Effects of high dose progestin on serum lipids and lipid metabolizing enzymes in patients with endometrial cancer

The effect of high dose medroxyprogesterone acetate (MPA) on serum lipids, on adipose tissue lipoprotein lipase (LPL) and serum lecithin cholesterol acyltransferase activities were studied in 15 postmenopausal patients with endometrial cancer. After 2 weeks of MPA treatment total cholesterol decreased by 14% (P less than 0.001) and HDL cholesterol by 33% (P less than 0.01) from the respective pretreatment values; correspondingly the ratio of HDL to total cholesterol decreased (P less than 0.05). The decrease of HDL2 cholesterol was 35% (P less than 0.01) and that of HDL3 cholesterol 15% (P less than 0.01). The levels of serum triglycerides decreased significantly (P less than 0.05) during the treatment period. Serum LCAT activity was significantly lower (P less than 0.05) after treatment than before, but adipose tissue LPL activity was not altered. The mean serum testosterone level decreased significantly (P less than 0.001) from the pretreatment values. Significant positive correlations were present between LPL activity and MPA concentrations and between LPL activity and testosterone concentrations after the drug treatment.

Low-risk amniocentesis in the third trimester under ultrasound control

Amniocentesis was performed under ultrasound control on 501 third-trimester gravidae out of the 509 referred. Eight patients were excluded based on the ultrasound examination, since practically no amniotic fluid could be detected. Ultrasound was used to find a pocket of amniotic fluid in which the puncture would carry no risk to the foetus. The puncture was made immediately after the examination, on the same examination table. In 17% of cases the puncture was made in the lower uterine segment behind the foetal neck. A diagnostic sample of the amniotic fluid was obtained in 87.4% of cases. In the other 12.6%, the sample either could not be obtained (7.8%) or contained blood (4.8%). In 1.8% of cases the membranes ruptured within 24 hours of the puncture. In no case could any damage be shown either to the foetus or to the placenta, nor were there any signs of intrauterine infection.

The subrenal capsule assay in mice. Prediction of rat tumor sensitivity to chemotherapy

The predictive value of the subrenal capsule (SRC) assay for cancer chemotherapy was tested in five rat tumors. Tumor-bearing rats were used as controls. In order to simulate clinical chemotherapy, different dose regimens and drug combinations were used. All five tumors were evaluable in in the SRC assay. Taking into account cytotoxic drugs, 86% compatibility was obtained between the SRC assay and the rat model. Antitumor effect of three antiestrogenic compounds could not be predicted by the SRC assay. It is concluded that the SRC assay can be expected to have predictive value in the assessment of tumor sensitivity to single and combination chemotherapy based on experimental animal models.

Microbiology of vaginitis associated with the intrauterine contraceptive device

A malodorous, homogeneous, grey, thin and non-purulent discharge, which resembles non-specific vaginitis occurs in 20% of women with an intrauterine contraceptive device (IUCD); four times more common than in non-users. The aim of this investigation was to study the bacteriological aetiology of this IUCD-associated vaginal discharge, and to assess whether the infection was ascendent. No specific microbiological aetiology was found, but the normal, Lactobacillus-dominated microbial vaginal flora was replaced by Gardnerella vaginalis and certain anaerobic species in IUCD-users with the discharge. Clue cells, pepper-salt phenomenon and curved rods and/or fusiform-shaped rods demonstrated by microscopy, were typical of symptomatic patients. The endometrium and the IUCD were infected with these species in the symptomatic group more often than in IUCD-users who had no symptoms or in the control women who did not use the IUCD.

