bluuebunny/crossref_metadata_2025 huggingface dataset:
Social support in elderly patients with bipolar disorder
Authors: Beyer John L , Kuchibhatla Maragatha , Looney Chris , Engstrom Elena , Cassidy Frederick , Krishnan K Ranga R
Published: March 2003

Objective:  The role of social support in bipolar disorder is poorly understood. It is known that young and middle‐aged patients with impaired social support are more likely to be treatment resistant and have increased hospitalization. However, the role of social support in elderly patients with bipolar disorder has not been studied. Our purpose was to evaluate social support in older adults with bipolar disorder compared with peer controls and younger bipolar patients. In addition, we looked at the role of social support in the age of illness onset.

Methods:  We evaluated social support of 29 older subjects with bipolar disorder (age 50 or older) and 56 younger subjects with bipolar disorder using the Duke Social Support Index, comparing them to non‐psychiatric, peer controls. Using logistic regression we then examined the relationship of demographic, social support factors, and age of onset.

Results:  Both older and younger bipolar subjects perceived their social support as inadequate (OR=14.98; OR=9.05) compared with similar aged controls. Younger bipolar subjects also had less social interactions than younger controls (OR=4.63). These findings remained significant when controlled for gender, marital status, race, and education. No significant differences were noted between early‐onset and late‐onset bipolar subjects.

Conclusions:  Older and younger bipolar patients have decreased perceptions of social support than older controls. No effect was found based on the age of illness onset. In addition, younger subjects had less social interactions than peer controls.
Do we need placebo control in maintenance studies in bipolar disorders?
Authors: Vieta E
Published: March 2003

Vieta E. Do we need placebo control in maintenance studies in bipolar disorders?  Bipolar Disord 2002: 4(Suppl. 1): 61. © Blackwell Munksgaard, 2002
Limits of the applicability and generalizability of drug trials in mania
Authors: Licht Rasmus W
Published: March 2003

Licht RW. Limits of the applicability and generalizability of drug trials in mania.  Bipolar Disord 2002: 4(Suppl. 1): 66–68. ©Blackwell Munksgaard, 2002

During recent years, the majority of drug trials in mania have been conducted for the purpose of drug approval. On this background, this paper addresses to what extent these trials may actually provide the practising clinician with useful information. One major point is that selection prior to the point of randomization in RCTs in mania may limit the applicability of study results to patients seen in ordinary clinical practice. Limitations in study credibility and study design are also discussed. The need for large scale pragmatic studies using broad inclusion criteria, comparing the various treatments, alone or in combination, is emphasized.
Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients
Authors: Schärer LO , Hartweg V , Valerius G , Graf M , Hoern M , Biedermann C , Walser S , Boensch A , Dittmann S , Forsthoff A , Hummel B , Grunze H , Walden J
Published: March 2003

Schärer LO, Hartweg V, Valerius G, Graf M, Hoern M, Biedermann C,Walser S, Boensch A, Dittmann S, Forsthoff A, Hummel B, Grunze H, Walden J. Life charts on a palmtop computer: first results of a feasibility study with an electronic diary for bipolar patients. Bipolar Disord 2002: 4(Suppl. 1): 107–108. © Blackwell Munksgaard, 2002
A prospective study of the discrete fascial defect rectocele repair
Authors: GLAVIND KARIN , MADSEN HANS
Published: March 2003

Background. The aim of this study is to describe the results of the discrete fascial defect rectocele repair with special emphasis on dyspareunia after the operation.

Methods. Sixty‐seven women underwent rectocele repair from October 1997 to January 1999. Repair was limited to reapproximation of discrete defects in the rectovaginal fascia when possible and a small perineorrhaphy. Each patient was evaluated as to whether or not a discrete defect was present and the location of the fascial defect. Outcome measures were complications, recurrent prolapse after 3 months, changes in defecation problems and dyspareunia after the operation.

Results. In 96% (64/67) of the patients a discrete defect was present. Before the operation 40% (27/67) reported problems with evacuation of the rectum and 12% (8/67) dyspareunia or problems with intercourse because of the prolapse. The patients were evaluated 3 months after the operation. Only three patients still complained of evacuation problems and only two patients with prior dyspareunia still had problems, which were cured after a further 3 months. Two patients had de novo dyspareunia but in only one patient was an anatomical defect found.

Conclusions. The discrete defect rectocele repair offers an anatomical correction of the rectocele, which alleviates the symptoms but, most important, does not give the woman dyspareunia. Long term results of the operation are awaited.
The prevalence and bothersomeness of lower urinary tract symptoms in women 40–60 years of age
Authors: ALLING MØLLER LARS , LOSE GUNNAR , JØRGENSEN TORBEN
Published: March 2003

Aim. To assess the prevalence and bothersomeness of lower urinary tract symptoms in women aged 40–60 years.

Study design. Ongoing longitudinal cohort study.

Methods. Four thousand women recruited on a random basis from the Civil Registration System, in one rural and one urban county in Denmark, were asked to fill in a self‐administered, validated questionnaire on lower urinary tract symptoms. Logistic regression analysis was performed to assess the relationship between LUTS, bothersomeness, age, and county residency. Symptom scores and bother scores were compared in order to obtain a valid measure of lower urinary tract symptoms (LUTS).

