bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of pretreatment squamous cell carcinoma antigen in predicting nodal metastasis in early stage cervical cancer
Authors: LIN HAO , CHANGCHIEN CHAN‐CHAO , HUANG ENG‐YEN , TSENG CHIH‐WEN , ENG HOCK‐LIEW , HUANG CHAO‐CHENG
Published: March 2003

Purpose. To evaluate whether the presence of pelvic lymph node metastasis can be predicted by pretreatment squamous cell carcinoma antigen (SCC‐Ag) levels in early stage squamous cervical carcinoma.

Materials and methods. Between 1994 and 1998, 284 patients with stage Ib and IIa cervical squamous cell carcinoma undergoing radical hysterectomy had preoperative SCC‐Ag determination. The correlation between clinicopathological findings on SCC‐Ag levels were examined. The Mann‐Whitney U test was used to statistically analyze differences between node positive and negative patients. Multiple regression analysis and a multiple logistic model were employed to examine the effect of clinicopathological findings on SCC‐Ag levels.

Results. Of the 284 patients, 56 patients were found to have nodal metastasis. Median serum levels and 90% ranges of SCC‐Ag were 0.74 μg/l (0.5–7.8) in the 228 nodal negative patients and 4.33 μg/l (0.5–48.5) in the 56 nodal positive patients (p<0.001). Lymph node metastasis and tumor size were found to have a significant impact on SCC‐Ag levels. Around 86% of the patients with SCC‐Ag levels below 8 μg/l showed no nodal metastasis, while about 65% of the patients with serum levels above 8 μg/l exhibited nodal metastasis. Multivariate analyses confirmed that only lymph node metastasis had a significant impact on the SCC‐Ag levels exceeding 8 μg/l.

Conclusion. For predicting nodal metastasis preoperatively, SCC‐Ag levels greater than 8 μg/l can be considered a high‐risk zone for nodal metastasis.
The pap‐smear history of women with invasive cervical squamous carcinoma
Authors: ANDERSSON‐ELLSTRÖM AGNETA , SEIDAL TOMAS , GRANNAS MARIANNE , HAGMAR BJÖRN
Published: March 2003

Background. Screening by cytology is a potentially highly effective procedure for preventing carcinoma of the uterine cervix. To elucidate any weaknesses in the screening procedure in a Swedish county where screening started many years ago, the detection of invasive cervical squamous cell carcinoma was compared to the prior cytological screening.

Methods. On the basis of the complete Pathology data files, including cytology and histology, all 112 women with invasive cervical squamous carcinoma were compared to 112 matched controls from the Swedish Population Register, regarding attendance rate and results of Pap‐smears prior to the date of discovery of an invasive carcinoma in the case.

Results. Almost as many cases as controls had a history of pap‐smear testing, but the cases had significantly more prior atypias registered. Only 16% of women with cervical carcinoma and younger than 60 years were lacking Pap‐smear tests prior to the carcinoma diagnosis, but 46% had former atypias registered. More than half of them presented, however, a negative Pap‐smear test less than three years before the diagnosis. Among the controls, 10% were lacking prior Pap‐smears and only 9% had former atypias registered.

Conclusion. The policy for follow‐up and treatment of cervical dysplasias has to be improved in order to achieve a further reduction of the incidence of invasive carcinoma.
Comparison of usefulness of estradiol vaginal tablets and estriol vagitories for treatment of vaginal atrophy
Authors: DUGAL RANDI , HESLA KNUT , SØRDAL TERJE , AASE KATHE HELEN , LILLEEIDET ODDVAR , WICKSTRØM EGIL
Published: March 2003

Background. Atrophic vaginitis is a common condition. This study compared the usefulness of estradiol vaginal tablets (EVT) and estriol vagitories (EV) in treatment of atrophic vaginitis.

Methods. Ninety‐six postmenopausal women with symptoms of atrophic vaginitis were treated for 24 weeks with either EVT or with EV. Patients used the medication daily for the first 2 weeks of the study, and twice‐weekly thereafter.

Results. Both EVT and EV were effective in treating vaginal atrophy and patients in both treatment groups experienced a significant improvement in vaginal symptoms such as itching, irritation, dryness, and dyspareunia. At the end of the study three (6%) EVT treated women reported leakage and none needed to use sanitary towels. Among the EV treated women 31 (65%) reported leakage and 14 (29%) required sanitary protection. Furthermore, 90% in the EVT group perceived the medication as hygienic compared to 79% in the EV group, and 49% in the EVT group indicated that the product was easy to use compared to 28% in the EV group. Endometrial thickness was increased (1.1 mm with EVT and 0.5 mm on EV) in both treatment groups during the first 2 weeks of the study, but returned to baseline levels when the frequency of drug application was reduced to twice‐weekly.

Conclusions. Estradiol vaginal tablets provides an effective alternative to traditional forms of local estrogen therapy.
Infants' length at birth: an independent effect on perinatal mortality
Authors: MELVE KARI KLUNGSØYR , GJESSING HÅKON K. , SKJÆRVEN ROLV , ØYEN NINA
Published: March 2003

Aim. To investigate whether variations in birth length (crown‐heel‐length) were associated with perinatal mortality rate independent of birth weight.

Material. The study population was singleton live‐ and stillbirths from 16 weeks of gestation compiled in the Medical Birth Registry of Norway from 1967 to 1997, totaling 1,705,652 births.

Method. The total population was analyzed using z‐scores for length at birth, birth weight and gestational age. Variation in perinatal mortality by length at birth was studied within birth weight strata (250 g) by logistic regression.

