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A Leminen

Publications and source records attributed to A Leminen.

At least 19 recordsLinked to original sources
PubMed2001

The levels of trypsinogen isoenzymes in ovarian tumour cyst fluids are associated with promatrix metalloproteinase-9 but not promatrix metalloproteinase-2 activation.

Proteolysis mediated by matrix metalloproteinases (MMPs) and serine proteinases is associated with cancer invasion and metastasis. Activation of latent proMMPs, and especially the proforms of the type IV collagen degrading gelatinases A and B (proMMP-2 and proMMP-9), is thought to be a critical step in this process. We have recently found that human tumour-associated trypsin-2 is a potent activator of proMMP-9 and it also activates proMMP-2 in vitro. Trypsinogen, MMP-2, and MMP-9 are expressed in ovarian cancer. To elucidate the function of trypsin in vivo, we studied whether high concentrations of trypsinogen-1, trypsinogen-2, their alpha(1)-proteinase inhibitor (API) complexes, and tumour-associated trypsin inhibitor (TATI) are associated with proMMP-2 and proMMP-9 activation in ovarian tumour cyst fluids. Zymography and immunofluorometric analysis of 61 cyst fluids showed a significant association between high trypsin concentrations and the activation of MMP-9 (P = 0.003-0.05). In contrast, the trypsin concentrations were inversely associated with the activation of MMP-2 (P = 0.01-0.02). Immunohistochemical analysis of ovarian tumour tissue demonstrated expression of trypsinogen-2 and TATI in the secretory epithelium. MMP-2 was detected both in stromal and epithelial cells whereas MMP-9 was detected in neutrophils and macrophage-like cells in stromal and epithelial areas. These results suggest that trypsin may play a role in the regulation of the MMP-dependent proteolysis associated with invasion and metastasis of ovarian cancer.

Adolescent↗
PubMed2001

Incidence of cancer among women using long versus monthly cycle hormonal replacement therapy, Finland 1994-1997.

OBJECTIVE: This study was initiated as a consequence of a clinical observation in one hospital of several endometrial carcinomas among users of a fixed combination of a 3-month cycle oral hormonal replacement therapy (HRT), which has been marketed in Finland since 1990. We studied whether the use of 3-month ("long") cycle HRT is accompanied by a higher risk of endometrial cancer than the use of monthly cycle HRT. METHODS: A nationwide cohort of 15,956 long cycle and 78,549 monthly cycle HRT users since January 1994 was extracted from the files of the national medical reimbursement register and followed up for cancer incidence through the Finnish Cancer Registry up to the end of 1997. RESULTS: There were 61 cases of endometrial cancer among long cycle HRT users which significantly exceeds the average incidence in the Finnish population (standardized incidence ratio (SIRlong) 2.0, 95% confidence interval (CI) 1.6-2.6). The SIR among users of monthly cycle HRT products (SIRmonthly) was 1.3 (1.1-1.6) and the ratio SIRlong/SIRmonthly thus 1.5 (95% CI 1.1-2.1). Endometrial cancers among long cycle HRT users occur more often in early stages than in the general population and are more often highly differentiated. A survey of a sample of endometrial cancer patients in the long cycle HRT group revealed that all of them also had a history of other HRT. Users of both long and monthly cycle HRT had a similar statistically significant 30% excess of breast cancer in comparison to national incidence rates, while the incidence of colon cancer was decreased in both groups. There was no difference between the HRT groups in overall cancer morbidity. CONCLUSIONS: Our results imply that all HRT users have an increased risk of endometrial cancer, and long cycle HRT carries a higher relative risk than monthly cycle HRT. However, in this non-randomized setting it is impossible to judge whether this excess is attributable to the type of HRT or to patient selection. In-depth studies are needed to find out possible dose-response associations and to evaluate the role of potential confounders in detail.

Adenocarcinoma↗
PubMed2000

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Journal Article↗
PubMed2000

Wound complications in patients with carcinoma of the vulva. Comparison between radical and modified vulvectomies.

