bluuebunny/crossref_metadata_2025 huggingface dataset:
Supra Vaginal Uterine Amputation VS. Hysterectomy
Authors: Kilkku Pentti , Grönroos Matti , Hirvonen Toivo , Rauramo Lauri
Published: December 2009

Abstract. Postoperative symptoms of hysterectomy have received relatively little attention. In the present study, the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with sup‐ravaginal uterine amputation preoperatively and 6 weeks, 6 months and 12 months postoperatively. Participation in the follow‐up study was 99.5% (211/212) at one year. This paper deals with the effects of the two operations on libido and the frequency of orgasms. In the statistical analysis, McNemar's test of symmetry and the Fisher exact test were used.

Weak or absent libido was reported preoperatively by 28.0% of hysterectomy patients and by 26.4% of amputation patients. One year postoperatively the corresponding figures were 35.4% and 31.4%. No statistical changes were observed between the two groups or within either group. In the frequency of orgasms a highly significant (p < 0.001) reduction from the situation before operation to one year postoperatively was detected after hysterectomy. In the supravaginal amputation group no statistically significant decrease was detected. Preoperatively the two groups were alike; one year postoperatively the difference was almost significant (p<0.05).

The reductions in orgasms after hysterectomy as compared with supravaginal amputation appears to result from the greater radicality of the former; at hysterectomy, the autonomous innervation of the proximal vagina and cervix is damaged more than in supravaginal amputation, the anatomy of the vagina is altered and scar tissue forms in the vagina. It is probable that these changes and subconscious psychological reactions due to total removal of the uterus explain why supravaginal uterine amputation gives better results than hysterectomy.
Serum Estriol Level During Treatment with Pivmecillinam
Authors: Kjer J. J.
Published: December 2009

Abstract. Asymptomatic bacteriuria in pregnant women shall always be treated, because of the risk of development of acute pyelonephritis. Some antibiotics reduce the level of serum estriol and therefore are less suitable in the treatment of cystitis in the last trimester of pregnancy. Mecillinam is found effective against the most frequent urinary pathogen in cystitis in pregnancy (escherichia coli), and as it is found not to reduce the level of serum estriol it is concluded that pivmecillinam/mecillinam is an alternative in the treatment of symptomatic and asymptomatic urinary tract infections in the last trimester of pregnancy.
Endometrial foam Cells
Authors: Ashkenazy Michael , Lancet Moshe , Borenstein Richard , Czernobilsky Bernard
Published: December 2009

Abstract. Four patients with endometrial foam cells are described. In one the endometrium was obtained after parturition. It showed decidua and endometritis, whereas in the second patient, who had received birth control medication in the past, the endometrium was proliferative. In both cases there was a considerable amount of endometrial hemorrhage. The foam cells in these two patients had little granularity, and their cytoplasm contained hemosiderin. The other two patients received exogenous estrogen and presented with endometrial hyperplasia and adenocarcinoma. In these latter cases the foam cells were more granular, and contained no hemosiderin. Our findings confirm the presence of two types of histologically similar endometrial foam cell: a histiocytic, “non‐estrogenic” reactive type capable of phagocytosis, and a stromal, “estrogenic” non‐phagocytic type which is associated with hyperplasia or carcinoma and which may also be related to estrogen administration. Staining for hemosiderin may be particularly helpful in differentiating between the two types of foam cell. Such a differentiation is of practical importance because of the biologic significance attached to the “estrogenic” foam‐cells which are usually indicative of endometrial hyperplasia or carcinoma.
Corpus Luteum Insufficiency as a Cause of Nidatory Failure
Authors: Kusuda M. , Nakamura G. , Matsukuma K. , Kurano A.
Published: December 2009

Abstract. To assess the clinical significance of corpus lute‐um insufficiency (CLI), 612 women with infertility but otherwise without ovulatory defects, organic disturbances, or other untoward factors were evaluated. The procedures included endometrial biopsy (E. Bx.), and monitoring of serum progesterone (Pr) and estradiol‐17β (E2) levels in association with the patterns (I to IV) of basal body temperature (BBT) chart.

The incidence of CLI varied depending on the method of evaluation. From the BBT, 65.4% of the 612 women were considered to have a CLI (patterns II, III, IV), but the short luteal phase (pattern IV) was detected in only 8.1%. The incidence of endometrial inadequacy determined by Noyes' criteria differed according to the method of dating, viz., premenstrual or postovulatory dating. Of 49 women with pattern IV, retarded endometrium was found in 65% according to premenstrual dating, as compared with only 10% according to postovulatory dating. Thirty‐one women became pregnant in the cycle of E. Bx., and only 3 aborted in the first trimester. 84% were dated postovulatorily as day ±0 to day —2. No specific features were observed in the E. Bx. in the cycle of conception. The Pr and E2 levels in the mid‐luteal phase were in the pattern order I, II, III, IV, but significant differences (p<0.05) were seen only between patterns I and IV. E. Bx. obtained twice in the same cycle in 85 women revealed that in 48% of those with the retarded type in the mid‐luteal phase, consistent endometrium was found in the late luteal phase and all 4 cases with an accelerated type in the mid‐luteal phase were of the consistent type in the late luteal phase. These results suggest 1) the importance of obtaining two specimens in the same cycle, on the basis of an accurate determination of the ovulatory day, 2) the endometrium is best prepared for nidation on day ±0 to day — 2 as defined by postovulatory dating, 3) the criteria of endometrial dating of Noyes. et al. for patients with a short luteal phase are not applicable.
Feto‐Maternal Plasma Oxytocin Levels in Normal and Anencephalic Pregnancies
Authors: Otsuki Yoshiro , Tanizawa Osamu , Yamaji Kenji , Fujita Masakazu , Kurachi Keiichi
Published: December 2009

