Replacement Therapy Group Research Articles

PP.71 Active Drug Use Vs Replacement Therapy or Abstinence During Pregnancy: Impact on the Outcomes For Mothers and Babies

AimsTo evaluate demographic characteristics of women with history of substance misuse, analyse the differences in the birth weights (term baby) amongst continuous drug users and the abstinent (or on replacement...

Continuous renal replacement therapy versus furosemide for management of kidney impairment in heart transplant recipients with volume overload

It is unknown whether continuous renal replacement therapy or furosemide therapy is superior in heart transplant recipients who are in postoperative kidney insufficiency and volume overload. This prospective non-randomized, controlled trial investigated the efficacy of the two methods after transplantation. We assigned heart transplant recipients 18 years of age or older who were oliguric (urine output < 400 ml/day); had volume overload and estimated glomerular filtration rate <60 ml/min/1.73 m(2) of body surface area calculated with the use of the Modification of Diet in Renal Disease equation, to designed initiation of intervention. We followed 30 patients for up to 30 days. The primary outcome was estimated glomerular filtration rate status after intervention. Between January 2010 and April 2012, a total of 30 adults (mean age: 37 years; 18 men and 12 women) were assessed for entry in this trial. Continuous renal replacement therapy, when compared with furosemide, was associated with a significant increase in estimated glomerular filtration rate of patients after intervention 61 ± 4.5 vs 55 ± 8.5l ml/min/1.73 m(2) (P = 0.02). Moreover, the mean glomerular filtration rate at discharge time for the continuous renal replacement therapy group was 72 ± 7.3 and 58 ± 7.4 ml/min/1.73 m(2) for the furosemide group (P < 0.001). During the follow-up period, 6 of 15 patients in the continuous renal replacement therapy group (40%) and 4 of 15 in the furosemide group (26.6%) died (P = 0.43). In this study, continuous renal replacement therapy in heart transplant recipients with reduced kidney function was associated with an improvement in estimated glomerular filtration rate status in comparison with furosemide.

Nicotine replacement therapy in critically ill patients: A prospective observational cohort study*

Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent nicotine withdrawal. However, recent studies have questioned the safety of this practice. The objective of this study was to determine the impact of nicotine replacement therapy on the outcomes of critically ill patients. Prospective observational cohort. The medical intensive care unit of a tertiary academic hospital. Active smokers admitted to the intensive care unit. None. After excluding 2,411 patients who did not meet the study inclusion criteria, 330 were included in the study, of which 174 patients received and 156 did not receive nicotine replacement therapy. There were no significant differences in the unadjusted hospital mortality between the two groups: 14 patients (7.8%; 95% confidence interval, 4-12) died in the nicotine replacement therapy group as compared with ten patients (6.3%; 95% confidence interval, 2.6-10.3) in the nonnicotine replacement therapy group (p = .59). After adjusting for severity of illness and propensity score for administration of nicotine replacement therapy on intensive care unit admission, nicotine replacement therapy was not associated with increased hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.5-3.9; p = .51). Single-center observational study. Nicotine replacement therapy is not associated with increased hospital mortality in critically ill patients. However, we were not able to demonstrate any clinically significant benefit from its use in the intensive care unit setting.

A Small-Scale Clinical Trial to Determine the Safety and Efficacy of Testosterone Replacement Therapy in Hypogonadal Men with Spinal Cord Injury

