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1.
Clin Transl Radiat Oncol ; 44: 100696, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37965060

ABSTRACT

Background: Elective neck irradiation (ENI) is performed in head and neck cancer patients treated with definitive (chemo)radiotherapy. The aim is to eradicate nodal metastases that are not detectable by pretreatment imaging techniques. It is conceivable that personalized neck irradiation can be performed guided by the results of sentinel lymph node biopsy (SLNB). It is expected that ENI can be omitted to one or both sides of the neck in 9 out of 10 patients, resulting in less radiation side effects with better quality of life. Methods/design: This is a multicenter randomized controlled trial aiming to compare safety and efficacy of treatment with SLNB guided neck irradiation versus standard bilateral ENI in 242 patients with cN0 squamous cell carcinoma of the oropharynx, larynx or hypopharynx for whom bilateral ENI is indicated. Patients randomized to the experimental-arm will undergo SLNB. Based on the histopathologic status of the SLNs, patients will receive no ENI (if all SLNs are negative), unilateral neck irradiation only (if a SLN is positive at one side of the neck) or bilateral neck irradiation (if SLNs are positive at both sides of the neck). Patients randomized to the control arm will not undergo SLNB but will receive standard bilateral ENI. The primary safety endpoint is the number of patients with recurrence in regional lymph nodes within 2 years after treatment. The primary efficacy endpoint is patient reported xerostomia-related quality of life at 6 months after treatment. Discussion: If this trial demonstrates that the experimental treatment is non-inferior to the standard treatment in terms of regional recurrence and is superior in terms of xerostomia-related quality of life, this will become the new standard of care.

2.
Opt Express ; 21(5): 5487-98, 2013 Mar 11.
Article in English | MEDLINE | ID: mdl-23482120

ABSTRACT

Software defined networking (SDN) and flexible grid optical transport technology are two key technologies that allow network operators to customize their infrastructure based on application requirements and therefore minimizing the extra capital and operational costs required for hosting new applications. In this paper, for the first time we report on design, implementation & demonstration of a novel OpenFlow based SDN unified control plane allowing seamless operation across heterogeneous state-of-the-art optical and packet transport domains. We verify and experimentally evaluate OpenFlow protocol extensions for flexible DWDM grid transport technology along with its integration with fixed DWDM grid and layer-2 packet switching.

5.
Actas Urol Esp ; 34(3): 238-41, 2010 Mar.
Article in Spanish | MEDLINE | ID: mdl-20416240

ABSTRACT

INTRODUCTION: Laparoscopic nephron-sparing surgery is among the most complex urological procedures currently performed. Open surgery continues to be the gold standard of care, but the laparoscopic approach is gaining ground slowly but surely. Our 5 years' experience is reported. MATERIALS AND METHODS: From September 2004 to March 2009, 38 laparoscopic nephron-sparing procedures were performed at our hospital. A transperitoneal laparoscopic approach was used in all cases, with en bloc clamping of renal hilum in most patients. RESULTS: Mean operating time was 141 min, mean intraoperative bleeding 130 mL, mean warm ischemia time 24 min, and mean hospital stay 3.3 days. Bleeding was the most common complication (requiring transfusion in 13.5% of patients). Positive surgical margins were found in 5.4% of patients. CONCLUSIONS: Adequate selection of the patient (tumor size, location) and the procedure to be used, surgeon experience, and surgical skills are essential for achieving good oncological results and for minimizing the complications of this demanding procedure.


Subject(s)
Kidney Neoplasms/surgery , Laparoscopy , Nephrectomy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nephrons , Time Factors
6.
Actas urol. esp ; 34(3): 238-241, mar. 2010. graf, tab
Article in Spanish | IBECS | ID: ibc-81695

ABSTRACT

Objetivo: La cirugía renal conservadora de parénquima laparoscópica es una de las técnicas más complejas que se pueden realizar en Urología en el momento actual. En la actualidad, la técnica abierta continúa siendo el gold standard, aunque lentamente la laparoscopia se va implantando. Presentamos nuestra serie de casi 5 años. Material y métodos: Desde septiembre de 2004 hasta marzo de 2009 se han realizado 38 cirugías conservadoras de parénquima renal por vía laparoscópica. Todas ellas se han realizado con el abordaje transperitoneal, con un clampaje en bloque del hilio renal en la mayoría de los casos. Resultados: El tiempo quirúrgico medio es de 141min, sangrado intraoperatorio medio de 130cm3, con un tiempo medio de clampaje de 24min y una estancia media postoperatoria de 3,3 días. La complicación más frecuente es el sangrado (transfusión, el 13,5%). El porcentaje de márgenes positivos es del 5,4%. Conclusiones: Con el fin de obtener unos buenos resultados oncológicos y reducir al mínimo las complicaciones, es fundamental la buena selección del caso (tamaño y localización del tumor) así como de la técnica que se va a emplear. La experiencia del cirujano y sus recursos laparoscópicos son de vital importancia (AU)


