Biomedical subjects
Publications and source records attributed to R Punnonen.
We diagnosed acute pyosalpinx in eight patients with laparoscopy. The pus was aspirated through the laparoscope in five cases, and antimicrobial treatment was started intravenously thereafter. The short-term recovery was uncomplicated. Laparoscopic treatment of acute pyosalpinx, in contrast to radical surgery, preserves reproductive potential and ovarian function.
The difference between the endometrial cancer incidence in Japanese and Finnish women (lower and higher incidence, respectively), was evaluated on the basis of data from cases of endometrial cancer, cervical cancer and benign gynecological disease in both countries. The comparison took into account the various personal and clinical characteristics of these cases. In endometrial cancer, Japanese and Finnish women had similar characteristics except for the age at first delivery, the age at last delivery and obesity. However, obesity in postmenopausal women in the two countries was similar. Common factors in the two countries included few pregnancies and deliveries, nullipara and single women. In cervical cancer, no difference between the characteristics of Japanese and Finnish women was found except that Japanese women had a higher frequency of pregnancy. In benign diseases, characteristics were similar to those of endometrial cancer in Finnish women, but this was not the case in Japanese women. These facts may indicate the number of Finnish women with endometrial cancer risk factors is greater than the number of Japanese women with these risk factors. This was thought to account for the difference in the incidence of endometrial cancer.
The fatty acid composition of fractionated phospholipids and neutral lipids was analyzed in human breast cancer tissues and the surrounding, apparently healthy tissue. In the cancer tissues the relative amounts of unsaturated fatty acids were increased in all the phospholipid subclasses analyzed. The differences were more marked in phosphatidylethanolamine than in the other phospholipid fractions and, furthermore, the relative amount of phosphatidyl-ethanolamine was increased in cancerous tissue. In blood-erythrocyte phospholipids, no differences in fatty acid composition could be found between breast cancer and control patients. The present study suggests that the lipid composition of cancerous breast tissues differs from that of the surrounding tissue and may be involved in carcinogenesis.
Chlamydia trachomatis was isolated from the distal part of the tube in a patient with salpingitis and perihepatitis 14 months after laparoscopic tubal occlusion. This suggests that chlamydial infection can spread by the lymphatic or hematogenous routes.
We measured serum levels of progesterone and estradiol among 35 patients with endometritis confirmed by endometrial biopsy. The onset of symptoms took place predominantly in the proliferative phase of the cycle. A negative correlation was found between the serum progesterone levels and the histopathologic severity of plasma cell endometritis. Our results suggest that the hormonal status contributes to the immune response and susceptibility to endometrial infection.
Eleven invasive and five non-invasive primary vaginal carcinomas were studied by DNA flow cytometry using archival paraffin-embedded tissue as starting material. Overall frequency of DNA aneuploidy in the invasive carcinomas was 8/11 (73%). DNA aneuploidy occurred in all four advanced stage (III-IV) and in 4/7 (57%) of the early stage (I-II) carcinomas. Among the squamous cell carcinomas aneuploid DNA content was also associated with non-keratinizing tumor type. Invasive vaginal carcinomas showed a high median S-phase fraction (SPF) (18.4%, range 6.9-31.8%). High SPF values were associated with advanced stage and non-keratinizing tumors. Corrected 5-year survival rate in invasive vaginal cancer was 44%, with no significant relation to DNA ploidy or SPF. In situ carcinomas were almost as often DNA-aneuploid (3/5, 60%) as the invasive carcinomas and had comparable median SPF value (13.4%, range 5.5-24.6). One in situ carcinoma with a high DNA-index and SPF relapsed, but overall 5-year survival rate was 100%. In conclusion, both invasive and in situ vaginal carcinomas frequently contain DNA-aneuploid stemlines and show a high SPF. Although DNA aneuploidy and high SPF correlate with advanced stage and non-keratinizing tumor type, they do not have much prognostic relevance in vaginal neoplasia.
The effect of cis-platinum treatment on the hearing of 23 ovarian cancer patients was evaluated using standard and high-frequency audiometry. Twenty-two percent of the patients developed a hearing loss of at least 15 db, 13% in the range 125-8000 Hz and 9% only in the high-frequency area above 8 kHz. However, due to the high-frequency hearing loss (presbyacusis) in older patients high-frequency audiometry was often unobtainable. Hearing screening using standard pure-tone audiometry is recommended for cis-platinum patients as a routine procedure.
