bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinic-Community Partnerships: A Foundation for Providing Community Supports for Diabetes Care and Self-Management
Authors: Brownson Carol A. , O'Toole Mary L. , Shetty Gowri , Anwuri Victoria V. , Fisher Edwin B.
Published: November 2007

In Brief

Addressing complex challenges such as diabetes calls for a comprehensive approach in which health care organizations and communities work together for change. This article describes approaches and lessons learned from eight clinic-community demonstration projects funded through the Diabetes Initiative of the Robert Wood Johnson Foundation.
From DSME to DSMS: Developing Empowerment-Based Diabetes Self-Management Support
Authors: Funnell Martha Mitchell , Tang Tricia S. , Anderson Robert M.
Published: November 2007

In Brief

Diabetes education has changed a great deal in recent years. Diabetes self-management education (DSME) programs have become more patient-centered and theoretically based, and there is a greater emphasis on providing ongoing support to sustain the self-management gains made by patients as a result of education. Based on the frameworks of self-determination and autonomy support,empowerment has served as the philosophical basis for diabetes self-management education for more than 15 years. This article describes the evolution of empowerment-based programs from DSME to ongoing diabetes self-management support and provides practical strategies for educators to use in the development of these programs.
Radiographic Assessment of Inverted Papilloma
Authors: Blackwell Keith E. , Anzai Yoshimi , Lufkin Robert B. , Bielamowicz Steven , Calcaterra Thomas C.
Published: November 2007

Radiographic studies were reviewed from a group of 24 patients with biopsy-proven inverted papilloma of the nasal cavity or paranasal sinuses. Thirty-two cases of computed tomography (CT), 17 cases of plain sinus radiography, four cases of polytomography, and three cases of magnetic resonance imaging (MRI) were retrieved for analysis. Although no preoperative MRI examinations were available for comparison, CT was the most helpful study for evaluation of primary, nonrecurrent inverted papilloma, demonstrating disease-related abnormalities in 90% of the cases. While no CT finding was pathognomonic, findings that helped to distinguish inverted papilloma from benign nasal polyposis included predominantly unilateral involvement (90%) and frequent unilateral bony remodeling (40%). Plain sinus X-rays were abnormal in 70% of cases of primary tumor, with all positive studies showing nonspecific unilateral opacification of the maxillary antrum. Both CT and MRI defined the extent of histologically proven recurrent disease, although it was impossible to radiographically distinguish recurrent disease from postoperative scar tissue or mucoperiosteal thickening.
Nasal Responses to Metabisulfite (MBS) Solution in Non-Atopic Subjects and Patients with Atopic Rhinitis
Authors: Śliwińska-Kowalska Mariola , Kowalski Marek L. , Sutkowski Wiestaw , Wesotowski Wiktor , Danzig Melvyn R.
Published: November 2007

In order to characterize the effect of metabisulfite (MBS) on human nasal mucosa, in 10 healthy, non-atopic subjects and in six patients with atopic rhinitis, 50 mg/mL and 100 mg/mL solutions of MBS were sprayed into both nostrils. Clinical symptoms and Nasal Peak Flow (NPF) were recorded. Nasal lavages were performed before and after MBS challenges. MBS challenge induced similar burning/itching sensation in both groups, but rhinorrhea was significantly more intense (P < 0.02) in atopic patients. There was no nasal congestion and no change in NPF after the challenge. Only in atopic patients were nasal symptoms accompanied by a dose-dependent increase in the concentration of total protein and glandular protein lysozyme in nasal washes (P < 0.05). No statistically significant changes were seen in the absolute amount of plasma protein albumin and albumin to total protein ratio (Albumin %) in nasal secretions. This study demonstrates that MBS induces nasal symptoms both in healthy, non-atopic subjects and in patients with allergic rhinitis; but secretory glandular responses are detected only in patients with allergic rhinitis.
Nasal Mucociliary Transport after Exposure to Swimming Pool Water
Authors: Benninger Michael S.
Published: November 2007

Swimmers often complain of nasal dryness, and reports have suggested that swimmers may have an increased incidence of chronic rhinosinusitis (“Swimmer's Sinusitis”). To assess the affect of swimming pool and ocean water on mucociliary transport, a saccharine-particle test was used after spraying the noses of 10 subjects under four test conditions: control, water, hypertonic saline (the concentration of ocean water), and swimming pool water. Nasal transit time was significantly prolonged after administration of swimming pool water, in comparison to the other three test conditions. Although hypertonic saline also prolonged transit times in comparison to water and control, these differences were not significant. The relationship between exercise, swimming pool water, and mucociliary transport will be discussed.
Latent Collagenase Production by Cells Derived from Nasal Polyps in Culture
Authors: Matsuzaki Tsutomu , Itoh Kazunori , Katahira Shoko , Ohyama Masaru , Fukuda Katsunori
Published: November 2007

We investigated the interactions between nasal polyp-derived fibroblast-like cells (NPFCs) and nasal secretions to clarify the role of connective tissue metabolism in nasal and paranasal pathology, especially in chronic sinusitis. In response to stimulation by human interleukin 1 (IL-1), NPFCs produced latent collagenase. Collagenase production was also stimulated by nasal secretions from patients with chronic sinusitis in vitro, but not by nasal secretions from nasal allergic patients. A soluble factor was isolated from the nasal secretions of patients with chronic sinusitis by ammonium sulfate precipitation and Sephadex G-75 gel chromatography. High performance liquid chromatography indicated that the molecular weight of the active fraction was approximately 20,000 daltons. This factor affected NPFCs, but did not affect the endothelial cells derived from nasal mucosa in culture. Collagenase production by NPFCs was considerably inhibited by anti-IL-1 antibody. These results indicate that IL-1 is one major factor to prolong the nasal and paranasal inflammatory lesions.
Inflammatory Cells and Mediators in Nasal Secretions during Early Response to Ragweed Challenge: Correlation between Type of Cellular Influx and Mediator Release
Authors: Georgitis John W. , Stone Brian D. , Gottschlich Greg
Published: November 2007

