bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in the Renin‐Angiotensin‐Aldosterone and Kallikrein‐Kinin Systems During Normal and Hypertensive Pregnancy
Authors: Karlberg Bengt E. , Rydén Gunnar , Wichman Klas
Published: December 2009

Abstract. We conducted a prospective and serial study of blood pressure (BP) and of the changes in the renin‐angiotension‐aldosterone system (RAAS) and of one factor in the kallikrein‐kinin system during normal pregnancy and in patients with pre‐existing or developing hypertension in pregnancy. Strict diagnostic criteria were used to define pre‐eclampsia (PE), essential hypertensives (EH) and other hypertension (OH) in pregnancy.

In normotensive pregnant women (n = 26) there was a rise in all components of the RAAS measured: plasma renin activty (PRA), plasma aldosterone concentration (PAC) and urinary aldosterone excretion (tU‐Aldo), from week 12 to week 20 of pregnancy, compared with non‐pregnant control subjects (n = 24) of similar age. Peak values were observed at week 30, whereafter fairly constant levels were maintained. Plasma and urinary aldosterone levels were increased 6‐10 fold. Urinary kallikrein excretion (tU‐Kall) was increased at weeks 12‐20, but at weeks 30‐36 roughly the same mean values were observed as for non‐pregnant control subjects.

On the other hand, different results were obtained in the hypertensive patients, especially those with PE (n = 18). PRA was depressed in the PE group to values about those observed in non‐pregnant control subjects. PRA was also significantly lower in the PE group than in EH (n = 8) or OH (n=16) groups. PAC and tU‐Ado were also much lower in PE patients than in normal pregnant women at comparable gestational ages, but not significantly different from EH patients, whereas those with OH had both PAC and tU‐Pldo values comparable to normal pregnant women.

In the PE group, tU‐Kall was significantly lower than for all other groups, but tU‐Kall values for EH and OH groups did not differ from those of normal pregnant women at the same gestational age.

We conclude that during normal pregnancy there is an early and very marked activation of the RAAS. Initially, the kallikrein‐kinin system also seems to be activated. With the development of or with pre‐existing hypertension, the activation of RAAS is diminished. The suppression of both renin and aldosterone is most obvious in PE. Concomitantly, tU‐Kall decreases in PE patients, which may contribute to the rise in BP due to diminished depressor activity of kinins.
The Influence of Different Positions and Korotkoff Sounds on the Blood Pressure Measurements in Pregnancy
Authors: Wichman Klas , Rydén Gunnar , Wichman Mette
Published: December 2009

Abstract. The influence of the patient's posture on the measurement of arterial blood pressure has been studied during pregnancy. The blood pressure (BP) measured on the right arm in the left lateral recumbent position is significantly lower than in the supine, sitting, or erect positions. This difference is assumed to be due to hydrostatic factors. The diastolic BP should be read off at Korotkoff IV because the hyperkinetic circulation during pregnancy causes a pronounced variation in BP values when measurements are performed at Korotkoff sound V. The roll‐over test seems inappropriate as a screening test to predict pre‐eclampsia, because of the numerous false‐positive tests. The importance of measuring the BP under standardized conditions during pregnancy in order to detect minimal changes in BP as indicative of pathophysiology in pre‐eclampsia is emphasized.
Characteristics of Hypertension in Pregnancy
Authors: Andersch Bjöm , Svensson Anders , Hansson Lennart
Published: December 2009

Abstract. During the period 1969‐73, 0.3% of 17000 unselected non‐diabetic pregnancies in our hospital were complicated by severe pre‐eclampsia, 0.6% by mild pre‐eclampsia and 0.6% by hypertension in pregnancy. Records from affiliated maternity centres and the hospital regarding these 261 women were studied and pertinent data assembled for comparison with 260 matched normotensive pregnancies. Instrumental deliveries were more common in all types of hypertensive pregnancy, with a 35% freqeuncy of caesarean section in severe pre‐eclampsia compared with fewer than 5% for controls. Significantly longer hospitalization and increased perinatal mortality were observed in hypertensive pregnancies, most pronounced in severe pre‐eclampsia. The combination of high blood pressure and proteinuria was associated with the greatest risk for premature birth, low infant weight and perinatal mortality. The overall incidence of hypertensive disorders in pregnancy was relatively low, 1.5%, but these women counted for a significant proportion of obstetric complications requiring hospitalization and instrumental delivery.
Labetalol for the Treatment of Hypertension in Pregnancy: Pharmakokinetics and effects on the uteroplacental blood flow
Authors: Nylund L. , Lunell N.‐O. , Lewander R. , Sarby B. , Thornström S.
Published: December 2009

Abstract. Plasma levels of labetalol were measured in 7 hypertensive pregnant women who were given 200 mg three times daily orally. The plasma concentrations were usually lower than those reported in the non‐pregnant state at a comparative dose. In 5 women the ratio between fetal and maternal plasma labetalol concentrations could be calculated at parturition. The median value of this quotient was about 50%. The effect of labetalol 1 mg/kg body weight intravenously was registered with functional placental scintigraphy. Fifteen women participated. A computer‐linked gamma camera above the uterus registered the radioactivity in the placental region after two intravenous bolus injections of 18.5 MBq indium‐113m chloride. From the radioactivity uptake curves, uteroplacental blood flow indices could be calculated before and 30 minutes after the labetalol injection. Despite a significant reduction in maternal blood pressure, no change in uteroplacental blood flow index was found. This could indicate that the vascular resistance in the maternal placental circulation was reduced by labetalol.
The Acute Effects of A Non‐Selective β‐Adrenergic Blocking Agent in Hypertensive Pregnant Rats
Authors: Karlsson Kirsten , Lundgren Yen , Ljungblad Ulf
Published: December 2009

