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Biomedical subjects

U Ulmsten

Publications and source records attributed to U Ulmsten.

At least 55 records · Page 3Linked to original sources
PubMed1997

Bone loss in elderly women prevented by ultralow doses of parenteral 17beta-estradiol.

OBJECTIVES: Our purpose was to assess whether an ultralow dose of parental estradiol, aimed for treatment of vaginal atrophy, affects bone metabolism and bone density. STUDY DESIGN: Thirty healthy women > or = 60 years old were randomly assigned to a 6-month treatment with either an ultralow dose of parenteral estradiol (7.5 microg/24 hours) delivered by vaginal rings or no treatment in the proportion 2:1. RESULTS: Forearm bone density increased in estradiol users by 2.1% (95% confidence interval 0.4 to 3.8, p = 0.008), contrasting to a decrease in nonusers of -2.7% (95% confidence interval -5.9 to 0.4, p = 0.077). In analysis of variance the changes in the two study groups differed significantly (p = 0.0004). Consistently, serum alkaline phosphatases, bone-specific alkaline phosphatases, and osteocalcin concentrations decreased in the treatment group (8%, p = 0.019; 14%, p = 0.0006; and 9%, p = 0.02, respectively), suggesting reduced bone turnover. No significant changes were found in nonusers. CONCLUSION: Ultralow doses of estradiol may potentially prevent bone loss in women > or = 60 years old.

Administration, Intravaginal↗
PubMed1997

Sex steroid receptors and human parturition.

OBJECTIVE: To investigate the correlation between sex steroid hormones and their receptors during normal and dysfunctional labor. METHODS: Myometrial and decidual biopsies along with maternal and cord blood samples were taken from women with or without labor activity. Estrogen and progesterone receptor contents in myometrium and decidua were determined by enzyme immunoassay, and hormone concentrations were analyzed by radioimmunoassay. RESULTS: In the lower segment of the uterus, the progesterone receptor concentrations of myometrium were significantly lower in oxytocin-resistant dystocia compared with those of normal labor and before labor (P < .04, P < .005, respectively). No significant difference was found in the estrogen receptors contents in the groups studied. The progesterone receptors of myometrium from the upper segment showed higher concentrations in active labor compared with those before labor and oxytocin-resistant labor (P <.01, P < .05, respectively). Estrogen receptors from the upper segment showed no significant difference in these regards. There was no difference in peripheral and myometrial sex hormone levels in the groups studied. CONCLUSION: These data suggest that, in the human, 1) oxytocin-resistant labor is associated with low levels of progesterone receptors, 2) estrogen receptors content in myometrium might have no or little relation to labor, and 3) functional labor seems not to be related to a decreased progesterone activity in the myometrium.

Adult↗
PubMed1997

Anisomycin and verapamil influence the action of progesterone on regulation of term human myometrial contractile activity.

OBJECTIVE: Progesterone has been shown to have both stimulatory and inhibitory effects on term human myometrial contractile activity. The mechanisms involved in this action of progesterone are still poorly understood. DESIGN: Myometrial tissues were obtained from the lower uterine segment at elective Caesarean section of 30 term pregnant women. The contractile activity of muscle strips was measured by a superfusion technique and protein synthesis evaluated by [3H]-leucine incorporation. RESULTS: [3H]-leucine incorporation into term myometrial strips was not affected by progesterone (10 mumol/l), but was markedly reduced by the protein synthesis inhibitor anisomycin (P < 0.05). However, progesterone increased frequency and tonus of contractions and reduced the activity-area of contractions (P < 0.01). Anisomycin (100 mumol/l) did not change these effects or the spontaneous contractile activity. Removal or extracellular Ca2+ or addition of the L-type calcium channel blocker verapamil prevented the spontaneous as well as the progesterone-induced contractions, but had less pronounced effects on contractions initiated by oxytocin. CONCLUSION: The results indicate that the actions of progesterone on term myometrial contractile activity occur without protein synthesis and that increased Ca2+ influx or decreased outward transport of Ca2+ may play a possible role)

Adult↗
PubMed1997

Human uterine smooth muscle exhibits a very low phosphocreatine/ATP ratio as assessed by in vitro and in vivo measurements.