Results. The prevalence of LUTS occurring more than weekly was 27.8% (95% CI: 26.2%–29.4%) and 16.1% (95% CI: 14.8–17.4) had urinary incontinence. The prevalence of stress incontinence increased from at 40 years up to the age of 55 years (OR=1.9 (95% CI: 1.3–2.7)) and declined thereafter. Irritative symptoms such as urge incontinence and urgency steadily escalated in an almost linear fashion with increasing age ((OR=2.7 (95% CI: 1.6–4.5) and OR=2.1 (95% CI: 1.5–2.8), respectively). Incontinence symptoms were the most bothersome. Age was positively associated with most LUTS, but not with bothersomeness. County residency was not associated with LUTS.

Conclusion. Women aged 40–60 years frequently have bothersome lower urinary tract symptoms. Age, but not county residency, is an important factor associated with the occurrence of lower urinary tract symptoms in perimenopausal women. LUTS occurring more often than weekly seem to be the most appropriate single measure of LUTS.
Effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice
Authors: MITSUHASHI YUICHI , OTSUKI KATSUFUMI , YODA AKI , SHIMIZU YUKIKO , SAITO HIROSHI , YANAIHARA TAKUMI
Published: March 2003

Background. The present study attempted to confirm the preventive effect of lactoferrin on lipopolysaccharide (LPS) induced preterm delivery in mice.

Methods. Female C3H/HeNCrj mice were pair‐mated with male Crj: B6D2F1 mice. On day 15 of gestation, a 50 μ/kg intraperitoneal injection of LPS (LPS group) was administered twice with a 3‐hour interval between injections (at 2:00 and 5:00 PM). The mice were also given an intraperitoneal injection of lactoferrin (0.2 or 1 mg/200 μl/body) 1 hour prior to each LPS injection) (at 1:00 and 4:00 PM). To determine the effect of LF on plasma IL‐6 level, mother mice were sacrificed and blood samples were obtained at 6 hours after the second treatment of LPS.

Results. Preterm delivery was induced by LPS in all mice on day 16 of gestation. Lactoferrin administration to LPS‐treated mice significantly prolonged (p<0.001) gestation when compared with the LPS group. Plasma levels of IL‐6 in the LPS group (1.628±115 pg/ml) were significantly higher (p<0.001) than in the untreated group (497±39 pg/ml). On the other hand, administration of lactoferrin (1 mg/body) to LPS‐treated mice significantly suppressed (p<0.001) IL‐6 levels (1.060±154 pg/ml).

Conclusions. Lactoferrin exerts a preventive effect on the incidence of preterm delivery in mice via a suppression of plasma IL‐6 augmentation by LPS.
Domestic violence during pregnancy
Authors: HEDIN LENA WIDDING , JANSON PER OLOF
Published: March 2003

Background. The aim of this study was to estimate the prevalence of physical injuries, alcohol and tobacco use, abortions and miscarriages due to domestic violence during pregnancy and to compare socio‐economic background factors between abused and non abused women.

Method. Personal interview combined with a standardized questionnaire involving 207 pregnant Swedish born women married to or cohabiting with Swedish born men. The women were consecutively chosen from three different antenatal clinics in Göteborg, Sweden.

Results. Overall 30 women were abused during the current pregnancy as defined from the category ‘symbolic violence’ in the Severity of Violence Against Women Scale (SVAW). The most frequent targets for physical abuse were: the upper arm, the forearm, and the face and neck region. Ninety‐five percent of women abused during pregnancy had been abused prior to the pregnancy. Notable was the finding that 4.3% of the pregnant women had been exposed to serious violence. Abused women were significantly younger and single, had lower income and education compared to the non abused women. In the group of abused women a higher proportion of women had undergone one or more abortions than in the non‐abused group. Smoking and alcohol use among partners were strongly correlated with physical and sexual abuse.

Conclusions. The results suggest that in antenatal and obstetric clinics, emphasis should be focused on previous history of abuse and a complete physical examination of the women. Since bruises often were located at hidden areas of the body, it is of importance to scrutinize those sites as part of a routine examination. It is also important to look for common defensive marks on the forearms. The partner's cigarette and alcohol use is also an important piece of information regarding risk factors connected to domestic violence.
Changing trends in genital herpes simplex virus infection in Bergen, Norway
Authors: NILSEN ARVID , MYRMEL HELGE
Published: March 2003

Aim of study. To document the proportion of each herpes simplex virus (HSV) type in genital HSV infection and changes over time during a 10 year period.

Design. Retrospective comparative study in sexually transmitted disease (STD) patients with genital HSV infection at the outpatient clinic for STD, Haukeland Hospital, Bergen, Norway.

Results. HSV‐2 was the major cause during the 80's, whereas HSV‐1 constitutes a greater part of the cases during the 90's, especially in female patients and in the younger age groups with primary or initial disease, where HSV‐1 is the causative viral type in up to 70–90% of the cases.

