Menopause is associated with decreased whole body fat oxidation during exercise.

The purpose of this study was to examine if fat oxidation was affected by menopausal status and to investigate if this could be related to the oxidative capacity of skeletal muscle. Forty-one healthy women were enrolled in this cross-sectional study [premenopausal (n = 19), perimenopausal (n = 8), and postmenopausal (n = 14)]. Estimated insulin sensitivity was obtained from an oral glucose tolerance test. Body composition was measured by dual-energy X-ray absorptiometry and magnetic resonance imaging. Fat oxidation and energy expenditure were measured during an acute exercise bout of 45 min of ergometer biking at 50% of maximal oxygen consumption (Vo2 max). Muscle biopsies from the vastus lateralis of the quadriceps muscle were obtained before and immediately after the exercise bout. Postmenopausal women had 33% [confidence interval (CI) 95%: 12-55] lower whole body fat oxidation (P = 0.005) and 19% (CI 95%: 9-22) lower energy expenditure (P = 0.02) during exercise, as well as 4.28 kg lower lean body mass (LBM) than premenopausal women. Correction for LBM reduced differences in fat oxidation to 23% (P = 0.05), whereas differences in energy expenditure disappeared (P = 0.22). No differences between groups were found in mRNA [carnitine palmitoyltransferase I, ß-hydroxyacyl-CoA dehydrogenase (ß-HAD), peroxisome proliferator-activated receptor-α, citrate synthase (CS), pyruvate dehydrogenase kinase 4, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α)], protein [phosphorylated AMP-activated protein kinase (AMPK), vascular endothelial growth factor, pyruvate dehydrogenase-1Eα, cytochrome oxidase I], or enzyme activities (ß-HAD, CS) in resting skeletal muscle, except for an increased protein level of cytochrome c in the post- and perimenopausal women relative to premenopausal women. Postmenopausal women demonstrated a trend to a blunted exercise-induced increase in phosphorylation of AMPK compared with premenopausal women (P = 0.06). We conclude that reduced whole body fat oxidation after menopause is associated with reduced LBM.

DIAGNOSIS OF ENDOCRINE DISEASE: Sex steroid action in adolescence: too much, too little; too early, too late.

ABSTRACT: This review aims to cover the subject of sex steroid action in adolescence. It will include situations with too little sex steroid action, as seen in for example, Turners syndrome and androgen insensitivity issues, too much sex steroid action as seen in adolescent PCOS, CAH and gynecomastia, too late sex steroid action as seen in constitutional delay of growth and puberty and too early sex steroid action as seen in precocious puberty. This review will cover the etiology, the signs and symptoms which the clinician should be attentive to, important differential diagnoses to know and be able to distinguish, long-term health and social consequences of these hormonal disorders and the course of action with regards to medical treatment in the pediatric endocrinological department and for the general practitioner. This review also covers situations with exogenous sex steroid application for therapeutic purposes in the adolescent and young adult. This includes gender-affirming therapy in the transgender child and hormone treatment of tall statured children. It gives some background information of the cause of treatment, the patient's motivation for medicating (or self-medicating), long-term consequences of exogenous sex steroid treatment and clinical outcome of this treatment.

Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long-pulsed diode laser vs. intense pulsed light.

BACKGROUND: Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. OBJECTIVES: To compare efficacy and safety of intense pulsed light (IPL) vs. long-pulsed diode laser (LPDL) in a well-defined group of hirsute women with normal testosterone levels. METHODS: Thirty-one hirsute women received six allocated split-face treatments with IPL (525-1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient-evaluated reduction in hairiness, patient satisfaction, treatment-related pain and adverse effects. RESULTS: IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow-up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4-7] than LPDL (median 3, IQR 2-5) (P < 0·001). CONCLUSION: Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.

The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy.

