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Biomedical subjects

U Schwartz

Publications and source records attributed to U Schwartz.

At least 19 recordsLinked to original sources
PubMed1999

The impact of an inadequate municipal water system on the residents of Chinhoyi town, Zimbabwe.

OBJECTIVE: To assess the use and impact of the water reticulation system in Chinhoyi on its residents. DESIGN: Cross sectional and case series studies. SETTING: Chinhoyi town. SUBJECTS: 600 Chinhoyi residents. MAIN OUTCOME MEASURES: Practices and perceptions of Chinhoyi residents on the water system, and distribution of water-related diseases per area of residence. RESULTS: Out of 600 respondents, 565 (99.3%) had access to piped water and 558 (98.0%) to flush toilets. Breakdowns of water supply and functioning of toilet facility were reported by 308 (77.0%) and 110 (28.0%) respondents in the previous six months, respectively. Main complaints of Chinhoyi residents were about low water quality (36.2%), inadequate sewage system (31.3%) and environmental pollution (26.5%). Cases of water-related diseases were not associated with natural water bodies. CONCLUSIONS: Chinhoyi residents have good access to the municipal water and an adequate sanitation system. However, low quality of the water, frequent system breakdowns and the degradation and loss of amenity of the environment impair their quality of life.

Attitude to Health↗
PubMed1999

Knowledge and practices of family planning in Zimbabwe.

OBJECTIVE: To assess the level of knowledge and use of family planning in Zimbabwe. DESIGN: Cross sectional study. SETTING: All eight provinces and two major cities in Zimbabwe. SUBJECTS: Women of child bearing age (15 to 49 years, 6,083 respondents). MAIN OUTCOME MEASURES: Number of live births, knowledge of contraceptive methods, previous, current and intention for future use of contraceptives, method related problems. RESULTS: The contraceptive prevalence rate was 59.6% (CI 95% 58.4 to 60.9). The median number of live births was two (Q1 = 1, Q3 = 4) among all women, and seven (Q1 = 6, Q3 = 8) among women aged 40 to 49 years. Of 6,083 women interviewed, 5,849 (96.2%) knew at least one method of modern family planning, and 4,743 (78.0%) had ever used contraceptive in their life. Health concerns were the main reason for both discontinuation (28.5%) and postponement (22.8%) of contraceptive use. CONCLUSIONS: As compared to the 1991 Mother and Child Health Survey, knowledge and coverage of family planning services have improved further, and the introduction of injectable contraceptives has proved a success. Areas which need attention include the groups with high parity that remain under served, the low knowledge and use of condoms as a contraceptive, and the high level of health concerns among current and potential users.

Adolescent↗
PubMed1998

In vivo testing of the therapeutic efficacy of chloroquine on falciparum malaria infections in Chirundu, Mashonaland West, Zimbabwe.

OBJECTIVE: To detect the level of the in vivo chloroquine efficacy in falciparum malaria infections, in order to assess the need for change in the management and treatment of uncomplicated malaria. DESIGN: Prospective descriptive study. SETTING: Chirundu Rural Clinic, Mashonaland West Province. SUBJECTS: 63 patients confirmed by a positive blood slide for P. falciparum who attended Chirundu clinic, who were eligible for the study and, who also agreed to participate. MAIN OUTCOME MEASURE(S): Frequency of treatment success, early treatment failure and late treatment failure in uncomplicated patients treated with chloroquine. RESULTS: Out of 63 cases enrolled and completely followed up, chloroquine treatment was effective in 54 cases (85.7%) and was not effective in nine cases (14.3%). All treatment failures were successfully treated with sulphadoxine + pyrimethamine (Fansidar) or quinine following the approved guidelines. CONCLUSIONS: Chloroquine remains highly effective in the treatment of malaria due to P. falciparum in the Zambezi Valley of Hurungwe district and therefore, has to remain the first line drug. Likewise, guidelines for the use of sulphadoxine + pyrimethamine (Fansidar) or quinine as second line drugs, are adequate to the local situation. Health workers directly supervised the patients when they were swallowing the tablets during the whole course, and this without doubt, indirectly increased the efficacy of chloroquine. It is vital to confirm the malaria diagnosis on the spot appointing microscopists or distributing a limited stock of Parasight-F test.

