Papers by Penny Fairhurst
BMJ, 2003
A 40 year old man presents with a two year history of chronic low back pain. For the past week he... more A 40 year old man presents with a two year history of chronic low back pain. For the past week he has had an exacerbation of his symptoms and intermittent pain radiating down his right leg. What issues you should cover Symptoms-Discuss the likely causes. Show him a diagram or model of the lumbar spine indicating the vertebrae, discs, and nerve roots. Explain that his leg pain is due to irritation of the nerve roots and that effective treatment should alleviate both his back pain and his leg pain. History-When taking a history, be alert to: x Any recent trauma, which may raise the possibility of a fracture x "Red flag" signs (see box), which may indicate serious spinal pathology x "Yellow flag" signs, which are factors recognised as having an influence on long term disease outcomes and which may cloud assessment and treatment. Examination-Look for reduced range of spinal movement, reduced straight leg raise, positive neural stretch tests, neurological deficit (sensory, motor, reflex impairment), distribution of paraesthesias or sensory loss, reduced ankle and great toe dorsiflexion, knee and ankle reflexes. Risk factors-Overweight, a sedentary lifestyle, smoking, heavy physical work, repetitive lifting, twisting, and prolonged standing in an awkward posture can all cause or exacerbate back problems.
The Journal of Clinical Endocrinology & Metabolism, 2005
Purpose: After menopause, women gain abdominal fat and become less sensitive to insulin. We sough... more Purpose: After menopause, women gain abdominal fat and become less sensitive to insulin. We sought to determine whether hormone replacement therapy (HRT) reduced intraabdominal and sc abdominal fat and improved insulin sensitivity in early menopausal women. Methods: Seventy-six postmenopausal women, age 51.6 ؎ 3.9 yr with body mass index of 24.9 ؎ 3.2 kg/m 2 , were randomized to conjugated estrogens (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) or placebo daily. Women received a computed tomography scan at the L4-L5 vertebral disk space, a dual x-ray absorptiometry scan, and a euglycemic hyperinsulinemic clamp at baseline, 6 months, 1 yr, and 2 yr. Results: Fifty-one women completed the trial and were analyzed (n ؍ 26 on HRT and n ؍ 25 on placebo). Intraabdominal fat, sc abdominal fat, total fat, percent fat, fat-free mass, and weight did not differ between treatment groups by time. Insulin sensitivity did not change in the placebo group, but decreased by 17% in the HRT group by 6 months and persisted at 2 yr (P < 0.01 for treatment by time effect). One year after the trial, insulin sensitivity increased by 25% in women who had taken HRT (P ؍ 0.006 for treatment by time effect), to a level similar to those women in the placebo group. Conclusions: Conjugated estrogens plus medroxyprogesterone acetate reduce insulin sensitivity in menopausal women without affecting body composition or body fat distribution. The reduction in insulin sensitivity is reversible after discontinuing HRT.
Fertility and Sterility, 2005
placebo (nϭ23) and group 2 used conjugated estrogen (0.625 mg/day) (nϭ28), 4 women did not come t... more placebo (nϭ23) and group 2 used conjugated estrogen (0.625 mg/day) (nϭ28), 4 women did not come to the second exam and were excluded from the study. Orbital Doppler color flow was performed before and on day 30 of treatment with placebo or estrogen. Both eyes were examined in two different positions: supine and seated. Three waveforms were analysed and the obtained averaged was considered for study. RESULTS: The pulsatility index (PI) of the central retinal arteries were similar in both eyes, therefore the mean value was used. PI decreased significantly (pϽ 0.05) in the group of women that used estrogen but did not in the placebo group, when women were examined in the seated position. When the exam was performed in the supine position values did not show any difference in both groups. CONCLUSIONS: Our study demonstrates that estrogen therapy reduce vascular resistance of the central retinal arteries. These results confirm that estrogen is a potent vascular dilator irrespective to the size of the artery. Also the observed central effect might help elucidate the possible effect of estrogen replacement therapy in the CNS.
Fertility and Sterility, 2006
Objective: To determine the effect of ovarian hormone deficiency on peripheral vascular function.... more Objective: To determine the effect of ovarian hormone deficiency on peripheral vascular function. Design: Randomized, single-blind, placebo-controlled. Setting: General clinical research center. Patient(s): Twelve healthy, lean, premenopausal women with regular menstrual cycles. Intervention(s): Measurements were made during the early to midfollicular and midluteal phases of the menstrual cycle. Patients were then randomized to an 8-week course of gonadotropin-releasing hormone agonist (GnRHa) (n ϭ 6) or placebo (n ϭ 6) and retested. On each occasion, blood flow was assessed in the basal postabsorptive state and under euglycemic-hyperinsulinemic-hyperaminoacidemic conditions. Main Outcome Measure(s): Calf blood flow by venous occlusion plethysmography. Result(s): No differences in calf blood flow under postabsorptive (1.65 Ϯ 0.09 vs. 1.73 Ϯ 0.16 mL/100 g tissue per minute) or insulin-stimulated conditions (2.24 Ϯ 0.20 vs. 2.30 Ϯ 0.18 mL/100 g tissue per minute) were found between the follicular and luteal phases of the menstrual cycle, respectively; therefore, pretreatment data were averaged. Ovarian hormone suppression did not alter postabsorptive calf blood flow (GnRHa: 1.68 Ϯ 0.13 to 1.69 Ϯ 0.15; placebo: 1.69 Ϯ 0.21 to 1.64 Ϯ 0.14 mL/100 g tissue per minute) or the blood flow response to insulin infusion (GnRHa: 2.40 Ϯ 0.21 to 2.37 Ϯ 0.29; placebo: 2.10 Ϯ 0.28 to 2.19 Ϯ 0.35 mL/100 g tissue per minute). Conclusion(s): Variation in ovarian hormones associated with the menstrual cycle or short-term ovarian hormone deficiency induced by GnRHa do not affect calf blood flow under postabsorptive conditions or the response to hyperinsulinemia.
Fertility and Sterility, 2005
The study is the first to provide evidence using immunocytochemical methods that the alprostadil ... more The study is the first to provide evidence using immunocytochemical methods that the alprostadil cream applied topically to the genital area of a female rat could intensively evoke the OT-LI expression of the PVN and the SON. The co-expression of c-Fos-LI with OT-LI indicated that the OT neuronal activities were increased by the alprostadil cream administration. The study results may support the benefit of considering the therapeutic rationale of alprostadil cream in the treatment of FSAD.
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Papers by Penny Fairhurst