bluuebunny/crossref_metadata_2025 huggingface dataset:
A NEW GEL FOR INTRACERVICAL APPLICATION OF PROSTAGLANDIN E2
Authors: Ulmsten Ulf , Kirstein‐Pedersen Anders , Stenberg Pål , Wingerup Lars
Published: December 2009

Abstract. A new gel‐formulation for intracervical application of prostaglandin E2 (PGE2) has been prepared. As a vehicle for the gel a cross‐link starch polymer is used. PGE2 substance is added to the starch polymer and after homo‐genization and lyophilization a PGE2 powder is obtained. The powder can be stored at room temperature for more than four months without inactivation of the prostaglandin. Before clinical application a few ml of saline is added to the powder giving, within 30 seconds, an easily‐handled ready to use PGE2‐gel. Chemical analysis by spectrophotometric technique reveals that the amount of unchanged PGE2 is the same in the new gel‐formulation as in a conventional cellulose gel.

In a randomized double‐blind study the new PGE2‐gel was intracervically applied to twenty nulliparae before abortion by dilatation and evacuation (D & E). Ten women were given a gel containing 0.25 mg PGE2 (PGE2‐gel) and ten a gel without PGE2 (placebo gel). It was found that the PGE2‐gel, in contrast to the placebo gel, produced a rapid ripening of the cervix facilitating the subsequent D & E. No adverse systemic or local reactions were found during or after the treatment.
THE DEVELOPMENT AND EVALUATION OF AN OVULATION INHIBITOR (DIANE®) CONTAINING AN ANTIANDROGEN
Authors: Lachnit‐Fixson U.
Published: December 2009

Abstract. The combination of 2 mg cyproterone acetate, a pronounced antiandrogenic substance, in combination with 0.05 mg ethinyl estradiol has undergone intensive multiphasic clinical evaluation. the preparation with the trade name Diane® has proven to be not only a reliable contraceptive, but also a very potent drug for the treatment of both acne and seborrhea, and of milder cases of hirsutism. the effect of Diane® on markedly increased hair growth was not so pronounced. in addition to the presentation of the most pertinent steps of the clinical investigation of Diane®, the possible mode of actions of antiandrogens alone and in combination with an estrogen is discussed.
PROSTAGLANDIN CHEMISTRY
Authors: Granström Elisabeth
Published: December 2009

Abstract. The prostaglandins and some related substances of biological importance constitute a rapidly growing family of compounds, all the members of which are oxygenated derivatives of certain polyunsaturated, essential fatty acids, such as arachidonic acid. Most cell types possess the enzyme systems necessary for the conversion of the precursor fatty acids into these compounds. The first step in the conversion leads to the production of cyclic peroxides, and this step is readily inhibited by the non‐steroidal anti‐inflammatory drugs. The further metabolism of the endoperoxides leads to the formation of other potent compounds: the “classical” prostaglandins, the thromboxanes and prostacyclin.
SOCIOECONOMIC IMPLICATIONS OF DYSMENORRHEA
Authors: Bergsjø Per
Published: December 2009

Abstract. Dysmenorrhea constitutes only a small fraction of the causes of absence from work among women of childbearing age. Nevertheless, every second woman in two Norwegian industrial companies experienced pain during menstruation and one in three had to stay in bed at least one day per month. Many women attend their jobs in spite of reduced capacity for work during periods of discomfort. The consequence for work output and hence economy may be impossible to estimate.

Socially the perimenstrual period has a negative effect on many women. Poor results at examinations, greater risk of being injured and a tendency to commit offences seem to cluster at this time. The social implications of dysmenorrhea may be as important as the economic ones.
EFFECT OF ACETYLSALICYLIC ACID, PARACETAMOL AND PLACEBO ON PAIN AND BLOOD LOSS IN DYSMENORRHEIC WOMEN
Authors: Janbu Torun , Løkken Per , Nesheim Britt‐Ingjerd
Published: December 2009

Abstract. The analgesic effect of paracetamol, acetyl‐salicylic acid, and placebo on dysmenorrhea were compared in a double‐blind cross‐over study of 30 women. There was a moderate placebo effect, but no significant difference was found between the three treatments. Blood loss was also measured and it did not vary, with the type of drug ingested. It is concluded that paracetamol and acetylsalicylic acid in the doses used (0.5 g x 4 for 3 days) were not effective against heavy dysmenorrhea, and that none of the drugs influenced the amount of blood lost.
NAPROXEN AND NAPROXEN SODIUM IN DYSMENORRHEA: DEVELOPMENT FROM IN VITRO INHIBITION OF PROSTAGLANDIN SYNTHESIS TO SUPPRESSION OF UTERINE CONTRACTIONS IN WOMEN AND DEMONSTRATION OF CLINICAL EFFICACY
Authors: Henzl Milan R. , Izu Allen
Published: December 2009

Abstract. “In vitro” experimentation has shown that naproxen inhibits prostaglandin synthetase generated by uterine microsomes of pregnant rats. In another in vitro system, naproxen inhibited electrically induced contractions of an isolated myometrial strip and abolished the sensitivity of the myometrium to oxytocin.

In in vivo experiments, naproxen prevented oxytocin‐induced “writhing” of rats and mice, and delayed parturition when given to pregnant rats.

In double‐blind placebo controlled clinical experiments naproxen sodium administration was followed by a steady decrease of intrauterine resting pressure, and the amplitude and frequency of uterine contractions.

