[Menorrhagia due to cystic degeneration of a uterine leiomyoma]. / Menorragisch bloedverlies door een cysteus gedegenereerd leiomyoom van de uterus.

A 47-year-old female patient presented with increasing menorrhagia. On ultrasound examination a smooth-walled intra-uterine enlargement with multiple clear areas was found. As these cystic changes were reported to be 'most likely blood vessels' the enlargement was expected to be a uterine leiomyoma, and drug therapy was started. Due to unsatisfactory results of this therapy and continuing growth of the mass, it was finally decided to perform a total abdominal hysterectomy. The pathology revealed cystic degeneration of uterine leiomyoma. Degeneration of uterine leiomyoma is common and can easily be confused with other abnormalities of the uterus or even other abdominal organs. Diagnosis can best be made by (transvaginal) ultrasonography, if necessary complemented by CT or MRI.

Submaximal endurance exercise performance during enalapril treatment in patients with essential hypertension.

In a double-blind randomized crossover study of 10 patients with mild essential hypertension, the influence of antihypertensive treatment with the angiotensin-I converting enzyme inhibitor enalapril (a single dose of 10 mg.day-1) on submaximal endurance exercise performance at a work rate eliciting a heart rate of 150 beats/min was studied. Resting and exercise blood pressure were significantly reduced during enalapril therapy. Heart rate was unaffected. Submaximal endurance exercise performance was reduced by 12% (p = 0.06). Plasma lactate concentrations were significantly increased and serum nonesterified fatty acid concentrations were decreased during exercise in patients receiving enalapril treatment. Plasma glucose and potassium levels and serum glycerol concentrations were not influenced by enalapril treatment. Because the impairment of endurance performance during enalapril treatment is relatively small compared with the reductions caused by other antihypertensive agents, such as beta-adrenoceptor blocking agents or diuretics, it is of minor clinical importance for most physically active patients with hypertension.

Diurnal variation in prorenin in relation to other humoral factors and hemodynamics.

Diurnal variation has been demonstrated for blood pressure and heart function. Several hormones influence these hemodynamic parameters. This study investigates the diurnal variation in plasma prorenin in relation to renin, atrial natriuretic peptide (ANP), norepinephrine, and hemodynamic changes. Circulating plasma prorenin may be able to serve as a marker for the activity of the local renin-angiotensin system. In 12 healthy male volunteers who were allowed to carry out quiet activity, hemodynamic factors and the plasma levels of hormones were monitored at 2-h intervals for 26 h. Blood pressure was measured every hour. In accordance with the literature, during the night blood pressure (4%), cardiac index (19%), stroke index (10%), and heart rate (10%) decreased in a classic day-night pattern. Systemic vascular resistance increased during the night (23%). No classic day-night pattern was found for ANP, although it increased (15%) at night and showed a peak early in the night. This peak seemed to be influenced by posture. A classic day-night pattern was demonstrated for norepinephrine and prorenin. Norepinephrine was lower (18%) at night and increased as soon as the subjects awoke, while they were still in bed. Therefore, plasma norepinephrine levels seemed to be related to awakening. Plasma prorenin decreased at night (6%). Renin fluctuated throughout the day, but showed no clear day-night pattern. In conclusion, renin fluctuated throughout the day and did not show a classic day-night pattern. In contrast, prorenin fluctuated less and showed 6% higher levels during the day compared to the night. The origin and clinical significance of this small diurnal variation in prorenin is not clear yet.

Surgery in ovarian cancer.

Ovarian cancer has the highest mortality of the cancers of the female genital tract. The signs and symptoms of ovarian cancer are either nonexistent or nonspecific. Women who are to undergo exploratory laparotomy without a definite diagnosis should have ovarian cancer considered as part of the differential diagnosis. Therefore, it is important that each surgeon know the current concepts of surgery for ovarian cancer. Documenting true extent of disease in those cases with limited ovarian cancer prevents the need for reexploration before adjuvant therapy. In those cases of disseminated disease, an attempt at tumor reduction should be undertaken, as reduction of tumor aggregates to less than 1.6 cm in greatest diameter improves prognosis. Surgery is the mainstay of therapy for ovarian cancer. Optimal initial surgery prevents the need for reexploration.

Physical activity, fitness, and selected risk factors for CHD in active men and women.

The association of physical activity and cardiovascular fitness with risk factors such as blood pressure, body composition, and smoking habits was evaluated in middle-aged men and women active in sports. Data were available for 2009 men and 898 women, all volunteers over 40 yr of age who were active in sports, were available. Physical activity was recorded as sport activity (number and type of sport, frequency, and duration), occupational activity, and the use of the bicycle for transport. Cardiovascular fitness was expressed as maximal power output (Wmax.kg-1) achieved during a progressive maximal cycle ergometer test. Pearson's product moment correlations between cardiovascular fitness and risk factors indicated significantly lower risks among more fit individuals. Except for smoking habits all risk factors showed better associations with fitness in women than in men. The association of physical activity indicators and risk factors was less strong than the fitness-risk factor association in both genders. In both genders, joggers had the most favorable risk profile compared with subjects who were active in one of the other four most popular sports. We conclude that in this relatively active and healthy population comparable associations of physical activity and cardiovascular fitness with risk factors for cardiovascular disease were found as in studies on less active populations.

