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Biomedical subjects

E Godehardt

Publications and source records attributed to E Godehardt.

At least 37 records · Page 2Linked to original sources
PubMed2001

Changes in coronary vessel resistance during postischemic reperfusion and effectiveness of nitroglycerin.

OBJECTIVE: Microvascular incompetence after ischemia and reperfusion may compromise the normal postischemic coronary perfusion and additionally jeopardize the recovery of the myocytes. We investigated whether such a form of acute endothelial dysfunction occurs in the routine operative setting despite the use of protective measures. For this purpose, we measured pressure-flow relations in the coronary vasculature during heart operations before and after ischemia and after reperfusion and their reaction to the nitric oxide donor nitroglycerin. METHODS: Forty-eight patients with a low risk profile scheduled for routine coronary artery bypass surgery were included. During normothermic extracorporeal circulation, the fibrillating heart was completely excluded from bypass by clamping of the ascending aorta and snaring of the caval veins. It was relieved of blood by opening the right atrium and venting the left atrium and ventricle to avoid distention. The coronary vessels were perfused under controlled flow, and the perfusion pressures were monitored. This protocol was performed in 24 patients before and immediately after ischemia and after a reperfusion period. RESULTS: Compared with the preischemic control, vascular resistance was decreased by 17% (P <.003) immediately after ischemia but increased again by 46% (P <.0001) during an average of 25 minutes of reperfusion and, even more important, by 23% (P <.028) in comparison with the preischemic values. In two groups of 12 patients, nitroglycerin was added to the perfusate either in a dosage of 3 microg. kg. min(-1) or as a bolus injection of 2 mg. Low-dose nitroglycerin did not reduce the elevated postreperfusion resistances significantly, but bolus injection did (P <.0002). Coronary vessel resistance increased during reperfusion in particular in patients with a history of hypertension. CONCLUSION: Coronary vasoconstriction during postischemic reperfusion is regularly present in the routine operative setting in cardiac surgery, despite myocardial protection measures. The amount of vasoconstriction varies considerably and is particularly increased in patients with hypertension. The nitric oxide donor nitroglycerin can normalize the elevated resistances, but only in high dosages. This demonstrates a preserved ability of vascular smooth muscle to relax. The phenomenon had no sequelae in our low-risk patients having elective operations. However, it may gain significance in the case of severe left heart hypertrophy and in patients at risk with both a postoperative low-output syndrome and reduced mean arterial pressures during reperfusion.

Aged↗
PubMed2000

Coadministration of the new macrolide immunosuppressant RAD and mycophenolate mofetil in experimental corneal transplantation.

INTRODUCTION: The effect of RAD, a new macrolide immunosuppressant, was examined as mono- and combination therapy with mycophenolate mofetil (MMF) in prevention of acute allograft rejection in murine corneal transplantation. METHODS: Both drugs were administered orally for 18 days beginning at the day of transplantation. The inbred strains Fisher and Lewis were used as donors and recipients, respectively. Five groups were involved: syngeneic control, allogeneic control, 2.5 mg/kg RAD, 40 mg/kg MMF, and double drug therapy with 1.5 mg/kg RAD and 20 mg/kg MMF. RESULTS: The median transplant survival time in the allogeneic combination was 12 (+/-0.3) days. Monotherapy with 2.5 mg/kg RAD and 40 mg/kg MMF led to a statistically significant prolongation of transplant survival to 25.5 (+/-12.5, P=0.0001) days and 19.5 (+/-13.9, P=0.0053) days, respectively. Combination therapy was superior to both monotherapies (100+/-15.8 days, P=0.03). There was a significant reduction in the number of CD4+, CD8+, as well as CD45RA+ cells in the RAD- and double drug-treated animals when compared with the allogeneic control. This significant reduction in graft-infiltrating lymphocytes has not been found in the MMF monotherapy. CONCLUSIONS: The unique finding of this first study on the combination of RAD and MMF in murine corneal transplantation is that double drug therapy produces a highly synergistic effect in prevention of acute allograft rejection without a higher incidence of complications related to drug toxicity or overimmunosuppression.

Animals↗
PubMed2000

[Determining left and right ventricular volume ejection fractions (VEF) with MRI at 1.0 T. Comparison of manual and semi-automated endocardium detection].

