Role of estrogen deficiency in the formation and progression of cerebral aneurysms. Part II: experimental study of the effects of hormone replacement therapy in rats

2005 ◽  
Vol 103 (6) ◽  
pp. 1052-1057 ◽  
Author(s):  
Mohammad A. Jamous ◽  
Shinji Nagahiro ◽  
Keiko T. Kitazato ◽  
Tetsuya Tamura ◽  
Kazuyuki Kuwayama ◽  
...  
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Cerebral Aneurysms ◽  
Induction Procedure ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The increased incidence of cerebral aneurysms in postmenopausal women appears to be related to low levels of circulating estrogen. Using a rat model of aneurysm induction, the authors found that oophorectomy increased the incidence of experimental cerebral aneurysms (Part I in this issue). In the current study they examined the effects of hormone replacement therapy (HRT) on the formation of cerebral aneurysms in rats. Methods. Forty-five female Sprague—Dawley rats were divided into three equal groups. The animals in Groups A and B were subjected to a cerebral aneurysm induction procedure (renal hypertension and right common carotid artery ligation) followed 1 month later by bilateral oophorectomy. After an additional week the rats in Group A received 17β estradiol continuous-release pellets. The rats in Group C served as controls. Three months after the aneurysm induction procedure, all the rats were killed and vascular corrosion casts of their cerebral arteries were prepared and checked for aneurysmal changes. Using a scanning electron microscope, the authors recorded aneurysmal changes as endothelial changes alone (Stage I), endothelial changes with intimal pad elevation (Stage II), and saccular aneurysm formation (Stage III). Aneurysmal changes (Stages I, II, and III) occurred in one third of rats that had undergone oophorectomy and were receiving HRT (Group A), compared with 87% of the rats that had undergone oophorectomy but did not receive HRT (Group B). Although most of the aneurysmal changes identified in Group A rats were limited to Stage I or II, most changes in Group B animals were identified as saccular dilation (Stage III). Conclusions. The findings demonstrated the significant protective role of estrogen against the formation and progression of cerebral aneurysms. It appears to be related to the beneficial effects of estrogen on the function and growth of endothelial cells, which play a major role in preserving the integrity of the vascular wall.

Comparative Study of Low Dose Conjugate Equine Estrogen 0.3 mg vs Standard Dose Conjugate Equine Estrogen 0.625 mg as Hormone Replacement Therapy

2013 ◽  
Vol 1 (2) ◽  
pp. 45-49
Author(s):  
Meeta Gupta ◽  
Poonam Yadav ◽  
Sarvesh Kumar
Keyword(s):  
Hormone Replacement Therapy ◽  
Comparative Study ◽  
Replacement Therapy ◽  
Low Dose ◽  
Standard Dose ◽  
Hormone Replacement ◽  
Mineral Density ◽  
Conjugate Equine Estrogen ◽  
Group A ◽  
Group B

ABSTRACT Introduction Since menopause was related to variety of genitourinary, vasomotor, psychological and musculoskeletal changes, conjugated equine estrogen (CEE) was introduced for all menopause-related symptoms in various doses. Materials and methods It is a comparative study in which 100 postmenopausal women were selected (natural or surgical menopause) with one or more menopausal symptoms. All patients were randomly divided in two groups. Group A received 0.3 mg CEE and group B received 0.625 mg CEE, and both groups were compared with each other in various aspects. Results Both the groups were comparable to each other with respect to mean age, residence, type of menopause, total duration of menopause. Both the groups show comparable improvement in vasomotor, genitourinary and psychological symptoms and p > 0.05 which is not significant. On evaluation of bone mineral density (BMD), the group B showed significant improvement than group A (p < 0.001). Effect on endometrium was not significant. Conclusion Because of the complications of estrogen ± progestin, it should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risk for individual women. How to cite this article Yadav P, Singh R, Kaur H, Gupta M, Kumar S. Comparative Study of Low Dose Conjugate Equine Estrogen 0.3 mg vs Standard Dose Conjugate Equine Estrogen 0.625 mg as Hormone Replacement Therapy. J South Asian Feder Menopause Soc 2013;1(2):45-49.

