Biomedical subjects

R Klein

Publications and source records attributed to R Klein.

At least 235 records · Page 13Linked to original sources

PubMed1998

Cigarette smoking and hearing loss: the epidemiology of hearing loss study.

CONTEXT: Clinical studies have suggested that cigarette smoking may be associated with hearing loss, a common condition affecting older adults. OBJECTIVE: To evaluate the association between smoking and hearing loss. DESIGN: Population-based, cross-sectional study. SETTING: Community of Beaver Dam, Wis. PARTICIPANTS: Adults aged 48 to 92 years. Of 4541 eligible subjects, 3753 (83%) participated in the hearing study. MAIN OUTCOME MEASURES: The examination included otoscopy, screening tympanometry, and pure-tone air-conduction and bone-conduction audiometry. Smoking history was ascertained by self-report. Hearing loss was defined as a pure-tone average (0.5, 1, 2, and 4 kHz) greater than 25-dB hearing level in the worse ear. RESULTS: After adjusting for other factors, current smokers were 1.69 times as likely to have a hearing loss as nonsmokers (95% confidence interval, 1.31-2.17). This relationship remained for those without a history of occupational noise exposure and in analyses excluding those with non-age-related hearing loss. There was weak evidence of a dose-response effect. Nonsmoking participants who lived with a smoker were more likely to have a hearing loss than those who were not exposed to a household member who smoked (odds ratio, 1.94; 95% confidence interval, 1.01-3.74). CONCLUSIONS: These data suggest that environmental exposures may play a role in age-related hearing loss. If longitudinal studies confirm these findings, modification of smoking habits may prevent or delay age-related declines in hearing sensitivity.

Aged↗

PubMed1998

The PTB electromagnetic undulator for BESSY II.

The Physikalisch-Technische Bundesanstalt (PTB) will operate an electromagnetic undulator designed for radiometry at the BESSY II storage ring. The undulator has a period length of 180 mm, 21 full periods and a maximum magnetic induction of 0.46 T, resulting in a tuning range of the first harmonic from 5 to 150 eV at 1.7 GeV electron energy. Moreover, the electromagnetic design allows the undulator to be operated in a special mode with the period length doubled to 360 mm, thus accordingly shifting the tuning range to lower energies. The main design parameters of the undulator for radiometric applications, as well as measured magnetic field data, are presented.

Journal Article↗

PubMed1998

Measurement of the electron energy and energy spread at the electron storage ring BESSY I.

Knowledge of the electron energy with a small uncertainty is necessary for the Physikalisch-Technische Bundesanstalt (PTB) to operate the electron storage ring BESSY I, and the future BESSY II, as a primary radiation source standard of calculable synchrotron radiation. At BESSY I the electron energy can now be measured either by the long-established method of resonant spin depolarization or by the newly set up method of Compton backscattering (CBS) of laser photons (CO(2) laser, lambda = 10.6 micro m). Results obtained at different electron energies by these two independent methods are presented. They agree within a relative uncertainty of better than 10(-4). The advantages and disadvantages of these two complementary techniques are described and applications of CBS for the measurement of other storage-ring parameters, e.g. the electron energy spread, are given.

Journal Article↗

PubMed1998

A plane-grating monochromator beamline for the PTB undulators at BESSY II.

At the BESSY II storage ring, the Physikalisch-Technische Bundesanstalt (PTB) will operate insertion devices dedicated to radiometric use. One branch of the appendant beamline system will be equipped with a grazing-incidence monochromator, described here. The monochromator concept is based on a plane grating operated in parallel light; therefore exact focusing is maintained for all photon energies irrespective of the angular setting at the grating. The monochromator has been optimized for small higher-order transmittance and high power throughput, as required by radiometric applications in the wide photon energy range from 20 eV to 1900 eV.

Journal Article↗

PubMed1998

Ephrin-B3, a ligand for the receptor EphB3, expressed at the midline of the developing neural tube.

