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Biomedical subjects

D M Hart

Publications and source records attributed to D M Hart.

At least 37 records · Page 2Linked to original sources
PubMed1991

Prevention of bone loss by hormone replacement therapy is probably not due to stimulation of calcitonin secretion.

Weekly fasting serum calcitonin levels and biochemical indices of bone metabolism were measured in 13 postmenopausal women being given hormone replacement therapy over a period of 8 weeks. All of the biochemical indices except urinary hydroxyproline creatinine ratios fell significantly, indicating that the treatments were effective in reducing bone turnover. Calcitonin levels fell significantly and, within the individual, levels were positively correlated with adjusted calcium levels. These findings do not support the theory that estrogen conserves bone by stimulating calcitonin secretion.

Alkaline Phosphatase↗
PubMed1990

Effects of bilateral oophorectomy on lipoprotein metabolism.

The effects of surgical menopause on lipoprotein levels and their time course were studied in 31 premenopausal women who were undergoing hysterectomy and bilateral oophorectomy for non-malignant conditions. Lipoprotein levels were measured before oophorectomy and afterwards at 6 and 12 weeks, then at intervals of 3 months for 18 months. Low density lipoprotein (LDL) cholesterol levels rose significantly (P less than 0.05) in the 6 weeks after operation from a mean of 3.57 (SD 0.66) mmol/l to 4.21 (SD 0.84) mmol/l with no significant changes thereafter. There were no significant changes in cholesterol in the other density fractions or in triglyceride levels. High density lipoprotein (HDL) subfractions were measured in 10 of the women to assess any change in the relative amounts of cholesterol carried on HDL2 and HDL3, since the protective effect of HDL is believed to be conferred by the HDL2 fraction only. No significant change was found in either fraction. The increase in LDL cholesterol would be expected to result in an appreciable increase in the risk of developing coronary heart disease, but cannot wholly account for the increase in cardiovascular disease associated with oophorectomy.

Adult↗
PubMed1989

Effect of etidronate disodium on bone turnover following surgical menopause.

A longitudinal study was performed to document the effect of surgical menopause and postmenopausal etidronate disodium therapy on several nonhistomorphometric indices of bone turnover. Twenty healthy, premenopausal women undergoing oophorectomy for nonmalignant conditions were studied preoperatively and at 3 monthly intervals postoperatively. Sequential measurements of serum calcium (Ca), alkaline phosphatase (AP), bone Gla protein (BGP), and urinary calcium and hydroxyproline excretion, expressed as a ratio of urinary creatinine (UCa/Cr and UOHp/Cr, respectively) were obtained. Twenty-four-hour whole body retention of diphosphonate (WBR) and radial bone density were also measured. When a postoperative increase in bone turnover was observed, patients were randomized to receive either 400 mg etidronate disodium daily or placebo for 3 months. Oophorectomy was associated with a significant increase in WBR, Ca, AP, and BGP and an insignificant rise in UCa/Cr. A variable pattern of UOHp/Cr was seen. Patients on placebo maintained these elevated levels of Ca, BGP, and UCa/Cr. WBR and AP continued to rise. Etidronate disodium therapy resulted in a fall towards premenopausal levels in WBR, Ca, and UCa/Cr. AP and BGP were unchanged. Three months after stopping etidronate, BGP fell significantly and the decrease in Ca was maintained; however, WBR and UCa/Cr had returned towards pretreatment values. Bone density measurements did not change significantly. An increase in several of the indices of bone turnover was seen following oophorectomy. Etidronate disodium suppressed this increase, affecting indices of both resorption and formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaline Phosphatase↗
PubMed1989

Blood coagulation profile in long-term hormone replacement therapy with mestranol.

The coagulation profile of oophorectomised women on long-term (15 yr) hormone replacement therapy with mestranol (30 micrograms/day) is compared to that of women on long-term placebo. Analysis of these data showed no significant difference in prothrombin time, partial thromboplastin time or in anti-thrombin III level in these groups.

Adult↗
PubMed1989

Differential effect of long-term oestrogen therapy on trabecular and cortical bone.

