[A new method against remaining trophoblastic tissue after surgery for ectopic pregnancy].
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Female↗
Biomedical subjects
B Lindblom
Publications and source records attributed to B Lindblom.
Combined use of progesterone and human chorionic gonadotropin determinations for differential diagnosis of very early pregnancy.
Progesterone (P) level and daily change in human chorionic gonadotropin (hCG) were determined in the serum of 307 patients with suspected ectopic pregnancy (EP). Of the viable intrauterine pregnancies (IUP), 99% had P values above 30 nmol/L, whereas 75% of the EP and 81% of the spontaneous abortions had P values less than 30 nmol/L. Among the viable IUP, 95% had normal hCG increases, whereas 89% of the EP and 99% of the spontaneous abortions had abnormal hCG increases. A P value less than 30 nmol/L combined with an abnormal hCG increase had a positive predictive value for pathological pregnancy of 1.0. Consequently, in such cases, further invasive diagnostic or therapeutic measures can be taken with a low risk of jeopardizing a viable IUP.
Abortion, Spontaneous↗
Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy.
OBJECTIVE: Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial. DESIGN: One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy. To evaluate adhesion formation and tubal status, 73 patients with strong desire of pregnancy underwent a second-look laparoscopy. The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy. RESULTS: Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy (P less than 0.001). Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group. Tubal patency did not differ between the groups. CONCLUSIONS: Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery.
Fallopian Tubes↗
Effects of bupivacaine and calcium antagonists on the rat uterine artery.
Bupivacaine is a commonly used local anesthetic in obstetrical practice, but since this compound also has a constrictor action on vascular smooth muscle it can be hazardous to the fetus. The aim of the present study was to analyze the effect of bupivacaine on the uterine vasculature using the rat uterine artery as a model. Small arterial segments were mounted in tissue chambers for isometric recording of vascular tension using a specially designed teflon-steel gauge. Bupivacaine induced marked vasoconstriction and this vasoconstriction was reduced considerably by two different Ca antagonists, verapamil and nifedipine. Verapamil (10(-5) mol.l-1) reduced bupivacaine-produced arterial contraction by a mean of 78% and nifedipine (2.9 x 10(-7) mol.l-1) reduced arterial contraction by a mean of 57%.
Animals↗
Effects of bupivacaine and calcium antagonists on human uterine arteries in pregnant and non-pregnant women.
Bupivacaine is a local anesthetic commonly used in obstetrical practice. Although not generally constrictive, it has a constricting effect on blood vessels in clinically used doses, and when administered close to the uterine vasculature, as in a paracervical blockade, it can induce severe fetal bradycardia and thus be hazardous to the fetus. The bupivacaine-induced vasoconstriction on uterine arteries from pregnant and non-pregnant women was effectively reduced by two different calcium antagonists, verapamil and nifedipine. In non-pregnant women, nifedipine (2.9 x 10(-7) mol.l-1) administered simultaneously with bupivacaine (5.8 x 10(-4) mol.l-1) caused a 96% and verapamil (10(-5) mol.l-1) an 84% reduction as compared with the control vessel where only bupivacaine (5.8 x 10(-4) mol.l-1) was administered. In pregnant women, nifedipine 2.9 x 10(-7) mol.l-1 and 2.9 x 10(-6) mol.l-1 produced 66% and 79% reductions, respectively. It is possible that calcium antagonists administered together with bupivacaine in paracervical blockade could reduce the risk of fetal bradycardia.
Arteries↗
Endothelin--a potent constrictor of small myometrial arteries of term pregnant women.
This study was performed to evaluate the in vitro effects of a new polypeptide, endothelin-1 (ET-1) on small intramyometrial vessels in comparison with the action of noradrenalin (NA). In connection with cesarean section, myometrial biopsies were obtained and small arteries (100-500 microns in diameter) were excised. Cylindrical segments of these vessels were used for registration of contractile activity after administration of ET-1 and NA. ET produced vasoconstriction and was approximately three times as powerful and 70-fold as potent as NA. It is suggested that ET may be involved in the regulation of human utero-placental blood flow.
