bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacokinetics and distribution of diazepam and oxazepam in early pregnancy
Authors: Jørgensen N. P. , Thurmann‐Nielsen E. , Walstad R. A.
Published: November 2007

The transfer of drugs from the mother to the fetus is important from the view of possible harmful as well as therapeutic effects on both mother and fetus. In the first trimester of pregnancy this has been sparsely investigated. In 66 first‐trimester pregnant women, who had applied for legal termination of the pregnancy, we have calculated different pharmacokinetic parameters of two benzodiazepine derivatives, diazepam and oxazepam, after administration of a single oral dose of 10 or 25 mg to the mother. The calculated pharmacokinetic parameters were within the normal range for healthy adults. The pharmacological active metabolite n‐desmethyldiazepam was measured in concentrations near the detection limit. The penetration of diazepam and oxazepam from maternal serum to placental tissue in a 4 h period after drug administration was 31.5% and 49%, respectively, indicating a rapid transfer.
Growth hormone secretion during termination of pregnancy
Authors: Eriksson Leif , Frankenne Francis , Eden Staffan , Hennen George , von Schoultz Bo
Published: November 2007

Serum profiles of growth hormone (GH), hPL and hCG were recorded in 5 pregnant women during termination of pregnancy at cesarean section and legal abortion. Two monoclonal antibodies directed against different epitopes on the GH molecule were used to distinguish the pituitary 22K‐GH from the placental GH variant. After placental removal at cesarean section, a rapid fall in GH as well as in hPL and hCG concentrations was recorded. On the other hand GH levels were unaffected when early pregnancy was terminated by legal abortion. The importance of an intact placental function for the maintenance of high GH levels lends further support to the concept that a placental GH variant is produced during late pregnancy.
Umbilical cord compression diagnosed by means of ultrasound
Authors: Selbing Anders
Published: November 2007

Two‐dimensional ultrasound in combinaton with a pulsed Doppler may be used during parturition to distinguish between the various causes of fetal heart decelerations during active labor: “placental insufficiency”, umbilical cord compression, and, fetal head compression. One case of umbilical cord compression is presented to illustrate the possibilities.
Menstruation‐related angioedema treated with tranexamic acid
Authors: Håkansson Ólafur M.
Published: November 2007

A case of menstruation‐related angioedema is presented. The symptoms observed were cyclically appearing hoarseness due to laryngeal edema without any pain. Symptoms disappeared during intake of contraceptive pills and during pregnancy with recurrence at the onset of menstruation post partum. A therapeutic trial with tranexamic acid was successful. The use of tranexamic acid in secondary and idiopathic angioedema should be considered.
Effect of Nipple Stimulation on Uterine Activity and on Plasma Levels of Oxytocin in Full Term, Healthy, Pregnant Women
Authors: Christensson Kyllike , Nilsson Bo A. , Stock Solveig , Matthiesen Ann Sofie , Uvnäs‐Moberg Kerstin
Published: November 2007

The effect of nipple stirnulation on uterine activity, foetal heart rate and plasma oxytocin level in healthy full term pregnant women was studied. Ten women in weeks 38–39 of pregnancy stimulated their nipples for 30 min. Nine of the ten experienced uterine contractions. One woman showed signs uterine hyperactivity (frequent contractions) and foetal heart rate decelerations. Blood samples were drawn at 15 s intervals during 5–6 contractions and oxytocin levels were measured with radioimmunoassay. Oxytocin levels rose significantly during the nipple stimulation and short bursts of oxytocin were recorded during contractions. Nipple stimulation has been used to induce labour and our data may suggest that oxytocin released in response to such stimulation is responsible for the contractions induced.
Non‐Radical Hysterectomy And The Function Of The Lower Urinary Tract: I: Urodynamic Quantification Of Changes In Storage Function
Authors: Vervest Harry A.M. , van Venrooij Ger E.P.M. , Barents Joop W. , Haspels Ary A. , Debruyne Frans M.J.
Published: November 2007

The intermediate sequelae of non‐radical abdominal and vaginal hysterectomies on the storage function of the lower urinary tract were studied by comparison of pre‐ and postoperative urodynamic parameters. A statistically significant reduction in maximum cystometric capacity after abdominal extrafascial and vaginal hysterectomies was found, together with a decline in bladder compliance. Both findings are attributed to a decrease in the musculoelastic properties of the detrusor muscle caused by edema and surgical injury. This reduction in capacity and compliance, however, appeared to have no clinical importance. Sensory innervation remained unaltered. In general no evidence was found that hysterectomy contributed to the development of involuntary detrusor contractions and motor urge incontinence. Urethral competence, assessed by urethral pressure profilometry and urethral leakage pressure measurement, remained unaffected. No increase in stress incontinence was seen after hysterectomy. Vaginal hysterectomy appeared to influence storage function slightly more than abdominal hysterectomy did. Postoperative lower urinary tract dysfunction is for the most part determined by the preoperative urological status.
Feto‐Placental Blood Volume In Severely Anemic Erythroblastotic Fetuses
Authors: Westgren Magnus , Stangenberg Magnus , Selbing Anders
Published: November 2007

