Frederick R. Jelovsek

Effects of long-term estrogen replacement therapy

Two groups of hypoestrogenic women are analyzed by retrospective comparisons. Patients were observed by a single group of physicians for at least five years; 301 patients were treated with replacement estrogen and 309 patients were untreated. Incidence figures for various metabolic diseases present at entry and both during and after estrogen therapy were compared by the usual statistical analysis and by statistical adjustments for certain group differences (Mantel-Haenszel statistic). The long-term administration of estrogen to these relatively young women with hypoestrogenism was associated with significantly lower rates of development of cardiovascular disease, hypertension, osteoporosis, and fractures. Detrimental effects were a higher rate of abnormal uterine bleeding and an increase in the likelihood of developing adenocarcinoma of the endometrium. Effects of estrogen preparation, dosage, method of therapy, duration of therapy, and the addition of synthetic progestins are presented.

Effects of long-term estrogen replacement therapy: II. Neoplasia☆

Abstract Two groups of hypoestrogenic women are analyzed by retrospective comparison. Patients were observed by a single group of physicians for at least five years—301 patients treated with replacement estrogen and 309 untreated patients. Of each group, 207 women had uteri in situ. Incidence figures for neoplasia (gynecologic, breast, and all sites) were compared between the two groups and with the Third National Cancer Survey, yielding a risk ratio for the development of adenocarcinoma of the endometrium among estrogen-treated women of 3.8 and 9.3, respectively. There was no increase among any other malignancies. The addition of synthetic progestin to estrogen therapy provided significant protection against the likelihood of developing endometrial cancer and did not reduce previously reported metabolic benefits of estrogen treatment. Data pertaining to estrogen use and details of the patients with endometrial carcinoma are presented.

Accuracy of ultrasonic fetal weight prediction in preterm infants.

We analyzed the accuracy of four previously reported ultrasound formulas by means of abdominal circumference and/or biparietal diameter measurement for the prediction of fetal weight in the preterm infant (less than 2,000 gm). The birth weights of 25 preterm infants delivered within 72 hours of ultrasound measurement were compared to the weights calculated by formulas derived from the ultrasound measurements, and the accuracy of each formula was determined. A high degree of correlation was found or the logarithmic formulas with the use of both biparietal diameter and abdominal circumference measurement. Our data suggest that the present ultrasound methodology is of sufficient accuracy to warrant the use of ultrasonic measurement to predict fetal weight prospectively before delivery of the very low-birth weight infant. We also retrospectively reviewed the previous 4-year neonatal mortality rate for infant weighing between 500 and 2,000 gm at birth at Duke University.

Amenorrhea: Observations based on the analysis of luteninizing hormone–releasing hormone testing

From 1973 to 1976, 130 patients with symptomatic amenorrhea were evaluated by pituitary gonadotropin response to a subcutaneous injection of luteinizing hormone–releasing hormone (LHRH). These patients were placed in 13 specific disease categories by extensive endocrine evaluation. The LHRH test itself was not used for diagnostic categorization. Test results from these groups of patients were compared with those from 18 early follicular control subjects using logarithms of four baseline and 13 response measurements. Results were as follows: Gonadotropin measurements demonstrated a logarithmic distribution. Each diagnostic category demonstrated multiple significant differences when compared to the control group. Statistical comparisons using logarithms yielded additional significant differences (when n

Effects of Long-Term Estrogen Replacement Therapy. II. Neoplasia

Two groups of hypoestrogenic women are analyzed by retrospective comparison. Patients were observed by a single group of physicians for at least five years -- 301 patients treated with replacement estrogen and 309 untreated patients. Of each group, 207 women had uteri in situ. Incidence figures for neoplasia (gynecologic, breast, and all sites) were compared between the two groups and with the Third National Cancer Survey, yielding a risk ratio for the development of adenocarcinoma of the endometrium among estrogen-treated women of 3.8 and 9.3, respectively. There was no increase among any other malignancies. The addition of synthetic progestin to estrogen therapy provided significant protection against the likelihood of developing endometrial cancer and did not reduce previously reported metabolic benefits of estrogen treatment. Data pertaining to estrogen use and details of the patients with endometrial carcinoma are presented.