RESUMO
It is already admitted that hormone replacement therapy (HRT) decreases the risk of developing cardiovascular disease, although its mechanism is not clear yet. In the present work, the effect of the HRT upon cellular and plasmatic haemorheological factors determining blood flow properties: blood viscosity, plasma viscosity, plasma fibrinogen, rigidity erythrocyte index and erythrocyte aggregation rate was studied. Menopausal women were followed through a whole year of HTR. Results demonstrate that after six months of treatment there is a diminution in relative blood viscosity and erythrocyte rigidity, with constant values along the second semester. Erythrocyte aggregation, plasmatic and blood viscosity diminution observed during the treatment can be explained by the simultaneous plasma fibrinogen decrease. Modified cellular and plasmatic rheology could produce beneficial effects on blood flow, particularly in microcirculation, presenting a possible mechanism by which HTR decreases the risk of cardiovascular disease development during menopause.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Viscosidade Sanguínea/fisiologia , Agregação Eritrocítica/fisiologia , Terapia de Reposição de Estrogênios , Hemorreologia , Análise de Variância , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Deformação Eritrocítica , Feminino , Fibrinogênio , Humanos , Lipídeos/sangue , Estudos Longitudinais , Menopausa , Seleção de PacientesRESUMO
According to previous pharmacokinetic studies the bioavailability of fluorine (F) from sodium monofluorophosphate (MFP) doubles that of sodium fluoride (NaF). This paper reports a study designed to verify whether the vertebral bone mass increasing effect of NaF (30 mg F/day) was comparable to that of MFP (15 mg F/day), given for 18 months to osteoporotic postmenopausal women. The BMD of lumbar vertebrae of both groups showed significant increases (MFP: 60 +/- 15 mg/cm2, NaF: and 71 +/- 12 mg/cm2) over basal levels (P < 0.001). The difference between treatments was not significant (P = 0.532). The serum levels of ionic F (the mitogenic species on osteoblasts) were not related to the above mentioned effects. In NaF-treated patients, the fasting levels of total serum F increased significantly (6.7 +/- 0.9 microM vs. Basal: 2.0 +/- 0.8 microM; P < 0.001). This phenomenon was accounted for by ionic fluoride that increased over 20-fold (6.5 +/- 1.9 microM vs. Basal: 0.3 +/- 0.04 microM). In MFP-treated patients the fasting serum levels of total (7.0 +/- 0.7 microM vs. Basal: 2.2 +/- 0.9 M) and diffusible F (0.5 +/- 0.02 microM vs. Basal 0.2 +/- 0.02 microM) increased significantly (P < 0.001). The increase in the non diffusible F fraction is accounted for by protein-bound F, probably by the complexes formed between MFP and alpha 2-macroglobulin and C3. Serum diffusible F was formed by two fractions: ionic F and F bound to low molecular weight macromolecule/s (2,200 +/- 600 Da), in approximately equal amounts. The general information afforded by the present observations support the hypothesis that ionic F is released progressively during the metabolism of MFP bound to alpha 2-macroglobulin and C3. These phenomena explain why comparable effects to those obtained with 30 mg F/d of NaF could by obtained with one half the dose of MFP.
Assuntos
Fluoretos Tópicos/uso terapêutico , Fluoretos/uso terapêutico , Osteoporose Pós-Menopausa/tratamento farmacológico , Fosfatos/uso terapêutico , Fluoreto de Sódio/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Feminino , Flúor/sangue , Humanos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
According to previous pharmacokinetic studies the bioavailability of fluorine (F) from sodium monofluorophosphate (MFP) doubles that of sodium fluoride (NaF). This paper reports a study designed to verify whether the vertebral bone mass increasing effect of NaF (30 mg F/day) was comparable to that of MFP (15 mg F/day), given for 18 months to osteoporotic postmenopausal women. The BMD of lumbar vertebrae of both groups showed significant increases (MFP: 60 +/- 15 mg/cm2, NaF: and 71 +/- 12 mg/cm2) over basal levels (P < 0.001). The difference between treatments was not significant (P = 0.532). The serum levels of ionic F (the mitogenic species on osteoblasts) were not related to the above mentioned effects. In NaF-treated patients, the fasting levels of total serum F increased significantly (6.7 +/- 0.9 microM vs. Basal: 2.0 +/- 0.8 microM; P < 0.001). This phenomenon was accounted for by ionic fluoride that increased over 20-fold (6.5 +/- 1.9 microM vs. Basal: 0.3 +/- 0.04 microM). In