Evaluation of conjugated estrogen plus medroxyprogesterone acetate versus tibolone in early postmenopausal Chinese women

BACKGROUND

The safety and efficacy of tibolone (Livial) were compared with the traditional cyclic, sequential conjugated estrogens/medroxyprogesterone acetate (Premarin/Provera; PP) regimen for the treatment of climacteric symptoms, prevention of postmenopausal bone loss, endometrial stimulation and influence on lipid profile.

METHODS

Forty women, one to three years postmenopause, were randomly enrolled in one of two treatment groups, receiving either tibolone (2.5 mg) every day for six months or Premarin (0.625 mg) every day plus Provera (5 mg) from day 1 to day 12 every month for six months. The scores of climacteric complaints, using the Greene Climacteric Scales, and bleeding pattern were recorded at baseline and follow-up visits at months 1, 3 and 6. Bone resorption (deoxypyridinium) and formation (osteocalcin) markers were measured at baseline, three and six months. Lipid profiles, bone density of the lumbar spine and neck of the femur measured by dual energy X-ray absorptiometry were checked at baseline and six months.

RESULTS

Tibolone was as effective as PP in alleviating climacteric complaints. Both regimens were effective in slowing bone metabolism and preventing bone loss. After six months of treatment, bone density of the lumbar spine increased 2.174% in the tibolone group. The endometrium of patients remained atrophic (< 4 mm); only one woman reported vaginal spotting after three months of tibolone therapy. Significant decreases in triglyceride (31.48%) and high-density lipoprotein (29.25%) were also observed. In the PP group, bone density of the lumbar spine increased 1.405%; cyclic withdrawal bleeding occurred in every patient. A significant increase in triglyceride (38.76%) and a significant decrease in low-density lipoprotein (15.10%) were observed.

CONCLUSIONS

Tibolone proved to be effective and safe in the treatment of women with climacteric symptoms and postmenopausal bone loss. As a form of hormone replacement therapy without the need for withdrawal bleeding, tibolone has great appeal to postmenopausal women, and compliance is higher than reported with other forms of hormone replacement therapy.

A simplified regimen of weekly high dose 5-fluorouracil and leucovorin as a 24-hour infusion in patients with advanced colorectal carcinoma

BACKGROUND

Reports of in vitro experiments in colorectal carcinoma cells suggest that prolonged cellular exposure to 5-fluorouracil (5-FU) combined with relatively low concentrations of leucovorin (LV) provides optimal enhancement of 5-FU efficacy. In this study, a simplified regimen of weekly 24-hour infusion of high dose 5-FU combined with a relatively low dose of LV was used to treat patients with advanced colorectal carcinoma.

METHODS

Thirty-six patients with advanced colorectal carcinoma received 5-FU, 2600 mg/m2, admixed with LV, 100 mg/m2, in a portable infusion pump administered intravenously over a 24-hour period. High dose 5-FU/LV was delivered once a week for 5 consecutive weeks followed by a 1-week recovery period. All patients were assessable for toxicity and response.

RESULTS

Two complete responses and 15 partial responses were observed (response rate of 47.2%; 95% confidence interval, 30.1-64.4%). The median response duration was 9.6 months. The median survival and time to progression were 11.9 months and 7.1 months, respectively. The toxicity was mild and acceptable. The major dose-limiting factors were hand-foot syndrome and fatigue.

CONCLUSIONS

This simplified regimen of weekly 24-hour continuous infusion of high dose 5-FU/LV is an effective regimen in the treatment of patients with advanced colorectal carcinoma. Further study of the pharmacokinetics of combination therapy with 5-FU and LV as used in this regimen and its correlation with response and toxicity is warranted.