The feto‐placental blood volume was studied using a hemoglobin hemodilution technique in 15 erythroblastotic fetuses at 43 intravascular transfusions. Four severely anemic fetuses (Hb 30 g/l) had significantly larger blood volumes than 11 moderately anernic fetuses (Hb 30–79 g/l), 169 ± 37 versus 105 ± 32 ml/kg fetal body weight (p<0.001). We speculate that hypovolemia might be an adaptive change to maintain an adequate hemoglobin concentration. An escape of fluid from the intra‐to the extra‐vascular space will probably compensate for the reduction in total red cell mass and thus slightly increase the hemoglobin concentration. Theoretically, interstitial fluid accumulation will continue until the hydrostatic pressure of the extravas‐cular tissue balances that of the capillary. This compensatory mechanism seems to function until the hemoglobin concentration drops below, 30 g/l, at which point the blood volume will increase, suggesting a change from a hypo‐to a hyper‐volemic state.
Preoperative Dilatation Of The Cervix At Legal Abortion With A Synthetic, Fast‐Swelling Hygroscopic Tent
Authors: Bokström Hans , Wiqvist Nils
Published: November 2007

Preoperative dilatation of the cervix at first trimester legal abortion has been shown to facilitate the vacuum aspiration procedure and to reduce per‐and postoperative complications as well as late sequelae. The present study represents a clinical trial in which a new synthetic hygroscopic tent, Dilapan®, has been evaluated. Dilapan tents of different diameters with different durations of cervical exposure were tested on a case material of 450 nulliparous women. It was found that treatment with 4 mm tents during 3–4 h or 3 mm tents during 16–20 h produced a cervical dilatation that allowed an easy evacuation of the uterus with a minimum of complications. The advantage of this particular tent is its property of rapid swelling.
Radical Hysterectomy And The Function Of The Lower Urinary Tract: Urodynamic Quantification Of Changes In Storage And Evacuation Function
Authors: Vervest Harry A.M. , Barents Joop W. , Haspels Ary A. , Debruyne Frans M.J.
Published: November 2007

The intermediate sequelae of radical hysterectomy on the storage and evacuation function of the lower urinary tract were studied by comparison of pre‐and postoperative urodynamic parameters. A modified surgical technique was employed in order to remove only the necessary part of the upper part of the vagina and paravaginal tissues. A non‐significant reduction in bladder capacity and compliance was found. Urethral function remained unaltered. The most prominent finding was a significant reduction in detrusor contractility and the development of abdominal straining in order to empty the bladder. The pathophysiologic mechanisms by which lower urinary tract is changed after radical hysterectomy are a decrease in the musculo‐elastic properties of the bladder wall caused by surgical injury, and partial damage to the neural innervation of the bladder.
Intravenous Leiomyomatosis
Authors: Konrad Peter , Mellblorn Lennart
Published: November 2007

A case of intravenous leiomyomatosis is presented along with a review of the literature. The condition is a neoplasia of smooth muscle originating from the uterus, with vermiform extensions into veins. Although histologically benign, the clinical course can be fatal if intravenous tumor progresses to the heart. Ordinary leiomyomas of the uterus are frequently coexistent. The symptoms are usually vague. The diagnosis should be suspected when a worm‐like, greyish tumor with a smooth surface is found in cut vessels or when right‐sided cardiac tumors are detected. Radical excision of the uterus and ovaries, as well as of the intravenous tumor extensions is recommended. In our case the tumor extended into the vena cava. The diagnosis was incidental during nephrectomy due to hydronephrosis. Tumor tissue was positive for estrogen and progesterone cytosolic receptors.
Quadruplets Following Cessation Of Clomiphene Citrate: A Case Of Sustained Effect
Authors: Ben‐Shlomo Lzhar , Zohar Shifra
Published: November 2007

We report a case of quadruplet birth in a young oligomenorrheic woman, who had been prescribed clomiphene citrate for two consecutive cycles. She conceived following cessation of treatment and an intervening menstruation. Ultrasonic follow‐up which concurred with the last menstrual period dating indicated multiple ovulation as a sustained effect of clomiphene citrate medicatiom.
Decreased Numbers Of Lymphocyte β2‐Adrenoceptors In Pregnant Women Receiving β2‐Adrenergic Agonist Therapy
Authors: Santala Markku , Saarikoski Seppo , Castrén Olli
Published: November 2007

Intravenous infusion of buphenine hydrochloride was admistered on 4 successive days to 8 pregnant women with imminent preterm labor. Serial blood samples taken before and throughout the study were assayed for lymphocyte β2‐adrenoceptor density and cyclic adenosine‐3′,5′‐monophosphate (cAMP). The lymphocyte β2‐adrenoceptor density declined significantly (p<0.01) during the treatment. The plasma cAMP concentration was highest 4 h after commencement of infusion and decreased thereafter. Despite the decrease in lymphocyte β2‐adrenoceptor density, the clinical response remained good and the parturients did not go into labor until several days after infusion was started.
The Effect Of Peroral Lynestrenol On Serum Lipids And Lipoproteins In Therapeutic Amenorrhea Of Mentally Retarded Women
Authors: Huovinen K. , Tikkanen M. J. , Varonen S. , Wilska M.‐L. , Westermarck T. , Vesterinen H.
Published: November 2007

Serum concentrations of total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), apolipoprotein A1 (Apo A1), apolipoprotein 6 (Apo B), and triglyceride (TG) were measured and that of low density lipoprotein cholesterol (LDL‐C) calculated in blood samples obtained from mentally handicapped women undergoing therapeutic amenorrhea (TA) induced by 5–10 mg of peroral lynestrenol, some receiving, some not receiving simultaneous anticonvulsant therapy Iphenytoin, carbamazepine or barbiturate, alone or in combination), In addition, these analyses were carried out in women receiving only anti‐convulsants and in controls (mentally handicapped women not receiving any of the above‐mentioned medications).