Clinical trials designed to prove the efficacy and acceptability of naproxen sodium in dysmenorrhea comprised 227 patients followed over a total of 623 painful menstruations. Complete or substantial pain relief was achieved by 77.9% of patients treated with naproxen sodium but only by 23% of placebo treated patients. The use of other analgesic agents was prominently reduced: only 28% naproxen sodium treated patients needed an additional pain medication over 18% painful menstruations while 70% placebo treated patients needed additional analgesics over 54% painful menstruations. Naproxen sodium treatment enabled the patients to continue their daily activities during dysmenorrhea: 77.3% patients who historically had to stay at home from school/work and/or in bed could continue their daily activities, while, in striking contrast 81.8% such patients of the placebo group remained fully incapacitated. Naproxen and naproxen sodium also reduced pain associated with IUD insertion; and in patients with dysmenorrhea secondary to IUD.

No meaningful side effects occurred throughout the trials.

The mode of naproxen's action in dysmenorrhea is probably by inhibition of microsomal prostaglandin synthetase. The in vitro conversion of arachidonic acid into PGF and PGE by uterine microsomes is reduced by naproxen in a dose‐related manner. Naproxen treatment substantially decreases PGF and PGE concentrations in uterine tissue of pregnant rats. In humans, the PGF content in menstrual blood becomes significantly reduced by naproxen sodium treatment as compared to menstruations with placebo treatment. This suggests causal associations between naproxen treatment, reduction of uterine prostaglandins, inhibition of uterine contractions, and relief of dysmenorrhea. Thus naproxen represents a rational therapy for dysmenorrhea.
A protocol design for studying alterations of pharmacokinetic parameters due to pregnancy
Authors: Philipson Agneta
Published: December 2009

A study protocol is described by means of which useful and pertinent information on possible alterations of pharmacokinetic parameters due to pregnancy can be investigated. Whenever any drug is prescribed to a pregnant woman for medical reasons, pharmacokinetic data for that drug can be obtained by determination of drug levels in urine, plasma or serum, or other possible tissues. The same data should later be obtained for an identical dose of the same drug given to the same woman after pregnancy. By comparing pharmacokinetic parameters in the same woman during pregnancy and after when she serves as her own nonpregnant control clinically and statistically significant differences may be discovered with a comparatively small patient material. As in each case the drug that is studied is prescribed for medical reasons, this protocol involves no undue risks for the pregnant woman or the fetus.
Treatment of cervical intraepithelial neoplasia with local excisional biopsy and cryosurgery
Authors: Tronstad Svein‐Erik , Kirschner Rolf
Published: December 2009

One hundred and ninety‐eight patients with abnormal cytologic smears had extensive diagnostic biopsy of the portio combined with endocervical curettage. Severe dysplasia or cancer in situ was found in 57 per cent of the patients. During a period of observation of 6‐42 months (average 18 months) the cervical intraepithelial neoplasia (CIN) regressed in 54 per cent.

Cryosurgery was used to treat 93 patients with persistent CIN after biopsy. Treatment was successful in almost 70 per cent after one single application of cryosurgery. The complications were negligible. Treatment was less successful with increasing histological severity as well as with increasing age of the patients; this applies both to biopsy and cryosurgery. Cryosurgery is significantly less effective when the CIN is of both ecto‐ and endocervical origin.

Extensive multiple biopsies of the portio in combination with endocervical curettage performed under general anaesthesia, followed by cryosurgery with persistent cytological abnormalities, are indicated as an alternative to conization, especially in younger patients with ectocervical CIN.
Torsion of the internal female genital apparatus
Authors: Andersen Jens Thorup , Buhl Jørgensen Svend Erik
Published: December 2009

A case of a huge right‐sided ovarian cyst associated with torsion of the whole internal female genital apparatus around the uterine collum, herniation of the transverse colon into the thoracic cavity and mechanical obstruction of the ileum is described. The symptomatology, pathogenesis and treatment of the condition is discussed.
Spontaneous Labor and Elective Induction—A Prospective Randomized Study: II. Bilirubin Levels in the Neonatal Period
Authors: Leijon Ingemar , Finnström Orvar , Hedenskog Staffan , Rydén Gunnar , Tylleskär John
Published: December 2009

The effect of induction of labor on the neonatal bilirubin levels was investigated in a prospective randomized study. Forty‐three infants born after elective induction with oxytocin using the Cardiff infusion system and 38 infants born after spontaneous delivery were studied. Several factors other than oxytocin administration which could influence the bilirubin levels such as gestational age, placental transfusion and feeding routines did not differ between the two groups. There were no differences with regard to pH in umbilical vein, Apgar scores, haemoglobin and erythrocyte volume fractions or bilirubin levels neonatally. Thus there was no evidence of an association between induction of labor with oxytocin and jaundice during the neonatal period.
Hyperprolactinemia in Cases of Infertility and Amenorrhea
Authors: Furuhjelm Mirjam , Rydner Thure , Carlström Kjell
Published: December 2009

Of 17 patients with longstanding (3–15 years, mean 7.7 years) amenorrhea and hyperprolactinemia, 8 developed their amenorrhea after the use of oral contraceptives (Group I) and 9 became amenorrhoic spontaneously (Group II). There were no differences between the groups with respect ot the basal serum levels of FSH, LH, low polar estrogens (estradiol‐17β + estrone) and prolactin. Tomography revealed pituitary adenoma in four patients. One of these developed symptoms of her tumor during pregnancy; the symptoms disappeared after delivery. The other patients with tumors are checked twice a year and have not yet received any treatment. The patients with no detectable tumors were treated with bromocriptine starting with 1.25 × 3 daily. The peripheral serum levels of prolactin, FSH, LH, low polar estrogens and progesterone were determined once a week and if the prolactin levels remained high, the bromocriptine dose was increased. All these patients started to menstruate as soon as prolactin returned to normal levels (below 25 μmg/l). All patients who wished to became pregnant, i. e. 6 patients. Three were delivered by cesarean section, one had a normal delivery and two are still pregnant.

