Transdermal oestrogen therapy protects postmenopausal liver transplant women from osteoporosis. A 2-year follow-up study.

BACKGROUND/AIMS: Hormone replacement therapy (HRT) prevents osteoporosis in postmenopausal women by inhibiting bone resorption, but the benefits of oestrogen therapy in liver transplant patients have not been studied. METHODS: The effect of transdermal HRT was studied in 33 postmenopausal liver transplant women. The main outcome measure was the change in bone mineral density (BMD) which was measured annually for 2 years. The effect on bone turnover was studied by assessment of the serum aminoterminal propeptide of type I procollagen (PINP). RESULTS: The mean lumbar BMD increased from 0.816 at baseline to 0.858 and to 0.878 g/cm2 (P < 0.001) after 1 and 2 years of therapy, respectively. The BMD of the femoral neck increased from 0.665 to 0.690 g/cm2 (P < 0.006). During the first and second years, the mean BMD of the lumbar spine increased by 5.3 and 1.2%, while that of the femoral neck increased by 3.3 and 1.2%. After 2 years of HRT, only one-fifth of the patients had osteoporosis, whereas over half of the women had osteoporosis at baseline. The median serum PINP decreased by 47% at 1 year and remained decreased at 2 years compared with baseline levels. CONCLUSION: Transdermal HRT decreased the turnover rate of mineralized bone matrix. Transplant women responded with increased BMD, just like healthy postmenopausal women.

Changes in prevalence and severity of asthma among schoolchildren in a Swedish district between 1985 and 1995.

The same questionnaire and study design was used in two surveys of asthma among all the children attending the 9-y compulsory school in Sundsvall in 1985 (n = 10527) and 1995 (n = 9165). A detailed questionnaire was distributed by post to the parents of all children who had answered in the affirmative to a simple screening question on asthmatic symptoms at the beginning of the autumn term. The questionnaire contained detailed questions on symptoms and asthma management. Our findings indicated a moderate increase in reported asthma-like symptoms and physician-diagnosed asthma between 1985 and 1995. The severity of symptoms was unchanged, despite a large community-based asthma campaign and a tenfold increase in the number of children receiving inhaled steroids. A validation analysis included an interview by a physician, a skin prick test, determination of specific IgE antibodies and spirometry. The oral interviews suggested that undertreatment was common. Many children had adequate medication at home, but this medication was not used properly. Finally, all 13-14-y-old children also replied to written and video questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC). It is likely that differences in study design explained the much higher prevalence of wheezing in this part of the study.

Lung volume and its correlation to nocturnal apnoea and desaturation.

The cross-sectional area of the upper airway is known to be lung volume dependent. If, and to what extent, lung volume variables correlate to nocturnal obstructive apnoeas and oxygen desaturations independently of other factors known to affect lung volumes and sleep disordered breathing is still unclear. A total of 92 subjects were examined by ambulatory recording of nocturnal obstructive apnoeas and desaturations. Sixty-nine of the subjects had a history of snoring and 23 were healthy subjects without complaints of snoring and daytime sleepiness. All subjects performed static and dynamic spirometry for measurements of lung volumes. To evaluate the correlation between lung volume variables and apnoea index (AI) and oxygen desaturation index (ODI), simple and multiple regression analysis was performed. Expiratory reserve volume (ERV) was found to be lower in subjects with snoring and apnoeas (ERV = 1.0 l) than in non-snoring subjects (ERV = 1.7 l), (P<0.001). Forced expiratory volume in 1 sec (FEV1)/vital capacity (VC) was slightly, but significantly (P = 0.031), lower in subjects with snoring and nocturnal apnoeas and desaturations. In the multiple regression analysis ERV was found to be independently correlated to both AI (R2=0.13; P=0.001) and ODI (R2 = 0.11; P = 0.002). Multiple regression analysis also revealed that ERV, body mass index (BMI) and habitual smoking together accounted for 43% of the variation in AI and 48% of the variation in ODI. We find a significant independent association between ERV and nocturnal obstructive apnoea and oxygen desaturation frequency. Our results indicate that ERV is correlated to these events to a similar extent, as is obesity.

Safety and efficacy of transdermal estradiol replacement therapy in postmenopausal liver transplanted women. A preliminary report.

OBJECTIVE: To determine the safety and efficacy of transdermal estrogen replacement therapy in liver transplanted menopausal women. SUBJECTS: Thirty-two menopausal women who had at least 6 months earlier undergone liver transplantation, ages from 46-70 years old receiving hormone replacement therapy. METHODS: The study was an open prospective. The subjects received transdermal estradiol replacement therapy in combination with progestin (EstracombR-Ciba, 50 microg/24 h, 250 microg/24 h) if the uterus was intact, and estradiol alone (EstradermR-Ciba, 50 microg) if the uterus had been removed. The follow-up time was 6 months. Liver function parameters and hemostatic parameters were measured at 0, 3 and 6 months. Gynecological transvaginal ultrasound (TVS) was performed at 0 and 6 months. The efficacy of the hormonal treatment was assessed by measuring serum concentrations of estradiol, estrone, FSH, LH and SHBG, by measuring endometrial thickness with TVS and by recording changes in subjective climacteric symptoms at 0 and 6 months. Safety was assessed by measuring liver enzyme activity, liver synthesis functions and coagulation factors. RESULTS: Estrogen replacement therapy did not impair any of the liver parameters measured and no thrombotic effect could be detected. Hormonal effects of the regimen prescribed could be verified both biochemically, clinically and by TVS. CONCLUSION: A clinically desired hormonal effect was achieved by the dose of 50 microg estradiol-17beta. Liver function and hemostatic balance were unaffected by the transdermal hormonal treatment. Immunosuppressive drugs and transdermal estrogen may well be combined.

Ventilatory response to CO2 in patients with snoring, obstructive hypopnoea and obstructive apnoea.

Obstructive sleep apnoea (OSA) is caused by an obstruction of the upper airway. Sufficient sensitivity to CO2 in the respiratory centre is known to be a critical factor for adequate tone in the upper airway muscles. The hypothesis of this study is, therefore, that the ventilatory response to CO2 is reduced in patients with OSA. Twenty-six patients who suffered from snoring, 19 snoring patients with obstructive hypopnoea (OH) and 33 snoring patients with obstructive apnoea (OA), were studied. The control group consisted of 25 subjects from a random sample with no history of snoring or daytime sleepiness. Tests of the hyperoxic and hypoxic ventilatory response to CO2 were performed, as well as static and dynamic spirometry. Subjects in the OA group displayed a higher hyperoxic (VE/FetCO2hy = 12.6 l min-1/%) and hypoxic (VE/FetCO2ho = 15.7 l min-1/%) ventilatory response to CO2 than patients with obstructive hypopnoea (VE/FetCO2hy = 8.6 l min-1/%; VE/FetCO2ho = 15.2 l min-1/%), snorers (VE/FetCO2hy = 8.4 l min-1/%; VE/FetCO2ho = 12.7 l min-1/%) and non-snorers (VE/FetCO2hy = 7.6 l min-1/%; VE/FetCOho = 9.6 l min-1/%). Multiple regression analysis reveals that neck circumference, apnoea index, oxygen desaturation index, PCO2 and sex (male gender) are correlated with VE/FetCO2hy (R2 = 0.43). Multiple regression analysis also reveals that ERV (expiratory reserve volume) and sex (male gender) are correlated with VE/FetCO2ho (R2 = 0.21). Arguing against the hypothesis, patients with OSA displayed an increased hyperoxic and hypoxic ventilatory response to CO2. Nocturnal apnoea frequency and the obesity factor in OSA may have contributed to these results.