Adult↗
Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy.
A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment with conventional conservative abdominal surgery for tubal pregnancy. Entry criteria were: size of the ectopic gestation less than 4 cm, hemodynamic stability, accessibility for laparoscopic treatment and a trained laparoscopist on duty. There was no difference between the groups regarding gestational duration, size and location of the ectopic gestation, or the mean preoperative hCG values. The groups differed with respect to total operation time (73 min for the laparoscopy group vs. 88 min for the laparotomy group), hospital stay (2.2 vs. 5.4 days) and convalescence period (11 vs. 24 days). The rates of elimination of hCG was similar in the groups, and there were no statistical difference in the rate of second intervention.
Chorionic Gonadotropin↗
Raised IgG and IgM in "epidemic" IDDM suggest that infections are responsible for the seasonality of type I diabetes.
Serum levels of immunoglobulins G, A and M were quantitatively measured at diagnosis and at regular intervals for four years in 92 type I (insulin-dependent) diabetes patients. The patients were 0.8-15.99 years of age at diagnosis. Thirty-six of them got diabetes during periods of high incidence (the "epidemic" group) and 56 of them were diagnosed during periods of seemingly low incidence (the non-"epidemic" patients). Fifty percent (18/36) of the "epidemic" group had infections less than two months preceding diagnosis as compared to 29% (16/56) (p less than 0.01) of the non-"epidemic" patients. At diagnosis immunoglobulins G, and M in the "epidemic" group were 11.28 +/- 2.0 and 1.97 +/- 0.77 as compared to 9.9 +/- 2.3 (p less than 0.01) and 1.31 +/- 0.58 (p less than 0.001) respectively in the non-"epidemic" patients. The same highly significant differences were observed when mean values of IgG and IgM were compared between children who had infections less than two months before diagnosis and those without preceding infections. Except for slightly higher (p less than 0.12) total (OKT3) T-lymphocytes and higher (p less than 0.03) B-lymphocytes at diagnosis in the "epidemic" group, there were no significant differences in quantitative T- and B-lymphocyte subpopulations between various groups. 6.3% (2/32) of the patients who had preceding infections had HLA-DR3/non-DR4 genotypes as compared to 30.6% (15/49); p less than 0.001, of those patients without preceding infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Endothelin, a vasoconstrictor important to the uteroplacental circulation in pre-eclampsia.
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Arm↗
Giant suprasellar varix: an unusual cause of chiasmal compression.
A 63-year-old woman developed visual field defects consistent with lateral compression of the optic chiasm. The cause of the compression was found to be a giant venous varix formed by the dilatation of the outflow vein from a dural arteriovenous fistula located in the superior petrosal sinus. After embolization and surgical obliteration of the fistula, the patient's visual function improved markedly.
Arteriovenous Fistula↗
Persistent trophoblast after conservative treatment of tubal pregnancy: prediction and detection.
The incidence of persistent trophoblast and risk of second surgical intervention after conservative treatment of tubal pregnancy are substantial. The preoperative and postoperative hCG patterns in patients with tubal pregnancy were studied to see whether this information could predict and detect persistent trophoblast at an early stage. Ninety-eight women with tubal pregnancy underwent conservative surgical treatment by laparoscopy or laparotomy. Eight developed postoperative complications necessitating a second operation, and seven of them had both biochemical and histologic evidence of persistent trophoblastic activity. In seven of 31 patients with preoperative hCG above 3000 IU/L, a second operation was necessary, whereas in 67 with preoperative hCG levels below 3000 IU/L, only one such intervention was necessary. Eight of the 22 patients with hCG above 1000 IU/L on the second day after surgery and seven of 11 patients with hCG above 1000 IU/L on the seventh day after surgery later needed a second surgical procedure. In contrast, 86 of 87 women with hCG below 1000 IU/L on the seventh day after surgery had an uneventful convalescence. We conclude that pre- and postoperative hCG measurements can identify patients at risk of developing persistent trophoblast. Further, in patients with preoperative hCG titers below 3000 IU/L, we recommend conservative surgery followed by measurement of hCG 1 week postoperatively.