There was no difference between Group I and Group II in the dose required or in the duration of treatment before menstruation started. Three cases of galactorrhea were found.
Duration of the Second Stage of Labor
Authors: Bergsø Per , Halle Christen
Published: December 2009

The second stage of labor, defined as the time from full dilatation of the external os to delivery of the child, was recorded during a three‐month period in 635 labors with vaginal delivery. The median duration in labors of spontaneous onset was 31.3 minutes in para 0 mothers, 14.3 minutes in para 1 mothers and 11.7 minutes in para 2 + mothers. In induced labors the second stage had approximately the same length as in labors with spontaneous onset. The time distribution showed that the second stage in para 0 mothers had a plateau in the 17.5s‐37.5 minute range, whereas para 1 + mothers had a sharper peak at 7.5 minutes. Forty and 45 minutes respectively seemed to be limits beyond which only very few second stages of labor lasted. Operative delivery terminated 18 per cent of para 0 labors and 6 per cent of the para 1 + labors entering the second stage. The operative interventions seemed to appear in two clusters for each parity group. It appeared that fetal asphyxia requiring intervention was discovered before 40 minutes of the second stage in para 0 and before 30 minutes in para 1 + mothers. Later operative termination was more often performed to relieve fatigued mothers.
Treatment of Labor Pain with Locally Applied Ketocaine
Authors: Ulmsten Ulf , Sandahl Björn , Lundén Christoffer , Andersson Karl‐Erik
Published: December 2009

Ketocaine, a new local anesthetic drug, was used for treatment of referred pain during labor. In a randomized, double‐blind manner, fifty primigravidae received compresses containing either ketocaine in a 10 per cent ethanol solution or compresses with saline (placebo). The compresses were applied to the skin areas where the patient experienced the most intense pain.

Nineteen of the 25 patients receiving ketocaine compresses reported good or moderate pain relief for an average of 2.5 h (range 1‐5 h). These patients had a mean cervical dilatation of 3 cm (range 2‐5 cm). In patients without effect of the compresses, the cervix was dilated to a mean of 6 cm (range 5‐8 cm). In patients reporting good effect of the treatment, pains were located mainly to the back.

Only six of the 25 patients receiving placebo compresses obtained relief of pain. The effect ceased immediately upon removal of the compresses. There was no relation between pain relief and the degree of cervical dilatation, or localization of the pain.

No maternal or fetal side‐effects related to the treatment were registered.
Diagnostic Ultrasound in Threatened Abortion and Suspected Ectopic Pregnancy
Authors: Jörgensen Connie , Skjaerris Johannes , Sundén Bertil , Åberg Anders
Published: December 2009

200 women threatened with abortion during the first 16 weeks of pregnancy were examined with diagnostic ultrasound to determine whether there were signs of intrauterine life. Of the 90 who showed positive signs, 8 aborted spontaneously later, the other 82 continued their pregnancy.

The ultrasound investigation revealed no signs of intrauterine life in 110 patients. Of these, spontaneous abortion or later evacuation because of missed abortion 101 (histo‐pathological examination showed degenerated villi in 98), not pregnant 4, mola hydatidosa 3, extrauterine pregnancies 2.

An ultrasound examination was performed to ascertain whether 136 women with suspected ectopic pregnancy had intrauterine pregnancies. 61 of them had an intrauterine gestational sac, confirmed at clinical follow‐up. One of the 61 was operated on with laparoscopy because of pain; no abnormalities were found. In 36 of the other 75, laparoscopy was performed. Ectopic pregnancy 21, ovarian or parovarian cyst 11, adhesions 2, salpingitis 1, and normal 1.

Diagnostic ultrasound is excellent for accurate prognosis in threatened abortion. Unnecessary operations avoided; hospitalization in suspected ectopic pregnancies reduced.
Alterations in the Electrocardiogram of the Fetal Lamb as a Sign of Fetal Asphyxia: A Comparison between the Scalp Lead and the Precordial Lead
Authors: Hökegård K.‐H. , Rosén K. G.
Published: December 2009

Progressive changes in the ST‐T period of the fetal electrocardiogram (FECG) were studied in 18 lamb fetuses, acutely exteriorized and subjected to graded hypoxia. The aim of the study was to compare the bipolar precordial lead (CR‐lead) with the unipolar scalp lead, and to correlate the alterations in the FECG to blood‐gas and acid‐base status. The scalp lead gave less information regarding fetal condition and was more difficult to interpret than the precordial lead. This might be one factor in the controversy regarding the significance of alterations in the FECG during asphyxia and labor, since the scalp lead is used mainly in clinical situations. Our previous results demonstrating progressive changes in the ST‐T period of the FECG during hypoxia in experimental animals and showing the same ECG changes in newborn human infants immediately after birth, were registered with the bipolar precordial lead. It is possible that a bipolar scalp lead might give more information regarding the fetal condition than the unipolar scalp lead mainly used in clinical practice.
Ectopic Pregnancy and IUDs; incidence, Risk Rate and Predisposing Factors
Authors: Meirik Olav , Nygren Karl‐GÖSta
Published: December 2009

