bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal, Fetal and Neonatal Effects of Beta‐Adrenergic Stimulation in Connection with cesarean Section
Authors: Jouppila R. , Kauppila A. , Tuimala R. , Pakarinen A. , Moilanen K.
Published: December 2009

To investigate the combined metabolic effects of beta‐mimetic therapy and general anesthesia on maternal and fetal/neonatal metabolism, 14 patients were treated with isotonic saline, 11 with intravenous fenoterol (3 μg/min) and 9 with intravenous isoxsuprine (150 μg/min) for 30 minutes prior to cesarean section. The maternal heart rate and blood pressure as well as the maternal and fetal acid‐base balance were followed. The neonatal glucose level was monitored for 36 hours after delivery.

The heart rate and the diastolic and systolic blood pressure values increased during the operation in each group, without any marked differences between the groups. At delivery, the mean maternal BD (base‐deficit) value was higher in the fenoterol patients than in the control patients, indicating a trend towards metabolic acidosis. The other values of acid‐base balance in the maternal and umbilical arterial and venous blood did not reveal any differences between the groups. The neonatal glucose level at 2 hours after delivery was higher in the fenoterol group than in the control group. The other values recorded during 36 hours revealed no differences between the groups.

Beta‐mimetic treatment preceding general anesthesia in cesarean section does not have unfavorable effects on the mother, the fetus or the newborn. Such therapy thus does not seem contraindicated when uterine contractions should be rapidly suppressed in cases of fetal distress before operation.
Gonorrheal Infection Followed by an Increased Frequency of Cervical Carcinoma
Authors: Furgyik Stefan , Åstedt Birger
Published: December 2009

In a town with a fairly centralized health service and a well organized gynecologic health control, women who had had gonorrhea in 1954 or 1955 were reviewed for presence of cervical neoplasia and compared with age‐matched controls. Of 164 women studied, 29 (17.7 per cent) had 24 or 23 years later developed cancer in situ, compared with 7 (4.3 per cent) of the controls (p < 0.001), while 8 (4.3 per cent) had invasive cancer colli uteri against only one (0.6 per cent) of the controls (p < 0.02). Malignant disease of the portio proved at least four times as common among the women with gonorrhea in their history as among the controls. The findings corroborate the view that cervical carcinoma is a sexually transmitted disease.

It may be assumed that at least every fourth woman who had had gonorrhea had been or is a carrier of the carcinogenic agent(s). It is probably easier to search for and detect such agents in association with gonorrhea than in patients with already manifest cancer of the uterine cervix.
Maternal Pulmonary Edema Occurring after Therapy with Ritodrine for Premature Uterine Contractions
Authors: Abramovici Haim , Lewin Aby , Lissak Arie , Palant Abraham
Published: December 2009

Intravenous administration of beta‐sympathomimetic drugs in combination with betamethasone or dexamethasone is a treatment often used for the suppression of premature uterine contractions and for the stimulations of fetal lung maturity. It has been suggested that the combination of these drugs may be responsible for maternal pulmonary edema and five such cases have been reported in the literature (1, 2).

We report a patient who developed pulmonary edema during ritodrine therapy. Corticosteroids were not given in this case.
Chronic Granulocytic Leukemia in Pregnancy: A Case Report and Review of the Literature
Authors: Shalev Oded , Heyman Samuel , Hod Giora , Adato Rahel
Published: December 2009

Chronic granulocytic leukemia (CGL) was diagnosed in the second trimester of pregnancy in a mother of four, who decided to terminate the pregnancy immediately. According to the literature this unusual combination is not a definite indication for abortion since CGL does not adversely affect the course of the pregnancy nor the pregnancy alter the course of the disease. Prudent treatment with busulfan or splenic irradiation, when indicated, apparently does not endanger the development of the fetus.
Induction of Labor by Oxytocin or Prostaglandin E2
Authors: Bremme Katarina , Bygdeman Marc
Published: December 2009

The efficacy and safety of oral PGE2 or intravenous infusion of oxytocin, in both cases combined with early amniotomy, for induction of labor on medical grounds, were compared in a randomized study of 200 women. After an initial dose of 0.5 mg, 1.0 mg of PGE2 was given at hourly intervals for up to 24 hours. Oxytocin was administered as an intravenous pump infusion, the dose being increased step wise up to 20 mIU/min. The two methods were equally effective. All patients went into labor and were delivered within approximately 24 hours. Of the total of 200 patients included in the study, 92 per cent were delivered vaginally and 8 per cent with Caesarean section. In 26 per cent the delivery was completed by vacuum extraction. The frequency of instrumental delivery was significantly lower in multiparous than in primiparous patients. If the patient was a multiparous woman and the modified Bishop score was 6 or more, the combined frequency of Caesarean section and instrumental delivery was for PGE2 2.5 per cent and for oxytocin 3.1 per cent.

No difference was found in the health status of neonates following labor induction with PGE2 and oxytocin respectively.

At the end of the 24‐hour observation period five patients were still in labor. These patients were delivered either by vacuum extraction (three patients) or by Caesarean section (two patients).

The duration of labor was slightly longer (mean 1.1 hour) following oral PGE2 than following intravenous infusion of oxytocin, mainly due to a prolongation of stage I.