The effect of long-term oestrogen therapy has been assessed in 40 oophorectomised women. Twenty-one of the women had received mestranol (mean 26 micrograms/day) and 19 received placebo tablets for a mean duration of 14 yr. A newly developed gamma-ray computed tomography (CT) scanner was used to measure trabecular and cortical bone separately in the distal radius. Bone density in the lumbar spine was measured using dual photon absorptiometry (DPA). Prevention against bone loss was demonstrated at all sites for the mestranol treated group (P less than 0.01). The deficit of radial trabecular bone (27%) was greater than that for radical cortical bone (14%). The deficit for the spine was intermediate (20%). One-year follow-up radial measurements showed a significant 1.2% increase (P less than 0.01) in cortical bone for the treated group. The DPA measurement was found to be best correlated (r = 0.80) with a mixed trabecular and cortical bone parameter in the radius. We conclude that the degree of bone loss at any site is dependent on the proportion of trabecular bone present.

Aged↗
PubMed1989

Effects of treatment with oestradiol/levonorgestrel on bone, lipoproteins and hormone status in postmenopausal women.

The aim of the study was to investigate the effects of an oestradiol/levonorgestrel regimen, administered parenterally, on bone metabolism, bone density, lipoprotein metabolism and hormone status. Twenty-five women who had undergone a surgical menopause had an oestradiol/levonorgestrel-containing vaginal ring pessary in situ for 6 months. Within the first month there were sustained changes in the biochemical indices of bone metabolism in keeping with a marked reduction in bone turnover and decrease in bone resorption. Bone mineral content in the distal forearm was measured in 14 patients and a small increase was noted in every patient. Levonorgestrel was well absorbed and the serum levels remained almost constant throughout treatment. There was a gradual increase in serum total oestradiol which became significant at 6 months. Dialysable oestradiol levels rose from 2.6% of total oestradiol at 0 time to 3.3% at 1 month with no further change thereafter. SHBG levels were 23% of pretreatment levels at 6 months. There were sustained decreases in triglyceride, VLDL and HDL cholesterol levels and a transient fall in LDL cholesterol. Total HDL, HDL2 and HDL3 cholesterol levels were reduced by 25, 40 and 21% respectively. The results suggest that levonorgestrel exerts a protective influence on bone either directly or by its effect on the proportion of oestradiol circulating in the free, physiologically active form. The effects on lipoproteins were predominately those of the progestogen component, the lipoprotein risk factors for coronary heart disease being adversely affected.

Administration, Intravaginal↗
PubMed1989

Lipoprotein and apolipoprotein levels in postmenopausal women on continuous oestrogen/progestogen therapy.

Levels of serum lipoproteins and apolipoproteins were monitored for 48 weeks in two groups of women taking part in a double-blind trial of continuous oestrogen/progestogen with and without oestriol. There were no differences between the effects of the two treatments on the substances measured. Triglycerides did not change and there was a transient fall in very low density lipoprotein cholesterol. Low density lipoprotein cholesterol fell over the first 24 weeks but rose thereafter to pretreatment levels. There was a decrease in high density lipoprotein (HDL) cholesterol due to a transient fall in HDL2 cholesterol and a gradual decrease in HDL3 cholesterol. Consequently, the only change in lipid levels present after 48 weeks was a decrease in HDL3 cholesterol, the clinical significance of which is uncertain. There was, however, an increase in apoprotein B levels and decreases in apoprotein AI and AII levels. These alterations in apoprotein levels may be unfavourable, since apoprotein B levels have been positively correlated and apoprotein AI and AII levels negatively correlated with coronary heart disease.

Apolipoproteins↗
PubMed1989

A study of the experience of Glasgow women in the climacteric years.

