Christopher John Haines. / Thesis (M.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 239-279). / LIST OF TABLES --- p.xviii / LIST OF FIGURES --- p.xxi / LIST OF ABBREVIATIONS --- p.xxii / Chapter CHAPTER1 --- INTRODUCTION --- p.1 / Problems related to the menopause / Research plan / Chapter CHAPTER2 --- OVERVIEW --- p.15 / Introduction / Atherosclerosis and the lipid profile / Coronary artery disease and lipid abnormalities in women / "Exogenous oestrogens, progestogens and coronary artery disease " / Lipoprotein (a) / Chapter CHAPTER3 --- GENERAL METHODOLOGY --- p.134 / Recruitment of cases / Pharmacokinetics / Data collection and analysis of samples / Ethical considerations / Chapter CHAPTER4 --- STUDY I -THE SHORT TERM EFFECTS OF ORAL OESTROGEN --- p.157 / Crossover analysis of effects of oral oestrogen on lipoprotein (a) and other lipoproteins / Relationship between lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER5 --- STUDY II -THE SUSTAINED EFFECTS OF ORAL OESTROGEN --- p.186 / Analysis of prolonged effects of oral oestrogen on lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER6 --- STUDY III -THE EFFECTS OF COMBINED CYCLICAL HORMONE REPLACEMENT THERAPY --- p.196 / Analysis of effect of combined cyclical hormone replacement therapy on lipoprotein (a) and other lipids and lipoproteins / Comparison between sampling during oestrogen alone and combined phase of treatment / Chapter CHAPTER7 --- STUDY IV -THE EFFECTS OF PERCUTANEOUS OESTROGEN --- p.214 / Analysis of effect of percutaneous on lipoprotein (a) and other lipids and lipoproteins / Chapter CHAPTER8 --- SUMMARY AND CONCLUSIONS --- p.228 / BIBLIOGRAPHY --- p.239

by Cheung Tak Chi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 117-123). / Abstract also in Chinese. / Acknowledgeements --- p.i / Abbreviations --- p.ii / Abstract --- p.v / List of Figures --- p.viii / List of Tables --- p.xiv / Contents --- p.xv / Contents / Chapter 1. --- Introduction --- p.1 / Chapter 1.1 --- Epidemiological Risk Factors --- p.1 / Chapter 1.1.1 --- Age --- p.1 / Chapter 1.1.2 --- Race --- p.2 / Chapter 1.1.3 --- Environmental or Migratory Factor --- p.2 / Chapter 1.1.4 --- Diet --- p.2 / Chapter 1.1.5 --- Genetics --- p.3 / Chapter 1.2 --- Regulation of Normal Prostate Development and Function --- p.4 / Chapter 1.3 --- Biochemistry and Development of Prostate Cancer --- p.6 / Chapter 1.3.1 --- Androgen-Dependent Prostate Cancer --- p.6 / Chapter 1.3.2 --- Androgen-Independent Prostate Cancer --- p.8 / Chapter 1.4 --- Classification of Prostate Cancer --- p.9 / Chapter 1.4.1 --- Stage A Prostate Cancer --- p.10 / Chapter 1.4.2 --- Stage B Prostate Cancer --- p.10 / Chapter 1.4.3 --- Stage C Prostate Cancer --- p.11 / Chapter 1.4.4 --- Stage D Prostate Cancer --- p.11 / Chapter 1.5 --- Methods for Early Detection of Prostate Cancer --- p.12 / Chapter 1.6 --- Clinical Treatment of Prostate Cancer --- p.12 / Chapter 1.6.1 --- Surgery --- p.12 / Chapter 1.6.2 --- Radiotherapy --- p.13 / Chapter 1.6.3 --- Chemotherapy --- p.13 / Chapter 1.6.4 --- Hormonal Therapy --- p.13 / Chapter 1.7 --- Objective --- p.14 / Chapter 1.8 --- Estrogen and Its Related Compounds --- p.16 / Chapter 1.8.1 --- 17β-Estradiol --- p.16 / Chapter 1.8.2 --- Tamoxifen --- p.18 / Chapter 1.8.3 --- Aromatase Inhibitor --- p.20 / Chapter 1.9 --- Anticancer Drugs --- p.23 / Chapter 1.9.1 --- Doxorubicin --- p.23 / Chapter 1.9.2 --- cis-Platinum --- p.24 / Chapter 1.10 --- Apoptotic Pathways --- p.25 / Chapter 1.10.1 --- BCL-2 /BAD Pathway --- p.26 / Chapter 1.10.2 --- FADD Pathway --- p.27 / Chapter 1.10.3 --- CAS Pathway --- p.27 / Chapter 2. --- Materials and Methods --- p.28 / Chapter 