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Biomedical subjects

I Milsom

Publications and source records attributed to I Milsom.

At least 109 records · Page 6Linked to original sources
PubMed1992

Quantification of naturally occurring benzodiazepine-like substances in human breast milk.

The possible occurrence of benzodiazepine-like substances in human breast milk was investigated in 35 healthy, newly delivered women who were known not to be taking benzodiazepines. Maternal blood samples and a sample of breast milk were obtained on the fifth post partum day. A radioreceptor technique (lower limit of detection 1.5 ng/ml; difference between duplicates at various concentrations less than 7%) was used for measuring benzodiazepine-like substances in blood and breast milk (with and without prior extraction). No benzodiazepine-like substances could be demonstrated in any of the blood samples taken from the 35 women. Measurable concentrations of benzodiazepine-like substances were demonstrated in all but 1 of the 35 breast milk samples. The mean concentration of benzodiazepine-like substances for all 35 women was 4.3 +/- 2.3 ng/ml (range 0-9.3 ng/ml) expressed as lorazepam. The corresponding value for extracted breast milk was 2.6 +/- 1.5 ng/ml (range 0-7.0 ng/ml). There was no association between concentrations of benzodiazepine-like substances in breast milk and maternal age, weight, height and body mass or parity, or the sex of the infant and infant birth weight. We suggest that non-detectable amounts of benzodiazepine-like substances in serum are concentrated in the mammillary glands and excreted in a higher concentration in breast milk. It is less likely that the relevant benzodiazepines are produced in the mammillary glands.

Adult↗
PubMed1992

The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status.

The influence of a low-dose combined oral contraceptive (ethinyl estradiol 30 micrograms + desogestrel 0.15 mg) on menstrual blood loss (MBL) was evaluated in 20 healthy, young women. MBL prior to commencing oral contraception was 60.2 +/- 5.6 ml (range 22-116 ml), and decreased (p < 0.001) to 36.5 +/- 5.2 ml (range 7-80 ml) and 33.7 +/- 4.1 ml (range 5-70 ml) after 3 and 6 months' oral contraceptive medication, respectively. The reduction in MBL during oral contraception was most apparent during the first two days of menstruation. Five women had an MBL > 80 ml prior to commencing oral contraceptive medication. In all of these women, MBL during the 6th menstrual period after commencing oral contraception was < 80 ml. All the women included in this study had a normal blood hemoglobin concentration, hematocrit and erythrocyte indices and there were no significant changes in these variables during the course of the study. Serum ferritin concentration prior to commencing oral contraception was 44.2 +/- 9.0 micrograms/l and was largely unchanged after 6 months' oral contraception (39.7 +/- 6.3 micrograms/l). On admission to the study, two women had a serum ferritin < 10 micrograms/l, indicative of low iron stores. Both these women had an MBL > 80 ml at the baseline assessment. Serum ferritin concentration increased during oral contraceptive medication in both women (from 8.5 micrograms/l to 12.0 micrograms/l and from 5.4 micrograms/l to 6.8 micrograms/l, respectively). The duration of menstruation (p < 0.01) and the number of women suffering from dysmenorrhea (p < 0.05) was reduced during oral contraception.

Adolescent↗
PubMed1992

Effects of nitrous oxide/oxygen inhalation on the maternal circulation during vaginal delivery.

The hemodynamic changes occurring during the first stage of labor were studied in 24 healthy pregnant women during inhalation of different nitrous oxide/oxygen (N2O/O2) gas mixtures (intermittent 70/30, 40/60, 0/100 and continuous 40/60). Cardiac output increased (P less than 0.01) from 6.6 +/- 0.2 l/min between uterine contractions to 8.5 +/- 0.3 l/min during contractions. Heart rate, stroke volume, systolic, diastolic and mean arterial pressures were increased (P less than 0.01) and total peripheral vascular resistance was reduced (P less than 0.01) during contractions compared to measurements performed between contractions. The maternal circulation was influenced by the use of N2O/O2. During intermittent inhalation, higher concentrations of N2O were associated with a decrease (P less than 0.01) in heart rate, cardiac output and arterial pressure as well as an increase (P less than 0.01) in stroke volume. The degree of pain relief also increased (P less than 0.01) with increasing concentrations of inhaled nitrous oxide. The circulatory influence of intermittent inhalation given during uterine contractions was also apparent during the interval between contractions when N2O/O2 was not administered. The most obvious effects on both circulation and pain were demonstrated during continuous inhalation of N2O/O2. There was a close association between analgetic and cardiovascular effects indicating that the latter, at least partly, were due to pain relief. However, it was not possible to exclude or confirm possible direct pharmacological effects of N2O/O2 on maternal circulation.

Adult↗
PubMed1991

A longitudinal study of contraception and pregnancy outcome in a representative sample of young Swedish women.