Adolescent↗
PubMed1989

Reduced O6-methylguanine repair in fibroblast cultures from patients with lung cancer.

The activity of O6-methylguanine-DNA methyltransferase was determined in fibroblast cultures from 45 patients with lung cancer, 39 patients with cutaneous malignant melanoma, and 29 healthy controls. This enzyme is a critical parameter for the capacity to repair O6-methylguanine (O6-mGua) adducts in DNA, and a decreased activity might therefore be responsible for an enhanced susceptibility to cancer. The assay was performed with 8 x 10(6) fibroblasts which were homogenized and incubated with a known amount of O6-mGua containing DNA. The remaining substrate was determined fluorimetrically after high performance liquid chromatographic separation. O6-mGua repair was significantly reduced in lung cancer patients [6.64 +/- 4.32 (SD) pmol O6-methylguanine repaired/8 x 10(6) cells] as compared to healthy controls [10.35 +/- 5.42, P less than 0.0022] or patients with cutaneous malignant melanoma [10.83 +/- 6.66]. The lowest mean values were detected in a subgroup of 16 lung cancer patients with a tumor manifestation below 46 years of age (5.06 +/- 3.89). Fibroblasts from 4 patients with lung cancer had no detectable repair. We conclude that a reduced capacity to remove O6-mGua adducts may represent a further mechanism of individually enhanced lung cancer risk.

Adult↗
PubMed1986

Technical difficulties of selective venous blood sampling in the differential diagnosis of female hyperandrogenism.

To determine glandular steroid release of adrenals and ovaries in female hyperandrogenism, a standardized method for percutaneous transfemoral venous blood sampling was developed. In eight volunteers and 67 patients, catheterization was performed during the early follicular phase (days 3-7; between 8 and 10 a.m.) to reduce interference from cyclic and circadian variations of secretion. Serial samplings reduced the episodic effluent changes. Anatomical variations and collateral flow as well as stress effects and the dosage of contrast media were studied. During catheterization, peripheral cortisol levels did not differ significantly from control groups. Collaterals had no effect on hormone levels. Contrast media increased cortisol effluent levels only when they were sampled following venography. Four-vessel venous sampling was found to be indicated if peripheral testosterone was more than 1.5 ng/ml and/or dehydroepiandrosterone sulfate more than 6,700 ng/ml. If an ovarian (adrenal)/peripheral gradient of testosterone exceeded 2.7 ng/ml, surgical intervention for tumor removal at the site of hormone excess was felt to be necessary.

Adolescent↗
PubMed1986

Gonadal and adrenal androgen secretion in hirsute females.

The pathophysiology of glandular androgen hypersecretion must be regarded as a continuous process without sharp borderlines from normal to non-tumorous conditions, such as polycystic ovaries and hyperthecosis, to neoplastic disease. Hirsutism and related symptoms are most often caused by excess androgens of ovarian and/or adrenal origin, i.e. testosterone, dihydrotestosterone, delta 4-androstenedione, dehydroepiandrosterone and its sulphate. As demonstrated by selective catheterization of glandular effluents, combined hypersecretion occurs more frequently then either purely gonadal or adrenal overproduction. No correlation can be found between the type, frequency and extent of hormonal changes and the clinical, laparoscopic, angiographic, or histological findings. Dynamic function tests do not reliably discriminate between the various aetiological subgroups due to extremely variable and even non-specific individual responsiveness. Selective catheterization is presently the most sensitive method for the preoperative identification and localization of androgen-secreting neoplasms.

Adrenal Gland Neoplasms↗
PubMed1986

[Hyperthecosis ovarii--a tumor-like change in androgenized females].

