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PubMed1982

Changes in skin blood flow and body temperatures during climacteric hot flushes.

Blood velocity changes in the radial, temporal and lateral thoracic arteries have been measured quantitatively during climacteric hot flushes by means of an ultrasonic velocity meter. In the radial artery the median increase in velocity was 6 times greater than the basal velocity (range 4-10); in both the temporal and the lateral thoracic arteries the median increase was 1.5 (1.5-3). Simultaneous temperature measurements showed a fairly high increase in finger temperatures. An initial increase in temperature on the forehead was followed by a decrease. The core temperature measured on the tympanic membrane decreased. The pattern of blood velocity which increases during hot flushes, is identical to the pattern seen when someone is transferred to an uncomfortably high temperature. This similarity points to the hot flush as a time in which a heat loss occurs. As temperature measurements show no accumulation of heat prior to the flushes, it is reasonable to assume that hot flushes are the result of a central disorder of temperature regulation.

Adult↗
PubMed1984

Spontaneous skin flushing episodes in the aging female rat.

It is well known that with the loss of gonadal function most women experience hot flushes, characterized by a rapid regional increase in cutaneous blood flow. Animal models for this vasomotor syndrome have been elusive, thus hampering efforts to evaluate the endocrine and neuronal substrates of the hot flush. In this report, evidence is reported for the occurrence in aging female rats of spontaneous tail skin temperature (TST) fluctuations which are similar in amplitude, duration and frequency to hot flushes reported for peri-menopausal women. Paradoxically, these TST pulses occur in animals with senescent reproductive states in which serum estrogen levels are moderately elevated and ovariectomy eliminates these rat flushing episodes. This demonstration of steroid-dependent, spontaneous flushing episodes indicates that the aging female rat can be used to evaluate the neuronal and hormonal basis of vasomotor instability.

Age Factors↗
PubMed2006

Hot flushes in breast cancer patients.

OBJECTIVES: A literature search was conducted to gather information concerning the pathophysiologic mechanisms leading to hot flushes, their prevalence and severity in breast cancer patients, their influence on quality of life, and the best therapeutic option. METHODS: Relevant studies in English were selected from Medline. RESULTS AND CONCLUSION: Pathophysiologic mechanisms leading to hot flushes are poorly understood. Estrogen withdrawal is considered to have a central role. Also, serotonin and norepinephrine seem to be involved in hot flush induction. Menopause induced by chemotherapy or ovarian ablation, is accompanied by an abrupt decrease in estrogen level, causing vasomotor symptoms. Hot flushes are also a side effect of tamoxifen and aromatase inhibitors. Quality of life in breast cancer patients may be negatively influenced by hot flushes, and therefore, adequate treatment is important. Currently, of the several non-hormonal options, the selective serotonin-reuptake inhibitor (SSRI) venlafaxine is the most effective in breast cancer patients. However, studies on interaction between SSRIs and tamoxifen may influence future recommendations.

Anti-Anxiety Agents↗
PubMed2003

Assessment of leukemia inhibitory factor levels by uterine flushing at the time of egg retrieval does not adversely affect pregnancy rates with in vitro fertilization.

OBJECTIVE: To assess intrauterine levels of leukemia inhibitory factor (LIF) by uterine flushing at the time of egg retrieval and to confirm that the procedure has no detrimental effect on pregnancy rates. DESIGN: Prospective study. SETTING: Assisted reproductive unit of a university hospital. PATIENT(S): Uterine flushing was performed in 148 IVF patients. The first 100 patients were compared with a matched control group. INTERVENTION(S): Uterine flushing at the time of egg retrieval. MAIN OUTCOME MEASURE(S): IVP-ET results, pregnancy rates, and intrauterine LIF levels. RESULT(S): Pregnancy rates were not different in the group of patients with (27%) or without uterine flushing (28%). Leukemia inhibitory factor was detected in 60 patients (46%). Pregnancy rates did not differ between patients' detectable LIF and those in whom LIF was undetectable. Mean levels of LIF were 30.1 +/- 49.3 pg/mL and 28.6 +/- 51.2 pg/mL in pregnant and nonpregnant patients respectively. CONCLUSION(S): The flushing procedure at the time of egg retrieval did not adversely affect pregnancy rates. Leukemia inhibitory factor was detected in 46% of patients at the time of egg retrieval, but no correlation were observed with better pregnancy rates in patients with detectable LIF. Mean LIF levels did not differ in pregnant and nonpregnant women. Access to endoluminal secretions of the endometrium during IVF-ET may represent a new research in human implantation.

