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Biomedical subjects

L E Nachtigall

Publications and source records attributed to L E Nachtigall.

At least 19 recordsLinked to original sources
PubMed1998

The use of transvaginal ultrasound and saline infusion sonohysterography for the evaluation of asymptomatic postmenopausal breast cancer patients on tamoxifen.

Tamoxifen has been shown to decrease the recurrence rate of breast cancer. Evidence that tamoxifen use may be associated with an increased risk of endometrial cancer has caused investigators to recommend routine invasive sampling. We have assessed a minimally invasive alternative for endometrial surveillance of tamoxifen-treated patients utilizing transvaginal ultrasound and saline infusion sonohysterography. Asymptomatic women (n = 44) with breast cancer on postoperative tamoxifen treatment were referred to our gynecological ultrasound unit. Initially, the endometrial echo was measured with unenhanced transvaginal ultrasound. If a distinct echo measured < or = 5 mm, no further procedure was performed. For thickened or inadequately visualized echoes, sonohysterography was performed. If a thin echo was noted on sonohysterography, no further procedure was performed. If focal changes were detected, hysteroscopy/dilatation and curettage (D&C) was performed. For generalized symmetrically thickened echoes, a blind biopsy was done. If sonohysterography was unsuccessful, hysteroscopy/D&C was performed. Eleven (25%) patients had thin unenhanced echoes of < or = 5 mm. Twenty-five (57%) patients had thickened endometrial echoes. Three (7%) had naturally occurring endometrial fluid outlining a polyp. An endometrial echo could not be visualized in five (11%) patients. Sonohysterography was successfully performed in 21 out of 30 (70%) patients with either thickened or non-visualized unenhanced echoes. Of these, two patients had thin endometria with coexisting myomas; seven had thin endometria with typical tamoxifen-induced subendometrial changes: and seven had focal polypoid thickening confirmed by hysteroscopy/D&C. Histology revealed carcinoma associated with two, proliferation in one and four polyps. Five patients had thickened unenhanced echoes with symmetrically thickened single-layer measurements on sonohysterography. Histology revealed that three were proliferative, one was inactive and one was hyperplastic. In the nine patients with unsuccessful sonohysterography, hysteroscopy/D&C revealed inactive endometria in six, and three polyps. Our paradigm of evaluating the endometrial response to tamoxifen is concluded to overcome the shortcomings of either unenhanced transvaginal ultrasound or blind biopsy alone while it kept the number of invasive sampling procedures to 55% (24 out of 44).

Aged↗
PubMed1998

Use of transvaginal ultrasonography to monitor the effects of tamoxifen on uterine leiomyoma size and ovarian cyst formation.

To evaluate the effects of tamoxifen on leiomyomas and ovarian cysts in postmenopausal breast cancer patients, uterine and leiomyoma volumes were monitored sonographically in 17 postmenopausal women receiving postoperative tamoxifen for breast cancer; patients were examined twice with a mean of 1.18 +/- 0.17 years between examinations. The mean increase in leiomyoma volume was 1.26 +/- 0.73 cm3. The mean myoma volume was significantly larger at follow-up evaluation than at initial ultrasonography (5.75 +/- 1.09 cm3 versus 4.36 +/- 0.817 cm3, respectively; Wilcoxon signed rank test, P = 0.0218). Six women developed new leiomyomas. Of the 21 leiomyomas initially detected, 13 increased, six decreased, and two were unchanged in volume. The mean increase in uterine volume was 17.45 +/- 8.49 cm3. Three patients had simple ovarian cysts at initial ultrasonographic examination, two of which remained unchanged in size, and the third resolved. Two patients had newly developed simple ovarian cysts. The increase in uterine and leiomyoma volumes with the development of new leiomyomas and the persistence or development of ovarian cysts in some patients support the existence of agonistic tamoxifen effects. Serial measurements of uterine and leiomyoma volumes and surveillance for ovarian cysts is recommended for tamoxifen users.

Aged↗
PubMed1997

Alterations in steroid hormone receptors in the tamoxifen-treated endometrium.