MFP-treated patients the fasting serum levels of total (7.0 +/- 0.7 microM vs. Basal: 2.2 +/- 0.9 M) and diffusible F (0.5 +/- 0.02 microM vs. Basal 0.2 +/- 0.02 microM) increased significantly (P < 0.001). The increase in the non diffusible F fraction is accounted for by protein-bound F, probably by the complexes formed between MFP and alpha 2-macroglobulin and C3. Serum diffusible F was formed by two fractions: ionic F and F bound to low molecular weight macromolecule/s (2,200 +/- 600 Da), in approximately equal amounts. The general information afforded by the present observations support the hypothesis that ionic F is released progressively during the metabolism of MFP bound to alpha 2-macroglobulin and C3. These phenomena explain why comparable effects to those obtained with 30 mg F/d of NaF could by obtained with one half the dose of MFP.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Pacientes , Pós-Menopausa , Doenças Ósseas Metabólicas , Osteoporose , Fatores de Risco , Densidade ÓsseaAssuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Densidade Óssea , Doenças Ósseas Metabólicas , Osteoporose , Pacientes , Pós-Menopausa , Fatores de RiscoRESUMO
Objetivo: Seleccionar un parámetro hormonal como mejor predictor de la respuesta a la HCG, en pacientes bajo Hiperestimulación Ovárica Controlada (H.O.C.). Material y Método: Se estudiaron 43 pacientes que iniciaron un ciclo para FIV o ICSI. La descarga ovulatoria se efectuó con 10.000 IU de HCG (Profasi, Serono; Endocorion, Elea, Pregnyl, Organón), en forma prospectiva y randomizada. En todas las pacientes se extrajo sangre a las 8 a.m. de los días 0 (día de la HCG), + 1 y + 2. En cada muestra se determinaron las concentraciones de LH, P y HCG. Todas fueron medidas en el mismo ensayo (RIA e IRMA). Otras variantes analizadas fueron edad, FSH y E2 al 3er. día del ciclo previo, E2 en el día 0, número de folículos punzados y ovocitos maduros (M II y M1B) recuperados. Las pacientes se dividieron en tres grupos según su respuesta ovárica: 1) Buena, relación ovocito recuperado/folículo punzado = 60 por ciento y = 5 ovocitos maduros obtenidos; 2) Moderada, < 60 por ciento de recuperación y 3) Pobre, < 5 ovocitos maduros recuperados. Análisis estadístico: Test no paramétrico U de Mann Whitney. Resultados: La edad promedio fue 35 años (r = 25-35). Las 43 pacientes se distribuyeron en Grupo I = 24, Grupo II = 7 y Grupo III = 12. Los tres preparados de HCG utilizados no mostraron diferencias entre sí. En los 3 días, la LH del G.I fue menor al G.III (p < 0,05). En los días + 1 y + 2, la P del G.I fue mayor a los G.II y G.III (p < 0,05). El incremento de P desde el día 0 al + 1 fue mayor en el G.I vs. G.III (p 0,05). El cociente LH/P arrojó diferencia entre G.I y III (p < 0,001 en el día + 1 y p < 0,007 en el día + 2). En la distribución de frecuencias, un cociente LH/P = 0,03 en el día + 1, separó los grupos I y III en un 90 por ciento. Conclusiones: Las diferencias de LH y P estrían reflejando una mejor sincronización de las células granulosas a la estimulación exógena, en el G.I. El índice LH/P en el día + 1, fue eficaz en separar los grupos de buena y pobre respuesta; un cociente = 0,03, predice en un 90 por ciento una respuesta ovárica adecuada (AU)
Assuntos
Humanos , Feminino , Gravidez , Gonadotropina Coriônica/uso terapêutico , Hormônio Luteinizante/sangue , Progesterona/sangue , Fertilização in vitro/efeitos dos fármacos , PrognósticoRESUMO
Objetivo: Seleccionar un parámetro hormonal como mejor predictor de la respuesta a la HCG, en pacientes bajo Hiperestimulación Ovárica Controlada (H.O.C.). Material y Método: Se estudiaron 43 pacientes que iniciaron un ciclo para FIV o ICSI. La descarga ovulatoria se efectuó con 10.000 IU de HCG (Profasi, Serono; Endocorion, Elea, Pregnyl, Organón), en forma prospectiva y randomizada. En todas las pacientes se extrajo sangre a las 8 a.m. de los días 0 (día de la HCG), + 1 y + 2. En cada muestra se determinaron las concentraciones de LH, P y HCG. Todas fueron medidas en el mismo ensayo (RIA e IRMA). Otras variantes analizadas fueron edad, FSH y E2 al 3er. día del ciclo previo, E2 en el día 0, número de folículos punzados y ovocitos maduros (M II y M1B) recuperados. Las pacientes se dividieron en tres grupos según su respuesta ovárica: 1) Buena, relación ovocito recuperado/folículo punzado = 60 por ciento y = 5 ovocitos maduros obtenidos; 2) Moderada, < 60 por ciento de recuperación y 3) Pobre, < 5 ovocitos maduros recuperados. Análisis estadístico: Test no paramétrico U de Mann Whitney. Resultados: La edad promedio fue 35 años (r = 25-35). Las 43 pacientes