Frans J.M. Huikeshoven

Androgen receptor expression in human ovarian and uterine tissue of long term androgen-treated transsexual women

Androgen receptor (AR) modulation in human uteri and ovaries of long term androgen-treated transsexual female patients was investigated. Androgen receptor expression was evaluated immunohistochemically in the ovaries of 11 and the endometria and myometria of six androgen-treated transsexual female patients. This was compared with AR expression in the ovaries and uteri of premenopausal and postmenopausal women not receiving treatment and in 10 ovaries of female patients with polycystic ovarian disease (PCOD). In the normal ovaries germinal epithelium, granulosa cells of antral follicles, corpus luteum, and thecal and stromal cells exhibited moderate AR expression. The more intense and uniform staining of ovarian stroma of female transsexual patients and those of patients with PCOD compared with ovarian stroma of normal controls was most remarkable. This similarity in histology and distribution of ARs supports the hypothesis that PCOD is an androgen-mediated disorder. Immunostaining for ARs was only occasionally detectable in the uteri of premenopausal and postmenopausal women. In contrast, myometrial and endometrial stroma of the uteri of female transsexual patients displayed an intense and diffuse nuclear immunostaining, but glandular epithelia remained unstained. Western blot analysis of the ovaries and uterine myometrial tissue samples from transsexual female patients confirmed the presence of the 110-kd AR molecule. Because the androgen treatment of some transsexual female patients was discontinued 6 weeks before they underwent hysterosalpingo-oophorectomy, our data indicate a stable and persistent androgen-induced up-regulation of AR expression in ovaries.

The occurrence of diversion colitis in patients with a sigmoid neovagina

Diversion colitis is an inflammatory process occurring in segments of the colorectum surgically diverted from the fecal stream. Clinical symptoms of this condition are rectal discomfort, pain, discharge, and bleeding. We diverted isolated segments of sigmoid to create neovaginas in patients with aplasia vaginae and in male to female transsexuals. In contrast to what is reported in most studies of diversion colitis, the neovagina consists of an isolated segment not connected to the anus in patients without any pre-existing bowel disease. To investigate the occurrence of diversion colitis in these sigmoid-neovaginas we studied biopsy specimens from 13 patients. Most of the patients complained of discharge and slight blood loss from their sigmoid-neovagina. Microscopic examination of the biopsy specimens showed lymphocytic infiltration in all cases. Four cases showed an acute inflammatory infiltrate in the lamina propria. Our results indicate that the changes observed on clinical and histopathologic examinations represent the entity of mild diversion colitis. We conclude that diversion colitis also occurs in a sigmoid neovagina.

Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion.

Background The incidence of pelvic and aortic lymph node involvement in endometrial carcinoma depends on both tumor differentiation grade and myometrial invasion depth. It was evaluated whether magnetic resonance imaging (MRI) provides a preoperative technique to assess the depth of myometrial invasion.

The incidence of cervical intraepithelial neoplasia among women with renal transplant in relation to cyclosporine

Objective To evaluate the policy of an annual smear to screen renal transplant recipients for cervical intraepithelial neoplasia and invasive carcinoma and to determine the incidence of abnormal smears and CIN before and after the introduction of cyclosporine (1983).

Hypocalciuria in hypertensive disorder in pregnancy and how to measure it

We studied the urinary calcium excretion in 41 patients in the third trimester of pregnancy. There was a significant decrease in 24-hour calcium excretion in hypertensive and pre-eclamptic patients. The 24-hour calcium excretion correlated well with the calcium to creatinine ratio of a single voided urine sample. We conclude that measuring urinary calcium excretion may be valuable in the care and the study of pregnant patients with hypertensive disorders, and that the 24-hour urinary calcium excretion can be estimated from a single voided urine sample.

Tubal damage after intratubal methotrexate treatment

We report on a case of seriously hampered tubal repair 6 months after local MTX treatment. Histopathological examination showed destruction of tubal mucosa and remnants of the EP.

A modified Raz bladder neck suspension operation. Results of a one to three years follow-up investigation.

Objective: Long term follow‐up study of stress incontinence operations shows a declining success rate in time, especially for the needle suspension technique. We evaluated the long term results of a modified bladder neck suspension operation.

Progesterone receptors in endometrial cancer invasion and metastasis: development of a mouse model

Progestagens inhibit growth of endometrial cancer cells in vivo and in vitro, and also are reported to inhibit endometrial cancer cell invasion. The progesterone receptor (PR) isotypes PRA and PRB have different transcriptional activity. There are indications that relative over expression of PRB could lead to development of a more invasive phenotype in endometrial cancer. To study the effect of progestagens and the two PR isotypes on tumor dissemination, in vitro and in vivo models should be applied. The Ishikawa endometrial cancer cell line (clone 3H12) was transfected to stably express a high level of human PRB (hPRB), which resulted in the PRB-1 sub-cell line. Ovariectomized athymic NMRI nu/nu mice were injected intraperitoneally with these PRB-1 cells. After 3, 5 and 10 weeks, the animals were sacrificed. Spread of PRB-1 cells in and outside the peritoneal cavity was studied macroscopically and microscopically, and also by PCR detection. After 10 weeks, the PRB-1 cells had formed extensive tumor mass in the peritoneal cavity. Also, cells could be detected outside the peritoneal cavity, indicating metastatic ability of these cells. The present study describes an in vivo model that can provide a valuable tool in studying the influence of progestagens and the two PR isotypes on endometrial cancer cell invasion and metastasis.

Elevated serum transaminase levels during ritodrine administration

Two cases are presented of the occurrence of elevated serum transaminase levels during ritodrine administration for the treatment of premature labor. The clinical course of these cases suggests that elevated transaminase levels per se do not require the discontinuation of beta-sympathomimetic tocolytic treatment.

The pliable obstetrical vacuum cup: application and opinions in The Netherlands

A questionnaire was sent to all hospital obstetric units in The Netherlands to obtain information about the use of soft cups for vacuum extraction. Over 90% of the 156 units responded. Vacuum extraction was used twice as often as forceps for instrumental vaginal delivery. In 12 units the flexible cup was applied in the majority of vacuum extractions and without specific restrictions. In 47 units a minority of vacuum extractions was performed with a flexible cup: its use was generally restricted to anticipated easy low outlet extractions. It is concluded that in The Netherlands the flexible cup is an accepted instrument used in about 13% of vacuum extraction deliveries.