Hee Young Hwang

Vascular Effects of Synthetic or Natural Progestagen Combined With Conjugated Equine Estrogen in Healthy Postmenopausal Women

BackgroundSynthetic, not natural, progestagen may negate the favorable effects of estrogen. Nonetheless, observational studies report no differences in risk for clinical cardiovascular events between users of unopposed estrogen and users of estrogen combined with synthetic progestin. Methods and ResultsIn a double-blind study, we randomly assigned 20 healthy postmenopausal women to micronized progesterone (MP) 200 mg or medroxyprogesterone acetate (MPA) 10 mg for 10 days with conjugated equine estrogen (CEE) 0.625 mg for 25 days and the remaining 5 days off cyclically during 2 months, followed by crossover to the alternate therapy. CEE+MP and CEE+MPA significantly improved the percent flow-mediated dilator response to hyperemia relative to baseline measurements (P =0.004 by ANOVA) by a similar degree (P =0.863). Both therapies significantly decreased E-selectin, intercellular adhesion molecule (ICAM)-1, and vascular cell adhesion molecule (VCAM)-1 levels from baseline values (P <0.001, P =0.048, and P =0.016 by ANOVA, respectively) by a similar degree (P =0.977 for ICAM-1 and P =0.541 for VCAM-1, respectively). CEE+MPA decreased E-selectin levels more than CEE+MP did (P =0.040). Both therapies significantly decreased monocyte chemoattractant protein-1 levels from baseline values (P <0.005 by ANOVA) by a similar degree (P =0.194). Both therapies significantly decreased tissue factor antigen and increased tissue factor activity levels from baseline values (P =0.003 and P <0.001 by ANOVA, respectively) by a similar degree (P =0.652 for antigen and P =0.173 for activity). Both therapies significantly lowered plasma plasminogen activator inhibitor-1 levels from baseline values (P <0.001 by ANOVA) by a similar degree (P =0.533). ConclusionsCEE+MP and CEE+MPA provide similar improvement in endothelium-dependent vasodilator responsiveness and effects on markers of inflammation, hemostasis, and fibrinolysis inhibition in healthy postmenopausal women.

Vascular effects of estrogen in type II diabetic postmenopausal women

OBJECTIVES We assessed the effects of estrogen on vascular dilatory and other homeostatic functions potentially affected by nitric oxide (NO)-potentiating properties in type II diabetic postmenopausal women. BACKGROUND There is a higher cardiovascular risk in diabetic women than in nondiabetic women. This would suggest that women with diabetes do not have the cardioprotection associated with estrogen. METHODS We administered placebo or conjugated equine estrogen, 0.625 mg/day for 8 weeks, to 20 type II diabetic postmenopausal women in a randomized, double-blinded, placebo-controlled, cross-over design. RESULTS Compared with placebo, estrogen tended to lower low-density lipoprotein (LDL) cholesterol levels by 15 +/- 23% (p = 0.007) and increase high-density lipoprotein (HDL) cholesterol levels by 8 +/- 16% (p = 0.034). Thus, the ratio of LDL to HDL cholesterol levels significantly decreased with estrogen, by 20 +/- 24%, as compared with placebo (p = 0.001). Compared with placebo, estrogen tended to increase triglyceride levels by 16 +/- 48% and lower glycosylated hemoglobin levels by 3 +/- 13% (p = 0.295 and p = 0.199, respectively). However, estrogen did not significantly improve the percent flow-mediated dilatory response to hyperemia (17 +/- 75% vs. placebo; p = 0.501). The statistical power to accept our observation was 81.5%. Compared with placebo, estrogen did not significantly change E-selectin, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, monocyte chemoattractant protein-1 or matrix metalloproteinase-9 levels. Compared with placebo, estrogen tended to decrease tissue factor antigen and increase tissue factor activity levels by 7 +/- 46% and 5 +/- 34%, respectively (p = 0.321 and p = 0.117, respectively) and lower plasminogen activator inhibitor-1 levels by 16 +/- 31% (p = 0.043). CONCLUSIONS The effects of estrogen on endothelial, vascular dilatory and other homeostatic functions were less apparent in type II diabetic postmenopausal women, despite the beneficial effects of estrogen on lipoprotein levels.

