bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endometrial thermoablation for treatment of menorrhagia: comparison of two methods in outpatient setting
Authors: Vihko Kimmo K. , Raitala Reijo , Taina Esko 
Published: December 2004

Background. Menorrhagia is one of the commonest reasons for gynecologic consultations. Inhibitors of fibrinolysis and non‐steroidal anti‐inflammatory drugs (NSAIDs) are generally used as therapy for the condition with an acceptable response in some patients. Endometrial ablation is one choice in patients suffering from menorrhagia. It can be performed in patients with no endometrial histological or anatomical pathology. In this method, the functional endometrial tissue is ablated under general anesthesia in an outpatient setting.Methods. We compared two methods that are widely used in Finland (Menotreat® and Cavaterm®) in thermoablation of endometrial tissue in 31 patients that were randomized into two treatment groups.Results. Endometrial ablation was effective in the treatment of menorrhagia in patients with normal endometrial structure. About 70% of the patients described the result of the treatment as ‘very good’. Only one patient underwent a hysterectomy during the 6‐month follow‐up period because of problems related to uterine bleedings. The two methods were similar in efficacy and patient acceptance.Conclusions. Both thermoablation techniques were well accepted by our patients and showed similar and good efficacy and patient acceptance.
Randomized, prospective, double‐blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse
Authors: Miskry Tariq , Magos Adam 
Published: December 2004

Background. To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse.Method. In a two‐center prospective, double‐blind randomized trial, 36 women with dysfunctional uterine bleeding, uterine fibroids or pelvic pain scheduled for hysterectomy were randomized to abdominal or vaginal hysterectomy. The primary outcome measure was the duration of hospital stay. Secondary outcome measures included analgesic requirements and return to normal health and function.Results. There were no significant differences in peri‐operative patient or surgical characteristics. Vaginal hysterectomy was associated with a reduction in hospital stay compared to abdominal hysterectomy (median stay 3 days vs. 5 days, p = 0.01). In addition, patients undergoing vaginal hysterectomy had reduced analgesic requirements (mean 75.4 mg vs. 131.4 mg morphine equivalent, p = 0.002), shorter need for intravenous hydration (mean 25.3 h vs. 32.7 h, p = 0.05), and faster return of bowel action (median 3 days vs. 4 days, p = 0.002). They also returned to normal domestic activities (mean 4.6 weeks vs. 8.5 weeks, p = 0.01) and work (mean 7.0 weeks vs. 13.9 weeks, p = 0.005), and completed their recovery (mean 7.9 weeks vs. 16.9 weeks, p = 0.008) more quickly.Conclusions. Vaginal hysterectomy was associated with significant benefits in terms of reduced hospital stay and improved patient recovery. Vaginal hysterectomy should be the route of choice not only for women with genital tract prolapse but also those without.
Reactions to awareness of activated protein C resistance carriership: a descriptive study of 270 women
Authors: Lindqvist Pelle G. , Dahlbäck Björn 
Published: December 2004

Background.  Around 25 million Caucasian women are carriers of the FV Leiden mutation that causes activated protein C (APC) resistance. This is a heritable condition with a lifelong increased risk of venous thromboembolism. We performed this study to investigate women's reactions to their awareness of being APC‐resistant and the consequences of this awareness.Methods.  All APC‐resistant women (n = 270) included in a prior study on APC resistance and pregnancy (n = 2480) were invited by written questionnaire to describe their reactions to having APC resistance, how this had changed their lives, and how they experienced our information. Answers were obtained from 215 of the 270 women (80%).Results.  More than 94% of the APC‐resistant women were satisfied with knowing themselves to be APC‐resistant and pleased that they had enrolled in the study. Of the women on combined oral contraceptives (COC), 84% changed their method of contraception, but 16% continued on COC. One‐third of the women reported becoming more worried or afraid of getting pregnant again as a result of their awareness of being APC‐resistant. The proportion of women who sought legal abortions during a 2‐year period after receiving this information was similar in both subgroups: 4.4% (12/270) vs. 4.3% (94/2210), p = 0.9.Conclusions.  We conclude that most APC‐resistant women were pleased to learn of their APC resistance status, that there was not an increased incidence of legal abortions, but almost one‐third reported being more worried or afraid of getting pregnant again.
Embryo transfer by midwife or gynecologist: a prospective randomized study
Authors: Bjuresten Kerstin , Hreinsson Julius G. , Fridström Margareta , Rosenlund Björn , Ek Ingvar , Hovatta Outi 
Published: December 2004

