bluuebunny/crossref_metadata_2025 huggingface dataset:
Volumetric brain imaging findings in mood disorders
Authors: Beyer John L , Krishnan K Ranga R
Published: March 2003

Volumetric neuroimaging is increasingly being used by researchers of affective disorders to assess potential involvement of different brain structures in mood regulation and to test neuroanatomic models of mood disorders. In unipolar depression, findings suggest abnormalities in the frontal lobe (particularly the subgenual prefrontal cortex), basal ganglia (particularly the caudate and putamen), cerebellum, and hippocampus/amygdala complex. In bipolar disorder, abnormalities in the third ventricle, frontal lobe, cerebellum, and possibly the temporal lobe are noted. We review the findings for the various regions of the brain, and discuss the implications on the understanding of mood disorders. Directions for future research in volumetric imaging is then discussed.
Volumetric MRI studies of mood disorders: do they distinguish unipolar and bipolar disorder?
Authors: Strakowski Stephen M , Adler Caleb M , DelBello Melissa P
Published: March 2003

The authors reviewed magnetic resonance imaging volumetric imaging results in major mood disorders, particularly comparing similarities and differences from studies of bipolar disorder and unipolar major depression. Abnormalities of cerebral brain regions appear inconsistently in mood disorders and, when present, typically consist of decreased frontal or prefrontal cortical volumes in both unipolar depression and bipolar disorder. In contrast, subcortical and medial temporal abnormalities are more commonly observed and are different between these two major classes of affective illness. Specifically, whereas structural enlargement of the basal ganglia and amygdala have been observed in bipolar disorder, in unipolar depression, these structures appear to be smaller in patients than healthy subjects. These findings suggest that affective illnesses may share in common an underdeveloped or atrophied prefrontal region, leading to loss of cortical modulation of limbic emotional networks. The effect of this loss results in unipolar depression or cycling (mania with depression) depending on the abnormalities of the subcortical structures involved. The cerebellum may also play a role in the presentation of mood disorders. This hypothesis remains speculative as much more research is needed to specifically examine how morphometric brain abnormalities translate into the neurophysiologic deficits that produce mood disorders.
Design and implementation of a randomized trial evaluating systematic care for bipolar disorder
Authors: Simon Gregory E , Ludman Evette , Unützer Jürgen , Bauer Mark S
Published: March 2003

Objectives:
Everyday care of bipolar disorder typically falls short of evidence‐based practice. This report describes the design and implementation of a randomized trial evaluating a systematic program to improve quality and continuity of care for bipolar disorder.

Methods:
Computerized records of a large health plan were used to identify all patients treated for bipolar disorder. Following a baseline diagnostic assessment, eligible and consenting patients were randomly assigned to either continued usual care or a multifaceted intervention program including: development of a collaborative treatment plan, monthly telephone monitoring by a dedicated nurse care manager, feedback of monitoring results and algorithm‐based medication recommendations to treating mental health providers, as‐needed outreach and care coordination, and a structured psychoeducational group program (the Life Goals Program by Bauer and McBride) delivered by the nurse care manager. Blinded assessments of clinical outcomes, functional outcomes, and treatment process were conducted every 3 months for 24 months.

Results:
A total of 441 patients (64% of those eligible) consented to participate and 43% of enrolled patients met criteria for current major depressive episode, manic episode, or hypomanic episode. An additional 39% reported significant subthreshold symptoms, and 18% reported minimal or no current mood symptoms. Of patients assigned to the intervention program, 94% participated in telephone monitoring and 70% attended at least one group session.

Conclusions:
In a population‐based sample of patients treated for bipolar disorder, approximately two‐thirds agreed to participate in a randomized trial comparing alternative treatment strategies. Nearly all patients accepted regular telephone monitoring and over two‐thirds joined a structured group program. Future reports will describe clinical effectiveness and cost‐effectiveness of the intervention program compared with usual care.
Quetiapine in the treatment of rapid cycling bipolar disorder
Authors: Vieta Eduard , Parramon Gemma , Padrell Elena , Nieto Evaristo , Martinez‐Arán Anabel , Corbella Barbara , Colom Francesc , Reinares Maria , Goikolea Jose M , Torrent Carla
Published: March 2003

Vieta E, Parramon G, Padrell E, Nieto E, Martinez‐Arán A, Corbella B, Colom F, Reinares M, Goikolea JM, Torrent C. Quetiapine in the treatment of rapid cycling bipolar disorder. Bipolar Disord 2002: 4: 335–340. © Blackwell Munksgaard, 2002

Introduction:
 This prospective open‐label study assessed the impact of add‐on quetiapine in the treatment of rapid cycling bipolar patients.

Methods:
 Fourteen rapid cycling bipolar patients were treated with quetiapine, which was added to their ongoing medication regimen for 112 ± 33 days. At the beginning of the study, five were manic, three were in a mixed state, three were depressed, two hypomanic and one was euthymic. Patients were assessed prospectively with a modified version of the Clinical Global Impression Scale for Bipolars (CGI‐BP), the Young Scale for mania (YMRS) and the Hamilton Scale for Depression (HDRS).

Results:
 A significant reduction of the following scale scores was observed:

• a 1.8 point reduction for the general CGI‐BP (p=0.013),

• a –1.3 point for the mania subscale (p=0.016),

• a –1.01 point for the YMRS (p=0.025).