The ephrins are a family of ligands that bind to Eph family receptor tyrosine kinases, and have been implicated in axon guidance and other patterning processes during vertebrate development. We describe here the identification and characterization of murine ephrin-B3. The cDNA encodes a 340 amino acid transmembrane molecule, most closely related to the two other known transmembrane ligands, ephrin-B1 and ephrin-B2. In addition to homology in their extracellular receptor binding domains, these transmembrane ligands share striking homology between their cytoplasmic domains, with 31 of the last 34 amino acids of ephrin-B3 being identical to ephrin-B2, suggesting functional interactions of the cytoplasmic tail. While most Eph family ligands are promiscuous in their interactions with Eph receptors, binding studies with the five receptors known to bind other transmembrane ligands only revealed a high affinity interaction of ephrin-B3 with EphB3, with a dissociation constant of approximately 1 nM. In situ hybridization of mouse embryos showed ephrin-B3 is expressed prominently at the dorsal and ventral midline of the neural tube, particularly in the floor plate, a structure with key functions in patterning the nervous system. The isolation of this ligand may help to elucidate the molecular basis of patterning activities at the neural tube midline.

Animals↗

PubMed1998

Relation of smoking to the incidence of age-related maculopathy. The Beaver Dam Eye Study.

To date, a number of reports have been published on the relation of cigarette smoking to age-related maculopathy, an important cause of blindness in the United States. However, few studies have examined the relation between smoking and the incidence of age-related maculopathy. In this report, the authors examine this association in persons aged 43-86 years (n = 3,583) at baseline who were participants in the baseline examination and 5-year follow-up of the Beaver Dam Eye Study, Beaver Dam, Wisconsin (1988-1990 and 1993-1995). Exposure data on cigarette smoking were obtained from questions about present and past smoking, duration of smoking, and the number of cigarettes smoked per day. Age-related maculopathy status was determined by grading stereoscopic color fundus photographs using the Wisconsin Age-related Maculopathy Grading System. After controlling for age, sex, vitamin supplement use, and beer consumption, men who smoked greater amounts of cigarettes were more likely to develop early age-related maculopathy (odds ratio (OR) per 10 pack-years smoked = 1.06, 95% confidence interval (CI) 1.00-1.13, p = 0.06) than men who had smoked less. This association was not observed in women. Men (OR = 3.21, 95% CI 1.09-9.45) and women (OR = 2.20, 95% CI 1.04-4.66) who were current smokers at the time of the baseline examination had significantly higher odds of developing large drusen (> or = 250 microns in diameter) after 5 years than those who had never smoked or who quit before the baseline study. Current or past history of cigarette smoking was not related to the incidence of retinal pigment epithelial depigmentation. The authors conclude that smoking appears to be related to the incidence of some lesions associated with early age-related maculopathy.

Adult↗

PubMed1998

Incidence of age-related cataract: the Beaver Dam Eye Study.

OBJECTIVE: To estimate the incidence of nuclear, cortical, and posterior subcapsular cataract in the Beaver Dam Eye Study cohort. DESIGN: A population-based study of the prevalence of age-related eye diseases was conducted between 1988 and 1990 (n=4926), and a follow-up study was conducted between 1993 and 1995 (n=3684). The evaluations included photographic documentation of the lens. Slitlamp photographs were taken to assess nuclear opacity, and retroillumination photographs were taken to assess cortical and posterior subcapsular cataract. The grading of photographs was done in a masked manner by trained graders using the same protocols for baseline and follow-up photographs. The graders were the same for both evaluations. PARTICIPANTS: Persons aged 43 to 86 years who were identified through a private census conducted from 1987 to 1988 of the population of Beaver Dam, Wis, were invited for a baseline examination held between 1988-1990 and again for a follow-up examination held between 1993-1995. RESULTS: Incident nuclear cataract occurred in 13.1%, cortical cataract in 8.0%, and posterior subcapsular cataract in 3.4% of right eyes. The cumulative incidence of nuclear cataract in right eyes increased from 2.9% in persons aged 43 to 54 years at baseline to 40.0% in those aged 75 years or older. For cortical and posterior subcapsular cataract, the corresponding values were 1.9% and 21.8% and 1.4% and 7.3%, respectively. Women were more likely than men to have nuclear cataract even after adjusting for age. CONCLUSIONS: Incident cataracts are common age-related problems, and incidence increases with increasing age at baseline. These data will help in planning for future care (eg, cataract surgery and change in spectacle correction) and in investigating the importance of risk factors.

Adult↗

PubMed1998

Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons.