The prevalence of contraception and pregnancy history in the same women, aged 19 and 24 years, was assessed in a longitudinal cohort study by means of a postal questionnaire. A one-in-four random sample of all the women born 1962, resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). The response rate was 91%. Respondents from 1981 were re-assessed in 1986 (response rate: 83%). The respondents from 1986 (n = 488) represent 74% of the original sample from 1981. Contraceptive usage in the same women aged 19 and 24 years (in brackets) was as follows: Oral contraception (OC) 47% (51%); intrauterine device 3% (11%), p less than 0.01; barrier methods 11% (11%); depot gestagen 0 (0.2%); no contraception 39% (26%), p less than 0.05. OCs were being taken or had been taken by 89%. Reasons given for cessation of OC were as follows: Contraception not required 10% (15%); fear of OC 26% (29%); menstrual disorder 17% (14%); weight increase 18% (10%), p less than 0.05; mental side effects 15% (9%); desire to become pregnant 7% (17%), p less than 0.01. Pregnancies (n = 362) were reported by 194 (43%) of the women. 44% of the pregnancies terminated in legal abortion. The medical complication rate following legal abortion was 15%. Thus, despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

Adult↗
PubMed1991

Vaginal immunoglobulin A (IgA) levels in post-menopausal women: influence of oestriol therapy.

The concentration of secretory immunoglobulin A (IgA) in the vaginal fluid of 20 untreated post-menopausal women (aged 75.4 +/- 1.4 years) was compared with the levels in a group of 20 post-menopausal women (aged 73.2 +/- 1.5 years) treated with oral oestriol (E3) (2 mg/day) and a further group of 20 healthy, non-pregnant, fertile women (aged 28.2 +/- 1.8 years). Secretory IgA was determined using a paper disc modification of the single radial immunodiffusion technique. The vaginal concentration of IgA in the untreated women was 41.5 +/- 5.7 mg/l, which was higher than that recorded in those treated with E3 (20.8 +/- 5.7 mg/l, P less than 0.05) and in the fertile women (16.4 +/- 3.7 mg/l, P less than 0.01). Epithelial cells predominated in the wet smear preparations obtained from the women who received E3 and the fertile women, while a predominance of leucocytes was observed in the untreated women. Lactobacilli were found more frequently in the vaginal flora of the women in the E3 group (P less than 0.001) and the fertile women (P less than 0.001) than the untreated group. Faecal-type bacteria were seen more frequently in the vaginal flora of the untreated women than the E3 group (P less than 0.01) or the fertile women (P less than 0.001). The possible implications of the present findings with regard to the individual variation in the intensity of symptoms experienced by women suffering from the oestrogen deficiency syndrome are discussed.

Adult↗
PubMed1991

Prevalence of fractures among 10,000 women from the 1900 to 1940 birth cohorts resident in Gothenburg.

The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.

Age Factors↗
PubMed1991

A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia.

Treatment with flurbiprofen (100 mg twice a day for 5 days), tranexamic acid (1.5 gm three times a day for 3 days and 1 gm twice a day for another 2 days), and an intrauterine contraceptive device releasing 20 micrograms levonorgestrel per day was compared in women with idiopathic menorrhagia. The menstrual blood loss during two control periods in 15 women subsequently treated with flurbiprofen and tranexamic acid was 295 +/- 52 ml and 203 +/- 25.2 ml in the 16 women later fitted with a levonorgestrel-releasing intrauterine contraceptive device. Menstrual blood loss was reduced by all three forms of treatment. The reduction in menstrual blood loss expressed as a percentage of the mean of two control cycles for each form of treatment was as follows: flurbiprofen, 20.7% +/- 9.9%; tranexamic acid, 44.4% +/- 8.3%; levonorgestrel-releasing intrauterine contraceptive device after 3 months, 81.6% +/- 4.5%; levonorgestrel-releasing intrauterine contraceptive device after 6 months, 88.0% +/- 3.1%; levonorgestrel-releasing intrauterine contraceptive device after 12 months, 95.8% +/- 1.2%. The reduction in menstrual blood loss achieved by the levonorgestrel-releasing intrauterine contraceptive device was greater than that recorded with flurbiprofen (p less than 0.001) and tranexamic acid (p less than 0.01), and was greater for tranexamic acid when compared with flurbiprofen (p less than 0.05). The levonorgestrel-releasing intrauterine contraceptive device was the only form of treatment to reduce mean menstrual blood loss below 80 ml per menstruation, the upper limit of normal menstrual blood loss.

Adult↗
PubMed1991

A comparison between experienced and objectively demonstrated urinary leakage in 85-year old men and women.

