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Biomedical subjects

M I Whitehead

Publications and source records attributed to M I Whitehead.

At least 73 records · Page 4Linked to original sources
PubMed1989

Consequences and treatment of ovarian failure after total body irradiation for leukaemia.

OBJECTIVE: To assess the incidence and severity of physical and psychosexual symptoms in young women due to ovarian failure caused by total body irradiation for leukaemia and the women's response to hormone treatment. DESIGN: Postal questionnaire and interview. SETTING: Leukaemia unit of oncology hospital. PATIENTS: Consecutive series of 46 English speaking women who had developed ovarian failure after total body irradiation and bone marrow transplantation as treatment for leukaemia. RESULTS: Of the 36 responders, 33 reported some symptoms, vaginal dryness being the most common (29). This profoundly affected sexual function. Although 22 women had had sexual intercourse within six months after treatment, 16 were less interested in and 18 experienced difficulties with sexual intercourse. Anxieties about sterility, femininity, and appearance were common and reduced self confidence. Almost half reported that they had changed their social habits and restricted their social activities. Treatment seemed effective in abolishing symptoms in 24 women, but vaginal dryness remained a problem in three. Two women failed to respond and intercourse remained impossible. CONCLUSIONS: Such patients are vulnerable and access to gynaecologists and endocrinologists soon after treatment would be valuable. The optimal treatment regimen and the long term benefits of treatment have yet to be established.

Adolescent↗
PubMed1989

Transabdominal ultrasound screening for early ovarian cancer.

OBJECTIVE: To assess the value of ultrasonography in a screening procedure for early ovarian cancer. DESIGN: Prospective study of at least 5000 self referred women without symptoms of ovarian cancer. Each woman was scheduled to undergo three annual screenings (consisting of one or more scans) to detect grossly abnormal ovaries or non-regressing masses. SETTING: The ovarian screening clinic at King's College Hospital, London. SUBJECTS: 5479 Self referred women without symptoms (aged 18-78, mean age 52). INTERVENTIONS: Women with a positive result on screening were referred for laparoscopy or laparotomy, or both. MAIN OUTCOME MEASURES: Findings at surgery and from histology of abnormal ovaries. RESULTS: A total of 14,594 screenings (15,977 scans) were performed. A positive result was obtained at 338 screens (2.3%) comprising 326 subjects (5.9%). Five patients with primary ovarian cancer (four stage Ia, one stage Ib; two at first screening three at second) were identified (prevalence 0.09%). An additional four patients had metastatic ovarian cancer (three at first screening, one at second). The apparent detection rate was 100%. It was not possible to differentiate between the ultrasonic appearance of early malignant and benign tumours. The rate of false positive results for primary ovarian cancer was 3.5% at the first screening, 1.8% at the second, and 1.2% at the third. Overall the rate of false positive results was 2.3%; the specificity was 97.7% and the predictive value of a positive result on screening was 1.5%. The odds that a positive result on screening indicated the presence of an ovarian tumour, any ovarian cancer, or primary ovarian cancer were about one to two, one to 37, and one to 67 respectively. CONCLUSION: Ultrasonography can be used to screen women without symptoms for persistent ovarian masses that will include early ovarian cancer.

Adolescent↗
PubMed1989

Transvaginal colour flow imaging: a possible new screening technique for ovarian cancer.

OBJECTIVE: To assess whether changes in the intraovarian vasculature or blood flow impedance can be used to identify potentially malignant masses. DESIGN: Open, non-comparative prospective study. SETTING: Ovarian screening clinics at King's College Hospital and the Hallam Medical Centre. SUBJECTS: 50 Women selected on the basis of their medical history and the result of a previous transvaginal ultrasound scan. Thirty women (10 premenopausal (scan taken on days 1 to 8 of the menstrual cycle) and 20 postmenopausal) had normal ovaries, and 20 had at least one ovary with an abnormal morphology or volume, or both. INTERVENTIONS: Women with a positive result on screening were referred for laparotomy. MAIN OUTCOME MEASURES: Presence or absence of coloured areas (neovascularisation) and the pulsatility index within each ovary. The pulsatility index is a measure of the impedance to blood flow, a low value indicating decreased impedance and a high value increased impedance to blood flow. RESULTS: Two women with a positive result on screening had hydrosalpinges, 10 a benign tumour or a tumour-like condition, and eight primary ovarian cancers. No areas of neovascularisation were seen in the 30 women with morphologically normal ovaries and the two patients with hydrosalpinges; the pulsatility index ranged from 3.1 to 9.4. Similarly, nine patients (10 affected ovaries) with a non-malignant mass had no signs of neovascularisation and the pulsatility index varied from 3.2 to 7.0. One patient with bilateral dermoid cysts containing nests of thyroid-like cells had vascular changes and pulsatility index values of 0.4 and 0.8. Seven patients (eight ovaries) with primary ovarian cancer (one stage IV, four stage II, and two stage Ia) showed clear evidence of neovascularisation and pulsatility index values were from 0.3 to 1.0. One patient with an intraepithelial serous cystadenocarcinoma in a small ovary (less than 5 ml volume) had no signs of any vascular change and the pulsatility index was 5.5. CONCLUSION: Transvaginal colour flow imaging may be used to identify potentially malignant ovarian masses and help elucidate the early stages of tumorigenesis. The routine application of this technique may reduce the rate of false positive results of an ultrasonography based screening procedure.