Background.  Embryo transfer (ET) in assisted reproduction treatments has traditionally been performed by gynecologists in the Nordic countries. As gynecologists often have a busy schedule, midwives and nurses have become increasingly important in performing the treatment, providing subject information, ultrasound monitoring and assistance at ET.As part of the continuous development of our IVF treatment we have carried out a prospective randomized pilot study where either a midwife or a gynecologist has performed ET. The aim of this study was to see if a skilled IVF midwife could perform ET with similar results to a gynecologist.Methods.  On the day of oocyte aspiration the subjects were randomized, by means of closed envelopes, for ET to be performed either by a midwife or a gynecologist. A total of 102 subjects were included in the study, 51 for ET by a skilled midwife and 51 by a gynecologist. There were no differences in the groups in respect to ET routine and catheters used.Results.  No significant differences were observed in subject characteristics as regards age, method of pituitary down‐regulation or proportion of IVF/ICSI cycles. Similar clinical pregnancy rates between ETs performed by midwives vs. gynecologists, 31% vs. 29%, respectively, were seen. Subject experience as judged by a questionnaire also showed high acceptance of ET by a midwife.Conclusion.  The results show that it is a feasible option to allow midwives to carry out ETs.
Feasibility of simultaneous application of fetal electrocardiography and fetal pulse oximetry
Authors: Luttkus Andreas K. , Stupin Jens H. , Callsen Tim A. , Dudenhausen Joachim W. 
Published: December 2004

Background.  Fetal pulse oximetry measures arterial oxygen saturation during delivery. The fetal electrocardiogram STAN S21 analyzes the repolarisation segment of ECG (ST) waveform, which is altered by the intramyocardial potassium release resulting from metabolic acidemia. This study aimed to evaluate the feasibility of a simultaneous application of pulse oximetry and fetal electrocardiography and to estimate any agreement between both methods indicating fetal compromise.Methods.  In an observational trial 35 fetuses were simultaneously monitored by pulse oximetry (OBS‐500) and electrocardiography. The evaluation focused on signal output and on the coincidence of desaturation in fetal pulse oximetry and on ST events. Desaturation was defined as a drop of at least 20% of oxygen saturation from base line level occurring within 1 min (steep desaturation) or duration of time (s) with oxygen saturation below the threshold of 30%. Statistical analysis was performed with the Mann–Whitney U‐test for continuous variables.Results.  Signal output of the simultaneous application of both sensors was not significantly reduced in the electrocardiogram and in pulse oximetry (8% vs. 12% reduction). In 15 of the 35 fetuses, ST events indicating fetal hypoxia occurred. In these cases, pulse oximetry showed significantly more episodes of desaturation in comparison with fetuses without ST events. Median saturation during the ST events was significantly lower than in the recordings without ST events (60% vs. 74%, p < 0.05). In the umbilical artery these neonates showed significantly lower pH (7.19 vs. 7.33, p < 0.001), significantly higher lactate (5.1 vs. 3.4 mmol/l, p < 0.05) and significantly lower base deficit (−9.4mmol/l vs. −4.0 mmol/l, p < 0.001) levels.Conclusions.  The combination of fetal pulse oximetry and fetal electrocardiography appears feasible and indicates signs of intermittent hypoxia. These findings may encourage the development of technology that combines these different methods of monitoring.
Effects of androgens on aromatase activity and 11C‐vorozole binding in granulosa cells in vitro
Authors: Kirilovas Dmitrijus , Naessen Tord , Bergström Mats , Bonasera Thomas A. , Bergström‐Pettermann Elisabeth , Holte Jan , Carlström Kjell , Simberg Niklas , Långström Bengt 
Published: December 2004