se distribuyeron en Grupo I = 24, Grupo II = 7 y Grupo III = 12. Los tres preparados de HCG utilizados no mostraron diferencias entre sí. En los 3 días, la LH del G.I fue menor al G.III (p < 0,05). En los días + 1 y + 2, la P del G.I fue mayor a los G.II y G.III (p < 0,05). El incremento de P desde el día 0 al + 1 fue mayor en el G.I vs. G.III (p 0,05). El cociente LH/P arrojó diferencia entre G.I y III (p < 0,001 en el día + 1 y p < 0,007 en el día + 2). En la distribución de frecuencias, un cociente LH/P = 0,03 en el día + 1, separó los grupos I y III en un 90 por ciento. Conclusiones: Las diferencias de LH y P estrían reflejando una mejor sincronización de las células granulosas a la estimulación exógena, en el G.I. El índice LH/P en el día + 1, fue eficaz en separar los grupos de buena y pobre respuesta; un cociente = 0,03, predice en un 90 por ciento una respuesta ovárica adecuada
Assuntos
Humanos , Feminino , Gravidez , Gonadotropina Coriônica/uso terapêutico , Hormônio Luteinizante/sangue , Progesterona/sangue , Fertilização in vitro , PrognósticoRESUMO
A cross-sectional study of vertebral morphometry in 449 unscreened postmenopausal women, from the ages of 40 to 80, is reported. The wedge angles of thoracic vertebrae T4-12 were found to increase exponentially as a function of age, up to 70 years. In addition to age, the wedging phenomenon was found to be accentuated by increased bone turnover due to low calcium intake, reduced physical activity, each successive delivery, and breast feeding. Most of these variables were not correlated with isolated vertebral wedge angles, but rather with the sum of them (Sigma, sigma), assumed to assess the impact of those variables on thoracic kyphosis. In a subset of women, sigma was found to be inversely correlated with low spinal mineral density at L2-4. T-11 and T-12 were the vertebrae most frequently deformed (wedge angle exceeding mean +/- 3 SD in a group of 50 young healthy women, 25-45 years old). The distribution of deformed vertebrae was found to be significantly different from those qualified as "fractured" according to Kleerekoper et al.'s (1984) and Melton et al.'s (1989) criteria. The overall information afforded by past and present data indicates that in postmenopausal women, vertebral deformation may occur with the help of mechanical solicitations plus high bone remodeling rates, as well as by structural collapse (fracture). The information obtained does not allow one to quantify the relative contribution of each set of factors to the wedging phenomenon.
Assuntos
Cifose/etiologia , Pós-Menopausa/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Densidade Óssea , Remodelação Óssea , Cálcio da Dieta/administração & dosagem , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Vértebras Torácicas/patologiaRESUMO
This paper reports the experience obtained in the last 8 years with an instrument (articulated rotative brush) that allows access to the entire endometrial surface, obtaining material for both histological and cytological study. The latter has the advantage of reducing the number of cases in which insufficient material frustrates endometrial assessment. In addition to the overall experience gained with this instrument, the proportion of agreement with anatomo-pathological diagnosis after hysterectomy in 61 patients was high (96%) and the unweighted kappa statistic (0.862) indicated very good accordance between these techniques. Comparison between the present method and hysteroscopic observations in 84 patients with perimenopausal bleeding revealed a general conformity of 0.65 and an unweighted kappa statistic of 0.368 (fair agreement). In a group of 72 cases with postmenopausal bleeding a general conformity value of 0.92 was obtained, with an unweighted kappa statistic of 0.84 (very good agreement). In 90% of the cases the procedure was well accepted. In 57.3% of the cases, no difficulties were encountered using the brushing technique; in 25.9% slight dilatation was deemed necessary, whereas in 16.8% technical difficulties could not be overcome and general anesthesia was indicated. A total of 769 outpatients were investigated, 75.3% of which had normal endometria, 12.7% benign hyperplasias, 2.6% precursor lesions, 1.7% suspect carcinoma, and 4.2% carcinomas. Insufficient material for diagnosis occurred in 3.5% of cases tested. The combined cytohistological and hysteroscopic assessment of the endometrium provides satisfactory results in the etiological diagnosis of peri and postmenopausal bleeding, and in the follow up of patients undergoing hormonal replacement therapy (HRT).
