Objective To determine whether hormone replacement therapy can reverse established renal microvascular damage in type 2 diabetes and hypertension.Design Prospective, single centre clinical trial.Setting Outpatient clinics. ParticipantsMethods Administration of a cyclic combination of oestradiol and norgestrel orally for 3.5 monthly cycles. ResultsComparing the baseline values, mean (SD) 24-hour urine protein excretion was reduced from 0.452 g (0-039) to 0.370 g (0-047) (P c 0.01) and creatinine clearance was increased from 1-68 d s e c (0.11) to 1.77 d s e c (0-08) (P < 0.05). Fasting plasma glucose also improved from 6.92 mmoVL (0.47) to 6.51 mmoVL (0.28) ( P c 0.05), as did serum total cholesterol from 7.26 mmol/L (0.28) to 6.65 mmoVL (0.14) (P < 0.05). Blood pressure did not change significantly.Univariate linear regression analysis showed no significant correlation between the individual changes in blood pressure, fasting plasma glucose or serum cholesterol and the individual changes in proteinuria or creatinine clearance.Conclusions This study shows that hormone replacement therapy may reduce proteinuria, and even improve creatinine clearance, in diabetic and hypertensive postmenopausal women. These effects are additive to nephroprotective therapy, and the mechanisms appear unrelated to conventional risk factors for vascular complications, such as high blood pressure, elevated plasma glucose or serum cholesterol.Sixteen diabetic and hypertensive postmenopausal women (age 47-57 years)

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Hormone replacement restores the reduced myeloperoxidase activity in menopausal women. Adding myeloperoxidase to neutrophil granulocytes, the production of free radicals decreases.

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Backgroundthe European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.Methodsunder the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.Resultsthe final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).Conclusionthe current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

Estradiol hormone replacement therapy (HRT) may exert a beneficial effect on myocardial perfusion in menopause by opposing the deterioration of biomechanical properties of intramural coronary resistance vessels induced by female sex hormone depletion.