Abstract. This study was designed to investigate the therapeutic efficacy of estrogen in female patients with dementia of the Alzheimer type (DAT). Fifteen DAT patients with a mean age of (x ± SE) 71.9 ± 2.4 years were treated with 0.625 mg of conjugated equine estrogens orally twice a day for 6 weeks. Of the 15 DAT patients, 4 were diagnosed as mild, 7 as moderate and 4 as severe. The effects of estrogen on DAT patients were evaluated by psychometric assessments, behavior rating scales, regional cerebral blood flow (rCBF) measurement and quantitative EEG analysis. Psychometric assessments consisted of Mini-Mental State Examination (MMSE) and Hasegawa Dementia Scale (HDS). Dementia syndromes were evaluated by the CBS-Scale (GBSS) and Hamilton Depression Rating Scale (HDRS). During estrogen replacement therapy (ERT), the mean MMSE score (x ± SE) increased significantly from 11.6 ± 1.9 to 13.2 ± 2.0 at 3 weeks (P<0.01) and 13.8 ± 2.0 at 6 weeks (P<0.001). The mean HDS score increased significantly from 8.6 ± 2.1 to 11.5 ± 2.3 at 3 weeks (P<0.001) and 11.6 ± 2.6 at 6 weeks (P<0.01). Significant improvements in the mean scores of the GBSS and HDRS were also observed in the estrogentreated group, but not in the untreated control group with a mean age of 71.2 ± 2.5 years (n=15). The rCBF was measured by single photon emission computed tomography (SPELT). ERT increased the mean rCBF significantly in the lower frontal region (P<0.01) and primary motor area (P<0.02) of the right hemisphere. The mean absolute power delta band values in both left and right frontal EEG (Fp, and Fp2) (P<0.01) and theta1 band values in Fp2 (P<0.05) decreased significantly during ERT. It is inferred that ERT significantly improves cognitive functions, dementia symptoms, regional cerebral blood flow and EEG activity in female patients with DAT.
Seven female patients with mild to moderate dementia of the Alzheimer type (DAT) were treated with long-term, low-dose estrogen replacement therapy (ERT) over a period of 5–45 months. Five of the 7 patients were cases who had responded well to short-term ERT with 1.25 mg/day of conjugated equine estrogens (CEE) for 6 weeks. The 7 patients from 56 to 77 years of age received 0.625 mg/day of CEE for 21 days, followed by a pause of 7 days. A28-day cycle of low-dose ERT was performed repeatedly. In 4 cases, these patients received 5 mg/day of medroxyprogesterone acetate (MPA) during the last 10–12 days of estrogen treatment. Therapeutic efficacy of estrogen was evaluated by psychometric assessments such as the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale (HDS) and a behavior rating scale of the Gottfries-Bråne-Steen geriatric rating scale (GBS). The MMSE and HDS evaluations were performed principally once in 2–4 weeks. In 4 out of the 7 patients, the MMSE and HDS scores were elevated above the pretreatment levels during ERT. The termination of ERT resulted in a decrease in both scores. Furthermore, the GBS scores and daily activities of the same 4 patients were improved during ERT. In these 4 patients cognitive functions were markedly improved throughout the treatment period, while the other 2 patients responded moderately well and another patient did not respond at all. These observations suggest that long-term, low-dose ERT improves cognitive functions, dementia symptoms and daily activities in women with mild to moderate DAT. However, the supplemental treatment with MPA seems to have an unfavorable effect on dementia symptoms and daily activities in the aged DAT patients.
Macrophage colony-stimulating factor (M-CSF) is a characteristic cytokine that plays an essential role in placenta maintenance, and thrombin-antithrombin III complex (TAT) is a hemostatic marker that is remarkably altered both in normal pregnancy and in preeclampsia. The present study was designed in order to show various levels of M-CSF and TAT in pregnancies. Peripheral blood was collected from 49 subjects, of whom 31 were normal pregnant women consisting of the four groups (namely 10th, 20th, 30th, and 38th weeks of gestation), 13 were preeclamptic pregnant women (37th week of gestation; mean blood pressure, 158/99 mm Hg), and 5 were nonpregnant controls. We compared blood M-CSF and TAT levels among them. Results showed that blood M-CSF and TAT levels increased significantly with gestational age. Furthermore, the ratio of increase in M-CSF was significantly lower than that in TAT in normal pregnant women compared with controls. In contrast, the ratio of increase in M-CSF was significantly higher than that in TAT in preeclamptic women compared with normal pregnant women. These results concerning the ratio of increase in M-CSF and TAT have not been reported. These findings show that M-CSF level increases significantly in preeclampsia even in its earlier stage, exhibiting a systolic blood pressure of less than 160 mm Hg.
In pregnancy, the decidual cells produce and secrete large amounts of macrophage colony-stimulating factor (M-CSF). M-CSF stimulates the proliferation and differentiation of trophoblasts. In addition, it stimulates them in a dose-dependent manner to produce certain hormones, such as human chorionic gonadotropin and human placental lactogen. Based on these facts, M-CSF is considered to be an essential cytokine for placental maintenance. Because placental dysfunction may sometimes result from preeclampsia, ascertaining blood M-CSF levels in preeclamptic patients would be of interest. The blood was collected from 33 subjects, of whom 19 were normal pregnant women and 14 were preeclamptic patients. The M-CSF level was determined by the sandwich enzyme-linked immunosorbent assay method using three antibodies. The investigators measured peripheral blood M-CSF levels in preeclamptic subjects and compared them with levels in subjects with normal pregnancies. This study showed that peripheral blood M-CSF levels were significantly higher in preeclamptic patients in the 30th and 38th weeks of pregnancy (P < .005). This is the first report concerning high M-CSF blood levels in preeclamptic patients.
In a study of 130 tubal pregnancies the relationships as to location of the corpus luteum, the implantation site, and the gross findings of the non-pregnant fallopian tube were analyzed. A contralateral corpus luteum was found in 20% of the cases. Hydrosalpinx, peritubal adhesions and/or thickening of the tubal wall were observed in 33% of the non-pregnant tubes. Grouping by implantation site--ipsilateral or contralateral corpus luteum--showed no statistical differences. The incidence of chronic pelvic inflammatory diseases was no greater in the subjects above 30 years of age and those having had more than 2 pregnancies. The results suggest that "tube locking" of the ovum, sometimesa result of previous tubal inflammatory disease, sometimes a result of supposed insufficiency of tubal peristalsis. was the major cause of tubal gestation. External migration of the ovum alone may not be an important factor in the genesis of tubal pregnancy.
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