Adult↗
PubMed2003

Effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the pulsatility index of the uterine and cerebral arteries.

OBJECTIVE: To determine the effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the vascular reactivity of uterine and cerebral arteries. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Healthy volunteers in an academic research environment. PATIENT(S): Sixty-two postmenopausal women aged 45-60 years attending the Outpatient Menopause Clinic of our gynecological departments. INTERVENTION(S): The patients were administered 72 mg of soy-derived isoflavones or placebo under double-blind conditions. The daily number of hot flushes was recorded in a diary. Endometrial thickness was measured by means of transvaginal ultrasound; the uterine, internal carotid, and middle cerebral arteries were evaluated using Doppler ultrasound. MAIN OUTCOME MEASURE(S): The daily number of hot flushes, endometrial thickness, and arterial pulsatility index (PI). RESULT(S): Both treatments led to a 40% reduction in the number of hot flushes. Soy-derived isoflavones had no effect on endometrial thickness or the PI of the uterine and cerebral arteries. CONCLUSION(S): The daily administration of 72 mg of soy-derived isoflavones is no more effective than placebo in reducing hot flushes in postmenopausal women. It also has no effect on endometrial thickness or the PI of the uterine and cerebral arteries.

Cerebral Arteries↗
PubMed1992

A prospective randomized study comparing aspiration only with aspiration and flushing for transvaginal ultrasound-directed oocyte recovery.

OBJECTIVE: To compare aspiration only with aspiration and flushing of ovarian follicles during transvaginal ultrasound (US)-directed oocyte recovery. DESIGN: Prospective randomized study. PATIENTS: One hundred patients who were undergoing an in vitro fertilization (IVF) treatment cycle. INTERVENTIONS: All patients underwent pituitary desensitization before the administration of gonadotropins. Monitoring of ovarian stimulation and the criteria for the administration of human chorionic gonadotropin were similar in both groups. In patients in whom aspiration alone was used, each follicle was aspirated until it was empty. The US probe was then rotated until every drop of follicular fluid had been aspirated before the next follicle was aspirated and the procedure repeated. For patients who had aspiration and flushing, each follicle was aspirated and then flushed up to a maximum of six times before moving to the next follicle. In both groups, all follicles greater than 10 mm were aspirated. RESULTS: The indication for IVF and mean age of the patients were comparable in the two groups. There were no significant differences between the aspiration and the aspiration and flushing groups in terms of the number of oocytes retrieved (11 versus 9), the oocyte recovery rates (77.5% versus 77.0%), the fertilization rates (55.6% versus 60.0%), the number of embryos transferred (2 versus 2), or the number of clinical pregnancies (12 versus 13). The time taken for oocyte recovery was significantly shorter (15 versus 30 minutes, P less than 0.00001), and the dose of pethidine required significantly less (50 mg versus 100 mg, P less than 0.00001) in the aspiration only group. CONCLUSIONS: Aspiration alone produces comparable oocyte recovery rates as aspiration and flushing while significantly reducing the length of the procedure and the dose of analgesia required. Aspiration alone suffices for virtually all cases during transvaginal US-directed oocyte recovery.

Adult↗
PubMed1994

Prevalence and duration of hot flushes after surgical or medical castration in men with prostatic carcinoma.

A total of 77 men with prostatic carcinoma treated with orchiectomy or a gonadotropin releasing hormone analogue before September 1987 underwent evaluation by a questionnaire regarding vasomotor symptoms. Answers were received from 84% of the patients. Of 63 patients 43 (68%) reported hot flushes during treatment, while 30 (48%) still had flushes 5 years after treatment. Of the latter 30 patients 28 (median 7.6 years after treatment) had vasomotor symptoms at the time of the study. Only 13 of 43 men with vasomotor symptoms after the start of treatment had relief 5 years later. At the time of the study 13 of 30 patients (more than 40%) still had flushes 8 years after castration. Most men reported that the flushes presently had the same frequency and duration as when they started therapy. Contrary to the general belief that the symptoms disappear with time, our study highlighted a long persistence of hot flushes after castration.

