bluuebunny/crossref_metadata_2025 huggingface dataset:
Serotonergic dysregulation in bipolar disorders: a literature review of serotonergic challenge studies
Authors: Sobczak S , Honig A , Van Duinen MA , Riedel WJ
Published: March 2003

Objectives:  Serotonin (5‐hydroxytryptamine; 5‐HT) and endocrine abnormalities have been repeatedly reported in bipolar disorders (BD). Useful methods to investigate 5‐HT responsivity, and the interaction with neuroendocrine functioning, are provided by acute 5‐HT challenge and depletion paradigms. In this review 5‐HT challenges are limited to paradigms that stimulate 5‐HT activity in BD.

Methods:  Literature was searched for in electronic libraries: MEDLINE and PSYCHLIT, period 1966–2001. Papers describing effects of an acute 5‐HT challenge on neuroendocrine functioning in BD patients were selected.

Results:  Review of the literature revealed 15 studies: five papers described the effects of 5‐HT challenges in manic BD patients, four papers in euthymic BD and seven in depressed BD patients. The reviewed 5‐HT challenge paradigms are acute administration of oral and intravenous (i.v.) dosage of d,l‐fenfluramine, tryptophan, 5‐hydroxytryptophan, ipsapirone and buspirone. There were no papers which investigated neuroendocrine effects of m‐chlorophenylpiperazine, clomipramine and citalopram in BD patients and were therefore not reviewed.

Conclusions:  The literature on 5‐HT challenge procedures in BD shows evidence for a blunted prolactin (PRL) in mania and depression as well as a blunted cortisol in euthymic BD patients. This suggests that in both mania and depression similar changes in the 5‐HT system are involved. It is speculated that blunting of cortisol responses in euthymic BD patients may be a result of chronically altered 5‐HT functioning, whereas changes in PRL release following 5‐HT challenges reflect more state‐dependent changes in 5‐HT activity. The 5‐HT responsivity in BD patients has also been associated with pharmacological treatment, suicidal behaviour, weight loss and age. Recommendations for future research are given.
Acute antimanic efficacy and safety of oxcarbazepine in an open trial with an on‐off‐on design
Authors: Hummel Barbara , Walden Joerg , Stampfer Robert , Dittmann Sandra , Amann Benedikt , Sterr Andrea , Schaefer Martin , Frye Mark A , Grunze Heinz
Published: March 2003

Rationale and Objectives:  Carbamazepine has shown reasonable antimanic properties, but its use has been limited because of enzyme‐inducing effects. The keto‐derivative oxcarbazepine (OXC) is very similar to carbamazepine, however, the metabolic pathway is different. OXC is not metabolized to the 10, 11–epoxide, which seems to be responsible for several undesirable side‐effects of carbamazepine and furthermore OXC has less enzyme‐inducing properties.

Methods:  In this non‐random open label study, patients were treated with OXC for 14 days, crossed over to no OXC for 7 days, and then crossed back over to OXC for the remaining 14 days. OXC was titrated to a final dose in a range of 900–2100 mg due to individual response. Treatment success was defined as a reduction of the original Young Mania Rating Scale (YMRS) score of more than 50% at the end of study period.

Results:  Four of the 12 included patients (33%) met defined response criteria at the end of study period. Fifty percentage of the patients had to be prematurely excluded from the trial. The mean YMRS scores of the on‐periods were obviously different from the off‐period. Forty‐two percentage of the patients experienced side‐effects leading to premature discontinuation in two of 12 patients.

Conclusion:  Antimanic activity of OXC was demonstrated in this pilot study only for patients with mild or moderate manic symptoms. Further studies are encouraged to clarify OXC's role as mood‐stabilizer and assess whether it has a profile similar to that of carbamazepine.
Oxcarbazepine treatment of refractory bipolar disorder: a retrospective chart review
Authors: Nassir Ghaemi S , Ko James Y , Katzow Jacob J
Published: March 2003

Objective:
To determine if oxcarbazepine is effective as treatment for refractory bipolar illness in a naturalistic setting.

  Methods: All charts of out‐patients treated with oxcarbazepine (n=13) were reviewed and clinical response assessed retrospectively using the Clinical Global Impression of Improvement (CGI‐I) rating scale. All patients had failed treatment with at least one previous mood stabilizer.

  Results: Mild improvement was seen in 46% (n=6) and moderate improvement in 16% (n=2). Fifty‐four percent (n=7) of the total sample discontinued treatment because of adverse effects.

  Conclusion: Oxcarbazepine may possess mild to moderate mood‐stabilizing properties in this refractory, mostly depressed, bipolar sample. This naturalistic study is limited by its uncontrolled nature.
Prevalence of bipolar disorder: a further study in The Netherlands
Authors: Regeer EJ , Rosso ML , Ten Have M , Vollebergh W , Nolen WA
Published: March 2003

Regeer EJ, Rosso ML, ten Have M, Vollebergh W, Nolen WA. Prevalence of bipolar disorder: a further study in The Netherlands.  Bipolar Disord 2002: 4(Suppl. 1): 37–38. © Blackwell Munksgaard, 2002
Thermal endometrial ablation: a simple technique
Authors: SINGH KISHOR C. , SENGUPTA RINKU , AGARWAL NEERA , MISRA KIRAN
Published: March 2003

Background. To evaluate the effectiveness and safety of a technique for thermal endometrial ablation.