Conclusion. The documented change from HSV‐2 towards HSV‐1 in cases of genital HSV infection may have implications as to prognosis, future usefulness of vaccines, present and future usefulness of new type‐specific serological tests.
Course and outcome of obstetric patients in a general intensive care unit
Authors: COHEN JONATHAN , SINGER PIERRE , KOGAN ALEX , HOD MOSHE , BAR JACOB
Published: March 2003

Background. To characterize the course, interventions required to achieve predetermined end‐points and outcome of obstetric patients admitted to a general intensive care unit.

Methods. A retrospective case series study was performed including all pregnant patients admitted to an 8‐bed general intensive care unit at a tertiary care university‐affiliated hospital over a 4‐year period. All patients referred by the obstetricians were admitted. Patients were divided into two groups: group 1, (n=19) those requiring mechanical ventilatory support and group 2, (n=27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores, intensive care unit course, types of interventions used and outcome. End‐points of therapy included systolic blood pressure 110–150 mmHg, urine output ≥1 cc/kg/h and oxygen saturation >95%.

Results. Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy‐induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25±80.9 (mean 48.8) hours. The median APACHE II score was 6±3.9 (mean 7.24) and the TISS score was >20 in both groups. Only one patient died (mortality rate 2.3%).

Conclusion. Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of intervention and care typically provided by a general intensive care unit.
Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy:
Authors: HÄRKKI‐SIRÉN PÄIVI , SJÖBERG JARI , TOIVONEN JUHANI , TIITINEN AILA
Published: March 2003

Background. To evaluate clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy.

Methods. Fifty women scheduled for abdominal hysterectomy were randomized to undergo either laparoscopic (n=25) or abdominal (n=25) hysterectomy. Surgical characteristics, hospital stay, convalescence and complications were analyzed. Blood samples for assay of markers of tissue trauma (interleukin‐6, C‐reactive protein, tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125) were taken preoperatively, on the first, second and seventh postoperative day and at the follow‐up visit four weeks after surgery.

Results. In uncomplicated hysterectomies (n=18) the operating time (85.3 min versus 57.5 min, p<0.00001) was longer for laparoscopic group but the hospital stay (2.1 days versus 3.4 days, p<0.00001) and sick leave (21.4 days versus 38.5 days, p<0.00001) were shorter in the laparoscopic group. Postoperative increases in all markers were significant in both groups. The interleukin‐6 concentration was highest on the first postoperative day in both groups, that of C‐reactive protein on the second postoperative day in both groups, tumor‐associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor‐associated antigen CA 125 on the seventh postoperative day in both groups. Both interleukin‐6 and C‐reactive protein levels were lower in the laparoscopic group on the first (p=0.01 and p=0.03, respectively) and on the second postoperative day (p=0.02 and p<0.001, respectively) compared with the abdominal group. No differences were seen in tumor‐associated trypsin inhibitor and tumor‐associated antigen CA 125 levels between the groups.

Conclusion. Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma.
Endothelin‐1 in feto‐placental tissues from normotensive pregnant women and women with pre‐eclampsia
Authors: Singh Harbindar Jeet , Rahman Abdul , Larmie Ernest Teiko , Nila Awang
Published: March 2003

Aims. The pathogenesis of pre‐eclampsia is still unclear. Placental hypoperfusion, which precedes the maternal manifestations of pre‐eclampsia, could be due to some vasoconstrictor factor/s like endothelin‐1. The aim of the study therefore was to estimate the levels of endothelin‐1 in feto‐placental tissue homogenates from normotensive pregnant women and women with pre‐eclampsia.

Method and material. Fresh, vaginally delivered placentae from ten normotensive pregnant women and nine women with pre‐eclampsia were carefully dissected and 4 gm each of amnion, chorion laeve, placental plate chorion, fetal placenta (fetal surface of the placenta) and maternal placenta (surface of the placenta attached to the uterine wall) were obtained. These tissues were then thoroughly washed in a 0.5 M phosphate buffer, pH 7.5, at room temperature and then individually homogenized for one minute in 4 ml of the same buffer. After centrifugation the supernatant was removed. The pellet was re‐suspended in buffer, re‐homogenized and then centrifuged. The supernatant was removed and the procedure was repeated once again and the three supernatants of each tissue were pooled. Endothelin‐1 was estimated by RIA. All results are presented as mean±SEM. Statistical analysis was performed using students ‘t’ test for unpaired samples and a ‘p’ value of <0.05 was considered significant.

Results. In tissues from normotensive pregnant women, no significant differences were evident in endothelin‐1 concentrations in the chorion laeve, fetal placenta and maternal placenta but were significantly higher than those in the amnion and placental plate chorion (p<0.01). In tissues from pre‐eclamptic women, no significant differences were evident between endothelin‐1 concentrations in the chorion laeve, placental plate chorion and fetal placenta. Mean endothelin‐1 concentration in the amnion and maternal placenta were significantly lower than those in chorion laeve, placental plate chorion and fetal placenta (p<0.01). Endothelin‐1 concentrations were significantly higher in the amnion, chorion laeve, placental plate chorion and fetal placenta from women with pre‐eclampsia when compared to tissues from normotensive pregnant women (p<0.01).

