bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre‐transplant cardiac testing for kidney–pancreas transplant candidates and association with cardiac outcomes
Authors: Lin Karen , Stewart Doug , Cooper Stephanie , Davis Connie L
Published: March 2003

Background: Coronary artery disease is a major cause of mortality following renal transplantation, especially in those patients with diabetes. The accurate prediction of cardiac risk is therefore a major focus of the pre‐transplant evaluation. The objective of this study was to retrospectively evaluate the ability of non‐invasive cardiac testing (standard echocardiography, stress echocardiography, exercise tolerance testing, and nuclear myocardial perfusion) performed within 1 yr of kidney–pancreas transplant to predict post‐transplant myocardial infarction.  Methods: Clinical history and pre‐transplant cardiac testing performed within 1 yr prior to transplantation were reviewed in a non‐blinded fashion for 165 kidney–pancreas transplantation patients receiving allografts between June 1990 and May 1998. The predictive values of clinical symptoms and cardiac testing for cardiac events (fatal and non‐fatal myocardial infarctions) up to 1 yr post‐transplant were calculated.  Results: Clinical history had a negative predictive value of 98% for cardiac events occurring within 1 yr following testing and 97% within 1 yr post‐transplant. Collectively, non‐invasive testing had a negative predictive value of 97% for 1 yr post‐testing and 1 yr post‐transplant.  Conclusion: Clinical history alone is highly suggestive but not sufficient for the prediction of post‐kidney–pancreas transplant myocardial infarction. Although a useful supplement, cardiac testing does not predict all cardiac events out to 1 yr post‐testing. In this high‐risk patient population with diabetes and renal failure, other methods of risk assessment are needed to more accurately predict long‐term cardiac outcome for patients awaiting transplantation.
Malignancies after heart transplantation: presence of Epstein–Barr virus and cytomegalovirus
Authors: Mattila Petri S , Aalto Sanna M , Heikkilä Lasse , Mattila Severi , Nieminen Markku , Auvinen Eeva , Hedman Klaus , Tarkkanen Jussi
Published: March 2003

The presence of Epstein–Barr virus (EBV), human papilloma virus (HPV), and cytomegalovirus (CMV) was studied in 20 patients who developed malignancies after heart transplantation in the Helsinki University Central Hospital. The tumors were analyzed for the presence of HPV by polymerase chain reaction and for EBV by in situ hybridization. Clinical CMV infection was verified by immunochemical quantitation of CMV antigen in peripheral blood cells. HPV was detected in one of the eight epithelial malignant tumors studied. Three of the six lymphomas were positive for EBV. Two (67%) of 3 patients with EBV‐positive lymphomas and one (33%) of the other three lymphomas but only 2 (14%) of 14 patients who developed other malignancies had a history of a manifest post‐transplantation CMV infection prior to the development of malignancy. These results confirm the presence of EBV in lymphomas of heart transplant recipients and suggest that CMV might have a contributory role in the development of EBV‐associated lymphomas.
Treatment of pulmonary nocardiosis in heart‐transplant patients: importance of susceptibility studies
Authors: Tripodi Marie‐Françoise , Adinolfi Luigi Elio , Andreana Augusto , Sarnataro Giuseppe , Durante Mangoni Emanuele , Gambardella Michele , Casillo Roberta , Farina Claudio , Utili Riccardo
Published: March 2003

Pulmonary nocardiosis is an infrequent but insidious disease in transplant patients. It has occurred in our centre in 3 out of 233 heart‐transplant recipients since 1988. Common clinical features were mild symptoms and a severe nodular lung involvement. Early diagnosis was based upon cultures of bronchoalveolar lavage or fine‐needle aspirate specimens of the lung lesions. Susceptibility studies and tests of antibiotic synergism guided the therapy. Two patients were treated with a combination of piperacillin‐tazobactam and ciprofloxacin, and one with imipenem and amikacin, for 3–4 wk followed by a 3‐month course of trimethoprim‐sulphamethoxazole. The nocardial disease was successfully treated in the 3 patients; however, one died of subsequent invasive pulmonary aspergillosis. In the absence of consensus on the length of therapy, this experience suggests that a synergistic combination of a beta‐lactam/beta‐lactamase inhibitor with ciprofloxacin or amikacin followed by a short course of trimethoprim‐sulphamethoxazole may be effective in eradicating nocardial disease and may reduce the need for long‐term treatment.
Efficacy of nifedipine or lisinopril in the treatment of hypertension after renal transplantation: a double‐blind randomised comparative trial
Authors: Midtvedt Karsten , Hartmann Anders , Holdaas Hallvard , Fauchald Per
Published: March 2003

