Successful treatment of infertility due to retrograde ejaculation by instillation of serum-containing medium into the bladder. A case report.

The treatment of infertility caused by retrograde ejaculation has often been ineffective. The unphysiological composition of the urine is the main reason complicating the recovery of motile sperm. We describe a case of retrograde ejaculation caused by a congenital defect of the internal sphinchter muscle of the urinary bladder. In this case, motile sperm were only recovered if the bladder had been filled previously with artificial culture medium (Ham's F-10) supplemented with the patient's own serum. Two pregnancies followed intrauterine insemination with sperm recovered in this way.

Effect of toremifene on estrogen primed vaginal mucosa in postmenopausal women.

The antiestrogenic effect of 20 mg toremifene daily for 7 days and 68 mg for 5 days was studied in postmenopausal women volunteers primed for 7 days with estradiol valerate (2 mg daily orally) which was continued throughout the study. A control group received estrogen only and a reference group estrogen with 60 mg tamoxifen for 5 days. No treatment opposed the action of the estrogen on the endometrium but both 68 mg toremifene and 60 mg tamoxifen statistically significantly decreased the maturity index of vaginal cells on day 13. A decrease was also evident on day 18 with 20 mg toremifene.

Endometrial stromal sarcoma: a report of nine cases.

Nine cases of endometrial stromal sarcoma are described. Four of the patients were categorized as having a uterine endolymphatic stromal myosis (ESM) with less than 10 mitoses per 10 HPF and five patients as having an endometrial stromal sarcoma (ESS) with more than 10 mitoses per 10 HPF. Another prognostic distinction based on the degree of stromal differentiation is also discussed. The symptomatology, diagnostic means, clinical features, and treatment are described.

Malignant pericardial effusion in ovarian carcinoma cured by systemic chemotherapy.

A case of malignant pericardial effusion in a 67-year-old patient with serous ovarian cystadenocarcinoma is presented. Pericardial effusion was treated successfully with cyclophosphamide, doxorubicin, and cisplatin. The primary tumor had previously been assumed to be sensitive to this combination by using an in vivo predictive test, the subrenal capsule assay.

Abdominopelvic actinomycosis associated with intrauterine devices. Two case reports.

Two case reports of abdominopelvic actinomycosis associated with an intrauterine device (IUD) are presented. In the first case, the association was difficult to establish and in the second one, a pelvic malignancy was suspected. The diagnosis and treatment of IUD-associated abdominopelvic actinomycosis are discussed on the basis of the present cases and the literature.

Serum free estriol inefficient in the detection of intrauterine growth retardation.

The value of a single serum free estriol (E3) measurement in the detection of intrauterine growth retardation (IUGR) was investigated. Among the group of 40 mothers later giving birth to a growth retarded baby, E3 was low, i.g. below the level of two lower standard deviations of the mean values, in 9 cases. In the control group of 50 mothers with appropriately grown newborns, none of the E3 values was low. In a group of 42 mothers with a low E3 level, only 10 gave birth to a growth retarded baby. Hence, the sensitivity of a single E3 measurement to detect IUGR is 38%, the specificity 61% and the predictive value 37%. E3 measurement is neither efficient nor accurate in the detection of IUGR.

Effect of low dose endometrial after-loading irradiation upon the hypophysis-ovarian axis.

Endometrial inactivation by irradiation, while simultaneously preserving the ovarian function is sometimes clinically indicated. We have found that after 1100 cGy (rad) the ovarian function remains intact, yet endometrial inactivation is unsatisfactory. Therefore, four premenopausal subjects, with clinical indications for eliminating disturbing uterine bleedings, received each an endometrial dose of 1600 cGy by using a Cathetron afterloading unit. When pre- and post-treatment cycles were compared, the circulating gonadotrophin and estrogen levels were unchanged in three subjects. Nine to 12 weeks after the treatments there were no signs of ovulation and the gonadotrophin levels were generally increased. None of the subjects had experienced any bleedings. We conclude that an endometrial dose of 1600 cGy is effective in inactivating endometrium, but may also lead to an impaired ovarian function and to a premature menopause.

Influence of preoperative intracavitary high (Co60, Cathetron) and low dose-rate (radium) irradiation on surgical difficulties and postsurgical morbidity in patients with uterine carcinoma.

A study was made to determine whether high dose-rate afterloaded Co60 (Cathetron) can be safely used in preoperative radiotherapy for patients with St. I-II cervical or endometrial cancer without an increase in surgical difficulties or postsurgical morbidity when compared with conventional radium therapy. Seventy-five patients with cervical cancer St. Ia-IIb were operated on radically two to three weeks after preoperative intracavitary radiotherapy of which 31 had been treated with the Cathetron and 44 with radium. Furthermore, 144 patients with endometrial cancer St. I-II were also operated on, of which 49 had received Cathetron and 95 radium treatment. No statistical differences were found between the two treatment groups in the duration of the operations, blood loss, or the frequency of early or late postoperative complications.

