bluuebunny/crossref_metadata_2025 huggingface dataset:
Local Application of Methotrexate for Ectopic Pregnancy with a Percutaneous Puncturing Technique
Authors: Mesogitis Spyros A. , Daskalakis George J. , Antsaklis Aristides J. , Papantoniou Nick E. , Papageorgiou John S. , Michalas Stylianos K.
Published: April 2003

Management of ectopic pregnancy remains traditionally surgical. Early detection of unruptured ectopic pregnancies, using both ultrasound techniques and β-human chorionic gonadotropin (β-hCG) assays, allows a more conservative treatment. Twenty-six tubal pregnancies, which were managed with local methotrexate (MTX) injection, are presented. A single dose of 10–12.5 mg of MTX was percutaneously injected into the gestational sac under abdominal sonographic control. Complete resolution was obtained in all our patients. Four of them required a second percutaneous administration 4 days after the first one. Negligible serum β-hCG levels (<10 mIU/ml) were reached within 42 days after treatment. No systemic side effects were observed. Local administration of MTX under abdominal sonographic control seems to be an effective alternative for the treatment of ectopic pregnancy. The main potential advantages of the method are (1) a greater antitrophoblastic effect; (2) a shorter treatment period; (3) reduced dosage, and (4) absence of side effects.
Transcervical Fallopian Tube Recanalization under Fluoroscopic Guidance
Authors: Hayashi Masatoshi , Iwasaki Naoya , Kuramae Shigeru , Izawa Yasuyuki , Murata Mitsutoshi , Yaoi Yoshimasa
Published: April 2003

This study was designed in order to assess whether the Iwasaki-Hayashi (IH) catheter can be fixed to the uterine cervix easily and successfully during transcervical fallopian tube recanalization (T-FTR) with fluoroscopic guidance, to try T-FTR in special cases, and to investigate the success rate. The study included 21 infertile women with tubal obstruction, diagnosed by hysterosalpingography examined at least twice to exclude tubal spasm. Using the IH catheter, which proved to be very useful, higher therapeutic efficacy could be obtained. A patient with unilateral proximal tubal obstruction became pregnant following natural fertilization in the fallopian tube which had been recanalized by T-FTR. The success rate of recanalization, the pregnancy rate and the take-home-baby rate were 95.2%/patient, 19.0 and 19.0%, respectively.
Disturbed Small Intestinal Motility in the Late Rat Pregnancy
Authors: Chang Full-Young , Lee Shou-Dong , Yeh Guey-Hwa , Lu Chien-Chen , Wang Paulus S. , Wang Shyi-Wu
Published: April 2003

We investigated whether various periods of pregnancy might disturb rat gastrointestinal motility. When the proestrus of female rats occurred, they were housed with male rats. Motility studies were conducted on day 7 (first period), day 14 (second) and day 21 (third) of pregnancy, respectively. After the orogastric feeding of radiochromium marker, rats were sacrificed 15 min later. Gastric emptyings of pregnant rats measured at various periods did not differ from the nonpregnant diestrus controls. The geometric center represented intestinal transits in the first, second and third periods of pregnancy and controls were (mean ±SEM) 4.54 ± 0.25, 4.47 ± 0.17, 3.61 ± 0.27 and 4.98 ± 0.13, respectively (p < 0.01) while their plasma progesterone levels were 15.6 ± 2.6, 18 ± 1.4, 7.1 ± 0.5 and 8.6 ± 0.4 ng/ml, respectively (p < 0.01). This shows that late pregnancy inhibits small intestinal transit, whereas gastric emptying remains unchanged. Altered progesterone during pregnancy is not a main mediator to disturb intestinal transit.
Urinary PGE2 and PGF2α Levels and Renal Functions in Preeclampsia
Authors: Vural Pervin , Akgül Cemil , Canbaz Mukaddes
Published: April 2003

The role of prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) in the pathogenesis of hypertension and altered renal functions, which are the main symptoms of preeclampsia, has gained importance. Serum and urine samples of 59 women (24 preeclamptic pregnant (PEP), 20 normotensive pregnant (NTP) and 15 nonpregnant) were investigated by means of prostaglandin levels and urea, creatinine and creatinine clearance values. PEP patients, when compared with NTP patients, show a significant decrease in PGE2 and PGF2α levels (p < 0.01 and p < 0.05, respectively) accompanied by changes in some parameters of renal function such as serum urea, creatinine and creatinine clearance. Although disorders in prostaglandin levels may be responsible for some renal pathologic changes, renal functional and morphologic alterations may also result in abnormal prostaglandin activity.
Compared Randomized Roles and Pain Factor by Vabra and Wallach Endocell in Endometrial Evaluation
Authors: Lambert Bernard , Gonthier Mariette , Dery Jean-Paul , Lepage Yves
Published: April 2003

This randomized study was carried out to compare pain factors of Vabra and Endocell by an ordered classification of one to ten to evaluate the respective pathological yield and to establish the clinical acceptability. Patients had endometrial evaluation either for abnormal bleeding, abnormal endometrial line as demonstrated by echography or abnormal endometrial cells in the Pap smear. Age, gravidity, parity and hysterometry were similar in both groups, with abnormal bleeding being the most frequent indication (250/370 patients, 67.5%). Both techniques yielded equal results for insufficient tissue retrieval at 46/184 (25.0%) for Vabra and at 50/183 (27.3%) for Endocell. The pain score differed significantly in favor of Wallach Endocell at 4.36 ± 2.38 versus Vabra at 5.65 ± 2.41 (p = 0.001). Vabra and Endocell give similar pathological results; however, Endocell is significantly less painful and easier to manipulate and carry because of its weight (1.69 g vs. 37.80 g).
CT and MRI Findings in a Case of Pelvic Schwannoma
Authors: Nasu Kaei , Arima Kazuyo , Yoshimatsu Jun , Miyakawa Isao
Published: April 2003

