Brigitte Schurz

Influence of oral contraceptive use on bone density in climacteric women

The aim of the study was to investigate the influence of long-term administration of oral contraceptives on bone density in climacteric women. The existence of a correlation between long-term use and bone density was confirmed.

Ophthalmic complaints as a climacteric symptom

The menopausal syndrome is characterized by a variety of emotional and physical symptoms of varying intensity. A total of 1287 women who attended the Outpatient Department for Climacteric Symptoms and Osteoporosis Prophylaxis (1st Department of Gynaecology and Obstetrics, University of Vienna Medical School) constituted the study population. These women, who were seeking relief from various complaints or for prophylactic assessment and treatment, visited the clinic over the period 1988-1989. We placed special emphasis on ophthalmic complaints as evidence of the incipient climacteric period. Of the 430 patients with eye complaints, 98 underwent ophthalmological investigation. Within our patient group, we analyzed the incidence and severity of menopausal eye complaints as well as therapeutic responses to hormone replacement therapy on an epidemiological scale. Potential endocrinological factors are discussed.

Sonographic changes in the endometrium of climacteric women during hormonal treatment

Vaginal sonography of the endometrium is a new method of monitoring the effects of progestogen replacement therapy during the post-menopausal period. The advantages of transvaginal ultrasonic diagnosis are that the uterus can be seen from the fornix vaginae (that is from close range) and that the examination can be carried out whether the bladder is full or not. The differences in the thickness and structure of the endometrium, and the boundary with the surrounding myometrium, enable most of the endometrial changes that occur during the post-menopausal period to be detected sonographically. In the first group of patients we investigated, endometrial carcinoma was detected in 2 out of 60 women suffering from post-menopausal metrorrhagia, the findings subsequently being confirmed histologically. It was observed that post-menopausal women who have regular bleeding during post-menopausal hormone therapy show signs of endometrial proliferation during oestrogen therapy and of secretion during progestogen therapy.

Screening for Epstein-Barr and human cytomegalovirus in normal and abnormal cervical smears by fluorescent in situ cytohybridization

SummaryUsing the routine Papanicolaou test for grouping, 35 normal and 148 abnormal cervical smears were screened by fluorescent in situ cytohybridization for Epstein-Barr (EBV) and human cytomegalovirus (HCMV). Viral presence was detected in 55% of all hybridized smears while routine Papanicolaou tests exposed no morphological evidence for HCMV or EBV. Thus in situ cytohybridization is necessary and suitable for direct identification of EBV and HCMV. The prevalence of viral infection for women with normal cervical smears was 29% for HCMV and 34% for EBV. Even smears of three of the four virgins were positive for HCMV and two had a mixed infection with EBV. The infection rate with at least one of these two herpesviruses was 51% in the control group, 56% in smears with reactive and reparative cell changes, 54% in mild (slight) dysplasias and 56% in moderate or severe dysplasias. Thus infection with HCMV and EBV did not differ significantly in controls and prevention groups. Both viruses were most frequently found in the age group 20 to 29 years. These data suggest that HCMV and EBV are not involved in the etiology of intraepithelial neoplasias and carcinomas of the uterine cervix.

Breast cyst fluid concentrations of beta-endorphin, steroids and gonadotrophins in premenopausal women with gross cystic disease