Results. Perinatal mortality varied more by birth length than by birth weight or gestational age, especially for values above the population means. Within birth weight strata, the association between perinatal mortality and length was similar in all 250 g birth weight categories above 1500 grams: mortality was lowest at birth lengths 0–2 cm below average, with mortality rates increasing exponentially in either direction.

Conclusion. Within all birth weight strata, and adjusted for gestational age, long infants had the higher risk of perinatal death, suggesting that length at birth may be a valuable predictor when assessing the risk of perinatal mortality.
Outcome of pregnancies subsequent to placental abruption: a risk assessment
Authors: RASMUSSEN SVEIN , IRGENS LORENTZ M. , DALAKER KNUT
Published: March 2003

Objective. To assess the risk of small for gestational age (SGA), preterm birth, pregnancy induced hypertension (PIH), and perinatal death in the pregnancy immediate subsequent to a placental abruption (PA) in the same mother.

Design. A cohort study based on the Medical Birth Registry of Norway.

Results. Odds ratios of SGA in subsequent PA‐ and non‐PA deliveries were 2.8 (absolute risk = 18.5%) and 2.0 (13.9%), respectively, compared with non‐PA deliveries without a history of previous PA among siblings (7.5%) after exclusion of cases with SGA in the immediate previous birth. After exclusion of cases with spontaneous preterm birth in the immediate previous delivery, odds ratios of spontaneous preterm birth in subsequent PA‐ and non‐PA deliveries were 17.0 (36.3%) and 2.1 (6.6%), compared with non‐PA deliveries without a history of previous PA among siblings (3.2%). After exclusion of cases with PIH in the immediate previous pregnancy, odds ratios of PIH in subsequent PA‐ and non‐PA pregnancies were 2.9 (6.3%) and 1.6 (3.4%), compared with non‐PA deliveries without a history of previous PA among siblings (2.3%). After adjustment for demographic variables and obstetrical complications, the increased risks persisted.

Conclusion. A pregnancy following a PA must be considered a high risk pregnancy, not only in terms of excess risk of recurrence, but also due to excess risk of SGA, preterm birth, and PIH irrespective of recurrence of PA. Consequently, all pregnancies following a pregnancy with PA should be offered close antenatal surveillance and care.
Obstetric history and the risk of placenta previa
Authors: RASMUSSEN SVEIN , ALBRECHTSEN SUSANNE , DALAKER KNUT
Published: March 2003

Objective. To evaluate secular trends in the occurrence of placenta previa and whether placenta previa is associated with the outcome of previous pregnancies, cesarean section, and sociodemographic factors.

Design. A cohort study based on the Medical Birth Registry of Norway. Placenta previa in the second pregnancy was investigated for associations with outcomes in the first pregnancy and sociodemographic factors.

Results. In birth orders 1 and 2 the occurrence of placenta previa was 1.2 and 2.2 per 1000, respectively, with no secular trend. The occurrence increased with maternal age and was lowest in women aged 20–29 years. The recurrence rate was 23 per 1000 (adjusted odds ratio (OR) of recurrence=9.7). In women with prior delivery at ≤25 gestational weeks the risk of placenta previa was 6.7 per 1000 (adjusted OR=3.0). In women with prior placental abruption the risk was 5.8 per 1000 (OR=2.6). In women with prior perinatal death the risk was 4.4 per 1000 (adjusted OR=1.8). No independent relationship emerged with socio‐economic factors, previous birthweight, and a history of pregnancy induced hypertension. Cesarean section was associated with subsequent development of placenta previa (adjusted OR=1.3).

Conclusions. We found no secular trends in the occurrence of placenta previa. Placenta previa is associated with previously described risk factors for placental abruption. The increased risk of placenta previa subsequent to placental abruption supports the theory of a shared etiologic factor. However, placenta previa and placental abruption do not share a common etiology in relation to a history of pregnancy induced hypertension, fetal growth retardation, and socio‐economic factors.
Knowledge and attitudes of folate, and use of dietary supplements among women of reproductive age in Norway 1998
Authors: VOLLSET STEIN EMIL , LANDE BRITT
Published: March 2003

Background. Authorities in many countries, including Norway from March 1998, recommend that women consume supplemental folate before and early in pregnancy to prevent neural tube defects. The aim of this survey was to establish Norwegian baseline data on knowledge, use and attitudes of folate and dietary supplements before implementing national campaigns on folate and pregnancy.

Method. A telephone survey was carried out in late 1998 among 1146 Norwegian women of reproductive age. The women were recruited from a nationally representative stratified random sample.

Results. Among the women aged 18–45 years, 50.4% had heard about folate, 32.9% knew about its role in pregnancy and 9.5% that it may prevent a malformation. Only 4.0% of the women knew that the critical period for folate supplementation to prevent a neural tube defect is before and early in pregnancy. The strongest determinants of knowledge were closeness to a pregnancy and educational level. Dietary supplements were used daily or almost daily by 53.3% of the women. The most commonly used types were multivitamin supplements and cod liver oil while only 0.9% of the women reported current use of supplemental folate. The women were also asked about use of folate and dietary supplements before or early in their last pregnancy: 44.3% reported that they had used a dietary supplement and 2.4% had used folate. Among the few women who had been pregnant within the last year of the interview, 10.3% reported use of a folate supplement. Overall, 56.0% of the women stated that they would use a folate supplement in a future pregnancy and 66.7% that they wanted more information about folate.