Conclusions. Endothelin‐1 levels were significantly higher in the placental tissues from women with pre‐eclampsia. Endothelin‐1, being a powerful vasoconstrictor, could cause significant vasoconstriction in the placental vasculature, and alterations in endothelin‐1 levels in placental vasculature may therefore have a role in the pathogenesis of pre‐eclampsia.
Who stops smoking during pregnancy?
Authors: Lindqvist Rune , Åberg Hans
Published: March 2003

Background. The proportion of women who stop smoking during pregnancy has varied between 17 and 40% percent in Sweden with a tendency of lower prevalence in recent years. The aim of the present study was to examine the factors that might influence the ability to stop smoking during pregnancy.

Method. One hundred and two women were interviewed shortly after their first visit to the antenatal clinic and a second time approximately one month after delivery. Two women who had late spontaneous abortions were excluded. The women were asked about background factors, smoking habits of their parents, smoking history and current smoking habits. The carbon monoxide in expiratory air was measured to verify reported smoking habits.

Results. Fifty‐six of the 100 participating women had stopped smoking before the second interview. Having started smoking at an older age, having no previous children, smoking few cigarettes, a higher level of education, positive support from the partner and having lived with non‐smoking parents were all associated with stopping smoking when tested as single factors. Reported smoking habits could be verified. Age, smoking habits of the partner, passive smoking at work, quality of sleep, general perceived health, length of sick‐leave or amount of nausea were not correlated to stopping smoking.

Conclusion. The presence of several factors found to influence stopping smoking during pregnancy, and the tendency for smoking habits to be passed over to the new generation, are reasons for comprehensive and individualized, anti‐smoking support.
Fear during labor
Authors: Alehagen Siw , Wijma Klaas , Wijma Barbro
Published: March 2003

Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.

Method. Thirty‐five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.

Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.

Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.
Recovery from vaginal hysterectomy compared with laparoscopy‐assisted vaginal hysterectomy:
Authors: Soriano David , Goldstein Andrei , Lecuru Fabrice , Daraï Emile
Published: March 2003

Objective. To evaluate short‐term recovery of vaginal hysterectomy with those of laparoscopic assisted vaginal hysterectomy performed in a prospective, randomized multicentric study.

Study design. Eighty patients referred for hysterectomy for benign pathology were randomized to either vaginal hysterectomy (40 patients) or laparoscopic assisted vaginal hysterectomy (40 patients). Inclusion criteria were uterine size larger than 280 g and one or more of the following: previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses, and indication for adnexectomy. No upper limit of uterine size was set. All the laparoscopic and the vaginal hysterectomies were done under endotracheal general anesthesia.

Results. There was no statistically significant difference in terms of patient’s age, parity, postmenopausal state, indication for surgery and mean uterine weight between the 2 groups. Laparoconversion was performed in three women in the laparoscopic group. Operative time was significantly shorter in the vaginal versus the laparoscopic groups 108±35 and 160±50 respectively (p<0.001). The use of paracetamol, non steroidal anti‐inflammatory drugs, and opioid during hospitalization were similar in the 2 groups. There was no difference in the 1st day hemoglobin level drop, time of passing gas and stool, or hospital stay between the 2 groups.

Conclusion. In contrast with earlier reports, there was no difference in short‐term recovery between patients undergoing vaginal or laparoscopic hysterectomy. No advantage was found performing laparoscopic assisted vaginal hysterectomy in comparison with the standard vaginal hysterectomy.
The expression of cyclooxygenase 2 and inducible nitric oxide synthase indicates no active inflammation in vulvar vestibulitis
Authors: Bohm‐Starke Nina , Falconer Christian , Rylander Eva , Hilliges Marita
Published: March 2003

Background. Although women with vulvar vestibulitis syndrome have principal symptoms of inflammation such as local erythema and pain in the mucosa around the vaginal introitus, it is not clear if vestibulitis is an inflammatory condition. Cyclooxygenase 2 and inducible nitric oxide synthase are known to be upregulated during inflammation. The aim of the present study was to analyze the expression of these enzymes in the vestibular mucosa in order to evaluate the inflammatory activity in the tissue.

Methods. Ten women fulfilling Friedrich's criteria of vulvar vestibulitis syndrome and ten control subjects were included in the study. Punch biopsies were obtained from the vestibular mucosa for analysis of cyclooxygenas 2 and inducible nitric oxide synthase, using indirect immunohistochemistry and Western dot‐blot analyses.

Results. Both methods used showed low expression of cyclooxygenas 2 and inducible nitric oxide synthase in the vestibular mucosa of all women. There was no difference observed between the groups.

