Biomedical subjects
Publications and source records attributed to G Berg.
We describe a patient with systemic lupus erythematosus, who presented with congestive heart failure. The diagnosis and favorable response to corticosteroid therapy was confirmed by myocardial biopsy and cardiac catheterization.
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A questionnaire on climacteric symptoms was sent to every woman living in the city of Linköping, Sweden (120,000 inhabitants) who was born in 1928 or 1930. Of the 1246 women concerned, 1118 (90%) responded. At the time of the survey, 252 women (23%) were pre-menopausal. In the total sample, 10% had undergone hysterectomy and/or bilateral oophorectomy. The median age at natural menopause was 51 yr. Climacteric symptoms were reported by 75% of the women, the predominating complaints being sweating attacks and hot flushes. Vaginal dryness and tenderness were experienced by 30% of the post-menopausal women, the discomfort tending to become more common as the duration of the post-menopausal period lengthened. After the menopause, every third women experienced periods of depression more often than previously. Depression was positively correlated to the severity of the vasomotor symptoms. Fifty percent of the women expressed interest in receiving oestrogen treatment, although only 7% were using oestrogens at the time of the survey. This discrepancy is probably due to widespread apprehension in Swedish society - shared by the doctors - in regard to 'hormonal treatment'.
Six laboratories actively involved in water virology research participated in a methods evaluation study, conducted under the auspices of the American Society for Testing and Materials Committee on Viruses in the Aquatic Environment, Task Force on Drinking Water. Each participant was asked to examine the Viradel (virus adsorption-elution) method with cartridge-type Filterite filters for virus adsorption and organic flocculation and aluminum hydroxide-hydroextraction for reconcentration. Virus was adsorbed to filter media at pH 3.5 and eluted with either glycine buffer (pH 10.5) or beef extract-glycine (pHG 9.0). Considerable variation was noted in the quantity of virus recovered from four 100-liter samples of dechlorinated tapwater seeded with low (350 to 860 PFU) and high (1,837 to 4,689 PFU) doses of poliovirus type 1. To have a more uniform standard of comparison, all the test samples were reassayed in one laboratory, where titers were also determined for the virus seed. Test results of the Viradel-organic flocculation method indicated that the average percentage of virus recovery for low-input experiments was 66%, with a range of 8 to 20% in two laboratories, 49 to 63% in three laboratories, and 198% in one laboratory. For the high-input experiments, two laboratories reported recoveries of 6 to 12%, and four laboratories reported recoveries of 26 to 46%. For the Viradel aluminum hydroxide-hydroextraction procedure, two laboratories recovered 9 to 11%, whereas four obtained 17 to 34% for low-input experiments. For the high-input tests, two laboratories reported a recovery of 3 to 5%, and four recovered 11 to 18% of the seeded virus.(ABSTRACT TRUNCATED AT 250 WORDS)
The correlation between cyclic AMP (cAMP) production in myometrial tissue and that in leukocytes was studied in 21 women delivered by cesarean section for obstetrical reasons. After in vitro beta-adrenoceptor stimulation, cAMP production in myometrial tissue was found to be closely correlated with that in leukocytes (r = 0.96). Using cAMP production in leukocytes as an indicator of the state of the beta receptor function in myometrium, 18 women treated with terbutaline for preterm labor were studied. Repeat analyses of cAMP production were made in leukocytes before, during and after treatment. The results showed a significant reduction in cAMP production 3-5 hours and 1-2 days after terbutaline infusion. The cAMP values remained low during infusion. In women orally treated with terbutaline, a slight reduction in cAMP production was found after the first dose, but there was no significant reduction after 1-14 days of treatment. After cessation of terbutaline treatment, cAMP production remained low during the following 3 days, but after 5-8 days an increase was found in 7 out of 9 patients. It is suggested that a desensitization of the beta-adrenoceptor system in leukocytes appears after beta-adrenoceptor agonist treatment in high doses and that measurement of cAMP production reflects the state of desensitization of the beta-adrenoceptors in myometrial cells too.
