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Australian and New Zealand Journal of Obstetrics and Gynaecology 2006; 46: 170– 178
Re: Effects of rosiglitazone on hormonal profile Ghazeeri et al., treatment with rosiglitazone resulted in the and ovulatory function in Chinese women with resumption of ovulation but no significant changes in testo-sterone and dehydroepiandrosterone sulphate.4 On the other hand, significant reduction in androgen levels was reportedin other recent studies.5,6 The lack of change in androgen Polycystic ovary syndrome (PCOS) is a disorder character- levels in our study may be the result of the small sample size ised by chronic anovulation, hyperandrogenism and hyper- or ethnic different in participants; further studies are insulinaemia. Treatment using insulin-sensitizing agents had yielded promising results.1 Rosiglitazone is a relatively new Nevertheless, the present study shows that the use of insulin-sensitizing agent belonging to the thiazolidinedione rosiglitazone may lead to the resumption of ovulation and class. There are only limited data concerning the therapeutic menstruation in Chinese women suffering from PCOS.
efficacy of rosiglitazone in women with PCOS, especially in Although the present study involves only a small number of patients, it shows that the option of rosiglitazone is feasible, We conducted a prospective observational study to evalu- and further study with a larger sample size and longer follow- ate the effects of rosiglitazone in seven Chinese women with up to evaluate the effects of rosiglitazone alone in PCOS PCOS (defined by the National Institutes of Health (NIH) criteria2). The study consisted of four menstrual cycles. Thefirst cycle was observational only without any treatment.
Rosiglitazone 4 mg daily was given throughout the second to Department of Obstetrics and Gynaecology, the Chinese fourth cycles. Pre- and post-treatment hormonal and bio- University of Hong Kong, Prince of Wales Hospital chemical profiles were compared by the paired t-test.
The mean age and body mass index were 28.1 years and 24.5 kg /m2, respectively. After rosiglitazone therapy, there Department of Obstetrics and Gynaecology, Princess Margaret was a significant increase in day 21 progesterone levels (2.3 ± 0.7 vs. 12.5 ± 8.4 nmol/L, P = 0.019) and a significantreduction in luteinizing hormone to follicular stimulatinghormone ratios (1.3 ± 0.8 vs. 0.7 ± 0.5, P = 0.049). Three outof seven (42.9%) cycles required progestogen induced with- References
drawal before commencement of rosiglitazone; this reduced 1 Azziz R, Ehrmann D, Legro RS et al. Troglitazone improves to 3 out of 21 cycles after treatment (14.3%) (P = 0.14).
ovulation and hirsutism in the polycystic ovary syndrome: a There were no differences in free testosterone (T), andro- multicenter, double blind, placebo-controlled trial. J Clin stenedione, dehydroepiandrosterone sulphate, sex hormone Endocrinol Metab 2001; 86: 1626 –1632.
binding globulin, fasting insulin and glucose before and after 2 Mitwally MFM, Duscu NK, Yalcinkaya TM. High ovulatory treatment. There is also no significant difference in hirsutism rates with use of troglitazone in clomiphene-resistant women score and acne score before and after rosiglitazone therapy.
with polycystic ovary syndrome. Hum Reprod 1999; 14: 2700 –
Recent studies suggested that rosiglitazone is effective in correction of hyperandrogenism and reversal of anovulation 3 Tarkun I, Cetinarslan B, Turemen E, Sahin T, Canturk Z, in women with PCOS.3–6 However, these data mainly studied Komsuoglu B. Effect of rosiglitazone on insulin resistance, C- Caucasian patients. Because there are known differences in reactive protein and endothelial function in non-obese young presentation and biochemical profile of PCOS patients of women with polycystic ovary syndrome. Eur J Endocrinol different ethic origins,7–9 we conducted the present study to 2005; 153: 115 –121.
evaluate the effects of rosiglitazone in Chinese women.
4 Ghazeeri G, Kutteh WH, Bryer-Ash M, Haas D, Ke RW.
In the present study, we found that there is a significant Effect of rosiglitazone on spontaneous and clomiphene citrate- increase in luteal phase progesterone levels and reduction of induced ovulation in women with polycystic ovary syndrome.
luteinizing hormone/follicular stimulating hormone ratios Fertil Steril 2003; 79: 562–566.
after rosiglitazone therapy. This translates to a higher per-centage of spontaneous menstruation without the need of Financial disclosure
progestogen withdrawal therapy, although the difference did This study is supported by the Hospital Authority Princess not reach statistical significance because of the small number.
Margaret Hospital Research Grant. Rosiglitazone used in this However, there was no significant change in male hormonal study was donated by the SmithKlein Beecham Pharmaceuticals.
profile after rosiglitazone therapy. Similarly, in the study by Journal compilation 2006 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 5 Sepilian V, Nagamani M. Effects of rosiglitazone in obese References
women with polycystic ovary syndrome and severe insulin
resistance. J Clin Endocrinol Metab 2005; 90: 60 – 65.
