bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal erythropoietin and endothelin‐1: relation to hypoxia and intrauterine growth retardation
Authors: ÖSTLUND EVA , LINDHOLM HENRY , HEMSEN ANNETTE , FRIED GABRIEL 
Published: March 2003

Background. We have examined whether endothelin‐1 (ET‐1) and erythropoietin (EPO) in amniotic fluid, and EPO in fetal serum obtained by cordocentesis from fetuses with signs of intrauterine growth retardation (IUGR), were correlated to fetal growth and/or chronic fetal hypoxia.Methods. Amniotic fluid and fetal serum were obtained by cordocentesis from 28 fetuses suspected to have IUGR and subsequently analyzed for EPO and ET‐1 by ELISA. These data were correlated to blood gas results and fetal/maternal parameters at delivery.Results. A novel finding was that ET‐1 correlated to pO2 in amniotic fluid. The average level of ET‐1 in amniotic fluid was 48.3±4.7 pmol/L. The results also showed a correlation between EPO levels in amniotic fluid and EPO in fetal serum. Furthermore, EPO correlated weakly to birth weight at delivery. Children with the lowest birth weights had the highest EPO levels. High EPO values, similarly to ET‐1, correlated to low pO2 values. The level of EPO in amniotic fluid was 8.0±1.6 mIU/ml and in cord blood 29.5±9.6 mIU/ml.Conclusions. The results indicate that ET‐1 levels may be a marker for short‐term hypoxia, but not for fetal growth, since ET‐1 in amniotic fluid was correlated to pO2 at the time of cordocentesis, but not to birth weight. The results also indicate that EPO levels in amniotic fluid and in fetal cord serum are highly correlated, and thus both can be used as markers for fetal growth and chronic hypoxia before the onset of labor.
Factors associated with climacteric symptoms and the use of hormone replacement therapy
Authors: STADBERG ELISABETH , MATTSSON LARS‐ÅKE , MILSOM IAN 
Published: March 2003

Background. To investigate factors associated with climacteric symptoms and the use of hormone replacement therapy (HRT).Methods. A random sample of women aged 46, 50, 54, 58 and 62 years resident in Göteborg, Sweden (n=5,990) were invited by letter to complete a postal questionnaire concerning the menopause and HRT use.Results. The response rate was 76% (n=4,504). Women with a higher education, who exercised regularly and who had regular spare‐time activities felt better and had fewer climacteric complaints (p<0.001) compared to lower educated women, women who exercised infrequently and women who had no spare‐time activities. Climacteric symptoms were associated with dryness symptoms (dry eyes, skin, hair and mouth), bilateral salpingo‐oophorectomy (SOE), use of psychotropical drugs and use of alternative remedies, previous hysterectomy and full‐time occupation. Stepwise multiple regression analysis showed significant correlations between vasomotor symptoms and various dryness symptoms, no menstrual periods and use of alternative remedies. Current HRT‐users (13%) had used estrogens for 4.0 years and past users (14%) for 4.3 years. A correlation (p<0.005) was found between HRT use and previous use of contraceptive pills, use of alternative remedies and hysterectomy. Education, occupation and the frequency of exercise did not influence the prevalence of HRT use.Conclusions. This study has shown that the experience of climacteric symptoms and well‐being is associated with many different factors. Women with a higher education and those who exercised regularly were more often symptom‐free. HRT use was associated with previous use of contraceptive pills, use of alternative remedies and hysterectomy.
A follow‐up study of birth outcome in users of pivampicillin during pregnancy
Authors: LARSEN HELLE , NIELSEN GUNNAR LAUGE , SØRENSEN HENRIK TOFT , MØLLER MARGRETHE , OLSEN JØRN , SCHØNHEYDER HENRIK C. 
Published: March 2003