Men with spinal cord injury are at an increased risk for secondary medical conditions, including metabolic disorders, accelerated musculoskeletal atrophy, and, for some, hypogonadism, a deficiency, which may further adversely affect metabolism and body composition. A prospective, open label, controlled drug intervention trial was performed to determine whether 12 months of testosterone replacement therapy increases lean tissue mass and resting energy expenditure in hypogonadal males with spinal cord injury. Healthy eugonadal (n = 11) and hypogonadal (n = 11) outpatients with chronic spinal cord injury were enrolled. Hypogonadal subjects received transdermal testosterone (5 or 10 mg) daily for 12 months. Measurements of body composition and resting energy expenditure were obtained at baseline and 12 months. The testosterone replacement therapy group increased lean tissue mass for total body (49.6 ± 7.6 vs. 53.1 ± 6.9 kg; p < 0.0005), trunk (24.1 ± 4.1 vs. 25.8 ± 3.8 kg; p < 0.005), leg (14.5 ± 2.7 vs. 15.8 ±2.6 kg; p = 0.005), and arm (7.6 ± 2.3 vs. 8.0 ± 2.2 kg; p < 0.005) from baseline to month 12. After testosterone replacement therapy, resting energy expenditure (1328 ± 262 vs. 1440 ± 262 kcal/d; p < 0.01) and percent predicted basal energy expenditure (73 ± 9 vs. 79 ± 10%; p < 0.05) were significantly increased. In conclusion, testosterone replacement therapy significantly improved lean tissue mass and energy expenditure in hypogonadal men with spinal cord injury, findings that would be expected to influence the practice of clinical care, if confirmed. Larger, randomized, controlled clinical trials should be performed to confirm and extend our preliminary findings.

Tei Index in Fabry Disease

Systolic and diastolic dysfunction of the left ventricle are present in patients with cardiac involvement in Fabry disease. The aim of this study was to investigate the diagnostic value of the Tei index, a marker for combined diastolic and systolic function, in patients with Fabry disease. A total of 66 consecutive patients with genetically confirmed Fabry disease were included in this study. Standard echocardiography, including the Tei index, and magnetic resonance imaging were performed. Patients were followed for 2.9 ± 1.9 years; 56 patients received enzyme replacement therapy, and 10 patients had natural history follow-up. Patients were subdivided into three groups: (1) those without cardiac involvement, (2) those with left ventricular (LV) hypertrophy and without late enhancement on magnetic resonance imaging, and (3) those with late enhancement on magnetic resonance imaging. The Tei index was significantly higher in the groups 2 (0.56 ± 0.10) and 3 (0.60 ± 0.16) compared with patients without cardiac involvement (0.44 ± 0.10) (P < .001). All patients with Tei indexes > 0.64 showed signs of cardiomyopathy. In contrast, ejection fractions were normal in all three patient groups and therefore not useful for the detection of cardiac involvement. A significant positive correlation was observed between LV wall thickness and the Tei index in the complete patient cohort. Moreover, receiver operating characteristic analysis revealed a large area under the curve for Tei index and hypertrophy, while the area under the curve for fibrosis was small. The Tei index remained unchanged in the natural history and enzyme replacement therapy groups during follow-up. In this cohort, the Tei index was of limited value to detect myocardial fibrosis and monitor enzyme replacement therapy. However, the progression of cardiomyopathy toward LV hypertrophy seems to be paralleled by global functional impairment, which can be assessed by the Tei index but not by ejection fraction. Thus, the Tei index seems to be a global parameter that can detect LV functional reduction in patients with Fabry disease.

Dietary intakes and antioxidant status in mind-body exercising pre- and postmenopausal women.

The decline in antioxidant defenses due to both estrogen loss and frequent adoption of poor dietary choices exposes postmenopausal women to cardiovascular diseases. Adequate nutrition and physical exercise are two factors of health promotion. This study investigated whether regular practice of mind-body exercise (yoga and/or tai chi) alters dietary intake and antioxidant status and balances the menopause-related increases in lipid peroxidation and cardiovascular risk. Cross-sectional study. The study was conducted in an urban community in Bangkok (Thailand) between May and August 2007. Premenopausal (Pre M; 39±8 yrs; n=56) and postmenopausal (Post M; 54±5 yrs; n=39) women who had been practicing yoga (Y) and/or tai chi (TC) more than 3 hours/week for a year, or who had no regular physical activity practice (sedentary, S). All participants completed food frequency questionnaires and 4-day food and activity records. Blood was collected on day 5. Factorial ANOVA tests were performed according to menopause status, exercise, and hormone replacement therapy (HRT) groups. Post M had higher (p = 0.01) dietary fiber intake compared with Pre M. Yoga practitioners had lower BMI (p = 0.004) and lower fat intake (p = 0.02) compared with their S and TC counterparts. Plasma total antioxidant status was significantly and independently lower and higher in Y and Post M groups, respectively. However, no difference was shown after adjusting for BMI. Regardless of menopause status and HRT, the activity of erythrocyte glutathione peroxidase - an aerobic training-responsive enzyme - was higher (p < 0.001) in TC practitioners compared with other groups. No effects were shown on erythrocyte superoxide dismutase activity, plasma lipid peroxidation (TBARS) or total homocysteine concentrations. Yoga and tai chi exercises can be used as components of a strategy to promote healthy lifestyles (balanced diet and moderate intensity exercise) in vulnerable populations, such as menopausal women, in order to prevent aging induced oxidative stress-related diseases.

