bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum
Authors: Chapron Charles , Jacob Sandrine , Dubuisson Jean‐Bernard , Vieira Marco , Liaras Etienne , Fauconnier Arnaud
Published: March 2003

Background. Two aims: 1) To assess the results of laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum (RVS); 2) to pinpoint the differences between this procedure and that used for deep endometriotic lesions located on the uterosacral ligaments (USL).

Methods. Descriptive retrospective study. Twenty‐nine consecutive patients operated for deep endometriosis infiltrating the RVS were included in this series.

Results. One patient only (3.5%) presented a major complication of the recto‐vaginal fistula type. After a one step reoperation under anesthesia, the post operative history was uncomplicated and no sequelae are to be deplored. With respect to dysmenorrhea (DM), deep dyspareunia (DP) and chronic pelvic pain (CPP), there was an improvement in respectively 91.7% (22 patients), 100% (24 patients) and 92.9% (13 patients) of cases. For each of these 3 symptoms the median score according to the visual analog scale was significantly lower after the operation (for DM: 7.6±2.0 versus 1.7±2.6; for DP 7.5±1.9 versus 0.5±1.1; for CPP 5.9±2.8 versus 1.4±3.2) (p<0.0001).

Conclusions. These results demonstrate that provided the surgeon is highly skilled in laparoscopy, operative laparoscopy is efficient for the treatment of patients presenting painful symptoms related to deep endometriotic infiltrating the RVS. From the technical point of view the rectum must be freed, leaving the deep endometriotic nodule attached to the posterior wall of the vagina. Resection of the whole lesion requires the posterior wall of the vagina to be resected, whereas ureterolysis is often unnecessary. So for lesions located on the RVS the vagina is opened systematically, unlike the situation when resecting deep endometriotic lesions infiltrating the USL. Deep pelvic endometriosis is not synonymous with endometriosis of the RVS. Lesions truly infiltrating the RVS represent only a small proportion of all deep endometriosis lesions.
Changes in serum vascular endothelial growth factor following initiation of estrogen replacement after hysterectomy and oophorectomy
Authors: Akkad Andrea , Al‐Azzawi Farook
Published: March 2003

Background. Vascular endothelial growth factor has been shown to play an important role in preservation and restoration of endothelial integrity. Similar effects on endothelial function have been described with estrogen replacement. This poses the question whether some of the mechanisms ascribed to estrogen are in fact vascular endothelial growth factor mediated. The objective of this study was to examine the effect of continuous transdermal estrogen replacement on serum levels of secreted vascular endothelial growth factor in women following hysterectomy and oophorectomy.

Methods. In a nonrandomized, prospective study, 40 hysterectomized and oophorectomized women were treated with transdermal estrogen. Their serum vascular endothelial growth factor levels were measured before and six months following estrogen treatment, using a commercially available ELISA kit.

Results. The mean serum vascular endothelial growth factor level fell from 328 ng/ml (s.d. 164) before treatment to 285 ng/ml (s.d. 124) following six months of estrogen replacement. This decrease was statistically significant (p<0.03).

Conclusion. Transdermal estrogen replacement in hysterectomized and oophorectomized women appears to be associated with a significant reduction in secreted serum vascular endothelial growth factor. However, the effect of hysterectomy and oophorectomy per se needs to be explained in appropriately designed trials.
Preoperative CA‐125 level as a predictor of non optimal cytoreduction of advanced epithelial ovarian cancer
Authors: Gemer Ofer , Segal Shmuel , Kopmar Alexander
Published: March 2003

Background. Suboptimal cytoreduction of advanced ovarian cancer is related to initial tumor bulk which correlates with CA125 level.

Methods. Retrospective record study of 40 patients with stage III ovarian cancer. The ability of a CA125 threshold level of 500 U/mL to predict suboptimal cytoreduction was determined.

Results. Twenty‐four (60%) of the patients were optimally cytoreduced. At the CA125 cut off level of 500 U/mL the sensitivity for predicting suboptimal debulking was 62% and specificity was 83%. Above a CA 125 level of 1500 U/mL none of the patients were optimally cytoreduced.

Conclusions. More data are needed to determine the CA125 cut off level at which the standard approach of initial laparotomy and cytoreduction may be modified.
Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment
Authors: Sohan Karen , Carroll Stephen G. , De La Fuente Sergio , Soothill Peter , Kyle Phillipa
Published: March 2003

Objective. To examine fetal outcome in hydrops fetalis in relation to gestational age at diagnosis and following investigation and treatment.

Methods. All cases of hydrops fetalis presenting to the Fetal Medicine Unit during the last seven years, between 1993 and 1999, were identified from the Fetal Medicine Database. During this time 87 of 13,980 patients who attended the Fetal Medicine Unit had hydrops fetalis. The cases were examined for gestational age at presentation according to etiology and fetal survival following investigation and treatment. The fetal survival rates for non‐immune cases of hydrops before and after 24 weeks were compared.

