96137544 Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer

Medic,ine.

Medical

.?71c7- 1040 FERTIL. STERIL.

Center

Boulecurd.

Winston

-Salem.

.VC‘

1996 655 (1031- 1035)

Objective: To evaluate the effects of conjugated equine estrogens. medroxyprogesterone acetate (MPA), conjugated equine estrogens combined with MPA, tamoxifen, and soybean estrogens on vaginal cytology in surgically postmenopausal cynomolgus macaques (Macaca firscwdari5 ). Design: Randomized long-term experimental trial. Setting: Cytologic samples were taken from animals in two longterm randomized studies of the effects of hormonal and dietary effects on atherosclerosis. Patients: Surgically postmenopausal cynomolgus macaques. Interventions: Conjugated equine estrogens. MPA, conjugated equine estrogens combined with MPA. tamoxifen, and soybean estrogens were given via the diet. at doses scaled from those given to women. Main Outcome Measure: Vaginal cytologic maturation index. Results: Conjugated equine estrogens elicited a marked maturation effect, which was antagonized partially by the addition of MPA. Tamoxifen produced a lesser estrogenic response. The cytologic pattern in animals given soybean estrogens or MPA alone did not differ from that of controls. Conclusion: Soybean estrogens at the doses given do not exert an estrogenic effect on the vagina of macaques. Conjugated equine estrogens are potent inducers of vaginal keratinization in this model; tamoxifen has a lesser effect. Medroxyprogesterone acetate partially antagonizes the effects of conjugated equine estrogens, and has no effect when given alone. The results support the possibility that soybean estrogens may be a ‘tissue-selective’ estrogen with minimal effects on the reproductive tract. 96135202 Carotid

plaque

regression

on

oestrogen

replacement:

A

pilot

study

Akkad A.; Hartshorne T.; Bell P.R.F.; Al-Azzawi

F.

Menopause Research ogy, Leicester Royal

Gynaecol-

Unit, Department Infirmary. Leicster

EUR. J. VASC. ENDOVASC.

Obstetrics LE2 7LX

SURG. 1996 11/3 (3477348)

Objective: To investigate the effect of unopposed oestrogen on atheromatous carotid plaques. Subjects: Seventeen postmenopausal women with known carotid disease. Methods: Carotid intimal thickness and plaque length and thickness were measured prior to and following 3 and 6 months of treatment, using Duplex ultrasound. A total of 22 plaques were followed up. Results: There was a reduction in plaque length after 3 (- 8.14%~. P = 0.001) and 6 months ( - 28%. P = 0.001) of treatment. The reduction in plaque thickness ( - 18%. P = 0.004) was significant after 6 months of treatment. Reductions in intimal thickness were not statistically significant. Conclusion: Our results suggest that oestrogen replacement is associated with significant plaque regression.

96335215 A double-blind, double-dummy, Menorest 50@ versus Premarin”’ menopausal tients with

symptoms menopausal

0.625

comparative study mg in the treatment

and the prevention symptoms

of bone

loss

of of in pa-

Studd J.W.W.: McCarthy Lann L.

K.: Zamblera D.: Darn M.P.: 1~

Chelsra fmd SW10 9NH

Hospital.

Wesfminster

CLIN. DRUG

INVEST.

Adham

Road.

Lotu/orr

1996 II:4 (205m 213)

Thirty-two menopausal women entered the study ( I6 in each treatment group). of whom 24 completed the trial. The objectives were to investigate the long term efficacy and the local and systemic tolerance of Menorest 50’” and Premarin” in the control of menopausal symptoms. After a 4-week treatmentfree run-in period, patients were treated with continuous estrogen therapy (a twice-weekly application with Menorest 50” or a daily oral administration of Premarin@ 0.625 mg) for I year. plus a sequential progestin. The main efficacy criterion as the reduction in the mean number of hot flushes per day at 12 months. This study was considered to be a pilot study to collect data on changes in the bone mineral density of lumbar spine (Ll-L4) assessments from baseline to weeks 30 and 56. Menorest 50@ and Premarina produced similar results in the relief of menopausal symptoms over the l-year period of treatment. The mean number of hot flushes per day decreased from 6.9 at baseline to 0.5 at 12 weeks and 0.1 at 12 months in the Menorest 50@ group, and from 7.0 to 0.3 and 0.0. respectively, in the Premarin@ group. The lumbar spine and hip densitometry results revealed that Menorest 50a prevented bone loss to the same extent as Premarin*. Tolerance was similar, with approximately the same number of patients with adverse events, severe adverse events and related-to-study-drug adverse events in both groups. Menorest 50’” and Premarin” 0.635 mg demonstrated similar results over the l-year treatment period in reducing the mean number of hot flushes and the severity score of menopausal symptoms, including vasomotar, psychological and urogenital symptoms.