Abstract. In 4 women with anencephalic fetuses, the oxyto‐cin level was measured in the maternal plasma in the second stage of labor and in the umbilical artery (UA) and umbilical vein (UV) by radioimmunoassay (RIA). In these cases, the mean maternal OT level was 13.4±8.0 μU/ml (mean ±S.E.), which was not significantly different from the OT levels in cases of normal spontaneous birth and elective cesarean section. The UA and UV plasma OT levels in these cases were below the detectable level (<2μU/ml), whereas in normal spontaneous births, they were 18.2±4.9 μU/ml and 12.2±2.3 μU/ml, respectively. The OT level in the UA was higher than that in the UV. There was no difference between the mean OT levels in patients with, versus those without contractions, but the plasma OT levels in the second stage of labor were higher than those in the first stage. In normal pregnancies the plasma OT concentration increased during parturition. These results suggest that pla‐cental transfer of maternal plasma OT to the fetal circulation is limited, and that in cases of anencephalic fetuses, maternal labor does not necessarily require fetal OT as a trigger or for its maintenance.
Incidence and Diagnosis of Deep Vein Thrombosis Associated with Pregnancy
Authors: Kierkegaard Asbjörn
Published: December 2009

Abstract. The incidence of deep vein thrombosis (DVT), diagnosed by ascending phlebography, has been calculated retrospectively in a group of 14 869 obstetrical patients. The incidence was calculated to 0.13 per thousand antepartum and 0.61 per thousand postpartum. The study revealed that clinical signs and symptoms of thrombosis are very unreliable in pregnant women but more reliable in puerperal women. It is concluded that objective diagnosis of thrombosis is important in pregnant women, and ascending phlebography is a rewarding objective method to use in pregnant women.
Priming and Induction of Labor with Oral PGE2 in Patients with Low Bishop Score
Authors: Somell C. , Larsson B.
Published: December 2009

Abstract. Oral prostaglandin in hourly doses of 0.5 mg PGE2 was given to 58 patients with an initial Bishop score of five or less, for two 12‐hour periods in order to prime the cervix. After priming, the patients were induced with oral PGE2; 90% of these patients were delivered. In a control group comprising 59 patients induced with oxytocin, the delivery rate was only 51%.
Epicutaneous Application of A2358 Compresses Containing Ketocaine for Pain Relief in Labor
Authors: Jouppila R. , Nuoranne E. , Tervilä L. , Gustafsson B.
Published: December 2009

Abstract. In the present multicenter trial 147 primigravidae were treated for low‐back pain during the first stage of labor. 72 parturients were treated with A2358 compresses containing ketocaine, which were applied to the sacral lower‐back region for one hour, 75 parturients were treated identically with compresses without the anesthetic drug.

The pain relieving effect was almost the same in both treatment groups. The low‐back pain was alleviated in about half of the mothers at 0.5, 10 and 1.5 hours after the application of both A2358 or control compresses. Supplementary analgesics had to be administered in about 60% of the parturients in both groups. The results show that factors other than ketocaine are involved in pain relief after application of A2358 compresses.
A Comparison Between Oral Ketoconazole and Topical Miconazole in the Treatment of Vaginal Candidiasis
Authors: Puolakka Jukka , Tuimala Risto
Published: December 2009

Abstract. Oral ketoconazole and topical miconazole were compared in the treatment of vaginal candidiasis, in an open trial. One group (n = 49) received of ketoconazole, 400 mg per day for 3 days, another group (n = 42) ketoconazole 200 mg per day for 6 days and the third (n = 49) miconazole vaginal tablets (100 mg) one per day for 14 days. One week after conclusion of the treatment the mycological cure rates (67%, 78% and 81%) were not statistically different from each other. The recurrence rates assessed one month after the treatment were also of same order (7%, 7% and 15%) and did not differ significantly from each other. Those patients who had previous had candidiasis showed lower cure rates than patients with their first vaginal candidiasis, following both miconazole and ketoconazole therapy. No adverse reactions attributable to the drugs were recorded. The advantages of ketoconazole in the treatment of vaginal candidiasis are: oral route of administration, short duration of the therapy (3‐6 days), high therapeutic effectiveness and lack of any significant side effects.
Spiral Artery Lesions in Relation to Metabolic Control in Diabetes Mellitus
Authors: Björk O. , Persson B. , Stangenberg M. , Václavínková V.
Published: December 2009

