bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a test model of induced dysmenorrhea
Authors: LIEDMAN RAGNER , SKILLERN LAURENCE , JAMES IAN , MCLEOD ALISON , GRANT LEE , ÅKERLUND MATS 
Published: December 2009

AbstractBackground. The myometrial hyperactivity and reduced uterine blood flow of primary dysmenorrhea is to a large extent caused by increased vasopressin secretion. A new therapeutic approach for this condition is to develop antagonists of uterine vasopressin V1a receptors. We studied a test model of vasopressin‐induced dysmenorrhea in healthy, sterilized women and compared responses against those in dysmenorrheic subjects. Methods. Eight women with primary dysmenorrhea and eight sterilized, healthy women participated in recordings of intrauterine pressure and experienced pain on days 1–2 of two menstruations. We tried to identify biochemical markers in plasma of uterine ischemia. Furthermore, the effects of repeated bolus injections of 10 pmol/kg b w of vasopressin or placebo on these parameters were assessed. Results. The vasopressin injections caused statistically significant increases in the area under the intrauterine pressure curve (AUC) in both healthy volunteers and patients with dysmenorrhea, the overall responses being greater in healthy volunteers. The experienced pain measured by visual analog scale in individual dysmenorrheic subjects tended to show higher maximal post‐dose scores for the vasopressin injections than for placebo. Maximum visual analog scale scores and maximum AUCs in individual subjects tended to be related. Mean creatine kinase MB levels were higher in women with dysmenorrhea than in healthy subjects both before and after vasopressin administration, the converse being observed for C‐reactive protein levels. Conclusions. The present model appears to be useful for evaluating new drugs for the treatment of primary dysmenorrhea.
Longitudinal trends in cervical cytological lesions and the effect of risk factors. A 30‐year overview
Authors: SIGURDSSON KRISTJAN , SIGVALDASON HELGI 
Published: December 2009

AbstractBackground. Cytological preinvasive changes are important precursors in cervical cancer, therefore variations in their trends affect screening guidelines. Methods. Trends in cytological preinvasive changes following the 1st to 5th screening visits in the 20–34 and 35–69 year age groups were analyzed for the period 1979–2002: a) the incidence rate (absolute risk) of higher grade cytology and the relative risk of risk factors on this rate; b) the cumulative incidence of low‐grade and higher grade smears after normal and abnormal screening results; c) the cumulative incidence of higher grade cytology at a fixed risk level after normal screening results; and d) the prevalence of higher grade smears at first screening visit in the 20–24/25–29 year age groups during 1971–2002. Results. An increased trend in the prevalence of higher‐grade smears was observed at the first screening visit after 1980. The main risk variables for higher‐grade smears in both age groups were low‐grade changes and inflammation followed in the younger age group by calendar year. However, age correlated with a decreased risk ratio. After normal screening the cumulative incidence rate of low and higher‐grade smears increased almost linearly with time. The screening interval before diagnosis of higher‐grade smears increased with both age and number of normal visits, but leveled out after the age of 35–40. Conclusions. Trends in higher‐grade smears indicate that screening should preferably start before age 25 with a maximum interval of 3 years. The interval can be extended after age 35–40. Low‐grade smears or inflammation need closer follow‐up.
Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy
Authors: MARRET H. , CHEVILLOT M. , GIRAUDEAU B. , LALITHA K. 
Published: December 2009