The early and late phase responses in nasal tissues exhibit release of lipid-derived mediators, granule-associated mediators, and a mixed cellular influx in separate nasal challenges. To explore this phenomenon further, concentrations of inflammatory mediators were measured along with characterization of cell influx during dose-dependent ragweed challenges. Ten allergic rhinitis subjects underwent two unilateral nasal lavages using incremental 3-fold concentrations of short ragweed antigen. Low doses of ragweed (0.016–0.114 units Amb a I) rarely induced cell influx (1/18 challenges), whereas moderate doses (0.432–1.3 units Amb a I) caused cell influxes in 7/18, and high doses (3.39–11.7 units Amb a I) resulted in cell influxes in 8/17. The eluent contained >50% neutrophils in 7 challenges; >50% eosinophils in 3; and a mixed pattern in 6. There was a significant association between the dose of antigen and the level of histamine, prostaglandin D2 (PGD2), and leukotriene C4/D4/E4 (LTC4/D4/E4). Challenges with an eosinophilic influx tended to be associated with higher concentrations of mediators than neutrophilic influxes. Similar to the immediate skin response, the early allergic response in the nose demonstrated a cell influx with release of histamine, PGD2, and LTC4/D4/E4. Nasal cellular inflammation, therefore, can occur within minutes of allergen exposure.
Correlation of Middle Meatal and Maxillary Sinus Cultures in Acute Maxillary Sinusitis
Authors: Vaidya Abhay M. , Chow James M. , Stankiewicz James A. , Young M. Rita I. , Mathews Herbert L.
Published: November 2007

Cultures obtained from the middle meatus have been used frequently in the past to direct therapy in patients with acute maxillary sinusitis. However, no convincing data have been published to indicate that middle meatal cultures accurately represent the bacterial flora within the maxillary sinus. The hypothesis of this experiment is that bacteria obtained by directed middle meatal cultures qualitatively and quantitatively correlate with cultures taken by maxillary sinus puncture. Acute sinusitis was induced by injecting 108 colony-forming units of bacteria directly into the maxillary sinuses of rabbits in which the ostia were occluded with cotton packs. Eight animals were injected with Staphylococcus aureus, eight with Haemophilus influenzae, and eight with Streptococcus pneumoniae. The packs were removed after 3 days, and specimens were obtained from the middle meatus in the region of the maxillary sinus ostium, and from the maxillary sinus, 1 day later. The contralateral maxillary sinuses of six of the animals were injected with normal saline and served as controls. There was a 100% correlation rate between cultures of specimens obtained from the maxillary sinus and from the middle meatus in all 24 animals. In addition, the quantitative counts from the middle meatus and the maxillary sinus correlated. Control animals showed no bacterial growth from either the middle meatus or the maxillary sinus. These results show that, in an animal model of acute sinusitis, cultures of specimens from the middle meatus reflect the contents of the maxillary sinus.
Bacteriology of Ethmoid Sinus in Chronic Sinusitis
Authors: Jiang Rong-San , Hsu Chen-Yi , Leu Jenn-Fuh
Published: November 2007

This study was designed to study the bacteriology of the ethmoid sinus in chronic sinusitis with a new sampling method to decrease nasal contamination. The anterior nose was disinfected with povidone-iodine solution. Then, the sample of ethmoid sinus was obtained with a cotton-tip stick through a cannula that was put into the ethmoid cavity after removing ethmoid bulla. Thirty-nine patients of chronic sinusitis were included with a total of 69 specimens. Fifty-eight bacterial isolates were recovered. The cultural rate was 60.9%. The most frequently isolated bacteria were Streptococcus viridans, Klebsiella pneumoniae, Proteus mirabilis, and Hemophilus parainfluenzae. Conversely, only three isolates of Staphylococcus epidermidis were obtained. The results show that the new sampling method used in this study could decrease the chance of nasal contamination and might, at the same time, make the study of the bacteriology of the ethmoid sinus more accurate.
Evaluation of Activated Eosinophil Infiltration for the Assessment of the Effect of Chemosurgical Treatment for Allergic Rhinitis Using Trichloroacetic Acid
Authors: Yao Kazuo , Shitara Tetsuya , Takahashi Hio-omi , Nishiyama Kouichiro , Iguci Yoshiaki , Yamamoto Kazuhiro , Okamoto Makito
Published: November 2007

An immunohistochemical study was made on the degree of activated eosinophil (EG2) infiltration in the inferior turbinate of 20 cases of perennial allergic rhinitis who underwent septal reconstruction and bilateral inferior turbinectomy approximately 5 months after the unilateral application of trichloroacetic acid (TCA). The distribution of EG2 was also evaluated in nasal smears obtained from the same subjects, and a comparison was made between TCA-applied and nonapplied sides. It was found that the number of EG2 was significantly decreased in the TCA-applied side. It was assumed that TCA application successfully suppressed reagin-dependent allergic reaction in the tissues.
Nasal Endoscopy: Its Role in Office Diagnosis
Authors: Benninger Michael S.
Published: November 2007