Aged↗
PubMed2000

Transdermal estrogen in the treatment of hot flushes in men with prostate cancer.

OBJECTIVES: To assess the effectiveness and tolerability of transdermal estrogen in men with hot flushes after hormonal therapy for prostate cancer. METHODS: Twelve men with moderate to severe hot flushes were randomized to receive either low-dose (0.05 mg) or high-dose (0.10 mg) estrogen patches applied twice weekly for 4 weeks. After a 4-week washout period in which no treatment was given, each patient received the alternative dose for 4 weeks. Treatment response was assessed by daily logs and questionnaires completed every 4 weeks that included a visual analog assessment. Serum luteinizing hormone, follicle-stimulating hormone, testosterone, and estradiol levels were also measured every 4 weeks during the study. RESULTS: There was a significant reduction in the overall severity of the hot flushes seen in patients with both the low and high-dose estrogen patch. A significant reduction in the daily frequency of the hot flushes was seen with the high-dose patch only. Overall, 10 (83%) of 12 men reported either mild, moderate, or major improvement in symptoms with either the low or high-dose patch. Mild, painless breast swelling or nipple tenderness was noted in 2 (17%) and 5 (42%) of 12 men treated with the low and high-dose estrogen patch, respectively. FSH levels decreased significantly with both the low and high-dose patch. Estradiol levels increased from 12.1 to 16.4 pg/mL and 26.9 pg/mL with the low and high-dose patch, respectively. There was no significant change in serum testosterone or luteinizing hormone levels. CONCLUSIONS: Transdermal estrogen appears to be a promising, well-tolerated therapy for men with hot flushes after endocrine treatment for prostate cancer. Further study in larger groups of patients is necessary to assess the relative effectiveness and morbidity of this treatment.

Administration, Cutaneous↗
PubMed2003

Improvement in recovery of embryos/ova using a shallow uterine horn flushing technique in superovulated Holstein heifers.

The aim of this study was two-fold: (1). to compare recovery of embryos/ova from superovulated Holstein heifers by flushing the uterine horns through insertion of the catheter very close to the tip of the horn (deep) or just after the uterine bifurcation (shallow) and (2). to evaluate the hormonal and superovulatory response to estradiol benzoate (EB) treatment prior to superovulation. Ten Holstein heifers (12-16 months) underwent two superovulatory treatments in a cross-over design. Heifers were treated with decreasing doses of FSH from Days 8 to 12.5 of a synchronized estrous cycle. At 4 days prior to superovulation, half of the heifers received EB (5mg, i.m.) or served as Controls, followed by the alternative treatment in the subsequent superovulation. At embryo recovery, one uterine horn was flushed with deep ( approximately 7 cm caudal to the tip of the horn) and the other with shallow ( approximately 5 cm cranial to the beginning of the uterine bifurcation) flushing techniques. Embryos/ova were recovered, counted, and scored. Number of ovulations was estimated by ultrasound. Pretreatment with EB reduced circulating FSH and regressed the first wave dominant follicle with no change in number of large follicles, number of ovulations, number of embryos/ova recovered, or number of transferable embryos. The shallow flushing technique was superior to the deep technique for number of embryos/ova recovered per horn (5.4+/-1.1 versus 3.9+/-0.8) or percentage of embryos/ova recovered per CL (63.9+/-8.6% versus 37.4+/-6.5%). Thus, flushing the entire uterine horn increased recovery of embryos/ova.

Administration, Intravaginal↗
PubMed1998

Influence of flushing on LH secretion, follicular growth and the response to estrus synchronization treatment in suckled beef cows.