AbstractBackground. To assess the probability of conversion of a laparoscopic myomectomy to an open procedure, we only found the score developed by Dubuisson et al. (2001) based on four preoperative risk factors. Routinely this score is not appropriate, as realized by the most skilled laparoscopic surgeons. Methods. The aim of this study was to identify the preoperative factors affecting the risk of conversion in data collected in different centers among a population of surgeons at the beginning of their experience in laparoscopic myomectomy. We collected preoperative clinical and ultrasonography data for all laparoscopic myomectomies performed in 11 hospital centers between January 1996 and December 2000. Data were available for 116 patients. Multiple logistic regression was use to develop a simple predictive model based on available preoperative risk factors of laparoconversion. Results. We encountered 33 laparoconversions (28%) compared to an expected number of 7.8 using Dubuisson's score. We confirmed the importance of two of the four risk factors in Dubuisson's model: biggest myoma size at ultrasonography (↑ 1 mm) (OR: 1.06) and intramural type (OR: 3.25) of the dominant myoma. However, we also identified another risk factors: surgeon's experience (OR: 0.15). Simple score was calculated and used to provide an estimated risk of conversion. Conclusion. Our model is a useful tool to predict laparoconversion for surgeons beginning in laparoscopic myomectomy. Ultrasound evaluation is essential before performing the procedure. Skilled surgeons in laparoscopy and in laparoscopic myomectomy must help their trainees during their learning curve in order to reduce laparoconversion rate.
Female patients report on health care staff's disobedience of ethical principles
Authors: Swahnberg Katarina , Wijma Barbro , Liss Per‐Erik 
Published: December 2009

AbstractBackground.Earlier studies have shown a high prevalence of abuse in health care (AHC). We hypothesized that patients might easily feel abused when staff do not follow prevailing ethical principles. Therefore we developed the Violations of Ethical Principles Questionnaire (ViolEP), with 30 examples of situations in health care where four ethical principles are disobeyed (autonomy, nonmaleficence, justice, and integrity). Respondents reported whether or not they had ever experienced each of the situations, and whether or not they had perceived that event as a violation. Research questions: 1. What proportion of female patients have ever experienced staff disobeying ethical principles in health care? 2. To what extent are such events perceived as violations? and 3. How well do perceived violations of ethical principles correspond to experiences of AHC?Method.Our sample was 661 consecutive female patients at the Department of Obstetrics and Gynecology in Linköping, Sweden. They completed ViolEP and NorVold Abuse Questionnaire (NorAQ) at home and returned them by post.Results.20/661 (64%) women answered the ViolEP and 426/661 (64%) returned the NorAQ. The majority (73%) (306/420) had experienced staff disobeying ethical principles. More than every second woman had perceived those events as violations (68%) (209/306). The prevalence of AHC was 23%. ViolEP had good sensitivity but low specificity when we used AHC according to NorAQ as the “gold standard”.Conclusion.The majority of the patients had experienced health care staff disobeying prevailing ethical principles. These events were not always perceived as violations. The reason for this discrepancy needs to be explored.
Endoscopic treatment of deep infiltrating endometriosis (DIE) involving the bladder and rectosigmoid colon
Authors: Langebrekke Anton , Istre Olav , Busund Bjørn , Johannessen Hans‐Olaf , Qvigstad Erik 
Published: December 2009

AbstractBackground. To study the feasibility, complications and symptom relief of laparoscopic treatment in patients with deep infiltrating endometriosis.Methods. From January 2004 to March 2005, 24 patients with deep infiltrating endometriosis were treated with laparoscopic techniques. Preoperative symptoms, staging, involvement of the disease, and surgical procedures were recorded. Operating time and perioperative complications were also registered, as well as follow‐up of the patients.Results. The surgical treatment was individualized with removal of deep infiltrating endometriosis in all 24 patients, additional bladder resection in five patients and colorectal resection in eight patients. In two cases laparoconversion was performed, and one patient had a temporary loop ileostomy. We observed no major peri‐ or postoperative complications. Median operating time was 3.4 h (range 1.4–8.0 h). All patients with bladder involvement were relieved of their urinary dysfunction, while all except three patients were successfully treated for their pain problems, and also these three patients had symptom relief.Conclusions. Patients with deep infiltrating endometriosis represent a challenge to surgical procedures. Our results show that radical laparoscopic surgery including colorectal and bladder resection is feasible, safe, and effective in almost all patients.
Primary surgery of genital prolapse: a shift in treatment tradition
Authors: Crafoord Kristina , Sydsjö Adam , Nilsson Kerstin , Kjølhede Preben 
Published: December 2009

