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Biomedical subjects

U Ulmsten

Publications and source records attributed to U Ulmsten.

At least 109 records · Page 6Linked to original sources
PubMed1993

Balance of amino acids in the pregnant human uterus at term.

The nutritive and metabolic state of the human uterus at term is evaluated by measuring the uptake and release of amino acids. The subjects are ten healthy women with normal pregnancy undergoing elective caesarean section at term, before onset of labour. Free amino acids in arterial (radial artery) and venous (plexus of the uterine and ovarian veins) blood are determined and arteriovenous (AV) differences in each amino acid across the uterus are calculated. Generally the AV differences are negative, i.e. uterus at term releases amino acids in most cases. The human pregnant uterus at term is characterized by a release of amino acids rather than uptake. This indicates that they are in excess and are not needed in anabolic processes or as a fuel, even when the uterine tissue at term is supposed to be preparing for its grand performance, i.e. the delivery.

Adult↗
PubMed1993

Oestradiol-releasing vaginal ring for treatment of postmenopausal urogenital atrophy.

A silicone vaginal ring releasing 5-10 micrograms oestradiol/24 h for a minimum of 90 days has been developed for treatment of urogenital mucosal atrophy. The efficacy, safety and acceptability of the oestradiol-releasing ring were studied in 222 postmenopausal women with symptoms and signs of atrophic vaginal mucosa. The maturation of the vaginal epithelium, as measured by cytological parameters, was significantly improved during treatment. No proliferation of the endometrium was encountered. The therapy had a significant effect on symptoms (vaginal dryness, pruritus vulvae, dyspareunia, urinary urgency) and on signs of atrophic vaginitis, with cure/improvement registered in > or = 90%. The patient acceptability was high, since > or = 90% did not report any discomfort with the ring. Almost all of the sexually active women had the ring in place during coitus and in < or = 2% of cases discomfort was noticed by them or the partner. It is concluded that a vaginal silicone ring giving a continuous release of an ultra-low dose of oestradiol is an effective and safe treatment for urogenital oestrogen deficiency. No addition of progestagen is needed.

Administration, Intravaginal↗
PubMed1993

Natural volume handwashing urethrocystometry: a physiological technique for the objective diagnosis of the unstable detrusor.

A group of 163 patients attending with a naturally full bladder had urethrocystometric assessment during provocation with a handwashing test. The results were compared with those from a similar group of 169 patients who were subjected to a handwashing test following the infusion of 500 ml of saline with fast-fill cystometry. The latter group was found to have an unacceptably high number of false-positive results. Also, the results appear to indicate that urine loss due to uncontrolled detrusor contraction may be mainly due to premature activation of the micturition reflex. A fall in the intraurethral pressure was found in 79% and a rise in detrusor pressure in 49% of the patients presenting with a prior history of an unstable bladder. Natural urethrocystometry appears to be a useful and informative technique for objectively assessing patients with a prior history of bladder instability.

False Positive Reactions↗
PubMed1993

Tests for 'detrusor instability' in women. These mainly measure the urethral resistance created by pelvic floor contraction acting against a premature activation of the micturition reflex.

The principal aim of this study was to analyse the simultaneous pressure readings derived from bladder and urethra during a handwashing test. A total of 163 patients with urinary incontinence were studied. It was demonstrated that contraction of the pelvic floor stretches the vagina. In many patients, this appeared to inhibit the micturition reflex, possibly by supporting the nerve endings at bladder neck, thereby inhibiting their premature activation. There was also evidence that this stretching activated reflex contraction of the urethra, the vagina-urethral (coital) reflex, thereby increasing the urethral resistance. On further analysis, it was concluded that urodynamic testing does not detect 'detrusor instability' per se. It detects the urethra's attempts at closure.

Adult↗
PubMed1993

The round ligament: a target organ for steroid hormones.

Samples of the round ligament from pre- and post-menopausal women were analyzed immunohistochemically for estrogen and progesterone receptors. The steroid hormone receptors were localized in the smooth muscle cell nuclei, with stronger staining for progesterone receptors and somewhat weaker for estrogen receptors. Our findings support the view that the round ligament is a target organ influenced by hormones, which has implications for the changes in the ligament during pregnancy and pre- and postmenopausally.

Adult↗
PubMed1993

Gap junction density in human myometrium at term revealed by an anti-peptide antibody and laser scanning confocal microscopy.