The effects of energy supplementation (flushing) on LH and estradiol secretion, follicular growth and the response to estrus synchronization treatment (Norgestomet + PMSG initiated 41.9 +/- 3.4 d after calving) were investigated in 16 suckled beef cows fed either 70% (Group C, n = 8) of energy requirements from calving to 3 wk after AI or fed the same restricted diet until 11 d before synchronization and then were supplemented with 2 kg concentrate until 3 wk after AI (Group S, n = 8). Concentrations of LH and estradiol 17 beta were measured from 3 sampling periods: 25 and 39 d after calving and between 29 and 49 h after implant removal. Ovaries were examined by ultrasonography 11 d before treatment to implant withdrawal (IR). The effects of energy level, day (or hour) of observation and corresponding interactions were tested on repeated measurements by split-plot ANOVA. No positive effect of flushing was observed on characteristics of LH secretion on Day 39. However, the size of the largest follicle and the number of large follicles were higher in Group S than in Group C cows, respectively, 7 and 9 d after the beginning of flushing to 2 d after the start of treatment. After IR, the estradiol secretion tended to be higher in Group S than in Group C cows (9.8 +/- 0.4 pg/mL vs 7.2 +/- 0.2 pg/mL; P = 0.06), but no effect on LH secretion was observed. After implant removal 12 cows ovulated (Group S: 7/8 vs Group C: 5/8; P > 0.05), 7 were pregnant at 21 d after AI (Group S: 6/8 vs Group C: 1/8; P < 0.05) and 4 at 45 d after AI (Group S: 4/8 vs Group C 0/8; P > 0.05). To conclude, flushing had a positive effect on follicular growth, which does not seem to be mediated by LH. In cows fed a restricted diet, flushing enhanced follicular growth, increased the fertilization rate and/or reduced early embryonic death.

Animals↗
PubMedDate not supplied

Effects of estrogen replacement therapy on rates of cyclic alternating patterns and hot-flush events during sleep in postmenopausal women: a pilot study.

The objective of this pilot study was to evaluate the effects of conjugated estrogens on the rates of cyclic alternating patterns of sleep (CAPS) and nocturnal hot flushes in symptomatic postmenopausal women. Seven postmenopausal or posthysterectomy women aged 45 to 60 years with nocturnal diaphoresis and/or hot flushes participated in this study. The study was conducted with a single-masked design using a matching placebo. The placebo baseline was followed by a 4-week, single-masked treatment of conjugated estrogens 0.625 mg taken 4 hours before bedtime. Each patient's sleep was monitored in the laboratory for 3 consecutive nights during placebo baseline and again for 3 consecutive nights after an at-home period of at least 24 days of estrogen replacement therapy. Estrogen therapy resulted in a statistically significant decrease in the overall number of hot flushes and the number of hot hot flushes associated with awakenings, as well as improvement in sleep efficiency and a reduction in the rate of CAPS. These data confirm earlier well-established reports that estrogens reduce the frequency of hot flushes and suggest that the frequency of nocturnal arousals decreases and sleep quality improves in conjunction with a reduction in the rate of CAPS.

Climacteric↗
PubMed2004

Controlled release, blind test of DNAPL remediation by ethanol flushing.

A dense nonaqueous phase liquid (DNAPL) source zone was established within a sheet-pile isolated cell through a controlled release of perchloroethylene (PCE) to evaluate DNAPL remediation by in-situ cosolvent flushing. Ethanol was used as the cosolvent, and the main remedial mechanism was enhanced dissolution based on the phase behavior of the water-ethanol-PCE system. Based on the knowledge of the actual PCE volume introduced into the cell, it was estimated that 83 L of PCE were present at the start of the test. Over a 40-day period, 64% of the PCE was removed by flushing the cell with an alcohol solution of approximately 70% ethanol and 30% water. High removal efficiencies at the end of the test indicated that more PCE could have been removed had it been possible to continue the demonstration. The ethanol solution extracted from the cell was recycled during the test using activated carbon and air stripping treatment. Both of these treatment processes were successful in removing PCE for recycling purposes, with minimal impact on the ethanol content in the treated fluids. Results from pre- and post-flushing partitioning tracer tests overestimated the treatment performance. However, both of these tracer tests missed significant amounts of the PCE present, likely due to inaccessibility of the PCE. The tracer results suggest that some PCE was inaccessible to the ethanol solution which led to the inefficient PCE removal rates observed. The flux-averaged aqueous PCE concentrations measured in the post-flushing tracer test were reduced by a factor of 3 to 4 in the extraction wells that showed the highest PCE removal compared to those concentrations in the pre-flushing tracer test.

Environmental Pollutants↗
PubMed2002

Androgens and estrogens in relation to hot flushes during the menopausal transition.

