Occurrence of climacteric symptoms in postmenopausal women after prophylactic bilateral ovariectomy.

PURPOSE OF INVESTIGATION: To analyse the quality of life in postmenopausal women after prophylactic bilateral ovariectomy depending on the time from menopause. MATERIALS AND METHODS: The study involved 252 postmenopausal women grouped according to the time from last menstruation: one to five years (group A), five to ten years (group B), and > ten years (group C). All women were ovariectomized during laparotomy performed for benign diseases of the uterus. Climacteric symptoms were measured with the Kupperman Index one day before and three months after surgery. RESULTS: Highly significant age differences and no substantial BMI differences were demonstrated among the study groups. Before and after surgery climacteric symptoms were reported by 17.06% and 57.8% of women, respectively. After surgery, group A women significantly more often had hot flushes, sweating, nervousness, and sleep disorders, the women in group B significantly more often reported sleep disorders, nervousness, and sweating, and the women in group C significantly more often complained of nervousness. CONCLUSION: In postmenopausal women, ovaries play the most important role during the first ten years from the last menstruation.

Does health status influence acceptance of illness in patients with chronic respiratory diseases?

The level of illness acceptance correlates positively with compliance to the doctor's recommendations, and negatively with the frequency and intensity of complications of chronic diseases. The purpose of this study was to determine the influence of the clinical condition on the level of illness acceptance, and to find variables which would have the most profound effect on the level of illness acceptance in patients with chronic respiratory diseases. The study group consisted of 594 adult patients (mean age: 60 ± 15 years) with mixed chronic respiratory diseases, recruited from patients of 136 general practitioners. The average score in the Acceptance of Illness Scale was 26.2 ± 7.6. The low level of illness acceptance was noted in 174 (62.6 %) and high in 46 (16.6 %) patients. Analysis of multiple regressions was used to examine the influence of explanatory variables on the level of illness acceptance. The variables which shaped the level of illness acceptance in our patients included: improvement of health, intensity of symptoms, age, marital status, education level, place of residence, BMI, and the number of chronic diseases. All above mentioned variables should be considered during a design of prevention programs for patients with mixed chronic respiratory diseases.

Adherence to therapy among liver transplant patients as related to depression, anxiety, acceptance of the disease, and social support.

OBJECTIVE: This study aimed to assess the patients' adherence to therapeutic regimens after liver transplantation, taking into account the levels of depression and anxiety, acceptance of the disease, and social support. PATIENTS AND METHODS: The study group included N = 112 patients selected from 669 patients after liver transplantation. The Delphi method was used to develop a tool to assess the level of adherence to treatment regimens. The sources of data for this study were recommendations and the work of an expert panel. The next method used in the study was a diagnostic survey based on the following standardized research instruments: Inventory of Socially Supportive Behaviors (ISSB), Acceptance of Illness Scale (AIS), Beck Depression Inventory-II (BDI-II) and State-Trait Anxiety Inventory (STAI). RESULTS: The study group showed a medium level of adherence to therapeutic recommendations (6.8 ± 1.85). We observed a statistically significant positive correlation between acceptance of the disease and adherence to therapeutic recommendations (r = -0.20, t = -2.040, p = 0.044). Among the factors analyzed, six predictors were identified that significantly affect the level of adherence to therapeutic recommendations in a group of liver transplant patients. CONCLUSIONS: 1. Patients who accept their disease are a group of people who significantly worse adhere to therapeutic recommendations. 2. The main positive predictors of treatment adherence in the group of transplant patients are the search for various sources of information and declarative adherence to treatment recommendations. Negative predictors include the duration of the disease, side effects of the applied treatment, and comorbidities. 3. The patients who were informed that results depend on regular medication intake significantly more often followed therapeutic recommendations.

The effect of vitamin D levels on lipid, glucose profiles and depression in perimenopausal women.