We compared the diagnostic utility of computed tomography (CT) and magnetic resonance imaging (MRI) in a patient with a pelvic schwannoma. This 46-year-old woman was admitted for evaluation of a retroperitoneal pelvic mass and myoma uteri. The retroperitoneal pelvic mass had been detected by a CT scan at a routine health examination. A CT scan revealed a well-circumscribed cystic tumor (4 × 3 cm) at the right internal obturator muscle portion. The CT number of the inner part of the tumor was 21. Only the cyst wall was enhanced by injection of a contrast medium. MRI showed a 4 × 3 × 3-cm retroperitoneal cystic tumor that demonstrated low-intensity signals on T1-weighted images and high-intensity signals on T2-weighted images. Small areas of low intensity inside the tumor were observed on T2-weighted images. Histological examination revealed a typical schwannoma of mixed Antoni type A and type B. These findings indicate that both MRI and CT are useful for diagnosis of retroperitoneal schwannomas.
Clinical Value of Creatinine Kinase in the Diagnosis of Ectopic Pregnancy
Authors: Vitoratos N. , Gregoriou O. , Papadias C. , Konidaris S. , Kalogirou D. , Kalampokis D. , Chryssikopoulos A.
Published: April 2003

The role of creatinine kinase (CK) in the diagnosis of ectopic pregnancy was studied. We selected 56 patients divided into 4 groups. Group A consisted of 10 patients with asymptomatic tubal pregnancy, group B consisted of 11 patients with symptomatic tubal pregnancy whereas groups C and D consisted of 20 and 15 patients with normal and threatened intrauterine pregnancy, respectively. Serum samples of CK were taken from all patients on admission. No significant difference was observed in the median CK value of cases with normal pregnancy (58.5 ± 7.24 U/l, mean ± SE) as well as threatened abortion (73 ± 11.43 U/l) compared to that of cases with asymptomatic 58.5 ± 12.42 U/l) or symptomatic tubal pregnancy (59 ± 10.08 U/l). We conclude that serum CK is not a useful biochemical marker in the diagnosis of ectopic pregnancy.
Some Unexpected Results in Time Distribution Analysis of Spontaneous Deliveries
Authors: Ghiandoni Gabriele , Seclì Roberto , Rocchi Marco B.L. , Ugolini Gilberto , Cancelli Valeria
Published: April 2003

Objective: To study time distribution of spontaneous deliveries. Methods: A retrospective analysis of 1,791 spontaneous deliveries over a 4-year period (1993–1996) was made at the department of Obstetrics and Gynaecology, Civil Hospital, Fano, Italy. Circular statistics techniques (maximization of mean vector length) were used. Results: Some unexpected infradian disuniformities (with 60- and 90-hour periods) were observed. Moreover, a correlation between the distribution of spontaneous deliveries and the lunar phases was found. Conclusions: In this study, some unexpected infradian disuniformities were found. However, no biological explanations appear to be reasonable in light of current knowledge, so the interpretation of these results remains an open question.
Prevalence and Background Factors of Maternity Blues
Authors: Murata Ami , Nadaoka Toshihide , Morioka Yukiko , Oiji Arata , Saito Hidekazu
Published: April 2003

To explore factors contributing to maternity blues, a longitudinal study was carried out on a group of 111 women who received obstetric care at Yamagata University Hospital from November 1994 to August 1995. Cases of maternity blues were found using Stein’s Self-Rating Maternity Blues Scale. Mother–child relationships in the women’s childhood were assessed using the Parental Bonding Instrument (PBI). Of the 111 women, 17 (15.3%) developed maternity blues during the first postpartum month. The PBI revealed that these depressed women appeared to be cared for less sufficiently in their own childhood than the non-depressed women. As revealed in interviews, they also seemed to receive less support from their families during pregnancy. These findings suggest that maternity blues may be related to insufficient maternal care in childhood, as well as to poor family support during pregnancy.
Interstitial Pregnancy Treated with Local and Systemic Methotrexate
Authors: De Bruyne Filip , Tutschek Boris , Hucke Jürgen , Crombach Gerd
Published: April 2003

We present a case of an intact interstitial pregnancy at 6 postmenstrual weeks and 4 days, which was successfully treated by combined local and systemic methotrexate administration. The embryonic cardiac activity stopped within 1 min after uneventful ultrasound-guided puncture and methotrexate instillation of the chorionic sac. While the β-hCG serum values returned to normal 59 days after local, and 52 days after systemic treatment, the echogenic lesion has reduced in size by 50%, but is still sonographically detectable 7 months after the procedure. This report shows that medical treatment of interstitial pregnancy may be an effective alternative to the surgical approach.
Vasospasms of Cerebral Arteries in Hyperemesis gravidarum
Authors: Kanayama Naohiro , Khatun Selina , Belayet Hossain M. , Yamashita Miwa , Yonezawa Masumi , Kobayashi Takao , Terao Toshihiko
Published: April 2003

Hyperemesis gravidarum is associated with nausea and vomiting during the 1st trimester of pregnancy. We report 2 cases of hyperemesis gravidarum associated with vasospasms of cerebral arteries recognized by magnetic resonance imaging angiography. The hyperemetic condition of the patients improved after fluid and electrolyte replacement therapy.
Transforming Growth Factor-β1 in Hemangioma of the Ovary
Authors: Loverro Giuseppe , Cormio Gennaro , Perlino Elda , Vicino Mario , Cazzolla Ambrogio , Selvaggi Luigi
Published: April 2003