Method. The study was carried out in three steps; step I on 10 fresh uterine specimens, step II on 14 intact uteri during hysterectomy and step III in five patients, two weeks prior to hysterectomy. A simple device comprising a Foley catheter No. 14F, a three way cannula and a 20 cc syringe was used for the procedure. The balloon of the catheter was inflated within the uterine cavity with boiling normal saline for 9 minutes. Uterine cavity and serosal temperature was recorded during the procedure. Thermal injury was assessed by gross and histological examination of the specimens.

Results. The mean maximum endometrial cavity temperature was 91° C whereas serosal temperatures in steps I and II were 34° C and 35.9°C respectively. None of the balloons ruptured in any of the steps and there were no complications. In 13 of 14 specimens in step II, there was a zone of hyperemia with a depth of 3 to 7 mm. The corresponding histological picture was extensive hemorrhage and fragmentation of glands throughout the endometrium including the cornual regions. Consistent findings were noted in step III in which all but one showed extensive coagulative necrosis of the whole of endometrium with edema of the underlying myometrium. There was a statistically significant positive correlation between the volume of fluid injected and depth of hyperemia.

Conclusion. This technique could be a simple, effective, inexpensive and safe alternative to hysteroscopic endometrial ablation.
Prevalence of menstrual cycle symptom cyclicity and premenstrual dysphoric disorder in a random sample of women using and not using oral contraceptives
Authors: SVEINDÓTTIR HERDÍS , BÄCKSTRÖM TORBJÖRN
Published: March 2003

Background. The prevalence of symptom cyclicity and premenstrual dysphoric disorder in randomly recruited samples of women has not been ascertained. We assessed this prospectively in 83 Icelandic women, aged 20–40 years, using and not using oral contraceptives (OCs).

Methods. A check list of 57 symptoms, divided into 7 symptom groups, was used to assess experiences. All symptoms and summarized symptom scores within symptom groups were tested for significant change between the follicular and the luteal phase of each menstrual cycle. When a symptom or a summarized symptom score was higher during the luteal phase compared to the follicular phase the cyclicity is labelled ‘expected’ cyclicity and the opposite ‘unexpected’ cyclicity.

Results. The women charted from 1–7 menstrual cycles each, with 66 of them charting 3–4 cycles. Cyclicity was never displayed by 9.6% of participants; 80.7% displayed expected cyclicity and 72.3% unexpected cyclicity at least once. Cyclicity in somatic symptoms was most often demonstrated by participants. Expected and unexpected cyclicity in summary symptom scores in well‐being and in psychoemotional symptoms was very similar among participants. There was not much difference in cyclicity between non OC users and OC users. Fifty‐one percent of the participants were self‐defined with premenstrual syndrome with 2%–6% of them meeting the criteria of premenstrual dysphoric disorder.

Conclusions. The normalcy of cyclicity found in this study might explain the high prevalence of premenstrual syndrome in many recall surveys. The importance of prospective daily ratings for establishing symptom cyclicity in women cannot be over emphasized.
Birth defects and paternal occupational exposure. Hypotheses tested in a record linkage based dataset
Authors: IRGENS ÅGOT , KRÜGER KIRSTI , SKORVE ANNE HELENE , IRGENS LORENTZ M.
Published: March 2003

Main question. To test previously established hypotheses on associations of birth defects with paternal occupation on the basis of a Norwegian registry material.

Methods. The study comprised all births in Norway 1970 ‐1993 for which linkage with population censuses 1970, ‐80 and ‐90 on parents' job title could be obtained – about 1 million births (75% all births). The reference population was offspring of the group that did not belong to the actual occupation.

Results. Vehicle mechanics had an association with hypospadias –OR 5.19 ( CI 1.31–14.24), painters had a non‐significant association with spina bifida – OR 2.03 (CI 0.99–3.75) and printers with club foot – OR 1.61 (CI 0.89–2.90). Associations observed previously in offspring of fathers in large occupational groups such as teachers, drivers, electricity related occupations, sales related occupations and agricultural workers were not confirmed in this dataset.

Conclusions. The study gave further evidence of cause effect relationships in the confirmed positive associations, though without any clarification of possible mechanisms involved. Possible false negative findings might be caused by low statistical power due to small occupational groups or non‐differential misclassification of exposure.
Assessing quality of obstetric care for low‐risk deliveries; methodological problems in the use of population based mortality data
Authors: MOSTER DAG , MARKESTAD TROND , LIE ROLV TERJE
Published: March 2003

Background. Studies evaluating safety of different birth settings for low‐risk deliveries are often difficult to interpret because of great methodological problems.

Objective. To assess potential bias in comparisons of mortality between maternity institutions with different size and level of care, particularly when using various definitions of low‐risk delivery and when studying stillbirth rates.

Design. Population‐based study.

Population. The population of 1.74 million births in Norway from 1967 to 1996 recorded in The Medical Birth Registry of Norway.

Methods. First we explored the problems of properly identifying low‐risk deliveries from population‐based data and calculated adjusted perinatal mortality rates in sub‐populations by excluding different risk factors. Then we measured the difference in apparent low‐risk deliveries between institutions of different size and level of care. Finally we explored bias by using stillbirths and discuss the loss of statistical power by studying only livebirths.