The purpose of the study was to investigate by in vitro and in vivo methods the phosphocreatine (PCr)/ ATP ratio as an expression of the energy metabolic state of human myometrium in comparison with striated skeletal muscle. The contents of PCr and adenylates in biopsies of uterine smooth muscle and m. rectus abdominis from seven term pregnant women were determined in vitro and compared with results obtained in vivo by phosphorus magnetic resonance spectroscopy (31P-MRS) in the uterus and m. gastrocnemius of eight non-pregnant women. The PCr/ATP ratio in the striated skeletal muscle was about three times higher than that of the myometrium. The results of the in vitro biopsy part of the study and the in vivo 31P-MRS part conformed with each other. In the biopsies both PCr and ATP concentrations were significantly lower in the myometrium than in the rectus muscle, but the difference for PCr was more pronounced, accounting for the significantly lower PCr/ATP ratio in the uterine smooth muscle. The energy metabolic pattern of uterine smooth muscle differs from that of striated skeletal muscle regarding the contents of high-energy phosphocompounds and the PCr/ATP ratio. This in vivo finding is the first report on human smooth muscle using 31P-MRS.

Adenosine Diphosphate↗
PubMed1997

Quantitative immunoconfocal analysis of human myometrial gap junction connexin43 in relation to steroid hormone concentrations at term labour.

The aim of this study was to quantify gap junction expression in the human myometrium in relation to progesterone and oestradiol concentrations, and to establish whether oxytocin-resistant dystocia is due to an abnormality in gap junction expression. Three groups of patients were investigated: (i) before labour (at term), (ii) normal labour and (iii) oxytocin-resistant dystocia (eight patients per group). For each patient, the concentrations of oestradiol and progesterone in maternal blood and in myometrial tissue were measured, and the number and area of immunostained connexin43 gap junctions per unit volume of tissue determined by quantitative analysis of digital images obtained by confocal microscopy. No significant difference in connexin43 gap junction content was observed between the three patient groups. When all groups were pooled, there was a significant positive correlation (P < 0.05) between the quantity of immunolabelled gap junctions and the oestradiol:progesterone ratio, but there was no significant difference in this correlation between the groups. Gap junction immunolabelling was not correlated with the progesterone or oestradiol concentration in the maternal blood or the myometrium. These data suggest that in human myometrium: (i) dystocia is not due to a reduced level of immunodetectable connexin43 gap junctions, (ii) onset of labour is not associated with a sudden increase in immunodetectable gap junction protein and (iii) gap junctions can be expressed in the presence of high progesterone concentrations.

Adult↗
PubMed1997

Sonographic assessment of symphyseal joint distention intra partum.

OBJECTIVE: To elucidate whether there is a distention of the symphysis pubis intra partum and whether a history of pelvic pain during pregnancy is associated with increased distention during delivery. METHODS: Using ultrasonography, the width of the symphysis pubis was measured on two occasions during delivery; firstly, upon engagement of the fetal head in the pelvic inlet, secondly, when the largest diameter of the fetal head was at the level of the ischiadic spines. The first measurement was conducted in 24 patients, the second measurement was obtained in 16 of these patients. RESULTS: The average width of the symphysis pubis at onset of labor was 5.8 mm. The average distention of the symphysis during labor was 1.1 mm for those without pelvic pain and 0.2 mm for those with a history of pelvic pain during pregnancy (p = 0.02). Parity and ensuing birth weight had no statistically significant influence on degree of distention. CONCLUSION: The symphyseal distention during labor is minimal regardless of parity and size of the child. No added symphyseal distensibility was found in patients with a history of pelvic pain.

Adult↗
PubMed1997

Some reflections and hypotheses on the pathophysiology of female urinary incontinence.

