Regional hemodynamic adaptation during the menstrual cycle.

OBJECTIVE: To determine whether regional differences exist in uterine and systemic hemodynamic responses to the menstrual cycle, whether the hormonal environment correlates with the changes, and whether uterine artery hemodynamic adaptation depends on the side of ovulation. METHODS: Twenty nulliparas had transvaginal Doppler ultrasonographic assessment of the uterine and upper-extremity radial arteries at three time points in each of two menstrual cycles. Doppler indices (peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, resistance index [RI], and blood flow) were measured in the radial and uterine arteries. Women were examined in the menstrual (cycle day 2-3), follicular (cycle day 9-10), and luteal phases (cycle day LH surge plus 9-10). At each time, serum estradiol (E2) and progesterone were measured by radioimmunoassay. Statistical analyses were repeated-measures analysis of variance and the Fisher least significant difference procedure. RESULTS: Thirty-four nonconception ovulatory cycles were evaluated. Blood flow in each uterine artery increased significantly from a mean (+/- standard deviation) of 22.4 +/- 7.3 mL/minute in the follicular phase to 30.7 +/- 13.7 mL/minute in the luteal phase, which coincided with a reduction in the RI. The changes were independent of the side of ovulation. The radial artery did not parallel these changes (follicular blood flow of 27.2 +/- 13.9 mL/minute; luteal blood flow of 24.7 +/- 10.5 mL/minute). We did not identify any significant correlation between these changes and serum E2 or progesterone concentrations. CONCLUSION: We identified differences in the hemodynamic responses of the uterine artery compared with the radial artery during the menstrual cycle. We believe the difference indicates distinct regional control of vascular response during the menstrual cycle.

Actinomycotic pelvic inflammatory disease simulating malignancy.

The protean and indolent nature of pelvic actinomycosis combined with the rarity of the disease poses a diagnostic dilemma. Woody induration and pelvic fibrosis may be present to such a degree that a diagnosis of pelvic malignancy is entertained. Early diagnosis and aggressive antibiotic therapy prior to definitive surgical management, even in the face of extensive anatomic changes, may enable the surgeon to perform relatively conservative surgery, obviating the need for procedures usually reserved for malignant disease.

A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer.

The murine monoclonal antibody OC 125 reacts with an antigen (CA 125) common to most nonmucinous epithelial ovarian carcinomas. An assay has been developed to detect CA 125 in serum. By this assay, only 1 per cent of 888 apparently healthy persons and 6 per cent of 143 patients with nonmalignant disease had serum CA 125 levels above 35 U per milliliter. In contrast, 83 of 101 patients (82 per cent) with surgically demonstrated ovarian carcinoma had elevated levels of antigen. In 38 patients with epithelial ovarian carcinoma monitored on 2 to 18 occasions during 2 to 60 months, antigen levels ranged from less than 1 to more than 8000 U per milliliter. Rising or falling levels of CA 125 correlated with progression or regression of disease in 42 of 45 instances (93 per cent). Determination of CA 125 levels may aid in monitoring the response to treatment in patients with epithelial ovarian cancer.

Monocyte chemotaxis mediated by formyl-methionyl-leucyl-phenylalanine conjugated with monoclonal antibodies against human ovarian carcinoma.

Availability of a chemically defined chemoattractant (fMLP) and of appropriate monoclonal antibodies may permit local manipulation of the inflammatory response to human tumors. fMLP has been conjugated with two monoclonal antibodies (OC125 and OC133) which react with human ovarian carcinomas. Conjugates retained the ability to bind to a human ovarian carcinoma line (OVCA433) judged by indirect immunofluorescence and by radioimmunoassay. The fMLP conjugate was maximally chemotactic for human blood monocytes and human peritoneal macrophages at protein concentrations of 300-900 micrograms/ml. Conjugates stimulated chemotaxis rather than chemokinesis. After incubation with an fMLP-antibody conjugate, antigen positive OVCA433 cells released chemotactic activity and attracted monocytes in vitro, whereas an antigen-negative ovarian cell line failed to do so. As monocytes can be important effectors of antibody dependent cell mediated cytoxicity, fMLP conjugates might increase monocyte concentrations at tumor sites and potentiate serotherapy for certain human neoplasms.

Risk factors for breast cancer.