Adult↗
PubMed1989

Progesterone in saliva as an index of ovarian function.

Progesterone was assayed in samples of saliva collected daily throughout the menstrual cycle and correlated with corresponding daily concentrations of pregnanediol-3 alpha-glucuronide in early morning urine. Ovarian follicular growth was monitored on a daily basis with a real-time sector scanner. The concentrations of salivary progesterone shows a specific pattern with a mid-cycle rise and a peak in the luteal phase. The mean concentration in the follicular phase, as determined, was 40.4 pmol/l (range 15.3-110.7 pmol/l). It increased in the peri-ovulatory period to a peak of 201.1 pmol/l (range 46.4-289.8 pmol/l) 6 days following follicular rupture.

Adult↗
PubMed1989

The effects of the addition of nomegestrol acetate to post-menopausal oestrogen therapy.

Progestogens are added to the oestrogen treatment for 10-12 days each cycle in order to prevent endometrial abnormalities. However, concern has been expressed about the safety of certain of the currently available progestogens because of the potential adverse metabolic effects. We have evaluated the effects of nomegestrol acetate - non-androgenic progestogen - for administration to post-menopausal oestrogen users. Thirty-six (36) women receiving 50 mg oestradiol implants at regular intervals also took nomegestrol acetate for 12 days each calendar month at doses of 0.5 mg, 1.0 mg and 2.5 mg daily. Allocation to one of the dose regimens was random. Physical and psychological side-effects were recorded and all vaginal bleeding was noted: an endometrial biopsy was performed on the sixth day of progestogen addition for histological, ultrastructural and biochemical evaluation. Adverse side-effects were responsible for a dose-dependent drop out rates of 17%. All patients experienced a regular, progestogen-induced withdrawal bleed each month; and histological, ultrastructural and biochemical changes were induced within the endometrium by all 3 doses. Nomegestrol acetate is a potent progestogen and further studies are required to determine its lowest effective dose.

Adult↗
PubMed1989

Are fixed-dose oestrogen/progestogen combinations ideal for all HRT users?

Although progestogens protect the endometrium against excessive oestrogen-induced stimulation, they can cause adverse symptomatic and psychological effects and may have undesirable metabolic consequences. Thus, the minimum progestogen dose which results in consistent endometrial transformation should be prescribed. To define this dose for norethisterone and dl-norgestrel, 197 endometrial samples obtained from postmenopausal women receiving conjugated equine oestrogens (0.625 mg or 1.25 mg daily) with one of six doses of norethisterone (or the acetate), or one of three doses of dl-norgestrel added for the first 12 days of each calendar month were examined with the light microscope; 109 samples were also assessed by transmission electron microscopy. There was an inverse relation between the percentage of samples showing proliferative features and the progestogen dose. However, proliferative endometrium was observed in 6% of samples with the highest dose of dl-norgestrel (500 micrograms) and in 3% of samples with 2.5 mg norethisterone. Conversely, complete secretory transformation was observed in 25% of samples with the lowest dose of norethisterone (0.1 mg) and in 40% of samples with 75 micrograms dl-norgestrel. Mild atypical hyperplasia was diagnosed in four samples. There was a wide inter-patient variation in response and none of the nine progestogen dose regimens induced secretory change in every patient.

Cell Division↗
PubMed1989

Characteristics of persistent ovarian masses in asymptomatic women.

Persistent ovarian masses have been found in a substantial proportion of 5479 self-selected asymptomatic women who were screened for early ovarian neoplasia. Each woman was scheduled to undergo three ultrasound screens (consisting of 1-12 scans) to detect regressing and non-regressing masses. A total of 14,594 screens (15,977 scans) was performed. The average interval between successive screens was 595 days (range 214-1134 days). Overall, 650 screens (4.4%; 10.1% of women) produced a positive result which became negative with successive scans (four times more frequently in pre- than naturally postmenopausal women), and 338 screens (2.3%; 5.9% of women) had a final positive result (at least one ovary that was grossly abnormal or contained a persistent mass). Biopsies were taken from 336 ovaries (89% of total, 271 women). Overall, 134 tumour-like conditions and 119 benign tumours were identified. The detection rate of tumour-like conditions was 1.5 times higher in premenopausal than naturally postmenopausal women, whereas the proportion of tumours to normal ovaries was similar in both groups. Overall, 51% of tumour-like conditions and 70% of all tumours were detected at screen 1. Four women had metastatic ovarian cancer (three at screen 1, one at screen 2; two were bilateral). Five women (0.1%) had a primary malignant tumour (two at screen 1, three at screen 2; four were stage 1a and one was stage 1b). All women are being monitored to obtain additional information about the significance of the findings.