OBJECTIVE: To evaluate complications after different vulvectomies performed because of vulvar cancer. STUDY DESIGN: Retrospective analysis of 149 patients who underwent vulvectomy. RESULTS: Wound infections was found in 58%. Overweight, central or bilateral location of the tumor, and non-radical surgery were significant predictors of wound infections. Patients with a wound infection had more often wound breakdown (P<0.001), prolonged healing time (P<0.000), and lymphedema (P<0.001) than patients without infection. Antimicrobial prophylaxis did not prevent wound infection. Wound infections were found in 75% after radical en bloc vulvectomy (RV) and in 47% after modified vulvectomies (MV) (P<0.001). Also wound breakdown (47 versus 20%) (P<0.001) and lymphedema (48 versus 12%) (P<0.0001) were more common in RV group than in MV group. Lymphocysts were found in 7%, and showed no association with wound infection or type of operation. The mean hospital stay was 26 days in patients with wound infection and 12 days in patients without infection, 31 days in RV group and 12 days in MV group, respectively. CONCLUSIONS: Wound infections are major determinants for both acute and late complications. Postoperative complications reduce with increasing use of modified vulvectomies.

Adult↗
PubMed2000

Reproductive features in women developing ovarian granulosa cell tumour at a fertile age.

Ovarian granulosa cell tumour (GCT) is a rare malignancy, which has been linked to both infertility and infertility treatment with ovulation inducers. The reproductive features were analysed of 146 women with GCT diagnosed between 1956 and 1996. During the study period no changes were found in the mean age (53 years), menopausal status (59% postmenopausal), parity (32% nulliparous) or tumour size or stage at diagnosis. The clinical features in women with GCT at fertile age were compared with GCT diagnosed later in life and to population-based data. Nulliparity (50%) and history of infertility (22%) were more frequent if the tumour occurred at fertile age (n = 50). Of the 12 infertile cases, seven had anovulatory infertility (58%); 11 occurred during the era of ovulation inducers, but only five had used these drugs (clomiphene citrate in five patients, gonadotrophins in two, and tamoxifen in one patient) and no patient had undergone in-vitro fertilization. Endometrial hyperplasia was associated with GCT at all ages, while endometrial cancer was found solely after the age of 45 years. In conclusion, GCT at fertile age is associated with nulliparity and with a clinical presentation of anovulatory infertility, while GCT later in life is associated with a more normal average fertility pattern and with occurrence of endometrial cancer.

Adolescent↗
PubMed2000

Comparison between personal learning curves for abdominal and laparoscopic hysterectomy.

BACKGROUND: To compare personal learning curves for abdominal and laparoscopic hysterectomy. METHODS: The first 200 patients scheduled for abdominal hysterectomy and the first 200 patients scheduled for laparoscopic hysterectomy by a single operator were compared using learning curves according to operation time, operative blood loss, and occurrence of complications. RESULTS: Learning curves for both types of hysterectomy were rather similiar, but the learning of the laparoscopic procedure seemed to be quicker. With increasing experience the operating time decreased by 25% in abdominal and by 41% in laparoscopic hysterectomies. The mean operating time in abdominal hysterectomy was 74 min and 70 min in laparoscopic hysterectomy. Operative blood loss decreased by 50% and 44%, respectively. The mean operative blood loss was smaller (203 vs 295 ml, p<0.0001) in laparoscopic hysterectomy. Increased experience had no effect on complication rates in abdominal hysterectomies, but a decrease of 44% was seen in laparoscopic hysterectomies (p<0.05). The overall complication rate (26% vs 22%) were similar for the two techniques, and only a few patients (1.5% vs 1%) had major (bladder or ureteric) complications. CONCLUSIONS: A trained gynecologist can learn the laparoscopic technique for hysterectomy at least as quickly as the abdominal technique.

Aged↗
PubMed1999

Spread of ovarian cancer after laparoscopic surgery: report of eight cases.

OBJECTIVE: The aim of this study was to describe early occurrences of metastases after laparoscopy of ovarian masses later found to be malignant. METHODS: The hospital charts of eight women having undergone laparoscopic surgery for ovarian mass were reviewed and analyzed. RESULTS: The mean age of the patients was 40 years (range 25 to 66). Size of the tumor ranged from 2 to 15 cm. In four patients the ovarian mass was suspected to be malignant in the laparoscopy. Diagnostic procedure (biopsy of the tumor) was performed in two and salpingo-oophorectomy in six patients. Staging laparotomy was performed within the mean of 17 days (range 7-29). In four patients (50%) the cancer had spread from a localized to an advanced stage during the delay. Ascites was present in the laparoscopy in two of the four patients with port site or abdominal wall metastases. CONCLUSIONS: Laparoscopic surgery of ovarian mass later found to be malignant can cause considerable and early spread of the cancer.