It is proposed that opening and closure of the proximal urethra and bladder neck are regulated by a battery of surrounding structures, the most important being the pubourethral-vesical ligaments, the suburethral vaginal wall, 'the hammock', the pubococcygeus muscles, the levator plate and the connective tissue which like glue connects these structures to each other. Inappropriate function in one of these structures can, to some extent, be compensated for by an improved function in another hereby maintaining continence. However, a significantly deteriorated function in the support of urethra--normally maintained by the pubourethral/pubovesical ligaments, the pubococcygeus muscles and suburethral vaginal wall--will result in pronounced stress incontinence. Severe defects in these structures can generally not be compensated for by exercises of the pelvic muscles. This is true, in particular, if there is also a defect function in the connective tissue which 'glues' the urogenital structures to each other. Under such circumstances surgical procedures have to be considered to alleviate the patients symptoms. What is said so far must not exclude the importance of recognizing the role of the internal urethral structures to maintain continence, in particular the quality of urethral muscles, connective tissue and vascularization. In some specific cases of mixed incontinence it can be speculated whether the urge symptom can be caused by an anatomical dysfunction causing the proximal urethra and the bladder neck to remain involuntarily open or to open promptly at even minor pressure provocations. If so distension of the bladder neck and proximal urethra may activate stretch receptors located here which will induce uninhibited detrusor contractions. The presence of estrogen receptors in many of the structures involved in preserving continence may explain the increased prevalence of dysfunctions in the urogenital tract in postmenopausal patients, in particular in those not on hormone replacement therapy.

Age Factors↗
PubMed1996

Clinical outcome and changes in connective tissue metabolism after intravaginal slingplasty in stress incontinent women.

The intravaginal slingplasty procedure (IVS) was carried out on 75 patients with genuine stress urinary incontinence. The main aims of the operation are to create an artificial pubourethral ligament and to tighten the suburethral vaginal wall. An important ingredient in the supportive structures of the genitourinary region is fibrous connective tissue, consisting mainly of collagen. To analyse this component biopsies were obtained transvaginally, close to the position of the sling, both preoperatively and 2 years after surgery, from 6 patients. Collagen was analysed for concentration and extractability. Extractability by pepsin digestion was increased by 60% 2 years following surgery. Postoperative follow-up studies from 12 months to 3 years showed complete restoration of continence in 63 patients (84%) and considerable improvement in 4 others (5%). The 8 failures (9%) were all related to early rejection of the sling. The IVS procedure is an attractive surgical procedure as it necessitates minimum invasion and can be performed under local anesthesia, with a short hospital stay and sick-leave period. The enhanced collagen extractability indicates a changed metabolism, most likely induced by the implanted sling, resulting in a restoration of the elastic properties of the connective tissue.

Adult↗
PubMed1996

An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence.

The object was to study prospectively the results of a modified intravaginal slingplasty for the surgical treatment of female stress incontinence, carried out under local anesthesia as a day procedure. Seventy five patients with genuine stress incontinence were operated upon and followed for a 2-year period. All patients were diagnosed urodynamically to have genuine stress incontinence. Pad tests and quality of life assessments were carried out in all patients both pre- and postoperatively. There were no intra- or postoperative complications and 63 patients (84%) were completely cured throughout the 2-year follow-up period. Six patients (8%) were significantly improved, i.e. they did not loose urine apart from an occasional leakage during severe cold etc. In the remaining 6 patients (8%) no improvement was seen. These failures were obvious at the first postoperative check-up after 2 months. Thus, there were no relapses after 2 months. All but 5 patients were able to void properly directly after surgery. These 5 needed an indwelling catheter during the night directly after the operation. All 75 patients were released from the hospital the same day or the day after surgery without catheterization. Mean sick leave was 10 days and mean operation time 22 minutes. No defect healing or rejection of the sling occurred. It is concluded that the procedure described is a promising new technique for the surgical treatment of female stress incontinence. Prospective long-term studies including more patients are in progress to establish the definitive place of this technique in the clinical routine.

Adult↗
PubMed1996

Androgen levels in women using a single implant of nomegestrol acetate.

