Effects of tamoxifen on tissue nitrite/nitrate levels and plasma lipid peroxidation in female rats.

PURPOSE OF INVESTIGATION: The effects of tamoxifen on lipid peroxidation and oxidant-antioxidant balance in an animal model were studied. METHODS: Twelve female adult rats were divided into two groups and DMSO and tamoxifen dissolved in DMSO were administered. Tissues taken from the brain, liver and ovary of rats were dissected. MDA, nitrite, nitrate levels and plasma LDL oxidation in brain, ovary and liver tissues were measured and compared. RESULTS: Induced LDL MDA levels were significantly lower in the tamoxifen group (p = 0.009). MDA levels in the liver were significantly lower in the tamoxifen group whereas nitrite levels were found significantly higher (p < 0.05). Brain and ovarian tissues demonstrated no significant difference with respect to MDA, nitrite and nitrate levels. CONCLUSION: Tamoxifen has no negative effects on lipid peroxidation in an animal model.

Vaginal fluid pH, cervicovaginitis and cervical length in pregnancy.

AIM: The purpose of this prospective study was to determine the possible association among vaginal fluid pH, cervicovaginitis and cervical length in singleton pregnancies at 16-22 weeks of gestation. METHODS: A total of 240 asymptomatic singleton pregnancies at 16-22 weeks of gestation were included to the study. Vaginal fluid pH was determined using pH paper in a sterile speculum examination, and cervical length was examined by transvaginal ultrasonographic measurement. Vaginitis was diagnosed by pH determination and wet mount smear; cervicitis was diagnosed by cervical examination. Patients were followed to delivery and hospital records were reviewed to extract obstetric information. Preterm delivery was defined as delivery at or prior to 36 weeks of gestation. Abnormal pH was defined as a pH of > 5.0. Patients with cervicovaginitis (n = 72) were compared with those without any trace of infection (n = 60). RESULTS: The mean gestational age was 20.3 +/- 1.4. We found an significant association among cervicovaginitis, cervical length and vaginal pH. There was a significant correlation between an elevated vaginal pH (> 5.0) and a shortened cervical length (r = -0.59, p < 0.001). Vaginal fluid pH > 5.0 was associated with increased risk of preterm delivery (OR 4.3, 95% CI 2.0, 9.3; p = 0.001) as well as delivering an infant of less than 2,500 g (OR 4.0, 95% CI 1.4, 11.0; p = 0.009). CONCLUSIONS: Elevated vaginal fluid pH in women at 16-22 weeks of gestation seems to be associated with a decreased cervical length and increased risk of preterm delivery.

Retrospective analysis of endometrial polyps carried out at Ege University Hospital.

OBJECTIVE: The aim of the present study was to assess the incidence of endometrial polyps in women presenting with different symptoms to Ege University Hospital. MATERIAL AND METHODS: Patient records were retrospectively scanned and patients with a histopathological diagnosis of endometrial polyps were included in the analysis. RESULTS: 53 patients had been diagnosed with endometrial polyps. Sixty-four percent of the patients were postmenopausal and the most common presenting symptom was postmenopausal vaginal bleeding (26.4%). Forty-nine percent of the diagnoses were made by endometrial sampling. CONCLUSION: In a university hospital setting the majority of the endometrial polyp cases diagnosed were in postmenopausal women. Standard endometrial sampling failed to detect almost half of the cases.

Effects of sequential combined transdermal and oral hormone replacement therapies on serum lipid and lipoproteins in postmenopausal women.

The aim of this study was to compare the effects of sequential combined transdermal and oral postmenopausal hormone replacement therapies on serum lipid-lipoprotein profiles risk markers for cardiovascular disease. A prospective randomize study was designed: Ninety-six healthy nonhysterectomised postmenopausal women were randomized to receive either transdermal continuous 17beta-estradiol, 0.05 mg/d (Estraderm TTS, Novartis, Basel, Switzerland), with transdermal sequential norethisterone acetate, 0.25 mg/d (Estragest TTS, Novartis, Basel, Switzerland), or oral continuous conjugated equine estrogens, 0.625 mg/d (Premarin 0.625 mg, Wyeth, Philadelphia, U.S.A.), with oral sequential medroxyprogesterone acetate, 10 mg/d (Farlutal 5 mg, Deva, Istanbul, Turkey). 84 women completed the trial, 42 in oral and 42 in the transdermal group. The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoproteins AI and apolipoproteins B at 6 months after starting treatment were compared with baseline values for both therapies. Both oral and transdermal therapies significantly reduced serum levels of total cholesterol (208-190 mg/dL and 216-199 mg/dL, respectively, p=0.0001) and LDL-cholesterol (128-112 mg/dL and 140-127 mg/dL, respectively, p=0.001). The serum levels of triglycerides did not show any significant change with oral therapy, whereas this lipid fell (128-101 mg/dL, p=0.0001) significantly with transdermal therapy. We found significant decrease in HDL-cholesterol with transdermal therapy while there was no significant change with oral therapy. Apolipoproteins AI, the major protein component of HDL2 subfraction, was increased by oral therapy and lowered by transdermal therapy. As a conclusion, we have found that serum total cholesterol and LDL-cholesterol were lowered by both therapies, with no significant differences between treatments, whereas there were significant differences between treatments according to effects on serum triglycerides and apolipoproteins AI.