The concept that the progesterone-estrogen ratio determines gap junction abundance in myometrium has developed from studies in laboratory animals. In the humans, however, gap junctions form in abundance at term despite a high progesterone-estrogen ratio. We have therefore examined the relationship between contractile activity, progesterone and estrogen levels and gap junction abundance in human myometrium at term. Myometrial tissue obtained from women who had an elective or emergency Cesarean operation at the 38th or 39th week of pregnancy was immunohistochemically examined using a polyclonal antiserum raised against a synthetic peptide matching part of the sequence of connexin43, the principal component of myometrial gap junctions. The concentration of progesterone and estradiol in the maternal blood was measured by means of radio-immunoassay. The number of gap junctions was estimated by counting of punctate staining patterns obtained in myometrial tissue as viewed by laser confocal microscopy and calculated per 1 microns 3 of tissue. The number of gap junctions measured was found to be related to the presence or absence of labor. In the myometrium of women in labor (active phase), the number of gap junctions was highest (45.25 +/- 35). When the myometrium was not contracting (non-labor) and when contractions were weak (pre-labor) the number of gap junctions was low (15.16 +/- 10-5.75 +/- 5). In the pre-and active phase of labor, the concentration of progesterone in maternal blood was significantly higher (P < 0.025 and 0.03, respectively) than in women who were not in labor. The present study shows the potential of using optical section series obtained by laser confocal microscopy for the quantification and mapping of the three-dimensional distribution of gap junctions in human myometrium at term.

Antibodies↗
PubMed1993

Antitachyphylactic effects of progesterone and oxytocin on term human myometrial contractile activity in vitro.

OBJECTIVE: To determine whether progesterone causes any changes in the action of oxytocin on the contractile activity of term human myometrium in vitro. METHODS: Myometrial biopsies from 13 term pregnant women undergoing cesarean delivery were immediately immersed in Hepes buffer or buffer containing 5 micrograms/mL progesterone. In the laboratory under a stereomicroscope, the specimens were dissected into 1 x 7.5-mm muscle strips. These were mounted into six tissue baths and superfused with Hepes buffer and buffer containing 5 micrograms/mL progesterone, 5 micrograms/mL progesterone plus 10 microU/mL oxytocin, 5 micrograms/mL progesterone plus 100 microU/mL oxytocin, 10 microU/mL oxytocin, and 100 microU/mL oxytocin. Isometric tension was recorded constantly for at least 3 hours. RESULTS: The frequency of myometrial contractions and tonus increased by superfusion with progesterone, progesterone plus oxytocin, and oxytocin alone compared to buffer. In addition, a gradual decrease in frequency was observed after 60 minutes of contractions with oxytocin alone, whereas progesterone plus oxytocin had no such decrease. The activity area of contractions was greater with 10 microU/mL oxytocin and decreased with progesterone, progesterone plus both concentrations of oxytocin, and 100 microU/mL oxytocin alone, compared to buffer. CONCLUSIONS: Progesterone stimulated the frequency of contractions and tonus of strips from the lower uterine segment of term human myometrium. A lasting increase in the frequency of contractions was observed with superfusion of progesterone plus oxytocin, suggesting that progesterone counteracted the reaction of tachyphylaxis to oxytocin.

Dose-Response Relationship, Drug↗
PubMed1993

Unexpected stimulatory effect of progesterone on human myometrial contractile activity in vitro.

OBJECTIVE: To investigate the effects of continuous exposure of progesterone on contractile activity of term human myometrium in vitro. METHODS: Myometrial biopsy specimens were obtained from 14 term pregnant women undergoing elective cesarean. The specimens were immediately immersed in Hepes buffer and buffer containing 0.33, 4.1, and 70 micrograms/mL progesterone. Muscle biopsies were dissected along the bundles of smooth muscle under stereomicroscope. These myometrial strips were mounted in tissue baths and superfused with Hepes buffer and buffer containing different concentrations of progesterone. RESULTS: The progesterone concentration of 0.33 microgram/mL had no significant effect on myometrial contractile activity. The concentrations of 4.1 and 70 micrograms/mL increased the frequency of contractions (P < .01 for each) and tonus (P < .01 for each), decreased the activity area of contractions (P < .01 for each), and delayed the onset of contractions (P < .01 and P < .05, respectively). CONCLUSION: When the myometrium is not deprived of progesterone, this hormone may have excitatory effects on the frequency of contractions and tonus of the lower uterine segment of term human myometrium.

Adult↗
PubMed1992

Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses.

Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography.