Introduction: Laparoscopic nephron-sparing surgery is among the most complex urological procedures currently performed. Open surgery continues to be the gold standard of care, but the laparoscopic approach is gaining ground slowly but surely. Our 5 years’ experience is reported. Materials and Methods: From September 2004 to March 2009, 38 laparoscopic nephron-sparing procedures were performed at our hospital. A transperitoneal laparoscopic approach was used in all cases, with en bloc clamping of renal hilum in most patients. Results: Mean operating time was 141min, mean intraoperative bleeding 130mL, mean warm ischemia time 24min, and mean hospital stay 3.3 days. Bleeding was the most common complication (requiring transfusion in 13.5% of patients). Positive surgical margins were found in 5.4% of patients. Conclusions: Adequate selection of the patient (tumor size, location) and the procedure to be used, surgeon experience, and surgical skills are essential for achieving good oncological results and for minimizing the complications of this demanding procedure (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Kidney Neoplasms/surgery , Nephrectomy/methods , Laparoscopy/methods , Urinary Catheterization , Age and Sex Distribution , Kidney Neoplasms/epidemiology
7.
Maturitas ; 56(1): 94-100, 2007 Jan 20.
Article in English | MEDLINE | ID: mdl-16887301

ABSTRACT

OBJECTIVE: To investigate the potential drug interaction between tibolone and warfarin in healthy postmenopausal women. METHODS AND RESULTS: The study was designed as a double-blind, randomized, placebo-controlled, two-way crossover study in postmenopausal women. After stabilization of the International Normalized Ratio (INR; a standardized prothrombin time, PT) between 1.4 and 2.0 with warfarin, subjects were randomized to receive either tibolone (2.5mg/day) or placebo for 21 days. After a 7-day wash-out period (during which warfarin treatment was continued) the treatments were crossed over. Primary efficacy parameters were INR and coagulation Factors II, VII, VIIa and X (means of measurements at Days 18 and 20 and Days 46 and 48). Treatment with tibolone induced a statistically significant increase in INR (estimate of mean difference=0.40; P=0.002), and a statistically significant decrease in coagulation factors. Treatments were generally well tolerated and no clinically significant adverse events were observed. CONCLUSIONS: Tibolone enhances warfarin-induced anticoagulation in postmenopausal women, as reflected by increases in INR and decreases in coagulation Factors II, VII, VIIa and X, compared to placebo. It is advisable to monitor for changes in coagulation status during (and after discontinuation of) simultaneous use of tibolone and warfarin.


Subject(s)
Anticoagulants/pharmacology , Blood Coagulation Factors/drug effects , Estrogen Receptor Modulators/adverse effects , Norpregnenes/adverse effects , Postmenopause/drug effects , Warfarin/pharmacology , Aged , Cross-Over Studies , Double-Blind Method , Drug Synergism , Female , Humans , International Normalized Ratio , Middle Aged
9.
J Contam Hydrol ; 54(3-4): 195-213, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11900328

ABSTRACT

Large-scale column experiments were undertaken to evaluate the potential of in situ polymer mats to deliver oxygen into groundwater to induce biodegradation of the pesticides atrazine, terbutryn and fenamiphos contaminating groundwater in Perth, Western Australia. The polymer mats, composed of woven silicone (dimethylsiloxane) tubes and purged with air, were installed in 2-m-long flow-through soil columns. The polymer mats proved efficient in delivering dissolved oxygen to anaerobic groundwater. Dissolved oxygen concentrations increased from <0.2 mg l(-1) to approximately 4 mg l(-1). Degradation rates of atrazine in oxygenated groundwater were relatively high with a zero-order rate of 240-380 microg l(-1) or a first-order half-life of 0.35 days. Amendment with an additional carbon source showed no significant improvement in biodegradation rates, suggesting that organic carbon was not limiting biodegradation. Atrazine degradation rates estimated in the column experiments were similar to rates determined in laboratory culture experiments, using pure cultures of atrazine-mineralising bacteria. No significant degradation of terbutryn or fenamiphos was observed under the experimental conditions within the time frames of the study. Results from these experiments indicate that remediation of atrazine in a contaminated aquifer may be achievable by delivery of oxygen using an in situ polymer mat system.