UNLABELLED: Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether HT reduces this risk associated with early menopause. OBJECTIVE: To analyse whether early menopause based on various causes are independent risk factors for ischaemic heart disease, and to investigate whether the risks are modified by use of HT. METHODS: In a prospective cohort study questionnaires were mailed to Danish female nurses above 44 years of age in 1993. Information on menopause, use of HT and lifestyle was obtained. In total 19,898 (86%) nurses fulfilled the questionnaire, among them 10.533 were postmenopausal with definable menopausal age, free of previous ischaemic heart disease, stroke or cancer. Through individual linkage to national register incident cases of ischaemic heart disease were identified until end of 1998. RESULTS: Menopause below both age 40 and 45 was associated with an increased risk of ischaemic heart disease, seeming most pronounced for women who had an early ovariectomy but also among spontaneous menopausal women. Generally HT did not reduce the risk except for the early-ovariectomised women, where no increased risk of ischaemic heart disease for HT users was found. CONCLUSION: We found an increased risk of ischaemic heart disease associated with early removal of the ovaries that might be reduced with HT. The present study need confirmation from other studies but suggests that early ovariectomised women could benefit from HT.

The influence of hormone replacement therapy on the aging-related change in cognitive performance. Analysis based on a Danish cohort study.

OBJECTIVE: A maintenance and/or improvement of cognitive performance with postmenopausal hormone replacement therapy (HRT) is biological plausible. The objectives of this study were to analyze the impact of HRT on aging-related changes in cognitive performances, and to assess whether women who choose HRT have better cognitive performance prior to HRT. METHODS: Data derives from a longitudinal sub-cohort of women participating in a large survey of the general adult population-The Danish MONICA (MONItoring CArdiovascular risk factors) Study. Main variables for analyses come from neuropsychological examination consisting of 28 cognitive parameters collected in 1982-1983 and again in 1993-1994, by a computer-aided test technique, the Cognitive Function Scanner((R)). The final analyses comprised 126 'never users', 40 'current users' at follow-up, and 30 'future users' of HRT (women who started HRT during the observation period subsequent to baseline registration). RESULTS: 'Current users' of HRT at follow-up showed a less pronounced decline in cognitive performance compared to 'never users' in one of six parameters for concentration ability and two of eight parameters for visuomotor function. 'Future users' of HRT had better cognitive performance at baseline compared to 'never users' in long-term visual memory, concentration, and reaction time. 'Future users' of HRT were more precise but spent more time in the tests for visuomotor function than 'never users'. CONCLUSION: HRT-treated women show a postponed aging-related decline in cognitive functioning, partly in concentration and partly in visuomotor function. However, women who choose HRT have better cognitive performance prior to the treatment.

Knowledge, attitudes and management strategies in Scandinavia concerning hormone replacement therapy: a comparison between gynecologists in Denmark, Norway and Sweden.

OBJECTIVES: To describe and compare attitudes, knowledge and management strategies concerning the prescription of hormone replacement therapy (HRT) between gynecologists from three Scandinavian countries. DESIGN AND METHODS: In a cross-sectional study gynecologists in Denmark (n=386), Norway (n=475) and Sweden (n=1323) were invited by letter to complete and return an enclosed questionnaire. Then 1653 of the 2184 (76%) contacted gynecologists completed and returned the questionnaire. RESULTS: of the 1653 Scandinavian gynecologists, 42% offered HRT to all women provided there was no contraindication, while 58% recommended HRT to selected women after considering the advantages and disadvantages of HRT. In Norway and Sweden, the proportion of gynecologists routinely prescribing HRT for women without contraindications increased with age and in the oldest age group of gynecologists (>55 years) 49 and 56%, respectively, recommended HRT to all women. The gynecologists were unanimous in their choice of the type of HRT for perimenopausal women as 94% preferred cyclical or sequential combined (estrogen/progestogen) treatment or estrogen monotherapy (orally or transdermally) for hysterectomized women (95%). For postmenopausal women, 75% of the gynecologists offered continuous combined HRT while cyclical combined therapy was chosen by 15% of the gynecologists. No significant differences were found between physicians in the three countries regarding indications and contraindications to HRT. CONCLUSIONS: Scandinavian gynecologists are generally well informed concerning HRT and liberally recommend HRT for women without contraindications.