Results. The occurrence of a whole spectrum of risk factors differed between small and large institutions, even after adjustment for birthweight. Although the majority of births were from low‐risk deliveries, only 1/10th of all perinatal deaths occurred in this group after admission to a maternity unit. There was a systematic difference in the reporting of time of death for stillbirths between types of institutions; the rate of stillbirths occurring during delivery was higher among small institutions, while large institutions were more often uncertain in classifying time of death for stillbirths.

Conclusions. Adjustments for a large number of different risk factors, large sample‐sizes and caution in including stillbirth as outcome measure are needed when comparisons of safety between different sizes of delivery units are made for low‐risk pregnancies.
Relation between viability of vaginal polymorphonuclear leukocytes and presence of histologic chorioamnionitis
Authors: YAMADA TETSUO , MATSUBARA SHIGEKI , MINAKAMI HISANORI , OHKUCHI AKIHIDE , HIRATSUKA MITSUHIRO , SATO IKUO
Published: March 2003

Background. The number and percentage of viable vaginal polymorphonuclear leukocytes (vPMNs) are known to be increased in women who experience preterm labor. Whether those parameters may be associated with the presence of histologic chorioamnionitis (CAM) is not known.

Methods. We investigated prospectively 39 women at 26.3±6.2 weeks of gestation. The following were determined in vaginal washings: total number of vPMNs and the percent that were viable, the pH, and the concentrations of granulocyte elastase and interleukin‐8 (IL‐8). In addition, the white blood cell count and the serum level of C‐reactive protein were determined in peripheral blood. The placenta and the umbilical cord were examined histologically with special reference to the presence of CAM. The optimal cutoff value for prediction of histologic CAM was obtained for each variable using receiver operating characteristic curves. A multivariate logistic‐regression model was used to determine the independent risk factors for this disorder.

Results. Histologic CAM was present in ten women (37.1±3.8 weeks) and absent in 29 women (38.2±1.5 weeks). The total number of vPMNs, the percent of viable vPMNs, and the IL‐8 level were all significantly increased in the women with CAM, in contrast to those without CAM. When the optimal cutoff value for each of seven covariates was entered into the model, only the percent of viable vPMNs, ≧11%, demonstrated a significant relationship with histologic CAM (odds ratio 26.9; 95% confidence interval 1.3 to 545; p<0.05).

Conclusions. Women with a % viability of vPMNs of ≧11% were at a significantly higher risk for histologic CAM. Data suggest that an influx of PMNs into the vagina occurs continuously in patients with histologic CAM.
Bacterial vaginosis in a family practice population
Authors: SCHMIDT HENRIK , HANSEN JENS G.
Published: March 2003

Background. To determine and evaluate the prevalence of bacterial vaginosis diagnosed according to three sets of diagnostic criteria in three well‐defined groups of non‐pregnant women attending a family practice, and to determine the proportion of women diagnosed with bacterial vaginosis during a year involving the entire population registered at the practice.

Methods. During a year, bacterial vaginosis was diagnosed both according to the composite clinical diagnosis, a new wet mount diagnosis, and Nugent's Gram stain diagnosis for bacterial vaginosis in women of reproductive age attending with new episodes either of abnormal vaginal discharge, other genito‐urinary symptoms, or for a routine check‐up.

Results. In non‐pregnant women, bacterial vaginosis was diagnosed in a third of those with abnormal vaginal discharge (n=189), and in a tenth of those without, regardless of whether they had other genito‐urinary symptoms (n=186) or not (n=273). Including all examined women, at least 11%, 13%, and 16% of the 880 women registered at the practice, were diagnosed with bacterial vaginosis according to the composite clinical, the wet mount, and the Gram stain diagnoses, respectively. The results were based on the 57% of the women who attended during the year. The prevalence data differed significantly according to which diagnostic method we used, the composite clinical lowest, the wet mount intermediate, and the Gram stain highest.

Conclusion. Both well‐defined criteria of inclusion and unison diagnostic procedures are necessary for reliable comparison and generalization of prevalence data of bacterial vaginosis.
Factors associated with pregnancy termination in Ukrainian women
Authors: MOGILEVKINA IRYNA , HELLBERG DAN , NORDSTROM MARIE‐LOUISE , ODLIND VIVECA
Published: March 2003

Objectives. To study differences in social and demographic characteristics between women undergoing an induced abortion and antenatal care attendants in the Ukraine.

Design. Hospital‐based unmatched case control study.

Methods. From a survey including 1,694 women of fertile age, who attended five women's clinics in the Donetsk region, Ukraine, we studied those who came for termination of pregnancy (n=919) and for antenatal care (n=478). The data were obtained through an anonymous self‐questionnaire. From the 192‐item questionnaire questions dealing with social and demographic characteristics, previous pregnancy experience, and attitude towards abortion were analyzed. Multiple logistic regression was used to analyze the risk of pregnancy termination.

Results. Termination of pregnancy was associated with being single (OR=11.8). Both previous childbirth and previous induced abortion were other determinants as well as being younger than 19 years old (OR=3.8), having a positive attitude towards abortion (OR=2.7), and sharing apartment with parents (OR=1.9). A higher risk for an induced abortion was found among women with a history of previous induced abortion(s). Neither income nor educational level was identified as a risk factor for pregnancy termination.

Conclusion. This study demonstrated major social and demographic differences between women attending for abortion and antenatal care patients, and highlights some of the factors influencing the decision to terminate a pregnancy.
Postpartum chills phenomenon: Is it a feto‐maternal transfusion reaction?
Authors: Ravid Dorit , Gidoni Yariv , Bruchim Ilan , Shapira Hava , Fejgin Moshe D.
Published: March 2003

Objective. To examine the theory that the postpartum shivering phenomenon is related to feto‐maternal bleed during the third stage of labor.