Conclusions. Although about half of Norwegian women had heard about folate in 1998, just below 10% knew that it could prevent a malformation. Use of folate supplements was low in 1998, but more than half of the women stated that they would use folate supplements in a future pregnancy.
Risk assessment at the end of pregnancy is a poor predictor for complications at delivery
Authors: BERGLUND ANNA , LINDMARK GUNILLA
Published: March 2003

Objective. To evaluate the usefulness of prenatal risk assessment for prediction of need for obstetric interventions.

Design. Area based retrospective study.

Setting. Västerås Central Hospital, Sweden, with all antenatal care units in the area.

Subjects. All women delivered at the only delivery ward in the area, after attending antenatal care at the affiliated
ANC‐units in 1990 (n=2008) and 1992 (n=1874).

Main outcome measures. Obstetric interventions at delivery.

Results. During the two years 81% and 83% of the study population delivered an infant in vertex presentation at term but 15% and 17% without risk factors or complications at the end of pregnancy had complications during delivery. The relative risk for interventions when risk factors were present was 2.2 and with spontaneous onset of labor 1.3/1.4. Low risk primiparae had unforeseen complications in 25% and multiparae in 10%. Relative risk for multiparae with risk factors and spontaneous labor was 2.2/1.8 and for primiparae 1.4/1.6.

Conclusions. Individual prediction of obstetric emergencies has low accuracy, which should be included in the information to women as well as in discussions with health planners.
Knowledge of and attitudes towards infertility held by members of two county councils in Sweden
Authors: KJELLBERG SVANTE , SYDSJÖ GUNILLA , GLEBE KRISTINA , SUNDELID MAGDALENA
Published: March 2003

Background. To investigate Swedish county council members knowledge of the laws regulating infertility treatment, their understanding of the suggestions put forward in the report ‘Priorities in Health Care’ and their attitudes towards infertility.

Methods. All members (n=182) of the 1998 county councils of Linköping and Jönköping were asked to participate in the study. In total, 153 answered the questionnaire.

Results. Different age groups did not show different levels of knowledge. Similarly, there was no significant difference between men and women concerning their knowledge of infertility laws. Furthermore, those committee members who were very positive towards infertility treatment did not have any better knowledge of such treatment than those who were less positive. The men and women who themselves had previously had or were dealing with infertility problems at the time of the survey (12 per cent) displayed the same level of knowledge as the other council members. They also expressed similar attitudes. The members showed very little familiarity with the priority groups suggested in the report from the Health Care Priority Committee. For example, only 18 per cent knew that this committee in priority group III placed infertility treatment and investigation. 31.3 per cent answered that infertility was placed in group V, a group that does not exist. The majority stated that they had a positive attitude towards the treatment of infertility. This is indicated, for example, by their rejection of the statement ‘it’s [infertility is] a luxury problem'.

Conclusions. The relative lack of knowledge of Swedish law and of the report from the Health Care Priority Committee might lead to a lower level of commitment to dealing with the problems that infertile couples face than if the members were better informed. In other words, this lack of knowledge might influence the decisions of the county council members.
Apoptosis in human cumulus cells in relation to maturation stage and cleavage of the corresponding oocyte
Authors: HØST ERIK , MIKKELSEN ANNE LIS , LINDENBERG SVEND , SMIDT‐JENSEN STEEN
Published: March 2003

Background. The purpose of this study was to determine the incidence of apoptosis in cumulus cells, and correlate these findings with the maturation stage, fertilization rate and embryo score of the corresponding oocyte, in couples undergoing ICSI due to a male factor.

Methods. The study group consisted of 21 couples where
ICSI was performed. The total number of oocyte‐cumulus complexes retrieved was 164. Sperm samples were assessed according to the WHO manual, morphology according to the strict criteria and for the presence of apoptosis. The degree of apoptotic
DNA fragmentation was determined using the free 3'OH
DNA termini in situ with chemically labeled and unlabeled nucleotides. The study was blinded for the technician involved in the assessments of apoptosis in the cumulus cells, apoptosis and morphology in spermatozoa. Ovarian hyperstimulation was carried out according to a long down regulation protocol using GnRH, rec FSH and hCG. A maximum of 3 embryos were transferred on day 2 after ICSI.

Results. This study demonstrated that the incidence of apoptosis was significantly higher in cumulus cells from germinal vesicle and metaphase I oocytes compared to cumulus cells from metaphase II oocytes (p<0.0001). Non‐fertilized metaphase II oocytes showed significantly higher incidence of apoptosis in cumulus cells compared to fertilized metaphase II oocytes (p=0.0082). Furthermore, apoptosis in spermatozoa had an impact on the embryo score (p=0.0087).

Conclusion. Comparing apoptosis in cumulus cells with maturity of the corresponding oocytes, a significantly higher degree was found related to immature oocytes. Apoptosis in cumulus cells from human metaphase II oocytes impaired the fertilization rate. The degree of fragmentation in the embryo might be correlated to apoptosis in the spermatozoa.
The influence of cotinine on interleukin 6 expression in smokers with cervical preneoplasia
Authors: EPPEL WOLFGANG , WORDA CHRISTOF , FRIGO PETER , MANAVI MAMOOD , CZERWENKA KLAUS
Published: March 2003

Background. Several epidemiological investigations have shown that cigarette smoking leads to increased serum IL‐6 levels and is a risk factor for cervical cancer.

Methods. We examined the levels of interleukin 6 (IL‐6) and the amount of cotinine in the cervical fluid of 78 women and compared the presence of human papillomavirus (HPV) in smokers and nonsmokers.