Adolescent↗
PubMed1992

Serum collagenase levels in relation to the state of the human cervix during pregnancy and labor.

OBJECTIVE: The purpose of our study was to investigate the role of collagenase in the cervical ripening and dilatation process in term pregnancy. STUDY DESIGN: Serum samples were obtained from nonpregnant women (n = 5) and term-pregnant women. The term-pregnant women were either admitted for elective cesarean section or labor induction (unfavorable cervix, n = 19; favorable cervix, n = 12) or in spontaneous, active labor (stiff and inelastic cervix, n = 7; soft compliant cervix, n = 8). Statistical analysis was performed with the Student t test. RESULTS: The nonpregnant women had low serum collagenase levels (5.2 +/- 0.7 micrograms collagen digested per minute per 100 ml serum, mean +/- SEM). At term but before labor, women with unripe cervices had higher collagenase levels (10.3 +/- 0.9). The women with ripe cervices had even higher serum collagenase levels (22.9 +/- 4.2; p < 0.001). During labor, women with stiff and inelastic cervices had lower serum collagenase levels compared with women with soft and compliant cervices (12.9 +/- 1.7 vs 28.0 +/- 4.2; p < 0.01). CONCLUSION: Serum collagenase during ripening at term and in active labor increases, supporting its active role in the ripening process.

Adult↗
PubMed1992

An analysis of rapid pad testing and the history for the diagnosis of stress incontinence.

Two rapid exercise pad tests, the vitamin B test, and the methylene blue test, are introduced for the diagnosis of urinary stress incontinence. The vitamin B test is entirely non-invasive, takes only a few minutes to perform, and is especially useful as an office test. The methylene blue test has fewer variables, and fits easily into a urodynamic routine. With the methylene blue test, a direct correlation was noted between amount of urine lost and pressure generated by the tests. This conforms to the definition of stress incontinence as a passive process. The sensitivity of the test in a group with mainly mixed symptoms was 89.5%, and the specificity 100%. The test is useful where objective diagnosis of stress incontinence is important. A group of 38 patients with a history (questionnaire) of stress incontinence exhibited a total of 105 positive individual symptoms out of a possible 228 symptoms (6 x 38), comprising a history of leaking at sneezing, coughing, exercise, laughing, walking, or bending. The individual symptoms were analyzed for accuracy and predictability by comparing them with six graded provocative exercises comprising a trampoline test, star jumps, coughing, stepping, bending and hand washing. The symptoms were graded into a hierarchy from the results. A history of stress incontinence was found to be an accurate determinant of stress incontinence, even in patients with mixed symptoms. This allows the questionnaire as presented to be used as a semiquantitative index for assessment purposes.

Adult↗
PubMed1992

Urge incontinence history is an accurate predictor of urge incontinence.

The reliability of urge symptoms associated with actual observed urine loss was tested using subtracted cystometry, and a hand-washing pad test in a total of 169 patients with urinary incontinence, 70 of whom had a prior history of urge incontinence. Our results showed: 1. that urodynamic or pad tests performed at a single point in time cannot retrospectively confirm a patient's past history of urge incontinence with any reliability; 2. a patient's history of urge incontinence is likely to be accurate.

Adult↗
PubMed1992

Surgery for female urinary incontinence.

There has been very little advance in the surgery of female urinary incontinence over the past 20 years. In our opinion this is due to 1) uncritical acceptance of the intraabdominal pressure transmission theory, 2) uncritical acceptance of the concept of "detrusor instability," and 3) limited and uncritical evaluation of results of surgery. A new theory for female urinary incontinence is presented. This theory explains existing phenomena in terms of anatomic defects in the vagina and its supporting ligaments. Based on this theory, a new classification of female urinary incontinence and several new minimally invasive surgical procedures are briefly introduced.

Female↗
PubMed1991

Placental morphology in relation to umbilical artery blood velocity waveforms.

The association between umbilical artery flow velocity waveforms, placental morphology and arterial vascular pattern was investigated in 30 pregnant women at risk for intra-uterine growth retardation. The blood velocity waveform was assessed in the umbilical arteries with pulsed Doppler ultrasound. Placentas from fetuses with an end-diastolic zero flow were small and thick with an extrachorial configuration, marginal cord insertion, magistral or mixed allantochorial vessel pattern and few cotyledons. The incidence and the extension of gross lesions were slightly increased in these placentas compared to placentas from fetuses with a normal S/D ratio (peak systolic velocity/minimum diastolic velocity). Placentas from fetuses with an increased S/D ratio (greater than +2SD) were large and thin with a high maximum diameter/maximum thickness ratio. Heavily smoking mothers were overrepresented in the group, with an increased S/D ratio and corresponding SGA infants. End-diastolic zero flow in the umbilical artery was strongly correlated with placental developmental abnormalities.