Breast cyst fluid (BCF) and plasma levels of beta-endorphin (beta-EP), oestradiol (E2), progesterone (P), luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), prolactin (PRL) and cortisol were assayed radiochemically in a group of 10 premenopausal women aged 45-50 years suffering from gross cystic breast disease. The concentration of beta-EP (fmol/ml) in BCF (17.6 +/- 4.6 S.E.) was over four times higher than that in plasma (4.2 +/- 0.5 S.E.). The level of E2 was 41 times higher (1738.2 +/- 350.5 S.E. pg/ml) and that of P was 47 times higher (65.47 +/- 8.25 S.E. ng/ml) in BCF than in plasma. The significantly increased values of beta-EP, E2 and P in BCF and the identification of beta-EP in the cyst-lining epithelium indicated that local synthesis occurs. Growth factor-like properties of beta-EP and E2 are responsible for the propagation of cystic changes. The autonomous formation and activity of beta-EP, E2 and P in cystic formations were not correlated with LH, FSH, TSH and cortisol levels, which were significantly higher in plasma than in BCF. The concentration of PRL in BCF was not significantly higher than that in plasma. Moreover, the plasma concentrations of testosterone, androstenedione, thyroxine, triiodothyronine, thyroxine-binding globulin and sex-hormone-binding globulin were within the normal ranges. In this study we demonstrated synergism between beta-EP and steroid hormones which encourages the development of gross cystic disease in premenopausal women.

Latente zervikale Virusinfektion als mögliche Ursache des Frühaborts

Zervixabstriche von 50 Frauen mit Abort wurden durch die Dot-Blot-Hybridisation auf DNS von (human) Papillomavirus (HPV), Herpes simplex-Virus (HSV) Typen 1 und 2 und Zytomegalievirus (ZMV) untersucht. PositivitAt fur die HPV-DNS-Typen 16 und 18 zeigte sich in 17,6% der FAlle; im Abortmaterial betrug sie dagegen 30,8%. IgM-positive Titerwerte lagen in wenigen Fallen vor. In Zervixabstrichen von Frauen mit intakten GraviditAten liess sich eine PositivitAt fUr die HPV-DNS-Typen 6 und 11 in 9,5% und fUr die HSV-DNS-Typen 1 und 2 und ZMV-DNS in 48,0% der FAlle nachweisen. In diesem Kollektiv lagen zumeist positive IgM- und IgG-Titer vor.

β-endorphin levels during the climacteric period

Abstract Hot flushes are not caused by hypergonadotrophinaemia. This is apparent because peaks of gonadotrophin in the serum do not coincide with cutaneously measured hot flushes while such flushes still occur in hypophysectomized women. Gonadotrophin-releasing hormone and other neurotransmitters (possibly β-endorphin) affect thermoregulation. The following hypothesis is advanced. During the climacteric period neurotransmitter changes, a decrease in catechol oestrogens, a decrease in α-2-adrenoceptor activity and cessation of ovarian steroid production may lead to alterations in endogenous opiate activity and thus to disturbances of thermoregulation, resulting in the occurrence of hot flushes. Low β-endorphin levels in the peripheral plasma, which rise again following oestrogen treatment, are observed during the climacteric. On the other hand, women with severe hot flushes caused by a stress event show enormously increased β-endorphin values, which are normalized by hormone substitution therapy acting via still unknown neuroendocrinological feedback mechanisms.

Successful ovulation induction by sandostatin‐therapy of polycystic ovarian disease

LH: luteinising hormone: PCOD: polycystic ovarian disease; FSH. follicle stimulating hormone; HMG: human menopausal gonadotropine: E2: estradiol: P: progesterone.

Early detection of ectopic pregnancy by transvaginal ultrasound

SummaryTransvaginal (TVU; 19 patients) and transabdominal ultrasound (TAU; 24 patients) were compared in their ability to visualize an ectopic pregnancy. The direct visualization of ectopic pregnancy (EUP) was 25% with TAU and 94.7% with TVU. All women had a proven EUP in laparoscopy. TAU approach showed a significant inferiority (P<0.02) and TVU a superiority (P<0.08) in comparison to clinical examination. 83% of 43 women had spotting. Nonspecific signs for EUP like fluid in the pouch of Douglas was seen in 20.9%. Thin endometrium was seen in 6.9%, in 37.2% the thickness of endometrium was under 10 mm, in 55.8% more than 10 mm. An intrauterine pseudogestation sac was detected in 6.9%, corpus luteum formation in 37.2%.

A new diagnostic method to detect ectopic pregnancy at a very early stage

Abstract We describe for the first time the use of a new ultrasonographic technique of low invasiveness for direct assessment of ectopic pregnancy.