Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women

STUDY OBJECTIVE

To compare oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis.

DESIGN

Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls.

SETTING

Gynaecological endocrine clinic in tertiary referral centre.

PATIENTS

Oral treatment group of 37 postmenopausal women (mean age 57.5 years, median 8.75 years from last menstrual period), compared with 41 women given oestrogen implants (mean age 56.2 years, median 9.5 years from last menstrual period) and 36 controls (mean age 51.8 years, median 2.0 years from last menstrual period). Weight was not significantly different among the groups.

INTERVENTIONS

Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycloprogynova) for a median of 8.0 years. Implant group was given subcutaneous implants of oestradiol 50 mg combined with testosterone 100 mg, on average six monthly for a median of 8.5 years. Controls were not treated.

END POINT

Significant increase in bone density.

MEASUREMENTS AND MAIN RESULTS

Bone density measured by dual beam photon absorptiometry was 1.02 (SD 0.13) g hydroxyapatite/cm2 in implant group versus 0.89 (0.11) in oral group (p less than 0.01) and 0.87 (0.14) in controls (p less than 0.01). Serum oestradiol concentration in implant group was (median) 725 pmol/l versus 170 pmol/l in oral group (p less than 0.01) and 99 pmol/l in controls (p less than 0.01). Serum follicular stimulating hormone was median 1 IU/l (range 1-11) in implant group (equivalent to premenopausal values) versus 43 (4-94) IU/l in oral group (p less than 0.01) and 72 (28-99) IU/l in controls (p less than 0.01).

CONCLUSIONS

Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved. It also avoids problems of compliance that occur with oral treatment.

Restriction endonuclease analysis of Leptospira interrogans serovar hardjo isolates from cattle

The genomes of 253 strains of Leptospira interrogans serovar hardjo were examined by restriction endonuclease analysis of their DNA. The strains had been isolated from cattle at an abattoir (190), milk of agalactic cows (seven) and from aborted bovine fetuses (56). Two distinct genome types, Hardjoprajitno and Hardjobovis, were detected. The majority (91 per cent) of isolates from abattoir cattle were of the Hardjobovis type while most (76 per cent) of the isolates from clinical/pathological material were similar to Hardjoprajitno.

Correlation of urethral physiology and skin collagen in postmenopausal women

Connective tissue collagen is thought to contribute to the generation of urethral pressure. It has been previously shown that skin collagen and urethral pressure are oestrogen dependent. This study demonstrates a correlation between urethral pressure measurements and skin collagen content. It is suggested that the beneficial effect of oestrogens on urethral function may be mediated by collagen.

The effect of vaginal delivery on the urethral sphincter

To investigate the aetiological role of vaginal delivery in genuine stress incontinence we compared two groups of women who underwent full urodynamic assessment in our department. The women in the first group had competent urethral sphincter mechanisms and those in the second group had genuine stress incontinence. There were no differences between the two groups in respect of parity, number of vaginal deliveries or birthweight of the heaviest baby. The group with competent urethral sphincter mechanisms did show some evidence to implicate an increased number of vaginal deliveries in poor function of the distal part of the urethral sphincter mechanism.

A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman

The skin collagen content, skin thickness, metacarpal index, and forearm bone mineral content in postmenopausal women showed a similar decline of between 1-2% per year after the menopause. All four parameters showed a decline that was significant when compared with the years from the menopause. Significant correlations between all four parameters suggest that a similar pathology causes the decrease in bone mass and skin thickness--a decline in the connective tissue element that is common to both bone and skin.

Response of skin thickness and metacarpal index to estradiol therapy in postmenopausal women

A radiologic method for measuring skin thickness and metacarpal index was used to investigate 41 postmenopausal women treated with estradiol (100-mg) subcutaneous implants (Organon, UK). All the women completed the first six months of the study, and 33 completed one year. Both skin thickness and metacarpal index increased to a statistically significant degree over the one-year period, with most of the increase occurring in the first six months of therapy. Skin thickness showed the largest increases, from a mean of 0.86 mm at the start of the study to 0.97 mm at six months and 1 mm at one year. The metacarpal index increased from a mean of 0.77 at the start of the study to a mean of 0.799 and 0.8 at six months and one year, respectively.

Commercial latex agglutination tests for detection of Haemophilus influenzae type b and Streptococcus pneumoniae antigens in patients with bacteremic pneumonia

The validity of commercial latex agglutination kits for detection of Haemophilus influenzae type b and Streptococcus pneumoniae antigens in serum and urine specimens was studied. We tested serum and urine specimens from 44 patients with bacteremic pneumonia (23 S. pneumoniae, 13 H. influenzae type b, 11 other) with commercial latex agglutination kits (Directigen, Bactigen) for S. pneumoniae and H. influenzae type b antigens. All specimen samples were randomized and read blindly by two readers. Interreader reproducibility was 100%. The sensitivity and specificity of both kits for H. influenzae type b antigens in serum and urine were greater than 90%. None of the 24 urine samples from S. pneumoniae bacteremic patients were positive by either kit, although 6 ng of type 3 polysaccharide could be detected in spiked urine. Sensitivity for S. pneumoniae antigens in serum was 27% for Directigen and 38% for Bactigen. Specificity for S. pneumoniae antigens in serum was 95% for Directigen and 74% for Bactigen. The results suggest that the kits are useful in diagnosing H. influenzae type b pneumonia. However, the commercially available S. pneumoniae reagents tested appear to have limited utility for diagnosing S. pneumoniae pneumonia because both kits lack sensitivity and Bactigen lacks specificity, as well.

