Laparoscopic treatment of ectopic pregnancy.
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Fallopian Tubes↗
Biomedical subjects
B Lindblom
Publications and source records attributed to B Lindblom.
A cost-effectiveness study of a randomised trial of laparoscopy versus laparotomy for ectopic pregnancy.
We compared the cost-effectiveness of therapeutic laparoscopy and open laparotomy for treatment of laparoscopically diagnosed ectopic pregnancy. Clinical outcomes of ectopic pregnancy treatment were based on results of a randomised trial done between 1987 and 1989 at Sahlgrenska University Hospital (Göteborg, Sweden). We estimated costs for inpatient and follow-up care of ectopic pregnancy by the two methods. Observed resource use (eg, procedure duration) was multiplied by 1992 estimates of resource unit cost (eg, cost per minute of laparoscopy time), based on detailed internal cost accounting data from Huddinge University Hospital. By specified criteria, the initial procedure eliminated trophoblastic activity without major complications in 81% (95% CI: 68-90) of 52 laparoscopy patients, versus 95% (85-99) of 57 laparotomy patients. Residual trophoblast or complications were successfully treated in all remaining patients. Mean simulated costs (standard error) for the overall laparoscopy strategy were 28,058 (1780) Swedish kronor versus 32,699 (1080) kronor for laparotomy (p = 0.03). In the baseline simulation and most sensitivity analyses, laparoscopy produced final outcomes equivalent to those of laparotomy at lower costs. As laparoscopic outcomes improve, this newer approach should become increasingly preferable.
Cost-Benefit Analysis↗
Lp(a) lipoprotein, IgG, IgA and IgM antibodies to Chlamydia pneumoniae and HLA class II genotype in early coronary artery disease.
The associations previously found between lipoprotein(a) (Lp(a)) levels and atherosclerotic disorders, diabetes, rheumatoid arthritis and renal diseases suggest that Lp(a) may be involved in autoimmune reactions. The relation found between Lp(a) levels and the HLA class II genotype in males with early coronary artery disease (CAD) further support that assumption. It was suggested that an autoimmune process, perhaps triggered by a concomitant intracellular infection may occur especially in patients with inherited high Lp(a) levels in combination with certain inherited HLA class II genotypes. In this study a Chlamydia pneumoniae IgG titer > or = 32 was significantly more common (P = 0.036) in CAD patients than in matched controls. This is in agreement with previous reports by other investigators. In addition, an IgG titer > or = 256 in combination with an Lp(a) level > or = 120 mg/l was found to occur significantly more often (P = 0.011) in male patients than in male controls. Certain HLA class II DR genotypes in combination with high Lp(a) levels and C. pneumoniae titers occurred more frequently in both male and female patients than in controls. Some combinations were very common in male patients, and the difference in comparison with male controls was highly significant.
Antibodies, Bacterial↗
Choroidal neovascularization with retinal pigment epithelial folds.
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Aged↗
A prospective study of dense spontaneous vitreous hemorrhage.
PURPOSE: We studied the incidence of vitreous hemorrhage in a well-defined population to determine the underlying causes of such hemorrhages. METHODS: We prospectively studied all eyes with dense spontaneous first-time vitreous hemorrhage during a 2 1/2-year period in the greater Göteborg area (542,000 inhabitants). Follow-up time was one year. RESULTS: Ninety-four patients (95 eyes) were included, corresponding to a yearly incidence of seven cases per 100,000 inhabitants. Because of demographic factors and the organization of Swedish ophthalmologic care, we believe that this is close to the true incidence. The cause of vitreous hemorrhage could be verified in all but four eyes but frequently not until late in the follow-up period. The most common underlying cause was vitreous detachment and traction to a retinal vessel (39 eyes). In 28 of these eyes a retinal tear was also present. Five of these eyes developed a retinal detachment. In 19 eyes, bleeding was caused by proliferative diabetic retinopathy. This figure was relatively smaller than in previous studies. Retinal vein occlusion was the cause of hemorrhage in 15 eyes. Retinal macroaneurysm (seven eyes) was an easily overlooked cause, often diagnosed late in the follow-up period. CONCLUSIONS: Because of the common diagnostic difficulties and the frequent need for laser treatment, vitrectomy, or both, it is recommended that eyes with vitreous hemorrhage be followed up in centers with ultrasonographic and surgical expertise.
Adult↗
Effects of hyperosmolar glucose, prostaglandin-F2 alpha and 15-methyl-prostaglandin-F2 alpha on human placental cells in vitro.