Assuntos
Biópsia/instrumentação , Climatério/fisiologia , Endométrio/patologia , Histeroscópios , Hemorragia Uterina/patologia , Adulto , Idoso , Assistência Ambulatorial , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
Fifteen percent (20/130) of a group of climacteric women on diets of their choice had urinary calcium (Ca) levels exceeding 4 mg/kg per day. Most of these hypercalciuric subjects had a daily Ca intake of 0.4-0.5 g. Their bone turnover rates were raised and high Ca absorption was observed in 4 cases. Serum Ca and total protein and glomerular filtration rates were normal in all the hypercalciuric patients. The calcium/creatinine (Ca/Cr) ratio (mg l-1/mg l-1, fasting, 09:00-10:00 h) was measured in 72 climacteric women, 35 of whom (49%) had ratios > 0.1. The latter defines a relative hypercalciuria as compared with premenopausal Ca excretion levels. Only 5 of the 35 subjects had calciuria levels above 4 mg/kg per day. The Ca/Cr ratio cannot replace daily urinary Ca measurements for the screening of subjects in whom calciuria may exceed net Ca absorption. Urinary saturation measurements were carried out in 70 women. Supersaturation was observed only in the case of Ca oxalate (CaOx) among several calcium salts usually found in urinary stones. CaOx supersaturation was observed in 95% of the hypercalciuric subjects and in 48% of the rest of the women investigated. The relatively high frequency of CaOx supersaturation can be attributed in part to the decreased excretion of citrate associated with ovarian failure. Oestrogen replacement therapy increased citrate excretion and lowered the level of CaOx supersaturation. Ca supplementation (1 g Ca/day) reduced the degree of supersaturation as a result of the concurrent reduction in oxalate excretion.
Assuntos
Cálcio/urina , Climatério/urina , Absorção , Adulto , Oxalato de Cálcio/urina , Cálcio da Dieta/administração & dosagem , Creatinina/urina , Terapia de Reposição de Estrogênios , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
This paper reports the measurement of whole body retention using fluoride (WBRF) as an estimator of skeletal turnover in a group of climacteric women that received an oral dose of 700 mumol of sodium fluoride. WBRF is defined as 100(1-(urinary fluoride/fluoride load)). WBRF was significantly correlated with whole body retention of 99m-Tc-methylene-diphosphonate, the serum levels of the bone alkaline phosphatase and the urinary excretion of hydroxyproline. WBRF values ranged from 20% to 95% and were affected by calcium intake and the urinary calcium excretion. In normal subjects with high turnover, the measurement of serum alkaline phosphatase activity and/or urinary hydroxyproline excretion helps to distinguish these cases from patients with metabolic bone diseases due to metastases, Paget disease, etc. The fact that the fraction of fluoride not incorporated into bone is not further metabolized plus the accuracy, preciseness and rapidity of fluoride measurements in urine are the main advantages of this technique.
Assuntos
Osso e Ossos/metabolismo , Climatério/metabolismo , Fluoretos/farmacocinética , Fosfatase Alcalina/sangue , Osso e Ossos/diagnóstico por imagem , Cálcio/urina , Feminino , Humanos , Hidroxiprolina/urina , Isoenzimas/sangue , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/metabolismo , Cintilografia , Medronato de Tecnécio Tc 99mRESUMO
This paper reports a two tracers (45Ca for estimating calcium absorption and stable fluoride for assessing skeletal turnover), single blood sample procedure that estimates the absorption of calcium in climacteric women. The proposed technique determines the percentage (Ac) of the dose of 45Ca administered orally (in the fasting state, diluted with 150 ml of milk), present in the extracellular fluid (estimated as 15% of body wt) five hours after intake, corrected for skeletal turnover (assessed by the whole body retention of fluoride). In a series of 13 patients, Ac has been found to be operationally equivalent to the ratio: net Ca absorption/Ca intake, measured under balance conditions. The calcium balances of 60 climacteric women, estimated as: net Ca absorption (Ca intake factored by Ac) minus calciuria was found, as expected, to be correlated with skeletal turnover.