Methods. One hundred laboring low‐risk women who had a normal vaginal delivery were observed for the presence of postpartum chills. The duration of the first and second stages of labor changes in body temperature, maternal and fetal blood types and the use of epidural anesthesia were recorded. Following the delivery maternal blood was examined for the presence of fetal red blood cells using the Kleihauer‐Betke stain.

Results. Complete data was available in 97 patients. Post‐partum chills occurred in 31 of them (32%). Women with and without chills were similar in their maternal and gestational age, the use of epidural anesthesia, and length of second stage of labor. Women with chills delivered smaller babies but the difference did not reach significance. Maternal‐fetal blood group incompatibility was significantly more common among shivering than non‐shivering women (48% vs. 20% respectively, p=0.006). Kleihauer‐Betke test was positive in 11 women. The only two women in this group who experienced chills had maternal‐fetal blood group incompatibility.

Conclusion. Post‐partum chills are a common phenomenon. It may be the clinical presentation of feto‐maternal transfusion reaction. The small number of positive Kleihauer‐Betke tests may reflect its low sensitivity in the detection of small feto‐maternal bleeds.
Doppler assessment of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction
Authors: Madazli Riza , Uludağ Seyfettin , Ocak Vildan
Published: March 2003

Background. The aim of the study was to determine the best use of information obtained from Doppler studies of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction.

Methods. The study group consisted of 100 pregnant women with intrauterine growth restricted fetuses. Doppler flow velocity waveforms were obtained from the umbilical artery, middle cerebral artery and thoracic aorta. The pregnancies were grouped according to the umbilical artery Doppler results. There were 29, 30 and 41 fetuses with normal and high PI (pulsatility index), and absent end‐diastolic velocity (AEDV) in the umbilical artery, respectively.

Results. Birth weight and umbilical vein pH at birth significantly decreased and perinatal mortality rates significantly increased with the worsening of the diastolic flow in the umbilical artery (p<0.01). Increased umbilical artery PI was significantly associated with increased thoracic aorta PI and decreased middle cerebral artery PI (r=0.75 and −0.55, p<0.01 respectively). Perinatal mortality due to fetal asphyxia in fetuses with AEDV in the umbilical artery and in both the umbilical artery and thoracic aorta was 39.5% and 50%, respectively. Detection of AEDV in the thoracic aorta was found to be the most significant predictive factor of perinatal deaths.

Conclusions. The degree of abnormality of the Doppler findings parallels the severity of fetal compromise. Growth restricted fetuses with AEDV detected both in the umbilical artery and thoracic aorta are severely compromised and time gained in utero has no benefit for these fetuses.
Clinical and pregnancy outcome following ectopic pregnancy; a prospective study comparing expectancy, surgery and systemic methotrexate treatment
Authors: Olofsson Jan I. , Sundström Poromaa Inger , Ottander Ulrika , Kjellberg Lennart , Damber Mats‐Göran
Published: March 2003

Background. The improved possibility of an early diagnosis of ectopic pregnancy by use of serial quantitative beta‐subunit human chorionic gonadotropin hormone levels together with transvaginal ultrasound has opened up options for conservative treatment. Systemic methotrexate treatment of unruptured ectopic pregnancy has emerged as a safe and effective alternative to surgical procedures. The aim of the present study was to investigate the effectiveness of methotrexate treatment in routine clinical practice, but also to assess pregnancy outcome during a 2.5‐year follow‐up period.

Methods. All patients presenting to the Department of Obstetrics and Gynecology, Umeå University Hospital, with signs and symptoms of ectopic pregnancy between January 1, 1995 and December 31, 1997 were included in this prospective study. Patients with ectopic pregnancy were either managed expectantly, treated with methotrexate or by laparoscopic or open surgery (salpingostomy/salpingectomy). Systemic methotrexate (Pharmacia & Upjohn, Stockholm, Sweden) was administered as an intramuscular injection of 50 mg/m2.

Results. One hundred and seven patients presented with signs and symptoms of a possible ectopic pregnancy, of these 89 patients eventually were diagnosed as having an ectopic pregnancy. Twenty‐six (29%) patients were treated with methotrexate, 46 (52%) patients with laparoscopy or laparotomy, and 17 (19%) patients by expectant management.

Success rate in the methotrexate group, after one or more injections, was 77% (20 patients out of 26). The mean time to resolution was 24±9 days. There was no difference in pregnancy rate following methotrexate treatment compared to surgical treatment.

Conclusions. Systemic single‐dose methotrexate treatment is a safe treatment option with a reasonably high success rate, with similar probability of a later intrauterine pregnancy as conventional surgical treatment.
A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage
Authors: Lokugamage Amali U. , Sullivan Keith R. , Niculescu Iosif , Tigere Patrick , Onyangunga Felix , Refaey Hazem El , Moodley Jagidesa , Rodeck Charles H.
Published: March 2003

Background. Post partum hemorrhage is a major cause of maternal death, particularly in developing countries, and most cases are due to an atonic uterus. Hemorrhage can occur despite active management of the third stage of labor. Presently, misoprostol (Cytotec, Searle Pharmaceuticals) is the only thermostable uterotonic agent potentially available which would be economically beneficial for developing countries where refrigeration of drugs poses a problem. The objective of the study was to compare intra‐muscular Syntometrine (Sandoz Pharmaceuticals) (ampoule=5 iu oxytocin and 500 mcg ergometrine maleate) plus Syntocinon (Sandoz Pharmceuticals) (10 iu oxytocin diluted in 500 ml normal saline) intravenous infusion versus 800 mcg misoprostol per rectum for treatment of primary post partum hemorrhage in a developing country.