Calcium channel blockers and angiotensin converting enzyme‐inhibitors are commonly used in the treatment of hypertensive renal transplant recipients. The purpose of this study was to investigate if the response rate to treatment differs with these drugs in this setting.  A single centre, prospective, randomised, double‐blinded, comparative study to address the efficacy of controlled release nifedipine or lisinopril in the treatment of hypertension (diastolic blood pressure ≥95 mmHg) in cyclosporin (CsA)‐treated renal transplant recipients was performed. Recipients were randomised to receive either lisinopril (10 mg once daily) or controlled release nifedipine (30 mg once daily). The dose was doubled on indication. The number of responders (diastolic blood pressure <90 mmHg on monotherapy) were addressed during the early post‐transplant phase (first 3 months) and during a late post‐transplant phase (from 3 to 12 months after renal transplantation) in the same patient population.  One hundred and fifty‐four patients (nifedipine=78, lisinopril=76) with untreated hypertension (diastolic blood pressure≥95 mmHg) were randomised within 3 wk after renal transplantation. One hundred and twenty‐tree patients (nifedipine=69, lisinopril=54) completed the study. Fourteen (20%) nifedipine‐treated recipients responded during the early, and 26 (38%) during the late post‐operative phase (months 4–12 after renal transplantation). Eleven (20%) lisinopril‐treated recipients responded during the early, and 18 (33%) during the late post‐transplant phase. Non‐responders were, on average, 8.5±1.5 kg heavier both in the early phase and after 1 yr of treatment (p<0.01), and 6.1±0.9 yr older than responders (p<0.05).  In conclusion, these results indicate that both controlled release nifedipine and lisinopril are equally efficient in the treatment of post‐transplant hypertension. As monotherapy, both drugs show a ‘response rate’ of 20–38%, depending on time intervalaftertransplantation.
Live donor renal transplants using kidneys with arteriographic evidence of mild renovascular disease
Authors: Hiramoto Jade S , LaBerge Jeanne M , Neymark Edward , Hirose Ryutaro
Published: March 2003

The objective of the study was to determine whether using a living donor kidney with arteriographic evidence of renovascular disease affects the outcome of the recipient's transplanted graft. Twenty‐eight patients who had unilateral renovascular abnormalities on conventional angiography underwent donor nephrectomy of the ipsilateral kidney. Results in the recipients who received these kidneys were reviewed. Comparison was made to a control group of living donor renal transplant recipients who were matched for donor, recipient age. Graft survival, patient survival, serum creatinine for all 28 recipients were evaluated. All 28 donors underwent a successful donor nephrectomy. Recipient graft survival was 96% at 1 yr, 92% at 3 yr, 71% at 5 yr, 62% at 10 yr. Mean serum creatinine values at 1 month, 1 yr, 3 yr were 1.5, 1.5, 1.6, respectively. Similar results were observed in the control group. We conclude that renal transplantation utilizing kidneys with arteriographic evidence of renovascular disease results in excellent short, long‐term renal allograft survival.
Upper gastrointestinal complications after renal transplantation: a 3‐yr sequential study
Authors: Logan Andrew J , Morris‐Stiff Gareth J , Bowrey David J. , Jurewicz W Adam
Published: March 2003

Background: Upper gastrointestinal complications have historically resulted in considerable morbidity and mortality to renal transplant recipients. Over the last decade, antiulcer prophylaxis with proton‐pump inhibitors and immunosuppression with tacrolimus‐based regimes have been introduced. Little has been written about foregut complications after renal transplantation since the use of these agents. The aim of this study was to compare the frequency of upper gastrointestinal complications after renal transplantation in patients treated with (i) omeprazole vs. ranitidine, and (ii) tacrolimus vs. cyclosporin based immunosuppression.

Methods: Information on 236 patients undergoing renal transplantation between January 1996 and December 1998 was collected prospectively onto a computerized database.

Results: Overall, 20 patients (8%) developed upper gastrointestinal complications, opportunistic infections accounted for 9/20 (45%). No patient developed gastroduodenal ulceration, required laparotomy, suffered graft loss or died. There was no significant difference in the frequency of complications between patients that received antisecretory therapy with omeprazole (9/118, 8%) and those that received ranitidine (11/118, 9%), nor between those that were on tacrolimus (7/101, 7%) and those on cyclosporin (13/135, 10%) based immunosuppression regimes. Patients that developed foregut complications were significantly older than those not developing complications (mean age 50 vs. 43 yrs, p=0.05). Further, patients that developed opportunistic infections were more frequently diabetic than those in whom opportunistic infections were not seen (4/31, 13% vs. 5/205, 2%), p=0.02.

Conclusions: We observed a low frequency (8%) of upper gastrointestinal tract complications after renal transplantation. There was no difference in the frequency of complications between patients on tacrolimus and those on cyclosporin based immunosuppression. Furthermore, the complication rates were similar in those that received omeprazole and those that received ranitidine as antiulcer prophylaxis, indicating the equivalence of these two agents in this setting.
Atelectasis – an unusual and late complication of lung transplant
Authors: Zhao Y , Al‐Kaade S , Keller CA , DeMello DE
Published: March 2003

We report a previously unrecognized late complication of allograft lung transplantation – persistent recurrent atelectasis of the transplanted lung. The patient developed sudden, severe respiratory distress about 2 yr after a right lung transplant, because of acute atelectasis of her transplanted lung. Multiple transbronchial biopsies at the time revealed minimal inflammation and no evidence of rejection. She was treated with surfactant replacement therapy, and her collapsed lung fully expanded following surfactant installation. To eliminate the possibility of acquired deficiency of surfactant lipids or proteins, ultrastructural examination and immunostains for surfactant proteins were performed in a transbronchial lung biopsy. No deficiency of surfactant lipids or proteins was found. On ultrastructural examination of the lung biopsy, the number of Type II cells per alveolus and the number of lamellar bodies per square micron of Type II cell cross‐sectional area was increased compared with an age‐matched control. We conclude that synthesis of surfactant lipids and proteins was unimpaired and because of the patient's response to surfactant replacement therapy, that the increase in number of lamellar bodies could reflect a compensatory mechanism for a surfactant functional defect. The patient later developed breast carcinoma to which she succumbed. We raise the possibility that the functional surfactant defect is a hitherto unrecognized non‐metastatic manifestation of malignancy.
Should moderate acute rejection of a cardiac transplant graft be treated?
Authors: Delgado DH , Luu L , Edwards J , Cardella C , Rao Vivek , Ross HJ
Published: March 2003

Abstract: Histologically proven, moderate acute rejection after orthotopic heart transplantation (OHT) is commonly treated with intravenous steroids. This regimen may result in severe metabolic and infectious side‐effects. The purpose of this study was to assess and compare outcomes in treated (T) versus not treated (N‐T) biopsy proven 3A rejection episodes in cardiac transplant recipients.