Conclusions. There is a low expression of the inflammatory markers cyclooxygenas 2 and inducible nitric oxide synthase in the vestibular mucosa of women with vulvar vestibulitis syndrome as well as in healthy control subjects. The results indicate no active inflammation present and imply that topical corticosteroids in the treatment of vulvar vestibulitis are unfounded.
Seropositivity of cytomegalovirus, parvovirus and rubella in pregnant women and recurrent aborters in Leningrad County, Russia
Authors: Odland Jon Ø. , Sergejeva Irina V. , Ivaneev Mikhail D. , Jensen Inge Panum , Stray‐Pedersen Babill
Published: March 2003

Background. The objectives of this paper were to assess the prevalence of different viral infections in relation to late abortions, stillbirths, and congenital malformations in sera from Russian pregnant women and recurrent aborters in order to establish basic knowledge for future pregnancy care.

Methods. Patients were recruited at the Women’s Clinic, Leningrad Regional Hospital during the period March–June 1995. One group of normally pregnant women (Group 1; n=182) and one group of recurrent aborters (Group 2; n=127) were evaluated, including demographic, medical, clinical, and serological data.

Results and conclusions. The mean age of the two groups was 27.1 and 28.2 years, respectively. The mean number of deliveries was low (0.4 and 0.5, respectively). Thirty‐one point six percent of Group 1 and 41.9% of Group 2 were daily smokers. The group of normally pregnant women had a significantly increased frequency of induced abortions compared to the recurrent aborters, while the recurrent aborters reported more genital infections. There was little difference in total antibodies to cytomegalovirus (CMV) (78.0% and 81.1%, respectively) or B19 IgG (75.3% and 66.9%, respectively) between the groups, while the normal pregnant women had a significantly higher prevalence of rubella antibodies (77.5% and 59.8%, respectively). Our results indicate that less women remain susceptible to primary CMV infection in pregnancy in Russia compared to western Europe and North America. The prevalence of B19 IgG was slightly lower than data from Sweden. Natural immunization against rubella virus was lower than in other, unvaccinated female populations. Vaccination strategies for rubella are now initiated in the Russian Federation. Results from this study are utilized in a federally supported, comprehensive pregnancy care project of North‐West Russia.
Diagnosis of celiac disease in pregnancy and puerperium: think about it
Authors: Corrado Francesco , Magazzu Giuseppe , Sferlazzas Concetta
Published: March 2003

We report 10 cases of celiac disease (CD) diagnosed after a pregnancy. During late pregnancy and/or puerperium a latent CD may be unmasked, so patients with mild gastrointestinal symptoms or anemia in pregnancy should be investigated to detect the disease before it might seriously affect maternofetal health.
Vulvar pain, sexual behavior and genital infections in a young population: a pilot study
Authors: Berglund Anna‐Lena , Nigaard Linda , Rylander Eva
Published: March 2003

Background.  To study the prevalence of pain during intercourse in a young population and analyze factors that may be associated with vulvar pain.

Methods.  During a 2‐month period, 172 women (aged 12–26 years) consulting four different adolescent health centres in Stockholm, Sweden, responded to a questionnaire concerning sexual habits, history of infections, and genital symptoms a priori vulvar pain. Multiple logistic regression model was used to evaluate the independent effects of the variables associated with vulvar pain.

Results.  One‐third of the women reported regular pain during and/or after intercourse. Having regular sexual intercourse before the age of 16 years and using oral contraception for more than 2 years were independent variables increasing the risk of vulvar pain. There was a correlation trend between vulvar pain and lack of sexual desire, recurrent candida infections, and urinary tract infections. However, there was no correlation to sexually transmitted diseases. More than 4 years of regular intercourse and coitus at least 4 times a week were factors that inversely correlated to vulvar pain.

Conclusions.  One‐third of young women answering a questionnaire at adolescent health centres reported regular pain during and/or after intercourse. Early regular coitus and long‐time use of oral contraceptives were factors associated with vulvar pain. Frequently rubbing a vulnerable mucosa may result in irreversible damage and vulvar vestibulitis syndrome.
Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination
Authors: Nakling Jakob , Backe Bjørn
Published: March 2003

Background.  Adverse obstetric outcome in fetuses that are smaller than expected at second trimester routine ultrasound examination.

Aim.  To assess the obstetric outcome when the interval between the estimated date of delivery by last menstrual period and the estimated date of delivery by second trimester ultrasound exceeds 14 days.

Materials and methods.  Population‐based prospective cohort study. Included were all women (n = 16 302) with a singleton pregnancy, in one Norwegian county from 1989 to 1999, with a reliable menstrual history and whose second trimester ultrasound examination was conclusive with a 35–60‐mm biparietal diameter.

Results.  Adverse outcome was defined as preterm birth (< 37 weeks), perinatal death, low birthweight (< 2500 g) and small‐for‐gestational age (< 2 standard deviation). The risk for perinatal death (odds ratio = 2.3), preterm birth (odds ratio = 1.7), low birth weight (odds ratio = 1.5), and small‐for‐gestational age (odds ratio = 1.5) was highly significantly increased in deliveries where the discrepancy between the two terms was more than 14 days. The increased risk is not explained by differences in parity, maternal age, smoking, fetal malformations, or use of oral contraceptives before pregnancy.