To clarify the role of nasal endoscopy in the diagnosis and treatment planning for patients with nasal or sinus complaints, 100 consecutive new patients were evaluated. Patients were excluded if their only complaint was obstruction and they had a septal deviation as the only clinical finding. Each patient underwent a thorough history and head and neck examination, including anterior rhinoscopy before and after decongestion, and the diagnosis and treatment plans were documented. Each then underwent nasal endoscopy, and the diagnosis and treatments were compared. The most common diagnoses after anterior rhinoscopy were allergic rhinitis (21), nonallergic rhinitis (12), chronic sinusitis with polyps (19) or without polyps (9), and nonsinus pain (13). Nasal endoscopy played a role in 11% of patients, although in no case did endoscopy change the diagnosis or treatment plan. Endoscopy allowed visualization past an enlarged turbinate or septal deviation in six patients, confirmed a suspected diagnosis in three by visualization of the middle meatus, and detected the site of a large choanal polyp in one. In one case, endoscopy identified a paradoxical turbinate on the side opposite the symptoms and radiological findings. Routine nasal endoscopy need not be part of the evaluation of all patients with nasal sinus disorders but is particularly valuable in confirming diagnoses, particularly in patients where anterior rhinoscopy is limited by anatomic vobstruction.
Effect of Systemic Corticoid and Antihistamine Alone or in Combination on Elements of the Response to a Two Dose Nasal Allergen Challenge
Authors: Brooks Carter D. , Chene Brenda L. , Klott Karen A. , Busboom Sherrill D. , Francom Steven F.
Published: November 2007

This study examined the effects of low dose systemic corticoid (methylprednisolone, MP), standard dose antihistamine (terfenadine, TF) or the combination on response to out-of-season acute allergen challenge. We feel that a single dose challenge delivered to the nose may represent real disease imperfectly and in this study used two doses given 1 hour apart, hoping to approximate better the circumstances of natural allergen stimulation. The study used clinical endpoints only: measured nasal airway resistance (NAR), sneeze count, and weight of blown nasal secretions. Subjects showed similar NAR, sneezing, and secretion response to both challenges. With placebo treatment, NAR rose after the first allergen provocation and returned to baseline about 30 minutes later. Antihistamine pretreatment appeared to delay but did not prevent this rise; low dose corticoid partially inhibited it, and the combination totally ablated the response. All active treatments suppressed sneezing and secretion better than placebo. Combination corticoid/antihistamine treatment showed no greater effect on sneeze/secretion than did antihistamine alone; this differs from our findings in separate studies comparing analogous drug combinations in naturally-acquired ragweed hayfever.
Effects of Housing Systems on Biochemical Indicators of Blood Plasma in Laying Hens
Authors: Pavlík A. , Pokludová M. , Zapletal D. , Jelínek P.
Published: November 2007

The aim of this study was to compare biochemical indicators of blood plasma of laying hens housed in three different housing systems (conventional cage system, enriched cage system and deep litter system). In each housing system, 12 ISA Brown laying hens were observed during the laying period from week 22 to 75 of age. Blood samples for determination of biochemical indicators in plasma were collected during this period in week 22, 47 and 75. Indicators of blood plasma metabolic profile of laying hens of all monitored groups during the laying period ranged in intervals stated for healthy animals. In some cases, significant differences between housing systems were found, however, these differences do not give clear evidence of the influence of the housing system on the health of animals. The differences were apparently due to different efficiency of each group during the laying period.
Lack of Correlation Between Umbilical Artery pH, Retinal Hemorrhages and Apgar Score in the Newborn
Authors: Svenningsen Leif , Eidal Kristin
Published: November 2007

Measurement of pH was carried out in blood from the umbilical artery in 100 uncomplicated deliveries immediately after birth. The data were correlated with the results of fundoscopic examination carried out on the same infants within the subsequent 24 h. No relationship could be demonstrated between the grade of retinal hemorrhages and the cord blood pH measurements. Similarly, none of the neonatal birth parameters, including Apgar scores, could be related to individual differences in umbilical blood pH or the incidence or grade of retinal bleedings. The duration of bearing down was significantly and positively correlated (p<0.001) to the degree of acidosis in the umbilical blood. It is concluded that the presence of retinal hemorrhages provides little or no information about neonatal wellbeing or the impact of spontaneous birth on the fetus.
Maternal and neonatal morbidity in instrumental deliveries with the kobayashi vacuum extractor and low forceps
Authors: Meyer Laurence , Mailloux Jacques , Marcoux Sylvie , Blanchet Pierre , Meyer Francois
Published: November 2007

Risks to the mother and newborn associated with the use of the Kobayashi Silastic vacuum extractor (n = 293) were compared with those associated with the use of low forceps (n = 468) in a retrospective chart review. Third or fourth degree perineal tears and vaginal and cervical lacerations were all observed less frequently among women delivered with the vacuum extractor. The need for post‐partum bladder catheterization was also reduced for these women. Babies born by the means of the vacuum extractor ran an increased risk of cephalhematoma and neonatal jaundice. No difference in major neonatal morbidity was observed between the two groups. The Kobayashi instrument appears to be a useful alternative to forceps in low vaginal instrumental deliveries.
Isolated arteritis of the uterine cervix
Authors: Lauritzen Anne F. , Meinecke Birgit
Published: November 2007

Isolated arteritis has the same histological picture as polyarteritis nodosa but affects the arteries of one organ only. Two cases in the uterine cervix are reported and a brief review of the features is given.
PUDENDAL BLOCK IN VAGINAL DELIVERIES
Authors: Schierup L. , Schmidt J. F. , Jensen A. Torp , Rye B. A. O.
Published: November 2007