Hemangioma of the ovary is extremely rare. We report the case of a 32-year-old woman who complained of pelvic pain due to a large right adnexal mass. On surgical exploration a 10 × 8 cm hemangioma of the ovary was resected. Expression of transforming growth factor-β1 was studied, and the possible role of this molecule in the development of the tumor is discussed.
Spontaneous Pregnancy after 13 Years of Amenorrhea in aPatient with a Voluminous Ovarian Dysgerminoma and Submitted to Left Adnexectomy and Radiotherapy
Authors: Garcea Nicola , Campo Sebastiano , Marone Maria , Garcea Riccardo
Published: April 2003

The authors illustrate the case of a 17-year-old patient who was submitted to left adnexectomy in view of an ovarian dysgerminoma 24 cm in diameter and weighing 2,800 g. She was subsequently submitted to two cycles of radiotherapy. Following a period of amenorrhea lasting 13 years and characterized by high serum levels of gonadotropins, the patient had a spontaneous pregnancy and at 33 weeks of gestation delivered a live and vital fetus. Therefore the occurrence of post-radiotherapy amenorrhea, characterized by high serum gonadotropin levels, should not always be considered pathognomonic of precocious menopause. The possibility that radiotherapy causes only a temporary alteration in ovarian activity should also be taken into consideration.
Disturbed Nitric Oxide/Endothelin-1 Equilibrium in Cultured Human Placental Endotheliocytes in Preeclampsia
Authors: Leszczyńska-Gorzelak Bożena , Oleszczuk Jan , Kamiński Krzysztof , Szymula Dariusz , Gorzelak Mieczysław , Oleszczuk Jarosław J.
Published: April 2003

Several observations suggest that endothelial cell dysfunction is a central pathophysiologic event of preeclampsia. Endothelin-1 (ET-1) is a vasoconstrictor peptide of the endotheliocyte and is increased in the sera of preeclamptic patients. The aim of this study was to investigate the possible regulatory mechanisms between ET-1 and nitric oxide (NO) production in cultured placental endotheliocytes. We report that endothelial cells of arterial placental blood vessels show a dysfunctional mechanism of negative feedback regulation of ET-1 production by cGMP or insufficient NO release in response to a stimulus in the form of an increasing ET-1 concentration.
Smoking, Hemoglobin Concentration and Pregnancy-Induced Hypertension
Authors: Rasmussen Svein , Øian Pål
Published: April 2003

The aim of the study was to assess the effect of cigarette smoking on first- to second-trimester change in hemoglobin (Hb) concentration and the presence of pregnancy-induced hypertension (PIH). In smokers and non-smokers the mean difference between the first- and second-trimester Hb concentration was 1.5–1.6 and 1.3 g/dl, respectively (p < 0.0001). The incidence of PIH among smokers and non-smokers was 4.0 and 7.5%, respectively (p < 0.0001). The risk of PIH increased with increasing second-trimester Hb. After adjustment for factors including previous pregnancies, maternal age and weight gain by logistic regression analysis, the increased Hb declined and the decreased incidence of PIH in smokers persisted.
Exhaled Oral and Nasal Nitric Oxide during L-Arginine Infusion in Preeclampsia
Authors: Grunewald Charlotta , Carlström Kjell , Kumlien Gunilla , Ringqvist Åsa , Lundberg Jon
Published: April 2003

Objective: To determine the effects of the nitric oxide (NO) precursor L-arginine on the airway NO concentration in patients with preeclampsia. Methods: NO was measured by a noninvasive chemiluminescence technique in air sampled directly from nasal and oral cavities during expiration before and during L-arginine infusion in 9 preeclamptic and 10 control pregnancies. Maternal blood pressure and heart rate were simultaneously recorded, and blood was sampled for analyses of cyclic guanosine monophosphate (cGMP) and nitrate. Results: Basal nasal and orally exhaled NO and the increment in nasal NO concentration during L-arginine infusion were similar in both groups. Basal plasma and platelet cGMP concentrations were similar in both groups. Following L-arginine infusion, plasma cGMP levels were significantly higher in preeclamptics (p < 0.01), while platelet cGMP was unaffected in both groups. Basal plasma nitrate was significantly higher in preeclamptics (p < 0.01), and this difference was not altered following infusion. Blood pressure and heart rate remained unaffected by the procedure in both groups. Conclusions: Blood pressure did not decrease in the preeclamptics following L-arginine infusion, despite a significant increase in nasal NO sampled during breathhold and a concomitant increase in plasma cGMP, possibly reflecting an endogenous NO production. These results do not support the idea of a generalized decrease in NO production being a major cause of hypertension in preeclampsia.
At 40 Years of the ‘Golden Chain’
Authors: Zwillenberg Lutz O.
Published: April 2003

In normal vaginal and ectocervical epithelium there is no consistent drop in density of the cytoplasmic ultrastructure at the transition between basal cells and parabasal cells. A peculiar golden-brownish argyrophilia, limited to the basal cells and vanishing in dysplasias, had been imputed to this density [2]. The reproducibility of the pertinent silver stain was improved. The phenomenon coincides with the known distribution of cytokeratin 19 and α3β1 integrin. Ultrastructural signs of a specialized anchoring function of the basal cells, published autoradiographic and immunohistological evidence, clues as to the interference with differentiation by persistent papilloma virus DNA, and striking differences in wound healing between keratinizing and nonkeratinizing squamous epithelia prompted the thesis that the true stem cells in this epithelium are not the basal cells but the next higher parabasal cells.
Increased Intraepithelial Innervation in Women with Vulvar Vestibulitis Syndrome
Authors: Bohm-Starke Nina , Hilliges Marita , Falconer Christian , Rylander Eva
Published: April 2003