Cardiovascular adaptations to intense swim training in sedentary middle-aged men and women

Central and peripheral cardiovascular adaptations to 12 weeks of intense swim training were characterized in 12 previously sedentary middle-aged men and women. Peak oxygen uptake (VO2) during upright bicycle exercise improved from 29.2 +/- 5.6 to 34.7 +/- 6.7 ml/kg/min (mean +/- SD, p less than .01) because of similar increases in peak cardiac output (CO) and calculated arteriovenous oxygen difference (both p = .02). Peak supine VO2 was 10% higher after training (p less than .005) solely because of enhanced CO (p = .005). Peak heart rate decreased in both postures; therefore stroke volume at peak exercise was greater by 10% and 18% in the upright and supine postures, respectively (p = .05 and p = .005). There was an identical 18% rise (p = .01) in peak supine left ventricular end-diastolic volume index by radionuclide ventriculography but no change in left ventricular ejection fraction or end-systolic volume index (ESVI). Peak systolic blood pressure (SBP) was unchanged in the upright posture but was 8% higher (p = .002) during recumbency despite a similar total peripheral resistance and SBP/ESVI ratio. Maximal calf conductance (Gmax), assessed separately by venous occlusion plethysmography after local ischemic exercise to fatigue, was augmented 20% (p less than .02) by training, resulting in an 18% greater hyperemic blood flow (p = .05). Peak VO2, CO, and Gmax were unchanged in five nonexercising control subjects. We conclude that in middle-aged humans, intense swim training for 12 weeks produces adaptations that include a greater capacity for vasodilatation in skeletal muscle and an enhanced cardiac pump capacity.

Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement

The thigh skin collagen content and the metacarpal index were measured in 69 untreated postmenopausal women and in 37 postmenopausal women who had been receiving oestradiol and testosterone implants for 2-10 years. There was a significant positive correlation between the skin collagen content and the metacarpal index in both groups of patients. In the untreated group, there was a statistically significant decrease both in the thigh skin collagen content and in the metacarpal index with the years since the menopause. This decrease was preventable in women who were on sex hormone replacement therapy.

Isolation of leptospires from the genital tract and kidneys of aborted sows

Twenty sows were examined as part of an investigation into the relative importance of the genital and urinary tracts as sites of leptospiral persistence in pigs. The sows had previously either aborted leptospire-infected fetuses or aborted on farms where leptospire infection had been demonstrated in other litters. Leptospires belonging to the Australis serogroup were recovered from the upper genital tract of all the sows. In contrast, leptospires were only recovered from 75 per cent of their kidneys. Isolates from 10 of the sows were identified to serovar level: six were serovar muenchen and four were bratislava. Persistence was observed in renal and genital tissues for up to 147 days after abortion.

Prevalence of Leptospira interrogans serovar hardjo in the genital and urinary tracts of non-pregnant cattle

In a bacteriological investigation of 60 cows and heifers from an abattoir Leptospira interrogans serovar hardjo was isolated from 39 (65 per cent) animals. The genital tract (57 per cent) appeared to be as important a site of hardjo localisation as the urinary tract (62 per cent). This is believed to be the first report of genital hardjo infection in naturally infected cattle.

Dihydrostreptomycin treatment of bovine carriers of Leptospira interrogans serovar hardjo

Ten non-pregnant heifers, experimentally infected with Leptospira interrogans serovar hardjo, were each given an intramuscular injection of dihydrostreptomycin at a dose rate of 25 mg kg-1. In five of these animals this treatment was repeated after 14 days. Treatment failed to remove established genital or renal infection in seven of the 10 heifers, although the number of organisms persisting was apparently reduced in these animals. Serovar hardjo infection persisted for at least 83 days in the oviduct and uterus and these tissues may be as important carrier sites for serovar hardjo as bovine kidney tissue.

Walking patterns of healthy subjects wearing rocker shoes

We compared walking in rocker shoes with walking in athletic shoes at free and fast velocities in 15 healthy women who were between the ages of 21 and 30 years. Footswitches, electrogoniometers, surface electromyograms, and a force plate were used for data collection. No significant differences were found in velocity, cadence, gait-cycle duration, single-limb support, or swing-stance ratios in free and fast walking. Double-limb support was decreased by 9% in the rocker shoes in free walking. The ankle range of motion showed accommodation of the foot to the 8.5 degrees of plantar flexion built into the rocker shoes. Electromyographic responses appeared to be similar regardless of shoes or cadence.