Improvement in depressive symptoms was not significant, neither in the CGI‐BP (–1 point, p=0.074) nor in the HDRS (–5.2 points, p=NS). The most common side‐effect was sedation (n=6, 43%). Doses of quetiapine were significantly reduced by the end of the study (443 ± 235 mg/day versus 268 ± 190 mg/day, p=0.008) and they also differed according to the initial episode to be treated (720 ± 84 mg/day for mania, and 183 ± 29 mg/day for depression, p=0.023).

Conclusions:
 Quetiapine could possibly be an effective treatment for rapid cycling bipolar patients. Adequate doses for acute episodes could significantly differ according to the episode polarity and the length of treatment.
Myo‐inositol‐1‐phosphate (MIP) synthase: a possible new target for antibipolar drugs
Authors: Agam Galila , Shamir Alon , Shaltiel Galit , Greenberg Miriam L.
Published: March 2003

Agam G, Shamir A, Shaltiel G, Greenberg ML. Myo‐inositol‐1‐phosphate (MIP) synthase: a possible new target for antibipolar drugs.  Bipolar Disord 2002: 4(Suppl. 1): 15–20. © Blackwell Munksgaard, 2002

Inositol metabolism is well characterized in yeast at a molecular level, and yeast is the only eukaryote in which genetic, molecular and functional genomic approaches to identify lithium, valproate and inositol targets may be combined readily. It has been shown that lithium inhibits yeast inositol monophosphatase (encoded by INM1 and INM2), and both valproate and lithium reduce intracellularinositol. Unlike lithium, valproate causes a decrease in intracellular inositol‐1‐phosphate as well, suggesting that myo‐inositol‐1‐P (MIP) synthase is a site of valproate action in the yeast PI cycle. MIP synthase is the rate‐limiting step in inositol biosynthesis and is highly regulated in response to inositol. Yeast genes that are affected by both lithium and valproate in the phosphoinositide pathways (INO1 increased over 10‐fold, INO2 increased twofold and INM1 decreased about twofold) have been identified. It has also been reported previously that both lithium and inositol mildly up‐regulate IMPA1 (encoding mammalian inositol monophosphatase) expression in human cells. These findings indicate that IMPA is regulated only mildly by lithium, and therefore may not be the major target in the inositol pathway. Given the substantial evidence for the role of inositol in the mechanism of action of lithium and valproate,the opposing and mild effects of lithium on the genes encoding inositol monophosphatase in yeast and human cells, but the powerful effect of lithium and valproate on INO1 in yeast, it is hypothesized that human hINO1 is a factor in the psychopharmacology of mood stabilizers.
Gene expression in bipolar disorder and schizophrenia: new approaches to old problems
Authors: Bahn Sabine
Published: March 2003

Bahn S. Gene expression in bipolar disorder and schizophrenia: new approaches to old problems.  Bipolar Disord 2002: 4(Suppl. 1): 70–72. © Blackwell Munksgaard, 2002
Thyroid hormone augmentation with levothyroxine in bipolar depression
Authors: Bauer Michael
Published: March 2003

Bauer M. Thyroid hormone augmentation with levothyroxine in bipolar depression. Bipolar Disord 2002: 4(Suppl. 1): 109–110. © Blackwell Munksgaard, 2002
Obesity is a risk factor for early pregnancy loss after IVF or ICSI
Authors: FEDORCSÁK PÉTER , STORENG RITSA , DALE PER OLAV , TANBO TOM , ÅBYHOLM THOMAS
Published: March 2003

Background. Experience with polycystic ovary syndrome shows that insulin resistance is related to early pregnancy loss. This association was examined by comparing pregnancy outcome in obese and lean women.

Methods. A cohort of 383 patients conceiving after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) was studied. Ovarian stimulation was achieved by GnRHa and FSH or hMG (n=362), by FSH or hMG alone (n=16), or by clomiphene citrate and FSH or hMG (n=5). Luteal phase was supported with progesterone. Pregnancies were defined by >10 IU/l plasma ß‐hCG on day 14. Ultrasound scan on week 6 and week 12 confirmed fetal viability.

Results. Lean group (body mass index [BMI]<25 kg/m2; n=304) and obese group (BMI ≥25 kg/m2; n=79) were established. Obese patients had fewer oocytes collected (median: 8 vs 10 p=0.03), they had higher abortion rate during the first 6 weeks (22% vs 12%; p=0.03) and lower live‐birth rate (63% vs 75%; p=0.04). The relative risk of abortion before week 6 was 1.77 (95% CI: 1.05 to 2.97). Multivariate logistic regression analysis revealed that obesity and low oocyte count were independently associated with spontaneous abortion. In the obese group, low oocyte number was associated with a more profound increase in the risk of abortion than among lean patients. The effect of age, history of past pregnancies, or infertility diagnosis on the probability of miscarriage were not significant.

Conclusions. Obesity is an independent risk factor for early pregnancy loss. This risk is, in part, related to the lower number of collected oocytes in obese women.
Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps
Authors: KAMEL HASSAN S. , DARWISH ATEF M. , ABDEL‐RADY MOHAMED SAFWAT
Published: March 2003

Background. The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared.

Methods. One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy.

Results. Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001).