OBJECTIVE: Our purpose was to evaluate whether tamoxifen has estrogenic endometrial effects as defined by histologic study or alterations in steroid hormone receptor expression. STUDY DESIGN: Nineteen postmenopausal tamoxifen-treated breast cancer patients who also had endometrial sampling were identified from files in the Department of Obstetrics and Gynecology. To examine the subgroup of 15 polyps, age-matched, non-hormonally treated patients with polyps (n = 8) or atrophic endometria (n = 5) served as comparison groups. Proliferative (n = 3) and secretory (n = 5) endometria served as procedural controls. Immunohistochemical studies for steroid receptors (estrogen, progesterone) were performed. RESULTS: Glandular cell progesterone receptor was significantly increased and stromal cell estrogen receptor was significantly decreased in tamoxifen-treated versus atrophic endometria. Progesterone receptor staining was not significantly different in tamoxifen-treated versus control polyps, although staining was high in both groups. Stromal cell estrogen receptor staining was significantly reduced in tamoxifen-treated versus control polyps, although there were no histologic differences. Reduced stromal cell estrogen receptor and increased glandular cell progesterone receptor staining was found in all tamoxifen-treated endometria regardless of the diagnosis. CONCLUSION: The tamoxifen-associated changes in endometrial steroid receptors support an estrogenic effect that is independent of histologic diagnosis and duration of use. This may contribute to the pathogenesis of tamoxifen-associated polyps and carcinomas.

Aged↗
PubMed1995

Emerging delivery systems for estrogen replacement: aspects of transdermal and oral delivery.

The ideal preparation for estrogen replacement therapy has been the object of intensive research for decades, and the search continues. More than 40 new products are in development in the United States, the United Kingdom, and Europe. Most are transdermal, which reflects the growing acceptance of patch technology at a time when the overwhelming majority of women who use estrogen replacement take oral formulations. Most of the new oral formulations are a combination of estrogen and progestin. Aspects of transdermal and oral estrogen are discussed, including the advantages and disadvantages for use in women with concomitant medical conditions.

Administration, Cutaneous↗
PubMed1995

Clinical trial of the estradiol vaginal ring in the U.S.

Vaginal atrophy can be reversed for most women through systemic hormones. Those women who cannot take systemic hormones can get relief of symptoms with local estrogen therapy, which ideally should be locally effective without significant systemic absorption and without endometrial stimulation. An estradiol-releasing vaginal ring was therefore tested for efficacy, safety and patient acceptability in a 15-week open-label, randomized parallel group trial with blinded evaluations of the cytological response data. Conjugated estrogen vaginal cream was used as a reference control. The primary objectives of the study were to evaluate whether the two treatments were equivalent regarding improvement in urogenital atrophy, improvement in physicians's overall evaluation of product performance on urinary and/or vaginal changes, and improvement in patient's assessment of urinary and/or vaginal symptoms. A secondary objective was to assess frequency of endometrial overstimulation during estrogen replacement therapy, to be measured by a progestogen challenge test. The ring and cream treatment produced an equivalent effect on the vaginal mucosa, and equivalence was also found in physician's and patient's assessments of both vaginal and urinary symptomatology. Both treatments were equally effective in improving the vaginal pH toward levels normally seen in fertile women (< 5.0). With regard to endometrial stimulation, significantly more patients had bleedings at progestogen challenge test after 3 months of treatment with cream than with the ring. The ring, however, was given significantly better overall product acceptability ratings by the patients. It can therefore be seen as an equally effective, but significantly more acceptable, new administration form for treatment of urogenital disorders due to estrogen deficiency, with a more favourable safety profile than vaginal cream.

Administration, Intravaginal↗
PubMed1994

Comparative study: Replens versus local estrogen in menopausal women.

This was an open-label study comparing effects of a nonhormonal drug-free bioadhesive vaginal moisturizer to a local estrogen therapy in the treatment of vaginal dryness symptoms. There were 15 women evaluated in each treatment group during a 12-week period. Results indicated that the bioadhesive vaginal moisturizer was a safe and effective alternative to estrogen vaginal cream, with both therapies exhibiting statistically significant increases in vaginal moisture, vaginal fluid volume, and vaginal elasticity with a return of the premenopausal pH state.

Administration, Topical↗
PubMed1992

Incidence of breast cancer in a 22-year study of women receiving estrogen-progestin replacement therapy.