Results. The results of our study showed that IL‐6 levels were higher in the cervical mucus of smokers than in nonsmokers. Fourteen percent of smokers were in the category with highest IL‐6 levels compared to 6% of nonsmokers. However, our IL‐6 results were not significant as they were probably influenced by the higher rates of HPV infection in smokers (17 cases) than in nonsmokers (4 cases). Significant findings showed that smokers had a higher prevalence of squamous intraepithelial lesions (SILs) than nonsmokers. Smokers' cotinine levels also exceeded those of nonsmokers: 13.95 ng/ml compared with 5.00 ng/ml. However, less IL‐6 activity was evident in smokers with high‐grade SILs and HPV infection of high‐risk types.

Conclusion. Our results suggest that smoking has a stimulatory effect on the production of IL‐6 in the cervix. Furthermore, smokers show a higher genital HPV infection rate and a higher prevalence of SILs.
Changes in molecular weight of hyaluronan and hyaluronidase activity in uterine cervical mucus in cervical ripening
Authors: Obara Mikitaka , Hirano Hideto , Ogawa Masaki , Tsubaki Hiromitsu , Hosoya Naoko , Yoshida Yuko , Miyauchi Satoshi , Tanaka Toshinobu
Published: March 2003

Background. This study was undertaken to investigate changes in the forms of hyaluronan and hyaluronidase activity in cervical mucus during cervical ripening.

Methods. Uterine cervical mucus was obtained from 57 pregnant women (25 at preterm gestation, ten at term gestation, 11 within 1 week before labor, and 11 during the first stage of labor). We determined 1) concentration of hyaluronan, 2) hyaluronidase activity, and 3) molecular weight of hyaluronan in cervical mucus. Data are presented as mean and range.

Results. The hyaluronan concentration in mucus in the 1st stage of labor (1.58 μg/ml, 0.46–23.96) was significantly (p<0.05) higher than that in all other groups (preterm: 0.29, 0.10–0.88; term: 0.24, 0.11–0.80; within 1 week before labor: 0.30, 0.18–0.62). Hyaluronidase activity both within 1 week before labor group (3.03 min., 1.12–3.95) and in 1st stage of labor group (3.52, 0.43–5.15) was significantly (p<0.05) higher than that in preterm group (1.70, 0.00–5.47). The molecular weight of hyaluronan in cervical mucus in the 1st stage of labor (0.97×106, 0.86–1.41) was significantly (p<0.05) lower than in the preterm and term groups (preterm: 1.60, 1.21–2.20, term: 1.41, 1.21–2.20). There was a significant correlation between hyaluronidase activity and molecular weight of hyaluronan (p<0.05, r=−0.41, n=23).

Conclusion. These findings suggest that either hyaluronidase or low‐molecular weight hyaluronan could be one of the most important regulators in the process of cervical ripening.
Ultrasonographic guided ovarian stroma hydrocoagulation for ovarian stimulation in polycystic ovary syndrome
Authors: Ramzy Abdel Maguid , Al‐Inany Hesham , Aboulfoutouh Ismail , Sataar Mehany , Idrees Omaima A. , Shehata Mohammed Hany
Published: March 2003

Objective. To evaluate the safety and effectiveness of transvaginal ultrasound guided injection of hot saline into the ovarian stroma in polycystic ovary syndrome (PCOS) cases in an office based gynecology practice under local anesthesia.

Setting. Outpatient gynecologic clinic.

Study design. Pilot study.

Participants. Fifty‐two anovulatory infertile females diagnosed as PCOS by clinical, chemical and ultrasound criteria were recruited for the study. All cases were resistant to clomiphene citrate for more than 6 months.

Intervention. Injection of warm sterile saline (75C) into the ovarian stroma under transvaginal monitoring using ovum pickup needle.

Outcome measures. Cycle regularity, ovulation rate and safety were primary outcomes. Pregnancy rate and patient convenience were our secondary outcomes.

Results. Ovulation has been achieved in 73.1% of clomiphene citrate resistant PCOS cases and resulted in pregnancy in 26.9% of these cases. No adverse effects were recorded and the procedure was tolerable in most cases.

Conclusion. Transvaginal ultrasound guided ovarian stroma hydrocoagulation (TOSH) in an office setting seems to be a safe, economic and practical procedure that is acceptable by the patients. If larger studies confirm its effectiveness it may be an attractive alternative to conventional ovarian drilling.
CO2 laser vaporization as primary therapy for human papillomavirus lesions
Authors: Savoca Stefano , Nardo Luciano G. , Rosano Tiziana F. , D'Agosta Sebastiana , Nardo Filadelfo
Published: March 2003

Background. Human papillomavirus manifestations occur with increased frequency and severity amongst sexually active people. Several therapeutic approaches have been suggested to treat this viral disease. The aim of this prospective observational study was to assess the effectiveness of CO2 laser vaporization for human papillomavirus warts.

Materials and methods. Eighty healthy sexually active women with cytologically, colposcopically and histologically diagnosed human papillomavirus urogenital and perianal warts were enrolled and then treated by CO2 laser (16–18 W). Male partners were also investigated, and interferon‐β was eventually administered. All patients were then followed up for twelve months consecutively.

Results. At twelve‐month follow‐up, warts clearance was observed in 70 (87.5%) women. Recurrence was reported in ten (12.5%) women with multiple partners and affected by flat or endophytic condiloma of the cervix. Moreover, there were no complaints of pain, scar tissue deformity or other side effects.

