Longitudinal changes in cognition, gait, and balance in abstinent and relapsed alcoholic men: relationships to changes in brain structure

Chronic alcoholism is associated with cognitive and motor deficits, and there is evidence for reversibility with sobriety. Alcoholic men were examined after 1 month of sobriety and 2 to 12 months later with cognitive and motor tests and magnetic resonance imaging. In this naturalistic study, 20 alcoholic participants had abstained and 22 had resumed drinking at retesting. Abstainers sustained greater improvement than relapsers on tests of delayed recall of drawings, visuospatial function, attention, gait, and balance. Shrinkage in 3rd ventricle volume across all participants significantly correlated with improvement in nonverbal short-term memory. Additional brain structure-function relationships, most involving short-term memory, were observed when analyses were restricted to alcoholic men who had maintained complete abstinence, were light relapsers for at least 3 months, or had consumed no more than 10 drinks prior to follow-up testing. Thus, alcoholic men who maintain abstinence can show substantial functional improvement that is related to improvement in brain structure condition.     

Hepatitis B vaccine: immunogenicity and follow-up including two year booster doses in high-risk health care personnel in a London teaching hospital

One hundred forty-four adult health care personnel (aged 18-62 years, median 33 years) considered at high risk of future HBV infection were vaccinated with a plasma-derived hepatitis B vaccine (20 micrograms HBVax at 0, 1, and 6 months) and followed-up for 2 years. Anti-HBs was present in only 6.9% prior to vaccination, and prescreening to detect this group would not have been cost-effective. At 9 months, 8.3% were nonresponders and a further 9% had anti-HBs levels less than 50 mIU/ml. Multivariate analysis showed that age was the single most important determinant of a poor response. In 47 of 52 individuals retested 2 years later, anti-HBs levels had fallen by 80% or more, and in four it had become undetectable. Response to a booster dose at this stage was excellent, with anti-HBs levels 3 months later much higher than at the end of the initial course. Additional booster doses of vaccine in two of the initial nonresponders at 14 and 22 months, respectively, also led to seroconversion. Although a significant proportion of health care workers in this study did not make a satisfactory response to the hepatitis B vaccine, later booster doses were very effective in subsequently increasing anti-HBs levels.     

Allergy to suxamethonium: persisting abnormalities in skin tests, specific IgE antibodies and leucocyte histamine release

Twenty-one patients, who had previously experienced an anaphylactic reaction to suxamethonium during general anaesthesia, were selected for this study. Initially, skin tests with muscle relaxants were carried out in the twenty-one patients, detection of specific anti-choline IgE in nineteen, and leucocyte histamine release in seventeen. These three tests were then repeated between 1 year and 4 years after the initial evaluation. In the majority of patients, sensitization to the muscle relaxants persisted for more than 1 year after the anaphylactic reaction. Only three patients out of twenty-one (4%) had negative skin tests when retested 1–4 years later. A reduction in leucocyte histamine release was noticed in one of the seventeen retested patients (6%). Modifications of anti-choline IgE were observed in five of nineteen patients (26%). The persistence of sensitization to suxamethonium may result from repeated stimulation by occasional contacts with quaternary ammonium compounds. This study demonstrates the reliability of skin tests, leucocyte histamine release and detection of anti-choline IgE to diagnose allergic reactions to suxamethonium, even when they are performed a long time after the initial anaphylactic reaction.     

Four-year safety follow-up of the tetravalent dengue vaccine efficacy randomized controlled trials in Asia and Latin America

ObjectiveOur objective was to describe the risk of hospital admission for virologically confirmed dengue (VCD) and the risk of clinically severe hospitalized VCD occurring up to 4 years after the first dose (years 1 to 4) in three randomized clinical trials comparing tetravalent dengue vaccine with placebo.MethodsThe relative risks (RR) for hospitalized VCD from first dose to year 4 were estimated by year and age-group in individual and combined studies.ResultsOverall, from Year 1 to Year 4, 233 and 228 participants had at least one episode of hospitalized VCD in the vaccinated (n = 22 603) and placebo (n = 11 301) groups, respectively (RR = 0.511, 95% CI 0.42–0.62). Among these, 48 and 47 cases, respectively, were classified as clinically severe. In children aged ≥9 years, 88 and 136 participants had at least one episode of hospitalized VCD in the vaccinated (n = 17 629) and placebo (n = 8821) groups, respectively (RR = 0.324; 95% CI 0.24–0.43). In vaccinated participants aged <9 years, particularly in those aged 2–5 years, there were more hospitalized VCD cases compared with the control participants in Year 3 but not in Year 4. The overall RR in those aged <9 years for Year 1 to Year 4 was 0.786 (95% CI 0.60–1.03), with a higher protective effect in the 6–8 year olds than in the 2–5 year olds.ConclusionsThe overall benefit-risk remained positive in those aged ≥9 years up to year 4, although the protective effect was lower in years 3 and 4 than in years 1 and 2.     

Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study

STUDY OBJECTIVES: To describe the stability of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) scores over 1 year among a population-based sample of black and white early middle-aged adults. PARTICIPANTS: More than 600 participants, aged 38 to 50 years, from the Chicago site of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS: The PSQI and ESS were completed twice, approximately 1 year apart, between 2003 and 2005. Seven PSQI 4-level component scores, a global PSQI score, and the ESS scores were calculated. A PSQI global score greater than 5 was classified as poor quality sleep, and an ESS score greater than 10 was classified as high daytime sleepiness. RESULTS: The mean+/-SD PSQI score was 5.7+/-3.1 in Year 1 and 5.9+/-3.1 in Year 2. The mean ESS score was 7.4+/-4.3 in Year 1 and 7.2+/-4.2 in Year 2. The Pearson correlation coefficient for the PSQI score in both years in the full sample was .68 and ranged from .54 among black men to .72 among black women. The Pearson correlation coefficient for the ESS score in both years in the full sample was .76 and ranged from .70 among black men to .80 among white men. In the full sample, 76% had the same PSQI dichotomous classification, and 85% had the same ESS dichotomous classification in both years. CONCLUSIONS: These results suggest that the PSQI and ESS are stable measures of sleep quality and sleepiness over the past year in early middle-aged adults.     

Motor immaturity and specific speech and language impairment: evidence for a common genetic basis

Previous studies have found an association between motor immaturity and specific language impairment in children. Data from two twin studies were used to address the question of whether these linked deficits have a common etiology. Study 1 involved 57 MZ and 22 DZ pairs where one or both twins had specific speech/language impairment. A control group of 173 single-born children was also tested. Motor skill was assessed using a tapping task, which was carried out with left and right hands. Tapping scores were converted to scaled scores adjusted for age and sex. Unaffected twins and single-born controls did not differ in motor skill, but twins with speech and/or language impairments obtained significantly poorer tapping scores than controls. Bivariate DeFries-Fulker analysis pointed to shared genetic influence on tapping speed and a measure of speech production accuracy. In study 2, 37 twin pairs from study 1 were retested 2-3 years later and combined with 100 twin pairs from a general population sample. A timed peg-moving task was used to assess motor skill. Children with combined speech and language impairments obtained poorer peg-moving scores than unaffected children. Bivariate DeFries-Fulker analysis found significant shared genetic variance for impairments on peg-moving and on a test of nonword repetition. It is concluded that genes that put the child at risk for communicative problems also affect motor development, with the association being most evident when speech production is affected.     

Hypothermia causes adult-like retention deficits of prior learning in infant mice

Nine-day-old S-W mice receiving deep body hypothermia or hyperthermia immediately after escape training were retested 1 or 24 hr later. Results indicated that hypothermia impaired 24-hr retention but had no effect upon 1-hr memory. Hyperthermia had no effect, with the mice demonstrating retention of the escape response at both retest intervals. In Experiment 2, administration of hypothermia or hyperthermia 23 hr after original training had no effect upon memory nor did either treatment produce motoric deficits upon retest 1 hr following thermal exposure. Experiment 3 indicated that hypothermia administered immediately after training produced retention deficits directly related to amount of body temperature reduction following hypothermia. These data are similar to those obtained with adult mice and suggest that memory processess occurring in 9-day-old mice may represent the onset of functioning of processes underlying adult long-term memory.     

A profile of neuropsychological deficits in alcoholic women

Neuropsychological deficits, most notable in executive, visuospatial, and functions of gait and balance, are detectable in alcoholic men even after a month of sobriety. Less well established are the severity and profile of persisting deficits in alcoholic women. The authors used an extensive test battery to examine cognitive and motor functions in 43 alcoholic women who were sober, on average, for 3.6 months. Functions most severely affected in alcoholic women involved visuospatial and verbal and nonverbal working memory processes as well as gait and balance. Areas of relative sparing were executive functions, declarative memory, and upper-limb strength and speed. The authors found that lifetime alcohol consumption was related to impairment severity on Block Design (Wechsler Adult Intelligence Scale-Revised, D. Wechsler, 1981) and verbal and nonverbal working memory, suggesting a dose effect of alcohol abuse. The alcohol-related deficits in working memory, visuospatial, and balance implicate disruption of prefrontal, superior parietal, and cerebellar brain systems.     