Results. The cause of hydrops was determined antenatally in 71 of the 87 (82%) cases. Of the 51 cases presenting before 24 weeks’ gestation, 23 (45%) were due to chromosomal abnormality. After 24 weeks, fetal tachyarrhythmias and hydrothorax were the most common causes and accounted for 14 (38%) of the 36 cases. Thirty‐four cases (39%) of hydrops received intrauterine treatment. The survival rates excluding chromosomal abnormalities in the non‐immune cases before and after 24 weeks’ gestation were 31% and 48%, respectively, and were not significantly different.

Conclusions. The survival rate in cases of hydrops fetalis may be improved with appropriate prenatal investigation and therapy. The etiology of hydrops is different before and after 24 weeks, and even when cases of chromosomal abnormality are excluded the survival rate is similar before and after 24 weeks.
Antibiotic treatment for threatened abortion during the early first trimester in women with previous spontaneous abortion
Authors: Ming‐Cheh Ou , Chung‐Chu Pang , Fu‐Min Chen , Chin‐Hsu Su , Dennis Ou
Published: March 2003

Background. We retrospectively examined the usefulness of antibiotic therapy for management of first‐trimester threatened abortion in women with previous spontaneous abortion.

Methods. From 1993 through 1999, women with first‐trimester threatened abortion received antibiotic therapy. Only those with gestational age less than 9 weeks and previous spontaneous abortion were included in this analysis. Women with mild abdominal cramping received amoxicillin plus erythromycin for 1 week; those with severe abdominal pain received amoxicillin plus clindamycin for 1 week. Recurrence was documented on the basis of either lower abdominal pain or vaginal bleeding.

Results. Of the 23 women included, 15 (65%) had abnormal vaginal flora (a score above 4, Nugent’s criteria). Seven of 16 women who received amoxicillin plus clindamycin and three of seven who received amoxicillin plus erythromycin had complete resolution of lower abdominal pain and vaginal bleeding without recurrence (p=1). The recurrence rate was higher, though not significantly, in women with abnormal bacterial vaginal flora (8/15 vs. 2/8, p=0.379). Twenty‐two (96%) of the 23 pregnancies were carried to term, with no identifiable neonatal anomalies.

Conclusions. These results suggest the usefulness of early antibiotic therapy in preventing pregnancy loss in women with threatened abortion early in the first trimester, and warrant further clinical trials.
Increased tissue concentrations of arachidonic acid in umbilical artery and placenta in fetal growth retardation
Authors: Matorras Roberto , López De Larrucea Arantza , Sanjurjo Pablo , Ignacio Ruiz Jose , Echevarría Yolanda , Nieto Aníbal , Perteagudo Lourdes , Aldamiz‐Echevarria Jose Luis
Published: March 2003

Objective. To compare the fatty acid phospholipid composition of the umbilical artery and the placenta in cases of fetal growth retardation (FGR) and of normal growth, as well as in symmetric and asymmetric FGR.

Design.. Case‐control study.

Setting. University hospital.

Population. Thirty‐nine FGR cases (12 asymmetric, 27 symmetric) and 78 cases with normal growth.

Main outcome measures. Thin layer gas‐liquid capillary chromatography of phospholipid fatty acids in umbilical artery and placental cotyledons. Newborns were classified as FGR if their weight was under the l0th percentile for our center. FGR was defined as symmetric if the ponderal index was >2.32, and as asymmetric if it was <2.32.

Results. In FGR, arachidonic acid was significantly increased both in placenta (24.05%±2.78 vs 22.46%±2.93) and in umbilical artery (16.76%±2.40 vs 15.58%±3.67). Indeed this increase was significantly higher in asymmetric than in symmetric FGR (25.70±2.32 vs 23.32±2.68 in placenta and 18.06±1.46 vs 16.14 ±2.53 in umbilical artery). On the other hand, in the placenta there were a number of differences in the metabolic ratios analyzed when comparing symmetric and asymmetric FGR, indicating a lower DHA availability and a higher n‐6 fatty acid elongation and desaturation in asymmetric FGR.

Conclusion. FGR is characterized by an increase in arachidonic acid both in the placenta and umbilical artery phospolipids, probably reflecting a different mobilization from tissue stores. It is speculated that the different arterial composition could be partially responsible for the increased cardiovascular risk of FGR in adulthood. On the other hand the metabolic status of the placenta concerning polyunsaturated fatty acids was very different in symmetric and asymmetric FGR, suggesting a different pathogenesis.
Comparison of Endorette® and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding
Authors: Epstein Elisabeth , Skoog Lennart , Valentin Lil
Published: March 2003

Main question. To compare the diagnostic properties of Endorette® and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women’s experiences of the two methods.

