Annales chirurgiae et gynaecologiae. Supplementum最新文献

The outcome of pregnancy and delivery was studied in 122 teenagers (under 18 years) and matched controls. There were no differences in complications during pregnancy, delivery method or outcome of pregnancy as measured by perinatal mortality and morbidity. Anemia post partum existed more often in the teenage group, and teenager's newborns were also lighter than those of the controls. This may be due to premature deliveries, which were more common in the teenage group. Premature deliveries were more common in patients who did not visit health centres or maternity outpatient clinics. The main problem is how to attach such teenagers to organized maternity care.

Endometrial inactivation by irradiation, while simultaneously preserving the ovarian function is sometimes clinically indicated. We have found that after 1100 cGy (rad) the ovarian function remains intact, yet endometrial inactivation is unsatisfactory. Therefore, four premenopausal subjects, with clinical indications for eliminating disturbing uterine bleedings, received each an endometrial dose of 1600 cGy by using a Cathetron afterloading unit. When pre- and post-treatment cycles were compared, the circulating gonadotrophin and estrogen levels were unchanged in three subjects. Nine to 12 weeks after the treatments there were no signs of ovulation and the gonadotrophin levels were generally increased. None of the subjects had experienced any bleedings. We conclude that an endometrial dose of 1600 cGy is effective in inactivating endometrium, but may also lead to an impaired ovarian function and to a premature menopause.

Cytosol steroid receptor contents of 2 tubular androblastomas were determined and that was correlated with the response to hormonal (tamoxifen and medroxyprogesterone acetate) and cytotoxic agents (chlorambucil, vincristine, cisplatin and etoposide) using a new in vitro method based on ATP measurement of cultured cells. Both androblastomas showed low receptor contents and no response to medroxyprogesterone acetate, tamoxifen or their combination was found. Furthermore, there was no response to chlorambucil or vincristine or their combination as well as to the combination of tamoxifen and vincristine in one tumor. The other tumor, however, showed good in vitro response to cisplatin and the combination of cisplatin and etoposide.

In 46 patients, age 17-46 years, 48 simple ovarian cysts with the median diameter of 4-14 cm were punctured using ultrasonic quidance. The aspirate of cysts was examined cytologically. The punctured cysts were observed by ultrasonic examinations performed one month and three months after the punctures. The recurred cysts (n = 16) were punctured again. If the cyst recurred again, the patient was operated. The experience up to now indicates that the results of the puncture treatment are good. Out of 46 patients of the study, 14 (30%) had to be operated, while 32 (70%) did avoid from laparotomy due to the puncture. In cytological examinations no malignant cells were established. Besides one haematoma, no complications appeared.

The effect of local oestriol treatment on the abdominal skin was studied in 14 postmenopausal women. Six control patients received a similar ointment without oestriol. The duration of the treatment in all cases was three weeks. The elastic fibers in the papillary dermis were thickened, better orientated and slightly increased in number in half of these patients but in none of the control patients. The epidermal thickness was slightly increased in four of the patients treated with oestriol. No significant changes were observed in the epidermal cell size, mitotic activity, dermal vascularization or inflammatory infiltrate between the specimens taken before and after the treatment or between the treatment groups.

28 patients were treated with the modified Pereyra procedure for female stress urinary incontinence. In 12 patients this was the primary operative correction of the complaints and resulted in total continence in 10 patients (83%). The other patients had a recurrent stress incontinence which might have contributed to lower success rate of 54% in the total series. Due to less extensive surgery than in suprapubic urethropexy and due to low complication rate we feel that the modified Pereyra procedure is a good alternative as a primary operation for stress urinary incontinence.

The sensitivity to medroxyprogesterone acetate (MPA) and tamoxifen (T) and their combination was assayed in 13 patients with untreated endometrial cancer by an in vitro ATP-bioluminescence method. The method measures the levels of adenosinetriphosphate (ATP), the basic energy source of living cells. A tumor was considered to respond to the drug, if the proportion of living cells after manipulation was 50% or less from unmanipulated control culture. Estrogen (ER) and progesterone (PR) receptors were assayed by the DCC-method and the results calculated by Scatchard-analysis. ER (greater than or equal to 3 fmol/kg cytosol protein) was present in all tumors and PR (greater than or equal to 10 fmol/kg cytosol protein) in 85% of the tumors. The response rate in vitro to MPA was 67% (8 out of 12 tumors), to T 18% (2 out of 11) and to their combination 69% (9 out of 13). The G1 tumors responded statistically significantly better to MPA (p less than 0.01) and MPA + T (p less than 0.02) as compared to T. MPA produced higher cell kill of G1 than G2 tumors (p less than 0.05). The ER content correlated with the effect of MPA in vitro in 67%, with the effect of T in 18% and with that of their combination in 69% of the tumors. The PR content correlated with the effects of MPA in vitro in 83%, with the effect of T in 36% and with that of their combination in 54% of the tumors. It was concluded that the in vitro ATP-bioluminescence method provides valuable information besides steroid receptor determinations for sensitivity testing of endometrial cancer to hormones.

We describe a case of a giant unhomogenous uterine leiomyoma that simulated ovarian cancer both clinically, roentgenologically (computerized tomography) and ultrasonically. As an incidental finding there was also a carcinoma in situ of the endometrium. The difficulties in the differential diagnosis of an abdomino-pelvic mass are discussed, and the significance of laparotomy also as a diagnostic method is emphasized.