In this paper, the association of hormones to vasomotor complaints during the menopausal transition is discussed. Fifty-seven regularly menstruating women without history of hormone replacement therapy (HRT) were selected for a longitudinal, prospective study around the menopausal transition. The mean age at the start of the study was 51.3 (+/-2.0) years. At intervals of 12 months all women went through a semi-structured interview and filled in questionnaires. Venous blood samples were collected every 12-month for analyses of estradiol (E2), testosterone, androstendione, dehydroepiandrosterone-sulphate (DHEA-S), follicle stimulating hormone (FSH), thyrotropin (TSH), and luteinizing hormone (LH). Vasomotor complaints were tested using questions about hot flushes and bouts of sweating in terms of occurrence, frequency and degree of distress. Forty-six percent of the subjects reported hot flushes and bouts of sweating before menopause, increasing to 67% during the first year after menopause and 49% in the second year postmenopause. Low levels of estradiol and high levels of FSH were associated with vasomotor complaints before menopause. During menopause high levels of TSH were related to vasomotor complaints. The first year after menopause, women, who at this point achieved hot flushes, were characterised by high levels of E2, but declining and low levels of FSH, but increasing. Postmenopausal, high levels of testosterone and DHEA-S seemed to protect against vasomotor symptoms. Our most important finding was, that among women who achieved hot flushes at the first assessment postmenopause, the high androgen levels was a significant predictor of recovery from hot flushes at the last assessment, 1 year later.

Androstenedione↗
PubMed1999

Some relationships between perceived control and women's reported coping strategies for menopausal hot flushes.

OBJECTIVES: This questionnaire study compared the patterns of reported coping strategies of women high and low in perceived control over hot flushes. METHOD: A volunteer sample of 38 women fully completed a postal questionnaire. Perceived control was measured by a standardised scale (Reynolds F. Maturitas 1997a;27:215-221) and respondents provided qualitative accounts of coping. RESULTS: Consonant with previous findings that higher perceived control is associated with lower distress, the data indicated that women high in self-rated perceived control tended to describe more numerous coping strategies to manage both the physical and socio-emotional discomfort of flush episodes. Preventive strategies were infrequently adopted in both groups. However, the links between distress, control and coping were complex and subject to several influences. Those feeling low in control tended to report rather more numerous flushes (although the differences did not quite reach significance). Also, qualitative analysis of coping strategies suggested that it is not always coping behaviour per se that differentiates more and less distressed women, but attitudes towards these behaviours. A coping strategy (such as wearing cotton fabrics) that seems satisfactory to one women may fundamentally challenge the body-image of another, increasing distress by making her feel drab and different from her pre-menopausal self. Also, women often make reference to situational influences on their coping choices. CONCLUSION: The data support further enquiries into the role of psychological interventions to enhance strategies for coping with hot flushes. Some relationships occur between perceived control and women's reported coping strategies for menopausal hot flushes.

Adaptation, Psychological↗
PubMed2002

The optimal pressure for initial flush with UW solution in heart procurement.

OBJECTIVE: University of Wisconsin (UW) solution is widely used in organ preservation. Some investigators have reported that high pressure during initial flush with UW solution may induce vasoconstriction and endothelial damage, because of its high potassium content and high viscosity. However, using lower pressure during the initial flush may lead to irregular distribution of the solution and incomplete flushing of blood components from coronary vascular beds. This experimental study evaluated the effects of a range of initial flush pressures during heart procurement, followed by orthotopic transplantation of the graft after 12 hours of preservation. MATERIALS AND METHODS: Twelve pairs of adult mongrel dogs, weighing 9 to 14 kg, formed the recipient-donor combinations. After determining hemodynamic status by measuring cardiac output, left ventricular pressure (LVP), and maximum positive and negative change in LVP (+/-LVdP/dt), donor hearts were excised. Coronary vascular beds were flushed with 4 degrees C UW solution at a pressure of 60 mm Hg in the low-pressure group (n = 6) and at 120 mm Hg in the high-pressure group (n = 6). After 12 hours of cold preservation, orthotopic transplantation was performed using cardiopulmonary bypass (CPB). The hemodynamics of the transplanted graft were assessed by comparing recovery rates (%) from donor hearts 2 hours after weaning from CPB. Endothelin-1 (ET-1) levels were measured in the blood obtained from the coronary sinus 30 minutes after reperfusion. The transplanted grafts were then harvested for histologic study and measurement of adenosine triphosphate (ATP) content. RESULTS: Cardiac output, LVP, LVdP/dt and myocardial tissue ATP content were significantly better (p < 0.05) in the high-pressure group than in the low-pressure group. We found no significant differences in ET-1 levels between the groups. Transmission electron microscopic findings revealed that degeneration of the mitochondria was less extensive in the high-pressure group than in the low-pressure group. We observed no obvious ultrastructural damage to the endothelial cells in either group. CONCLUSION: When using UW solution in heart procurement, high pressure is better to completely wash out the blood components and distribute the solution.

