Breast Density In Women With Premature Ovarian Failure Or Postmenopausal Women Using Hormone Therapy: Analytical Cross-sectional Study [densidade Mamária Em Mulheres Com Falência Ovariana Prematura Ou Na Pós-menopausa E Em Uso De Terapia Hormonal: Estudo Transversal Analítico]

Context and objective: Studies on postmenopausal women have reported increased risk of breast cancer relating to the type and duration of hormone therapy (HT) used. Women with premature ovarian failure (POF) represent a challenge, since they require prolonged HT. Little is known about the impact of prolonged HT use on these women's breasts. This study aimed to evaluate the effects of one type of HT on the breast density of women with POF, compared with postmenopausal women. Design and setting: Cross-sectional study at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). Methods: 31 women with POF and 31 postmenopausal women, all using HT consisting of conjugated equine estrogen combined with medroxyprogesterone acetate, and matched according to HT duration, were studied. Mammography was performed on all subjects and was analyzed by means of digitization or Wolfe's classification, stratified into two categories: Non-dense (N1 and P1 patterns) and dense (P2 and Dy). Results: No significant difference in breast density was found between the two groups through digitization or Wolfe's classification. From digitization, the mean breast density was 24.1% ± 14.6 and 18.1% ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfe's classification identified dense breasts in 51.6% and 29.0%, respectively (P = 0.171). Conclusion: There was no difference in breast density between the women with POF and postmenopausal women, who had used HT for the same length of time. These results may help towards compliance with HT use among women with POF.1284211214Rossouw, J.E., Anderson, G.L., Prentice, R.L., Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results From the Women's Health Initiative randomized controlled trial (2002) JAMA, 288 (3), pp. 321-333Beral, V., Breast cancer and hormone-replacement therapy in the Million Women Study (2003) Lancet, 362 (9382), pp. 419-427. , Million Women Study CollaboratorsConner, P., Svane, G., Azavedo, E., Mammographic breast density, hormones, and growth factors during continuous combined hormone therapy (2004) Fertil Steril, 81 (6), pp. 1617-1623Chen, F.P., Cheung, Y.C., Teng, L.F., Soong, Y.K., The relationship between mammographic density and duration of hormone therapy: Effects of estrogen and estrogen-progestin (2005) Hum Reprod, 20 (6), pp. 1741-1745Harvey, J., Scheurer, C., Kawakami, F.T., Hormone replacement therapy and breast density changes (2005) Climacteric, 8 (2), pp. 185-192Junkermann, H., von Holst, T., Lang, E., Rakov, V., Influence of different HRT regimens on mammographic density (2005) Maturitas, 50 (2), pp. 105-110Christodoulakos, G.E., Lambrinoudaki, I.V., Vourtsi, A.D., The effect of low dose hormone therapy on mammographic breast density (2006) Maturitas, 54 (1), pp. 78-85Kavanagh, A.M., Mitchell, H., Giles, G.G., Hormone replacement therapy and accuracy of mammographic screening (2000) Lancet, 355 (9200), pp. 270-274Banks, E., Hormone replacement therapy and the sensitivity and specificity of breast cancer screening: A review (2001) J Med Screen, 8 (1), pp. 29-34Warren, R., Hormones and mammographic breast density (2004) Maturitas, 49 (1), pp. 67-78Armitage, M., Nooney, J., Evans, S., Recent concerns surrounding HRT (2003) Clin Endocrinol (Oxf), 59 (2), pp. 145-155Mann, R.D., Hormone replacement therapy and breast cancer risk: Studies of the last fifteen years (1992) Hormone replacement therapy and breast cancer risk, pp. 1-8. , In: Mann RD, editor, New Jersey: Parthenon Publishing GroupBoyd, N.F., Byng, J.W., Jong, R.A., Quantitative classification of mammographic densities and breast cancer risk: Results from the Canadian National Breast Screening Study (1995) J Natl Cancer Inst, 87 (9), pp. 670-675Byrne, C., Schairer, C., Wolfe, J., Mammographic features and breast cancer risk: Effects with time, age, and menopause status (1995) J Natl Cancer Inst, 87 (21), pp. 1622-1629Maskarinec, G., Meng, L., A case-control study of mammographic densities in Hawaii (2000) Breast Cancer Res Treat, 63 (2), pp. 153-161Vachon, C.M., Kuni, C.C., Anderson, K., Anderson, V.E., Sellers, T.A., Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States) (2000) Cancer Causes Control, 11 (7), pp. 653-662Noh, J.J., Maskarinec, G., Pagano, I., Cheung, L.W., Stanczyk, F.Z., Mammographic densities and circulating hormones: A cross-sectional study in premenopausal women (2006) Breast, 15 (1), pp. 20-28Laya, M.B., Gallagher, J.C., Schreiman, J.S., Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern (1995) Radiology, 196 (2), pp. 433-437Collaborative Group on Hormonal Factors in Breast Cancer (1997) Lancet, 350 (9084), pp. 1047-1059. , Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancerMarugg, R.C., van der Mooren, M.J., Hendriks, J.H., Rolland, R., Ruijs, S.H., Mammographic changes in postmenopausal women on hormonal replacement therapy (1997) Eur Radiol, 7 (5), pp. 749-755Koukoulis, G.N., Hormone replacement therapy and breast cancer risk (2000) Ann N Y Acad Sci, 900, pp. 422-428Lundström, E., Wilczek, B., von Palffy, Z., Söderqvist, G., von Schoultz, B., Mammographic breast density during hormone replacement therapy: Effects of continuous combination, unopposed transdermal and low-potency estrogen regimens (2001) Climacteric, 4 (1), pp. 42-48Greendale, G.A., Palla, S.L., Ursin, G., The association of endogenous sex steroids and sex steroid binding proteins with mammographic density: Results from the Postmenopausal Estrogen/Progestin Interventions Mammographic Density Study (2005) Am J Epidemiol, 162 (9), pp. 826-834de Moraes-Ruehsen, M., Jones, G.S., Premature ovarian failure (1967) Fertil Steril, 18 (4), pp. 440-461Cymberknoh, M., Mamografia digital (1994) Mastologia atual, pp. 75-78. , In: Dias EN, Caleffi M, Silva HMS, Figueira-Filho ASS, eds., Rio de Janeiro: RevinterWolfe, J.N., Breast patterns as an index of risk for developing breast cancer (1976) AJR Am J Roentgenol, 126 (6), pp. 1130-1137Snedecor, W.G., Cochram, W.G., The comparison of two samples (1989) Statistical methods, pp. 83-102. , In: Snedecor WG, Cochram WG, editors., 8thed Ames: Iowa State University PressPersson, I., Thurfjell, E., Holmberg, L., Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density (1997) J Clin Oncol, 15 (10), pp. 3201-3207Harvey, J.A., Bovbjerg, V.E., Quantitative assessment of mammographic breast density: Relationship with breast cancer risk (2004) Radiology, 230 (1), pp. 29-4