Hyperthecosis has been repeatedly described as a disease entity separate from polycystic ovaries (PCO) as characterised by stromal luteinisation, obligatory virilism and purely ovarian androgen hypersecretion. This study compares the findings in patients with hyperthecosis (n = 10), PCO (n = 33) and androgen-secreting ovarian tumours (n = 7). It included selective ovarian-adrenal vein catheterisation with measurement of testosterone (T), dihydro-T, androstenedione, DHEA and its sulfate, 17 alpha-hydroxyprogesterone and cortisol before and after dexamethasone; determination of free T, oestrone, oestradiol and prolactin as well as LH and FSH before and after GnRH. In histologically proven hyperthecosis, signs of virilism were absent in 6 cases. A specific hormone profile could not be identified. Mixed ovarian-adrenal androgen hypersecretion was documented in 4 patients (purely ovarian: n = 6). Ovarian T output frequently fell within the tumour range (n = 4). It is concluded that the minor differences between hyperthecosis and PCO represent only variable manifestations of the same heterogeneous disturbance of androgen metabolism. However, it is of special clinical relevance to rule out a tumour in patients with hyperthecosis.

Adult↗
PubMed1985

Oral contraceptives and pituitary response to GnRH: comparative study of progestin-related effects.

GnRH double stimulation (2 X 25 micrograms i.v. at a two-hour interval) was used to assess the dynamics of LH and FSH release in 25 healthy women on oral contraceptives, all containing 50 micrograms of ethinylestradiol (EE). The study included two sequential regimens (50 micrograms EE X 7 days, 50 micrograms EE + 0.125 mg desogestrel X 15 days; 50 micrograms EE X 7 days, 50 micrograms EE + 2.5 mg lynestrenol X 15 days) and three combined preparations (biphasic: 50 micrograms EE + 1 mg norethisterone acetate (NETA) X 11 days, 50 micrograms EE + 2 mg NETA X 10 days; monophasic: 50 micrograms EE + 2 mg cyproterone acetate X 21 days; 50 micrograms EE + 2.5 mg lynestrenol X 21 days). The tests were always performed on days 19 to 21 of the first treatment cycle and compared to results obtained in normally cycling controls and in women receiving 50 micrograms EE daily alone. It was found that the EE-induced augmentation of pituitary responsiveness to GnRH is diminished by the addition of progestins. LH and FSH reactions to stimulation were both affected. The degree of inhibition depended not only on the chemical structure and daily dose of the progestin component, but also on the duration of its administration per treatment cycle.

Adult↗
PubMed1985

[Polycystic ovaries: specific disease picture or nonspecific symptom?].

This study compares the clinical, biochemical and laparoscopic findings in androgenized patients with (n = 33) and without (n = 17) polycystic ovaries (PCO). It included selective ovarian-adrenal vein catheterisation with measurement of testosterone, dihydrotestosterone, delta 4-androstendione, dehydroepiandrosterone and its sulfate, 17 alpha-hydroxyprogesterone and cortisol in peripheral and glandular venous samples; determination of free testosterone, oestradiol, oestron, LH, FSH and prolactin in peripheral blood; GnRH and TRH double stimulation, as well as dexamethasone suppression tests. There was no correlation between the morphological, clinical, and endocrine changes. A PCO-specific hormonal pattern was not identifiable. Based on catheterisation data, combined ovarian-adrenal androgen hypersecretion was found in 46% of PCO cases; purely ovarian (21%) or adrenal (12%) overproduction were not as frequent. The dynamic function tests proved to be non-specific; e.g., dexamethasone suppressed not only adrenal, but also ovarian androgen output. It is concluded from these data that PCO are not a nosologic entity, but rather a non-obligatory sign of hyperandrogenism. Laparoscopy is, therefore, without clinical relevance in these patients with non-neoplastic hyperandrogenaemia.

Adult↗
PubMed1984

[Differential use of sex hormones during the perimenopause].