Adenosine↗
PubMedDate not supplied

[Effectiveness of heparin versus NaCl 0.9% in central venous catheter flushing. A systematic review].

OBJECTIVE: To determine the effects of intermittent flushing with heparin versus NaCl 0.9% solution on prevention of thrombotic events and infections in central venous catheters. METHOD: A systematic review of controlled trials, randomized or not, in whose intermittent flushing with heparin versus NaCl 0.9% in central venous catheters were compared was carried out. Any publication was excluded because of patients age, country or language. Studies were identified by computerised searches (MEDLINE and CINAHL 1996-2004, EMBASE Drugs and Pharmacology 1991-2004, Cochrane Library up 2005, ISI Web of knowledge 1990-2004), clinical trials metaregister http://www. controlled-trials.commrct/mrct_info_es.asp, and scanning references. RESULTS: Only two clinical trials, involving 94 patients, fulfilled inclusion criteria for obstruction. Methodological quality of trials was poor and heterogenicity was also very significant. It made impossible meta-analytical combination of results. No studies comparing heparin vs. NaCl 0.9% solution flushing in catheter-related infection prophylaxis were reported. CONCLUSIONS: Poor evidence supports effectiveness of intermittent heparin flushing vs. NaCl 0.9% solution, although methodological limitations and small sample size make these findings very inconsistent. In infection prophylaxis, there is no data allowing us to conclude if heparin flushing is more effective than NaCl 0.9% solution. More randomized clinical trials are needed.

Catheterization, Central Venous↗
PubMed2006

Flushing the endometrium prior to the embryo transfer does not affect the pregnancy rate.

This study aimed to determine whether direct flushing of endometrial cavity with culture media just after cervical irrigation at the time of embryo transfer has any effect on pregnancy rates. A total of 240 women were prospectively randomised; one group of patients (group 1) underwent intrauterine direct flushing of endometrial cavity with culture media just after cervical irrigation at the time of embryo transfer as detected by transabdominal ultrasound and the other group of patients (group 2) had cervical flushing but did not undergo intrauterine flushing. Pregnancy (positive human chorionic gonadotrophin) rates were 57.5% and 62.9% for group 1 and group 2, respectively. Clinical pregnancy (positive fetal heart rate) rates were 45.2% and 51.4% for group 1 and group 2, respectively. Implantation rates were 20.0% and 21.2% for group 1 and group 2, respectively. Ongoing pregnancy (>12 weeks of pregnancy) rates were 47.9% and 47.2% for group 1 and group 2, respectively. There were no significant differences in pregnancy rates, clinical pregnancy rates, implantation rates and ongoing pregnancy rates between the two groups. In conclusion, even direct flushing of media into the uterine cavity neither improves nor adversely affects the pregnancy rate.

Adult↗
PubMed1982

Aspirin blocks nicotinic acid-induced flushing.

Nicotinic acid flushing after placebo and 975-mg oral doses of aspirin was assessed in 29 normal subjects over a range of nicotinic acid doses. Intensity of flushing was assessed by the change in malar thermal circulation index (delta MTCI). Aspirin pretreatment resulted in smaller delta MTCIs at the higher doses of nicotinic acid. At the lower doses the change in the index after pretreatments with both aspirin and placebo remained low, suggesting that very little flushing was provoked by these doses. These results are compatible with the proposed mediation by prostaglandins of the nicotinic acid-induced flush. According to the delta MCTI method, flushing is quantitatively characterized as a nonquantal, dose-response reaction of variable intensity.

Adult↗