Biomedical subjects
Publications and source records attributed to S Iosif.
Sertoli cell tumors are rare low-grade malignancies occurring in the testis and the ovary. No chromosome studies of this tumor type have yet been reported. We observed an extra i(1q) as the sole chromosome anomaly in an ovarian Sertoli cell tumor.
During a 9-year period, 92 women with squamous cell carcinoma of the cervix, FIGO stages IA1-IIA, were subjected to primary surgery according to Wertheim Meigs. Grading according to a malignancy grading score (MGS) and evaluation of tumor size before surgery together with surgical findings of positive nodes or insufficient surgical margin at the primary site were used to identify persons prospectively at high risk for relapse. Twenty-five women thus received postoperative treatment. Results among node-positive patients were good; only 2 out of 12 patients relapsed. Among 67 node-negative patients in stages IA2-IIA, 4 relapses occurred. These 4 patients had greater than or equal to 16 risk points according to MGS, but small tumors. Instead of tumor size, supplementary risk factor is therefore needed. Among the few patients in stage IA1, no high-point patients relapsed. These patients would probably have done just as well with less-extensive surgery.
Progesterone receptors were measured in both cytosolic and nuclear fractions in vaginal tissue samples obtained from a total of 17 post-menopausal women. Ten of the women were given oestriol (E3) intravaginally 6-24 h before surgery, while the remaining 7 received no treatment. Cytosolic receptors were not detected in any of the 7 tissue samples from the untreated women, but nuclear receptors were present in two cases. In the 10 women treated with E3, it was possible to measure cytosolic receptors in 5 tissue samples and nuclear receptors in 7 samples. The mean receptor concentrations in the cytosolic and nuclear fractions were similar (45-65 fmol/mg protein) and the apparent dissociation constant of the receptors in all the samples was 1-2 nmol/1. These data would seem to indicate that oestrogen treatment results in the synthesis of new receptors, although not in all tissues, which compounds the scepticism regarding the validity of the classical two-step model for steroid hormone action.
Specific binding of estradiol was measured in both cytoplasmic and nuclear fractions of uterine arteries obtained from ten women (39-52 years of age) undergoing hysterectomy. Seven patients were menstruating regularly and three were perimenopausal. Whereas nuclear receptors could be quantified in all ten tissues, cytoplasmic receptors were detected only in four. The mean receptor concentrations in the nuclear and cytosolic fractions were similar (31-42 fmol/mg protein), and the apparent dissociation constant of the receptor from all tissues was 1-2 nM. There was no relationship between the age and nuclear receptor concentration, but there was a tendency towards a negative correlation between the plasma progesterone:estradiol ratio and receptor levels. The presence of estrogen receptor in the nuclear fraction and its absence in the cytoplasm may warrant modification of the classical two-step model for steroid hormone action.
The effects of low doses (0.05 to 20 micrograms./kg.) of estradiol-17 beta (E2) and estriol (E3) on blood perfusion in the genitourinary tissues were examined two and 24 hours after an intra-arterial injection into rabbits. Whereas 0.05 microgram./kg. E2 or E3 caused no detectable change, 0.5 microgram./kg. of either E2 or E3 markedly increased blood flow measured after two hours in urethra, vagina and uterus. No significant increase in the blood flow in the urinary bladder or the ureters was observed. With 20 micrograms./kg. E2 or E3 a much greater increase (10 to 25-fold) in the blood flow in the urethra, vagina and uterus was observed after two hours. At this time a small increase (about two-fold) could also be measured in urinary bladder and ureters. Twenty-four hours after this treatment (20 micrograms./kg. E2 or E3), the blood flow in the urinary organs was not significantly different from the pretreatment values but it was still significantly elevated in uterus and vagina. These data show that the blood flow in the female urethra is just as sensitive to low doses of estrogens as uterus and vagina. Both E2 and E3 seem to be equally effective in increasing blood perfusion in the urogenital tissues.
Specific progesterone receptors were measured in both cytoplasmic and nuclear fractions of vaginal tissues obtained from 17 women between 33 and 53 years in age. Whereas nuclear receptors could be measured in 11 of 17 tissues examined, cytoplasmic receptors were detected in only four. The distribution of receptor-positive tissues was similar in the follicular and luteal phases and no significant difference was observed in the nuclear receptor concentration in the two phases. The receptor concentration from all tissues examined ranged from 31 to 105 pmol/mg of protein and the apparent dissociation constant was 1 to 2 nmol/L. The presence of progesterone receptors in the nuclear fraction and their absence in the cytoplasm raise questions about the authenticity of the classical two-step model for steroid hormone action.