Background. Pivampicillin is a prodrug which is widely used in Scandinavian countries for oral antibiotic therapy. The pivaloyl moiety has a carnitine depleting effect, which has caused doubts about the safety of administering pivampicillin during pregnancy. The aim of the study was to evaluate the risk of congenital malformations in general, preterm delivery and low birth weight in users of pivampicillin.Methods. Seven hundred and ninety‐one women who had redeemed a prescription of pivampicillin during their first pregnancy from 1 January 1991 to 31 December 1996 were identified in the North Jutland Pharmaco‐Epidemiological Prescription Database. By linkage to the Danish Medical Birth Registry and Regional Hospital Discharge Registry we compared their birth outcomes (malformations, preterm delivery and low birth weight) with the outcomes in 7472 reference pregnancies on which the mother had not redeemed any prescription at all during pregnancy.Results. The prevalence of malformations was 5.5% (11 cases) in offspring of 199 women who had used pivampicillin during the first trimester, and 5.6% (420 cases) in offspring of controls (OR: 0.95, 95% CI: 0.51–1.76). Furthermore, we did not find any significant risk of preterm delivery (OR: 0.75, 95% CI: 0.54–1.05) or low birth weight (OR: 0.93, 95% CI: 0.55–1.57).Conclusion. This study showed no increased risk of congenital malformations, preterm delivery or low birth weight in offspring of women who had redeemed a prescription for pivampicillin during pregnancy.
Association between external pelvimetry and vertex delivery complications in African women
Authors: LISELELE HUBERT BOLEMBA , TSHIBANGU CLÉOPHAS KALALA , MEURIS SYLVAIN 
Published: March 2003

Objective. To assess association between external pelvimetry and delivery complications in vertex presentation.Methods. Prospective cohort study of 2413 pregnant women antenatally measured for height and external pelvimetry in four hospitals of the former Republic of Zaire. Outcome measures: Complications during delivery of single fetus weighing 2000 g or more in vertex presentation. Cut‐off values at risk for delivery complications were height and pelvic distances closest to the study population 10th percentile.Results. In univariate analysis, maternal height showed significant relative risk for predicting primary cesarean section for failure to progress: 2.0 (95%
CI=1.0–4.1; p=0.050) and vacuum or forceps delivery: 15.7 (95%
CI=6.6–37.5; p<0.001). Selected external pelvic distances showed significant relative risks for predicting the following complications: primary cesarean section for failure to progress, elective repeat cesarean section, vacuum or forceps delivery and spontaneous intrapartum stillbirth. Among pelvic predictors, transverse diagonal (TD) of Michaelis sacral rhomboid area was associated with all of these complications. Intertrochanteric (IT) diameter was associated with three of them. The relative risks ranged from 2.3 (95%
CI=1.1–6.3; p=0.030) to 9.6 (95%
CI=4.1–22.5; p<0.001) for these strongest predictors.Conclusions. External pelvic distances help to predict vertex delivery complications in African women. The predicted complications are compatible with the cephalopelvic disproportion concept (CPD). After validation of current results in a separate cohort, measurements of IT and/or TD are recommended to improve antenatal screening of women at risk for CPD in limited resources settings.
Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy
Authors: BERKANE NADIA , COCHETON JEAN‐JACQUES , BREHIER DELPHINE , MERVIEL PHILIPPE , WOLF CLAUDE , LEFÈVRE GUILLAUME , UZAN SERGE 
Published: March 2003

Objective. We studied the clinical and biological effects and safety of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy (ICP).Methods. All cases of ICP treated with ursodeoxycholic acid in our department from January 1st, 1991 to May 31st, 1997 were reviewed.Results. Forty‐three patients had ICP, of whom 19 received ursodeoxycholic acid. The first symptoms appeared after a mean of 29.7 weeks of pregnancy (WP). Treatment was started after a mean of 32 WP, and lasted a mean of 28.5 days. Fourteen patients showed a clinical improvement on UDCA, and 11 showed a biological improvement. Two had a biological deterioration with increased liver enzyme concentrations.Conclusions. Ursodeoxycholic acid appears to be an effective treatment for ICP, but further studies are needed to confirm its safety in pregnancy.
Do practice guidelines guide practice? A prospective audit of induction of labor – three years experience
Authors: MOUSA HATEM A. , MAHMOOD TAHIR A. 
Published: March 2003