Abstract. Pudendal block with 20 ml 1% mepivacaine with and without epinephrine was performed in 151 patients during the second stage of labor. No differences in efficacy of the block or in Apgar scores between the two groups were found. The maternal mepivacaine concentration was higher in the plain group than in the epinephrine group (p>0.01), but toxic levels were never reached. In the infants, no difference in mepivacaine concentration was found between the groups ((p < 0.05, type II error 9%) and toxic levels were not reached. The time elapsed from the pudendal block until delivery was prolonged when epinephrine was added (p >0.02). We found no effect on blood pressure in either of the groups, with or without oxytocin and/or methergin. Twenty ml 1% mepivacaine (plain) is a safe choice for pudendal block without the possible disadvantages of adding epinephrine.
MICROSURGICAL REVERSAL OF FEMALE STERILIZATION
Authors: Dahl C. , Kjaer S. Krüger , Bagger P. , Stakemann G.
Published: November 2007

Abstract. Between 1979 and 1985, 25 consecutive, unselected women (age 28–40 years, median 34) underwent microsurgical tubo‐tuba1 anastomosis for reversal of sterilization. The overall pregnancy rate was 44%. The incidence of pregnancy was correlated to the tubal length after reversal. Of 12 women with tubal lengths exceeding 5.5 cm, 8 (67%) became pregnant. Of the 13 women with tubal lengths under 5.5 cm only 3 (23%) conceived (p >0.04). There was no significant correlation between pregnancy rate and age, interval since sterilization, or the sterilization procedure itself.
Relationship Between Placental Shape, Cord Insertion, Lobes and Gestational Outcome
Authors: Nordenvall M. , Sandstedt B. , Ulmsten U.
Published: November 2007

Singleton placentas from 330 consecutive births were examined for size, shape, cord insertion, allanto‐chorial vascular pattern and lobes. These factors were considered regarding possible interactions and correlation to pregnancy and perinatal outcome. Marginal cord insertion was correlated to extrachorial and bilobate placenta and to magistral or mixed allanto‐chorial vascular pattern. A paucity of lobes (<151 was associated with extrachorial placenta, marginal cord insertion, pre‐eclampsia, gestational age less than 38 weeks and small for gestational age infants. The common denominator for abnormal configuration and marginal cord insertion seemed to be the paucity of lobes.
Influence of Operations for Stress Incontinence And/Or Genital Descensus on Sexual Life
Authors: Haase Peter , Skibsted Lillian
Published: November 2007

A variety of operations for stress incontinence or genital descensus are performed in gynecological departments. The purpose of this study was to find out whether these operations influenced the patients’ sexual life. In a prospective study of 55 women, all sexually active prior to the operation, various characteristics were evaluated by interview and gynaecological examination, immediately before and 6 months after the operation. We had adviced early resumption of sexual intercourse. Postoperatively, 13 of 55 (24%) patients experienced improvement in their sexual life, 37 of 55 (67%) no change, and 5 of 55 (9%) experienced a deterioration. Improvement often resulted from cessation of urinary incontinence. Deterioration was in all 5 cases due to dyspareunia and all 5 patients underwent a posterior colporrhaphy as part of the operation. We conclude that provided the patients are well‐informed the prognosis for sexual life after these operations is good. However, colpoperineoplasty in combination with anterior colporrhaphy might cause dyspareunia in some patients.
Human Chorlonlc Gonadotropin in Cord Blood and Peripheral Maternal Blood in Singelton and Twin Pregnancies at Delivery
Authors: Steier Johan Arnt , Myking Ole L. , Ulstein Magnar
Published: November 2007

The influence of fetal sex on human chorionic gonadotropin IhCG) in cord and peripheral maternal blood was studied at delivery in 57 twin and 66 singleton uncomplicated pregnancies. In twin pregnancies the hCG levels were about twice as high in female‐female and in female‐male vis‐à‐vis male‐male combinations in both maternal and cord blood. In singleton pregnancies the hCG levels were significantly higher in maternal and in cord blood in cases of female vis‐his male infants. The ratio of maternal hCG/placental weight was also highest in the twin pregnancies when one or both infants were female. This suggests a “female effect”, possibly genetically based.
Classification Of Perinatal And Late Neonatal Deaths In Iceland
Authors: Georgsdóttir Ingibjörg , Geirsson Reynir Tómas , Jóhannsson Jóhann Heidar , Biering Gunnar , Snzdal Gunnlaugur
Published: November 2007

A retrospective case record analysis of all perinatal and late neonatal deaths in Iceland in the periods 1976–80 and 1981–85 was done and the causes of death classified according to the extended Aberdeen classification. There was a significant (p<0.0001) reduction in number of deaths between the two periods with perinatal mortality rates declining from 10.6/1000 in 1976–80 to 6.8/1000 in 1981–85. In 1976–80 there were 81 (33%) antepartum, 37 (15%) intrapartum and 128 (52%) neonatal deaths compared to 61 (38%) antepartum, 13 (8%) intrapartum and 86 (54%) neonatal deaths in 1981–85.

Fetal abnormality was the most common cause of death in both periods followed by the category Low birthweight in 1976–80. In 1981–85 increased morphological detection of infection in infants of very low birthweight by placental examination and autopsies lead to a shift from the category Low birthweight to Maternal Disease, the second most common cause in that period.

