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Biomedical subjects

L Forssman

Publications and source records attributed to L Forssman.

At least 37 records · Page 2Linked to original sources

Treatment of bacterial vaginosis with an acid cream: a comparison between the effect of lactate-gel and metronidazole.

Bacteriological isolation of anaerobes, Gardnerella and lactobacilli was carried out in a group of 62 women with the diagnosis bacterial vaginosis and 42 control women. Lactobacilli were the predominant organisms in the control group whereas anaerobes dominated the flora in bacterial vaginosis patients. Lactate-gel (pH 3.5, 5 ml) inserted into the vagina daily for 7 days is as effective as oral metronidazole, 500 mg twice daily for 7 days. The women in both groups became symptom-free and objectively improved. Anaerobes were significantly reduced (p less than 0.0001) in both groups after 1-week treatment but Gardnerella was not significantly reduced. As bacterial vaginosis is generally looked upon as a mild noninflammatory condition lactate-gel seems to be an ideal treatment for this disease.

Adult↗

An evaluation of automated indirect blood pressure measurement during pregnancy.

An automatic microcomputer-assisted instrument (Dinamap) for indirect determination of blood pressure was evaluated in 10 healthy women in the last trimester of pregnancy. Blood pressure determined intra-arterially was significantly (p less than 0.001) higher than indirect blood pressure determined with the Dinamap instrument or by manual sphygmomanometry. However, there was no significant difference in the mean change in blood pressure determined by the three techniques under investigation. A close correlation was recorded between systolic and diastolic blood pressure determined intra-arterially and with the Dinamap instrument (r = 0.92, r = 0.90), and between blood pressure determined intra-arterially and indirectly by auscultation (r = 0.93, r = 0.81). There was no significant difference in the reproducability of individual blood pressure values determined intra-arterially (systolic, 2.4 mmHg, diastolic, 3.7 mmHg) or by the Dinamap instrument (systolic, 2.8 mmHg, diastolic, 3.4 mmHg) or by auscultation (systolic, 5.0 mmHg, diastolic, 4.9 mm Hg). The Dinamap instrument proved reliable for the measurement of changes in blood pressure during late pregnancy. The technique eliminates the problem of inter-observer error which otherwise becomes evident when checking blood pressure antenatally.

Adult↗

Repeated candidiasis: reinfection or recrudescence? A review.

Candida vulvovaginitis is one of the most common infections encountered by obstetricians and gynecologists from all parts of the world. The modern treatment of vaginal candidiasis with imidazole antimycotics such as clotrimazole has been shown to be highly effective. However, there is a small group of women who experience repeated episodes of vaginal candidiasis. This article reviews possible predisposing factors related to recurrent vaginal candidiasis.

Anti-Bacterial Agents↗

Treatment of recurrent vaginal candidiasis.

In recurrent vulvovaginal candidiasis, predisposing factors should be eliminated wherever possible. Reduction of the gastrointestinal yeast flora by oral antimycotic treatment does not prevent recurrences. Perianal application of antifungal cream might be an alternative in preventing reinfection from the rectum. Venereal spread of yeasts does not seem to be an important factor, and partner treatment does not significantly alter treatment results. Traditionally, prolonged treatment periods are recommended to prevent recurrences. Patient compliance may then become a factor limiting efficacy. One-dose treatment has been shown to give results that compare favorably with traditional treatment schedules. Results in recurrent cases were comparable with those in primary infections. Thus one-dose treatment could be an acceptable alternative to longer treatment periods in schedules for treatment of recurrent cases. Intermittent prophylactic one-dose application appears to be a promising method of reducing recurrences.

Administration, Oral↗

Maternal haemodynamic changes during caesarean section: a comparison of epidural and general anaesthesia.