PURPOSE: To evaluate method- and user effects as well as the required time in the determination of left- and right ventricular ejection fractions in comparing manual and semiautomatic border detection of the endocardium. METHODS: In 22 patients with varying cardiac diseases endocardial borders were detected either manually or semi-automatically (seeded ROI) and subsequently the right and left ventricular volume ejection fractions were computer-calculated. Two investigators defined the endocardial borders for both ventricles using both methods. For statistical analysis two-factorial analyses of variance were performed for the four variables: VEF right ventricle, VEF left ventricle, required time right ventricle, required time left ventricle (SAS, Anova). RESULTS: There was no user or method effect detectable for both ventricles. The required time for both ventricles also did not reveal a user effect, but there was a dramatic method effect concerning a reduction of the required time for analysis for both ventricles > 50%. CONCLUSIONS: The semiautomatic mode for detecting the endocardial borders in determining right and left ventricular ejection fractions did not demonstrate results differing from the results of the manual method, but is significantly superior concerning the time required for analysing ejection fractions of both ventricles with a reduction of over 50%. This might significantly reduce the expenditure for personnel.

Adult↗
PubMed2000

Right and left ventricular volume measurements in an animal heart model in vitro: first experiences with cardiac MRI at 1.0 T.

The aim of this study was to determine the accuracy in quantifying right and left ventricular volumes using a 1.0-T system and commercially available, standard equipment. For exact comparison of MRI measurements and real volumes we used an animal heart model ex vivo. Eight pig hearts were explanted and prepared by removal of the atria. Aorta and pulmonary truncus were cannulated. Definable volumes were injected into the ventricles. Magnetic resonance imaging was performed at 1.0 T (Gyroscan T10 NT, Philips, Eindhoven, The Netherlands); sequence: fast field echo-echo planar (multishot EPI); body coil; MR software: Cardiac Application Package (Philips). Statistical analysis correlated the real volumes and MR measurements separately for both ventricles and two investigators (SAS, ANOVA). For both ventricles and both investigators the correlation between real volumes and MR measurements was greater than 0.99. There was no significant systematic false estimation for both ventricles. Magnetic resonance imaging at 1.0 T using standard hardware and software equipment enables the quantification of right and left ventricular volumes with high approximation to the real volumes in vitro. There is a clear restriction in translating these data into a clinical application because under experimental conditions no motion-induced artifacts existed.

Animals↗
PubMed2000

[Local cyclosporin A in nummuli after keratoconjunctivitis epidemica. A pilot study].

BACKGROUND: Recurrences are common after discontinuing topical steroids against nummular infiltrates following adenoviral keratoconjunctivitis (AK). To avoid the potentially serious side effects of resumed steroid treatment at increased doses we tested topical 2% cyclosporin A (CSA). PATIENTS: We applied four drops of CSA daily to 70 eyes (48 patients) with persistent nummular infiltrates after AK. Treatment began 18.5 months (3-72) after the acute phase of AK. Dose reduction depended on resolution of the nummuli in the individual patients. RESULTS: Of the 70 eyes 40 responded positively to therapy, 16 showed no change, therapy was stopped in 4 because of ocular discomfort (burning), and in 10 eyes follow-up is still less than 3 months. CONCLUSIONS: CSA was effective in eliminating or reducing nummuli in the majority of patients. More than one-half of the responding eyes had a complete cure and did not experience recurrences after stopping therapy. We therefore consider topical CSA to be a safe and effective alternative to topical steroids for treating nummular infiltrates after AK.

Adult↗
PubMed2000

Influence of membrane differential filtration on the natural course of age-related macular degeneration: a randomized trial.

PURPOSE: Membrane differential filtration is able to optimize rheologic parameters by eliminating high molecular weight proteins and lipoproteins from the blood. Following the hypothesis that these changes result in an improvement of the microcirculation, the authors tested the efficacy of membrane differential filtration in improving visual function in patients with age-related macular degeneration (ARMD). METHODS: Forty patients (40 eyes) were randomized into two groups. The treatment group was treated five times over a period of 21 weeks. In both groups, 9/20 of the eyes showed subfoveolar subretinal neovascularization. The main parameter of the study was visual acuity (VA). Electroretinogram (ERG), electrooculogram, and macular visual evoked potentials were also recorded. Plasma and whole blood viscosity and erythrocyte aggregation were measured. RESULTS: The 20 patients treated repeatedly over a period of 21 weeks showed a mean improvement of 0.63 lines (SD 1.8) of VA on Early Treatment Diabetic Retinopathy Study charts. The control group showed a deterioration of 0.94 lines (SD 1.7) compared to VA at baseline examination. The amplitude of the ERG photopic a-wave and the flicker ERG was significantly increased. The rheologic parameters were lowered in all treated patients. CONCLUSION: Repetitive treatment with membrane differential filtration is able to improve visual acuity of patients with ARMD and the natural course of this disease. Several questions arise from the results of this study. Further research will show if it is possible to optimize the selection of patients for subgroups with predictive responses through morphologic and functional tests and how to create an optimized and individual treatment strategy determined by the quality, intensity, and frequency of treatment sessions.

