Endometrial carcinoma: clinical-pathologic comparison of cases in postmenopausal women receiving and not receiving exogenous estrogens

Clinical and pathologic findings were compared in 43 postmenopausal endometrial carcinoma patients who had received exogenous estrogens prior to diagnosis and 79 similar patients unexposed to estrogens. Estrogen non-users were more likely to manifest lower parity, later menopause, obesity, hypertension, and diabetes, all of which have been considered to be constitutional risk factors for the development of endometrial carcinoma. Although estrogen users and non-users had similar extent of disease as judged by clinical stage, there was a tendency to more myometrial invasion in hysterectomy specimens from non-users, as well as greater frequency of unfavorable histologic types and grades of tumor. At short-term follow-up, more recurrences occurred in non-users, and this tendency appeared to be independent of clinical stage, histologic type, histologic grade, or modality of treatment. The significance of these and other observation to the determination of the risk-benefit ratio for estrogen administration is discussed.

Redistribution of cardiac output and oxygen delivery in the hypoxemic fetal lamb

In hypoxia, fetal cardiac output and the product arterial O2 content x blood flow to the fetal heart and central nervous system (CNS) tend to remain constant. As a consequence the percentage of cardiac output directed to the heart and CNS increases hyperbolically in inverse relation to the oxygen content of the fetal ascending aorta, [O2]as. The fetal lamb maintains [O2]as approximately 0.45 mM (0.45 +/- 0.02 SEM) higher than the O2 content in the abdominal aorta, [O2]ab, over a wide range of oxygenation. When [O2]as decreases below the 2 mM level, the [O2]as--[O2]ab difference (delta O2) decreases also. A mathematical model of the fetal circulation shows that delta O2 is a function of the ratio oxygen consumption of fetal upper body/abdominal aorta blood flow (VU/FA). The behavior of delta O2 in hypoxia can be explained by assuming that the VU/FA ratio is maintained in moderate hypoxia and decreases in sever hypoxia.

Blood flow to fetal organs as a function of arterial oxygen content

In a sheep preparation the blood flow to fetal organs was studied 3 to 10 days after surgery by means of the microsphere technique over a range of fetal arterial O2 content from 6 to 1 mM. Blood flows to neural tissues (cerebrum, cerebellum, brain stem), heart, and the adrenals increased in inverse relation to arterial O2 content. As a result the arterial supply of O2 to these organs tended to remain constant over the O2 range studied. Blood flow to the fetal lungs decreased progressively with hypoxia. The blood flow to kidneys, digestive tract, pancreas, and carcass had a tendency to remain constant or increase gradually in the transition from high to moderately low levels of arterial O2 content and then to decrease abruptly in more severe hypoxia. Umbilical blood flow did not change systematically in relation to arterial O2 content.

Utilization of gyniatricians as primary health care providers for women

The role, functions, activities, educational preparation and relationship with other health professionals of a new type of primary health care provider is described. The name gyniatrician has been applied to this kind of physician, who will be qualified to provide overall primary health care for women from the onset of puberty through adult life.

Regulation of cerebral blood flow in the ovine fetus

The effects on fetal cerebral blood flow (Qc) of changes in the carotid arterial and sagittal sinus venous PO2, PCO2, and oxygen content were studied in the chronically catheterized ovine fetus in utero at 130-140 days of gestation. Forty-seven measurements of Qc were made in 20 fetuses with radioactive microspheres. In 11 of these animals, 84 measurements of cerebral arteriovenous differences of oxygen content were performed, permitting an indirect measurement of cerebral blood flow (Qc*), assuming a constant cerebral metabolic rate. Arterial and, in 11 animals, sagittal sinus blood was withdrawn for analysis of PO2, PCO2, oxygen content, and pH at the time of the flow measurements. Preliminary analysis showed the best predictor of Qc and Qc* to be the reciprocal of the arterial oxygen content (1/CaO2). Multiple linear regression analysis combining the effects of 1/CaO2 with arterial PCO2 (PaCO2) gave the following equations: Qc = 458.8 (1/CaO2) + 2.68 PaCO2 - 107.93 (R2 = 0.68); Qc* = 435.54 (1CaO2) + 2.20 PaCO2 - 75.03 (R2 = 0.86). As a result of the hyperbolic relationship between Qc (and Qc*) and CaO2, changes in CaO2 at the low levels found during intrauterine life exert an important influence on the fetal cerebral circulation.