Methods: A retrospective analysis was conducted to identify all biopsy proven 3A rejection episodes that occurred over the time period 1995–2000 in patients (patients) ≥ 6 months after OHT (n=48 episodes in 35 patients). Of the 48 episodes, 19 were N‐T and 29 were T. Decision to treat 3A rejection was based on time after transplant, haemodynamic and/or clinical compromise and left ventricular (LV) dysfunction measured by 2D echo. Most N‐T episodes received an increase in background immunotherapy.

Results: Time from transplant to index 3A episode in N‐T patients was 4.2  versus 2.7 yr for the T patients (p=0.06). There were no differences seen between T and N‐T groups for the first and second post‐3A biopsy results or LV function post‐3A. Presence of coronary disease or death were not different between groups. Of the 29 patients with T episodes, no differences in outcomes (death, first and second post‐3A biopsy score, coronary disease, myocardial infarction, or LV function) were seen based on use of treatment with intravenous versus oral steroid.

Conclusion: In patients more than 6 month after OHT, there were no differences in outcomes (ongoing rejection or LV function) between N‐T episodes of 3A rejection and T episodes. In T patients the use of oral steroids was equally as effective for treatment of 3A episodes as intravenous steroids.
Traveling after heart transplantation
Authors: Kofidis T , Pethig K , Rüther G , Simon AR , Strueber M , Leyh R , Akhyari P , Wiebe K , Haverich A
Published: March 2003

Background. With evolving medical techniques and post‐operative care, the quality of life after cardiac transplantation is improving over the recent years. However, the need for continuous immunosuppressive therapy may result in restrictions from some social and recreational activities, including traveling. The aim of this study was to analyze traveling activities and complications in a large cohort of heart transplant recipients, with the intention to develop adequate safety and behavioral guidelines.

Methods: Using a standardized questionnaire, 103 consecutive patients (pts) were asked to report about time and destination of their traveling activities, predominant activities, as well as potential travel‐related complications. Documented rejection episodes as well as laboratory data are listed.

Results: Feedback was 97% (of 103 pts asked). Out of 100 pts who responded, [82 males, 18 females, mean age 52.3 ± 12.4 yr, 6.9 ± 3.8 yr post‐heart transplantation (HTX)] 95 reported on traveling activities (95%). Concomitant disease was present in form of diabetes (n=8), renal insufficiency (n=5) and cardiac allograft vasculopathy (n=12). Mean cumulative traveling time was 120 ± 125 d (3–560 d). Except from domestic journeys, 79 pts chose destinations within Europe, and 29 to overseas countries. Complications were reported by 15 of 95 pts (15.8%), being mostly small accidents and febrile episodes. Rejection episodes or other life threatening events were not observed. There was no significant correlation between observed complications and gender, age, time post‐HTX, immunosuppression or comorbidities.

Conclusions: Traveling after HTX appears to be safe and favorably improves quality of life, if certain precautions are met.
Duct‐to‐duct biliary reconstruction in adult‐to‐adult living donor liver transplantation
Authors: Takatsuki Mitsuhisa , Yanaga Katsuhiko , Okudaira Sadayuki , Furui Jyunichiro , Kanematsu Takashi
Published: March 2003

Takatsuki M, Yanaga K, Okudaira S, Furui J, Kanematsu T. Duct‐to‐duct biliary reconstruction in adult‐to‐adult living donor liver transplantation. Clin Transplant 2002: 16: 345–349. © Blackwell Munksgaard, 2002

In living donor liver transplantation (LDLT), Roux‐en‐Y hepaticojejunostomy has been a standard technique for biliary reconstruction because the majority had been pediatric patients with biliary atresia. Adult‐to‐adult LDLT using the right lobe graft has recently been developed and we introduced duct‐to‐duct biliary reconstruction (hepaticohepaticostomy) in such cases. The aim of this study is to evaluate the feasibility of this procedure in adult‐to‐adult LDLT. From August 2000 to October 2001, five patients underwent adult‐to‐adult LDLT using the right hepatic lobe and were followed for more than 6 months at our institution. All patients underwent duct‐to‐duct biliary reconstruction (single hepaticohepaticostomy in one, multiple in four). For the grafts with multiple bile ducts, various techniques were used for reconstruction. In all patients, oral intake could be started early after the operation, and biliary leakage was not encountered. One patient developed two episodes of acute cholangitis who later developed biliary anastomosis stricture which required percutaneous dilatation at 11 months postop. However, otherwise, there were no infectious complications postoperatively. We conclude duct‐to‐duct biliary reconstruction is feasible and effective in adult‐to‐adult LDLT.
Regular physical exercise improves endothelial function in heart transplant recipients
Authors: Schmidt Alice , Pleiner Johannes , Bayerle‐Eder Michaela , Wiesinger Günther F , Rödler Suzanne , Quittan Michael , Mayer Gert , Wolzt Michael
Published: March 2003

Background: Impaired endothelial function is detectable in heart transplant (HTX) recipients and regarded as risk factor for coronary artery disease. We have studied whether endothelial function can be improved in HTX patients participating in a regular physical training program as demonstrated in patients with chronic heart failure, hypertension and coronary artery disease.