Chorionic Gonadotropin↗
Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study.
OBJECTIVE: To find out whether a 10-14 days' course of antibiotics early in the course of reactive arthritis associated with enteric infections could reduce the severity and duration of the disease and whether the antibody response in patients with reactive arthritis associated with yersinia infection differed between those treated and those not treated with the antibiotics. DESIGN: Prospective multicentre trial in which patients were randomised to treatment or no treatment with antibiotics. Patients were seen at three and six weeks and three, six, nine, 12, and 18 months after their first visit. SETTING: Departments of infectious diseases in three hospitals in Linköping, Malmö, and Stockholm, Sweden. PATIENTS: 40 Consecutive patients who had had symptoms of reactive arthritis associated with enteric infection for less than four weeks. INTERVENTIONS: 20 Patients were allocated to treatment with antibiotics and 20 patients did not receive antibiotics. All patients received non-steroidal anti-inflammatory drugs, and four also received intra-articular steroid injections after at least six weeks' observation. MAIN OUTCOME MEASURES: Arthritic symptoms assessed clinically and by using Ritchies' index; blood measurements reflecting inflammatory activity; serum IgG, IgM, and IgA antibody titres; HLA tissue type. RESULTS: No difference was observed concerning duration of arthritis, grade of inflammation, and number of joints affected between patients treated and those not treated with antibiotics. Furthermore, there was no significant difference between the two groups in erythrocyte sedimentation rate and haptoglobin, IgG, and IgA concentrations. All values had returned to normal within three months. No patient developed chronic arthritis, but sustained slight arthralgia occurred in three patients. The HLA-B27 antigen was found in 23 (58%) of the patients, and its presence did not affect clinical outcome. The IgG, IgM, and IgA antibody responses were similar in patients treated with antibiotics and those not treated. CONCLUSION: Short term antibiotic treatment has no beneficial effect on the clinical outcome of reactive arthritis associated with enteric infection.
Adult↗
The value of endovaginal sonography and urinary human chorionic gonadotropin tests for differentiation between intrauterine and ectopic pregnancy.
Effectiveness of vaginal sonography combined with urinary human chorionic gonadotropin (hCG) for identification of ectopic pregnancy (EP) was studied in 107 pregnant women. Eighty-nine women had clinical symptoms suspicious of EP. It was suggested that 18 women carried an increased risk for developing EP. In 63 women endovaginal sonography showed no evidence of intrauterine pregnancy. Fifty-eight of these turned out to be pathological pregnancies. In 44 women endovaginal ultrasonography revealed intrauterine pregnancies. Thirty-two of these turned out to be viable, 10 were not viable and resulted in spontaneous abortions, and 2 turned out to be EP. The sensitivity of vaginal sonography to identify a viable intrauterine pregnancy thus was 81% and its specificity was 97%. The sensitivity and the specificity for endovaginal ultrasonography for identifying EP was 96% and 71%, respectively. Endovaginal ultrasonography demonstrated an intrauterine gestational sac in 54% of the women with urinary HCG as low as 40 IU/L to 500 IU/L. These results show that endovaginal ultrasonography is a sensitive instrument for identifying both early normal intrauterine pregnancies as well as pathological pregnancies.
Diagnosis, Differential↗
Treatment of tubal pregnancy by laparoscope-guided injection of prostaglandin F2 alpha.
