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Biomedical subjects

T Römer

Publications and source records attributed to T Römer.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Parameters of lipid metabolism in postmenopausal women on oral or transdermal hormone replacement with or without progesterone].

OBJECTIVE: Aim of the study was to show different influences of transdermal and oral hormone replacement therapies (conjugated and micronized estrogens) with or without varying dosages of C21-progestogens on serum lipids and lipoproteins. MATERIAL AND METHODS: We report on serum triglycerides, cholesterol, HDL-, LDL-cholesterol, apolipoprotein A 1 and B levels of 80 postmenopausal women, who received hormone replacement therapies for more than one year. RESULTS: All patients showed increasing (non-significant) serum HDL/LDL-cholesterol-ratios. Transdermal estrogen monotherapy also influenced the lipid parameters in a positive way. Apolipoprotein B, cholesterol and LDL-Cholesterol decreased, apolipoprotein A 1 increased. Transdermal replacement therapy combined with C21-progestagens and all oral therapies resulted in HDL-cholesterol increases. Positive changes in lipid parameters were most remarkably in women receiving oral therapies. The addition of 42 mg medrogestone/cycle caused a more significant decrease of cholesterol serum levels than higher dosages of medrogestone did. During subsequent treatment cycles, serum triglycerides showed increasing levels within the reference limits in women receiving conjugated estrogens and medrogeston. CONCLUSIONS: Transdermal and oral hormone replacement therapies with and without C21-progestogens are ideal for hormone replacement therapy in postmenopausal women with normal or minor pathological lipid parameters. The lowest possible medrogestone dose necessary for endometrium protection should be used.

Administration, Cutaneous↗
PubMed2000

Hydrothermal ablation. A new simple method for coagulating endometrium in patients with therapy-resistant recurring hypermenorrhea.

Hydrothermablation is a new method which could replace the electrosurgical method of endometrial ablation. Some prospective studies were carried out to assess efficacy, safety and tolerability of hydrothermablation in the treatment of recurrent menorrhagias. Hydrothermablation is an intervention with coagulation at the endometrium: temperature 90 degrees C and duration 10 min with simultaneous hysteroscopic control. In a follow-up of least 12 months, about 35% of the patients had an amenorrhea and the treatment was successful (reduction of pathological blood flow) in about 87% of the patients. Complications were vaginal burns in 2 cases. No other intra- or postoperative complications occurred. Hydrothermablation is a safe and effective method for treatment of recurrent menorrhagias. This method offers a simple possibility to perform endometrial ablation without extensive training of the surgeon and can contribute to avoid hysterectomy.

Adult↗
PubMed2000

Pre- and postoperative hormonal treatment in patients with hysteroscopic surgery.

Hysteroscopic surgery is widely used for the treatment of patients suffering from infertility and menorrhagia. Preoperative and postoperative treatment plays an important role in this kind of surgery. The indications for hormonal pre- and postoperative treatment are very different and depend on the type of surgery and the condition of the patient. For a septum dissection, preoperative treatment is not necessary. Postoperative estrogen therapy can be helpful especially after dissection of a large septum. For intrauterine adhesiolysis, preoperative treatment is without benefit. In cases of adhesions of grades 3 and 4, postoperative treatment entailing insertion of an IUD and application of estrogens for about 3 months is recommended. A higher amenorrhea rate after endometrium ablation can be reached by pretreatment with a GnRH analogue or danazol. For resection methods, pretreatment is not necessary in any case. The success rate of endometrium ablation (reduction of blood loss) is not influenced by pretreatment. Pretreatment can be useful in coagulation techniques in patients suffering from secondary anemia and in high-risk patient. In patients who need hormone replacement therapy after endometrium ablation, gestagen application is necessary. For prevention of bleedings, a continuous combined hormone replacement therapy should be used and so a bleeding-free treatment is possible. The residual endometrium will so be protected against hyperplasia. Another alternative postoperative method after endometrial ablation is insertion of a levonorgestrel IUS. Our studies show advantages for protection of the endometrium, for contraception and a high amenorrhea rate. Prior to a hysteroscopic myoma resection, pretreatment with GnRH analogues is indicated for all myomas with a diameter of more than 3 cm and/or an intramural portion or for patients suffering from secondary anemia. The aim of the pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of the myomas. The failure rate in patients not treated with GnRH analogues is higher especially in large intramural myomas. Pre- and postoperative hormonal treatment can be effective, especially in the treatment of patients suffering from menorrhagia. The indications for hormonal pre- and postoperative treatment should be very strong. A hysteroscopic surgeon should be also have some experience in hormonal treatment.