Female↗
PubMed1988

Dietary intake of calcium and postmenopausal bone loss.

The use of calcium supplements to prevent postmenopausal bone loss and hence osteoporosis is widespread, but the evidence for their efficacy, either alone or in combination with other treatments, is contradictory. Skeletal measurements and dietary intake of calcium were determined in 59 healthy postmenopausal women, most of whom were within five years of the menopause. No correlation was found between current intake of calcium and either total calcium in the body or the density of trabecular or cortical bone in the forearm or vertebral trabecular bone. Dietary intake of calcium did not influence the rate of postmenopausal bone loss in the 54 women who completed 12 months of active or placebo treatment. Even when extremes of calcium intake were examined no difference was found in bone measurements between the women with the highest and lowest intakes. The results of this study suggest that the bone density of women in the early menopause is not influenced by current dietary intake of calcium.

Adult↗
PubMed1988

Calcitonin for prevention of postmenopausal bone loss.

A 2-year randomised pilot study was conducted in 70 patients to see whether the osteoclast-inhibiting effect of calcitonin would reduce postmenopausal vertebral bone loss. An oestradiol-treated group was included in the study as a positive control since oestrogens are known to be effective. Calcitonin reduced vertebral bone loss in doses above 250 micrograms human calcitonin (50 international units) a week, and at this dose was as effective as oestradiol.

Administration, Oral↗
PubMed1988

Elevated 7B2 levels during normal human pregnancy.

In a cross-sectional study the plasma concentrations of immunoreactive 7B2, a novel protein originally isolated from the pituitary gland, was measured in 60 healthy pregnant and postpartum women. The mean circulating concentration of 7B2 immunoreactive equivalents was found to be significantly increased throughout pregnancy (10 to 12 weeks, 52.2 +/- 13.1 pmol/L; 20 to 22 weeks, 74.4 +/- 20.1 pmol/L; 30 to 32 weeks, 56.0 +/- 12.9 pmol/L; and 36 to 40 weeks, 85.7 +/- 13.6 pmol/L) when compared with a group of 32 age-matched nonpregnant controls (19.7 +/- 5.0 pmol/L); (p less than 0.01). The highest 7B2 plasma concentrations were found shortly before delivery (36 to 40 weeks) and fell sharply after birth, returning to normal within 4 to 6 weeks. Fetal plasma from both umbilical artery and vein was found to have particularly high concentrations of 7B2-like immunoreactivity (396 +/- 19 and 361 +/- 24 pmol/L, respectively), and 7B2 was extractable from the placenta. Chromatographic analysis of plasma and tissue extracts showed the main peak of immunoreactivity to coincide with that originally described in the pituitary gland. Although the function of 7B2 is at present unknown, our data suggest that 7B2 immunoreactivity in fetal blood originates from the fetus and may play an important role in pregnancy.

Adolescent↗
PubMed1988

Ovarian size in postmenopausal women.

Ovarian volumes have been determined by pelvic ultrasonography in 2246 apparently healthy postmenopausal women of whom 2221 were included in the statistical analysis. Factors associated with gonadal size have been identified, and reference ranges for derived indices have been determined for use (in association with criteria for abnormal morphology) in a screening programme for ovarian carcinoma. The right ovary was present in 98.9% of subjects and the left in 99.1%. The mean (SD; range) of right and left ovarian volumes were 3.58 (1.40; 1.00-14.01) and 3.57 (1.37; 0.88-10.9) ml respectively. Significant predictors of ovarian volume were years since the menopause, weight, parity, age at menopause, a history of hormone replacement therapy, and previously diagnosed breast cancer. Abnormal ovarian volumes were assessed from a score equal to the (observed mean log volume (MLV) minus the predicted MLV)/0.327. A simplified nomogram has been prepared for routine clinical use. The relative abnormality of one ovary was assessed from a ratio score equal to loge (larger ovarian volume/smaller ovarian volume)/0.211 compared with the 99th centile for the Gaussian distribution.

Age Factors↗
PubMed1988

Correlation of ovarian follicle size and the urinary excretion of oestrone glucuronide, luteinizing hormone and pregnanediol glucuronide in spontaneous cycles.

Ovarian follicular development was investigated in 17 apparently normal women in whom ovulation was dated using real-time ultrasonography. Ultrasonic determination of follicular growth was performed on a daily basis with a real-time sector scanner, and correlated with daily concentrations of oestrone-3-glucuronide (E1-3-G), luteinizing hormone (LH) and the ratio of E1-3-G to pregnanediol-3 alpha-glucuronide (Pd-3 alpha-G) in early morning urine. The main results from ultrasonography showed that all patients except one developed follicles greater than 1.8 cm, with a mean growth rate of 0.18 cm/day. There was a statistically significant correlation between the mean follicular diameter and the mean concentrations of urinary E1-3-G (r = 0.95, P less than 0.001) and ratio of E1-3-G to Pd-3 alpha-G (r = 0.97, P less than 0.001) during the 8 days prior to ovulation.

Adult↗