Showing papers in "Acta Obstetricia et Gynecologica Scandinavica in 1964"
280 citations
TL;DR: Opinions differ as to the best initial treatment in tumours localized to the cervix and upper part of the vagina but experts seem to agree that irradiation and surgery should complement each other.
Abstract: The primary therapeutic measures generally employed in treatment of patients with invasive carcinoma of the cervix include surgical procedures, radiation therapy and a combination of radiation and surgical treatment. Infusion and perfusion with chemotherapeutic drugs of various kind have been applied in cases of advanced carcinoma but actually this therapy still has only significance from a palliative point of view. Controversy has for many years existed on the early stages while irradiation is universally employed in the more advanced cases. For the present time being experts seem to agree that irradiation and surgery should complement each other. Opinions differ as to the best initial treatment in tumours localized to the cervix and upper part of the vagina. We have to look for improved knowledge of factors which affect the healing of a cancer. This has been important since cytology, colposcopy and other tests have caused a reversal of the clinical staging percentages.
114 citations
97 citations
Journal Article•
76 citations
66 citations
50 citations
45 citations
TL;DR: November 16th, 1899, was the first time that W e r t h e i m carried out the operation which is, in all essentials, used to this very day, abdominal radical hysterectomy with removal of lymph node metastases.
Abstract: The earliest attempts at treating cancer of the cervix uteri were merely palliative. The first surgeon to tackle this disease by an operation intended to be curative was W. A. F r e u n d (1881) who performed total hysterectomy with removal of lymph node metastases. Similar operations were carried out by R i e s and C l a r k in 1895, and in 1899 W e r t h e i m elaborated the technique. November 16th, 1899, was the first time that W e r t h e i m carried out the operation which is, in all essentials, used to this very day. This operation consisted in abdominal radical hysterectomy, removing the parametrium, the paravaginal tissue and the pelvic lymph nodes. Lymph node dissection was not, however, done as a matter of routine, but in a b w t 40 per cent of the first 300 patients. We cannot but admire the men who had the courage to embark upon such formidable surgical procedures under the circumstances prevailing at the time. The primary mortality was high (25-30 per cent) and postoperative complications almost inevitable. However, it was an encouragement that now it was possible to treat a number of patients who had previously been beyond the reach of any treatment. In an effort to reduce the primary mortality and to avoid some
34 citations
34 citations
TL;DR: The author has made an attempt to assess how far the vascularization and the oxygen tension of cancer of the cervix affects the radiocurability of this specific human malignancy.
Abstract: Investigations on factors influencing the radiosensitivity and radiocurability of human malignancies have mainly been concerned with morphological characteristics as e . g. the macroscopical extent and the microscopical appearance of the tumours. In the last decade, however, attention has been focussed on some physiological factors that may be of equal importance for the outcome of radiotherapy. In experimental radiobiology it is a well established fact, that many of the changes induced in chemical and biological systems by ionizing radiation are dependent on the oxygen tension of the system. There are reasons for believing that the occurrence of hypoxic or anoxic foci in tumours may militate against their curability (Gray , 1961). The author has made an attempt to assess how far the vascularization and the oxygen tension of cancer of the cervix affects the radiocurability of this specific human malignancy (K o 1 s t a d, I 964). The material investigated comprised 30 cases of benign lesions, 51 cases of dysplasia, 109 cases of carcinoma in situ, 32 early invasive cancers, and 185 invasive cancers of the cervix. The vascularization of the tumours was studied by colpophotography. The blood oxygen tension in capillary blood samples from the tumours was determined by a spectrophotometric
33 citations
TL;DR: The rates of inflow to the vaginal cavity and outflow from the vagina were measured quantitatively and the degree of reabsorption is calculated as the difference between these two opposite processes.
Abstract: Vaginal discharge is one of the most common and most complex symptoms encountered in clinical gynaxology. The mechanisms behind the occurrence of this symptom are known only to a small extent in spite of decades of clinical and experimental research. The question will here be investigated from new aspects, with special emphasis laid on the production and pathways of the liquid phases of the contents of the vaginal cavity. It is well known that the cervix uteri secretes certain amounts of mucoid substances which contain over 90 per cent water. There is also a continuous exfoliation of watercontaining cells from the vaginal epithelium. In spite of these contributions of aqueous material into the vaginal lumen, the normal vaginal discharge is usually very small. It was therefore suspected that mechanisms might be present causing reabsorption of water from the vagina. Various aspects of this question will be investigated in this paper. The rates of inflow to the vaginal cavity and outflow from the vagina were measured quantitatively and the degree of reabsorption is calculated as the difference between these two opposite processes. Possible sites of water reabsorption from the vagina were investigated and will be discussed. Evidence obtained Supported by a grant from the Swedish Medical Research Council, project no T 253.
