University Times

High hormone levels may reduce asthma severity, improve lung function

Progesterone and estrogen appear to have a positive effect on lung function and reduce the symptoms of asthma, according to a report published by Pitt Graduate School of Public Health (GSPH) researchers in the March issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology.

“We found that women’s lung function and asthma symptoms improve when estrogen and progesterone levels are raised, both naturally during certain times in the menstrual cycle and with the administration of oral contraceptives or hormone replacement therapy,” said Catherine L. Haggerty, GSPH post-doctoral fellow and senior author of the report. “These studies suggest that estrogen and progesterone play a role in strengthening respiratory muscle and in increasing relaxation of bronchial smooth muscle, thereby reducing the contractile response. The two hormones also have been shown to exhibit anti-inflammatory properties.”

Haggerty and her colleagues reviewed scientific data generated between 1966 and 2001 and discovered that asthmatic patients experienced increased asthma episodes, increased hospitalizations for asthma and decreased pulmonary function during the premenstrual and menstrual phase, when hormonal levels are low. Conversely, some women experience improved pulmonary function and a decrease in asthma exacerbation while taking oral contraceptives and hormone replacement therapy.

“Estrogen and progesterone are highly elevated during pregnancy, reaching their greatest concentrations during the final trimester. In some women, improvements in asthma symptoms from preconception to pregnancy parallel these changes in hormonal levels, with the lowest rate of symptoms occurring during the last four weeks,” Haggerty said.

According to the authors, certain subgroups of women may be more susceptible to hormone cycles. Testosterone, estrogen and progesterone may each independently affect pulmonary function to varying degrees.

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Surgery for obesity most successful when done by experienced surgeons

The risk of complications following gastric bypass surgery for obesity is significantly lower when performed by a surgeon with greater experience in the procedure, according to a Pitt study.

The study, presented March 21 at the Central Surgical Association in Toronto by Anita Courcoulas, assistant professor of surgery at Pitt’s School of Medicine, and director of bariatric surgery at the University of Pittsburgh Medical Center’s Shadyside Hospital, is the first to address the relationship between patient volume and outcome for the rapidly growing and complicated field of gastric bypass surgery.

In the surgery, a small stomach pouch is created to restrict food intake. Then a Y-shaped portion of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum, and the first section of the jejunum. This bypass reduces the amount of calories and nutrients the body can absorb.

The study found that surgeons performing fewer than 10 bypass procedures per year had a 28 percent risk of adverse outcomes and a 5 percent risk of mortality compared to 14 percent and 0.3 percent, respectively, for high-volume surgeons.

“With the introduction of the laparoscopic approach both the complexity and prevalence of these gastric bypass procedures are increasing,” Courcoulas said.

The data used in the study were obtained from the Pennsylvania Health Care Cost Containment Council. Risk factors include age, gender, race, co-morbid medical conditions and illness severity, among others. Over the three-year period of the study, gastric bypass surgery in the state increased by 100 percent each year. Of the 4,674 cases studied, females comprised 82 percent of patients, whites made up 70 percent, blacks made up 10 percent, and 20 percent were other races. Ages ranged from 16 to 74 years. The study data encompassed 73 hospitals and 129 surgeons.

There were 28 in-hospital deaths and 813 adverse outcomes during the study period. Nearly 17 percent of patients had one or more postoperative complications that ranged from major to minor while in the hospital following surgery in this study group.

“The data showed a clear and significant trend to fewer adverse outcomes with more experienced surgeons,” said Courcoulas. The study also demonstrated several interactions in a risk-adjusted model, between surgeon and hospital volume.

“Surgeons performing 10 to 50 cases per year, operating in low-volume hospitals had the highest adverse outcome rate of 55 percent. Surgeons performing more than 50 cases a year did not operate in low to medium volume hospitals. The subset of surgeons who performed fewer than 10 cases per year in a medium-volume hospital had the highest increase in mortality with a rate of 7 percent.

“Although the relationship between provider volume and outcome for gastric bypass surgery is clear in this study, mortality and complications are only part of the full range of outcome measures that are meaningful after major procedures such as gastric bypass surgery,” Courcoulas said.

“These outcome measures include long-term weight loss, improvement in functional status, improved quality of life, patient satisfaction and service quality. These measures of quality of care will need to be more thoroughly investigated in the rapidly growing field of obesity surgery. Future studies, with larger sample sizes, will need to address both volume-outcome relationships and the broad range of clinical outcomes and other multiple factors that influence overall quality of care.”

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Parkinson’s symptoms shown for first time on PET scans of living patients

A Pitt neurologist has used an advanced form of brain imaging to identify changes in small regions of the brains of living Parkinson’s disease patients for the first time. These results were presented April 2 at the American Academy of Neurology meeting.

Robert Y. Moore, Love Family Professor and professor of neurology and neuroscience and co-director of the National Parkinson Foundation Center of Excellence at Pitt, analyzed positron emission tomography (PET) scans of the brains of 41 Parkinson’s patients and 16 normal individuals obtained at the Hammersmith Hospital, part of the Imperial College of Medicine in London. The scans focused on two small areas found deep in the brain called the locus coeruleus and raphe, areas that control attention and wakefulness. His analysis found evidence of degeneration of nerve cells in these areas.

“We were able to see changes in these areas for the very first time,” Moore said. “Before now, we could only see these changes on post-mortem examinations. The implications of this are enormous because it shows that we can now begin to gain a better understanding of the progression of this disease and treatment using PET.”

PET is an imaging method that provides high-resolution pictures of the chemistry of the brain by measuring the concentration of positron-emitting radioisotopes. An individual undergoing a PET scan is intravenously administered a drug containing a radioactive isotope specifically formulated to be taken up by specific groups of nerve cells.

“PET scans are important in helping us develop methods to make an earlier diagnosis of Parkinson’s disease and even to identify people who have no symptoms but are at risk of developing the disease so that we can begin treatment and prevent severe disability from occurring,” he said. “There are several drugs now in FDA phase I and II trials that hold promise for this.”

An estimated 1 million people in the United States suffer from Parkinson’s, a degenerative neurological disease that selectively affects nerve cells that are important in the control of movement. The major early signs include slowness of movement, an abnormal increase in muscle tone and tremor. Many patients also experience disruptions of the sleep/wake cycle and their ability to mentally focus attention.

It is believed the loss of nerve cells usually begins 5 to 7 years before symptoms develop. The disease is most common in those over 50, though younger persons, such as actor Michael J. Fox and television talk show host Montel Williams, also have developed Parkinson’s.