Methods. In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette® sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling.

Results. Endorette® sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette® sampling, and the doctor underestimated the pain in 62% of the women. Endorette® failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette® device had not reached the uterine fundus. In women with endometrium <7 mm, Endorette® and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium ≥7 mm, Endorette® yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C.

Conclusion. Endorette® and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium <7 mm. D&C is superior to Endorette® in women with endometrium ≥7 mm.
A low dose (‘Dhaka’) magnesium sulphate regime for eclampsia
Authors: Begum Rashida , Begum Anowara , Johanson Richard , Ali Mohammad Nawsher , Akhter Syeba
Published: March 2003

Background. Eclampsia remains a common cause of maternal death in Bangladesh. Early experience of magnesium sulphate use for eclampsia in Bangladesh was based on a lower dose regime, tailored for use in the smaller woman.

Objectives. a) To determine the recurrent convulsion rate with the low dose ‘Dhaka’ magnesium sulphate regime (recognizing the limitations of sample size). b) To identify whether toxicity occurs with this regime. c) To measure serum level of magnesium with this regime.

Methods. This prospective study included 65 eclamptic patients receiving lower dose magnesium sulphate therapy at Dhaka Medical College Hospital from 25 March 1998–15 June 1998. The loading dose of magnesium sulphate was 10 gm. Following this 2.5 gm was given intramuscularly 4 hourly, for 24 hours after administration of the first dose. Four blood samples were collected for serum magnesium levels. Patients were monitored hourly by observing their respiratory rate, knee jerks and urinary output. Findings were matched with serum magnesium levels.

Results. The range of serum magnesium levels was 1.74 to 6 mg/dl with mean (s.d.) values of 3.87 (0.78). Only five (9%) patients had diminished knee jerks 6, 10, 12, 12 and 15 hours after administration of the loading dose. But at those times the serum magnesium levels were 3.2 mg/dl, 3.8/dl, 3.4 mg/dl and 3.3 mg/dl respectively. Of the 65 patients, only one developed recurrent convulsions. This was 3 hours after the loading dose and was controlled by diazepam treatment and maintenance magnesium sulphate.

Conclusion. Half of the standard dose of magnesium sulphate appeared to be sufficient to control convulsions effectively and serum levels of magnesium remained lower than levels which produce toxicity.
Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints
Authors: Damen Léonie , Buyruk H. Muzaffer , Güler‐Uysal Füsun , Lotgering Frederik K. , Snijders Chris J. , Stam Hendrik J.
Published: March 2003

Objective. The aim of this study was to investigate the association between pregnancy‐related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity.

Methods. A cross‐sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP−) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively.

Results. Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP− group (3.0 versus 3.4 TU). The mean left‐right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP− group (0.9 TU). In the PRPP− group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50).

Conclusions. Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.
Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta‐analysis
Authors: Gupta Janesh K. , Chien Patrick F. W. , Voit Doris , Clark T. Justin , Khan Khalid S.
Published: March 2003

Our aim was to determine the diagnostic accuracy of endometrial thickness measurement by pelvic ultrasonography for predicting endometrial carcinoma and disease (hyperplasia and/or carcinoma) during an investigation of postmenopausal bleeding. We performed a systematic quantitative review of the available published literature, which consisted of online searching the MEDLINE and EMBASE databases (1966–2000) coupled with scanning of bibliography of known primary and review articles. The selection of studies, assessment of study quality, and extraction of data were performed in duplicate under masked conditions. Included in the analyses were 57 studies with 9031 patients . Accuracy data were summarized using likelihood ratios for various cut‐off levels of abnormal endometrial thickness. The commonest cut‐offs were 4 mm (9 studies) and 5 mm (21 studies), measuring both endometrial layers. None of the nine studies using the ≤ 4 mm cut‐off level were of good quality. Only four studies (out of the 21) used the ≤ 5 mm cut‐off level, which employed the best‐quality criteria. Using the pooled estimates from these four studies only, a positive test result raised the probability of carcinoma from 14.0% (95% CI 13.3–14.7) to 31.3% (95% CI 26.1–36.3), while a negative test reduced it to 2.5% (95% CI 0.9–6.4). In conclusion, ultrasound measurement of endometrial thickness alone, using the best‐quality studies cannot be used to accurately rule. However, a negative result at ≤ 5 mm cut‐off level measuring both endometrial layers in the presence of endometrial pathology rules out endometrial pathology with good certainty.
Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits
Authors: Sydsjö Gunilla , Sydsjö Adam
Published: March 2003

Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant women's own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis.

Methods. All of the 384 women who were delivered at the University Hospital during a 2‐month period were asked to answer a questionnaire anonymously. Information was sought concerning sickness absence and the use of parental benefits. In addition, questions were asked about working conditions and about each mother's own estimate of her level of ‘well being’. The women's attitudes towards work absence due to illness and towards social benefit programs were registered.