Methods. Randomized single blinded two‐center study, set in both a township and teaching hospital in South Africa. Sixty‐four women with primary post partum hemorrhage due to an atonic uterus were recruited. The primary outcome measure was whether the hemorrhage ceased within 20 minutes of administering the first line treatment, once hemorrhage was clinically recognized.

Results. There was a 28.1% difference between the misoprostol arm and the Syntometrine and Syntocinon arm (p=0.01). This result had a greater than 80% power. Misoprostol performed better.

Conclusion. 800 mcg misoprostol per rectum is effective at treating primary post partum hemorrhage.
Early pregnancy termination with mifepristone and misoprostol in Norway
Authors: Bjørge Line , Johnsen Synnøve Lian , Midbøe Grete , Augestad Grete , Økland Ingrid , Helland Harald , Stray‐Pedersen Sverre , Iversen Ole Erik
Published: March 2003

Objectives. Medical abortion was first introduced in Norway in April 1998. The aims of this study were to assess the efficacy, side effects, and acceptability of medical abortion using mifepristone orally and misoprostol vaginally in a Norwegian population.

Design. The study included the first 226 pregnant women with gestational age of <63 days who requested nonsurgical abortion during the first year in the first Norwegian hospital using this regimen.

Methods. All women received a single dose of mifepristone 600 mg orally, followed at 48 hours by 800 μg misoprostol vaginally. Treatment outcome and complications were the principal outcome measures. We also measured the rates of side effects such as abdominal pain and bleeding and the women’s acceptability of treatment.

Results. Abortion was successful in 95%, surgical evacuation became necessary in 4%, and the pregnancy continued in one woman. During the study period the method was chosen by 23% of those requesting abortion before 63 days amenorrhea; 80% would use the method again; 81% would recommend it to a friend; in retrospect, 69% would not have been willing to be randomly allocated to either a medical or a surgical method.

Conclusions. The combination of orally administrated mifepristone and vaginally administrated misoprostol is an abortion method that is both effective and safe, has few side effects and is well accepted by Norwegian women.
Reproductive hormones and stress urinary incontinence in pregnancy
Authors: Kristiansson Per , Samuelsson Eva , Von Schoultz Bo , Svärdsudd Kurt
Published: March 2003

Background. The cause of transient stress urinary incontinence during pregnancy remains uncertain. Anatomical change, such as a pressure effect of the enlarged uterus, changes in renal function, and alterations in bladder and urethral function have been proposed. There is little information about the role of reproductive hormones in stress urinary incontinence with onset during pregnancy.

Methods. In a prospective, longitudinal, observational cohort study 200 consecutive women attending in early pregnancy were observed by repeated measurements of stress urinary incontinence, its possible determinants as well as serum concentrations of progesterone, estradiol and relaxin.

Results. The prevalence rate of stress urinary incontinence increased to a stable level of about 25% from mid‐pregnancy and increased with parity. A higher serum relaxin value early in pregnancy was correlated to a lower prevalence rate of stress urinary incontinence with onset during pregnancy, also when the influence of potentially important factors was taken into account in a multivariate analysis. No significant difference was shown regarding serum concentrations of estrogen or progesterone, maternal age, weight gain, time since last delivery or smoking, although this can be due to a small sample size.

Conclusion. The reproductive hormone relaxin might have a role in maintaining urinary continence during pregnancy. A mechanism is uncertain.
Relation of vitamin D receptor FokI start codon polymorphism to bone mineral density and occurrence of osteoporosis in postmenopausal women in Taiwan
Authors: Chen Huey‐Yi , Chen Wen‐Chi , Hsu Cheng‐Der , Tsai Fuu‐Jen , Tsai Chang‐Hai
Published: March 2003

Background. Osteoporosis is a common disorder with a strong genetic component. Our aim was to evaluate the correlation of the vitamin D receptor FokI start codon polymorphism to bone mineral density and the occurence of osteoporosis.

Methods. We determined the vitamin D receptor FokI start codon polymorphism using polymerase chain reaction‐based restriction analysis in 163 postmenopausal women in Taiwan. The vitamin D receptor gene polymorphism was detected by the restriction enzyme FokI, where the F allele indicated the absence of the cuttable site and the f allele its presence. We then related the genotypes to bone mineral density and the occurence of osteoporosis in these women.

Results. The allelic frequencies for 163 postmenopausal women in Taiwan were 59.2% for F and 40.8% for f in FokI restriction fragment length polymorphisms. The prevalence of each genotype in the study population was: 42.3% FF, 33.7% Ff and 24% ff. The three genotypic groups differed significantly in bone mineral density at the lumbar spine (P = 0.029). Bone mineral density was highest in the Ff group and lowest in the ff group at the lumbar spine and the femoral neck. The FokI vitamin D receptor genotype showed a significant effect on the prevalence of osteoporosis in the subjects at the lumbar spine. That is, women with genotype ff had a 2.8 times greater risk for osteoporosis (P < 0.05), and those with genotype FF had a 0.8 times greater risk than women with genotype Ff.

