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Biomedical subjects

P G Stumpf

Publications and source records attributed to P G Stumpf.

At least 19 recordsLinked to original sources
PubMed1994

Compliance problems with hormone replacement therapy.

Because menopause and its consequences constitute an endocrinopathy, long-term administration of HRT is often necessary to achieve optimal results. Compliance is therefore an important consideration in the clinical use of HRT. A number of factors appear to influence physicians in their prescribing of HRT, including estimates of benefits and risks that may not be supported by scientific data. In addition, some physicians appear to use patterns of administration of HRT that may diminish the chance of appropriate patient compliance, or of maximizing benefits while minimizing risks. Patients may elect to avoid HRT or stop HRT prematurely because of incorrect impressions about the benefits and risks, or because of bothersome side effects. Although the side effects are more prevent some appropriate candidates from using HRT. Fortunately, a range of possible options is available for prescribing HRT, and modifications may be used for patients who are experiencing problems. In order for patients to receive maximum benefit from HRT, clinicians must be willing to educate and reassure patients, and to adjust therapy when problems occur.

Drug Administration Schedule↗
PubMed1990

Pharmacokinetics of estrogen.

The main types of pharmacologic therapy used to treat the hormone deficiency of menopause are parenteral and oral administrations of estrogen. Parenteral administration results in predictable absorption without major intermediary metabolism, whereas all oral estrogens are subject to intestinal metabolism before entering the systemic circulation. Various options are available. Injectable estrogens, because of rapid absorption and metabolism, are impractical for long-term replacement therapy. The primary drawback to subcutaneous estradiol pellets is the surgical procedure required for their insertion and removal. Vaginal epithelium is an effective pathway for absorption of estrogen given by solution, tablet, or cream, although only the latter is currently approved for clinical use; relatively constant serum levels of estradiol can be obtained with vaginal rings. Transdermal patches provide controlled hormone levels for up to 3.5 days. Although oral conjugated equine estrogens have been used extensively, they introduce types of estrogen, such as equilin, that are not naturally found in humans and that can produce a pronounced hepatic response. Micronized estradiol, oral estrone, and other estrogens have been used as alternatives to equine estrogens. Clinicians should understand the pharmacokinetics of the various options for replacement therapy and select a course of treatment that is safe, effective, and convenient for the patient.

Drug Administration Routes↗
PubMed1989

Mechanisms that subserve estradiol's induction of increased prolactin concentrations: evidence of amplitude modulation of spontaneous prolactin secretory bursts.

Estradiol stimulates hyperprolactinemia in human beings and in experimental animals by mechanism(s) that remain largely undefined. We have tested the hypothesis that estrogen modulates episodic and rhythmic prolactin release. To this end we studied six postmenopausal women by repetitive venous sampling basally and on days 1, 5, 10, and 30 after intravaginal placement of an estradiol-impregnated polymeric silicone (Silastic) ring. Computerized analysis of episodic prolactin pulsatility revealed that estrogen amplified prolactin pulse amplitude threefold without changing prolactin pulse frequency. Fourier analysis disclosed heightened amplitudes of specific ultradian rhythms, and deconvolution analysis demonstrated a sevenfold increase in the mass of prolactin secreted per pulse with no change in its half-life. We conclude that estradiol selectively augments the amplitude of episodic prolactin pulsatility, amplifies ultradian rhythms, and increases the mass of prolactin released per secretory burst.

Activity Cycles↗
PubMed1988

Incomplete Behcet's syndrome in the differential diagnosis of genital ulceration and postcoital bleeding. A case report.

Behcet's syndrome occasionally produces significant vaginal bleeding requiring operative intervention. Our patient had genital and oral ulcerations but did not have uveitis or iritis, therefore representing incomplete Behcet's syndrome. The oral and genital lesions associated with Behcet's syndrome resemble those produced by herpes infection and must be considered in the differential diagnosis of genital ulceration.

Adult↗
PubMed1987

Establishing early pregnancy levels of serum progesterone in functionally agonadal women using polysiloxane vaginal rings and cylinders.