Cultured keratinocyte grafts are recognized, but not rejected by CD8+ T cells in vivo.

It has been shown in the mouse that cultured keratinocyte allografts [fully major histocompatibility complex (MHC) mismatched] survive for at least 100 days without evidence of rejection. In an attempt to analyze the immune mechanisms underlying this phenomenon we have investigated the induction of tolerance to such grafts. Primary cultures of BALB/c keratinocytes were prepared using irradiated 3T3 feeder cells, and the cultured cell sheets were grafted, using a silicone transplantation chamber, onto CBA recipients. After the cultured grafts had been in place for 4-6 weeks full-thickness tail skin from BALB/c donors was grafted onto the dorsal flank opposite the cultured graft. The median graft survival time of these full-thickness allografts was 15.5 days compared to 13 days in the control group. These data show that in the absence of Langerhans cells and MHC class II expression, keratinocytes expressing class I and minor histocompatibility antigens induce a prolonged survival of full-thickness skin allografts. The results from experiments in which T cell subsets were depleted in vivo suggest that CD8+ cells (a) recognize the class I alloantigens of the cultured graft, (b) do not reject the cultured graft and (c) do not progress further in their maturation pathway. We propose that these CD8+ T cells might have been partially primed by receiving only the first signal of activation and that they may be equivalent to "poised" cytotoxic T cells. These CD8+ cells can reject non cultured full-thickness skin grafts, and do so more effectively after removing CD4+ cells