OBJECTIVE: To identify the content area for a questionnaire designed to measure vision-targeted health-related quality of life and to determine whether problems with vision-related functioning are qualitatively similar across different common eye diseases. DESIGN: Twenty-six condition-specific focus groups were conducted with 246 patients from 5 geographic regions to identify the content area for a questionnaire for use among persons with diabetic retinopathy, glaucoma, macular degeneration, cytomegalovirus retinitis, and cataract. A standard protocol was used to structure each focus group discussion. Sessions were audiotaped, transcribed, and coded in preparation for a content analysis. SETTINGS: Five university-based ophthalmology practices and 1 nonprofit eye care foundation. PARTICIPANTS: Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. All eligible persons were older than 21 years, spoke English, and had sufficient cognitive function to provide informed consent. RESULTS: Among the 246 participants, 2623 problems with vision-related functioning were mentioned. The mean number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glaucoma. For the sample overall, reading problems were mentioned most frequently, followed by driving, general problems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each problem were difficulty or ease of performance (13%), psychological distress associated with performance of the activity (11%), and complete inability to participate in a visual activity (11%). CONCLUSION: An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual functioning in every-day life. Although participants mentioned problems that were unique to their disease, across conditions the problems mentioned were similar. These findings provide empirical evidence of content validity for a vision-targeted, health-related quality-of-life survey designed for use across conditions.

Adult↗

PubMed1998

Is age-related maculopathy related to hearing loss?

OBJECTIVE: To describe the relationship of age-related maculopathy (ARM) to hearing loss. DESIGN: Population-based cohort study. PARTICIPANTS: All 3397 adults (age range, 48-92 years) living in Beaver Dam, Wis, who were examined for age-related eye disease and hearing loss from March 1, 1993, to July 18, 1995, and who had analyzable hearing thresholds in at least 1 ear and fundus photographs gradable for ARM in at least 1 eye. METHODS: Characteristics of drusen and other lesions typical of ARM were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. We used standard protocols of pure-tone air-conduction audiometry to assess hearing loss, which was defined as the pure-tone average of hearing thresholds at 500, 1000, 2000, and 4000 Hz greater than 25-dB hearing level. RESULTS: The prevalence of ARM was 25.4% and of hearing loss was 45.0% in this population. Both conditions were present in 15.1%. The relationships between early ARM lesions and hearing loss were not statistically significant. After controlling for age and sex, persons with late ARM were more likely (odds ratio, 3.15; 95% confidence interval, 1.34-7.42) to have hearing loss than persons without late ARM. This relation did not change when other factors related to ARM or hearing loss (eg, cigarette smoking status, history of occupational noise exposure, and history of cardiovascular disease) were entered into multivariate models. CONCLUSIONS: These population-based estimates document the frequent coexistence of signs of ARM and hearing loss. As late ARM is an important cause of loss of vision, and as hearing loss is associated with difficulty in communicating, the high frequencies of sensory comorbidity may affect maintenance of independent functioning as people age. Further study is necessary to examine why late ARM and hearing loss are associated.

Adult↗

PubMed1998

The relationship of ocular factors to the incidence and progression of age-related maculopathy.

OBJECTIVE: To examine the association between ocular factors and the incidence and progression of age-related maculopathy. PARTICIPANTS: A population of 3684 adults (43-86 years of age at baseline) living in Beaver Dam, Wis, studied at baseline and 5 years later. METHODS: Standardized protocols for refraction and determination of iris color, administration of a questionnaire, and slitlamp and retroillumination photographs of the lenses to determine cataract type and stereoscopic color fundus photographs to determine presence and severity of age-related maculopathy. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy. RESULTS: After controlling for age, eyes that had undergone cataract surgery before baseline were more likely to have progression of age-related maculopathy (odds ratio, 2.71; 95% confidence interval [CI], 1.69-4.35) and to develop signs of late age-related maculopathy (odds ratio, 2.80; 95% CI, 1.03-7.63) than were eyes that were phakic at baseline. These relationships remained after controlling for other risk factors in multivariate analyses. There was no relationship of nuclear cataract, cortical cataract, or iris color to the incidence and progression of age-related maculopathy. CONCLUSION: These findings indicate a relationship between cataract surgery and increased risk of progression of age-related maculopathy.