Using a polysiloxane cylinder impregnated with crystalline progesterone (P4), combined with a 17 beta-oestradiol (E2) and P4 vaginal ring, we produced first trimester pregnancy levels of serum P4 in six functionally agonadal women scheduled for transfer of donated embryos. With this 4 g P4 cylinder worn from cycle day 15 to day 30, overall mean serum P4 concentrations were 15.03 +/- 1.56 ng/ml, with a mean peak level of 21.34 +/- 1.85 ng/ml. These levels were significantly higher than those obtained by us previously in five subjects using a 2 g P4 cylinder [P = 0.007]. The cylinder produced minor but significant complications including small vulvovaginal lacerations, difficulty in removing the device, and vaginal discharge. We conclude that the steroid impregnated polysiloxane vaginal ring and cylinder system provides: continuous and sustained hormone release, and levels of serum P4 in the normal range for early pregnancy. Side effects however, may limit its clinical usefulness.

Administration, Intravaginal↗
PubMed1986

Effect of vaginal contraceptive sponges on growth of toxic shock syndrome-associated Staphylococcus aureus in vitro.

Toxic Shock Syndrome (TSS) is associated with certain toxin-producing strains of Staphylococcus aureus (TSS-S aureus), and with the use of some vaginal devices such as tampons or contraceptive diaphragms. The present study was designed to examine the effect of Nonoxynol-9 (N-9), and of a newly-approved vaginal contraceptive sponge (VCS) containing N-9 on the growth of TSS-S aureus in vitro. Flasks containing culture media inoculated with TSS-S aureus were incubated at 37 degrees C for 30 hours, in the presence or absence of either a VCS, or N-9 alone. At 0.5, 1, 2, 6, and 12 hours, there was suppression of TSS-S aureus colony counts in media containing VCS, compared to control. Colony counts from media containing N-9 demonstrated suppression at 0.5, 1, 2, and 6 hours. After incubation as long as 30 hours, colony counts from VCS-containing media approached, but did not exceed, counts from control media. From these data, it is concluded that this VCS containing N-9 does not enhance the growth of TSS-S aureus in vitro. Instead, an inhibition of bacterial growth for at least 12 hours is observed in media containing VCS, consistent with a bacteriostatic effect. If such an effect is also present in vivo, it would suggest that this type of VCS is unlikely to increase the risk of TSS.

Contraceptive Agents↗
PubMed1986

Women athletes with menstrual irregularity have increased musculoskeletal injuries.

We have performed a retrospective three-phase study to evaluate the effect of menstrual status upon musculoskeletal injuries in women athletes. Initially, we collected the menstrual and running histories of women participants in a regional 10-km footrace. In this study, 61% of the respondents to our questionnaire reported a continuous running program, and 39% reported an interruption of at least 3 months of their running program. The most common cause for interruption was injury. Those who had interrupted their running were more likely to have had irregular or absent menses and less likely to have been using oral contraceptives than the group of continuous runners. Secondly, we obtained information on the relationship between bone injury and menstrual status by reviewing the sports medicine records of 207 collegiate women athletes. We found that X-ray-documented fractures occurred in 9% of women athletes with regular menses and in 24% of women athletes with irregular or absent menses. Subsequently, we collected data from a larger population of more serious, but still recreational runners, participating in a national 10-km race. Each portion of this study has yielded similar results: those women who had been injured during their running program were more likely to have had absent or irregular menses, were less likely to have used oral contraceptives, and had been running for more years. We conclude that premenopausal women who have absent or irregular menses, while engaged in vigorous exercise programs, are at increased risk for musculoskeletal injury.

Adult↗
PubMed1986

Polysiloxane vaginal rings and cylinders for physiologic endometrial priming in functionally agonadal women.

