Bioidentical hormone therapy (BHT) refers to the use of hormones that are molecularly and chemically identical to endogenous hormones for purposes of hormone replacement therapy. The specific hormones used in BHT include estrone, estradiol, estriol, progesterone and testosterone. Since the result of the Women's Health Initiative (WHI) trial documented the increased risk of breast cancer, cardiovascular disease and stroke in users of conventional hormone therapy (CHT), use of CHT has declined and there has been increased interest in BHT. Bioidentical hormones have some distinctly different physiologic effects compared with synthetic hormones. Synthetic progestin is associated with an increased risk for breast cancer and cardiovascular disease, while natural progesterone is associated with a decreased risk of breast cancer and cardiovascular disease. Estriol has some unique physiologic effects, which differentiate it from estrone and estradiol. Estriol is associated with a lower risk of breast cancer and would be expected to prevent breast cancer, but few randomized controlled trials have been documented. Some clinical data demonstrate that BHT is associated with a lower risk of breast cancer and cardiovascular disease, and is more efficacious than synthetic hormones. However, there is little evidence in support of this claim. Moreover, estriol has not been approved by the U.S. Food and Drug Administration (FDA). Further studies are needed to confirm the safety and efficacy of BHT.
Breast Neoplasms ; Butylated Hydroxytoluene ; Cardiovascular Diseases ; Estradiol ; Estriol ; Estrone ; Female ; Hormone Replacement Therapy ; Humans ; Menopause ; Progesterone ; Stroke ; Testosterone ; United States Food and Drug Administration ; Women's Health

Bioidentical hormone therapy (BHT) refers to the use of hormones that are molecularly and chemically identical to endogenous hormones for purposes of hormone replacement therapy. The specific hormones used in BHT include estrone, estradiol, estriol, progesterone and testosterone. Since the result of the Women's Health Initiative (WHI) trial documented the increased risk of breast cancer, cardiovascular disease and stroke in users of conventional hormone therapy (CHT), use of CHT has declined and there has been increased interest in BHT. Bioidentical hormones have some distinctly different physiologic effects compared with synthetic hormones. Synthetic progestin is associated with an increased risk for breast cancer and cardiovascular disease, while natural progesterone is associated with a decreased risk of breast cancer and cardiovascular disease. Estriol has some unique physiologic effects, which differentiate it from estrone and estradiol. Estriol is associated with a lower risk of breast cancer and would be expected to prevent breast cancer, but few randomized controlled trials have been documented. Some clinical data demonstrate that BHT is associated with a lower risk of breast cancer and cardiovascular disease, and is more efficacious than synthetic hormones. However, there is little evidence in support of this claim. Moreover, estriol has not been approved by the U.S. Food and Drug Administration (FDA). Further studies are needed to confirm the safety and efficacy of BHT.
Breast Neoplasms ; Butylated Hydroxytoluene ; Cardiovascular Diseases ; Estradiol ; Estriol ; Estrone ; Female ; Hormone Replacement Therapy ; Humans ; Menopause ; Progesterone ; Stroke ; Testosterone ; United States Food and Drug Administration ; Women's Health

OBJECTIVE: Elective surgical approaches and trauma cause changes in the production of different cytokines. The aim of this study was to evaluate the effects of laparoscopic surgery on the immune system of patients with gynecologic diseases. METHODS: We recruited the open surgery group (n=20) and laparoscopic surgery group (n=33). In a prospective study we examined the C-reactive protein (CRP) level, the production of the cytokines Interleukin-1beta (IL-1beta), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and TNF-alpha concentrations by ELISA. In addition the fibrinogen, transferrin, albumin, hemoglobin and hematocrit were measured. Statistical analysis was made by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: There were significant statistical differences in the CRP, IL-6 and IL-8 between the open surgery group and laparoscopic surgery group after surgery. The CRP and IL-8 showed a more distinct increase in open surgery group 24 hours after surgery, the differences between the two surgical approaches were significant (p<0.05). CONCLUSION: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines. Laparoscopic surgery cause less activation of the CRP and IL-8 than open surgery.
C-Reactive Protein ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrinogen ; Genital Diseases, Female* ; Hematocrit ; Humans ; Immune System* ; Interleukin-10 ; Interleukin-1beta ; Interleukin-6 ; Interleukin-8 ; Laparoscopy* ; Prospective Studies ; Transferrin ; Tumor Necrosis Factor-alpha