Adult↗
PubMed1998

Nationwide data on falling incidence of ovarian granulosa cell tumours concomitant with increasing use of ovulation inducers.

The genesis of ovarian granulosa cell tumours (GCT) has been linked to high gonadotrophin levels, and therefore also to the use of ovulation inducers and combined contraceptive pills (OC). We analysed the occurrence of GCT in the whole of Finland in 1965-1994, the period when ovulation inducers and OC became available. All women with GCT were traced from the Finnish Cancer Registry. The numbers of courses of clomiphene citrate and gonadotrophin (human menopausal gonadotrophin: HMG) and number of courses of OC used in Finland during the same period were calculated from sales statistics on these agents. In 1965-1994, 590 patients contracted GCT. The incidence of GCT declined by nearly 40% from 0.74/100000 in 1965-1969 to 0.47/100000 in 1985-1994, a fall occurring at the same time that the use of clomiphene citrate increased 13-fold, that of HMG 200-fold and that of OC 5-fold. Our nationwide data on the incidence of GCT falling concomitantly with increasing use of ovulation inducers can be seen as one piece of evidence that ovulation inducers are unlikely to cause GCT.

Adolescent↗
PubMed1998

Pre-operative serum level of tumour-associated trypsin inhibitor and residual tumour size as prognostic indicators in Stage III epithelial ovarian cancer.

OBJECTIVE: To evaluate the use of the pre-operative tumour-associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer. DESIGN: Retrospective cohort study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland. PARTICIPANTS: Ninety-eight women with Stage III ovarian cancer. METHODS: TATI was measured by radioimmunoassay from serum samples obtained within one week before surgery. A cutoff value of 22 microg/L was used. Multivariate analysis included pre-operative TATI level, age, histologic grade and histologic type. Mantel-Cox test was used for calculating statistical significance of differences in survival between groups. MAIN OUTCOME MEASURES: Cumulative five-year survival, pre-operative serum TATI level and residual tumour size. RESULTS: Surgery was optimal (residual tumour size < or = 2 cm) in 55 patients and suboptimal (residual tumour size > 2 cm) in 43. Pre-operative TATI level < or = 22 microg/L predicted better prognosis both in patients with optimal and suboptimal surgery compared with patients with pre-operative TATI level > 22 microg/L. Patients with optimal surgery and a pre-operative TATI > 22 microg/L had a twofold relative risk of death compared with those with a pre-operative TATI < or = 22 microg/L. The cumulative survival was less than three years for patients with suboptimal surgery and pre-operative TATI > 22 microg/L. CONCLUSIONS: Pre-operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.

Adult↗
PubMed1997

Malignant tumors of the ovary or the breast in association with infertility: a report of thirteen cases.

BACKGROUND: Many questions have been raised recently about the relationship between infertility, fertility drugs and cancer. This prompted us to evaluate our patients having ovarian or breast cancer with a known history of infertility. METHODS: We report thirteen women who had been examined and/or treated for infertility before the occurrence of malignant tumors of the ovary or the breast at an age under 50 years in 1990-1995 in our unit. RESULTS: Mean age of the patients was 35 years (s.d. 5.9 years, range 28-47 years). Of the 11 ovarian tumors, one was a malignant teratoma, two were granulosa cell tumors and eight epithelial ovarian cancers. Ten women had received either clomiphene citrate alone or together with gonadotrophins, one had used only gonadotrophins, and in two patients ovarian cancer was detected during an infertility work-up but before any treatment. Four women had used clomiphene for more than twelve cycles. Two patients had ductal breast cancer. CONCLUSIONS: Our patients emphasize the need for follow-up and long-term prospective studies in infertile women who have been evaluated or treated for infertility.

Adult↗
PubMed1995

Hereditary aspects of endometrial adenocarcinoma.