The effects of oestrogen and of oestrogen combined with progesterone were examined on the fractional distribution of cardiac output (blood flow) in the genitourinary tissues of the female rabbit. Oestradiol treatment significantly increased blood perfusion in the uterus, vagina and urethra but caused no change in the perfusion of the urinary bladder or the kidneys. The wet weight of the uterus and vagina increased significantly and in the urethra there was a tendency to weight gain following oestradiol treatment. Progesterone treatment following oestrogen appeared to reduce the effect of oestrogen on both perfusion and weight gain.
An improved technique for direct vision chorionic biopsy that gives a clear view of the amniotic sac was developed. With this technique, used in 48 women prior to vacuum aspiration and in six cases for diagnosis (karyotyping or enzyme analysis), it was possible to obtain chorionic villi free from contamination by maternal tissue. It was also possible to pick out villi (rich in blood vessels and with abundant buds on their surface) found to be most capable of growing in vitro. In the diagnostic cases, the pregnancies have continued uneventfully since the sampling; one pregnancy is now in the 32nd week.
Explore the source record for details and available documents.
Four hundred forty-seven patients with urinary incontinence were examined at the outpatient clinic and then referred to urodynamic investigation by urethral pressure profile measurement and simultaneous urethrocystometry. On urodynamic investigation, 55 patients showed signs of an unstable urethra (momentary variations in urethral pressure exceeding an amplitude of 15 cm of water by or without registration of bladder instability). Urethral instability was found in 15 patients with stress incontinence, in 23 patients with urge incontinence, and in 13 patients with combined stress and urge incontinence (i.e., signs and symptoms of both stress and urge incontinence). In four patients, urethral instability was the only pathologic finding when the recordings were made. From the pressure recordings, three types of urethral instability could be recognized: type 1, relatively small fluctuations in the urethral pressure at large bladder volumes; type 2, relatively large variations in urethral pressure with frequent decreases in the pressure, often combined with signs of unstable bladder; type 3, marked variations in the urethral pressure which appeared already at the start of urethrocystometry, i.e., at low bladder volumes. The variations in urethral pressure prevailed during the whole recording procedure, whereas bladder pressure was completely stable at all times.
Twelve pregnant women were examined by urethral pressure profile measurement and simultaneous urethrocystometry early in pregnancy (weeks 12 to 16), in the thirty-eighth week, and 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early 5 to 7 days after delivery. All patients reported symptoms of stress incontinence starting at an early gestational age, it was found that that the stress incontinent women, compared to 14 continent, healthy women from whom measurements were obtained earlier, had shorter urethral lengths. Furthermore, no increase in urethral length during pregnancy was registered among the stress incontinent women, whereas such an increase did occur in the continent women. In contrast to the continent women, the incontinent patients had a low urethral closure pressure at rest and this pressure did not appear to increase sufficiently to compensate for the progressive increase in bladder pressure during pregnancy. As a result the urethral closure pressure in the stress incontinent women, therefore, decreased more and more during stress situations as pregnancy progressed, resulting in an increased leakage of urine.
A retrospective follow-up investigation dealing with the frequency of stress incontinence was carried out among maternities at the Women's Clinic in Lund over a period of 15 months. Of 1400 newly-delivered women whose interviews were solicited, 1411 responded. Twenty-two percent indicated symptoms of stress incontinence. These were examined gynecologically, including Bonney's test. The material may be divided into four groups according to the onset and type of stress incontinence:--Onset of stress incontinence prior to pregnancy in connection with puberty: 8.5% of the total number of stress incontinents (2% of th entire material). -- Permanent stress incontinence with onset during pregnancy; 23% of all stress incontinents (5% of the entire material). --Temporary, mild, "physiological" stress incontinence, manifest only during the second part of the pregnancy and disappearing approximately 3 months after delivery. This type of incontinence represents 50% of all stress incontinence (11% of the entire material). --Stress incontinence arising in conjunction with or following parturition; 19% of all cases of stress incontinence (4% of the entire material). Of the patients in this group 8% were temporarily incontinent. Eleven percent (2.3% of the entire material), represents women suffering from constant incontinence which first appeared in connection with childbirth. It is more often the case that stress incontinence begins during the first pregnancy rather than during subsequent pregnancies (statistical significance P less than or equal to 0.05). The results indicate that the pregnancy itself and hereditary factors predispose more readily than the parturition trauma to the occurrence of stress incontinence.