OBJECTIVE: To review the incidence of breast cancer in a continuous 22-year study of conjugated estrogen-medroxyprogesterone acetate hormone replacement therapy. METHODS: Eighty-four pairs of continuously hospitalized postmenopausal women who were matched for age, smoking history, and medical diagnosis were treated with estrogen-progestin hormone replacement therapy or placebo in a prospective and double-blind manner for 10 years. In the subsequent 12 years, the women were offered the choice of starting, stopping, or continuing hormone replacement therapy. RESULTS: After the initial 10 years, the incidence of breast cancer in the placebo group was 4.8%, whereas no cancers were found in the hormone replacement therapy group (P = .12). After an additional 12 years of follow-up, the overall incidence of breast cancer in the women who had never taken hormone replacement therapy was 11.5%, whereas no breast cancers had developed in the women who had ever taken hormone replacement therapy (P < .01). CONCLUSIONS: These data suggest that the 22-year administration of estrogen-progestin hormone replacement therapy did not increase the incidence of breast cancer in a small group of continuously hospitalized postmenopausal women.

Adult↗
PubMed1992

Hormone replacement therapy.

Although hormone replacement therapy (HRT) has been available for almost 100 years, conflicting opinions still exist about its efficacy and safety. There is uniform agreement that vasomotor instability and vaginal atrophy are totally reversible with HRT. Effective treatment of bone loss with HRT depends on the number of years of estrogen deprivation, peak bone mass, and rapidity of bone loss. Oral, transdermal, and pellet estrogens are equality effective. Mortality from coronary heart disease decreased 20% to 40% in women on HRT, yet the mechanism has not yet been ascertained. The increased risk of endometrial cancer has been confirmed, but better diagnostic techniques for detection in the precancerous state have been developed. The relationship of breast cancer to estrogen use has not been conclusive. Meta-analysis of 13 studies results in a relative risk of 1.06, whereas a large case-control study reveals a relative risk of 0.9. However, it is clear that in the average, healthy woman, low-dose estrogen replacement for less than 10 years does not increase the risk of breast cancer. Physicians are encouraged to help patients weigh the risks and benefits of HRT.

Atrophy↗
PubMed1990

Enhancing patient compliance with hormone replacement therapy at menopause.

Physicians who prescribe hormone replacement therapy for menopausal women should explain the purpose, risks, and side effects of the treatment. This enhances compliance and discourages patients from discontinuing therapy because of fears of cancer or misconceptions about hormone replacement therapy. The physician should explain that the risk of endometrial cancer is virtually eliminated (reduced to that of a normal woman or a woman not receiving therapy) by the addition of progestogen to estrogen regimens, and that when this cancer does occur, it is usually diagnosed and treated early. Recent studies have not conclusively shown a significant effect of progestogen on lipid profiles relevant to cardiovascular disease. Hormone replacement therapy does not appear to be associated with an increased risk of breast cancer. Nuisance side effects (such as edema and breast tenderness) can be better tolerated if the physician prepares the patient, offers a solution, and helps to put the problem in perspective. Other measures, such as providing written information and avoiding unnecessary biopsies, also enhance compliance.

Attitude to Health↗
PubMed1990

Protecting older women from their growing risk of cardiac disease.

Heart disease is the leading cause of mortality and a major cause of morbidity in women in the United States. Premenopausal and postmenopausal risk factors for cardiac disease must be reduced to protect women from this major health hazard. The main coronary risk factors for premenopausal women are hypertension, smoking, hyperlipidemia, obesity, and diabetes. Postmenopausal women have these risk factors in addition to a lack of estrogen. Most studies have shown that replacing estrogen in the menopausal woman reduces cardiovascular disease, probably by increasing HDL and decreasing LDL.

Aged↗
PubMed1987

Cardiovascular disease and hypertension in older women.

Cardiovascular disease is extremely rare in premenopausal women except for those who have diabetes or hypertension. It can be surmised, but is not yet proved, that protection from atherosclerotic coronary artery disease is an action related to the production of estrogen. In the consideration of hypertension, true systemic hypertension must be differentiated from blood pressure that is elevated spuriously from excessive sclerosis of the large arteries, which is more common in elderly patients. Both types of hypertension tend to increase with advancing age, and women have a greater incidence overall. All hypertensives should be actively treated.

Age Factors↗
PubMed1985

Is estrogen replacement therapy necessary?

Estrogen replacement therapy (ERT) is the most effective treatment for vasomotor hot flushes and urethrovaginal atrophy in postmenopausal women. Evidence also suggests that ERT delays osteoporosis and may even reduce the risk of atherosclerosis. Despite continuing controversy, the risks of ERT are now considered minimal. With individualized therapy and appropriate monitoring, ERT with progestin supplements appears to be safe and effective for the great majority of postmenopausal women.

Arteriosclerosis↗