Methods: Male HTX patients and healthy, age‐matched controls were studied. Seven HTX patients (age: 60 ± 6 yr; 6 ± 2 yr of HTX) participated in an outpatient training program, six HTX patients (age: 63 ± 8 yr; 7 ± 1 yr of HTX) maintained a sedentary lifestyle without regular physical exercise since transplantation. A healthy control group comprised six subjects (age: 62 ± 6 yr). Vascular function was assessed by flow‐mediated dilation of the brachial artery (FMD). Systemic haemodynamic responses to intravenous infusion of the endothelium independent vasodilator sodium nitroprusside (SNP) and to NG‐monomethyl‐L‐arginine (L‐NMMA), an inhibitor of constitutive nitric oxide synthase, were also measured.

Results: Resting heart rate was significantly lower (p < 0.05) in healthy controls (66 ± 13) than in the HTX training group (83 ± 11) and in non‐training HTX patients (91 ± 9), baseline blood pressure also tended to be lower in healthy subjects and in the training HTX patients. FMD was significantly higher (p < 0.05) in the control group (8.4 ± 2.2%) and in the training group (7.1 ± 2.4%), compared with non‐training HTX patients (1.4 ± 0.8%). The response of systolic blood pressure (p=0.08) and heart rate (p < 0.05) to L‐NMMA was reduced in sedentary HTX patients compared with healthy controls and heart rate response to SNP was also impaired in sedentary HTX patients.

Discussion: Regular aerobic physical training restores vascular function in HTX patients, who are at considerable risk for developing vascular complications. This effect is demonstrable in conduit and systemic resistance arteries.
Haemodynamic monitoring and liver function evaluation by pulsion cold system Z‐201 (PCS) during orthotopic liver transplantation
Authors: Díaz Susana , Pérez‐Peña José , Sanz Javier , Olmedilla Luis , Garutti Ignacio , Barrio José M.
Published: March 2003

Abstract: Pulsion cold system (PCS, COLD) is a haemodynamic monitoring system that allows measurement of cardiac output (CO), partial blood volumes, lung water, and liver function. The aim of the study was to evaluate this monitoring system during human orthotopic liver transplantation (OLT) for the following: (a) to determine agreement between CO measurements via pulmonary artery thermodilution (CO TDpa), and aortic transpulmonary thermodilution (CO TDa); (b) to compare the preload dates obtained with the COLD with central venous pressure (CVP) and pulmonary capillary wedge (PCWP); and (c) to assess the use of the plasma disappearance rate (PDR) of indocyanine green (ICG) as a measure of graft function. Fifteen consecutive patients undergoing OLT were studied. Each patient received a pulmonary artery catheter and a 5F aortic catheter with an integrated thermistor. The thermistor of the aortic catheter were connected to one computer system (COLD‐Z201, Pulsion Medical Systems, Munich, Germany). Haemodynamic data were registred an all the phases of OLT. PDR was measured during surgery in 12 patients. Correlations between PDR and the other markers of graft function (transaminases, protrombine time, and bile production) were sought. The correlation coefficient between CO TDa (COLD) and CO TDpa was r = 0.766 (p < 0.001), and an additional analysis according to Bland–Altman was also performed. There was a better correlation between the cardiac index (determined by two monitoring systems) and the volume measurements than the correlation observed with pressure preload parameters. The best correlations were found between the cardiac index in the femoral artery and intrathoracic blood volume index (ITBVI) and pulmonary blood volume index (PBVI) (r = 0.79 and r = 0.72, respectively; p < 0.01). PDR measured in the group patients with bad early graft function were lower (13.6 ± 2.7) than those in the group with a good graft function (21.6 ± 9) (p < 0.05). The degree of discrepancy between femoral and pulmonary thermodilution cardiac output measures is very wide during OLT so as to make the techniques using the COLD machine clinically useless. On the other hand, the volumes measured by COLD, specially ITBVI and PBVI, are more useful to asses the pre‐load than pressure measurements. In OLT, the PDR measured within the first few hours after liver reperfusion may become a useful tool for early diagnosis of primary graft dysfunction (PDF).
Myers Briggs Type Indicator and Tridimensional Personality Questionnaire differences between bipolar patients and unipolar depressed patients
Authors: S Janowsky David , Morter Shirley , Hong Liyi , Howe Laura
Published: March 2003

Objectives:The current study was designed to compare personality differences between bipolar patients and unipolar depressed patients, as evaluated on the Myers Briggs Type Indicator (MBTI) and the Tridimensional Personality Questionnaire (TPQ).   Methods:A group of bipolar and a group of unipolar depressed patients filled out the MBTI, the TPQ, the Beck Depression Inventory, and the CAGE questionnaire. The two groups were compared with each other as to responses on the above surveys, and subgroups of bipolar depressed and bipolar patients with manic symptoms were also compared.   Results:Bipolar patients were found to be significantly more extroverted (p=0.004) and less judging (p=0.007) on the MBTI. They were significantly more novelty seeking (p=0.004) and less harm avoidant (p=0.002) on the TPQ. Of the above differences, only the TPQ harm avoidance scale appeared strongly linked to the patients’ level of depression.   Conclusion:Significant differences in personality exist between bipolar disorder and unipolar depressed patients.
Pharmacologic loading in the treatment of acute mania
Authors: Keck Paul E , McElroy Susan L , Bennett Jerry A
Published: March 2003