Danazol↗
PubMed2000

[Effect of isoflavones on mammary gland and endometrium of postmenopausal macaques (Macaca fascicularis)].

OBJECTIVE: Because of their beneficial effects on atherosclerosis and cancer risk, isoflavones may be useful as a dietary alternative or supplement to postmenopausal hormone replacement therapy. Isoflavones belong to the most important phytoestrogens. They may have estrogenic and antiestrogenic effects. We examined this in a well-characterised primate model of the postmenopause. MATERIAL AND METHODS: Adult, surgically postmenopausal female macaques were treated with isoflavones, estradiol or placebo for 6 months. After 6 months of therapy histopathological, morphometrical, and immunohistochemical measurements of endometrium and mammary glands were performed. RESULTS: 6 months of isoflavone-therapy did not induce proliferation or any other clinical important changes in endometrium and mammary tissue. Phytoestrogentherapy did not show estradiol comparable effects. We are discussing our results with the results of other studies, which are sometimes in contrast. CONCLUSIONS: Our results indicate that isoflavones do not have estrogenic effects in the tissues studied.

Animals↗
PubMed2000

[Clinical relevance of drug interactions between sexual steroids and other medications].

Drug interactions of clinical relevance with hormonal contraceptives can occur with antibiotics, antiepileptic agents and anticoagulants. For a prevention, non hormonal contraceptives, short-term use of higher dosage of oral contraceptives or, for long-term application, continuous administration (i.e. without hormonal pause) of monophasic micro-pill preparations containing 30 micrograms ethinyl estradiol and higher progestin doses should be preferred. The contraceptive effect also can be impaired using barbiturates and rifampicin; the demand of insulin or oral antidiabetics can be altered during medication with oral contraceptives. Regarding investigations of possible drug interactions only few studies have been performed with hormonal replacement therapy in peri- and postmenopause. Drug interactions could develop above all treating risk patients with internal diseases. Treatment regimens using the physiological, human hormone estradiol instead of conjugated equine estrogens should be preferred. We recommend transdermal hormonal application especially if hepatic drug interactions could occur.

Dose-Response Relationship, Drug↗
PubMed2000

[Maternal CA 125 serum level in intrauterine pregnancy and abortion in the first trimester].

OBJECTIVE: Maternal CA 125 levels are supposed to rise in pregnancies complicated by vaginal bleedings in dependence to the extent of decidual disruption which is directly related to the outcome of pregnancy. MATERIAL AND METHODS: The prognostic value of maternal CA 125 serum measurement was investigated in 239 women with a first trimester intact pregnancy, imminent, incomplete, complete or missed abortion. RESULTS: 43.9% of the CA 125 serum levels were without normal range (> 20 U/ml). Mean CA 125 serum levels were higher in patients with incomplete (52.4 +/- 67.4 U/ml), complete (34.3 +/- 46.1 U/ml), and imminent abortion (33.0 +/- 45.8 U/ml) as compared with normal pregnancies (28.9 +/- 28.8 U/ml) and missed abortion (23.5 +/- 21.5 U/ml). CA 125 levels in first trimester pregnancies tended to be higher in patients with vaginal bleedings than in patients without bleeding (40.5 U/ml +/- 55.0 vs. 28.9 U/ml +/- 28.8; p = 0.65). CONCLUSIONS: For clinical use CA 125 serum measurement is not relevant. First trimester CA 125 measurement can not serve as an accurate predictor of pregnancy outcome due to the wide overlap of ranges.

Abortion, Incomplete↗
PubMed2000

[Effect of hormone replacement therapy during the climacteric on cerebrovascular diseases].

In epidemiological and animal studies it could be shown that a hormone replacement therapy decreased the risk of stroke. Sonographical blood flow measurement shows a positive effects to the cerebrovascular system caused by estrogen which was not modified by gestagens. In morphometric investigations by sonographical measurements of intima-media-thickness, it could be demonstrated that a positive influence by hormone replacement therapy can be achieved for a longer time. The intima-media-thickness, as a sign of a complex atherosclerosis, is decreased. The number of atherosclerotic plaques is significantly lower in patients receiving hormone replacement therapy (HRT) in comparison to a control group. A regression of the plaques by estrogen replacement therapy could be shown in one study. Although the group of patients suffering from stroke is heterogeneous, the benefit of HRT for prevention of cerebrovascular diseases could clearly be demonstrated. HRT is not contraindicated in patients suffering from cerebrovascular diseases. In most of cases, HRT is recommended in these patients. The therapeutic effect of HRT for cerebrovascular disease should be proved in further prospective studies.