Conclusions. CO2 laser vaporization is an effective, as well as safe and simple therapeutic approach for treatment of human papillomavirus warts. Its use should be encouraged for condyloma acuminata not associated with malignancy, as well as during pregnancy.
Relationship of upper body obesity to menstrual disorders
Authors: Douchi Tsutomu , Kuwahata Riki , Yamamoto Shinako , Oki Toshimichi , Yamasaki Hideki , Nagata Yukihiro
Published: March 2003

Background. The purpose of the present study was to investigate the relative contribution of upper and lower body obesity to obesity‐related menstrual disorders.

Methods. Women with polycystic ovary syndrome (PCOS) were excluded from the study. Eighty‐three obese women with a body mass index (BMI, Wt/Ht2) of more than 25 kg/m2 were classified into two groups according to their menstrual status: one with menstrual disorders (n = 39; mean age ± standard deviation, 31.6 ± 4.9 years) and the other group (controls) with regular menstruation (n = 44; 32.2 ± 4.4 years). Age, age at menarche, height, weight, and BMI were recorded. Trunk fat mass, leg fat mass, the ratio of trunk to leg fat mass amount (trunk‐leg fat ratio), body fat mass, and the percentage of body fat were measured by whole‐body scanning with dual‐energy X‐ray absorptiometry. Baseline characteristics and anthropometric variables were compared between the two groups.

Results. Trunk‐leg fat ratio in women with menstrual disorders was 1.48 ± 0.29, which was significantly higher than that in controls (1.25 ± 0.38, p < 0.01). Trunk fat mass was also significantly higher in women with menstrual disorders than in controls (14.9 ± 4.1 kg vs. 12.9 ± 3.8 kg, p < 0.05). However, BMI, percentage of body fat, body fat mass, and leg fat mass did not differ between the two groups. Age, age at menarche, height, and weight did not differ between the two groups.

Conclusion. Upper body, but not lower body, obesity is associated with menstrual disorders.
A comparison of two dosage regimens of oral misoprostol for labor induction at term
Authors: Shetty Ashalatha , Martin Ruth , Danielian Peter , Templeton Allan
Published: March 2003

Methods. 251 women with indications for labor induction at term were randomised to receive either 50 or 100 µgs of oral misoprostol, repeated every 4 h to a maximum of 5 doses. Parous women in the higher dose group received 50 µgs as their first dose, subsequent doses being 100 µgs. Women who failed to respond to the 5 doses of misoprostol had the option of having vaginal PGE2 gel. The primary outcome measure was the induction to delivery interval in those who delivered vaginally. Patient satisfaction was assessed by postnatal questionnaire.

Results.  The induction to vaginal delivery interval, although shorter in the 100 µgs group was not statistically significant (26.8 versus 33.7 h, mean difference 6.9 h, 95% CI 0.4–13). There were, however, more failed inductions with misoprostol in the 50 µgs group (12.7% Vs 4.8%, RR 2.6, 95% CI 1.07–6.5). There were no differences in the modes of delivery, number of caesarean sections for fetal distress or in the neonatal outcomes in the two groups. Most patients, 83% and 92% in the 50 and 100 µgs, respectively, were satisfied with their inductions, and 64% of patients would prefer to have the inducing agent given orally if they were to have another induction.

Conclusion.  Oral misoprostol is effective in inducing labor and seems acceptable to patients. Both the 50 and 100 µgs dose regimens have a reasonable safety profile, but in view of the higher incidence of failed inductions with the 50 µgs dosage, the 100 µgs dose regimen may be the preferred dose regimen.
Profile of trace element concentrations in the feto‐placental unit in relation to fetal growth
Authors: Osada Hisao , Watanabe Yoshito , Nishimura Yoshikazu , Yukawa Masae , Seki Katsuyoshi , Sekiya Souei
Published: March 2003

Background.  During pregnancy, trace elements are indispensable for life maintenance not only for the mother but also for the fetus. The purpose of this study was to examine whether fetal growth is associated with altered levels of trace elements in maternal blood, fetal blood, and placenta tissue.

Methods.  Twenty‐one pairs of healthy mothers and their newborns with intrauterine growth restriction delivered after 34 weeks of gestation were recruited for the study. In addition, 30 pairs of healthy mothers and their appropriate for gestational age newborns were included as controls. Maternal venous blood, umbilical cord venous and arterial blood, and placenta tissue were collected immediately after delivery. Six essential elements, magnesium, manganese, iron, copper, zinc, and selenium, and four other elements, rubidium, strontium, cadmium, and cesium, in those samples were determined by inductively coupled plasma mass spectrometry or inductively coupled plasma atomic emission spectrometry.

Results.  Compared with appropriate for gestational age cases, intrauterine growth restriction cases showed higher magnesium, copper, and selenium concentrations in umbilical cord arterial sera, and higher magnesium and selenium concentrations in placenta tissue, but no significant differences appeared for the elements measured in maternal and umbilical cord venous sera. The umbilical cord venous vs. maternal sera concentration ratio was elevated for copper, and the umbilical cord arterial vs. umbilical cord venous sera concentration ratios were elevated for copper and zinc, but there were no differences in placenta tissue vs. maternal sera concentration ratios in intrauterine growth restriction cases.