Haemodynamic measurements were performed on 20 healthy women before and during elective caesarean section under epidural (10 women) or general anaesthesia (10 women). The influence of the two anaesthetic techniques on the haemodynamic changes associated with operative delivery was compared. The following haemodynamic variables were studied: cardiac output (CO), stroke volume (SV) determined non-invasively with impedance cardiography, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), pulse pressure, mean arterial pressure (MAP) and total peripheral vascular resistance (TPR). During epidural anaesthesia, SV was largely unchanged before delivery but increased (P less than 0.05) following delivery. However, CO increased (P less than 0.05) prior to delivery due to an increase (P less than 0.01) in HR. A further increase (P less than 0.05) in CO was recorded following delivery. SBP, DBP, MAP and TPR decreased (P less than 0.01) during epidural anaesthesia. In the patients undergoing general anaesthesia, SV decreased (P less than 0.05) prior to delivery. However, CO remained largely unchanged due to an increase (P less than 0.01) in HR. Following delivery, CO (P less than 0.05) and SV (P less than 0.01) increased whereas HR decreased (P less than 0.01). SBP, DBP and MAP increased (P less than 0.01) prior to delivery, returning to the same level as prior to induction of anaesthesia following delivery. TPR was largely unchanged prior to delivery but decreased (P less than 0.01) following delivery.

Anesthesia, Epidural↗

Factors influencing aortocaval compression in late pregnancy.

The circulatory effects of postural change in late pregnancy were investigated in 20 healthy pregnant women. Maximum stroke volume (93.2 +/- 11.9 ml) was recorded with the subject in the left lateral position and was significantly (p less than 0.001) reduced in the supine, right lateral, and lithotomy positions, but was largely unchanged in the standing motionless position (89.9 +/- 12.6 ml). Diastolic, systolic, and mean arterial blood pressures and total peripheral vascular resistance were significantly (p less than 0.001) increased in the supine, right lateral, lithotomy, and upright motionless positions when compared to the same variables in the left lateral position. The following factors were found to be significantly correlated to the hemodynamic response to the supine recumbent position: maternal age (p less than 0.05), the position of the fetus in the uterus (p less than 0.05), and systolic (p less than 0.001) and diastolic (p less than 0.001) blood pressures measured with the subject in the left lateral position. The implications of the present findings for modern obstetric delivery care and the etiology of the supine hypotensive syndrome are discussed.

Adult↗

Measurement of cardiac stroke volume during cesarean section: a comparison between impedance cardiography and the dye dilution technique.

Simultaneous determination of cardiac stroke volume by impedance cardiography and the dye dilution technique was compared in ten women undergoing elective cesarean section performed under general or epidural anesthesia. The influence of delivery and the anesthetic procedures used on stroke volume determination by the two methods was evaluated and compared. The correlation coefficients for measurements performed before and during anesthesia showed little variation and were largely unchanged after delivery of the child (r = 0.90-0.97). Mean stroke volume determined by impedance cardiography was significantly (P less than 0.001) lower than mean stroke volume calculated from the dye dilution technique. However, there was no significant difference between the mean change in stroke volume determined by the two techniques during serial measurements. Impedance cardiography was found to be a safe, reliable, non-invasive technique for the measurement of changes in stroke volume during cesarean section. The ability of the impedance method to determine changes in stroke volume was unaffected by the anesthetic procedures employed or by delivery of the child.

Anesthesia, Epidural↗

Measurement of cardiac stroke volume by impedance cardiography in the last trimester of pregnancy.

Simultaneous determination of cardiac stroke volume by impedance cardiography and the dye dilution technique was compared in 10 women during the last trimester of pregnancy. Measurements were performed in different body positions to investigate the influence of body position on stroke volume. The correlation coefficient for all measurements was 0.87. Mean stroke volume determined by impedance cardiography was significantly (p less than 001) lower than mean stroke volume calculated by the dye dilution technique. There was no significant difference between the mean change in stroke volume determined by the two techniques during serial measurements. The reproducibility of individual impedance-determined stroke volumes (6.1 ml) did not differ significantly from individual values obtained by dye dilution (9.3 ml). Maximum mean impedance-determined stroke volume was recorded in the left lateral position (83.8 +/- 4.0 ml). Mean stroke volume was significantly (p less than 0.01) reduced in the supine position (17.9%). A smaller (14.4%) reduction was registered in the right lateral position. These changes in stroke volume according to body position were equally evident by both methods. Impedance cardiography is a safe, reliable, non-invasive technique for the measurement of changes in stroke volume during late pregnancy. The ability of impedance cardiography to determine changes in stroke volume was unaffected by changes in body position.

Adult↗

Treatment of vaginal candidosis with a single 500-mg clotrimazole pessary.