The importance of heredity in the etiology of endometrial cancer (EC) was examined in a series of 326 patients with EC diagnosed at age 60 years or less. If one or both of the proband's parents had died of cancer, a thorough family history of malignancies was studied. Altogether 291 cases with complete parental data were found. Nine kindred (3.1%) showed features compatible with the dominantly inherited cancer trait known as hereditary non-polyposis colorectal cancer (HNPCC). In another 9 cases, clustering of malignancies in 2 or more successive generations was indicative of familial cancer. Aspecific cancer aggregates were found in 112 probands' families, and family history was negative in 161 cases. No families had gynecological cancer as the only malignancy. HNPCC, the genetic etiology of which was recently revealed, seems to be an important risk factor for EC, indicating the significance of family-history investigations of all patients with EC. Colorectal carcinoma (CRC) was here associated with EC also in families with clusterings of malignancies, but in these families no typical features of any known hereditary cancer syndrome could be found. On the basis of the results of the present study, proper surveillance for colorectal cancer should be recommended for patients with endometrial carcinoma if they belong to a family with features indicative of HNPCC. Furthermore, healthy gene carriers in an HNPCC family also need careful surveillance for CRC, EC and perhaps for other extra-colonic malignancies typical for HNPCC. Prophylactic surgery should even be considered in these cases.

Adenocarcinoma↗
PubMed1995

Endometrial adenocarcinoma with clinical evidence of cervical involvement: accuracy of diagnostic procedures, clinical course, and prognostic factors.

BACKGROUND: The accuracy of clinical staging is known to be insufficient in stage II endometrial carcinoma. Also the optimal management of this disease is controversial. In this study we evaluate diagnostic accuracy and prognostic factors with special reference to treatment modalities of stage II endometrial carcinoma. METHODS: Of 1297 patients with endometrial adenocarcinoma (EAC) treated between 1970 and 1980 at Departments of Obstetrics and Gynecology, Helsinki University Central Hospital, 140 (11%) cases represented clinical stage II and were retrospectively analyzed. RESULTS: Median age of the patients was 63.5 years (range 40-85 years). Accuracy of Papanicolaou smear was 50%, and that of endocervical curettage 51%. Most of the tumors were histopathologically pure adenocarcinomas (88%), well differentiated (43%), and superficially invaded to myometrium (44%). Thirty-four (24%) of the patients developed a recurrent disease during the first five years afterwards. Median time of recurrency was 17 months (range 4-35 months). The disease free 5- or 10-year survival were 72% and 67%. Survival was significantly correlated with menopausal state (p < 0.01), tumor grade (p < 0.05), myometrial invasion (p < 0.001), surgical stage (p < 0.0001), and mode of treatment, i.e. operation done or not (p < 0.05). Survival was not affected by the radical nature of the operation (radical vs. simple hysterectomy). When all prognostic variables were analyzed by Cox's regression model (multivariate analysis) in 10-years follow-up, only menopausal state, myometrial invasion, and mode of treatment, i.e. operation done or not (p < 0.01), were independent prognostic factors. CONCLUSIONS: The only relevant staging procedure is the histological examination of cervix without the preoperative irradiation. According to our results it seems that simple hysterectomy instead of radical (Wertheim operation) hysterectomy may be a sufficient operative treatment of stage II endometrial carcinoma.

Adenocarcinoma↗
PubMed1995

Therapeutic and prognostic considerations in primary carcinoma of the vagina.

We analyzed 46 patients with primary carcinoma of the vagina treated between 1969 and 1990. Median age of the patients was 67 years (range 33-89 years). Most (52%) of them were obese and 35% were nulliparous. Four (9%) had suffered from other gynecologic carcinoma and had been operated six to 23 years before the current carcinoma. Forty (87%) patients had squamous cell carcinoma. Stage 0 (carcinoma in situ) was found in three (7%) cases and stage I-IV in 21 (54%), 10 (22%), four (9%) and eight (17%) cases, respectively. Most (81%) of the patients were treated with radiotherapy (alone or in combination with other treatments): combination of brachytherapy and external radiotherapy were used in 45% of the cases. Surgery was used in all stage 0 cases and in 52% of stage I cases. Recurrence of the disease was found in 20 (43%) cases during the follow-up of 10 years. Most often (40%) site of the recurrence was the vagina. Both 5- and 10-year survival were 38%. Stage and extent of the tumor were independent prognostic factors in stepwise multivariate analysis.