Guglielmi Detachable Coil embolization of cerebral aneurysms: 11 years' experience

2003 ◽  
Vol 98 (5) ◽  
pp. 959-966 ◽  
Author(s):  
Yuichi Murayama ◽  
Yih Lin Nien ◽  
Gary Duckwiler ◽  
Y. Pierre Gobin ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
The Past ◽  
Guglielmi Detachable Coil ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. Methods. Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%. Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm. Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms. Conclusions. The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.

Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option

2000 ◽  
Vol 93 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Christian Raftopoulos ◽  
Pierre Mathurin ◽  
Dutcho Boscherini ◽  
Rudolf F. Billa ◽  
Michel Van Boven ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Clinical Status ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option.Methods. Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (≥ 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1–3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1–3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C.Conclusions. Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

Beta—tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 350-354 ◽  
Author(s):  
Takashiro Ohyama ◽  
Yoshichika Kubo ◽  
Hiroo Iwata ◽  
Waro Taki
Keyword(s):  
Lumbar Spine ◽  
Tricalcium Phosphate ◽  
Interbody Fusion ◽  
Donor Site ◽  
Posterolateral Approach ◽  
Content Type ◽  
Spine Model ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site—related complications can still occur. In this study a synthetic ceramic, β—tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. Methods. In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. Conclusions. Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

Abstract TP197: Risk of Stroke in Women with use of Testosterone-Containing Hormone Replacement Therapy

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Haseeb A Rahman ◽  
Ahmed Malik ◽  
Aesha Rahman ◽  
Saqib Chaudhry ◽  
Malik M Adil ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Risk Factor ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Stroke Risk ◽  
Hormone Replacement ◽  
Future Studies ◽  
Baseline Visit ◽  
Using Data

Background: There has been debate in the role of exogenous testosterone as a risk factor for stroke. Hormone replacement therapy (HRT) is considered a risk factor for stroke. The risk of ischemic stroke may increase when using testosterone-containing HRT. Methods: Using data from the observational component of the Women’s Health Initiative (WHI) [WHI Observational Study (OS)], we analyzed the 93,676 women aged 50-79 years, who participated in the OS over a period of 12±1 years. We compared the outcome of stroke in participants with reported use of a combination of testosterone and estrogen, estrogen alone, progesterone alone, and a combination of estrogen and progesterone, as recorded at the baseline visit. A logistic regression analysis was run to determine the odds of developing stroke. Results: Of the 93, 676 participants, 1772 used a combination of testosterone and estrogen (Estratest) HRT, 11,282 used progesterone alone, 10,808 used a combination of estrogen and progesterone, and 31,673 used estrogen alone. A smaller proportion of participants who developed an outcome of stroke had used Estratest as compared to estrogen alone or a combination of estrogen and progesterone (1.9% vs. 96.3% p=0.62). In the logistic regression, participants who had used Estratest were 1.2 times as likely to develop stroke as users of other hormone replacement therapy (OR 1.2 95%CI (0.96-1.6)), while women who had used progesterone only were 0.87 times less likely to develop stroke than users of other hormone replacement therapy (OR 0.874 95%CI (0.77-0.99)). After adjusting for confounders, the risk of developing stroke increased in users of Estratest (OR 1.25 95%CI (0.96-1.6) p=0.04), and decreased in users of progesterone only (OR 0.873 95%CI (0.77-0.99) p=0.038). Conclusion: Use of testosterone-containing HRT slightly increased the risk of stroke in women when compared to progesterone alone HRT, although this was not found to be significant. Stroke risk with Estratest may be considered to be similar to estrogen only and combination of estrogen plus progesterone HRT. Future studies are required to investigate these correlations.

Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma

2003 ◽  
Vol 99 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Takeo Goto ◽  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Misao Nishikawa ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deterioration ◽  
Fisher Exact Test ◽  
Content Type ◽  
Exact Test ◽  
Spinal Ependymoma ◽  
Group A ◽  
Delayed Neurological Deterioration ◽  
Group B ◽  
Fine Print

Object. The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas. Methods. Twenty-five patients with spinal ependymoma underwent surgery between 1978 and 2002. There were 16 male and nine female patients whose ages at the time of surgery ranged from 14 to 64 years (mean 41.8 years). The follow-up period ranged from 6 to 279 months (mean 112.4 months). In the initial 17 patients (Group A), the procedure to prevent arachnoidal adhesion consisted of the layer-to-layer closure of three meninges and laminoplasty. In the subsequently treated eight patients (Group B), the authors performed an alternative technique that included pial suturing, dural closure with Gore-Tex membrane—assisted patch grafting, and expansive laminoplasty. In Group A, postoperative adhesion was radiologically detected in eight cases (47%), and delayed neurological deterioration secondary to posterior tethering of the cord was found in five cases. In Group B, there was no evidence of adhesive posterior tethering or delayed neurological deterioration. A significant intergroup statistical difference was demonstrated for radiologically documented posterior tethering (p < 0.05, Fisher exact test). Moreover, patients with radiologically demonstrated posterior tethering suffered a significant delayed neurological functional deterioration (p < 0.01, Fisher exact test). Conclusions. This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.

scholarly journals The role of bilateral ovariectomy in the impairments of prooxidant-antioxidant balance and renal concentrating capacity in rats in the period of late manifestations of the traumatic disease and the efficacy of hormone replacement therapy

2021 ◽  
Vol 11 (2) ◽  
pp. 277-289
Author(s):  
I. Lutsiv ◽  
A. Hudyma ◽  
S. Halnykina ◽  
O. Denefil
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Renal Cortex ◽  
Hormone Replacement ◽  
Female Rats ◽  
Control Groups ◽  
Renal Tubular ◽  
Trauma Model ◽  
Renal Concentrating Capacity

Introduction. Traumatic events are currently considered to be one of the topical issues. The progression of renal failure plays an important role in the pathogenesis of traumatic disease. It is essential to evaluate the ability of renal tubular epithelium to the urine osmotic concentration in order to indicate the direct renal tubular damage. A sodium-free water clearance (S-CH2O) is a sensitive indicator reflecting the kidneys ability to concentrate the urine. It is established that the renal functional state, the resistance of the kidneys to the development of various disorders depends on the estrogen concentration. The key mechanism of the indirect effect of estrogens on the kidneys is via their direct antioxidant action. However, the role of estrogens in the pathogenesis of oxidative and functional impairments of the kidneys in the presence of cranioskeletal trauma is insufficiently studied. There is no data available on the efficacy of hormone replacement therapy under those circumstances.The objective of research: to determine the pro-oxidant-antioxidant balance and renal concentrating capacity following the cranioskeletal trauma model in rats with bilateral ovariectomy in the period of late manifestations of the traumatic disease and evaluate the efficacy of hormone replacement therapy.Material and methods: The experimental studies were conducted on 64 white non-linear female rats weighing 200-220g. The experimental model of hypoestrogenism was performed through the surgical removal of gonads. The rats were subjected to the cranioskeletal model one month after removal of the gonads. Hormone replacement therapy (HRT) was used as a corrective treatment in the separate subgroup of gonadectomized rats subjected to the cranioskeletal trauma. The control groups consisted of intact animals and rats 1 month after removal of the gonads that were not injured. The renal functional state was determined via a water loading test in the control groups of animals and after 1 and 2 months of postrraumatic period. The sodium concentration, as well as the S-CH2O value was measured in serum and urine. The content of thiobarbituric acid reactive substances (TBARs) and catalase activity were determined in renal cortex and medulla. The prooxidant/antioxidant ratio (ProAntidex) was calculated based on the above data.The results and discussion. The conducted studies indicated the considerable decrease in ProAntidex value in renal cortex and medulla in the group of gonadectomized rats compared to the animals without gonadectomy after 1 month of the posttraumatic period, confirming the protective antioxidant role of estrogens in adequate renal function. The cranioskeletal trauma model led to the declined parameter value in renal cortex and medulla in both experimental groups after 1 month of the posttraumatic period. The prooxidant/antioxidant ratio was significantly decreased in the first month following the trauma in the gonadectomized rats as compared to the rats without the gonadectomy, and remained at the same level up to the 2nd month of the posttraumatic period. The identified abnormal value of ProAntidex in the posttraumatic period clearly affected the dynamics of S-CH2O. This parameter was reported as decreased in both experimental groups compared to the control. However, the parameter was substantially decreased 1 and 2 months after trauma under conditions of the gonadectomy.                   The administration of hexestrol and progesterone to the gonadectomized rats with trauma model resulted in the considerable increase in value of ProAntidex in renal cortex and medulla starting from the 1st day of the posttraumatic period compared to the animals without corrective medication. Moreover, it was accompanied by a statistically significant increase in S-CH2O rate, indicating the enhancement in the functional capacity of the renal tubules.Conclusions. The value of ProAntidex decreases in renal cortex and medulla in the group of gonadectomized female rats after 1 month of the posttraumatic period, and is significantly lower compared to the animals without removal of the gonads. The cranioskeletal trauma model leads to the substantially declined prooxidant/antioxidant ratio value in renal cortex and medulla, which is reported as considerably greater in the group of gonadectomized animals after 1 month of the posttraumatic period, showing no tendency to enhance after 2 months of the experiment. The administration of hormone replacement therapy to the gonadectomized rats is accompanied by the increase in ProAntidex value and S-CH2O rate compared to the animals without corrective medication.