Lingual infarction in giant cell arteritis. A case report.

Giant cell arteritis is a disease of the elderly, affecting the temporal or other cranial arteries, often in patients with polymyalgia rheumatica. A case of giant cell arteritis with necrosis of the tongue in a 77-year-old woman is reported. It is important to be aware of this condition because of the serious complications. As the lesion is focally distributed, it is necessary to obtain a large biopsy specimen from the superficial temporal artery in order to make a correct diagnosis. Prompt treatment with corticosteroid in large doses followed by a lower maintenance dose is important to prevent vascular complications.

[Pain and sensory impairment following parotidectomy. A descriptive study]. / Smerter og sensibilitetsforstyrrelser efter parotidektomi. En deskriptiv undersøgelse.

From 1985 to 1992 parotidectomy was performed at Vejle Hospital in 114 patients with a parotid tumour. Ninety-five of the patients completed a questionnaire. Twenty-four reported various degrees of pain at the time of the investigation, and 57 reported numbness or uncomfortable sensations of the skin. No association between symptoms and age, gender or follow-up time could be traced. Twenty patients with clinically significant complaints were subsequently interviewed and examined. Five patients had a neuroma in the scar region. Hypoaesthesia was found in 18/20 of the patients. The results emphasize the importance of avoiding unnecessary division of the great auricular nerve in order to reduce the risk of pain and sensory impairment postoperatively. The authors suggest that the posterior branch of the great auricular nerve be spared whenever possible. Patients should be informed about the risk preoperatively.

[Endogenous opioids and their therapeutic use in the treatment of pain]. / Endogene opioider og deres terapeutiske anvendelse i smertebehandling.

Cancer patients with chronic pain and obstetric patients have participated in clinical trials of the analgesic effects of endogenous opioids. It is possible to achieve adequate relief of pain in these patients following epidural or intrathecal administration of endogenous opioids. Further investigations are required.

[Pemphigus vulgaris and benign cicatricial mucous membrane pemphigoid in the upper respiratory tract and esophagus]. / Pemphigus vulgaris og benignt cikatricielt slimhindepemfigoid i øvre luftveje og esophagus.

Pemphigus vulgaris and benign cicatricial membrane pemphigoid are both autoimmune, blistering, dermatologic diseases characterised clinically by tense bullae on skin or on mucous membranes. Both diseases are rare, but very serious, associated with a high death rate (pemphigus) or high morbidity with cicatricial mucosal lesions (pemphigoid) if untreated. These diseases are discussed and two case stories mentioned where the primary focus was in the upper aerodigestive tract, which is very seldom. The otolaryngologist can make an important contribution to the early recognition, diagnosis, and management of these diseases. The biopsy must undergo immunofluorescence examination.

[Ambulatory mediastinoscopy]. / Dagkirurgisk mediastinoskopi.

INTRODUCTION: The present study was undertaken to investigate the safety of mediastinoscopy as a routine outpatient procedure. METHODS: We reviewed the first 108 mediastinoscopies performed at our outpatient surgery centre. RESULTS: During the period, 1996 to 1999, 108 out of 206 (52%) mediastinoscopy patients were admitted to the outpatient surgery centre, and 86 (80%) of these were discharged the same day. These numbers were 86% and 86% for 1999 alone, which reflects acceptance of outpatient surgery. One patient was admitted because of preoperative mediastinal venous bleeding, which required compression for 24 hours, and 19 more patients were admitted without strict medical indications. Two patients were admitted later the same day after discharge, because of minor wound bleeding, which was stopped by infiltration with adrenalin. DISCUSSION: Mediastinoscopy can be performed safely as an outpatient procedure on most patients.

Physiological effects of ovarian hormones: clinical aspects and compliance.

Menopause is marked by the permanent cessation of menstrual bleeding. Deprivation of ovarian hormones due to decreasing ovarian activity causes widespread physiological effects. Disturbances in menstrual pattern and hot flashes are major reasons for hormone replacement therapy (HRT), but prevention of osteoporosis and cardiovascular disease are other considerations. Despite the large number of different hormone treatment regimens available, such problems as continued bleeding and concern about side effects engenders low compliance. To enhance compliance, it is important to ensure that post-menopausal women and their physicians are aware of the probable risks and benefits of hormone therapy before deciding whether or not to use preventive HRT.