96137544 Ovarian function chemotherapy

in premenopausal for

breast

women

treated

with

adjuvant

qf

Internal Harrison.

cancer

Bines J.; Oleske D.M.; Cobleigh M.A. Division Medicine, Chicago,

oj

HematologylOncology~ Rush-Presbyterian-SLMC. IL 60612

J. CLIN. ONCOL.

Department 1725

W

1996 14/5 (171881729)

Purpose: Adjuvant chemotherapy for breast cancer causes significant changes in ovarian function. More young women survive breast cancer than ever before and they are at risk of the sequelae of early menopause. We attempted to: (I) define menopausal states in the setting of adjuvant chemotherapy; (2) define chemotherapy-related amenorrhea (CRA); (3) document rates of permanent amenorrhea, temporary amenorrhea, and oligomenorrhea among different regimens; and (4) analyze

Abstract

section

I Maturitas

variables that influence ovarian function. Design: We reviewed reports of theeffects of adjuvant chemotherapy for breast cancer on ovarian function in premenopausal women. We searched Medline and Cancerlit from 1966 to 1995 on the following terms: breast neoplasms; chemotherapy, adjuvant; menstruation disorders; premature menopause; and amenorrhea. Further references were obtained from reports retrieved in the initial search. Results: A uniform definition of menopause and CRA is lacking. The wide range of CRA rates reported in adjuvant chemotherapy trials is a result, at least in part, of this problem. The average CRA rate reported in regimens based on cyclophosphamide, methotrexate, and fluorouracil (CMF) is 68% (95% confidence interval [CI], 66-70X), with a range of 20- 100%. CRA incidence varies with age, cytotoxic agent, and cumulative dose. Conclusion: Ovarian damage is the most significant long-term sequela of adjuvant chemotherapy in premenopausal breast cancer survivors We suggest a common definition of the following important terms: menopausal status, CRA (early and late), temporary CRA, and oligomenorrhea in the setting of adjuvant treatment. With uniform definitions in place, regimens can be more precisely compared with respect to this important complication. 96142537 Risk factors for central retinal vein occlusion Yannuzzi L.A.; Sorenson J.A.; Sobel RX; Daly J.R.; DeRosa J.T.; Seddon J.M.; Gragoudas E.S.; Puliafito C.A.; Gelles E.; Gonet R.; Burton T.C.; Culver J.; Metzger K.; Kalbfleish N.; Zarling D.; Farber M.D.; Blair N.; Stelmack T.; Sperduto R.D.; et al. Division of Biometry/Epidemiology, MSC 2510, 31 Center Dr, Bethesda,

ARCH. OPHTHALMOL.

National Eye MD 20892-2510

Institute,

1996 114/5 (545-554)

Objective: To identify possible risk factors for central retinal vein occlusion (CRVO). Design: Between May 1, 1986, and December 31, 1990, 258 patients with CRVO and 1142 controls controls were identified at five clinical centers. Data were obtained through interviews, clinical examinations, and laboratory analyses of blood specimens. Results: An increased risk of CRVO was found in persons with systemic hypertension, diabetes mellitus, and open-angle glaucoma. Risk of CRVO decreased with increasing levels of physical activity and increasing levels of alcohol consumption. In women, risk of occlusion decreased with use of postmenopausal estrogens and increased with higher erythrocyte sedimentation rates. Cardiovascular disease, electrocardiographic abnormalities, history of treatment of diabetes mellitus, higher blood glucose levels, lower albumin-globulin ratios, and higher l-globulin levels were associated with increased risk only for ischemic CRVO. Systemic hypertension was associated with increased risk for ischemic and nonischemic CRVO, but odds ratios were greater for the ischemic type. Conclusions: our results suggest a cardiovascular risk profile for persons with CRVO, in particular, patientsa with the ischemic type. The findings reinforce recommendations to diagnosse and treat systemic hypertension, advise patients to increase physical exercise, aand consider use of exogenous estrogens in postmenopausal women.

25 (1996)

157

155-159

96131949 Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women Kushi L.H.; Folsom A.R.; Prineas R.J.; Mink P.J.: Wu Y.; Bostick R.M. Division Health,

of Epidemiology, Minnesota 1300 S. Second St., Minneapolis,

Univ. MN

School Public 55454-1015

NEW ENGL. J. MED. 1996 334/18 (115661162) Background: The role of dietary antioxidant vitamins in preventing coronary heart disease has aroused considerable interest because of the knowledge that oxidative modification of low-density lipoprotein may promote atherosclerosis. Methods: We studied 34486 postmenopausal women with no cardiovascular disease who in early 1986 completed a questionnaire that assessed, among other factors, their intake of vitamins A, E, and C from food sources and supplements. During approximately seven years of follow-up (ending December 31, 1992), 242 of the women died of coronary heart disease. Results: In analyses adjusted for age and dietary energy intake. vitamin E consumption appeared to be inversely associated with the risk of death from coronary heart disease. This association was particularly striking in the subgroup of 21 809 women who did not consume vitamin supplements (relative risks from lowest to highest quintile of vitamin E intake, 1.0. 0.68, 0.71. 0.42, and 0.42; P for trend, 0.008). After adjustment for possible confounding variables, this inverse association remained (relative risks from lowest to highest quintile, 1.0, 0.70, 0.76, 0.32, and 0.38; P for trend, 0.004). There was little evidence that the intake of vitamin E from supplements was associated with a decreased risk of death from coronary heart disease, but the effects of high-dose supplementation and the duration of supplement use could not be definitively addressed. Intake of vitamins A and C did not appear to be associated with the risk of death from coronary heart disease. Conclusions: These results suggest that in postmenopausal women the intake of vitamin E from food is inversely associated with the risk of death from coronary heart disease and that such women can lower their risk without using vitamin supplements. By contrast, the intake of vitamins A and C was not associated with lower risks of dying from coronary disease. 96153999 Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures Marshall D.; Johnell 0.; Wedel H. Dept. Health,

Epidemiology Box 12133,

Biostatistics, Nordic S-40242 Gothenhurg

School

of’ Public

BR. MED. J. 1996 312/7041 (125441259) Objective: To determine the ability of measurements of bone density in women to predict later fractures. Design: Meta-analysis of prospective cohort studies published between 1985 and end of 1994 with a baseline measurement of bone density in women and subsequent follow up for fractures. For comparative purposes, we also reviewed case control studies of hip