Specialist contraceptive counselling and provision after termination of pregnancy improves uptake of long-acting methods but does not prevent repeat abortion: a randomized trial

BACKGROUND: One in four abortions in the UK is undertaken for women who have had one before. Women undergoing abortion in Edinburgh were targeted for improved contraceptive advice and provision in this randomized trial. METHODS: Between November 2001 and May 2002, women recruited at assessment for abortion were randomized at admission to receive specialist contraceptive advice and enhanced provision (316 women) or standard care (297 women). Randomization was based on the week of admission. Contraceptive use 16 weeks after abortion was assessed by questionnaire and subsequent abortions by review of the hospital records 2 years later. RESULTS: Women receiving specialist advice and enhanced provision were more likely to leave the hospital with contraception (271 versus 115, P < 0.001), which was more likely to be a long-acting method (141 versus 78, P < 0.001) than women receiving standard care. Four months later, there was no significant difference in contraceptive prevalence or continuation, but women in the intervention group were more likely to be using contraceptive implants (32 versus 6, P < 0.001). Two years later, 14.6% of women in the intervention group (44/302) and 10% of controls (27/268) had undergone another abortion in the same hospital (P = 0.267). CONCLUSIONS: Specialist contraceptive advice and enhanced provision had a short-lived effect on contraceptive uptake and increased the use of long-acting methods but did not appear to reduce repeat abortions.     

Neuropsychological measures and event-related potentials in alcoholics: Interrelationships,long-term reliabilities,and prediction of resumption of drinking

Sober male and female alcoholics and peer controls were tested and then retested 14 months later on neuropsychological performance tests (NTP) and also had event-related potentials (ERPs) recorded (non-concurrently) to visual stimulation. Both NTP and ERP measures distinguish male alcoholics from peer controls at test and retest; NTP, but not ERP, scores distinguish female alcoholics from peer controls. Both measures manifest moderate to high reliabilities over time and are correlated modestly. NTP and ERP measures obtained at the end of treatment predict future resumers and abstainers 8 to 14 months later. The results demonstrate the utility of biopsychological approaches to alcoholism and support Grant's (1986) concept of alcoholics as suffering from an intermediate duration (subacute) organic mental disorder.     

Age-related ability of rats kept on a life-long hypocaloric diet in a spatial memory test. Longitudinal observations

Cognitive behavior was assessed in a test specific for spatial memory, according to a longitudinal experimental model, in populations of 12-, 24- and 30-month-old rats which were fed ad lib either a standard (ST) or a hypocaloric (HY) diet, that had been shown to reduce age-related pathologies and to increase survival. Already at 12 months of age, some cognitive deficits were observed in ST but not in HY rats. When retested 12 and 18 months later, the animals performed better at the beginning of the test than when tested for the first time, indicating that some aspects of previous experience lead to a preservation of spatial memory. Deficits which had been previously observed in 2-year-old groups in a cross-sectional experimental model were not evident this time. Some of the differences between the two diet groups observed 12 months before disappeared. When testing was repeated for the third time at 30 months of age, ST fed rats presented very marked deficits in learning and in memory, which were not seen in the HY group. It thus appears that a dietary regimen in which part of the calorie-rich components, such as lipids and carbohydrates, are replaced with vegetable fibers, retards some of the age-related deteriorations of brain functions.     

A prospective study of eating disturbances in the ballet

A group of 35 ballet students was assessed and then retested between 2 and 4 years later to determine the persistence of eating symptoms and to identify factors which predict eating disorders. Of those interviewed at follow-up, 25.7% had anorexia nervosa and 14.2% had either bulimia nervosa or a 'partial syndrome'. 'Drive for thinness' and 'body dissatisfaction' scales of the Eating Disorder Inventory were the only measures which predicted development of eating disorders at follow-up. The finding that most cases of anorexia nervosa gained weight at follow-up was similar to an earlier report; however, the view that these disorders were benign adaptations to the ballet subculture was challenged by the observation that many continued to experience significant eating disorder symptoms at follow-up. Findings indicate that vulnerable adolescents may be identified early using economical self-report measures as the initial step in a two-stage screening process.     