Abstract. It is generally accepted that hypertensive cardiovascular complications can be prevented by treatment. However, during pregnancy, antihypertensive drugs might be hazardous in view of their influence on the fetus. Nevertheless, in spite of the diverging published results, even β‐blockers have been used in the pregnant patient. As our basic knowledge concerning the circulatory and fetal effects is minimal, we decided to elucidate the influence of the non‐selective β‐blocker, propranolol, on the haemodynamic circumstances in hypertensive pregnant rats. Renal hypertension was induced by clamping both renal arteries 4 weeks before pregnancy. Shortly before term, cardiac output was determined with the dye‐dilution technique and utero‐placental blood flow was determined with the microsphere technique, both before and after propranolol injection. Mean arterial pressure and heart rate were registered continuously. The acute propranolol injection reduced mean arterial pressure by 26%. This was due mainly to a 32% decrease in cardiac output, which in turn was due to a 24% decrease in stroke volume and a 6% decrease in heart rate. Both myometrial and placental blood flow decreased significantly, by 45 and 50%, respectively. It was furthermore of interest to observe the significant increase in blood flow resistance in both myometrium and placenta.

In conclusion, it can be stated that the non‐selective β‐blocker propranolol, which lacks intrinsic stimulating activity, reduces mean arterial pressure mainly by a cardiac output decrease. The present results further indicate that the influence on peripheral blood flow might be caused by cardiac output changes as well as by direct effects on the utero‐placental vascular bed.
Some Notes on the Hormonal and Haemodynamic Responses to Stressful Stimuli
Authors: Werner O.
Published: December 2009

Abstract. The symptoms of hypertension in pregnancy may be exacerbated by pain or other stressful stimuli, arising during labour. The anaesthetist has a part to play in alleviating these problems, through his knowledge of analgesic techniques. In addition, pre‐eclampsia sometimes necessitates delivery by cesarean section. Increases in arterial pressure during intubation and surgery may be poorly tolerated. Proper anaesthetic management of pre‐eclampsia therefore requires knowledge of circulatory and other, e.g. hormonal, responses to pain and other types of stress. The present paper gives a short review of these aspects.
Cardiovascular Changes in Pre‐Eclampsia
Authors: Carlsson Christer
Published: December 2009

Abstract. Pre‐eclampsia is associated with a hyperdynamic circulation (increased cardiac output, systemic vascular resistance) and increased mean arterial blood pressure, and a diminished plasma volume. Expansion of plasma volume without simultaneous measures on circulation or proper monitoring may be detrimental, leading to pulmonary and brain edema.
EFFECT OF LONG‐TERM THERAPY WITH ESTROGEN AND PROGESTERONE ON THE ENDOMETRIUM OF POST‐MENOPASUAL WOMEN
Authors: Varma T. R.
Published: December 2009

Abstract. We studied a group of 398 patients who had been receiving estrogen replacement therapy since 1976. Group I consisted of 138 patients who received Premarin (conjugated equine estrogen, Ayerst) in two different dosages (0.625; 1.25 mg) and progestational agents such as Neogest (Norgestrel, Schering), Duphaston (Dydrogesterone, Duphar) 5 mg and Primolut N (Norethisterone, Schering) 5 mg, for a period ranging between 7 and 21 days. Group II consisted of 106 patients who received Harmogen (Pipera‐zine Oestrone Sulphate, Abbott) in two different dosages (1.5 mg; 2.25 mg) with the above‐mentioned progestational agents for a period ranging between 7 and 21 days. Group III consisted of 154 patients who received Progynova (Oestradiol Valerate, Schering) in two different dosages (1 mg; 2 mg) with the above‐mentioned progestational agents for a period ranging between 7 and 21 days. When increasing dosages of estrogen with progestational agents were added for 7 days, this produced cystic hyperplasia of the en‐dometrium. When the duration of progestational agents was increased to 10 days or more, a more atrophic and secretory endometrium resulted and there was no incidence of cystic hyperplasia.
EFFECT OF ACUTE HYPOXIA ON HUMAN FETAL HEART RATE
Authors: Thaler Israel , Timor‐Tritsch Ilan E. , Blumenfeld Zeev
Published: December 2009

Abstract. The fetal heart rate response to acute hypoxemia was observed during an accidental drop in oxygen concentration inspired by the mother in labor. There was a marked increase in FHR variability in the early stage of hypoxia and also during the recovery phase. While an increase in fetal heart variability is generally considered to be a normal physiological event, it may also indicate a state of fetal hypoxemia associated with an intact fetal circulation, and should be treated with caution during labor.
MODE OF DELIVERY IN THE LOW BIRTH WEIGHT FETUS. DELIVERY BY CESAREAN SECTION INDEPENDENT OF FETAL LIE VERSUS VAGINAL DELIVERY IN VERTEX PRESENTATION
Authors: Westgren M. , Dolfin T. , Halperin M. , Milligan J. , Shennan A. , Svenningsen N. W. , Ingemarsson I.
Published: December 2009

Abstract. In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow‐up until 18‐24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p<0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.
NORMAL GROWTH OF THE FETAL BIPARIETAL DIAMETER AND THE ABDOMINAL DIAMETER IN A LONGITUDINAL STUDY
Authors: Eriksen Poul Sindberg , Secher Niels Jørgen , Weis‐Bentzon Michael
Published: December 2009