Weekly 24-h infusion of high-dose 5-flurouracil and leucovorin in patients with advanced gastric cancer

The effect of biochemical modulation of weekly high-dose 5-fluorouracil (5-FU) 24 h infusion by leucovorin (LV) in the treatment of 39 consecutive patients with advanced gastric cancer without prior chemotherapy from October 1996 to August 1997 was examined. There were 21 male and 18 female patients with a median age of 56 years. The regimen consisted of 5-FU 2600 mg/m2 and LV 150 mg administered by 24 h infusion weekly for 6 weeks followed by a 2 week break. The treatment was repeated every 8 weeks until disease progression, patient refusal or unacceptable toxicity. Placement of a central vascular device and a portable external infusion pump was required in all patients and was used for outpatient treatment. The response to treatment was evaluated every 8 weeks. A total of 395 chemotherapy treatments were given with a mean of 10 (2-24). This response rate was: 33% (12 of 36) partial response (PR) rate, 33% (12 of 36) stable disease (SD) and 33% (12 of 36) progressive disease (PD). In general, the toxicity was mild but two toxic deaths occurred, one due to neutropenic sepsis and the other due to hyperammonemia. The median time to progression was 4 months. The overall median survival was 7 months. The survivals of the PR, SD and PD were 12, 8 and 5 months, respectively. This regimen showed a modest activity against gastric cancer with acceptable toxicity. Weekly 24 h infusion of high-dose 5-FU with LV in an outpatient setting for patients with gastric cancer is feasible and deserves further study as a basis for combination therapy.

Risk of transient hyperammonemic encephalopathy in cancer patients who received continuous infusion of 5-fluorouracil with the complication of dehydration and infection

From 1986 to 1998, 29 cancer patients who had 32 episodes of transient hyperammonemic encephalopathy related to continuous infusion of 5-fluorouracil (5-FU) were identified. None of the patients had decompensated liver disease. Onset of hyperammonemic encephalopathy varied from 0.5 to 5 days (mean: 2.6 +/- 1.3 days) after the initiation of chemotherapy. Plasma ammonium level ranged from 248 to 2387 microg% (mean: 626 +/- 431 microg%). Among the 32 episodes, 26 (81%) had various degrees of azotemia, 18 (56%) occurred during bacterial infections and 14 (44%) without infection occurred during periods of dehydration. Higher plasma ammonium levels and more rapid onset of hyperammonemia were seen in 18 patients with bacterial infections (p=0.003 and 0.0006, respectively) and in nine patients receiving high daily doses (2600 or 1800 mg/m2) of 5-FU (p=0.0001 and < 0.0001, respectively). In 25 out of 32 episodes (78%), plasma ammonium levels and mental status returned to normal within 2 days after adequate management. In conclusion, hyperammonemic encephalopathy can occur in patients receiving continuous infusion of 5-FU. Azotemia, body fluid insufficiency and bacterial infections were frequently found in these patients. It is therefore important to recognize this condition in patients receiving continuous infusion of 5-FU.

Successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and subsequent gonadotropin-releasing hormone agonist: a case report

Adenomyosis is a common pathologic finding significantly related to the menstrual and reproductive characteristics of women. Although noted during younger reproductive years, it usually presents in women over 35 years of age. For those with a strong desire to preserve fertility, there is presently no uniform agreement on the most appropriate therapeutic methods to manage the condition. Herein, we present a case of long-term secondary infertility with successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and a subsequent six-month course of gonadotropin-releasing hormone agonist (GnRHa) therapy. For those who want to conceive, early combined GnRHa therapy immediately following cytoreductive surgery and a delay of four to six months before attempting to fall pregnant is advisable. This is because adenomyosis tends to recur rapidly and the myometrium can be significantly disrupted during surgery. The major obstetric complications, such as uterine atony, rupture or placenta accreta, do not increase with adenomyosis during pregnancy. Although two events of threatened abortion and one of preterm labor were encountered during the pregnancy course, a healthy 2,900-g female was delivered by low transverse cesarean section at term. A cesarean section was performed because of previous large cytoreductive surgery. In contrast to GnRHa therapy alone, we report an effective alternative to hysterectomy in order to maintain fertility and achieve successful pregnancy.

Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy and is rarely spontaneous. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, it will not be surprising to observe that this phenomenon has increased significantly. However, diagnosis is often delayed because of its rarity and difficulty. We report a case of a woman with a viable intrauterine pregnancy who had a complication of ovarian hyper-stimulation syndrome secondary to ovulation induction following in vitro fertilization and embryo transfer, but who, during hospitalization, presented with clinically progressive abdominal pain. An unruptured ectopic pregnancy of the right fallopian tube was diagnosed accidentally by laparoscopy and laparoscopic salpingectomy was immediately performed. Post-operative follow-up revealed that the intrauterine pregnancy continued normally. She delivered a normal female baby at 38 weeks of gestation. The promising neonatal outcome might suggest that laparoscopy might be safely performed to aid differential diagnosis in an uncertain condition during pregnancy: therefore, laparoscopic surgery might be an appropriate method to manage some carefully selected patients with HP. A brief review of the published literature on the role of laparoscopy in the diagnosis and management of heterotopic pregnancy is given.

Effects of alendronate on bone turnover markers in early postmenopausal women

BACKGROUND

Alendronate sodium (Fosamax, Merck, Sharp & Dohme, Whitehouse Station, NJ, USA) is an aminobisphosphonate that can inhibit osteoclast-mediated bone resorption activity to reduce bone turnover rate and improve progressive gains in bone mass.

METHODS

This was a randomized, double-blind, placebo-controlled study comparing the effects on bone turnover markers between daily treatment with alendronate sodium 10 mg and placebo. Forty early postmenopausal women completed three months of treatment. The bone turnover rate was determined by measuring the biochemical markers at baseline, week 6 and at the end of the three-month treatment period. All adverse events were recorded during each follow-up visit.

RESULTS

Patients receiving alendronate treatment had a significant decrease in urinary excretion of the bone resorption marker deoxypyridinoline (Dpd) as well as one of the bone formation markers, bone-specific alkaline phosphatase (AlkP-B). Patients receiving placebo tended to have increased urinary excretion of bone resorption and formation markers. At the end of three months, the mean percentage change of Dpd and AlkP-B from baseline in the group receiving 10 mg alendronate was 30.49% and 29.45% reduction, respectively. The placebo group had 2.39% and 1.52% increase, respectively. Overall, three biochemical markers (Dpd, AlkP-B and osteocalcin) differed significantly between the treatment and control groups after three months of treatment. The drug was well tolerated, without a significant increase in incidence of adverse effects such as gastrointestinal discomfort and esophageal irritation.

CONCLUSIONS

Bone turnover rate decreased quickly following drug administration. The incidence of adverse effects did not differ significantly between the alendronate and placebo groups. Alendronate is, therefore, recommended as an effective nonhormonal treatment for postmenopausal osteoporosis.

Optimal dispersion maps for wavelength-division-multiplexed soliton transmission

We propose an advantageous dispersion-management scheme for wavelength-division-multiplexed soliton transmission in which optimal launch points are obtained whose locations are independent of the fibers' dispersion parameters. Inasmuch as using such optimal launch points minimizes dispersively shed radiation, it is possible to optimize the transmission simultaneously in several different channels. For the particular case of a two-step dispersion map we demonstrate that this result can be achieved by proper choice of the fiber lengths.

Haemoperfusion treatment in pigs experimentally intoxicated by paraquat

1. Because of their similarity in renal morphology and physiology to humans, domestic pigs (gilts, 70 kg) were bolus treated by intramuscular injection of 74, 17, and 6 mg kg-1 and by oral loading (70 mg kg-1 n = 4) of paraquat. The concentration peak of plasma paraquat was reached at 1.5 - 2.5 h. Renal clearance of paraquat rose to its maximum at 5-6 h after intoxication and then sharply decreased indicating renal failure. All the intoxicated pigs died. 2. An additional 10 gilts were also orally treated with 70 mg kg-1 paraquat but received haemoperfusion from 2 h post intoxication for either 2 h (n = 6) or 6 h (n = 4). The 2 h haemoperfusion resulted in a 5.1% toxin removal but failed to save any of six poisoned pigs. Prolonged 6 h haemoperfusion successfully rescued three out of four intoxicated pigs. 3. The plasma paraquat concentrations of the three surviving pigs were above 2 mg l-1 at 10 h post intoxication. This level is not only similar to those of untreated animals that died later, but also well beyond the suggested limit for survival of poisoned patients. 4. Pigs proved to be a good animal model for studies in paraquat poisoning and/or haemoperfusion. It is also suggested that early haemoperfusion is effective in treating paraquat poisoning even in very severe cases due to its possible detoxicating effect in addition to toxin removal.

