L. Rauramo

The effect of estriol succinate therapy on plasma renin activity and urinary aldosterone in postmenopausal women

The effects of estriol succinate (Synapause, 2 mg daily) on the renin-aldosterone system and blood pressure (RR) were studied in 14 postmenopausal women after bilateral oophorectomy. Plasma renin activity (PRA) and daily urinary aldosterone excretion (dU-Ald) were determined 1 mth after the operation and before estrogen treatment, at the end of 2 mth therapy, and, for the third time, 2 mth after the termination of treatment with the drug. No changes in PRA, dU-Ald or RR were found in normotensive women, or in 3 women with hypertension in this group. Another group of 11 postmenopausal women was investigated after long-term estriol succinate therapy, which had lasted for 5-8 yr after oophorectomy. PRA, dU-Ald and RR were measured during treatment and 2 mth after terminating the therapy. No changes were found either in hormone differences in the mean levels of PRA or dU-Ald. The results suggest that estriol succinate is devoid of general harmful effects on the renin-aldosterone system during postmenopausal therapy for climacteric symptoms.

Supra Vaginal uterine amputation with peroperative electrocoagulation of Endocervical Mucosa

Abstract. Discussion on the advantages of abdominal hysterectomy versus supravaginal uterine amputation has concentrated on the incidence of carcinoma in the remaining stump, mortality, and other serious complications. During the period 1952‐78 we have performed 2712 supravaginal amputations with peroperative electrocoagulation of en‐docervical mucosa. The incidence of stump carcinoma was 0.11% in this material. In our prospective studies we have shown that supravaginal amputation has certain advantages over abdominal hysterectomy as regards long‐term morbidity. In this paper we describe the method we are using when performing supravaginal uterine amputation.

Skinfold thickness and long-term post-menopausal hormone therapy

Skinfold thickness was measured in 130 post-menopausal women treated with long-term hormone therapy. One group of 50 women took oestradiol valerate 2 mg/day for 3 wk out of 7, a second group comprising 19 women received oestriol succinate 2 mg/day and the remaining group of 61 women used oestradiol valerate 2 mg/day combined sequentially with norgestrel 0.5 mg/day. The duration of treatment in these groups was 6.3 +/- 0.4, 6.4 +/- 0.4 and 3.3 +/- 0.3 yr, respectively. The control group was made up of a further 89 post-menopausal women. The skinfold thickness in all the treated groups was significantly greater than that in the controls.

Conservative treatment of urinary incontinence in women with special reference to the use of oestrogens.

Urinary incontinence was treated conservatively in 100 patients. The follow-up period was 12-24 mth. For post-menopausal women, the oestrogen therapy consisted of oral oestradiol valerate or vaginal oestrone sulphate combined with emepronium bromide. In post-menopausal patients the best results were noted when incontinence had begun at the menopause and when the duration of the complaint was not more than 3 yr. For pre-menopausal patients, the treatment given was generally emepronium bromide. During the follow-up period 15 of the patients, 11 of whom were post-menopausal, became symptomless and 77 improved; that is, the incontinence was only slight and occasional. The treatment was without any effect in 8 of the patients. Oestrogen therapy was successful in most post-menopausal women. In these patients, the best results were obtained when the duration of the incontinence was not more than 3 yr.

Ovarian Production of Estrogens in Postmenopausal Women

We investigated the possible secretory capacity of the ovaries of 79 postmenopausal women with and without endometrial carcinoma using chemical, enzymehistochemical and ultrastructural methods. The mean serum levels of estrone, estradiol and total estrogens were higher in ovarian effluent blood than the corresponding values in cubital venous blood. There was a positive correlation between the difference of total estrogens in ovarian and cubital vein sera and, on the other hand, enzymehistochemical and ultrastructural findings in ovarian tissue. No statistical differences were found in the peripheral mean values of estrone and total estrogens between the two groups. The mean level of estradiol, however, seemed to be higher and that of estriol lower in the carcinoma patients than in the control groups.

Long-term post-menopausal hormone therapy and serum HDL-C, total cholesterol and triglycerides

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.

The vaginal absorption of oestrogens in post-menopausal women

Serum E1, E2 and E3 concentrations and E2/E1 ratio were measured after vaginal application of conjugated oestrogens, micronized 17 beta-oestradiol and oestriol. 2.4 mg of conjugated oestrogens caused a prompt elevation in the serum E1 concentration; the E2 level changed only slightly. After vaginal application of 2 mg micronized 17 beta-oestradiol the main serum oestrogen is E2 and the conversion of E2 to E1, as in oral administration, does not occur. A significant elevation in the serum E3 concentration was noted 2 h after the vaginal application of 0.5 mg oestriol. The E2/E1 ratio changed little after the application of conjugated oestrogens but increased considerably after the vaginal administration of 2 mg micronized 17 beta-oestradiol.

Monitoring perinatal mortality by birth weight specific mortality rates

The perinatal mortality at University Central Hospital of Turku, Finland decreased significantly from 15.7/1000 in years 1970–1975 to 8.9/1000 in years 1976–1978. The main decrease has occurred in weight groups of 1000 g and more. In years 1976–1978 the perinatal mortality of non‐malformed babies in the weight group 1500–1999 g was 93/1000, in the group 2000–2499 g 21/1000 and in the group of 2500 g and over 1.7/1000. The early neonatal mortality of non‐malformed infants has decreased significantly only in the weight group of 1500–1999 g. The 1‐week survival rate has been 48% in the weight group 500–999 g, but 77% in the weight group 1000–1499 g. The birth weight specific mortality rates are greatly required when the quality of obstetrical care is assessed. Birth weight specific neonatal mortality rates are essential when guidelines for elective termination of third trimester pregnancy are designed.

Ultrastructural features of endometrial atypical adenomatous hyperplasia and adenocarcinomas and the plasma level of estrogens

Abstract The ultrastructure of one endometrial atypical adenomatous hyperplasia and 15 adenocarcinomas of postmenopausal patients were studied by light and electron microscopy. Seven of the adenocarcinomas were well differentiated, four moderately, and four poorly. The plasma levels of estrone, estradiol, and estriol were also measured. We found ciliated cells and nuclei with mesh-basket appearance in the premalignant and malignant endometrial lesions reflecting a possible relationship between the carcinogenesis and estrogens. On the other hand, no correlation was found between the plasma level of estrogens and the ultrastructure of the endometrial lesions of various grades of malignancy. There also were no ultrastructural features which could aid in the differentiation between the premalignant and malignant endometrial lesions. Thus light microscopy is still considered the method of choice in differentiating the before mentioned endometrial lesions.

ETIOLOGY OF PREMALIGNANT CERVICAL LESIONS IN TEENAGERS

Abstract. The etiology of premalignant cervical lesions was investigated anamnestically in teenagers. The material comprised of 54 patients (mean age 18.0 years, range 12‐19 years) treated in 1973‐77. Early coital practise and frequent change of sexual partners were usual. Previous abortions and frequent genital infections were also typical. The rising frequency of dysplasias in young age groups calls for increased general knowledge and information even among teenagers and, if possible, mass screening.