To achieve lower perinatal mortality rates efforts should be directed towards lowering anteparturn losses near term and increasing survival of very low birthweight infants.
Fetal Blood Velocity Waveforms In Normal Pregnancies
Authors: Åström Kjell , Eliasson Arne , Hareide Jens H. , Maršal Karel
Published: November 2007

Blood velocity in the umbilical artery, fetal descending aorta and fetal middle cerebral artery was recorded by means of 3.5 MHz pulsed Doppler ultrasound in 22 normal pregnancies. The measurements were performed longitudinally between 25 and 42 weeks of gestation. The maximum blood velocity curves were analysed for pulsatility index (PI), systolic/diastolic velocity ratio (S/D ratio) and in the middle cerebral artery also for the resistance index according to Pourcelot (RI). In the umbilical artery, all variables decreased significantly with increasing gestational age as an expression of the decreasing placental vascular resistance. PI in the descending aorta remained fairly constant during the examined period of gestation. In the middle cerebral artery, all three variables (PI, S/D ratio, RI) decreased significantly as gestation advanced. With the exception of the umbilical artery at 28–32 weeks, PI and S/D ratio were not influenced by the heart rate in any of the vessels examined. Diagrams of the gestational age‐related reference values (means 2 SD) for the variables of the blood velocity waveforms were established. Additionally, a ratio of the PI and S/D was calculated for the umbilical artery and middle cerebral artery.
Concept of the Existence of Human Papillomavirus (HPV) DNA in Histologically Normal Squamous Epithelium of the Genital Tract Should be Re‐Evaluated
Authors: Syrjänen Kari , Syrjänen Stina
Published: November 2007

Because of the crucial importance of guiding current thinking in the field of HPV epidemiology, the concept of the existence of HPV DNA in histologically normal squamous epithelium was re‐evaluated. A series of 102 randomly collected cervical punch biopsies, previously proved to contain the DNA of HPV types 6, 11, 16, 18, 31 or 33 by in situ hybridization were subjected to analysis for the localization of HPV DNA, i.a., whether found in the normal epithelium or at the lesion site only. This material consisted of a representative series of flat, endophytic and papillary HW lesions with all histological grades from HPV‐NCIN to HPV‐CIN 111, and the six HPV types in the same proportions as they occur in non‐selected series of HPV lesions. Weak signals of HW DNA were found in the basal cells in 6/102 (5.8%) of the biopsies. HPV DNA was constantly present in the parabasal cells in 25/102 (25.4%). in the intermediate cell layers in (98/102, 96%), and in the superficial cells of all 102 lesions. Noteworthy was the constant failure to reveal even weak signals of HPV DNA (of any of the six types) in histologically normal squamous epithelium of any of the 87 lesions, where such an epithelium was detectable. The present findings confirm our previous ‘impression’ that HW DNA rarely if ever appears in the histologically normal squamous (or columnar) epithelium in the genital tract, when analysed using the in situ hybridization. Thus, great care should be exercised in interpreting results that suggest the discovery of HW DNA in normal genital tract epithelium, unless based on firm documentation by in situ hybridization.
Dedifferentiated Chondrosarcoma Metastasizing to the Pancreas in Pregnancy
Authors: Mikhail M. G. S. , Lim K. B.
Published: November 2007

Acute abdomen in pregnancy can present difficulties in both diagnosis and treatment. In this patient the presentation of an acute abdomen was due to some intra‐peritoneal hemorrhage complicating a pancreatic metastasis from a primary dedifferentiated chondrosarcoma arising from the right iliac bone. Neither the primary nor the secondary growths had been suspected previously.
Serum Concentrations of Progesterone and 5α‐Pregnane‐3,20‐Dione During Lr and Early Post Partum
Authors: Löfgren M. , Bäckströmxy3 T.
Published: November 2007

Serum 5α‐pregnane‐3,20‐dione (5αDHP) and progesterone (P) concentrations were studied in 11 women with uncomplicated pregnancies and deliveries during spontaneous labor and immediately after delivery. Blood samples were drawn 3–6 times during labor, as soon as possible post partum and 1, 3, 6 and 12 h post partum. P and 5αDHP were analysed using RIA methods. There were no significant changes during labor in serum concentration of P and 5αDHP, the values being 366 nmol/l ± 25 SE and 128 nmol/l ±16 SE respectively. Whereas an earlier study has shown a significant decrease in 5αDHP serum concentration between late pregnancy and spontaneous labor, this study showed no decrease during labor, indicating that the decrease occurred before the onset of labor. After parturition, the elimination of P from serum was faster and proportionally greater than for 5αDHR with a half‐life of 38 min for P and 58 min for 5αDHP. About 2—3 h post partum the serum concentrations stabilized just above luteal phase values. 12 h post partum, P and 5αDHP were 12% and 23% respectively of pre‐partum values.
Use of Goserelin Depot, A Gonadotropin‐Releasing Hormone Agonist, for the Treatment of Menorrhagia and Severe Anemia in Women with Leiomyomata Uteri
Authors: Candiani Giovanni Battista , Vercellini Paolo , Fedele Luigi , Arcaini Luisa , Bianchi Stefano , Candiani Massimo
Published: November 2007

Menorrhagia is the most frequent symptom in women with leiomyomata uteri. We induced transient hypoestrogenism with a gonadotropin‐releasing hormone agonist, goserelin (Zoladex, I. C. I.), in a depot formulation, to resolve severe anemia in 16 women with uterine myomas. Subcutaneous administration of goserelin 3.6 mg was repeated every 28 days for 6 months. Thirteen patients became amenorrheic in 5 weeks and 3 reported scanty bleeding. Estradiol fell to postmenopausal levels after one month's treatment with hormonal surges on only three occasions. Uterine volume decreased by 49% after 3 months’ treatment but subsequent reduction was not achieved. Mean hemoglobin rose from 7.4 g/dl pretreatment to 13.2 g/dl at 3 months (+ 78.3%) and mean hematocrit from 26.1% to 39.8% (+52.4%) without any further improvement. Serum ferritin increased constantly during the 6 months. Goserelin depot therapy in severely anemic patients with leiomyomas and menorraghia is practical, safe and may avoid the need for preoperative transfusion.
Pathologic Torsion of the Pregnant Uterus
Authors: Jensen John G.
Published: November 2007