In a prospective, multi-disciplinary study thirteen men with protracted, organic erectile impotence were examined before and after penile implantation. Outcome after one year was judged as favourable in nine, doubtful in two, and unfavourable in two cases. Neurotic functioning was unexpectedly common in the group and the more neurotic subjects fared less well after surgery and reported less benefit from it. Findings in the preoperative psychiatric examination that correlated significantly with unsuccessful outcome were immature and neurotic, particularly hysterical traits, low sexual drive, low sexual activity, disavowal of ambivalence towards penile implantation and high "femininity" scores on a sex role inventory, the Gough Femininity Scale.
Continuous terbutaline infusion in 8 women with premature labour arrested the uterine contractions within 1.5 h in 7 of them when an infusion rate of 10 micrograms/min was used. The plasma concentrations of terbutaline were in the range 10-14 micrograms/L after 1 h. In 4 other women with less severe contractions, labour could be stopped with infusion rates of 5 or 7.5 micrograms/min. A condition approaching steady state seemed to be attained after infusion at a constant rate of 2.5 micrograms/min for 17-34 h with a mean plasma concentration of 6.7 micrograms/L. This value would give a mean total body clearance of 0.30 L/min which is about one third higher than that previously found in healthy men. The terbutaline plasma concentrations determined in this study were compared with simulated curves based on pharmacokinetic parameters obtained in healthy male volunteers. The data correlated well during the first 3 h of infusion, indicating similar distribution kinetics in the patients and the volunteers. After infusion for a longer period (greater than 10 h), the measured plasma concentrations were generally lower than those predicted by the simulation. Treatment of 10 women (7 initially treated intravenously) with terbutaline tablets 5 mg three times daily postponed delivery for more than 7 days in 9 of the patients. The mean plasma concentrations of terbutaline during repeated tablet treatment were 3.4, 4.1 and 4.1 micrograms/L at 1, 2 and 4 h after administration, respectively. No serious side-effects occurred.
Since terbutaline treatment in premature labor has been shown to increase phosphodiesterase activity in the myometrium, the phosphodiesterase-inhibiting effect of theophylline and papaverine on myometrial preparations from pregnant women has been studied. The patients were either treated with terbutaline during the last 3 weeks of pregnancy or not treated. The results showed that papaverine is about 100 times more potent than theophylline in both phosphodiesterase-inhibiting effect and muscle-relaxing effect. No differences in effects were found in myometrial strips from terbutaline-treated or untreated women. A possible improvement in the tocolytic therapy with a combination of a beta-sympathomimetic and a phosphodiesterase-inhibiting drug is suggested.
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A survey of triplet pregnancies in Linköping, Sweden, 1973-1981, showed a low perinatal mortality (4%) and low morbidity possibly due to prophylactic bed rest and tocolytic treatment. All children were followed at child health clinics. In one child, a persistent growth retardation was recorded at 4 years of age. No psychomotor deviations were found in the group. An interview concerning social and economic factors after delivery was carried out. The answers revealed considerable strain in daily life for all families.
Thirty-three adult hypospadiacs and 36 matched controls were investigated by means of Rorschach's test, in a double-blind design. From psychoanalytic theory predictions were made about the effects of the influences of the genital malformation and its treatment on the psychological adjustment. The hypospadiacs differed significantly from the controls as predicted. They exhibited more neurotic constriction with less ego-strength and less utilization of resources. Their anxiety and hostility levels were judged higher and they showed less self-esteem and activity as well as less capacity for interpersonal relations. The results are compatible with psychoanalytic theory on the role of castration anxiety in the neurosis formation. The need for psychotherapeutic support for these boys and their parents is stressed.