Cerebrovascular Disorders↗
PubMed1999

Hormone replacement therapy in postmenopausal women: carotid intima-media thickness and 3-D volumetric plaque quantification.

OBJECTIVE: The relationship between postmenopausal hormone replacement therapy (HRT) and the risk of stroke has been investigated in a number of epidemiological studies. However, data concerning the quantitative effects of HRT on carotid atherosclerosis, as measured by noninvasive ultrasound methods, are sparse. METHODS: In the present case, we examined 55 postmenopausal women (mean age 57.6 +/- 4.2 years) who were treated for 4.7 years with estrogens, either alone (n = 11) or in combination with progestins (n = 44). They were compared to 46 control subjects without HRT who were matched for age, hypertension, and various other vascular risk factors. At the study onset and 1.5 years later, all participants were examined by Doppler ultrasound and B-mode sonography, and plaque visualization, intima-media-thickness (IMT) and volumetric quantification of carotid plaques was performed. RESULTS: The HRT group had a significantly lower incidence of carotid plaques (18%) than the control group (61%). The mean TMT for the HRT subjects was 0.52 mm in the common carotid artery and 0.46 mm in the internal carotid artery, as compared to 0.68 and 0.62 mm, respectively, for the control subjects. No significant changes in IMT were found in either group. 3-D evaluation of carotid plaques showed increased plaque volume in women without HRT compared to women with HRT. CONCLUSION: We have obtained quantitative data using different noninvasive ultrasound techniques which demonstrate that women receiving HRT develop less severe carotid atherosclerosis, an effect which may be mediated by direct hormonal effects on the carotid wall and, in part, by the indirect influence of hormones on lipoproteins. HRT may, indeed, be more effective on existing atherosclerotic plaques.

Adult↗
PubMed1999

A simple method of coagulating endometrium in patients with therapy-resistant, recurring hypermenorrhea.

STUDY OBJECTIVE: To assess the efficacy, safety, and tolerability of hydrothermablation in the treatment of recurrent menorrhagia. DESIGN: Prospective, nonrandomized survey (Canadian Task Force classification II-2). SETTING: Endoscopic center at a university hospital. PATIENTS: Eighteen premenopausal women with recurring menorrhagia resistant to hormone treatment. INTERVENTIONS: Coagulation of the endometrium at 90 degrees C for 10 minutes under hysteroscopic control. MEASUREMENTS AND MAIN RESULTS: During follow-up of least 12 months, nine (50%) of patients had amenorrhea and 17 (94%) had reduction or cessation of pathologic blood flow. One woman underwent hysterectomy because of recurrent dysmenorrhea. CONCLUSION: In this study, hydrothermablation was a safe and effective method of treating recurrent menorrhagia. It does not require extensive training and may help avoid hysterectomy. (J Am Assoc Gynecol Laparosc 6(3):265-268, 1999)

Adult↗
PubMed1999

Treatment of recurrent bleeding disorders during hormone replacement therapy by transcervical endometrial ablation.

If bleeding disorders, which could not be treated by modification of steroid dosages, occurred during sequential hormone replacement therapy (HRT), most of the patients stopped HRT. In these cases a diagnostic outpatient hysteroscopy with biopsy was carried out. In most of the cases no intrauterine cause for the bleeding disorder was found. In 35 patients we performed an endometrial ablation without intra- or postoperative complications. After this procedure all patients received a combined continuous HRT. In a follow-up of 12 months 34 patients were amenorrheic and satisfied with the treatment. One patient stopped HRT because of suffering from other side effects. Endometrial ablation represents a method of treating patients with bleeding disorders without intrauterine causes with a minimal invasive procedure. A continuous combined HRT is possible after the endometrial ablation in perimenopausal and postmenopausal patients without bleeding disorders. In selected cases endometrial ablation can contribute to the increase of the compliance with HRT.

Endometrium↗
PubMed1999

[Effect of long-term hormone substitution therapy on serum TSH level in postmenopausal women].

OBJECTIVE: Dysfunction's of the thyroid gland are one of the most important endocrinological diseases. We report serum TSH levels in postmenopausal women before and during long-term hormone replacement therapy. MATERIAL AND METHODS: 107 postmenopausal patients participated in this study. Criteria for inclusion were: no known thyroid dysfunction and request for hormone replacement. Before starting therapy TSH serum levels were measured in each patient. If basal levels were within normal range TSH serum levels were reported over 4 years of hormone replacement therapy. RESULTS: More than 10% of the postmenopausal women showed pathological TSH-levels without clinical symptoms requiring further diagnostic. During subsequent treatment cycles (4 years) serum TSH in euthyroid patients did not show significant changes. Women using hormone replacement therapy developed no new manifestation of thyroid disease. CONCLUSION: In euthyroid women using long-term hormone replacement therapy are no changes in thyroid function caused by hormone replacement therapy to expect.

