Tubal pregnancy after vaginal hysterectomy.
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Biomedical subjects
Publications and source records attributed to R Punnonen.
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The binding of 3H-estradiol and 3H-R5020 (dimethyl-19-norpregna-4,9-diene-3,20-dione) to estrogen (ER) and progesterone (PR) receptors in human uterus and oviduct were studied. The binding of the ligands to their respective receptors were of high specificity and affinity. The equilibrium dissociation constants for ER and PR were 0.07 +/- 0.025 nM respective 0.76 +/- 0.22 nM in the oviduct and 0.065 +/- 0.015 nM respective 0.82 +/- 0.25 nM in the uterus (mean +/- SE) (n = 12). Sucrose density gradient centrifugation revealed in both tissues specific binding in the area sedimenting at 8 S whereas the slower sedimenting 4 S and 5 S peaks contained both specific and non-specific binding. The oviductal cytosol contained a similar proteolytical activity that has been described in human uterine and breast cancer tissue. The protease, which can be inhibited by diisopropylfluorophosphate, converts the 8 S receptor from into a 4.2 S proteolytic fragment. The KCl-extracted uterine and oviductal estrogen and progesterone receptors sedimented at 5.2 S in both low salt (0.01 M KCl) and high salt (0.4 M KCl) sucrose gradients. It is well known that the suppression of the estrogen receptor system by progesterone correlates with suppressed function in the oviduct but with increased growth and secretory activity in the uterus. In the light of the present data it is concluded, that the difference in the hormonal response in the two tissues is most likely not due to differences in the binding characteristics of the estrogen or progesterone receptors.
The prevalence of cervical Chlamydia trachomatis infection in healthy, symptomless full-term pregnant women (n = 92) was found to be low (1.1%). Chlamydial cervical IgA antibodies, as measured by solid-phase radioimmunoassay (RIA), were found in 5.3%, but amniotic fluid chlamydial RIA IgA antibodies were almost absent. Serum IgG antibodies were measured with indirect immunofluorescence (IF). Of the mothers 9.8% had a titer greater than or equal to 1:64, correlating closely with the figure of 10.9% for infants' cord-blood IF serology. Finally, a case report is presented. A child born to a Chlamydia trachomatis positive mother developed isolation positive chlamydial pneumonia.
The human myometrial estrogen receptor (ER) and progesterone receptor (PR) are stabilized in the presence of 25 mM molybdate. The stabilizing effect is very palpable for the PR; even after 15 min of incubation at 37 degrees C only 15% of the binding activity is lost in the presence of molybdate, whereas during the same period of time 75% of the binding activity is lost in the absence of molybdate. In the presence of molybdate the ER yield is increased by 27.7 +/- 16.3% (mean +/- SD) and the yield of PR is increased by 34.3 +/- 18.3%. Also in the presence of 2 mM diisopropylfluorophosphate (DFP) the PR yield is increased by 25.5 +/- 16.7% whereas the ER recovery is decreased by 22.7 +/- 12.8%. The DNA-binding activities of ER and PR are greatly enhanced in the presence of DFP whereas this activity is blocked by molybdate. No shifts in the sedimentation values of either ER or PR was observed in the presence of molybdate as compared to the sedimentation values obtained in the presence of DFP. Also the equilibrium dissociation constants of ER and PR bindings were not affected by molybdate. DFP however caused a decrease in both the affinity and the binding capacity of the ER whereas the binding characteristics of the PR remained unchanged.
Postmenopausal women were given estriol succinate orally in a daily dose of 4 mg X 2 for 14 days or 4 mg X 2, 8 mg X 1 and 2 mg in the morning + 2 mg at noon + 4 mg in the evening for 4 wk. Each group consisted of 4 women. The effect of the estrogen treatment was estimated by the endometrial curettage samples taken both before and after the hormone treatment. The curettage samples were studied by both light and electron microscopy. The results showed that a treatment period of 4 wk was necessary to obtain any effect. When 8 mg of estriol succinate was given in a single dose only a slight effect was obtained on the endometrium but when the same dose was divided in 2 daily 4 mg parts, the endometrium showed clearly proliferative changes. Thus estriol is able to produce the same endometrial effect as estradiol. Ultrastructurally the hormone treatment caused an increase in the cytoplasm of the endometrial epithelial cells. Also, whorls of cytoplasmic microfilaments often appeared near the nucleus of the cells.
Serum high-density lipoprotein cholesterol (HDL cholesterol), total cholesterol and triglyceride concentrations were determined in 158 post-menopausal women following long-term oral hormone replacement therapy. Oestradiol valerate (2 mg/day) was taken by 53 of the women and oestriol succinate (2 mg/day) by 42 others. The duration (means +/- SD) of the oestradiol valerate therapy was 6.4 (+/- 2.9) yr and of the oestriol succinate therapy 6.4 (+/- 2.3) yr. The remaining 63 women received oestradiol valerate (2 mg/day) combined sequentially with norgestrel (0.5 mg/day). The average duration of treatment with this combination was 3.3 (+/- 2.4) yr. The control group comprised 100 post-menopausal women who received no hormone therapy whatsoever. The HDL cholesterol levels in the women receiving oestradiol valerate were higher than those in the controls (P = 0.001) and in the women on oestradiol valerate plus norgestrel therapy (P less than 0.001). The HDL cholesterol levels in the oestriol succinate group did not differ significantly from those in the controls. The women receiving oestradiol valerate in combination with norgestrel had lower serum HDL cholesterol concentrations than the controls (P less than 0.05). Serum total cholesterol and triglyceride concentrations did not differ in either oestrogen group from those in the controls, but were lower in the oestradiol valerate-plus-norgestrel group than in the controls (P less than 0.001). There were no differences in serum total oestrogen, oestrone, oestradiol and oestriol levels between control subjects with normal HDL cholesterol concentrations and those with low concentrations.