Gastric Emptying And Intragastric Distribution Of A Solid Meal In Functional Dyspepsia: Influence Of Gender And Anxiety

Background: Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. Goals: To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. Methods: A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Results: Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men (119 ± 41 min vs. 78 ± 22 min) and to female controls (96 ± 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. Conclusion: Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.383230236Malagelada, J.R., Functional dyspepsia. Insights on mechanisms and management strategies (1996) Gastroenterol Clin North Am, 25, pp. 103-112Urbain, J.-L.C., Charkes, N.D., Recent advances in gastric emptying scintigraphy (1995) Semin Nucl Med, 25, pp. 318-325Quartero, A.O., De Wit, N.J., Lodder, A.C., Disturbed solid-phase gastric emptying in functional dyspepsia. A meta-analysis (1998) Dig Dis Sci, 43, pp. 2028-2033Kellow, J.E., Delvaux, M., Azpiroz, F., Principles of applied neurogastroenterology: Physiology/motility sensation (1999) Gut, 45, pp. 1117-1124Troncon, L.E.A., Bennett, R.J.M., Ahluwalia, N.K., Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients (1994) Gut, 35, pp. 327-332Stanghellini, V., Tosetti, C., Paternicò, A., Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia (1996) Gastroenterology, 110, pp. 1036-1042Hutson, W.R., Roehrkasse, R.L., Wald, A., Influence of gender and menopause on gastric emptying and motility (1989) Gastroenterology, 96, pp. 11-17Hermansson, G., Silvertsson, R., Gender-related differences in gastric emptying rate of solid meals (1996) Dig Dis Sci, 41, pp. 1994-1998Gryback, P., Naslund, E., Hellstrom, P.M., Gastric emptying of solids in humans: Improved evaluation by Kaplan-Meier plots, with special reference to obesity and gender (1996) Eur J Nucl Med, 23, pp. 1562-1567Knight, L.C., Parkman, H.P., Brown, K.L., Delayed gastric emptying and decreased antral contractility in normal premenopausal women compared with men (1997) Am J Gastroenterol, 92, pp. 968-975Bennink, R., Peeters, M., Van Den Maegdenbergh, V., Comparison of total and compartmental gastric emptying and antral motility between healthy men and women (1998) Eur J Nucl Med, 25, pp. 1293-1299Whitehead, W.E., Psychosocial aspects of functional gastrointestinal disorders (1996) Gastroenterol Clin North Am, 25, pp. 21-34Cheng, C., Seeking medical consultation: Perceptual and behavioral characteristics distinguishing consulters and nonconsulters with functional dyspepsia (2000) Psychosom Med, 62, pp. 844-852Magni, G., Di Mario, F., Bernasconi, G., DSM-III diagnoses associated with dyspepsia of unknown cause (1987) Am J Psychiatry, 144, pp. 1222-1223Lorena, S.L.S., Almeida, J.R.S., Mesquita, M.A., Orocecal transit time in patients with functional dyspepsia (2002) J Clin Gastroenterol, 35, pp. 21-24Thompson, D.G., Richelson, E., Malagelada, J.-R., Perturbation of gastric emptying and duodenal motility through the central nervous system (1982) Gastroenterology, 83, pp. 1200-1206Thompson, D.G., Richelson, E., Malagelada, J.-R., Perturbation of upper gastrointestinal function by cold stress (1983) Gut, 24, pp. 277-283Camileri, M., Malagelada, J.