Background. To examine the effect of implementation of guidelines for induction of labor on the process of care and outcome measures.Method. Guidelines for induction of labor were implemented in January 1996 following an audit report identifying inconsistency in clinical practice. A prospective audit was carried out following the implementation of a new strategy directed towards pre‐induction cervical ripening in nulliparae with unfavorable cervices and the use of low dosages of vaginal prostaglandin E2 for induction of labor. Level of compliance and outcome measures were compared before and after implementation of guidelines.Results. In the period of January 1995 to November 1997, 1,230 women were induced with a singleton viable pregnancy in a cephalic presentation with a gestational age ≥37 weeks with no history of rupture of membranes or cesarean section. Completed forms were available for 1,147 women (370, 421 and 356 in 1995, 1996 and 1997, respectively). Among nulliparous women, there was a reduction in the number of women who were admitted with cervical score of ≤4 (24%, 40%, and 54% in 1997, 1996, and 1995, respectively; p=0.0001), an increase in the number of women who had amniotomy on admission (32%, 25% and 12% in 1997, 1996, and 1995, respectively; p=0.0001) and a shorter induction‐delivery interval. No change in outcome measures was noted among multiparous women despite reduced dose of prostaglandin E2 used for induction of labor. A marginal reduction of both Cesarean section and failed induction rates were noted in both nulliparae and multiparae. Level of compliance improved with successive rounds of audit.Conclusion. Explicit guidelines do improve clinical practice, when introduced and monitored in the context of rigorous evaluations. However, the size of improvement could vary.
Induction of endometriosis in the mouse inhibits spleen leukocyte function
Authors: Somigliana Edgardo , Viganò Paola , Zingrillo Beatrice , Ranieri Stefania , Filardo Paola , Candiani Massimo , Vignali Mario 
Published: March 2003

Background. It is still unclear whether the immunologic perturbation observed in women with endometriosis represents an intrinsic defect of the immune system or it is consequent to the presence of endometrium in ectopic sites. The present study was aimed to evaluate the immunoregulatory properties of ectopic endometrial implants in a model of experimental endometriosis in mice.Methods. Endometriosis was induced in n=10 mice by inoculating endometrial fragments obtained from syngenic donor mice into the peritoneal space. Twelve mice were similarly treated but were not inoculated with endometrium and were used as control mice. At an explorative laparotomy performed in all the animals after three weeks, the extent of peritoneal lesions, when present, was evaluated by weight assessment and surface area measurement. In both mice that were inoculated with endometrium and control animals, spleens were removed. The effect of endometriosis induction on concanavalin A‐induced spleenocyte proliferation was investigated.Results. A significant inhibition of spleenocyte growth was demonstrated in mice in which endometriosis was induced (36156±3061 cpm) compared to control animals (47172±3210 cpm; p<0.05). Moreover, a significant inverse correlation was found between spleenocyte proliferation and weight and surface area of the peritoneal endometriotic lesions (r=0.76; p<0.02 and r=0.75; p<0.02, respectively).Conclusion. These findings suggest that the presence of ectopic endometrial implants within the peritoneal cavity leads to substantial changes of the immune response in vivo. These changes may have significant implications for the understanding of the etiopathogenesis of endometriosis.
Risk for anogenital cancer and other cancer among women hospitalized with gonorrhea
Authors: Johansen Christoffer , Mellemkjær Lene , Frisch Morten , Kjær Susanne K. , Gridley Gloria , Olsen Jørgen H. 
Published: March 2003

Background. We investigated the relationship between infections with Neisseria gonorrhoeae and anogenital and other cancers.Methods. Nationwide and population based register linkage study utilizing prospectively notified information. The observed numbers of cancers among the women were compared with those expected on the basis of national incidence rates.Results. In a cohort of 4440 women hospitalized for gonorrhea we observed a total of 227 cases of cervical intraepithelial neoplasia grade III (CIN III), with 103 expected (standardized incidence ratio (SIR), 2.2; 95% confidence interval (CI), 1.9–2.5). No significantly increased risk for other anogenital cancers or cancer at other sites was seen.Conclusions. These results support the view that the observed association between gonorrheal infection and subsequent cervical preneoplasia is due mainly to surveillance bias. However, our results also indicate that women hospitalized with a N. gonorrhoeae infection will benefit from the compliance with the regular Pap smear screening programs.
Can the endometrial thickness as measured by trans‐vaginal sonography be used to exclude polyps or hyperplasia in pre‐menopausal patients with abnormal uterine bleeding?
Authors: Dueholm Margit , Jensen Marianne Lidang , Laursen Hanne , Kracht Per 
Published: March 2003