Conclusions.  Among the trace elements evaluated, magnesium, copper, zinc, and selenium showed elevated concentrations in umbilical cord arterial blood, or elevated umbilical cord arterial vs. umbilical cord venous blood concentration ratios in intrauterine growth restriction cases. Reduced consumption efficiency of these four essential trace elements may be closely associated with retarded fetal development.
Domestic violence in late pregnancy and splenic injury: delayed presentation
Authors: McKenna Daniel , Adair Steven , Price John
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 95–96. © Acta Obstet Gynecol Scand 2003
Successful balloon tamponade of post cesarean hysterectomy pelvic bleeding: a case report
Authors: Fahy Una , Sved Amber , Burke Gerry
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 97–98. © Acta Obstet Gynecol Scand 2003
Identification of androgen, estrogen and progesterone receptor mRNAs in the eye
Authors: Wickham L. Alexandra , Gao Jianping , Toda Ikuko , Rocha Eduardo M. , Ono Masafumi , Sullivan David A.
Published: March 2003

Purpose: Previous research has demonstrated that sex steroids exert a significant influence on the structure and function of numerous ocular tissues. To begin to explore the underlying basis of this hormone action, we examined whether various anterior and posterior tissues of the eye contain androgen, estrogen and progesterone receptor mRNAs.

Methods: Tissue samples were obtained from adult male and female rats, rabbits and humans, processed for the isolation of total RNA and analyzed by RT‐PCR, agarose gel electrophoresis and Southern blot hybridization. All PCR amplifications included positive and negative controls.

Results: Our findings showed that androgen, estrogen and/or progesterone receptor mRNAs are present in the lacrimal gland, lacrimal gland acinar epithelial cells, meibomian gland, lid, palpebral and bulbar conjunctivae, cornea, iris/ciliary body, lens, retina/uvea, retina/choroid and retinal pigment epithelial cells of rats, rabbits or humans.

Conclusions: Our findings demonstrate that sex steroid receptor mRNAs exist in a variety of ocular tissues and suggest that these sites may represent target organs for androgens, estrogens and/or progestins.
Myopisation: The refractive tendency in teenagers. Prevalence of myopia among young teenagers in Sweden
Authors: Villarreal M. Gerardo , Ohlsson Josefin , Abrahamsson Maths , Sjöström Anders , Sjöstrand Johan
Published: March 2003

Purpose: 1045 children between 12 and 13 years old were examined in a field study in the Göteborg area (Sweden). The aim of this study was to report the prevalence of refractive errors, with special attention to myopia, since there are no previous reports in Sweden about this age group.

Methods: The examination included visual acuity testing and refraction under cycloplegia.

Results: We found a prevalence of myopia (≥−0.5D) of 49.7% and a prevalence of bilateral myopia of 39%. In the whole population, 23.3% were considered to need glasses (≥−0.75D). We also found a prevalence of high myopia (≥−5D) in 2.5% of the children.

Discussion: No statistically significant difference in myopia with respect to gender was found. The proportion of children needing glasses is considered the best indicator of the prevalence of myopia in this sample. The results confirm that this tendency towards myopisation in a teenage population in Göteborg is similar to the prevalence found in other parts of the world.
A clinical comparison of the Xpert non‐contact tonometer with the Goldmann applanation tonometer after penetrating keratoplasty
Authors: Lisle Chris , Ehlers Niels
Published: March 2003

Purpose: To assess the agreement between the Xpert non‐contact tonometer (NCT) and the Goldmann applanation tonometer in patients who have undergone penetrating keratoplasty.

Methods: The study material consisted of 42 consecutive patients (43 eyes) who had undergone penetrating keratoplasty within the previous 13 months.

Results: The slope of the linear relationship between the two measurement methods did not differ significantly from 1.0. The mean difference between the methods of 0.96 mmHg was not statistically significant. The range of intraindividual differences between the methods was from −9.8 to 22.8 mmHg. The standard deviation of differences was 6.62 mmHg. The 95% limits of agreement were −12.00 to 13.94 mmHg. There was no significant correlation between the central corneal thickness, astigmatism or transplant size and the difference between the methods.

Conclusion: The Xpert NCT shows considerable variation from the Goldmann values. The degree of agreement with the true IOP value remains to be shown.
Cataract surgery and effectiveness. 1. Variation in costs between different providers of cataract surgery
Authors: Lundström Mats , Brege Klas Göran , Florén Ingrid , Roos Pontus , Stenevi Ulf , Thorburn William
Published: March 2003

Purpose: To describe and analyse the cost of cataract surgery in four community‐run eye clinics in Sweden and also to analyse differences in cost between these clinics.

Methods: The average cost of a cataract surgery episode was calculated including one pre‐operative visit, the surgery itself and the post‐operative visits. Included in the analysis were the costs of disposables, personnel, rent, depreciation, general anaesthesia, bed days and education. Excluded were the costs of complications and overhead costs.

Results: The average cost for one cataract surgery episode was 5052/6915 SEK (1 Euro =8.57 SEK) with a variation from 4436/6202 to 6130/8293 between the clinics. The lower sum represents a minimum cost of personnel, the higher sum a maximum cost.

Conclusion: A large variation in costs of cataract surgery was found in four providers of cataract surgery. Nearly all clinics studied had one or more areas with much higher costs than average.
Ocular manifestations of incontinentia pigmenti
Authors: Holmström G. , Thorén K.
Published: March 2003

Purpose: The study aimed to evaluate the ocular manifestations in patients with incontinentia pigmenti (IP).

Methods: Thirty patients from different parts of Sweden participated. Orthoptic and ocular examinations were performed as well as evaluation of refraction and visual acuity.

Results: Ocular manifestations, probably associated with IP, were found in 77% (23/30) of the patients. Thirteen had serious or vision‐threatening eye manifestations in one eye, of whom 7 were totally blind in that eye from retinal detachments. Ten patients had minor retinal and/or corneal changes.