OBJECTIVE: To investigate the relationship between Fas gene & Fas-ligand gene polymorphisms, and bone mineral density (BMD) after hormone therapy (HT) in postmenopausal women. METHODS: Restriction fragment length polymorphisms at the Fas A670G, G1377A gene site and Fas-ligand C843T, IVS3nt169 (T/delT) gene site and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal women receiving sequential HT for 1 year. BMD were measured by DEXA. The subjects were divided in normal, osteopenic and osteoporotic on the basis of the T-score values according to the classification of the World Health Organization (WHO). RESULTS: After adjusting for potential confounding factors such as age, BMI, and menopause duration, A670G polymorphism was significantly associated with BMD at the lumbar spine, the femur neck and trochanter in osteopenic and osteoporotic groups, and G1377A polymorphism was significantly associated with BMD at lumbar spine and the femur neck in osteopenic group. C843T polymorphism was significantly associated with BMD at lumbar spine and ward triangle in osteoporotic group, IVS3nt169 (T/delT) was not associated with BMD. In osteoporotic group after HT in postmenopausal women, A670G polymorphism A/A, G1377A polymorphism G/G, C843T polymorphism T/T were associated with significant annual bone mineral density change, compared with other polymorphism at the same gene. CONCLUSION: These findings suggest that Fas, Fas-ligand gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal women. and that a specific Fas, Fas-ligand polymorphisms are associated with significant BMD change in postmenopausal women after HT.
Bone Density ; Classification ; Female ; Femur ; Femur Neck ; Humans ; Menopause ; Osteoporosis ; Polymorphism, Restriction Fragment Length ; Spine ; World Health Organization

During the menopausal transition there are changes in body fat and its disrtribution, and central adiposity is associated with the metabolic complications such as insulin resistance and dyslipidemia. Adipose tissue is increasingly recognized as an endocrine organ with many secretory products and a part of the innate immune system. With obesity, macrophages infiltrate into adipose tissue, and numerous adipokines and cytokines are secreted by both macrophages and adipocytes. The adipokines play important roles in the pathogenesis of metabolic complications such as insulin resistance, dyslipidemia, hypertension, ectopic fat accumulation, type 2 diabetes, and cardiovascular disease. It has been shown that adipocytes secrete several proteins including tumor necrosis factor-alpha (TNF-alpha), IL-6 and adipokines such as leptin, adiponectin, resistin, retinol binding protein 4, visfatin. Adiponectin improves insulin sensitivity, but leptin, resistin, pro-inflammatory cytokines increase insulin resistance. It is well known that menopause is associated with notable change in levels of the adipokines toward the direction to increase of metabolic complications, but the influence of menopause on adipokine levels is still poorly understood. Further studies are needed to understand the relationship of adipokines and metabolic syndrome, cardiovascular disease in the postmenopausal women.
Adipocytes ; Adipokines ; Adiponectin ; Adipose Tissue ; Adiposity ; Cardiovascular Diseases ; Carrier Proteins ; Cytokines ; Dyslipidemias ; Female ; Humans ; Hypertension ; Immune System ; Insulin Resistance ; Interleukin-6 ; Leptin ; Macrophages ; Menopause ; Nicotinamide Phosphoribosyltransferase ; Obesity ; Postmenopause ; Proteins ; Resistin ; Tumor Necrosis Factor-alpha ; Vitamin A

OBJECTIVE: To examine the relationship between Osteoprotegerin gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Osteoprotegerin A163G (promoter), G1181C (exon 1) gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. RESULTS: The distribution of A163G and G1181C polymorphisms in all postmenopausal women was as follows: AA 54.6%, AG 37.1%, GG 8.3%; GG 52.4%, GC 38.0%, CC 9.6%, respectively. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A163G polymorphism was significantly associated with BMD at the lumbar spine and G1181C polymorphism BMD at the trochanter in all postmenopausal women. A163G polymorphism was significantly associated with BMD at the lumbar spine in normal and osteoporotic patients, and BMD at the femur neck and wards triangle in normal patients. G1181C polymorphism was significantly associated with BMD at the femur neck in osteopenic and osteoporotic patients, and BMD at the wards triangle and trochanter in osteoporotic patients. CONCLUSION: These findings suggest that osteoprotegerin gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.
Bone Density ; Female ; Femur ; Femur Neck ; Humans ; Menopause ; Osteoprotegerin* ; Polymorphism, Restriction Fragment Length ; Spine

OBJECTIVE: Menopause status may lead to increases of body fat, abdominal obesity, and the incidence of metabolic syndrome (MS). Leptin is an adipokine that is secreted by adipocytes and plays an important role in regulating energy homeostasis and the reproductive system. This study examined the relationship among obesity, MS, and serum leptin levels in pre- and postmenopausal women. METHODS: We divided 168 women who visited St. Vincent Hospital of the Catholic University of Korea in 2006 and 2007 into premenopausal vs. postmenopausal, obese vs. non-obese groups based on their body mass index (BMI) and the presence of MS. We measured serum follicle-stimulating hormone (FSH) level, serum estradiol level, BMI, the waist-hip ratio (WHR) and visceral fat area (VFA), serum fasting glucose, lipid profile, blood pressure, and serum leptin level. RESULTS: Of 56 premenopausal and 112 postmenopausal women, there were 21 (37.5%) premenopausal and 51 (45.5%) postmenopausal women with MS. In the non-obese premenopausal and postmenopausal women, there were positive correlations between FSH, markers of abdominal obesity such as WHR and VFA, and serum leptin after adjusting for BMI in postmenopausal women. In the MS group, only WHR was correlated with the serum leptin level after adjusting for BMI in all groups. CONCLUSION: Increased serum FSH level and abdominal obesity lead to an increased serum leptin level in postmenopausal women. Further studies are needed to clarify the relationship between leptin and the metabolic syndrome, risk of cardiovascular disease in postmenopausal women.
Adipocytes ; Adipokines ; Adipose Tissue ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Estradiol ; Fasting ; Female ; Follicle Stimulating Hormone ; Glucose ; Homeostasis ; Humans ; Incidence ; Intra-Abdominal Fat ; Korea ; Leptin ; Menopause ; Obesity ; Obesity, Abdominal ; Postmenopause ; Waist-Hip Ratio