Twenty-six cases of unruptured tubal pregnancy were treated by laparoscope-guided injection of prostaglandin (PG) F2 alpha into the affected tube and the ovary containing the corpus luteum. Preoperative serum human chorionic gonadotropin (hCG) levels were 22 to 2,050 IU/L (mean 328 IU/L). The procedure was successful in 24 patients (92%), as indicated by reduction of hCG values to less than 20 IU/L. The remaining 2 cases showed an initial fall in hCG after injection and thereafter a plateau phase indicating the persistence of trophoblast. In both cases, a second surgical intervention was necessary. The total subsequent conception rate among 19 women desiring pregnancy was 90% (17/19). The intrauterine conception rate was 58% (11/19), and the repeat rate of ectopic pregnancy was 32% (6/19). Two-thirds (12/19) of the subsequent pregnancies occurred within 6 months "at risk" for conception. It is concluded that local injection of PGF2 alpha represents an attractive method for termination of selected cases of tubal pregnancy, preferentially in subjects with low trophoblastic activity.
Abortion, Legal↗
Evaluation of time-resolved fluoroimmunoassay for analysis of sex steroids in serum.
The performance characteristics of time-resolved fluoroimmunoassays (FIAs) for oestradiol and progesterone were evaluated in an in-vitro fertilization/embryo transfer (IVF/ET) programme and for use in differential diagnosis of early pregnancy. Comparisons were made with commercially available radioimmunoassays (RIAs) and the correlations between the results obtained were analysed. The possible clinical impact of the differences was assessed in 30 women undergoing ovarian stimulation for IVF/ET and also in 68 women presenting with suspected pathological gestation. There was good agreement between the performance characteristics observed in the present study and those claimed by the manufacturer. There was also a strong correlation between RIA and FIA within the working ranges of the assays. The differences in the results obtained with the two methods were within the normal limits of variation of the assays, and, consequently, the clinical relevance was minimal. In conclusion, for the clinical purposes in question, the FIAs perform at least as well as commercially available RIAs, and may, therefore, be regarded as an alternative to RIAs for many laboratories.
Embryo Transfer↗
Single progesterone assay for early recognition of abnormal pregnancy.
Serum progesterone and human chorionic gonadotrophin (HCG) were analysed using a time-resolved fluoroimmunoassay in an unselected group made up of 158 women with clinical suspicions of abnormal early gestation. Only cases in which endovaginal sonography had failed to localize the pregnancy were included. A single HCG determination had no diagnostic value. On the other hand, a critical progesterone level of 30 nM was determined below which no viable intrauterine pregnancies were found. Eighty-eight per cent of the ectopic pregnancies (n = 97) and 83% of the spontaneous abortions had progesterone levels below this limit. The discriminatory efficacy of one single progesterone determination was independent of the actual HCG level and serial determinations of progesterone did not increase the discriminatory power.
Abortion, Spontaneous↗
Acoustic estimations of the front cavity in apical stops.
Sweep-tone measurements of front-cavity resonances in apical stops are reported. Volumes inferred from resonance frequency data are presented as a function of place of articulation. The results indicate that, for post-dental points of contact, a cavity located under the tongue tip is formed. It is shown that this sublingual cavity plays a very important role in shaping the spectral structure of apical stops.
Humans↗
Influence of bupivacaine and morphine on human umbilical arteries and veins in vitro.
Strips from human umbilical arteries and veins were prepared by microdissection. The vessel strips were mounted in tissue baths for isometric recording of contractile activity. The local anesthetic drug bupivacaine induced a concentration-dependent increase of tone in both artery and vein, whereas morphine had no effect. Nor did morphine influence the increase in vessel tone induced by bupivacaine. If applicable in vivo, the results suggest that morphine has little influence on umbilical vessel tone, whereas bupivacaine may reduce the umbilical blood flow, at least when the local concentration of bupivacaine exceeds a certain critical level. The addition of morphine to local anesthetics did not increase any adverse effects on the umbilical vessels in this study.
Bupivacaine↗