Olof Widholm

Dysmenorrhea During Adolescence

Abstract. Different aspects of the menstrual pattern including dysmenorrhea, premenstrual tension and working performance during menstruation was studied in three different investigations.

Suspected ectopic pregnancy: ultrasound findings and hCG levels assessed by an immunofluorometric assay

Summary. One hundred suspected ectopic pregnancies were assessed by ultrasound on the basis of the following criteria: (A) viable intrautcrine fetus, intrauterine pregnancy is certain; (B) intrauterine double sac or eccentric ring, intrauterine pregnancy is probable; (C) empty uterus or central ring but no adnexal mass or cul‐de‐sac fluid, ectopic pregnancy is possible; (D) empty uterus or central ring and an adnexal mass or cul‐de‐sac fluid, ectopic pregnancy is probable; (E) viable ectopic fetus, ectopic pregnancy is certain. Serum human chorionic gonadotrophin (S‐hCG) was detected by an immunofluorometric assay (sensitivity 0.2 i.u./l, cut‐off level 10 i.u./l). All the 51 patients in groups A and B had an intrauterine pregnancy. Normal gestational sacs were found also at S‐hCG levels of <3600 i.u./l, the lowest level being 894 i.u./l. Ectopic pregnancy was confirmed in 29 of the 30 women in groups D and E. In the 19 women categorized into group C serial hCG assay and repeated sonography diagnosed ectopic pregnancy in 12 and miscarriage of an intrauterine pregnancy in the other seven. Ectopic pregnancy was always found when no gestational sac was seen by sonography and the hCG level was > 1000 i.u./l.

Estradiol and progesterone receptors in two cases of endometrial stromal sarcoma

The presence of estradiol and progesterone receptors in endometrial stromal sarcoma (ESS) has not been studied previously. Two cases of ESS are reported in which high concentrations of these receptors were found in the tumor tissue. One of these patients had retained the reactivity to hormone treatment for several years. It is suggested that the steroid receptors should be analyzed in all cases of ESS to find tumors with a high receptor content. Hormone treatment of these patients should be part of the primary adjuvant therapy. In cases of a good response the therapy should be prolonged and continued for the rest of the patients life.

Estradiol and Progesterone Receptors in Gynecologic Sarcomas

Abstract. We report the concentrations of estradiol and progesterone receptors found in the tumor tissue of 5 patients with leiomyosarcoma, 4 of uterine and one of ventricular origin, and of 5 patients with uterine or ovarian carcinosarcoma. Steroid receptor positive and negative tumors were present in both groups of sarcoma. One uterine leiomyosarcoma had a high concentration of estradiol and progesterone receptors, 37 fmoles/mg protein and 156 fmoles/mg protein, respectively. We suggest that steroid receptors should be analysed in all gynecologic sarcomas.

Changing pattern of cervical carcinoma: A report of 709 cases of invasive carcinoma treated in 1970–1974

Seven hundred and nine new cases of carcinoma of the uterine cervix were treated by surgery, radiotherapy, or both at Helsinki University Central Hospital between 1970 and 1974. Of these, 241 (34.0%) died of the disease during the 5-year follow-up period. Three hundred and eighty-three (53.9%) of the patients were operated on and in 112 (29.3%) of them the stage of the disease had been underestimated preoperatively. This was mainly due to the undetected lymph node involvement observed first at operation in 72 cases (18.8%). In 237 of the patients carcinoma was confined to the cervix according to findings at operation but in 24 (10.1%) of them a relapse or metastasis was observed within 5 years. Comparison of the results for 1970-1974 with those from the same hospital for 1926-1969 revealed a reversal in the steady improvement in the total 5-year survival rates. It is concluded that, even if the incidence of cervical carcinoma in Finland is to decrease, the prognosis for the disease may become poorer. This is mainly due to a shift in the peak incidence of cervical carcinoma to older age groups. Also a mass screening program is likely to decrease the relative number of slowly growing, less aggressive type of the disease.

Comparison of Mass Spectrometry and Radioimmunoassay to Measure Medroxyprogesterone Acetate in Patients with Endometrial Cancer

Serum medroxyprogesterone acetate (MPA) was measured by radioimmunoassay (RIA) and gas chromatography-mass spectrometry (GC-MS) in patients with endometrial cancer. Samples were obtained 3, 6 and 24 h after the oral administration of 100 or 200 mg MPA once a day. The levels obtained by GC-MS were lower (median 16-29%) than those obtained by RIA, which is probably attributable to the presence of metabolites interfering with the RIA. Two commercial MPA formulations gave different MPA serum levels by both RIA and GC-MS. The levels obtained by GC-MS were so low that frequently only partial saturation of the endometrial progesterone receptor may be achieved which may explain why high oral doses are needed to produce optimum therapeutic response.

Menstrual Disorders in Adolescence Observations and Comments

Papers on the gynecologic disorders of adolescence are being published in in creasing numbers, reflecting not only more medical knowledge of the problems of adolescence, but also increased enlighten ment and improved social conditions on the part of the public.

Oestradiol and progesterone receptors in carcinoma of the human fallopian tube

SummaryIt is not known whether or not malignantly transformed epithelium of the fallopian tube retains its receptors or if tubal carcinoma is hormone dependent. Cytosol oestradiol and progesterone receptor contents of four carcinomata originating in the tubal epithelium are described. There was one patient with an oestradiol and progesterone receptor positive tumour, in which the progesterone receptor concentration was high.

Diverticulum of the Female Urethra

Diverticulum of the female urethra, although a relatively infrequent finding, in recent years has attracted increasing attention, and the number of patients seeking treatment has risen rapidly. Disorders of the female urethra are seen sometimes by the gynaecologist and sometimes by the urologist, but because the urethra is located in “no man’s land” neither of these special fields has given it much attention and abnormalities such as diverticula may pass unnoticed.