Results. Forty‐three per cent of the women stated that they had been on sick leave during pregnancy. The main reason for sick leave was reported back pain. Seventy‐four per cent of the women who were on sick leave stated, nevertheless, that they had been in ‘good’ or ‘excellent’ health during pregnancy. Of the 149 women who did not take sick leave, 10 reported being in ‘bad’ or ‘very bad’ health during pregnancy. 4.3% of the women stated that they had considered themselves to be ill due to an obstetric condition.

Conclusion. In addition to actual disease and severe discomfort, certain social conditions and attitudes as well, are likely to explain the increase of pregnant women on sick leave.
Prognostic value of screening for irregular antibodies late in pregnancy in rhesus positive women
Authors: Andersen Anita S. , Prætorius Lisbeth , Jørgensen Henrik L. , Lylloff Kirsten , Larsen Kim T.
Published: March 2003

Background.  To evaluate the prognostic value of screening for irregular antibodies late in pregnancy (third trimester) in rhesus positive women. Only those cases where irregular antibodies have not previously been demonstrated during routine screening in the first trimester with regard to clinically relevant complications in the newborn, were studied.

Materials and methods.  All women living in Frederiksborg county and giving birth in 1996 (n = 4216) were assessed for inclusion in the study. This was done by gathering the files at the Hillerød and Hørsholm Hospitals' blood banks for antibody test results. Six hundred women were excluded because of the lack of either the rhesus type or the late antibody test.

Results.  Of the 3616 women, 3046 were rhesus positive, and 3012 of these had a negative first trimester screen test. Fifteen of the 3012 women later developed irregular antibodies in the third trimester, and were included in the study. This corresponds to only 0.5%, and none of these cases entailed perinatal complications for the mother or the child.

Conclusion.  Routine screening of rhesus positive pregnant women in the third trimester is not rational from a cost‐benefit perspective, if the only purpose is to prevent hemolytic disease of the newborn.
Patient‐rating of distressful symptoms after treatment for early cervical cancer
Authors: Bergmark Karin , ÅVall‐Lundqvist Elisabeth , Dickman Paul W. , Henningsohn Lars , Steineck Gunnar
Published: March 2003

Background. More refined information on sources of symptom‐induced distress in a patient population can improve the quality of pretreatment information, make follow‐up visits more efficient and guide research priorities in the efforts to modify treatments.

Methods. In a population‐based epidemiological study covering all of Sweden, data were collected 1996–97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB‐IIA cervical cancer registered in 1991–92 at the seven departments of gynecological oncology in Sweden.

Results. A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom‐induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each).

Conclusions. The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.
Symptom‐free women at increased risk of ectopic pregnancy: should we screen?
Authors: Mol Ben W. J. , Van der Veen Fulco , Bossuyt Patrick M. M.
Published: March 2003

Background.  Transvaginal sonography, serum human chorionic gonadotrophin (hCG) measurement, and serum progesterone measurement provide the possibility to screen symptom‐free women at increased risk of ectopic pregnancy. The objective of the present study was to evaluate the cost‐effectiveness of screening for ectopic pregnancy, by addressing the expected benefits and costs of screening for ectopic pregnancy.

Methods.  Screening programs incorporating transvaginal sonography, serum hCG measurement, and serum progesterone measurement were compared with a ‘watchful waiting’ strategy. Data were extracted from the literature. The strategies were compared on the expected number of prevented tubal ruptures, the expected number of false‐positive diagnoses, and expected costs.

Results.  The cost‐effectiveness of screening appeared to be strongly dependent on the prevalence of ectopic pregnancy. At a prevalence of ectopic pregnancy of 6%, a screening program with transvaginal sonography and serum hCG measurement would reduce the number of patients with ruptured ectopic pregnancy from 2.1 to 0.61 per 100 screened women. Screening was expected to cost approximately Euro 933 per prevented tubal rupture, whereas the number of expected false‐positive diagnoses was 0.64 per prevented tubal rupture.

Conclusion.  We conclude that screening for ectopic pregnancy reduces the number of patients with tubal rupture, but only at the expense of a large false‐positive rate. Although sonography in symptom‐free women at risk of ectopic pregnancy might be justified for psychological reasons, the medical and economic benefits of such a policy seem to be limited.
Amniotic fluid index in low‐risk pregnancy as an admission test to the labor ward
Authors: Ghosh Gisela , Marsál Karel , Gudmundsson Saemundur
Published: March 2003

Background.  Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low‐risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress.

Methods.  Ultrasonically estimated four‐quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective ‘blind’ study comprising 600 low‐risk pregnancies. Oligohydramnios was defined as an amniotic fluid index ≤ 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit.

Results.  Two‐hundred and sixty‐seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25–11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied.