The type of delivery following oral PGE2 or intravenous infusion of oxytocin in combination with early amniotomy was compared with that following spontaneous labor and following labor induction by oxytocin alone. The frequency of Caesarean section was the same but the frequency of instrumental delivery was lower in the former two groups of patients. The difference could at least partly be explained by a higher frequency of patients who obtained epidural analgesia in the randomized trial. Oral PGE2 or intravenous infusion of oxytocin combined with early amniotomy was obviously more effective than oxytocin alone for labor induction. With oxytocin alone, two days of infusion was required in 53.8 per cent and four or more days in 2.4 per cent of the patients.

It may be concluded that oral PGE2 therapy combined with amniotomy is a valuable alternative to intravenous infusion of oxytocin for labor induction at or near term. The method is generally well accepted by the patient. The main advantage is the ease and simplicity of the treatment. Complications are rare, particularly in multiparous patients with good prospects of inducibility.
INTERVILLOUS BLOOD FLOW IN NORMAL AND COMPLICATED LATE PREGNANCY MEASURED BY MEANS OF AN INTRAVENOUS 133XE METHOD
Authors: Käauäaur K. , Jouppila P. , Kuikka J. , Luotola H. , Toivanen J. , Rekonen A.
Published: December 2009

Abstract. Intervillous blood flow (IVBF) was measured intravenously with a new quantitative 133Xe method in 50 normal and 74 complicated late pregnancies between the 35th and 42nd weeks. The distribution of individual flow rates seemed to be fairly wide in both the normal and the pathological groups. The mean rate of IVBF in normal pregnancies was 140 ml/100 ml of intervillous space/min. The lowest mean flow values were observed in pregnancies complicated by diabetes mellitus (class B‐E), cholestasis of pregnancy and severe pre‐eclampsia, a highly significant difference (p<0.001) from the mean IVBF observed in normal pregnancies. The significance of the results in the different groups has been discussed in detail. This method may open up a new diagnostic area in the management of high‐risk pregnancies.
WATER AND ION METABOLISM IN PLACENTA (III)
Authors: Castaldo F. , Cittadini A. , Romor R. , Paparella P. , And A. Bompiani , Terranova T.
Published: December 2009

Abstract. Rabbit placenta slices incubated at 38°C in oxygenated medium, in the presence of endogenous substrates + 5 mM glucose, after a period of preincubation of 120 min at 0–1°C, show a net accumulation of potassium and extrusion of water, sodium and calcium. The movement of potassium, sodium and calcium appears to be related to the rate of oxygen consumption of the slices and to be inversely proportional to the age of the tissue. The efficiency of cations movement is also dependent on the nature and composition of the incubation medium. In this respect the potassium concentration of the medium plays a major role. The movement of water, on the other hand, seems to be completely independent from both the rate of respiration and the age of the tissue. The results are discussed in terms of relation between placenta age and senescence, and efficiency of the mechanisms devoted to the cell regulation of water and ions content.
RECURRENT URINARY INCONTINENCE TREATED NEUROSURGICALLY
Authors: Walter Steen , Hald Tage , Nordling Jôrgen , Buhl Jens , Astrup Aage
Published: December 2009

Abstract. Neurogenic bladder dysfunction can be difficult to manage and is usually impossible to cure. This case report describes neurosurgical treatment of a case of recurrent urinary incontinence in a 56 years old woman who was previously treated on four occasions with vaginal repair operations with no beneficial effect. Cystometry revealed detrusor hyperreflexia (supranuclear bladder paresis). Myelography demonstrated cervical spinal cord compression. She was treated with spondylodesis of the cervical spine with complete relief of incontinence. 18 months postoperative cystometry was normal and after three years she was free of symptoms.
The frequency of disorders of the lower urinary tract, urinary incontinence in particular, as evaluated by a questionnaire survey in a gynecological health control population
Authors: Iosif Serafim , Henriksson Lars , Ulmsten Ulf
Published: December 2009

Four thousand four hundred women were examined under the gynecological health control program in Malmö municipality during a period of 11 months. Nine hundred and forty‐four (21 per cent) reported that they were troubled by disorders of the urinary tract. These women were given copies of a separate questionnaire, which was subsequently properly answered by 512 women. Of these, 321 (62.7 per cent) indicated urinary incontinence. From the questionnaire alone, it was difficult to characterize the different types of urinary incontinence in the patients. Thus only 42 women (8.2 per cent) seemed to suffer from genuine stress incontinence and 34 women (6.6 per cent) from genuine urge incontinence, whereas 245 (47.9 per cent) had to be characterized as “mixed incontinent”. Hence, it is obvious that in several patients suffering from urinary incontinence, written or combined written and oral interviews do not produce a clear‐cut diagnosis and that the etiology and treatment of incontinence in these patients may be uncertain. It is concluded that interviews with most patients suffering from urinary incontinence must be supplemented by objective recordings before a definitive diagnosis and treatment can be prescribed.
Treatment of pulmonary endometriosis with danazol
Authors: Rönnberg Lars , Ylöstalo Pekka
Published: December 2009

A successful treatment of pulmonary endometriosis with Danazol is reported. A 25‐year‐old woman who suffered from hemoptysis during her menstrual periods was at first treated with lynestrenol, but the hemoptysis recurred immediately after treatment. Following 6 months' therapy with Danazol she has now been symptom‐free for 12 months.