Abstract. Normal growth curves of the fetal biparietal diameter (BPD) and abdominal diameter (AD) were measured by ultrasound in 41 normal pregnant women who had had regular menstruation with a known last menstrual period. The women were studied longitudinally from the 13th‐14th week of gestation and thereafter every 2‐4 weeks until spontaneous onset of labor. The BPD curve proved to be uniform, with a deviation of 4.7 days (1 SD) before the 21st week. A 3rd‐degree polynomial was found to be adequate to describe the results for BPD and AD. The value of longitudinal studies is emphasized by the fact that by using the same curve with individual plateaus rather than a common curve, as most often reported in the literature, it is possible to reduce the variance for BPD and AD by 54% and 40% respectively. There was a difference of up to 7 days for the mean BPD value prior to the 24th week of gestation between the present results and previously published normal curves collected in cross‐sectional investigations. When calculating the mean fetal weight on the basis of measuring the BPD and AD, we found a linear correlation between the estimated fetal weight in the 3rd trimester and the duration of pregnancy (r = 0.99, p<0.001). The mean per‐centual difference in weight between the estimated and the actual weight was 1.2%±10.5% (1 SD), which is acceptable for routine clinical use.
Gynecological follow‐up of parkinsonian patients on long‐term bromocriptine treatment
Authors: Grönroos M. , Salmi T. , Erkkola R. , Liukko P. , Rinne U. K.
Published: December 2009

Abstract. Bromocriptine given for prolonged times at high doses has been found to induce tumors in the uterus in aged rats. To elucidate the possible tumorigenic effect of long‐term treatment with bromocriptine in humans, 35 women treated with this drug for chronic parkinsonism were studied. For each patient a gynecological anamnesis and examination were performed; one or several cervicovaginal smears and endometrial samples were also taken, by jet‐wash. No evidence of malignant changes was seen. Thus, in this respect bromocriptine would appear to be a safe drug, even for long‐term use.‐
TREATMENT OF ADVANCED ENDOMETRIAL CARCINOMA WITH CISPLATIN, CYCLOPHOSPHAMIDE AND DOXORUBICIN
Authors: Deppe Gunter , Liu Tian Lin
Published: December 2009

Abstract. A patient with advanced adenocarcinoma of the endometrium was treated with cisplatin, cyclophosphamide and doxorubicin. This regimen achieved surgically proved complete remission. No severe drug‐related toxicity occurred.
GYNECOLOGIC PRESENTATION OF PELVIC LYMPHOMA
Authors: Beckman E. Mark , Beller Uziel , Forman Jeffrey D.
Published: December 2009

Abstract. Advanced pelvic lymphoma is rarely encountered by the gynecologist. Two cases of pelvic lymphoma involving the reproductive tract are reported. Long‐term survival is achieved by minimal surgical intervention, correct histo‐logic examination and treatment with local radiation therapy and systemic chemotherapy.
GIANT CHORIOANGIOMA OF THE PLACENTA
Authors: Arodi J. , Auslender R. , Atad J. , Weill S. , Abramovici H.
Published: December 2009

Abstract. We report a case of giant chorioangioma of the placenta which was complicated by breech presentation, placenta praevia, hydramnios, toxemia and premature separation of the placenta. These complications are described separately in the literature as being associated with chorioangioma of the placenta, but rarely appear together in a single case.
BETA‐THROMBOGLOBULIN (β‐TG) AND PLATELET FACTOR 4 (PF4) IN OBSTETRICAL CASES
Authors: Arocha‐Piñango C. L. , Ojeda A. , López G. , García L. , Linares J.
Published: December 2009

Abstract. The plasma levels of β‐Thromboglobulin (β‐TG) and Platelet Factor 4 (PF4) were measured in patients during the normal obstetrical period and in pre‐eclampsia. A significant increase was observed in the two proteins with respect to the non‐pregnant control group but no difference was seen between pregnancy and puerperium in either the normal or pre‐eclamptic cases. The one significant variation in the concentration of the two proteins was a sharp rise during parturition. There was no correlation between β‐TG, PF4 and either the platelet count or creatinine but urea and uric acid did show a slight correlation with the two platelet proteins.
CHLAMYDIA, MYCOPLASMAS, UREAPLASMAS, AND YEASTS IN THE LOWER GENITAL TRACT OF FEMALES
Authors: Møller Birger R. , Jørgensen Annelise Sparre , From Ellis , Stenderup Aksel
Published: December 2009

Abstract. 162 women were investigated. Group I consisted of 85 women, who were partners to men with non‐gonococ‐cal urethritis (NGU) or presented macroscopic signs of cer‐vicitis; patients who had harbored Neisseria gonorrhoeae were excluded from the study. Group II was a control group of 77 women without any complaints from the urogenital tract and with normal findings at pelvic examination. All the women were tested for infection with Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealy‐ticum, and Candida albicans. In group I, chlamydiae and mycoplasmas were recovered in 44% and 36%, respectively, the corresponding figures for the control group (group II) being 5% and 19%. The difference is highly significant. No such difference between the two groups was found for ureaplasmas. Sixteen percent of the patients in group I were positive for C. albicans; 12% were positive in group II. Fifty per cent of asymptomatic NGU‐partners were chlamydia‐positive, and about one‐third of patients with either dysuria or vaginal discharge harbored the organism. No difference in the isolation frequency of mycoplasmas was observed between asymptomatic partners to male NGU carriers and women with increased vaginal discharge, whereas the organism was isolated more frequently from patients with dysuria. Fifty‐nine per cent of patients with cervicitis were chla‐mydia‐positive, compared with 30% of patients with normal cervical appearance and normal vaginal discharge. Samples obtained from the cervix were more often positive than samples from the urethra. In conclusion, if samples can be taken from only one of the two sites in patients with lower genital tract infection, the cervix is the optimal sampling site.
SERUM LIPIDS AND LIPOPROTEINS IN PATIENTS WITH ENDOMETRIAL CARCINOMA RECEIVING ADJUVANT TREATMENT WITH HYDROXYPROGESTERONE CAPROATE
Authors: Onsrud Mathias
Published: December 2009

