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Biomedical subjects

B W Mol

Publications and source records attributed to B W Mol.

106 records · Page 6Linked to original sources
PubMed1996

Serum human chorionic gonadotropin clearance curves in patients with interstitial pregnancy treated with systemic methotrexate.

OBJECTIVE: To evaluate short-term effectiveness of systemic methotrexate (MTX) in interstitial pregnancy. DESIGN: Case series. SETTING: Two Dutch teaching hospitals. PATIENT(S): Eight consecutive patients with an unruptured interstitial pregnancy. INTERVENTION(S): Four doses of 1.0 mg/kg IM MTX alternated with 0.1 mg/kg oral folinic acid. Serum hCG concentrations were determined before the first MTX injection and followed until levels were undetectable. A second MTX course was started on day 14, if by then serum hCG concentrations were > 40% of the initial value. Serum hCG clearance curves of all patients in the present study were compared with those from our earlier studies, in which a different folinic acid regimen (15 mg orally) was used. MAIN OUTCOME MEASURE(S): Serum hCG clearance curves. RESULT(S): All patients were treated successfully: five with one course and three with two courses. Serum hCG clearance curves of these patients tended to decline more rapidly than those successfully treated with the 15 mg folinic acid regimen. CONCLUSION(S): Systemic MTX is an attractive therapeutic option in the conservative treatment of unruptured interstitial pregnancy. The regimen of four doses of 1.0 mg/kg IM MTX alternated with 0.1 mg/kg folinic acid is effective. Serum hCG clearance curves may serve as a guideline for monitoring MTX treatment, thus enabling a timely detection of impending treatment failure.

Adult↗
PubMed1996

Reproducibility of the interpretation of hysterosalpingography in the diagnosis of tubal pathology.

The aim of the study was to estimate the inter- and intra-observer reproducibility of the interpretation of hysterosalpingography (HSG) in the diagnosis of tubal pathology, and associate reproducibility with diagnostic accuracy. Four observers evaluated 143 HSGs twice, on proximal tubal obstruction, distal tubal obstruction, hydrosalpinx and peritubal adhesions. Diagnostic laparoscopy with chromopertubation was considered to be the reference strategy. Reproducibility (inter- and intra-observer agreement) was expressed in terms of kappa-values. Accuracy was expressed in terms of sensitivity, specificity and likelihood ratios. kappa-values for reproducibility between observers were almost perfect for proximal obstruction, substantial for distal obstruction and hydrosalpinx, and moderate for adhesions. kappa-values for reproducibility within observers were almost perfect for proximal obstruction and substantial for distal obstruction, hydrosalpinx and adhesions. HSG had a high specificity for proximal obstruction, but a low sensitivity. Distal obstruction, absence of hydrosalpinx and adhesions had a poor accuracy. The likelihood ratio for the presence of hydrosalpinx was high. In conclusion, proximal tubal obstruction detected on HSG changes the pre-test probability of proximal tubal obstruction from 16 to 50%. Proximal tubal patency detected on HSG changes the pre-test probability of proximal tubal patency from 16 to 9%. It is unlikely that a lack of reproducibility of the interpretation of proximal tubal patency is responsible for the low sensitivity; alternative explanations are artefacts occurring while performing HSG or an imperfect reference strategy diagnostic laparoscopy. HSG is of limited use in diagnosing distal tubal obstruction and hydrosalpinx, and has no value in the detection of peritubal adhesions.

Fallopian Tube Diseases↗
PubMed1996

Progesterone alone versus progesterone combined with HCG as luteal support in GnRHa/HMG induced IVF cycles: a randomized clinical trial.

Two different regimens of luteal support in gonadotrophin hormone-releasing hormone (GnRH) analogue/human menopausal gonadotrophin (GnRHa/HMG)-induced in-vitro fertilization cycle (IVF) were compared in a randomized clinical trial. After embryo transfer, either vaginal progesterone alone was administered (n = 89, P group), or a combination of vaginal progesterone and human chorionic gonadotrophin (n = 87, P/HCG group). The primary aim of this study was to assess the effect of the different regimens of luteal support on the pregnancy rate. The secondary aim was to compare oestradiol and progesterone concentrations in the luteal phase between the two groups, and assess their effect on the pregnancy rate. A clinical pregnancy rate of 15% was found in the P/HCG group in comparison with 26% in the P group (odds ratio 0.49; 99% confidence interval: 0.18-1.3). The luteal serum oestradiol and progesterone values in the P/HCG group were significantly higher when compared with the P group on the 6th, 9th and 12th day after oocyte retrieval (Wilcoxon P < 0.001). In accordance with the high oestradiol concentrations, more cases of ovarian hyperstimulation syndrome (OHSS) were found in the P/HCG group. Oestradiol values on the 9th day after oocyte retrieval, presumably the day of implantation, appeared to be higher in women who did not become clinically pregnant. We conclude that vaginal progesterone alone provides sufficient luteal support in GnRHa/HMG induced IVF cycles. The combination of vaginal progesterone and HCG as luteal support leads to significant high luteal oestradiol and progesterone concentrations. But a high concentration of oestradiol seems to have a deleterious effect on the implantation process, resulting in a low pregnancy rate.