During a period of 4 years, 1974–77, in Uppsala county; Sweden, 203 women underwent surgery for ectopic pregnancy with histological proof of the diagnosis. For the female population of fertile age this corresponds to 0.11 ectopics per 100 women 15–44 years of age, or 1.08 per 100 notified pregnancies, or 1.53 per 100 births. Fifty‐five of the women with ectopic pregnancy were using an intrauterine device (IUD) (48 a copper‐bearing IUD and 7 some other type of device), and 6 women used a low dose progestogen contraceptive. For users of copper‐bearing IUDs the risk of an ectopic pregnancy was estimated to be 0.15 per 100 women years. When comparing this latter risk rate with the overall incidence rate of 0.11, it must be observed that the populations forming the denominator in these two rates differ with respect to some crucial characteristics. Nulliparity and predisposing factors were found statistically significantly more often in non‐IUD‐users with an ectopic pregnancy than in IUD‐users. Such predisposing factors may be less prevalent in IUD‐users, as in other populations. This may explain why ectopic pregnancy has been found to occur less frequently than theoretically expected among IUD‐users. The “ectopic preventing” capacity of the IUD may therefore be considerably lower than has been previously claimed.
Acute Spontaneous Puerperal Inversion of the Uterus
Authors: Skarra Øyvin , Leikanger Kaare
Published: December 2009

Acute inversion of the uterus is a very uncommon but potentially fatal obstetric complication. A case of acute spontaneous puerperal inversion is presented, together with a survey of data concerning this obstetric emergency.
Serum Ferritin in the Evaluation of Iron Status in Young Healthy Women
Authors: Puolakka Jukka
Published: December 2009

The iron stores of 17 healthy young women were evaluated by a serum ferritin assay and by bone marrow iron determinations. Iron stores were absent or scanty in about 70% of subjects. A high degree of correlation was demonstrated between serum ferritin concentration and bone marrow iron stores. The mean serum ferritin level in women with absent iron stores was 26 μg/l, compared with 114 μg/l in women with sufficient bone marrow iron stores. Repeated measurements of serum ferritin, iron, transferrin and blood hemoglobin during the menstrual cycle revealed no significant changes in these parameters.
Serum Ferritin as a Measure of Iron Stores During and After Normal Pregnancy with and Without Iron Supplements
Authors: Puolakka J. , Jäne O. , Pakarinen A. , Järvinen P. A. , Vihko R.
Published: December 2009

The iron stores of 32 healthy pregnant women were evaluated longitudinally during pregnancy and 6 months post partum by serum ferritin assay and by bone marrow iron content. Half of the women were receiving oral iron while the others were not given iron supplementation.

Women receiving iron could maintain their iron stores throughout the pregnancy. By contrast, women without iron therapy had low serum ferritin values, pointing to the absence of iron stores during the last trimester, and 6 of these 16 women developed anemia. This was confirmed by estimation of the quantity of stainable iron in the bone marrow. In addition serum iron, transferrin and red cell MCV values indicated iron deficient erythropoesis.

During a 6‐month period after pregnancy the women receiving supplemental iron during pregnancy had a significant increase in their serum ferritin concentrations, indicating restoration of iron stores. Women not receiving iron during pregnancy had exhausted iron stores at term and serum ferritin values stayed low even at 6 months after delivery. If iron therapy was instituted after parturition, serum ferritin assays indicated restoration of iron stores within the ensuing 6 month. To prevent iron deficiency anemia during pregnancy supplemental iron is advisable for all pregnant women in our country.
A Comparative Study of Uterine Activity and Fetal Heart Rate Pattern in Labor Induced with Oral Prostaglandin E2or Oxytocin
Authors: Bremme Katarina , Bygdeman Marc
Published: December 2009

Labor was induced for medical reasons at or near term in altogether 200 patients. The women were randomly assigned to low amniotomy and either oral PGE2or intravenous infusion of oxytocin. The initial PGE2dose was 0.5 mg, followed by 1.0 mg every hour for up to 24 hours. Oxytocin was given as an intravenous pump infusion, starting with 5 mIU/min and rising stepwise to 20 mIU/min. Uterine contractility and fetal heart rate (FHR) were recorded by cardiotocography in 61 women receiving oxytocin and in 63 given prostaglandin E2. A detailed analysis of the contractility pattern was performed in 16 women, eight from each group.

Labor was established slightly earlier in the oxytocin group than in the prostaglandin group of patients. When in labor, frequency and amplitude of contractions as well as uterine contractility were the same in both treatment groups. The frequency of atypical contractility patterns was higher in labor induced with PGE2than with oxytocin. One period of hypertonus was observed in one patient treated with PGE2but it was not associated with alterations in FHR and disappeared without additional therapy. Both mild and more severe variations in FHR occurred but were equally common in both treatment groups. There was no perinatal mortality among the newborns and the Apgar score 5 minutes after delivery was 8 or more.
URINARY ESTROGEN EXCRETION AND CONCENTRATION OF SERUM HUMAN PLACENTAL LACTOGEN IN PREGNANCIES FOLLOWING LEGALLY INDUCED ABORTION
Authors: Obel Erik B. , Madsen Mette
Published: December 2009

Abstract. Feto‐placental function was assessed by 24‐hour excretion of estrogens in urine and by the concentration of human Placental Lactogen (hPL) in serum in pregnant women whose previous pregnancy was terminated by legally induced abortion. The mean 24‐hour excretion of estrogens in urine and the mean concentration of hPL in serum were no lower in this group than in women without previous induced abortion. Neither was the frequency of a low 24‐hour excretion of estrogens in urine or low concentration of hPL in serum (values less than mean − 1.96 s) found to be increased.