Various regimens are available for hormone replacement in perimenopausal patients. Their pharmacodynamic effects differ e.g. in respect to the relief of subjective climacteric symptoms, the risk of endometrial cancer, the prevention of osteoporosis and the alterations of lipid metabolism. In view of the conflicting epidemiologic data general long-term prophylaxis in all climacteric women cannot be recommended at present. The institution of therapy requires valid indications and careful assessment of relative risks. Today, the cyclic administration of oral estrogen-progestin combinations may be regarded as the method of choice. However, treatment can and should be individualized. The practical aspects of a differential management are discussed. With prudent use, the benefits of perimenopausal hormone replacement clearly outweigh their potential disadvantages.

Arteriosclerosis↗
PubMed1984

Ovarian and adrenal vein steroids in healthy women with ovulatory cycles--selective catheterization findings.

Bilateral ovarian-adrenal vein catheterization and androgen measurements in the efferent samples were utilized to directly assess glandular steroid release in 8 healthy volunteers with proven ovulatory cycles during the early follicular phase. Side effects did not occur in any of the women. Hormone levels were as follows (mean +/- SD; ng/ml) T: peripheral vein (PV) 0.36 +/- 0.16, ovarian veins (OV) 0.39 +/- 0.13, adrenal veins (AV) 0.85 +/- 0.63; dihydro-T (DHT): PV 0.25 +/- 0.09, OV 0.29 +/- 0.10, AV 0.93 +/- 0.65; delta 4-androstendione (A): PV 0.88 +/- 0.34, OV 1.82 +/- 1.04, AV 9.22 +/- 8.04; DHEA; PV 5.13 +/- 1.96, OV 6.73 +/- 2.69, AV 146.79 +/- 217.24; DS PV 1860 +/- 850, OV 1937 +/- 1039, AV 2567 +/- 1201; 17 alpha-hydroxyprogesterone (17P): PV 0.60 +/- 0.19, OV 1.46 +/- 1.64, AV 6.94 +/- 6.20; F: PV 170 +/- 50, OV 130 +/- 21, AV 788 +/- 1320; the bilateral differences of effluent levels were not significant. Glandular-peripheral vein steroid gradients served as semiquantitative estimates of momentary secretory activity; they were as follows (mean +/- SD; ng/ml) T: ovarian-peripheral vein gradient (OPG) 0.03 +/- 0.09, adrenal-peripheral vein gradient (APG) 0.48 +/- 0.57; DHT: OPG 0.05 +/- 0.05, APG 0.69 +/- 0.60; A: OPG 0.97 +/- 1.13, APG 8.33 +/- 7.86; DHEA: OPG 1.70 +/- 1.80, APG 141.80 +/- 216.60; DS: OPG 191 +/- 72, APG 706 +/- 824; 17P: OPG 0.87 +/- 1.67, APG 6.30 +/- 6.10; F: OPG 38 +/- 11, APG 610 +/- 1329. Gradient, analysis revealed that the ovaries produced significant quantities of A, DHEA and 17P, but no T, DHT or F between day 3-7 of the cycle; direct gonadal DS output was detected in 2 individuals. A significant OPG for DS was detected in two individuals possibly indicating its partially gonadal origin. The adrenals released larger amounts of A, DHEA and 17P than the ovaries at this stage (P less than 0.05); also, they consistently secreted T, DHT, DS and F.

17-alpha-Hydroxyprogesterone↗
PubMed1984

Ovarian and adrenal vein steroids in patients with nonneoplastic hyperandrogenism: selective catheterization findings.