Adult↗
PubMed1996

Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma.

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on 122 of these patients had ligament ruptures. At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures. Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.

Adolescent↗
PubMed1996

Risk factors for ectopic pregnancy: a meta-analysis.

OBJECTIVE: To review current knowledge on the risk of ectopic pregnancy (EP), with the exception of contraceptive methods. DESIGN: Meta-analysis. SETTING: Case control and cohort studies published between 1978 and 1994 in English, French, German, or Dutch, retrieved by Medline search, crossover search from the papers obtained, and hand-search on recent medical journals. PATIENTS: A total number of 6,718 cases of EP in 27 case control studies and 13,049 exposed women in 9 cohort studies. MAIN OUTCOME MEASURES: Detected studies were tested for homogeneity. If homogeneity was not rejected, Mantel-Haenszel common odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: Previous EP, previous tubal surgery, documented tubal pathology, and in utero diethylstilbestrol (DES) exposure were found to be associated strongly with the occurrence of EP. Previous genital infections (pelvic inflammatory disease [PID], chlamydia, gonorrhoea), infertility, and a lifetime number of sexual partners > 1 were associated with a mildly increased risk. For gonorrhoea, PID, previous EP, previous tubal surgery, and smoking, a higher common OR was calculated when using pregnant controls compared with using nonpregnant controls. CONCLUSIONS: The strong risk in women with a previous EP, previous tubal surgery, documented tubal pathology, or in utero DES exposure justifies the exploration of a screening policy for EP among these women. If a risk factor reduces fertility chances, the OR detected when using pregnant controls is higher than the OR calculated using nonpregnant controls.

Case-Control Studies↗
PubMed1995

Contraception and the risk of ectopic pregnancy: a meta-analysis.

The current knowledge of the association between contraceptive methods and the risk of ectopic pregnancy was evaluated by means of a meta-analysis. Case-control and cohort studies published between 1978 and 1994 in English, French, German and Dutch were retrieved by a search in Medline, a hand-search on recent medical journals and cross-references. Papers reporting on the association between contraceptives and ectopic pregnancy were judged according to predefined entrance criteria concerning selection of control groups, and retractability of raw data enabling the calculation of crude odds ratios. Common Odds Ratios (COR) and 95% confidence intervals were calculated if homogeneity was not rejected. Twelve case-control studies and one cohort study were detected. CORs could be calculated for current and past use of oral contraceptives, past IUCD use and tubal sterilization. All assessed contraceptives protect against ectopic pregnancy. Women becoming pregnant after sterilization or while currently using an IUCD are at an increased risk. The IUCD is the only contraceptive method associated with an increased risk after discontinuation of its use.

Case-Control Studies↗
PubMed1995

Nuchal translucency measurement in normal fetuses.

OBJECTIVE: To construct a normal range for the nuchal translucency measurement in chromosomally and phenotypically normal fetuses between 9 and 14 weeks' gestation. METHODS: The nuchal translucency was measured prospectively in 771 chromosomally normal fetuses of women attending our antenatal clinic or prenatal diagnosis center. The nuchal translucency measurement was expressed as the median and fifth, 25th, 75th, and 95th percentiles according to completed weeks of gestation based on ultrasound measurements. RESULTS: The median nuchal translucency measurement increased from 0.7 mm at 10 weeks' gestation to 1.5 mm at 13 weeks. A nuchal translucency measurement greater than 2.5 mm was found in 4.6% of the fetuses at 10 weeks' gestation; the incidence increased to 8.7% at 14 weeks. CONCLUSION: In normal fetuses, there is a physiologic variation in the nuchal translucency measurement between 9 and 14 weeks' gestation. The calculation of risk for trisomies based on this measurement should take this variation into account. The adoption of a gestational age-dependent cutoff point, based on the deviation of a given measurement from the median, may reduce the number of false-positive test results requiring invasive procedures for karyotyping.

Adolescent↗
PubMed1995

The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis.