OBJECTIVE: Vitamin D deficiency is a significant problem that affects the population living in most countries. This issue is independent by place of residence, sex, age or skin color. It is mainly influenced by the environment we live in and by an unhealthy lifestyle, including bad eating habits. The aim of this study was to evaluate lipid profile, glucose levels, and vitamin D levels, considering sociodemographic variables, smoking and alcohol consumption in perimenopausal women. Depressive mood was also assessed considering sociodemographic variables and vitamin D levels. PATIENTS AND METHODS: The study was conducted on a group of 191 women and performed in two stages. The first of them was carried out using a diagnostic survey with the use of a technique questionnaire. The applied research instruments were the author's questionnaire (concerning sociodemographic and selected medical data), and the Beck Depression Inventory. The second stage of the study involved the collection of peripheral blood from each respondent, in order to determine lipid profile, glycemia and serum vitamin D levels. RESULTS: The age of the female respondents ranged from 45 to 65 years, mean age was 53.1 ± 5.37 years, median 53 years. Vitamin D levels were below normal in 78%; 77% had elevated total cholesterol levels; 91.6% of the respondents had high density lipoprotein (HDL) cholesterol levels within the normal range; 64.4% was characterized by too high (low-density lipoprotein) LDL cholesterol, and 84.8% of the women showed normal triglyceride levels. Among the respondents, 91.1% had normal glycemic levels. Analysis of the collected data showed a weak negative correlation between serum vitamin D levels and the levels of total cholesterol (rho=-0.14; p=0.05), LDL cholesterol (rho=-0.16; p=0.026), and triglycerides (rho=-0.22; p=0.002). Only in the case of HDL cholesterol (p=0.067), there was no statistically significant correlation. There were also no statistically significant correlations between serum vitamin D levels and glycemia or severity of depression. CONCLUSIONS: 1. The majority of the women did not manifest depressive disorders. Of all factors analyzed, only education was associated with the severity of depressiveness. 2. Smoking adversely affected serum vitamin D levels in the studied women. 3. The cessation of menstruation affected carbohydrate metabolism and vitamin D levels. Blood glucose levels increased with the age of the studied women. 4. Relationships were found between the levels of vitamin D and the levels of total cholesterol, LDL cholesterol, and triglycerides. Therefore, it is important to maintain normal vitamin D levels.

Assessment of serum ionized magnesium levels in healthy volunteers, in patients with coronary artery disease and/or hypertension and in hypertension alone.

We examined ionized magnesium concentration by blood analysis in patients with hypertonia arterialis, ischemic heart diseases, both of them and in a control group. Slighty lower mean serum ionized magnesium concentration was found in the study group hypertonia arterialis when compared to the control group. In patients both group "B" with coronary artery diseases and group "C" with hypertonia arterialis + ischemic heart diseases, mean serum ionized magnesium concentrations were higher then in the control group, the differences were statistically significant.

[Levels of ionized magnesium in women with various stages of postmenopausal osteoporosis progression evaluated on the basis of densitometric examinations]. / Poziom magnezu zjonizowanego u kobiet w róznym stopniu zaawansowania osteoporozy pomenopauzalnej ocenionym na podstawie badania densytometrycznego.

The aim of the work was the estimation of the ionized magnesium level in postmenopausal osteoporotic women in different stage of osteoporosis progression assessed in densitometrical investigation. The study included 53 women, divided due to T index into 3 subgroups compatible with WHO osteoporosis classification criteria. The control group included 20 healthy women at perimenopausal age. In the group of women with osteoporosis and severe osteoporosis significantly lower ionized magnesium level was determined in comparison with the control group and the group of women with osteopenia (p < 0.05). No correlation between T index (assessing the stage of osteoporosis progression) and hypomagnesaemia was found.

Analysis of pituitary gonadotropin concentration in blood serum and immunolocalization and immunoexpression of follicle stimulating hormone and luteinising hormone receptors in ovaries of postmenopausal women.