Women with vulvar vestibulitis syndrome (VVS) suffer from severe pain and discomfort in the area around the introitus at almost any stimulus that causes pressure within the vestibule. In spite of the severe sensory symptoms present in these women, the influence of the peripheral nerves in the vulvar vestibulum has not been clarified before. In this study the nerve supply in the vestibular mucosa in women with VVS and in healthy women free from vulvar symptoms has been revealed by PGP 9.5 immunohistochemistry. The results show a significant increase in the number of intraepithelial nerve endings in women with VVS, indicating an alteration in the nerve supply in the afflicted area.
Torsion of the Fallopian Tube following Sterilization
Authors: Ikeda Shun-ichi , Sumiyoshi Minoru , Oki Chie
Published: April 2003

A 45-year-old woman presented severe right lower abdominal pain. Transabdominal sonography demonstrated bilateral adnexal cystic masses. At surgery, these cystic masses were bilateral simple hydrosalpinges with torsion of the right side. She had previously had tubal ligation. When we encounter an adnexal torsion, we should consider tubal torsion when there is a history of tubal ligation.
Prenatal Diagnosis and Obstetric Management of Larsen’s Syndrome in a Patient with an Unrecognized Family History of the Disease
Authors: Dören Martina , Rehder Helga , Holzgreve Wolfgang
Published: April 2003

We report the third case of a prenatal diagnosis of Larsen’s syndrome, which is the first report affecting both a 37-year-old primiparous caucasian woman and her fetus not considered to have Larsen’s syndrome until the finding of bilateral clubfeet was demonstrated on screening ultrasound at 23 weeks of gestation. History and physical examination of the pregnant woman revealed severe impairment in the mobility of hip, elbow and knee joints starting in early childhood. Additional findings were spatulate thumbs and a flat nasal bridge. The mother of the pregnant woman demonstrated similar joint symptoms. The differential diagnosis of Larsen’s syndrome was considered for the first time in both women. The patient wished to terminate her pregnancy, as the potential early onset of the same disorder was suggested by the finding of clubfeet. An intraamniotic instillation of ethacridinic acid was performed. On pathological examination including radiography of the male stillborn, various anomalies of the face, and upper and lower extremities were demonstrated compatible with Larsen’s syndrome.
Upper Body Obesity and Hyperinsulinemia Are Associated with Anovulation
Authors: Morán Carlos , Hernández Eugenia , Ruíz Julia E. , Fonseca María E. , Bermúdez José A. , Zárate Arturo
Published: April 2003

The objective of this study was to determine the effect of body fat distribution and hyperinsulinemia on the occurrence of ovulation. Fifty-six women (20–35 years old) either with overweight or obesity (body mass index ≥25) were studied. They were classified in two groups according to waist/hip ratio (WHR); one with predominance of adiposity in the upper body segment (n = 29, WHR >0.85) and the other with predominant adiposity in the lower body segment (n = 27, WHR ≤0.85). Basal body temperature and serum progesterone were determined in each cycle during 6 months. Serum insulin levels were measured at baseline and 30, 60, 90, 120 and 180 min after a 75-gram oral glucose load. The mean insulin values in response to oral glucose load in patients with upper body segment obesity were significantly higher than those corresponding to women with lower body segment obesity. Furthermore, the ratio between ovulated cycles and all the cycles studied in patients with upper body segment obesity was significantly lower than that observed in patients with lower body segment obesity. Upper body obesity seems to affect the ovulatory process and this may be related to the presence of hyperinsulinemia.
Placenta previa: Effect of Age, Gravidity, Parity and Previous Caesarean Section
Authors: Abu-Heija Adel T. , El-Jallad Fayez , Ziadeh Saeed
Published: April 2003

Objective: To study the effect of maternal age, gravidity, parity, previous abortion and previous caesarean section on placenta previa. Methods: We reviewed records of 95 women with placenta previa and compared with 190 women delivered during the same period, all delivering between 16 April 1994 and 15 May 1997. We compared maternal age, parity, gravidity, previous abortion, and previous caesarean section. Results: Placenta previa is higher among women gravida > 4 (p < 0.002), para > 3 (p < 0.01) and previous caesarean section (p < 0.02). There is no increase in the incidence of placenta previa with increasing maternal age and previous abortion. Conclusion: The risk of placenta previa is increased with higher gravidity, higher parity, previous lower segment caesarean section, while increasing maternal age and previous abortion had no significant effect.
Clinical Experience of Long-Term Transdermal Treatment with Nitric Oxide Donor for Women with Preeclampsia
Authors: Nakatsuka Mikiya , Tada Katsuhiko , Kimura Yoshihiro , Asagiri Kazuo , Kamada Yasuhiko , Takata Masayo , Nakata Takakimi , Inoue Nanako , Kudo Takafumi
Published: April 2003