Conclusion: Ocular lesions in patients with IP may be serious and lead to blindness because of retinal disease. Ophthalmological follow‐up is essential in the neonatal period and such a programme is recommended.
Colour contrast sensitivity in cataract and pseudophakia
Authors: Friström Björn , Lundh Björn L.
Published: March 2003

Purpose: To study the influence of cataract on peripheral and central colour contrast sensitivity.

Methods: Peripheral and central colour contrast sensitivity was measured with a computer graphics system along the protan, deutan and tritan axes. Included were 30 patients with cataract divided into three sub‐groups: cortical cataract, nuclear sclerosis and posterior subcapsular cataract. Colour contrast was measured before and after cataract operation.

Results: There were significant differences in peripheral colour contrast thresholds comparing the preoperative and postoperative results. This difference existed even in patients (n=19) with a pre‐operative visual acuity ≥0.5 (mean 0.6). The tritan axis was the one most affected by cataract. There was no significant difference between cataract sub‐groups. Also, the central colour contrast sensitivity was affected by cataract. Again, the tritan axis was the most affected one. There was no significant difference between the cataract sub‐groups. We also found large and significant differences in central colour contrast thresholds between normal subjects and postoperative values from the cataract group in all colour axes. The colour contrast sensitivity was poorer in pseudophakes than in normals. There was a difference between the three groups of different IOL material used (PMMA, acrylic and silicone). The difference was significant in the protan axis, the acrylic group having the best colour contrast sensitivity.

Conclusion: Peripheral colour contrast sensitivity was affected by cataract, even when only moderately developed. This finding is of importance and should be considered when the method is used to study other eye diseases e.g. glaucoma. Central colour contrast sensitivity was also affected by cataract. The pseudophakes were found to have poorer colour contrast sensitivity than normals. The material in the IOL seemed to be of importance for colour contrast.
Ophthalmological findings in children with congenital toxoplasmosis
Authors: Fahnehjelm Kristina Teär , Malm Gunilla , Ygge Jan , Engman Mona‐Lisa , Maly Eva , Evengård Birgitta
Published: March 2003

ABSTRACT. Congenital toxoplasmosis may lead to severe visual impairment or neurological sequelae in the child.

Purpose: To study the severity of the primary and late ophthalmological dysfunction during a prospective incidence study of congenital toxoplasmosis in the Stockholm and Skåne counties.

Methods: Blood collected on phenylketonuria (PKU) cards from 40  978 consecutively born children were investigated for antitoxoplasma antibodies. Children with verified congenital toxoplasmosis were treated for 12 months with antiparasitic therapy and followed ophthalmologically, neurologically and serologically every third month.

Results: Three children had congenital toxoplasmosis. Two of these were asymptomatic at birth and would have escaped early detection without screening. One child had unilateral severe visual impairment and CNS involvement. The incidence of congenital toxoplasmosis was less than 1:10  000.

Conclusion: Neonatal screening is of importance to diagnose asymptomatic infected children with congenital toxoplasmosis as treatment has been shown to reduce long‐term sequelae. Ophthalmological investigations should start early and continue in co‐operation with paediatricians.
High prevalence of sleep‐disordered breathing in patients with primary open‐angle glaucoma
Authors: Onen S. Hakki , Mouriaux Frédéric , Berramdane Lotfi , Dascotte Jean‐Claude , Kulik Jean‐François , Rouland Jean‐François
Published: March 2003

Purpose: Elevated intraocular pressure and systemic hemodynamic changes are main risk factors in primary open‐angle glaucoma (POAG). Sleep‐disordered breathing (SDB) characterized by snoring, excessive daytime sleepiness and insomnia is accompanied by large swings in blood pressure and repetitive hypoxic periods during sleep. The aim of this study was to evaluate whether there is any relationship between SDB and POAG.

Methods: Consecutively, 212 outpatients with POAG and 218 outpatients without POAG were recruited. Both eyes were examined. An interviewer‐administered semi‐structured questionnaire was used to collect SDB‐related symptoms.

Results: After controlling for age, relative to control group, POAG patients showed a high prevalence of snoring (47.6%, p=0.04), snoring plus, excessive daytime sleepiness (27.3%, p=0.01) and snoring plus, excessive daytime sleepiness, plus insomnia (14.6%, p=0.01).

Conclusion: We found a high prevalence of SDB in patients with POAG. Chronic hemodynamic changes and recurrent severe hypoxia resulting from SDB may contribute to anoxic optic nerve damage, implicated in glaucoma.
Solitary peripapillary hemangioblastoma
Authors: Joussen Antonia M. , Kirchhof Bernd
Published: March 2003

ABSTRACT. Purpose: Hemangioblastomas are highly vascularized tumors of not well‐defined histological origin. They are the most frequent manifestation of the von‐Hippel‐Lindau (VHL) disease, but also occur as sporadic non‐hereditary tumors. Much has been learned in the recent past about the genetic background, however, the cellular origin of the tumor is still not resolved.

Methods: We report a rare case of sporadic peripapillary hemangioblastoma in a 58‐year‐old patient.

Results: Histological examination demonstrated a highly vascularized tumor with intercapillary stromal cells. The tumor did not invade the adjacent tissues. Surrounding retinal areas showed cystic and gliotic changes. Immunohistochemistry was unable to prove neuroglial origin of the stromal cells.

Conclusion: Histological findings show similarities to the findings in cerebral hemangioblastomas. The tumor location in this case together with the known response of glial cells to VHL, might indicate their involvement in the pathogenesis of hemangioblastoma.
Histology of microcornea complicated by bullous keratopathy
Authors: Inoue Yumiko , Inoue Tomoyuki , Ishii Yasuo , Shimomura Yoshikazu , Tano Yasuo
Published: March 2003

ABSTRACT. Purpose: To report a child with a microcornea complicated by bullous keratopathy and to present the results of a developmental and histological investigation of a microcornea.