Significantly lower HDL‐C, Apo A1, TG and cholesterol concentrations were measured in TA patients receiving lynestrenol only, than in those receiving anticonvulsants only, or in controls (p<0.001). With regard to HDL‐C and Apo A1, patients receiving both lynestrenol and anticonvulsants were intermediate between lynestrenol only patients and controls, but the HDL‐C/LDL‐C and Apo A1/Apo B ratios were similar to those observed in lynestrenol only patients.

Addition of 8 or 12 mg of estriol succinate to the lynestrenol regimen was virtually without an effect. However, halving of the lynestrenol dose resulted in a significant increase in HDL‐C and in the HDL‐C/LDL‐C and Apo A1/Apo B ratios (p<0.001 or p<0.01), respectively. The lynestrenol dose was thus the most important determinant of lipoprotein pattern and should be kept as small as possible in order to reduce cardiovascular risk.
Abnormal Papanicolaou Smear: A Population‐based Study of Risk Factors in Greenlandic and Danish Women
Authors: Kjær Susanne K. , Poll Paul , Jensen Henning , Engholm Gerda , Haugaard Birthe J. , Teisen Chantal , Christensen Rene B. , Möller Knud A. , Vestergaard Bent Faber , De Villiers Ethel‐Michele , Lynge Elsebeth , Jensen Ole M.
Published: November 2007

Possible risk factors for abnormal Papanicolaou smear were investigated in a population‐based cross‐sectional study. From Nuuk (Greenland) and Nykebing Falster (Denmark), random samples of 800 women aged 20–39 years were drawn. Totals of 586 and 661 women were included in Greenland and Denmark, respectively. All women went through a personal interview, and had a gynecologic examination including a PAP smear and cervical swab for HPV analysis. A blood sample was taken for analysis of HSV type specific antibodies. Multiple sexual partners was the most important risk factor for abnormal cervical cytology (OR = 4.2). An infectious etiology was also indirectly supported by a relatively protective effect of barrier contraceptive methods (OR = 0.6). The simultaneous finding of HPV 16/18 as a significant risk factor (OR = 2.4) cannot be taken uncritically as support for a causal effect of this HPV type, since such a relationship between cytological changes of the cervix and HPV infection could also emerge if the positive PAP smear was not just a measure of intra‐epithelial neoplasia but also an expression of the infection itself on the cervix.
Cyclic Changes of the Functional Ovarian Compartments: Echographic Assessment
Authors: Mercé L T. , Andrino R. , Barco M. J. , de la Fuente F.
Published: November 2007

Using tridimensional echography, 25 normal ovulatory cycles were evaluated. the following parameters were assessed: 1) ovarian volume, 2) volume of the dominant follicle, 3) corpus luteum volume, 4) residual follicular volume, and 5) stromal volume. Ovarian volume and dominant follicle volumes reached their maximum on day −1: 11.68 ±2.87 ml and 3.60 ± 1.20 ml respectively. the maximum stromal volume was seen during the follicular phase: 7.98 ± 2.29 ml. In the dominant ovary the maximum corpus luteum volume was observed on day +1 and the maximum stromal volume on day +7 (8.64 ± 2.53 ml). In the contralateral ovary, the stromal volume did not show significant changes. the residual follicular volume in both ovaries diminished gradually from the early follicular phase except for a slight postovulatory rise. In this study, normal values during the ovulatory cycle were obtained as indicated above. the use of bidimensional echography in the diagnosis of functional disorders of the ovary is stressed.
Effect of Cortisol on the secretion of testosterone and estradiol‐17β by human granulosa‐luteal cell cultures
Authors: Tsai Li , Pousette Åke , Johansson Christer , Carlström Kjell
Published: November 2007

The combination of hypercortisolism and usually low androgen and estrogen levels is frequently observed in female long distance athletes. In order to find a useful model system for studying the underlying mechanisms, the following studies were performed. The effect of Cortisol on the secretion of testosterone (T) and estradiol‐17β (E2) by human granolosa‐luteal cells was studied in vitro in cultures of cells recovered from mature follicles of gonadotrophin stimulated women (participating in the IVF program). Following 24 hours of culture in tissue culture medium without hormonal additives, the granulosa‐luteal cells were incubated for 6 hours in media with addition of 4‐androstene‐3,17‐dione (A‐4) as precursor and hMG and Cortisol in different combinations. The secretion of T was significantly stimulated by Cortisol but not by human menopausal gonadotrophin (hMG). Cortisol, but not hMG, also increased the secretion of E2, although this effect was not statistically significant.

These in vitro findings make a direct effect of Cortisol upon ovarian sex steroid secretion less likely as the mechanism behind the subnormal sex steroid levels in female long distance athletes. Instead, inadequate gonadotrophic stimulation, related to hypothalamic amenorrhea, and/or a selective decrease in the adrenal secretion of precursor steroids, may be an explanation.
Intervention during labor: risk factors associated with complete tear of the anal sphincter
Authors: Bek Karl Møller , Laurberg Søren
Published: November 2007

Among 41,200 consecutive deliveries there were 152 cases of complete tear of the anal sphincter (complete tear). In a case‐control design, the association between interventions during labor (forceps, vacuum extraction, use of oxytocin and prostaglandins and mediolateral episiotomy) and complete tear, were evaluated by confounder control using multiple logistic regression analysis. Controls chosen were the patients delivering just before and after the index patient with complete tear.