Sequential combined transdermal and oral postmenopausal hormone replacement therapies: effects on bleeding patterns and endometrial histology.

OBJECTIVES: To determine the endometrial response and bleeding patterns in postmenopausal women taking a sequential combined hormone replacement regimen either orally or transdermally. METHODS: Seventy-two postmenopausal women with amenorrhea of 6 months or longer with follicle stimulating hormone and estradiol levels in the postmenopausal range and normal endometrium were included in the study. The patients randomly received sequential combined hormone replacement regimen with oral (n=37) or transdermal route (n=35). The total duration of treatment was 6 months (6 cycles of 28 d). The subjects kept daily bleeding diaries, and endometrial biopsies were taken at baseline and after 6 months of therapy. RESULTS: The rates of adequate progestational response (secretory or atrophic) were 83.8% and 82.9% in the oral and transdermal hormone replacement groups, respectively (p>0.05). In the oral hormone replacement group, there were 16.2% of inadequate progestational response, 2.7% had endometrial hyperplasia and 13.5% proliferative endometrium. In the transdermal hormone replacement group, there were 17.1% of inadequate progestational response, 2.9% had endometrial hyperplasia and 14.3% proliferative endometrium. Cyclic bleedings occurred in 92.4% and 92% of all cycles in the oral and transdermal treatment groups, respectively. The mean duration of bleeding per cycle were 3.9+/-0.9 and 3.8+/-0.9 d in the oral and transdermal treatment groups, respectively. CONCLUSION: Sequential combined transdermal hormone replacement therapy is as effective as oral therapy in preventing the development of endometrial hyperplasia. Satisfactory control of bleeding is achieved with both regimens.

Effects of oral and transdermal hormone replacement therapy on internal carotid artery pulsatility indices in postmenopausal women. A prospective, randomized, comparative study.

OBJECTIVE: To compare the effects of oral and transdermal hormone replacement therapy on the internal carotid artery pulsatility index in postmenopausal women. STUDY DESIGN: Thirty-seven women were randomized to six months of treatment with oral (n = 19) or transdermal (n = 18) sequential combined hormone replacement therapy. The internal carotid artery pulsatility index was assessed by color Doppler ultrasound at baseline and after six months of treatment. RESULTS: Carotid artery pulsatility indices were significantly lower than the mean of 0.939 +/- 0.139 at 0.860 +/- 0.084 in the oral hormone replacement group and significantly lower than the mean of 0.928 +/- 0.092 at 0.891 +/- 0.046 in the transdermal hormone replacement therapy group (P = .042) after six months of treatment. The mean changes in the carotid artery pulsatility index between the oral and transdermal hormone replacement groups were nonsignificant (-0.078 +/- 0.131 and -0.037 +/- 0.067, respectively; P = .53). There was a significant negative correlation between the change in pulsatility index during treatment and baseline values in the carotid artery (r = -.81, P = .001), but no correlation was found with time since menopause and serum estradiol level. CONCLUSION: Oral and transdermal sequential hormone replacement therapy are similarly effective at six months in reducing impedance to flow in the internal carotid artery.

The effect of medroxyprogesterone acetate and heparin in the prevention of postsurgical adhesion formation in the rat uterine model.

OBJECTIVE: To evaluate the effects of depot medroxyprogesterone acetate and heparin in preventing postsurgical adhesion formation in the rat model. METHODS: A hundred and five female Wistar rats were divided into 7 groups. Groups 1 and 2 were injected with intramuscular 15 mg medroxyprogesterone acetate 3 weeks before surgery and at the end of laparotomy. Groups 3 and 4 were given 15 mg medroxyprogesterone acetate by intramuscular injection, 3 weeks before surgery. An equal volume of intramuscular sterile saline was injected to control groups, 3 weeks before and at the end of surgery. Before abdominal closure, 2 ml of Ringer's lactate was instilled into the peritoneal cavity of all rats, except group 7. Groups 1, 4, and 5 were given 2 ml of intraperitoneal Ringer's lactate containing 500 U heparin/ml. A standardized surgical injury was performed in all rats. Two weeks after surgery, the adhesions were scored on a scale of 0 to 3 according to their thickness-tenacity and vascularity. Kruskall-Wallis and Mann-Whitney U statistical test were used. RESULTS: The preoperative and postoperative administration of medroxyprogesterone acetate resulted in the least number of and the least severe adhesions, when compared with single dose medroxyprogesterone acetate treated rats and controls (p < 0.05). However, the combination of medroxyprogesterone acetate and intraperitoneal heparin did not enhance the adhesion reducing capacity of medroxyprogesterone acetate. CONCLUSIONS: Concurrent preoperative and postoperative administration of medroxyprogesterone acetate results in the most significant reduction of postsurgical adhesions. The combination treatment of medroxyprogesterone acetate and heparin does not show any additional effect in the reduction of adhesion formation, when compared with medroxyprogesterone acetate treatment alone.