17 beta-estradiol (E2)-and/or crystalline progesterone (P)-impregnated polysiloxane vaginal rings and cylinders were tested as a system for endometrial priming in functionally agonadal women awaiting donor embryo transfer. Endometrial tissue was obtained by a transcervical biopsy procedure on simulated cycle day 26. The adequacy of the replacement regimen was judged by endometrial histologic dating, scanning electron micrographs, receptor content, and circulating E2 and P serum concentrations. Endometrial dating was consistent with cycle day 26. Electron micrographs showed normal surface characteristics. E2 and P receptor concentrations were within the normal range. Serum E2 levels were midfollicular, 105 +/- 12.8 pg/ml (mean +/- SEM), and midcycle, 254 +/- 28.6 pg/ml. P levels during the simulated follicular phase were undetectable (less than 0.2 ng/ml) but rose to a mean peak level of 17.3 +/- 1.8 ng/ml. The steroid-impregnated polysiloxane vaginal ring and cylinder system provided continuous and sustained hormone release, morphologically and endocrinologically normal endometrium, serum levels of E2 and P within the normal range for the entire menstrual cycle, and a convenient and physiologic therapeutic alternative to oral, vaginal, or intramuscular steroid replacement.

Adult↗
PubMed1986

Selecting constant serum estradiol levels achieved by vaginal rings.

Prolonged, constant, systemic administration of estradiol-17 beta is useful for research and clinical purposes. Sustained systemic administration of estradiol-17 beta can be accomplished by means of estradiol-17 beta-containing polydimethylsiloxane vaginal rings. The ability to preselect a specific circulating serum level of estradiol-17 beta from several possible levels using estradiol-17 beta vaginal rings would be advantageous. In the present study, the author examined the effects of changes in the surface area and estradiol-17 beta content of estradiol-17 beta vaginal rings on the resulting serum levels of estradiol-17 beta. During three months of estradiol-17 beta vaginal ring exposure, the average serum levels of estradiol-17 beta produced were 53 +/- 10 pg/mL with a 100-mg estradiol-17 beta vaginal ring, 81 +/- 7 pg/mL with a 200-mg estradiol-17 beta vaginal ring, and 152 +/- 14 pg/mL with a 400-mg estradiol-17 beta vaginal ring. When compared with levels of estradiol-17 beta observed in normal menstrual cycles, the levels obtained with the 100-mg estradiol-17 beta vaginal ring, 200-mg estradiol-17 beta vaginal ring, and 400-mg estradiol-17 beta vaginal ring correspond to early follicular phase, midfollicular phase, and complete menstrual cycle, respectively. The author concludes that stable circulating levels of estradiol-17 beta resulting from estradiol-17 beta vaginal ring administration resemble estradiol-17 beta levels characteristic of specific phases of the normal menstrual cycle. Therefore, estradiol-17 beta administration by estradiol-17 beta vaginal ring may be helpful for research and clinical applications.

Adult↗
PubMed1985

46,XY gonadal dysgenesis: is oncogenesis related to H-Y phenotype or breast development?

Among women with 46,XY gonadal dysgenesis, there is a high incidence of gonadal tumors. Because of evidence of a connection between occurrence of those tumors, H-Y phenotype, and breast development, we surveyed 55 cases of 46,XY gonadal dysgenesis and 12 related cases involving chromosomal and/or skeletal abnormalities. Our survey, including three new cases presented here, indicates that H-Y phenotype but not breast development may be related to the development of the gonadoblastoma-dysgerminoma. Thus among women with 46,XY gonadal dysgenesis, there are H-Y- and H-Y+ classes, but gonadal tumors are found almost exclusively in the H-Y+ class. Yet one of our patients may represent an exception to the association of H-Y+ phenotype and gonadal tumors in this syndrome.

Adolescent↗
PubMed1985

In vitro penetration of human sperm into bovine cervical mucus: effects of sperm washing and exposure to low temperature.