Use of Kielland forceps, mediolateral episiotomy, shoulder dystocia and nulliparity were significantly associated with complete tear. Maternal age, presentation in labor, duration of second stage of labor and the indication for instrumental deliveries and episiotomy had no significant association with complete tear.
Vaginismus ‐ iatrogenic precipitation and maintenance
Authors: Pedersen Beth Lilja , Møhl Bo
Published: November 2007

Four cases of vaginismus are presented. Two of them illustrate an iatrogenic precipitation of vaginismus, one misdiagnosis of vaginismus, and one shows the use of unnecessary hymenectomy as the first choice of treatment of vaginismus.

The etiology of vaginismus and the indications of first pelvic examinations are discussed.
Urge incontinence history is an accurate predictor of urge incontinence
Authors: Petros Peter Papa , Ulmsten Ulf
Published: November 2007

The reliability of urge symptoms associated with actual observed urine loss was tested using subtracted cystometry, and a hand‐washing pad test in a total of 169 patients with urinary incontinence, 70 of whom had a prior history of urge incontinence. Our results showed: 1. that urodynamic or pad tests performed at a single point in time cannot retrospectively confirm a patient's past history of urge incontinence with any reliability; 2. a patient's history of urge incontinence is likely to be accurate.
Detection of scar dehiscence at delivery in women with prior cesarean section
Authors: Gemer Ofer , Segal Shmuel , Sassoon Essi
Published: November 2007

Transcervical examination of a prior cesarean scar after vaginal delivery is commonly advised. A retrospective study of 1023 parturients with prior cesarean delivery was undertaken, 475 of whom delivered vaginally. Thirteen cases of scar dehiscence were found at laparotomy, and only one case was discovered by transcervical examination. The value of routine postdelivery examination of uterine scar is doubtful.
Changing concepts of medical treatment of endometriosis
Authors: Kauppila Antti
Published: November 2007

Studies on the natural history of endometriosis have demonstrated that the majority of endometriosis implants tend to progress, a finding that indicates eradication of the lesions by medical and/or surgical approaches. Infertility and dysmenorrhea are other indications for medical therapy in this disease.

In recent prospective and controlled studies, progestin (at high doses), gestrinone and GnRH agonist analogues have been equally effective as regards elimination of endometriosis and relief of endometriosis‐associated symptoms, compared to danazol, a standard treatment in endometriosis. These four classes of drugs differ, however, in their adverse effects and as regards compliance. Danazol is a steroid with androgenic and anabolic effects and it adversely affects lipid metabolism. Gestrinone and 17‐OH progestins are weaker, and GnRH agonist analogues and some progestins neutral in these respects. GnRH agonist analogues induce a hypo‐estrogenic state with associated climacteric symptoms and mineral loss from the bones. The clinical value of combinations of GnRH analogue and steroid(s), used to prevent these side‐effects, is so far unclear.

Laparoscopic microsurgery has revolutionized the treatment of endometriosis lesions. Hence, hormone treatment as a supplement to microsurgical approaches may become a dominant form of medical therapy in endometriosis. The definitive value of pre‐ or post‐operative hormonal treatment in this disease should, however, be tested in controlled trials. Such studies have proved antiprostaglandins to be useful in the treatment of dysmenorrhea secondary to endometriosis.

Because each of the four drugs was ineffective in the treatment of infertility associated with endometriosis it is a waste of time to expose patients desiring pregnancy to long‐term hormonal therapy. Ovarian hyperstimulation with IVF and other methods of assisted fertilisation are promising alternatives, but their definitive value is so far unproven in this disease. Conclusively, the significance of medical therapy in endometriosis is only partly resolved, and therefore, many therapeutic problems await prospective randomised trials and new innovations.
Comparison of ultrasonic measurement of biparietal diameter and last menstrual period as a predictor of day of delivery in women with regular 28 day‐cycles
Authors: Kieler Helle , Axelsson Ove , And Staffan Nilsson , Waldenstrom Urban
Published: November 2007

Within a randomised trial, 1713 women with regular 28‐day cycles were studied to evaluate whether the day of delivery is predicted best from the last menstrual period (LMP) or ultrasonic measurement of the fetal biparietal diameter (BPD). Among 727 women, with a spontaneous onset of labor, where the estimated day of delivery (EDD) was derived from BPD, 91.8% delivered within +14 days and 61.8% delivered within seven days of EDD. Corresponding figures for 741 women where EDD was derived from LMP were 91.6% and 61.1%, respectively. Comparison of EDDs calculated from BPD and LMP in the same woman showed that BPD postponed EDD more than seven days in 18.0% and advanced EDD more than seven days in 1.8%. When the difference in EDD between the two methods was more than seven days the BPD estimate was a better predictor of day of delivery.
Iodine deficiency in pregnancy in Denmark
Authors: Nøhr Susanne B. , Laurberg Peter , Børlum Karl‐Gerhardt , Pedersen Klaus M. , Johannesen Peter L. , Damm Peter , Fuglsang Ebbe , Johansen Allan
Published: November 2007

Iodine requirements are increased during pregnancy and lactation and adequate iodine intake is important for normal brain development of the fetus/newborn child.

The aim of the present study was to evaluate the extent to which this increase in iodine requirement is met in pregnant women living in various regions of Denmark. One hundred and fifty‐two healthy pregnant women admitted to five different Danish departments of obstetrics participated in the study. Iodine status was evaluated by measurement of iodine in spot urine at day five after delivery and by careful history of the intake of iodine containing vitamin/mineral tablets.

