The value of CA 125 measurement before second-look laparotomy in patients with ovarian carcinoma.

Serum CA 125 levels were evaluated in 71 patients undergoing second-look laparotomy for primary epithelial ovarian cancer. With a cut-off limit of 35 U/ml, 17 of 45 patients with residual disease (38%) were CA 125-positive. All of 26 patients with pathological complete response were marker-negative. Second-look laparotomy may be avoided in a select group of patients with elevated CA 125 values.

[Hormonal contraception with ethinylestradiol and gestoden. The effects on glucose tolerance and lipid metabolism]. / Hormonal kontraception med etinyløstradiol og gestoden. Effekt på glukosetolerans og lipidmetabolisme.

PIP: Only a few years following the introduction of combination oral contraceptives, it was determined that these hormonal preparations led to changes in the glucose and lipid metabolisms, which must be considered as potentially harmful. For example, women with no known disposition to diabetes mellitus may acquire diabetic glucose-overloading with use of oral contraceptives. In addition, the increased occurrence of cardiovascular complications among oral contraceptive users is thought to be directly associated with the effect of lipoprotein displacement. To reduce these effects, a new triphasic combination oral contraceptive, consisting of ethinyl-estradiol and gestodene (15-levonorgestrel), has been introduced. This study specifically investigated the effects of glucose tolerance and lipid metabolism from using this new preparation. 10 women between ages 21-32 (average age 25) participated. All had normal weights and were without known disposition to diabetes mellitus or heart disease. After receiving a medical examination, the women were given the 3-phase pill for 6 months. The pills were administered cyclically according to the usual schedule for oral contraceptives. In each cycle, the dosage consisted of 0.030 mg ethinyl-estradiol (EE) and 0.050 mg gestodene from day 1-6, then 0.400 mg EE and 0.070mg GD from days 7-11, and finally 0.030 mg EE and 0.100 mg GD in the last 10 days. Laboratory tests were done in the luteal phase before the trial's start, and before the final 10 days of the trial in the 2nd and 6th cycle. Fasting levels of plasma glucose and insulin were monitored. Though there are as yet no publications which deal with the influence of gestodene on glucose tolerance, the results from the present study indicate that gestodene in this 3-phase pill does not alter glucose tolerance in women with normal health. The raised AVC value for insulin, which was observed 6 months after treatment, may however indicate that he glucose homeostasis during treatment was maintained due to raised endogenous insulin secretion. It is therefore possible that individuals with latent insulin deficiency might acquire diabetic glucose tolerance because of an inability to show adequate insulin response.^ieng

Maternal condylomata and juvenile laryngeal papillomas in their children.

In the literature a connection is postulated between maternal condylomata and juvenile laryngeal papillomatosis in their children. We have attempted to shed light on the connection partly by seeking information about the children of 77 mothers with condylomata during delivery, and partly by seeking information about the mothers of nine children with juvenile laryngeal papillomatosis. Our research has not shown a clinical connection between the two diseases.

Comparative trial of the effects on glucose tolerance and lipoprotein metabolism of two new oral contraceptives containing gestoden and desogestrel.

The effects of two new low-dose oral contraceptives (triphasic ethinyl estradiol/gestoden and monophasic ethinyl estradiol/desogestrel) on glucose tolerance, plasma insulin response to glucose, fasting plasma cortisol, triglycerides (TG), total cholesterol (C), HDL-C, LDL-C, VLDL-C and sex hormone binding globulin (SHBG) were investigated in two groups of healthy women (n = 10). Investigations were performed prior to hormone ingestion and after treatment for 2 and 6 months. In both groups, fasting plasma levels of glucose and insulin as well as the areas below the glucose concentration curves were unchanged during treatment, whereas the insulin response to oral glucose was equally increased (p less than 0.05). Intake of both compounds was followed by similar increases in the levels of HDL-C (p less than 0.05) and in the HDL-C/total-C (p less than 0.05). A transient decrease in the levels of LDL-C was observed in both groups after two months. During intake of the gestoden-containing compound increases in VLDL-C and TG levels were registered after six months (p less than 0.05). Plasma levels of SHBG increased similarly in both groups (p less than 0.01). The study indicates, that intake of both hormonal compounds is free from adverse effects on glucose tolerance and lipoprotein metabolism known to be of clinical significance. No differences in the metabolic effects were found between the two compounds.

Estrogen and progesterone receptors in endometrial carcinoma: comparison of immunohistochemical and biochemical analysis.

In 159 endometrial carcinomas, estrogen (ER) and progesterone receptors (PR) were determined biochemically by dextran-coated charcoal (DCC) assay and immunohistochemically (ICA) on frozen sections. ICA receptor content was estimated by a total histologic score (HSCORE), including all tissue components, and by a cancer HSCORE, including malignant cells only. These scores were closely correlated. A single biopsy was found to be representative for each tumor. ER-DCC status was positive in 90.3% and PR-DCC status in 92.2% of the tumors. ER total HSCORE was positive in 47% and PR total HSCORE in 89% of tumors. ER and PR correlated inversely with tumor grade (p < 0.001). Correlations were found between ER and PR content determined by either method (DCC: r = 0.77; ICA: r = 0.50), as well as between DCC and ICA content (ER: r = 0.52; PR: r = 0.76). The association between DCC and ICA was affected by the tumor grade: the DCC values decreased relatively more than total HSCOREs with increasing grade. The sensitivity of ICA against DCC assay was 56% for ER and 86% for PR. Maximal agreement between receptor status as determined by ICA and by DCC would result from a DCC cutoff level of 130 fmol/mg for ER and 114 fmol/mg for PR.