Conclusion. Our findings indicate that the vitamin D receptor FokI start codon polymorphism is associated with reduced bone mineral density and predisposes women to osteoporosis at the lumbar spine.
Clinical evaluation of MRI in the diagnosis of borderline ovarian tumors
Authors: Takemori Masayuki , Nishimura Ryuichiro , Hasegawa Kazuo
Published: March 2003

Objective. To evaluate the clinical potential of contrast‐enhanced MRI with Gd‐DTPA (gadopentetate dimeglumine) in the diagnosis of borderline ovarian tumors.

Methods. Thirteen patients with 14 borderline ovarian tumors were evaluated with serum levels of four tumor markers (CA125, CA19‐9, SLX and CEA) and contrast‐enhanced MRI.

Results. Among the 13 patients, five had normal serum levels of all four tumor markers, and five had high serum levels of plural tumor markers. The positive rates of CA125, CA19‐9, SLX, and CEA were 46.2% (6/13), 38.5% (5/13), 30.8% (4/13), and 7.7% (1/13), respectively. With contrast‐enhanced MRI, all 13 patients were diagnosed as having malignant tumors using the widely accepted criteria of MRI findings for the diagnosis of malignant ovarian tumors.

Conclusions. In the present study, all 14 borderline tumors had similar MRI findings to those of malignant tumors and were diagnosed as ovarian cancers with contrast‐enhanced MRI, unrelated to the serum levels of tumor markers.
Correlation of survivin mRNA detection with histologic diagnosis in normal endometrium and endometrial carcinoma
Authors: Lehner Rainer , Enomoto Takayuki , Mcgregor James A. , Shroyer Laurie , Haugen Bryan R. , Pugazhenthi Umarani , Shroyer Kenneth R.
Published: March 2003

Background. The objective of this study was to determine if survivin mRNA expression is a marker of endometrioid adenocarcinoma and if survivin mRNA levels correlate with tumor grade and stage.

Methods. Twenty‐six samples of endometrioid adenocarcinoma and 18 cases of benign endometrium were obtained at surgery. RNA was extracted from tissues and was used for quantitative real‐time RT‐PCR, targeting a 91‐bp sequence of survivin mRNA and the levels were standardized to the levels of ribosomal RNA. Statistical analysis of the correlation between histologic diagnosis and the corrected survivin mRNA levels was performed by the Fisher Exact test and the Kruskal–Wallis test.

Results. Survivin mRNA was detected in all specimens. Survivin mRNA levels were increased in proliferative endometrium (P = 0.0509) and was increased in correlation with ascending grade in endometrioid adenocarcinoma (P = 0.01).

Conclusion. Survivin mRNA is not a specific marker of endometrial cancer, but may reflect an important mechanism in tumor progression of the endometrial mucosa.
Under‐reporting of direct and indirect obstetrical deaths in Austria, 1980–98
Authors: Karimian‐Teherani Daniela , Haidinger Gerald , Waldhoer Thomas , Beck Adolf , Vutuc Christian
Published: March 2003

Background.  Under‐reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under‐reported in Austria and to determine factors that might explain under‐reporting.

Methods.  Confidential enquiries on maternal deaths for the period 1980–98 were linked with the official mortality statistics from Statistics Austria. Maternal deaths were classified as direct and indirect obstetric deaths.

Results.  Between 1980 and 1998 a total of 119 maternal deaths (112 direct and seven indirect obstetric deaths) were registered at Statistics Austria. Confidential inquiries into maternal deaths accumulated 191 maternal deaths (an additional 43 direct obstetric deaths and 29 indirect obstetric deaths). Total under‐reporting was 38% (95% CI 31–45). Significantly more indirect obstetrical deaths were under‐reported (81%; 95% CI 64–92) than direct obstetrical deaths (28%; 95% CI 21–36).

Conclusions.  This study demonstrates the shortcomings of official registration of maternal deaths. Thus, maternal mortality cannot be seen as a reliable basis for health policy decisions.
Stem cells for obstetricians and gynecologists
Authors: Rygaard Kåre , Lindenberg Svend
Published: March 2003

Stem cells are a subject of immense research interest, and may in the not too far future provide the basis for a number of new therapies aimed at substituting damaged or lacking cells, tissues, and even organs. A number of stem cell types have been identified, including embryonal stem cells, umbilical cord blood stem cells, and bone marrow stem cells. Two of the most promising stem cell types, embryonal stem cells and umbilical cord blood stem cells, are obtained from sources within the field of gynecology and obstetrics, namely fertility clinics performing in‐vitro fertilization, and labor wards, respectively. This review focuses on the biological potentials of stem cells with a primarily gynaecological‐obstetrical perspective. It is not the aim of this review to discuss the many important ethical aspects of stem cell technologies.
Mother and child health care in Kabul, Afghanistan with focus on the mother: women's own perspective
Authors: Kaartinen Leena , Diwan Vinod
Published: March 2003

Background. The study examined the pattern of utilization of Maternal and Child Health (MCH)‐services of women with child‐bearing experience in a suburb of city Kabul.

Methods. A semi‐structured questionnaire administered to 100 women in the community and 40 in the maternal hospital. Interviews and observations in the local MCH‐clinic were used to collect the relevant information.