Background. Locally produced androgens and estrogens are important in the hormonal regulation of follicular development. The present study aimed to further elucidate the mechanism through which androgens exert their ambivalent effects on aromatization.Methods. Non‐cultured human granulosa‐luteal cells (GC) were treated with different concentrations of androstenedione (A4), testosterone (T), 5α‐androstane‐3,17‐dione (5α‐A) and dihydrotestosterone (DHT). The effects on aromatase activity were evaluated in a tritiated water assay (incubation time 2 h) and the availability of aromatase active sites was measured in a radiotracer‐binding assay using the non‐steroidal competitive aromatase inhibitor [11C]‐vorozole (incubation time 15 min).Results. A4, T and 5α‐A caused dose‐dependent inhibition of both aromatase activity and [11C]‐vorozole binding; IC50‐values for both inhibition processes were calculated for these three steroids, revealing A4 as the most potent inhibitor and T and 5α‐A as moderate inhibitors. At low concentrations (0.01 and 0.1 µM), DHT stimulated aromatase activity but did not affect [11C]‐vorozole binding. At the higher concentrations tested (1 and 10 µM) DHT suppressed both processes thus weakly binding the aromatase active site.Conclusion. Because the incubation time in the tritiated water assay was short, the stimulation by DHT at low concentrations might therefore most likely include mechanisms other than new synthesis of aromatase protein such as allosteric action of DHT upon aromatase or liganded androgen receptor–aromatase interaction.
Short convalescence after vaginal prolapse surgery
Authors: Ottesen Marianne , SØrensen Mette , Kehlet Henrik , Ottesen Bent 
Published: December 2004

Objective. Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996–98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999–2000 at a Danish University Hospital.Methods. The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast‐track setting using a multimodal rehabilitation model with well‐defined recommendations for the convalescence period.Results. In the retrospective study, 188 women (79%) with a median age of 66 years (range, 30–88) answered the questionnaire. They had been recommended a convalescence of median 6 weeks (range, 1–12) for most activities. The subjective recurrence rate was 22% within median 6 months (range, 0–24) after first‐time prolapse surgery. In the prospective study, there were 41 consecutive women with a median age of 69 years (range, 44–88). Convalescence was median <1 week for most non‐strenuous activities, <2 weeks for light work and <4 weeks for sexual intercourse, sports and work with lifts exceeding 10 kg. Limiting factors were fatigue and pain. The 1‐year subjective recurrence rate was 17%.Conclusion. Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1–3 weeks with a multimodal rehabilitation model with revised, non‐restrictive recommendations. Further studies are necessary to evaluate the impact of different convalescence recommendations on the recurrence of prolapse.
Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes
Authors: Jacobsson Bo , Mattsby‐Baltzer Inger , Andersch Björn , Bokström Hans , Holst Rose‐Marie , Nikolaitchouk Natalia , Wennerholm Ulla‐Britt , Hagberg Henrik 
Published: December 2004