Conclusions. Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill.
Umbilical cord knots
Authors: SØRNES TORGRIM
Published: March 2003

Background. Umbilical cord knots may represent a hazard to the fetus, particularly as regards intrauterine death and fetal distress or asphyxia in labor. The object of this study was to analyze the impact of associated umbilical cord encirclements and cord length on fetal outcome and fetal weight deviation.

Methods. Among 22,012 births occurring in Akershus Central Hospital, there were 216 instances of umbilical cord knots. Fetal outcome, fetal weight deviation, associated umbilical cord encirclements and cord length were assessed.

Results. Neonates with a knotted cord are more often large‐for‐gestational age compared to other babies, and have longer umbilical cords. There is a 10 times higher chance of intrauterine fetal death with a knotted cord, but if this does not occur then there is no increased risk of obstetrical intervention and Apgar scores are the same as in other babies and other fetuses.

Conclusion. There is an association between umbilical cord knots and umbilical cord encirclements. Knotting of the cord is not by itself lethal. Pregnancies with knotted cords have characteristics different from those with ordinary umbilical cord encirclements.
Fetal oxygen saturation during epidural and paracervical analgesia
Authors: KAITA TANJA MARJUT , NIKKOLA EEVA MARIA , RANTALA MIKA ILARI , EKBLAD URPU ULLA , SALONEN MARKKU ARVI OLAVI
Published: March 2003

Background. We wanted to assess changes in fetal oxygenation during maternal epidural or paracervical analgesia in labor.

Methods. A prospective, open and non‐randomized study. Twenty healthy parturients were enrolled before they asked for pain relief. Informed consent was obtained. Fetal and maternal oxygen saturations were measured before and up to 1 h after the initiation of analgesia. Fetal oximetry was performed with the Nellcor N‐400 oximeter+FS‐14B fetal oxygen sensor (Nellcor Puritan Bennett, Pleasanton, California, USA). Maternal oximetry was done with Datex Satlite portable monitor (Datex, Finland). Visual analog scale was used for assessing pain relief. Two‐way analysis of variance and students t‐test were used for statistical analyses.

Results. Fetal oxygenation initially improved in both groups. The saturation then returned to baseline in both groups. In the epidural group, the values remained at baseline or slightly below, while in the paracervical group the saturation remained a little higher than baseline (p=0.009). No change was seen in maternal oxygenation or heart rate. No change in fetal heart rate was found either. Epidural block was superior to paracervical block with respect to pain relief (p=0.002).

Conclusions. There was a small but significant difference in fetal oxygenation between epidural and paracervical groups during the observation period. The magnitude of the difference is hardly clinically significant. A larger, randomized study is needed to elucidate the mechanisms behind this finding.
Diabetic retinopathy in pregnancy during tight metabolic control
Authors: LAUSZUS FINN , KLEBE JOACHIM G. , BEK TOKE
Published: March 2003

Background. The relation between retinopathy and the parameters: 24‐h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin‐dependent diabetes mellitus on tight metabolic control during pregnancy.

Methods. Prospective study of 112 pregnant women with insulin‐dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Århus University Hospital. Changes in retinopathy were related to 24‐h blood pressure, blood glucose, albuminuria, and adverse perinatal outcome.

Results. There was an association between grade of retinopathy and HbA1c before (Spearman's rho=0.49, p<0.04) and after pregnancy (Spearman's rho=0.42, p<0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14±8 years, range 1–27) than those women with improvement or no progression of retinopathy (19±8 years, range 1–36, p<0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied.

Conclusions. Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.
Pregnancy complications and delivery practice in women with connective tissue disease and inflammatory rheumatic disease in Norway
Authors: SKOMSVOLL JOHAN FREDRIK , ØSTENSEN MONIKA , IRGENS LORENTZ M. , BASTE VALBORG
Published: March 2003

Objective. To assess possible associations between inflammatory rheumatic disease and pregnancy complications/delivery practice.

Methods. In a population based study proportions were compared of obstetrical complications and interventions at delivery notified to the Medical Birth Registry of Norway during the years 1967–95 in women with (3,403) and without (671,221) rheumatic disease.

Results. Women with rheumatic disease had significantly higher rates of preeclampsia and cesarean section. The relative risk of preeclampsia was particularly high in women with connective tissue disease in the years 1977–86. In women with inflammatory arthritides, the relative risk of preeclampsia was particularly high during 1987–95. The relative risk of cesarean section was high in all patient groups throughout the observation period and particularly in women with connective tissue disease.

Conclusion. High rates of preeclampsia and cesarean section in connective tissue disease pregnancies documented in a population based study emphasize the importance of monitoring and obstetrical interventions.
Erythrocyte zinc protoporphyrin testing in pregnancy
Authors: HARTHOORN‐LASTHUIZEN ELSE J. , LINDEMANS JAN , LANGENHUIJSEN MART M. A. C.
Published: March 2003

Background. To compare the usefulness of serum ferritin, hemoglobin and erythrocyte zinc protoporphyrin estimations as indicators of the need of iron supplementation in pregnancy.

Methods. In 97 healthy pregnant women serum ferritin, hemoglobin and erythrocyte zinc protoporphyrin concentrations were measured at each trimester period. Iron supplementation was prescribed at hemoglobin values below 113 g/L.