Cryocoagulation of the endometrium at the uterine cornua

A cryoprobe that will produce coagulation necrosis and subsequent scar formation of the cornual areas of the uterus has been tested. A discussion is made of the developmental program, including the design of the instrument, efficacy and safety testing in baboons, and preliminary investigations of the safety of this procedure in man.

Fetal cerebral oxygen consumption at different levels of oxygenation

Cerebral oxygen consumption (VCO2) was measured in 10 unanesthetized, chronically catheterized fetal sheep at 130-140 days of gestation. The VCO2 was calculated using cerebral blood flow (QC) measured with radioactive microspheres and the cerebral arteriovenous difference of O2 content (C(a-V)O2) calculated from preductal arterial and sagittal sinus venous blood. The ewe was exposed to varying concentrations of oxygen, resulting in fetal arterial oxygen contents (CaO2) of 0.89-5.58 mM, arterial oxygen tension (PaO2) values of 14-36 Torr, and cerebral venous oxygen tension (PVO2) values of 9-25 Torr. Although there was a clear relationship between the fetal CaO2 and C(a-V)O2, this was shown to be the result of changes in Qc rather than changes in VCO2. There was not a statistically significant correlation between either CaO2 or PVO2 and VCO2 over this range of oxygenation. On the other hand, C(a-V)O2 was highly correlated with Qc. There is no evidence that VCO2 is a function of oxygen tension (PO2) in the unanesthetized fetal sheep as long as the sagittal sinus PO2 is greater than or equal to 9 Torr.

Endometrial carcinoma in women under 40 years of age: comparison of cases in oral contraceptive users and non-users

Women under 40 years of age rarely develop carcinoma of the endometrium, this age group comprising less than 3% of all cases in most large series. The Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents has recorded and studied 30 cases in women under 40 with a history of oral contraceptive administration, and these are compared with 25 cases in the same age group which were accessioned at the Armed Forces Institute of Pathology prior to the era during which these agents have been available, and with series reported in the literature totaling 137 cases with no contraceptive history. In the first group, special attention is paid to the 20 women who received sequential agents exclusively or predominantly, since the association with these agents (primarily Oracon) is much higher than would be expected from the fact that less that 10% of oral contraceptives used in this country are of the sequential type. An analysis of the three groups reveals a similar incidence of the various histologic types (primarily well differentiated tumors with a relatively favorable prognosis), the only difference being the presence of secretory features in 14 of 29 oral contraceptive users vs. only two of 25 women not taking these agents. Clinical and pathologic staging were also predominantly favorable, and comparable in all groups. There were, however, notably higher incidences of nulliparity, obesity, and sclerocystic ovaries--all features traditionally associated with endometrial carcinoma--in the patients not receiving oral contraceptives or receiving combined agents, suggesting that the group receiving sequentials may not represent the same constitutionally predisposed population. Only three of 55 women among our personally reviewed cases have thus far died of cancer (one in the contraceptive group and two in the non-user group) and all three of these had poorly differentiated tumors with myometrial invasion. The excellent prognosis for most patients in this age group is thus confirmed.

The effect of various vasoactive compounds upon the uterine vascular bed

The effects of various vasodilators on the uterine vascular bed were investigated in nonpregnant, oophorectomized sheep with chronically implanted flow probes and catheters inserted into branches of the uterine arteries. A 1 mug dose of estradiol-17beta (0.224 muM) produces a maximum uterine blood flow response after intra-arterial injection. Adenosine (24 muM) and bradykinin (0.02 muM) were observed to increase blood flow to levels achieved by 1 mug of estradiol-17beta. Acetylcholine, isoproterenol, and histamine were less potent in their vasodilator activity. Atropine, propanolol, and diphenhydramine did not inhibit the increase of uterine blood flow induced by estrogens.

Effect of estradiol-17beta on blood flow to reproductive and nonreproductive tissues in pregnant ewes

The effect of estradiol-17beta (1 mug per kilogram) on regional blood flow and cardiac output was studied by means of radionuclide-labeled microspheres in 6 nonpregnant and 13 pregnant ewes five to seven days after operation. Estradiol caused vasodilation in myometrium, endometrium, and placental cotyledons throughout pregnancy, but these responses were significantly less than the fifteenfold increase seen in the nonpregnant uterine tissues. Significant vasodilation also occurred in the ovaries, cervix, vagina, uterine tubes, mammary gland, skin, and adrenal glands of pregnant ewes. Cardiac output increased by 14%. No significant change in uterine oxygen consumption was associated with the increase in blood flow to the pregnant uterus.