Conclusion.  Fetuses that are smaller than expected at the mid‐second trimester ultrasound corresponding to a discrepancy of more than 14 days have an increased risk for adverse obstetric outcome.
Reproductive tract infections and the risk of HIV among women in Moshi, Tanzania
Authors: Msuya Sia E. , Mbizvo Elizabeth , Stray‐Pedersen Babill , Sundby Johanne , Sam Noel E. , Hussain Akhtar
Published: March 2003

Objectives.  The objectives of the study were to determine the prevalence of HIV and reproductive tract infections (RTIs); to compare the occurrence of RTIs among HIV‐infected and non‐infected women; and to assess the association of HIV with RTIs and behavioral factors among women aged 15–49 years.

Methods.  A cross‐sectional study was conducted in late 1999 among 382 consenting women attending three primary healthcare clinics. They were interviewed and screened for HIV‐1 and RTIs.

Results.  The prevalence of HIV‐1 was 11.5%. Sixty‐four percent of the women had one ongoing treatable RTI. Endogenous and sexually transmitted RTIs were higher in HIV‐positive than negative women and 84% of the HIV seropositive women were co‐infected with one treatable RTI. HIV was significantly associated with cervicitis (chlamydial or gonococcal) [OR = 3.2 (CI 1.1–13.2)], HSV‐2 [OR = 2.6 (CI 1.3–5.1)], bacterial vaginosis [OR = 1.9 (CI 1.1–4.1)], genital warts [OR = 4.8 (CI 1.1–22.2)], and presence of vaginal discharge [OR = 2.7 (CI 1.3–5.2)]. Having more than one lifetime sexual partner, a history of infant mortality or a partner who had other wives or resided away from home > 6 months, were risk factors for HIV infection.

Conclusion.  HIV‐1 and RTIs are a major public health problem among women in this population. Integration of routine screening and treatment of RTIs in the reproductive health clinics will be an important strategy to combat HIV in the area. Further, innovative behavior interventions targeting both men and women, preferably as couples are needed.
The use of clomiphene citrate/human menopausal gonadotrophins in conjunction with GnRH antagonist in an IVF/ICSI program is not a cost effective protocol
Authors: Mansour Ragga T. , Aboulghar Mohammed A. , Serour Gamal I. , Al‐Inany Hesham G. , Fahmy Ibrahim , Amin Yehia
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 48–52. © Acta Obstet Gynecol Scand 2003

Objective.  To evaluate the cost effectiveness of a clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/GnRH antagonist protocol versus a long‐acting GnRH agonist/hMG protocol.

Participants & Methods.  One hundred eighty nine couples having their first trial of ICSI for male factor infertility were divided into two groups. Group I (no = 33) received CC 100–150 mg/day for five days starting from day 2 of the cycle and 150 IU of hMG/day on days 6–10. GnRH antagonist (Centrorelix) 0.25 mg/day was started when the leading follicle reached 16 mm in the absence of an LH surge. Group II (no = 156) received 0.1 mg Deacapeptyl/day as our standard long protocol.

Results.  Clinical pregnancy was observed in 8 out of the 33 cases in group I (24%) while in group II, 92 out of 156 achieved clinical pregnancy (59%), the difference was statistically significant (P = 0.019). The cost of medications/cycle was estimated to be 1110±492 E.P in group I, while it was 1928±456 E.P. in group II. However, the total cost per pregnancy was 19653 EP in group I and 10047 EP in group II.

Conclusion.  The use of the clomid/hMG/antagonist protocol is not a cost effective strategy and should not be recommended in IVF‐ICSI cycles.
Quality improvement project in cervical cancer screening: practical measures for monitoring laboratory performance
Authors: Tarkkanen Jussi , Geagea Antoine , Nieminen Pekka , Anttila Ahti
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 82–88. © Acta Obstet Gynecol Scand 2003

Background.  We conducted a quality improvement project in a cervical cancer screening programme in Helsinki in order to see if detection of precancerous lesions could be influenced by external (participation rate) and internal (laboratory praxis) quality measures.

Methods.  In order to increase the participation rate, a second personal invitation to Pap‐test was mailed to nonparticipants of the first call. In order to improve the quality of screening, the cytotechnicians monitored their performance longitudinally by recording the number of slides reviewed per day, the pick‐up rate of abnormal smears, the report of the consulting cytopathologist, and the number of histologically verified lesions detected from the cases that they had screened. Regular sessions were held to compare the histological findings with the cytological findings of all cases referred for colposcopy. No pressure was applied on the cytotechnicians to ensure that they felt comfortable with their daily workload.

Results.  A total of 110 000 smears were screened for cervical cancer at the Helsinki City Hospital during 1996–99. Initially, the overall participation rate increased from 62% to 71%. The number of histologically confirmed precancerous lesions (CIN 1–3) more than doubled and their detection rate increased from 0.32% to 0.72%.