-R., Kao, P.C., Gastric and autonomic responses to stress in functional dyspepsia (1986) Dig Dis Sci, 31, pp. 1169-1177Haug, T.T., Svebak, S., Hausken, T., Low vagal activity as mediating mechanism for the relationship between personality factors and gastric symptoms in functional dyspepsia (1994) Psychosomatic Med, 56, pp. 181-186Zigmond, A.S., Snaith, R.P., The hospital anxiety and depression scale (1983) Acta Psychiatr Scand, 67, pp. 361-370Talley, N.J., Stanghellini, V., Heading, R.C., Functional gastroduodenal disorders (1999) Gut, 45, pp. 1137-1142Wegener, M., Borsch, G., Schaffstein, J., Frequency of idiopathic gastric stasis and intestinal transit disorders in essential dyspepsia (1989) J Clin Gastroenterol, 11, pp. 163-168Urbain, J.L.C., Vekemans, M.C., Parkman, H., Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia (1995) J Nucl Med, 36, pp. 1579-1586Talley, N.J., Shuter, B., McCrudden, G., Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia (1989) J Clin Gastroenterol, 11, pp. 625-630Chen, T.S., Doong, M.L., Chang, F.Y., Effects of sex steroid hormones on gastric emptying and gastrointestinal transit in rats (1995) Am J Physiol, 268, pp. G171-G176Liu, C.Y., Chen, L.B., Liu, P.Y., Effects of progesterone on gastric emptying and intestinal transit in male rats (2002) World J Gastroenterol, 8, pp. 338-341Horowitz, M., Fraser, R.J.L., Gastroparesis: Diagnosis and management (1995) Scand J Gastroenterol, 213, pp. 7-16Bortolotti, M., Bolondi, L., Santi, V., Patterns of gastric emptying in dysmotility-like dyspepsia (1995) Scand J Gastroenterol, 30, pp. 408-410Hausken, T., Berstad, A., Wide antrum in patients with non-ulcer dyspepsia. Effect of cisapride (1992) Scand J Gastroenterol, 27, pp. 427-432Tack, J., Piessevaux, H., Coulie, B., Role of impaired gastric accommodation to a meal in functional dyspepsia (1998) Gastroenterology, 115, pp. 1346-1352Thumshirn, M., Camilleri, M., Saslow, S.B., Gastric accommodation in non-ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function (1999) Gut, 44, pp. 55-64Hausken, T., Svebak, S., Wilhelmsen, I., Low vagal tone and antral dysmotility in patients with functional dyspepsia (1993) Psychos Med, 55, pp. 12-22Lorena, S.L.S., Figueiredo, M.J.A., Almeida, J.R.S., Autonomic function in patients with functional dyspepsia assessed by 24-hour heart rate variability (2002) Dig Dis Sci, 47, pp. 27-31Manes, G., Malfertheiner, P., Relationship of Helicobacter pylori with gastrointestinal motility (1999) Ital J Gastroenterol Hepatol, 8, pp. 705-712Pieramico, O., Ditschuneit, H., Malfertheiner, P., Gastrointestinal motility in patients with non-ulcer dyspepsia: A role for Helicobacter pylori? (1993) Am J Gastroenterol, 88, pp. 364-368Tucci, A., Corinaldesi, R., Stanguellini, V., Helicobacter pylori infection and gastric function in patients with chronic idiopathic dyspepsia (1992) Gastroenterology, 103, pp. 768-77

Gastric emptying and intragastric distribution of a solid meal in functional dyspepsia - Influence of gender and anxiety

Background: Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. Goals: To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. Methods: A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Results: Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men (119 +/- 41 min vs. 78 +/- 22 min) and to female controls (96 +/- 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. Conclusion: Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.38323023