Abstract. Decidual and intramyometrial spiral arteries from 18 insulin‐dependent diabetic and 18 non‐diabetic women were compared histologically. All women were normoten‐sive and none had signs of pre‐eclampsia. None of the infants in either group had intra‐uterine growth retardation. Metabolic control in the diabetic women was assessed by pregnancy glucose level from the last trimester of pregnancy and by C‐peptide in amniotic fluid and cord blood as a measure of the fetal beta‐cell function. The intramyometrial and decidual parts of the spiral artery were normal in the non‐diabetic group. None of the diabetic patients showed pathological changes in the intramyometrial part of the spiral artery. Two of the 18 diabetic patients had pathological changes (intramural fibrosis) in the decidual portion of the spiral artery. These two women had signs of diabetic angiopathy (White's class D and F) and in one of them, the background diabetic retinopathy progressed markedly during pregnancy. The pregnancy glucose level was above normal (>6.2 mM/1) in 3 of 18 diabetics. The C‐peptide values in amniotic fluid and cord blood were above normal in 11 of 17 and in 5 of 17, respectively. Both patients with spiral artery lesions had pregnancy glucose levels in the upper range, 5.86 and 5.98 mM/1, respectively and the highest value of C‐peptide in the amniotic fluid and cord blood, suggesting exaggerated fetal beta‐cell function.
Epidural Anesthesia for Cesarean Section
Authors: Hanson A. L. , Hanson B. , Matousek M.
Published: December 2009

Abstract. Two groups of mothers who underwent elective cesarean section under epidural analgesia, were studied with the aim of comparing the analgesic potency and side effects of two solutions: morphine‐bupivacaine and morphine‐saline. Each group comprised 100 patients.

The intraoperative anesthesia was established with bupi‐vacaine plain, 5 mg/ml, in amount 85‐125 mg.

Immediately after the infant was delivered, the mothers received a single epidural dose of 3 mg of preservative‐free morphine chloride mixed with either 5 ml of 0.25% bupiva‐caine (Group I) or 0.9% saline (Group II). The intraoperative observations showed “good effect” without need for supplementation of analgesia in 82 mothers in Group I, compared with 61 mothers in Group II (p<0.001).

The postoperative observations showed that 82 mothers in Group I were satisfied with a single dose of morphine for more than 24 hours, while in Group II the corresponding number was 63 (p<0.01).

A significant difference in the incidence of nausea and vomiting was found between the groups; 7 of the mothers experienced nausea and 4 vomited in Group I and 17 experienced nausea and 13 vomited in Group II (p<0.05, for both variables). Respiratory depression was seen in one mother during surgery immediately after supplementation of morphine‐bupivacaine analgesia with ketamine. Other side effects, such as itching, bradycardia and Homer's triad were rare.

It may be concluded that a single epidural dose of morphine in bupivacaine will augment intraoperative analgesia and prolong postoperative analgesia. Less favorable results were obtained when morphine in saline was used. Synergism between bupivacaine and morphine is suggested.
Preserved Prolactin Fluctuations and Response to Metoclopramide in Ovulatory, Infertile, Hyperprolactinemic Women
Authors: Andersen Anders Nyboe , Pedersen Henning , Larsen JØRgen Falck , Djursing Henning
Published: December 2009

Abstract. The study included 18 infertile, hyperprolacti‐nemic women with preserved menstrual cycles. Among 13 women with consistently elevated prolactin (PRL) levels, 6 had either anovulatory cycles or luteal insufficiency, whereas 7 had apparently normal ovulatory cycles. Comparisons of these two groups showed that basal levels were similar but the PRL response to metoclopramide (MTC) and the day‐to‐day fluctuations were significantly lower in the group with altered oyulatory function. In this group the PRL response to MTC was significantly greater than in control patients with hyperprolactinemic amenorrhea (n = 12), but lower than in normal women (n = 10). The PRL response to MTC in hyperprolactinemic women with normal ovulatory function did not differ significantly from that of normal women, irrespective of whether hyperprolactinemia was sustained (n = 7) or intermittent (n = 5).

The study indicates that the degree of autonomy of PRL secretion reflected by both the fluctuations in basal levels and the response to a dopamine antagonist, may be used to evaluate whether or not slightly elevated PRL levels are of clinical significance in relation to fertility.
Normal and Abnormal Prolactin Levels During Human Pregnancy
Authors: Andersen Anders N. , Pedersen Henning , Westergaard Jes G. , Schiøler Vibeke , Arends JØRgen
Published: December 2009

Abstract. Serial measurements of serum prolactin (PRL), chorionic gonadotropin (hCG), estradiol and progesterone were performed during 16 normal pregnancies. The same hormone analyses were performed in a woman with the galactorrhea‐amenorrhea syndrome and a pituitary adenoma during two pregnancies, with and without continued treatment with bromocriptine throughout gestation. The study indicates that marked differences in circulating PRL levels do not influence the fetoplacental hormone levels. Furthermore, tumor expansion may possibly be prevented and successful breast‐feeding can be achieved after treatment with bromocriptine throughout gestation.
Urinary Incontinence in the Female
Authors: Walter Steen , Meyhoff Hans Henrik , Gerstenberg Thomas , Nordling Jørgen , Hald Tage
Published: December 2009

Abstract. The long‐term effect of anticholinergic medication in female patients with overactive detrusor function was studied in a group of 73 patients. The definition of overactive detrusor function is in accordance with the terminology and definition of the International Continence Society. The patients were mailed a questionnaire about the medication, its effect on the continence situation, the side effects, and whether they still used the drugs. The duration of observation was more than 12 months.