The participation of gonadotropins in ovarian carcinogenesis is well known and is supported by studies with inhibition of pituitary gonadotropin secretion, which results in a diminished risk of cancer. However, there are few data on localization and expression of Follicle Stimulating Hormone and Luteinising Hormone Receptors (FSHR and LHR) in ovaries of healthy postmenopausal women, and their correlation with FSH and LH concentration in blood serum is unknown. The aim of our study was to analyze gonadotropin concentration in blood serum and the expression of FSHR and LHR in ovaries of 207 postmenopausal women. Patients included in the study were divided into three groups depending on the number of years since menopause. We analyzed the concentration of FSH and LH in blood serum and the expression of FSHR and LHR in ovaries. Ovaries of postmenopausal women showed numerous morphological changes in the cortex and medulla when compared to the structure of ovaries of women at reproductive age. In all groups of patients clefts in the surface epithelium and epithelial inclusion cysts were found. The concentration of FSH and LH in the blood serum of women studied increased significantly with time from menopause. Significant differences between analyzed menopausal groups were found. The highest FSH and LH concentration in blood serum were found in women with the longest period of time from menopause. Quantitatively similar expression of FSHR and LHR was found in ovarian surface epithelial cells, in epithelial inclusion cysts and in the connective tissue cells of ovarian stroma. The intensity of the immunohistochemical reaction decreased with time from menopause and with age.

Immunohistochemical analysis of steroid receptors in ovaries of postmenopausal women--effects of aging and hormone status.

Current knowledge on immunolocalization and immunoexpression of steroid hormone receptors, especially estrogen receptor alpha (ER-alpha), progesterone receptor (PR) and androgen receptor (AR) in normal ovaries in postmenopausal women is not complete. The recognition of localization of these receptors in postmenopausal women is crucial, as many of these women receive estro-progestagene therapy, and its participation in the pathogenesis of ovarian cancer should be carefully studied. In our paper we present the results of immunohistochemical studies performed on samples from 100 post-menopausal women (aged: 48 to 60 years) who did not use hormonal therapy. The ovaries were removed during elective operation due to uterine leiomyoma, endometriosis and/or prolapsed uterine. PR, ER-alpha and AR were detected in the normal ovaries of postmenopausal women in stroma and in ovarian surface epithelium, as well as in its invagination and in epithelial inclusion cysts. The expression of PR and AR did not change, while the expression of ER-alpha decreased in time from menopause, and it was also detected in patients more than 10 years after menopause. Women older than 60 were not included in the study. The concentration of selected hormones was measured in the serum. The immunohistochemical expression of PR and AR were similar in all examined patients and did not correlate with FSH, LH, T, A, DHEAS concentrations in serum, while immunohistochemical expression of ER-alpha correlated with FSH, LH, T, A, DHEAS concentrations in serum. The significant correlation of decreasing expression of ER-alpha in normal ovarian tissue and decreasing concentrations of T, A and DHEAS in serum were found, as well as increasing serum concentrations of FSH and LH.

Human postmenopausal ovary--hormonally inactive fibrous connective tissue or more?

The ovary undergoes several changes after the menopause. In this period, the main structural changes in both the cortex and medulla were observed. In the cortex, they included: 1) reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring the line between medulla and cortex; 4) reduction of follicles number; 5) tendency to fragmentation of corpora albicantia; 6) surface epithelium invaginations. Whereas the changes in the medulla included: 1) fibrosis and scars in stroma; 2) architectonical changes in blood vessels with hyalinization of walls and constriction of lumen. The loss of follicles and several changes in the ovary are due to apoptotic processes. Despite age related atrophic changes, the postmenopausal ovary is not devoid of hormonal activity. Our results are coherent with the reports of other researchers, and reveal that postmenopausal ovary produces trace quantities of steroid hormones, mainly androgens, and confirm the presence of steroid receptors and activity of main enzymes involved in steroidogenesis process.