The rapid and safe reduction of manic symptoms is an important initial goal of the pharmacologic treatment of acute mania. The pharmacokinetics and studies of pharmacologic loading of lithium, valproate, and carbamazepine were reviewed. In addition, the feasibility of administering other agents with potential efficacy in mania, e.g., atypical antipsychotics and new anticonvulsants, was discussed. Further double‐blind, controlled studies with adequate sample sizes comparing loading strategies with more gradual titration schedules of candidate antimanic agents are needed.
Response to lithium maintenance treatment in bipolar disorders: comparison of women and men
Authors: Viguera Adele C , Baldessarini Ross J , Tondo Leonardo
Published: March 2003

Objectives:
Possible sex differences in responses to mood‐stabilizing treatment remain poorly defined. Since women with bipolar disorder reportedly have more features that may predict a poor prognosis (depression and rapid cycling), we tested the hypothesis that women respond less well to lithium maintenance treatment.   Methods: Clinical characteristics of 360 women and men with DSM‐IV bipolar I or II disorder were compared before and during clinical lithium maintenance monotherapy in a mood disorders clinic by preliminary bivariate comparisons, multivariate analysis, and survival analysis of time stable during treatment.   Results: Women (n=229) versus men (n=131) were: more likely to have type II disorder (1.6 times), 3.2 years older at illness onset, more often depressed‐before‐manic (1.4 times), considered unipolar depressive 1.9 years longer and started maintenance treatment 5.5 years later. However, women differed little from men before treatment in overall morbidity, average episode frequency and risk of suicide attempts. Contrary to prediction, women showed non‐significantly superior responses to lithium treatment, and a significant 60% longer median time before a first recurrence during treatment, despite 7% lower average serum lithium concentrations.   Conclusions: Women were diagnosed as bipolar later than men with corresponding delay of lithium maintenance treatment that proved to be at least as effective as in men.
Menstrual cycle related mood changes in women with bipolar disorder
Authors: Rasgon Natalie , Bauer Michael , Glenn Tasha , Elman Shana , Whybrow Peter C
Published: March 2003

Objectives:  A relationship between affective symptoms and menstrual cycle in women with bipolar disorder (BPD) has been suggested. This study investigates the influence of the menstrual cycle on mood in women with BPD who are taking medication, but not selected for menstrual abnormalities.

Methods:  Data from women with BPD (n=17) consecutively enrolled into a ChronoRecord validation study were included in the current analysis. All women received medication for BPD, in addition, 35% received oral contraceptives (OC). Participants entered mood, menstrual data, psychiatric medications, and life events daily for a 3‐month period using a computerized version (ChronoRecord) of an established paper based form for self‐reporting (ChronoSheet).

Results:  The majority of women treated for BPD (65%) reported significant mood changes across the menstrual cycle. Long menstrual cycle was present in 59% of subjects, including those taking OC.

Conclusions:  Women with BPD taking medication report a high rate of long menstrual cycles, and significant mood changes in relation to menstrual cycle phase.
Expression of G‐proteins and regulators of G‐protein signalling in neutrophils of patients with bipolar disorder: effects of mood stabilizers
Authors: Willmroth F , Spleiß O , Wiesmann K , Moser D , Atmanspacher R , Van Calker D
Published: March 2003

Willmroth F, Spleiß O, Wiesmann K, Moser D, Atmanspacher R, van Calker D. Expression of G‐proteins and regulators of G‐protein signalling in neutrophils of patients with bipolar disorder: effects of mood stabilizers.  Bipolar Disord 2002: 4(Suppl. 1): 75–76. © Blackwell Munksgaard, 2002
Structural MRI and MRS abnormalities in bipolar disorder
Authors: Soares Jair C
Published: March 2003

Soares JC. Structural MRI and MRS abnormalities in bipolar disorder.  Bipolar Disord 2002: 4(Suppl. 1): 87. © Blackwell Munksgaard, 2002
Evidence for teaching bipolar disorder patients to identify early symptoms and obtain treatment
Authors: Morriss Richard
Published: March 2003

Morriss R. Evidence for teaching bipolar disorder patients to identify early symptoms and obtain treatment.  Bipolar Disord 2002: 4(Suppl. 1): 103. © Blackwell Munksgaard, 2002
Oral guar gum, a gel‐forming dietary fiber relieves pruritus in intrahepatic cholestasis of pregnancy
Authors: RIIKONEN SEIJA , SAVONIUS HANNELE , GYLLING HELENA , NIKKILÄ KATRIINA , TUOMI ANNA‐MAIJA , MIETTINEN TATU A.
Published: March 2003

Background. Guar gum is a gel‐forming fiber, which increases fecal elimination of bile acids. It may therefore be beneficial in the treatment of intrahepatic cholestasis of pregnancy.

Methods. Forty‐eight patients with intrahepatic cholestasis of pregnancy were randomized double‐blind to receive either guar gum or placebo until delivery. Serum bile acid concentration was measured. Pruritus was assessed by both the investigator and the patient.

Results. At baseline, the intensity of pruritus and the serum bile acid concentration were significantly related. Guar gum diminished or prevented worsening of pruritus, while in the placebo group pruritus was enhanced (p<0.05). In the placebo group serum bile acid concentration increased significantly, whereas in the guar gum group it remained unchanged (p<0.05 between the groups). Guar gum treatment‐induced changes of the pruritus score and serum bile acid concentrations were significantly related (p<0.01).