This study could not demonstrate an increased frequency of dysfunction of the feto‐placental unit during the last part of pregnancy in women with previous legally induced abortion. These findings indicate that legal abortion does not seem to increase the frequency of retarded intrauterine growth in a subsequent pregnancy.
HISTOLOGICAL APPEARANCES OF THE HUMAN PLACENTA OBSERVED BY ELECTRON MICROSCOPY AFTER HYPERTONIC SALINE ABORTION
Authors: Stegeman J. H. J. , Treffers P. E.
Published: December 2009

Abstract.Placentae obtained after Hypertonic Saline Induced Abortion (HSIA) were compared with placentae delivered by hysterotomy between 16 and 20 weeks of pregnancy. When investigated by routine light microscopy the greater part of the placental tissue seemed to be normal, changes were confined to a thin subchorionic layer. Transmission and scanning electron microscopy revealed serious damage especially to the syncytium, not only in the subchorial zone but also in the transitional and in the decidual zone. In vitro experiments demonstrated that a very short exposure to hypertonic solution can produce impressive histological changes in placental tissue.
Ratio of human placental lactogenic hormone (hpl) in amniotic fluid/maternal serum
Authors: Nielsen Peter Vest , Schiøler Vibeke
Published: December 2009

The predictive value of the ratio of hPL concentrations in amniotic fluid/maternal serum has been investigated in 24 complicated pregnancies. A correct prediction of the fetal outcome with respect to low birth weight and/or dysmaturity was found in 75 per cent of the pregnancies compared to 67 per cent for total estriol in serum. Serum hPL alone did not seem to have a satisfactory predictive value in this small study.
Complicated hydronephrosis of pregnancy
Authors: Kinn Anne‐Charlotte
Published: December 2009

The aggrevated course during pregnancy of previously moderate hydronephrosis due to functional obstruction at the pelvi‐ureteral junction is described. One patient underwent nephrectomy after parturition, because of severe hematuria, while another woman had a percutaneous nephrostomy in late pregnancy but could complete her pregnancy without further renal damage.
PLACENTA PREVIA AND PREVIOUS CESAREAN SECTION
Authors: Singh P. M. , Rodrigues C. , Gupta A. N.
Published: December 2009

Abstract. In a retrospective analysis over the six year period, January, 1973 to December, 1978, the incidence of placenta previa in cases with previous cesarean section (C.S.) was found to be 3.9 per cent as compared to an overall incidence of 1.9 per cent (p <0.01) The risk of placenta previa was greater in the pregnancy immediately following the cesarean section. The incidence of a morbidly adherent placenta was also significantly higher in these cases.
TERBUTALINE INHALATION FOR ALLEVIATION OF SEVERE PAIN IN ESSENTIAL DYSMENORRHEA
Authors: Kullander S. , Svanberg L.
Published: December 2009

Abstract. In a double‐blind cross‐over study the effect of terbutaline spray (Bricanyl aerosolR) inhalations was tested in 14 women with severe dysmenorrhea.

A significant relief was noted in association with an increased menstrual blood loss. The side effects were few.
VON WILLEBRAND'S DISEASE AND PREGNANCY
Authors: Punnonen R. , Nyman D. , Grönroos M. , Wallén O.
Published: December 2009

Abstract. Seven new cases of pregnancy combined with von Willebrand's disease have been reported. Altogether the patients had 11 deliveries, and one abortion after 10 weeks' gestation. The diagnosis was based on the determination of the bleeding time, factor VIII coagulant activity (VIII C), factor VIII‐related antigen (VIII RAg) and the ristocetin co‐factor (VIII RCoF). Two of our 6 parturients showed profuse bleeding at delivery; in addition one patient showed bleeding after abortion at 10 weeks' gestation. Vaginal delivery is generally safe in patiens with von Willebrand's disease. There is a great risk of copious bleeding especially in connection with early abortion, when factor VIII levels are low.
ADVANCED OVARIAN CANCER WITH SPLENIC INFARCT
Authors: Kirkinen Pertti , Kauppila Antti , Lohela Pentti
Published: December 2009

Abstract. Findings obtained with and significance of eight methods of diagnosing splenic infarct combined with advanced ovarian cancer are presented. The internal structures of the affected spleen were visualized only by ultrasonography and computer‐assisted roentgen‐ray tomography, revealing the enlarged spleen with its multilocular fluid‐filled structure. Total remission of this poorly differentiated ovarian adenocarcinoma was achieved by combined cytotoxic therapy with adriamycin, f‐ftorafur and cisplatinum.
Ectopic Pregnancy During 1961–78 in Uppsala County, Sweden: Impact of Demographic Factors on Overall Incidence
Authors: Meirik Olav
Published: December 2009

From 1961—66 to 1973—78 in Uppsala county, Sweden the overall incidence rate of ectopic pregnancy rose from 0.31 per 100 notified pregnancies or 0.28 per 1000 women 15—44 years of age, to 1.00 and 0.96, respectively. The impact of demographic changes on the increase in the overall incidence was studied. By using indirect age standardization it was found that 13% of the increase in the overall rate of ectopics per 1000 women was attributable to a change in the age distribution of women in the fertile agespan.
Clinical Evaluation of two Formulas for Ultrasonic Estimation of Fetal Weight
Authors: Eik‐Nes Sturla H. , Gröttum Per , Andersson Nils J.
Published: December 2009