Epidemic shigellosis on a worktrain in Labrador.

An epidemic of shigellosis occurred on a worktrain in western Labrador in October 1974. During the outbreak 62 persons out of a crew of 91 became ill, 11 having recurrent illness; 14 were hospitalized. Epidemiologic analysis with laboratory confirmation implicated unchlorinated and contaminated lake water as the source of the epidemic. Faulty design of water storage tanks perpetuated the use of contaminated water; hence a second wave of illness occurred. The tanks were then thoroughly drained, cleaned and repaired. Many deficiencies in sanitation measures (most of which have since been rectified) were noted at the site of the epidemic as well as at other locations along the railway. Careful sanitation controls are essential in rapidly developing areas of northern Canada.

Hormone replacement therapy and risk of non-fatal stroke.

BACKGROUND: The effect of postmenopausal hormone replacement therapy (HRT) on the risk of subtypes of stroke is as yet unclear. To investigate the effect of oestrogen and combined oestrogen-progestagen therapy on the risk of non-fatal haemorrhagic and thromboembolic stroke, we carried out a case-control study. METHODS: From the Danish National Patient Register we identified all Danish women aged 45-64 years who had a non-fatal, first-ever cerebrovascular attack during 1990-92. Two age-matched controls were randomly selected for each case from the Danish National Person Register. Important correlates of hormone use and stroke, on which information was obtained from postal questionnaires, were controlled for by multivariate analyses based on log-linear graphical models. The analyses included data on 1422 cases classified in four subtypes of stroke (160 subarachnoid haemorrhage, 95 intracerebral haemorrhage, 846 thromboembolic infarction, 321 transient ischaemic attack) and 3171 controls. FINDINGS: After adjustment for confounding variables and correction for the trend in sales of HRT preparations, no significant associations were detected between current use of unopposed oestrogen replacement therapy and non-fatal subarachnoid haemorrhage (odds ratio 0.52 [95% CI 0.23-1.22]), intracerebral haemorrhage (0.15 [0.02-1.09]), or thromboembolic infarction (1.16 [0.86-1.58]), respectively, compared with never use. Current use of combined oestrogen-progestagen replacement therapy had no significant influence on the risk of subarachnoid haemorrhage (1.22 [0.79-1.89]), intracerebral haemorrhage (1.17 [0.64-2.13]), or thromboembolic infarction (1.17 [0.92-1.47]). A significantly increased incidence of transient ischaemic attacks among former users of HRT and among current users of unopposed oestrogen may to some extent be explained by selection--HRT users being more aware of symptoms than non-users. INTERPRETATION: Unopposed oestrogen and combined oestrogen-progestagen replacement therapy have no influence on the risk of non-fatal thromboembolic or haemorrhagic stroke in women aged 45-64 years.

Two-dimensional nuclear Overhauser enhancement NMR experiments on pelargonidin-3-glucopyranoside, an anthocyanin of low molecular mass.

Pelargonidin-3-glucoside has been isolated from the acidified methanolic extract of strawberries (Fragaria anannassa variety Corona) by successive application of an ion-exchange resin, droplet-counter chromatography and gel filtration. The pigment in acidified methanolic solution was studied by means of the two-dimensional nuclear Overhauser enhancement NMR technique, and the sugar unit was found to be attached to the 3-position on the aglycone. At +20 degrees C the pigment was found to be in the extreme narrowing limit where the NOESY cross-peaks are negative. However, at -20 degrees C this low-mass anthocyanin could be studied in the slow motion regime where the NOESY cross-peaks are positive. With a mixing time of 0.3 s, the glucose H1"-H4" proton pair was measured in the initial cross-relaxation rate and their cross-peak volume corresponded to the H1"-H4" distance found in a 4C1 chair conformation.