Hysterography in evaluating the uterine cavity in patients with endometrial carcinoma.

In 49 patients with endometrial carcinoma hysterographic study was performed. This finding was correlated with fractional curettage, hysteroscopy and surgery. The best correlation was noted between hysterography and hysteroscopy. The flow into the tubes or abdominal cavity using low pressure was found in 20% of the cases. In our opinion hysterography is a useful aid when examining the uterine cavity and cervical canal, and, thus, important when planning treatment and determining clinical stage.

Multicentre study of effects of Org OD 14 on endometrium, vaginal cytology and cervical mucus in post-menopausal and oophorectomized women.

A multicentre study covering 69 post-menopausal or oophorectomized women was performed to determine whether Org OD 14 [7 alpha, 17 alpha)-17-hydroxy-7-methyl-19-norpregn-5(10)-en-20-yn-3-one) administered orally in a daily dose of 2.5 mg for 90 consecutive days induces endometrial proliferation. The treatment with Org OD 14 was continued in combination with 1 mg/day of lynestrenol from day 91 for 10 days to ascertain whether secretory transformation of the endometrium and subsequent withdrawal bleeding would occur. Endometrial biopsies were obtained before treatment and on day 91. The effects of Org OD 14 on vaginal mucosa and cervical mucus were also evaluated. Org OD 14 did not display any effect on the endometrium in 56 of the study subjects (83.5%). Weak stimulation (initial proliferation) was seen in 11 of the subjects (16.4%) and withdrawal bleeding occurred in only 5 of these after cessation of the combined treatment with lynestrenol. However, moderate 'oestrogenic' effects on vaginal mucosa and cervical mucus were induced in all study subjects.

Repeat laparotomy as a preclinical diagnostic and therapeutic method for treating ovarian carcinoma.

One hundred forty-two cases of epithelial ovarian carcinoma were treated from 1972 to 1976 in the Department of Obstetrics and Gynaecology, University Central Hospital, Turku, Finland. Repeat laparotomy was performed on 37 of the patients about six months after total extirpative surgery (group I). In addition, a second laparotomy was performed on 14 patients after partial surgery or exploratory laparotomy (group II). All patients were given external radiation therapy combined with cytostatic treatment prior to the repeat laparotomies. A preclinical carcinoma was detected in six of the 37 patients in group I. Two of them are asymptomatic after five years of follow-up. In group II, total surgery after initial partial or exploratory laparotomy succeeded in half of the cases. Serous and endometroid carcinomas appeared to respond best to conservative therapy preceding repeat laparotomy.

Carcinoma in situ cervicis uteri: diagnosis, treatment and prognosis.

A total of 252 patients with carcinoma in situ colli uteri were treated at the Women's Clinic at Turku University between 1964 and 1971. Seventy-seven percent of the patients came to the clinic for treatment after they had participated in a mass screening program (cytodiagnosis, colposcopy). Extrafascial hysterectomy was performed most often on women in the older age groups, while most of the younger patients were treated by conization. Patients were followed up for a minimum of 5 years. There was a 1.0% recurrence of invasive carcinoma and a 4.0% recurrence of noninvasive carcinoma. All invasive recurrences occurred after hysterectomy. None of the patients died from complications of carcinoma.

Maternal and fetal plasma renin activity during ritodrine infusion to the mother.

The effect of ritodrine to the mother on plasma renin activity (PRA) in the mother and fetus was examined in 10 mothers coming to elective cesarean section. 10 comparable mothers without ritodrine infusion served as controls. At the end of 2 h infusion of ritodrine, the mean maternal PRA was significantly (p less than 0.001) higher than in the control group. Also the mean PRA levels in the umbilical vein (p less than 0.001) and umbilical artery (p less than 0.01) were significantly higher after ridodrine infusion to the mother than the respective levels in the control group.

Effect of oral contraceptive containing a new progestin (ORG 2969) on plasma renin activity, growth hormone and immunoreactive insulin.