Piper sarmentosum enhances fracture healing in ovariectomized osteoporotic rats: a radiological study

INTRODUCTION:Osteoporotic fractures are common during osteoporotic states. Piper sarmentosum extract is known to possess antioxidant and anti-inflammatory properties.OBJECTIVES:To observe the radiological changes in fracture calluses following administration of a Piper sarmentosum extract during an estrogen-deficient state.METHODS:A total of 24 female Sprague-Dawley rats (200-250 g) were randomly divided into 4 groups: (i) the sham-operated group; (ii) the ovariectomized-control group; (iii) the ovariectomized + estrogen-replacement therapy (ovariectomized-control + estrogen replacement therapy) group, which was supplemented with estrogen (100 µg/kg/day); and (iv) the ovariectomized + Piper sarmentosum (ovariectomized + Piper sarmentosum) group, which was supplemented with a water-based Piper sarmentosum extract (125 mg/kg). Six weeks after an ovariectomy, the right femora were fractured at the mid-diaphysis, and a K-wire was inserted. Each group of rats received their respective treatment for 6 weeks. Following sacrifice, the right femora were subjected to radiological assessment.RESULTS:The mean axial callus volume was significantly higher in the ovariectomized-control group (68.2±11.74 mm3) than in the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups (20.4±4.05, 22.4±4.14 and 17.5±3.68 mm3, respectively). The median callus scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups had median (range, minimum - maximum value) as 1.0 (0 - 2), 1.0 (1 - 2) and 1.0 (1 - 2), respectively, which were significantly lower than the ovariectomized-control group score of 2.0 (2 - 3). The median fracture scores for the sham-operated, estrogen-replacement-therapy and Piper sarmentosum groups were 3.0 (3 - 4), 3.0 (2 - 3) and 3.0 (2 - 3), respectively, which were significantly higher than the ovariectomized-control group score of 2.0 (1 - 2) (p<0.05).CONCLUSION:The Piper sarmentosum extract improved fracture healing, as assessed by the reduced callus volumes and reduced callus scores. This extract is beneficial for fractures in osteoporotic states.

Acupuncture and Auricular Acupressure in Relieving Menopausal Hot Flashes of Bilaterally Ovariectomized Chinese Women: A Randomized Controlled Trial

The objective of this study is to explore the effects of acupuncture and auricular acupressure in relieving menopausal hot flashes of bilaterally ovariectomized Chinese women. Between May 2006 and March 2008, 46 bilaterally ovariectomized Chinese women were randomized into an acupuncture and auricular acupressure group (n = 21) and a hormone replacement therapy (HRT) group (Tibolone, n = 25). Each patient was given a standard daily log and was required to record the frequency and severity of hot flashes and side effects of the treatment felt daily, from 1 week before the treatment started to the fourth week after the treatment ended. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment. After the treatment and the follow-up, both the severity and frequency of hot flashes in the two groups were relieved significantly when compared with pre-treatment (P < .05). There was no significant difference in the severity of hot flashes between them after treatment (P > .05), while after the follow-up, the severity of hot flashes in the HRT group was alleviated more. After the treatment and the follow-up, the frequency of menopausal hot flashes in the HRT group was reduced more (P < .05). After treatment, the levels of FSH decreased significantly and the levels of E2 increased significantly in both groups (P < .05), and they changed more in the HRT group (P < .05). Acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot flashes for those bilaterally ovariectomized women who are unable or unwilling to receive HRT.