Conclusion.  The results indicate that measurement of the amniotic fluid index in low‐risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.
Transvaginal hydrolaparoscopy: a new diagnostic tool in infertility investigation
Authors: Jónsdóttir Kristín , Lundorff Per
Published: March 2003

Background.  To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo‐ovarian structures in the management of patients with unexplained infertility.

Methods.  A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy. The remaining 106 patients had transvaginal laparoscopy performed under local anesthesia, with standard laparoscopy performed only on those with pathology, which required operative intervention. Information on pathology, complications, and successful access to the pouch of Douglas were recorded.

Results.  The successful rate of access was 93%. Pathology was found in 29 patients, of whom 15 required operative laparoscopy. Also, out of 19 patients with adhesions, 11 (58%) had normal dye test bilateral, and only two (11%) had bilateral occlusion of the tubes. No complications were observed.

Conclusion.  Transvaginal hydrolaparoscopy is a safe and well‐tolerated method for investigating the tubo‐ovarian structures in unexplained infertility. It is superior to hysterosalpingography for diagnosis of adhesions.
Serum insulin‐like growth factor‐I and insulin‐like growth factor binding protein‐3 in premature rupture of membranes
Authors: Loukovaara Mikko , Koistinen Riitta , Kalme Tarja , Kurki Tapio , Leinonen Pekka , Seppälä Markku
Published: March 2003

Background.  The aim of the study was to evaluate whether the circulating levels of insulin‐like growth factor‐I (IGF‐I) and its major circulating binding protein, IGFBP‐3, are affected in premature rupture of membranes (PROM) and preterm delivery.

Methods.  The levels of IGF‐I and IGFBP‐3 were measured in 32 pregnant women with PROM and in 27 healthy gestational age‐matched pregnant women. Statistical analyzes were performed by analysis of variance.

Results.  All the patients with PROM had preterm delivery, at a gestational age of 31.9 ± 0.4 weeks (mean ± SEM). In the control subjects, pregnancy proceeded to term. In the PROM patients, the serum IGF‐I and IGFBP‐3 levels (289 ± 21 ng/ml and 8248 ± 407 ng/ml, respectively) were not statistically different from those in the control subjects (275 ± 22 ng/ml and 7579 ± 488 ng/ml). Seventeen patients with PROM showed a rise in serum C‐reactive protein, indicating subclinical intrauterine infection. Also in this subgroup of patients the levels of serum IGF‐I (281 ± 27 ng/ml) and IGFBP‐3 (9010 ± 633 ng/ml) were not different from those in the control subjects. Before delivery, serial serum samples were available from 22 patients with PROM. No consistent changes in IGF‐I or IGFBP‐3 concentrations were seen during the mean follow‐up period of 9 days.

Conclusions.  IGF‐I and IGFBP‐3 do not appear to play any significant role in the maintenance of pregnancy in PROM patients with preterm delivery, whether or not associated with emerging intrauterine infection.
Response to activated protein C decreases throughout pregnancy
Authors: Benedetto Chiara , Marozio Luca , Tavella Anna Maria , Maulà Vincenza , Carmignani Daniela , Curti Antonella
Published: March 2003

Background.  The possibility that changes in activated protein C anticoagulant activity may contribute to the hemostatic changes associated with pregnancy has been previously investigated, but the results of the studies are still controversial.

Methods.  Nine hundred and sixty‐one healthy nonpregnant and 711 normal pregnant women who were noncarriers of factor V Leiden at different weeks' gestation were included in a cross‐sectional trial. Moreover, the APC ratio was repeatedly measured in 45 women throughout pregnancy. The activated protein C ratio was tested using the modified activated partial thromboplastin time‐based assay.

Results.  A significantly lower APC ratio was observed at 20–28 and 32–38 (p= 0.0001) weeks' gestation compared with nonpregnant values. The decrease in the APC ratio throughout pregnancy showed a significant trend (p= 0.014). In none of the subjects did the APC ratio reach the cut‐off values for APC resistance.

Conclusions.  Our data confirm a reduction in the APC ratio throughout pregnancy. In our series, an APC ratio of less than 2.0 according to the cut‐off point of our laboratory).
Preoperative transcervical analgesia for laparoscopic sterilization with Filshie clips.A double blind randomized trial
Authors: Schytte Tine , Aage Soerensen Jens , Hauge Benedicte , Andersen Bent
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 57–60. © Acta Obstet Gynecol Scand 2003

Objective. To evaluate the use of preoperative transcervical analgesia for reducing postoperative pain from laparoscopic sterilization with Filshie clips.

Design. A double blind, randomized, placebo‐controlled trial.

Setting. Gynecologic day‐care clinic of Vejle Hospital, Vejle, Denmark.

Sample.  Seventy‐eight healthy women were attending the public hospital requesting sterilization.