The objective of this study was to assess the ability of certain drugs, used for local injection therapy of ectopic pregnancy, to suppress the activities of cultured human placental cells. Placental cells from legal first trimester abortions were prepared by collagenase treatment and density gradient centrifugation. The cells were exposed to hyperosmolar glucose (500 mg/ml), 15-methyl-prostaglandin-F2 alpha (15-m-PGF2 alpha; 10(-7) to 10(-3) mol/l) and prostaglandin-F2 alpha (PGF2 alpha; 10(-5) to 5 x 10(-3) mol/l) for 30 min on days 2-4 after seeding. The effects on the secretion of human chorionic gonadotrophin (HCG) and progesterone, as well as on the protein content per culture well, were measured. Hyperosmolar glucose was the most effective drug and caused a marked decrease of the protein content in the culture wells and a reduction of progesterone secretion. Of the two prostaglandins, only 15-m-PGF2 alpha affected the viability of the cells and reduced the protein content of the wells. The clinical effectiveness of the two groups of drugs seems to be similar but certain in-vitro effects are different. Thus in vivo they may act on different target tissues. Against this background, the combination of hyperosmolar glucose and prostaglandins might be an interesting approach for local injection therapy for tubal pregnancy.
Carboprost↗
Confocal fundus imaging with a scanning laser ophthalmoscope in eyes with cataract.
AIMS/BACKGROUND: The study aimed to determine the influence of increased intraocular light scatter on the contrast in scanning laser ophthalmoscope (SLO) images and to examine to what extent SLO images can visualise the fundus through media opacities due to cataract. METHODS: Intraocular light scatter was estimated from measurements of letter contrast sensitivity before and after cataract surgery in five eyes. SLO images were obtained before and after surgery using confocal apertures of 1, 2, 4, and 10 mm, at laser wavelengths of 633 and 780 nm. Visibility of the fundus was determined by measurements of retinal contrast. SLO images were compared with standard fundus photographs. RESULTS: SLO images obtained before surgery revealed details of the retina that were unresolvable in the fundus photographs because of light scattering. By using one of the three smallest apertures, image contrast was further improved. However, no simple relations between aperture size, estimated light scatter, and image contrast could be found. CONCLUSION: SLO imaging was found to be superior to fundus photography for viewing the retina in eyes with cataract. Owing to the inhomogeneous nature of cataracts, the optimal choice of confocal aperture and laser wavelength is not simple and must be individualised.
Aged↗
[Myoma: uterus can be saved with new therapeutic methods].
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Adult↗
Linguistic experience alters phonetic perception in infants by 6 months of age.
Linguistic experience affects phonetic perception. However, the critical period during which experience affects perception and the mechanism responsible for these effects are unknown. This study of 6-month-old infants from two countries, the United States and Sweden, shows that exposure to a specific language in the first half year of life alters infants' phonetic perception.
Analysis of Variance↗
Calculation of restriction fragment lengths by image processing.
The image processing system, LabEye Profile, calculates the size of DNA restriction fragments according to the formula MD = f(x); x = 1/log bp. The migration distances (MD) of known fragment sizes are interpolated by the use of cubic splines. Cubic splines are also used to correct for gel distortions. A comparison to the Biotrac system, which uses the reciprocal method, gives almost identical standard deviations for calculated sizes compared to known sizes, 0.88% for LabEye Profile and 0.89% for Biotrac. The measurement error for LabEye Profile is 0.24% of the size of the fragments.
Base Composition↗
Effects of laser-induced retinal lesions on perimetric thresholds.
Differential light sensitivity and high-pass resolution thresholds were studied before and after pan-retinal photocoagulation in subjects with proliferative diabetic retinopathy. The photocoagulated retinal area was measured and the relative change in ganglion cell separation was estimated. The change in differential light thresholds after treatment, when expressed in decibels, appeared to be linearly related to the calculated change in ganglion cell separation. At present, this empirical finding lacks a theoretical explanation. For high-pass resolution, theory predicts a direct proportionality between the change in ganglion cell separation and resolution threshold. This relationship was confirmed, supporting the claim that high-pass resolution directly reflects the number of functional retino-cortical neural channels.
Adult↗
Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial.
OBJECTIVE: To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy. DESIGN: A randomized trial versus laparotomy was performed between May 1987 and June 1989. SETTING: The study was conducted in a clinical university center, the Sahlgrens Hospital. PATIENTS: A group of 105 patients with tubal pregnancy were stratified with regard to risk determinants and age and randomized to laparoscopy or laparotomy. Eighty-seven patients who desired pregnancy were evaluated for subsequent fertility outcome. INTERVENTIONS: Linear salpingotomy was performed in both surgical groups. MAIN OUTCOME MEASURE: We evaluated the fertility outcome after laparoscopic salpingotomy for comparison with the outcome after laparotomy. RESULTS: There was no difference between the groups in the overall fertility outcome. A substantially higher proportion of patients in the laparotomy group were subjected to adhesiolysis performed at a second-look laparoscopy. CONCLUSIONS: The fertility prospects are not impaired by laparoscopic surgery. Adhesiolysis at a second-look laparoscopy, especially after laparotomy, might be beneficial in selected cases and may serve to improve subsequent fertility.