Methods: Clinical and histopathological examination.

Results: Histopathological examination of the microcornea showed that the microcornea of our case lacked the non‐banded zone of Descemet’s layer and formed collagenous layer and secondary Descemet’s membrane.

Conclusion: This case demonstrates that histological finding of microcornea is not necessarily normal.
The value of electrophysiology results in patients with epilepsy and vigabatrin associated visual field loss
Authors: Hardus P. , Verduin W. M. , Berendschot T. T. J. M. , Kamermans M. , Postma G. , Stilma J. S. , Van Veelen C. W. M.
Published: March 2003

ABSTRACT. Purpose: To determine the value of electrophysiological findings in patients with temporal lobe epilepsy and to relate these findings to the amount of concentric contraction of the visual field and the use of vigabatrin.

Methods: Electro‐retinograms and electro‐oculograms were done on 30 patients, operated for temporal lobe epilepsy. The patients were divided into three groups: (A) concentric contraction of the visual field associated with a history of vigabatrin medication (15 patients), (B) normal visual field with vigabatrin use (11 patients) and (C) normal visual field without vigabatrin medication (4 patients).

Results: Electrophysiological abnormalities were found in 50% of the patients in group A. The Arden ratio of the EOG was lowered in 57%. Abnormalities in the ERG were found: b‐wave implicit time photopic F was prolonged (50%), b‐wave amplitudes scotopic B (53%), C (73%) and G (50%) and photopic H (50%) were diminished. The amount of visual field loss and the total dose of vigabatrin used, showed only slight correlation with the ERG and EOG. The use of vigabatrin during the ERG and EOG recording in group A, gave a higher b‐wave amplitude scotopic G in 64% of cases. The a‐wave implicit times scotopic G (73%) and photopic G (59%) and H (73%) were shortened in group B.

Conclusion: EOG was abnormal in 57% in group A. ERG abnormalities could only be found in 50% of group A, mainly in the inner retina. Since also the total dose of vigabatrin and the amount of visual field loss did not really show a correlation with the electrophysiological findings and results of literature are not unanimous, electrophysiology does not appear at present to be a good method to detect patients with, or at risk of, vigabatrin associated visual field loss. Regularly performed visual field examination remains the cornerstone in screening.
Corneal pathology and outcome of keratoplasty in autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED)
Authors: Tarkkanen Ahti , Merenmies Lauri
Published: March 2003

ABSTRACT. Background: Disabling, chronic, persistent keratoconjunctivitis is an essential ocular manifestation in autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED).

Purpose: Because of the paucity of previous studies our aim is to describe the main histopathological features of the keratopathy and to report the long‐term outcome of corneal grafting.

Material: Four corneal buttons obtained at keratoplasties. Two patients with clinical follow‐up data of 30 years.

Results: The corneal epithelium showed a severe atrophy with even areas of incipient epidermalization. The Bowman’s membrane was destroyed. The anterior corneal stroma was replaced by vascularized scar tissue with areas of chronic inflammatory cell infiltration consisting mainly of lymphocytes and plasma cells. The posterior corneal stroma, the Descemet’s membrane and the endothelium were normal. Rejection occurred after each keratoplasty. The last visual acuity of the first patient was finger counting of the right eye and 0.3 of the left eye and of the second patient 0.08 of both eyes.

Conclusion: In chronic keratopathy of APECED the anterior corneal layers, the epithelium, the Bowman’s membrane and the anterior corneal stroma are affected while the posterior cornea appears normal. As after keratoplasty rejection may be expected, its prevention and management need intensive attention.
Treatment of post‐keratoplasty astigmatism by topography supported customized laser ablation
Authors: Hjortdal Jesper Ø. , Ehlers Niels
Published: March 2003

ABSTRACT. Purpose: To evaluate the clinical and optical efficiency of topography modulated customized corneal ablations for irregular corneal astigmatism.

Material & methods: Sixteen eyes of 16 patients with iatrogenic corneal astigmatism (post keratoplasty) were consecutively included. Based on preoperative corneal topographic measurements height deviations from a spherical corneal shape were calculated and transferred to a flying‐spot excimer laser. Photo‐refractive keratectomy of the topographic irregularities was then performed. Clinical and optical efficiency was evaluated by best corrected visual acuity and by computation of corneal wavefront aberrations before and up to one year after treatment. Wavefront aberrations were decomposed by Zernike polynomial analysis.

Results: Before treatment the average best‐corrected visual acuity was 0.23. Three and 12 months after PRK the average best‐corrected visual acuity had increased to 0.37 (p<0.05) and 0.45 (p<0.05), respectively. Corneal wavefront aberrations (root‐mean‐square) were 3.35 before surgery and 1.88 (p<0.05) and 1.51 (p<0.05) at three and 12 months after treatment. Zernike polynomial decomposition of the wavefront aberrations revealed that regular corneal astigmatism was the most important aberration component before and after surgery. Regular astigmatism was significantly decreased by the procedure, whereas coma, spherical aberrations, and higher‐order aberrations were not reduced significantly.

Conclusion: Topography modulated photorefractive keratectomy of highly astigmatic corneal grafts can improve best corrected visual acuity and reduce corneal wavefront aberrations. Even in apparently irregular topographic astigmatism, regular astigmatic wavefront aberration may be the most important contributor to wavefront errors.