Conclusions. Guar gum relieved the intensity of pruritus without any side effects and prevented the rise in serum bile acid concentration in this placebo‐controlled and double‐blind study of patients with intrahepatic cholestasis of pregnancy.
Secular trends in peri‐ and neonatal mortality in breech presentation; Norway 1967–1994
Authors: ALBRECHTSEN SUSANNE , RASMUSSEN SVEIN , IRGENS LORENTZ M.
Published: March 2003

Objectives. To assess secular trends in mortality rates in breech presentation in Norway and the effects of gestational age, birth defects and delivery method.

Material and methods. The Medical Birth Registry of Norway 1967–1994, with 45,579 breech presentation births from 24 weeks of gestation onwards, with mortality rate comprising all stillbirths from 24 completed weeks of gestation and all neonatal deaths (extended peri‐ and neonatal mortality) as main outcome variable.

Results. The extended peri‐ and neonatal mortality rate in breech presentation births declined during the study period from 9.2% in 1967–76 to 5.5% in 1977–86 and to 3.0% in 1987–94. The highest relative risk of mortality in breech presentation versus the total birth population was observed in intrapartum death and in mortality less than 24 hours after delivery. Stillbirth represented about half of the extended peri‐ and neonatal mortality throughout the study period. Also in infants with birth defects, the survival increased during the study period. The extended peri‐ and neonatal mortality was highest in vaginal deliveries, but decreased during the period, irrespective of delivery method.

Conclusions. Probably due to improved obstetrical and neonatal care, mortality associated with breech presentation has substantially decreased. Increased focus especially on stillbirth, might be instrumental in further reducing the mortality associated with breech presentation.
Seroprevalence of Toxoplasma gondii among pregnant women in Sweden
Authors: PETERSSON KARIN , STRAY‐PEDERSEN BABILL , MALM GUNILLA , FORSGREN MARIANNE , EVENGÅRD BIRGITTA
Published: March 2003

Background. Primary infection with Toxoplasma gondii during pregnancy can cause fetal infection with a risk of complications for the fetus. The proportion of women at risk of acquiring the infection during pregnancy in Sweden is not known.

Methods. The seroprevalence of Toxoplasma gondii among pregnant women in Sweden was calculated when 40 978 blood samples collected on filter paper eluates from newborns were tested for Toxoplasma specific immunoglobulin G. The newborns in two geographically different areas (Stockholm County and Skåne County) were investigated during a 16‐month period between April 1997 and July 1998. The anti‐toxoplasma IgG antibodies detected in the eluates were considered to be of maternal origin and to reflect the immune status of the mother.

Results. The seroprevalence was 14.0% in Stockholm County and 25.7% in Skåne County. The seroprevalence among women born in the Nordic countries was 11.1% in Stockholm and 24.9% in Skåne. The corresponding figures for women born outside the Nordic countries were 24.3% and 29.4%. On comparing the seroprevalence found in this study with older data, the overall seroprevalence in pregnant women born in the Nordic countries and living in Stockholm was found to have decreased between 1969 and 1998. The seroprevalence in different birth cohorts, longitudinally followed in the previous and the present studies, remained at the same level over 20 years despite the increasing age of the women.

Conclusion. These results suggest that the majority of seropositive pregnant women in Sweden today have seroconverted before entering the childbearing period and that the percentage of women in Sweden acquiring toxoplasmosis during the childbearing period is low.
Exposure to and actions against passive smoking in non‐smoking pregnant women in Guangzhou, China
Authors: LOKE ALICE YUEN , LAM TAI HING , PAN SU CI , LI SU YUN , GAO XIAO JIAN , SONG YAN YAN
Published: March 2003

Background. The objective was to describe the extent of passive smoking exposure and preventive actions against passive smoking in non‐smoking pregnant women and to analyze factors associated with preventive actions.

Methods. This was a cross‐sectional survey on 1449 never‐smoking pregnant women who made their first prenatal visit to the Women and Children's Hospital of Guangzhou, China during 1996–97.

Results. 60.2% (95% Confidence Interval 57.7%–62.7%) of the never‐smoking pregnant women had a husband who currently smoked. Women with smoking husbands (n=872) were more exposed to ETS than those with non‐smoking husbands (n=577) at home (71% vs. 33%), in public places (77% vs. 66%) and at work (60% vs. 50% of working women), and they took less actions against passive smoking in public places. Women with better education and knowledge on smoking and passive smoking had stronger preventive actions.

Conclusions. Non‐smoking pregnant women in China are often exposed to passive smoking and their preventive actions are weak. Passive smoking is an important obstetric and public health problem in developing countries and deserves urgent international attention.
Radiotherapy alone for invasive vaginal cancer: outcome with intracavitary high dose rate brachytherapy versus conventional low dose rate brachytherapy
Authors: Kucera Herwig , Mock Ulrike , Knocke Thomas H. , Kucera Elisabeth , Pötter Richard
Published: March 2003

Purpose. Our aim was to compare the role of remote afterloaded high‐dose‐rate brachytherapy (HDRB) with traditional low‐dose‐rate brachytherapy (LDRB) for patients with invasive primary vaginal carcinoma.