2.1 --- Materials --- p.28 / Chapter 2.2 --- Cell Lines --- p.32 / Chapter 2.3 --- Preparation of Drugs --- p.32 / Chapter 2.4 --- Drug Sensitivity Assay --- p.33 / Chapter 2.5 --- Cell Cycle Analysis --- p.35 / Chapter 2.6 --- DNA Fragmentation Assay --- p.36 / Chapter 2.7 --- Annexin Binding Assay --- p.37 / Chapter 2.8 --- Western Blot Analysis --- p.38 / Chapter 2.9 --- Data Analysis --- p.41 / Chapter 3. --- Results --- p.42 / Chapter 3.1 --- Response of Human Androgen-Independent Prostate Cancer Cells to Doxorubicin and cis-Platinum --- p.42 / Chapter 3.2 --- The Effect of 17p-Estradiol on the Growth and Anticancer Drug Sensitivity of Human Androgen-Independent Prostate Cancer Cells --- p.45 / Chapter 3.2.1 --- 17β-Estradiol on Cell Growth --- p.45 / Chapter 3.2.2 --- 17β-Estradiol on Anticancer Drug Sensitivity --- p.45 / Chapter 3.2.3 --- 17β-Estradiol and Doxorubicin on Cell Cycle Progression --- p.51 / Chapter 3.2.4 --- 17β-Estradiol and Doxorubicin Induced DNA Fragmentation --- p.57 / Chapter 3.2.5 --- 17β-Estradiol and Doxorubicin on Annexin Staining --- p.59 / Chapter 3.2.6 --- 17β-Estradiol and Doxorubicin on Apoptotic Protein Expression --- p.62 / Chapter 3.3 --- The Effect of Tamoxifen on the Growth and Anticancer Drug Sensitivity of Human Androgen-Independent Prostate Cancer Cells --- p.64 / Chapter 3.3.1 --- Tamoxifen on Cell Growth of Human --- p.65 / Chapter 3.3.2 --- Tamoxifen on Anticancer Drug Sensitivity --- p.65 / Chapter 3.3.3 --- Tamoxifen and Doxorubicin on Cell Cycle Progression --- p.71 / Chapter 3.3.4 --- Tamoxifen and Doxorubicin Induced DNA Fragmentation --- p.76 / Chapter 3.3.5 --- Tamoxifen and Doxorubicin on Annexin Staining --- p.78 / Chapter 3.3.6 --- Tamoxifen and Doxorubicin on Apoptotic Protein Expression --- p.79 / Chapter 3.4 --- The Effect of Aromatase Inhibtiors on the Growth and Anticancer Drug Sensitivity of Human Androgen-Independent Prostate Cancer Cells --- p.81 / Chapter 3.4.1 --- Aromatase Inhibitors on Cell Growth --- p.81 / Chapter 3.4.2 --- Aromatase Inhibitors on Anticancer Drug Sensitivity --- p.83 / Chapter 3.4.3 --- 4-AcA and Doxorubicin on Cell Cycle Progression --- p.93 / Chapter 3.4.4 --- 4-AcA and Doxorubicin Induced DNA Fragmentation --- p.99 / Chapter 3.4.5 --- 4-AcA and Doxorubicin on Annexin Staining --- p.100 / Chapter 3.4.6 --- 4-AcA and Doxorubicin on Apoptotic Protein Expression --- p.102 / Chapter 4. --- Discussion --- p.105 / Chapter 4.1 --- 17 β-Estradiol and Anticancer Drug Sensitivity --- p.106 / Chapter 4.2 --- Tamoxifen and Anticancer Drug Sensitivity --- p.109 / Chapter 4.3 --- Aromatase Inhibitors and Anticancer Drug Sensitivity --- p.112 / Chapter 4.4 --- DU145 Cells vs PC3 Cells --- p.115 / Chapter 5. --- Conclusion and Perspectives --- p.116 / Chapter 6. --- References --- p.117

OBJETIVOS. Verificar os efeitos da terapia hormonal com derivados estrogênicos e progestogênicos, isolados ou associados à metiltestosterona, na sexualidade e nos sintomas climatéricos em mulheres na pós-menopausa e comparar os dois tipos de terapia hormonal. CASUÍSTICA. Selecionaram-se sessenta mulheres sexualmente ativas, com queixas sexuais, com relacionamento estável com parceiro capacitado para o coito, com idade de 42 a sessenta anos (média etária 52,1 + 4 anos) e tempo de menopausa de um a 28 anos (média 5,6 anos). Excluíram-se mulheres com doenças sistêmicas, doenças psiquiátricas, endócrinas, distopias genitais, tabagistas e usuárias de terapia hormonal ou de medicamentos que apresentavam interferência na sexualidade. METODOLOGIA. Realizou-se estudo de coorte progressiva, duplo-cego, randomizado, com duração de 12 meses. As mulheres foram divididas