Serum levels of CA 125 and other selected tumour markers were measured in 31 patients with proven pelvic inflammatory disease (PID). Ten (32%) of the patients had elevated CA 125, one (4%) had elevated CEA, and none had elevated CA 15-3, AFP or beta 2-microglobulin. Compared to patients with normal CA 125, patients with elevated CA 125 were older, more often users of intrauterine contraceptive devices, had longer duration of symptoms, higher erythrocyte sedimentation rates, and more often had an adnexal mass on pelvic examination. There was a correlation between CA 125 levels and the severity of adnexal inflammation as defined by laparoscopy. Isolation of specific micro-organisms from the upper genital tract was not associated with elevated CA 125. In most women serum levels of CA 125 decreased during treatment. PID should be considered as a major cause of positive CA 125 findings among young women.
An enzyme immunoassay was used to determine IgM, IgG, and IgA antibodies to gonococcal pili in 68 patients with uncomplicated gonorrhoea, 35 women with pelvic inflammatory disease, and in 115 normal controls. A clear difference in response rate in all three antibody classes between patients with gonorrhoea and healthy controls was evident. Among women with gonorrhoea, the magnitude of antibody response was higher than among men with gonorrhoea, especially in the IgM class. No major differences were found in the overall distribution of serological findings between women with uncomplicated gonorrhoea and those with gonococcal pelvic inflammatory disease. Among this last group, however, high IgM antibody levels in acute phase sera were significantly associated with the isolation of Neisseria gonorrhoeae in the upper genital tract.
Urethral closure function was measured before and 3 months after operation in 18 patients having hysterectomy and 13 patients having supravaginal uterine amputation performed. Sixteen patients had a symptom of mild stress incontinence before and 11 after the operation. The urethral closure function at rest and under stress was measured by urethrocystometry. No operation-induced changes in urethral closure pressure, functional length, pressure transmission, urethral relaxation or urethral resistance to stress were found after either operation.
We have previously defined three types of tumor DNA histograms, which are associated with favourable, intermediate and poor prognosis of patients with ovarian cancer. In the present study we evaluated the value of DNA histogram type combined with clinicopathological data in predicting long-term clinical outcome in stage I ovarian cancer. A stepwise discriminant analysis was done to find out the best combination of prognostic parameters in the distinction of two groups of stage I ovarian cancer patients; those with less than 5-year overall survival (22 cases) and those with longer than 5-year recurrence-free survival (47 cases). DNA histogram and histological type as well as FIGO stage in that order proved to be the most discriminating parameters and their combination allowed the correct prediction of clinical outcome in 78% of stage I ovarian cancer patients. In stage Ia the proportion of correctly classified cases based on DNA histogram and histological type was 82%. If DNA histogram was omitted from the discriminant analysis, the combination stage and histological type correctly classified a significantly lower percentage (68%) of patients. DNA flow cytometry thus improved the prognostic evaluation in stage I ovarian cancer, but even when combined with conventional clinicopathological factors failed to give correct prognostic assessment in about 20% of patients with stage I ovarian cancer.
We studied the clinical and microbiological response to two treatment regimens in 36 patients with acute pelvic inflammatory disease (PID). All patients were hospitalized and underwent laparoscopy and endometrial biopsy. Cervical, endometrial, tubal and peritoneal cultures for Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, facultative and anaerobic bacteria and Herpes simplex virus were obtained. The patients were randomly assigned to two treatment groups: 16 women received ciprofloxacin 200 mg b.i.d. iv. for two days, followed by oral administration with 750 mg b.i.d. to complete a 14-day course of treatment. Twenty women received the combination of doxycycline and metronidazole according to a similar scheme of administration. The response was evaluated with repeated clinical examinations, monitoring of the erythrocyte sedimentation rate and serum C-reactive protein concentration, and repeated microbial culture from the cervix. Ciprofloxacin treatment was successful in all nine patients with chlamydial or gonococcal PID and in six of seven with nonchlamydial nongonococcal PID. Doxycycline plus metronidazole regimen was successful in five of seven patients with chlamydial or gonococcal PID and in nine of 13 patients with nonchlamydial nongonococcal PID. Thus, the overall success rate was 94% (15 of 16) with ciprofloxacin and 70% (14 of 20) with doxycycline plus metronidazole. Our study suggests that ciprofloxacin is a promising new alternative for the treatment of acute PID.