Results. Neither in the first nor in the second trimester differences in serum ferritin and erythrocyte zinc protoporphyrin values have been found between women who got iron therapy prescribed and women who did not get iron therapy, whereas already in the first trimester hemoglobin values were lower in the group that got iron therapy. These results indicate that hemodilution rather than iron deficiency determined which women got iron therapy. In the third trimester 14 out of 80 women without iron supplementation had depleted iron stores and a significant erythrocyte zinc protoporphyrin increase, indicating evolving iron deficiency anemia. However, only five of them showed hemoglobin levels below 113 g/L and got iron therapy. Low serum ferritin levels were found in 23% of the women at booking and in 92% in the third trimester. Serum ferritin levels neither predicted the development of iron deficient erythropoiesis nor of anemia.

Conclusions. Iron deficiency can neither be diagnosed nor predicted by serum ferritin or hemoglobin measurements at booking or later on in pregnancy. Erythrocyte zinc protoporphyrin measurements can be of help in determining which women have iron deficient erythropoiesis and may benefit by iron therapy.
Sex hormone‐binding globulin in gestational diabetes
Authors: BARTHA JOSE L. , COMINO‐DELGADO RAFAEL , ROMERO‐CARMONA RAQUEL , DEL CARMEN GOMEZ‐JAEN MARIA
Published: March 2003

Background. Insulin is an important regulator of serum sex hormone‐binding globulin ( SHBG) concentration which works by inhibiting its production in hepatocytes. Low SHBG level is associated with increased insulin resistance and hyperinsulinemia. Our purpose was to compare maternal serum SHBG level between normal and gestational diabetic pregnant women and to study the relationships between SHBG, SHBG/insulin and SHBG/glucose ratio and several endocrine, metabolic and clinical parameters.

Methods. Serum SHBG concentrations were measured in 34 women with gestational diabetes and in 32 matched controls. Glucose, insulin, C‐peptide, fructosamine, β‐ HCG, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, total and free T4, total and free estriol, T3 and IGF‐1 were measured. Insulin sensitivity was estimated using the short insulin tolerance test.

Results. SHBG,
SHBG/insulinemia ratio and
SHBG/glucose ratio were significantly lower in the diabetic group (309.54±112.22 vs 460.54±144.54, p=0.00001), (33.55±16.62 vs 72.56±66.50, p=0.0006 using log‐transformed values), (5.88±1.87 vs 3.39±1.23, p<0.00001).
SHBG was negatively correlated with insulinemia (r=−0.40, p=0.001), C‐peptide (r=−0.41, p=0.001), glycemia (r=−0.27, p=0.02), diastolic blood pressure (r=−0.41, p=0.001) and β‐
HCG (r=−0.41, p=0.001) and positively correlated with LDL‐c (r=0.25, p=0.04) and apolipoprotein B (r=0.33, p=0.007).

Conclusions. SHBG concentrations are lower in gestational diabetic pregnant women and are related to insulin levels but not to peripheral insulin sensitivity. Since insulinemia was similar in normal and gestational diabetic pregnant women, we speculate that gestational diabetes is characterized by a higher peripheral insulin resistance, a fasting normal insulinemia and a higher hepatic insulin sensitivity, at least in other actions than on carbohydrate metabolism. The role of sex steroids, T4 and IGF‐1 in regulating SHBG appears to be limited during pregnancy.
Effects of prandial glycemic changes on objective fetal heart rate parameters
Authors: SERRA‐SERRA VICENTE , CAMARA ROSA , SARRIÓN PASCUALA , JAREÑO MILAGROS , CERVERA JESÚS , BELLVER JOSÉ , PERALES ALFREDO
Published: March 2003

Background. There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation.

Methods. Study design: prospective clinical descriptive study. Subjects: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non‐diabetic pregnant volunteers (control group). Treatment: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre‐ and 1 h post‐meal. Statistical analysis: descriptive statistics, Student t‐tests and Pearson correlation studies.

Results. Maternal capillary glucose levels ranged between 2.7–10.5 mmol/l pre‐meal and 4.2–14.8 mmol/l post‐meal. The differences between objective FHR parameters pre‐ and post‐meal were not significant in any of the groups of women studied. No correlation was found between prandial glycemic and FHR changes. Women with optimal and suboptimal glycemic control exhibited similar objective FHR parameters pre‐ and post‐meal. Women with gestational diabetes showed similar prandial cardiotocographic changes irrespective of whether they were on insulin therapy or on hypoglycemic diet only.

Conclusions. Objective FHR parameters are unaffected by prandial glycemic changes over a wide range of maternal glucose levels. Timing the non‐stress test in relation to the meals seems irrelevant in clinical practice.
Relationships between serum leptin level and regional bone mineral density, bone metabolic markers in healthy women
Authors: IWAMOTO ICHIRO , DOUCHI TSUTOMU , KOSHA SHOICHIRO , MURAKAMI MASATO , FUJINO TOSHINORI , NAGATA YUKIHIRO
Published: March 2003

Background. Leptin might affect bone metabolism. This study was performed to investigate the relationship of leptin to bone metabolism in detail in premenopausal and postmenopausal healthy women.

Methods. The relationships between serum leptin level and bone mineral density of several regional sites of the body as well as whole body, along with bone metabolic markers, were examined in 47 premenopausal and 29 postmenopausal healthy women.

