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Biomedical subjects

M Dören

Publications and source records attributed to M Dören.

At least 37 records · Page 2Linked to original sources
PubMed1997

Uterine perfusion and endometrial thickness in postmenopausal women on long-term continuous combined estrogen and progestogen replacement.

We assessed the resistance index (RI) and pulsatility index (PI), peak and average systolic velocities in uterine, arcuate and radial arteries, and endometrial thickness (ET) by transvaginal B mode and color Doppler sonography in patients on continuous combined hormonal replacement therapy (HRT) and controls. HRT consisted of 2 mg estradiol, 1 mg estriol and 1 mg norethisterone acetate daily (n = 33) compared to controls, who received none of these (n = 21). Age was 61 +/- 6 and 59 +/- 9 years (mean +/- standard deviation) in the HRT and control groups, respectively. The duration of HRT was 5 +/- 2 years, with a minimum of 1 year. We found that the uterine RI and, to a lesser extent, the uterine PI were significantly lower and the radial peak systolic velocities were significantly higher in the HRT group compared to controls. The highest uterine PI values were measured in controls with the shortest life-time exposure to endogenous estrogens, i.e. late menarcheal age or early menopause. The endometrial thickness of 2.8 +/- 1.8 mm in the HRT group was not significantly different from that in the controls (4.2 +/- 5.6 mm). In conclusion, the alteration in blood flow parameters demonstrated in this study would suggest that the long-term use of continuous oral estradiol 2 mg, estriol 1 mg and norethisterone acetate 1 mg daily is associated with a slight increase of flow in the uterine arteries compared to controls matched for (postmenopausal) age. Endometrial thickness does not increase with duration of use of continuous combined HRT.

Adult↗
PubMed1997

Prenatal diagnosis of a highly undifferentiated brain tumour--a case report and review of the literature.

Intracranial tumours, often presenting with progressive hydrocephalus, are rare congenital diseases accounting for 0.5-1.5 per cent of all cases of brain tumours diagnosed during childhood. The differential diagnosis includes vascular malformations, infarctions, and haemorrhages. Sonographic signs suggestive of glioblastoma, teratoma, and astrocytoma do not establish the histological diagnosis, however. We report a case of an undifferentiated fetal glioma detected at 29 weeks' gestation. The diagnosis of an undifferentiated brain tumour was suspected by sonography because of the lack of normal brain structures in conjunction with a diffuse echogenic central lesion and an external hydrocephalus. Because of the very poor prognosis, we induced labour by intravaginal and intravenous administration of prostaglandin E2 and achieved the vaginal delivery of a stillborn child whose head circumference corresponded to 38 weeks of pregnancy. Histological and immunochemical features of this undifferentiated congenital glioma (glioblastoma) are presented.

Adult↗
PubMed1996

Long-term compliance of continuous combined estrogen and progestogen replacement in postmenopausal women.

The occurrence of uterine bleeding usually associated with hormonal replacement therapy is not acceptable for many women. Our objective was to review data on compliance and bleeding patterns in 70 postmenopausal women on oral replacement with estradiol 2 mg, estriol 1 mg, and norethisterone acetate 1 mg daily administered in a continuous combined fashion to avoid withdrawal bleeding. After 1 year, compliance was 97%, after 5 and 9 years 76% and 58%. The most common reason for discontinuation was spotting. Reproductive history, body weight and pretreatment estradiol and FSH concentrations were not different between the subgroups with bleeding-19%- and without bleeding-81%. The probability to maintain amenorrhoe on HRT did not increase with the length of the postmenopausal interval or weight. Endometrial histology revealed one case of a highly differentiated in situ adenocarcinoma of the endometrium. In the women with bleeding, induced serum estradiol levels were significantly and pretreatment SHBG-levels lower compared to the non-bleeders. Whether these findings may be significant for election of patients for continuous combined HRT remains to be determined. In conclusion, we demonstrate that adherence to this treatment regimen apparently provides a choice patients considering long-term HRT should be informed about. However, the lack of parameters to elect patients in conjunction with the problem of uterine bleeding does not permit the recommendation to regard continuous combined HRT as first line therapy for long-term HRT. Criteria need to be developed when to obtain an endometrial histology once uterine bleeding occurs, as the optimal surveillance of this mode of HRT is presently unknown.

Adult↗
PubMed1996

Are the antioxidative effects of 17 beta-estradiol modified by concomitant administration of a progestin?

