Abdullah Turfanda

Postmenopausal Hormone Replacement Therapy Use Decreases Oxidative Protein Damage

Objectives: The aim of this study is to evaluate oxidative protein damage (OPD) by investigating protein carbonyl (PCO) and nitrotyrosine (NT) levels, oxidative stress by total thiol (T-SH), erythrocyte glutathione (GSH) and nitric oxide (NO) levels in women receiving hormone replacement therapy (HRT). Materials and Methods: To examine the influence of oxidative stress on OPD, we studied 12 postmenopausal women who had received HRT for 6 months, and 13 postmenopausal women who did not receive HRT, as the control group. All subjects were non-smokers. Blood samples were drawn in the fasting state and processed within 1 h of collection. For NT and NO, serum samples were stored at –70°C until analysis; all other parameters were determined on the same day of collection. Results: After 6 months, plasma PCO and T-SH levels were decreased, GSH and NO levels were increased, and NT levels were not changed in 12 postmenopausal women receiving HRT. Except the NT levels, the rest of the parameters did not significantly change in the control group. Interestingly, mean NT levels in the control group increased significantly. Conclusions: A crucial part of the protective effect of HRT on the cardiovascular system arises secondary to the interaction between estrogen and vessel wall. Our results suggest that an important component of the mechanism underlying this interaction may depend on estrogen’s antioxidant effect and its preventive role in OPD.

Effects of Long-Term Oral Hormone Replacement Therapy on Plasma Nitric Oxide and Beta-Endorphin Levels in Postmenopausal Women

Objectives: The aim of this study is to evaluate the relationship between plasma nitric oxide (NO) and β-endorphin levels in women using hormone replacement therapy (HRT) for 12 months. Material and Methods: Our study group was composed of 55 patients who were in at least their second postmenopausal year. Of the 55 patients, 25 were in the control group. All 30 women in the study group received 2 mg 17β-estradiol + 1 mg norethisterone acetate tablets daily for 12 months. Plasma NO and β-endorphin levels were measured both before and after the study period and possible relationships were analyzed. Results: There was a significant increase in both β-endorphin (p = 0.0001, 10.93 ± 2.25 vs. 14.85 ± 2.49) and NO (p = 0.0001, 19.79 ± 4.01 vs. 27.83 ± 10.27) levels measured after the study in the HRT group. A correlation was seen between the increments in β-endorphin and NO levels in the HRT group. Conclusion: Continuous combined HRT raises both plasma NO and β-endorphin levels and a close relationship was found between the two molecules after therapy. We postulate that the increment in these molecules may explain some of the beneficial effects of HRT on cognitive function and mood.

Vascular Effects of Estrogen and Progestins and Risk of Coronary Artery Disease: Importance of Timing of Estrogen Treatment

The effects of estrogen and progestins on the vascular wall have drawn major medical attention, and significant controversy over various studies has been developed. Several experimental and observational studies have shown cardioprotective effects; however, prospective randomized trials showed an increase in cardiovascular events in postmenopausal women on estrogen/ medroxyprogesterone acetate treatment. The most significant parameter for cardiovascular benefit of estrogen seems to be the interval since the onset of menopause. In the early postmenopausal years, estrogen has beneficial effects on the vascular wall by inhibition of atherosclerosis progression, whereas in the late postmenopause, adverse effects like upregulation of the plaque inflammatory processes and plaque instability may develop. The effects of progestins on the cardiovascular system are not as clear and may differ according to the choice of progestins that is used. The aim of this review is to summarize the effects of estrogen and progestins on the vascular wall and their clinical implications.

P3.11.31 Unscarred uterine rupture after the induction of labor with misoprostol

Study methods: Symptomatic pregnant women who were treated for obstructive uropathy during the period 1988-1998 are included in this descriptive retrospective study. Results: Eighteen patients presented with symptomatology of urinary obstruction; eight of them &feted from recurrent urinary tract infections. Whilst investigated an ultrasound scan performed, confirmed the presence of upper urinary tract dilatation. Their mean age was 26.8 years (ranging from 19 to 34 years) and the mean gestational age was 31.2 weeks (ranging from 29 to 35 weeks). When a double .I ureteral catheter was placed patients’ symptoms regressed without any further serious complications for the rest of the antenatal period and labour. This self-sustained ureteral catheter was removed between 6’h and 10th day postpartum. An ultrasound scan of the kidneys and urinary tract was performed after the removal of the catheter. The patients were followed up for twelve months with a repeat scan and intravenous pyelogram at 6 months postdelivery. Fifteen of them remained asymptomatic and three had minor urological problems. Conclusions: Dilatation of the upper urinary tract in pregnancy secondary to obstructive uropathy could be safely and effectively managed in selected cases by insertion of ureteral catheters in order to relieve patients’ symptoms and prevent renal insufficiency.

P3.13.25 The effects of tibolone on peripheral vascular system

Objectives: Estrogen has been traditionally considered to have positive effects on pelvic floor relaxation, although no randomized, clinical trials have validated this perception. Pelvic floor relaxation has been associated with two SERMs to date, levormeloxifene and idoxifene. The objective of this analysis was to determine whether raloxifene increased the incidence of pelvic floor relaxation requiring surgical intervention, as compared with placebo. Study Methods: Safety data from 3 double-blind, placebo-controlled, randomized clinical trials of osteoporosis, which enrolled a total of 6926 postmenopausal women without prior hysterectomy treated for 36 months, were pooled for this analysis. Studies 1 and 2 enrolled younger (mean age =54.8; n=969), healthy postmenopausal women randomized to 30,60, or 150 mgiday raloxifene or placebo. Study 3 enrolled older (mean age = 66.5; n=5957) osteoporotic, postmenopausal women randomized to raloxifene 60 or 120 mgiday or placebo. Indications for any reported pelvic surgeries were identified. Procedures performed for pelvic floor relaxation or urinary incontinence, including hysterectomies, were included in this analysis. Results: When considering all surgical procedures for pelvic floor relaxation, including hysterectomies, a total of 34 (1.5%) patients in the placebo group and 38 (0.8%) patients in the combined raloxifene groups underwent a surgical procedure for some type of pelvic floor repair. The relative risk for pelvic floor repair was 0.51 (95%CI: 0.32, 0.80). There was an overall statistically significant reduction in the incidence of procedures indicated for the treatment of pelvic floor relaxation in the combined raloxifene groups, as compared with the placebo group. (p=O.O04). Conclusions: These findings suggest that raloxifene may help reduce the incidence of pelvic floor relaxation requiring surgery.