A satisfactory effect of the treatment was found in 43% while 50% reported no effect or severe side effect. Only 5% stopped the medication because of side effects, 18% because of lack of effect, while 42% had resigned themselves to their voiding disorders. Twenty‐nine claimed to be cured or were still using the drug with beneficial effect. Nevertheless the treatment had continued for 6 months in both the group with no effect and in the group with good effect.

The anticholinergic medication is of some value because it helps the patient to accept the bladder dysfunction, to alter the micturition habits and to assist in re‐establishing inhibition of the micturition reflex.
A Continuous Estrogen ‐ Progestogen Regimen for Climacteric Complaints
Authors: Mattsson Lars‐Åke , Cullberg Göran , Samsioe Göran
Published: December 2009

Abstract. The lipid composition of serum and the lipoprotein fractions, very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) were determined in 26 peri‐ and postmenopausal women treated with a daily dose of 2 mg 17‐β‐estradiol, 1 mg estriol and 1 mg norethisteroneacetate in a continuous regimen for 12 months. A decrease was noted in all serum lipids, triglycerides, cholesterol and phospholipids during treatment. When comparing the lipid values after 3 and 12 months of treatment a tendency was found to approach pre‐treatment values with time. A reduction of triglycerides in VLDL after 3 months, concomitant with a decrease in HDL‐cholesterol, was interpreted as an effect mainly of the progestogen component. A decrease of free cholesterol in LDL was found during treatment. The ratio of LDL‐choles‐terol/HDL‐cholesterol was unaltered when comparing values before vs. after 3 and 12 months of treatment. Decreased levels of HDL‐cholesterol and elevated levels of LDL‐cholesterol are considered to be risk factors for coronary heart disease. The significance of lipid metabolic effects induced by treatment in the present study on a long‐term basis is hard to evaluate in terms of atherogenicity.
Sexuality During and After Pregnancy
Authors: Ryding Elsa‐Lena
Published: December 2009

Abstract. The effects of pregnancy and childbirth on sexuality were studied in 50 women. Dyspareunia was more common in primiparae, but in other respects the same reactions and changes in behaviour were reported by multipar‐ous and primiparous women. Coital frequency and orgasmic capacity decreased during pregnancy. The period of abstinence from coitus before and after delivery varied considerably. During pregnancy 72% of the women experienced a waning of sexual desire. Three months after childbirth 20% of the women still‐had little desire for and a further 21% had a complete loss of desire for or aversion to sexual activity. Sexual desire increased for a few women both during pregnancy as well as after childbirth. Pre‐disposing factors in relation to diminished desire are discussed. The role of Maternity Clinic staff in providing information and advice is emphasized.
PH Measurement from the Fetus During Labor A Task for the Midwife?
Authors: Löfgren Olof
Published: December 2009

Abstract. After theoretical education on the development of fetal acidosis and the fetal blood sampling technique, 12 midwives in a training program carried out or assisted in 40 fetal blood sampling procedures. Sampling was possible at a cervical dilatation of 1.5 cm. 11/12 midwives were successful in their first sampling attempt. The instrument used for analysis was an automated microprocessor device with a minimum sampling volume of 15 μl of blood. There was a statistically highly significant correlation between the results obtained with the instrument tested and the reference device (r = 0.9; n = 36). 82% of the measurements fell within ±0.04 pH units of the reference device. With the instrument placed in the labor room, and using the current technique with very small blood samples, it is possible to obtain a fetal pH value within 10 minutes after the development of a pathological fetal heart rate pattern.
Placenta flow Reduction in Pregnant Smokers
Authors: Andersen Karen Vitting , Hermann Niels
Published: December 2009

Abstract. Using a radio‐isotope method, the perfusion through the intervillous spaces of the placenta was recorded in 23 pregnant smokers and 23 pregnant non‐smokers between 33rd and 37th week of gestation. All women were normotensive and the two groups were comparable in all essential variables. As compared with that in the non‐smokers, the perfusion was significantly lower in the smokers and the infants borne by the smokers had a significantly lower birth weight. In both groups there was a positive correlation between the perfusion values and the birth weights. Because we found a slight, chronic reduction in the blood flow through the invervillous space of the placenta in pregnant smokers, the results suggest that the changes caused by smoking are rather permanent. We find it well‐founded to advise pregnant women against smoking.
Ultrasonic Real Time Diagnosis of Hydrothorax before Delivery in an Infant with Extralobar Lung Sequestration
Authors: Kristoffersen S. E. , Ipsen L.
Published: December 2009

Abstract. A female infant with extralobar lung sequestration (ELS) combined with bilateral hydrothorax and ascites is presented. A 34‐year‐old para II, pregnant in the 29th gestation week, was referred to hospital because of acute hy‐dramnios. Ultrasound examination demonstrated marked hydramnios, together with ascites and bilateral pleural effusion in the fetus. In the amniotic fluid, alfafetoprotein was found normal and the karyotype showed a normal chromosome pattern, 46 xx. The hydramnios was so severe and the cervix so unripe, that cesarean section had to be undertaken, and a girl of 1 650 g, and 42 cm long was born. Just after delivery the infant had bradycardia, cyanosis and respiratory insufficiency, with Apgar score 2 during the first 15 min. Manual ventilation followed by Servo respirator with 100% oxygen was given, but with poor effect. The infant lived only 6 3/4 hours. At autopsy there was hydro‐thorax, bilateral collapsed lungs and ascites and ELS as the only congenital malformation.
Genital Colonization by Actinomyces Israelii and Serologic Immune Response to the Bacterium after Five Years use of the Same Copper Intra‐Uterine Device
Authors: Persson Elisabeth , Holmberg Kenneth
Published: December 2009