Aged↗
PubMed2000

Mitroflow pericardial valve prosthesis in the aortic position: an analysis of long-term outcome and prognostic factors.

BACKGROUND AND AIM OF THE STUDY: Pericardial valves combine optimal hemodynamic properties with limited durability. To describe the long-term performance of Mitroflow pericardial valves in the aortic position, outcome and risk factors up to 12 years after implantation were analyzed. METHODS: A retrospective study, based on follow up of 1,029 patients who received 1,044 Mitroflow pericardial valves in the aortic position between February 1985 and December 1996, was performed. Follow up was 98.2% complete. Average follow up was 3.79 years. Mean patient age was 75.2+/-6.5 years (range: 27.9-90.9 years). At surgery, 86.3% of patients were aged over 70 years. Among patients, 482 (46.8%) had concomitant operations. RESULTS: Results (+/- SE) are given for evident and possible (in parentheses) valve-related events; the latter included all reported postoperative strokes and sudden deaths. Actuarial event-free rates after 5 and 10 years respectively were: structural valve deterioration: 99.2+/-0.5% and 77.6+/-4.4%; non-structural valve deterioration: 99.7+/-0.2% and 99.7+/-1.2%; valve-related complications: 95.7+/-0.9% and 73.5+/-4.0% (5 years 90.1+/-1.2%, 10 years 57.0+/-4.3%); endocarditis: 96.6+/-0.8% and 92.6+/-1.6%; explantation: 98.6+/-0.5% and 80.1+/-3.9%; cerebrovascular accident 95.2+/-0.9% and 82.5+/-3.5%; embolism 99.9+/-0.1% and 99.9+/-0.5%; bleeding 99.8+/-0.2% and 99.8+/-1.3%; overall mortality 69.9+/-1.8% and 35.3+/-3.0%; valve-related death 97.5 +/-1.1% and 95.1+/-4.2% (5 years 91.9+/-1.4%, 10 years 76.1+/-3.2%). The 30-day mortality rate was 4.1%. Patients aged 70 years or more with valve diameters of < or =23 mm showed 10-year freedom rates of 85.8+/-4.6% for structural valve degeneration and 95.1+/-1.2% for evident valve-related death. The detailed risk factor analysis showed results that were in accordance with clinical experience. CONCLUSION: Long-term results with Mitroflow pericardial valves in the aortic position compare well with those for other widely used bioprostheses, especially in patients aged > or =70 years and with small aortic root diameters (< or =23 mm).

Adult↗
PubMed1999

Beneficial effect of preoperative mycophenolate mofetil in murine corneal transplantation.

To investigate the effect of preoperative mycophenolate mofetil (MMF) on allograft survival in a murine corneal transplantation model. Corneal grafting was performed from Brown Norway to Lewis rats. Groups were divided as follows: Rats that received syngeneic or allogeneic grafts without therapy served as controls. MMF treatment was either started 7 days prior to transplantation and continued for 14 postoperative days (POD) or started at the day of corneal grafting until POD 14. MMF (20 mg/kg) administered postoperatively had no significant beneficial effect on corneal graft survival when compared with controls. However, the group receiving 40 mg/kg MMF postoperatively showed a statistically significant prolonged graft survival. A 1-week preoperative administration of 20 mg/kg MMF allowed superior graft survival. Priming the immune system of corneal transplant recipients preoperatively with MMF proved to be a beneficial therapeutic regimen for prolonging corneal allograft survival in rats.

Animals↗
PubMed1999

Research and quality control in natural family planning with relational database systems.