This study was undertaken to evaluate the effects of a single implant containing nomegestrol acetate (Uniplant) on plasma levels of sex hormone-binding globulin (SHBG), testosterone, free testosterone, androstenedione and on blood pressure, body weight, and the development of acne vulgaris. Plasma levels of sex hormone-binding globulin, testosterone, free testosterone and androstenedione were measured. Blood pressure and body weight were determined. The development of acne vulgaris was evaluated. Total testosterone and androstenedione decreased significantly during two years of Uniplant use but all levels were within the normal range. There were no significant differences in sex hormone-binding globulin and free testosterone during 24 months of Uniplant use. All changes observed in this study were within normal range. SHBG was not affected by Uniplant use. No significant increase in androgen levels and in the development of acne vulgaris was observed in these women using nomegestrol acetate implant during two years. Based on these results, it is possible to conclude that Uniplant had no androgenic effect in women during this study.

Acne Vulgaris↗
PubMed1996

Myometrial steroid concentration and oxytocin receptor density in parturient women at term.

The aim of this study was to measure oxytocin receptor concentration in myometrial tissue from term pregnant women with normal and dysfunctional labor and to relate this concentration to the progress of labor and to the levels of estradiol and progesterone in the same myometrium. Myometrial biopsies were obtained from 50 term pregnant women undergoing cesarean section. The patients were categorized as follows: not in labor, normal labor, successful oxytocin-augmented labor, and oxytocin-resistant labor. Specific binding of [3H]oxytocin to high-affinity sites in membrane preparations from myometrial tissues was determined. Estradiol and progesterone were assayed using tritiated steroids with a sensitive radioimmunoassay technique. Oxytocin receptor density was significantly lower in oxytocin-resistant labor compared to successful oxytocin-augmentated labor (P < 0.04) and to spontaneously active normal labor (P < 0.02). Oxytocin receptor concentration was also significantly lower in non-labor patients compared to normal spontaneous labor (P < 0.01), and successful oxytocin-augmented labor (P < 0.02). There was a positive relationship between the progress of cervical dilatation (cm/h) and oxytocin receptor density in the myometrium (r = 0.408, P < 0.025). The concentration of progesterone and estradiol in the pregnant myometrium did not differ in patients with different types of labor or with the state of uterine contractile activity. Our results suggest that individual myometrial sensitivity is an important determinant of the response to administered oxytocin in humans. Furthermore, myometrial oxytocin receptor expression in vivo seems not be related to ovarian steroid concentration in the myometrium. The low oxytocin receptor density in oxytocin-resistant dystocia needs further investigation.

Adult↗
PubMed1996

Effects of progesterone and oxytocin on intracellular elemental composition of term human myometrium in vitro.

OBJECTIVE: To study the effects of progesterone and oxytocin on contractile activity related to the intracellular elemental composition of human pregnant myometrium. STUDY DESIGN: Myometrial strips were mounted in tissue baths and superfused with plain buffer, oxytocin or progesterone. Progesterone was initially added to the tissue bath or at the onset of spontaneous contraction of the strips. The myometrial contractile activities were recorded isometrically and the results were analyzed by a specific computer program. The effects of oxytocin and progesterone on the intracellular elemental composition were studied by X-ray microanalysis in an electron microscope. RESULTS: The contractile activity in terms of frequency and tonus of the muscle strips was increased by oxytocin and progesterone. This increase was more pronounced if progesterone was added to the bath at the start of the experiment. After 120 min of incubation with oxytocin and progesterone the total intracellular concentration of calcium was significantly higher (P < 0.0001 and P < 0.002, respectively) compared to buffer. CONCLUSIONS: (i) Oxytocin increases total intracellular calcium concentration concomitant with an increase in uterine contractile activity. (ii) Progesterone increases the myometrial tone and frequency of contractions, simultaneously with an increase in total intracellular calcium.

Calcium↗
PubMed1996

Prevalence of genitourinary and other climacteric symptoms in 61-year-old women.