Approximately one third of the women had received tablets containing iodine. In women who had not received iodine supplementation urinary iodine was low with a median value of 39,7 μg/g creatinine (Aalborg 28, Randers 33, Ringkabing 34, Arhus 43 and Copenhagen 62 μg/g creatinine).

These values are far below internationally recommended levels. The consequences remain to be evaluated and no firm recommendations can be given. It seems reasonable, however, to recommend a high intake of food containing iodine (e.g. milk products) during pregnancy and lactation. Since nearly all the women took some kind of vitamin/mineral supplementation it could be considered to advocate intake of vitamin/mineral tablets containing iodine.
Prehysterectomy curettage in women with uterine fibromyomata is not worthwhile
Authors: Møller Lars Mikael Alling , Berget Arne
Published: November 2007

Objective: To study the value of prehysterectomy curettage in women referred on the suggestion of uterine fibroids.

Design: A retrospective study.

Setting: Gentofte Hospital, University of Copenhagen.

Subjects: Four hundred and eleven patients with a curettage prior to hysterectomy on suspicion of uterine fibroids.

Main outcome measure: Histological accuracy, frequency of (pre)malignancies and clinical consequences due to routine curettage.

Results: Curettage disclosed two cases of endometrial cancer and four cases of ON. It missed two cases of CIN and one case of endometrial cancer in a postmenopausal women. In no case did the final histology disclose diseases that had not been taken care of during the laparotomy.

Conclusion: Curettage in women with a preoperative diagnosis of uterine fibromyomata is not worthwhile.
Management of functional ovarian cysts after induction of ovulation
Authors: Ben‐Ami M. , Geslevich Y. , Battino S. , And M. Matilsky , Shalev E.
Published: November 2007

To investigate the need for hormonal treatment in patients with functional ovarian cysts after induction of ovulation, a randomized prospective study was performed. Fifty‐four patients who were found to have ovarian cysts after induction of ovulation were randomly assigned to two groups:

a) Treatment with estrogen /progesterone.

b) Expectant management.

The main outcome measure was resolution of ovarian cysts. There was no significant difference between the groups. We conclude that hormonal treatment is not necessary in cases with functional ovarian cysts after induction of ovulation.
Severe lacerations after childbirth
Authors: Hordnes Knut , Bergsjo Per
Published: November 2007

We have reviewed the literature on third and fourth degree perineal lacerations, with respect to occurrence, risk factors, repair, short and long term morbidity, and secondary treatment. Suggestions of delivery procedures aiming to reduce the extent of perineal trauma are given. The long term sequelae of severe lacerations are clearly underestimated.
Evaluation of a new Swedish protocol for alloimmunization screening during pregnancy
Authors: Gottvall Tomas , Selbing Anders , Hilden Jan‐Olof
Published: November 2007

Screening protocols for alloimmunization during pregnancy usually make a difference between primi‐ and multigravidae as well as between Rh(D) negative and Rh(D) positive pregnant women. We have evaluated a new screening program including antibody tests at 25 and 35 gestational weeks only, for all, and regardless of Rh(D) group. During the time period 1983–89, 78,300 consecutive pregnancies were tested. Red cell antibody immunizations were detected in 287 (0.37%) pregnancies subdivided into fourteen different red cell IgG antibody specificities. Significant antibody titers (defined as IAT or enzyme titers ≤8) were observed in 225 pregnancies, where 127 (56%) were previously unknown. A majority (63%) of the new immunizations occurred among the Rh(D) positive pregnant women. All newborns that needed phototherapy or exchange transfusion due to alloimmunization were recognized at the time of delivery. We conclude that antibody screening tests at 25 and 35 gestational weeks for both Rh(D) negative and positive pregnant women is sufficient, effective and a safe procedure for the fetus as well as for the mother.
Selective salpingography and fluoroscopic transcervical salpingoplasty for diagnosis and treatment of proximal fallopian tube occlusions
Authors: Martensson Olle , Nilsson Bo , Ekelund Leif , Johansson Jan , Wickman Göran
Published: November 2007

In 25 women with primary or secondary infertility, primary hysterosalpingography (HSG) or laparoscopy with chromopertubation indicated 33 proximal and 2 distal tubal obstructions. Four salpingectomies had been performed earlier. All patients were considered for transcervical catheter salpingoplasty (TCSP) to reconstruct tubal patency. Secondary examination with repeat HSG or selective osteal salpingography confirmed 26 proximal and 3 distal tubal occlusions while 17 tubes were patent. Selective osteal salpingography was performed successfully in 32 of 33 (97%) tubes. Sixteen of 26 (61.5%) proximalfy occluded tubes were successfully recanalized by coaxial catheter and guidewire technique while two of three distally occluded tubes were reopened by forceful flushing of contrast medium. So far, one ectopic and five intrauterine pregnancies were achieved in ten patients with observation time more than four months. Three patients have had normal deliveries. The favorable results, lack of complications and low costs seem to justify the recommendation to use selective salpingography and fallopian tube recanalization as the first intervention in patients with obstruction of the proximal fallopian tube.
Adipose tissue fatty acids and dietary fat sources in relation to endometrial cancer:
Authors: Lissner L. , Kroon U.‐B. , Björntorp P. , Blosk S. , Wilhelmsen L. , Silverstolpe G.
Published: November 2007