Standardized bilateral ovarian-adrenal vein catheterization was utilized to assess directly glandular steroid release in 60 androgenized women without evidence of a functional neoplasm. Testosterone (T), dihydrotestosterone (DHT), androstenedione (delta 4 A), dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), 17-hydroxyprogesterone (17-OHP), and cortisol (F) were measured by radioimmunoassay in samples obtained from a peripheral vein and the four glandular veins (all values are given as nanograms per milliliter, mean +/- standard deviation). Peripheral values were as follows: T, 0.68 +/- 0.43; DHT, 0.32 +/- 0.13; delta 4 A, 2.2 +/- 2.0; DHEA, 8.8 +/- 8.9; DHEA-S, 3137 +/- 1774; 17-OHP, 2.0 +/- 3.0; and F, 216 +/- 121. Peripheral elevations of at least one androgen were found in 80% of the 60 cases (T, 38%; DHT, 18%; delta 4 A, 50%; DHEA, 45%; and DHEA-S, 37%). Ovarian-peripheral vein gradients ( OPGs ) and adrenal-peripheral vein gradients ( APGs ) served as semiquantitative estimates of glandular secretion. OPGs were as follows: T, 0.4 +/- 1.1; DHT, 0.1 +/- 0.2; delta 4 A, 3.4 +/- 7.0; DHEA, 14.6 +/- 100; DHEA-S, -288 +/- 523; 17-OHP, 4.5 +/- 8.4; and F, -35 +/- 47. APGs were as follows: T, 0.88 +/- 1.3; DHT, 1.1 +/- 0.9; delta 4 A, 14.4 +/- 38.4; DHEA, 327 +/- 367; DHEA-S, 854 +/- 1223; 17-OHP, 20.8 +/- 41.3; and F, 1252 +/- 2023. Excess ovarian and/or adrenal androgen output was assumed in a given individual when one or more of the respective T, DHT, delta 4 A, DHEA, and DHEA-S gradients exceeded the upper 95% confidence limits of normal previously established in this laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Ovarian and adrenal vein steroids in seven patients with androgen-secreting ovarian neoplasms: selective catheterization findings.

Standardized bilateral ovarian-adrenal vein catheterization was utilized to preoperatively assess glandular steroid release in seven consecutive cases of occult virilizing gonadal neoplasms. Peripheral testosterone (T) exceeded 1.5 ng/ml in all instances (range, 1.51 to 8.67 ng/ml). Endoscopy and radiography failed to locate the functional lesions. Catheterization showed a unilateral elevation of the ovarian-peripheral vein gradient for T greater than 2.7 ng/ml in six women. In the remaining patient, gradient analysis ruled out an adrenal tumor but did not facilitate lateralization of the gonadal lesion due to subselective ovarian effluent sampling. In addition to the consistent hypersecretion of T, variable excess gonadal output of dihydrotestosterone, androstenedione, dehydroepiandrosterone, and 17 alpha-hydroxyprogesterone was evident. Associated adrenal androgenic hyperfunction was documented in three subjects. Histologic evaluation of the implicated ovaries revealed three lipid cell, two Leydig cell, and two Sertoli-Leydig cell tumors, respectively, measuring between 0.6 and 2.2 cm in diameter. No correlation was found between any of the following parameters: peripheral or glandular vein steroid levels, androgen gradients, severity of symptoms, tumor morphology, and tumor size. In conclusion, appropriate application of selective catheterization may considerably reduce the frequency and extent of operative intervention.

Adrenal Glands↗
PubMed1983

A Sertoli-Leydig cell tumor and pregnancy. Clinical, endocrine, radiologic, and electron microscopic findings.

An extremely rare case of a conception occurring in a 26-year-old patient with a small virilizing Sertoli-Leydig cell tumor (diameter: 0.6 cm), bilateral polycystic ovaries and non-tumorous adrenal hyperandrogenism is presented. Prepregnancy findings included hirsutism, clitoromegaly, secondary amenorrhea, and elevated peripheral plasma testosterone (T; 5.7 ng/ml). Extensive basal steroid screening, dynamic function tests, conventional radiologic procedures, selective glandular vein catheterization, and laparoscopy failed to localize unequivocally the source of androgen excess, but suggested bilateral adrenal involvement. The patient conceived during the diagnostic work-up; peripheral T levels increased to 12.1 ng/ml within the first trimester. An exploratory laparotomy with left adrenalectomy, right adrenal biopsy and left ovarian wedge resection revealed an incompletely removed Sertoli-Leydig cell tumor, but normal adrenal histology. The pregnancy was terminated, a left oophorectomy and right ovarian wedge resection were performed at 14 weeks' gestation. Subsequently, peripheral androgens returned to normal, regular menses resumed, and hirsutism disappeared. Three years later the patient delivered a healthy female infant.