Gender identity and sexual orientation were investigated in 34 men operated for hypospadias in childhood and in 36 matched control subjects. Independent psychiatric assessments from semi-structured interviews, and double-blind formalized psychological ratings from the Rorschach, yielded similar findings. The probands were less secure in their maleness but were similar in sexual orientation as compared to the controls. A third blind, independent measure of unconscious gender identity, the Franck Drawing Completion Test, gave further evidence of uncertain gender identity in the patients. A self-administered inventory, the Gough Femininity Scale, showed a tendency for the patients to take more feminine sex roles. The findings are discussed from psychoendocrinological as well as psycho-analytical view points. The need for early psychological preventive measures for hypospadic boys and their parents is stressed.
Serum levels of LH, FSH, prolactin and androgens were assayed in 33 adult men operated for a penile malformation (hypospadias) in childhood and in 34 matched controls. Two cases of severe hypospadias had signs of hypergonadotrophic hypogonadism. Three moderately severe cases possibly had a central relative androgen receptor insensitivity. Patients had lower levels of 5 alpha-dihydrotestosterone in serum, unrelated to the severity of the hypospadias. The hypospadias patients have previously been shown to be more neurotic and inhibited both socially and sexually than the controls, which might be related to defective androgenic functioning. Relations between androgen levels and psychological variables were studied. Low testosterone levels were related to higher hostility scores in Rorschach. Relations between androgens and other personality characteristics could not be shown.
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Immunoelectron microscopy was performed on live, cultured early postnatal mouse cerebellar cells to identify and ultrastructurally characterize those cells which express nervous system antigen-1 (NS-1) and beta-D-galactocerebroside (GalCer) on their surfaces. These two antigens are expressed on oligodendroglia with similar ultrastructural features. These cells are mainly of the immature type, possessing numerous polysomes, mitochondria and microtubules. Filaments are not observed. These oligodendroglia are sometimes surrounded by NS-1 and GalCer-positive membranous material, Few (less than 5%) mature oligodendrocytes are present in the dissociated cerebellar cultures.
A 39-year-old woman presented with secondary amenorrhoea in the absence of galactorrhoea, hirsutism or virilization. Investigation revealed a strikingly elevated serum testosterone, dihydrotesterone, free testosterone and LH level. At laparotomy a large granulosa cell tumour was encountered and totally removed. Analysis of the tumour revealed 127 ng of testosterone/mg of tumour tissue. The testosterone was localized immunocytochemically to the granulosa cells, which demonstrated typical ultrastructural characteristics of oestrogen rather than androgen secreting tissue. A study of androgen binding and metabolism prior to tumour resection revealed a normal androgen receptor as evidenced by normal maximum binding, dissociation constant and nuclear uptake. Removal of the tumour resulted in a return to normal of all abnormalities. We conclude that granulosa cell tumours may rarely secret large amounts of testosterone and that in this situation their ultrastructure is unchanged. Furthermore, absence of LH suppression or hirsutism in an amenorrhoeic patient does not dismiss the possibility of a significant androgen-secreting tumour. In this situation, the failure to virilize may be due to a post-nuclear translocational defect.
Aspects of mental health were investigated by means of interviews and register data in 34 men operated on for hypospadias in childhood and in 36 matched control subjects. Most hypospadiacs adjust well both in childhood and adult age. However, they reported more neurotic disturbances in their childhood than the controls. Shyness and enuresis were common troubles among the probands, and they had been more timid, isolated and mobbed. Similar although less striking differences in mental health were reported also in adult age. Depression and anxiety were dominating symptoms. The interviewer assessed the hypospadiacs to show more anxiety and to use more immature defence mechanisms and consequently to have less stress tolerance. The probands were further judged to have less capacity for social relations and their overall capacity to utilize existent psychological resources was small as compared to the controls. The findings indicate that hypospadiacs are more prone to neurotic (but not psychotic) disturbances than other young men and have more disturbed social relations. The need for psychological guidance for the boys and their parents is stressed.