Results. Serum leptin level was weakly correlated with bone mineral density of pelvis (Pearson's correlation coefficient r=0.39, p<0.05) and left leg (r=0.41, p<0.01) in the premenopausal women, although the correlation decreased after adjustment for
BMI. There was no significant relationship between serum leptin level and whole body bone mineral density both in the premenopausal and postmenopausal women. Serum leptin level was correlated with serum alkaline phosphatase (r=0.56, p<0.001) and urinary deoxypyridinoline/cr (r=−0.32, p<0.05) by Pearson's correlation test in the premenopausal women; the relationships were maintained even after adjustment for BMI (r=0.50 and −0.48, respectively).

Conclusions. Leptin is not a key regulator of bone metabolism, although it may have some effects on bone metabolic markers and BMD regionally in premenopausal women.
Transvaginal color Doppler study of uterine blood flow in primary dysmenorrhea
Authors: DMITROVIĆ ROMANA
Published: March 2003

Background. The pain in primary dysmenorrhea is caused by excessive prostaglandin production that leads to vasoconstriction and uterine ischemia. Changes in uterine blood flow are important factors in pathophysiology of primary dysmenorrhea. The aim of the study was to determine if vasoconstriction of the uterine vessels in patients with primary dysmenorrhea is detectable by transvaginal color Doppler ultrasound.

Methods. Forty‐two women with primary dysmenorrhea and fifty healthy controls were included in this prospective study. Women were examined with transvaginal color Doppler ultrasound on first day of the cycle, once in the follicular and once in the luteal phase. Measurements of pulsatility index in uterine, arcuate, radial and spiral arteries were performed. Student's t‐test was used to establish statistical significance between groups.

Results. Women in dysmenorrhea group had significantly higher uterine blood flow indices than healthy controls in all three measurements periods. This includes all vessels studied on the first day of the cycle, the radial and spiral arteries during the follicular phase and the arcuate, radial and spiral arteries during the luteal phase.

Conclusions. We found that women with primary dysmenorrhea have elevated Doppler indices in uterine arteries not only on first day of the cycle but throughout the whole cycle. Therefore we postulated that primary dysmenorrhea is not only the disorder of menstruation but also a disease of a menstrual cycle as a whole.
Long‐term follow‐up of 246 hyperprolactinemic patients
Authors: Touraine Philippe , Plu‐Bureau Geneviève , Beji Claudine , Mauvais‐Jarvis Pierre , Kuttenn Frédérique
Published: March 2003

Background. We wanted to evaluate the very long‐term effects of bromocriptine on prolactin (PRL) levels and pituitary tumor size in a large cohort of hyperprolactinemic patients.

Methods. We conducted a retrospective cohort study in the Department of Endocrinology from Necker Hospital in Paris, France. Two hundred and forty‐six patients consulted primarily for menstrual disorders, with diagnosis of hyperprolactinemia. Patients were followed‐up for 99.9±3.6 months. One hundred and ninety‐one were treated with bromocriptine, 32 underwent surgery, and 23 received no treatment.

Results. The mean initial plasma PRL level was 135.0±20.2 ng/ml. Presence of an adenoma was detected in 60% of our patients and comprised a microadenoma in 64% of cases. Compared to oligomenorrheic women, amenorrheic patients had significantly higher levels of PRL and larger pituitary tumor size. In the bromocriptine group, PRL levels decreased from 99.6±7.9 to 20.0±1.5 ng/ml (p=0.00001). The medical treatment was associated with disappearance of the adenoma in 45% of the women and with stabilization of pituitary tumor size in 40% of patients. Surgery led to disappearance of the adenoma in almost all cases, but failed to definitively cure hyperprolactinemia.

Conclusion. In this large‐scale retrospective study, the medical treatment of mild hyperprolactinemia was shown to be effective and sufficient after 9 years of follow‐up.
A randomized, controlled trial comparing effect of oral misoprostol and intravenous syntocinon on intra‐operative blood loss during cesarean section
Authors: Acharya Ganesh , Al‐Sammarai Mohammad Tawfiq , Patel Nilkanth , Al‐Habib Ansam , Kiserud Torvid
Published: March 2003

Background. Oxytocics are routinely used in an attempt to prevent excessive blood loss during cesarean section. Misoprostol, a potent uterotonic agent, has been reported to be useful in the prevention and treatment of postpartum hemorrhage by several investigators but its use during cesarean section has not been described. The objective of this study was to randomly compare the effectiveness of oral misoprostol with intravenous syntocinon on blood loss during elective cesarean sections under regional anesthesia.

Methods. Sixty pregnant women were randomized either to receive misoprostol 400 micrograms orally or syntocinon 10 IU intravenously during cesarean section. The primary outcome measure was intra‐operative blood loss as estimated by physicians, and by values of preoperative and postoperative hemoglobin concentration and hematocrit. Demographic characteristics of the subjects and outcomes were compared using χ‐square test for categorical and two‐sample t‐test for continuous data.

Results. Baseline characteristics in terms of age, body weight, parity, gestational age and indications for cesarean section were similar in both groups. The estimated blood loss was 545 ml (CI 476–614) in misoprostol group and 533 ml (CI 427–639) in syntocinon group (p=0.85). Differences in preoperative and postoperative hemoglobin and hematocrit values were also similar in both groups. Two women in the misoprostol group and three in the syntocinon group (p=0.64) required additional oxytocics. One patient in each group required blood transfusion. No serious side effects were noted in either group.