Effects of synaptic plasticity regulated by 17beta-estradiol on learning and memory in rats with Alzheimer's disease.

To investigate whether estrogen modulates learning and memory and long-term potentiation (LTP) in the hippocampus of rats with Alzheimer's disease (AD). The rats were divided into ovariectomy (OVX) and estrogen replacement therapy (ERT) groups. Rats in the ERT group received OVX, followed by ERT, while rats in the OVX group received only OVX. The rat model of AD was established by injection of 1 microL (10 microg/microL) amyloid-beta peptide 1-40(Abeta1-40) into the hippocampus. The learning and memory ability and LTP were determined by Morris water maze and electrophysiological method, respectively. The escape latency in Morris water maze significantly decreased in ERT group compared with that in OVX group (P< 0.05). Besides, rats in ERT group exhibited a significant enhancement of the magnitude of LTP at 30 min after high-frequency stimulation (HFS), compared with that in OVX group (P< 0.01). ERT can attenuate the cognitive deficits in the rat model of AD, and estrogen can regulate LTP and synaptic remodeling in AD rats.

Acupuntura y acupresión auricular para el alivio de los sofocos de la menopausia: ensayo aleatorizado controlado en mujeres chinas sometidas a ovariectomía bilateral

The objective of this study is to explore the effects of acupuncture and auricular acupressure in relieving menopausal hot fl ashes of bilaterally ovariectomized Chinese women. Between May 2006 and March 2008, 46 bilaterally ovariectomized Chinese women were randomized into an acupuncture and auricular acupressure group (n = 21) and a hormone replacement therapy (HRT) group (Tibolone, n = 25). Each patient was given a standard daily log and was required to record the frequency and severity of hot fl ashes and side effects of the treatment felt daily, from 1 week before the treatment started to the fourth week after the treatment ended. The serum levels of follicle stimulating hormone (FSH), LH and E2 were detected before and after the treatment. After the treatment and the follow-up, both the severity and frequency of hot fl ashes in the two groups were relieved signifi cantly when compared with pre-treatment (P < 0.05). There was no signifi cant difference in the severity of hot fl ashes between them after treatment (P > 0.05), while after the follow-up, the severity of hot fl ashes in the HRT group was alleviated more. After the treatment and the follow-up, the frequency of menopausal hot fl ashes in the HRT group was reduced more (P < 0.05). After treatment, the levels of FSH decreased signifi cantly and the levels of E2 increased signifi cantly in both groups (P < 0.05), and they changed more in the HRT group (P < 0.05). Acupuncture and auricular acupressure can be used as alternative treatments to relieve menopausal hot fl ashes for those bilaterally avariectomized women who are unable or unwilling to receive HRT.

Discontinuation of continuous renal replacement therapy: A post hoc analysis of a prospective multicenter observational study*

To describe current practice for the discontinuation of continuous renal replacement therapy in a multinational setting and to identify variables associated with successful discontinuation. The approach to discontinue continuous renal replacement therapy may affect patient outcomes. However, there is lack of information on how and under what conditions continuous renal replacement therapy is discontinued. Post hoc analysis of a prospective observational study. Fifty-four intensive care units in 23 countries. Five hundred twenty-nine patients (52.6%) who survived initial therapy among 1006 patients treated with continuous renal replacement therapy. None. Three hundred thirteen patients were removed successfully from continuous renal replacement therapy and did not require any renal replacement therapy for at least 7 days and were classified as the "success" group and the rest (216 patients) were classified as the "repeat-RRT" (renal replacement therapy) group. Patients in the "success" group had lower hospital mortality (28.5% vs. 42.7%, p < .0001) compared with patients in the "repeat-RRT" group. They also had lower creatinine and urea concentrations and a higher urine output at the time of stopping continuous renal replacement therapy. Multivariate logistic regression analysis for successful discontinuation of continuous renal replacement therapy identified urine output (during the 24 hrs before stopping continuous renal replacement therapy: odds ratio, 1.078 per 100 mL/day increase) and creatinine (odds ratio, 0.996 per [micro]mol/L increase) as significant predictors of successful cessation. The area under the receiver operating characteristic curve to predict successful discontinuation of continuous renal replacement therapy was 0.808 for urine output and 0.635 for creatinine. The predictive ability of urine output was negatively affected by the use of diuretics (area under the receiver operating characteristic curve, 0.671 with diuretics and 0.845 without diuretics). We report on the current practice of discontinuing continuous renal replacement therapy in a multinational setting. Urine output at the time of initial cessation of continuous renal replacement therapy was the most important predictor of successful discontinuation, especially if occurring without the administration of diuretics.