Angiography↗
PubMed1991

Regional differences in energy charge of the pregnant human uterus regardless of functional status in comparison with the non-pregnant uterus.

The energy status of the cell is mainly dependent on adenine nucleotides and can be expressed as energy charge (EC). EC is known to be kept at narrow limits near 0.90 under normal conditions in most cells. We recently reported remarkably low EC values in the human uterus under apparent steady-state conditions. The present paper is an extension of previous work. It shows that EC varies in different regions of the uterus in that the isthmic part in pregnant women displays a higher EC than the fundus of the uterus. There were no intergroup differences between non-pregnant and term pregnant women, nor between those who were in active normal labour, dysfunctional labour or those who were not in labour at all. On the other hand, EC in uterine muscle of post-menopausal women showed a significantly lower EC value. Human uterus seems to manage its metabolic requirements under different functional conditions in spite of low ATP and EC values. This suggests that ATP occurs in sufficient amounts to pertinent enzyme reactions, especially ATPases, which means Km values adapted for this unusually low ATP concentration.

Adenosine Triphosphatases↗
PubMed1991

Proteoglycan metabolism in the connective tissue of pregnant and non-pregnant human cervix. An in vitro study.

Profound changes occur in the cervix during pregnancy. In particular, the connective tissue is remodelled. To elucidate the mechanisms behind this process, the metabolism of cervical connective tissue was studied using tissue cultures. Cervical biopsies from non-pregnant and pregnant women were incubated with [35S]sulphate. The proteoglycans of the tissue specimens were purified by ion-exchange and gel chromatography and characterized by SDS/PAGE and by enzymic degradation. In the non-pregnant cervix, the incorporation of [35S]sulphate into the proteoglycans was linear for 48 h. During the first 6 h of incubation the accumulation of chiefly one small labelled proteoglycan (apparent Mr 110,000) substituted with dermatan sulphate was recorded. This is in accordance with the known proteoglycan composition of non-pregnant cervical tissue. In addition, small amounts of two larger radioactive dermatan/chondroitin sulphate proteoglycans (apparent Mr values 220,000 and greater than 500,000) were recorded. After longer periods of incubation the proportion of heparan sulphate proteoglycans increased considerably. The pregnant tissue showed a clearly different composition of labelled proteoglycans. An increased accumulation of the two larger dermatan/chondroitin sulphate proteoglycans was seen in addition to the dominant small dermatan sulphate proteoglycan of the non-pregnant cervix. The rate of accumulation of these two proteoglycans was about 3 times higher in the pregnant tissue, whereas that of the small dermatan sulphate proteoglycan was only increased 2-fold. The fact that the concentration of proteoglycans in the pregnant cervix is approximately one-half of that in the non-pregnant cervix indicates that the turnover of proteoglycans in pregnant cervical tissue is significantly increased. The major effect of this profound change of metabolism was a 50% decrease in proteoglycan content and a 2-fold increased proportion of a dermatan sulphate proteoglycan with an apparent Mr of 220,000.

Adult↗
PubMed1991

Transvaginal ultrasound for identifying endometrial abnormality.

Transvaginal ultrasound was used preoperatively to evaluate the endometrium in 96 patients referred for dilatation and curettage. The sonographic display was correlated to the histopathologic diagnosis. In 45 patients with postmenopausal bleeding, 4 patients had adenocarcinoma of the endometrium. All were identified by ultrasound. None of the 22 patients with a normal sonographic appearance had an abnormal histopathologic diagnosis. An endometrial thickness (single layer) cut-off point of greater than or equal to 4 mm precluded any missed malignancies but halves the number of dilatations and curettages in this postmenopausal group. The sensitivity of ultrasound in diagnosing endometrial pathology was 100% and the specificity was 61%. The positive and negative predictive values were 39% and 100% respectively. In 51 premenopausal women there was good agreement between histology and ultrasound. In this group a cut-off point of greater than or equal to 8 mm was used. The sensitivity in diagnosing endometrial pathology was 67% and the specificity 75%. The positive and negative predictive values were 14% and 97%. With further experience, transvaginal ultrasound might be used in clinical routine for diagnosing endometrial pathology.

Adenocarcinoma↗