Methods. The study group comprised 190 patients with invasive carcinoma of the vagina. The patients were staged according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Eighty patients were treated with intracavitary high‐dose rate iridium 192 brachytherapy with or without external beam therapy. These patients are compared with a historical group of 110 patients treated with intracavitary low‐dose‐rate radium 226 or cesium 137 brachytherapy with or without external beam therapy.

Results. No significant differences were found for stages, tumor grade or location between the two groups. Crude 5‐year survival for all patients was 41% in the former LDRB group, 81% in stage I and 43% in stage II. Overall actuarial 3‐year survival and disease‐specific survival rates for all patients in the HDRB series were 51% and 66%, respectively. Disease‐specific 3‐year survival attained 83% in stage I and 66% in stage II. There were no significant differences in local and distant recurrences between the treatment modalities. The comparison of treatments with or without external beam radiation and of complications showed no significant differences between the HDRB and LDRB series.

Conclusion. With HDRB and its advantages of decreased radiation exposure and patient immobilization and precise positioning, treatment results to be obtained are at least similar to traditional LDRB for primary vaginal cancer.
The very preterm infant – a population‐based study
Authors: Holmgren Per Åke , Högberg Ulf
Published: March 2003

Objectives. The aim of this study was to assess perinatal risk factors and the survival of the very preterm infant in comparison with birth beyond 32nd birthweek, as well as health care utilization by mothers and infants in the Northern Health Region of Sweden.

Design. A population‐based study was designed of all children (66,646) born in the Northern Health Region of Sweden during 1991–1996 and registered in the Swedish Medical Birth Registry.

Methods. Maternal and perinatal factors of infants born very preterm, that is, at ≤27 and 28–31 weeks of gestation, were analyzed for relative risk (RR), and a 95% confidence interval (CI), and compared with those of infants born 32–36 weeks of gestation.

Results. Of the 66,646 infants registered, 3,493 (5.2%) were born at 32–36 weeks, 394 (0.6%) at 28–31 weeks, and 199 (0.3%) at 22–27 weeks’ gestation. No special socio‐demographic maternal factors characterized these preterm births. The very preterm infants were more prone to perinatal complications such as premature rupture of the membranes (PROM) (RR=4.13; 95% CI=3.07–5.55), and both PROM and hemorrhage (RR=7.80; 95% CI=3.43–17.72). Infants born very preterm were more often twins, growth‐retarded, malformed, and affected by sepsis and respiratory distress. There was significantly better survival of preterm infants born at ≤27 weeks’ gestation if their mothers were given tertiary perinatal care. For infants born extremely preterm, survival tended to be better if they were delivered by cesarean section.

Conclusion. The very preterm birth is more often than not a result of a complicated pregnancy. The infant is often sick before birth, and for its survival is highly dependent on the highest level of perinatal care.
Complications of induced abortion and miscarriage in three African countries: a hospital‐based study among WHO collaborating centers
Authors: Goyaux Nathalie , Alihonou Eusèbe , Diadhiou Fadel , Leke Robert , Thonneau Patrick Fernand
Published: March 2003

Objective. The aim of this study was to describe two of the outcomes of pregnancy, induced abortion and miscarriage, in three African countries. Major maternal risk factors were also evaluated.

Methods. The study was prospective and based on the medical files of all 1,957 women admitted to participating health care structures.

Results. Overall, 988 women were admitted for complications of miscarriage, and 969 for complications of induced abortion. Gestational age was lower in women with miscarriages (p<0.002). The level of use of contraceptive methods ((p<0.003) and educational level ((p<0.005) were lower in women who had had an induced abortion. In our study, 26 maternal deaths were recorded, 22 of which were associated with induced abortion. Infection was the most important risk factor for death (OR=4.8; 1.9–12.4).

Conclusion. Maternal deaths related to abortion complications often occurred shortly after hospital admission and with signs of sepsis. This demonstrates the importance of effective emergency services. Unfortunately, hospital‐based studies alone cannot assess all maternal death risk factors, especially those for maternal death related to induced abortion complications. It is therefore important to determine what happened to the woman before hospital admission and during her stay in hospital. Combinations of qualitative and quantitative methods could be used to increase our understanding of this problem and to help us to solve it.
Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding
Authors: Sousa Rita , Silvestre Margarida , Almeida E Sousa Luis , Falcão Francisco , Dias Isabel , Silva Teresa , De Oliveira Carlos , Oliveira Henrique Miguel
Published: March 2003

Objective. To determine the diagnostic value of transvaginal ultrasonography and hysteroscopy in patients with postmenopausal bleeding.

Material and methods. Between January 1, 1998 and June 30, 1999, 88 outpatient women with postmenopausal bleeding were enrolled in a prospective study. They underwent transvaginal ultrasonography and hysteroscopy, and were submitted to directed biopsy during hysteroscopy. Findings were classified as normal endometrium, suggestive of atrophy, focal abnormality (benign or suspicious), and diffuse thickness (benign or suspicious). Data was compared with the final diagnosis, established by histological examination, as atrophy, benign pathology, atypical hyperplasia and endometrial carcinoma.

Results. Among 88 women enrolled, 15 were excluded because hysteroscopy was impossible, and four had abandoned the study. The histological findings were scanty material in 12 (17.4%), atrophy in 24 (34.8%), cystic atrophy in one (1.4%), normal endometrium in five (7.2%), tuberculous endometritis in one (1.4%), polyps in 12 (17.4%), leiomyoma in one (1.4%), non‐atypical hyperplasia in three (4.3%), atypical hyperplasia in one (1.4%) and endometrial carcinoma in nine cases (13.0%). For the assessment of endometrial carcinoma, ultrasonography revealed sensitivity 77.8%, specificity 93.3%, positive predictive value 63.6%, negative predictive value 96.6%; and hysteroscopy revealed sensitivity of 88.9%, specificity 98.3%, positive predictive value 88.9%, negative predictive value 98.3%. The combined use of both methods revealed sensitivity 100%, specificity 91.7%, positive predictive value 64.3%, negative predictive value 100%.