Abstract. An increased risk of developing genital actinomy‐cosis has been found with long‐term use of IUDs. In this study a group of women who had used their IUDs for 60 ± 6 months was compared with a group having worn their IUDs for 36 ± 6 months. None of the women examined had symptoms of genital infection. No significant differences could be found in colonization frequency of A. israelii on the IUDs or in humoral antibody response to the bacterium.
Retinal Hemorrhages in the Preterm Neonate
Authors: Maltau Jan M. , Egge Kjell , Moe Narve
Published: December 2009

Abstract.The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29–35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28‐35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.
Oral Glucose Tolerance Test in Pregnancy
Authors: Hanson Ulf , Kallner Anders
Published: December 2009

Abstract. After initial screening for gestational diabetes, 182 3‐hour OGTTs in altogether 168 patients with determination of plasma glucose at 30‐minute intervals were performed. Two‐hour and 3‐hour areas below the curve were calculated. Twenty‐two patients had a reduced glucose tolerance test as judged by the 3‐hour areas. Twenty of the 22 patients had a reduced glucose tolerance even according to the 2‐hour areas. The correlation coefficient between the 3‐hour areas and the 2‐hour areas was 0.97. In 160 observations plasma glucose and capillary blood glucose were compared. The correlation coefficient between plasma glucose and capillary blood glucose concentrations was 0.99. It is concluded that the discriminatory power of the 2‐hour OGTT with capillary blood glucose determinations is comparable to that of the 3‐hour OGTT with venous plasma glucose determinations. The simplicity of the suggested method makes it suitable for use in instances with moderate or small laboratory resources.
Prevalence of Genitourinary Symptoms in the Late Menopause
Authors: Iosif Constantin S. , Bekassy Zoltan
Published: December 2009

Abstract. One thousand two hundred women, aged 61, randomly selected from a defined geographical area in South Sweden, were interviewed by an anonymous questionnaire about their urogenital symptoms. Seventy‐five percent cooperated, of whom 29.2% admitted to some degree of urinary incontinence and 48.8% some degree of lower genital tract disorder. Stress incontinence symptoms were reported by 11.8% of the women, urge incontinence by 7.9% and both types combined—“mixed” by 9.5%. Four percent of all women (18% of stress incontinence) experienced a loss sufficient to necessitate the wearing of a sanitary napkin or change of under clothing several times a day. Thirteen percent had repeated urinary tract infections. Itch, discharge and smarting pain was reported by 15%. Thirty‐eight percent had vaginal dryness and dyspareunia. Only 4% of the women were undergoing estrogen therapy.
Blood‐Oxygen Transport in First Trimester of Diabetic Pregnancy
Authors: Madsen Hans , Ditzel Jeø
Published: December 2009

Abstract. Factors involved in blood‐oxygen transport were studied in 46 pregnant women during the first trimester. All had type 1 (insulin‐dependent) diabetes and comparisons were made with similar measurements from 19 non‐diabetic pregnant women, also in the first trimester. The concentration of hemoglobin 1c (HbA1c) was significantly increased (7.6% versus 4.4%, p <0.01) and arterial oxygen saturation was decreased (0.95 versus 0.98 mol/mol, p<0.01) in the pregnant diabetics compared with the non‐diabetics. The hemoglobin concentration was significantly elevated in the diabetic women (12.9 versus 12.1 g/100ml, p<0.01). Even though the red cell 2,3‐diphosphoglycerate content was the same in the two groups, and pH was significantly lower in the diabetic women, hemoglobin‐oxygen affinity was slightly increased in the diabetic patients (P50 at actual pH: 26.2 versus 26.7 mmHg, p<0.05; P50 at pH 7.40: 27.0 versus 28.0 mmHg, p<0.01). The study has demonstrated certain modifications in the blood oxygen transport system in the first trimester of pregnancy of diabetic women that are possibly related to the presence of excess amounts of glycosylat‐ed hemoglobin with increased oxygen affinity. This disturbance in maternal oxygen transport, particularly when associated with diabetic vascular disease, may lead to episodes of fetal hypoxia. Such fetal hypoxia may be a pathogenetic factor for the development of congenital malformations in the outcome of diabetic pregnancy.
Physiological Characteristics of Diameter Pulses in the Fetal Descending Aorta
Authors: Eriksen P. Sindberg , Gennser G. , Lindström K.
Published: December 2009

Abstract. A study was performed to establish the dynamic behavior in situ of the descending aorta in the human fetus. The pulsatile movements of the vessel walls were recorded in 36 clinically normal fetuses using a real‐time phase‐locked ultrasonic system measuring echo movements with high spatial and temporal resolution. The mean amplitude of the diameter pulsations was similar in the 28th 35th week to that in the 36th 40th week but, as the apparent diastolic diameter increased, the pulse‐elicited increment of the cross‐sectional area was 29% larger in the older group. The diastolic diameter decreased (p<0.001) and the amplitude of the diameter pulsation increased (p<0.001) with prolongation of the previous beat interval. The diameter pulse velocity was positively correlated to gestational age (p<0.001), ranging between 1.35 and 2.89 m/sec. The incremental phase of the pulse curve diminished in duration with increasing distance from the heart (p< 0.001) and with decreasing duration of the previous beat interval (p< 0.001). The maximum slope of the incremental phase was higher in the more distal part of the aorta (p<0.001). The study demonstrates that the diameter pulses contain useful information on the cardiovascular dynamics and provides evidence that the Frank‐Starling mechanism is effective also in the human fetus.
Sciatic Nerve Injury
Authors: Deppe Gunter , Hercule Jacques , Gleicher Norbert
Published: December 2009