Methods. Participants received bupivacaine 0.25% 20 mL or placebo normal saline 20 mL injected into the uterus, though the fallopian tubes and into the pelvis before tubal occlusion with Filshie clips.

Main outcome measures. Post‐operative visual analog pain score and request for analgesia were recorded.

Results. At 30 min after clip application there was a non‐significant reduction in pain‐score on VAS. However, at 1, 2, 3 and 4 h median pain score on VAS was similar in both groups. Patients request for postoperative analgesia was similar in the two groups.

Conclusions. Preoperative transcervical perfusion of the uterus, fallopian tubes and into the pelvis did not reduce postoperative pain or request for analgesics after laparoscopic sterilization with Filshie clips.
Is sleep disorder treatment appropriate for premenstrual syndrome?
Authors: Herr Joseph R.
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 99. © Acta Obstet Gynecol Scand 2003
Eye injuries from fireworks in Western Sweden
Authors: Sundelin Karin , Norrsell Kerstin
Published: March 2003

Purpose: To investigate the extent and type of, as well as the circumstances connected with, ocular injuries caused by pyrotechnical products in the Western region of Sweden (1 750 000 inhabitants).

Methods: A three‐year prospective observational study was carried out to register, interview and follow‐up all patients with ocular injuries caused by fireworks. The patients were reported by all ophthalmologists in the area.

Results: 52 patients (72 injured eyes) were reported, 49 males and 3 females. 39 of 52 (75%) were younger than 18 years. 15 patients (including the three females) were bystanders. The injuries ranged from conjunctivitis to complete loss of the eye. The pyrotechnical device had been manipulated or misused in 19 (37%) of the 52 accidents. Seriousness of injury could not be correlated to type of device or to whether the injured person was active in launching the firework or not. 20 (38%) of the 52 patients had permanent damage to the eye.

Conclusion: Ocular injuries from fireworks remain a problem. Preventive measures such as protective glasses and legislation are being discussed.
Comparison of ranked segment analysis (RSA) and cup to disc ratio in computer‐assisted optic disc evaluation
Authors: Gundersen Kjell Gunnar , Åsman Peter
Published: March 2003

Purpose: Ranked segment analysis is a new method for evaluation of optic nerve head topography with the Heidelberg Retina Tomograph. This analysis ranks sector measurements around the optic disc and compares these measurements with rank specific significance limits. We evaluated the diagnostic precision of the ranked segment analysis in a large clinical sample and compared with vertical cup/disc ratio measurements. Vertical cup/disc ratio measurements were not corrected for disc size.

Methods: We analysed optic disc images from 153 normal and 75 glaucomatous eyes using the Heidelberg Retina Tomograph (software version 2.01). Ranked segment analyses and vertical cup/disc ratio measurements were obtained from each optic disc image, and ROC curves were plotted.

Results: At the 95% specificity level, sensitivity was significantly lower for ranked segment analysis (70%) compared to vertical cup/disc ratio measurements (85%). Almost 30% of the discs in the glaucoma group were classified as normal using the ranked segment analysis.

Discussion: Ranked segment analysis yielded unacceptably poor discrimination, in fact, worse than cup/disc ratio with its known clinical limitations. Glaucomatous disc damage typically occurs at the vertical poles of the disc. High rank measurements (low sector values) in normal eyes, on the other hand, are more common in the temporal disc sectors. Important spatial information is lost during the ranking procedure. This may partly explain the low sensitivity of the ranked segment analysis observed in our study. The results raise serious concerns regarding the clinical usefulness of ranked segment analysis.
Colour slides or digital photography in diabetes screening – a comparison
Authors: Henricsson Marianne , Karlsson Cathrin , Ekholm Leif , Kaikkonen Pirjo , Sellman Anders , Steffert Eva , Tyrberg Maria
Published: March 2003

Purpose: The aim of this study was to compare digital images with slides in detecting and grading diabetic retinopathy, and to assess the retinopathy screening performed by ophthalmic nurses.

Method: 283 consecutive patients were examined using digital colour and redfree photography (Topcon Imagenet System 1.53) and 35 mm slides (Topcon TRC‐50 VT fundus camera, Kodachrome 64 colour film). The images were graded by the worst eye according to the Wisconsin classification by an ophthalmologist and ophthalmic nurse independently.

Results: There was exact agreement between grades obtained from the colour slides and the digital colour images in 82% (weighted kappa 0.88; 95% CI 0.80–0.96), and in 85% when redfree images were used as an adjunct to the digital colour images. There was a tendency towards undergrading of the digital colour images and overgrading of the digital redfree images, compared with the colour slides. Inter‐ and intragrader agreement (weighted kappa) varied between 0.77 and 0.84 for digital photography and between 0.88 and 0.90 for colour slides.