Sexual behaviour and cervical intraepithelial neoplasia in teenagers.

Four groups of females 19 years of age were studied in order to investigate the sexual factors in the development of cervical intraepithelial neoplasia (CIN) in teenagers. Group A consisted of 101 females treated for CIN, group B of 55 females with inflammatory atypic cytology (Pap cl. II), group C of 73 women with cervical chlamydial infection, and group D of 114 females with normal cervical cytology and negative chlamydial isolation. Subjects in group A had had significantly more deliveries and legal abortions than the subjects in the other groups. They used also more often oral contraception and had been treated more often for vaginal infections than the subjects in the other groups. Coital activities in group A had started at a significantly younger age than in group D; in the latter group 40% had no history of sexual intercourse. Also the numbers of partners and the coital frequency in group A were significantly higher than in group D. Our study provides further evidence for the theory that CIN is, at least partly, a sexually transmitted disease.

A giant unhomogenous leiomyoma simulating ovarian cancer. A case report.

We describe a case of a giant unhomogenous uterine leiomyoma that simulated ovarian cancer both clinically, roentgenologically (computerized tomography) and ultrasonically. As an incidental finding there was also a carcinoma in situ of the endometrium. The difficulties in the differential diagnosis of an abdomino-pelvic mass are discussed, and the significance of laparotomy also as a diagnostic method is emphasized.

Steroid receptors and response to hormonal and cytotoxic agents in vitro in two cases of androblastoma.

Cytosol steroid receptor contents of 2 tubular androblastomas were determined and that was correlated with the response to hormonal (tamoxifen and medroxyprogesterone acetate) and cytotoxic agents (chlorambucil, vincristine, cisplatin and etoposide) using a new in vitro method based on ATP measurement of cultured cells. Both androblastomas showed low receptor contents and no response to medroxyprogesterone acetate, tamoxifen or their combination was found. Furthermore, there was no response to chlorambucil or vincristine or their combination as well as to the combination of tamoxifen and vincristine in one tumor. The other tumor, however, showed good in vitro response to cisplatin and the combination of cisplatin and etoposide.

Genital herpes infection simulating cervical cancer. Case report.

A severe case of ulcerative, herpetic infection of the vagina and uterine cervix simulating cancer is described.

Colposcopic, cytological and histological evaluation of the cervical stump 3 years after supravaginal uterine amputation.

Colposcopic, cytological and histological (endocervical curettage) evaluation of the remaining cervical stump was done 3 years after 99 supravaginal uterine amputations performed for benign condition. Peroperative electrocoagulation of the endocervical mucosa had been done in all the patients and postoperative ectocervical electrocoagulation in 39 (39.4%) cases. No active inflammatory, premalignant or malignant changes were detected at the 3-year examination of the cervix. Furthermore, normal adenomatous epithelium had been wholly or partly relaced by squamous epithelium in 89% of the cases.

Intravenous leiomyomatosis.

Intravenous leiomyomatosis of the uterus with extension to the right common iliac vein in a 34-year-old woman is reported. The successful treatment consisted of abdominal hysterectomy, bilateral salpingo-oophorectomy, venotomy and extraction of 3 cm long mobile tumour from the right common iliac vein. The presence of cytoplasmic oestrogen and progesterone receptors in the tumours indicates that intravenous leiomyoma is hormone-dependent.

Ibuprofen versus placebo in the relief of post-episiotomy pain.

Thirty post-partum patients, aged 19 to 37 years, were treated for episiotomy pain and inflammation with either 1600 mg ibuprofen (400 mg every 6 hours) or placebo daily for 7 days in a completely randomized, double-blind study. Pain intensity, movement restriction and extent of swelling in the episiotomy were recorded prior to treatment and at intervals of 1, 3, 5 and 7 days. The difference scores of pain intensity, movement restriction and extent of swelling were calculated from the differences between pretreatment and post-treatment values. By all methods of evaluation, ibuprofen was significantly more effective than placebo at 1 and 3 days after the initiation of the treatment. Only 2 minor side-effects were recorded, both in the placebo group.

Operative treatment of rectal endometriosis.

27 patients with rectal endometriosis were operated upon in Turku University Central Hospital in 1967-1976. The main symptom was defecation pain especially during menstruation. Eighteen patients had had previous surgery for endometriosis of the pelvic area. A palpable tumor was found on gynaecological examination in every patient. The tumors did not grow through the rectal wall. Three kinds of operative procedures were applied (a simple excision method, a so called "window" operation, and resection of rectum) and the results were good.