Analysis of enhanced-power solitons in dispersion-managed optical fibers

We analyze pulse propagation in an optical fiber employing a periodic dispersion map. Second-order averaging is used to determine a general evolution equation valid for both return-to-zero and non-return-to-zero pulses in dispersion-managed systems. The equation is then applied to the case of solitons, and an analytic expression for the power enhancement arising from the dispersion management is obtained.

Heterotopic pregnancy after GIFT managed with expectancy: a case report

A 29-year-old female patient visited our out-patient department (OPD) due to primary infertility in March 1993. Hysterosalpingography revealed cervical canal stricture. Gamete intra-Fallopian transfer (GIFT) was performed on Apr. 10, 1993 after ovulation induction. Three oocytes were placed into each Fallopian tube, then the patient was afflicted with lower abdominal discomfort and fullness 2 weeks later. Ovarian hyperstimulation syndrome (OHSS) was diagnosed. Ultrasonography showed intrauterine twin pregnancy and bilateral tubal pregnancy. During admission, supportive care for OHSS and expectant management only for ectopic pregnancies were given. OHSS resolved gradually. After a series of sonographic follow-up, disappearance of fetal heart beat (FHB) in the left ectopic gestational sac, resolution of bilateral ectopic gestational sacs and normal growth of intrauterine pregnancies were noted. On Dec. 16, 1993, the patient received cesarean section (C/S) due to twin pregnancy with vertex and breech presentation at the 37th gestational week. Twin A was female. Birth weight was 2590 gm. Apgar scores at 1 and 5 min. were 7 and 9. Twin B was also female. Birth weight was 2930 gm. Apgar scores at 1 and 5 main. were 8 and 9. Urinary bladder was injured accidentally at C/S. Repairment was done. The patient and her twins were discharged one week later in stable condition. Literature on heterotopic pregnancy after assisted reproductive technique (ART) was reviewed and discussed in this article.

The efficacy and safety of a 19 nor-steroid in the treatment of endometriosis

BACKGROUND

An oral synthetic 19 norsteroid (gestrinone) characterized by antigonadotropic activity and antioestrogenic properties provides its use in the treatment of oestrogen depending pathologic conditions. The purpose of this open study is to evaluate the efficacy and tolerance of gestrinone in the treatment of endometriosis.

METHODS

Twenty premenopausal women with laparoscopically confirmed endometriosis received 2.5 mg gestrinone two times per week for six months. Laparoscopy was performed before treatment, and clinical responses were determined by second laparoscopy after six months. Serum CA-125 level, plasma lipid and bone density measurements during and after therapy were compared with baseline.

RESULTS

The mean endometriosis score, defined by the revised American Fertility Society scoring system, decreased from 20.16 to 4.68 (p < 0.01). The mean serum level of CA-125 also declined from 44.04 U/ml to 18.64 U/ml (p < 0.01). Metabolic studies showed a significant decrease of cholesterol in high-density lipoprotein (p < 0.05), a moderate increase in low-density lipoprotein (p > 0.05), and a slight increase in both triglyceride and total cholesterol levels (p > 0.05). Bone density in this study also showed no significant difference in either spine or femur neck for a duration of six months treatment. Hot flush occurred in less frequency in gestrinonetreated group than in gonadotropin releasing hormone agonist (GnRHa-treated group), where the side effects of weight gain and acne were less often than in the danazol group well.

CONCLUSIONS

Gestrinone 2.5 mg given twice a week for six months provides an effective and safe treatment for those women suffering from endometriosis.