This study describes associations between early‐stage endometrial cancer and type of dietary fat consumed, based on (i) adipose tissue fatty acid content (a biomarker for dietary fat) and (ii) self‐reported frequencies of selected high‐fat foods. Because obesity may be associated with high dietary fat intake as well as endometrial cancer, a secondary objective is to determine whether the observed dietary associations are statistically independent of body composition, assessed as percent body fat. To achieve these aims, we examined 20 cases of endometrial cancer in remission and 20 community controls, all aged 55–64. Abdominal adipose tissue biopsies from cases contained significantly higher concentrations of saturated fatty acids of intermediate chain length (C12‐C16), lower ratios of polyunsaturated to saturated fatty acids (P:S ratio), and lower concentrations of CI8 polyunsaturated as well as CI8 saturated fatty acids. These differences were independent of degree of adiposity measured in a whole body 40K counter and several measurements of regional fat distribution. In addition, each subject's consumption of 20 high‐fat items was reported by means of a semiquantitative food frequency questionnaire. Analysis of these data indicated that cases consumed more animal‐derived fats, again independent of obesity. In particular, cases used more butter in cooking, ate more bacon, and drank more whole milk. Animal‐derived fat intake displayed an inverse association both with the P: S ratio and the C18 polyunsaturated fatty acid content of adipose tissue, lending internal validity to the dietary data. These findings are consistent with the hypothesis that the type of dietary fat consumed may influence the occurrence of endometrial cancer.
Diffuse leiomyomatosis of the uterus with local pelvic spread
Authors: Beattie G. J. , Williams A. R. W. , Duncan A. , Smart G. E.
Published: November 2007

The clinical and pathological findings of a case of diffuse leiomyomatosis of the uterus are described. The unique feature of this case is the extension of the disease process to the pelvic mesocolon. The diagnostic difficulties encountered in the histological assessment of smooth muscle tumors of the uterus are discussed.
Phenylethanolamine‐N‐methyl transferase and catechol‐O‐methyl transferase activity in rat uterus
Authors: Casimiri Viviane , Cohen Wayne R. , Parvez Simone , Hobel Calvin , Parvez Hasan
Published: November 2007

Purpose. The activity of phenylethanolamine‐N‐melhyl‐transferase (PNMT) and catechol‐O‐methyl‐transferasc (COMT) was studied in uterine homogenates from adult female Wistar rats with normal cycles and that had been ovariectomized. adrenalectomized. and steroid‐treated.

Results. Activities of the two enzymes changed significantly during the normal estrus cycle. Both peaked during metestrus. with COMT showing a secondary peak of activity at proestrus. Progesterone treatment significantly increased and estradiol decreased PNMT activity in comparison to untreated controls. Hydrocortisone administration had no effect on uterine PNMT activity. COMT activity was not affected significantly by any of the steroid treatments.

Conclusion. The data confirm that uterine tissues possess the enzymatic machinery to synthesize epinephrine from norepincphrine. and suggest the activity of this pathway may be mediated by variations in the sex hormone environment of the uterus.
Comparison of outcome of labetalol or hydralazine therapy during hypertension in pregnancy in very low birth weight infants
Authors: Hjertberg R. , Faxelius G. , Belfrage P.
Published: November 2007

Ninety‐seven women with moderate to severe preeclampsia (PE) were allocated at random to labetalol or hydralazine treatment. Of these, 22 women with severe PE gave birth to neonates with VLBW (very low birth weight ≥ 1500 g). Seven were allocated to labetalol treatment (Group A), eight to hydralazine treatment (Group B) and seven women received both drugs due to poor blood pressure control with a single drug therapy (Group C). No difference in cesarean section rate or in the indication for operative delivery could be seen. Gestational age was 29.9 weeks (25.4–32.5) in Group A. 28.6 weeks (26.6–33.4) in Group B and 27.3 weeks (26.7–31.1) in Group C (median and range). Birth weight did not differ between groups and 13 of the 22 infants weighed below 1000 g. There was a tendency to lower Apgar scores at five minutes in the hydralazine group. Time spent in the neonatal intensive care unit did not differ between groups. Five of the 11 neonates with gestational age (GA)≥28 weeks and three of the seven neonates in GA 29–30 weeks died. Neither the number of infants requiring intermittent positive pressure ventilation or duration of O2‐treatment, nor number of infants with respiratory distress syndrome differed between groups. We did not find any difference in the outcome of the VLBW infants when the hypertensive mother had been treated with either hydralazine or labetalol.
Effect of iron‐folate supplementation on serum copper concentration in late pregnancy
Authors: Burns James , Paterson Colin R.
Published: November 2007

The effect of iron‐folate supplementation on maternal serum copper concentration in late pregnancy (33 to 35 weeks gestation) was examined. In the 30 women who had taken daily iron‐folate supplements since the start of the second trimester (11 to 15 weeks gestation), the median serum copper concentration was lower than that in the 27 women who had taken no supplements (p < 0.005). However, in the supplemented women the median values for serum iron concentration and blood hemoglobin concentration were higher, and the median value for serum transferrin concentration was lower, than the corresponding median values in the unsupplemented women (p< 0.001, p<0.02 and p< 0.001. respectively). Further work is needed to determine whether the difference between the median values for serum copper concentration is due to a reduction in values in the women who took iron‐folate, perhaps as a result of an interaction between iron and copper, or is due to an increase in values in the unsupplemented women secondary to their apparently reduced iron status.
Tests for ‘detrusor instability’ in women
Authors: Papa Petros P. E. , Ulmsten U.
Published: November 2007