Conclusion: Good to excellent agreement was found between the grading of colour slides and digital colour images, the latter, however, associated with a slightly lower reliability. The adjunct of redfree images seemed to facilitate the detection of retinopathic lesions.
Survival of long‐term retinal cell transplants
Authors: Sharma Rajesh K. , Bergström Anders , Zucker Charles L. , Adolph Alan R. , Ehinger Berndt
Published: March 2003

Purpose: If retinal cell transplants are to be used in the management of retinal degeneration, they will need to survive in the eye for long time. This study assesses the fate of neural retinal transplants in the eye after long survival times.

Methods: Fragmented pieces of neural retinas from embryonic day 15 rabbits were transplanted to the subretinal space of adult animals of the same strain. The transplants were allowed to survive for up to 583 days prior to sacrifice and light microscopic examination.

Results: In most grafts, both neural and glial cells survived, however, some of the grafts seemed to contain predominantly glial cells. Only when the photoreceptors in the graft were apposed to the host pigmented epithelium did they survive. Otherwise, the neuronal components of the grafts were largely cells typically found in the inner retina. The long‐term transplants were much thinner than short‐term ones. Even after long survival times, the transplants lacked vascularization. No inflammatory cells were seen in or around the grafts.

Conclusion: The results suggest that the cells of the inner retina survive for long periods after transplantation, but the photoreceptor cells seem to need the support of the host pigmented epithelium for long‐term survival. It may therefore be important to have a transplantation technique where the graft photoreceptors can be placed in apposition with the host pigment epithelium.
Cone electroretinogram amplitude growth with light adaptation in patients with retinitis pigmentosa
Authors: Yamamoto Shuichi , Hayashi Masanori , Takeuchi Shinobu
Published: March 2003

Purpose: It has been hypothesized that the increase in the b‐wave during light adaptation is directly related to the level of cone malfunction in patients with retinitis pigmentosa (RP). Because this hypothesis has important bearing on the mechanism for the increase in the electroretinogram (ERG), we examined the increase in the amplitude of the cone ERG during light adaptation in patients with typical RP.

Methods: Cone ERGs were recorded to Ganzfeld white flash stimuli in the presence of white background illumination in 51 RP patients and in 27 normal subjects.

Results: In the normals, the increase in the b‐wave amplitude during light adaptation ranged from 14–92% of the dark‐adapted amplitude. All RP patients showed an amplitude increase that ranged from 5 to 100% of the baseline amplitude. This increase was not significantly different from that of the normals (p=0.71, unpaired t‐test). The baseline amplitudes and the increase in the relative amplitude were weakly correlated in the RP patients (r=0.31; p=0.029). No significant difference was observed in the amplitude increase between patients with near normal b‐wave implicit times and those with delayed times (p=0.17, unpaired t‐test). Changes of the b‐wave implicit time were not significantly different from those in the controls.

Conclusion: These findings that the changes in the cone ERG with light adaptation in the RP patients were very similar to those in normal subjects do not support the proposed hypothesis that the increase in the b‐wave amplitude during light adaptation was directly related to the level of cone malfunction.
Short term visual prognosis after retinal laser photocoagulation for diabetic maculopathy
Authors: Bek Toke , Møller Flemming , Klausen Bodil
Published: March 2003

Purpose: Retinal photocoagulation can improve the visual prognosis of patients with diabetic maculopathy complicated with clinically significant macular oedema. However, this effect covers a wide variation of visual outcome with some patients improving and other patients worsening several visual acuity steps. Therefore, parameters are needed that can be used to ensure that treatment is modified or avoided in those patients who are at risk of experiencing visual loss.

Methods: The change in visual acuity shortly after laser photocoagulation for diabetic maculopathy was assessed in 95 eyes of 79 patients as a part of a routine quality assessment programme, and was compared to the age at onset of diabetes, the pre‐treatment duration of diabetes, the number of retinopathy lesions and the number of laser applications given to treat the maculopathy.

Results: On average visual acuity was unchanged at the post treatment control (mean=−0.04, SD=0.15), however, with a wide variation (range: −0.44 to 0.33). There was no correlation between the change in visual acuity and any of the studied background parameters.

Conclusions: It is concluded that the treatment intervention rather than the general disease state is the main determining factor for the visual prognosis after laser photocoagulation for diabetic maculopathy. Other parameters should be identified to act as a basis for differentiating and improving laser photocoagulation of diabetic maculopathy. One such possible parameter might be the distance of retinopathy lesions and laser applications from the retinal fixation area.
Photocoagulation of diabetic macular oedema; complications and visual outcome
Authors: Lövestam‐Adrian Monica , Agardh Elisabet
Published: March 2003

Purpose: To describe complications and visual outcome of photocoagulation for clinically significant macular oedema.

