Serdar Özşener

Mammographic density changes during different postmenopausal hormone replacement therapies

OBJECTIVE To determine the degree of change in mammographic breast densities during different types of postmenopausal hormone replacement therapies. DESIGN A retrospective study. SETTING Ege University Hospital. PATIENT(S) The mammographies of 216 women on various postmenopausal hormone replacement therapies were evaluated. INTERVENTION(S) Estrogen alone (n = 76) or estrogen in cyclic (n = 44) or continuous (n = 61) combination with progestin or tibolone-only (n = 35) replacement therapies were used. Mammographic density was quantified according to the Wolfe classification in patients with different hormone replacement regimens. MAIN OUTCOME MEASURE(S) Mammographic density changes were interpreted. RESULT(S) An increase in mammographic density was much more common among women receiving continuous combination hormone replacement therapy 31.1% (19 of 61) than among those receiving estrogen-only 3.9% (3 of 76) treatment. There were no significant mammographic breast density changes among women receiving cyclic continuous combination hormone replacement therapy or tibolone-only treatment. The increase in density was apparent already at first visit after the start of hormone replacement therapy. In continuous combined postmenopausal hormone replacement therapy with norethisterone acetate, the increase in mammographic density was 34.1% (15 of 44), followed by medroxyprogesterone acetate 23.5% (4 of 17). CONCLUSION(S) Our findings show that mammographic breast density changes related to postmenopausal hormone replacement therapy are dependent on the selected hormone regimen. The continuous administration of the progestin component of the combined-hormone replacement therapy seems to effect the breast density most.

Comparison of the reduction of postoperative adhesions by two barriers, one solution, and two pharmacologic agents in the rat uterine model

OBJECTIVE To evaluate the effects of two barriers, one solution, and two pharmacologic agents, in single or in combined use, for preventing postsurgical adhesion formation in the rat model. DESIGN A randomized, prospective study to evaluate the ability of leuprolide acetate, oxidized regenerated cellulose, medroxyprogesterone acetate, sodium hyaluronate, sodium hyaluronate/carboxymethyl cellulose, in single or in combined use, for preventing adhesion formation in a rat model. ANIMAL(S) Wistar female rats. SETTING University animal laboratory. INTERVENTION(S) Intramuscular injection of pharmacologic agents before surgery and intraperitoneal application of barriers and solution at the end of surgery. MAIN OUTCOME MEASURE(S) Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. RESULT(S) All the treatment groups had fewer, less severe adhesions when compared with controls. The combination of medroxyprogesterone acetate and oxidized regenerated cellulose did enhance the adhesion-reducing capacity of oxidized regenerated cellulose. The performance of sodium hyaluronate solution for adhesion prevention was statistically significant, when compared with oxidized regenerated cellulose alone, or sodium hyaluronate used with carboxymethyl cellulose film. CONCLUSION(S) Pharmacologic agents, barriers, or solutions result in significant reduction of postsurgical adhesions. The sodium hyaluronate solution alone and medroxyprogesterone acetate treatment alone had the least adhesion prevention scores. However, neither monotherapy nor combined therapy proved to be significantly more beneficial.

Effects of sequential combined transdermal and oral hormone replacement therapies on serum lipid and lipoproteins in postmenopausal women.

Abstract The aim of this study was to compare the effects of sequential combined transdermal and oral postmenopausal hormone replacement therapies on serum lipid-lipoprotein profiles risk markers for cardiovascular disease. A prospective randomize study was designed: Ninety-six healthy nonhysterectomised postmenopausal women were randomized to receive either transdermal continuous 17β-estradiol, 0.05 mg/d (Estraderm TTS, Novartis, Basel, Switzerland), with transdermal sequential norethisterone acetate, 0.25 mg/d (Estragest TTS, Novartis, Basel, Switzerland), or oral continuous conjugated equine estrogens, 0.625 mg/d (Premarin 0.625 mg, Wyeth, Philadelphia, U.S.A.), with oral sequential medroxyprogesterone acetate, 10 mg/d (Farlutal 5 mg, Deva, Istanbul, Turkey). 84 women completed the trial, 42 in oral and 42 in the transdermal group. The serum levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoproteins AI and apolipoproteins B at 6 months after starting treatment were compared with baseline values for both therapies. Both oral and transdermal therapies significantly reduced serum levels of total cholesterol (208– 190 mg/dL and 216–199 mg/dL, respectively, p=0.0001) and LDL-cholesterol (128–112 mg/dL and 140– 127 mg/dL, respectively, p=0.001). The serum levels of triglycerides did not show any significant change with oral therapy, whereas this lipid fell (128–101 mg/dL, p=0.0001) significantly with transdermal therapy. We found significant decrease in HDL-cholesterol with transdermal therapy while there was no significant change with oral therapy. Apolipoproteins AI, the major protein component of HDL2 subfraction, was increased by oral therapy and lowered by transdermal therapy. As a conclusion, we have found that serum total cholesterol and LDL-cholesterol were lowered by both therapies, with no significant differences between treatments, whereas there were significant differences between treatments according to effects on serum triglycerides and apolipoproteins AI.