Danazol appears to have a more lasting effect on ectopic foci of endometriosis than has progestin.
ULTRASOUND DIAGNOSIS OF INTERSTITIAL PREGNANCY
Authors: Smith Hans‐Jørgen , Hanken Helge , Brundelet Pablo Jimenez
Published: December 2009

Abstract. A 25‐year‐old woman presented with a 9‐week amenorrhea, lower abdominal pain and a positive pregnancy test. Ultrasonography disclosed an intact pregnancy in the interstitial portion of the right Fallopian tube. Surgical and pathological findings confirmed the diagnosis. The value of ultrasonography in the diagnosis of ectopic pregnancy is emphasized.
REGENERATION OF THE HUMAN ENDOMETRIUM AND PRESENCE OF INFLAMMATORY CELLS FOLLOWING DIAGNOSTIC CURETTAGE
Authors: Johannisson Elisabeth , Fournier Karine , Riotton Gustave
Published: December 2009

Abstract. The regeneration of the human endometrium, with particular emphasis on the presence of inflammatory cells, was studied in 106 women undergoing hysterectomy following curettage. The interval between the last curettage and the hysterectomy varied from 1 day to 12 months. A slight but significant increase in the number of neutrophil cells was observed during the first 7 days after the curettage in proliferating endometrium. This increase was considered to reflect the regeneration phenomenon rather than a true infection. No statistically significant increase in the number of neutrophils and mononuclear cells was observed after the first week following the curettage. The study does not provide any evidence that the introduction of a curette or a suction instrument in the uterine cavity increases the risk of endometritis.
PAIN RELIEF IN LABOR BY TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
Authors: Bundsen Peter , Peterson Lars‐Erik , Selstam Urban
Published: December 2009

Abstract. The study evaluated transcutaneous electrical nerve stimulation (TNS) for pain relief in labor, used in parallel with conventional methods. The investigation comprised 566 vaginally delivered women, 283 of whom were given TNS. Pain relief was evaluated with a questionnaire which the women answered shortly after delivery. With a statistical multivariate technique, it was concluded that TNS has a specific effect on pain localized to the back. Few women in either the TNS or the control group reported good relief of pain localized to the suprapubic region. Nitrous oxide‐oxygen mixture was used less often in the TNS group than in the controls. Duration of labor and maternal blood loss were comparable in the two groups. The babies borne by primiparae in the TNS group tended to have better Apgar scores. Fewer babies of primiparae in the TNS group required observation for two days or more on the neonatal ward than was the case with the controls. However, the electrical stimulation could not be used optimally as it interfered with monitoring of the fetal heart rate in half the cases.

It is concluded that although TNS has a good effect on low‐back pain and seems to have no negative effects on the mother or child, it is only a complement to conventional methods.
PROGNOSTIC VALUE OF HUMAN PLACENTAL LACTOGEN (HPL) IN AN UNSELECTED OBSTETRICAL POPULATION
Authors: Nielsen Peter Vest , Egebo Kirsten , Find Claus , Olsen Carl Eli
Published: December 2009

Abstract. A prospective study on the value of routine HPL determination as a supplement to clinical antenatal care is presented. The HPL values in the apparently normal pregnant woman were not known to the clinicians.

The material comprised 1 660 pregnancies and deliveries, in 87% of which at least one HPL value was available.

The results are expressed as the ability of a low HPL value to predict the birth of a distressed infant and/or an infant of low birth weight, a normal HPL value the birth of a non‐distressed infant and/or an infant of normal birth weight. Moreover, the results show how many of the distressed infants and infants of low birth weight were born to mothers with low HPL values.

Like a number of other authors, we found that HPL screening increases the prognostic reliability in pregnancies with complications. On the other hand, its value in normal pregnancies could not be confirmed.
PREGNANCY SPECIFIC β1 GLYCOPROTEIN AND CHORIONIC GONADOTROPHIN IN EARLY HUMAN PREGNANCY
Authors: Lenton E. A. , Grudzinskas J. G. , Gordon Y. B. , Chard T. , Cooke I. D.
Published: December 2009

Abstract. Venous blood samples were collected prospectively in ten menstrual cycles where conception occurred, and for several weeks thereafter, and the circulating concentrations of pregnancy specific β1 glycoprotein (SP1) and human chorionic gonadotrophin (HCG) determined using specific radioimmunoassays. The data were converted to logarithms and pooled using the day of the LH peak as zero time. The concentration profiles so obtained were remarkably similar and showed a rapid exponential increase in concentration during the very early stage of pregnancy. The doubling times were 2.4 days and 2.3 days for SP1 and HCG respectively and both proteins were initially secreted in approximately equivalent concentrations. However, some 30 days following the LH peak, the concentration profiles began to diverge, with SP1 levels continuing to rise whilst HCG concentrations showed the characteristic plateau at 8 and 10 weeks of gestation.
DIAGNOSIS AND TREATMENT OF PRIMARY VAGINAL CARCINOMA IN SITU AND DYSPLASIA
Authors: Punnonen R. , Grönroos M. , Meurman L. , Liukko P.
Published: December 2009

Abstract. Fifteen cases of primary carcinoma in situ or severe or moderate dysplasia of the vagina have been diagnosed and treated during the period 1966–75 at the Department of Obstetrics and Gynecology, Turku University Central Hospital. Because of abnormal vaginal cytology the lesion was localized by means of colposcopy and iodine staining. For 6 patients local estrogen treatment was applied to increase the thickness of the epidermal layer. For 6 patients, treatment consisted of simple excision. Nine patients, including both those with carcinoma in situ, were treated with intravaginal radiation therapy. The radiation dosage was 2000 to 2600 rad at a distance of 1 cm from the surface of the epithelium. None of the patients showed any complications, and all are now symptom‐free.
GIGANTOMASTIA
Authors: Wølner‐Hanssen P. , Palmer B. , Sjöberg N.‐O. , Åstedt B.
Published: December 2009