International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at 1 year.

There are 1.1 billion smokers worldwide. Traditional smoking cessation methods, such as nicotine replacement therapy and smoking cessation groups, yield between 14% and 27% abstinence rates at 6 months. Evidence-based Internet interventions with comparable abstinence rates could be a powerful global tool to reduce tobacco-related morbidity and mortality. We report a randomized control trial in which 500 Spanish-speaking and 500 English-speaking adult Internet users, smoking at least 5 cigarettes/day and intending to quit in the next month, were recruited online from 68 countries. Consenting participants who completed baseline measures, logged cigarettes smoked on 3 days within a week, and set a quit date were randomized to four conditions. Each condition added new elements: Condition 1 was the "Guía Para Dejar de Fumar," a static National Cancer Institute evidence-based stop smoking guide; Condition 2 consisted of Condition 1 plus E-mail reminders to return to the site; Condition 3 consisted of Condition 2 plus mood management lessons; and Condition 4 consisted of Condition 3 plus a "virtual group" (an asynchronous bulletin board). Main outcome measures were 7-day point prevalence abstinence at 1, 3, 6, and 12 months after initial quit date. There were no significant differences among the four conditions. The overall 12-month 7-day abstinence rates were 20.2% for Spanish speakers and 21.0% for English speakers when those with missing data were assumed to be smoking. Internet smoking cessation interventions with such abstinence rates provided globally in additional languages could contribute substantially to tobacco control efforts.

Therapy outcome in peritoneal dialysis patients transferred from haemodialysis

Haemodialysis (HD) and peritoneal dialysis (PD) should be regarded as complementary methods of renal replacement therapy. Approximately 10-20% of patients on PD are transferred annually to HD due to technique failure. Much smaller proportion of patients changes modality from HD to PD, predominantly due to vascular access problems, cardiac disease or patient preference. The effects of these transfers on therapy outcome, patient and technique survival have not been studied, with research focusing on outcome measures within the single modality and comparisons between the two methods. We have analysed retrospectively a cohort of 264 patients treated with PD in a single PD centre during 1994-2006. Patient characteristics, therapy measures and outcome of patients were compared between patients for whom PD was the initial method of renal replacement therapy (group 1, n = 197) and those transferred to PD from haemodialysis because of complications (group 2, n = 67). The Kaplan-Meier method and Cox proportional hazards multiple regression analysis were used to assess patient and technique survival. In patients transferred from HD, significantly less had diabetes (11.9% versus 38.1%, P < 0.0001) and there were also significantly more females (57% versus 42.2%, P < 0.05). Baseline Kt/V was significantly higher in the primary PD therapy group (2.46 +/- 0.57 versus 2.11 +/- 0.48, P < 0.001), due to lower residual renal function in patients transferred from HD. Group 2 had also significantly higher peritonitis rate (0.86 versus 0.62 episode/year, P < 0.05). During the time of observation, 71 patients have died, in 100 patients kidney transplantation was performed, 56 were transferred to HD, renal function recovered in 5 and 32 were still on PD at the end of the study. No significant differences were observed in unadjusted patient survival, but technique survival was significantly lower in group 2 (P < 0.05). In the Cox multiple regression model, diabetes status, age and albumin level significantly influenced survival. Relative risk of death was not increased significantly in patients transferred from HD. Our data suggest that outcome of patients transferred from HD is similar to that achieved in patients in whom PD is the first choice therapy. Thus, this option should be strongly considered in patients experiencing complications on HD, mainly vascular access problems, heart failure or intradialytic hypotension.