em dois grupos: EP (n=29), medicadas com estrogênios conjugados (EEC) 0,625 mg + acetato de medroxiprogesterona (AMP) 2,5 mg + placebo, e grupo EP+A (n=31), medicadas com EEC 0,625 mg + AMP 2,5 mg + metiltestosterona 2,0 mg. Para estudar a sexualidade, utilizou-se o Questionário Sexual do Hospital das Clínicas e foram avaliados o desejo sexual, a excitação e a capacidade orgástica nas atividades desenvolvidas com o parceiro, o interesse sexual não vinculado, exclusivamente, às atividades desenvolvidas com o parceiro, a dispareunia, a secura vaginal e a freqüência sexual. Para as análises estatísticas, utilizaram-se Modelos Lineares Gerais para Medidas Repetidas, Análise de Variância (ANOVA), Modelos de Regressão Logística Multinomial e Qui-quadrado de Pearson. O nível de significância foi de 5%. RESULTADOS. Nos grupos EP e EP+A, houve aumento no escore de desejo sexual vinculado, exclusivamente, às atividades desenvolvidas com o parceiro (F=18,334; p<0,001), no escore de excitação sexual (F=14,022; p < 0,001), na capacidade orgástica (F=34,650; p < 0,001) e na freqüência sexual (F=7,687; p=0,008), bem como redução da secura vaginal (?2=44,153; p<0,001), da dispareunia (?2=34,447; p < 0,001) e do índice menopausal de Kupperman (F=158,460; p < 0,001). A análise comparativa entre os grupos EP e EP+A mostrou maior interesse sexual não vinculado, exclusivamente, às atividades com o parceiro (?2=11,551; p=0,021) e mais altos índices de Castelli I (F=8,542; p < 0,001) e índices de Castelli II (F=11,500; p < 0,001) no grupo EP+A. Não se observaram hirsutismo nem alopécia em nenhum dos grupos; acne grau I foi observada em duas mulheres do grupo EP e em 13 do grupo EP+A. CONCLUSÕES. As terapias hormonais com derivados estrogênicos e progestogênicos, isolados ou associados à metiltestosterona, causaram impacto positivo em todos os parâmetros sexuais e nos sintomas climatéricos analisados. A associação de metiltestosterona ao tratamento estro-progestacional aumentou o interesse sexual não vinculado, exclusivamente, às atividades com o parceiro e os índices de Castelli I e II. Nos demais parâmetros estudados, não houve diferença entre os dois grupos / Objectives: To verify the effects of hormone therapy with estrogen and progesterone derivatives when used singly or combined with methyltestosterone, on sexuality and on climacteric symptoms in postmenopausal women. Subjects: The series included sixty-sexually active women, with sexual complaints, in a stable relationship with a partner capable of intercourse, ages ranging from 42 to sixty years (average 52,1 + 4) and menopause time from one to 28 years (average 5,6). Excluded were women with systemic diseases, psychiatric and endocrine disorders, genital dystopias, smokers and those on hormone therapy or medications that affect sexuality. Method: A double blind, randomized, progressive cohort study was performed over a twelve month period. The women were divided into two groups: EP (n=29), medicated with conjugated estrogens (EEC) 0,625 mg + medroxyprogesterone acetate (AMP) 2,5 mg + placebo, and group EP+A (n=31), medicated with EEC 0,625 mg + AMP 2,5 mg + methyltestosterone 2,0 mg. For the study of sexuality, the Hospital das Clínicas Sex Questionnaire was utilized, assessing sexual desire linked exclusively to activities developed with the partner; excitation and orgasmic capacity in activities with the partner; sexual interest not linked exclusively to activities developed with the partner; dyspareunia, vaginal dryness and sexual frequency. For statistical analysis, the General Linear Models for Repeated Measures, Analysis of Variance (ANOVA), Multinomial Logistic Regression