Research and quality control in natural family planning (NFP) is based on continuous data collection in prospective studies. The quality of the data is determined by the reliability of collection, input, management, and retrieval. During a period of ten years, different relational databases were programmed to manage the large number of very different data in NFP studies. Recently, all experience with different database systems has been summarized by writing and testing a completely new data management system based on MS Access 97: NFPDAT 1.0. This new software is used for data collection, evaluation and administration in NFP Study Groups. Over 200 internal formulae guarantee maximum data consistency while 30,000 cycles from 1477 patients were stored. Easy data evaluation for research and administration is possible with the help of a new report generator even without prior knowledge of SQL (System Query Language) or Visual Basic for MS Access 97. Using this method, interim results for research and quality control can be obtained at any time. NFPDAT can be used by all Natural Family Planning Study Groups using the symptothermal method for research and administration. With the help of NFPDAT, various prospective studies of Natural Family Planning were conducted.

Austria↗
PubMed1999

[Modification of vision by change in rheologic parameters in senile macular degeneration through membrane differential filtration--initial results of a randomized study].

BACKGROUND: Membrane differential filtration (MDF) is known to optimize rheological parameters by eliminating high molecular weight proteins und lipoproteins from the blood and was shown to influence ocular perfusion parameters. Following the hypothesis that these changes may influence the natural course of age-related macular degeneration (AMD) we tested their efficacy in improving visual function in these patients in a randomized trial. PATIENTS AND METHODS: 20 patients (36 eyes) were randomized into two groups. Ten patients (18 eyes) were treated with MDF and ten (18 eyes) served as controls. The first group was treated five times over a period of 21 weeks. In both groups 8/18 of the eyes showed subfoveolar subretinal neovascularisations. Main parameter of the study was visual acuity. Macular visual evoked potentials were also recorded. Plasmaviscosity, whole blood viscosity and erythrocyte aggregation were measured. RESULTS: The ten patients, treated repeatedly over a period of 21 weeks, showed a mean improvement 1.1 (SD 1.9) lines after 21 weeks, while the control group showed a deterioration of visual acuity (0.6 lines, SD 1.7). The macular visual evoked potentials showed an increase of 0.28 microV (SD 1.12) for the therapy group and a deterioration of 0.57 microV (SD 1.31) in the control group. The rheological parameters were lowered in all patients. CONCLUSIONS: We conclude that repetitive treatment with MDF is able to improve visual function in patients with AMD. Further research is necessary to show how to optimize the selection of patients and how to create an individual treatment strategy.

Aged↗
PubMed1999

[Endothelial evaluation of corneal transplants by digital imaging].

BACKGROUND: Evaluation of corneal graft endothelium in organ culture comprises judgement of cell area, cell form and cell density by phase contrast microscopy after cell border swelling in hypotonic solution. Up to now, cell density has been determined via counting cells by hand within a fixed frame on polaroid images regarding the magnification factor. It was the purpose of this paper to establish a facilitated and reliable method for endothelial cell count by digital imaging and to compare it with our standard procedure of endothelial cell count by hand. MATERIAL AND METHODS: After cell border swelling in hypotonic solution endothelial images are recorded by a digital camera that is connected to a computer system where the grey scale images are processed into binary images using specialized enhancement and thresholding techniques. A fuzzy logic based computer program was developed in order to differentiate between single and multiple objects, i.e. living and necrotic cells. This digital imaging system determines endothelial cell density automatically and offers the possibility to correct the data in any case of misinterpretation. Twenty corneal grafts were evaluated with this system by two experienced investigators and the results were compared with endothelial cell count by hand. RESULTS: Using the new system, intra- and interindividual variability of endothelial cell count was statistically significantly lower compared with evaluation by hand. Furthermore, less time for evaluation and documentation was necessary. CONCLUSIONS: In a reduced period of time endothelial cell density of corneal grafts in organ culture can be determined reliably and reproducibly with the new digital imaging system if the possibility of data correction is used in case of misinterpretation. In the future, the necessity of corrections should be reduced and the use of multiple fixed frames should further improve quality control of corneal grafts.

Cell Count↗
PubMed1999

Mycophenolate mofetil versus cyclosporin A in high risk keratoplasty patients: a prospectively randomised clinical trial.