AbstractBackground. The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10‐year period. Methods. A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data. Results. The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001). Conclusion. The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.
Risk factors for forceps delivery in nulliparous patients
Authors: MAZOUNI CHAFIKA , PORCU GÉRALDINE , BRETELLE FLORENCE , LOUNDOU ANDERSON , HECKENROTH HÉLÈNE , GAMERRE MARC 
Published: December 2009

AbstractObjective. To identify risk factors for forceps delivery during first pregnancy. Materials and methods. A retrospective case–control study was carried out in a tertiary maternity ward between January 2001 and December 2003. A total of 582 nulliparous women, with full‐term (>37 weeks gestation), singleton, cephalic pregnancies, who delivered by the vaginal route with or without instrumental assistance were evaluated. Results. The strongest risk factors for forceps delivery were birth weight greater than 4000 g (OR: 6.5; 95% CI: 1.6, 26.9), the occiput posterior position of the fetal head (OR: 5.8; 95% CI: 2.5, 13.8), and epidural analgesia (OR: 7.7; 95% CI: 4.1, 14.7). Other significant risk factors for forceps delivery were age over 35 years (OR: 2.4; 95% CI: 1.1, 5.1), induction of labor (OR: 2.1; 95% CI: 1.4, 3.1), first stage of labor longer than 420 min (OR: 2.3, 95% CI: 1.3,4.2), and a prolonged second stage of labor (OR: 1.6, 95% CI: 1.1, 2.4). Conclusion. Age over 35 years and induction of labor are risk factors for forceps delivery at admission. Epidural use, fetal head in occiput posterior position, and birth weight >4000 g are strong intrapartum risk factors for instrumental delivery in nulliparous women.
Fetal heart rate patterns and neurodevelopmental outcome in very low birth weight infants
Authors: Nisenblat Vicki , Alon Eran , Barak Shlomi , Gonen Ron , Bader David , Ohel Gonen 
Published: December 2009

AbstractBackground. To evaluate the validity of fetal heart rate monitoring during the last hour prior to birth, as a predictor of long term neurodevelopmental outcome of very low birth weight infants. Methods. A total of 111 very low birth weight infants were included in the study. Fetal heart rate tracings were obtained during the last hour prior to delivery. A perinatologist, blinded to the neonatal outcome, evaluated the tracings and divided them into three groups: reassuring, nonreassuring, and pathological. Neurodevelopmental status was evaluated at age 2 years. The relationship between fetal heart rate monitoring results and the neurodevelopmental outcome at 2 years of age was assessed with a chi‐square test and the Student's t‐test. Results. At 2 years of age 97 (87.4%) of the children had normal neurodevelopmental function, while 14 (12.6%) had variable degrees of neurodevelopmental impairment. The fetal heart rate monitoring results were classified as reassuring (normal) in 35 cases (31.5%), nonreassuring in 56 cases (50.5%), and pathological in 20 cases (18.0%). Both normal and pathological fetal heart rate patterns were associated with similar incidence of abnormal neurodevelopmental outcome, 14.3% and 15.0% of cases, respectively (p=0.778). Pathological fetal heart rate patterns as a predictor of neurodevelopmental outcome had a sensitivity of 27%, specificity of 74%, positive predictive value of 15%, and negative predictive value of 86%. Conclusion. Electronic fetal heart rate monitoring prior to delivery is not a reliable tool for the prediction of neurodevelopmental impairment in premature infants of very low birth weight, at 2 years of age.
Choosing fertilization method by analyzing sperm morphology or by performing swim‐up preparation
Authors: SÖDERLUND BRITA , LUNDIN KERSTI 
Published: December 2009