A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus

1999 ◽  
Vol 91 (4) ◽  
pp. 605-609 ◽  
Author(s):  
Petra M. Klinge ◽  
Georg Berding ◽  
Thomas Brinker ◽  
Wolfram H. Knapp ◽  
Madjid Samii
Keyword(s):  
Positron Emission Tomography ◽  
Emission Tomography ◽  
Chronic Hydrocephalus ◽  
Content Type ◽  
Cerebrovascular Reserve ◽  
Shunt Placement ◽  
Positron Emission ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. In this study the authors use positron emission tomography (PET) to investigate cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in chronic hydrocephalus.Methods. Ten patients whose mean age was 67 ± 10 years (mean ± standard deviation [SD]) were compared with 10 healthy volunteers who were 25 ± 3 years of age. Global CBF and CVR were determined using 15O—H2O and PET prior to shunt placement and 7 days and 7 months thereafter. The CVR was measured using 1 g acetazolamide. Neurological status was assessed based on a score assigned according to the methods of Stein and Langfitt.Seven months after shunt placement, five patients showed clinical improvement (Group A) and five did not (Group B). The average global CBF before shunt deployment was significantly reduced in comparison with the control group (40 ± 8 compared with 61 ± 7 ml/100 ml/minute; mean ± SD, p < 0.01). In Group A the CBF values were significantly lower than in Group B (36 ± 7 compared with 44 ± 8 ml/100 ml/minute; p < 0.05). The CVR before surgery, however, was not significantly different between groups (Group A = 43 ± 21%, Group B = 37 ± 29%). After shunt placement, there was an increase in the CVR in Group A to 52 ± 37% after 7 days and to 68 ± 47% after 7 months (p < 0.05), whereas in Group B the CVR decreased to 14 ± 18% (p < 0.05) after 7 days and returned to the preoperative level (39 ± 6%) 7 months after shunt placement.Conclusions. The preliminary results indicate that a reduced baseline CBF before surgery does not indicate a poor prognosis. Baseline CBF before shunt placement and preoperative CVR are not predictive of clinical outcome. A decrease in the CVR early after shunt placement, however, is related to poor late clinical outcome, whereas early improvement in the CVR after shunt placement indicates a good prognosis.

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