Exercise training-induced lowering of inflammatory (CD14+CD16+) monocytes: a role in the anti-inflammatory influence of exercise?

Exercise training or higher levels of physical activity are known to exert anti-inflammatory effects. CD14+CD16+ monocytes are potent producers of inflammatory proteins, and elevated levels of these "inflammatory" monocytes have been implicated in disease development. Little is known about the influence of exercise training on this cell population. On the basis of their physical activity pattern, male and female subjects, 65-80 years old, were assigned to a physically active (PA; n=15) or inactive (PI; n=15) group. The PI group performed 12 weeks (3 days/week) of endurance (20 min at 70-80% heart-rate reserve) and resistance exercise training (eight exercises, two sets at 70-80% of one repetition maximum). Subjects in the PA group maintained their habitual activity level. Flow cytometry was used to determine monocyte phenotype and monocyte TLR4 expression. ELISAs were used to measure whole blood, LPS-stimulated TNF-alpha production, and serum C-reactive protein (CRP). At baseline, the PA group had a lower percentage of CD14+CD16+ monocytes and lower unstimulated production of TNF-alpha than the PI group. CD14+CD16+ monocyte percentage and 1 ng/ml LPS-stimulated TNF-alpha production were reduced after the PI group underwent 12 weeks of exercise training. PI subjects also had higher TLR4 expression on classical monocytes, but there were no significant exercise training-induced changes in monocyte TLR4 expression. The PA group had significantly lower serum CRP than the PI group. Physical activity was associated with lower CD14+CD16+ monocyte percentage and LPS-stimulated TNF-alpha production. Exercise training-induced reductions in CD14+CD16+ monocytes may contribute to the anti-inflammatory effects of exercise training.     

Psychomotor performance in the senescent rodent: reduction of deficits via striatal dopamine receptor up-regulation

JOSEPH, J. A., R. T. BARTUS, D. CLODY, D. MORGAN, C. FINCH, B. BEER AND S. SESACK. Psychomotor performance in the senescent rodent: Reduction of deficits via striatal dopamine receptor up-regulation. NEUROBIOL AGING 4(4) 313–319, 1983.—In order to determine the relationship between striatal dopamine (DA) receptor density and psychomotor performance in senescent animals, two experiments were carried out. In the first, the age-related motor deficits were characterized using a battery of four psychomotor tests (rod walking, wire hanging, inclined screen, plank walking). These tests were administered to three gro groups of male Fischer rats (mature, 6–8 months; middle aged, 12–18 months; and senescent, 25 months) and performance measured. Age-related differences were observed on all the tasks, with the oldest animals showing the poorest performance. These animals were then used in a second experiment in which one-half of the group of animals from each age was administered 1.86 mg/kg/day of haloperidol for 14 days (via surgically implanted Alza Minipumps). Control groups of animals from each age were given pumps which contained only the vehicle (HCl diluted with distilled water, pH = 2.9). Following the 14 day drug administration, the pumps were surgically removed and 3 days later all the groups were retested on the psychomotor tests. Stereotypy (to 0.5 mg/kg of apomorphine, sniffing, licking, grooming and cage crossings) was also re-examined. Results show that haloperidol-treated animals from all three age groups display greater response times (i.e., better performance) than vehicle-treated animals on the battery of four motor tests and, the haloperidol-treated old animals exhibit more sniffing and grooming than the vehicle-treated old animals. Parallel increases in [³H]spiperone binding seen in all haloperidol-treated groups suggest a relationship between increases in the density of striatal DA receptors and improvement in motor performance.     

How children with neurofibromatosis type 1 differ from "typical" learning disabled clinic attenders: nonverbal learning disabilities revisited

To further investigate cognitive deficits in children with Neurofibromatosis Type 1 (NF-1), children with NF-1 were compared to typical learning disabled clinic attenders (LD-clinic), all of whom had reading disabilities, as well as to a group with no disabilities (NoDx). Results indicated that both the NF-1 group and LD-clinic group had reading and reading-related deficits when compared to the NoDx group; however, the NF-1 group was more globally language impaired than the LD-clinic group. In addition, the NF-1 group scored significantly lower than the LD-clinic group, but not the NoDx group, on the visuospatial measures, thus confirming that children with NF-1 have visuospatial deficits not typical of a general LD-clinic population. The NF-1 group was not impaired in comparison to the NoDx group on certain language and visuospatial tasks that were previously found to be deficits in sibling pairwise matched designs; thus, the importance of considering genetic and familial context when studying the impact of genetic disorders on cognition was demonstrated.     