AbstractBackground. Evaluation of sperm morphology has been used as a screening method for choosing between intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF). However, sperm morphology analysis is a time‐consuming and often subjective scoring method, and may lead to an unnecessarily large proportion of invasive and costly ICSI treatments. The aim of this study was to evaluate if the yield after swim‐up preparation could be of advantage over sperm morphology evaluation for choosing fertilization method. Material and methods. In the first part of the study 53 split cycles with less than 5% normal forms in the ejaculate were retrospectively evaluated. Part 2 is a prospective evaluation including 357 cycles where the number of sperm available after a standardized swim‐up procedure was used for choosing fertilization method. In all cycles where ≤1 million sperm were obtained after swim‐up, conventional IVF was performed. Results. In the first part no statistically significant difference in fertilization rates was found for IVF and ICSI respectively (59.2% versus 64.7%). Four IVF cycles ended up in total fertilization failure (TFF) while in no ICSI cycle was TFF obtained. In the second part 8.9% TFF was obtained in the poor sperm morphology group compared to 1.3% in the good morphology group. These TFF corresponded to 1% of all our treatment cycles. Conclusion. The present strategy reduced ICSI treatments by 10%, thereby reducing the cost and workload. It can be discussed if an increase of TFF in absolute number of eight is balanced by a reduced workload of 100 ICSI treatments.
Preserved microcirculatory response to acute estrogen not reflected by exercise capacity
Authors: Fogelberg Monika , Löfman Ida , Carlström Kjell , Freyschuss Anna , Henriksson Peter 
Published: December 2009

AbstractBackground. To assess the acute effect of a single dose of 10 mg oral micronized 17β‐estradiol on microcirculation in postmenopausal women with and without coronary artery disease and its potential influence on exercise capacity. Methods. Postmenopausal women (n=11) with coronary artery disease had symptoms of ischemic heart disease and at least 1 mm ST depression at exercise. Microcirculation was examined by vital microscopy, with and without the acute administration of estrogen in a placebo‐controlled cross‐over design. Exercise test was performed on bicycle. The microcirculatory findings were contrasted to those in 14 healthy postmenopausal women. Results. 17β‐Estradiol in serum and blood flow velocity increased significantly after acute oral estrogen administration both in women with coronary artery disease (p<0.001) and in healthy women (p<0.0001), with no significant difference between the two groups. No effect on exercise capacity or ST depression at exercise was detected. Conclusions. Previously reported data that a single dose of estrogen administered to postmenopausal women results in positive effects on exercise was not reproduced. An increased peripheral microvascular flow velocity was detected in women with coronary artery disease and this increase was not accompanied by an increased exercise capacity.
No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy – a preliminary study
Authors: Oscarsson Ulf , Sundström Poromaa Inger , Nüssler Emil , Löfgren Mats 
Published: December 2009

AbstractBackground. Although a number of well‐designed studies have concluded that laparoscopic hysterectomy is associated with less postoperative pain, reduced hospital stay, and shorter periods of sick leave, thus far, studies on the perioperative and postoperative outcomes of laparoscopic supravaginal hysterectomy (LSH) versus abdominal supravaginal hysterectomy (ASH) are lacking. By applying multimodal intervention program for the postoperative care of patients, the primary aim of the current study was to compare length of hospital stay, time to convalescence, and long‐term patient satisfaction between LSH and ASH. Method. The study was conducted at the departments of Obstetrics and Gynecology, Skellefteå Hospital and Lycksele Hospital. Forty‐seven consecutive women scheduled for supravaginal hysterectomy were randomly assigned to LSH or ASH. Perioperative and postoperative parameters were compared between the two groups. Results. The length of the postoperative hospital stay did not differ between patients undergoing LSH and ASH, but the number of disability days was greater in the ASH group. The operating time was significantly longer in the LSH group compared with the ASH group, whereas the estimated perioperative bleeding was greater in the ASH group. At the 6‐month follow‐up, 87.0% of patients in the ASH group and 91.3% in the LSH group were satisfied or very satisfied with the overall result of the surgical procedure. Conclusion. The present study has indicated that by applying a multimodal intervention program for the postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered for the length of postoperative hospital stay and long‐term patient satisfaction.
Laparoscopic‐assisted vaginal vs. abdominal surgery in patients with endometrial cancer stage 1
Authors: Tollund Lisbeth , Hansen Birgit , Jørgen Kjer Jens 
Published: December 2009