Conclusion. Oral misoprostol appears to be safe and as effective as intravenous syntocinon in reduction of intra‐operative blood loss during elective cesarean section under regional anesthesia and merits further investigation.
Comparison of cervical smears secured with different instruments
Authors: Valenzuela Pedro , Martinez Pilar , Santana Alicia , Garrido Nurin , Cano Ana , Arnanz Fuencisca
Published: March 2003

Background. In this presentation we have compared the results from cytologic samples obtained with the cervical brush and Ayre‘s wooden spatula, against samples obtained with Acellon Combi.

Methods. One thousand cervical smears were collected. This was a cross‐sectional study, where it was decided randomly to use cervical brush for sampling of the endocervix and Ayre‘s wooden spatula for exocervix or Acellon Combi for both.

Results. The combination of the cervical brush and the wooden spatula yielded an acceptable quantity of columnar cells in 71.6% of the cases, during both endocervical and exocervical sampling, while the Acellon Combi yielded an acceptable quantity in 61.7% of the cases (p<0.01). The combination of brush/spatula yielded an acceptable quantity of squamous cells from samples of endocervix and exocervix in 87.5% cases, while with the Acellon device amounted to 77.4% (p<0.001). Highly significant differences in the state of cellular preservation of samples from endocervix obtained with cervical brush technique were found upon comparison to Acellon group.

Conclusions. Henceforth, we believe that the use of the cervical brush and the Ayre wooden spatula increases the quantity and preservation of the cells retrieved during cervical smears compared to Acellon Combi.
Osteoclast‐like giant cells in leiomyomatous tumors of the uterus
Authors: Aru Antonio , Norup Peter , Bjerregaard Beth , Andreasson Benny , Horn Thomas
Published: March 2003

Osteoclast‐like giant cells (OLGC) in leiomyomatous tumors of the uterus are rarely seen, and their significance is unknown. We present a case of a large leiomyomatous tumor in which OLGC were found in only few sections showing leiomyosarcoma whereas the majority of sections revealed a leiomyoma. Though radically operated, the patient died a few months later with recurrent tumor in the pelvis and metastases to the lungs.
Association of polymorphism of methylene‐tetrahydro‐folate‐reductase with urinary albumin excretion rate in type 1 diabetes mellitus but not with preeclampsia, retinopathy, and preterm delivery
Authors: Lauszus Finn Friis , Grøn Poul Lange , Klebe Joachim G.
Published: March 2003

Aim. The genetic setting is a potential risk factor for dysfunction of vascular endothelial cells. The prevalence of polymorphism in the methylene‐tetrahydro‐folate‐reductase (MTHFR) gene (677C→T) was evaluated in diabetic pregnancy complicated by preeclampsia, nephropathy, retinopathy, and preterm delivery. The role of hyperhomocysteinemia in microangiopathy in diabetes mellitus has been debated and is mainly seen with reduced activity of the MTHFR gene. A polymorphism in the gene for MTHFR is identified causing this phenomenon.

Design. Two hundred and sixty‐eight pregnant women with type 1 diabetes mellitus were recruited. Two hundred and thirty‐three women were successfully analyzed for MTHFR gene polymorphism 677C→T and compared to the incidence of the polymorphism in the background population (n=1084). The pregnancy data charts were reviewed retrospectively.

Results. The frequency of the MTHFR polymorphism in the background population was 29% and the heterozygozity 42%. The women with type 1 diabetes mellitus had a higher frequency of the MTHFR polymorphism with 52% heterozygotes and 9% homozygotes than had the background population (heterozygotes, background vs. type 1 diabetes mellitus: χ2=14, df=1, p<0.0002). The odds ratio for heterozygozity of the MTHFR polymorphism was 1.8 (95% Cl: 1.3–2.4) in women with type 1 diabetes mellitus. Women with either micro‐ or macroalbuminuria had a higher frequency of MTHFR polymorphism with 61% heterozygotes and 3% homozygotes than had the background population (heterozygotes: χ2=8.9, df=1, p<0.01). The odds ratio for heterozygozity of the MTHFR polymorphism was 2.3 (95% CI: 1.4–4) in women with type 1 diabetes mellitus.

Conclusion. An association was demonstrated between the MTHFR polymorphism and type 1 diabetes mellitus as well as increasing albumin excretion rate in pregnant women.
Factors influencing the decision to use or discard cryopreserved embryos
Authors: Svanberg Agneta Skoog , Boivin Jacky , Bergh Torbjörn
Published: March 2003

Background. Couples’ reasons for discarding supernumerary fertilized cryopreserved embryos and gender differences in attitudes toward the frozen embryos were investigated among Swedish couples undergoing in vitro fertilization (IVF) at a private clinic. At the time of the study Swedish law stipulated that couples could keep their frozen embryos for a maximum of one year, with the possibility of an extension based on individual requests.

Methods. A questionnaire with structured and unstructured questions was sent to 124 women and 124 men who had entered the IVF treatment and obtained supernumerary embryos from 1 January 1994 to 1 March 1995. Eighty‐two women and 74 men completed the questionnaire.