Variability and reliability of joint measurements.

The purpose of this study was to determine the variability and reliability of joint measurements as carried out by three physician observers. The intratester variation and reliability of nine different joint measurements was determined in eight healthy subjects. The measurements were taken in eight sessions by each tester. In this population also the intertester variation and reliability was determined by the three observers. This was also done in a population of middle-aged athletes over a period of 2.5 years. The results indicate that it is difficult to show either an improvement or worsening of a joint motion of less than 5 degrees to 10 degrees for most joints measured by the same tester. The intertester variation is not consistent over a longer period of time, so differences between observers during long-term studies cannot be corrected on the basis of a single study at a single point in time. The reliability of all nine joint measurements is not very high, but is probably sufficient if the results are used to compare groups within a single population and for large studies with experienced observers. Because the reliability strongly depends on the interindividual variation, it is preferable to determine the reliability for each study population.

Angiosarcoma of the uterus following radiotherapy for squamous cell carcinoma of the cervix.

A case report of a 61-year-old woman who developed a uterine angiosarcoma 6.5 years after primary radiotherapy for a moderately well differentiated squamous cell carcinoma of the uterine cervix stage IB is presented. The diagnosis was confirmed by immunohistochemical studies showing positive staining for Ulex europaeus agglutinin 1 and supported by ultrastructural studies. Though various post-irradiation angiosarcomas are reported in the literature, this is, to our knowledge, the first report of an angiosarcoma of the uterus after radiotherapy.

Extra-uterine endometrial stromal sarcoma with DNA flow cytometric analysis.

A case of a primarily extra-uterine low-grade endometrial stromal sarcoma is described. The patients clinical course, including various surgical, chemotherapeutical and hormonal therapies, is outlined and discussed. Transition from benign endometriosis to clinically malignant endometrial stromal sarcoma is illustrated by microscopy and DNA flow cytometry. A change in nuclear DNA content is demonstrated. This is possibly a useful aid in identifying the malignant potential of this tumor with such a misleading microscopic appearance.

[Follow-up not according to guidelines after an abnormal cervix smear]. / Follow-up na een afwijkend cervixuitstrijkje niet conform de adviezen.

OBJECTIVE: To investigate whether the recommendations for the follow-up after a positive cervical smear test, made within the Dutch national screening programme on cervical cancer, are followed in practice. DESIGN: Descriptive. SETTING: The Rotterdam Municipal Health Services Area. METHOD: All cytological and clinical-histological findings on women who had a Pap smear of at least Pap class IIIA in the period 1989-1991, were collected from the Pathological Anatomical National Automised Archives (PALGA). Per smear test result, the cervix-cytological and histological examinations that took place after the screening programme were arranged in order of occurrence. RESULTS: 61% of the women with Pap class IIIA had been followed according to the recommendations, in 12% no follow-up had been done. Repeat cytology was often done much later than after three months as recommended. After Pap class IIIB, IV or V smear test outcome the recommendations were followed in respectively over half, about three-quarters, and all cases. In 9% of women with Pap class IIIB or IV, no follow-up was recorded in the PALGA data base. CONCLUSION: Often, the recommendations for follow-up after a positive smear were followed poorly. Further research into the problems in the follow-up route is necessary.

[Disappointing effectiveness of population screening for cervical cancer]. / Tegenvallende effectiviteit van bevolkingsonderzoek naar baarmoederhalskanker.

Systematical screening by cytological cervix examination has not reduced the mortality from cervical carcinoma as much as was expected. One important cause of this is the varying sensitivity of the screening owing to the large number of smears, most of which are normal. Some improvement of the effect of screening might be achieved by combination with computer-assisted microscopical evaluation and with testing for human papilloma virus (PV).

Effects of diurnal variability and exercise training on properties of large arteries.

OBJECTIVE: To examine the diurnal variability in arterial distensibility and compliance and to study the effects of exercise training on these large artery properties. DESIGN: Vessel wall properties of the elastic common carotid and muscular brachial arteries were measured non-invasively with a vessel wall movement detector system in 12 healthy volunteers. Properties of the common carotid, the femoral and the brachial arteries were studied in 15 sedentary males in comparison with 15 male cyclists. RESULTS: Diurnal changes in the carotid and brachial arteries were similar. Blood pressure decreased at night while arterial diameter increased. Distensibility decreased and compliance was preserved at night. The vessel wall properties of the carotid artery did not differ between the sedentary males and the cyclists, but the femoral and brachial arteries were more elastic in the cyclists. The diameter of the femoral artery was larger in the cyclists. CONCLUSIONS: We found a diurnal pattern in changes in diameter and distensibility of elastic and muscular large arteries. Compliance, the buffering capacity of larger arteries, was preserved at night. The supplying femoral artery was larger and more distensible in cyclists. Exercise training did not affect the elastic carotid artery, but improved vessel wall properties of the brachial, and maybe also of other, muscular large arteries.