Models and Pearson Chi square were employed. A 5% significance level was adopted. Results: In groups EP and EP+A, was observed an increase in the sexual desire score linked exclusively to activities developed with the partner (F=18,334; p<0,001), sexual excitation (F=14,002; p<0,001), orgasmic capacity (F=34,650; p < 0,001) and in sexual frequency (F=7,687; p=0,008), as well as an reduction in vaginal dryness (x2=44,153; p < 0,001), dyspareunia (x2=34,447; p < 0,001) and in the Kupperman menopausal index (F=158,460; p < 0,001). Comparative analysis between groups EP and EP+A revealed a greater sexual interest not linked exclusively to activities with the partner (x2=11,551; p=0,021) and higher Castelli I index (F=8,542; p < 0,001) and Castelli II index (F=11,500; p<0,001) in group EP+A. Neither hirsutism nor alopecia were noticed in either group; Class I acne was observed in two women of group EP and in 13 of group EP+A. Conclusion: Hormone therapy with estrogen and progesterone derivatives used singly or together with methyltestosterone had a positive result on all sexual parameters and on climacteric symptoms analyzed. Association of methyltestosterone to estrogen-progesterone treatment increased sexual interest not linked exclusively to activities with the partner and Castelli I and II indexes. No difference between the two groups in the other parameters studied was demonstrated

OBJETIVOS. Verificar os efeitos da terapia hormonal com derivados estrogênicos e progestogênicos, isolados ou associados à metiltestosterona, na sexualidade e nos sintomas climatéricos em mulheres na pós-menopausa e comparar os dois tipos de terapia hormonal. CASUÍSTICA. Selecionaram-se sessenta mulheres sexualmente ativas, com queixas sexuais, com relacionamento estável com parceiro capacitado para o coito, com idade de 42 a sessenta anos (média etária 52,1 + 4 anos) e tempo de menopausa de um a 28 anos (média 5,6 anos). Excluíram-se mulheres com doenças sistêmicas, doenças psiquiátricas, endócrinas, distopias genitais, tabagistas e usuárias de terapia hormonal ou de medicamentos que apresentavam interferência na sexualidade. METODOLOGIA. Realizou-se estudo de coorte progressiva, duplo-cego, randomizado, com duração de 12 meses. As mulheres foram divididas em dois grupos: EP (n=29), medicadas com estrogênios conjugados (EEC) 0,625 mg + acetato de medroxiprogesterona (AMP) 2,5 mg + placebo, e grupo EP+A (n=31), medicadas com EEC 0,625 mg + AMP 2,5 mg + metiltestosterona 2,0 mg. Para estudar a sexualidade, utilizou-se o Questionário Sexual do Hospital das Clínicas e foram avaliados o desejo sexual, a excitação e a capacidade orgástica nas atividades desenvolvidas com o parceiro, o interesse sexual não vinculado, exclusivamente, às atividades desenvolvidas com o parceiro, a dispareunia, a secura vaginal e a freqüência sexual. Para as análises estatísticas, utilizaram-se Modelos Lineares Gerais para Medidas Repetidas, Análise de Variância (ANOVA), Modelos de Regressão Logística Multinomial e Qui-quadrado de Pearson. O nível de significância foi de 5%. RESULTADOS. Nos grupos EP e EP+A, houve aumento no escore de desejo sexual vinculado, exclusivamente, às atividades desenvolvidas com o parceiro (F=18,334; p<0,001), no escore de excitação sexual (F=14,022; p < 0,001), na capacidade orgástica (F=34,650; p < 0,001) e na freqüência sexual (F=7,687; p=0,008), bem como redução da secura vaginal (?2=44,153; p<0,001), da dispareunia (?2=34,447; p < 0,001) e do índice menopausal de Kupperman (F=158,460; p < 0,001). A análise comparativa entre os grupos EP e EP+A mostrou maior interesse sexual não vinculado, exclusivamente, às atividades com o