Ultrasound measurement of fetal body dimensions provides a non‐invasive and precise way of obtaining information of fetal size. We applied clinically two methods for fetal weight estimation described by Hansmann. The first method employed ultrasonic measurement of the fetal biparietal diameter (BPD) and the transverse diameter through the lower fetal thorax aperture (THQ). This method was applied to 383 fetuses within 4 days of delivery. Weight range of the birth weights was 680‐5070 g. SD of prediction errors was 264 g. The method overestimated (p <0.01) the fetuses weighing less than 3000 g and underestimated (p <0.001) the fetuses weighing above 4000 g. The results for the fetuses weighing between 3000 and 4000 g were adequate. The second method employed the BPD, THQ and the gestational age for fetal weight prediction. We applied this method to 174 fetuses and obtained SD of prediction errors of 259 g. The results were adequate in all weight groups except for the fetuses weighing over 4000 g; this group was underestimated (p <0.001). The reason for the inaccuracy in the high weight groups is discussed. It is concluded that both formulas for fetal weight prediction can be used clinically when the fetal weight is expected to be below 4000 g.
Termination of Midtrimester Pregnancies Induced by Hypertonic Saline and Prostaglandin F2α: 116 Consecutive Cases
Authors: Bostofte E. , Legarth J.
Published: December 2009

In 116 patients, abortion was induced in midtrimester by intra‐amniotic administration of 20% hypertonic saline and 25 mg prostaglandin F2α. Within 60 hours 113 aborted (success rate 97.4%). Of these 68.1% had aborted within 24 hours and 92.9% within 48 hours. Thirteen patients who had not aborted within 24 or 48 hours were treated with oxytocin drip. It is concluded that the combination studied is an effective abortifacient in midtrimester and that the injection‐abortion time is reasonable, the great majority aborting within 48 hours. No live fetuses were delivered, and the complication rate was acceptable.
A Study of Estrogen and Progesterone Cytosol Receptor Concentration in Benign and Malignant Ovarian Tumors and A Review of Malignant Ovarian Tumors Treated with Medroxy‐Progesterone Acetate
Authors: Bergqvist A. , Kullander S. , Thorell J.
Published: December 2009

ER and PR were assayed in 13 malignant and 20 benign ovarian tumors of different histologic types. ER was detectable in 67% and PR in 40% of the malignant tumors, compared with 35 and 45% in the benign tumors, respectively. The ER concentration was somewhat higher in the malignant lesions but there was no difference in the PR level.

A retrospective review of 39 primary ovarian tumors of different pathologic stages and classes, treated postoperatively with medroxyprogesterone acetate (MPA, Depo‐Provera, Upjohn) and in most cases Melphalan, showed a high Karnofsky performance index and good complete and partial response rates. The need for a prospective, controlled study of the role of MPA treatment of malignant ovarian tumors is evident.
LH(hCG) Receptor in Benign and Malignant Tumors of Human Ovary
Authors: Rajaniemi H. , Kauppila A. , Rönnberg L. , Selander K. , Pystynen P.
Published: December 2009

LH(hCG) receptors were identified with [125I]hCG in 38 benign and 26 malignant ovarian tumors of the human ovary. Eighteen per cent of all the benign and 27% of all the malignant tumors were LH(hCG) receptor‐positive. Four of 12 benign serous tumors and 3 of 17 benign mucinous tumors displayed definitive binding of [125I]hCG. Two Brenner tumors failed to bind [125I]hCG. Six of 21 malignant epithelial tumors displayed definitive binding of [125I]hCG. Only one out of 4 malignant granulosa cell tumors bound [125I]hCG, while the other sex cord stromal tumors as well as one dysgerminoma failed to bind [125I]hCG. LH(hCG) receptor content in the benign and malignant receptor‐positive tumors was low compared with the normal ovarian tissue. The presence of LH(hCG) receptors in certain benign and malignant ovarian tumors may be a sign of the gonadotropic control of these tumors. The possible applications of these findings for the diagnosis and treatment of human ovarian tumors is discussed.
EFFECT OF AN ORAL CONTRACEPTIVE ON UTERINE TONICITY IN WOMEN WITH PRIMARY DYSMENORRHEA
Authors: Lalos O. , Joelsson I.
Published: December 2009

Abstract. Hysterometry, a method for quantitative evaluation of the effect of pharmacologically active agents on the myometrium, has been applied to determine the effect of an oral contraceptive on uterine tonicity. Hysterometry was performed on the first day of each of two consecutive menstrual periods in 5 dysmenorrheic women. During the second cycle the women were given ethinylestradiol 50 μg and lynestrenol 1 mg per day for 22 days. After the intake of this oral contraceptive, uterine tonicity decreased in all women, the decrease being accompanied by relief of dysmenorrheic pain.
AMPHETAMINE ADDICTION AND PREGNANCY
Authors: Eriksson Margareta , Larsson Gunilla , Zetterström Rolf
Published: December 2009

Abstract. The adverse effects of amphetamine addiction during pregnancy and the neonatal period were studied in 69 Swedish women. Almost one‐third of the women (Group I) succeeded in overcoming their addiction in early pregnancy. The women in Group I (n = 17), unlike those in Group II (n = 53), received the same amount of prenatal care as the average Swedish woman. An increased rate of preterm deliveries (25%) as well as a higher perinatal mortality (7.5%) was found in Group II. During the neonatal period an increased incidence of mother‐infant separation was found since many of the infants (46%) were transferred to pediatric wards for medical and social reasons. All new‐borns in Group I and 74% of infants born to mothers with continuous amphetamine addiction throughout pregnancy remained in their mother's custody following discharge from the maternity clinic.
RESPIRATORY DISTRESS ASSOCIATED WITH ELECTIVE REPEAT CESAREAN SECTION
Authors: Schreiner R. L. , Hutton N. M. , Hannemann R. E. , Golichowski A.
Published: December 2009