Background.  Previous studies have shown an association between intra‐amniotic microbial invasion and/or inflammation and spontaneous preterm birth. The aim of this study was to investigate the occurrence of intra‐amniotic microorganisms and cytokines [interleukin (IL)‐6 and IL‐8] in a Swedish population, with low incidence of preterm birth, of women with preterm prelabor rupture of membranes and their correlation to preterm birth.Methods.  Amniotic fluid was retrieved transabdominally from 58 patients with preterm prelabor rupture of membranes before 34 weeks of gestation. Polymerase chain reaction (PCR) analyses for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL‐6 and IL‐8 were analyzed with enzyme‐linked immunosorbent assay (ELISA).Results.  Microorganisms in amniotic fluid were detected in 13 patients (25%). Patients with bacteria detected in the amniotic fluid had significantly higher levels of IL‐6 and IL‐8. An amniotic fluid concentration of IL‐6 ≥ 0.80 ng/ml [relative risk 1.93, 95% confidence interval (CI) 1.13–3.29, sensitivity 63%, specificity 75%] was associated with an increased risk of delivery within 7 days. There was also an association between IL‐8 and preterm birth (< 34 weeks).Conclusions.  Intra‐amniotic microbial invasion and inflammation in this population of Swedish women with preterm prelabor rupture of membranes were similar to data reported from populations with a higher incidence of preterm delivery. Amniotic IL‐6 correlated to the presence of microorganisms and delivery within 7 days and IL‐8 to delivery before 34 weeks.
Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants
Authors: Ullberg Ulla , Lingman Göran , Ekman‐Ordeberg Gunvor , Sandstedt Bengt 
Published: December 2004

Background.  The aim of this study was to investigate the occurrence and appearance of the anastomosis between the two umbilical arteries in placentas from infants small for gestational age (SGA).Methods.  The arterial systems of 64 placentas from singleton pregnancies resulting in SGA infants were visualized by angiography. The method allowed study of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each artery. The results were compared with findings in a previous study of appropriate for gestational age (AGA) infants. One‐way analysis of variance (anova) and χ2‐analyses were used for statistics.Results.  In 56 placentas the anastomosis was represented by a true vessel, in two by a fenestration, and in another two cases by fusion of the umbilical arteries. The anastomosis was absent in one case and another three cases had a single umbilical artery (SUA). When the diameter of the anastomosis was thinner than that of the umbilical arteries, their supply areas were significantly (p ≤ 0.001) more symmetrical than in cases with a wider anastomosis.The anatomy of the anastomosis and the relationship between its width and the symmetry between the supply areas of each umbilical artery did not differ in placentas from SGA and AGA infants, despite various types of cord insertion and placentation.Conclusion.  Static measurements of Hyrtl's anastomosis do not indicate a contributing part for intrauterine growth retardation.
Alcohol use as predictor for infertility in a representative population of Danish women
Authors: Tolstrup Janne Schurmann , Kjær Susanne Krüger , Holst Claus , Sharif Heidi , Munk Christian , Osler Merete , Schmidt Lone , Andersen Anne‐Marie Nybo , GrØnbÆk Morten 
Published: December 2004

Background. Our aim was to examine the association between use of alcohol and subsequent incidence of primary infertility.Methods. The study subjects were chosen from a population‐based cohort of Danish women aged 20–29 years. Eligible women were nulliparous and not pregnant (n = 7760). Information on alcohol intake and potential confounders (age, education, marital status, diseases in the reproductive organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility problems during follow‐up was obtained by record linkage with the Danish Hospital Discharge Register and the Danish Infertility Cohort Register. Main outcome measures were hazard ratios of infertility according to alcohol intake at baseline estimated in a multivariate Cox proportional hazards model.Results. During a mean follow‐up of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline was unassociated with infertility among younger women, but was a significant predictor for infertility among women above age 30. In this age group, the adjusted hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence interval: 1.19–4.32) compared with women consuming less than one drink per week.Conclusions. These findings suggest that alcohol intake is a predictor for infertility problems among women in the later reproductive age group.
Women's experience of coping with a positive Pap smear: a register‐based study of women with two consecutive Pap smears reported as CIN 1
Authors: Ideström Monica , Milsom Ian , Andersson‐Ellström Agneta 
Published: December 2004