The ability of 37 urinary incontinent 85-year old men and women to perform the 48-h pad test in their home environment was studied. Assessment of the magnitude of urinary incontinence by the 48-h pad test was compared with a subjective assessment, performed by the men and women themselves. Twenty-eight of the 37 men and women successfully performed the 48-h pad test. Early signs of dementia and defective vision were the main reasons for not completing the test successfully. The six women who considered their urinary incontinence to be slight had a maximum leakage per pad of 5.3 +/- 1.4 g. The corresponding figure for women with moderate incontinence was 48.8 +/- 12.3 g. None of the women considered their incontinence to be severe, even though eight of the women had a leakage per pad of greater than 30 g. Six men considered their incontinence to be moderate (25.0 +/- 8.1 g) and one man considered his incontinence to be severe (31 g/pad). Fourteen of the 28 men and women underestimated the magnitude of their urinary incontinence.

Aged↗
PubMed1991

A health care program for the investigation and treatment of elderly women with urinary incontinence and related urogenital symptoms.

The assessment and treatment of urinary incontinence and related urogenital symptoms using an algorithm model was evaluated in 364 elderly women complaining of urinary incontinence. The women (age 72.1 +/- 1.5 years, range 65-84 years) were assessed by a 48-hour pad test, a cough provocation test, micturition lists and a gynecological examination which included a smear test, measurement of vaginal pH and bacterial cultures. The diagnosis of urinary incontinence was confirmed in 346 women (stress 26.3%; urge: 32.7%; mixed: 41.0%). Women suffering from stress incontinence were younger (p less than 0.05) and had experienced a larger number of deliveries (p less than 0.05) than women with urge incontinence. All the women were treated with oral estriol, 3 mg daily for 4 weeks followed by 1-2 mg daily. The total urinary leakage per 48 hours (p less than 0.01) and maximum single leakage (p less than 0.05) were reduced in women with mixed incontinence, while the frequency of micturition decreased (p less than 0.05) in women with urge incontinence after 12 weeks treatment with oral estriol. There were no significant changes in any of the objective micturition parameters in women with stress incontinence following treatment. Karyopyknotic index and the presence of lactobacilli were increased (p less than 0.001), and vaginal pH decreased (p less than 0.001) following treatment in women with all types of incontinence. More than 70% of all the women treated in this algorithm model judged themselves to be improved, much improved or cured.

Aged↗
PubMed1991

The influence of epidural blockade and pethidine administered during delivery on neonatal myocardial performance.

The aim of the present study was to investigate whether obstetric analgesia with an epidural blockade (Marcaine, bupivacaine hydrochloride, 141.5 +/- 56.8 mg) and pethidine (95.0 +/- 30.7 mg) influenced neonatal myocardial function following vaginal delivery. Left ventricular output and other left ventricular function indices were measured 5.6 +/- 4.3 h postpartum with Doppler and M-mode echocardiography in a group of healthy, full-term, appropriate-for-gestational-age infants (n = 10) whose mothers had received both bupivacaine and pethidine during delivery, and in a similar group of newborn infants (n = 10) whose mothers had received only nitrous oxide/oxygen analgesia. In 7 of the 10 infants in each groups, a second assessment of myocardial function was performed 21.7 +/- 4.6 h post partum. There were no significant differences in any of the variables used to assess left ventricular function at either of the measurement points between the group of infants whose mothers had received bupivacaine/pethidine during delivery, and the group of infants whose mothers had received nitrous oxide/oxygen analgesia only.

Anesthesia, Epidural↗
PubMed1990

The influence of copper surface area on menstrual blood loss and iron status in women fitted with an IUD.

The influence of copper surface area on menstrual blood loss (MBL) was evaluated in 34 healthy women (mean age 36.4 +/- 1.4 yr, range 27-46 yr), who were fitted with a Multiload intrauterine device (IUD) with either 250 mm2 (MLCu-250) or 375 mm2 (MLCu-375) copper wire. MBL prior to IUD insertion was 54.4 +/- 10.3 ml for women subsequently fitted with a MLCu-250 and 56.9 +/- 6.9 ml for women fitted with a MLCu-375. An increase (p less than 0.01) in MBL was recorded 3 months after IUD insertion for both the women fitted with a MLCu-250 (86.4 +/- 10.3 ml) and a MLCu-375 (81.1 +/- 8.3 ml). This increase in MBL remained unchanged throughout the study period of one year. At no point were there any significant differences in MBL or increase in MBL between women fitted with a MLCu-250 or MLCu-375. There were no significant differences in serum ferritin, blood hemoglobin, hematocrit or erythrocyte indices before IUD insertion in the women grouped according to type of IUD, nor were any significant changes recorded in any of these parameters after IUD insertion. Thus, our findings that the increase in copper surface area from 250 mm2 to 375 mm2 had no effect on MBL were also substantiated by the hematological findings.