Contrast enhancement versus vasculature of uterine tumors

The relative contrast enhancement of normal myometrium and small or medium size uterine fibroids and clinical stage I endometrial carcinomas were correlated to their microangiographically demonstrable vascularity. In four cases small uterine fibroids showed contrast enhancement equal to normal myometrium, independent of their vascularity in microangiography. In five, endometrial carcinomas contrast enhancement was always below that of the surrounding myometrium in CT. Intratumour vasculature showed great variability in microangiography. No correlation between the topographic variations in the arrangement or density of tumour blood vessels and the degree of contrast enhancement was found. Contrast enhancement of small uterine fibroids was greater than that of small adenocarcinomas. More contrast material accumulates tissue of the fibroid than into the extravascular space of endometrial carcinoma.

Steroid receptors and response of ovarian cancer to hormones in vitro

Oestrogen receptor (ER) and progesterone receptor (PR) content and the response in vitro to tamoxifen (T), medroxyprogesterone acetate (MPA) and to a combination of the two hormones were determined in 21 epithelial ovarian carcinomas. The response was assessed by the level of adenosinetriphosphate in the cells. ER and PR were detected in 62% and 57%, respectively, with significant variations between the different histopathological cancer types. ER and PR predicted the response in vitro in 62% of the tumours exposed to the combined hormones, and in 38% and 33% of those exposed to T and MPA, respectively. The value of steroid-receptor determinations in selecting the proper hormonal treatment in ovarian cancer is significantly reduced because of the high proportion of incorrect predictions.

Steroid receptors and response of ovarian cancer to cytostatic drugs in vitro

Samples of 21 ovarian cancers were assayed for oestrogen receptor (ER) and progesterone receptor (PR) content, and the response in vitro to treatment with a combination of doxorubicin, diacetyldian hydrogalactitol and cisplatin was determined. The number of living cells after drug exposure was estimated by a new ATP-bioluminescence method and the tumours were considered responsive if cell survival was less than or equal to 50% of the value in a corresponding control culture. Of the 16 tumours that responded to drug exposure, nine were ER-positive, seven ER-negative and eight were PR-positive, eight PR-negative. The mean percentages of surviving cells ranged from 22.2% in PR-negative tumours to 30.9% in PR-positive tumours. There were no differences in the response rates or in the degree of response to the cytostatics in terms of either receptor status or tumour histology. The results were also compared with those obtained in the same tumour samples exposed to hormones, tamoxifen and medroxyprogesterone acetate. The average response of all tumours was better to cytostatics than to hormones (P less than 0.05); this was particularly marked in the ER-negative tumours. Cytostatics may be preferable to hormones as the primary drug treatment for ovarian cancers but steroid-receptor determinations appear not to help in formulating the optimum drug treatment.

Effect of prostaglandin inhibitor and oestrogen on climacteric symptoms and serum free fatty acids

Oestradiol and naproxen were compared in a double-blind, cross-over study of 20 women suffering from climacteric symptoms. Subjective symptoms were assessed before and after treatment. In addition, serum levels of prostaglandin precursors and of certain other free fatty acids were determined. Oestradiol was found to have a slightly more pronounced effect than naproxen on symptoms and on fatty acid levels. Nevertheless, a large number of the patients reported significant alleviation of their symptoms on naproxen. Some of the climacteric symptoms may thus be mediated by prostaglandins. In most patients the fatty acid levels decreased after treatment with both substances, but there were two exceptions. It is suggested that there may be two separate types of metabolic response to these drugs.

A prospective, randomized, national trial for treatment of ovarian cancer: the role of chemotherapy and external irradiation

A prospective, randomized, national trial for comparing the effects of cytotoxic agents and radiotherapy on survival in primary epithelial ovarian cancer stages I-IV was carried out in 363 patients. After laparotomy, the patients were staged according to disease spread and randomized into treatment groups within each stage. The single or combined cytotoxic agents used were: cyclophosphamide (C) and vincristine (V); 5-fluorouracil (F) and dactinomycin (D) and V; treosulfan (T); and CF. In stages I, II and III there was one treatment group receiving external irradiation; in stage IV only different cytostatics were used. It was found that, in stage I, surgery alone was superior to surgery +CV or surgery + irradiation. In stage II disease, no differences in survival between treatment groups receiving pelvic irradiation or FDV, and in stage III between whole abdomen + pelvic irradiation or CV or FDV were found. In stage IV, FDV, T and CF were of similar, poor efficacy. The authors conclude that in stage I pelvic irradiation or combined chemotherapy do not improve survival. In advanced disease, chemotherapy may be better tolerated and thus preferable to whole abdomen irradiation; the combination of more modern cancer drugs with the ones used in this study is probably likely to improve the treatment results.