TL;DR: Only reliable data on the rate of progesterone production in normal pregnancy can guide attempts to compensate for a suspected progesterOne insufficiency, and from a theoretical point of view, it should be known whether the reactivity of the myometrium during human pregnancy is related to the amount of progestersone produced.
Abstract: The significance of progesterone in the maintenance of human pregnancy has been under discussion for several decades. Until recently most research in progesterone problems in the human was performed by means of urinary pregnanediol determinations in normal and abnormal pregnancies and by therapeutic trials of gestagens in threatened abortion and premature labour. It is now evident that these complicated problems must be attacked on a much broader basis, including the chemistry, production, circulation, storage, metabolism, excretion and physiology of progesterone. One of the first links in this chain of problems is the rate of progesterone production in different stages of pregnancy. This is of both theoretical and clinical significance. From a theoretical point of view, it should be known whether the reactivity of the myometrium during human pregnancy is related to the amount of progesterone produced, as it seems to be in the rabbit (Mikhail et al., I 961). From a clinical point of view, only reliable data on the rate of progesterone production in normal pregnancy can guide our attempts to compensate for a suspected progesterone insufficiency.
TL;DR: The 5HT content in the uterus and placenta of normal and toxaemic patients have been compared and the activities of 5-hydroxytryptophan decarboxylase (5HTPD) and monoamine oxidase (MAO) in toxaemia and normal cases are assessed, using 5-HydroxyTryptamine as the substrate in assessing the M A 0 activity.
Abstract: The clinical picture of toxaemia has led it to be regarded as possible that biologically active amines play a part in the pathogenesis of the toxaemic syndrome. Thus it has been attempted to elucidate the possible participation of 5-hydroxytryptamine (5HT) as an aetiological factor in toxaemia by estimating the mine in question and its metabolites in the blood and urine. In this study, the 5HT content in the uterus and placenta of normal and toxaemic patients have been compared. We have also tried to assess, if there are in the same tissues any differences between the activities of 5-hydroxytryptophan decarboxylase (5HTPD) and monoamine oxidase (MAO) in toxaemic and normal cases, using 5-hydroxytryptamine as the substrate in assessing the M A 0 activity.
TL;DR: An evaluation of operative therapy yersus radiotherapy is necessary today, as indeed it has been for decades, in the management of gynaecological tumours.
Abstract: Vcry common types of cancer in women are those of the corpus uteri and of the cervix (3,686 registered cases in Finland in 1953-1958) and the development of methods for their treatment is of primary importance. An evaluation of operative therapy yersus radiotherapy is necessary today, as indeed it has been for decades, in the management of gynaecological tumours. In previous years tlie general opinion was completely in favour of surgery; excision of the lumour appeared to be essential. Now t h a t improved in\-cstig:ition methods make i t possible t o establish with increasing accuracy the mode of spread of tumours, i t is possible tha t operalivc tlicrapy lias reached its maximum usefulness considering the prcscnt state of knowledge and the technical facilities of surgical tren tmcnt. I t is known tha t many apparently localised tumours Iiavc in reality already become more widespread, and tumour tissue may be encountered unexpectedly a t operation. Although suspect pelvic lymph nodes are removed as far as possible, not all thcni can be scen, palpated or otherwise identified. Of course, there will always be cases in which operation is clearly indicated and it is often tlie correct procedure in the initial phases. IYhat is tlicre to replace surgery? Many claim t h a t radiotherapy also often leaves something to be desired. However, radiotherapy has rcceiitly entered a phase of promise. The new high-energy and high-efficiency radiation units make it possible to give the desired
TL;DR: In this article, post-Natal Subgaleal Haematomas were identified as the most common cause of haematoma deaths in women in Scandinavia and Sweden.
Abstract: (1964). Post-Natal Subgaleal Haematomas. Acta Obstetricia et Gynecologica Scandinavica: Vol. 42, No. 4, pp. 358-366.
TL;DR: The results relating to serum uric acid in pregnancies accompanied by hyperemesis, toxsemia and pre-eclampsia are less clearcut, but the majority of authors have reported that the uric Acid concentration in the serum is elevated in these conditions, particularly in severe cases of toxemia.