Isosorbide dinitrate (ISDN), a nitric oxide donor, was applied transdermally for 4–16 days to 4 preeclamptic women with oligohydramnios, intrauterine fetal growth retardation (IUGR), and elevated resistance of blood flow in the uterine arteries. Pulsed Doppler ultrasonography revealed immediate and drastic improvement of pulsatility index (PI) of uterine arteries following treatment with ISDN. The average PI in uterine arteries of the 4 patients was reduced to approximately 67% of that of the untreated state. In 2 patients the amniotic fluid gradually increased over a few days which suggested improvement of fetoplacental circulation during administration of ISDN. This study suggests that long-term transdermal ISDN is an effective therapy, at least in a portion of preeclamptic women, to avoid maternal hypertension, fetal distress, oligohydramnios, and IUGR, and consequentially to prolong the gestational period.
Memory Functioning at Menopause: Impact of Age in Ovariectomized Women
Authors: Nappi R.E. , Sinforiani E. , Mauri M. , Bono G. , Polatti F. , Nappi G.
Published: April 2003

Estrogens are known to act selectively on some components of memory, exerting beneficial effects on cognitive performances. However, there are few data on the long-term effect of the lack of estrogen in postmenopausal women. Therefore, we investigated attentive and verbal memory performances in physiological and surgical menopause, drawing attention to the impact of age at menopause, and we compared a well-known aging and estrogen-dependent index, the entity of bone mass loss to memory functioning. No significant differences were found in the mean scores of attentive and psychomotor performances between physiological and surgical menopause, whereas a lower number of recalled words (recency effect = PS2) was found in surgical menopause (p < 0.001) in comparison to physiological menopause. In addition, both the age at the time of ovariectomy (r = 0.47; p = 0.014) and the years since surgery (r = –0.64; p = 0.000) correlated to short-term verbal memory performance (PS2) with better scores when surgery occurred later in women’s lives. Surgical menopause is able to affect short-term verbal memory more than physiological menopause and seems to represent a critical negative event within the female brain, in particular when it occurs prematurely.
Effects of Add-Back Therapy on Bone Mineral Density and Pyridinium Crosslinks in Patients with Endometriosis Treated with Gonadotropin-Releasing Hormone Agonists
Authors: Gnoth Christian , Gödtke Katrin , Freundl Guenter , Godehardt Eberhardt , Kienle Erika
Published: April 2003

Treatment of endometriosis with gonadotropin-releasing hormone agonists (GnRHa) is limited to 6 months because of possible adverse effects on bone metabolism. We designed a randomized, double-blind, placebo-controlled, prospective study of 27 patients with endometriosis who were given GnRHa with or without hormone add-back therapy (+ 20 µg of ethinyl estradiol with 0.15 mg desogestrel) designed to suppress the adverse effects of hypoestrogenism while preserving the efficacy of GnRHa. Both regimens showed significant improvements in endometriosis, dysmenorrhea, and pelvic pain; effects were significantly better in the GnRHa + placebo group. The GnRHa + placebo group had significantly higher serum calcium levels and a significantly higher loss of lumbar spine bone mineral density (BMD). Urinary levels of pyridinium crosslinks increased significantly in the GnRHa + placebo group, and declined to normal in the GnRHa + add-back group. The add-back therapy protects women taking GnRHas from severe loss of BMD and accelerated bone collagen resorption, but reduces the efficacy of the GnRHa.
Management and Prognosis of Primary Fallopian Tube Carcinoma
Authors: Rosen A.C. , Klein M. , Hafner E. , Lahousen M. , Graf A.H. , Reiner A.
Published: April 2003

We retrospectively analyzed 143 women treated in 28 departments from 1980 to 1995, to study the impact of prognostic factors in primary carcinoma of the fallopian tube. Further aims of the study were to evaluate the treatment of fallopian tube carcinoma in Austria. Staging of disease was done according to the modified FIGO system, and grading according to the criteria suggested by Hu et al. The mean age of the patients was 62.5 years. Sixty (42%) tumors were found to be in stage I, 28 (19%) in stage II, 38 (27%) in stage III, and 17 (12%) in stage IV. Radical resection was achieved in 102 (71%) patients. In 122 (85%) women surgery involved removal of the uterus, the adnexa, and/or the omentum or lymph nodes. Postoperatively patients underwent adjuvant therapy consisting of either irradiation (n = 40; 28%) or chemotherapy (n = 70; 49%); 33 women (23%) did not receive any treatment after surgery. The 5-year survival rate for all stages of disease was 43%. The 5-year survival rate was 59% for stages I and II and 19% for stages III and IV. FIGO stage, histologic grading and residual tumor showed an independent prognostic impact in multivariate analysis.
Bilateral Oophorectomy in Asymptomatic Women over 50 Years Old Selected by Ovarian Cancer Screening
Authors: Hayashi Hiroaki , Yaginuma Yuji , Kitamura Shinitsu , Saitou Yuji , Miyamoto Toshinobu , Komori Harumi , Wada Keiko , Ishikawa Mutsuo
Published: April 2003

The purpose of this study was to evaluate bilateral oophorectomy in women over 50 years old found to have an adnexal mass using transvaginal ultrasonography (TVS) as a mass screening. With TVS a total of 23,451 women without symptoms were examined for ovarian cancer at annual screening for uterine cervical cancer. Two hundred fifty-eight women over 50 years old persistently had abnormal TVS results and 95 women gave informed consent for surgical tumor removal. In the 95 women operated, 7 malignant ovarian cancers were found. Especially adnexal masses which were thought to be benign were treated by laparoscopic surgery.
Malignant Mixed Mesodermal Tumors of the Ovary: Preoperative Diagnosis
Authors: Wang Peng-Hui , Lee Rheun-Chuan , Lin Grace , Lai Chung-Ru , Yu Ken-Jen , Chao Hsiang-Tai
Published: April 2003