Adult↗

PubMed1998

Screening for diabetic retinopathy: the utility of nonmydriatic retinal photography in Egyptian adults.

Although regular screening for diabetic retinopathy with ophthalmoscopy or retinal photography is widely recommended in the United States and Europe, few reports of its use in developing countries are available. We compared the performance of screening by retinal photography with that of indirect ophthalmoscopy by using data from a population-based survey of diabetes and its complications in Egypt. During that project, 427 persons with diabetes underwent an eye examination and fundus photography with a non-mydriatic camera through a dilated pupil. Data from the examinations of the right eye of each patient are presented. Ninety-two (22%) of the 427 retinal photographs were ungradable; in 58 eyes (63%), this was due to media opacity (42 eyes with cataract, 3 with corneal opacity, and 13 with both). Agreement between retinal photography and indirect ophthalmoscopy was poor (kappa = 0.33; 95% CI = 0.27-0.39) and primarily due to the large number of eyes (n = 79) with ungradable photographs that could be graded by ophthalmoscopy. None of these eyes was judged by ophthalmoscopy to have sight-threatening retinopathy. Fifty-four photographs were diagnosed with greater retinopathy than found on ophthalmoscopy. Retinal photography with the nonmydriatic camera through a dilated pupil is a useful method to screen for diabetic retinopathy in most adults in Egypt. However, such screening strategies have limited use in older persons and in persons with corneal disease or cataract.

Adult↗

PubMed1998

Estrogen replacement therapy and worsening of radiographic knee osteoarthritis: the Framingham Study.

OBJECTIVE: To examine whether estrogen replacement therapy (ERT) prevents worsening of radiographic knee osteoarthritis (OA) in elderly women. METHODS: A total of 551 women ages 63-91 years (mean age 71) in the Framingham Study were followed up from biennial examination 18 (1983-1985) to examination 22 (1992-1993). Data on postmenopausal ERT were obtained every 2 years. Subjects were classified into 3 groups according to their estrogen use at biennial examination 18: never users (n = 349), past users (n = 162), and current users (n = 40). Women received anteroposterior weight-bearing knee radiographs at examinations 18 and 22. Using the Kellgren and Lawrence criteria, global radiographic knee OA was assessed, (grade range 0-4) and individual radiographic features, such as osteophytes and joint space narrowing, were scored from 0 to 3. Worsening was defined as either development of radiographic OA that was not present at baseline (incident OA) or progression of baseline radiographic OA by > or =1 Kellgren and Lawrence grade (progressive OA). Potential confounding factors included age, body mass index, weight change, smoking, knee injury, physical activity level, and bone mineral density at the femoral neck. RESULTS: During 8 years of followup, 17.4% of knee radiographic scores worsened by 1 grade and 5.8% by 2 or 3 grades among never users of ERT. Among current estrogen users, only 11.7% of knee radiographic scores worsened by 1 grade and none worsened by more than 1 grade. After adjusting for age and other potential confounding factors, the relative risk of incident radiographic knee OA in comparison with never users of estrogen was 0.8 (95% confidence interval [95% CI] 0.5-1.4) in past users and 0.4 (95% CI 0.1-3.0) in current users. Current use of estrogen also showed a trend toward decreased risk of progressive knee OA compared with never use (odds ratio [OR] 0.5, 95% CI 0.1-2.9). When both incident and progressive radiographic knee OA cases were combined, current ERT use had a 60% decreased risk compared with never use (OR 0.4, 95% CI 0.1-1.5). CONCLUSION: This is the first prospective cohort study to examine the effects of ERT on radiographic knee OA. The results indicate that current use of ERT had a moderate, but not statistically significant, protective effect against worsening of radiographic knee OA among elderly white women. These findings corroborate those of cross-sectional studies and point further to a potential benefit of female hormones in OA.

Aged↗

PubMed1998

A randomised double-blind 16-week study of ritanserin in fibromyalgia syndrome: clinical outcome and analysis of autoantibodies to serotonin, gangliosides and phospholipids.