Abstract. A case of gigantomastia is reported. The breast enlargement started some years before first pregnancy, during which a tremendous acceleration was observed. Various laboratory investigations elicited normal values, except for some high values of prolactin. No treatment was given. After delivery, the patient nursed her baby. Thirteen weeks later, lactation was inhibited with bromocriptine. A further 3 weeks later, a reduction mammoplasty was performed. One year later, the prolactin values were still normal. The etiology of this disease is not known. One possible explanation is an increased number or increased sensitivity of prolactin receptors in the target organ.
Follicular Stimulating Hormone, Luteinizing Hormone and Estrogen Levels before and After Female Sterilization
Authors: Sørensen Torsten , Ladehoff Poul , Lindholm Per , Qvist Kirsten
Published: December 2009

A prospective pilot investigation of 14 women subjected to sterilization via laparoscopy, using bipolar electrocoagulation of the Fallopian tubes, did not reveal any significant change in the levels of follicular stimulating hormone (FSH), luteinizing hormone (LH) or estradiol either before or 3 months after the operation. However, the investigation gave evidence of a slight decrease in estradiol levels in the first 3 months after sterilization.
Endometrial Carcinoma Insensitive to Progestin and Cytotoxic Chemotherapy May Respond to Tamoxifen
Authors: Kauppila A. , Vihko R.
Published: December 2009

Estrogen and progestin receptor‐positive endometrial carcinoma, which did not respond with remission to progestin or cytotoxic combination chemotherapy, was sensitive to tamoxifen. This was demonstrated by the complete resolution of pulmonary metastases and pleural effusion, a marked decrease in ESR, and improvement in the general condition of our patient. Although it is very likely that progestin and antiestrogen therapies operate by similar molecular mechanisms, they may be complementary.
Progesterone Action in Mammalian Uterus
Authors: Jänne Olli A.
Published: December 2009

The present article describes some of the factors regulating progesterone action in mammalian uterus. The main emphasis is laid on the role of cytosol receptor concentrations in the ultimate expression of progestin action. In addition, recent findings on the regulation of uteroglobin (a progesterone‐stimulated rabbit uterine protein) are dealt with, especially in the light of estrogen‐progestin interaction in this regulation. The current evidence suggests that estradiol is able to mimic and modify progesterone action in a dose‐related fashion: small doses of estradiol potentiate the progesterone effect, whereas higher concentrations of this steroid almost completely block expression of progestational response. These actions of estradiol seem to occur via mechanisms distal to progesterone receptor synthesis, since the doses of estradiol which most markedly inhibit progesterone action on uteroglobin synthesis bring about a significant increase in uterine progesterone receptor concentrations.
Estrogen and Progesterone Cytosol Receptor Concentration in Endometriotic Tissue and Intrauterine Endometrium
Authors: Bergqvist A. , Rannevik G. , Thorell J.
Published: December 2009

Cytosol estrogen (ER) and progesterone (PR) receptors were assayed in peritoneal and ovarian endometriotic tissue from 20 patients. In 12 of the cases the intrauterine endometrium was assayed as well. The control material consisted of normal endometrium from 30 women. The receptor content of the endometriotic tissue was less than that of the endometrium of the same patient. In most cases no receptors could be detected (12/20 cases ER‐, 719 cases PR‐) irrespective of the phase of the menstrual cycle. The endometrial receptor concentrations were that same in patients with endometriosis as in the control group. There were no differences in binding characteristics of the receptors in the two tissue types. It is concluded that endometriotic tissue contains lower a concentration of cytoplasmic ER and PR than the normal endometrium.
Medroxyprogesterone Acetate (MPA) Plasma Levels After Oral and Intramuscular Administration in A Long‐Term Study
Authors: Hesselius Inge , Johansson Elof D. B.
Published: December 2009

In a long‐term study (1 year) the plasma concentration of medroxyprogesterone acetate (MPA, Depo‐Provera, Provera, Upjohn) was measured in 30 patients with endometrial carcinoma treated with MPA in the following dosages:

MPA 1 000 mg i.m. weekly

MPA 1 000 mg i.m. once every second week, and

MPA 100 mg orally twice daily.

In the orally treated group the blood samples were taken just before the next tablet. The plasma concentration in the orally treated group rapidly reached steady state, while the i.m. treated group showed gradually increasing levels that had a tendency to level off after 6 months. The mean concentration at the end of the year was about three times higher for MPA 1 000 mg i.m. weekly than for MPA 100 mg orally twice daily. This does not take into consideration the peak MPA level that occurs 2‐4 hours after each tablet. MPA i.m. has a very good depot effect, with release of MPA from the injection site for up to 9 months. The steady initial increase in MPA plasma concentration seen in the i.m. treated groups is probably due to the additions of new depots rather than accumulation in the body generally.
PLASMA AND RED BLOOD CELL FOLATE DURING NORMAL PREGNANCIES
Authors: Ek Johan , Magnus Erik M.
Published: December 2009

Abstract. Plasma and red cell folate concentrations (Lactobacillus casei activity) have been studied in 43 women during pregnancy. Iron, but no folic acid supplement was given. The plasma folate concentrations decreased significantly during pregnancy and were lower than in the reference cases at term. The red cell folate concentrations were compatible with the reference material during early pregnancy, and significantly higher than the reference material at term. A significant decrease was observed during the last two months of pregnancy. The plasma folate and the red cell folate concentrations at different stages of pregnancy were correlated and a relationship was demonstrated between these parameters at different stages of pregnancy. The hemoglobin concentrations were compatible with the reference material during early pregnancy and at term.