Overall, 424 women between 40 and 60 years of age were interviewed with reference to their experience of the menopause; 179 (42%) expressed a 'need for treatment' which was more marked in those who had had a hysterectomy (57%) or oophorectomy (76%). Of those who sought help (174) a large majority (92%) had seen their general practitioner and 72% received some form of drug therapy, predominantly hormone replacement therapy (HRT) or psychotropic drugs. Twenty-eight women were currently having HRT (7%) and 39 (9%) had previously had HRT. Only 12 women (3%) had received greater than 3 years of HRT and nine of these had had an oophorectomy. Only 1% of other women were 'long-term' users of HRT. Of the 424 women 11% expressed dissatisfaction with their general practitioner's approach to this subject.

Adult↗
PubMed1988

Changes in the bone and liver isoenzymes of alkaline phosphatase in postmenopausal women being treated with norethisterone.

The effects of norethisterone therapy on alkaline phosphatase isoenzyme activities were studied in a group of postmenopausal women. There was a significant fall in total alkaline phosphatase activity after 8 wk which was still in evidence after 24 wk. Both bone and liver alkaline phosphatase isoenzyme activities were decreased during the first 16 wk on treatment, but after 24 wk only the bone phosphatase activity was significantly lower than the pretreatment level. The other biochemical indices of bone metabolism and liver function were also measured during the study. The results indicate that bone specific alkaline phosphatase activity is a more sensitive index of bone activity than total alkaline phosphatase and that monitoring of total activity may in some instances be misleading.

Alkaline Phosphatase↗
PubMed1988

Effects of conjugated equine oestrogens with and without the addition of cyclical norgestrel on serum and urine electrolytes, and the biochemical indices of bone metabolism and liver function.

Serum and urine electrolytes, and biochemical indices of bone metabolism and liver function were measured in 51 post-menopausal women treated with two hormone replacement therapy regimens for 24 wk. Twenty-six of the women were treated continuously with conjugated equine oestrogens (0.625 mg/day) and the remainder were treated as above with the addition of norgestrel (0.15 mg/day) during the last 12 days of each 28-day cycle. Both treatment regimens affected electrolytes in a similar manner. The most consistent effect was a reduction in serum sodium levels and a reduction in urinary sodium/creatinine ratios. The combined regimen appeared to have a greater effect on sodium reabsorption. Both regimens decreased all the biochemical indices of bone metabolism measured, viz serum calcium (corrected for albumin), phosphate and alkaline phosphatase and urinary calcium/creatinine and hydroxyproline/creatinine ratios. The preparations used decreased the parameters by similar amounts over the 24 wk indicating that both were equally effective in reducing bone turnover. The data suggested, however, that the combined regimen had a more profound effect on bone metabolism during the early phase of treatment. The two treatment regimens had broadly the same effects on the biochemical indices of liver function, reducing albumin levels and all the liver enzymes. Judging by these indices neither regimen had a deleterious effect on liver function. We conclude that the two hormone replacement regimens have similar effects on the biochemical indices measured, but there are subtle differences between the two treatments which merit further research.

Bone and Bones↗
PubMed1988

Effects of nadolol on arrhythmias during laparoscopy performed under general anaesthesia.

Cardiac arrhythmias are a well recognized complication of anaesthesia for laparoscopy. The effect of nadolol, given by mouth 12 h before operation, was compared with placebo on arrhythmias in 86 females undergoing laparoscopy. All types of arrhythmia were documented; there was a 97% incidence in the placebo group, but in the nadolol group there was a smaller incidence of supraventricular tachycardia, ventricular ectopics and atrioventricular dissociation (P less than 0.01). There was no significant difference in the incidence of sinus bradycardia. Nadolol may be recommended as a safe agent to be given by mouth before laparoscopy to reduce the frequency of cardiac arrhythmias during anaesthesia.

Adult↗
PubMed1988

The variation in cervical hydroxyproline and cervical water with age.

The squamocolumnar junction is frequently not visible in the postmenopausal patient. This study attempts to identify some of the changes in the cervix that may account for this observation. Twenty-four cervical biopsy samples taken at the squamocolumnar junction were analysed for hydroxyproline (collagen) and water content. There was significantly more hydroxyproline (collagen) in the premenopausal woman than the postmenopausal woman. Similarly, there was higher percentage of water in the biopsies in the premenopausal woman than the postmenopausal woman. Further samples obtained deeper in the cervical stroma did not confirm these differences. It appears likely that differences in cervical water and cervical collagen near the surface of the cervix account, at least in part, for the lack of visibility of the squamocolumnar junction in the older woman.