Adult↗
PubMed1990

The influence of different combined oral contraceptives on the prevalence and severity of dysmenorrhea.

The influence of different oral contraceptives (OC) on the prevalence and severity of dysmenorrhea was investigated longitudinally (from age 19 to 24 years) in a representative sample of young women from an urban Swedish population. The women were grouped according to the type of OC used at the time of assessment: monophasic OC with low gestagen activity; progestogen-dominated monophasic OC; triphasic OC; neither OC nor an intrauterine device (IUD). At the age of 19 years, the severity of dysmenorrhea was lower in users of monophasic OCs with low gestagen activity (p less than 0.05) and users of progestogen-dominated monophasic OCs (p less than 0.001) compared to women who used neither OC nor an IUD. At 24 years of age, the severity of dysmenorrhea was lower in users of monophasic OCs with low gestagen activity (p less than 0.001), users of progestogen-dominated monophasic OCs (p less than 0.001) and users of triphasic OCs (p less than 0.001), compared to women who used neither OC nor an IUD. The severity of dysmenorrhea in women who did not use an OC or IUD when 19 years old was reduced in the same women who used OCs when 24 years old, compared (p less than 0.001) to women who still used neither an OC nor an IUD. There were no significant differences in the prevalence and severity of dysmenorrhea between the users of monophasic OCs, irrespective of progestagen activity, and users of triphasic preparations.

Adult↗
PubMed1990

An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women.

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of Göteborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.

Age Factors↗
PubMed1990

Effect of oral oestriol on vaginal flora and cytology and urogenital symptoms in the post-menopause.

The effect of oral oestriol (3 mg/day for 4 weeks followed by 2 mg/day for a further 6 weeks) on the vaginal bacterial flora, vaginal cytology and urogenital symptoms was assessed in a double-blind, placebo-controlled study in 35 women with symptoms of the urogenital oestrogen deficiency syndrome. No significant differences were observed with regard to the occurrence or severity of urogenital symptoms, vaginal pH, karyopyknotic index (KPI) or the baseline results of vaginal bacterial cultures in the 18 patients (mean age 71.6 +/- 1.0 years) treated with oestriol and the 17 women (mean age 72.6 +/- 1.4 years) who received placebo tablets. A decrease in both vaginal pH (P less than 0.001) and the proportion of faecal-type bacteria (P less than 0.05), and an increase in the KPI (P less than 0.01) and the proportion of lactobacilli (P less than 0.001) were recorded after 10 weeks of treatment with oral oestriol. At the end of the following 10 medication-free weeks all of these parameters except vaginal pH had returned to values that were not significantly altered from the corresponding baseline levels. In the patients treated with placebo no significant changes occurred in vaginal pH, KPI or the proportion of lactobacilli in vaginal cultures during the course of this study. Urogenital symptoms improved in both groups after medication (and even after the medication-free period) in relation to the baseline assessment, which reflects the latter's subjective nature.

Administration, Oral↗
PubMed1990

Factors in the infertile couple influencing the success of artificial insemination with donor semen.

Factors influencing the success of artificial insemination with donor semen (AID) were investigated in a series of 928 infertile couples. A simple approach with one insemination/cycle, timed only by cycle length and basal body temperature, was used. The overall life-table cumulative conception rate was 82% and the average fecundability was 10%. The following factors were associated with a higher success rate: women less than 36 years, azoospermic compared with oligozoospermic husband and women with no history of abdominal surgery. The success rate decreased with increasing duration of infertility and in women with an abnormal hysterosalpingography or laparoscopy, and was unrelated to menarcheal age, the distance between the couples place of residence and the clinic, or if the woman had been pregnant before starting AID treatment.

Female↗
PubMed1990

The prevalence of urinary incontinence and use of incontinence aids in 85-year-old men and women.

The prevalence of urinary incontinence and the use of incontinence aids was investigated in 85-year-old men and women resident in the city of Göteborg. The overall prevalence of urinary incontinence was 37.2%. Urinary incontinence was more prevalent (p less than 0.001) in women (43.2%) than men (24.0%), and in residents of a nursing home or hospital (83.9%) than in men and women living at home (29.4%). Urinary incontinence was more commonly encountered in men with neurological (p less than 0.001) and respiratory (p less than 0.05) illnesses, and in women suffering from cardiovascular (p less than 0.05), neurological (p less than 0.001) and urogenital (p less than 0.01) illnesses. Incontinence aids were used more often (p less than 0.001) by incontinent women (67.9%) then men (42.9%) living in the community, and were used by 86.4% of the incontinent men and 91.5% of the incontinent women living in an institution. Pads were the commonest form of incontinence aid used, irrespective of whether the men and women lived in the community or in an institution. Indwelling urinary catheters were used by only 2% of the 85-year-old men and women.

Aged↗