BACKGROUND/AIMS: The requirement for an effective, minimally toxic immunosuppressive agent remains a major obstacle to performing high risk corneal transplantation. Although therapy with cyclosporin A (CSA) allows superior graft survival, its use is limited because of a wide range of side effects. Mycophenolate mofetil (MMF) has been shown to be a safe and effective immunosuppressive agent following renal transplantation. This prospective, randomised clinical trial was carried out to investigate the efficacy and safety of MMF in preventing corneal allograft rejection. METHODS: Recipients of corneal transplants who were at high risk for graft failure were randomly assigned to either CSA or MMF immunosuppressive therapy. CSA was given in doses to achieve whole blood trough levels of 120-150 ng/ml. MMF was given in a daily dose of 2 g. Both therapy groups additionally received oral corticosteroids (fluocortolone 1 mg/kg) which were tapered and discontinued within the first 3 postoperative weeks. Patients were monitored closely for evidence of corneal graft rejection and adverse side effects. Drug efficacy was measured, primarily, by the number of patients who experienced at least one episode of clinical graft rejection. Safety analysis focused on reported adverse side effects and laboratory measurements. RESULTS: 41 patients were enrolled in the study. There was no statistically significant difference between the two groups. 20 patients received CSA and 21 patients received MMF. Two patients in each group showed evidence of acute graft rejection which could be treated effectively by corticosteroids. All corneal grafts remained clear throughout the follow up. CONCLUSIONS: In this study it was shown that MMF is just as effective as CSA in preventing acute rejection following high risk corneal transplantation. Mycophenolate mofetil represents a promising alternative therapeutic option in patients who are at high risk for corneal graft failure.

Adult↗
PubMed1999

Effects of add-back therapy on bone mineral density and pyridinium crosslinks in patients with endometriosis treated with gonadotropin-releasing hormone agonists.

Treatment of endometriosis with gonadotropin-releasing hormone agonists (GnRHa) is limited to 6 months because of possible adverse effects on bone metabolism. We designed a randomized, double-blind, placebo-controlled, prospective study of 27 patients with endometriosis who were given GnRHa with or without hormone add-back therapy (+ 20 microg of ethinyl estradiol with 0.15 mg desogestrel) designed to suppress the adverse effects of hypoestrogenism while preserving the efficacy of GnRHa. Both regimens showed significant improvements in endometriosis, dysmenorrhea, and pelvic pain; effects were significantly better in the GnRHa + placebo group. The GnRHa + placebo group had significantly higher serum calcium levels and a significantly higher loss of lumbar spine bone mineral density (BMD). Urinary levels of pyridinium crosslinks increased significantly in the GnRHa + placebo group, and declined to normal in the GnRHa + add-back group. The add-back therapy protects women taking GnRHas from severe loss of BMD and accelerated bone collagen resorption, but reduces the efficacy of the GnRHa.

Amino Acids↗
PubMed1998

A comparative investigation of FK506 and cyclosporin A in murine corneal transplantation.

BACKGROUND: Acute rejection is the cause of over 50% of transplant opacifications in some immunological high-risk groups. More potent immunomodulating substances must be found in order to allow extended or individualised therapeutic options for combating rejection. METHODS: Rats of the inbred strains Brown Norway and Lewis were used as donors and recipients, respectively. FK506 (Prograf) was administered intraperitoneally for 14 days in a dosage of 0.3 mg/kg bw, and cyclosporin A (CSA; Sandimmun) was administered, likewise for 14 days, in an intramuscular dosage of 10 mg/kg bw. The transplants were examined every 3rd day by slit-lamp microscopy. Every transplant was subjected to histological or immunohistological evaluation. RESULTS: The average transplant survival period in the allogeneic strain combination was 7.9 days (SEM = 1.1). Therapy with FK506 led to a statistically significant prolongation of transplant survival to 17.1 days (SEM = 1.5, P < 0.05). Therapy with CSA delayed transplant rejection to 21 days (SEM = 0.0, P < 0.05). No statistically significant difference was found between the two therapeutic regimens. There were no significant histomorphologic differences in rejected grafts in the FK506- and CSA-treated animals. CONCLUSIONS: In this study we have shown that FK506 is able to delay corneal allograft rejection at a much lower dosage than CSA without a higher incidence of side effects related to toxicity or overimmunosuppression.

Animals↗
PubMed1998

Retrospective clinical trial of contraceptive effectiveness of the electronic fertility indicator Ladycomp/Babycomp.