The aim of the study was to evaluate in a double-blind manner the effect of the long-acting 5-hydroxytryptamine 2 (5-HT2)-receptor blocker Ritanserin on clinical symptoms in patients with fibromyalgia syndrome (FM) and on production of antibodies to serotonin, gangliosides and phospholipids, recently shown to have a high incidence in this disease. Fifty-one female patients with typical FM were included in the 16-week study: 24 received Ritanserin and 27 received a placebo. Antibodies to 5-HT, gangliosides (Gm1) and phospholipids (thromboplastin) were determined by enzyme-linked immunosorbent assay at day 0 and at the end of week 16. The psychological and physical status, including tender points, of the patients was evaluated at day 0 and at the end of weeks 4 and 16. At the end of the study, there was an improvement (p < 0.05) in feeling refreshed in the morning in the Ritanserin-treated group and headache was also significantly improved compared with the placebo group. There was no difference in pain, fatigue, sleep, morning stiffness, anxiety and tender point counts in the Ritanserin and placebo groups. Fifty-one per cent of the 51 patients had at least one of the three antibodies to 5-HT, Gm1 and phospholipids. The incidence and activity of these antibodies were not influenced by Ritanserin or placebo. The observation that Ritanserin has only a small effect on clinical symptoms indicates that disturbances in serotonin metabolism or uptake may be only one factor in the pathogenesis of the disease. The high incidence of a defined autoantibody pattern in FM could again be confirmed in this study. However, it remains speculative whether immunological reactions are, indeed, involved.

Adult↗

PubMed1998

Favorable outcome of giant cell glioblastoma in a child. Report of an 11-year survival period.

Giant cell glioblastomas are defined as glioblastomas with a marked predominance of bizarre, multinucleated giant cells. They represent about 5% of all glioblastomas and can occur at any site of the central nervous system, but the temporal and frontal lobes are the sites of predilection. Overall, giant cell glioblastomas show a prolonged survival period compared with common glioblastoma multiforme, and survival periods of 7 and 9 years have been reported in adults. Here we report on a child aged 11 years at diagnosis, who has so far survived for 11 years since operation and adjunctive radio- and chemotherapy.

Adult↗

PubMed1998

Ocular symptoms in association with antiphospholipid antibodies.

OBJECTIVE: To describe the clinical and serologic findings of 50 antiphospholipid antibody (APA)-positive patients within a retrospective study. METHODS: Measurement of visual acuity, slit-lamp biomicroscopy, tonometry, fundus examination and perimetry. Laboratory tests were performed for detection of APA against thromboplastin and cardiolipin. Antinuclear antibodies (ANA), antibodies to dsDNA, antithyroidal and antiparietal antibodies were also tested. RESULTS: A combination of both transient and permanent visual disturbances was noticed in more than half of the patients. Transient visual disturbances included transient blurred vision, partial defects of the visual fields and amaurosis fugax. The most frequent permanent abnormalities were optic atrophy in 20 patients, due to AION in 9 cases, and disturbances of the choroidal circulation in 17 patients. Fourty-six patients had positive levels of thromboplastin APA; cardiolipin APA were found to be increased in 36 patients. CONCLUSIONS: We did not find a clear correlation between APA activity or the immunoglobulin classes in the individual and the severity of the ocular disease. The benefit from a therapy with the antiplatelet agent acetylsalicylic acid was evident in a reduction of the patients' transient visual disturbances and, in most cases, no further progression of permanent visual field defects was observed.

Adolescent↗

PubMed1998

Hormonal responses to physical training in high-level peripubertal male gymnasts.

The effects of performing intensive training during growth remains controversial, with claims of negative effects upon growth and maturation purportedly due at least in part to a combination of hormonal disturbances and inappropriate nutrition. We examined the training-related responses of total testosterone (T), insulin-like growth factor-1 (IGF-1), cortisol (C) and diet in 16 peripubertal (pubertal stage <2) male gymnasts [mean (SD) age 10.5 (0.9) years, training 17.2 (5.6) h x week(-1)] and 17 controls [mean (SD) age 9.6 (1.2) years] over a 10-month period. Fasted, resting morning blood samples (0730-0900 hours) were taken from all children on Monday, Wednesday and Friday during a single week towards the end of each of three phases of gymnastics training: routine development (RD), precompetition (PC) and strength conditioning (SC). Serum concentrations of T, C and IGF-1 did not differ between the groups at any time. The ratio between IGF-1 and cortisol was significantly reduced in gymnasts relative to controls during RD and SC training (P<0.05), although no differences were detected for the T:C ratio. Diet did not correlate with any of the hormonal measurements, and no intergroup differences were found for the rate of growth in height. In summary, these results suggest that either the gymnastics training performed by these subjects was not intense enough to alter adrenal function, or that the gymnasts were well adapted to the training. In contrast, the reduction in the anabolic to catabolic balance represented by the IGF-1:C ratio is suggestive of a catabolic state, perhaps resulting from overstrain, insufficient recovery and/or inadequate caloric intake relative to energy output. While physical training during growth may induce a catabolic state, further research is needed to determine the biological significance of this finding, particularly with regard to growth and maturation.