Composition of free fatty acids at the end of pregnancy and inducibility of labor

The concentrations of free fatty acids which included prostaglandin precursors were investigated in a group of 54 healthy women coming to elective induction of labor. There were no differences between the concentrations of the fatty acids when the mothers were divided in two groups according to whether induction was successful or not. There were slightly more mothers with successful induction, who had the total prostaglandin precursor level above average than among mothers with unsuccessful induction (p less than 0.05). The rates of false positives or false negatives were so high, however, that this determination can not be clinically used in predicting the outcome of labor induction.

Serum prostaglandin precursors after vaginal examination and amniotomy

The effect of vaginal or cervical examination during pregnancy upon the levels of circulating prostaglandin precursors and other free fatty acids was investigated. Of 31 mothers coming to elective induction of labor, a plain vaginal examination was performed in 9 cases, the cervix was penetrated by a finger and the membranes were slightly swept off the uterine wall in 10 cases and an amniotomy was performed in 12 cases. The blood samples were collected before and 5 minutes after the procedure. No changes were observed in prostaglandin precursors or in other free fatty acid levels. Also the precursors/other fatty acids ratio was unchanged. The demonstrated changes in circulating prostaglandin levels after these procedures are not reflected in the circulating precursor levels.

Predicting malignancy of suspected ovarian tumours by CT

The CT appearance of 47 clinically suspected ovarian tumours was analysed and compared to operative findings. By using simple differential diagnostic criteria, such as the relative amount of cystic and solid tumour tissue, presence of ascites and density readings, it was possible to correctly predict the malignancy of 18 out of 20 primary and 4 out of 5 recurrent ovarian tumours. In 6 out of 16 benign ovarian tumours or pelvic masses the CT pattern was either indeterminate or similar to malignant neoplasms. Since some non-ovarian tumours may produce an identical picture, the site of origin of large tumours could not be always detected. CT provides significant complementary information on the characteristics of suspected ovarian malignancies. A tumour which has a typical benign, cystic CT appearance is very likely benign, while some of the masses which contain solid tissue, consistent with a malignancy, may still be benign.

Immune function in patients with ovarian carcinoma treated with irradiation or with cytostatics

The immunocompetence of 25 patients with ovarian cancer was followed up during and after radiation or chemotherapy, by using the number of lymphocytes, E-rosette-forming cells, and mitogen responses as parameters. In comparison with chemotherapy, the irradiation caused a profound and permanent immunosuppression. In patients treated with chemotherapy, the number of E-rosette-forming cells and the mitogen responses were fewer in the patients who developed recurrence or dissemination.

Computer-tomographic evaluation of gynecologic tumors

The accuracy of contrast-enhanced computer tomography (CT) of the pelvis in the detection, characterization and staging of known or suspected pelvic tumors was compared with clinical and operative findings in a prospective study of 79 patients (25 cervical carcinomas, 27 endometrial carcinomas, 10 ovarian carcinomas, 4 vulval or vaginal carcinomas and 13 benign ovarian or uterine tumors). In cervical carcinoma, there was a tendency towards lower staging of the tumor, especially in stage IIa, which is not easily detected in CT. Even small tumors of the cervix and endometrium can be visualized by contrast enhancement, which clearly delineates heavily vascularized myometrium and less enhancing tumor tissue. The accuracy of CT in tumor detection, characterization and evaluation of spread was best in ovarian neoplasms, weakest in cervical carcinomas. The importance of proper CT technique is stressed.