Conclusions.  Continuous education and feedback from daily work performance were important, yet rather inexpensive means in increasing laboratory performance. Additional measures are needed to further increase the participation rate. Impact of the quality measures on cancer incidence needs to be assessed later on.
Impaired dark adaptation in polycythemia. Improvement after treatment
Authors: Havelius Ulf , Berglund Stig , Falke Pia , Hindfelt Bengt , Krakau Torsten
Published: March 2003

Purpose: To determine if dark adaptation is reduced in individuals with polycythemia and if so whether there is any improvement in dark adaptation after treatment.

Methods: Dark adaptation was recorded monocularly by automatic dark adaptometry in ten consecutive patients with polycythemia before and after treatment. Analogue investigations were performed in 31 healthy control subjects.

Results: Dark adaptation was markedly impaired in the patients as compared with the control subjects. After reduction of the red cell count and normalization of the hematocrit and hemoglobin the dark adaptation was markedly improved. There was no significant change in dark vision in the control subjects negating a confounding learning effect.

Conclusion: The findings indicate a sustained but reversible neuronal hypofunction secondary to polycythemia. As the rheological abnormality was normalized, dark adaptation was improved, probably secondary to normalized microcirculation within the retina or the brain, or both, possibly with reactivation of formerly inactive neuronal cells.
The acoustic lighthouse effect
Authors: Fledelius Hans C. , Scherfig Erik
Published: March 2003

Purpose: To discuss and possibly explain the ultrasonic lighthouse effect, a metaphor suggested for an artifact‐like phenomenon sometimes found by B‐scan in eyes having had intra‐ocular perfluorocarbon and/or silicone oil injected as part of vitreoretinal surgery.

Method: Analysis of the ultrasonic findings with a view to the specific gravities of the above injected substances. Compared to water, perfluorocarbon has a higher and silicone oil a lower gravity; they are heavy and light, respectively.

Results: The elicited lighthouse effect may appear localized or ‘mobile’. When evoked only from specific positions on the globe, most likely it is explained by a lens‐like accumulation of material trapped at the vitreous base just under the transducer. When mobile it depends on head position; there is a gravitational shift in position of the material, as evident in particular when becoming visible in the anterior chamber.

Conclusions: In case reports in literature slit‐lamp verified anterior segment perfluorocarbon remnants have caused acoustic disturbances of a similar nature. In this study we found evidence that also silicone oil can underlie the acoustic lighthouse effect.
Spontaneous involution of a large retinal arterial macroaneurysm
Authors: Ohno‐Matsui Kyoko , Hayano Masato , Futagami Soh , Tokoro Takashi , Ohno Seiji
Published: March 2003

Background: Acquired retinal macroaneurysms are round dilatations of retinal arterioles that occur in the posterior fundus. They tend to rupture before they grow large and cause a visual decrease. The average diameter of macroaneurysms in the previous reports is 281 micrometer.

Methods: A 63‐year‐old man complained of a sudden decrease of visual acuity in the left eye. Fundus examination of his left eye revealed a large protruded mass, 2 disc diameters in size, at the first bifurcation of the inferotemporal retinal artery. Preretinal vitreous bleeding and serous retinal detachment were observed around the lesion. Indocyanine green (ICG) angiography showed this mass to be continuous with the inferotemporal retinal artery and ICG dye leaked from the retinal artery into the lumen of the mass, with pulsation.

Results: Six months later, the large macroaneurysm underwent spontaneous involution.

Conclusion: As shown in this patient, retinal macroaneurysms may grow extremely large. ICG angiography was useful to diagnose this large retinal arterial macroaneurysm.
Paediatric chiasmal neuritis – Typical of post‐Epstein‐Barr virus infection?
Authors: Beiran Itzchak , Krasnitz Irene , Zimhoni‐Eibsitz Maya , Gelfand Yuval A. , Miller Benjamin
Published: March 2003

ABSTRACT. A case of chiasmal neuritis with bilateral, asymmetric optic nerve involvement is presented. Association with recent Epstein‐Barr virus infection is suggested. The clinical picture, possible aetiological factors, and causative relation to Epstein‐Barr virus are presented.
Effects of prostaglandins on form deprivation myopia in the chick
Authors: Jin Niyun , Stjernschantz Johan
Published: March 2003

Purpose: To investigate the possible role of endogenous prostaglandins in the development of form deprivation myopia, as well as the effects of exogenous prostaglandins using atropine as a positive control.

Methods: Monocular form deprivation was accomplished by mounting a translucent occluder on one eye of 2–3 day old chicks for 1–4 weeks. Ocular occlusion for 1–2 weeks was used for pharmacological blocking experiments. The axial length of the eye was measured by ultrasonography.

Results: Indomethacin, administered intramuscularly, subconjunctivally or intra‐vitreally had no significant effect on myopia development. Exogenous PGE2, PGF2α and latanoprost acid administered subconjunctivally, or topically as isopropyl ester eyedrops had no statistically significant effect on the myopia development. However, PGF2α significantly (p<0.01) attenuated the development of myopia after intravitreal injection. The other two prostaglandins had no statistically significant effect.