Adenocarcinoma↗
PubMed1994

Tumour-associated trypsin inhibitor (TATI): comparison with CA125 as a preoperative prognostic indicator in advanced ovarian cancer.

We have evaluated the prognostic value of tumour-associated trypsin inhibitor (TATI) in stage III or IV ovarian cancer. Tumour-associated trypsin inhibitor (TATI) and CA 125 were determined in serum samples from 66 patients taken before primary surgery. TATI was elevated (> 22 micrograms l-1) in 27 patients (41%). These had a 5 year cumulative survival of 8%, whereas survival was 45% in 39 patients with normal preoperative TATI values. By contrast, the preoperative CA 125 level did not predict survival. In multivariate analysis which included age, stage, histological grade and preoperative TATI and CA 125 levels, patients with elevated preoperative TATI levels had a 2.3-fold relative risk of death (95% confidence interval 1.23-4.20; P = 0.002) compared with patients with normal preoperative levels. This result was comparable with the predictive value of primary residual tumour size, since patients with residual tumour larger than 2 cm in diameter had a 5.2-fold relative risk of death (95% confidence interval 2.55-10.68) compared with patients with a smaller or no residual tumour. Thus, preoperative determination of serum TATI may have a place in the pretreatment evaluation of patients with advanced ovarian cancer.

Adolescent↗
PubMed1993

Pretreatment sonographic evaluation of inguinal lymph nodes in patients with vulvar malignancy.

The state of the inguinal nodes is a major prognostic factor in vulvar carcinoma. Because of new surgical trends with selective inguinal lymphadenectomy, the preoperative evaluation of inguinal lymph nodes is essential for adequate treatment of vulvar carcinoma. To evaluate the adequacy of clinical examination and high-frequency transducer sonography in detecting metastatic inguinal lymph nodes, we studied 25 patients with vulvar malignancy who underwent operation. Histopathologically proved lymph node metastases were found in 11 (22%) of 50 inguinal areas studied. All of the suspected metastases were in patients with stage III-IV disease. The inguinal lymph node metastases were found by sonography in nine (82%), by preoperative palpation in one (9%), and by operative palpation in six (55%) of 11 areas. The difference between sonography and palpation was statistically significant (P < 0.01). The sensitivity and specificity were 82% and 87% for sonography, 9% and 100% for preoperative palpation, and 55% and 90% for operative palpation.

Adult↗
PubMed1992

Pre- and posttreatment serum antibody responses to HPV 16 E2 and HSV 2 ICP8 proteins in women with cervical carcinoma.

Serum antibodies to early proteins of human papillomavirus type 16 (HPV 16 E2 protein) and herpes simplex virus type 2 (HSV 2 ICP8) can be measured by ELISA. In the serum of 122 newly diagnosed cervical carcinoma patients and age-matched controls, enhanced IgA antibody levels to an HPV-16 E2 protein derived peptide no. 245 indicated a 9.5-fold (95% confidence limits 2.8-57.2) relative risk of cervical carcinoma. No significant risk was found with a corresponding HPV 6 E2 peptide or HSV 2 ICP8. To evaluate the HPV 16 E2 peptide as a possible tumor marker for cervical carcinoma serial postoperative serum samples were tested from 27 women with cervical carcinoma. Antibody responses to the HPV 16 E2 peptide depended on the clinical stage. Stage I and II patients showed decreasing posttreatment IgA and/or IgG antipeptide antibody levels. Stage III and IV patients initially showed decreasing antipeptide antibody levels followed by increasing levels. These patients also showed increasing IgG antibody levels to the HSV 2 ICP8. However, increasing antibody levels to the HPV 16 E2 peptide indicated significantly (P less than 0.05) worse 2-year disease free survival (recurring disease) than did stable or decreasing antibody levels. The results suggest that serum antipeptide antibodies to the HPV 16 E2 peptide no. 245 can be used for the monitoring of cervical carcinoma.

Adenocarcinoma↗