Individual hormone replacement therapy.

Although hormone replacement therapy is widely used in western countries, compliance is not very good; only a minor proportion of women starting the treatment continue it for over 5 years. However, long-term treatment is essential for primary prevention of cardiovascular diseases and osteoporosis. One reason for low compliance is that treatment is not planned individually. After using a fixed estradiol dose, serum levels of estradiol show 10-fold differences between subjects, independently of the routes of administration. This article briefly summarizes the possibility of using tailored treatment and thus improving long-term compliance with HRT.

The total peroxyl radical-trapping ability of plasma and cerebrospinal fluid in normal and preeclamptic parturients.

Plasma and cerebrospinal fluid total peroxyl radical-trapping antioxidative parameter (TRAP) and the main antioxidant components of TRAP (vitamin E, ascorbic acid, uric acid, protein sulfhydryl groups, and the unidentified antioxidant proportion) were analyzed in 11 preeclamptic parturients, 9 healthy parturients with an uncomplicated pregnancy, and 10 healthy nonpregnant women. In addition, the possible effects of ongoing labor were studied in 10 healthy parturients. The samples of plasma and cerebrospinal fluid (CSF) were collected at cesarean section (pregnant women) or minor surgical procedure (nonpregnant women). Normal pregnancy or ongoing labor induced no significant changes in total TRAP, as compared with nonpregnant women, but significant changes in the percentage contributions of individual antioxidants were noted in plasma and CSF. In preeclampsia, a significant increase in TRAP was noted in both plasma and CSF. This increase was mainly due to an increased proportion of uric acid and unidentified antioxidants in plasma samples, and an increased proportion of unidentified antioxidants in CSF. The concentration of CSF ascorbic acid was decreased in preeclampsia, and a negative correlation between CSF ascorbic acid and blood pressure was observed.

Findings on lipid peroxidation and antioxidant function in hypertensive complications of pregnancy.

OBJECTIVE: To assess lipid peroxidation and antioxidant function in hypertensive complications of pregnancy. DESIGN: Cross sectional study comparing pre-eclamptic and control patients. SETTING: Tampere University Hospital, Finland. SUBJECTS: Twenty healthy women with normal, uncomplicated pregnancy; 23 women with severe pre-eclampsia; 20 women with mild pre-eclampsia; and 13 women with pregnancy-induced hypertension. MAIN OUTCOME MEASURES: Conjugated dienes; thiobarbituric acid--reactive material or malondialdehyde (MDA); fluorescent chromolipids (FCL); glutathione peroxidase (GSHPx); selenium; uric acid; and vitamin E. RESULTS: Lipid peroxidation assessed by the appearance of conjugated dienes and malondialdehyde was significantly increased in the hypertensive patients as compared with control patients. Lipid peroxidation products also showed high correlation to the level of blood pressure, but failed to show significant relation to the outcome of the fetus. The activities of erythrocyte and plasma glutathione peroxidase were increased in severe pre-eclampsia, and high levels of plasma or platelet glutathione peroxidase were found to have some association with fetal growth retardation or asphyxia. CONCLUSIONS: Our findings give support to those few studies considering lipid peroxidation as an important factor in the pathogenesis of pre-eclampsia. The rise in antioxidants is probably of compensatory nature responding to the increased peroxide load in pre-eclampsia and may reflect the severity of the disease.

Maternal hormone levels during Na 872 infusion in late pregnancy.

In order to assess the effects of Na 872 infusion on maternal endocrinology during late pregnancy, we measured serum estradiol, estriol, progesterone, human placental lactogen, follicle simulating hormone, prolactin, cyclic adenosine monophosphate, cortisol and insulin before, during and after Na 872 infusion (bromhexine 2 mg/min for one hour) in ten mothers. As compared to six control mothers, no changes could be observed. This suggests that the claimed maturing effect of Na 872 on the fetal lungs is not mediated by the hormonal changes measurable in maternal blood.

Antipyrine metabolism and liver function in patients treated with high-dose medroxyprogesterone.

The effect of high-dose medroxyprogesterone acetate (MPA, 250 mg intramuscularly for six days) on hepatic drug-metabolism and liver function was investigated in eleven females with endometrial carcinoma. Antipyrine plasma clearance, an index of hepatic drug-metabolizing ability, improved significantly during this treatment, and the serum total bilirubin level was lowered, whereas other liver function tests, including alkaline phosphatase, and albumin values in the serum, remained unchanged. The results demonstrate that therapy with MPA has an inducing effect on hepatic enzyme activity and antipyrine metabolism. The findings may be of importance when prescribing drugs for females receiving large doses of MPA.

PIP: The effects of high doses of medroxyprogesterone acetate (MPA) on liver metabolism were investigated by determining the plasma antipyrine clearance rates for a group of 11 patients with endometrial cancer both before and during use of MPA in therapy. MPA dosage was 250 mg, intramuscularly, for 6 days. The antipyrine half-life was prolonged in 4 patients. MPA treatment had an inducing effect on antipyrine metabolism; the plasma half-life of the drug was shortened and apparent clearance rate increased; however, no change occurred in the apparent volume of distribution of the drug. Significant decreases in bilirubin were also seen (P .01), but no other liver function tests showed significant differences. When the patients were divided into 2 groups according to age over or under 60 years, there was a significant difference (P .05), with the younger group having a half-life of 8.1 hours and the older group evincing a half-life of 13.6. These half-lives were reduced by MPA treatment to 7.5 and 11 hours, respectively. The results indicate that MPA therapy has an inducing effect on hepatic enzyme activity and antipyrine metabolism.

Response of pituitary-adrenal axis on partal stress.

The circulating level of ACTH (by radioimmunoassay) and cortisol (by competitive protein binding) were determined at 1- to 2-hour intervals during spontaneous labor (N=8) and induced labor (N=28) and after delivery. There were no differences in ACTH levels between primiparous and multiparous women. The primiparous women displayed a higher level of cortisol throughout labor than the multiparous women, but not after delivery. After spontaneous onset of labor, ACTH levels were always lower than after elective induction of labor, while there were no differences in the levels of cortisol. The hypertensive complications of pregnancy did not affect the secretion of ACTH. In normal pregnancy the rise of cortisol during labor and after delivery was significant, but it was not significant in the group of patients with hypertensive complications.