Mammary blood flow and endocrine changes during parturition in the ewe

The temporal relationship between changes in mammary blood flow (MBF) and changes in the concentration of plasma prolactin, progesterone, estradiol-17beta, and cortisol, was examined in chronic sheep preparations undergoing spontaneous labor (Group I) or labor induced by an infusion of dexamethasone (1 mg/24 h) to the fetus (Group II). In Group I, an increase in prolactin (45 to 489 ng/ml), a decrease in progesterone (15 to 4 ng/ml), and an increase in MBF (97 to 365 ml/min) occurred at about the same time, whereas increases in estradiol-17beta (80 to 211 pg/ml) and cortisol (9 to 39 ng/ml) followed the change in MBF. A similar pattern of changes in MBF and hormonal concentrations occurred over a shorter period when premature labor was induced in the animals in Group II. These findings suggest that changes in plasma prolactin and progesterone concentrations play an important role in the regulation of MBF at the time of parturition.

Endometrial carcinoma in young women taking oral contraceptive agents

The first 21 cases recorded in the Registry for Endometrial Carcinoma in Young Women Taking Oral Contraceptive Agents are reported. We have found no other such cases in the literature, and indeed several authors have stated that these agents, because of their predominantly progestional action, would be expected to be protective against this disease. In 8 of the 21 patients, factors were present which militated against a close relation between oral contraceptives and carcinoma, and 5 of these 8 patients had taken only or predominantly combined agents. On the other hand, 11 of the remaining 13 patients took sequential agents, a ratio directly opposite that of the usage of combined and sequential agents in the American population. The possible reasons for the excess of sequential agents, chiefly Oracon, are discussed, and directions for future study are suggested.

Relationship of mammary blood flow to parturition in the ewe

Mammary blood flow was measured in conscious, unanesthetized ewes with electromagnetic flow probes prior to spontaneous labor (four animals) or during the induction of premature labor (four animals) by administration of dexamethasone, 1 mg/24 h, to the fetus. In all animals an increase in mammary blood flow was noted prior to delivery. Dexamethasone administered to one mother in the same dose did not induce labor or produce an increase in mammary blood flow. These results suggest that the fetal adrenal gland influences maternal mammary blood flow prior to delivery.

Cerebral metabolism in sheep: a comparative study of the adult, the lamb, and the fetus

The cerebral uptakes of glucose, oxygen, lactate, pyruvate, acetoacetate and beta-hydroxybutyrate were compared in the adult, the fetal, and the newborn sheep. Beginning 1-2 days after surgery, we withdrew samples simultaneously from an artery and from the sagittal sinus for up to 2 wk. At all ages glucose was the only substrate taken up in significant quantity relative to oxygen. The glucose-oxygen quotients were 0.98 less than 1.03 less than 1.08 in adults; 0.92 less than 0.99 less than 1.06 in lambs; 0.92 less than 0.98 less than 1.03 in fetuses. These quotients were not significantly different. There was a significant (P less than .05) arteriovenous difference for lactate in the adult (-0.031 mM), but not in the lamb or fetus. A significant (P less than .05) arteriovenous difference pyruvate was found in the adult (-0.013 mM) and in the fetus (-0.020 mM). The findings of a glucose-oxygen quotient of approximately 1 and the lack of significant lactate production in fetal sheep brain are consistent with the hypothesis that anerobic glycolysis is unimportant to the steady-state cerebral metabolism of the fetal sheep.

The effect of actinomycin D on estrogen-induced uterine blood flow

The effect of actinomycin D on estrogen-induced uterine blood flow was studied in four nonpregnant, oophorectomized sheep, utilizing electromagnetic flow probes chronically implanted around the uterine arteris. Two hours after the intravenous injection of 1 mug of estradiol-17beta per kilogram of body weight, incorporation of [3H]-uridine into RNA was two- to threefold higher (2.7 plus or minus 0.4 S.E.M.) in the control horn than the uterine horn that had received an intra-arterial injection of actinomycin D. Actinomycin D had no effect on the estrogen-induced increase in uterine blood flow.