Since 1976, data were collected to evaluate risk factors for breast cancer in a hospital-based case-control study of 1185 women with breast cancer and 3227 controls. The risk of breast cancer increased with increasing age at first birth; this effect was not accounted for by parity. An early age at first birth appeared to reduce the risk relative to no pregnancy, whereas a late age at first birth was associated with a higher risk than not having a full-term pregnancy. High parity was associated with a reduction in the risk that was independent of that of age at first birth: for parity greater than or equal to 5, compared with parity 1-2, the relative risk estimate was 0.7 (95% confidence interval, 0.5-1.0). Late age at menarche was associated with a lower risk among premenopausal women but not among postmenopausal women. The relative risk decreased with increasing obesity among premenopausal women. Among postmenopausal women, the risk was higher among those who were obese, but there was no evidence of a trend with increasing body mass index. Risk did not vary materially according to history of abortion when gravidity was controlled. Risk was lower among postmenopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone. A positive history of benign breast disease, a positive family history of breast cancer, Jewish religion, and 12 or more years of education were each independently associated with an increased risk of breast cancer.

Thrombocytopenia complicating preeclampsia: data to support a new model.

Thrombocytopenia can be associated with preeclampsia without evidence of consumptive coagulopathy and may contribute to placental insufficiency. In the case reported here, the patient's platelets agglutinated in vitro in the presence of her serum when the serum had been preincubated with her placental cells. The reaction was calcium and, probably, complement dependent. Mixtures of sera and placentas from normal APO-matched control pregnancies caused no agglutination of the patient's platelets. The capacity of her serum and placental cells to agglutinate her own platelets was not found in the sera obtained 60 days post partum. These findings suggest that in some cases of preeclampsia the platelets may be involved in an immune-mediated phenomenon that can induce platelet agglutination and is probably accentuated in the placenta, thus attenuating placental blood flow.

Use of thyroid supplements in relation to the risk of breast cancer.

We conducted a case-control study to determine whether the use of thyroid supplements increases the risk of breast cancer. We compared 659 women with breast cancer and 1,719 control subjects. The rates of use of thyroid supplements were 9.1% and 8.7%, respectively (age-standardized rate ratio, 1.0; 95% confidence interval, 0.7 to 1.3). There was no evidence of an association when women known to be at increased risk for breast cancer (eg, nulliparae) were examined, even when thyroid supplements were taken for more than 15 years. Overall, there were no grounds to suggest that the long-term use of thyroid supplements increases the risk of breast cancer.

Decreased risk of endometrial cancer among oral-contraceptive users.

PIP: A case-control study was carried out to assess the effects of OC (oral contraceptive) usage on the risk of endometrial cancer. The cases were chosen from an ongoing case-control surveillance program at the Drug Epidemiology Unit of Boston University Medical Center. 154 women with a diagnosis of endometrial cancer were compared with 525 controls as to OC usage. 1% of the cases and 2% of the controls had used sequential OCs, numbers too small for inclusion in the study. 6% of the cases and 13% of the controls had used combination OCs. The relative risk of developing endometrial cancer was found to be only .5 for women who had used combination OCs. This halved risk rate falls to .3 for use that lasted for 3 or more years. There was no evidence that the time of last use affected the reduced risk factor; i.e., the reduced risk appeared to persist for at least 5 years after discontinuation of OC use. This protection against endometrial cancer offered by combined OC use may begin to show up in incidence rates for the disease soon if the protective effect does indeed remain after usage.^ieng

Recent and past use of conjugated estrogens in relation to adenocarcinoma of the endometrium.

It has been suggested that the reported association between estrogen use and endometrial cancer may have been biased because estrogens provoke uterine bleeding in women with otherwise asymptomatic disease. To evaluate this hypothesis we compared 149 patients with endometrial cancer and 402 control subjects with other conditions with reference to the time when they had last used conjugated estrogens. In women who had last used conjugated estrogens two or more years previously and who had taken them for at least five years, the rate-ratio estimate was 3.3 (95 per cent confidence interval, 1.4 to 8.0) relative to women who had never used them. Uterine bleeding, and hence the diagnosis of otherwise asymptomatic cancer, cannot be attributed to estrogen use that ceased in the distant past. Our results suggest that such use has a residual effect on the risk of endometrial cancer; this effect is not accounted for by biased selection of cases according to estrogen use.

Cor triatriatum with mitral regurgitation in a 52-year-old male.

The clinical, echocardiographic, and cineangiographic features of the oldest known living case of cor triatriatum are presented. Mitral regurgitation, also found in this patient, has been reported on only two previous occasions to coexist with other wise uncomplicated cor triatriatum. The value of two-dimensional echocardiography in the identification of this congenital anomaly is confirmed.