OBJECTIVE: Estrogens are known to exhibit antioxidative effects. At present little information exists on the influence of co-administered progestins upon this effect. Therefore we investigated the influence of levonorgestrel, a potent antiestrogenic progestin, on the inhibition of the low-density lipoprotein (LDL) oxidation by 17 beta-estradiol or 17 beta-estradiol valerate in vitro and ex vivo. METHODS: After isolation from blood, the in vitro oxidation of LDL was induced by copper ions and measured continuously by monitoring the formation of conjugated dienes. In 21 female ovariectomized White New Zealand rabbits the antioxidative action of 17 beta-estradiol alone or in combination with levonorgestrel after subcutaneous infusion for 3 days was determined using the copper-induced LDL-oxidation as an endpoint. Eleven postmenopausal women were exposed to sequential estrogen-progestin replacement therapy (day 1-21:2 mg estradiol valerate/day, day 10-21: 0.15 mg levonorgestrel/day). Blood samples were collected at three times: on day 1, on day 10, on day 22 (after the combination phase). The lag time of ex vivo oxidation of LDL, the plasma estradiol and estrone levels were estimated. RESULTS: In the chosen cell-free system, 17 beta-estradiol increased the lag time of the LDL-oxidation in a dose-dependent manner. Levonorgestrel showed neither pro-oxidative nor antioxidative effects when administered alone in different concentrations. Co-administration of different doses of levonorgestrel did not modify the antioxidative action of estrogen either. The two ex-vivo models confirmed these results. In rabbits the co-administered 19-nortestosterone derivative levonorgestrel did not impair or reverse the estradiol-dependent effect. In postmenopausal women the daily oral administration of levonorgestrel in conjunction with 17 beta-estradiol valerate did not diminish the antioxidative action of this estrogen given for the first 9 days. CONCLUSION: The antioxidative potential of estradiol and estradiol valerate is maintained in the presence of levonorgestrel.

Animals↗
PubMed1995

Superior compliance and efficacy of continuous combined oral estrogen-progestogen replacement therapy in postmenopausal women.

OBJECTIVE: We assessed compliance, relief of climacteric symptoms, and impact on lumbar bone mineral density in two groups of 140 patients treated with a sequential estrogen-progestogen or a continuous combined replacement therapy in comparison with controls. STUDY DESIGN: Patients were randomized to 2 mg of estradiol valerate daily and 5 mg of medroxyprogesterone acetate daily for 12 days per month sequentially to induce withdrawal bleeding (group A) or 2 mg of estradiol, 1 mg of estriol, and 1 mg of norethisterone acetate daily continuously to maintain amenorrhea (group B) or a control group (group C). RESULTS: Compliance was 93% after 1 year and 73% after 2 years in group B and 66% and 49% in group A after 1 and 2 years, respectively. Improvement of climacteric symptoms was similar in groups A and B. Uterine bleeding in 24% of patients in group A and 3% in group B was the most frequent reason for discontinuation of drug intake. Only continuous combined therapy (group B) increased bone mineral density after 1 and 2 years compared with baseline: +13% and 17% (p = 0.01). In groups A and C no significant changes in bone mineral density were recorded. Compliance was unrelated to the age of menopause. CONCLUSION: Continuous combined therapy is superior to sequential estrogen progestogen replacement in compliance and prevention of bone loss but not with regard to relief of climacteric symptoms.

Analysis of Variance↗
PubMed1995

Prenatal sonographic diagnosis of a vein of Galen aneurysm: relevance of associated malformations for timing and mode of delivery.

The term 'aneurysm of the vein of Galen' encompasses a range of different midline arteriovenous fistula malformations. Prenatal real-time and Doppler sonography can contribute to the differential diagnosis of fetal cerebral cystic lesions of various origins, pineal and choroid tumors, and intracerebral hematoma. Regardless of the type of treatment, perinatal morbidity and mortality are high, often due to cardiac failure. A case of spontaneous delivery at 36 weeks of gestation by a 30-year-old woman presenting with a fetal aneurysm of the vein of Galen is described. As the extrauterine cardiac function was normal and a steal phenomenon was not present, expectant management was justified. Five arterial embolizations within the following 4 years were performed as a means of treating the primary lesion. Our case illustrates the fact that elective spontaneous vaginal delivery followed by serial embolization is possible in cases of arteriovenous fistula malformation without signs of cardiac insufficiency.

Adult↗
PubMed1994

[Diagnostic value and interpretation of imaging bone densitometry based on quantitative CT].

Quantitative CT of the axial skeleton (aQCT) may serve as an example of the evaluation and interpretation of bone densitometric data as it is the only state-of-the-art technique with valid longitudinal observations. The value of bone density measurements in interindividual cross sections refers to a grading derived from a representative reference population and provides an evaluation of fracture risk. The presence and rate of any bone loss can only be evaluated in an intraindividual longitudinal follow-up. Adequate follow-up for trabecular bone requires at least 3 to 5 years intervals to discriminate between different loss rates. Bone losses induced by steroid therapy or immobilisation may have faster kinetics apparent within months; bone density increase due to hormone substitution may be significant after one to two years. Morphological data allow critical evaluation of the quantitative measurements, eliminating false values and differentiating between rarefying and destructive osteopenia.

Absorptiometry, Photon↗
PubMed1994

[Estrogen substitution in the postmenopause--effect and compliance].