Early diagnosis of malignant mixed mesodermal tumors of the ovary is very difficult because of the rarity and the insidious onset. The purpose of this report is to review the magnetic resonance imaging features of an ovarian malignant mixed mesodermal tumor, which occurred in a 52-year-old woman, aiding in the differential diagnosis.
Total Fibronectin in Maternal Plasma as a Predictor for Preeclampsia
Authors: Gredmark Thomas , Bergman Boinge , Hellström Lajla
Published: April 2003

Objective: To assess the ability of measuring total maternal plasma fibronectin in predicting the risk of developing preeclampsia. Method: In a cohort of 657 initially normotensive pregnant nulliparous women blood samples were collected at 26, 30 and 34 weeks of gestation. After delivery 3 groups were selected for measurement of total plasma fibronectin. The first group comprised 24 women who developed preeclampsia; the second 21 women who developed gestational hypertension, and the third 89 age-matched controls who remained normotensive. Results: In women who developed preeclampsia the fibronectin levels were higher at 26 (p < 0.01), 30 (p < 0.001) and 34 weeks of gestation (p < 0.001) than in pregnant controls. In the general population of pregnant nulliparous women the estimated risk of subsequent preeclampsia correlated with the fibronectin level at each measurement. In women with fibronectin levels within the 25th percentile at the 26th week of gestation, the risk was ≤1.9% and within the 90th percentile ≥6.2%. The change in fibronectin levels between 26 and 34 weeks of gestation was the only variable that remained statistically associated with preeclampsia (p = 0.0002) in multivariate analysis. In this model the risk figures for the corresponding percentiles were ≤1.0 and ≥5.8%, respectively. Conclusion: Longitudinal assessment of the change in total fibronectin levels predicted preeclampsia slightly better than cross-sectional analysis of fibronectin at any gestational age. Nevertheless, measurement of total fibronectin in maternal plasma could not be proven to be a useful clinical predictor for preeclampsia in a general obstetric population of nulliparous women.
Endothelial Cell Lesion in Preeclampsia
Authors: Gilabert Rosa , Bellart Jordi , Jové Montserrat , Miralles Ramón M. , Piera Verónica
Published: April 2003

Morphofunctional study of umbilical cords from pregnancies complicated by preeclampsia shows both activation and lesion of endothelium. The cellular findings in umbilical cords from pregnancies complicated by preeclampsia can be summarized as: (i) higher number of cells with secretion bladders and increase in the number and size of both secretion bladders and microvilli-like protrusions; (ii) increase in collagen, fibrin, fibronectin and lipidic vesicles in the vessel wall; (iii) vacuolization of endothelial cells; (iv) presence of lipidic vacuoles and lipophages in the vessel wall; (v) erosion and disorganisation of the endothelium that exposes extracellular proteins to the blood flow. Endothelial cell cultures from preeclamptic pregnancies show kinetic disorders and cell detachment. The results confirm that an endothelial cell lesion occurs in preeclampsia and this cellular disorder can be reproduced in vitro.
Glutathione S-Transferase in Human Endometrium: Quantitation and Interindividual Variability in Isoform Content
Authors: Barnette K. Gary , Sarkar Mohamadi A. , Glover Douglas D. , Li Ping , Boyd Carole , Lalka David
Published: April 2003

Objectives: The goals of the present study were to determine whether human endometrium contains glutathione S-transferases (GSTs), to identify the isoforms present (if any) and to assess the causes of any intersubject variability which was observed. Method: Hysterectomy patients (n = 32, 13 with endometrial carcinoma) were examined in the core study. The ability of cytosol from these endometria to conjugate 1-chloro-2,4-dinitrobenzene was measured. Additional studies with chemical inhibitors and monoclonal antibodies to GSTπ were also performed. Results: The pattern of inhibition caused by ethacrynic acid and cibacron blue strongly suggests substantial interindividual variability in type (α and π dominant) and amount (∼10-fold) of this important group of enzymes. Significantly lower GST activity was seen in cancer patients who were smokers when compared with all other subjects (p < 0.05). Conclusion: There are substantial interindividual differences in the GST content of human endometrium. Furthermore, lower GST activity in tissues from endometrial carcinoma patients with a history of smoking may have contributed to the neoplastic transformation of this tissue.
Endoscopic Management of a Case of Complete Septate Uterus with Unilateral Pyometra
Authors: Batioglu Sertac , Zeyneloglu Hulusi B.
Published: April 2003

We report a case with an unusual müllerian anomaly: complete uterine septum and pyometra in the right hemicavity and pyocolpos along with a longitudinal vaginal septum. A patient with recurrent low-grade fever and lower abdominal pain was admitted. Pyometra and pyocolpos were detected in the right uterine hemicavity and in the right hemivagina. The septa were resected, the cavities were irrigated, and the patient was treated with antibiotics. The patient conceived 8 months later. Patients with abnormal vaginal findings should be approached with caution; precise knowledge of urogenital anatomy and urogenital anomalies is necessary in the management of these patients.
Failure of High-Dose Chemotherapy with Peripheral Blood Stem Cell Support for Refractory Placental Site Trophoblastic Tumor
Authors: Aoki Yoichi , Kodama Shoji , Kurata Hitoshi , Kase Hiroaki , Tanaka Kenichi
Published: April 2003

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease. The metastatic and refractory cases have a very poor prognosis. To our knowledge, this is the first report of the application of high-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT) for the treatment of refractory metastatic PSTT. A 36-year-old woman had a metastatic PSTT refractory to several lines of chemotherapy. She was treated with high dose of carboplatin and etoposide with autologous PBSCT. She showed only a temporary response to high-dose chemotherapy with PBSCT support and died of disease.
Emergency Cervical Cerclage: Relation between Its Success, Preoperative Serum Level of C-Reactive Protein and WBC Count, and Degree of Cervical Dilatation
Authors: Minakami Hisanori , Matsubara Shigeki , Izumi Akio , Kosuge Shuichi , Watanabe Takashi , Iwasaki Ryuhiko , Sato Ikuo
Published: April 2003