In a double-blind study the therapeutic efficacy of a single 500-mg clotrimazole pessary was compared with that of a 200-mg clotrimazole pessary inserted once daily for three days in 72 patients with vaginal candidosis confirmed by culture. On clinical assessment four weeks after completion of treatment with the single-dose pessary the cure rate was 86% compared with 92% after the three-day regimen. There was no significant difference in the eradication rate between the single-dose (94%) and three-day regimens (89%). Four weeks after completion of treatment the recurrence rates by culture were 18% with the single-dose and 24% with the three-day regimen. The former treatment was well tolerated and as effective as the three-day clotrimazole regimen.

Adult↗

Conservative treatment of uterine arteriovenous fistula.

A case of a uterine arteriovenous aneurysm in a 20-year-old woman is described. The patients's main symptom was copious uterine bleeding. The diagnostic difficulties are described and the importance of arteriography is emphasized. The aneurysm was occluded at laparotomy by introducing gel-foam into the uterine artery. The patient subsequently became pregnant and after an uneventful pregnancy was delivered of a healthy child. Thus, this type of conservative treatment seems to offer a possible means of avoiding hysterectomy in young patients with this rare condition who wish to retain their fertility.

Adult↗

Metronidazole-resistant Trichomonas vaginalis.

A 36-year-old woman with symptomatic metronidazole-resistant trichomonal vaginitis for 10 years had a total of 22 courses of treatment with either metronidazole or tinidazole according to different schedules. The minimum trichomonicidal concentration of metronidazole for the strain of Trichomonas vaginalis isolated from the patient was 160 microgram/ml compared with 1.25-10 microgram/ml for other freshly isolated strains. The former strain also showed a definitely decreased sensitivity to ornidazole and tinidazole (80 microgram/ml). The mechanisms behind the appearance of resistance in this clinical isolate are at present unknown and require further study from the theoretical as well as the therapeutic viewpoint.

Adult↗

[Pain relief during delivery by transcutaneous electrical nerve stimulation (author's transl)].

The analgesic effect of transcutaneous electrical nerve stimulation (TNS) during delivery has been evaluated. The usual technique of TNS was modified to suit the specific needs of pain control during the whole course of delivery. Two pairs of electrodes were taped to the patient's back, one pair level with the spinal processes Th 10-L1 and the other with S2-S4, corresponding to the influx of pain during the first and second stages respectively. Stimulation was delivered as biphasic pulses at 60-80 Hz. A low-intensity stimulation was given continuously, and a high-intensity stimulation was initiated by the patient herself whenever pain increased. As a rule, stimulation via the thoracic electrodes was given throughout delivery and sacral stimulation added from the later part of the first stage. No complications with respect to mother or child have occured. Three hundred and forty-seven women have been treated, 47% of them considered the analgesia with TNS to be good or very good, 42% experienced a certain effect whil 11% considered that TNS made no difference. In view of the relatively good results and the absence of complications, the authors recommend the method as a primary pain relieving measure to which conventional methods can be added if necessary.

Afferent Pathways↗

Blood flow in myomatous uteri as measured by intra-arterial 133Xenon.

Uterine blood flow has been studied using intra-arterial 133Xenon. Compartment analysis was used for calculation of blood flow from the wash-out curves. In 7 myomatous uteri the mean blood flow was 11.6 +/- 1.70 ml-min-1-100 g-1. In 8 control cases the mean blood flow was 20.1 +/- 2.27 ml-min-1-100 g-1. The difference is statistically significant on the 1% level. From the present study it cannot be decided how the uterine blood flow is distributed between myomata and surrounding myometrium.

Adult↗

Distribution of blood flow in myomatous uteri as measured by locally injected 133Xenon.

Regional blood flow in the myometrium and myomata has been measured during laparotomy in 11 patients using locally injected 133Xenon. Blood flow was calculated from the wash-out curves using both initial slope technique and compartment analysis. Assuming equal partition coefficients in myometrium and myomata the following values in ml-min-1-100 g-1 are seen: initial slope technique-myometrium 15.6 +/- 2.29, myomata 5.1 +/- 0.95, compartment analysis-myometrium 20.01 +/- 3.21, myomata 5.5 +/- 1.16. The blood flow was always lower in myomata than in myometrium of the same uterus. The main reason for the reduction of blood flow per unit weight of uterus in patients with myomata previously reported thus seems to be low blood flow in the myomata. A slight reduction of blood flow in the surrounding myometrium, however, also seems probable.

Female↗