A case of 90°C dextro‐torsion of the uterus in the 36th gestational week is reported. The case was asymptomatic and was discovered at cesarean section carried out because of transverse lie following rupture of the membranes. Mother and child were discharged in perfect health
Idiopathic Recurrent Spontaneous Abortion: Evidence of a Familial Predisposition
Authors: Christiansen Ole B. , Mathiesen Ole , Lauritsen J. Glenn , Grunnet Niels
Published: November 2007

Pregnancy outcome was investigated: 1) in fifteen women suffering from idiopathic recurrent spontaneous abortion (RSA) and who had experienced pregnancies with two different partners, and 2) in the mothers, the sisters and wives of the brothers of 90 consecutively referred women with RSA. After adjusting for ascertainment bias, the patients with 2 partners had an abortion rate of 72% with the first spouse (significantly increased compared with the expected rate) and a nearly 100% abortion rate with the second spouse. This suggests that, in the main, RSA is not partner‐specific. The sisters of the patients had suffered a significantly increased miscarriage rate (25.3%) compared with the observed rate in a Danish control group. The wives of the brothers had an abortion rate of 18.8%, which was not significantly increased vis‐a‐vis the controls. The sisters showed a lifetime incidence of RSA (10.6%) which was significantly greater than comparable estimates in the literature. These results suggest the existence of a familial predisposition to spontaneous abortion in families where RSA occurs.
Inter‐Relationships of Storage Iron in the Mother, the Placenta and the Newborn
Authors: Wong Chong‐Thim , Sana Nilmani
Published: November 2007

The influence of maternal storage iron and placental iron levels on the storage iron and serum transferrin levels in newborns, placental non‐haem iron, serum ferritin and transferrin concentrations was studied in 72 mothers and their singleton healthy newborns following uncomplicated pregnancies. Serum ferritin and transferrin concentrations were measured using ELIZA and immunoelectro‐phoretic methods, respectively. Placental non‐haem iron was measured chemically. Cord serum ferritin (142 ± 68.6 µ.g/1) and transferrin (1.66 ± 0.56 µg/l) levels and placental non‐haem iron concentrations (41.1 ± 20.2 µ.g/g) were not correlated with the maternal serum ferritin levels (17.4 ± 12.5 µ.g/1). No significant difference was observed in these parameters in the newborns of mothers with low (<10 µ.g/1) and high (> 20 µ.g/1) levels of serum ferritin. Thus mothers with a reduced store of iron at term can still manage to provide sufficient iron for the fetus.
Iron supplementation during pregnancy
Authors: Guldholt Inger S. , Trolle Birgitta G. , Hvidman Lone E.
Published: November 2007

192 pregnant women were consecutively randomized to either a vitamin‐mineral pill or a vitamin mineral pill with a high iron content in a prospective, open, randomized investigation. The participants were advised about iron‐rich foodstuffs twice during pregnancy. Iron status of the mother proved to be without any significance for the outcome of pregnancy. A serum ferritin level of 80 pmol/l in mid‐pregnancy followed by a control in the last trimester was suggested as a guide in deciding of whether or not to prescribe supplementary iron during pregnancy.
The effect of mediolateral episiotomy at delivery on pelvic floor muscle strength evaluated with vaginal cones
Authors: Röckner Gunny , Jonasson Aino , Ölund Anders
Published: November 2007

In a prospective study, pelvic floor muscle strength was investigated pre‐ and post partum in 87 women with uncomplicated pregnancies. Those vaginally delivered were 71 primiparas, while 16 underwent an elective cesarean section. The objective was to evaluate the effect of the delivery procedure on the pelvic floor muscle strength with the aid of vaginal cones. In the group of women with vaginal delivery three subgroups were identified: episiotomy, spontaneous laceration and intact perineum. Pelvic floor muscle strength was weakest in the episiotomy subgroup, the difference in values between this subgroup and each of the other subgroups and the elective cesarean section group being significant. No significant difference was evident between the spontaneous lacerations and intact perineum subgroups.
Efficacy of laparoscopic electrocoagulation in infertile patients with minimal or mild endometriosis
Authors: Arumugam Kulenthran , Urquhart Rennie
Published: November 2007

The cumulative pregnancy rates in 17 infertile patients with minimal or mild endometriosis who underwent laparoscopic electrocoagulation were compared with those of 20 similar patients who underwent only diagnostic laparoscopy. A life‐table method of analysis was used. No significant differences in pregnancy rates was evident at either 6 months (p > 0.5) or 12 months (p > 0.5) of follow‐up. These results question the use of laparoscopic electrocoagulation for the treatment of infertile patients with minimal or mild endometriosis.
Laser and cryo surgery for cervical intraepithelial neoplasia: A randomized trial with longterm follow‐up
Authors: Berget A. , Andreasson B. , Bock J. E.
Published: November 2007