OBJECTIVE: To assess the value of hysterosalpingography (HSG) in diagnosing tubal patency and peritubal adhesions using laparoscopy with chromopertubation as the gold standard. DESIGN: Meta-analysis of 20 studies comparing HSG and laparoscopy for tubal patency and peritubal adhesions. PATIENTS: Four thousand one hundred seventy-nine patients with infertility in 20 studies. INTERVENTION: Hysterosalpingography and diagnostic laparoscopy as part of infertility workup. MAIN OUTCOME MEASURE: Tubal patency and peritubal adhesions. RESULTS: For tubal patency the reported sensitivity and specificity differed between studies. In a subset of studies that evaluated HSG and laparoscopy independently, a point estimate of 0.65 for sensitivity and 0.83 for specificity was calculated. For peritubal adhesions a summary receiver operating characteristic curve could be estimated. CONCLUSIONS: Although HSG is of limited use for detecting tubal patency because of its low sensitivity, its high specificity makes it a useful test for ruling in tubal obstruction. For the evaluation of peritubal adhesions HSG is not reliable.

Fallopian Tube Diseases↗
PubMed1995

Clearance curves of serum human chorionic gonadotrophin for the diagnosis of persistent trophoblast.

A well recognized hazard of conservative surgical treatment of tubal pregnancy is incomplete removal of trophoblastic tissue. Persistent trophoblast can be detected by postoperative serum human chorionic gonadotrophin (HCG) monitoring. The impact of various surgical techniques on the post-operative clearance of serum HCG was investigated in a retrospective study. The medical records of 97 patients treated surgically for tubal pregnancy in the Academic Medical Center of the University of Amsterdam, The Netherlands, between 1 January 1992 and 1 August 1994 were reviewed; 28 patients were treated by salpingostomy by laparoscopy, 16 by salpingostomy by open surgery and 53 by salpingectomy by either method. There was no difference in the post-operative clearance of serum HCG after successful conservative surgery compared to radical surgery. However, persistent trophoblast occurred in eight patients (29%) after laparoscopic salpingostomy and in only one patient (6.3%) who had a salpingostomy by open surgery (relative risk 4.57). Serum HCG clearance curves allow early identification of patients with persistent trophoblast after conservative surgical treatment. Moreover, monitoring of post-operative serum HCG until it becomes undetectable is mandatory in order to reveal late-onset types of persistent trophoblast.

Chorionic Gonadotropin↗
PubMed1995

Intermethod variation in detection of human papillomavirus DNA in cervical smears.

In order to investigate the reliability of detection of human papillomavirus (HPV) DNA in cervical smears, we have compared the performance of two HPV PCR systems, the CPI/IIG and MY09/11 primer-mediated PCRs and the Hybrid Capture System HPV DNA detection test (hybrid capture assay), in detecting HPV DNA in cervical smears. We also included in our study the MY09/11B PCR plus SHARP (solution hybridization assay for PCR products) Signal System. This SHARP Signal System was recently developed to detect MY09/11B-generated biotinylated PCR products. The detection rate of the hybrid capture assay was lower than those of the CPI/IIG and MY09/11 PCRs and the MY09/11B PCR plus SHARP Signal System. The detection rates of the CPI/IIG PCR and the MY09/11B PCR plus SHARP Signal System were similar and higher than that of the conventional MY09/11 PCR system. The agreement beyond chance of the PCR methods was nearly perfect (kappa value between 0.82 and 0.84). The agreement beyond chance of the hybrid capture assay and the PCR methods was fair to good (kappa value between 0.64 and 0.70). The systems detected HPV DNA in different but overlapping sets of smears. Our results indicate that each of the detection methods alone underestimates the prevalence of HPV.

Analysis of Variance↗
PubMed1995

Suspected ectopic pregnancy: expectant management in patients with negative sonographic findings and low serum hCG concentrations.

Between July 1989 and December 1994, we performed a prospective study in 265 patients with suspected ectopic pregnancy to assess the value of expectant management in patients with negative transvaginal sonographic findings and low serum human chorionic gonadotropin (hCG) concentrations. All patients had serum hCG concentrations < 1500 IU/l. Eventually, ectopic pregnancy was diagnosed in 68 patients (25.6%), intrauterine pregnancy in 81 patients (30.6%) and trophoblast in regression in 116 patients (43.8%). Test results of our diagnostic strategy, that integrated the results of serial transvaginal sonography, serum hCG monitoring and expectant management, were good: sensitivity 90%, specificity 98%, likelihood ratio of a positive test result 45 and likelihood ratio of a negative test result 0.1. Expectant management in patients with suspected ectopic pregnancy and low serum hCG concentrations proved to be safe, and it enabled us to avoid untimely invasive interventions in patients with an early intrauterine pregnancy or with trophoblast in regression.

Abdominal Pain↗