Plasma renin activity (PRA), Growth hormone (GH) and immunoreactive insulin (IRI) were studied in seven healthy subjects during the ovulatory menstrual cycle and during the first and third cycles of oral contraception with 0.05 mg of ethinylestradiol and 0.100 mg or 0.125 mg of a new progestogen, 17 alpha-ethinyl-18-methylene-4-estren-17 beta-ol. The PRA level in the second half of the control cycle was significantly higher than in the beginning of the cycle. At the end of the treated cycles it was significantly higher than at the end of the control cycle. Neither GH nor IRI showed significant changes during the control cycle. GH was significantly higher at the end of the first and third treated cycles than at the end of the control cycle. IRI was significantly higher both in the beginning and at the end of the first treated cycle than the corresponding IRI levels in the control cycle. IRI at the end of the third treatment cycle was not significantly different from corresponding means at the end of the control cycle or the first treated cycle.

PIP: A new oral contraceptive (Org 2969) formulated of .05 mg of ethinyl estradiol and .1 mg or .125 mg of a new progestagen, 17 alpha-ethinyl-18-methyl-11-methyl-ene-4-estren-17 beta-ol, was studied to determine its effects in human volunteers on plasma renin activity (PRA), growth hormone (GH), and immunoreactive insulin (IRI). 7 healthy subjects were studied during an ovulatory menstrual cycle and during the 1st and 3rd cycles of oral contraception. 1 of 7 subjects showed ovulation after the 1st cycle of contraceptives; the remainder were anovulatory, and all subjects were anovulatory by the 3rd cycle of contraception. PRA on the 22nd day of the control cycle was significantly (P .01) higher than the mean PRA on days 2-5 of control. Mean PRA at the beginning of the 1st treatment cycle was not significantly higher than control cycles. By day 22 of treatment, however, it was significantly (P .001) higher than day 22 of control cycle. A significant PRA Increase after the 1st treatment cycle (P .05) was noted along with a continued significance in the 3rd cycle (P .05). At the end of the treatment cycle, GH was significantly higher (P .05) than at the end of the control cycle. The rise of GH over the 1st treatment cycle compared with control cycle was insignificant, but after the 3rd treatment cycle, GH was significantly higher than the control cycle values (P .05). There were no differences in GH throughout the control cycle. IRI did not differ within the control cycle. By the 2nd-4th day of the 1st treatment cycle, mean IRI was significantly higher than comparable control cycle values (P .01). The rise in IRI during treatment was also significant (P .05). No correlations were found among the individual GH and IRI values, and no significances for same sampling periods were found. Levels of the 3 parameters were unaffected by dosage of the new progestin.

Methods for evaluating the intrauterine location of carcinoma.

The intrauterine location of endometrial carcinoma was investigated with curettage, hysterography and hysteroscopy in 83 patients. These three methods are complementary. Curettage provides important information about the differentiation of the tumor. Hysterography is suitable especially for elucidating the anatomy of the cervical canal and uterine cavity. Direct examination by hysteroscopy gives a reliable picture when defining the boundary between stages I and II.

Transfer of lorazepam and its conjugate across the human placenta.

The concentrations of lorazepam and its conjugate were determined in maternal venous serum, in umbilical vein and artery serum, and in amniotic fluid after a single 2 mg intramuscular and 2.5 mg oral maternal administration. During normal delivery (2 mg intramuscular injection) and caesarean section (2.5 mg orally) both the unconjugated and conjugated forms of lorazepam were found in the umbilical circulation and amniotic fluid. The serum protein unbound fraction was 14.0 +/- 4.8 (S.D.) % in maternal circulation and 20.8 +/- 3.1% in umbilical circulation. Generally, lorazepam was a useful anxiolytic agent during normal delivery and as a sedative on the night before caesarean section.

Pregnancy and delivery after conization of the cervix.