Female↗
High-pass resolution perimetry in neuro-ophthalmology. Clinical impressions.
High-pass resolution perimetry is a new technique for visual field testing that determines extrafoveal resolution thresholds. The authors used this method in a neuro-ophthalmology clinic and compared it with other visual field tests. The main advantages of the technique were the short test time and the strong preference by patients for this technique over conventional automated perimetry. The sensitivity and specificity of the test seemed to be as good as or better than conventional perimetry. A minor disadvantage was its slightly less precise spatial definition of field defects. In this report, the authors present their experiences with this new perimetric technique.
Adult↗
Optic nerve sheath meningioma. Definition of intraorbital, intracanalicular, and intracranial components with magnetic resonance imaging.
Magnetic resonance imaging with fat saturation after the administration of gadolinium-DTPA can detect and demarcate meningioma of the optic nerve sheath with a precision not attainable with any other current imaging technique. This article describes some of the clinical implications of this technique and illustrates the appearance of this tumor on magnetic resonance images.
Adolescent↗
Placental protein 14 in human in-vitro fertilization early pregnancies.
Placental protein 14 (PP14) and human chorionic gonadotrophin (HCG) were analysed in patients participating in an in-vitro fertilization-embryo transfer programme which did not include any kind of luteal support. Women with normal pregnancies, spontaneous abortions, ectopic pregnancies, biochemical pregnancies and non-pregnant women were compared. A combination of HCG and PP14 analyses distinguished between normal and abnormal implantation as early as 15 days after oocyte retrieval. The product of HCG (IU/l) and PP14 (micrograms/l) concentrations differed significantly between normal pregnancy, spontaneous abortion and ectopic pregnancy (P = 0.0248). It is concluded that both endometrial (PP14) and trophoblastic (HCG) markers, when used in combination, exhibit changes in abnormal implantation which may be clinically useful.
Abortion, Spontaneous↗
Spatial uncertainty in stereoacuity tests: implications for clinical vision test design.
In an attempt to design a new stereo vision test we found that the spatial uncertainty effect had substantial impact on the measured stereo acuity thresholds. This effect is present whenever there is uncertainty of where the critical information occurs in a visual target. We studied the spatial uncertainty effect for stereo acuity and for line length estimation. In addition, we determined the temporal uncertainty effect in a stereoacuity test. In foveal vision, uncertainty effects increased visual thresholds, sometimes dramatically. For example, for an uncertainty factor of 25 (i.e., the critical information occurred randomly in any of 25 positions) stereo thresholds increased more than four-fold compared to those obtained without uncertainty. Although the uncertainty effect has been well described theoretically, we think that it is not always appreciated in the design of clinical or experimental visual tests. In tests aimed at determining visual thresholds, spatial and temporal uncertainty factors should be minimized.
Adult↗
Uncertainty effects in orientation discrimination of foveally seen lines in human observers.
1. The effect of spatial uncertainty on line orientation thresholds was studied in normal observers. Vertical lines, 5 min of arc long, built up a matrix in which one of the line elements could be tilted to the left or right. The orientation thresholds depended strongly on the number of alternative test positions. There was a linear relation between log (threshold) and log (P), where P is the probability that a particular line element was the one being tested. 2. The uncertainty effect was shown to be time dependent. The effect was more marked for the shortest stimulus duration (1 s). However, even with a 6 s stimulus duration, allowing several re-fixations, the thresholds were significantly higher in the presence of uncertainty, compared to the situation in which the test position was fixed and known to the observer. 3. When the measurements were restricted to the centre line in a matrix, thresholds were more than twice as high when the test line could be in any of the centre 3 x 3 positions, compared to the case in which there was no uncertainty as to the test position. Foreknowledge of location of the test line within the matrix improved the threshold further, even if the whole matrix was displaced to different retinal positions. 4. It is concluded that the physiological mechanism mediating threshold improvement probably operates on a cortical processing apparatus more central than V1.
Adult↗
Formant frequency estimates for abruptly changing area functions: a comparison between calculations and measurements.
Vocal tract area functions may contain quite abrupt changes in cross-sectional area. In formant frequency calculations for such area functions, an inner length correction (ILC) should be applied. The relevance of this correction was investigated by comparing acoustic measurements obtained from a physical model of the vocal tract with data gathered by means of computer simulations. Calculating formant frequencies without applying internal length corrections caused substantial errors, particularly for area functions representing apical stops just anterior to occlusion. Decentering and axial symmetry in the arrangement of the area elements of the physical model were briefly studied and found to have effects on the formant frequency values.
Humans↗