Subject(s)
Atrazine/metabolism , Herbicides/metabolism , Soil Pollutants/metabolism , Water Pollutants/metabolism , Biodegradation, Environmental , Oxygen , Polymers , Soil Microbiology
10.
Atherosclerosis ; 159(2): 433-9, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11730824

ABSTRACT

Low HDL cholesterol increases the risk of coronary heart disease. Treatment of postmenopausal women with tibolone lowers HDL cholesterol. We elucidated the consequences of this unwanted side effect in a randomized, double-blind study, where 12 women received 2.5 mg tibolone per day and 6 women, placebo. Blood samples were collected on days -1 (i.e. baseline), 28, 56, and 84 for the analysis of various parameters of lipid metabolism and HDL function. Compared to placebo, treatment with tibolone led to statistically significant decreases of HDL cholesterol (-22% to -32%), apoA-I (-14% to -22%), and HDL subclass LpA-I (-30% to -40%) but to no significant changes in apoA-II and HDL subclass LpA-I,A-II. These changes were not associated with statistically significant changes in the activity of plasma to release 3H-cholesterol from radiolabeled fibroblasts or in the serum activity of the anti-oxidative enzyme paraoxonase/arylesterase. There were no significant changes in either serum levels of triglycerides, LDL cholesterol, apoB, and leptin, or in LDL size. We conclude that changes in insulin do not contribute to the lowering of HDL cholesterol by tibolone. Despite decreased HDL cholesterol, putatively anti-atherogenic activities of HDL remained unchanged.


Subject(s)
Anabolic Agents/administration & dosage , Apolipoprotein A-I/blood , Cholesterol, HDL/blood , Coronary Artery Disease/diagnosis , Esterases/metabolism , Norpregnenes/therapeutic use , Aged , Apolipoprotein A-II/blood , Aryldialkylphosphatase , Cholesterol/metabolism , Coronary Artery Disease/enzymology , Double-Blind Method , Female , Hormone Replacement Therapy/methods , Humans , Middle Aged , Postmenopause , Reference Values , Statistics, Nonparametric
11.
Lung Cancer ; 32(1): 13-8, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11282424

ABSTRACT

Some patients with non-small cell lung cancer (NSCLC) will also have a synchronous malignant lesion. The lung imaging fluorescence endoscopy (LIFE) has proven better than conventional white light bronchoscopy (WLB) for visualizing premalignant lesions or early stages of lung cancer. In this study, the additional value of LIFE in diagnosing synchronous lung cancers as well as the impact of these findings on definite therapy was analyzed. Seventy-two patients with recently diagnosed NSCLC or pulmonary lesions highly suspect of lung cancer were studied. Patients underwent WLB, followed by LIFE. Apart from the primary lesions, additional abnormal and suspicious lesions seen at WLB and LIFE were scored separately and biopsied. Sixty-nine patients had NSCLC and three patients had small cell lung carcinoma. Apart from the primary lesion, one up to six additional endobronchial lesions were visualized in 48 patients by WLB and/or LIFE. High-grade dysplastic lesions were detected in ten patients, three of whom were eligible for surgery of the primary tumor after completion of the investigations. Three other patients (4.3%) had synchronous cancers (NSCLC). In one patient, the lesion was visualized by LIFE and by WLB. The other two malignant lesions were detected only by LIFE. In these three latter patients, diagnostic work-up and definite treatment was changed, as a result of detection of synchronous lesions. In conclusion, LIFE has additional value in detecting synchronous malignant lesions in patients with primary lung cancer. The detection of these lesions changed diagnostic work-up and definite treatment plan. Therefore, LIFE should be used in the work-up of patients with primary lung cancer.


