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An estrogen patch in combination with an intrauterine device (IUD) that slowly released progestin proved as effective and safe as oral estrogen and progestin for menopausal women. Progestin prevents the abnormal growth of the uterine lining that occurs with estrogen alone. Forty menopausal women were randomly assigned to one or the other therapies. The IUD was sufficiently large that insertion was only attempted in women who had previously born children and who had been pretreated for one month with estrogen. Even so, the device could not be inserted in one patient and four others had it removed because of continuous pain and bleeding. Two oral medication patients withdrew because of spotting and one because of dry eyes and headache. Women with the IUD were more likely to spot within the first three months, but this subsided. Transvaginal ultrasound established that neither regimen caused abnormal growth of the uterine lining. Menopausal symptoms were relieved equally well in both groups.

Background. Insulin-like growth factor I (IGF-I) is a potent mitogen for breast cancer cells. The majority of IGF-I in plasma is hound to IGF binding proteins (IGFBPs), which modulate the biologic effects of IGF-I. Methods. Plasma concentrations of IGF-I, IGFBP-I, and IGFBP-3 were compared between 40 postmenopausal breast cancer patients receiving long term tamoxifen therapy and 39 breast cancer patients receiving no hormonal treatment. In an additional group of seven patients, serum levels of IGF-I and IGFBP-1 were determined before and during treatment at 6 and 12 months. Results. The tamoxifen and the control groups did not differ with respect to age, parity, age at menopause, or body mass index. There were no significant differences in the mean concentrations ([+ or -] standard error of the mean) of IGF-I (10.0 [+ or -] 0.4 nmol/l and 11.2 [+ or -] 0.5 nmol/l, respectively) and IGFBP-3 (3.2 [+ or -] 0.1 mg/l and 3.1 [+ or -] 0.1 mg/l, respectively), whereas the mean value of IGFBP-1 was significantly higher in the tamoxifen group (6.0 [+ or -] 0.6 ([mu]g/l versus 2.8 [+ or -] 0.3 [mu]g/l, P = 0.0001). No significant differences were found in the insulin levels. During the treatment, concentrations of IGF-I decreased at 6 months and began increasing at 12 months. IGFBP-1 levels increased at 6 months and remained elevated at 12 months. Conclusions. The tamoxifen-induced increase in IGFBP-1 plasma levels may be an important mechanism modulating IGF-I action at the tissue level. Cancer 1994; 74:618-24.

To determine whether maternal midtrimester serum N-terminal peptide of proatrial natriuretic peptide, free beta subunit of human chorionic gonadotropin (hCGβ), or alpha-fetoprotein (AFP) levels can predict preeclampsia.

Cholic and chenodeoxycholic acids were determined in 42 cord plasma samples after pregnancies complicated by maternal intrahepatic cholestasis and in 20 cord plasma samples after uncomplicated pregnancies with a gas-chromatographic method. The mean total amount of these bile acids was 1.8 μg per milliliter after uncomplicated pregnancies as compared to 5.6 μg per milliliter (P < 0.001) in the cholestasis group. These bile acids were also determined in six maternal plasma samples where, as compared to the cord plasma of their babies, higher levels were found in every case. These results show that in addition to changes in the maternal circulation, maternal cholestasis elevates bile acid levels in fetal circulation. A more frequent occurrence of signs of fetal distress during pregnancy or labor was found in those cholestasis cases where cord plasma bile acid levels were high. The relationship of fetal bile acid levels to fetal steroid hormone metabolism was studied by correlating total bile acid levels with the concentrations of a number of steroid sulfates in cord plasma. An interesting finding was a negative correlation between fetal bile acid levels and concentrations of 16-oxygenated steroid sulfates, which are important estriol precursors produced by the fetus. These observations led to the conclusion that bile acids or other substances which are retained in maternal circulation as a result of cholestasis may, after transplacental passage, cause some kind of distress to the fetus.