Child↗

PubMed1998

Diabetes, cardiovascular disease, selected cardiovascular disease risk factors, and the 5-year incidence of age-related cataract and progression of lens opacities: the Beaver Dam Eye Study.

PURPOSE: To describe the relationships of diabetes mellitus, cardiovascular disease, and selected cardiovascular disease risk factors to cumulative incidence of age-related cataract and to progression of lens opacities over a 5-year interval. METHODS: A follow-up examination of the Beaver Dam Eye Study cohort was performed 5 years after the baseline evaluation. Ages at the census prior to baseline ranged from 43 to 84 years of age. Protocols for examination, lens photography, and grading were the same for both examinations. RESULTS: Age at baseline was the most significant characteristic associated with incidence of nuclear, cortical, and posterior subcapsular cataract in those without diabetes (P < .001) for all cataracts. The positive association of age with cataract was found for nuclear and cortical cataract in the worse eye (P < or = .04) but not posterior subcapsular cataract in those with diabetes. Progression of nuclear sclerosis was common, occurring in about 70% of subjects when considering either eye. Incident cortical and posterior subcapsular cataracts (P < or = .001 for worse eye for each lesion) and progression of cortical and posterior subcapsular opacities were more common in those with diabetes (P < or = .001 for either eye for each lesion). Increased glycated hemoglobin level was associated with increased risk of nuclear and cortical cataracts in those with diabetes. Relationships of risk factors to posterior subcapsular cataracts, especially among those with diabetes, were often in the expected direction but lacked significance possibly due to small samples. CONCLUSIONS: Diabetes mellitus is associated with incidence over 5 years of cortical and posterior subcapsular cataract and with progression of more minor cortical and posterior subcapsular lens opacities. These changes may be related to level of glycemia. Cardiovascular disease and its risk factors have little effect on incidence of any age-related cataract.

Adult↗

PubMed1998

Unexpected vaginal bleeding and associated gynecologic care in postmenopausal women using hormone replacement therapy: comparison of cyclic versus continuous combined schedules.

OBJECTIVE: To measure gynecologic resources required to care for women who have unexpected vaginal bleeding while using hormone replacement therapy (HRT). DESIGN: A retrospective cohort study based on review of medical records. SETTING: A large health maintenance organization. PATIENT(S): We studied 284 women using continuous combined HRT and 306 women receiving cyclic HRT. MAIN OUTCOME MEASURE(S): We noted episodes of unexpected vaginal bleeding and associated clinic visits and gynecologic procedures recorded during a mean follow-up period of 2 years. RESULT(S): Among women using cyclic HRT for the first time, 38.3% had > or = 1 visit for unexpected bleeding and 12.3% had > or = 1 endometrial biopsy. Among women starting continuous combined HRT, 41.6% had > or = 1 visit for unexpected bleeding and 20.1% had > or = 1 endometrial biopsy. After adjusting for potential confounding variables, we found that recipients of cyclic and continuous combined HRT had similar risks of unexpected bleeding and endometrial biopsy. However, among women continuing HRT for >2 years, those using the continuous combined regimen had somewhat lower rates of unexpected bleeding (22.3 events per 100 patient-years) and endometrial biopsy (10.3 events per 100 patient-years) than those using the cyclic regimen (37.8 episodes of unexpected bleeding per 100 patient-years and 13.9 endometrial biopsies per 100 patient-years). CONCLUSION(S): Unexpected vaginal bleeding and the gynecologic resources required to manage it decreased after 2 years in women using continuous combined HRT but did not decline among those using cyclic HRT.

Aged↗