Subject(s)
Bronchoscopy/methods , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Small Cell/diagnosis , Lung Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Adult , Aged , Aged, 80 and over , Biopsy , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/therapy , Female , Fluorescence , Humans , Light , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Male , Middle Aged , Neoplasm Staging , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/therapy , Sensitivity and Specificity , Treatment Outcome
12.
J Steroid Biochem Mol Biol ; 79(1-5): 41-7, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11850206

ABSTRACT

We have investigated aromatase and the inducible cyclooxygenase COX-2 expression using immunocytochemistry in tumors of a series of patients with advanced breast cancer treated with aromatase inhibitors. Aromatase was expressed in 58/102 breast cancers. This is similar to the percentage previously reported for aromatase activity. Interestingly, aromatase was expressed in a variety of cell types, including tumor, stromal, adipose, and endothelial cells. Since prostaglandin E2 is known to regulate aromatase gene expression and is the product of COX-2, an enzyme frequently overexpressed in tumors, immunocytochemistry was performed on the tissue sections using a polyclonal antibody to COX-2. Aromatase was strongly correlated (P<0.001) with COX-2 expression. These results suggest that PGE2 produced by COX-2 in the tumor may be important in stimulating estrogen synthesis in the tumor and surrounding tissue. No correlation was observed between aromatase or COX-2 expression and the response of the patients to aromatase inhibitor treatment. However, only 13 patients responded. Nine of these patients were aromatase positive. Although similar to responses in other studies, this low response rate to second line treatment suggests that tumors of most patients were no longer sensitive to the effects of estrogen. Recent clinical studies suggest that greater responses occur when aromatase inhibitors are used as first line treatment. In the intratumoral aromatase mouse model, expression of aromatase in tumors is highly correlated with increased tumor growth. First line treatment with letrozole was effective in all animals treated and was more effective than tamoxifen in suppressing tumor growth. Letrozole was also effective in tumors failing to respond to tamoxifen, consistent with clinical findings. In addition, the duration of response was significantly longer with the aromatase inhibitor than with tamoxifen, suggesting that aromatase inhibitors may offer better control of tumor growth than this antiestrogen.


Subject(s)
Aromatase/metabolism , Breast Neoplasms/enzymology , Isoenzymes/metabolism , Prostaglandin-Endoperoxide Synthases/metabolism , Adipocytes/enzymology , Adult , Aged , Aged, 80 and over , Animals , Aromatase Inhibitors , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Cyclooxygenase 2 , Dinoprostone/metabolism , Endothelium/enzymology , Enzyme Inhibitors/therapeutic use , Epithelial Cells/enzymology , Estrogen Receptor Modulators/therapeutic use , Estrogens/biosynthesis , Female , Humans , Immunohistochemistry , Letrozole , Mammary Neoplasms, Experimental/drug therapy , Mammary Neoplasms, Experimental/enzymology , Mammary Neoplasms, Experimental/pathology , Membrane Proteins , Mice , Mice, Inbred BALB C , Middle Aged , Neoplasms, Hormone-Dependent/drug therapy , Neoplasms, Hormone-Dependent/enzymology , Nitriles/therapeutic use , Stromal Cells/enzymology , Tamoxifen/therapeutic use , Triazoles/therapeutic use
13.
Metabolism ; 48(11): 1371-7, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10582544

ABSTRACT

We prospectively studied the effects of cross-sex hormone administration on fat cell size and in vitro lipolytic activity in subcutaneous abdominal and gluteal fat biopsies obtained from 19 male-to-female (M-F) transsexuals and 17 female-to-male (F-M) transsexuals. The amount of subcutaneous fat at the abdominal and gluteal levels was quantified with the use of magnetic resonance imaging (MRI). Before cross-sex hormone administration, M-F transsexuals had less subcutaneous fat with smaller fat cells compared with F-M transsexuals, with a higher baseline in vitro lipolytic activity expressed as glycerol release per milligram of triglyceride (TG) in the abdominal region (P < .05). Before cross-sex hormone treatment, no differences in lipolytic activity stimulated with arterenol (ART), isoproterenol (ISO), or ISO + insulin (INS) were observed between groups or regions. After a 1-year treatment with estrogens and antiandrogens in M-F transsexuals, subcutaneous fat areas on MRI and fat cell size were increased (P < .001) and reductions were observed in the basal lipolytic activity of gluteal and abdominal fat biopsies (P < .05). Following administration of testosterone to F-M transsexuals, subcutaneous fat and fat cell size at the gluteal and abdominal depots were decreased (P < .01) and basal lipolysis was increased significantly at the abdominal level (P < .05) but not at the gluteal level. In both M-F and F-M transsexuals, no effect of sex hormone administration was observed on stimulated lipolytic activities. In conclusion, regional sex differences in the amount of subcutaneous fat, adipocyte size, and in vitro basal lipolytic activity were demonstrated that could be largely reversed by cross-sex hormone treatment in adult subjects, providing evidence for their dependence on the sex steroid milieu.