Research on antioxidant effects and estrogenic effect of formononetin from Trifolium pratense (red clover)

Antioxidant and estrogenic effects of formononetin on ovariectomized mice have been investigated in the present study. The adult female Kunming mice were divided into 5 groups: sham-operated group, ovariectomized group, stilbestrol replacement therapy group (0.20 mg/kg day), low-dose formononetin group (0.05 g/kg day) and high-dose formononetin group (0.5 g/kg day). The mice in the latter 4 groups were ovariectomized. The drug was given by oral administration for 6 months. Estrogenic effect was determined by the change of uterine weight, and oxidant effects were determined by the content of SOD, GSH-Px, CAT and MDA. The intake of formononetin increased the uterine weight of the mice significantly as well as the content of SOD, GSH-Px, CAT, and reduced MDA in body. Formononetin had obvious antioxidant effects and estrogenic effect, and the estrogenic effect was not dosage-related.

Abstract 1844: Increased Mortality And Perioperative Complications In Patients After Previous Elective Percutaneous Coronary Interventions Undergoing Coronary Artery Bypass Surgery

Introduction. The number of patients with previous Percutaneous Coronary Interventions (PCI) referred to Coronary Artery Bypass Grafting (CABG) is continuously increasing. The relationship between previous elective PCI and the perioperative outcome after CABG remains undetermined. The aim of the study was to investigate whether patients referred to CABG after previous elective PCI have an increased perioperative risk. Methods. Between January 2002 and May 2007, 4412 consecutive patients underwent first-time open heart surgery at our department. After excluding patients with a history of emergent PCI, we isolated 306 patients after previous elective PCI during the last 24 months before CABG (Group 1). Those patients were compared to 452 consecutive patients without history of previous PCI, who underwent CABG during the same period and who were matched for age, gender and preoperative risk factors (Group 2). Both groups were compared in terms of 30-day mortality, Major Adverse Cardiac Events (MACEs), and perioperative complications. Results. Both groups were comparable concerning preoperative linear EuroSCORE (Group 1: 4.83±0.18, Group 2: 4.72±0.14, p=0.63). Patients with previous elective PCI before CABG had increased perioperative mortality (Group 1: 3.3% vs Group 2: 1.9%, p&lt;0.001) and MACEs (Group 1: 7.9% vs 4.3%, p&lt;0.001). This fact was associated with a worse logistic perioperative outcome (Group 1: 1.26±0.39, Group 2: 2.33, p=0.044). In addition, the incidence of bleeding complications (Group 1: 5.9% vs Group 2: 3.8%, p=0.017) and the number of blood products (Group 1: 1.70±0.31 vs 0.61±0.17, p&lt;0.001) used were higher in patients of the Group 1. A higher incidence of acute renal failure (Group 1: 5.9% vs 2.7%, p=0.025) and renal replacement therapy (Group 1: 3.6% vs Group 2: 1.7%, p=0.03) was observed in patients of the same group. Conclusions. Patients with previous elective PCI before referral to CABG have a worse perioperative outcome in terms of mortality, MACE and perioperative complications as compared to patients with no history of PCI.

Continuous vs. intermittent hemodialysis: with which spin will my patient win?

Intervention: Patients were randomized to intermittent haemodialysis (n=184) or continuous venovenous haemodiafiltration (n=175). Guidelines were provided to achieve optimum haemodynamic tolerance and effectiveness of solute removal in both groups. The two groups were treated with the same polymer membrane and bicarbonate-based buffer. Measurements and main results: The primary endpoint was 60-day survival based on an intention-to-treat analysis. Rate of survival at 60-days did not differ between the groups (32% in the intermittent haemodialysis group versus 33% in the continuous renal replacement therapy group [95 % CI 8.8 to 11.1,]), or at any other time.

Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial

Whether continuous renal replacement therapy is better than intermittent haemodialysis for the treatment of acute renal failure in critically ill patients is controversial. In this study, we compare the effect of intermittent haemodialysis and continuous venovenous haemodiafiltration on survival rates in critically ill patients with acute renal failure as part of multiple-organ dysfunction syndrome. Our prospective, randomised, multicentre study took place between Oct 1, 1999, and March 3, 2003, in 21 medical or multidisciplinary intensive-care units from university or community hospitals in France. Guidelines were provided to achieve optimum haemodynamic tolerance and effectiveness of solute removal in both groups. The two groups were treated with the same polymer membrane and bicarbonate-based buffer. 360 patients were randomised, and the primary endpoint was 60-day survival based on an intention-to-treat analysis. Rate of survival at 60-days did not differ between the groups (32% in the intermittent haemodialysis group versus 33% in the continuous renal replacement therapy group [95 % CI -8.8 to 11.1,]), or at any other time. These data suggest that, provided strict guidelines to improve tolerance and metabolic control are used, almost all patients with acute renal failure as part of multiple-organ dysfunction syndrome can be treated with intermittent haemodialysis.

Different Effects of Transdermal and Oral Hormone Replacement Therapy on the Renin-Angiotensin System, Plasma Bradykinin Level, and Blood Pressure of Normotensive Postmenopausal Women

This study compared the efficacy of transdermally administered estradiol with that of orally administered conjugated equine estrogens (CEE) on the renin-angiotensin system, plasma bradykinin level, and blood pressure (BP) in normotensive postmenopausal women (PMW). A total of 38 normotensive PMW were randomly assigned to two groups. The transdermal hormone replacement therapy (HRT) group consisted of 19 women treated with a continuous transdermal estradiol patch (36 microg/day) plus cyclic oral medroxyprogesterone acetate (MPA; 2.5 mg/day for 12 days) for 12 months. The oral HRT group consisted of 19 women who received continuous oral CEE (0.625 mg/day) plus cyclic oral MPA (2.5 mg/day for 12 days) for 12 months. Plasma renin activity (PRA), serum angiotensin-converting enzyme (ACE) activity, plasma angiotensin (Ang) I, Ang II, and bradykinin concentrations, and BP were measured before and 12 months after the start of HRT. Transdermal HRT significantly decreased both diastolic and mean BP and concomitantly reduced bradykinin levels (all P < .05). However, no significant changes in PRA, ACE activity, Ang I, or Ang II levels were observed. The BP remained unchanged in the oral HRT group, but the PRA, Ang I, Ang II, and bradykinin levels had significantly increased and ACE activity had significantly decreased (all P < .05) at 12 months after the start of HRT. Transdermal HRT decreased BP in normotensive PMW without influencing Ang II, whereas oral HRT increased Ang II without altering BP. Transdermal HRT may be more beneficial than oral HRT with regard to BP and Ang II levels.

Advice has changed for hormone therapy in the WHI era

Advice has changed for hormone therapy in the WHI era

Hormonal function after ovarian transposition to the abdominal subcutaneous fat tissue

We previously reported a new technique for ovarian transposition to the abdominal subcutaneous fat tissue (OTAFT) following hysterectomy. The purpose of this study is to assess the hormonal function after OTAFT. From 1993 to 2000, OTAFT was performed in 27 patients (group A). Forty-two women underwent hysterectomy and retained ovaries without transposition (group B). In 19 cases, bilateral oophorectomy with hysterectomy was performed, and they received a hormone replacement therapy (HRT) (group C). Serum follicle-stimulating hormone (FSH) level of patients was monitored every 2-12 months, and the time of menopause (defined as FSH >40 mIU/mL two times consecutively) was determined in groups A and B. After a median follow-up of 65 months, cumulative ovarian survival did not show significant difference between group A and group B (HR = 0.52, 95% CI = 0.17-1.16; P= 0.10). In patients who were 40 years old or younger, ovarian function declined significantly in group A compared to group B (HR = 0.29, 95% CI = 0.02-0.91; P= 0.04). However, FSH level of postmenopausal patients in group A was not different from FSH level of patients in group C, but FSH level of postmenopausal patients in group B was significantly higher than FSH level of patients in group C (P= 0.002). Although the procedure of OTAFT may somewhat affect the ovarian function, the transposed ovary in postmenopausal women presumably still secrete a small amount of estrogen which is equivalent to an estrogen level by HRT.