Bent Ottesen

Risk factors among young women with endometrial cancer: A Danish case-control study☆☆☆★

OBJECTIVE This study was undertaken to identify and quantify risk factors for endometrial cancer among young women. STUDY DESIGN This case-control study included all Danish women <50 years old who had endometrial cancer diagnosed during the period 1987 to 1994. A total of 237 case patients and 538 population control subjects matched with the case patients for age and residence were included in the analysis. RESULTS Women with a family history of endometrial cancer had an odds ratio for endometrial cancer of 2.1 (95% confidence interval, 1.1-3.8)). Completion of 1 term pregnancy implied an odds ratio of 0.6 (95% confidence interval, 0.3-1.1). The risk of endometrial cancer decreased significantly with increasing age at first birth and with the number of induced abortions. Use of oral contraceptives for 1 to 5 years decreased the risk of endometrial cancer (odds ratio, 0.2; 95% confidence interval, 0.1-0.3). The odds ratio for endometrial cancer among women who received hormone replacement therapy for 1 to 5 years was 3.1 (95% confidence interval, 1.4-7.0). Body mass index was not demonstrated to be an independent risk factor in this study. The protective impacts of the different exposures (risk factors) can be expressed as etiologic fractions, which indicate how much each exposure reduces the occurrence of endometrial cancer compared with a situation without the existence of that particular exposure. These fractions were as follows: oral contraceptive use for > or =1 year, -45%; 2 term pregnancies, -88%; age > or =30 y when giving birth for the first time, -38%; and a history of incomplete pregnancy, -16%. CONCLUSION A number of risk factors for endometrial cancer are common to premenopausal and postmenopausal women: family history, reproductive history, hormone replacement therapy, and the use of oral contraceptives. Among young women reproductive variables imply the greatest prophylactic potential.

Sexuality after total vs. subtotal hysterectomy.

Background.  The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.

The effect of galanin, CGRP and ANP on spontaneous smooth muscle activity of rat uterus

In the present study the effect of the newly isolated peptides galanin, calcitonin gene-related peptide (CGRP) and atrial natriuretic peptide (ANP) was examined on spontaneous uterine smooth muscle activity on the rat in vitro. Galanin showed a slight and insignificant stimulatory effect on the amplitude, while both CGRP and ANP were found to be potent inhibitors of the uterine smooth muscle contractions. In connection with the recent demonstration of galanin and CGRP nerves in the genital tract, these pharmacological findings suggest that the peptides may participate in the control of nervous control of uterine muscular activity, although the exact physiological roles remain to be clarified.

Vasoactive intestinal polypeptide and other preprovasoactive intestinal polypeptide-derived peptides in the female and male genital tract: Localization, biosynthesis, and functional and clinical significance

Vasoactive intestinal polypeptide, a neuropeptide with wide distribution in the central and peripheral nervous system, has a broad spectrum of biologic actions. The demonstration of vasoactive intestinal polypeptide containing nerve fibers within the female and male genital tract 17 years ago indicated a putative role for this peptide in the local nervous control of reproductive functions. The genes encoding the preprovasoactive intestinal polypeptide precursor molecule and the vasoactive intestinal polypeptide receptor have been identified. The gene expression has been studied by the use of specific antibodies against the functional domains of the vasoactive intestinal polypeptide precursor and the biologic action elucidated by both in vivo and in vitro methods. Evidence has been provided to support vasoactive intestinal polypeptide as a neurotransmitter in several physiologic events in the genital tracts (i.e., blood flow and nonvascular smooth muscle relaxation). In the ovary vasoactive intestinal polypeptide seems to play an important role as regulator and/or modulator of folliculogenesis and steroidogenesis. In the male genital tract vasoactive intestinal polypeptide seems to participate in the control of erection. Vasoactive intestinal polypeptide has been suggested as a causative factor in some diseases of the genital organs (e.g., it may play a pathophysiologic role in male impotence and the peptide is currently used in the treatment of this condition). Vasoactive intestinal polypeptide may be important for control of the low resistance in the fetomaternal vascular bed and is therefore a putative factor involved in the development of preeclampsia. The therapeutic potential of vasoactive intestinal polypeptide and future agonists and antagonists will be revealed by ongoing and forthcoming studies.

The association between leisure time physical activity in the year before pregnancy and pre-eclampsia

In order to investigate the association between leisure time physical activity in the year before pregnancy and pre-eclampsia, stratifying for maternal BMI, a prospective study was carried out from 1996 to 1998. Pregnant women attending their first antenatal care visit, were invited to participate in the study. Inclusion criteria: Danish-speaking, ≥18 years of age, gestational age <22 weeks, no psychiatric disease, or abuse. The participants (n = 2,793) self-filled a questionnaire at 12–18 gestational weeks. Leisure time physical activity was categorised as sedentary, light and moderate-to-heavy. The results showed that pre-eclampsia occurred in 4.2%, 4.2% and 3.1% of women with sedentary, light and moderate-to-heavy leisure time physical activity, respectively. Although we found a tendency towards a lower risk of pre-eclampsia in women with the highest degree of physical activity during leisure time, especially in overweight women, no significant associations were found. It was concluded that leisure time physical activity the year before pregnancy does not protect against pre-eclampsia.

Total versus subtotal hysterectomy: an observational study with one-year follow-up.

The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF‐36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1‐year postoperative. Eighty women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had their cervix removed.

Serum-hCG: still a problematic marker

LINE RODE, GEDSKE DAUGAARD, MOGENS FENGER, LINDA HILSTED, LARS KRAG MØLLER, LASSE RAABERG AND BENT OTTESEN From the Department of Obstetrics and Gynecology, Hvidovre Hospital, Copenhagen, Department of Oncology, Rigshospitalet, Department of Clinical Biochemistry, Hvidovre Hospital, Copenhagen, Department of Clinical Biochemistry, Rigshospitalet, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark

Randomized clinical trial of total vs. subtotal hysterectomy: validity of the trial questionnaire

Background.  To ensure the internal validity of a trial it is recommended to undertake a validation study of the method measuring the outcome.

All prepro-VIP-derived peptides, except , are expressed in the female rat anterior pituitary and increased by estrogen

The expression of VIP precursor products: prepro-VIP(22-79), peptide histidine isoleucine (PHI), peptide histidine valine (PHV), prepro-VIP(111-122), VIP, prepro-VIP(156-170), and prepro-VIP mRNA in the anterior pituitary of estrogen-treated, ovariectomized rats, of ovariectomized controls, and of sham-operated controls was examined. Using radioimmunoassays based on antisera against each of the prepro-VIP sequences, we found that all sequences were expressed and markedly induced by estrogen, except PHI and PHV, which both were undetectable. By immunohistochemistry, it appeared that the number of cells immunoreactive for each of these sequences was increased in the estrogen-treated animals. However, PHI/PHV-immunoreactive cells could not be detected, despite the use of four different PHI antisera with different specificities. Estrogen treatment increased the prepro-VIP mRNA as judged by Northern blotting. In situ hybridization signals for both VIP mRNA and PHI mRNA were observed in few pituitary cells from control animals whereas strong positive signals were observed in a larger number of cells after estrogen treatment. The findings show that estrogen causes activation of the VIP gene expression in anterior pituitary cells, and that the absence of PHI and PHV probably is due to translational or posttranslational events.