Subject(s)
Adipocytes/metabolism , Gonadal Steroid Hormones/administration & dosage , Gonadal Steroid Hormones/pharmacology , Lipid Metabolism , Transsexualism/metabolism , Abdomen , Adult , Buttocks , Drug Administration Schedule , Estradiol Congeners/administration & dosage , Estradiol Congeners/pharmacology , Ethinyl Estradiol/administration & dosage , Ethinyl Estradiol/pharmacology , Female , Humans , Magnetic Resonance Imaging , Male , Prospective Studies , Testosterone/administration & dosage , Testosterone/pharmacology
14.
Clin Endocrinol (Oxf) ; 51(4): 449-54, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10583311

ABSTRACT

OBJECTIVE: Women have higher leptin levels than men at a certain degree of adiposity. The role of oestrogens in the regulation of serum leptin levels remains inconclusive. The aim of the present study was to investigate the effect of unopposed oestrogen replacement therapy, during two months, on serum leptin levels in postmenopausal women. DESIGN: A double-blind, placebo-controlled, randomized study. SUBJECTS: Twenty-five healthy postmenopausal women were studied (mean (+/- SD) age: 52.9 +/- 2.7 years, range of age: 48.7-57.4 years; mean body mass index (BMI): 26.4 +/- 4.2 kg/m2, range of BMI: 21.0-39.0 kg/m2). Twelve of these women were treated with 2 mg 17beta-oestradiol daily, and 13 postmenopausal women received placebo. MEASUREMENTS: Before and at the end of a 2-month study period, anthropometric and bio-electrical impedance measurements were performed, and fasting blood samples were taken, to determine serum levels of sex hormones and leptin. RESULTS: During the 2-month study period, body weight had increased significantly in the placebo group compared with the treatment group, but no significant changes were observed in percentage of body fat or the amount of body fat in kg between the groups. Following administration of 17beta-estradiol, the median leptin level increased from 17.6 microg/l to 24.1 microg/l after 2 months (P = 0. 008 compared with baseline). This increase was significantly different from the placebo group (P = 0.019), which showed no change in circulating leptin levels. CONCLUSION: This study demonstrates that unopposed oestrogen replacement therapy during 2 months in postmenopausal women slightly, but significantly, increases total serum leptin levels. This observation suggests a role for oestrogens in the regulation of leptin.


Subject(s)
Estradiol/therapeutic use , Estrogen Replacement Therapy , Leptin/blood , Body Composition , Body Mass Index , Double-Blind Method , Electric Impedance , Estradiol/blood , Female , Humans , Insulin/blood , Middle Aged , Sex Hormone-Binding Globulin/analysis , Statistics, Nonparametric , Testosterone/blood
15.
Hypertension ; 34(4 Pt 1): 590-7, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10523332

ABSTRACT

Arterial stiffness may be influenced by sex steroids and insulin; the association with fasting insulin level may be stronger in women than in men. Therefore, we analyzed the effects of sex steroid administration on (1) arterial stiffness and (2) the relationship between fasting insulin level and arterial stiffness. Twelve male-to-female transsexuals were treated with ethinyl estradiol and cyproterone acetate, and 18 female-to-male transsexuals were treated with testosterone esters, with assessments made at baseline and after 4 and 12 months. Changes in distensibility and compliance coefficients (DC and CC, respectively) of the common carotid artery, femoral artery (FA), and brachial artery (BA) were analyzed in relation to changes in fasting plasma levels of glucose, insulin, HDL-cholesterol, and triglycerides. After 4 months of estrogens and antiandrogens in men, significant reductions in the CC and DC of the FA (P=0.006 and P=0.04, respectively) and BA (P=0.04 and P=0.04, respectively) were observed. In women, testosterone, on average, did not affect DC or CC, but the changes in fasting insulin level were strongly negatively associated with changes in the CC and DC, especially in the FA and BA. These associations were significantly less strong in genetic men and were independent of age, mean arterial pressure, and glucose and lipid levels. This experimental study shows (1) that short-term administration of estrogens and antiandrogens increases FA and BA stiffness in men and (2) that the fasting insulin level is a stronger determinant of arterial stiffness in women than in men.