Abstract. A case is presented of injury to the sciatic nerve at the time of resection of a retroperitoneal lipoma. The diagnosis, treatment and prognosis of this surgical complication are discussed.
Pathologic Torsion of the Pregnant Uterus
Authors: Crona Nils , Bachrach Isak
Published: December 2009

Abstract. Pathologic transrotation of the pregnant uterus, a fairly common disorder in veterinary medicine, is extremely rare in the human. Since Virchow (1) described the first documented case in 1863, only 113 cases have been found in the literature. A rotation exceeding 45° of the uterus about its radial axis is considered pathologic, thus excluding the slight dextrorotation of the uterus which occurs in 80% of all pregnancies.
Growth and Function of Human Placenta and Amnion Grafted to Nude Mice
Authors: Boltenberg A. , Furgyik S. , Kullander S. , Rausing A. , Seppälä M. , Wahlsträm T.
Published: December 2009

Abstract. Normal human placenta and amnion from the 20th week of pregnancy were transplanted into nude mice. The transplants retained the histological and immunohistochemical picture of the original tissue and maintained synthesis of human chorionic gonadotropin (hCG), pregnancyspecificβ 1glycoprotein (SP1), GnRH and placental proteins PP5, PP11 and PP12 for 5 weeks. This experimental model has a wide potential application for studies on placental protein synthesis and the hormonal influence of human placenta on other simultaneously transplanted human tissues.
Culture of Human Endothelial Cells Derived from Capillaries of the Decidual Tissue
Authors: Johannisson Elisabeth , Redard Mireille
Published: December 2009

Abstract. Human endothelial cells derived from the capillary bed of endometrial decidua were studied in vitro using medium 199 supplemented with 20% fetal calf serum. Cells in primary and subcultures were identified in parallel by electron microscopy and indirect immunofluorescence microscopy. The abundance of microfilaments appearing in small bundles, the micropinocytotic vesicles in the cell periphery, the occurrence of characteristic Weibel‐Palade bodies and the intense and specific fluorescence after decoration with antibodies to Factor VIII protein all were criteria for a positive demonstration of the endothelial character in the cell cultures derived from the capillary bed of the human decidua. The proliferative activity of the in vitro system was studied by autoradiography of the endothelial cells after exposure to [3H]‐thymidine at various periods of incubation. A statistically highly significant difference (p>0.001) was found between periods of 4‐6 and 6‐8 days of incubation and between 6‐8 and 8‐10 days of incubation (p>0.01). No such difference was found between 8‐10 and 10‐14 days of incubation. When the medium was switched to complete M 199+ 10% fetal calf serum and 10% human plasma containing 76 pg/ml of estradiol the thymidine index was 5 to 4 times as high as in the control medium after 5 to 6 days of incubation.

The results indicate that the in vitro system developed on endometrial capillaries derived from human decidua provides a stable low background of DNA synthesis against which small amounts of possible mediators of endothelial mitoses, e.g. estradiol, progesterone and various synthetic progestogens, can be tested.
Villous structure in different parts of the cotyledon in placentas of insulin‐dependent diabetic women
Authors: Björk O. , Persson B.
Published: December 2009

Abstract. Placentas from 13 insulin‐dependent diabetic mothers and 10 non‐diabetics were compared by means of photographic planimetry. The material was investigated in fresh state and obtained from three well‐defined areas within a cotyledon, central, intermediate and lateral regions. Length and area of the villi in each region were calculated. The non‐diabetics showed a consistent organization of the cotyledon, with increasing villous length towards the periphery. The surface areas increased with increasing length. In placentas of diabetic mothers, this organization was disrupted. The villi were of even length throughout the cotyledon. The average length of a villus in the diabetic group did not differ from the average length in the control group. Despite this fact, the average surface area in the diabetic was greater than that in the controls. This increased surface area was due to increased branching of peripheral villi in the diabetic group.

The degree of blood glucose control of the diabetic mothers was assessed by the day‐to‐day variation in maternal blood glucose levels (MODD) for periods 12th to 32nd week and 32nd week to term and by “pregnancy glucose value”, i.e. the mean of four consecutive daily blood glucose levels from the 32nd week of gestation to term. Only MODD values based on blood glucose values from 12th to 32nd week of gestation were correlated to the villous surface area. The greater the blood glucose variability, the greater was the surface area.
Effect of smoking on red cell oxygen transport and release in diabetic pregnancy
Authors: Madsen Hans , Ditzel Jøm
Published: December 2009

