Premenopausal hysterectomy and risk of cardiovascular disease.
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Biomedical subjects
Publications and source records attributed to R Punnonen.
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Serum concentrations of vitamin A (retinol), vitamin E (alpha-tocopherol) and total carotene were measured in 88 women with gynecologic cancer (9 vulvar, 15 cervical, 36 endometrial and 28 ovarian carcinomas) and 31 healthy controls. No significant differences were found in the serum levels of the vitamins and carotene in patients with vulvar, cervical or endometrial cancer compared to the controls. The patients with ovarian cancer had a significantly (P less than 0.01) lower mean serum level of vitamin A than the controls, while carotene and vitamin E level were similar in both groups. The results indicate that vitamin A may have a role in the metabolism of patients with advanced ovarian cancer.
Serum lipids were measured in 30 Finnish and Japanese postmenopausal women. Total cholesterol, HDL cholesterol, LDL cholesterol, apo B and the HDL cholesterol/apo A1 ratio were higher in Finnish than in Japanese women. The LDL cholesterol/apo B and apo A1/apo B ratios were lower in Finns than in Japanese. In serum phospholipids the percentage of arachidonic acid was higher and the percentage of the n - 3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid, and the eicosapentaenoic acid/arachidonic acid ratio were lower in Finnish than in Japanese women. No significant correlations were found between serum oestrone levels and lipid parameters.
The effects of ovariectomy on serum 6-keto-PGF1 alpha and TXB2 concentrations and platelet fatty acids were investigated. One month after ovariectomy the levels of 6-keto-PGF1 alpha were unaltered, whereas those of TXB2 were significantly increased. Ovariectomy had no effect on the fatty acid composition of platelets. Thus, the present study suggests that the hormonal changes at the time of menopause may modify the formation of metabolites of arachidonic acid.
Upper genital tract infection was investigated in 45 women admitted to hospital for suspected acute pelvic inflammatory disease (PID). Salpingitis was diagnosed by laparoscopy in 30 (67%) women. Histopathological evidence of endometritis was found significantly more often in the 30 women with salpingitis (87%) than in the other 15 women without salpingitis (33%). C. trachomatis or N. gonorrhoeae, or both, were isolated from the upper genital tract in 14 of the 31 women who had both salpingitis and endometritis or endometritis only but in none of the four women who had salpingitis alone and in none of the 10 women who had no evidence of PID. Bacterial vaginosis was associated with histopathological evidence of upper tract infection. Non-chlamydial non-gonococcal organisms were frequently isolated from the upper genital tract. No organisms were isolated from the upper genital tract from 9 of 35 women with laparoscopic or histopathological evidence of PID compared with 7 of 10 women without evidence of PID. C. trachomatis or N. gonorrhoeae in the endometrium was associated with lymphoid follicles comprising transformed lymphocytes, and correlated with the density of plasma cells on biopsy. The microbiological results support the recommendations of broad spectrum antimicrobial therapy for PID.
Tissue samples from 17 intracranial tumors were analysed for the cytosolic estrogen and progestin receptor concentration. Three of the four meningiomas were progestin receptor-positive, but all were estrogen receptor-negative. All the four meningioma patients were postmenopausal women. The intracranial metastasis of a mammary carcinoma contained both estrogen and progestin receptors. Low progestin receptor concentration was found in an astrocytoma of a postmenopausal women. In addition, the presence of estrogen and progestin receptors was studied in four prolactinomas, two glioblastomas, two oligodendrogliomas, two mixed-cell carcinomas and one astrocytoma. All these tumors were estrogen and progestin receptor-negative.
We used second laparoscopy with dye insufflation to evaluate tubal findings in 20 women 15-45 weeks after treatment for acute pelvic inflammatory disease. Eight women had pelvic adhesions, including all six women with adhesions seen at first laparoscopy. However, in five of the six women, adhesions were milder or had disappeared unilaterally. Dye insufflation revealed tubal occlusion in five of eight women with adhesions and one of 12 women without adhesions. Thus, nine women (45%) had pelvic adhesions or tubal occlusion at second laparoscopy. Second laparoscopy is useful to objectively assess posttreatment tubal and peritubal morphology. Larger studies are needed to evaluate the cost-effectiveness of the procedure and the correlation of second laparoscopy findings to future infertility.