Non-specificity of symptoms related to adenomyosis. A prospective comparative survey

A total of 212 patients coming for removal of the uterus due to a benign condition were interviewed by the first author before operation. Of these patients 28 had adenomyosis, while 157 had neither adenomyosis nor external endometriosis; these two groups were compared with respect to duration of menstrual bleeding, dysmenorrhea, dyspareunia, urinary symptoms and sacral and lower abdominal pain. There were no inter-group differences in the frequencies of these symptoms. It is concluded that although patients with adenomyosis have many symptoms, none specific to adenomyosis can be found.

Bioluminescence of cellular ATP: a new method for evaluating cytotoxic agents in vitro

Rat Walker 256 carcinosarcoma, human MCF-7 cell line and a specimen of ovarian serous cystadenocarcinoma were cultured in vitro and exposed to different cytostatic drugs. The drug effects were evaluated by bioluminescence, i.e., by measuring the levels of adenosine triphosphate (ATP), the basic energy source of the living cells. The intracellular ATP was released by TCA or NRS -reagent, and the ATP levels were measured directly from an aliquot of the growth medium without any extraction or precipitation steps. ATP level was significantly correlated with cell number, viability, [3H]-thymidine incorporation and stem cell assay. The most important advantages of bioluminescence method was speed, technical simplicity and good sensitivity (about 500 cells/sample easily quantitated, the results are seen directly within a few seconds) and flexibility (any cell line and drug may be studied by many different test designs). ATP method obviously describes the "well- being" of the cultured cells. According to our experience, the ATP-bioluminescence method is a powerful alternative to any other cell growth estimation method in vitro. It can be used especially in primary screening of the cytostatic activity of any known or unknown substance as well as in attempts to select an individual drug therapy for patients with cancer.

Maternal serum copper and zinc concentrations in normal and small-for-date pregnancies

Serum concentrations of copper (Cu) and zinc (Zn) were determined in 20 non-pregnant healthy menstruating women and in 20 pregnant women during the 1st, 2nd and 3rd trimesters and 5 weeks postpartum as a longitudinal study. Also a cross-sectional population of 106 women was studied. Further, Cu and Zn concentrations were measured in 13 pregnant women who gave birth to small-for-date (SFD) infants; this was done during the 3rd trimester of pregnancy. The serum Cu concentration in nonpregnant women was 0.91 +/- 0.19 mg/l. During pregnancy it was significantly higher (1.48 +/- 0.31, 1.91 +/- 0.25 and 2.20 +/- 0.36 mg/l during the 1st, 2nd and 3rd trimesters, respectively) and 5 weeks postpartum it was still higher (1.09 +/- 0.17 mg/l) than in the nonpregnant women. In the cross-sectional population, serum Cu and Zn values were of the same magnitude as in the longitudinal study. When longitudinal and cross-sectional values of serum Cu during the 3rd trimester were combined, the mean level (2.23 +/- 0.40 mg/l) was significantly higher than that in the SFD group (2.06 +/- 0.25 mg/l). Serum Zn in the SFD group (0.48 +/- 0.12 mg/l) did not differ significantly from the normal pregnant values.

In vitro functions of lymphocytes during high-dose medroxyprogesterone acetate (MPA) treatment

The number and function of T and B lymphocytes were studied in endometrial cancer patients during 3 months' treatment with high-dose medroxyprogesterone acetate (MPA). No significant changes were observed in the proportions of T and B cells or in the function of B cells during MPA treatment. At 3 months, lymphocyte blastogenic responsiveness to mitogens was slightly reduced both in patients treated with standard therapy alone (intracavitary radium and surgery) and in patients receiving additional MPA therapy. These results indicate that other factors than progesterone are responsible for the suppression of lymphocyte blastogenesis induced by mitogens during high-dose progestin treatment.