Abortion, Therapeutic↗
PubMed1983

Antiandrogens in the treatment of acne and hirsutism.

The review discusses (1) the relationship between the endocrine actions of antiandrogens and their therapeutic efficacy and (2) recent chemical and pharmacokinetic data on cyproterone acetate (CPA). It also provides (3) a comparison of CPA and spironolactone regarding the tentative benefits and risks and offers (4) general rules for the drug treatment of androgenized women. Clinical results indicate that those agents are most effective which not only competitively inhibit androgen binding at the receptor level but also suppress androgen secretion and/or production. The combined mode of action is observed with CPA as well as spironolactone. Pharmacokinetic studies underline the necessity to restrict CPA administration in huge doses to the first half of a treatment cycle in order to avoid bleeding disturbances. Also it appears that individual differences in CPA bioavailability do not satisfactorily explain the lack of therapeutic response in about 30% of the cases. Data are presented hinting that the 15 beta-hydroxy-, metabolite of CPA may actually be the biologically active agent. In addition preliminary results are given indicating that intramuscular CPA is therapeutically more effective than oral CPA.

Acne Vulgaris↗
PubMed1983

The diagnostic value of plasma free testosterone in non-tumorous and tumorous hyperandrogenism.

The clinical significance of total and free testosterone (T) estimates for the diagnostic approach to hirsute patients was assessed. Plasma T was measured by radioimmunoassay and its non-protein-bound fraction was determined by equilibrium dialysis, thus facilitating the calculation of apparent free T (AFT). The cases of 162 subjects were investigated; the subjects included 75 women in whom glandular androgen release had been defined by selective catheterization. A positive linear correlation was observed between both parameters over a wide range of concentrations (T, 153 to 10,700 pg/ml; AFT, 0.8 to 342 pg/ml; P less than 0.001). Significant differences of mean T and AFT levels were found between healthy control subjects (n = 8) and subjects with non-tumorous hyperandrogenism (n = 60; P less than 0.005). Individual values overlapped considerably; elevated T (greater than 640 pg/ml; 48%) or AFT (greater than 7.2 pg/ml; 52%) were present in only half the hirsute women. However, the upper 95% confidence limits of normal for both indices were exceeded in all patients with androgen-secreting ovarian tumors (n = 7). It is concluded that the indirect estimation of AFT in addition to T is time-consuming, costly, without practical value in selecting the proper treatment, and therefore not mandatory in the routine evaluation of androgenized women.

Adolescent↗
PubMed1983

[Treatment of virilized women with intramuscular administration of cyproterone acetate].

Management of hirsutism with high-dose oral cyproterone acetate (CPA) is associated with a failure rate of about 30%. The present investigation analyses the efficacy of parenteral CPA administration in non-tumorous hyperandrogenism. Medium-dose CPA (300 mg) was injected intramuscularly once per month, followed by oral ethinylestradiol (40 micrograms daily) for 21 days in 42 patients (total of 293 treatment cycles). The onset of withdrawal bleeding was 3 to 8 days later. This regimen was used as primary therapy (group A; n = 18) as well as follow-up therapy in low-dose (group B; n = 10) and high-dose oral standard CPA failures (group C; n = 14). The following satisfactory or good response rates were observed in regard to hirsutism: group A 83,5%, group B 100%, group C 57%; seborrhea A and B 100%, C 89%; acne and androgenetic alopecia A and B and C 100%. Clinical side effects occurred in 20 patients; they corresponded in type and frequency to those elicited by the high-dose oral standard medication and resulted in termination of treatment in only 3 patients. Pilot studies regarding the pharmacokinetics of CPA as well as the effects on plasma total and free testosterone and prolactin failed to explain the therapeutic superiority of parenteral CPA (n = 7 women). Still, it may be concluded that intramuscular CPA administration represents a new and highly effective means of managing hirsute females.

Acne Vulgaris↗