Of 327 patients who had undergone conization of the cervix in 1968-74 in the Department of Obstetrics and Gynecology, Turku University Central Hospital, 249 replied to a questionnaire. Eighty-nine of these had had total of 112 pregnancies after conization. Conization had only minimal influence on the pregnancies and none on the deliveries. Over 90 per cent of the newborns delivered were full term and without anomalies. The incidence of spontaneous abortions also did not differ from normal.

Etiology of premalignant cervical lesions in teenagers.

The etiology of premalignant cervical lesions was investigated anamnestically in teenagers. The material comprised of 54 patients (mean age 18.0 years, range 12--19 years) treated in 1973--77. Early coital practise and frequent change of sexual partners were usual. Previous abortions and frequent genital infections were also typical. The rising frequency of dysplasias in young age groups calls for increased general knowledge and information even among teenagers and, if possible, mass screening.

Appendicectomy during pregnancy.

Twenty-four appendicectomies were performed during intra-uterine pregnancy at the Department of Surgery of the University Central Hospital, Turku, in the period 1963--77. Six out of 14 cases of appendicitis occurred in the third trimester. The incidence of appendicitis during pregnancy was 1 : 1 445. In 9 cases the appendices removed were normal. The diagnostic difficulties were greatest during the final phase of pregnancy. The location of palpation tenderness in these cases differed from that in the cases with a normal appendix. Fever was generally slight and was sometimes completely absent. The appendix had perforated in 2 cases in both of which premature delivery occurred on the third postoperative day. The infant died in one of these two cases because of immaturity. The pregnancy of the other patients continued uneventfully to term. Appendicitis and appendecectomy performed in good time generally do not involve risk for the continued progress of pregnancy. Progesterone or isoxuprine may have beneficial effect on the course of the pregnancy.

Diagnosis and treatment of primary vaginal carcinoma in situ and dysplasia.

Fifteen cases of primary carcinoma in situ or severe or moderate dysplasia of the vagina have been diagnosed and treated during the period 1966-75 at the Department of Obstetrics and Gynecology, Turku University Central Hospital. Because of abnormal vaginal cytology the lesion was localized by means of colposcopy and iodine staining. For 6 patients local estrogen treatment was applied to increase the thickness of the epidermal layer. For 6 patients, treatment consisted of simple excision. Nine patients, including both those with carcinoma in situ, were treated with intravaginal radiation therapy. The radiation dosage was 2 000 to 2 600 rad at a distance of 1 cm from the surface of the epithelium. None of the patients showed any complications, and all are now symptom-free.

Hormone response in gynecologic surgery.

We measured plasma arginine vasopressin (AVP), plasma renin activity (PRA), human growth hormone (HGH), immunoreactive insulin (IRI), and blood glucose in 25 gynecologic inpatients. Six were undergoing dilatation and curettage (Group 1), nine were undergoing hysterectomy (Myomata uteri) and receiving acetated Ringer's lactate without glucose (Group 2), and ten were undergoing hysterectomy and receiving acetated Ringer's lactate in 5% glucose (Group 3). The measurements were made the night before the operation, during the operation, and postoperatively. Plasma AVP did not change significantly in Group 1, but it increased in both Groups 2 and 3. PRA showed no significant changes in any group studied. HGH decreased slightly at the end of the operation in Groups 1 and 2, but it increased significantly in Group 3 in the recovery room 1 h after surgery. Blood glucose and insulin remained at normal levels in Groups 1 and 2, but they increased significantly in Group 3. We believe that stress was caused more by greater surgical trauma than by the depth of anesthesia and anesthetic agents in Groups 2 and 3, when compared to Group 1; this is a possible mechanism of the increased AVP secretion. Acetated Ringer's lactate without glucose appeared to cause a more physiologic response during gynecologic surgery than did acetated Ringer's lactate in 5% glucose.

Treatment of vulval epithelial lesions by pulsed high-frequency therapy.

The effect of pulsed high-frequency therapy has been investigated in 25 patients, who had various chronic vulval lesions resulting in continuous, annoying pruritus, smarting or pain, resistant to conventional therapy. The beneficial effect of pulsed high-frequency therapy was either definite or good in 80% of all the cases.