The aerobic bacteriology of infected skin lesions in children of the Eastern Highlands Province

Of 480 children studied, the relative frequency of skin infections divided into three categories were: score 266 (55%), infected scabies 164 (34%) and tropical ulcers 50 (10%). Infected scabies was more prevalent in the less than 2 year age group and tropical ulcers were commonest in the 9-12 year age group and these differences were significant. The majority of lesions occurred on the lower extremities with the trunk the least commonly affected area. No significant differences were found in different age groups between males and females. Beta haemolytic streptococci (95%), Staphylococcus aureus (83%), Corynebacterium diphtheriae (72%) and Corynebacterium haemolyticum (35%) were the major bacteria isolated. Beta haemolytic streptococci were the most prevalent in infected scabies and least in tropical ulcers and these differences were significant. Three major Lancefield groups were isolated: group A (61%), group C (19%) and group G (19%). The distribution of these groups were unequal with group A most common in infected scabies but rarely seen in tropical ulcers. Groups C and G were found more commonly in tropical ulcers than the other two groups of lesions and these differences were significant. Multiple populations of beta haemolytic streptococci in a single lesion were seen in 19% of children. Less than one third of Streptococcus pyogenes were M typable and of these 18% were known nephritogenic serotypes. Staphylococcus aureus was significantly more common in infected scabies and least common in tropical ulcers. The prevalence of Vincent's organisms in tropical ulcers (74%) was significantly higher than scores (9%) and infected scabies (1%). The isolation rate of Corynebacterium diphtheriae was significantly higher in infected scabies than the other two groups. The most common biotype isolated was var mitis (72%). Only 2% of isolates were toxigenic. Corynebacterium haemolyticum was isolated significantly more frequently in tropical ulcers than the other lesions. All major bacteria, excluding betalactamase-producing Straphylococcus aureus, were uniformly sensitive to penicillin. Methicillin resistance was found in 1% of Staphylococcus aureus isolates and is reported here for the first time in this country. These isolates were also multiply resistant to erythromycin, chloramphenicol and tetracycline.

Pathogens detected in the faeces of children with diarrhoea in a Sydney hospital

During a 54-week period, faecal samples taken from 350 children under 5 years of age, who were admitted with acute diarrhoea to the infectious diseases ward of a Sydney hospital, were examined for pathogens. Rotavirus was detected as the sole agent in the specimens of 58 patients (16.6%), enteroviruses in those of 26 patients (7.4%), salmonellae in those of 19 patients (5.4%) and Campylobacter jejuni in those of 15 patients (4.3%). Shigellae were not detected. The results are discussed and, in view of the changing patterns of infection, it is suggested that there is a continuing need for research into the causes of enteritis in Australia.

The bacteriology of skin sores in Goroka children

The bacteriology of infected skin lesions was studied in paediatric outpatients. Thirty-nine untreated lesions were studied: 37 (95%) grew beta haemolytic streptococci (46% group A, 3% group B, 23% group C, 26% group G), 21 (54%) grew Staphylococcus aureus and 13 (33%) grew Corynebacterium haemolyticum. No attempt was made to selectively isolate Corynebacterium diphtheriae in this study. Vincent's organisms were seen in 13 (37%) of 35 gram stains from untreated lesions, including eight (73%) of 11 tropical ulcers. Twenty-three (92%) of the 25 strains of S. aureus isolated from untreated sores were resistant to penicillin.

Distribution and relationship to serotype of Haemophilus influenzae biotypes isolated from upper respiratory tracts of children and adults in Papua New Guinea

The relationship between serotypes and biotypes of 505 carriage strains of Haemophilus influenzae isolated from the upper respiratory tracts of well children, children with pneumonia, and healthy adults was studied. All except serotype c were significantly associated with one or two specific biotypes (P less than 0.001). No encapsulated organisms belonging to biotypes V, VI, or VII were encountered. No significant difference in the interaction of biotypes and serotypes isolated from well and sick children was present. Both encapsulated and nonserotypable biotype I H. influenzae strains were commonly carried in the upper respiratory tracts of healthy Melanesian children. The distribution of nonserotypable H. influenzae strains occurred throughout all biotypes, and the frequency of nonencapsulated biotype III and IV strains differed significantly from serotypable organisms with the same biotype (P less than 0.001).

Carriage of Corynebacterium diphtheriae in children of the Eastern Highlands province

The incidence of Corynebacterium diphtheriae in infected skin sores and the nasopharynx of 99 children from the Asaro Valley in the Eastern Highlands is reported. C. diphtheriae was isolated from 88% of skin sores and 26% of nasopharyngeal swabs. The most common biotype seen was C. diphtheriae var mitis. Toxigenic strains were uncommon, occurring in 5% of skin lesions and 15% of nasopharyngeal swabs. All isolates were sensitive to penicillin, erythromycin and chloramphenicol.