The principal aim of this study was to analyse the siniultaneous pressure readings derived from bladder and urethra during a handwashing test. A total of 163 patients with urinary incontinence were studied. It was demonstrated that contraction of the pelvic floor stretches the vagina. In many patients. this appeared to inhibit the micturition reflex, possibly by supporting the nerve endings at bladder neck, thereby inhibiting their premature activation. There was also evidence that this stretching activated reflex contraction of the urethra, the vagina‐urethral (coital) reflex. thereby increasing the urethral resistance. On further analysis, it was concluded that urodynamic testing does not detect ‘detrusor instability’ per se. It detects the urethra's attempts at closure.
Osteopenia caused by heparin treatment in pregnancy
Authors: Haram Kjell , Hervig Tor , Thordarson Hrafnkell , Aksnes Lage
Published: November 2007

A case is reported of severe osteopenia caused by heparin treatment of thrombosis in the eleventh week of pregnancy followed by heparin prophylaxis (5000 IU three times daily) during pregnancy and lactation. The mother complained of back pain during the last two weeks of pregnancy. Six weeks post parturn, generalized osteopenia in the skeleton was diagnosed and a compression fracture of the body of the sixth thoracic vertebra. During prcgnancy the mother had relatively low serum concentrations of 1,25(OH)2D, the active metabolite of vitamin D. and six weeks after delivery the serum concentration had fallen to about 50% of the lowest reference level. Eight and fourteen weeks after delivery. when heparin trentnient had been discontinued, the serum concentrations of 1,25(OH)2D were within the reference range for non‐pregnant adults.
Large solitary luteinized follicle cyst of pregnancy and puerperium
Authors: Thomas Susanna , Krishnaswami Hemalatha , Seshadri Lakshmi
Published: November 2007

A case of large solitary luteinized follicle cyst of pregnancy and the puerperium. arising in a 22 year old primipara. three months post partum, is presented with clinical and pathological details. This is a rare type of follicle cyst and has to be differentiated from a cystic neoplasm.
Evaluation of endometrial thickness measured by endovaginal ultrasound in women with postmenopausal bleeding
Authors: Dørum Anne , Kristensen G. B. , Langebrekke A. , Sørnes T. , Skaar O.
Published: November 2007

Endovaginal ultrasound scanning was used preoperatively in 100 women with postmenopausal vaginal bleeding referred for dilatation and curettage. The ultrasonographic appearance of the endometrium was related to the histologic diagnosis. Endometrial malignancy was found in 15 patients, in 2/45 (4.4%) of women aged less than 60 years and in 13/55 (23.6%) of women aged 60 years or more. Out of 54 patients with an endometrial thickness of less than 5 mm as measured by ultrasound, 3 had an endometrial malignancy, and 12 of 45 with an endometrial thickness of 5 mm or more, had an endometrial malignancy. The sensitivity of ultrasound to detect malignancy was 80%, the specificity was 60%, the positive and negative predictive values were 26% and 94.4%. The sensitivity and the negative predictive value was not high enough to replace histologic examination of the endometrium.
Congenital pseudarthrosis of the clavicle
Authors: Morin Lue R. M. , Fossey Francois P. , Besseliévre Alain , And Jean‐Claude Loisel , Edwards John N. T.
Published: November 2007

Congenital pseudarthrosis of the clavicle is a rare anomaly in which the clavicle is formed in utero in two separate segments. Clinically, there is a bump and a palpable discontinuity at the middle of the clavicle. There is no swelling or tenderness, nor disability. Radiologically, the medial ends of both clavicular segments are blunt and there is no interruption of cortical bone. The differential diagnosis includes birth fracture of the clavicle and craniocleidal dysostosis. The obstetrician should be aware of this condition as, if it is misdiagnosed, he may be wrongly accused of birth fracture.
The effect of magnesium sulfate on maternal and fetal blood flow in pregnancy‐induced hypertension
Authors: Belfort Michael A. , Saade George R. , Kenneth J. Moise
Published: November 2007

The purpose of this study was to evaluate the effects of magnesium sulfate on maternal and fetal blood flow in pregnancy‐induced hypertension. Twelve patients with pregnancy‐induced hypertension were prospectively studied with transcranial pulsed Doppler and transabdominal color flow Doppler before and after infusion of a 6 gram intravenous loading dose of magnesium sulfate. The maternal vessels studied included the middle cerebral, common carotid, and internal carotid arteries. The fetal vessels studied included the middle cerebral, renal, and umbilical arteries. In addition the maternal circulation in the placental base plate was imaged. The results of this descriptive study suggest that a 6 gram loading dose of magnesium sulfate significantly vasodilates the vascular bed distal to the maternal middle cerebral artery, and increases blood velocity in this distribution. There was no significant change in pulsatility index or blood velocity in the central large vessels of the head and neck. There were no acute effects noted in the fetal or placental vessels evaluated.
Meconium stained amniotic fluid is associated with maternal infectious morbidity in pre term delivery
Authors: Markovitch Ofer , Mazor Moshe , Shoham‐Vardi Ilana , Chaim Walter , Leiberman Joseph Reuben , Glezerman Marek
Published: November 2007

The purpose of the study was to determine if intra partum meconium stained amniotic fluid (MSAF) is associated with infectious morbidity in women with pre term delivery. The study group was composed of 89 women with pre term delivery and MSAF. The control group comprised 89 women with pre term delivery and clear amniotic fluid, matched for maternal age, gravidity, parity, gestational age, rate of premature rupture of membranes, breech presentation and mode of delivery. The parameters of maternal infectious morbidity were compared between the two groups during pregnancy, delivery and puerperium. The prevalence of recurrent urinary tract infections was significantly higher in the study group than those in the control group, 7.8% (7/89) vs. 0% (0/89), respectively (p = 0.02). During delivery women with MSAF had a significantly higher rate of clinical chorioamnionitis than women without MSAF, 6% (6/89) vs. 0% (0/89), respectively (p = 0.03). Histological chorioamnionitis was also significantly higher in patients with intra partum MSAF, as compared to those with clear amniotic fluid, 11.2% (10/89) vs. 0% (0/89), respectively (p = 0.03). In addition, women in the study group had a significantly higher post partum infectious morbidity rate and endometritis than women in the control group [52.8% (47/89) vs. 37.1% (33/89) (p = 0.05); 18% (16/89) vs. 7.8% (7/89) (p = 0.03), respectively]. We conclude that intra partum MSAF should be considered as a potential marker for infectious morbidity in women with pre term labor and delivery.
Embryonal reduction using transvaginal saline injection in a sextuplet pregnancy after ovulation induction with human menopausal gonadotropin
Authors: Yaron Yuval , Botchan Amnon , Lessing Joseph B. , Peyser M. Reuben
Published: November 2007

A sextuplet pregnancy occurred in a first treatment cycle of ovulation induction with human menopausal gonadotropins. The serum 17‐β‐estradiol concentration was 1245 pg/ml on the day of human chorionic gonadotropin administration. Embryonal reduction of four fetuses was carried out at nine weeks gestation using a transvaginal ultrasound‐guided approach. Under general anesthesia, a 16‐gauge in vitro fertilization needle was introduced through the posterior fornix and uterine wall, into the nearest gestational sac. The embryo was penetrated and 0.9% saline solution was injected until disintegration was noted, and confirmed by a lack of pulse for more than two minutes. The same procedure was applied to the three embryos in closest proximity to the needle. The patient delivered healthy twins in the 34th week of gestation after having had pre‐term contractions for two weeks.
Accessory spleen presenting as adnexal mass
Authors: Azar Ghassan B. , Awwad Johnny T. , Mufarrij Ibrahim K.
Published: November 2007

Pelvic splenic ectopia is a very rare entity, often unsuspected preoperatively. We report a case of an ectopic spleen presenting as an adnexal mass in a middle‐aged woman. Diagnosis was achieved intraoperatively, and confirmed pathologically. Pelvic ectopic spleen should be considered in the differential diagnosis of adnexal masses.
A possible effect of ultrasound on RNA synthesis in cultured amniocytes
Authors: Zur Orit , Shneyour Yona , Dan Uzi , Chemke Juan , Shneyour Amir , Shalev Eliezer
Published: November 2007

The effect of both diagnostic and therapeutic ultrasound on cellular RNA synthesis was investigated in amniocytes cultured in F‐10 medium enriched with fetal calf serum. The rate of RNA synthesis was tested using incorporation of H3 uridine, which was added following the exposure to acid insoluble RNA. Cultured amniocytes which were not exposed to ultrasound served as the control. Different results were obtained following the two ranges of exposure. A significant decrease in RNA synthesis was demonstrated immediately following diagnostic ultrasound and a certain increase in RNA synthesis was demonstrated soon after exposure to therapeutic doses. These effects were transient and could not be shown 24 hours later. It is concluded that the routine use of ultrasound can not have any clinical implications on RNA synthesis.
First‐ and second‐trimester hemoglobin levels
Authors: Rasmussen Svein , Øian Pal
Published: November 2007

The computerized records of 3074 women who were delivered during the period 1987–1990 were analysed. We studied possible relations of birth weight and gestational age to maternal first‐ and second‐trimester hemoglobin levels. Birth weight and gestational age were taken as outcome variables in a multiple stepwise regression analysis, including factors that might interact with hemoglobin levels. A strong independent inverse correlation between the lowest second‐trimester hemoglobin and birth weight was observed. First‐trimester hemoglobin levels explained little with regard to birth weight, but had a small negative correlation to gestational age. For gestational age > 259 days we found a strong positive correlation between the first‐ to second‐trimester decrease in hemoglobin and birth weight.
Amniotic fluid epidermal growth factor concentrations
Authors: Hofmann Glen E. , Romaguera Josefina , Williams Robert F. , Adamsons Karlis , Norfolk V. A. , San Juan P. R.
Published: November 2007

Intra‐amniotic thyroxine (200–500 ug) was administered weekly to 29 women in the third trimester to enhance fetal maturation. Lecithin‐sphingomyelin ratio (L/S) and epidermal growth factor (EGF) were measured in amniotic fluid (AF) before (n = 58) and after (n = 92) administration of thyroxine. The AF L/S ratio and EGF concentration increased linearly with increasing gestational age both before (r = 0.76, p > 0.0001; r = 0.41, p > 0.001, respectively) and after (r = 0.62, p > 0.0001; r = 0.43, p > 0.001 respectively) initiation of thyroxine treatment. The slopes of gestational age vs L/S (0.07) and EGF (0.004) before T4 increased significantly after initiation of T4 therapy (L/S:0.23, p > 0.001; EGF:0.015, p > 0.01, respectively). L/S ratios correlated with AF EGF levels before (r = 0.77, p > 0.001) and after (r = 0.63, p > 0.001) initiation of T4 therapy. These results demonstrate that intra‐amniotic thyroxine accelerates not only the progression of the amniotic fluid L/S ratio, but the appearance of EGF.