AbstractBackground. The development of new diagnostic and surgical methods has brought a differentiated approach to the surgery of endometrial cancer. The aim of this study was to verify the peri‐ and postoperative differences between laparoscopic and open procedures. Methods. In the period from January 1995 to August 2001 a total of 86 patients were treated for endometrial cancer stage 1. Of these, 28 patients were treated by laparoscopic‐assisted vaginal hysterectomy (LAVH) and bilateral salpingo‐oophorectomy (BSO), while 58 patients were treated by total abdominal hysterectomy (TAH) and BSO. The two patient groups were comparable in all aspects. Results. The average hospital stay in the LAVH group was 2.7 days compared to 5.4 days for the TAH group. There were fewer complications in the LAVH group (7%) compared to the laparotomy group (14%). Conclusions. Laparoscopic‐assisted vaginal hysterectomy seems to be acceptable in the treatment of stage 1 endometrial carcinoma.
A prospective study on whether a tension‐free urethropexy procedure affects the residual urine and flow up to 4 years after the operation
Authors: Glavind Karin , Bjørk Jonna , Nøhr Mads , Jaquet Annette , Glavind Laura 
Published: December 2009

AbstractBackground. Sling procedures performed for urinary stress incontinence can be complicated by urinary retention and flow problems. The aim of this study was to evaluate the flow and the residual urine before and after a tension‐free vaginal urethropexy procedure performed for stress urinary incontinence. Methods. A total of 72 women were included in the study. For voiding phase assessment, patients had spontaneous flow and residual urine measurements performed before the operation and 3 months and 1, 2, 3, and 4 years after the operation. Results. The patients experienced an increase in residual urine 3 months postoperatively, but returned toward preoperative values in the following 4 years. A statistically significant decrease in maximum flow, average flow, and corrected maximum flow was observed 3 months after the operation, which was unchanged in time and thus did not increase over the years. Conclusion. The tension‐free urethropexy operation had an influence on flow which did not deteriorate over the years. Whether this change in flow will have any influence on the detrusor function or create voiding problems in years to come is unknown.
Previous aneuploidic offspring in a young woman does not increase the risk for somatic random aneuploidy in subsequent pregnancies
Authors: Biron‐Shental Tal , Amiel Aliza , Fejgin Moshe D. 
Published: December 2009

AbstractThe cause of aneuploidy in fetuses of young women is not fully understood. As such women are considered to be at risk of repeating the “error”, it is customary to recommend chromosomal evaluation (karyotyping) in subsequent pregnancies. Individuals predisposed to meiotic nondisjunction exhibit aneuploidy in their mitotic cells (mosaicism). The aim of this study was to assess the actual risk for repeated aneuploidy in patients who had a previous pregnancy with aneuploidy by estimating the rate of somatic random aneuploidy in their normal pregnancy and to assess whether this risk is heritable. With utilization of FISH, we assessed the number of chromosomes 9 and 18 in amniocytes from the following pregnancies: 1. Fourteen of the women had a history of chromosomal aneuploidy in a previous pregnancy (study group). 2. Ten women had previous normal pregnancies (control). 3. Nine samples were assessed in amniocytes taken from aneuploid pregnancies (positive controls). A mean of 458±65.66 amniocytes were evaluated (range 97–500 nuclei). There was no significant difference in the rate of aneuploidy of both chromosomes between the study and control groups. However, this rate was significantly higher in the aneuploid pregnancies (p<0.05). Conclusion. The known tendency for repeated nondisjunction shown in women with previous aneuploid babies could not be demonstrated in their offsprings.