Subjects and Methods: Evaluation of macular oedema and complications of photocoagulation in 194 eyes, defined as subretinal fibrosis, atrophic creep of the pigment epithelium and subretinal neovascularization was based on stereo fundus photo grading. The study included 25 patients with type 1 and 93 patients with type 2 diabetes (age 32±10 and 65±9 years, respectively). The statistical evaluations were based on one eye per patient.

Results: Follow‐up time was 5.5±2.4 years (mean±SD). Complications within 1/3 ODD from the centre of the macula were seen in 4% (1/23) of eyes of patients with type 1 diabetes, compared to 26% (20/76) of eyes among patients with type 2 diabetes (p=0.02). Hard exsudates before treatment were more common in type 2 than in type 1 diabetic eyes, 70/82 vs. 11/23 (p<0.001). In all eyes, hard exsudates were more often associated with subretinal fibrosis or atrophic creep (35/133 eyes) than diffuse oedema (5/44 eyes) (p=0.04).

Conclusion: Photocoagulation for clinically significant macular oedema with hard exudates, particularly when subfoveally located, was more often associated with subretinal fibrosis or atrophic creep of the pigment epithelium than photocoagulation of oedema without hard exudates. Hard exudates as well as complications after photocoagulation were more common in type 2 than in type 1 diabetes, resulting in poorer visual outcome in this group of patients.
Contrast sensitivity and visual recovery time in diabetic patients treated with panretinal photocoagulation
Authors: Lövestam‐Adrian Monica , Svendenius Nils , Agardh Elisabeth
Published: March 2003

Purpose: To study patients treated with panretinal photocoagulation regarding contrast sensitivity and visual recovery time after exposure to glare.

Methods: To compare contrast sensitivity and visual recovery‐time after exposure to glare in eyes (n=20) from 20 type 1 diabetic patients treated with panretinal photocoagulation for proliferative retinopathy with eyes (n=19) from 19 un‐treated type 1 diabetic patients. Contrast sensitivity was tested with a low contrast acuity chart, before and during exposure to either a uniform background illumination or a spotlight. Visual recovery time was defined as the time required to regain baseline visual acuity during light exposure.

Results: Contrast thresholds values were higher in eyes treated with panretinal photocoagulation compared to un‐treated eyes before illumination 4.2±1.2% vs. 3.1±1.7% (p=0.006), during background illumination 5.8±5.1% vs. 3.9±4.8% (p=0.001), and during spotlight exposure 5.6±2.2% vs. 3.2±1.8% (p<0.001). Furthermore, recovery time was longer both during background illumination, 20; 5–50 sec vs. 2; 2–80 sec. (md;range), (p<0.001) and during spotlight illumination 27; 5–70 sec vs. 2;1–60 sec. (md;range) (p<0.001).

Conclusion: Eyes treated with panretinal photocoagulation had higher contrast threshold levels at baseline and during glare, as well as a prolonged visual recovery time compared to un‐treated eyes with mild background retinopathy.
A retrospective study of patients with retained nuclear fragments after cataract extraction
Authors: Olsson Rønnaug Brandser , Ritland Jon Ståle , Bjørnsson Òlafur Màr , Syrdalen Per , Eide Nils , Øvergård Ralf
Published: March 2003

Purpose: A registration and follow‐up of patients who underwent pars plana vitrectomy after dislocated nuclear fragments to the vitreous following cataract extraction.

Material and methods: A retrospective study of 125 patients referred to The National Hospital during the years 1991 to 1998. Phacoemulsification and extracapsular technique were used in 115 eyes and 10 eyes, respectively. A pars plana vitrectomy was performed within an average of 13 days (1–99 days) after cataract extraction. Average follow‐up period was 9 months (0.5–35 months).

Results: The visual acuity at follow‐up was ≥ 0.5 in 67 eyes (55.4%), <0.5‐>0.1 in 32 eyes (26.4%), and ≤0.1 in 22 eyes (18.2%). The total number of retinal detachments was 26 (21.5%).

Conclusion: Retained nuclear fragments in the vitreous is a serious complication and most eyes achieve acceptable visual results.
Phaco‐vitrectomy for full‐thickness macular holes
Authors: Simcock Peter R. , Scalia Sergio
Published: March 2003

Purpose: To investigate the role of combined phaco‐vitrectomy surgery in the management of full‐thickness macular holes.

Methods: Thirteen eyes with full‐thickness macular holes had combined phacoemulsification cataract removal and vitrectomy surgery with instillation of 20% C2F6 gas.

Results: The mean duration of macular holes prior to surgery was 6.5 months. Eleven holes closed, 2 remained opened. All patients except one had an improvement in visual acuity. Laser treatment was performed to treat retinal breaks noted intraoperatively in 4 patients.

Conclusion: Combined cataract and vitrectomy surgery for full‐thickness macular holes enables good visibility during surgery. A large gas bubble can be obtained with excellent tamponade of the hole. Combined surgery prevents the patients having to return for cataract surgery.