Pregnancy and delivery in Ehlers-Danlos syndrome. Role of copper and zinc

Two pregnancies of a patient with the mitis type of the Ehlers-Danlos syndrome (EDS) were followed up. The first pregnancy ended at 26 weeks. The second one proceeded to term, but the infant had a low birth weight and the placenta showed dysmaturity. In view of these pregnancies, the authors consider the vaginal route as an alternative to caesarean section for delivery of patients with the mitis type of EDS. In connection with both deliveries, serum zinc and copper levels were determined with the method of particle-induced X-ray emission (PIXE); the concentrations of both trace elements were low. The ceruloplasmin levels, on the other hand, were within the normal range. The relevance of these findings is discussed.

The role of calcium, copper, iron and zinc in preterm delivery and premature rupture of fetal membranes

Maternal and cord blood samples were collected in 60 cases with or without rupture of membranes before and at term. Serum concentrations of calcium, copper, iron and zinc were determined by proton-induced X-ray emission. Maternal and cord serum ceruloplasmin and maternal hemoglobin were also determined. Mothers with preterm delivery showed significantly lower hemoglobin values than those with delivery at term. Concentrations of calcium, iron and zinc were higher in cord than in maternal serum whereas maternal copper levels were higher than respective cord levels in all groups. The cord copper and ceruloplasmin and also their fetal/maternal ratios were significantly lower in the group with preterm premature rupture of fetal membranes (PROM) than in other groups. Maternal serum zinc and calcium were lower in preterm groups than in term groups. The study suggests a possible role of copper in preterm PROM and of zinc in the initiation of preterm labor, whereas calcium and iron do not seem to be involved in the etiology of prematurity or PROM.

Breast stimulation test in fetal surveillance

The usefulness of breast stimulation to elicit uterine contractions as a contraction stress test in fetal surveillance in high-risk pregnancies was investigated. The test was successful in fulfilling the criteria of contraction stress testing in 48 out of 76 mothers (62%). Success rates were not affected by the duration of pregnancy after 36 weeks. Nor did parity have any significant effect. The results of the breast stimulation test (BST) correlated well with the preceding non-stress test. Only one positive BST was detected in this population. In this case the late decelerations were present even during labor the next day. BST seems to be a practicable tool, in preference to the oxytocin challenge test, for fetal surveillance.

Analysis of intrapartum fetal deaths: their decline with increasing electronic fetal monitoring

Over a 12-year period, from 1970 to 1981, 30 600 babies were born at the Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland. During that period, the use of electronic fetal monitoring increased remarkably, being involved in 9, 12, 33 and 95% of all vaginal deliveries during four consecutive 3-year periods. The number of intrapartum deaths during the same 12-year period was 52, giving an overall rate of 1.7 per thousand. When 15 lethally malformed infants are excluded, the rate becomes 1.2 per thousand. In the four consecutive 3-year periods, the death rates were 1.7, 1.9, 1.0 and 0.3 per thousand. Electronic fetal monitoring was not undertaken in any of the cases leading to fetal death. The main factor leading to fetal death could be considered to be hypoxia in approximately 90% of the deaths of normally formed babies. The most common reasons for hypoxia were placental abruption and cord entanglement, yet in many cases only the decreased placental perfusion could be suggested to have caused the hypoxia. The mean weight of those babies that died intrapartally decreased significantly, being approximately 1 250 g during the last 3-year period.

Trace metals in postdate pregnancy

Maternal and cord serum calcium, copper, iron and zinc concentrations were analyzed in 20 women with a postdate pregnancy. The control group consisted of 20 parturients with delivery at term and their newborns. Serum free estriol (E3) was also determined. Maternal serum copper, zinc and E3 were statistically significantly lower, while cord serum copper and fetomaternal ratio of zinc were significantly higher in the study group than in the control group. Further, a positive correlation between E3 and maternal serum copper level (r = 0.63) was found.