Subject(s)
Arteries/drug effects , Estradiol/pharmacology , Insulin/blood , Testosterone/pharmacology , Transsexualism/metabolism , Adolescent , Adult , Analysis of Variance , Blood Glucose/drug effects , Cholesterol, LDL/blood , Elasticity/drug effects , Female , Hemodynamics/drug effects , Humans , Male , Middle Aged , Prospective Studies , Sex Characteristics , Transsexualism/physiopathology
16.
Neth J Med ; 55(2): 76-9, 1999 Aug.
Article in English | MEDLINE | ID: mdl-10474276

ABSTRACT

Erdheim-Chester disease is a rare multisystem disease in which a progressive xanthogranulomatous infiltration of several tissues can be seen. We describe a woman, known to have diabetes insipidus for ten years, with periorbital, retroperitoneal, mediastinal, axillar and inguinal involvement. On histological examination a granulomatous infiltration of fatty tissue and striated muscle was seen, consisting of Touton giant cells, histiocytes with foamy cytoplasm and lymphocytes. Immunohistochemical staining with CD-1a and S-100 was negative and on electron microscopy no Langerhans granules were seen. These findings led to the diagnosis of Erdheim-Chester disease. She had a good response on steroids. Because of some similar clinical features of Langerhans cell histiocytosis and Erdheim-Chester disease, a histiocyte disorder seems the most probable cause.


Subject(s)
Granuloma/pathology , Histiocytosis/diagnosis , Xanthomatosis/pathology , Axilla/pathology , Biopsy , Diabetes Insipidus/complications , Diagnosis, Differential , Female , Glucocorticoids/therapeutic use , Granuloma/complications , Histiocytosis/complications , Histiocytosis/drug therapy , Histiocytosis/pathology , Humans , Middle Aged , Orbit/pathology , Prednisone/therapeutic use , Remission Induction , Xanthomatosis/complications
17.
Acta Chir Belg ; 99(2): 92-4, 1999 Apr.
Article in English | MEDLINE | ID: mdl-10352741

ABSTRACT

Intravenous leiomyomatosis with cardiac extension is a rare entity. The case of a 49-year-old patient is described: she was operated on for intracaval intra-atrial leiomyomatosis. After an incomplete procedure (the tumour appeared not totally resectable), the patient was treated for a period of three years with a GnRH-analogue, whereafter the patient was doing clinically well and the tumour, although it regained some growth, was in a stable situation. This new strategy seems of certain importance to the surgeon, as it carries an alternative to a high-risk reoperation. To our knowledge, this is the first description of such a combined therapeutical approach.


Subject(s)
Heart Neoplasms/therapy , Leiomyomatosis/therapy , Vascular Neoplasms/therapy , Antineoplastic Agents, Hormonal/therapeutic use , Combined Modality Therapy , Female , Goserelin/therapeutic use , Heart Atria/pathology , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Humans , Leiomyomatosis/pathology , Leiomyomatosis/surgery , Middle Aged , Vascular Neoplasms/pathology , Vascular Neoplasms/surgery
18.
Diabetologia ; 42(2): 214-21, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10064102

ABSTRACT

Large artery stiffening could contribute to the development of cardiovascular disease. The aim of this study was to investigate associations between arterial stiffness and diameter with insulin sensitivity and body composition in healthy men and women. In healthy, young (< 41 years old), non-obese (BMI < 27 kg/m2) men (n = 17) and women (n = 17), we measured the arterial diameter, the distension, the distensibility coefficient and the compliance coefficient of the elastic common carotid and muscular femoral arteries with a non-invasive ultrasonographic method. We also assessed glucose uptake (by a euglycaemic hyperinsulinaemic clamp technique), total body fat and lean body mass (by bioelectrical impedance analysis) and abdominal subcutaneous and visceral fat area (by magnetic resonance imaging). In women, but not in men, the distension and distensibility and compliance coefficients of the femoral artery were negatively associated with insulin concentrations (beta = -0.62, p = 0.008; beta = -0.65, p = 0.005 and beta = -0.59, p = 0.01), and positively with glucose uptake (beta = 0.59, p = 0.02; beta = 0.68, p = 0.005 and beta = 0.54, p = 0.04). Associations with glucose uptake were independent of the mean arterial pressure and body composition. In men and women, arterial compliance was positively associated with fat mass variables, which were mediated by a strong association between the femoral artery diameter and lean body mass (beta = 0.80, p < 0.001) and between the common carotid artery diameter and visceral fat area (beta = 0.56, p = 0.001). We found an independent association between insulin resistance and arterial stiffness, which was more pronounced in women than in men.