Abstract. In order to investigate the effect of smoking on the red cell oxygen transport and release in pregnant diabetic women, 23 smokers and 23 non‐smokers were studied in the third trimester. The two groups were comparable with regard to blood glucose regulation, as the median concentration of blood glucose and glycosylated hemoglobin (Hb A1c) did not differ. Red cell 2, 3‐diphosphoglycerate (2, 3‐DPG) levels were significantly lower in the smokers than in the non‐smokers (16.5 vs 17.8 μmol/gHb, p>0.01). P50 of the oxyhemoglobin dissociation curve at actual pH and at pH 7.40 was also significantly lower in the smokers (25.9 vs 26.9 mmHg, p>0.01, and 26.5 vs 27.8 mmHg, p>0.01 respectively). Red cell 2, 3‐DPG was significantly correlated with P50 at pH 7.40 (r = 0.73, p>0.001). Arterial oxygen saturation was reduced to the same degree in smokers and in non‐smokers, as compared with healthy non‐smoking pregnant women and no adaptive increase in the hemoglobin concentration occurred in the pregnant diabetic smokers. The study suggests that smoking in pregnant diabetic women impairs the adaptive increase in 2, 3‐DPG associated with diabetes‐induced hypoxia.
Acute Effects of Maternal Smoking on Fetal Blood Flow
Authors: Eriksen Poul Sindberg , Marŝál Karel
Published: December 2009

Abstract. Thirty healthy pregnant women were studied to assess the immediate cardiovascular responses of the fetus to the smoking of one cigarette. The fetal blood flow was measured in the aorta and in the umbilical vein by combining real‐time ultrasonography and the pulsed Doppler technique. Following maternal smoking, a significant increase was found in the maternal heart rate and also in the blood pressure. In the fetus, a significant transient increase in the aortic and the umbilical blood flow was measured, as characterized by the increase in the fetal heart rate, the mean and maximum blood velocity, and the vessel diameter. Thus, maternal smoking induced acute circulatory changes in the fetus similar to those found in adults. Furthermore, the study demonstrated the feasibility of the method to evaluate non‐invasively the immediate effect of a given stress stimulus on the cardiovascular system of the human fetus.
Detection of Cervical Incompetence by Ultrasound
Authors: Feingold M. , Brook I. , Zakut H.
Published: December 2009

Abstract. Ultrasonography was used to measure the width of the internal os in 96 pregnant women, of whom 43 were considered to have cervical incompetence and were scheduled for cerclage. The remainder of the women were divided into two control groups: (a) 28 women with a normal obstetric history, and (b) 25 women with a history of either previous abortion or traumatic delivery. The mean width of the internal os in the three groups was 25.9 mm±3.7, 15.8 mm±2.7, and 18.2 mm±6.5 respectively; statistically, significant difference were seen between the first group and each of the control groups. All the women in the first control group gave birth successfully at term; of those in the second control group, 5 presented with premature rupture of the membranes. The mean cervical os width in these 5 women was 29 mm, as compared with a mean of 18.2 mm for this group as a whole. We suggest that ultrasonic measurement of the internal os during pregnancy can be a useful and objective new method for the diagnosis of cervical incompetence.
Factor VIIIR: Ag/Factor VIII:C and their Ratio in Obstetrical Cases
Authors: Caires D. , Arocha‐Pinango C. L. , Rodriguez S. , Linares J.
Published: December 2009

Abstract. Factor VIIIR: Ag and Factor VIII: C levels were found to be significantly increased during pregnancy, labor and puerperium, but not to the extent observed by European and American authors. The ratio Factor VIIIR: Ag/Factor VIII:C was elevated only between the third and sixth hour of labor with respect to early labor, and during parturition and early puerperium with respect to late labor. However, this ratio was in the same range as the normal non‐pregnant controls, but in the cases of complicated pregnancy, the ratio reached values much higher than the normal. It was concluded that determination of the ratio appears to be of little value in normal cases but may be of use when there are obsterical complications. Studies are being performed to try to explain the limited rise in Factor VIII: Ag and Factor VIII: C levels observed in our cases.
Ovarian Tumors in Pregnancy
Authors: Struyk A. P.H.B. , Treffers P. E.
Published: December 2009

Abstract. The results of 90 pregnancies complicated by an ovarian tumor are analysed. On this basis it seems advisable to follow a ‘wait‐and‐see’ policy until the 16th week. Tumors persisting into the second trimester can best be extirpated between the 16th and 20th week. Ovarian tumors present after the first trimester can lead to serious complications. However, an ovarian tumor discovered in the second half of pregnancy calls for temporization of treatment. Ce‐sarean section at term with simultaneous extirpation of the tumor is the treatment of choice.
Inaccurate Gestational Dating and Maternal Serum Alpha‐Fetoprotein Screening
Authors: Schnittger Agneta , Selbing Anders
Published: December 2009

Abstract. The consequences of erroneous gestational dating on the efficiency of a maternal serum alpha‐fetoprotein (MS‐AFP) screening program has been studied in 1050 early pregnant women. The gestational age of each woman was independently estimated by means of menstrual dates as well as by ultrasonic measurements of the fetal crown‐rump length before the 15th week of gestation.

Misinterpretation of the AFP‐test results because of incorrect gestational dating according to menstrual dates was observed in 5.4% of all women screened. 40% of the pregnant women with true “elevated” MS‐AFF values, according to ultrasonic dating, would have been misinterpreted as “normal” using menstrual dating. Incorrect menstrual dating was also found to account for 22% of all elevated MS‐AFP test results observed.