Abstract. Serum levels of triglycerides, total cholesterol, and HDL‐cholesterol were determined in 57 patients who were undergoing treatment for stage 1 endometrial carcinoma. The patients belonged to a clinical trial where group A (control) was treated with surgery plus intravaginal irradiation, whereas group B in addition was treated with hy‐droxyprogesterone caproate (5000 mg i.m. as a loading dose followed by 1000 mg every 2 weeks for one year). In group B patients followed during the first 13 weeks of treatment, the level of serum triglycerides remained stable, whereas the level of total cholesterol and HDL‐cholesterol increased significantly. This increase could not, however, have been caused by the progestogen treatment, as similar changes were seen in group A patients followed for the same period of time. Long‐term effects were looked for in patient groups examined 3‐12 months after the start of treatment and in groups examined 3—6 months after the hormone therapy was stopped. In neither group could any significant difference in cholesterol or HDL‐cholesterol be found. It is concluded that this type of progestogen treatment causes no significant change in the levels of triglycerides, cholesterol, and HDL‐cholesterol.
LIPID METABOLIC STUDIES IN WOMEN WITH A POLYCYSTIC OVARY SYNDROME DURING TREATMENT WITH A LOW‐DOSE DESOGESTREL–ETHINYLESTRADIOL COMBINATION
Authors: Cullberg GÖRan , Hamberger Lars , Mattsson Lars‐Åke , Mobacken HÅKan , Samsioe GÖRan
Published: December 2009

Abstract. Twenty women with the polycystic ovary syndrome (PCO) were treated with a combination of deso‐gestrel and ethinylestradiol (EE) and the effects on lipids and lipoproteins were compared with those induced in a group of 13 regularly menstruating, healthy women. All women were examined before and after 3 months of treatment. Compared with the regularly menstruating women, the PCO women had significantly higher body weights and blood pressure as well as elevated levels of triglycerides in serum and VLDL. During treatment, 14 out of 20 women affected by PCO lost weight. No significant change in blood pressure was observed. In the PCO group, moderate increments were encountered in serum cholesterol, phospholipids and triglycerides. No significant changes were seen in LDL‐cholesterol or HDL‐cholesterol. The ratio LDL‐chol‐esterol/HDL‐cholesterol did not alter. The level of total cholesterol in VLDL rose during treatment. These changes in serum and lipoprotein lipids in PCO patients were of the same type and magnitude as those found in the control group, apart from an increase in HDL‐cholesterol in the latter. The only remaining difference after treatment was a slightly higher level of VLDL triglycerides in the PCO women. Thus only moderate changes were induced in lipid and lipoprotein patterns by the combination of desogestrel and EE. A “positive” influence on lipids and lipoproteins cannot be considered as a further advantage, added to the list of indications when hormonal treatment is used in PCO‐af‐fected women. The clinical implications of elevated triglycerides remain to be clarified.
BASAL CELL CARCINOMA OF THE VULVA
Authors: Simonsen Ernst , Johnsson John‐Erik , Tropé Claes , Alm Per
Published: December 2009

Abstract. A clinical and histopathologic study of material from a series of 21 patients with basal cell carcinoma treated from 1960 until 1979 are reviewed. In 3 patients ‘mixed’ tumor was recorded. The histopathologic diagnosis: baso‐squamous carcinoma and the behavior of this carcinoma are discussed. The mean age of the patients was 76 years. Presenting symptomatology consisted primarily of bleeding, burning or itching, and ulcerations. No case of pure basal cell carcinoma gave metastasis to the regional lymph nodes, in no case could the cause of death be attributed directly to this kind of lesion. A conservative approach consisting of wide local excision is suggested.
ANALGESIA AND MATERNAL SIDE EFFECTS OF PUDENDAL BLOCK AT DELIVERY
Authors: Langhoff‐Roos Jens , Lindmark Gunilla
Published: December 2009

Abstract. In a randomized double‐blind study, 1 048 women received pudendal block (PDB) at vaginal delivery, using three different local anesthetics: mepivacaine 1% plain, mepivacaine 1% with epinephrine, and bupivacaine 0.25% plain. The PDB was given transvaginally in doses of 8 ml × 2.

Mepivacaine – epinephrine was found to be more effective than the other local anesthetics. Loss of bearing down reflex after PDB was found in 31.2% of the mothers and most commonly when mepivacaine – epinephrine was used. Inhibition of labor was slightly more pronounced with mepivacaine‐epinephrine. The different durations of the local anesthetics did not affect the analgetic effect in clinical use. It is concluded that as the adverse effects on labor are quite common, PDB should not be given as a routine before delivery, but may be offered liberally when pain in the pudendal area is a main part of the pain of childbirth.
CORRELATION BETWEEN 2,3‐DIPHOSPHOGLYCERATE AND RED CELL MASS IN THE THIRD TRIMESTER OF PREGNANCY
Authors: Tsai Ching‐Hui , de Leeuw Nannie K.M.
Published: December 2009

Abstract. In 30 non‐anemic, and in 7 non‐thalassemic, anemic pregnant women the red cell mass (RCM) was determined at 32–36 weeks of pregnancy, using isotopes, and was correlated with red cell 2,3‐DPG, using the method of Keitt. The increase in 2,3‐DPG in pregnant women with low RCM was in the same range as in those with increased RCM. Thus, 2,3‐DPG can not be used to diagnose a RCM deficit in pregnancy. The relationship between 2,3‐DPG and RCM in the third trimester was complex: in the 7 anemic women there was an inverse relationship, which failed to reach statistical significance, probably because of the small number of cases; in the 30 non‐anemic women there was a significant, positive correlation between 2,3‐DPG and RCM. The cause of this positive relationship needs further investigation.
CORRELATION BETWEEN NEWBORN GASTRIC ASPIRATE MICROVISCOSITY AND GESTATIONAL AGE
Authors: Luerti M. , Castiglioni M. , Zavattini G. , Canonica S. , Salmona M.
Published: December 2009

Abstract. Fluorescence polarization (FP) values were determined in 59 samples of amniotic fluid and in 56 samples of newborn gastric aspirate, collected from the 28th to 41st week of gestation. Both amniotic fluid and gastric aspirate FP values showed a significant correlation respectively with gestational age (r = 0.77; p<0.01 and r = 0.50; p<0.01). The two regression. lines were parallel (F = 0.052; p = 0.8046). Mean FP of gastric aspirate were about 0.05 lower than those of amniotic fluid. One infant whose gastric aspirate FP value was 0.342 developed RDS.
BLADDER TUMOR AS APPARENT CAUSE OF VAGINAL BLEEDING IN PREGNANCY
Authors: Bendsen J. , Meller‐Ernst K. , Povey G.
Published: December 2009

Abstract. The purpose of publishing this case story concerning macroscopic hematuria during pregnancy, is to draw attention to causes of bleeding in the pregnant. The cause in this case was found to be a papillomatous tumor originating from the bladder. This is emphasized as a possibility in the differential diagnosis from other causes of hemorrhage during the third trimester.
GRANULOSA‐THECA CELL TUMOR IN A ONE‐YEAR‐OLD INFANT
Authors: Lessing J. B. , Michowitz M. , Baratz M.
Published: December 2009

Abstract. A case is presented of a 12‐month‐old female infant, with sexual precocity due to a Granulosa‐Theca cell tumor which presented with vaginal bleeding, breast development and pubic hair growth. The 17β‐estradiol levels prior to operation were 300 pg/ml. Levels of gonadotropins were undetectable. Postoperative estradiol levels were measured and found to be 10 pg/ml. This tumor is very rare in infants, and there have been only four previously reported cases in children under 2 years of age.
A CASE OF PRIMARY OVARIAN PREGNANCY
Authors: Maeyama Masao , Inoue Satoru , Yoshikawa Atsushige , Tooya Toshimitsu , Iwamasa Teruo
Published: December 2009

Abstract. This report describes a 40‐year‐old woman with primary ovarian pregnancy which was mistaken clinically and grossly for germ cell tumor of the ovary, since it was associated with a high level of serum α‐fetoprotein (278 ng/ml) and with excretion of urinary hCG (1000 IU/1). The ovarian mass measured 10 × 10 × 11 cm, and weighed 215 g. Total hysterectomy and bilateral salpingo‐oophorectomy were performed. The bisected specimen revealed a centrally located macerated fetus with a crown –rump length of 3.5 cm.
OVARIAN STEROID PRODUCTION IN A WOMAN WITH POLYCYSTIC OVARY SYNDROME ASSOCIATED WITH ENDOMETRIAL CANCER
Authors: Dennefors Bo L. , Knutson Folke , Janson Per Olof , Jansson Inge , Hamberger Lars
Published: December 2009

Abstract. A young woman with typical polycystic ovary syndrome (PCO) underwent laparotomy for moderately differentiated endometrial cancer. Specimens from the hyper‐plastic thecal and stromal tissue of the ovaries were incubated for 2 hours in the presence or absence of hCG, 100 IU/ml. Following incubation the tissue content of cyclic AMP and the amounts of progesterone (P), androstene‐dione (A), testosterone (T) and estradiol‐17β (E2) in the incubation medium were analysed. For comparison, thecal cells from normal ovaries of regularly menstruating women were incubated under identical conditions. In vivo, the PCO ovaries secreted several‐fold greater amounts of T than normal ovaries. In vitro, the thecal cells were much more active, steroidogenically, than the stromal cells of the PCO ovary. Furthermore, the hyperplastic thecal cells of the PCO ovary produced several‐fold greater amounts of an‐drogens, and appeared more sensitive to stimulation with hCG, as compared with thecal cells from normal ovaries. The results indicate that in women with PCO associated with endometrial cancer the hyperplastic thecal cells are a significant site of abnormal androgen production and abnormal sensitivity to gonadotropin.
CYCLICAL MOOD CHANGES AS IN THE PREMENSTRUAL TENSION SYNDROME DURING SEQUENTIAL ESTROGEN‐PROGESTAGEN POSTMENOPAUSAL REPLACEMENT THERAPY
Authors: Hammarbäck Stefan , Bäckström TorbjöRn , Hoist Juhani , von Schoultz Bo , Lyrenäs Sven
Published: December 2009

Abstract. The etiology of the cyclical mood changes seen in the premenstrual syndrome is still unknown. A close relation to the luteal phase has been shown. One of the differences between the follicular and the luteal phase is the higher plasma progesterone concentration during the luteal phase. The present investigation has been conducted to study the effect of exogenously administered estrogen/gestagen sequential postmenopausal replacement therapy on mood and physical signs.

Twenty‐two women requiring postmenopausal estrogen treatment were recruited and divided into two groups. Eleven women were given estradiol treatment only (Oestro‐gelR creme 3 mg percutaneously/day) for 21 days with a subsequent break of 7 days. The other 11 women were in addition given progestagen (Lynestrenol, OrgametrilR 5 mg/‐day) during the last 11 days of treatment. The women were asked to keep a daily record of their mood, using a visual analogue scale earlier tested in women with premenstrual syndrome. They also kept a record of physical signs and sexual feelings. The records were kept for between one and 6 months.

The group with estrogen treatment only did not show any cyclical worsening in mood or physical signs during the treatment. The women who in the latter stage of the estrogen treatment cycle also received progestagen, showed significant cyclicity in both moods and physical signs, with a maximum symptom degree during the final days of gestagen treatment. The negative mood change started 1–3 days after the progestagen was added to the treatment. The results suggest that progestagens are involved in the provocation of cyclical symptom changes seen in the premenstrual syndrome.
BROMOCRIPTINE INHIBITION OF HYPERPROLACTINEMIA DURING SURGERY
Authors: Jullien Y. , Rochette A. , Desch G. , Descomps B. , du Cailar J.
Published: December 2009

Abstract. The material included two groups of 10 women undergoing diagnostic laparoscopy. General anesthesia was administered by injection of 0.1 mg fentanyl followed by infusion of propanidide‐succinylcholine. The control group received no medication prior to surgery, whereas patients in the experimental group were given 5 mg bromocriptine per os. Blood samples for prolactin determinations were drawn as the patients were placed on the operating table and immediately following surgery. The association of anesthesia and surgery caused prolactin levels to rise from 10.9±3.5 to 168+18.7 ng.ml−1 in the control group (p <0.001) and from 3.5±0.5 to 7.5±1.1 ng.ml−1 in the test group (p<0.001). A significant difference was noted between the two groups for their pre‐ and postoperative levels and prolactin response (p<0.05, p<0.001 and p<0.001, respectively). The proposed protocol successfully suppresses prolactin increase during surgery and constitutes a useful tool for investigating hyperprolactinemia and its consequences during this same time. Possible applications include in vitro fertilization and studies on prolactin receptor‐bearing tumors.
RITODRINE AND TERBUTALINE COMPARED FOR THE TREATMENT OF PRETERM LABOR
Authors: Kosasa Thomas S. , Nakayama Roy T. , Hale Ralph W. , Rinzler Gary S. , Freitas Cora A.
Published: December 2009

Abstract. A prospective study comparing intravenous rito‐drine and terbutaline was initiated to assess the efficacy of each drug in arresting preterm labor. Delivery was delayed for 25.8 days in patients treated with terbutaline and 13.0 days in patients treated with ritodrine. Patients treated with terbutaline gave birth to infants with a mean birthweight of 2 588 grams and 60% achieved a gestation of 36 weeks. Patients treated with ritodrine gave birth to infants with a mean birthweight of 2 392 grams and 39% achieved a gestation of 36 weeks. From this study it is evident that parturition was more effectively delayed in women treated with terbutaline than in a similar group of women treated with ritodrine.
AN EVALUATION OF ROUTINE EARLY PREGNANCY ULTRASONOGRAPHY
Authors: Imoedemhe D. A. G. , Mitford E. , Chan R. , Djahanbakhch O.
Published: December 2009

Abstract. A review of 1 000 pregnancies in which routine early pregnancy scanning was performed is reported. Ultrasound predicted accurately (to within ±14 days) the date of confinement in more than 90% of women who were unsure of their dates. Clinical estimation of gestation age compared well with ultrasound report in 90% of singleton pregnancies. Scanning diagnosed 3 out of 4 lethal congenital abnormalities in early pregnancy. The diagnosis of multiple pregnancy and placenta praevia have no immediate clinical implication in early pregnancy. Early pregnancy scan is recommended for women who are uncertain of their last menstrual period and for those with identified early pregnancy risks. Routine use of ultrasonography in early pregnancy should be related to the identified need of the population served and should be employed with caution. Where the policy of routine scanning is adopted, optional information is obtained when the procedure is carried out between the 14th and 18th week of gestation. Clinical pelvic examination in early pregnancy remains a valuable practice for the estimation of gestational age.
ADVANCED PREGNANCY IN THE RUDIMENTARY HORN OF A BICORNUATE UTERUS
Authors: Liang S. T. , Woo J. S. K. , Tang L. C. H. , Wong R. L. C.
Published: December 2009

Abstract. Ultrasound was useful for the diagnosis of advanced pregnancy in the non‐communicating rudimentary horn of a bicornuate uterus. The role of ultrasonography in early diagnosis of this condition in order to improve fetal salvage was discussed.
FETAL HYDROTHORAX AND BILATERAL PULMONARY HYPOPLASIA
Authors: Peleg Dan , Golichowski Alan M. , Ragan William D.
Published: December 2009

Abstract. Bilateral pulmonary hypoplasia associated with hydrothorax is an unexplained entity. The purpose of this study was to evaluate an ultrasonic diagnostic approach towards this problem. Antenatal screening of pregnancies at risk for fetal hydrothorax, early detection of suspected hypoplasia and active management might afford the fetus adequate pulmonary function to support extra‐uterine life.
EFFECT OF PHARMACOLOGICALLY ACTIVE AGENTS UPON THE HUMAN MYOMETRIUM IN VIVO
Authors: Joelsson Ingemar , Rydnert Jan
Published: December 2009

Abstract. Smooth muscle is capable of contracting in response to mechanical distension. Even though the structural basis for this phenomenon is not completely clear, a method has been designed by which the contractile response to mechanical distension of the human uterine muscle can be determined in vivo. The distension is enforced sinusoidally within the frequency range 0.006— 1 Hz, by filling and emptying a rubber balloon introduced into the uterine cavity. A tonometric index of the myometrium is defined using Hook's law after the approximate evaluation of a contratile modulus and the tangential stress and strain in the innermost layer of the uterine wall. The regression lines of tonometric indices upon frequency are determined and intercepts of the equations for basic conditions are compared with those obtained during the administration of pharmacologically active agents.

In a pilot study, this system, now modified for the evaluation of drug effects during early pregnancy, has been tested and found reliable.
CONCENTRATION OF UNCONJUGATED ESTRIOL IN CAPILLARY WHOLE BLOOD FROM PREGNANT WOMEN
Authors: Axelsson Ove , Hofstedt Margareta , Wide Leif
Published: December 2009

Abstract. A radio‐immunological method applied to the estimation of unconjugated estriol in capillary whole blood is described. The concentration of unconjugated estriol in capillary whole blood and venous serum from 35 pregnant women was measured. Close relation was found between values in venous serum and capillary whole blood. The intra‐assay variation was 4.9% for venous and 7.8 % for capillary whole blood samples when analysed in duplicate. The day‐to‐day variability was of the same order for venous (10.0%) as for capillary (8.4%) samples. It is concluded that unconjugated estriol can be measured in small amounts (25 μl) of capillary whole blood and that this method offers practical advantages over methods using venous serum or plasma.
CRITICAL EVALUATION OF METHODS FOR ELECTRON MICROSCOPY OF CERVICAL MUCUS
Authors: Ulstein Magnar , Myklebust Reidar
Published: December 2009

Abstract.the ultrastructure of cervical mucus has been studied by scanning (SEM) and transmission (TEM) electron microscopy. the images differ according to the methods used for preparation; different patterns were found in the same sample when the freeze‐drying and critical point‐drying methods were used for SEM.

When using TEM, the specimen appeared more homogeneous, with fine fibrils and granules. This accords with the theory that the cervical mucus consists of a randomly entangled fibrillar network. Electron microscopy of cervical mucus requires preparation procedures which involve considerable risk of creating artefacts. in our experience the TEM technique produces fewer artefacts and therefore gives pictures more true to the in vivo situation.
INTRAMUSCULAR ADMINISTRATION OF HYDROXYPROGESTERONE CAPROATE IN PATIENTS WITH ENDOMETRIAL CARCINOMA
Authors: Onsrud Mathias , Paus Elisabeth , Haug Egil , Ørstad Kjell K.
Published: December 2009

Abstract. A radio‐immunoassay for the determination of the serum concentration of hydroxyprogesterone caproate (HPC) was established. After a single intramuscular injection of 1 000 mg, the mean serum level reached its maximum (44–81 nmol/1) after 2–7 days. Patients on long‐term adjuvant HPC treatment (consisting of 1000 mg daily for 5 days followed by 1000 mg every 2 weeks) presented peak hormone levels 2 weeks after commencing treatment. After a drop at 5 weeks, the mean serum level slowly increased again to 130 nmol/1 after 25 weeks of treatment. Patients being treated with weekly injections had significantly higher serum levels than those treated every 2 weeks. Considerable inter‐individual differences were observed. the serum concentrations of HPC measured in this study compare favorably with those previously found in patients treated with medroxyprogesterone acetate. the patients on adjuvant HPC showed no significant change in the levels of cortisol, dehydroepiandrosterone sulphate, androstenedione, or estrone during the first 25 weeks of treatment.
AN INCIDENT OF BILATERAL MASTODYNIA AFTER THE MENOPAUSE
Authors: Kallner Gunnar
Published: December 2009

Abstract. A 54‐year‐old postmenopausal woman is described who quite suddenly experienced intense tenderness and tension in both breasts lasting for about 3 weeks. Subsequently she had a uterine bleeding. Excessively increased levels of estradiol (peak value 2 325 pmol/1) were found during the period of mastodynia. Seven months previous to this event, hyperthyroidism had been diagnosed. She had, however, been treated with porpylthiouracil and was euthyroid long before and during the period of mastodynia.
SOME ANTHROPOLOGICAL ASPECTS OF THE CLIMACTERIC SYNDROME
Authors: Samsioe Göran , Bryman Inger , Ivarsson Elisabeth
Published: December 2009

Abstract. The female climacteric is known from the literature for centuries. Certain signs are obvious, but some symptoms are deliberately concealed by many women as they are regarded askance by herself and by society at large. Only very recently did knowledge of the psychological and physiological processes involved in the female climacteric reach the point of medical science. This has been accompanied by a more open attitude on the part of society towards climacteric problems of various kinds. The number of newspaper articles dealing with the climacteric, books with advice for climacteric women and courses on the management of climacteric symptoms is steadily growing. The fear for and the fear of climacteric symptoms have therefore declined among the population and a substantial number of women now consult their doctors to obtain relief. For Sweden, only the last decade has involved programmes for climacteric women. Such programmes comprise not only hormonal replacement therapy but also in addition attempts to increase knowledge among women and in society as well as efforts to obtain a social, psychological and physical wellbeing.
THE HORMONAL SITUATION IN THE PERIMENOPAUSAL PERIOD
Authors: Nilsson Lars
Published: December 2009

Abstract. Follicular function starts in the foetal ovary in the 20th week of gestation and continues until or shortly past the menopause. Luteal steroid production occurs only during the fertile period. After the menopause only stromal steroid production continues in the ovary and is probably increased by the increase in gonadotropin levels. The changes in hormonal levels and effects in the pre‐, peri‐ and postmenopausal years are described as a function of these changes.
ESTROGENS AROUND THE MENOPAUSE
Authors: von Schoultz Bo
Published: December 2009

Abstract. Estrogen substitution around the menopause has rapidly become a major indication for hormonal treatment and its benefits are obvious to the clinician. A prompt relief of vasomotor symptoms generally occurs during treatment and nervous and sexual disorders often improve considerably. Regardless of which one of the numerous estrogen treatment regimens available is used, it enables many women to cope better with their daily life. On the other hand all estrogens, when given in sufficient therapeutic amounts, will also produce a systemic metabolic response. Effective estrogen treatment thus gives rise to a multitude of biological effects in many different organs and systems. At present, one main problem is the difficulty of quantifying both beneficial effects and hazards. Furthermore it is often difficult to distinguish the valid symptoms of estrogen deficiency from those of ageing and the effects of social, environmental and emotional problems of the middle‐aged woman.
CONTINUOUS TREATMENT WITH A COMBINATION OF ESTROGEN AND GESTAGEN—A WAY OF AVOIDING ENDOMETRIAL STIMULATION
Authors: Staland B.
Published: December 2009

Abstract. Nearly 5 years' experience of continuous treatment with a preparation consisting of natural estrogens combined with norethisterone acetate is presented. The effect on both climacteric symptoms and hormonal parameters was good, even though the endometrium remained atrophic or became so. This was the case even when the endometrium was hyperplastic and/or atypical prior to treatment. This treatment appears to be better than those in common use—at least in selected cases.
THE INFLUENCE OF HORMONAL REPLACEMENT THERAPY ON LIPID AND LIPOPROTEIN METABOLISM
Authors: Crona N. , Silfverstolpe G. , Samsioe G.
Published: December 2009

Abstract. The widespread use of exogenous sex steroids for contraception, treatment of climacteric deficiency symptoms, etc., has led to the development of new compounds and combinations. Before new combinations of exogenous sex steroids or new steroidal compounds are introduced in clinical practice, evaluation of possible adverse metabolic effects should be mandatory.
DOES ESTROGEN REPLACEMENT THERAPY PREDISPOSE TO THROMBOSIS?
Authors: Åstedt Birger
Published: December 2009

Abstract. Several studies have been carried out to evaluate the risk of thrombosis when using contraceptive steroids (for reference, see Åstedt 7). The estrogenic component of oral contraceptives (OC) has been held responsible for a thrombogenic effect (18, 22, 31). Similar extensive epidemiologic studies dealing with the risk of thrombosis when using climacteric substitution therapy are not available. However, the Boston Collaborative Drug Surveillance Program (38) was unable to show any relationship between estrogen replacement therapy and thrombosis.
LACK OF EFFECT OF ARBAPROSTIL ON THE HUMAN NON‐PREGNANT UTERUS
Authors: Reele S. B. , Euler A. R. , Hanover C. K. , Lookabaugh J. L.
Published: December 2009

Abstract. Arbaprostil ((15R)‐15‐methyl Prostaglandin E2) is being studied for the treatment of gastrointestinal illness. To determine its effect on the human uterus, eight sterilized pre‐menopausal women were studied during the proliferative phase of their menstrual cycle. Using a microtransducer catheter, intra‐uterine pressures were recorded for at least 30 minutes prior to and 2 hours after arbaprostil administration. Each subject was studied four times, at 48‐hour intervals, receiving in a double‐blind manner; 0,10, 25, and 50 μg. Arbaprostil at doses up to 50 μg was found not to have any clinically significant effects on the non‐pregnant human uterus.
NO EFFECT OF VITAMIN B‐6 AGAINST PREMENSTRUAL TENSION
Authors: Hagen Inger , Nesheim Brittingjerd , Tuntland Tove
Published: December 2009

Abstract. Vitamin B‐6 100 mg given daily throughout the menstrual cycle was compared with placebo in a randomized, double‐blind crossover trial in 34 women who suffered from premenstrual tension. Vitamin B‐6 was no better than placebo. There was a substantial period effect, as the women evidenced a considerable preference for the second drug they received, irrespective of whether this was vitamin B‐6 or placebo. Blood magnesium was measured; no significant difference was found between the 34 women with premenstrual tension and 10 healthy women without such complaints. Vitamin B‐6 caused a small but statistically significant rise in blood magnesium level. In the individual patients, no correlation was found between changes in blood magnesium and premenstrual symptoms.
Serum Lactoferrin and C‐Reactive Protein in Mother and Newborn After Preterm Rupture of Membranes
Authors: Gutteberg Tore Jarl , Askvik Kjell , Jørgensen Trond
Published: December 2009

Eleven of 15 serum lactoferrin (S‐LF) values and all 16 C‐reactive protein (CRP) values were significantly elevated in cases of premature rupture of the amniotic membranes (PROM). There was no correlation between values of C‐reactive protein and lactoferrin in either mothers or their newborn. The difference in C‐reactive protein between mothers and their newborn was significant, but this was not the case with serum lactoferrin. This suggest that there is no transplacental transfer of C‐reactive protein, even in preterm rupture of the membranes, and this is probably also the case with lactoferrin.