The Babycomp/Ladycomp (Valley Electronics Ltd., Eschenlohe, Germany) is an electronic device that combines the temperature method and calendar method for planning and preventing pregnancy by identifying the fertile and infertile phases of the menstrual cycle. In a retrospective clinical trial, the system was tested as a contraceptive aid. A total of 648 women from Germany and Switzerland have participated: 597 women with 10,275 months of use used the device for contraception. Thirty-three unplanned pregnancies were identified, giving a total pregnancy rate of 3.8 use effectiveness according to the Pearl Index. Six method-related pregnancies occurred, producing a method Pearl Index of 0.7. Calculating the cumulative pregnancy rates by life-table analysis, it was found that, after about one year of exposure, the probability of an unintended pregnancy was 5.3% (0.053), after 2 years it was 6.8% (0.068) and after about 3 years of exposure it was 8.2% (0.082). The mean length of the identified fertile period was 14.3 days with a standard deviation of 4.6 days in all cycles reported. The acceptance of the device by the woman and her partner was good. In fact, 21 of the 33 women who became pregnant would still recommend the device for further use (63.6%).

Actuarial Analysis↗
PubMed1998

Effect of mycophenolate mofetil, cyclosporin A, and both in combination in a murine corneal graft rejection model.

AIMS: To compare the effectiveness of mycophenolate mofetil (MMF), cyclosporin A (CSA), and both in combination, in preventing rejection following corneal transplantations. METHODS: Rats of the inbred strains Brown Norway and Lewis were used as donors and recipients respectively. MMF was administered orally in both monotherapy and combination therapy for 14 days in a dosage of 40 mg/kg body weight, and CSA was administered, likewise for 14 days, in an intramuscular dosage of 10 mg/kg body weight. The transplants were examined every third day by slit lamp microscopy. Every transplant was subjected to histological or immunohistological evaluation. RESULTS: The average transplant survival rate in the allogenic strain combination was 7.9 days (SEM 1.1). Monotherapy with MMF led to a statistically significant prolongation of transplant survival to 11.6 days (SEM 0.9, p < 0.05). Monotherapy with CSA delayed transplant rejection statistically significantly longer than MMF (21 days, 0.0, p < 0.05). The combination therapy with CSA and MMF was statistically significantly superior to the monotherapy with MMF (22.3 days, 0.5, p < 0.05). The combination therapy prolonged transplant survival compared with the CSA monotherapy, albeit not to a statistically significant extent. CONCLUSIONS: In this study we were able to prove the immunosuppressive effect of oral MMF on acute rejection following corneal transplantation. Double drug therapy with CSA and MMF conferred a marginal benefit without a higher incidence of complications related to drug toxicity or overimmunosuppression.

Animals↗
PubMed1998

Steroidal 'add-back' therapy in patients treated with GnRH agonists.

GnRH analogues (GnRH-a) are well established in the treatment of endometriosis. However, due to hypooestrogenic effects, treatment is limited to 6 months. The aim of this randomized, double-blind, comparative study was to evaluate whether symptoms and signs of hypooestrogenism, e.g. hot flushes, sweating and sleeplessness, could be avoided by a steroidal add-back regimen, while the beneficial effect of a GnRH-a on endometriosis could be maintained. In group A, 14 patients were treated with 3.75 mg leuprorelin acetate depot per month i.m. in combination with 20 mg ethinyloestradiol plus 0.15 mg desogestrel orally for 3 weeks. In group P, 13 patients received leuprorelin acetate, following the same schedule as in group A, and placebo. Treatment duration was 6 months. At first-look laparoscopy (postoperatively) group A had an r-AFS score of 23.57 and group P of 24.23. After 6 months of treatment with leuprorelin acetate depot r-AFS scores had dropped to 16.14 in group A and to 6.25 in group P at second-look laparoscopy, achieving statistical significance in both groups (p < 0.001). Hypooestrogenic adverse drug reactions (e.g. hot flushes, sweating and sleeplessness) were more frequently reported in group P, whereas the occurrence of headache was comparable in both groups. Dysmenorrhoea was significantly reduced in both groups, whereas dyspareunia was only decreased in group P. Variations in laboratory values were within normal ranges and did not give any concern about drug safety. Loss of bone mineral density caused by the GnRH-a was reduced by the combined oestrogen/progestin add-back therapy. In conclusion, this therapy can lead to a reduction in hypooestrogenic adverse drug reactions and mostly preserves agonist efficacy with the chance of treatment prolongation.

Adult↗