Abstract. One hundred and forty‐five elective repeat cesarean sections performed in one large medical community during a two‐year period were studied. Ninety‐nine of the patients had no prenatal test for determination of pulmonary or fetal maturity; 18 patients had an amniocentesis for L/S ratio. Only two infants were thought to be delivered prematurely, at 37 weeks gestational age. One of these infants had no respiratory distress. The other infant was delivered before the EDC by menstrual dates because a single ultrasound measurement performed one week before delivery suggested “a term fetus”, and this infant had severe hyaline membrane disease. Six other infants had mild respiratory distress compatible with transient tachypnea or aspiration. In this medical community, one must question whether the risk of routine amniocentesis for L/S ratio before every elective repeat cesarean section might outweigh the potential benefits of the procedure.
SURFACE ULTRASTRUCTURE OF AMNIOTIC FLUID CELLS AND FETAL TISSUES OF THE RHESUS MONKEY
Authors: Tydén O. , Bergström S. , Nilsson B. A.
Published: December 2009

Abstract. Amniotic fluid cytology is considered to reflect other organ maturity more faithfully than the L/S ratio. In order to assess the origin of amniotic fluid cells a pilot study was undertaken in the Rhesus monkey with the purpose of correlating the surface ultrastructure of amniotic fluid cells and various tissues facing, or communicating with the amniotic cavity. Three distinct cell types were found in the amniotic fluid, out of which two were obviously related to maturational events in fetal skin. The remaining cell type seemed to be derived from umbilical cord, fetal vagina and to some extent oral mucosa. No exfoliation was observed in the urinary bladder, trachea, lungs or amniotic membranes. It is concluded that correlation of cytology and tissue surface morphology in the monkey amniotic fluid compartment may give clues to the origin of amniotic fluid cells in the human.
THE TREATMENT OF ESSENTIAL HIRSUTISM IN WOMEN WITH CYPROTERONE ACETATE AND ETHINYL ESTRADIOL
Authors: Frey Harald , Aakvaag Asbjørn
Published: December 2009

Abstract. Ten women with essential hirsutism were treated for one year with cyclic administration of cyproterone acetate and ethinyl estradiol. Biochemical and clinical control took place after 1, 3, 6 and 12 months of treatment.

In 4 patients great improvement of hirsutism was noted, but only after 6 months of therapy. In 4 patients there was some improvement, while 2 were resistant. Side effects included reduced libido in 4 cases, mental depression in 3, dry skin and itching in 4 and transient nausea in one, but never necessitated cessation or interruption of treatment.

Several changes in endocrine function took place during treatment: testosterone secretion rate diminished together with the urinary excreetion of 17‐KS and 17‐KGS, while the serum concentration of testosterone binding globulin increased. There was a reduction in the serum concentration of total endogenous estrogens and progesterone as well as LH. No changes in hepatic, renal or hematologic parameters were found except for a slight increase in plasma pro‐thrombin time.

Clinical outcome of therapy could not be correlated with a pretreatment endocrine “profile”, nor with the changes that this therapy induced in endocrine function.

It is concluded that the anti‐androgenic effect is probably the most important in this drug regimen, but that reversibility of hirsutism may depend upon factors not directly related to androgen influence.
Oral Contraception and Some Debatable Side Effects
Authors: åstedt Birger
Published: December 2009

Abstract. Published by the author in its main part also in Gynecologic Endocrinology, Third edition, Harper & Row, Publishers Inc. Permission granted by the Publisher.
Dose‐Dependent Effects of Synthetic Progestins on the Biochemistry of the Estrogenized Post‐Menopausal Endometrium
Authors: Siddle N. C. , Townsend P. T. , Young O. , Minardi J. , King R. J. B. , Whitehead M. I.
Published: December 2009

Abstract. Symptomatic post‐menopausal women were treated with conjugated equine estrogens (Premarin; Ayerst International) 1.25 mg daily, continuously, adding either norethisterone (Primolut N; Schering Chemicals) 1, 2.5, 5 or 10 mg daily or D/L norgestrel (Wyeth Laboratories) 150 or 500 μg daily for 10 days each calendar month. Endometrial biopsies were obtained during estrogen therapy alone and oh the 6th day of combined estrogen/progestin administration.

Sensitive biochemical indices of estrogen and progestogenic activities were measured in the endometrial samples. These included measurements of DNA synthesis in epithelium and stroma by tritiated thymidine autoradiography; nuclear estradiol receptor content, and the activities of estradiol 17β and isocitric dehydrogenase and acid and alkaline phosphatase.

Low dosages of progestins achieved maximal biochemical effects and the larger doses failed to enhance these responses. It is concluded that the dosages of progestins currently added in post‐menopausal estrogen therapy are greatly in excess of those necessary to suppress endometrial proliferation effectively; lowering the daily progestin dosage is unlikely to result in any lessening of this protective effect and will probably reduce the incidence of side effects, as these appear to be dose‐dependent.
Changes Xsin Central Circulation in Premenopausal Women During Application of an Estradiol Valerate ‐ Norgestrel Combination (CyclabilR)
Authors: Backman Christer , Sandström Bo , Solheim Folke
Published: December 2009

