摘要:

ObjectiveTo compare carotid vascular resistance in long-term estrogen users with that of age-matched nonusers.MethodsPairwise comparisons between 18 long-term users of 17β-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.ResultsEstrogen users compared with age-matched non-users 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.ConclusionLong-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.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo test whether hydrolysis of low-density lipoprotein (LDL) triglyceride by lipolytic enzymes decreases the size of LDL particles in women treated with estrogen replacement.MethodsFifteen postmenopausal women received 0.625 mg conjugated equine estrogens daily for 3 months. Plasma concentrations of total cholesterol, triglyceride, and high-density lipoprotein (HDL) cholesterol were measured before and after therapy. We also assayed levels of total, free, and esterified cholesterol, triglyceride, and protein in LDL. Plasma samples were incubated at 37C for 24 hours and LDL fractions were isolated by ultracentrifugation. After LDL samples were further incubated with or without lipoprotein lipase (500, 700, and 1000 ng/mL) at 37C for 24 hours, LDL triglyceride, LDL protein, and the diameter of LDL particles were measured.ResultsEstrogen decreased total cholesterol and increased triglyceride and HDL cholesterol in plasma. Estrogen treatment decreased the ratio of cholesteryl ester/protein, whereas the ratio of triglyceride/protein increased. Estrogen decreased LDL particle diameter. Incubation of plasma increased the ratio of LDL triglyceride/protein from 0.40 ± 0.14 to 0.48 ± 0.15 (P< .05) and decreased the ratio of LDL cholesteryl ester/protein from 1.17 ± 0.25 to 1.09 ± 0.22 (P< .05), but LDL particle diameter did not change. Incubation of LDL with lipoprotein lipase reduced the LDL triglyceride/protein ratio, and decreased the diameter of LDL particles from 25.61 ± 0.87 nm to 24.89 ± 0.88 nm (500 ng/mL,P< .05), 24.62 ± 1.20 nm (700 ng/mL,P< .05), and 24.67 ± 1.19 nm (1000 ng/mL,P< .05).ConclusionIn women treated with estrogen, hydrolysis of triglyceride in LDL particles might be accompanied by reduced particle size.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo identify the effects of GnRH agonist therapy on body composition (lean and fat mass components) and body fat distribution.MethodsFifteen women with uterine leiomyomas were given a GnRH agonist (leuprorelin acetate, 3.75 mg) monthly for 4 months. Weight, height, and body mass index (BMI, weight/height2) were recorded. Regional and total body composition, trunk-leg fat ratio, bone mineral density of the lumbar spine (L2–L4), and total body were assessed by whole-body scanning with dual-energy x-ray absorptiometry before and after treatment. Uterine volume was measured by transabdominal ultrasonography.ResultsThe mean (± standard deviation [SD]) lean mass of total body, trunk, and leg decreased significantly (36.3 ± 4.9 to 35.4 ± 4.4 kg,P< .01; 18.8 ± 2.8 to 18.1 ± 2.8 kg,P< .05; and 11.4 ± 1.8 to 11.1 ± 1.6 kg,P< .05; respectively), whereas body fat mass, percentage of body fat, and trunk fat mass increased significantly (20.8 ± 4.8 to 21.8 ± 4.6 kg,P< .01; 34.9 ± 5.9 to 36.5 ± 5.2%,P< .01; and 8.6 ± 3.0 to 9.3 ± 3.0 kg,P< .01; respectively). Trunk-leg fat ratio increased significantly (1.03 ± 0.32 to 1.12 ± 0.33,P< .05). Weight, BMI, arm tissue composition (lean and fat mass components), and leg fat mass did not change during 4 months of GnRH agonist therapy. Bone mineral density and uterine volume decreased significantly.ConclusionHypogonadism by GnRH agonist therapy induces lean mass loss, increased adiposity overall, and upper body fat accumulation.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare the efficacy of topically applied heat for menstrual pain with oral ibuprofen and placebo treatment.MethodsWe conducted a randomized placebo and active controlled (double dummy), parallel study using an abdominal patch (heated or unheated) for approximately 12 consecutive hours per day and oral medication (placebo or ibuprofen 400 mg) three times daily, approximately 6 hours apart for 2 consecutive days. Pain relief and pain intensity were recorded at 17 time points. There was at least 85% power to detect a true one-unit difference in the 2-day pain relief treatment means for comparisons with the unheated patch plus oral placebo group using a one-tailed test at the .05 level of significance, based on an observed within-group standard deviation of 1.147.ResultsEighty-four patients were enrolled and 81 completed the study protocol. Over the 2 days of treatment, the heated patch plus placebo tablet group (mean 3.27,P< .001), the unheated patch plus ibuprofen group (mean 3.07,P= .001), and the combination heated patch plus ibuprofen group (mean 3.55,P< .001) had significantly greater pain relief than the unheated patch plus placebo group (mean 1.95). Greater pain relief was not observed for the combination heated patch plus ibuprofen group compared with the unheated patch plus ibuprofen group (P= .096); however, the time to noticeable pain relief was statistically significantly shorter for the heated patch plus ibuprofen group (median 1.5 hours) compared with the unheated patch plus ibuprofen group (median 2.79 hours,P= .01).ConclusionContinuous low-level topical heat therapy was as effective as ibuprofen for the treatment of dysmenorrhea.