Prognostic factors of locoregionally recurrent nasopharyngeal carcinoma--a retrospective review of 182 cases

Locoregional relapse is the major cause of failure of nasopharyngeal carcinoma (NPC) after radical radiation therapy. The prognosis of such patients is dismal, and the factors related to the outcome are not well identified. Between January 1983 and December 1989, 1,168 new patients with biopsy-proven NPC were seen at this hospital. Eight hundred and eighty-three of these patients were treated uniformly with radical external irradiation and intracavitary treatment with or without chemotherapy. The clinical courses, retreatment outcomes, and prognostic factors for locoregional relapse and subsequent distant metastasis were analyzed. During the follow-up period of 3-10 years or until death, 182 patients (20.6%) developed locoregional relapses without distant metastasis initially. T stage and age were significant prognostic factors for locoregional recurrence. In contrast, histopathologic subtype, N stage, sex, and systemic chemotherapy were not. There were 36 patients (19.8%) who developed subsequent distant metastasis with or without retreatment. The median time from locoregional relapses to distant metastasis was 6 months in this study, and bone was the most frequent and the earliest site of distant metastasis. The N stage at diagnosis, the initial disease-free interval, the presence of neck nodal disease at relapse, and age were the significant factors for predicting the subsequent distant metastasis in locoregionally recurrent NPC patients. We recommend that additional systemic chemotherapy should be considered for retreatment of locoregional relapsed NPC, not only for enhancement of local control but also for eradicating microscopic metastasis as anticipated.

Primary cardiac chondrosarcoma

A case of primary cardiac chondrosarcoma in a 41-year-old woman who presented with cardiac tamponade and cardiac intracavitary obstruction is described. The tumor originated from the right atrium and invaded the adjacent right ventricular wall and interatrial septum. Primary cardiac chondrosarcoma is extremely rare, and its clinical, computed tomographic, echocardiographic, and magnetic resonance imaging findings are described.

The evaluation of a new 7-day gonadotropin-releasing hormone agonist protocol in the controlled ovarian hyperstimulation for in vitro fertilization

OBJECTIVE

Gonadotropin-releasing hormone agonist (GnRHa) was used in the controlled ovarian hyperstimulation (COH) for the in vitro fertilization program. However, the traditional long protocol demanded more human menopause gonadotropin (hMG) and sometimes causes unnecessary delay in the procedure. A new 7-day GnRHa/hMG protocol required to conserve cost and time is thus evaluated for better outcome.

METHODS

Sixty consecutive IVF candidates less than 40 years of age were recruited for the study. Cases with severe male factor or polycystic ovarian disease were excluded. The perspective candidates were divided into two groups, one received the traditional, GnRHa2hMG protocol and the other received the new 7-day regimen.

RESULTS

When comparing the results in pregnancy rate (33.3% vs 30%), cleavage rate (75.7% vs 75.5%), and the number of oocyte obtained (5.96 +/- 0.91 vs 6.63 +/- 0.90), the 7-day GnRHa/hMG protocol is as good as those of the traditional regimen. The amount of hMG used nevertheless was significantly less (21.48 +/- 0.78 vs 50.59 +/- 2.07).

CONCLUSIONS

The new regimen will surely reduce the cost to relieve patient's financial burden and to increase patient's comfort.