Cord blood coagulation studies in infants of high-risk pregnant women

A prospective study of cord blood for coagulability, evidence for disseminated intravascular coagulation (DIC), and hematocrit was done in 106 infants who were offspring of mothers with high-risk pregnancies (pre-eclampsia, diabets mellitus, third-trimester bleeders, severe erythroblastosis fetalis, maternal hypertension, fetal distress, and spontaneous premature labor). Significant changes of hypercoagulability (low AT-III and abnormal TEG) were seen in the third-trimester bleeder and premature labor groups which also had the highest incidence of IRDS and necrotizing. Infants undergoing "stress" (pre-eclampsia, fetal distress) had elevated levels of factors V and VIII but were not hypercoagulable or AT-III deficient. Except for mild thrombocytopenia, infants of the diabetic mothers, a group with increased thrombotic complications, did not show any cord blood abnormalities. Offspring of third-trimester bleeders were anemic. The EBF infants were also anemic, severely hypercoagulable, and showed coagulation changes compatible with severe liver disease and/or DIC. Mild changes compatible with intravascular coagulation were seen in six infants and were not related to the the development of IRDS.

The glucose/oxygen quotient of the term human fetus

Glucose/oxygen quotients were obtained at repeat elective cesarean section from appropriately grown, normoxemic term human fetuses. The mean glucose/oxygen quotient for these 11 fetuses was 0.81. Umbilical arterial glucose concentration and the maternal-fetal glucose concentration gradient were found to be functions of the maternal venous glucose concentration. Umbilical blood samples obtained following labor and vaginal delivery may not represent the normal metabolism of the fetus prior to the onset of labor. Similarly, samples obtained at cesarean section may not be representative if fetal hypoxemia associated with transient maternal hypotension occurs.

Growth of uterine oxygen and glucose uptakes during pregnancy in sheep

The growth of uterine oxygen and glucose uptakes (Qo₂, Q glucose) throughout pregnancy was determined in sheep with chronically implanted uterine artery electromagnetic flow probes and arterial and uterine venous catheters. The flow probe measurements were corrected to total uterine blood flow by means of an equation based on simultaneous flow probe and radioactive microsphere determinations. Uterine Qo₂, and Q glucose increased logarithmically as gestation progressed. During the last third of gestation, the mean Qo₂ for twin pregnancies was 44<i>%</i> higher than Qo₂ for single pregnancies. In the last 3 weeks of gestation the uterine glucose/oxygen quotient was 0.76 (95<i>%</i> confidence limits 0.65–0.87), which is significantly less than one and significantly greater than the 0.46 umbilical glucose/oxygen quotient determined in previous studies. This result indicates that substrates other than glucose are used in large amounts in order to satisfy the requirements of uterine oxidative metabolism in late pregnancy and that the placenta has a relatively high glucose/oxygen quotient. Uterine arteriovenous differences of fructose and pyruvate measured at intervals throughout gestation revealed that there is no significant uptake of these substrates by the pregnant uterus.

Circulatory changes in the reproductive tissues of ewes during pregnancy

The blood flows to reproductive organs were measured by means of radionuclide-labeled microspheres in 24 pregnant ewes with gestational ages ranging from 38 to 141 days. The microspheres were injected in the left ventricle of the non-anesthetized animal 4–7 days after surgery and while uterine blood flow was recorded continously by means of electromagnetic probes on both uterine arteries. The blood flow to ovaries with corpus luteum was maximum in early pregnancy and greater than in ovaries without corpus luteum. Placental blood flow increased from &#8764;30 to &#8764;300 ml/min during the stage of placental growth (40–90 days). In the last 50 days of pregnancy placental weight declined, whereas placental flow continued to rise and attained &#8764;1,500 ml/min near term. The growth curves of fetal weight and placental blood flow followed a similar pattern, but the early increase in placental flow was more rapid than the increase in fetal weight. Hence placental flow per gram of fetus was larger in early pregnancy (&#8764;9 ml/min&#183;g) than near term (&#8764;0.25 ml/min&#183;g). In twin pregnancies the placenta of each fetus received a smaller blood flow than the placenta of a singleton of comparable age. Mammary blood flow demonstrated no change until the last 60 days, when it increased from &#8764;10 to &#8764;200 ml/min. This phenomenon coincided with an increase in mammary weight and the final progressive increase of placental blood flow.