In a randomized study, 204 patients with exocervical intra‐epithelial neoplasia were allocated to either laser evaporation (103) or cryocoagulation (101). The patients were treated on an outpatient basis without anesthesia. In the case of initial treatment failure the same method was to be used for retreatment. One hundred and eighty‐seven patients were followed‐up for an average of 50 months (12‐80). Eighty‐six of 94 laser‐evaporated patients (91%) and 89 of 93 cryocoagulated patients (96%) were cured after one treatment. Five of 8 laser failures and 3 of 4 cry0 failures were cured by retreatment. The cure rate after one or two laser evaporations was 97% (91 of 94 patients), and after one or two cryo coagulations, 99% (92 of 93 patients). Eighty per cent of residual or recurrent neoplasia occurred within 15 months and 96% within 2 years of treatment. No invasive neoplasia occurred during the follow‐up period and no tendency was seen towards higher grades of intra‐epithelial neoplasia in the failures compared with the initial diagnoses. It is concluded that laser evaporation and cryocoagulation are equally effective for the treatment of exocervical intra‐epithelial neoplasia.
Oxytocin, somatostatin, insulin and gastrin concentrations vis‐à‐vis late pregnancy, breastfeeding and oral contraceptives
Authors: Silber Märta , Larsson Bertil , Uvnäs‐Moberg Kerstin
Published: November 2007

Oxytocin concentrations increased during pregnancy and during medication with low‐dose oral contraceptives (o.c). Postprandial somatostatin concentrations were lower during medication with o.c. Insulin concentrations were elevated during pregnancy with the same tendency during medication with o.c. Gastrin levels were unaffected during the peripartal period and during medication with o.c. Women who were breastfeeders at 3 months after delivery had higher concentrations of oxytocin and lower somatostatin concentrations post‐prandially during pregnancy and fasting at 3 months after delivery compared with non‐breastfeeders at 3 months after delivery. Metabolic and behavioral implications are discussed.
Incidence of fetal chromosome abnormalities in insulin dependent diabetic women
Authors: Henriques Carsten Ulrik , Damm Peter , Tabor Ann , Goldstein Henri , Mølsted‐Pedersen Lars
Published: November 2007

In order to screen for fetal neural tube defects and chromosome abnomalities, amniocentesis was carried out in 334 women with insulin‐dependent diabetes mellitus (IDDM) between 1979 and 1987. Two cases (0.6%; 95% confidence limits 0.1–2.2%) of fetal chromosome abnormality were found: one case of Klinefelter's syndrome and one case of de novo translocation. This is comparable to the overall incidence of chromosome abnormality found at birth and is also comparable to the incidence of fetal chromosome abnormality (1.0%) found by amniocentesis at our Department in a group of 2,264 young non‐diabetic women with little risk of contracting genetic disorders. The results suggest that maternal IDDM does not increase the risk of fetal chromosome abnormality and consequently screening by amniocentesis for chromosome abnormalities among diabetic women does not seem to be indicated.
Pregnancy outcome in patients undergoing long‐term hemodialysis
Authors: Hsieh T'Sang T'ang , Chen Kuang Chao , Cheng Bor Jen , Chiu Tsung Hong
Published: November 2007

Three uremic patients receiving hemodialysis for more than 5 years became pregnant and proceeded to the third trimester. A variety of complications were noted, including threatened abortion, vanished twin, preterm premature rupture of membranes, polyhydramnios, intra‐uterine fetal death, intra‐uterine growth retardation, premature labor and hypertension. Two of these 3 mothers gave birth to healthy babies under the management of the high‐risk pregnancy team.
The use of episiotomy in primiparas in Sweden: A descriptive study with particular focus on two hospitals
Authors: Röckner Gunny , Ölund Anders
Published: November 2007

This study has examined the use of episiotomy (Ep) in primiparas on all labor wards (65) in Sweden, focusing on two hospitals in particular. The information was obtained by means of a questionnaire and from original medical records at the two hospitals. Whereas the mean incidence of Ep for the whole country was 30%, we found a wide variation (9–77%) from hospital to hospital. When delivery positions were compared, the lowest Ep rate was reported from those hospitals where women frequently used “alternative positions”. The results suggest that efforts should be directed to a more restrictive use of Ep in normal delivery.
Heterotopic pregnancy following in vitro fertilization
Authors: Tanbo Tom , Dale Per Olav , Lunde Ottar , Åbyholm Thomas
Published: November 2007

We report 4 cases of heterotopic pregnancy following in vitro fertilization. AH 4 patients were treated by surgical removal of the ectopic pregnancy products. In 3 patients, the intra‐uterine fetus was alive prior to surgery. Two of the 3 gave birth to a healthy baby while the third pregnancy has progressed uneventfully for 12 weeks since the operation.
Hemodialysis rescued the mother in a case of severe chronic renal failure accompanied by perirenal hematoma due to HELLP syndrome
Authors: Katsuragawa Hiroshi , Yoshida Masumi , Miyamoto Umio
Published: November 2007

We present a case of severe maternal renal failure, accompanied by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Since her renal function deteriorated in addition to the anemia and thrombocytopenia from 25 weeks' gestation, hemodialysis was performed three times a week. Unfortunately intra‐uterine fetal death suddenly occurred at 30 weeks' gestation, and maternal right perirenal hematoma was diagnosed after delivery. The anemia and thrombocytopenia improved dramatically and the perirenal hematoma resolved uneventfully by late puerperium. The management of severe maternal renal failure with HELLP syndrome is described.
Electrical injury from tasering and miscarriage
Authors: Mehl Lewis E.
Published: November 2007

A case report is presented of a woman who was “Tasered”® by law enforcement personnel while 12 weeks pregnant. The Taser® (Thomas A. Swift's Electric Rifle) is an electronic immobilization and defense weapon that has been commercially available since 1974. The Taser® was developed as an alternative to the 38 special handgun. The patient was hit with Taser® probes in the abdomen and the leg. She began to spontaneously miscarry 7 days later and received a dilatation and curettage procedure 14 days later for incomplete abortion. The world's literature on electrical and lightning injury to pregnant women is reviewed, and the mechanism of action of Taser® injury is discussed. As use of the Taser® becomes more common, obstetrical clinicians may encounter complications from the Taser® more often
Lymphoid cell distribution as prognostic factor in carcinoma of the uterine cervix
Authors: Onsrud Mathias , Grahm Irmelin , Gaudernack Gustav , Trope Claes
Published: November 2007