Abstract: (1964). Serum Uric Acid in Toxaemia of Pregnancy With Special Reference to the Prognosis of the Fœtus. Acta Obstetricia et Gynecologica Scandinavica: Vol. 43, No. 4, pp. 330-337.
TL;DR: According to the Finnish cancer register 1876 cases of invasive carcinoma of the cervix were diagnosed in Finland during the years 1953-1957, and 33.2 per cent of them were treated at the First and the Second Women’s Clinic, Central Hospital, University of Helsinki.
Abstract: According to the Finnish cancer register 1876 cases of invasive carcinoma of the cervix were diagnosed in Finland during the years 1953-1957, and 33.2 per cent of them were treated at the First and the Second Women’s Clinic, Central Hospital, University of Helsinki. The number of such cases treated at the Women’s Clinic in 1953-1958 was 741 [or 753, if the twelve hopeless cases mentioned below are included). The treatment was partly surgical, partly radiological. The distribution of the patients into groups according to the stage of carcinoma is given in Table I. The table shows that carcinoma of the cervix of Stage III was present in 26 per cent of the cases, a percentage which, in spite of an intensive publicity campaign and numerous mass examinations, remained almost as high as the frequency recorded by Tu T t o 1 a and Put kin e n for the corresponding cases treated at the Women’s Clinic in 1941-1952. This high frequency impairs the results obtained. K ah a n p a a and T ur t o 1 a reported carcinoma of the cervix of Stage 111 in as many as 37 per cent of the cases treated at the Radiological Clinic of the University of Helsinki in 1942-1949, whereas the corresponding figure was much lower, 20.9 per cent, in the series of cases from the year 1964 reviewed by Kottmeier.
TL;DR: In an investigation of the vascularization and oxygen tension in preinvasive and invasive carcinomas of the cervix, the author has employed this method since 1960 and 671 biopsies from photographically clearly definable areas were available for analysis.
Abstract: At The Norwegian Radium Hospital, a refined colpophotographical method was introduced in 1956 with the aim to get an objective registration of the vascular patterns of the cervix in normal and pathological conditions (K o 11 e r, I 963). In an investigation of the vascularization and oxygen tension in preinvasive and invasive carcinomas of the cervix, the author has employed this method since 1960. In a material comprising 335 patients with: benign lesions (27) , dysplasia (45), carcinoma in sin! (95), early invasive carcinoma (20 ) , and invasive carcinoma of the cervix (14s)~ approximately 6000 colpophotographs were taken. The pictures were enlarged ten times as related to the object plane and put together into composite photographs covering the whole lesion of each case. After exposure of the pictures, two or more colposcopically selected biopsies were taken from different sites of each lesion. The sites were carefully mapped out in a sketch and afterwards in the composite photographs. The interpretation of the colposcopical and the histological pictures were made by two independent observers. Altogether 671 biopsies from photographically clearly definable areas were available for analysis. The results are shown in the following Tables. Punctation (ground) and mosaic terminal vessels (for definitions: see K o 1-
TL;DR: The main purpose of the present report is to describe similar changes occuring in the earlier stages of pregnancy, and the effect of aminoguanidine upon the urinary excretion of histamine.
Abstract: In a previous paper we reported some observations on changes in blood and urinary histamine during the last weeks of normal and pathological pregnancies, and in the puerperium (B j u r 6, Lindberg and West l ing, 1961). The main purpose of the present report is to describe similar changes occuring in the earlier stages of pregnancy, and the effect of aminoguanidine upon the urinary excretion of histamine. In addition a few observations on the urinary excretion of 5-hydroxyindoleacetic acid are reported.
TL;DR: Combined therapy in gynzcologic tumours has been used with increasing frequency since 1947 and has not found the procedure to possess any serious disadvantages; the results of treatment have continuously improved.
Abstract: The treatment of malignant growths may be either a radiotherapeutic or a surgical problem, depending on the site, the size of the growth, and the extent to which it has spread along the lymphatics and blood vessels. Radiotherapy in combination with surgery has been discussed and considered by many as unwise. At the Gynecologic Department of Konung Gustaf V:s Jubileumsklinik, Lund, Sweden, however, combined therapy in gynzcologic tumours has been used with increasing frequency since 1947. We have not found the procedure to possess any serious disadvantages; on the contrary, the results of treatment have continuously improved.