Results. Sixty one of the 100 women in the community delivered at home exclusively, 35 having experienced both home and institutional deliveries, four women had hospital childbirths only. Approximately half of the women decided about utilizing the modern MCH services themselves. Women valued in the MCH‐clinic mainly medical care and vaccinations. Delivery was seen primarily as a technical event, but when probed more deeply it was obvious, that fear of death was the driving power for decisions made. With at‐home deliveries female relatives were preferred as birth assistants. If outside assistance was required, trained midwives were preferred rather than traditional birth attendants. Institutional delivery was seen as the last resource for complicated deliveries, but was also esteemed by many because of the security and cleaness. Professional skill, but also empathy and justice were appreciated in professionals.

Conclusions. Promoting rooming‐in and early breast feeding in the maternity wards, ongoing education of the MCH‐staff about communication skills, ethics and teaching methods, dialogue with decision makers on all levels in the society about MCH including family planning, ongoing training and support of community midwives (dayas) in the community by local MCH‐staff, adequate supplies, inexpensive services, incentive money for the competent staff members are recommended.
The term breech presentation. A retrospective study with regard to the planned mode of delivery
Authors: Belfrage Patrick , Gjessing Leif
Published: March 2003

Background. To analyze retrospectively a large group of term breech and vertex deliveries, with regard to the influence of the mode of delivery on the frequency of fetal and maternal complications.

Methods. All singleton breech deliveries after completed 36 weeks of pregnancy, with a live fetus, delivered at Rogaland Central Hospital, from September 1 1996 to the May 10 2001 were included (n = 575). Correspondingly as a control group, 582 cases in vertex presentation were analyzed.

Results. Planned vaginal delivery (VD) for the fetus in breech presentation (n = 448) in comparison with elective caesarean section (CS) (n = 127) increased early neonatal morbidity (3.6% vs. 0%). The frequency of Apgar scores < 7 at 5 min also increased (4.2% vs. 0.8%), as well as umbilical artery pH < 7.0 (4.4% vs. 0%), and referrals to the neonatal intensive care unit (NICU) (15.8% vs. 6.3%). Corresponding figures for planned VD of the fetus in vertex presentation were: 0.5% neonatal morbidity, 0.2% Apgar scores < 7 at 5 min, 8.1% admissions to NICU and 1.5% pH < 7.0 in umbilical arteries. Results comparing maternal morbidity in the different breech groups were inconclusive, but there were more maternal complications in the breech group planned for VD than in the corresponding vertex group (5.1% vs. 1.9%).

Conclusions. Elective CS for breech presentation will significantly decrease the risks for the fetus in comparison with planned VD.
Development and clinical experience with the new evidence‐based tocolytic atosiban
Authors: Husslein Peter
Published: March 2003

The incidence of preterm birth has remained unchanged for the last few decades. This is due, in part, to the complex etiology of preterm labor, and the limited ability of tocolytic agents to prolong pregnancy as a result of limited efficacy and poor safety profiles. The recent introduction of the oxytocin antagonist, atosiban, represents a new generation of uterine‐specific tocolytics, which are associated with more favorable safety profiles. This paper discusses the rationale behind the development of the oxytocin antagonists and provides a review of the phase II and III trials that have investigated atosiban. Also included is a retrospective analysis of 83 women assessed in the Vienna Medical School, providing an insight into the benefits associated with atosiban in the everyday clinical setting.

The introduction of a safer tocolytic agent offers the potential to change the current approach to the management of preterm labor. This includes a prolonged period of treatment at earlier or later gestational ages and possibly an extended use to women with contraindications who would normally have been excluded from treatment, e.g. preterm premature rupture of the membranes.
Soluble tumor necrosis factor receptor II and soluble cell adhesion molecule 1 as markers of tumor necrosis factor‐α release in preeclampsia
Authors: Visser Wil , Beckmann Ilse , Knook Marco A. H. , Wallenburg Henk C. S.
Published: March 2003

Background.  The purpose of this case‐controlled study was to investigate whether plasma concentrations of TNF‐receptors I and II and tumor necrosis factor‐α‐induced cell adhesion molecule 1 VCAM‐1 could serve as more sensitive markers of tumor necrosis factor‐α release in preeclamptic women than a direct measurement of circulating tumor necrosis factor‐α.

Methods.  Plasma concentrations of soluble tumor necrosis factor receptor I and II, immunoreactive tumor necrosis factor‐a and soluble cell adhesion molecule VCAM‐1 were determined in 21 patients with severe proteinuric preeclampsia (23–35 weeks' gestation) and 21 gestational age‐matched normotensive controls by enzyme‐linked immunoassays. Concentrations of bioactive tumor necrosis factor‐α were assessed by the WEHI 164 bioassay. Data were statistically evaluated by Wilcoxon's rank sum and sign tests, and Spearman's test was used to evaluate clinical and biochemical correlations.

Results.  Bioactive tumor necrosis factor‐α was detected in 19 of 21 preeclamptic and 18 of 21 normotensive women, with no difference in plasma concentrations between both groups. Immunoreactive tumor necrosis factor‐α, soluble TNF‐receptors and soluble cell adhesion molecule VCAM‐1 were significantly increased in plasma of preeclamptic patients, and a statistically significant positive correlation was observed between immunoreactive tumor necrosis factor‐α and TNFRII. In preeclamptic patients a statistically significant negative correlation was observed between TNFRII and platelet count, and between soluble cell adhesion molecule VCAM‐1 and birthweight ratio.

