Bone mineral density changes after 4 years of hormone replacement therapy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the various effects of hormone replacement therapy (HRT) on bone mineral density (BMD) for 4 years in postmenopausal women and to compare the characteristics of non-responders to HRT. METHODS: A total of 100 postmenopausal women have been treated with HRT or estrogen replacement therapy for 4 years. Spinal BMD was measured by dual energy X-ray absorptiometry. RESULTS: The mean age and menopausal age of the study subjects was 53.3+/-3.6 and 4.7+/-4.0 years. According to the baseline BMD, 32 and 9 women were osteopenic and osteoporotic. Compared with the baseline value, the lumbar BMD increased significantly after one and two years of HRT, but after three years the rate of increment has slowed. However, the change of BMD has significantly increased again after four years of HRT (3.98%, 5.36%, 5.41%, 6.16%, in each year, respectively). Women with baseline osteopenia and osteoporotis gained significantly more BMD after 1 year of HRT than women with baseline normal BMD (p=0.02). There were no significant differences of BMD changes among the 3 treatment regimens (continuous combined, cyclic combined, and estrogen only). After 1 year of HRT, 14 non-responders were indentified who had reduced BMD (-1.7+/-1.6%) compared with baseline BMD whereas 86 responders had increased BMD (4.9+/-4.1%). In the non-responder, BMD increased in two year of HRT but decreased in the three and four year of HRT while BMD increased in the two, three and four year of HRT in responders. After 4 years of HRT, 17 nonresponders (-3.0%+/-1.8%) and 83 responders (8.2+/-7.1%) were indentified. There was no significant difference in age, year since menopause, body mass index and baseline BMD between non-responders and responders. However, non-responders loose their BMD after 1 and 4 year of HRT. CONCLUSION: After HRT, the BMD increased not only first and second year but also fourth year of treatment. The BMD changes did not different according to the treatment regimens. The lower the women's baseline BMD, the greater the BMD increase after HRT. After four years of HRT, 17% of women lose their BMD compared to baseline BMD. The BMD changes in the first year of HRT may be an important predictive factor for the long-term BMD response to HRT in postmenopausal women.

The Sex Ratio of Offspring in Pregnancies Complicated with Hyperemesis Gravidarum / 대한주산의학회잡지

OBJECTIVES: There are a few studies reporting difference in sex ratio at birth in pregnancies complicated with hyperemesis gravidarum but it has not been reported in domestic journals yet. The purpose of this study is to evaluate difference of sex ratio in hyperemesis gravidarum patients compared to normal pregnant women. MATERIALS AND METHODS: We identified 111 women who were diagnosed as hyperemesis gravidarum and had delivered babies in Hanyang University Hospital between Jan. 1995 to Dec. 2000. The control group was 1995 women who had no obstetric problems including hyperemesis gravidarum during the pregnancy and had delivered baby at term. We compared the sex ratio of infant and the characteristics of these two groups. The study group was divided into two subgroups depending on the severity of disease, mild group and severe group, and difference of sex ratio in these group were also compared. We analyzed the data using student T-test and chi-square test and p-value < 0.05 was considered as statistically significant. RESULTS: Compared to sex ratio(female:male) of control group(44.8:55.2), hyperemesis gravidarum showed the sex ratio of 58.6:41.4(p=0.005). There was no further difference of sex ratio between two subgroups of hyperemesis gravidarum according to severity of disease. CONCLUSION: In pregnancies complicated with hyperemesis gravidarum the sex ratio of female was significantly high. The studies based on more variables and larger population would produce more accurate results.

The study on the regression time and pattern of the serum beta-hCG in gestational trophoblastic disease / 대한산부인과학회잡지

OBJECTIVES: It is now conventional practice to use human chorionic gonadotropin (hCG) as the marker of tumor activity in gestational trophoblastic disease (GTD). The interpretation of serial serum beta-hCG regression patterns is important in monitoring the course of the disease. The purpose of this study was to establish a regression time and pattern of the serum beta-hCG in which GTD is divided into hydatidiform mole and malignant trophoblastic disease. MATERIALS & METHODS: During the period from January 1990 through December 2000, 46 patients with GTD were histopathologically diagnosed and treated at the department of Obstetrics and Gynecology in Hanyang University Hospital. For the purpose of analysis and comparison, patients were divided into 19 cases of hydatidiform mole and 27 cases of malignant trophoblastic disease which was subdivided into nonmetastatic (17) and metastatic (10). Patients were followed clinically and by weekly estimations of quantitative serum beta-hCG until negative (<3 mIU/ml). After three consecutive negative beta-hCG, serum beta-hCG were drawn monthly in all patients for one year. The level of serum beta-hCG was detected by two-site sandwich immunoassay (Chiron Diagnostics Automated Chemiluminescence System 180). The obtained data were analyzed using t test and ANOVA test by SPSS. RESULTS: The incidence of the GTD compared with delivery was one per 182.7 deliveries. The mean value of serum beta-hCG regression time in hydatidiform mole was 12.8+/-1.1 (SEM) weeks (7.0-26.0 weeks) and 17.9+/-1.4 (SEM) weeks (8.0-34.0 weeks) in malignant trophoblastic disease. The regression time was significantly shorter in hydatidiform mole than that of malignant trophoblastic disease (P<0.01). The differences of mean value of serum beta-hCG regression time between the groups with nonmetastatic (18.0 weeks) and metastatic (17.8 weeks) were not statistically significant(P =0.946). The mean values of serum beta-hCG in both hydatidiform mole and malignant trophoblastic disease declined following a log-normal distribution. CONCLUSIONS: The regression pattern of serum beta-hCG in present study was similar to that of which in Western and also similar to that of which in Korea in 1980s. The present study supports the continued use of individual patients serum beta-hCG regression curve to make treatment decision and to recognize malignant trophoblastic disease promptly.