Background.  In Sweden approximately 40 000 women receive information annually that their Papanicolaou (Pap) smear test showed dysplasia and about 400 women are diagnosed with invasive cervical cancer. The aim of this study was to evaluate women 5 years after two consecutive Pap smears diagnosed with mild dysplasia (CIN 1), by describing their experience of receiving information about the results of the smear and how examinations, treatment and follow‐up had affected them.Methods.  A questionnaire was sent in 1999 to 329 women who according to the Department of Clinical Pathology, Karlstad, had two consecutive Pap smears reported as mild dysplasia (CIN 1) during 1993 and who as a result of this finding should have undergone colposcopy and biopsy according to an agreed general program.Results.  The questionnaire was completed by 242 women (74%). The finding of mild dysplasia was obtained at a screening test in 95%, and 96% reported that they had participated in the follow‐up program. One hundred and eighty‐four women (76%) experienced follow‐up in a positive way. Seventy‐two percent considered they understood the meaning and consequences of having mild dysplasia. Nevertheless, feelings of worry and anxiety affected 59%. For 30% it affected everyday life between being informed of the result of the first Pap smear test and subsequent further investigation. Twenty women (8%) reported a remaining negative influence on sexuality and their experience of sexual intercourse as a consequence of the management of mild dysplasia. This finding was correlated with less satisfaction with follow‐up and a negative influence on self‐esteem.Conclusion.  Women felt vulnerable when being investigated for intraepithelial neoplasia, but this did not influence willingness to participate in follow‐up. The discovery created unnecessary worry and a negative experience that may be solved by a better‐developed educational program at the time of screening. There were no signs of remaining anxiety 5 years later, but 8% of women reported a remaining negative influence on their sexual life.
Ectopic pregnancy in African developing countries
Authors: Goyaux Nathalie , Leke Robert , Keita Namory , Thonneau Patrick 
Published: December 2004

Objective. We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20 years and available from several databases (MEDLINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications).Results. Although hospital‐based African studies indicate EP incidence has probably increased in Africa in recent decades, major methodological limitations in the published literature make it impossible to draw formal conclusions concerning the incidence of EP in Africa in recent years. As in industrialized countries, pelvic inflammatory disease (PID) associated with sexually transmitted diseases (STDs) must be considered as the most important risk factor for EP in developing countries. In African developing countries, a majority of hospital‐based studies have reported EP case fatality rates of around 1–3%, 10 times higher than that reported in industrialized countries. Late diagnosis, leading in almost all cases to major complications, and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering from EP in Africa.Conclusion. EP should be considered a relevant public health indicator in developing countries, providing an overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergency situations, especially in the field of obstetrics and gynecology.
Phytoestrogens increase the capacity of serum to stimulate prostacyclin release in human endothelial cells
Authors: García‐Martínez María Cinta , Hermenegildo Carlos , Tarín Juan J. , Cano Antonio 
Published: December 2004

Background.  Both the estrogen receptor (ER) alpha and beta isoforms are expressed in the endothelium. The ER beta has been assigned a crucial role in normal vascular wall function. Prostacyclin has been ascribed a beneficial effect on vessel wall physiology. Isoflavones bind with higher affinity to ER beta. We investigated the hypothesis that their administration to postmenopausal women can promote endothelial prostacyclin production.Methods.  Twenty‐five healthy postmenopausal women with mild climacteric symptoms received capsules containing 55 mg/day isoflavones derived from soy and red clover for 6 months. Cultured human umbilical vein endothelial cells (HUVECs) were exposed for 24 h to serum collected before the initiation of therapy and then after 3 and 6 months of continuous therapy. Prostaglandin production was measured in culture medium.Results.  In the presence of serum obtained after isoflavone treatment, the prostacyclin production increased significantly from 2.7 ± 0.5 ng/mg protein at baseline to 3.4 ± 0.7 ng/mg protein at 3 months (p ≤ 0.05), and to 3.8 ± 0.7 ng/mg protein at 6 months (p ≤ 0.05 vs. baseline and 3 months' treatment).Conclusions.  Serum obtained from postmenopausal women treated with isoflavones stimulates the capacity to produce prostacyclin by HUVECs in culture, an effect that could contribute to a beneficial cardiovascular effect of phytoestrogens.