Women who intend to take part in MS‐AFP screening programs should preferably have their gestational age determined be ultrasonography prior to blood sampling.
Regression of endometriosis following shorter treatment with, or lower dose of danazol: Comparison of pre‐ and post‐treatment laparoscopic findings in the Scandinavian multi‐center study
Authors: Döberl Anton , Bergqvist Agneta , Jeppsson Sten , Koskimies Aarne I. , Rönnberg Lars , Segerbrand Erik , Starup Jørgen
Published: December 2009

Abstract. One hundred and sixteen patients with laparosco‐pically confirmed primary or recurrent endometriosis were treated with danazol, either 600 mg daily for 4 months (group A, n = 76) or 600 mg daily for the first 2 months, followed by 400 mg daily for an additional 4 months (group B, n = 40). The only surgery performed before treatment was biopsies, resection of endometriomas 23 cm and/or adhe‐siolysis. The extent of endometriosis before and after treatment was established laparoscopically and recorded by means of a modified AFS record as mean additive diameter of implants (mean ADI) in millimeters. This provided a uniform and reproducible quantitative registration for each type and location of endometriotic implant.

Both treatment schemes resulted in a highly significant (p<0.001) reduction of endometriosis, by 79 and 89% in groups A and B, respectively. However, the reduction in mean ADI was significantly greater (p< 0.025) in group B which had been treated for a longer period. Morevoer, the proportion of patients with extensive pre‐treatment lesions (mean ADI 240 mm) was significantly greater in this group.

Active residual endometriosis was found in 21 and 17.5% in groups A and B, respectively. These patients had significantly more extensive endometriosis before treatment. The regression of endometriotic implants was independent of type and/or location, i.e. superficial or scarred; peritoneal, ovarian, or tuba]. There was no apparent correlation between the quantitative reduction of endometriosis and amenorrhea versus occasional spotting and/or irregular menstruations.

Despite the marked reduction of endometriotic tissue following both treatment schemes, only 4 months of treatment with 600 mg daily appears to be too short a period to ensure elimination of endometriosis, leaving a number of small residues at the end of treatment. Six month's treatment according to schedule B produced a significantly greater reduction in endometriotic tissue, but lowering of the dose to 400 mg daily after 2 months was associated with a significant increase of irregular vaginal bleeding.

Although the choice of danazol dose and duration of treatment in endometriosis depends on the objective and approach in the individual case, the authors do not feel confident in recommending less than 600 mg daily for 6 months, if a high probability of complete resolution of all endometriotic implants, other than endometriomas, is desired.
In vitro effect of danazol on steroidogenesis in developing human follicles
Authors: Nilsson Lars , Dennefors Bo , Olsson Jan‐Henrik , Hillensjö Torbjörn , Rannevik Gunnar
Published: December 2009

Abstract. In order to show whether or not danazol exerts direct effects on the cells Of the human ovarian follicle, fOI% cular granulosa and thecal cells of follicles in different stages of development are currently being investigated in short‐term incubation experiments and during more prolonged cell culture.

Cells are isolated by free‐hand dissection from follicles of 8 to 25 mm diameter, corresponding approximately to cycle day 7 to 14. Granulosa and thecal cells have so far been incubated for 2 to 4 hours in the presence or absence of hCG and/or danazol. A small number of cell cultures of granulosa cells have been performed for up to 6 days in the presence or absence of danazol, hFSH, and hLH, in various combinations.

The progesterone (P), estradiol‐17β (E) and androstene‐dione (A) content of the incubation or culture medium and the tissue content of cyclic AMP (CAMP) were measuerd.

Danazol (10 μg/ml) inhibited thecal cAMP production in most short‐term experiments but only the hCG‐stimulated cAMP production of granulosa cells. Short‐term production of P and E by granulosa and of A and E by thecal cells was also inhibited by danazol in certain circumstances. In tissue cultures of granulosa cells lasting up to 4 days, danazol (1 and 10 μg/ml) inhibited both the FSH and LH‐stimulated P production.

Provided that any unspecific effects of the concentrations of danazol used can be ruled out, the results seem to indicate that this substance may act directly upon steroidogenesis at the ovarian follicular level.
Atenolol and Metoprolol. A Comparison of Their Excretion into Human Breast Milk
Authors: Kulas Josip , Lunell Nils‐Olov , Rosing Ulf , Stéen Bengt , Rane Anders
Published: December 2009

Abstract. The transfer of atenolol and metoprolol to human breast milk was studied in 7 lactating women with hypertension. Concentrations of atenolol and metoprolol in maternal plasma and milk and in plasma of the nursed infants were determined. Blood samples were obtained from the women and from the infants during a dose interval. Milk was collected repeatedly from the left breast but only twice from the right breast. The ratio between the area under the milk concentration versus time curve (AUCm) and the area under the plasma concentration versus time curve (AUCp) in the mother varied between 2.0 and 3.1 for metoprolol and 1.1 and 3.1 for atenolol. The milk concentrations of metoprolol in the right breast were similar to those in the left breast, although the latter had been emptied more frequently. For atenolol the milk concentrations in the right breast were lower than in the left breast. The plasma concentrations of metoprolol and atenolol in the infants were negligible or below the limit of detection. Our results show that exposure of the infant to metoprolol can be minimized if nursing is not undertaken earlier than 3‐4 hours after dose intake.