Psychomotor performance in the senescent rodent: reduction of deficits via striatal dopamine receptor up-regulation

JOSEPH, J. A., R. T. BARTUS, D. CLODY, D. MORGAN, C. FINCH, B. BEER AND S. SESACK. Psychomotor performance in the senescent rodent: Reduction of deficits via striatal dopamine receptor up-regulation. NEUROBIOL AGING 4(4) 313–319, 1983.—In order to determine the relationship between striatal dopamine (DA) receptor density and psychomotor performance in senescent animals, two experiments were carried out. In the first, the age-related motor deficits were characterized using a battery of four psychomotor tests (rod walking, wire hanging, inclined screen, plank walking). These tests were administered to three gro groups of male Fischer rats (mature, 6–8 months; middle aged, 12–18 months; and senescent, 25 months) and performance measured. Age-related differences were observed on all the tasks, with the oldest animals showing the poorest performance. These animals were then used in a second experiment in which one-half of the group of animals from each age was administered 1.86 mg/kg/day of haloperidol for 14 days (via surgically implanted Alza Minipumps). Control groups of animals from each age were given pumps which contained only the vehicle (HCl diluted with distilled water, pH = 2.9). Following the 14 day drug administration, the pumps were surgically removed and 3 days later all the groups were retested on the psychomotor tests. Stereotypy (to 0.5 mg/kg of apomorphine, sniffing, licking, grooming and cage crossings) was also re-examined. Results show that haloperidol-treated animals from all three age groups display greater response times (i.e., better performance) than vehicle-treated animals on the battery of four motor tests and, the haloperidol-treated old animals exhibit more sniffing and grooming than the vehicle-treated old animals. Parallel increases in [³H]spiperone binding seen in all haloperidol-treated groups suggest a relationship between increases in the density of striatal DA receptors and improvement in motor performance.     

Factors associated with regular episodes of dysuria among women in one rural general practice.

The aim of this study was to ascertain the factors associated with frequency-dysuria (urethral) syndrome in a population of women. The study included all women aged 25 years and over on 1 May 1987 who had been registered with one rural, dispensing practice over the study period, 1 May 1985 to 1 May 1989. A self-administered questionnaire was sent to the women on 1 May 1987 and a second, similar, questionnaire was sent two years later. A total of 721 women responded to the two questionnaires (response rate 97%). Regular symptoms of frequency and dysuria were reported by 8% of women in 1987 and 14% in 1989. Four percent of women reported symptoms throughout the four year study period. Symptoms were found to be least common in the 55-74 years age group. Although none of the women who were sexually inactive reported regular symptoms no association was reported between recent sexual intercourse and symptoms. Neither was an association demonstrated between type of contraception used and symptoms. However, it was found that premenopausal women reported significantly more symptoms than postmenopausal women. The number of women involved in this study was too small to allow the importance of change of sexual partner to be determined. Significantly more of the women who reported regular symptoms had been treated for urinary tract infection than of those who did not report regular symptoms. Although a history of regular frequency and dysuria points to a diagnosis of urethral syndrome, general practitioners must assess each case in order to exclude urinary tract infection.     

Home-orienting behavior in rat pups surviving postnatal or intergenerational malnutrition

Growth and home-orienting behavior were studied during the 1st 12 days of life in 3 groups of rat pups: (1) those with intergenerational malnutrition; (2) those with postnatal malnutrition produced by cross-fostering pups born of well-nourished mothers to lactating females maintained on a low-protein diet; and (3) well-nourished control pups. Growth of pups was impaired in both malnourished groups, and eye-opening was similarly delayed. On tests of homing behavior, both malnourished groups were impaired to a similar extent and were less likely to find their way to the nest than were control pups. However, survival rates were significantly lower (50%) in the postnatally malnourished group but not in the intergenerationally malnourished group (73%), as compared with controls (100%). These findings suggest that adaptation occurs to long-term malnutrition with increased survival. However, physical characteristics and homing behavior in early life are not distinguishable in those surving short- or long-term malnutrition. This is in contrast to the finding of more severe behavioral deficits in later life among rats subjected to many generations of malnutrition than among those malnourished for only 1 generation.     