Effect of hormone replacement therapy on nitric oxide bioactivity and monocyte chemoattractant protein-1 levels

BACKGROUND Vascular inflammation plays an important role in the pathogenesis of atherosclerosis. We investigated the effect of hormone replacement therapy (HRT) on vasomotor function and monocyte chemoattractant protein (MCP)-1 levels, an important serological marker of inflammation. METHODS We administered micronized progesterone (MP) 200 mg for 10 days with conjugated equine estrogen (CEE) 0.625 mg for 25 days and remaining 5 days off cyclically during 2 months to 20 healthy postmenopausal women (PMW). We measured NO bioactivity and plasma levels of MCP-1 before and after HRT in 20 PMW. And we measured plasma levels of MCP-1 in each 20 subjects of premenopausal women, men <50, and men >50 years, respectively. RESULTS MP combined with CEE significantly improved the percent flow-mediated dilator response to hyperemia relative to baseline measurements (P<0.001). PMW receiving HRT had lower levels of MCP-1 than those not receiving HRT (121+/-38 versus 146+/-44 pg/ml, P<0.001). In all comparisons, subjects with high estrogen status had significantly lower MCP-1 levels than subjects with low estrogen status (P<0.001 by ANOVA). Premenopausal women had lower levels of MCP-1 than men of a similar age (106+/-14 versus 164+/-40 pg/ml, P<0.001). PMW not receiving HRT had similar levels of MCP-1 compared with men of a similar age (146+/-44 versus 143+/-29 pg/ml, P=0.816). Premenopausal women had markedly lower levels of MCP-1 than PMW not receiving HRT (106+/-14 versus 146+/-44 pg/ml, P=0.001). PMW receiving HRT had similar levels of MCP-1 compared with premenopausal women (121+/-38 versus 106+/-14 pg/ml, P=0.323). CONCLUSION These findings might provide at least a partial explanation for the protection against cardiovascular disease experienced by premenopausal women, and the loss of that protection following menopause.

MRI of Neurosyphilis Presenting as Mesiotemporal Abnormalities: a Case Report

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.

Differential Diagnosis of Focal Epididymal Lesions With Gray Scale Sonographic, Color Doppler Sonographic, and Clinical Features

Objective. To determine whether focal epididymal lesions can be differentiated on gray scale sonographic, color Doppler sonographic, and clinical features. Methods. This was a retrospective analysis of 60 focal epididymal lesions in 57 patients. Focal epididymal lesions were classified into 3 groups: nonspecific epididymitis (n = 43), tuberculous epididymitis (n = 10), and benign epididymal masses (n = 7). The following gray scale sonographic, color Doppler sonographic, and clinical features were analyzed: size, location, echogenicity, and heterogeneity of the lesion; hypoechoic or hyperechoic rim presence; hydrocele presence; degree of blood flow in the lesion; patients age; duration of symptoms; and scrotal tenderness. Results. Lesions were larger in patients with tuberculous epididymitis than in those with either nonspecific epididymitis (P = .007) or benign epididymal masses (P = .0017). The hypoechoic or hyperechoic rim of the lesion was more common in patients with benign epididymal masses than in those with nonspecific epididymitis (P = .002). The degree of blood flow in the lesion was greater in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P = .0019) or benign epididymal masses (P < .001). The duration of symptoms was shorter in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P = .0092). The frequency of scrotal tenderness was higher in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P < .001). Conclusions. Gray scale sonographic, color Doppler sonographic, and some clinical features may be helpful for differential diagnosis of focal epididymal lesions.

MDCT with Coronal Reconstruction: Clinical Benefit in Evaluation of Suspected Acute Appendicitis in Pediatric Patients

OBJECTIVE The purpose of this study was to assess the role of the addition of coronal reformatted images to MDCT in the evaluation of suspected acute appendicitis in pediatric patients. CONCLUSION In pediatric patients with suspected appendicitis, the addition of coronal reformatted scans to axial images in MDCT increases confidence in the diagnosis or exclusion of acute appendicitis.

Utility of MR Cholangiography for Follow-up Examination after Metallic Stent Placement in the Bile Duct

Purpose: To evaluate the efficacy of MR cholangiography for follow-up examination after metallic stent placement in the bile duct. Materials and Methods: Between December 1999 and June 2000, 15 patients with biliary obstruction in whom metallic biliary stents had been placed underwent MR cholangiography during follow-up examination. The causes of obstruction were hilar cholangiocarcinoma (n=6), common bile duct cancer (n=5), gall bladder cancer (n=1) and pancreatic cancer (n=3). The types of self-expandable metallic stent employed were the nitinol stent (n=2), the Endocoil nitinol stent (n=3), the Ultraflexed Diamond stent (n=5), and the Wallstent (n=5). Using MR cholangiography, we measured the diameter of that part of the biliary stent which showed high signal intensity, assigning one point if this was less than one third of the stent diameter, two points if between one third and two thirds, and three points if more than two thirds. We decided that a higher score indicated fewer artifacts. Results: The score was 1.7-3 (mean, 2.3) points for the Endocoil nitinol stent, 1.7-2.3 (mean, 2) for the nitinot stent, and 1-3 (mean, 1.7) for the Ultraflex Diamond stant. In most cases, two thirds of the stent diameter was observed. For the Wallstent, the score was 1-1.7 (mean, 1.3) points and the inner portion of the stent was almost invisible. Conclusion: MR cholangiography is not useful for follow-up examination after the placement of Wallstents and three other types of nitinol stent in the bile duct.