Abstract. The orthostatic circulatory reaction, the physical working capacity on a bicycle ergometer, the indirectly measured blood pressure at rest and after the ergometer test, the total hemoglobin content, blood volume and the heart volume in supine position were all determined on three separate occasions in the 17 premenopausal women who were taking an estrogen‐progestogen combination as premenopausal substitution (2 mg estradiol valerate and 0.5 mg norgestrel, CyclabilR, Schering AG). Twelve women not receiving steroid treatment served as controls. The examinations were performed once prior to the commencement of the medication and 6 and 12 months thereafter. The orthostatic pulse reaction, the physical working capacity, the total amount of hemoglobin and the blood volume did not change during the 12 months. Heart volume increased in both groups but there was no difference between the groups. Systolic and diastolic blood pressure increased slightly in the treated group during the first 6 months but returned towards the initial values at 12 months. The transitory blood pressure increase when using the estrogen‐progestogen combination in the premenopause during 12 months is similar to that earlier reported in younger women taking low‐dose steroid contraceptives (8). It is conceivable that an adaptative mechanism in the vascular system will work in both situations.
Utero‐Placental Blood Flow and the Effect of β2‐Adrenoceptor Stimulating Drugs
Authors: Lunell Nils‐Olov , Joelsson Ingemar , Lewander Rolf , Nylund Lars , Sarby Bert , Thornström Stig , Wager Jan
Published: December 2009

Abstract. The immediate effect of a β2‐adrenoceptor stimulating drug, salbutamol, on utero‐placental blood flow in the last trimester of pregnancy was evaluated in 16 women without uterine contractions, using a method applying 113‐m Indium and a computer‐linked gamma camera. Serial scintigrams over the placental site showed a 15 per cent increase in activity during a short salbutamol infusion, denoting an augmented blood pool in the intervillous space. At the end of a 25–30 min salbutamol infusion, a mean prolongation of the rise time of the isotope accumulation curve by 100 per cent could be calculated. A utero‐placental blood flow index derived from the ratio of the maximum activity and the rise time of the accumulation curve above the placenta showed a decrease ranging from 18 to 50 per cent. It is conceivable that this initial decrease would disappear during continued infusion, as has been shown to occur in the pregnant sheep model.
Central and Peripheral Effects of Desogestrel 15–60 μg Daily for 21 Days in Healthy Female Volunteers
Authors: Cullberg Göran , Lindstedt Göran , Lundberg Per‐Arne , Steffensen Kjeld
Published: December 2009

Abstract. Desogestrel (Org 2969, 17α‐ethinyl‐18‐methyl‐11‐methylene‐4‐estrene‐17β‐01) was given for 21 days to 6 female volunteers in daily doses of 15, 30 or 60 μg until ovulation inhibition was achieved. Control cycles were studied before and after each treatment cycle. Blood samples for determinations of serum FSH, LH, unconjugated 17β‐estradiol, progesterone, prolactin, ceruloplasmin, and orosomucoid were taken at intervals of 1–2 days. The karyopyknotic index and the amount of cervical mucus, ferning, Spinnbarkeit and sperm penetration were also assessed at 2‐day intervals. An endometrial biopsy was taken on day 22 from 5 volunteers receiving the 30 μg dose.

The results of FSH, LH, 17β‐estradiol and progesterone determinations indicate that 2 of the 4 volunteers ovulated whilst taking the 15 pg dose; however, one of the 2 displayed corpus luteum dysfunction. On the 30 μg dose, 5 out of 6 volunteers had anovulatory cycles; the sixth volunteer was then given 60 μg desogestrel, which resulted in inhibition of ovulation.

In all volunteers treated with desogestrel (even those who ovulated during treatment), the cervical mucus was under progestational influence, resulting in a low Spinnbarkeit and impaired sperm penetration. The microscopic appearance of the endometrium varied but was clearly under progestational influence in all volunteers treated with desogestrel. Ovulation occurred in all post‐treatment cycles. No side effects were seen, except for ‘spottings’ during half of the treatment cycles. No changes attributable to the treatment were seen in serum concentrations of prolactin, ceruloplasmin or orosomucoid.
Computer Description of the Cardiotocogram
Authors: Nielsen Peter Vest , Stigsby Bjarne , Olesen Mogens Brix , Jaszczak Poul , Larsen Jørgen Falck , Lenstrup Carsten
Published: December 2009

Abstract. Two hundred and ten minutes of CTG from five different deliveries were described by a computer program and by four obstetricians independently of each other. The program automatically recognized and measured the variables in the CTG. Compared to the obstetricians' average measurements only minor differences were found. It is concluded that the computer program describes the CTG in almost the same way as the obstetricians, with the advantage of automated quantification and treatment of large amounts of data.
A Comparative Longitudinal Study on Sex Hormone Binding Globulin Capacity During Estrogen Replacement Therapy
Authors: Helgason S. , Damber J. E. , Damber M. G. , von Schoultz B. , Selstam G. , Södergård R.
Published: December 2009

Abstract. An aqueous two‐phase equilibrium partition system was used to assay SHBG‐binding capacity. Sera from groups of postmenopausal women before and during unopposed estrogen replacement therapy were analyzed. The induction of SHBG showed considerable differences between different estrogens. Ethinyl‐estradiol in a daily dose of 0.05 mg gave a 70% increase in the serum concentration of this liver derived protein. Estradiol‐17β, 2 mg daily and estrone sulphate 1.25 mg gave moderate changes, whereas estriol in different doses had no effect. SHBG induction may reflect estrogen overtreatment.
Does Cervix Conization Increase the Risk of Complications in Subsequent Pregnancies?
Authors: Moinian Mahmud , Andersch Björn
Published: December 2009

Abstract. In a series of 414 patients who underwent cervix conization because of cancer in situ, the risk of complications in subsequent pregnancies was analyzed by studying the outcome of their 923 pregnancies before and after cone biopsy.

After conization the incidence of late spontaneous abortion was seven times higher than before. Moreover, 20.5% of pregnancies following cone biopsy required cervix cerclage because of suspected cervical insufficiency, or cesarean section because of a scarred cervix stenosis.