One hundred and sixty‐six women were also studied at term to evaluate the effect of repeated pregnancies on the folate status. Repeated pregnancies did not influence the plasma and red cell folate concentrations at term.

We conclude that the folate intake is adequate to meet the increased requirements during pregnancy, and folic acid supplementation is therefore not recommended as a routine in normal pregnancies in this population.
OVARIAN PREGNANCY IN IUD‐USERS
Authors: Kjer J. J. , Holm B. , Hertz J.
Published: December 2009

Abstract. Three cases of ovarian pregnancy are reported in the presence of an intrauterine device, bringing the total number of reported cases to 53.

The literature concerning the frequency, the possible mechanism and some clinical characteristics of ovarian pregnancy is summarized.
A Comparison of Clinical Results Following High Dose‐Rate Intracavitary Afterloading Irradiation with Co60 (Cathetron) and Conventional Radium Therapy for St. I‐II Cervical Carcinoma
Authors: Taina Esko , Grönroos Matti , Taina E.
Published: December 2009

Abstract. From 1969 to 1976, 101 patients with St. Ia‐IIb cervical carcinoma were treated with the Cathetron (C) and 84 patients with radium (R). Surgery was carried out on 56.4% of the patients in group C and 60.7% in group R two weeks after the intracavitary radiotherapy and 51.5% of the patients in group C and 45.2% in group R received external irradiation with or without an operation. There was no statistical fifference in the survival between the two treatment groups, the 5‐year crude survival rate being 81.6% for group C and 78.6% for group R and the 3‐year crude survival rates 85.1% and 83.3% respectively. Local recurrence of tumour was more frequent in group R (10.7%) than in group C (3.0%) (p=0.03). There were more early complications during or after the Cathetron (10.9%) than radium treatment (3.6%), without any statistical significance, however. No differences were found in operative difficulties or early postoperative morbidity between the two groups during or after radical operations after intracavitary radiotherapy.
TDF (Time‐Dose Factor) Analysis of High (CO60, Cathetron) and Low Dose‐Rate (Radium) Intracavitary Radiotherapy for Uterine Carcinoma
Authors: Taina Esko , Vanhatalo Juha , Taina E.
Published: December 2009

Abstract. TDF (time‐dose factor values for both low (radium) and high dose‐rate (Co60, Cathetron) intracavitary regimes in the treatment of cervical and endometrial carcinoma were calculated. Although some statistical differences were found between the TDF values of patients with and without complications, individualization of the treatment is of utmost importance in preventing radiation‐induced complications. Patients treated by the Cathetron with single fractions of 10 Gy each had statistically more complications and higher TDF values than patients treated with fractions of 7.5 Gy each. Optimum TDF values for low and high dose‐rate treatments are given although it is shown that the TDF system overestimates the required dose at high dose‐rate by approximately 33%. Therefore a new normalizing constant of 1.18, instead of 1.57 as used so far, is proposed.
Carbohydrate Metabolism in Relation to Hormonal Replacement Therapy
Authors: Notelovitz Morris
Published: December 2009

Abstract. The effect of hormone replacement therapy on carbohydrate metabolism in menopausal women is briefly reviewed. Estrogen treatment has a bi‐phasic effect; abnormal glucose tolerance with a normal insulin level is commonly found within 3 months of treatment, followed by normalization of the glycemia when treatment is extended beyond one year. Normal tolerance usually occurs once treatment is stopped. Estrogens may therefore be regarded as being glucogenic (reversible blood glucose elevation) rather than diabetogenic (permanent hyperglycemia). With some exceptions, progestogens have little effect on glucose tolerance within the first 3–6 months of treatment; thereafter progressive hyperglycemia and hyperinsulinemia occur. Postulated mechanisms for the hormonal effect on carbohydrate metabolism are noted, including the possible synergistic effect of estrogens on progestogen glucogenic activity. The significance of chronic hyperglycemia and vascular disease is commented upon.
Metabolic and Circulatory Effects of Intravenous and Oral Salbutamol in Late Pregnancy in Diabetic and Non‐Diabetic Women
Authors: Wager Jan , Fredholm Bertil , Lunell Nils‐Olov , Persson Bengt
Published: December 2009

Abstract.The present study investigated the cardiovascular and metabolic “side‐effects” of the β2‐adrenoceptor stimulating drug salbutamol in the third trimester of pregnancy in diabetic and non‐diabetic women.

Salbutamol was administered either orally or as an intravenous infusion. Blood samples were collected for analyses of plasma cyclic AMP, insulin, C‐peptide, and carbohydrate and lipid metabolites. Fetal heart rate, maternal heart rate, and blood pressure were registered simultaneously.

After both intravenous and oral salbutamol, there was a statistically significant decrease in diastolic blood pressure, increase in maternal heart rate, plasma levels of cyclic AMP, insulin, and carbohydrate and lipid metabolites showing stimulation of glycogenolysis, lipolysis, and insulin secretion. The increase in fetal heart rate was slight. In diabetic women, the glycogenolytic and lipolytic effects of salbutamol were significantly more pronounced than in non‐diabetics.