Background. To combine findings of normal mid‐line echoes from TVS (trans‐vaginal sonography) with cut‐off levels for endometrial thickness, in order to examine the associated risk of abnormalities in the uterine cavity.Design and Setting. Two center prospective study at a university clinic and a central hospital in Denmark.Participants. Three hundred and fifty‐five pre‐menopausal patients with abnormal uterine bleeding, and indications for endometrial sampling or surgery.Interventions. The thickness of the endometrium was measured, and the mid‐line echoes were evaluated using TVS. The findings from the endometrial sampling, combined with the evaluation of the uterine cavity using operative hysteroscopy (115), hysterectomy (74) or HSE (hysterosonographic examination) (166), were used as the true values.Results. The mean (±s.d.) endometrial thickness was significantly different in patients with hyperplasia 11.5 mm (±5.0), polyps 11.8 mm (±5.1), sub‐mucous myomas 7.1 mm (±3.4) and in patients without these abnormalities 8.37 (±3.9) (p<0.001). Hyperplasia and/or polyps were present in 20% of all patients, and in 8% of 143 patients with an endometrial thickness of ≤7 mm. This proportion did not decrease with lower cut‐off levels for endometrial thickness. Receiver operating characteristic (ROC) curves were not optimal for excluding hyperplasia or polyps by endometrial thickness. In 173 cases with a distinct, regular midline echo without echo‐dense foci in TVS the proportion of patients with abnormalities was 16% (11–23). This proportion did not decrease with cut‐off levels for endometrial thickness.Conclusions. Using TVS, low levels of endometrial thickness reduced the possibility of abnormalities such as polyps and hyperplasia, but did not exclude them. Low cut‐off levels for endometrial thickness did not increase the diagnostic performance in cases with normal sonograms.
Y‐chromosomal microdeletions among infertile Finnish men
Authors: Aho Milla , Härkönen Kati , Suikkari Anne‐Maria , Juvonen Vesa , Anttila Leena , Lähdetie Jaana 
Published: March 2003

Background. Microdeletions in the Y‐chromosome are known to cause a significant proportion of azoo‐ and oligozoospermia in men. The reported frequency of deletions varies greatly between the studies. Probable reasons for this variation are different selection criteria and number of patients included, and possibly also methodological aspects, whereas the contribution of environmental and genetic factors is not known. The aim of this study was to determine the incidence of Y‐chromosome microdeletions among infertile Finnish men.Methods. Two hundred and one men showing azoospermia (n=68) or severe oligozoospermia (n=133) were included. Multiplex polymerase chain reaction method was used to amplify specific sequence tagged sites (STS) along the Y chromosome.Results. Microdeletions were observed in 18 men (9%), of whom four were azoospermic and 14 oligozoospermic.Conclusions. The incidence of Y‐deletions in the study population of infertile Finnish men falls within the range published in other countries.
Immunolocalization of transforming growth factor‐β3 in pregnant human myometrium
Authors: Kuşcu Naci Kemal , Laçin Selman , Vatansever Seda , Yildirim Yasemin , Var Ahmet , Uyanik Bekir Sami , Koyuncu Faik 
Published: March 2003

Background. Transforming growth factor‐β3 is a cytokine which is involved in cell growth regulation and differentiation, stimulation of extracellular matrix and modulation of immune responses. The goal of this study was to detect the presence of this cytokine in the myometrium of preterm and term, nonlaboring and laboring patients, and to measure serum levels of interleukin‐1β (IL‐1β), IL‐6 and IL‐8 before cesarean section.Methods. In this prospective study, we obtained samples of myometrium from the lower uterine segment during elective and emergency cesarean sections (term non‐laboring, n=8; term laboring, n=7; preterm non‐laboring, n=3; and preterm laboring, n=19) and stained for transforming growth factor‐β3. Blood was also sampled from the same patients to determine IL‐1β, IL‐6 and IL‐8 levels.Results. Different intensities of staining were detected in preterm laboring, term nonlaboring and term laboring groups, but there was no staining in preterm nonlaboring group. We also found a statistically significant difference in IL‐6 levels between laboring and nonlaboring groups (p=0.028).Conclusion. Different intensities of TGF‐β3 which appeared in different stages of myometrium made us consider that TGF‐β3 might prepare myometrium to labor, and IL‐6 was more important than the other interleukins in initiation of labor.
Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding
Authors: Epstein Elisabeth , Ramirez Anette , Skoog Lennart , Valentin Lil 
Published: March 2003