Plasma oestrogens in postmenopausal women with endometrial cancer.

OBJECTIVE: To study plasma levels of estrogens and androgens, sex hormone-binding globulin (SHBG) and follicle stimulating hormone (FSH) in postmenopausal patients with endometrial cancer. DESIGN: Patients and controls were matched for age, body mass index, parity and years since menopause. SETTING: Department of Obstetrics and Gynaecology, Hvidovre Hospital, Denmark. SUBJECTS: Fifty postmenopausal patients with endometrial cancer and 54 matching controls. MEASUREMENTS: Plasma levels of SHBG, FSH, oestrone, oestradiol, oestrone-sulphate, dehydro-epiandrosterone sulphate, testosterone, and androstenedione were measured by radio-immunoassays. Free fractions of oestradiol and testosterone were calculated according to levels of SHBG and albumin. RESULTS: The levels of oestradiol, free oestradiol, and oestrone were elevated (P < 0.001) in patients compared with controls (oestradiol: 51 (45-59) vs 37 (34-41) pmol/l; free oestradiol: 0.69 (0.59-0.80) vs 0.48 (0.42-0.54) pmol/l; oestrone: 180 (159-204) vs 119 (107-133) pmol/l (mean values (95% CI) in patients vs controls)). Furthermore, an increased oestrone:androstenedione ratio (0.095 vs 0.072, P < 0.01) was found in patients. SHBG correlated negatively (P < 0.001) with body mass, while the free fractions of oestradiol and testosterone correlated positively (P < 0.01) with body mass, in both patients and controls. Multiple regression analysis showed that the differences in oestrogen levels between the two groups persisted when controlling for the effect of body mass, age, years since menopause, parity, and levels of SHBG and FSH. CONCLUSION: Patients with endometrial cancer exhibit increased plasma levels of oestradiol and oestrone. Speculatively, these oestrogens may result from an increased oestrone conversion from androstenedione, an increased ovarian and adrenal secretion of androstenedione, or alternative oestrogen production routes. The present findings support the hypothetical role for oestrogens in the aetiology of endometrial cancer.

CA 125, placental alkaline phosphatase, and tissue polypeptide antigen in the monitoring of ovarian carcinoma. A comparative study of three different tumor markers.

Three different tumor markers, placental alkaline phosphatase (PLAP), tissue polypeptide antigen (TPA), and cancer antigen 125 (CA 125), were measured in serum samples obtained during chemotherapy in 57 ovarian carcinoma patients. At the start of chemotherapy, 37, 63, and 77% had elevated serum values of PLAP, TPA, and CA 125, respectively. During chemotherapy, changing PLAP serum levels reflected disease regression and, later, progression in only 2 patients. TPA serum levels reflected the disease course in 15 patients and CA 125 in 28 patients. Rising CA 125 values predicted disease progression in 12 patients for a median of 2 months. At second-look laparotomy, all 11 patients with pathological complete response were marker negative. In the remaining 46 patients with residual or progressive disease, 27, 50, and 61% had elevated serum levels of PLAP, TPA, and CA 125, respectively. None of the markers reflected microscopic disease or pure carcinomatosis. For management decisions, CA 125 was clearly the most useful of the markers. In this study no further information was gained from the other two markers.

Wound infection after cesarean section.

A prospective multicenter study of 1,032 cesarean sections was performed to identify risk factors for postoperative wound infection. The overall rate of wound infection was 6.6% (3.8% in elective cases and 7.5% following nonelective operations), with considerable interhospital variation. Obesity was recognized as a patient-related risk factor, while risk factors inherent to the obstetric situation were duration of ruptured membranes prior to operation, fetal and labor monitoring by intrauterine devices, and omission of the use of plastic draping and redisinfection of the skin before closure. Logistic regression analysis was used to estimate the influence of these factors on the probability of wound infection. Certain risk factors associated with and over-represented in nonelective operations would explain the increased infection rates in these, and the observed interhospital variations did not differ from the expected rates when the distribution of other risk factors was considered.

CA-125, placental alkaline phosphatase and tissue polypeptide antigen as preoperative serum markers in ovarian carcinoma.

Blood samples were drawn before laparotomy in 42 cases of benign, 17 cases of borderline, and 53 cases of malignant epithelial ovarian neoplasms. The concentrations of CA-125, tissue polypeptide antigen, and placental alkaline phosphatase (PLAP) were determined. No significant difference was found between the levels of CA-125 and TPA. No significant correlation was seen between tumour type and these two markers; however, both were significantly correlated to tumour malignancy and clinical stage, and CA-125 was also correlated to tumour grade. No correlation was found between PLAP and the other markers or any of the above-mentioned parameters. If at least one of two or three markers was requested to be positive, a moderate increase in the 'detection rate' of malignant tumours was found. However, the rate of positive benign samples increased to as much as 41%. Requesting at least two markers out of two or three to be positive certainly reduced the number of 'false-positive' benign tumours, but the sensitivity for malignant tumours was reduced concomitantly to levels where marker determinations would be of little use. The study demonstrated a possible, but limited role for preoperative determinations of the markers. A combination of two or three markers was not superior to single markers. The results indicate that neither of these markers will be of significant value in a screening context.