Paraffin-embedded tumor samples from 157 ovarian cancer patients were analyzed by DNA flow cytometry. Tumor ploidy had prognostic significance in both early and advanced ovarian cancer. After adjusting for stage, residual tumor mass, histopathologic type, treatment, and age of patient in a Cox regression analysis, the relative risk of death was two-fold higher in single DNA-aneuploid and sixfold higher in DNA-multiploid tumors as compared to DNA-diploid tumors (P less than 0.0001). A tetraploid DNA index was associated with a relatively low risk ratio, whereas hypertetraploid tumors were highly malignant. S-phase fraction (SPF) had prognostic value especially in DNA-diploid tumors. The simultaneous evaluation of DNA index, the number of aneuploid cell clones, and SPF gave more prognostic information than the determination of tumor ploidy alone. On the basis of these parameters we have developed a classification of tumor DNA histograms for better prognostic assessment of ovarian cancer.
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The importance of monitoring luteinizing hormone (LH) secretion during gonadotropin stimulation remains controversial. In the present study, the authors evaluated the occurrence of spontaneous LH surges in 170 cycles stimulated by clomiphene citrate and human menopausal gonadotropin, and correlated the success rate of embryo cleavage to the time interval between the occurrence of the LH surge peak value and the time of human chorionic gonadotropin (hCG) administration. LH was quantitated from urine by an avidin-biotin enzyme immunoassay. The results indicated that a spontaneous LH surge occurred in 18% of the cycles. The number of oocytes recovered was not affected by the occurrence of a spontaneous LH surge. In 12% of all cases, the spontaneous LH surge occurred less than 12 hours before the administration of hCG, and in these cases embryo cleavage was not reduced. In 6% of all cases, the spontaneous LH surge occurred over 12 hours before hCG administration, and in these cases embryo cleavage was reduced significantly.
We analyzed nuclear DNA content and S-phase fraction (SPF) from 157 paraffin-embedded ovarian tumors by flow cytometry and compared the results with the clinicopathological features of the tumors. DNA aneuploidy was more common and mean SPF was higher in advanced than in early-stage tumors (p less than 0.001). DNA aneuploidy was most often (75%) observed in undifferentiated tumors (World Health Organization classification) and most seldom (30%) in mucinous carcinomas. Mean SPF values ranged from 17.7% in undifferentiated carcinomas to 11.1% in mucinous carcinomas. DNA flow cytometric results correlated better with nuclear than with histological tumor grade. The proportion of DNA-aneuploid tumors increased from 30% in nuclear grade I to 93% in nuclear grade III, and mean SPF increased from 9.9 to 20.2% (p less than 0.001). DNA ploidy and SPF were independently associated with both stage and nuclear grade of the tumor, whereas the differences between the histopathological tumor types virtually disappeared when the groups were adjusted for nuclear grade. On the basis of these clinicopathological correlations, it appears that DNA ploidy and SPF reflect the malignant potential of ovarian tumors and thus complement the routine histopathological evaluation.
The concentrations of 25-hydroxyvitamin D (25-OHD), vitamin A and vitamin E were measured in serum samples of Finnish and Floridian women; the samples were collected in spring. The Floridians had twice as much 25-OHD in serum as the Finns, but the levels of the two other fat-soluble vitamins were equal. Thus, in Florida there is very little risk for vitamin D deficiency, and vitamin A and E status seems to be unaffected by differences in dietary habits.
The effects of halothane and isoflurane anaesthesia on plasma renin activity and plasma concentrations of aldosterone and vasopressin were investigated in 20 cholecystectomy patients. Plasma renin activity rose significantly during both halothane and isoflurane anaesthesia without surgery, and increased further after the commencement of operation. Plasma aldosterone increased slightly during halothane and isoflurane anaesthesia, but the highest concentrations, three times the control values, were measured during surgery in both groups. Plasma vasopressin decreased during halothane and isoflurane anaesthesia to half of the control values, but rose significantly during cholecystectomy. During anaesthesia and surgery there were no significant differences in the mean arterial pressures of the groups. The results demonstrate that isoflurane stimulates the renin-angiotensin system to a similar extent as halothane, although it causes hypotension by a different mechanism. The activation of the renin-angiotensin-aldosterone system may be an essential compensatory mechanism, which antagonizes the decrease of blood pressure. Plasma vasopressin probably has no role in regulating blood pressure during anaesthesia.