The acute maternal circulatory and metabolic effects after salbutamol are probably too slight to have any clinical significance in healthy women. However, in diabetics, due to their impaired insulin function, a serious metabolic deterioration after salbutamol might occur.
Is the Relaxing Effect of β‐Adrenergic Agonists on the Human Myometrium only Transitory?
Authors: Rydén Gunnar , Andersson Rolf G. G. , Berg Göran
Published: December 2009

Abstract. The β‐adrenergic receptor function in myometrial strips taken from pregnant women at cesarean section was studied. The material consisted of myometrial strips from 10 patients treated with terbutaline for threatening premature parturition and an untreated control group of 10 patients. The basal cAMP levels were lower and the cAMP production after receptor stimulation in vitro was less in myometrial strips taken from terbutaline‐treated women than in the untreated control group. The phosphodiesterase activity was greater in myometrial strips taken from terbutaline‐treated women, indicating a faster rate of degradation of cAMP in these women. Studies on the β‐adrenergic receptor function in leukocytes from venous blood Samples during treatment with terbutaline for preterm labor demonstrated a gradual decline in receptor function, as shown by a successive reduction in cAMP production after stimulation with a β‐adrenergic agonist in vitro. The results presented may explain the merely temporary inhibitory effect on uterine contractions often obtained during treatment with β‐mimetics. It is suggested that intermittent usage or combined treatment with drugs inhibiting phosphodiesterase activity might improve the results in the treatment and prevention of premature birth.
Development of Tolerance to the Metabolic Actions of β2‐Adrenoceptor Stimulating Drugs
Authors: Fredholm Bertil B. , Lunell Nils‐Olov , Persson Bengt , Wager Jan
Published: December 2009

Abstract. Considerable evidence exists that treatment with β‐receptor stimulating drugs causes desensitization in several different tissues in vitro. There is also evidence that the administration of β‐receptor stimulating drugs during asthma therapy leads to the development of tolerance of at least some actions of β‐stimulating drugs.

The present communication presents data from experiments in animals, including humans, suggesting that treatment with an oral salbutamol leads to the development of tolerance of metabolic actions of β‐adrenergic stimulating drugs. Rats given salbutamol, 20 mg/kg/day, showed a decreased lipolytic response to salbutamol and to noradrenaline. By contrast, rats subjected to adrenal demedullation showed an increased lipolytic response. These results suggested that β2‐adrenoceptor‐stimulating drugs may cause desensitization and also that the normal circulating levels of catecholamines may be sufficient to regulate the responsiveness of the adipose tissue.

The effect of a single oral dose of salbutamol was compared in 10 women not previously given salbutamol and in 13 women treated with oral salbutamol in a dose of 4 mg 4 times/day for 12–33 days preceding study. The salbutamol‐induced increase in the levels of insulin, C‐peptide, glucose, and glycerol were significantly reduced in those exposed to salbutamol before the test. The rise in cyclic AMP and non‐esterified fatty acids was not significantly affected. There were also differences in the salbutamol‐induced fall in diastolic blood pressure and in heart rate. These differences in cardiovascular responsiveness could be accounted for by a difference in the values of these parameters before the test.

Our results suggest that women receiving 16 mg/day of salbutamol, i.e. a normal clinical dose of the drug sufficient to achieve relaxation of the uterus, develop tolerance to some metabolic side effects. This, and the development of tolerance to the tremorogenic effect of β‐adrenoceptor‐stimulating drugs, may be clinically advantageous, but the possibility exists that tolerance may develop also to some of the therapeutic actions. The literature concerning the development of tolerance to β2adrenoceptor‐stimulating drugs is briefly reviewed, and some possible explanations for what appears to be an organ‐selective development of tolerance is discussed.
Desogestrel, a New Progestational Compound
Authors: Cullberg Göran , Eriksson Olof , Knutsson Folke , Steffensen Kjeld
Published: December 2009

Abstract. A new progestational compound, desogestrel, was given orally to four otherwise healthy, ovariectomized volunteers who had first been treated for two cycles with ethinylestradiol and lynestrenol (given sequentially) and then primed with ethinylestradiol. The effects of decreasing doses of desogestrel (250 to 15 μg) in combination with 50 μg ethinylestradiol were compared with those of 1 mg lynestrenol plus 50 μg ethinylestradiol. Variables studied were basal body temperature, vaginal cytology (karyopyknotic index), cervical mucus (including Spinnbarkeit and ferning) and endometrial biopsies. In addition, body weight, blood pressure and selected biochemical variables were monitored.

No side effects attributable to the treatment were noted. Progestational effects were observed on all variables in volunteers with adequate priming. Basal body temperature rose in all volunteers on desogestrel at doses down to 60 μg to the same extent as those with I mg lynestrenol. The karyopyknotic index did not react to estrogen priming in 2 volunteers, and the results with the 2 other volunteers were inconclusive. Cervical mucus became thick and scanty with reduced Spinnbarkeit at doses of desogestrel down to 60 μg as well as with 1 mg lynestrenol. Crystallization of mucus (ferning) ceased at a dose of 30 pg desogestrel and endometrial biopsies showed marked secretion at doses of desogestrel down to 30 μg; 60 μg was considered to be equipotent to 1 mg lynestrenol. The ovariectomized woman with her uterus intact appears to be a good model for the initial testing of progestational compounds.
Scandinavian Trial of an Oral Contraceptive Containing 0.150 Mg Desogestrel and 0.030 Mg Ethinylestradiol
Authors: Borglinl Nils Erik , Christensen Ole J. E. , Cullberg Göran , Enger Lennart , Fjárestads Ingemar , Klottrup Paul , Odlind Viveca , Sandager Torben , Secher Kirsten , Assendorp Roel
Published: December 2009