Objective: To assess the relation between the preoperative serum level of C-reactive protein (CRP) and the WBC count and the efficacy of emergency cervical cerclage. Study Design: We retrospectively reviewed the medical records of 17 women (16 singleton pregnancies and 1 twin pregnancy) who underwent emergency cervical cerclage (McDonald technique) between 21 and 26 weeks of gestation. The uterine cervix was dilated ≥3.0 cm and the intact (not ruptured) fetal membranes were visible or protruded into the vagina in all patients. The serum level of CRP and the WBC count were determined preoperatively and postoperatively. Emergency cervical cerclage was considered successful if delivery occurred ≥14 days after the procedure. Results: Emergency cervical cerclage was successful in 12 women, including the woman with a twin pregnancy, but failed in 5 women. The preoperative serum level of CRP and the WBC count were significantly lower and dilatation of the cervix was significantly less in the success group than in the failure group. Cerclage was successful in all eight patients with cervical dilatation ≤4.0 cm, but in only 4 of 9 patients with cervical dilatation >4.0 cm (p < 0.05). Cerclage was successful in all 11 women with a preoperative serum level of CRP ≤4.0 mg/dl and a WBC count ≤14,000/µl compared with 1 of 6 women with either a CRP level >4.0 mg/dl or a WBC count >14,000/µl (p < 0.01). Conclusion: A preoperative CRP value ≤4.0 mg/dl, a WBC count ≤14,000/µl, and cervical dilatation ≤4.0 cm were significantly associated with prolongation of pregnancy after emergency cervical cerclage.
Fetal Size as a Determinant of Obstetrical Outcome of Post-Term Pregnancy
Authors: Ryo Eiji , Kozuma Shiro , Sultana Jafreen , Kikuchi Akihiko , Fujii Tomoyuki , Unno Nobuya , Okai Takashi , Taketani Yuji
Published: April 2003

Hypothesis: We hypothesized that there might be differences in the outcomes of post-term pregnancy according to fetal size. Methods: A retrospective analysis of 143 women with uncomplicated pregnancy that persisted beyond 42 weeks was conducted. Ultrasound dating was performed between 8 and 14 weeks in all cases. The obstetrical outcomes were compared between the cases in which neonatal birth weight was <3,600 g (non-large group) and ≥ 3,600 g (large group). Results: In primiparous women, there was no significant difference between the non-large and large groups in terms of the rate of cesarean section, but the rate of cesarean section for fetal distress in the non-large group was significantly higher than that found in the large group. In addition, the non-large group showed a significantly higher incidence of low pH (<7.20) compared with the large group (14/58 vs. 0/22, p < 0.01). In contrast, the rate of prolonged labor (>24 h) and induction failure in the non-large group were significantly lower than that in the large group. In multiparous women, there was no significant difference in obstetrical outcomes between the non-large and large groups. Conclusions: Primiparous women who were delivered of fetuses weighing not less than 3,600 g at post-term periods were at lower risk of fetal distress on the one hand and at higher risk of induction failure associated with infavorable cervix on the other. This study suggests that post-term pregnancy should be dealt with differently based on fetal weight.
The Staffs’ Views Regarding Young Men Involved in Decisions on Abortion:Preliminary Information from a Study ofOutpatient Clinics for Adolescents in Sweden
Authors: Holmberg Lars I. , Wahlberg Vivian
Published: April 2003

The purpose of this study was to obtain knowledge about the opportunities available to Swedish teenage boys and young men for obtaining advice and support during the process involved in making decisions on abortion. The study was carried out at Swedish Outpatient Clinics for Adolescents. We also wanted to obtain knowledge about the staffs’ views of male attitudes and feelings regarding abortion. This knowledge is intended for use in developing models for advice and support in this difficult situation. A questionnaire focused on current management routines and staff experiences of questions and problems taken up by the male partner concerning abortion. Questionnaire answers indicated that the potential father, as well as the mother, requires active care and information together with the partner. There was also a need for individual support and information for male partners requiring engagement of health care professionals who are familiar with the problems involved.
25 mg or 50 mg of Oral Methotrexate Followed by Vaginal Misoprostol 7 Days after for Early Abortion
Authors: Carbonell Esteve J.L. , Varela L. , Velazco A. , Tanda R. , Sánchez C.
Published: April 2003

Background: Several combinations of oral or intravenous methotrexate plus vaginal misoprostol have been used for early abortion with success rates varying widely. So far, any study has evaluated the efficacy and safety of lower doses of oral methotrexate followed by vaginal misoprostol for early abortion. Objectives: To evaluate the efficacy and safety of methotrexate 25 or 50 mg orally and 800 μg of misoprostol vaginally 7 days after the methotrexate for abortion at ≤56 days of gestation. Study Design: Three-hundred and ten pregnant women seeking elective abortion were randomly allocated to receive 25 mg (group I) or 50 mg (group II) of methotrexate orally and 800 μg of misoprostol vaginally 7 days after the methotrexate. The misoprostol dose was repeated 48 and 96 h later if the abortion did not occur. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side effects and vaginal bleeding. Relative risks were used for the comparison between the outcomes from both treatment regimens. Results: In group I aborted 135/148 cases (91%, 95% CI 85, 95%), and 139/154 cases (90%, 95% CI 84, 94%) aborted in group II (relative risk [RR] = 1.01, RR 95% CI 0.94, 1.09). Conclusions: The two treatment regimens showed the same efficacy and safety, so it would be advisable at least to use the smaller methotrexate dose, i.e. 25 mg.
Intravenous Iron Therapy in Pregnancy Anemia: Hematological Response in Relation to Gestational Age
Authors: Carretti Nicola , Paticchio Maria Rosa
Published: April 2003