From a questionnaire survey dealing with urinary incontinence during pregnancy and after childbirth 62 women were randomly selected. These women underwent simultaneous urethrocystometry including urethral profile measurement 7--14 days after parturition. From the case history two groups of patients could be distinguished. One group consisted of women who experienced only occasionally urine leakage after delivery. Pressure recordings in these previous patients were normal, moreover the urethral closure pressure was positive, also at cough provocations. The urethral length and pressure were similar to that found in continent females. The other group of patients reported stress incontinence of a more serious and permanent nature; the symptoms did not disappear after delivery. In all these women negative urethral closure pressures were recorded at cough provocations and simultaneously leakage of urine from the urethra was observed. In addition the urethral length was shorter and urethral resting pressure lower than that recorded in the first group of patients. The reversible symptoms in the first group of women may be a consequence of the pressure exerted by the uterus upon the bladder at coughing combined with a hormonal relaxation of the urethral suspension. In the second group, the enduring symptoms suggest irreversible damage to the urethra and its suspension system during pregnancy.
Four thousand four hundred women were examined under the gynecological health control program in Malmö municipality during a period of 11 months. Nine hundred and forty-four (21 per cent) reported that they were troubled by disorders of the urinary tract. These women were given copies of a separate questionnaire, which was subsequently properly answered by 512 women. Of these, 321 (62.7 per cent) indicated urinary incontinence. From the questionnaire alone, it was difficult to characterize the different types of urinary incontinence in the patients. Thus only 42 women (8.2 per cent) seemed to suffer from genuine stress incontinence and 34 women (6.6 per cent) from genuine urge incontinence, whereas 245 (47.9 per cent) had to be characterized as "mixed incontinence". Hence, it is obvious that in several patients suffering from urinary incontinence, written or combined written and oral interviews to not produce a clear-cut diagnosis and that the etiology and treatment of incontinence in these patients may be uncertain. It is concluded that interviews with most patients suffering from urinary incontinence must be supplemented by objective recordings before a definitive diagnosis and treatment can be prescribed.
The urethral pressure profile was recorded, at rest and under stress, from six women in fertile age, before and at the end of an eight-week treatment during which the probands received daily doses of 600 mg of Danazol. Only moderate decrease in maximum urethral pressure was established, at rest, though oestrogen production was markedly reduced. Reduction in transmission of intra-abdominal pressure to the urethra was registered under stress, but urethral closure pressure remained positive in all subjects. Bladder pressure and functional length of the urethra were almost unaffected. Danazol treatment does not seem to jeopardize maintenance of urinary continence in young females.
Fourteen primiparas (11 pregnant for the first time, and three with a history of one abortion) were examined during pregnancy to elucidate changes in parameters of importance of maintenance of urinary continence. Urethral pressure profile measurements and simultaneous urethrocystometry were carried out in the beginning of pregnancy (weeks 12 to 16), in the thirty-eighth week, and 5 to 7 days after delivery. Both the absolute and functional lengths of the urethra were found to increase throughout pregnancy by median values of 6.7 and 4.8 mm, respectively. Also, the maximum urethral pressure increased gradually during pregnancy, returning within 1 week after delivery to almost the same value as at the beginning of pregnancy. The urethral closure pressure also increased throughout pregnancy. Thus, the results of the investigation revealed that the physiologic changes which took place within the urethra during pregnancy were to advantage from standpoint of maintaining continence.
Over a 2-year period, 401 patients with urinary incontinence were examined at the Women's Clinics in Lund and Malmö and then investigated by urethral pressure profile measurement and simultaneous urethrocystometry. After full investigation the patients could be classified as follows: 214 (53.4%) had genuine stress incontinence, 48 (12.0%) had genuine urge incontinence, 41 (10.2%) had mixed incontinence, 20 (5.0%) had urgency-frequency, 6 (1.5%) had neurogenic incontinence, 9 (2.2%) had incontinence of uncertain aetiology, and 63 (15.7%) of the patients were apparently continent with normal urethral pressure profiles and urethrocystometrograms.
Twenty-one women, 11 suffering from both prolapse and stress incontinence and 10 with prolapse only were investigated before and at different intervals after surgical repair of the disorders. The investigations comprised a gynaecological examination, urine culture, observation of residual urine and simultaneous urethro-cystometry including measurement of the urethral pressure profile.--The prolapse patients were operated upon by conventional Manchester technique. The patients suffering from both prolapse and stress incontinence were operated with a combined vaginal-abdominal repair using Lyodura slings.--It was found that the pre-operative urethral pressure at rest was lower in the inconinent-prolapse patients compared with that in patients suffering from prolapse only. After surgery the urethral pressure at rest was significantly decreased in the incontinent-prolapse patients whereas it did not change in patients operated because of prolaspe only.--Prior to the operation, all incontinent-prolapse women had a negative urethral closure pressure at stress. After surgery the closure pressure became positive in all patients and none complained about urinary incontinence. In all patients suffering from prolapse only the urethral closure pressure was positive at stress before as well as after surgery. The functional and the absolute urethral lengths increased in both categories of patients after the operation.