Results. After a mean storage time of 25.3 (±11.0) months 22 (26.8%) of the responding couples had their embryos discarded. The reasons were mainly practical, such as a positive outcome of IVF and a legally too short storage time. Comparisons between women and men showed that fewer women (13;17.6%) than men (20;27%) had been uncertain during the IVF treatment about using the frozen embryos at a later date and that men more often than women expressed anxieties about possible effects of the freezing procedure on the potential child (p=0.009).

Conclusion. A positive outcome of the original IVF treatment and a short maximum legal time of cryopreservation were the most common reasons why couples discarded their embryos. The men more often than women expressed anxieties about possible effects on a potential child. The results emphasize the need for giving detailed information to the couples about cryopreserved embryos and children born by this method.
Torsion of the previously normal uterine adnexa
Authors: Chen Ming , Chen Chin‐Der , Yang Yu‐Shih
Published: March 2003

Background. Treatment of adnexal torsion remains a clinical dilemma when future fertility is wanted. The purpose of this study was to evaluate the correlation between the pathological changes and the clinical characteristics on patients having torsion of the previously normal uterine adnexa which may help us decide whether detorsion is worthwhile.

Methods. A retrospective study of 69 patients undergoing surgical intervention for adnexal torsion was performed. Among them, 13 patients diagnosed with torsion of the previously normal adnexa were identified. Their clinical and pathological features were compared.

Results. Extensive hemorrhagic necrosis of the twisted ovary was observed in five patients, and each of them had their duration of torsion last 48 hours or longer. Three of 13 cases (23.1%) with torsion of the previously normal adnexa had local thrombus formation within the twisted adnexa. Their duration of torsion varied from 18 hours to 288 hours.

Conclusions. The likelihood of preserving viable ovarian tissue is significantly decreased if the duration of torsion lasts 48 hours or longer. Local thrombus formation in the twisted adnexa cannot be predicted simply from the duration of torsion.
Induction of labor in women with previous cesarean section using the double balloon device
Authors: Khotaba Samia , Volfson Margaret , Tarazova Lidya , Odeh Marwan , Barenboym Rafael , Fait Vladimir , Ophir Ela , Oettinger Moshe
Published: March 2003

Background and methods. To evaluate the efficacy and safety of labor induction by the double balloon device in women with previous cesarean section. Induction of labor was carried out in 37 women with previous cesarean section for various indications. All the inductions of labor were performed using the Atad double balloon device (ARD).

Results. Cervical ripening (Bishop scores above 5) was achieved in 82.3% of the induced women with subsequent vaginal delivery in 78.6% and repeat cesarean section in 22.3%. An important observation of the results was the chances to achieve a vaginal delivery according to the second Bishop score that was recorded 12 hours following the insertion of the device. When the second was above 5 the chances for vaginal delivery were 79.4%. The mean time from removal of the device to delivery was 10.8 hours. No complications were noted using the device.

Conclusions. The double balloon device appears to be a safe and effective method of inducing labor in women with a previous lower segment cesarean section. Wide scale studies and further use of the device for induction of labor in women who have had previous cesarean sections are warranted.
Induced abortion and placenta complications in the subsequent pregnancy
Authors: Zhou Weijin , Nielsen Gunnar Lauge , Larsen Helle , Olsen JØrn
Published: March 2003

Background. To study the risk of placenta complications following an induced abortion as a function of the interpregnancy interval.

Methods. This study is based on three Danish national registries; the Medical Birth Registry, the Hospital Discharge Registry, and the Induced Abortion Registry. All primigravida women from 1980 to 1982 were identified in these three registries. A total of 15,727 women who terminated the pregnancy with a first trimester induced abortion were selected to the abortion cohort, and 46,026 women who did not terminate the pregnancy with an induced abortion constituted the control cohort. By register linkage all subsequent pregnancies were identified from 1980 to 1994. Only women who had a non‐terminated pregnancy following the index pregnancy were selected to the study. Placenta complications were identified using either the Hospital Discharge Registry ICD‐8 codes or the Medical Birth Registry records.

Results. A slightly higher risk of placenta complications following an abortion was found. Retained placenta occurred more frequently in women with one, two or more previous abortions, compared with women without any previous abortion of similar gravidity. Adjusting for maternal age and residence at time of pregnancy, the interpregnancy interval, and the number of previous miscarriages (control cohort only), the odds ratios of retained placenta in deliveries of singleton live births in women with one previous abortion was 1.17 (95%CI=1.02–1.35), and for women with two or more previous abortions it was 1.68 (95%CI=1.23–2.30), respectively, compared with the control cohort of similar gravidity. Only for women who had one abortion did the results follow the predicted pattern of a higher risk of retained placenta after a short pregnancy interval. No association with placenta previa was seen.

Conclusions. The findings suggest a positive association between abortions and retained placenta in subsequent singleton live births, but the association was weak and confounding cannot be ruled out.
Ultrasonographic monitoring of pregnancies complicated by red blood cell alloimmunization in a cohort with mild to moderate risk according to previous obstetric outcome
Authors: Haugen Guttorm , Husby Henrik , Helbig Ann E. , Schmidt‐Melbye Anne‐Christine
Published: March 2003

Aim. To evaluate the detection rate of fetal anemia and pregnancy outcome as related to our policy of monitoring pregnancies with red blood cell alloimmunization.