The outcome of pregnancy and delivery was studied in 122 teenagers (under 18 years) and matched controls. There were no differences in complications during pregnancy, delivery method or outcome of pregnancy as measured by perinatal mortality and morbidity. Anemia post partum existed more often in the teenage group, and teenager's newborns were also lighter than those of the controls. This may be due to premature deliveries, which were more common in the teenage group. Premature deliveries were more common in patients who did not visit health centres or maternity outpatient clinics. The main problem is how to attach such teenagers to organized maternity care.
The concentrations of vasopressin in the amniotic fluid were measured in 40 patients. The pregnancies were complicated by diabetes, toxemia or imminent premature delivery and in one case by polyhydramnion. The gestation time varied from 33 to 41 weeks. In addition, we measured vasopressin concentrations after transabdominal drainage of fetal bladder in three cases with urethral obstruction. Detectable concentrations of vasopressin in the amniotic fluid were found in all but four of the 40 cases observed. The vasopressin concentrations varied from 0.21 to 1.81 pg/ml. There were no systematic differences in the values in relation to duration of gestation or disease present. The highest vasopressin concentration was observed in the patient with polyhydramnion. No detectable amount of vasopressin was found in the urine of the three fetuses examined. The results suggest that, in contrast to earlier studies, the placenta may be permeable to small amounts of vasopressin or may itself be an origin of this hormone. The maternal complications present seem to have no effect of the vasopressin concentrations in the amniotic fluid.
The effect of local oestriol treatment on the abdominal skin was studied in 14 postmenopausal women. Six control patients received a similar ointment without oestriol. The duration of the treatment in all cases was three weeks. The elastic fibers in the papillary dermis were thickened, better orientated and slightly increased in number in half of these patients but in none of the control patients. The epidermal thickness was slightly increased in four of the patients treated with oestriol. No significant changes were observed in the epidermal cell size, mitotic activity, dermal vascularization or inflammatory infiltrate between the specimens taken before and after the treatment or between the treatment groups.
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Serum concentrations of vitamins A and E, selenium, and cholesterol were measured in 30 Finnish and 30 Japanese postmenopausal women. While both groups had identical serum vitamin A levels, the other serum factors differed significantly between the groups, the Finns having higher serum vitamin E and cholesterol and lower serum selenium levels. Adjusted to serum cholesterol, which correlated significantly with vitamin E in both groups, the vitamin E levels were, however, similar in the groups. The differences in the serum levels of these nutritional factors may be associated with the differences in the risk of coronary heart disease and cancer between Finnish and Japanese populations.
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We have studied the role of serum C-reactive protein determination in the diagnosis of acute pelvic inflammatory disease. Acute-phase serum C-reactive protein concentration reflected the extent and the severity of pelvic inflammatory disease more closely than erythrocyte sedimentation rate or white blood cell count determinations. We recommend that both C-reactive protein concentration and erythrocyte sedimentation rate should be routinely used to augment the clinical diagnosis of pelvic inflammatory disease.
Fatty acid composition and arachidonic acid metabolites in ascitic fluids of patients with ovarian cancer were compared to those in the peritoneal fluids of patients with benign gynecologic conditions. Substantial amounts of PGE2, PGF2 alpha, TXB2, and leukotriene B4 were detected in the fluids of the both patient groups. In the group of the cancer patients the concentrations of TXB2 were slightly smaller than those in the control group. In the percentage amounts of the eicosanoid precursor fatty acids there could not be detected differences between these two groups. However, in the peritoneal fluids of the cancer patients the percentage amount of palmitoleic acid (16:1) was significantly higher than that in the control group.
Calcium (Ca) metabolism, with particular reference to serum vitamin D metabolites, was investigated in 40 women with femoral neck fracture (mean age 77.1 +/- 8.6 yr). All the patients were ambulant before the fracture; eight were long-term geriatric in-patients. Serum total and ionised calcium and serum albumin levels were significantly lower, and serum parathormone (PTH) levels significantly higher in fracture patients than in controls. Both serum 25-OH-D and 1,25-(OH)2D were significantly lower in fracture patients than in controls. We concluded that vitamin D, serum PTH and calcium levels should be checked with greater frequency in patients at high risk for osteoporosis and osteomalacia before they reach the age of 70.