parceiro (?2=11,551; p=0,021) e mais altos índices de Castelli I (F=8,542; p < 0,001) e índices de Castelli II (F=11,500; p < 0,001) no grupo EP+A. Não se observaram hirsutismo nem alopécia em nenhum dos grupos; acne grau I foi observada em duas mulheres do grupo EP e em 13 do grupo EP+A. CONCLUSÕES. As terapias hormonais com derivados estrogênicos e progestogênicos, isolados ou associados à metiltestosterona, causaram impacto positivo em todos os parâmetros sexuais e nos sintomas climatéricos analisados. A associação de metiltestosterona ao tratamento estro-progestacional aumentou o interesse sexual não vinculado, exclusivamente, às atividades com o parceiro e os índices de Castelli I e II. Nos demais parâmetros estudados, não houve diferença entre os dois grupos / Objectives: To verify the effects of hormone therapy with estrogen and progesterone derivatives when used singly or combined with methyltestosterone, on sexuality and on climacteric symptoms in postmenopausal women. Subjects: The series included sixty-sexually active women, with sexual complaints, in a stable relationship with a partner capable of intercourse, ages ranging from 42 to sixty years (average 52,1 + 4) and menopause time from one to 28 years (average 5,6). Excluded were women with systemic diseases, psychiatric and endocrine disorders, genital dystopias, smokers and those on hormone therapy or medications that affect sexuality. Method: A double blind, randomized, progressive cohort study was performed over a twelve month period. The women were divided into two groups: EP (n=29), medicated with conjugated estrogens (EEC) 0,625 mg + medroxyprogesterone acetate (AMP) 2,5 mg + placebo, and group EP+A (n=31), medicated with EEC 0,625 mg + AMP 2,5 mg + methyltestosterone 2,0 mg. For the study of sexuality, the Hospital das Clínicas Sex Questionnaire was utilized, assessing sexual desire linked exclusively to activities developed with the partner; excitation and orgasmic capacity in activities with the partner; sexual interest not linked exclusively to activities developed with the partner; dyspareunia, vaginal dryness and sexual frequency. For statistical analysis, the General Linear Models for Repeated Measures, Analysis of Variance (ANOVA), Multinomial Logistic Regression Models and Pearson Chi square were employed. A 5% significance level was adopted. Results: In groups EP and EP+A, was observed an increase in the sexual desire score linked exclusively to activities developed with the partner (F=18,334; p<0,001), sexual excitation (F=14,002; p<0,001), orgasmic capacity (F=34,650; p < 0,001) and in sexual frequency (F=7,687; p=0,008), as well as an reduction in vaginal dryness (x2=44,153; p < 0,001), dyspareunia (x2=34,447; p < 0,001) and in the Kupperman menopausal index (F=158,460; p < 0,001). Comparative analysis between groups EP and EP+A revealed a greater sexual interest not linked exclusively to activities with the partner (x2=11,551; p=0,021) and higher Castelli I index (F=8,542; p < 0,001) and Castelli II index (F=11,500; p<0,001) in group EP+A. Neither hirsutism nor alopecia were noticed in either group; Class I acne was observed in two women of group EP and in 13 of group EP+A. Conclusion: Hormone therapy with estrogen and progesterone derivatives used singly or together with methyltestosterone had a positive result on all sexual parameters and on climacteric symptoms analyzed. Association of methyltestosterone to estrogen-progesterone treatment increased sexual interest not linked exclusively to activities with the partner and Castelli I and II indexes. No difference between the two groups in the other parameters studied was demonstrated