Effect of increased plasma non-esterified fatty acid concentrations on endurance performance during beta-adrenoceptor blockade.

Inhibition of adipose tissue lipolysis, leading to a reduced availability of non-esterified fatty acids for energy production in the active skeletal muscles, may be involved in the impairment of endurance exercise capacity after administration of a beta-adrenoceptor blocking agent. The effect of increasing the availability of plasma NEFA during exercise after beta-blocker administration was studied. In a double-blind, randomized cross-over study 12 healthy volunteers were treated for 14 days with placebo, atenolol, and propranolol. On the 7th and 14th day of each treatment period an endurance exercise test at 70% of maximal aerobic power until exhaustion was performed while a continuous infusion of saline or triglycerides (Intralipid)+heparin was administered. Endurance time was reduced by 11% (n.s.) during atenolol and 40% (p < 0.01) during propranolol. Intralipid administration had no statistically significant effect on endurance in any treatment. Plasma NEFA and glycerol concentrations were elevated above control levels during Intralipid infusion, plasma glucose and lactate concentrations were unaffected. These results suggest that reduced availability of NEFA is not a major factor in the reduction of endurance performance during beta-adrenoceptor blockade, although an effect of beta-blockade on NEFA membrane transport cannot be excluded.

Influence of anabolic steroids on body composition, blood pressure, lipid profile and liver functions in body builders.

The effects of anabolic steroids on body composition, blood pressure, lipid profile and liver functions were studied in male body builders who received a weekly i.m. injection of nandrolone-decanoate (100 mg) or placebo for 8 weeks in a double blind way. In addition, 5 body builders received the same dosage of nandrolone-decanoate or placebo, in a double blind cross-over design during two 8-week periods, interspersed by 12 weeks. Anabolic steroids induced a 25-27% decrease in HDL-cholesterol, which was virtually reversed 6 weeks after cessation of drug use. In the SAD group an increase in diastolic blood pressure was observed, which returned to pre-anabolic values approximately 6 weeks after cessation of drug administration. No deleterious effects of anabolic drugs on plasma activity of liver enzymes were found. Increases in lean body mass were found in all groups, though the increase in the subjects who received anabolic steroids was superior to that in the placebo-treated subjects. The increase in lean body mass suggests increases in muscle mass.

Muscle ultrastructure after strength training with placebo or anabolic steroid.

The influence of strength training on muscle fiber area, capillary ultrastructure, and capillary supply was studied in experienced male bodybuilders taking either anabolic steroids or a placebo. During 8 weeks, 13 subjects received a weekly injection of either placebo or nandrolone decanoate (starting dose 200 mg, followed by 100 mg weekly), in a double-blind, counterbalanced design. Before and after 8 weeks a needle biopsy was taken from the vastus lateralis muscle for studying morphometric characteristics of fibers and ultrastructure and morphometric characteristics of capillaries. The fiber cross-sectional area increased significantly only after steroid treatment. Capillary ultrastructure and capillary supply were not changed after the training period. In none of the measured parameters was any difference found between placebo and steroid treatment.

Body composition, cardiovascular risk factors and liver function in long-term androgenic-anabolic steroids using bodybuilders three months after drug withdrawal.

The purpose of this study was to investigate in a cross-sectional design body composition, muscle fiber characteristics, cardiovascular risk factors and liver enzymes in long-term androgenic-anabolic steroids (AAS) using bodybuilders three months after drug withdrawal (AAS group; n = 16) and in non-users (CO group; n = 12). Training and dietary data were collected in all subjects. Anthropometry included weight, height, 8 skinfolds and 11 circumferences. Percentage fat (%FAT), fat mass (FM) and lean body mass (LBM) were calculated. In a muscle biopsy from the vastus lateralis muscle water content, fiber type distribution and diameters of fiber type I and type II were determined. Age, height, training characteristics, nutrition, skinfolds, %FAT and FM did not differ between the groups. The AAS group had greater BW and LBM, and larger circumferences of thorax, waist, upper arm and thigh than the CO group. Muscle biopsy data were comparable, except for muscle fiber diameter of type I which was larger in the AAS group. No differences in serum values of total cholesterol, HDL-cholesterol and triglycerides, nor in systolic and diastolic blood pressure were observed. In both groups serum alkaline phosphatase and gamma GT were within the normal range. This study suggests that in long term AAS using body-builders, after a three months AAS free period, BW is greater than in non drug users. This is reflected in larger LBM, circumferences and diameter of muscle fiber type I. In addition, no differences in fat mass, blood pressure, lipoprotein profiles and liver enzymes exist between AAS users three months after interrupted drug use and their non drug using counterparts.