Conclusion.  These results show that plasma concentrations of soluble tumor necrosis factor receptor II and soluble cell adhesion molecule VCAM‐1 reflect the release of tumor necrosis factor‐α and provide sensitive markers of excessive release of this cytokine in preeclampsia.
Experience of in vitro fertilization surrogacy in Finland
Authors: Söderström‐Anttila Viveca , Blomqvist Tom , Foudila Tuija , Hippelainen Maritta , Kurunmaki Henri , Siegberg Rita , Tulppala Maija , Tuomi‐Nikula Merja , Vilska Sirpa , Hovatta Outi
Published: March 2003

Background.  In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10‐year period.

Methods.  This retrospective study included 17 women who underwent ovarian stimulation in connection with surrogacy in 1991–2001 at four clinics. The surrogate mothers were unpaid volunteers: six sisters, three mothers, one husband's sister, one cousin, four friends and three other volunteers. Thorough counseling was given to the commissioning couples and to the surrogate mothers and their partners. The commissioning couples were prepared to adopt their biological children.

Results.  Twenty‐eight surrogate IVF cycles were started in 17 women. One couple received donated oocytes. Trans‐vaginal oocyte retrieval was feasible in every case, including those five women with congenital absence of the vagina and uterus. An average of 1.8 embryos was transferred at a time, and 11 pregnancies were achieved [50% per fresh embryo transfer (ET) and 16% per frozen‐thawed ET]. Nine healthy singletons and one set of twins were born. One pregnancy ended in miscarriage. The mean birth weight of singleton infants was 3498 g (2270–4650 g). The birth weights of the twins were 2900 and 2400 g. In all cases the genetic parents took care of the infant immediately after birth. Two surrogate mothers had postpartum depression.

Conclusions.  Altruistic IVF surrogacy works well, but careful counseling of all parties involved is essential.
Effect of magnesium sulfate, isradipine, and ritodrine on contractions of myometrium: pregnant human and rat
Authors: Kantas Emine , Cetin Ali , Kaya Tijen , Cetin Meral
Published: March 2003

Background.  Magnesium sulfate, isradipine, and ritodrine are smooth muscle relaxants used for treating preterm labor. The aim of this study is to investigate the action profile of these drugs on the amplitude and frequency of spontaneous contractions of isolated myometrial strips of pregnant human and rat.

Material and methods.  Isolated myometrial strips were obtained from humans undergoing elective cesarean section at term pregnancy and Wistar albino rats on gestational days 19–21. These strips were mounted in organ baths for recording of isometric tensions. The effect of magnesium sulfate, isradipine, and ritodrine on the amplitude and frequency of spontaneous contractions was compared with the anova test.

Results.  Ritodrine (10−8−10−5 M) concentration‐dependently inhibited the frequency and amplitude of spontaneous contractions of myometrial strips. At 10−4 M, tachyphylaxis of ritodrine occurred and contractions started again. Magnesium sulfate (10−7−10−4 M) inhibited the frequency but did not change the amplitude of the spontaneous contractions. Isradipine (10−7−10−4 M) had a concentration‐related inhibitor effect on both the frequency and amplitude of the spontaneous contractions. The effects of magnesium sulfate, isradipine, and ritodrine were considerably similar in myometrium strips obtained from pregnant rats and humans.

Conclusions.  Because of tachyphylaxis, the effectiveness of ritodrine is limited for inhibition of myometrial contractions. Magnesium sulfate reduced the frequency of spontaneous contractions without affecting the amplitude. Isradipine may be an interesting therapeutic alternative in situations where inhibition of uterine activity is desirable.
Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of analgoritm
Authors: Mathiesen Elisabeth R. , Christensen Ann‐Birgitte L. , Hellmuth Ellinor , Hornnes Peter , Stage Edna , Damm Peter
Published: March 2003

Objective.  Poor glycemic control is often a serious clinical problem during glucocorticoid treatment for fetal lung maturation in pregnant women with diabetes. An algorithm for improved subcutaneous insulin treatment during glucocorticoid treatment in insulin‐dependent diabetic women was developed and tested.

Study design.  
The sample, divided into two cohorts, consisted of all insulin‐dependent diabetic women (
n
=16) receiving glucocorticoid treatment (betamethasone 12 mg i.m., repeated after 24 h) from 1996 to 1999. In the first cohort the increments of insulin dose were based on the level of blood glucose obtained. Based on the first cohort an algorithm to determine increments of insulin dose was developed. In the second cohort (
n  = 8) the insulin dose was increased by up to 40%, according to the algorithm, starting immediately after glucocorticoid treatment; prior to a detectable increase in blood glucose.

Results.  
After betamethasone, the daily insulin dose for the following 5 days was increased by 6, 38, 36, 27 and 17% in the first cohort vs. 27, 45, 40, 31 and 11% in the second cohort. The algorithm was used in the second cohort. The median blood glucose was 6.7, 14.3, 12.3, 7.7 and 7.7 vs. 7.7, 8.2, 9.6, 7.0 and 7.4 mmol/l (
p <0.05 for day 2 and 3) in the two cohorts, respectively. None developed ketoacidosis or severe hypoglycemia.

Conclusion.
 
An algorithm with an increasing insulin dose of up to 40% shortly after glucocorticoid treatment for fetal lung maturation in diabetic women prevents severe dysregulation of metabolic control.