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo estimate the incidence and relative risk of postpartum urinary incontinence in primiparas.MethodsOver 3 years (1996–1998), healthy nulliparas with no significant history of urinary tract abnormalities were prospectively enrolled. Power analysis indicated that 452 women must complete the study. Participants completed a questionnaire about urinary, fecal, and flatal incontinence. At 6 weeks' and 6 months' postpartum, the same questionnaire was mailed to participants. Statistical analysis consisted of chi-square and Fisher exact tests for nominal variables and analysis of variance and Kruskal–Wallis tests for interval variables. Logistic regression tested independence of variables.ResultsA total of 690 primiparas were enrolled in the study and 595 delivered at our hospital: 147 (25%) cesareans, 333 (56%) spontaneous vaginal deliveries, and 115 (19%) instrumental vaginal deliveries. Median birth weight was 3489 g. Urinary incontinence rate at 6 months was 26%. Vaginal delivery was associated with a higher incidence of urinary incontinence (relative risk, 2.8) compared with cesarean. Forceps delivery increased the risk of urinary incontinence (relative risk, 1.5) compared with spontaneous vaginal delivery. There was no significant difference between cesareans done before and during labor. None of the obstetric risk factors were independently significant.ConclusionCesarean delivery at any stage of labor reduces postpartum urinary incontinence. With multivariable analysis, obstetric risk factors are not significant.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo detect human papillomavirus (HPV) in semen and find if sperm washing removes HPV DNA.MethodsAmplification by nested polymerase chain reaction (PCR) was used to detect viral DNA sequences in semen samples from 85 volunteers. Forty-five men had historical or clinical evidence of genital HPV infection (study group) and 40 were healthy, clinically HPV-negative semen donors.ResultsWe detected HPV DNA in the sperm cells of 24 of 45 subjects (53%) with past or current HPV infections in contrast to three of 40 healthy subjects (8%) (P< .001). Overall, PCR detected HPV in 21 of 32 subjects (66%) with identifiable lesions and six of 53 (11%) without them (P< .001). Swim-up washings of all 27 prewash sperm cells with HPV reduced cellular HPV DNA below detectable levels in only two cases.ConclusionHPV is present in sperm cells from infected and apparently healthy subjects, and sperm washing does not eliminate the risk of HPV transmission to recipients. We suggest that HPV DNA testing should be done on the semen of prospective donors, and those with positive tests should be excluded from donation.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess maternal blood pressure (BP) responses to working outside the home in late pregnancy, using 24-hour ambulatory BP monitoring.MethodsOur paired observational study involved 24-hour ambulatory BP monitoring of 100 normotensive women (51 primiparas, 49 multiparas) on work and nonwork days. Mean BP differences were calculated for working, postworking, sleeping, and 24-hour periods on both days. Main outcome measures were BP differences between work and nonwork days and subsequent pregnancy hypertension. Comparisons in BP between work and nonwork days were done with Student pairedttest. Comparisons between study subgroups were done with unpairedttest. Potential predictors of change in BP were examined using multiple linear regression.ResultsDuring job time, BP was significantly higher on work days than on nonwork days. The mean increase in BP associated with work was 2.6 mmHg (systolic BP,P< .001), 2.8 mmHg (diastolic BP,P< .001), and 2.9 mmHg (mean arterial BP,P< .001). Those observations were independent of parity. More than 10% of our subjects had increased mean arterial BP of 10 mmHg or more during job time on work days compared with nonwork days. Higher absolute BP levels (regression coefficient 0.21,P= .04) and greater perceived job stress (regression coefficient 1.34,P= .04) correlated positively with BP increases at work. Twelve women developed hypertension. Those women had a larger increase on work days in mean systolic (6.6 mmHg compared with 2.1 mmHg,P= .013), mean diastolic (6.4 mmHg compared with 2.3 mmHg,P= .014), and mean arterial (7.4 mmHg compared with 2.3 mmHg,P= .002) BP compared with normotensive women. The magnitude of BP responses to work was a significant predictor of pregnancy hypertension, independent of absolute BP level.ConclusionBlood pressure increased in women when they worked outside the home. The effect of maternal work is important when treating pregnancy hypertension. Ambulatory BP monitoring makes assessment of maternal BP responses to work a practical clinical option.