Subject(s)
Arteries/physiology , Body Composition/physiology , Compliance , Insulin/pharmacology , Sex Characteristics , Abdomen , Adipose Tissue , Adult , Blood Glucose/metabolism , Blood Pressure , Carotid Arteries/anatomy & histology , Cholesterol, HDL/blood , Female , Femoral Artery/anatomy & histology , Humans , Linear Models , Male
19.
Am J Physiol ; 276(2): E317-25, 1999 02.
Article in English | MEDLINE | ID: mdl-9950792

ABSTRACT

We investigated prospectively the effect of sex steroids on regional fat depots and thigh muscle mass in adult transsexuals. Ethinyl estradiol in combination with cyproterone acetate, a progestational antiandrogen, was given to 20 male-to-female (M-F) transsexuals, and parenteral testosterone esters were given to 17 female-to-male (F-M) transsexuals. Before and after 12 mo of cross-sex hormone administration, several anthropometric measurements (weight, skinfolds, body circumferences, and bioimpedance) were performed, and transverse magnetic resonance images were obtained at the level of the abdomen, hip, and thigh to quantify fat depots (subcutaneous and visceral) and muscle areas. We observed that treatment with ethinyl estradiol in M-F transsexuals induced a significant increase in all subcutaneous fat depots, with a lesser but proportional and significant increase in the visceral fat depot and a decrease in thigh muscle area. Testosterone administration in F-M transsexuals markedly increased thigh muscle area, reduced subcutaneous fat deposition at all levels measured, but slightly increased the visceral fat area. We conclude that sex steroid hormones are important determinants of the sex-specific localization of body fat.


Subject(s)
Adipose Tissue/drug effects , Adipose Tissue/pathology , Androgen Antagonists/therapeutic use , Cyproterone Acetate/therapeutic use , Estradiol Congeners/therapeutic use , Ethinyl Estradiol/therapeutic use , Magnetic Resonance Imaging , Transsexualism/drug therapy , Adolescent , Adult , Anthropometry , Drug Combinations , Female , Humans , Male , Prospective Studies , Sex Characteristics , Transsexualism/blood , Transsexualism/diagnosis , Transsexualism/urine
20.
Arterioscler Thromb Vasc Biol ; 18(11): 1716-22, 1998 Nov.
Article in English | MEDLINE | ID: mdl-9812909

ABSTRACT

Increased plasminogen activator inhibitor type-1 (PAI-1) levels, leading to impaired fibrinolysis, are associated with increased visceral fat in middle-aged and obese subjects. It is unknown, however, whether this association is independent of other disturbances clustered in the insulin resistance syndrome. We analyzed this association in young, nonobese transsexual men and women before and after administration of cross-sex steroids, which potentially influence many elements of the insulin resistance syndrome, including PAI-1 levels and visceral fat accumulation. We assessed the visceral fat area (by MRI); total body fat; insulin sensitivity (with a glucose clamp technique); and plasma levels of PAI-1, insulin, and triglycerides in young (<37 years old), nonobese (body mass index <28 kg/m2), healthy men (n=18) and women (n=15) before and after 12 months of cross-sex hormone administration. Men were treated with ethinyl estradiol 100 microgram/d plus cyproterone acetate 100 mg/d, and women were treated with testosterone esters 250 mg IM every 2 weeks. At baseline, only visceral fat area was significantly correlated with plasma PAI-1 levels in both men (r=0.57, P=0.03) and women (r=0.59, P=0.03). In multivariate linear regression analysis, this association was independent of total body fat, insulin sensitivity, and plasma levels of triglycerides and insulin. After 12 months of cross-sex hormone administration, the plasma PAI-1 levels were no longer correlated with visceral fat (which had increased). We conclude that in young, nonobese men and women, visceral fat area is an important determinant of plasma PAI-1 levels. After cross-sex hormone administration, this association was no longer demonstrable.


Subject(s)
Adipose Tissue/metabolism , Gonadal Steroid Hormones/therapeutic use , Plasminogen Activator Inhibitor 1/metabolism , Transsexualism , Viscera/metabolism , Adolescent , Adult , Female , Humans , Insulin Resistance , Linear Models , Male , Obesity/metabolism
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