At least one of four women will suffer from osteoporosis with fractures of vertebrae, forearm or hip. Maintenance of bone mass is a crucial argument for long-term estrogen replacement for prophylaxis of osteoporosis. 2 mg estradiol or 0.625 mg conjugated estrogens orally or 50 to 100 micrograms estradiol percutaneously are equally sufficient for prevention of osteoporosis. The additional use of a progestogen in women with intact uterus may support the antiresorptive effects of estrogens. Improvement of patients' compliance-administered today by only 25% of postmenopausal women in Germany through sufficient information upon estrogen replacement therapy provided by the medical community is a rewarding task for physicians and scientists engaged in the field of menopause and prevention of osteoporosis.

Estrogen Replacement Therapy↗
PubMed1994

[Treatment of osteoporosis by the gynecologist].

At least one of four women is suffering from osteoporosis with fractures of vertebrae, forearm or hip. Maintenance of bone-mass is a crucial argument for long-term estrogen replacement for prophylaxis of osteoporosis. 2 mg estradiol or 0.625 mg conjugated estrogens, or 50-100 micrograms estradiol percutaneously are equally sufficient for prevention of osteoporosis. The additional use of a progestagen in women with intact uterus may support the antiresorptive effects of estrogens. Improvement of patients' compliance of estrogen substitution--administered today in only 25% of postmenopausal women in Germany--by sufficient information upon estrogen replacement therapy provided by the medical community is an awarding task for physicians and scientists engaged in the field of menopause and prevention of osteoporosis.

Administration, Cutaneous↗
PubMed1994

Estrogen-progestogen replacement therapy in postmenopausal women--is 1 mg estradiolvalerate sufficient to maintain axial trabecular bone density?

An oral estrogen-progestogen replacement therapy consisting of 1 mg estradiolvalerate +2 mg estriol/day for 21 days in combination with 0.25 mg levonorgestrel/day for the last 10 days sequentially may be sufficient to maintain lumbar trabecular bone density in climacteric pre- and postmenopausal women as demonstrated by serial bone density measurements (single-energy quantitative computed tomography of the lumbar spine) in 7 individuals with longitudinal follow-up for up to 5 years. At present, only postmenopausal women with induced estradiol levels of at least > or = 220 pmol/l (> or = 60 pg/ml) provided by estrogen replacement therapies containing higher daily estradiol doses as the above described preparation have been shown to be protective against loss of trabecular bone at the lumbar spine. Preliminary pharmacokinetic results obtained from 14 postmenopausal women being treated with the low-dose estrogen-progestogen replacement demonstrated peak estradiol concentration of 120-160 pmol/l (32-43 pg/ml) 10 hours after oral ingestion, suggesting bone preserving properties by these considerably lower estradiol concentrations.

Administration, Oral↗
PubMed1992

[The morphological analysis of the vertebral spongiosa in quantitative CT].

The diagnostic ranking of trabecular morphology for the evaluation of osteoporosis in quantitative CT (QCT) is presented. 5 patterns of cancellous bone correlating with trabecular density may be discerned. However, these patterns may indicate osteoporotic changes in particular cases only, by confluent rarefactions if the density is still within the normal range. There is neither a predictive value for the degree of spontaneous or therapy-induced bone loss, nor for therapy response. The trabecular appearances remain unchanged in short term even under strong quantitative changes and are therefore of no value for follow-up.

Adrenal Cortex Hormones↗
PubMed1992

Cyclic corticosteroid immunosuppression is unsuccessful in the treatment of sperm antibody-related male infertility: a controlled study.

In this double blind cross-over study, 20 infertile men, who had sperm antibodies detected by the mixed antiglobulin reaction (MAR test) in the ejaculate and by the tray agglutination test (TAT) in serum, were treated with 40 mg/day prednisolone or placebo from days 1 to 10 of the partners' menstrual cycle. Patients were randomly allocated to different treatment groups. While group 1 started with placebo followed by verum for three consecutive cycles, group 2 began with verum and continued with placebo. All patients had regular intercourse (n = 19) or intra-cervical insemination at ovulation (n = 1). A post-coital test or a sperm penetration test was performed during verum and placebo regimes. Blood samples were drawn from the male partner at this time to control the efficacy of prednisolone treatment by checking the TAT titre. No pregnancy occurred during prednisolone or placebo treatment. In eight of 12 patients, post-coital testing showed little improvement and antibody titres decreased in seven of 16 patients. Side-effects from medication were reported by eight patients (seven verum and one placebo cycle) and caused treatment to be discontinued in two cases. Five patients' partners conceived at a later stage by intrauterine insemination with spermatozoa prepared by 'swim up' (n = 3) or by in-vitro fertilization (IVF n = 2). Thus high dose corticosteroid therapy was ineffective in achieving pregnancies induced by infertile men positive for antisperm antibodies. Since side-effects of corticosteroids should not be underestimated in otherwise healthy men, other reproductive techniques such as intrauterine insemination or IVF should be offered to such couples.

Adult↗