1 Thomas SV. Neurological aspects of eclampsia. J Neurol Sci 6 Dereli D, Dereli T, Bayraktar F, Ozgen AG, Yilmaz C. Endo- 1998; 155: 37– 43.
crine and metabolic effects of rosiglitazone in non-obese 2 Thomas SV, Somanathan N, Radhakumari R. Interictal EEG women with polycystic ovary disease. Endocr J 2005; 52: 299 –
changes in eclampsia. Electroencephalogr Clin Neurophysiol 1995; 94: 271–275.
7 Williamson K, Gunn AJ, Johnson N, Milsom SR. The impact 3 OsmanaGaoGlu MA, Dınç G, OsmanaGaoGlu S, Dınç H, of ethnicity on the presentation of polycystic ovarian syn- Bozkaya H. Comparison of cerebral magnetic resonance and drome. Aust N Z J Obstet Gynaecol. 2001; 41: 202–206.
electroencephalogram findings in pre-eclamptic and eclamptic 8 Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA.
women. Aust N Z J Obstet Gynaecol 2005; 45: 384 –390.
Does ethnicity influence the prevalence of adrenal hyper-
androgenism and insulin resistance in polycystic ovary syndrome?
Am J Obstet Gynecol 1992; 167: 1807–1812.
9 Lam PM, Ma RC, Cheung LP, Chow CC, Chan JC, Haines CJ. Polycystic ovarian syndrome in Hong Kong Chinese women: patient characteristics and diagnostic criteria. Hong
Kong Med J
2005; 11: 336 –341.
We thank Drs Kho LK and Dunne JW for their letter withregard to our published paper.1 The type of electroencephalogram (EEG) apparatus used was described in this study as Nihon Kohden, Japan. Afterdiscussion with the department of Neurology, we have found Re: Comparison of cerebral magnetic that the description of the EEG apparatus should be DG resonance and electroencephalogram findings in Examiner digital EEG (Medelec, Oxford, UK). This appara- tus has been replaced with a new version and its manu-facturer guide could not been found. Oral advice to us had, The interictal electroencephalograph (EEG) findings unfortunately, provided this incorrect company name.
reported in eclampsia vary from normal to focal and diffuse The seizure activities on the recordings were visually slowing and epileptiform activity.1,2 This is certainly an area labelled by a neurologist from the Neurosciences Depart- where more data are needed. Although OsmanaGaoGlu et al.’s study was unable to reach any clinically useful conclusions,3 All of the EEG examinations were recorded using the correlating magnetic resonance (MR) with EEG findings Medelec DG Examiner digital EEG machine (UK) and were and combining them to try and determine prognosis in these performed by the same technician using high-frequency filter of 70 Hz, low-frequency filter of 0.5 Hz, and sensitivity of However, OsmanaGaoGlu et al. did not describe a number 10 µV/mm. The scalp electrodes were placed at 16 according of important features of their EEG findings. These include a to the International 10–20 system.2 Impedance was kept description of the nature of the epileptiform activity and the below 5 kΩ in all cases. A sampling rate of 256 Hz was used slowing of the EEGs, their topography (i.e. distribution of for digitisation and minimum recording lenght of each EEG- these abnormalities), their intensity and whether the abnor- trace was 20 min in resting conditions. Analysed results were malities were intermittent or persistent. For example, ‘diffuse given in four different frequency bands (delta (θ), 0–4 Hz; slowing’ is a very limited description of an EEG abnormality.
theta (δ), 4–8 Hz; alpha (α), 8–12 Hz; and beta (β) The method of EEG reporting was absent. It is essential also > 13 Hz) as percentages of each frequency band. The EEG to know whether the person reading the EEG was already findings were analysed without knowledge of the MRI find- ings and the clinical diagnosis of the patients by the same Unfortunately, although MRI (magnetic resonance imaging) methodology and findings were clearly described, importanttechnical EEG data were omitted, including the type of EEG apparatus used (N.B. Medelec and Nihon Kohden are unre- lated companies), the number of EEG channels, a descrip- tion of their modified International 10–20 System, electrode Karadeniz Technical University, Faculty of Medicine, impedances, bandpass and sensitivities, the duration of each Department of Obstetrics and Gynecology, Trabzon/Turkey study and activation procedures performed, if any.
The absence of technical EEG information and an accu- rate description of the EEG findings have markedly limited References
1 OsmanaGaoGlu MA, Dınç G, OsmanaGaoGlu S, Dınç H, Bozkaya H. Comparison of cerebral magnetic resonance and W.A. Adult Epilepsy Centre, Royal Perth Hospital, Western electroencephalogram findings in pre-eclamptic and eclamptic women. Aust N Z J Obstet Gynaecol 2005; 45: 384 –390.
Journal compilation 2006 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 46: 170– 178


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VIDENSKAB OG PRAKSIS | Retningslinjer for behandling af overvægt/fedme anno 2006 STATUSARTIKEL Overlæge Ole Lander Svendsen, overlæge Søren Toubro, øgning af fysisk aktivitet og motion vanskelig at gennemføre læge Jens Meldgaard Bruun, læge Jens Peder Linnet & for fede personer, og øgningen i sig selv fremkalder ofte kun et beskedent vægttab. Hvis man kombinerer øget fysi

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