Abstract. The clinical efficacy of an oral contraceptive containing 0.150 mg desogestrel+0.030 mg ethinylestradiol was studied by nine Scandinavian investigators in a total of 198 women and 2055 cycles. The preparation was found to be highly effective, and a low incidence of minor adverse side effects was reported. The incidence of spotting and breakthrough bleeding, though initially rather high, decreased over the first six cycles, and coincided with a high incidence of missed tablets. No serious side effects occurred, and there were few withdrawals because of complaints suspected of being attributable to the preparation.
Routine Liver Function Testing During Long Term Administration of the Oral Contraceptive Preparation 0.150 Mg Desogestrel Plus 0.030 Mg Ethinylestradiol to Healthy Female Volunteers in Scandinavia
Authors: Odlind Viveca , Borglin Nils Erik , Christensen Ole J. E. , Cullberg Göran , Enger Lennart , Fjárestad Ingemar , Klottrup Paul , Sandager Torben , Secher Kirsten
Published: December 2009

Abstract. During administration of an oral contraceptive pill containing 0.150 mg desogestrel and 0.030 mg ethinyles‐tradiol, routine liver function tests were performed before and after 3, 6, and 12 months of treatment. No significant changes in serum amino aspartate transferase or serum alanine amino transferase were recorded during treatment. The serum alkaline phosphatase level decreased significantly after 3 and 6 months and then returned to normal. No changes in serum bilirubin were found. Briefly, no significant changes in the liver function tests were found, indicating no impairment of the liver function throughout the medication period.
Low Dose Rhesus Immunoprophylaxis after Early Induced Abortions
Authors: Gjøde P. , Moulvad I. , Hansen J. Trier , Jørgensen J.
Published: December 2009

Abstract. A dose of 50 μg anti‐D immunoglobulin was administered as rhesus immunoprophylaxis following induced abortion performed by suction curettage before the thirteenth week of pregnancy in 463 consecutive patients. A feto‐maternal blood loss of less than 2 ml was detected in 44 women (12%). After 6 months, a follow‐up of 381 patients (82%) established that none of these patients was rhesus immunized with in vitro demonstrable antibodies. It is concluded that the low dose of anti‐D administered is to be recommended for rhesus immunoprophylaxis after first trimester abortion.
Pain Relief in Labor by Transcutaneous Electrical Nerve Stimulation
Authors: Bundsen Peter , Ericson Klas , Peterson Lars‐Erik , Thiringer Klara
Published: December 2009

Abstract. In this prospective randomized study of pain relief in labor, the effect of transcutaneous electrical nerve stimulation (TNS) performed over both the low‐back and suprapubic region was evaluated and compared with a control group not receiving TNS. Both high frequency and pulse train TNS were used. The study included 24 induced labors. In the TNS group, conventional methods were added when needed, while in the control group only conventional methods were used. Assessment of low‐back and suprapubic pain was performed by the parturient each hour during the first stage. In the TNS group most of the parturients reported minimal or moderate low‐back pain throughout labor, while parturients in the control group reported an increased intensity of low‐back pain as labor progressed. The effect on suprapubic pain was insignificant in both groups. Neither TNS nor nitrous oxide‐oxygen mixture and pethidine could reduce this pain component. Course of labor, uterine activity and fetal heart patterns were similar in the two groups. The neonates were evaluated with Apgar score, assays of blood samples from the umbilical vein including blood lactate, plasma hypoxanthine and blood gas, and neurobehavioral assessment on two occasions. All newborn infants were in good condition and no significant differences between the two groups could be demonstrated.
Reproductive Performance of Women with Uterine Anomalies
Authors: Heinonen Pentti K. , Saarikoski Seppo , Pystynen Paavo
Published: December 2009

Abstract. A total of 182 women with uterine anomalies were observed over a period of 18 years. In all, 126 women had 265 pregnancies, fetal survival rate was 66%, perinatal mortality 8% and premature labors occurred in 23%. When the uterine anomalies were grouped according to degree of failure of normal uterine development, the complete septate uteri had the best fetal survival rate (86%), complete bicornuate uteri (50%) and unicornuate (40%) poorest. Cervical cerclage was applied most in the partial bicornuate uteri (17%), where fetal survival in operated cases was: before operation, 53% and after, 100%. The frequency of breech presentation was 40–50% in all groups except complete septate uteri (25%) and complete bicornuate (0%). The highest cesarean section rate (82%) was in deliveries of patients with uterus didelphys. The frequency of cesarean section among total deliveries was 53%. Metroplasty was carried out on 19 patients. The obstetric outcome improved from 10% successful pregnancies before surgery to 88% postoperatively.
Massive Hyperstimulation and Borderline Carcinoma of the Ovary
Authors: Atlas M. , Menczer J.
Published: December 2009

Abstract. A patient with persistent ovarian cysts subsequent to clomiphene‐induced severe hyperstimulation was found to have borderline ovarian carcinoma. Since several endocrine and epidemiological studies implicate hormonal factors in the genesis of ovarian tumors, a possible association between ovarian hyperstimulation and neoplasia is suggested.
Peroperative Electrocoagulation of Endocervical Mucosa and Later Carcinoma of the Cervical Stump
Authors: Kilkku Pentti , Grönroos Matti
Published: December 2009