Conclusions: Endogenous prostaglandins are unlikely to play a significant role in the development of form deprivation myopia in the chick. However, PGF2α suprisingly seems to retard the development of form deprivation myopia, but only when administered intravitreally. Whether the mechanism of the myopia retardation is direct or indirect remains unknown.
The anterior lens capsule used as support material in RPE cell‐transplantation
Authors: Nicolini Jair , Kiilgaard Jens Folke , Wiencke Anne Katrine , Heegaard Steffen , Scherfig Erik , Prause Jan Ulrik , La Cour Morten
Published: March 2003

Purpose: To investigate the use of an ocular basement membrane as support material for transplanted porcine RPE cells.

Methods: Porcine RPE cells were grown on bovine corneal extracellular matrix (ECM), isolated bovine‐ and porcine lens capsules, and tissue culture plastic. Cell density, and cell morphology were studied by phase contrast microscopy and transmission electron microscopy.

Results: RPE cells grown on porcine anterior lens capsule and on ECM obtained better morphology and higher final cell density than cells grown on plastic and on bovine anterior lens capsule. It was possible to transplant the porcine anterior lens capsule to the subretinal space in pigs. Within two weeks of observation, the lens capsule was well tolerated in the subretinal space.

Conclusion: The anterior lens capsule seems to be promising as support material for use in RPE cell‐transplantation.
An Efficacy and Tolerance Comparison of Emedastine Difumarate 0.05% and Levocabastine Hydrochloride 0.05%: Reducing Chemosis and Eyelid Swelling in Subjects with Seasonal Allergic Conjunctivitis
Authors: Secchi A. , Leonardi A. , Discepola M. , Deschenes J. , Abelson M. B. ,   the Emadine Study Group
Published: March 2003

Purpose: To compare emedastine ophthalmic solution 0.05% BID to levocabastine ophthalmic suspension 0.05% BID in reducing chemosis, eyelid swelling and other signs and symptoms in subjects with seasonal allergic conjunctivitis.

Methods: In a randomized, double‐masked, parallel controlled study, emedastine ophthalmic solution 0.05% BID was compared to levocabastine ophthalmic suspension 0.05% BID for control of chemosis, eyelid swelling and other parameters in the environmental allergy study model.

Results: At Days 7, 14, 30 and 42, emedastine was significantly better than levocabastine at controlling chemosis and eyelid swelling (p<0.05). A statistical trend was seen at Day 3 (0.05<p<0.10). Results were clinically relevant at Days 30 and 42. Emedastine was also significantly better at reducing redness and itching at Days 7, 14, 30 and 42 (p<0.05).

Conclusion: Emedastine is more efficacious than levocabastine in reducing chemosis, eyelid swelling and other efficacy variables associated with seasonal allergic conjunctivitis.
Wound healing response in the presence of stromal irregularities after excimer laser treatment
Authors: Weber Beat A. , Gan Lisha , Fagerholm Per
Published: March 2003

ABSTRACT. Purpose: To trace the fate of stromal irregularities after excimer laser treatment and to increase our knowledge of the reasons why surface irregularities in the ablation bed cause inferior postoperative results.

Methods: Twelve New Zealand White rabbits received a transepithelial photoablation to a preset depth of 60 μm. An electron microscopy specimen grid was then placed on the denuded stroma and another 20 μm ablation was applied in order to produce surface irregularities. Another six rabbits received a plano transepithelial photoablation to a preset depth of 80 μm. The treated corneas were harvested at various timepoints and differentially further processed for microradiography, hematoxylin‐eosin ‐, hyaluronan (HA)‐ and leukocyte protein L1 staining.

Results: In the grid treated corneas the subepithelial mesh pattern is clearly discernible after 1 week, and after 4 weeks it is replaced by a subepithelial layer containing HA and water. The thinning of this layer between 1 and 12 weeks is statistically significant (p<0.05). After 4 and 8 week the plano treated corneas only exhibit some subepithelial HA‐ and water accumulation. After 1 day the grid treated corneas show an extensive stromal infiltration of leukocytes. In the plano treated corneas the leukocytes mainly remain on the surface.

Conclusions: During the healing process stromal irregularities are flattened, leaving a homogeneous zone with increased water content. This subepithelial layer is rarefying as new subepithelial tissue is forming. Postablational irregularities induce a more pronounced healing reaction when compared to a smooth ablation surface. Leukocyte infiltration seems to play a role in this process.
Surgical decompression in traumatic optic neuropathy
Authors: Wohlrab Thomas‐Michael , Maas Stefan , De Carpentier J.P.
Published: March 2003

Background:  The management of traumatic optic neuropathy remains controversial. This retrospective study presents the results of 19 cases of indirect optic neuropathy where surgical decompression represented the primary mode of treatment.

Methods:  Nineteen patients (20 optic nerves) with traumatic optic neuropathy underwent primary surgical decompression. The surgery was performed using the transethmoidal technique.

Results:  The extent of bony optic canal injury documented during surgery indicated that this had been underestimated in this series by CT findings. Vision improved in eight patients, five of whom had had no light perception preoperatively.

Conclusion:  Primary surgical decompression of the optic nerve within 48 h of injury produces beneficial results. Testing of visual acuity 6 weeks after surgery does not serve as a reliable predictor of final outcome.