In a population-based cohort study, 1280 women, aged 61, were interviewed regarding their genitourinary and other postmenopausal symptoms by means of an anonymous questionnaire. The group selected was to constitute all women of 61 years of age living in Uppsala county, Sweden. The response rate was 84%. All were postmenopausal women. Seventy-three percent of the women answering admitted some degree of urinary incontinence and 33% more severe degree. Forty-nine percent reported some degree of stress incontinence, 25% a more severe degree. Thirty-one percent experienced urge incontinence, 14% severely. A minority (4%), had had more than two urinary infections during the last year. The majority (67%) had changed urinating habits, going to the toilet at night and a minority complained of increased frequency of micturation (8%). Of the participating women, 59% were still sexually active, 43% had trouble with vaginal dryness and 10% with vaginal burning. Vasomotor problems such as hot flushes (30%), daily (33%) and nightly sweating (36%) were all common troubles. Forty-seven percent of the women had asked for medical help for estrogen deficiency problems, 82% were satisfied with the help they had received. Thirty-four percent were on estrogen therapy, 16% had systemic therapy 18% low dose estrogen treatment.

Climacteric↗
PubMed1996

Temporal relationship between Uniplant insertion and changes in cervical mucus.

This study was undertaken to determine the time required by a single implant containing nomegestrol acetate to affect cervical mucus production and sperm penetration in women. All subjects were investigated and, if necessary, treated for any kind of cervicitis or vaginitis prior to starting cervical mucus study. The subjects had not used hormonal contraception for at least three months prior to investigation. They were counseled to use condoms during this study and also to refrain from intercourse during the period of cervical mucus sampling. Follicular development and endometrial thickness were analyzed by transvaginal sonography. Cervical mucus examination, sperm penetration test, and transvaginal sonography were performed during the control cycle and during the first cycle of Uniplant use. Blood samples were taken for the measurement of estradiol, LH, and progesterone. Cervical mucus and sperm penetration tests were evaluated according to the World Health Organization (WHO) criteria. In the treated cycle, when cervical mucus reached a score of 8-10, Uniplant was inserted, independent of the day of the cycle. Cervical mucus was then collected at 0, 4, 8, 12, 24, 48, and 96 h later until a marked change in volume, consistency, ferning spinnbarkheit, and cellularity was observed. All samples were also used for sperm penetration test. Preovulatory estradiol and LH peak decreased significantly compared to pre-implant insertion. Progesterone levels were within the normal limit. Cervical mucus and sperm penetration tests were not affected by Uniplant in the first 12 h. Twenty-four hours after Uniplant insertion, cervical mucus and sperm penetration tests were affected in 70.6% of the women. Forty-eight hours after implant insertion, the women were affected. Follicular rupture occurred in the majority of the women 48 h after implant insertion. Based on these results, it is possible to conclude that Uniplant can affect estradiol and LH preovulatory peaks and disrupt the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted in the preovulatory phase.

Adult↗
PubMed1996

Effects of a single contraceptive Silastic implant containing nomegestrol acetate on ovarian function and cervical mucus production during 2 years.

OBJECTIVE: To study the mechanism of action of Uniplant (South to South Corporation in Reproductive Health, Salvador, Brazil), a single Silastic capsule containing nomegestrol acetate (Lutenyl, Theramex, France) in women during 2 years. DESIGN: Comparison between the hormonal levels, follicular development, cervical mucus (CM) production, and endometrial thickness in the menstrual cycle before implant insertion and at 1, 6, 12, 18, and 24 months after implant insertion. PARTICIPANTS: A total of 15 women of reproductive age were enrolled for the 1st year of use. Twelve of these women continued for a 2nd year of Uniplant use. MAIN OUTCOME MEASURES: Hormonal plasma levels were measured in control cycles and at 1, 6, 12, 18, and 24 months of Uniplant use. Cervical mucus, follicular development, and endometrial thickness also were evaluated. RESULTS: In this study, Uniplant blocks ovulation in 86 percent of cycles studied. Disturbances in follicular growth were observed also. Cervical mucus was scanty and viscous in all women during this study. Endometrial thickness was <8 mm in all cycles studied. CONCLUSION: This study shows that Uniplant is a long-acting contraceptive that probably acts at the hypothalamic-pituitary levels, on the ovary, on CM production, and on the endometrium. These properties suggest the use of Uniplant as a contraceptive agent, especially if one considers the lack of androgenic and metabolic effects and the maintenance of periodic bleeding similar to menstruation.

Adolescent↗