This study was undertaken to evaluate the response to parenteral administration of iron in 62 pregnant patients with asiderotic anemia and mean initial hemoglobin (Hb) concentrations (Hb1) of 9.91 ± (SD) 1.13 g/dl. Iron (742 ± 366 mg) was administered intravenously, and the response to treatment was classified according to the rise in Hb (VarHb; 0.97 ± 0.77 g/dl) and evaluated after 19.5 ± 14.6 (range 4–57) days. It was found that the VarHb was inversely correlated with the Hb1 value (r = –0.46; p <0.001) and only weakly correlated with the number of vials administered. In addition, two-cluster analysis of patients on the basis of VarHb and gestational age resulted in two significantly different groups (p <0.001): >28 weeks of pregnancy (n = 39, group 1: 1.27 ± 0.66, range 0.1–3.3 g/dl) and ≤28 weeks of pregnancy (n = 23, group 2: 0.45 ± 0.69, range 0.4–2.3 g/dl). No difference was found between groups 1 and 2 in relation to Hb1, iron dose, and therapy duration. The number of patients with VarHb >0.8 g/dl was found to be higher in group 2 than in group 1: 31/39 versus 8/23 (p <0.001). These results indicate that the response to intravenous iron therapy in pregnancy anemia is related to Hb1 level and gestational age at the onset of treatment and probably depends on the erythropoietin response to anemia.
Simplified Biophysical Profile: An Antepartum Fetal Screening Test
Authors: Kamel Hassan S. , Makhlouf Ahmed M. , Youssef Alaaeldin A.
Published: April 2003

A total of 330 high-risk pregnant women with gestational ages of 32–42 weeks were followed until delivery using the biophysical profile (BPP) and a screening test consisting of the amniotic fluid index together with fetal acoustic stimulation under ultrasound M-mode scanning. The test was compared with the BPP and nonstress test (NST) for predicting abnormal outcome. The sensitivities of the BPP, NST and the proposed test were 100, 98.4 and 100%, respectively, the negative predictive values were 100, 99.4 and 100%, while the false-positive rates were 21.3, 39.3 and 67%. Our simplified biophysical testing method is suggested to be a good negative preliminary screening test, while positive results require further fetal testing methods. This test reduced the need for BPP in many high-risk patients and had the advantages of simplicity, low cost and less time consumption.
Immunologic and Biochemical Factors in Hyperemesis gravidarumwith or wit hout Hyperthyroxinemia
Authors: Leylek Ozkan Aydin , Toyaksi Mehmet , Erselcan Taner , Dokmetas Sebila
Published: April 2003

Objective: This study was set up to investigate the relationship between immune process and high levels of human chorionic gonadotropin-β (βhCG) in hyperemesis patients with or without hyperthyroxinemia. Methods: βhCG, immune parameters and thyroid related hormones were assayed in hyperemesis patients and in controls. Results: Mean serum βhCG, fT4 and TSH levels were significantly higher in hyperemesis patients than in controls (p < 0.01, p < 0.01, p < 0.05, respectively). Further, immune parameters regarding IgG, IgM, C3, C4 and lymphocyte count were significantly higher in patients than in controls (p < 0.05, p < 0.01, p < 0.01, p < 0.05, p < 0.01, respectively). In hyperemesis patients with hyperthyroxinemia, mean serum βhCG, IgG and IgM were significantly higher than in hyperemesis women without hyperthyroxinemia (p < 0.001, p< 0.05, p < 0.05, respectively). βhCG was positively correlated with fT4 (r = 0.45, p < 0.05), with lymphocyte count (r = 0.47, p < 0.01), with IgM (r = 0.38, p < 0.05) and with C3 (r = 0.40, p < 0.05) in hyperemesis patients. A negative correlation between βhCG and TSH (r = –0.43, p < 0.05) was noted in the hyperemesis group. Free T4 showed a positive association to IgM (r = 0.49, p < 0.01), to IgG (r = 0.40, p < 0.05), to lymphocyte count (r = 0.45, p < 0.05). Conclusion: Immunologic activity in pregnancy may have an effect or role on the stimulatory mechanism of βhCG in hyperemesis patients with or without hyperthyroxinemia.
Pharmacokinetics of Fem7®, a Once-Weekly, Transdermal Oestrogen Replacement System in Healthy, Postmenopausal Women
Authors: Geyer D. , Gerrits M.G.F. , Renoux A. , Uhl W.
Published: April 2003

This open-label, randomized study in 36 healthy postmenopausal women, investigated the pharmacokinetics of Fem7® (an oestradiol matrix-type patch), at doses of 25, 50, 75 and 100 μg/24 h, applied once weekly. Maximum plasma concentrations of oestradiol and oestrone were observed 14–20 h after patch application, remaining within the therapeutic range until removal, and returning to baseline within 12 h thereafter. Plasma oestradiol concentrations increased in a dose-dependent manner for all four doses, and plasma oestrone increased for the three highest doses. Fem7 treatment was well tolerated at all four doses and no severe adverse reactions were reported. Fem7 is a convenient and well-tolerated form of hormone-replacement therapy that delivers oestradiol in a consistent and predictable manner.