Methods. From August 1997 to July 2000 35 pregnant women with maternal red blood cell alloantibodies were monitored by ultrasonographic measurements of the fetal spleen perimeter and peak systolic Doppler flow velocities of the middle cerebral artery, by semiquantification of maternal antibody titers and by general ultrasonographic and clinical evaluation. According to previous obstetric outcome they all had mild to moderate risk of developing fetal anemia.

Results. Eleven fetuses were anemic defined as a hemoglobin value ≤ 2SD according to gestational age. A spleen perimeter > + 2SD and a middle cerebral artery peak systolic velocity > 95% prediction interval showed sensitivity and specificity of 64 and 92% and 45 and 100%, respectively. The area under receiver operating characteristic curves was 0.926 (95% CI 0.842–1.000; P < 0.001) for the spleen perimeter and 0.837 (95% CI 0.688–0.987; P < 0.01) for the middle cerebral artery peak systolic velocity. Cordocentesis was performed in one pregnancy only. None of the fetuses developed hydrops and all infants survived. Twelve women delivered before 37 weeks gestation. In 10 patients cesarean section was performed due to possible fetal anemia. Six of the 10 neonates had normal hemoglobin values.

Conclusions. The ultrasonographic parameters did not predict all cases of fetal anemia defined as a hemoglobin concentration ≤ 2SD according to gestational age. The present policy of monitoring seemed to reduce the number of invasive tests but possibly increased the number of preterm and cesarean deliveries.
Perinatal complications among ethnic Somalis in Norway
Authors: Vangen Siri , Stoltenberg Camilla , Johansen R. Elise B. , Sundby Johanne , Stray‐Pedersen Babill
Published: March 2003

Background. The majority of ethnic Somali women in Norway have undergone an elaborate form of circumcision (infibulation). The aim of this study was to examine the risk of perinatal complications among ethnic Somalis and to discuss its relation to circumcision.

Methods. We conducted a cross‐sectional population‐based registry study. Data on all births to women born in Somalia (1733) and Norway (702 192) from 1986 to 1998 was provided from the Medical Birth Registry of Norway. We analyzed the risk of perinatal complications among women of Somali origin vs. ethnic Norwegians using univariate and multivariate methods.

Results. Perinatal complications were more frequent among women of Somali origin than among ethnic Norwegians. These included induction of labor, fetal distress, secondary arrest, prolonged second stage of labor, operative delivery and perinatal death. Particularly elevated odds ratios were found for fetal distress (odds ratio=2.6, 95% confidence interval (CI); 2.2–3.0), emergency cesarean sections (odds ratio=3.0, 95% confidence interval 2.6–3.4), Apgar scores below seven (odds ratio = 3.1, 95% confidence interval 2.4–4.0) and prelabor fetal deaths (odds ratio=2.5, 95% confidence interval 1.7–3.7).

Conclusion. Similar findings in infibulated vs. noncircumcised women have been demonstrated previously in other studies indicating that circumcision could play a role. The current study is the first to be conducted among Somali women in Europe. However, the results are not informative on whether the adverse birth outcomes are caused by infibulation as such or in combination with suboptimal perinatal care, intercurrent diseases and sociocultural factors. Somali women represent a high‐risk group in obstetrics, calling for special attention and care.
Gestational trophoblastic disease: one more risk in adolescent pregnancy
Authors: Uberti Elza M. H. , Diestel Maria Do Carmo F. , Guimarães Fernando E. , Goloubkova Tatiana , Rosa Marcos W. , De Nápoli Gilberto
Published: March 2003

Background.  An evaluation of the performance of a Referral Center in the diagnosis, treatment and follow up of adolescents with gestational trophoblastic disease.

Methods.  In a 13‐year prospective cohort study, between March 1987 and March 2000, 124 adolescents with gestational trophoblastic disease were followed up and/or treated by a multidisciplinary team. Adolescents underwent strict clinical and laboratory control after mole evacuation to guarantee adhesion to follow up, early diagnosis, and prompt treatment of persistent disease. The Student‐Fischer t‐test and the chi‐square test were used for the statistic analysis of the results.

Results.  Adolescents represented 21.3% of the 583 patients with gestational trophoblastic disease: 102 (82.3%) had uncomplicated hydatidiform moles, and 22 (17.7%) underwent chemotherapy for persistent gestational trophoblastic disease or a gestational trophoblastic tumor. Complications were diagnosed earlier (p < 0.001) in patients managed and treated at the referral center. Of the adolescents with complications, 81.8% were low risk, 54.5% were at the International Federation of Gynecology and Obstetrics stage I, and 90.9% were treated with chemotherapy only. Time to remission and follow up were shorter for uncomplicated hydatidiform moles (9.8 ± 3.4 weeks and 8.8 ± 1.8 months, respectively) than for persistent disease (16.2 ± 5.8 weeks and 45 ± 24.5 months, respectively). Adhesion to follow up was similar in the two groups (84.2% and 91.8%). To this date, 50% of the adolescents have had one or more gestations, and 82% of these pregnancies were normal.

Conclusions.  Adolescents comprise approximately 20% of all gestational trophoblastic disease patients and have high adhesion to follow up. The disease did not affect their reproductive capacity, and chances of a normal subsequent gestation were high.