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The aetiological role of Chlamydia trachomatis (CT) and herpes simplex virus (HSV) was investigated in 189 patients with threatened abortion. Assessment of infection was based on isolation, and on determination of serum immunoglobulin (Ig)G and IgA antibodies as well as cervical IgA antibody levels with new sensitive radioimmunoassay (RIA) techniques. One third of the women were delivered of a healthy infant and two thirds aborted, but the two groups were otherwise clinically similar. By isolation, only 2.7% of the patients were CT-positive, but increased cervical IgA antibody level to CT was detected in 41.3%. The mean level of these local antibodies was similar in both study groups, but the mean levels of serum IgA and IgG antibodies were somewhat higher in the patients who aborted although the difference was not significant. None of the cervical specimens was positive for HSV by isolation but the cervical IgA antibody level to HSV was raised in 47.1% of the patients. Both cervical and serum IgA antibody levels to HSV were significantly raised among the patients who aborted, but there were no differences between the patients with spontaneous abortion and those with a blighted ovum. There was no clear association between CT and abortion, but an association between HSV and abortion is possible. The incidence of raised levels of both CT and HSV IgA antibodies in the cervix was surprisingly high in both groups and the significance of this finding remains to be investigated.
Plasma vasopressin concentrations were measured on days 5-7, 11-13, 15-17 and 21-23 of the normal menstrual cycle in 14 healthy women. The four determinations of vasopressin concentrations did not differ significantly. Plasma vasopressin showed, however, a tendency to increase on days 11-13, when the peak concentration of serum estradiol occurs. After the ovulation a decreasing tendency was seen. There was no significant correlation between circulating vasopressin and 17 beta-estradiol studied in four stages of the menstrual cycle.
Simultaneous determinations of LDH activity in the vaginal epithelium and the maturation index of the vaginal smear were performed for 7 postmenopausal women receiving estrogen therapy and for 4 premenopausal women. Of the premenopausal women, 1 was receiving cyclic estradiol valerate-levo-norgestrel therapy; the others were menstruating regularly and had no hormone therapy. A good correlation was found between the strength of the estrogen therapy and LDH activity. In general, a positive correlation was found between a high level of LDH activity and a shift to the right in the maturation index. Where inflammation occurred, the LDH activity reflected the estrogen effect, whereas the maturation index did not do so.
During the years 1971-1980, genital tuberculosis was found in seven patients examined for infertility at the Department of Obstetrics and Gynaecology, Turku University Central Hospital. None of these patients had a previous history of tuberculosis manifestations. Chest X-ray examinations were normal for all patients. Six of the patients had tuberculous endometritis. Infertility was the only one had tuberculous endometritis. Infertility was the only symptom for these patients. The findings for the hysterosalpingogram were varied and generally not typical of genital tuberculosis described in the literature. All diagnoses were confirmed histologically. Two cases of full-term pregnancy after treatment of genital tuberculosis are described. In one case there was a purulent tuberculous salpingo-oophoritis and in the other case there were tuberculous implants at the surfaces of the uterus and ligamentum latum. In addition two cases of extrauterine pregnancy are described.
Effects of a massive single oral dose of oestradiol valerate were studied in a young woman. A slight increase in serum triglyceride and phospholipid concentrations was seen soon after the oestrogen administration. A marked rise in the serum cortisol concentration was evidently caused by psychic stress on the patient. The EEG examined on the first day after oestrogen administration showed findings typical of subcortical disturbance. One week later the EEG was normal. The low toxicity and slight side effects of a large overdosage of oestradiol valerate by month are worth noting.
Plasma vasopressin concentrations were determined in 27 patients undergoing vaginal operations for pelvic relaxation. Thirteen of the 27 patients were operated upon under lumbar epidural analgesia and 14, under general anesthesia. The blood samples for plasma vasopressin determinations were taken before, during and after the operation. The blood pressure and plasma osmolality were measured each time a blood sample was taken. In patients receiving a general anesthetic, the plasma vasopressin concentration was significantly higher 30 minutes after the beginning of the operation and at the end of the operation than immediately before premedication, p less than 0.05. In patients given lumbar analgesia, there were no significant differences among the plasma vasopressin values. Neither in the anesthesia nor in the epidural group was there a significant difference in blood pressure or plasma osmolality. It is concluded that the main cause of vasopressin release after vaginal operations lies in nerve impulses originating at the operative site.
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When small amounts of trypsin were added to prelabelled estrogen receptors in 24 human breast cancer cytosols there was a substantial increase in the binding capacity [79 +/- 11 (SE)%]. At the same time the affinity of the hormone receptor interaction was maintained at a very high level or even increased. This finding is discussed in relation to previous results where a diisopropylfluorophosphate (DFP) inhibitable protease activity was shown to cause a similar augmentation of estrogen binding sites in human myometrial cytosols. Addition of sodiummolybdate at or immediately after homogenization led to a similar increase in estrogen binding sites. Because these two effects were not additive we propose that the limited trypsin treatment reactivates the binding sites previously inactivated through a mechanism which can be inhibited by sodiummolybdate.