Acceleration of skin graft healing by growth factors

A special local burn wound treatment, using a healing promotion factor, attempted to achieve earlier wound closure. Clinically it is not difficult to harvest autologous human platelet-derived wound healing factor (HPDWHF) from burn patients. Another study has proved that porcine pituitary extract (PPE) could be one of the supplements for growing human keratinocytes in vitro (Wang HJ, Chen TM, Tung YM et al. Burns 1995). Initially, using the ELISA immunoassay, we detected titres of platelet-derived growth factor heterodimer AB (PDGF-AB) and epidermal growth factor (EGF) in HPDWHF and PPE. After elevating a 6 X 9 cm2 flap on the backs of Sprague-Dawley (SD) rats 1 ml of heterologous HPDWHF and PPE were sprayed topically on the wound and followed by grafting six pieces of 1 cm2 autologous full-thickness skin. The flap wound was then closed with a piece of large-pore Biobrane interposed between the skin graft wound and the flap. On postgraft day 7, the wound was reopened to measure the area of the full-thickness skin graft (FTSG) using micrographic paper; the results are reported as the percentage of graft expansion beyond the original size. In the cytokine study, we found that the concentrations of PDGF-AB dimer in HPDWHF and PPE were 5222 +/- 102 and 375 +/- 12 pg/ml (both values are reported after a 1:10 dilution) (n = 3), whereas the EGF concentration was 245 +/- 9 pg/ml, and undetectable in undiluted PPE (n = 3), thereby proving that the PDGF-AB and EGF fibres in the HPDWHF were significantly higher than in the PPE Both the HPDWHF (n = 6, with each animal grafted with six skin graft samples) and PPE (n = 7) demonstrated significant accelerations of FTSG growth, with 14.41 +/- 1.08 per cent and 13.16 +/- 3.25 per cent increases in the FTSG size when compared to the sham control group 1.39 +/- 3.26 per cent (n = 5) (P < 0.05). Comparisons between the treatment groups showed no evidence to indicate that the HPDWHF is superior to the PPE in accelerating FTSG growth (P > 0.05). This supports the hypothesis that PDGF appears to transduce its signal through wound macrophages and may trigger the induction of positive autocrine feedback loops and synthesis of endogenous wound PDGF and other growth factors, thereby enhancing the cascade of tissue repair (Pierce GF, Mustoe TA, Altrock B et al. 1991; J Cell Biochem 1991; 45: 319-326), and the effect that PDGF-AB on wound healing is not dose dependent (Mustoe TA, Cutler NR, Allman RM et al. Arch Surg 1994; 129: 213-219). In future studies we expect to show that autologous HPDWHF and heterologous PPE will promote skin graft wound healing in burn patients since they contain a high concentration of PDGF-AB.

Intra-abdominal desmoplastic small cell tumors: report of two cases

Two young adults that presented with intra-abdominal desmoplastic small cell tumors (DSCT) without any evidence of a primary site are described. Both cases share the clinical characteristic features of this rare tumor which include predominant intra-abdominal location as initial presentation, nesting pattern of growth, intense desmoplastic reaction, immunohistochemical reactivity for epithelial, neural and muscle markers, and highly aggressive behavior. Aggressive chemotherapy with a cisplatin-containing regimen was the main therapy to our patients. Up to the present, both cases are alive with disease. The survival is 18 and 15 months from the initial diagnosis, respectively. Interestingly, one of the cases encountered an episode of cerebral infarction at the territory of the left middle cerebral artery 12 days after the first cycle of chemotherapy. This is a previously unrecognized manifestation for this tumor type. This causal relationship between chemotherapy and an acute vascular event is the most likely explanation for our patient's stroke.

Regional skin blood flow in deep burn wounds: a preliminary report

Local skin blood flow (LSBF) using the Walker's deep burn rat model was studied on the first three postburn days using the carbon-14 iodoantipyrine ([14C]IAP) perfusion method. The radioactive [14C]IAP (12.5 microCi) was infused through the femoral vein over a period of 30 seconds and the blood samples were collected by a free flow from the femoral artery at 5-s intervals to evaluate the concentration of the isotope, in the blood. At the conclusion of the infusion, the rats were guillotined and biopsies were obtained from the burned skin, unburned skin from burned rats and skin from sham control rats to assay the isotope in the skin. The LSBF was calculated from the skin tissue and plasma radioactivity data using Jay's equation. The results showed significant decreases of the skin blood flow in the deep burn wound with 4.05 +/- 1.16, 5.31 +/- 1.32 and 4.77 +/- 2.48 ml/100 g/min as compared to the LSBF of unburned skin 10.27 +/- 1.49, 12.39 +/- 2.05, 14.79 +/- 1.85 ml/100 g/min on postburn days 1, 2 and 3 (P < 0.05). The blood flow of the control group skin was 11.5 +/- 1.97 ml/100 g/min (P < 0.05). There were also significant differences of LSBF among burn wounds on postburn days 1, 2 and 3 (P < 0.05). Pathological study of the deep burn wound showed that more of the blood flow was in the subcutaneous adjacent areolar tissue, than in the deep reticular dermis, and only a little occurred in the upper reticular dermis occasionally.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of human menopausal gonadotropin and follicle-stimulating hormone with gonadotropin-releasing hormone agonist desensitization for controlled ovarian hyperstimulation in in vitro fertilization

BACKGROUND

A pregnancy in patients treated with gonadotropin-releasing hormone agonists (GnRHa) using follicle-stimulating hormone (FSH) alone was first reported by Shaw et al. in 1991. Recently, several comparative trials have shown that FSH is as effective as human menopausal gonadotropin (hMG) in this indication. In other words, the residual endogenous levels of luteinizing hormone (LH) in GnRHa treated cycles may be generally sufficient to support FSH-induced follicular development to exempt from the co-administration of exogenous LH.