Human T-cell lymphotropic virus type 1 infection among pregnant women in northeastern Brazil

An evaluation of human T-cell lymphotropic virus type 1 (HTLV-1) infection among 6754 pregnant women in Salvador, Bahia, Brazil using enzyme-linked immunosorbent assay, Western blot analysis, and polymerase chain reaction assay found a rate of infection of 0.84% (57 of 6754 women). Epidemiologic and obstetric data on the HTLV-1-positive pregnant women were analyzed and compared with data on a control group of HTLV-1-negative pregnant women. The mean age of the HTLV-1-positive women was 26.2 years. All were seronegative for HIV and syphilis, and only 2 reported a past history of sexually transmitted infection and more than 10 sexual partners. Of the HTLV-1-positive women, 88.5% were breast-fed, 4% were bottle fed, and 7.5% did not know. Six women had received blood transfusions, and only 1 reported intravenous drug use. Fifty-two HTLV-1-positive women could be followed: 45 had full-term deliveries, 5 had premature deliveries, and 2 had abortions. Our results indicate that (1) the frequency of HTLV-1 infection among pregnant women is relatively high in Salvador, Bahia, Brazil; (2) maternal infection was probably acquired more frequently through breast-feeding, but the sexual route was certainly the second most important means of transmission; (3) HTLV-1-positive women had a history of eczema-like infections in childhood more frequently than the control group; (4) HTLV-1 infection did not interfere in the course of pregnancy; and (5) no associated congenital infections were observed in the HTLV-1-positive women.     

A prospective study on women with a history of breast cancer and with or without estrogen replacement therapy

Objective: Because a categorical refusal of estrogen replacement therapy (ERT) from postmenopausal patients with a history of breast cancer is not based on any research evidence and may be more harmful than beneficial, we evaluated the safety and efficacy of ERT in these women. Methods: We recruited 131 patients who had been treated for breast cancer for a mean of 4.2 years (range 1 month to 20 years) before. Eighty-eight decided to use ERT, whereas 43 refused or had no need for ERT. At recruitment, the patients were carefully examined for breast and gynaecologic findings. Non-hysterectomized patients wishing to receive ERT (n=54) then started using estradiol as oral tablets (2 mg/day) (n=44) or as transdermal gel (1.5 mg/day) (n=10) in combination with 10-day courses of oral medroxyprogesterone acetate at 4-week intervals, whereas hysterectomized patients (n=34) used only estradiol, orally (2 mg/day) (n=31) or transdermally (1.5 mg/day) (n=3). The patients using ERT were carefully examined 6 and 12 months later, and then annually at a specific outpatient department, and the mean follow-up time is now 2.5 years (range from 1 month to 5.2 years, 216 woman-years). The 43 patients not wishing to receive ERT were followed annually at the oncologic department for a mean of 2.6 years (range from 1 month to 4.7 years), and served as a control group. Results: ERT significantly reduced climacteric symptoms, and the Kupperman score fell by 63%, from 26.9±8.6 to 9.9±6.7 (mean±SD). In non-hysterectomized women, medroxyprogesterone acetate triggered withdrawal bleeding in all except seven women. Seven patients (13%) experienced spotting during ERT. In 27 women, endometrial thickness exceeded 10 mm, and two of the total of 54 patients (3.7%) had simple hyperplasia. This vanished spontaneously in 3–6 months. Ten patients terminated the use of ERT within the first 12 to 39 months due to the lack of severe vasomotor symptoms (n=4) or due to the recurrence of breast cancer or to cancer of the contralateral breast (n=6). Eighty-one of the 88 patients (92%) using ERT showed no evidence of recurrence, whereas five patients (5.7%) had recurrence in 12–36 months and two patients (2.3%) developed a cancer of the contralateral breast in 14–24 months; another one of those wanted to continue with ERT. Thus the combined risk of recurrence or a new cancer of the contralateral breast in ERT users was 7/216 woman-years (3% per year). In the control group, 38 of 43 patients (88.4%) showed no evidence of recurrence or contralateral cancer, whereas four patients had recurrence and one developed a contralateral breast cancer (5/112 woman-years, 4% per year). Conclusions: Symptomatic climacteric patients with a history of breast cancer benefited from ERT without increasing their risk of recurrence, but the short follow-up and the small number of patients limit any definitive recommendations.