Conclusions. Both imagiological methods were found to be useful screening tests for endometrial carcinoma. Hysteroscopy was a superior diagnostic procedure.
Psychosocial predictors of disappointment with delivery and puerperal depression
Authors: Saisto Terhi , Salmela‐Aro Katariina , Nurmi Jari‐Erik , Halmesmäki Erja
Published: March 2003

Background. To examine the extent to which personality characteristics, depression, fear and anxiety about pregnancy and delivery, and socio‐economic background, predict disappointment with delivery and the risk of puerperal depression.

Methods. Two hundred and eleven women filled in questionnaires measuring personality traits, socio‐economic factors, and marital satisfaction once before and once after the 30th week of pregnancy, and 2–3 months after delivery, when obstetric data about pregnancy and delivery was also collected.

Results. The women who were disappointed with their delivery or suffered from puerperal depression had been more depressed already in early pregnancy. Regression analysis showed that the strongest predictors of disappointment with delivery were labor pain (increase in R2=0.14, p<0.001) and emergency Cesarean (increase in R2=0.18, p<0.001).

Puerperal depression was predicted by depression (increase in R2=0.16, p<0.001), and by personal traits such as general anxiety, vulnerability and neuroticism (increase in R2=0.32, p<0.001), both before 30 weeks of pregnancy and prior to the delivery (for depression increase in R2=0.05, p<0.001, and for anxiety and vulnerability increase in R2=0.04, p<0.01). The strongest predictors were depression at both time points before delivery (beta=0.51, p<0.001, and beta=0.39, p<0.001). Pregnancy‐ and delivery‐related anxiety prior to the delivery also predicted puerperal depression, but complications of the pregnancy and delivery did not.

Conclusions. Depression in early pregnancy predicts disappointment with the delivery and is a strong predictor of puerperal depression.
Serum leptin levels in pregnant women with type 1 diabetes mellitus
Authors: Lauszus Finn F. , Schmitz Ole , Vestergaard Henrik , Klebe Joachim G. , Pedersen Oluf
Published: March 2003

Background. Leptin is an important weight regulator and during pregnancy leptin is not only synthesized in adipose tissue but also in the placenta.

Aim. To examine changes in serum leptin levels in women with type 1 diabetes mellitus during pregnancy and post delivery in relation to concomitant changes in maternal body weight, birth weight, glycemic control, and blood pressure.

Methods. Non‐fasting serum leptin from 45 women with type 1 diabetes mellitus were studied consecutively throughout pregnancy and 3 months post partum.

Results. Serum leptin was positively associated with HbA1c in week 18, 22 and 30 (r=0.38, 0.41, and 0.54, respectively, p<0.05, adjusted for body weight). Moreover, serum leptin correlated positively with maternal body weight and BMI (0.45<r<0.66, p<0.05). Serum leptin was significantly lower after delivery than during pregnancy where the levels showed no change from gestational week 14 to week 38. In obese women (BMI >25 kg/m2), the changes during pregnancy and the level of serum leptin were significantly greater compared to lean women (p<0.05). The women with low ambulatory blood pressure (lower tertile, mean arterial blood pressure <83.4 mmHg) showed the lowest level of serum leptin throughout pregnancy and it changed significantly differently from the women with higher blood pressure (p<0.05).

Conclusion. Changes in serum leptin levels of pregnant women with type 1 diabetes mellitus were associated with parallel changes in maternal body weight and glycemic control. Women with low blood pressure had the lowest serum leptin levels throughout pregnancy.
Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding
Authors: Krampl Elisabeth , Bourne Tom , Hurlen‐Solbakken Heidi , Istre Olav
Published: March 2003

Objective. To evaluate the diagnostic accuracy of transvaginal ultrasonography, sonohysterography and hysteroscopy in patients presenting with abnormal uterine bleeding.

Design. Prospective, blind, comparative study.

Setting. Outpatient clinic and day surgery unit of a district hospital specializing in operative hysteroscopy.

Patients. One hundred consecutive patients referred with abnormal uterine bleeding (AUB).

Interventions. Transvaginal ultrasonography and sonohysterography were performed in the outpatient clinic. Within 1 week, all patients underwent operative hysteroscopy.

Main outcome measures. All diagnoses established by transvaginal ultrasonography, and sonohysterography were compared to the appearance of the cavity using hysteroscopy as well as the histological diagnosis from removed tissues.

Results. In 88 patients information suitable for analysis was obtained by all methods. The detection rate of focal intrauterine pathology using sonohysterography was (94.1%), but was significantly lower with transvaginal ultrasonography (23.5%). In about 75% of all cases none of the methods used was able to correctly detect endometrial hyperplasia.

Conclusions. Sonohysterography was significantly better than transvaginal ultrasonography in detecting focal intrauterine pathology. Visual examination at operative hysteroscopy yielded no additional information to the detection or exclusion of focal lesions than was obtained at outpatient sonohysterography. All methods performed equally in assessing endometrial pathology. We conclude that sonohysterography may replace diagnostic hysteroscopy in many patients with AUB.