Climacteric↗
PubMed1998

Laparoscopic removal of a 5-cm subserous pedunculated myoma with small instruments.

A mobile, subserous, pedunculated myoma was located on the anterior surface of the uterus in a 45-year-old woman. Bipolar coagulation was performed on the pedicle, and the myoma was dissected with an electrical morcellator and removed through the umbilicus. This technique required placement of one 5- to 12-mm cannula in the umbilicus and two 2-mm miniports at the pubic hairline. This technique is easy to perform, and the patient benefits from minimal postoperative pain and excellent cosmetic results.

Female↗
PubMed1998

Benefit of GnRH analogue pretreatment for hysteroscopic surgery in patients with bleeding disorders.

Hysteroscopic surgery is widely used for the treatment of patients suffering from menorrhagia. In different studies, pretreatment of the endometrium with GnRH analogues (GnRH-a) prior to endometrial ablation has been reported to increase the success rate, as well as to reduce the menstrual blood flow, accounting for a significantly higher postoperative amenorrhea rate (42% in pretreated patients vs. 24% in those receiving no pretreatment). The aim of pretreatment is not only to obtain a thin endometrium but also to reduce the size and vascularization of myomas being treated. In our study, GnRH-a administration prior to endometrial ablation was shown to have the following advantages: improved hysteroscopic view, reduced blood loss, absorption of uterine distending fluid and higher postoperative amenorrhea rates. Prior to hysteroscopic myoma resection, pretreatment with GnRH-a may be particularly indicated for all myomas with a diameter of more than 3 cm and/or with an intramural portion, or for patients suffering from secondary anemia. GnRH-a pretreatment is thus indicated before endometrial ablation, and in most cases, before hysteroscopic resection of submucous myomas, and combined medical and surgical therapy has clear benefits in the treatment of bleeding disorders.

Endometrium↗
PubMed1998

[The value of GnRH agonist treatments before hysteroscopic septum dissection].

In a retrospective study was investigated, whether a GnRH-analogue-pre-treatment has advantages during the hysteroscopic septum dissection in infertile and sterile patients with a uterus septus. The results show, that a GnRH-analogue-pre-treatment has no positive effect on intraoperative data (time of surgery, fluid deficit), the rate of complications, the postoperative anatomical results (residual septus) and the pregnancy rate. A GnRH-analogue-pre-treatment for a hysteroscopic septum dissection is not generally necessary. The surgery should be carried out in the proliferative phase of the menstrual cycle.

Adult↗
PubMed1998

[Endoscopic management of uterine perforation with the ENDO-UNIVERSAL surgical stapler].

The management of an uterine perforation occurring during a D & C, in which a bleeding could not be stopped by coagulation per laparoscopiam is described. The closing of the bleeding injury in the uterus wall was performed by ENDO-UNIVERSAL-clip-instrument. The wound was closed and the bleeding stopped. The possibility to manage an uterine perforation with this simple method is reported and discussed.

Aged↗
PubMed1998

[Therapy of recurrent menorrhagia--Cavaterm balloon coagulation versus roller-ball endometrium coagulation--a prospective randomized comparative study].

In a prospective study 20 patients suffering from recurrent, therapy-refractory menorrhagias were pre-treated for endometrial ablation after exclusion of intrauterine abnormalities and histological pathology. Two injections of GnRH-analogues (3.75 mg leuprorelinacetate depot, Enantone Gyn, Takeda Pharma GmbH Aachen, Germany). Two weeks after the last injection a hysteroscopic surgery by roller-ball-techniques was performed in 10 patients and a balloon-thermocoagulation by Cavaterm-technique (Wallsten Medical, Morges, Schweiz) was performed in 10 patients. Both patients groups were comparable according to age and anamnesis. In a follow-up of 9 to 15 months we found about identical results. All 20 patients were satisfied with the treatment. The Cavaterm-coagulation is in comparison to the operative hysteroscopy a simple method for endometrial coagulation, and can also be used by an hysteroscopically inexperienced gynaecologists with simple technical equipment. In strict indication the Cavaterm-coagulation is a simple method of endometrial ablation in many patients.

Catheterization↗