Mammographic density changes in postmenopausal women using tibolone therapy

Mammography is an effective tool for the early detection of breast cancer. Hormone replacement therapy is associated with an increase in mammographic breast density in a significant proportion of postmenopausal women 1,2 . Current use of postmenopausal hormone replacement therapy may also be associated with lower sensitivity of screening mammography 3 . In this preliminary study, we investigated the degree of change in mammographic breast densities in postmenopausal women receiving tibolone Ž . Livial , Organon at a daily dose of 2.5 mg. The mammographies of 50 postmenopausal women receiving tibolone therapy were evaluated retrospectively. Mammographic density was quantified according to the Wolfe classification 4 . Forty-two Ž . Ž . Ž . 84% , 6 12% , and 2 4% patients were sub-

Does tibolone affect serum leptin levels and body weight in postmenopausal women

ObjectivesLeptin has a significant role in body weight regulation and energy balance. We examined the effect of tibolone on the body weight and serum leptin levels in postmenopausal women.Study designTwenty women (aged 43–60 years) participated in this prospective study. All women in this study protocol received 2.5 mg/day of tibolone. Absolute and body mass index (BMI)-corrected serum leptin concentrations and BMI values were measured at baseline, after 3 months, and after 6 months of the tibolone therapy.ResultsTibolone did not affect absolute and BMI-corrected serum leptin levels, and BMI values during the treatment. A significant linear correlation between BMI values and serum leptin levels was observed (p<0.05, r=0.67).ConclusionsTibolone seems not to affect serum leptin levels, body weight and BMI values of postmenopausal women. There is a significant correlation between serum leptin levels and BMI values.

Conservative management of placenta previa percreta by leaving placental tissue in situ with arterial ligation and adjuvant methotrexate therapy

Placenta percreta is one of the life-threatening conditions in modern obstetrics. The rising caesarean section rate means rising placenta percreta rate. Treatment strategies range from a caesarean hysterectomy to leaving the placenta in situ with or without internal iliac artery ligation/uterine artery embolisation and/or methotrexate therapy. We describe a case of placenta previa percreta which we managed successfully with conservative modalities.

A comparison of continuous combined hormone replacement therapy, HMG-CoA reductase inhibitor and combined treatment for the management of hypercholesterolemia in postmenopausal women.

Objectives: To compare the lipid‐altering effects of hormone replacement therapy alone and in combination with HMG‐CoA reductase inhibitor in postmenopausal women with hypercholesterolemia.

The effect of continuous combined oral estradiol and norethisterone on the renal and internal carotid artery pulsatility indices in postmenopausal women.

Postmenopausal estrogen administration results in a marked reduction in the prevalence of cardiovascular disease, particularly coronary heart disease, an effect that does not appear to be lost when cyclical progestogen is also included. Estrogen acts directly on blood vessels through both endothelium-dependent and calcium-dependent mechanisms to improve arterial function. Not only does it have a beneficial effect on the circulating blood lipid fractions, but it is now established that estrogen has a positive influence in preventing the deposit of cholesterol in the arterial endothelium; it also induces vasodilatation, increases pe-

The Effect of Medroxyprogesterone Acetate and Heparin in the Prevention of Postsurgical Adhesion Formation in the Rat Uterine Model

Objective: To evaluate the effects of depot medroxyprogesterone acetate and heparin in preventing postsurgical adhesion formation in the rat model.

Intracranial Venous Thrombosis Associated with Severe Antithrombin-III Deficiency in Pregnancy

We report a patient with intracranial venous thrombosis in the third trimester of pregnancy associated with severe antithrombin‐III deficiency. The evaluation of protein C, protein S and antithrombin‐III levels in patients with thrombotic events during pregnancy may reveal the specific cause of the thrombotic event and thereby influence patient management