Pretreatment assessment of blood lymphoid cells was performed in 44 patients with carcinoma of the cervix and in 19 healthy controls. White blood cells were determined by routine differential counting, and T‐lymphocyte subsets and monocytes were quantitated using monoclonal antibodies. Increase in monocyte numbers, as determined by the 1D5 antibody, was seen in the cancer patients, especially in the group with advanced disease. No change in T‐lymphocyte subpopulations could be found. During the 5‐year follow‐up period, 17 patients had a recurrence or died of cancer. The best prognostic information was obtained from conventional clinical parameters, e.g. stage, tumor size and lymph node status. Increased numbers of granulocytes and monocytes were found in advanced stage disease but had no independent prognostic influence. In pelvic lymph node biopsies taken from patients undergoing Wertheim‐Meigs operation the T‐helper/T‐suppressor ratio was higher and the monocyte number lower than in peripheral blood. No correlation could be detected between node cell distribution and the prognosis. It is concluded that immunological testing, as performed in this study, elicits very little new prognostic‐information.
Fetal death following labetalol administration in pre‐eclampsia
Authors: Olsen Karsten Skovgaard , Beier‐Holgersen Randi
Published: November 2007

Labetalol (Trandate®) 50 mg i.v. was administered to a pre‐eclamptic primigravida with an asphytic fetus prior to cesarean section, in order to reduce the risk of excessive increase in blood pressure during induction of anesthesia. Blood pressure fell rapidly from 170/110 to 115/85 mmHg. A dead infant was born. Oral labetalol is arguably a suitable remedy for pre‐eclampsia, but if i.v. administration is necessary, an initial dose of 5–10 mg is recommended.
Amelanotic malignant melanoma arising in an ovarian dermoid cyst
Authors: Borup Kirsten , Rasmussen Kjeld Leisgård , Schierup Lars , Møller Jens Christian
Published: November 2007

Malignant transformation occurs in about 2% only of ovarian dermoid cysts. The clinical and histopathological findings in a rare case of primary ovarian malignant melanoma of amclanotic type are presented.
Medical termination of early pregnancy with mifepristone (RU 486) followed by a prostaglandin analogue: Study in 16, 369 women
Authors: Ulmann Andre , Silvestre Louise , Chemama Laurence , Rezvani Yvonne , Renault Marguerite , Aguillaume Claude J. , Baulieu Etienne‐Emile
Published: November 2007

We report the results of a large‐scale trial with mifepristonc (RU 486) followed by the administration of a prostaglandin (PG) analogue for the medical termination of early pregnancy. Altogether, 16,173 patients from 300 centers were evaluated. 48 women (0.3%) were lost to follow‐up prior to, and 416 (2.6%) after the PG administration, and therefore the efficacy was evaluated in 15,709 women. Overall. the success rate was 95.3%. with no statistical difference regarding the nature and dose of PG used. The median duration of bleeding was 8 days, being 12 days or less in 89.7% of the women. Bleeding was significant cnough to necessitate a vacuum aspiration or a dilatation and curettage in 0.8% of the cases. A blood transfusion was necessary in 0.1% of the women (11 patients). Serious cardio‐vascular side‐effects were reported in 4 cases after the PG (sulpro/tonc) injection: they consisted of one acute myocardial infarction attributed to a coronary spasm. and in marked hypotension in the other 3 woman. All patients recovered uneventfully. In conclusion, RU 486 followed by a PG analogue provides an efficient and safe medical alternative to surgery for early pregnancy termination, provided that the recommended protocol is adequately followed and the contraindications to prostaglandins are respected.
Triplet, quadruplet and quintuplet pregnancies: Management and outcome
Authors: Ron‐El R. , Mor Z. , Weinraub Z. , Schreyer P. , Bukovsky I. , Dolphin Z. , Goldberg M. , Caspi E.
Published: November 2007

The management and outcome of 46 pregnancies, 37 triplets, 7 quadruplets and 2 quintuplets, were analysed. Management of pregnancies, initiated upon diagnosis of multiple pregnancy, included bed rest, β‐mimetic agents, dexamethasone late in the second trimester and selective cerclage. The mean gestational age at labor was 235 days in triplet pregnancies, 241 for quadruplets and 220 days for quintuplets. Fifty‐four percent of the deliveries were by cesarean section and the remainder per vaginam. The mean weight of the neonates was 1809 g for the triplets, 1837 g for quadruplets and 1284 g for the quintuplets. The mean overall Apgar score was 8.13, total perinatal mortality 14.8% and 9.4% in cases more than 28 weeks. There was no statistically significant difference in the outcome for triplets born vaginally or by cesarean section. In recent years there has been a pronounced reduction in neonatal mortality, dropping from 17.3% during 1970–78 to 5.9% from 1979 to 1983 (p<0.05), probably due to the improved neonatal treatment.
Postpartum rupture of a subcapsular hematoma of the liver
Authors: Wilson Richard H. , Marshall Barry M. S.
Published: November 2007

We report a case of postpartum rupture of a subcapsular hematoma of the liver. The etiology, pathology, diagnosis and treatment of this condition are discussed. We emphasize the modern concepts in treatment of hepatic hemorrhage. This knowledge and an awareness of the possible diagnosis will help to decrease the high morbidity and mortality rates associated with this disorder.