METHODS

A total of 42 consecutive candidates for in vitro fertilization (IVF) participated in a prospective randomized study. In this study, the efficacy of two different gonadotropins (Pergonal and Metrodin, Serono, Italy) in inducing ovulation was investigated. All treated women were less than 40 years of age and had received a long desensitized protocol by a GnRHa (Leuprolide acetate, Takeda or Decapeptyl, Ferring). Ovarian inactivity was monitored by plasma estradiol and LH concentration. After the pituitary gland was down-regulated, all patients were given either hMG (n = 25) or FSH (n = 17) for controlled ovarian hyperstimulation (COH).

RESULTS

The mean number of gonadotropin ampoules and the peak estradiol level were significantly higher in hMG group than in the FSH group. No significant differences were found between both groups in the incidence of cancelled cycles, failed oocyte recovery, mean number of oocytes recovered per patient, the fertilization and embryo cleavage-rate. However, the hMG group demonstrated a higher pregnancy and abortion rate.

CONCLUSIONS

There is no significant difference between hMG and FSH stimulation when used following GnRHa desensitization for COH, so the cost should be considered.

Efficacy and safety of estriol replacement therapy for climacteric women

BACKGROUND

As an estrogen derivative, estriol is rather effective in the relief of climacteric symptoms due to estrogen deficiency. When given one dose a day, it will not provoke endometrial proliferation and shedding. Thus, it is suitable for postmenopausal women who no longer want to have uterine bleeding and for those with comparatively higher risk of endometrial hyperplasia. In the aspect of postmenopausal osteoporosis, the prevention of further bone loss due to estrogen deficiency is also important and to be evaluated.

METHODS

We collected 20 patients, aged 44-62 years, who had undergone either natural or surgical menopause and were treated with estriol succinate (Synapause; Organon; Holland 2 mg/tab) 2 mg/day for 2 years, with relief of climacteric symptoms evaluated after the first 3 months of treatment. Bone mineral density (BMD) of lumbar spine was measured using quantitative computed tomography (QCT) after one and two years of treatment, respectively.

RESULTS

Estriol was very effective in the improvement of major subjective climacteric complaints in 86% of patients, especially hot flush and insomnia within 3 months. The atrophic genital changes caused by estrogen deficiency were also improved satisfactorily. No subjective symptoms induced by the therapy were seen. The rate of uterine bleeding was low, complained by only one patient. However, our study did not show the preventive effect of estriol against osteoporosis.

CONCLUSIONS

Estriol can be a safe and effective alternative in the relief of climacteric symptoms for postmenopausal women, but it cannot prevent the bone loss.

Pharmacokinetic properties of recombinant porcine growth hormone in pigs

The plasma pharmacokinetic profile of recombinant porcine growth hormone (rpGH) was studied in six healthy gilts after a rapid single i.v. injection of 250 micrograms/kg rpGH. The linear pharmacokinetic properties of rpGH were investigated by giving four different doses of the hormone at intervals of 2 days. The plasma rpGH concentration was determined by radioimmunoassay with a lowest detection limit of 50 pg/ml. Plasma levels of rpGH were fitted to a three-compartment open model; a triexponential decrease in plasma rpGH with a rather long mean terminal half-life of 40.22 +/- 5.623 min was obtained in these pigs. Linear pharmacokinetic properties of rpGH were confirmed in the additional pig that received doses between 25 and 250 micrograms/kg rpGH. The small volume of distribution, 0.029 +/- 0.003 l/kg, indicated that most of the injected rpGH was confined to the blood and probably lymph. The total plasma clearance of rpGH was 31.80 +/- 2.802 ml/h x kg. The results not only contribute significantly to our knowledge about rpGH pharmacokinetics, but also to future studies for the rational design of optimal dosage regimens and the development of a controlled-release device for rpGH.