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo measure the correlation of plasma adenosine levels with platelet activation in women with preeclampsia.MethodsPlasma adenosine concentration and expression of P-selectin, a marker for platelet activation, were measured in 18 normal pregnant women and 18 preeclamptic women. The effect of 8-sulfophenyltheophylline, an adenosine receptor blocker, on expression of P-selectin on platelets also was measured.ResultsPlasma adenosine level averaged 0.77 ± 0.11 μM (standard error of the mean [SEM]) in women with preeclampsia, significantly higher than the mean level of 0.47 ± 0.08 μM in women with normal pregnancies (P< .05). Expression of P-selectin on platelets averaged 7.8 ± 1.2% in women with preeclampsia, also significantly higher than the mean level of 4.7 ± 0.7% in normal pregnancy (P< .05). Adenosine receptor blockade significantly increased expression of P-selectin on platelets in women with preeclampsia by 26% (P< .05), which was significantly higher than the 13% increase of activation in those with normal pregnancies (P< .05).ConclusionAdenosine is an established platelet activation suppressor. Increased plasma levels of adenosine in preeclampsia might partially compensate and tend to prevent further excessive platelet activation in women with preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo investigate whether neutrophils and systemic complement are activated in pregnancies complicated by preeclampsia more than in normal pregnancies.MethodsWe measured native complement components and activation products in plasma by enzyme immunoassays in 19 women with uncomplicated pregnancies, 15 with preeclampsia before cesarean deliveries, and 16 nonpregnant women. Neutrophil activation was measured by specific enzyme immunoassays for myeloperoxidase and lactoferrin.ResultsMyeloperoxidase was significantly higher in women with preeclampsia (197 μg/L, 95% confidence interval [CI] 94, 646) than in women with uncomplicated pregnancies (124 μg/L, 95% CI 70, 289;P= .009), whereas lactoferrin did not differ between groups. C4 was decreased in preeclamptic women (0.16 g/L, 95% CI 0.07, 0.48) compared with women with uncomplicated pregnancies (0.21, 95% CI 0.10, 0.30,P< .001). There were no differences for the other native complement components. There was a significant decrease in C1rs-C1 inhibitor, 13 AU/mL (95% CI 9, 34) versus 19 (95% CI 13, 38) (P≤ .001) in normal pregnant women compared with nonpregnant women. There also was an increase in C3, C4, C9 (data not shown), C4bp, 132% (95% CI 94%, 161%) versus 91% (95% CI 57%, 128%); C3bc (7.4 AU/mL, 95% CI 4.2, 10.7) versus 4.8 AU/mL (95% CI 3.2, 7.3) and C4bc (8.6 AU/mL, 95% CI 5.7, 14.0) versus 3.5 AU/mL (95% CI 2.2, 6.7) in normal pregnant women compared with nonpregnant women (P≤ .001).ConclusionNeutrophil activation in preeclampsia was shown by systemic increases in myeloperoxidase. Except for a decrease in C4, systemic complement activation could not be detected in preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare extra-amniotic infusion of diluted prostaglandin (PG) E2solution with saline infusion in balloon cervical ripening and labor induction.MethodsWomen with pregnancy complications and Bishop scores of 3 or lower (n= 116) were assigned randomly to receive extra-amniotic infusion (1 mL/minute) of normal saline or PGE2in saline (0.5 μg/mL) through a Foley catheter with a 30-mL inflated balloon. We induced labor using intravenous oxytocin only when labor had not developed by 6 hours after balloon expulsion. Analysis was by intent-to-treat. We assessed ripening efficiency and course of labor in women who had spontaneous balloon expulsion (n= 110) and trial of labor (n= 107), respectively.ResultsRipening with PGE2was associated with significantly shorter mean (± standard error of the mean [SEM]) time for balloon expulsion (4.7 ± 0.4 versus 6.5 ± 0.6 hours) and with significantly higher Bishop scores (P< .002), compared with ripening with saline. In the PGE2group, rates of labor induction (15%) and oxytocin use (37%) were significantly lower than in the saline group (51% and 72%, respectively). The groups did not differ significantly in other labor abnormalities, labor duration, mode of delivery, birth weight, Apgar scores, and puerperal morbidity.ConclusionCervical ripening by extra-amniotic balloon and PGE2infusion is faster and more effective than by balloon and saline infusion, resulting in a higher rate of spontaneous labor and a lower rate of oxytocin use.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID