bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Exogenous Estrogens On Lh and Fsh Secretion in Women with Hypothalamic Amenorrhea
Authors: Smiljanić Nikola
Published: December 2009

Abstract. The effects of estradiol on FSH and LH secretion in 5 women with hypothalamic amenorrhea are presented. the functional capacity of the pituitary to secrete FSH and LH had been proved by testing with synthetic luteinizing hormone‐releasing hormone (LH‐RH) 100 μg i.m. the thyroid and adrenal functions were normal. in 3 patients estrogens were low‐normal and in the other 2 extreme hypoestrogenism was found. Twelve days after the appearance of withdrawal bleeding each patient was given 10 mg estradiol benzoat (EB) i. m. in 3 patients a significant increase in the LH and a slightly smaller increase in the FSH concentration were noted, with an LH peak 60 to 84 hours after injection of EB. the first of these 3 patients became pregnant, in the second the biphasic BBT curve, urine pregnanediol excretion above 2.5 mg/24 hr and the histological finding of secretory endometrium indicated that ovulation had been successfully induced, while in the third patient, despite a satisfactory increase in the LH and FSH concentrations, ovulation could not be induced. in the remaining 2 patients no increase in the LH and FSH concentrations was noted even as late as % hours after the injection of EB. in these women bleeding began on the 18th and 22nd day of the cycle, respectively, when histological examination revealed proliferative endometrium. the first 3 cases are classified as hypothalamic amenorrhea with dysfunction of the cyclic centre and the other 2 as hypothalamic amenorrhea with dysfunction of the tonic centre. the effect of exogenous estrogens in patients with hypothalamic amenorrhea depends both on the functional capacity of the hypophysis and the capacity and condition of the tonic and cyclic centres in the hypothalamus.
Value of External Version in Fetal Malpresentation in Combination with Use of Ultrasound
Authors: Ylikorkala Olavi , Hartikainen‐Sorri Anna‐Liisa
Published: December 2009

Abstract. During 1969–1974 six hundred and forty‐nine external versions were attempted during the last trimester on 491 mothers with fetal malpresentation. the procedure was monitored with ultrasound in 1969–1974. Most of attempts (70.0%) were made during the 32nd–36th weeks. the final version rate after one or more attempt was 76.2%, being lower (67.0%) in nulliparous than parous women (84.6%). the incidence of breech presentation at birth decreased from 4.5 to 2.9% (p<0.001). the most serious complication was one premature labor but the infant survived. the perinatal mortality was 2.0% and, after excluding abnormal infants, 0.8%. the combination of external version and the use of ultrasound is a safe method which avoids hazardous vaginal breech delivery and is recommended in obstetric practice.
URETHRAL PRESSURE PROFILE BEFORE, DURING AND AFTER PUBOCOCCYGEAL REPAIR FOR STRESS INCONTINENCE
Authors: Öbrink A. , Bunne G. , Ulmsten U. , Ingelman‐Sundberg A.
Published: December 2009

Abstract. In two groups of women the urethral pressure profile was recorded using a microtransducer catheter. Both groups were of approximately the same age, one consisting of continent women, the other of women with severe stress incontinence. Sixteen stress incontinent women were examined before and after pubococcygeal repair and 10 of these were also examined during the operation. The two groups were compared for differences in the urethral pressure profile in the continent and incontinent states. The stress incontinent women had a significantly shorter functional length of the urethra (10 mm) but the same maximal urethral pressure as continent women. Remarkable changes in these parameters were seen during the operation. However, at the examination 3 months postoperatively, they had totally disappeared. The only change in the urethral pressure profile which persisted after the operation was a higher pressure in the proximal part of the urethra, so that a urethral maximal pressure plateau had been established. This plateau was also seen, on a higher level, in the continent state.
IMMUNOCHEMOTHERAPY IN ADENOCARCINOMA OF THE OVARY
Authors: Kalpaktsoglou P. K. , Ioannidou G. B. , Kondyli A. P. , Lekou S. I. , Papaconstantinou D. , Comninos A. C.
Published: December 2009

Abstract. Immunochemotherapy combined with total hysterectomy was used in the treatment of 21 cases of adenocarcinoma of the ovary, of which 7 were in stages Ic–IIb, 8 in stage III and 6 in stage IV. Another 6 cases had irradiation with or without hysterectomy, or various other schemes of treatment prior to immunochemotherapy. The immunotherapy depends on stimulation of the humoral and cellular immunity by a battery of antigens (Te, Di–Te, influenza, mumps). Chemotherapy starts by administration of cyclophosphamide three days after each course of immunotherapy. Each course of immunochemotherapy is followed by a period of 10 days free from any medication. The stimulation of the immune mechanism with B. C. G. starts 10 days after the 4th course of immunochemotherapy. This last course of treatment is repeated up to the end of the first year of immunochemotherapy. The same annual scheme of treatment is constantly repeated. The patients are under constant clinical and laboratory follow‐up. The cyclophosphamide is discontinued when ever the WBC falls below 4500 to 4000 per cmm. All patients receive vitamins A, E, C and B complex. All our cases of stages Ic–IIb, and III, with total hysterectomy and without any prior treatment, showed a progressive recovery and are living normal lives. The lymphocytes, the immunoglobulins and the E rosettes returned, in most of our cases to normal levels. The favourable results and the survival rate obtained in cases of cancer without distant metastasis may be attributed to the reduction of the tumour masses by surgery, to the administration of antigens prior to chemotherapy, which seems to diminish the side effects of cyclophosphamide, to the administration of cyclophosphamide in small daily doses to avoid leukopenia and, finally, to the fact that patients are under continuous protective immunochemotherapy.
VAGINAL AGENESIS
Authors: Salvatore Carlos Alberto , Lodovicci Orlando
Published: December 2009

Abstract. This study of 90 cases of vaginal agenesia showed the following results: 50% of the patients sought medical advice when between 16 and 20 years of age; 71.1 % of the patients were not married; amenorrhea was present in 100% of the cases, with hypogastric pains in 20%; the uterus was not palpable clinically in 77.7% of the cases; 77.7% of the patients had total agenesis, 11.1% had partial agenesis and 7.7% had homatometra; through laparotomy, 75.5% were found to have normal ovaries, 92.5% of the cases were histologically normal; laparotomy showed the uterus as solid rudimentary in 55.5% of the cases and absence of the uterus in 24.4% of the cases; the Fallopian tubes were normal in 32.22% of the cases and rudimentary in 46.6%; excretion urography disclosed renal anomalies in 17.5%; surgical treatment by the Mclndoe technique, carried out in 90 cases, gave 90.5% satisfactory results; the follow‐up made between one and 5 years, in which the long‐term use of an acrylic mould is recommended in those who do not have sexual relations, showed permanence of the satisfactory results in 91.3% of the cases, of which 83.3% were after one operation only; neovaginal cytology, done between one and 6 years, showed 72.2% of the cases with acidophyl cells between 5 and 20% with acidophily between 21 and 40%.
Effect of fasting on blood glucose of parturient and her full term infant
Authors: Ikonen R. S. , Hagman E. , Pystynen P.
Published: December 2009

The series consists of 100 parturients and their full term infants. According to the fasting time of the parturients before delivery the series was divided into three groups: Group I, fasting from 6 to 12 hours (49); Group II, from 12 to 18 hours (38); and Group III, over 18 hours (13 parturients). The blood glucose level of the mothers was examined immediately after delivery, and that of their infants at birth and at the age of two and six hours. There were no significant differences between the mean blood glucose level of the mothers in different fasting groups: 5.0±0.8 mmol/1 in Groups I and II, and 5.2±0.9 mmol/1 in Group III. There was a significant positive correlation between the blood glucose level of infants at birth and that of their mothers (r 0.44, p<0,001). The blood glucose level of the infants at the age of two and six hours did not correlate to that of their mothers. Blood glucose of the infants was lowest at the age of two hours (mean 2.510.6 mmol/1), and there was no significant difference between the groups at any age. Hypoglycaemia (blood glucose less than 1.7 mmol/1) was found in 15 cases (15%). Four were treated because of symptomatic hypoglycaemia.
Ultrastructure of human umbilical veins: observations on veins from newborn children of smoking and nonsmoking mothers
Authors: Asmussen Inger
Published: December 2009

Abstract. The umbilical vein was chosen as a possible model for evaluating the vascular injury provoked by tobacco‐smoking in humans. Umbilical veins from newborn children of 4 nonsmoking and 4 heavy‐smoking mothers were examined in the transmission electron microscope. Severe changes were present in the intima and media of veins in the heavy‐smoker group. Pronounced edema was found in the subintimal space, combined with destruction of intimal elastic membranes, a marked decrease in collagen content and a proliferative reaction of the myocytes. Similar changes have been observed in animal studies involving exposure to carbon monoxide, hypoxia or nicotine. The present study supports the concept that tobacco‐smoking is harmful to the human vascular system and illustrates the mechanism through which the vascular injury is provoked in heavy smokers. The study also indicates that tobacco‐smoking causes severe damage during pregnancy to the cord. Similar pronounced changes might be expected in the newborn children of smoking mothers. Tobacco‐smoking should therefore be abandoned during pregnancy. Smoking during pregnancy carries a high risk for the fetus, including an increased risk of abortion and stillbirth, as well as death soon after delivery. It is also well established that the average weight of newborn children of smoking mothers is 150–300 g less than that of those born to nonsmoking mothers (1, 5, 11, 12, 17). The present study evaluates the ultrastructural changes found in the umbilical veins of newborn children of heavy‐smoking mothers compared with a control group.
Seasonal Birth Pattern in Sweden in Relation to Birth Order and Maternal Age
Authors: Sandahl Björn
Published: December 2009

Abstract. The influence of both maternal age and parity on seasonal birth patterns in Sweden was studied, using the Swedish Medical Birth Register for 1973. The register contained reports of 109342 pregnancies. A test for seasonality, using a squared sinus function and an analysis of variance, was performed for each age and parity group. Significant differences were shown for parity irrespective of age and age groups within parity groups. There was one exception: no influence of parity could be demonstrated in women more than 35 years of age. For the lowest and the highest age groups (all parities), there was no significant seasonality in birth rate tested by the squared sinus method. This was also true for parity 3 (age group 20–24) and parity 1 (age group 30–34). The other age groups and parity classes show a significant seasonality with a maximum of births in April and May.
Changes in Bone Mineral Content in Women with Natural Menopause During Treatment with Female Sex Hormones
Authors: Dalén Nils , Furuhjelm Mirjam , Jacobson Bertil , Lamke Bertil
Published: December 2009

Abstract. The bone mineral content was determined in eleven women with a natural menopause by X‐ray spectrophotometry during treatment with a combination of estrogens and a gestagen. During a three‐year follow‐up period the hormone treated women significantly increased (P<0.05) their mineral content by 3% a year on average, as compared with a control group. Even in patients who had passed the menopause several years previously, the increase occurred and was particularly great during the first year of treatment.
Amniotic fluid phosphatidylinositol and phosphatidylglycerol: I. Normal pregnancies
Authors: Skjáraasen J. , Stray‐Pedersen S.
Published: December 2009

Abstract. Phosphatidylinositol (PI) and phosphatidylglycerol (PG) appear normally in the amniotic fluid during the last weeks of pregnancy. The present study indicated as have previous studies (5, 6, 8, 10) that these phospholipids are linked to the surfactant system in the fetal lung.

The concentrations of lecithin (L), PI, PG and sphingomyelin (S) were measured in 207 samples from 165 normal pregnancies. The augmentation in PI was found to parallel that in lecithin, and the PI/S ratios reached maximum values at about 36 weeks of gestation. The augmentation in PG appeared about two weeks later.

Eleven premature infants who contracted respiratory distress syndrome (RDS) had significantly lower PG concentrations than 15 premature infants with no RDS (p < 0.01). No correlation to the PI concentrations could be observed. All but one of the 11 affected infants had low L/S ratios.
Intrauterine progesterone contraceptive system as an alternative in cases where conventional iud's are unsuitable
Authors: Ylöstalo P. , Rantakyla P. , Järvinen P.A. , Kauppila E.
Published: December 2009

Abstract. A progesterone intrauterine device (IUD), ProgestasertR, was prescribed for 25 patients unable to use an ordinary non‐hormonal IUD. Both the amount of menstrual bleeding and the discomfort was observed to decrease more often than increase during the period of use of the progesterone IUD. Hemoglobin, hematocrit and the serum iron levels either remained static or increased. Continuation rate was 76 per cent after one year. The authors consider ProgestasertR a suitable alternative to the ordinary non‐hormonal IUD in women with dysmenorrhea or menorrhagia and those in whom a previous IUD had been associated with pain or increased menstruation.
X/X translocation and turner's syndrome in a woman with climacterium praecox
Authors: Nielsen Johannes , Kristoffersen Erik , Homma Akira
Published: December 2009

Abstract. A woman with X/X translocation is presented, and the association between the different types of X/X translocation and Turner's syndrome as well as the question of menstruations and fertility in women with Turner's syndrome are discussed. It is concluded that streak gonads should most probably not be included in the definition of Turner's syndrome.
PLASMA PROGESTERONE, SERUM ESTRIOL AND PLASMA HPL DETERMINATIONS DURING THE LAST TRIMESTER TO DETECT CHANGES BEFORE SPONTANEOUS LABOR
Authors: Ottesen B. , Lebech P. E.
Published: December 2009

Abstract. Conflicting results have been published regarding changes in plasma progesterone during the last trimester of pregnancy. Some have demonstrated a fall in plasma progesterone before labor, and this has been taken as a possible explanation of the onset of labor. It has been suggested that the various results could be due to differences in methods for progesterone determination.

In this study the progesterone levels were determined by both RIA and CPB. In 11 women the plasma progesterone, human placenta lactogen, and serum estriol were measured weekly during the last trimester of normal pregnancies and immediately after delivery. All samples were analysed radioimmunologically. In order to compare the radioimmunoassay and competitive protein binding techniques (RIA and CPB), the progesterone levels were determined by both methods. This was also done for 80 successive plasma progesterone routine samples drawn from women who were not pregnant or who were in the early stages of pregnancy.

Both methods showed a significant rise in the plasma progesterone level during the last 6 weeks before spontaneous labor. However, the values obtained were lower when assayed by CPB than by RIA, presumably because of a higher specificity and a cross reaction in RIA.

Serum estriol exhibited increasing values throughout pregnancy, but without a significant rise during the last few weeks.

Plasma HPL settled at a constant level during the last few weeks before labor.
SEGMENTAL EPIDURAL ANALGESIA FOR LABOR AND DELIVERY
Authors: Gal D. , Choudhry R. , Ung K. A. , Abadir A. , Tancer M. L.
Published: December 2009

Abstract. A study to evaluate segmental epidural analgesia in labor is described. Bupivacaine (0.25 per cent) was used during the first stage of labor and for the second stage, either 3 per cent ‐ Chloroprocaine delivered through the catheter (Group I) or 1 per cent Lidocaine as a perineal infiltrate (Group II) was used. There were 124 full term patients of whom, 36 were nulliparous and 88 were multiparous. The effects of segmental epidural analgesia on maternal blood pressure, pain relief, preservation of lower limb motor power, duration and progress of labor, and fetal outcome were evaluated. Pain relief during the first stage of labor was satisfactory in 114 (92 per cent) of the patients. There were no significant changes in maternal blood pressure, motor power in lower limbs, efficiency of uterine contractions and internal rotation of the presenting part when analgesia was effective. The use of 2‐Chloroprocaine for second stage pain relief required low forceps delivery in 84 (91 per cent) patients, as compared to 14 (44 per cent) patients that had 1 per cent Lidocaine local infiltration. Fetal outcome, was excellent in all cases in that the one minute Apgar score was never lower than 7.
Menstrual Regulation as a Method for Early Termination of Pregnancy
Authors: Mandelin Matti , Karjalainen Olavi
Published: December 2009

Abstract. 116 women with documented or suspected pregnancy underwent an endometrial aspiration for early termination. Their menses delay was between 7 and 22 days. A standard 3 mm Vabra® aspirator was used. 90.5% were actually pregnant. The success rate was 97.1%. The total complication rate was 6.8%, the most common complication being endometritis. Three patients required a re‐evacuation because of prolonged bleeding. In this series there were two ectopic pregnancies and nine cases of ovum abortivum, of which one later turned out to be a hydatiform mole. The procedure was well tolerated by the patients. No sick‐leave was given. The postoperative bleeding averaged 10 days in primigravid and 7 days in parous patients.
Prophylactic Salpingo‐Oophorectomy in Cancer of the Cervix
Authors: Bremme Katarina , Einhorn Nina
Published: December 2009

Abstract. It is considered that the presence of infection during the course of treatment for cancer of the cervix can have a bearing of the prognosis (3, 5, 6, 7, 9, 14, 22). In a number of series the survival rate has been lower for such patients suffering from pelvic infection than it has for those without such infection. That agressive treatment of infection during the therapy can greatly improve the survival rate was observed by Heyman (9) and Kottmeier (14). Irrespective of the stage reached in the treatment of the cervical cancer, Kottmeier recommended immediate salpingo‐oophorectomy in patients with acute salpingitis (15). He reported that this measure improved the 5‐year survival rate for these patients from 14 to 66% (15). He also reported 5‐year survival rates of 21 and 56% for patients with and without infection, respectively (14).

It has been debated whether, in view of the supposed hormonal dependence of cervical cancer (8, 19), the improvement of the survival rate for patients undergoing elective salpingo‐oophorectomy might be due to the hormonal consequences of removing the ovaries (15). Arising out of these discussions, an investigation was undertaken in 1958 of the effect of prophylactic salpingo‐oophorectomy. This operation was performed in all patients less than 60 years of age with cancer of the cervix, starting in 1959. It was carried out prior to their admission to the Department of Gynaecological Radiotherapy (15). The measure was discontinued in 1961 because an increase was observed in the incidence of intestinal complications.

Since the introduction of antibiotic therapy the incidence of severe pelvic infections has diminished. Still it was considered that an analysis of this logically designed series might throw light on infection prophylaxis and possibly also on a hormonal influence in carcinoma of the cervix.

The prognosis for cancer of the cervix is held to be poorer in younger women (2, 4, 10, 18, 21) and the explanation may lie in the hormonal activity of the ovaries. If this is the case the survival rate would presumably be higher for patients undergoing oophorectomy than in a control group where the ovaries had not been removed. It was also considered that an analysis of the case material might show whether, and to what extent, the incidence of radiation reactions is influenced by the fact that surgery has been performed prior to radiotherapy.
EFFECTS ON FETAL BREATHING MOVEMENTS OF MATERNAL CHALLENGES
Authors: Maršál Karel , Gennser Gerhard , Löfgren Olof
Published: December 2009

Abstract. Ten women in the last trimester of a normal pregnancy were subjected to five different loads in a cross‐over study. Fetal breathing movements (FBM), fetal heart rate (FHR), maternal heart rate (MHR), and mean arterial pressure (MAP), maternal transcutaneously measured pO2 (Tc‐pO2), and the energy supply to the Tc‐pO2 electrode were recorded continuously before, during, and after the load. Maternal capillary pH and pCO2 were measured at three representative time points. The immediate responses of the incidence of FBM to the different challenges were: increase after dynamic work (bicycle test); no change after static work (isometric muscle contraction) and passive movements; decrease after hyperventilation and hyperoxygenation. FHR was unaffected by all challenges. The FBM incidence varied in parallel with pCO2 after dynamic work and hyperventilation and inversely with the Tc‐pO2 rise caused by hyperoxygenation. Maternal pH was increased after passive movements (no change in FBM) and after hyperventilation (decreased incidence of FBM). FBM seem to be more sensitive to environmental changes than is the FHR. Mechanical stimuli to the uterus were not responsible for the augmentation of FBM seen after the bicycle test. The present observations reveal the multifactorial nature of the regulation of FBM, and support the role of CO2 as a major stimulator of breathing movements also in prenatal life.
PREGNANCY COMPLICATIONS FOLLOWING CONIZATION OF THE UTERINE CERVIX (II)
Authors: Weber Tom , Obel Erik B.
Published: December 2009

Abstract. The effect of conization upon the course of pregnancy and the fertility has been evaluated. 44 women had a total of 66 pregnancies following conization. These 44 women were compared with an age‐matched group of non‐conized women, as well as with a group of non‐conized women matched for both age and parity.

There were more smokers among conized than among non‐conized women. All other descriptive variables were found to be without significant differences between the groups compared.

There was no significant difference in the frequency of spontaneous and induced abortion, prematurity or cesarean section between conized and non‐conized women. The second stage of labor was found to be protracted in conized women.

Fertility judged by the “latent period” ‐ the time elapsed from the couple started sexual intercourse without use of contraception to the present pregnancy ‐ showed no difference between conized and non‐conized women.

We conclude that although a greater number of patients is necessary to permit definite conclusions concerning the risk of pregnancy and delivery complications in conized women, it is of special interest that the present study did not demonstrate an increased risk of spontaneous abortion nor of prematurity.
AMNIOTIC FLUID CELL EXFOLIATION IN EARLY HUMAN PREGNANCY
Authors: Bergström Staffan
Published: December 2009

Abstract. An ultrasctructural study of amniotic epithelium and fetal periderm was undertaken in order to investigate the exfoliative capacity in these tissue surfaces in early human pregnancy. Contrary to earlier reports, no exfoliation could be detected from amniotic epithelium, while a heavy detachment of cells and cell fragments was observed from fetal skin. The importance of meticulous tissue preparation is obvious; detachment phenomena are easily produced artifactually by tissue scrapings and improper tissue preparation for morphological investigations.
THE EFFECT OF MISSED ABORTION AND SPONTANEOUS ABORTION ON THE FATE OF SUBSEQUENT PREGNANCIES
Authors: Levin S. , Amsterdam E. , Brook I. , Insler V.
Published: December 2009

Abstract. Sixtytwo patients with spontaneous abortion and 58 with missed abortion were all promptly treated with curettage. The reproductive performance and the subsequent fertility of both groups during a five year period before and after the abotion were compared. To our surprise, no significant differences were found between the two groups.
HETEROGENEOUS RESPONSE OF DISSEMINATED HUMAN OVARIAN CANCERS TO CYTOSTATICS IN VITRO
Authors: Tropé C. , Aspegren K. , Kullander S. , Åstedt B.
Published: December 2009

Abstract. Cell suspensions from nine human ovarian primary cancers, their metastases and ascitic cells were treated in vitro with amethopterin and melphalan. Effects were measured by incorporation of H3‐TdR or H3‐UdR into the cells. There was significant heterogeneity of cytostatic effects on cells from the three sources in a given patient. Ascitic cells did not represent a “mean” of the cancer cell clones. The implications of these findings should be considered if cytostatic in vitro prediction tests are used to guide cytostatic treatment of patients.
DETERMINATION OF MYOMETRIAL TENSION DURING LABOR BY COMBINED MICROTRANSDUCERU IUP‐RECORDING AND ULTRASONIC EXAMINATION OF THE UTERINE CAVITY
Authors: Ulmsten U. , Andersson K.‐E. , Lindström K. , Persson P.‐H.
Published: December 2009

Abstract. In twelve women, in whom labor was induced by oxytocin infusion, intra‐uterine pressure (IUP) was recorded by micro‐transducers, and simultaneously the diameter of the uterine cavity was estimated by means of ultrasound. Myometrial tension was calculated according to the law of Laplace. In the ten women who were delivered within eight hours after the start of induction, myometrial tension was clearly higher than in the two in whom induction failed. No technical problems were encountered during the registrations, which in some cases lasted for more than five hours. It is suggested that with the described technique, a more accurate determination of myometrial activity is possible than with the generally used methods for IUP recording. The technique might facilitate evaluation of drug effects on the uterus during labor, and improve the IUP‐part of intrapartum clinical monitors.
Is there a physiological intravascular coagulation in obstetrical cases?
Authors: Arocha‐Pinango C. L. , Linares Jesús , Cova Armando , Martínez Paul
Published: December 2009

Abstract. The concentrations of plasmatic fibrinogen and its degradation products (FDPs), and the paracoagulation test using serial dilution of protamine sulphate (SDPS) were determined during the third trimester of pregnancy, labor, and puerperium. Significant increases in the concentrations of fibrinogen and FDPs were observed throughout the process of pregnancy and birth, combined with both positive and negative SDPS tests. We suggest that these findings do not indicate a process of physiological DIC.
Squamous cell carcinoma in situ from the uterine cervix to the distal end of the fallopian tube
Authors: Punnonen Reijo , Gronroos Matti , Vaajalahti Pekka
Published: December 2009

Abstract. An unusual case of squamous cell carcinoma of the uterine cervix is described in which spread occurred intraepithelially along the endometrium and one of the fallopian tubes. This marked superficial extension is an example of abnormal spread of a malignant tumour whose prognostic significance is unknown.
Multichannel intrauterine pressure recording by means of microtransducers
Authors: Ulmsten Ulf , Andersson Karl‐Erik
Published: December 2009

Abstract. Intrauterine pressures (IUP) were recorded simultaneously at the fundus, the isthmus, and cervix uteri by means of three micro‐transducers (in 20 healthy, nonpregnant women, and in 5 patients with severe, primary dysmenorrhoea). Recordings were performed during the first 3 days of the menstrual cycle. Both incoordinate and coordinated myometrial activity was recognized. When coordination was present, the contraction wave as a rule started in fundus and was propagated towards the isthmus and cervix. Pinching and/or palpation of the cervix elicited retrograde contractions, i.e. the contraction wave started in the cervix and moved towards the fundus. It was frequently observed that during vigorous contractions of the fundus, the pressure increase in the isthmus was small; in some cases even a decrease in pressure occurred in this region. The pressure recording technique functioned perfectly during all recordings and seems to facilitate detailed studies of myometrial activity in the non‐pregnant uterus.
OVULATION INHIBITION WITH DIFFERENT DOSES OF LEVONORGESTREL* AND OTHER PROGESTOGENS: CLINICAL AND EXPERIMENTAL INVESTIGATIONS
Authors: Spona J. , Schneider W. H. F. , Bieglmayer Ch. , Schroeder R. , Pirker R.
Published: December 2009

Abstract. Model systems were evaluated, which can be used to determine biological activities of progestogens at various cell levels of the anterior pituitary gland. in addition, various progestogens at different dose levels were tested in females to evaluate the ovulation inhibition dose. the association of progestogens with the cytosol receptor of the adenohypophysis of the rat was studied in vitro. Sucrose gradient centrifugation analysis revealed material sedimenting in the 4‐5 S and 6‐7 S region, resp., and both binding proteins were found to specifically bind progestogens. a small displacement by cortisol was observed in the 4‐5 S area. Relative affinity constants were estimated for various progestogens by incubation of cytosol samples with radioactive labeled progestins, and a close correlation between affinity and biological activity was recorded. Adult female rats seven days after castration were used to study the influence of various progestogens on LH‐RH stimulated gonadotropin release. Levonorgestrel was found to augment LH‐RH provoked LH release in vivo, whereas both basal as well as LH‐RH stimulated FSH serum levels were noted to be impaired at higher doses of the steroid. Similarly, δ15‐levonorgestrel was observed to increase the response of LH to LH‐RH. on the other hand, δ15‐levonorgestrel greatly augmented basal as well as LH‐RH induced FSH serum levels up to a dose of 10 μg. At 100 μg of δ15‐levonorgestrel FSH serum levels were suppressed again. But, only 1/3 of the levonorgestrel dose was necessary to produce these effects, i. e. δ15‐levonorgestrel was found ca. 3‐times more potent than the native progestogen. Experiments performed in a cell culture system of anterior pituitary cells revealed an impairment of LH‐RH stimulated gonadotropin release. LH and FSH release was suppressed to 40 and 50%, resp., at ED50 of LH‐RH in the presence of 3×10−8M levonorgestrel. LH and FSH release was reduced to 50 and 70%, resp., when anterior pituitary cells were incubated with LH‐RH in the presence of 3×10−8M δ15‐levonorgestrel. Thus, cell culture experiments also suggested that the potency of the δ15‐derivative of levonorgestrel was ca. 3‐times more potent. Analysis of patterns of cervical scores and karyopyknotic index as well as of serum levels of 17β‐estradiol, progesterone, LH and FSH revealed a borderline ovulation inhibition dose of levonorgestrel and δ15‐levonorgestrel at 50 and 30 μg, respectively. Cyproterone acetate, which is used in an oral contraceptive to treat acne and hirsutism was found to inhibit ovulation at a borderline dose of 1 mg. the present data combine to suggest that all model system are efficient to evaluate new progestogens, and that δ15‐levonorgestrel exerts a some 3‐times greater biological activity than levonorgestrel itself. Thus, a dose reduction of the progestogen component in oral contraceptives seems to be possible.
EFFECTS OF THREE DIFFERENT COMBINATIONS OF ETHINYL ESTRADIOL AND LEVONORGESTREL ON PLASMA LIPIDS AND HIGH DENSITY LIPOPROTEINS
Authors: Larsson‐Cohn Ulf , Wallentin Lars , Zador Göran
Published: December 2009

Abstract. Seventy‐five menstruating women seeking contraceptive advice were randomly allocated to treatment with combined oral contraceptives containing either ethinyl estradiol 30 μg+levonorgestrel 150 μg (30/150), ethinyl estradiol 50 μ+levonorgestrel 125 μg (50/125) or ethinyl estradiol 50 μg+levonorgestrel 250 μg (50/250). the concentrations of cholesterol, phospholipids, high density lipoprotein (HDL)‐cholesterol, HDL‐phospholipids and triglycerides were determined prior to treatment and after one, three and six months of medication. Triglycerides increased by 18‐42 per cent after one to six months of treatment with 50/125. the HDL‐cholesterol and HDL‐phospholipids were reduced by 10 per cent during 50/250 medication. No other parameters showed any consistent alteration in any of the treatment groups. Raised triglyceride concentration and/or decreased HDL concentration may increase the risk for cardiovascular disease. It is therefore suggested that in order not to alter the HDL concentration a combined oral contraceptive agent should probably not contain more 19‐nortestosterone type of progestogen than corresponding to 125‐150 μg of levonorgestrel. to avoid a rise of the triglyceride level the weight relation between levonorgestrel and ethinyl estradiol should be about 5:1.
TREATMENT OF POST‐MENOPAUSAL HYPERCHOLEROLAEMIA WITH ESTRADIOL
Authors: Tikkanen M. J. , Kuusi T. , Vartiainen E. , Nikkilä E. A.
Published: December 2009

Abstract. Replacement therapy with estradiol valerate in 29 post‐menopausal women reduced low‐density lipoprotein (LDL) cholesterol concentrations by 22% and increased high‐density lipoprotein (HDL) cholesterol by 21% after 12 months. Apart from a 67% increase of HDL‐triglyceride estradiol had only a slight effect on the levels of lipoprotein triglycerides. Post‐heparin plasma lipoprotein lipase (LPL) activity was significantly decreased in subjects with normal pre‐treatment very‐low‐density lipoprotein (VLDL) triglyceride levels, and hepatic lipase (HL) activity was significantly decreased in the group as a whole. It is suggested that estradiol replacement therapy should be considered in climacteric women with high LDL‐cholesterol or low HDL‐cholesterol levels, or both.
SIDE‐EFFECTS OF PROSTAGLANDIN SYNTHETASE INHIBITORS
Authors: Andersson Karl‐Erik
Published: December 2009

Abstract. A short review is given of some of the adverse reactions to prostaglandin synthetase inhibitors. Broadly, these side‐effects can be divided into those common to the whole group, and those more or less characteristic of the individual drugs. Among the former, symptoms from the gastrointestinal tract and from the central nervous system are the most conspicuous. Skin reactions, bronchospasm, and serious blood dyscrasias have been reported for several of these drugs and the list of more rare side‐effects is long. It is concluded that drugs like phenylbutazone and oxyphenbutazone should not be used for treatment of dysmenorrhea because of the risks of serious adverse reactions. However, even if among the newly introduced compounds none can be said to be free from risks, some seem to have an acceptable ratio between therapeutic efficacy and side‐effects.
Pharmacokinetic Studies on Low Dose Estradiol 17β Administered Orally to Postmenopausal Women
Authors: Sipinen S. , Lähteenmäki P. , Luukkainen T.
Published: December 2009

Peripheral plasma from four postmenopausal women was analysed for estrone, estradiol, luteinizing hormone and follicle stimulating hormone during 24 hours following an oral intake of a single dose of 1.0 mg micronized estradiol, on the first day of therapy and after one month. A similar study was carried out with another four postmenopausal patients, who received 0.2 mg estradiol three times daily. The measurements were performed by radioimmunoassay (RIA).

It is concluded that the plasma concentrations of estrone and estradiol are higher and those of FSH lower after one month of therapy than on the first treatment day, while plasma LH remains unchanged. Micronized estradiol is rapidly absorbed from the gastrointestinal tract and converted to estrone, and the plasma profiles of estrone during the day are more constant with a divided daily dose than with a single higher dose. The divided daily dose results in an equally good clinical effect even though the total administration of estradiol is lower.
Do Estrogen and Progesterone Receptors (E2R and PR) in Metastasizing Endometrial Cancers Predict the Response to Gestagen Therapy?
Authors: Benraad Th. J. , Friberg L. G. , Koenders A. J. M. , Kullander S.
Published: December 2009

In a prospective investigation biopsy specimens were obtained of 150 women with primary, untreated endometrial carcinoma for determination of the content of estrogen and progesterone receptors (E2 and PR). After a varying interval 13 who developed metastases despite routine surgical and radiation therapy received treatment with gestagens. The clinical effect of the hormone was studied for any correlation with the initial content of E2 and PR.

Eight of the women (61–71 years) proved E2R positive (> 10 fmoles/mg cytosolprotein), 2 had no PR and the remaining 6 had PR in a concentration of 7–892 fmoles/mg cytosolprotein). 7 responded clinically to gestagen therapy (tumors poorly differentiated in 3 and moderately in 4).

Five of the women (50–84 years) were E2R negative; they had no PR, they did not respond to gestagen therapy and died after 2–8 months (tumors poorly differentiated in 2 and moderately in 3).

Determination of E2R and PR in endometrial carcinoma appears to be a clinically useful test for predicting whether a patient is likely to respond to treatment with gestagens.
The Effect of Cervical Encerclarge on Uterine Dimensions
Authors: Levin S. , Brook I. , Feingold M. , Insler V.
Published: December 2009

Observation of women who underwent cerclage of the uterine cervix in pregnancy indicated that during the first 24 hours after operation a marked increase of the uterine size takes place.

Since this feature came rather as a surprise, seventy one cases were studied carefully.
Correlation of Fetal Heart Rate Patterns with Umbilical Artery pH and Catecholamines During Last Hour of Labor
Authors: Bistoletti P. , Lagercrantz H. , Lunell N.‐O.
Published: December 2009

Fetal heart rate (FHR) patterns were analysed during last hour of labour and correlated to umbilical artery pH and catecholamine (CA) levels. Fetuses with pathological FHR had significantly higher levels of CA than those with normal FHR. Particulary high levels were found in fetuses with bradycardia and late decelerations.

FHR was further analysed by a computer (DPAC, data processor and computer) in 100 women during last hour of labor. No correlation between deceleration areas or variability and umbilical artery pH and CA was found. It is concluded that although there is a good correlation between the general FHR‐pattern and umbilical artery CA and pH it is impossible to quantify the degree of fetal distress by calculation of deceleration areas and variability.
Controlled Sodium Bicarbonate Infusion and Maternal Acid‐Base Balance During Labor
Authors: Ron‐El Raphael , Caspi Eliahu , Modai David
Published: December 2009

The effects of a controlled sodium bicarbonate (S.B.) infusion on the acid‐base balance of primiparas in normal labor and delivery were studied and compared to a similar control group of primiparas without S.B. infusion. Beginning at 6 cm cervical dilatation, 2mEq of S.B./kg of total body weight were infused to patients in the study until full cervical dilatation. The dosage given to this group emerged from a study of base deficit dynamics and space distribution of S.B. in a control group of patients during labor and delivery.

Significant variations in pH, base excess, and plasma bicarbonate were observed, beginning 44±19 minutes after the S.B. infusion. These variations in acid‐base parameters persisted for 10 minutes following delivery.

While no adverse effects were observed in our patients, this experimental design represents a preliminary approach toward correcting deleterious fetal acid‐base variations during labor and delivery.
Effect of Dihydroergotamine on Coagulation Factors and Components of the Fibrinolytic System
Authors: Svanberg Lars , Bernstein Kurt , Kullander Stig , Åstedt Birger
Published: December 2009

Dihydroergotamine (DHE) was given to 20 gynecological patients, 0.5 mg i.m. preoperatively and again every twelfth hour for 7 days. No cases of thrombosis occurred as judged by the 125I‐fibrinogen test. Increased concentrations, but within normal range, were found for fibrinogen, factor VIII activity and related antigen, plasminogen and antithrombin III and decreased concentration for α2‐macroglobulin. The fibrinolytic activity of the wall of a superficial hand vein was not suppressed, which otherwise occurs postoperatively. Together with the increased concentration of antithrombin III this might explain the potentiating effect of DHE on prophylactic treatment with low‐dose heparin.
Effects of Ethinylestradiol/D—Norgestrel Combinations on Serum Lipoproteins
Authors: Rössner Stephan , Frankman Olle , Marsk Lars
Published: December 2009

Serum lipoproteins were analyzed in 33 young women (mean age 22 years) before and after two cycles of treatment with one of the following ethinylestradiol/d‐norgestrel combinations (μg/μg): 30/150, 50/150 and 50/250. A slight but significant weight increase of 1.2 kg was found only in the 50/150 group. All three hormone combinations had similar effects on the lipoproteins. Before treatment all subjects had normal lipoprotein concentrations. Whole serum triglyceride (TG) and cholesterol concentrations were not significantly affected. In the whole group the LDL‐TG concentration increased from 0.24 to 0.33 mmol/l (p<0.001) and HDL‐cholesterol fell from 1.54 to 1.35 mmol/l (p<0.001). Smokers tended to have lower HDL‐cholesterol than non‐smokers. It is possible that HDL reductions for longer periods of time may be one of the factors that promote the development of atherosclerotic manifestations in young women on oral contraceptives.
Amenorrhea Following Oral Contraception
Authors: Smiljanić N. , Ciglar S. , Bistricki J.
Published: December 2009

In 21 patients with amenorrhea after taking oral contraceptives, the urinary excretion of estrogens and the plasma concentrations of LH, FSH and prolactin were determined. In five of these women the amenorrhea was accompanied by galactorrhea. Ten of the 21 patients had had origomenorrhea before contraceptive therapy. The progesterone test was negative in 9 patients and clomiphene test was negative in 10 patients. The urinary excretion of estrogens and plasma LH and FSH values were low normal while the prolactin concentration in group A (amenorrhea without galactorrhea) amounted to 12.8±2.4 μg/l of plasma and in group B (amenorrhea with galactorrhea) to 85.4±15.8 μg/l (p>0.01). The pituitary response to 100 μg synthetic LH‐RH i.m. was similar to that found in the early follicular phase of the ovulatory cycle and showed that the pituitary was capable of synthesizing and secreting LH and FSH. Two of the three women from group A who wanted to become pregnant conceived under the therapy with Clomid and HCG. In all women from group B, in response to Parlodel (bromocriptine) therapy administered in 5‐mg dose daily, the plasma concentration of prolactin decreased to a normal level, galactorrhea ceased within 15–62 days, and menstruation resumed within 38–75 days. In three women it is very probable that the cycle became biphasic, and a previously clomiphene negative patient became a clomiphene responder.
Spontaneous Rupture of the Liver in Pregnancy
Authors: Westergaard Lars
Published: December 2009

A case of spontaneous rupture of the liver in pregnancy, fatal to mother and child, is described. The patient, a multiparous, 36‐year‐old diabetic, presented in the 27th week of pregnancy with upper abdominal pains resembling biliary dyskinesia. After 8 hours' observation in the hospital she suddenly developed hypovolaemic shock and fetal heart tones disappeared. On acute cesarean section a dead fetus was delivered. Hemoperiteoneum was present, arising from a huge subcapsular hematoma of the right lobe of the liver, with rupture of Glisson's capsule. The hematoma was evacuated and tears in the liver parenchyma sutured. Disseminated intravasal coagulation complicated the early postoperative cause. A bacterial infection supervened later and the patient died in a septic stage on the 19th postoperative day. The literature is reviewed, and it is pointed out that greater awareness of the diagnosis could lead to better timing of surgery and an improved prognosis for mother and child.
A LONGTERM ISOTOPE RENOGRAPHY FOLLOW‐UP OF PATIENTS FOLLOWING PREGNANCY COMPLICATED BY PRE‐ECLAMPSIA AND HYPERTENSION
Authors: Laakso L. , Jalkanen M. , Castréean O. , Suonio S.
Published: December 2009

Abstract. 61 patients were studied with the renography and urography during puerperium ten years ago and now again. The technique and analyses were identical. The results showed that some of these parameters (SV, K, and T 1/2) were either decreased or prolonged more than ten per cent during this period in nearly all cases. However, these changes occurred in both the normal and complicated groups without any correlation with the original diagnosis from the first study. Hypertension has developed in 10 per cent of the toxemic group.
PROGESTERONE AND HUMAN CHORIONIC GONADOTROPHIN IN SERUM AND PREGNANDIOL IN URINE IN THREATENED ABORTION
Authors: Hertz Jens B. , Larsen Jöurgen Falck , Arends Jöourgen , Nielsen Jan
Published: December 2009

Abstract. Progesterone and human chorionic gonadotrohin (HCG) in serum and pregnandiol in urine were measured in 64 patients admitted to hospital because of threatened abortion. Blood samples were taken and urine specimens collected at regular intervals during admission and after discharge during the rest of the pregnancy. A reference range was worked out for each hormone based on the hormone values obtained from the pregnancies proceeding to term. The predictive significance of values within and below the reference range was determined, for the initial sample and for serial samples. An association between hormone levels and outcome of pregnancy was observed but it is concluded that both single and serial determinations of progesterone and pregnandiol and serial determinations of HCG are unsatisfactory for the evaluation of threatened abortion. However, an initial progesterone value below the reference range and HCG values below 10000 mlU/ml between the 8th and 15th week of pregnancy was in every case always followed by spontaneous abortion. A hormonal test of fetoplacental origin is recommended for monitoring threatened abortion.