Standardized bovine cervical mucus penetration by human sperm in vitro provides information for evaluating male fertility. Normal semen specimens from 20 sperm donors and 17 infertile men were tested for cervical mucus penetration. Rigorous control of test temperature was necessary to guarantee the reliability and reproducibility of cervical mucus penetration. Sperm washing was found to significantly improve cervical mucus penetration for infertile men, from 18 +/- 2.2 to 27 +/- 3.4 mm, P less than .025. Sperm washing for normal donors had no apparent effect on cervical mucus penetration (58 +/- 1.5 mm prewash, 55 +/- 1.7 mm postwash, P greater than .1). The authors conclude that: 1) temperature for cervical mucus penetration testing is critical to reliability, and 2) cervical mucus penetration is a useful screening tool for in vitro procedures proposed to improve sperm function.

Adult↗
PubMed1985

Stenosis and fistulae with neglected vaginal foreign bodies. A case report.

Foreign bodies present in the vagina for long periods of time are infrequent but potentially serious findings in adult women. Significant injury can occur to bowel, bladder or other pelvic structures. Repair of fistulae is delayed following removal of the foreign bodies until the chronic inflammation produced by the objects has resolved. Coexisting psychiatric illness or physical abuse may complicate the evaluation and treatment of some women with long-standing vaginal foreign bodies.

Adult↗
PubMed1984

Results of establishing medical guidelines for selecting oral contraceptive types in family planning agencies.

Family planning agencies are attempting to increase their efficiency and cost-effectiveness in delivering services, as federal funding is diminishing. We have examined the effects of establishing guidelines in a family planning agency, outlining the types of OCs to be routinely prescribed. We found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.

Contraceptives, Oral↗
PubMed1984

Insertion technique, not design, affects expulsion rates of postpartum intrauterine device.

A Lippes type intrauterine device (IUD) was modified to be used for immediate postpartum insertion. In 114 patients in whom the modified IUD was inserted immediately after delivery, expulsion rates at six months averaged approximately 30%. Expulsion rates were significantly different, at p less than 0.05, for women in whom the IUD was inserted digitally (19.5 +/- 5.6% at 6 months) compared to those in whom it was inserted using surgical forceps (39.6 +/- 7.1%). Furthermore, expulsion rates were higher for inexperienced inserters (p less than 0.01). We conclude that: 1) this modification of an otherwise standard IUD has a continued high expulsion rate, and 2) the technique of insertion has significant impact upon the likelihood of expulsion.

Adult↗
PubMed1984

Effects of temperature on in vitro penetration of human sperm into bovine cervical mucus.

A standardized bovine cervical mucus preparation was used to test the hypothesis that the penetration of human sperm into cervical mucus is a temperature-dependent process. Cervical mucus penetration (CMP) was tested in vitro at several incubation temperatures around "room" temperature. Semen specimens were also exposed to cold (0 C) for various periods of time and then tested for CMP at 37 C incubation. We found that incubation at 37 C produced optimal sperm-mucus penetration. Minor fluctuations in ambient laboratory temperature, such as may occur during a workday or between seasons, produced significant variations in CMP results and precluded the comparison of test results longitudinally over time. Prior exposure of normal semen specimens to 0 C for as long as 45 minutes, such as might occur in transport, did not reduce CMP significantly if incubation was performed at 37 C. We conclude that 37 C is the optimal incubation temperature for CMP testing and that if temperature is controlled, CMP is sufficiently simple and reproducible for routine use in physicians' offices and clinical laboratories.

Adult↗
PubMed1982

Development of a vaginal ring for achieving physiologic levels of 17 beta-estradiol in hypoestrogenic women.

The ability of polysiloxane vaginal rings containing 17 beta-Estradiol (E2) to deliver E2 into the systemic circulation at a steady rate over long periods of time was evaluated in castrate and postmenopausal volunteers. Standard laminar designs, used to release contraceptive gestagens, deliver low levels of E2 (about 50 pg/ml) and only for 1 month. With a modified design, E2 levels of 109 to 159 pg/ml were maintained for at least 3 months, and circulating gonadotropins were suppressed to values approaching the premenopausal range. This homogeneous design provides for physiologic replacement of E2 as well as a practical research tool for studying chronic effects of E2 in human subjects.

Adult↗