Adult↗
PubMed1988

The effects of conjugated equine estrogens plus cyclical dydrogesterone on serum lipoproteins and apoproteins in postmenopausal women.

Serum lipoprotein and apoprotein concentrations were monitored for 24 weeks in 26 postmenopausal women treated with conjugated equine estrogens (0.625 mg/day) with the addition of dydrogesterone (10 mg/day) for the last 12 days of each 28 day cycle. The women had had no previous hormone replacement therapy. The estrogen plus dydrogesterone regimen caused significant (P less than 0.05) increases in triacylglycerol and HDL cholesterol concentrations. Both HDL2 and HDL3 cholesterol were increased. There were no other significant changes in lipoprotein concentrations. Both apoprotein AI and apoprotein AII concentrations increased significantly (P less than 0.05) over the study period. The ratios of apoprotein AI to apoprotein AII, apoprotein AI to HDL cholesterol and apoprotein AII to HDL cholesterol did not change. At the doses employed in this study, the use of dydrogesterone as a progestogen alters the effects of conjugated equine estrogens on lipoproteins and reinforces the view that the effects of a combined HRT regimen cannot be predicted from a consideration of the effects of the individual components.

Apoproteins↗
PubMed1987

A comparison of the effects of lipoproteins of two progestogens used during cyclical hormone replacement therapy.

Lipoprotein levels were measured in 11 women who had been treated with 0.625 mg/day conjugated equine oestrogens with the addition of 0.15 mg/day DL-norgestrel for the last 12 days of each 28 day cycle for 48 wk. Treatment was then changed to an identical oestrogen regimen with dydrogesterone, 10 mg/day, as progestogen and monitoring continued for a further 24 wk. The oestrogen plus norgestrel regimen caused a significant reduction in low density lipoprotein (LDL) cholesterol levels. During the 24 wk after the change of therapy, levels of high density lipoprotein (HDL) increased significantly due to an increase in the HDL2 fraction and there was an upward trend in LDL cholesterol which did not attain statistical significance. We conclude that, when used in combination with conjugated equine oestrogens, changing from norgestrel, 0.15 mg/day, to dydrogesterone, 10 mg/day, does not lead to any significant improvement in lipoprotein profile.

Cholesterol, LDL↗
PubMed1987

Evaluation of a psychological treatment programme for climacteric women.

A psychological assessment and treatment programme designed for a group of climacteric women with severe and varied psychological complaints and symptoms is described and evaluated. All the women were currently experiencing stressful psychosocial difficulties within their life situation. The treatment programme comprised an educational, a counseling and a behavioural component. By the end of the sixth session of therapy, most women showed a significant improvement in their main complaint, accompanied by improvements in general symptoms and personal adjustment. Two-thirds considered that they had benefited substantially from treatment. The outcome of the treatment was considered to be encouraging in what might otherwise be considered a potentially unresponsive group of women.

Adult↗
PubMed1987

Sex steroid replacement in post-menopausal women: effects on thyroid hormone status.

We have measured serum thyroxine (T4), triidothyronine (T3), thyroid-stimulating hormone (TSH) free thyroxine (FT4) and thyroxine-binding globulin (TBG) levels in a total of 5 post-menopausal women who were receiving oestrogen alone (Premarin, n = 19), progestogen alone (Primolut-N, n = 12), a combination of oestrogen and progestogen (Prempak C, n = 14) or no treatment (control group, n = 12). No differences were observed between the Premarin and Prempak C groups; both exhibited elevated T4 and TBG levels, although free thyroxin (FT4) and T4/TBG concentrations were normal relative to those in the control group. The Primolut-N subjects showed subnormal T3 and FT4 levels relative to the controls. It was concluded that it is not possible to make general statements regarding the effects of sex steroids on FT4 levels.

Estrogens, Conjugated (USP)↗