Abstract. The incidence of carcinoma of the cervical stump is, according to literature, 0.3—1.9%. During the years 1952–78, 2712 subtotal hysterectomies for benign conditions were performed in the Department of Obstetrics and Gynecology in Turku. During the operation the endocervical mucosa was electrocoagulated before closing the stump. Of these patients, 3 have since developed carcinoma of the cervical stump; thus the incidence in our material is 0.11%. It has been supposed that subtotal hysterectomy might have certain benefits in some cases. If so, and in view of the cancer risk being so low in our material, we feel that subtotal hysterectomy is still an applicable method.
Pelvic Inflammatory Pseudotumor (Xanthogranuloma)
Authors: Shalev E. , Zuckerman H. , Rizescu I.
Published: December 2009

Abstract. A case is presented of a patient with xanthogranulomatous pseudotumor in the pelvic region. The pseudotumor was probably the result of inflammatory reaction in both tubes and in the uterine cavity, with pyometra. The condition is very rare and only 5 cases could be found in the literature.
Treatment of Vaginal Candidosis with Natamycin and Effect of Treating the partner at the same time
Authors: Buch Annette , Christensen Else Skytte
Published: December 2009

Abstract. Thirty‐three patients with vaginal candidosis were treated with natamycin vaginal tablets for 10 days and their partners were treated double‐blind with natamycin cream/ placebo cream. Follow‐up examinations were carried out one week after the treatment was discontinued and again about one month later. The cure rate in patients having actively treated partners was 94%, not differing significantly from the cure rate of 88% in patients whose partners had been treated with placebo. One month after the treatment there was a high recurrence/re‐infection rate, about 30% in both groups. Thus, treating the partners of patients with vaginal candidosis has no influence upon the therapeutic outcome or recurrence rate. The recurrence is presumably due to re‐infection from the patient herself.
Hilus cells from human postmenopausal ovaries: Gonadotrophin sensitivity, steroid and cyclic amp production
Authors: Dennefors B. L. , Janson P. O. , Hamberger L. , Knutsson F.
Published: December 2009

Abstract. Strips of ovarian hilar tissue taken from 11 post‐menopausal women were examined histologically and found to contain clusters of hilus cells in contiguity with non‐mye‐linated nerve fibers. No other steroidogenically active structures were found. Specimens from these strips were incubated for 30 and 240 minutes in Krebs bicarbonate buffer containing 5.5 mM glucose and 1% bovine serum albumin. The specimens produced measureable amounts of androstene‐dione, estradiol‐17β and progesterone in vitro. The major steroid formed was androstenedione, and this pattern of steroidogenesis appeared similar to that of postmenopausal ovarian stroma. However, the amounts of steroids formed were considerably higher than in stromal tissue. This implies that the hilus cells possibly may be of greater importance, qualitatively, than the stroma cells for steroidogenesis in the postmenopausal ovary.

Addition of hCG to the incubated specimens elicited increase in both cyclic AMP formation and steroid synthesis, especially of estradiol‐17β, indicating a preserved responsiveness to gonadotrophin in hilus cells from postmeno‐pasual ovaries.
Outcome of Pregnancy After Conization
Authors: Larsson Göran , Grundsell Hans , Gullberg Bo , Svennerud Sven
Published: December 2009

Abstract. The outcome of 635 pregnancies in 197 women before and after conization is reported. After conization a significant increase in premature deliveries occurred in young women (age 21‐25), nulliparae representing the highest risk. The rate of premature deliveries in this age group was 4.4% before conization and 30.6% after conization. No such increase could be found in any other age group.

Labor was notably short in non‐parous women and in parous women it started with rupture of the membranes significantly more often after conization. In addition, a significant increase in the frequency of cervical stenosis was observed, but this was of clinical significance in only one case.

Treatment in the form of prophylactic cerclage did not reduce the incidence of either premature delivery or of late spontaneous abortion.
Technical Difficulties in Fetal Skin Sampling
Authors: Löfberg Lars , Gustavii Björn
Published: December 2009

Abstract. Attempts were made to obtain skin biopsies from the fetuses of 18 women in the 16th to 21st week of gestation. In four of them the purpose was prenatal diagnosis because of the risk that the fetus might be affected with a severe skin disorder; the remaining women were to undergo elective abortion by hysterotomy. In the first 13 cases the conventional “blind” biopsy procedure was used. Of 71 biopsy specimens obtained with this technique, only one out of every three consisted of skin; the remainder comprised fetal membranes, myometrium, or trophoblast. In one of the diagnostic cases where the “blind” procedure was used, inadvertent removal of tissue specimens from the amniotic sac was probably responsible for the intermittent leakage of amniotic fluid that occurred in this woman from the 26th week of gestation and for the premature delivery in the 33rd week. In the remaining five women (including one for diagnosis), a two‐cannula procedure was employed (one cannula for the optic instrument and the other for the biopsy forceps), permitting biopsy of the skin under direct vision. All the biopsy specimens taken by this method consisted of skin.
Malignant Cervical Teratoma of the Fetus
Authors: Shoenfeld A. , Ovadia J. , Edelstein T. , Liban E.
Published: December 2009

Abstract. Cervical teratomas have been defined and one new case is now added to the 116 cases previously reported. We have been able to find only six reports of malignant teratoma in the literature so far. The problems of diagnosis and obstetrtic management are discussed briefly. The incidence of appearance of the tumor is described and the likelihood of hydramnios or of acute obstructive symptoms of the trachea and esophagus at birth ar discussed. The differential diagnosis includes cystic hygroma, congenital goitre, bronchial cyst, lymphangioma, neuroblastoma, parotid tumor and carcinoma of the thyroid.

The object of this review is to present a synoptic description of these tumors, their clinical manifestations, management, treatment and prognosis, so that it may afford the attending obstetrician a guideline in understanding this rare entity.