Objective. To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium ≥5 mm and the extent to which such lesions can be correctly diagnosed by D&C.Methods. In a prospective study, 105 women with postmenopausal bleeding and endometrium ≥5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty‐four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one.Results. Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy.Conclusion. If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium ≥5 mm.
Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery
Authors: Ladfors Mona B. , O. Löfgren Mats. E. , Gabriel Barbara , Olsson Jan‐Henrik A. 
Published: March 2003

Background. In 1996, the Swedish National Register for Gynecological Surgery started to collect pre‐ and postoperative information on patients using questionnaires given out as part of routine medical care. The information is used in providing clinical care to the patient and for quality assessment.Aims. To evaluate patients' acceptance of questionnaires as a means of collecting information, and to investigate whether the questionnaire is a suitable tool for follow‐up of patients.Methods. In 1998, evaluations of the ordinary questionnaires were done by an evaluation questionnaire mailed to 80 patients who had been recently hysterectomized. The results were triangulated with results from the register's database and data from interviews with physicians and secretaries.Results. The majority of the patients appreciated the questionnaires. Patients did not report any major problems in filling in the questionnaires. Most problems were due to administrative errors of the departments. Up to 36% of the patients missed the scheduled follow‐up visit 2 months after the operation. Two out of four departments regarded the follow‐up visit necessary and requested by the patients. Out of 1226 patients followed up postoperatively by questionnaire, 75% stated that they did not need any medical care. Among physicians, some distrust of questionnaires was noted.Conclusions. The patients in this study preoperatively, and for short‐ and long‐term follow‐up, accepted the questionnaire as an instrument of data collection. Questionnaires provide a more complete collection of post‐treatment information than follow‐up visits do. A large number of unnecessary follow‐up visits can be avoided through use of a questionnaire.
Intra‐hepatic cholestasis of pregnancy in hepatitis C virus infection*
Authors: Paternoster Delia M. , Fabris Franco , Palù Giorgio , Santarossa Cinzia , Bracciante Roberto , Snijders Deborah , Floreani Annarosa 
Published: March 2003

Background. Aims of this study were to investigate whether hepatitis C virus infection influences the incidence and natural history of intrahepatic cholestasis of pregnancy (ICP) and whether ICP has different characteristics in hepatitis C virus (HCV) positive women from ICP in HCV negative women.Methods. A prospective study for the prevalence of the HCV infection and for the incidence of ICP was carried out in the 5840 patients admitted to the Prenatal Department of Padua University, Italy, between January 1996 and January 1999. Testing was done for HCV by the enzyme linked immunosorbent assay (ELISA 3), recombinant immuno blot assay (RIBA 3) and polymerase chain reaction (PCR). The diagnosis of ICP was made on clinical grounds based on the occurence of pruritus with onset during pregnancy, persisting up to the time of delivery and disappearing after delivery, supported by demonstrating an elevation of both serum ALT and total serum bile acids. The Student's t‐test, one way anova and chi‐square tests were used for statistical analysis.Results. During the study period, 56 of 5840 patients developed ICP (0.96%). Of these, 12 were also HCV‐RNA positive. The rate of ICP was observed more commonly in HCV‐RNA positive women than in HCV‐RNA negative women (20.33% or 12/59 versus 0.78% or 44/5767, P = 0.001Conclusions. Occurrence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Although the diagnosis of ICP is not confirmed by specific tests, we confirmed a higher risk of HCV infection in this condition. Therefore, occurence of ICP during the third trimester should be an indication to investigate the HCV status of the patient. Broader studies are necessary to assess the impact of infection on the perinatal outcome of ICP.