OBJECTIVE: To examine the relationship between Osteoprotegerin gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Osteoprotegerin A163G, T950C, G1181C gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. The subjects were divided in normal, osteopenic and osteoporotic on the basis of the T-score values according to the classification of the World Health Organization (WHO). RESULTS: The genotype distribution of A163G, T950C and G1181C polymorphisms in all postmenopausal women was as follows: AA 54.6%, AG 37.1%, GG 8.3%, T/T 17.5%, T/C 44.1%, C/C 38.4%; GG 52.4%, GC 38.0%, CC 9.6%, respectively. Significant differences in the distribution of A/A and A/G genotype among osteoporotic group were observed. No significant differences in the distribution of T950C and G1181C genotypes among three groups were observed. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A163G polymorphism was significantly associated with BMD at the lumbar spine in normal and osteoporotic patients and BMD at the femur neck and wards triangle in normal patients, and G1181C polymorphism BMD at the trochanter in all groups and BMD at the femur neck in osteopenic and osteoporotic patients, and BMD at the wards triangle and trochanter in osteoporotic patients. But There was no relationship between T950C gene polymorphism, and BMD. CONCLUSION: These findings suggest that osteoprotegerin gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.
Bone Density ; Classification ; Female ; Femur ; Femur Neck ; Genotype ; Humans ; Menopause ; Osteoprotegerin* ; Polymorphism, Restriction Fragment Length ; Spine ; World Health Organization

PURPOSE: To assess the usefulness of a CT severity index(CTSI) for the evaluation of acute pancreatitis and to correlate it with clinical findings. MATERIALS AND METHODS: We retrospectively evaluated contrast enhanced CT in 34 patients with acute pancreatitis. They were categorized into low-score(0-2), middle-score(3-6), and high-score(7-10) groups according to CTSI points, and those groups were correlated with duration of fasting period, days in hospital morbidity and mortality. We attempted to determine the differences in CTSI between pancreatitis caused by alcohol and by biliary tract disease. RESULTS: Of 34 patients, 11 were placed in the low-score group, 19 in the middle-score group, and 4 in the high-score group. The patients in the middle-score group experienced longer fasting period and stayed longer in hospital than those in the low-score group(p<.05 and p=.08, respectively). Morbidity was 0% in the low-score group, 37% in the middle-score group and 50% in the high-score group. Mortality occurred in two patients in high-score group, only. Alcohol-induced pancreatitis generally showed a higher CTSI and more severe clinical course than pancreatitis caused by biliary tract disease. CONCLUSION: In the evaluation of acute pancreatitis, CTSI can be a useful predictor of its prognosis.
Biliary Tract Diseases ; Fasting ; Humans ; Mortality ; Pancreatitis* ; Prognosis ; Retrospective Studies

Human ovarian follicles reduce rapidly in number throughout fetal and adult life. Throughout the menstrual cycles, primordial follicles grow into mature follicles and then ovulate to form corpus luteum. Apoptosis has been implicated in several events that occur during the process of follicular growth, atresia and the regression of the corpus luteum. By the use of immunohistochemistry, we clarified the involvement of apoptosis in the human ovary during follicular growth, regression and atresia by investigating the expression of Fas, Fas-ligand, Bcl-2 and Bad in primordial follicles, primary follicles and mature follicles. Fas immunostaining was present in primordial oocytes, both oocytes and granulosa cells of primary follicles, preantral follicles and all follicular cells of mature follicles. Fas-ligand and Bad immunostaining patterns were similar to those of Fas except for theca cells. Bcl-2 immunostaining was present in both oocytes and granulosa cells of primary, preantral and mature follicles. In corpus luteum, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were observed and decreased in the regressing corpus luteum. In postmenopausal ovary, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were entirely negative. Bad immunostaining was observed but Bcl-2 was not in atretic follicle. These results suggest that Fas, Fas-ligand, Bcl-2 and Bad may play important roles in human ovary during follicular growth, regression and atresia simultaneously. Further studies should be required to elucidate the underlying mechanism and apoptosis of the disease associated with normal and abnormal ovarian aging.
Adult ; Aging ; Apoptosis ; Corpus Luteum ; Female ; Granulosa Cells ; Humans* ; Immunohistochemistry ; Menstrual Cycle ; Oocytes ; Ovarian Follicle* ; Ovary ; Theca Cells