectively), suggesting reduced bone turnover. No significant changes were found in nonusers. CONCLUSION: Ultralow doses of estradiol may potentially prevent bone loss in women > or = 60 years old.


Assuntos
Envelhecimento/fisiologia , Estradiol/uso terapêutico , Osteoporose Pós-Menopausa/prevenção & controle , Administração Intravaginal , Idoso , Fosfatase Alcalina/sangue , Análise de Variância , Atrofia , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Osso e Ossos/metabolismo , Cálcio/sangue , Relação Dose-Resposta a Droga , Estradiol/administração & dosagem , Estradiol/farmacologia , Estrona/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Pessoa de Meia-Idade , Osteocalcina/sangue , Osteoporose Pós-Menopausa/sangue , Osteoporose Pós-Menopausa/fisiopatologia , Doenças Vaginais/tratamento farmacológico , Doenças Vaginais/patologia
20.
Clin Endocrinol (Oxf) ; 44(6): 651-8, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8759177

RESUMO

OBJECTIVE: It has previously been shown that 17 beta-oestradiol (E2) implants counteract the formation of more acidic isoforms of the gonadotrophins in post-menopausal women. A much lesser effect was observed on the charge of the gonadotrophin isoforms in women with chronic oral daily therapy with 2 mg E2 combined with a progestogen, 1 mg norethisterone acetate (NETA), in spite of similar serum levels of E2 and SHBG. The presence of the progestogen in the latter study may explain the difference observed. The present study investigated the effect of the progestogen NETA on the charge and concentration of serum FSH and LH in E2 implant treated women. DESIGN: A group of 8 post-menopausal women, mean age 65 years (range 50-80 years) treated with 20 mg E2 implants every 6 months, participated in the study. The women were given a daily oral medication of 5 mg NETA for a 4-week period starting at 4 weeks after the insertion of an E2 implant (mean serum E2 420 pmol/l). This treatment with NETA was repeated in 6 of the women starting at 18 weeks after the insertion of the E2 implant (mean serum E2 317 pmol/l). Blood samples were obtained at the start of the NETA therapy, after 2 and 4 weeks of treatment and at 4 weeks after the last NETA treatment. The effects of NETA therapy on the charge of the serum gonadotrophin isoforms was determined by electrophoresis in 0.1% agarose suspension and FSH, LH, E2, and SHBG were determined with fluoroimmunoassays. RESULTS: The NETA treatment decreased the serum FSH and LH levels after 2 weeks to 24 and 23% of the levels before NETA and after 4 weeks to 14.6 and 8.8%, which were 1.3 and 2.2% of the mean levels for non-treated post-menopausal women. Both FSH and LH isoforms became more acidic during the first 2 weeks of treatment. During the following 2 weeks of NETA treatment the isoforms of both FSH and LH became more basic again. Ten weeks later both the concentration and the charge of the gonadotrophins were similar to those before the NETA treatment. The changes in concentration and charge of the gonadotrophins during the second treatment period were similar to those during the first. All the changes were statistically significant (P < 0.05 - < 0.001). The mean SHBG level decreased (P < 0.01) from 84.5 to 70.6 nmol/l after 2 weeks and to 59.9 nmol/l after 4 weeks of NETA treatment and increased (P < 0.01) 10 weeks later to 77 nmol/l. CONCLUSION: In the oestradiol treated women, the effect of the progestogen norethisterone acetate on the charge of the gonadotrophin isoforms was time-related. The oestradiol effect on the charge was counteracted during the first 2 weeks of progestogen treatment and more acidic isoforms appeared in the circulation. During the following 2 weeks the isoforms became more basic again. The levels of the gonadotrophins were efficiently decreased after 2 weeks of progestogen treatment and further decreased after 4 weeks. The time-related effect of the progestogen on the gonadotrophin isoforms may be mediated via changes in the pattern of GnRH release from the hypothalamus. The observed gradual decrease in the SHBG level during the progestogen therapy may cause an increased oestradiol effect on the hypothalamus and pituitary.


Assuntos
Estradiol/uso terapêutico , Terapia de Reposição de Estrogênios , Gonadotropinas Hipofisárias/sangue , Noretindrona/análogos & derivados , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Implantes de Medicamento , Eletroforese em Gel de Ágar , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Concentração de Íons de Hidrogênio , Histerectomia , Isomerismo , Hormônio Luteinizante/sangue , Pessoa de Meia-Idade , Noretindrona/uso terapêutico , Acetato de Noretindrona , Globulina de Ligação a Hormônio Sexual/análise , Fatores de Tempo
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