[Medication causing sexual dysfunction].
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Biomedical subjects
Publications and source records attributed to M Ulstein.
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Plasma concentrations of vitamin D metabolites in 17 non-pregnant women, 22 pregnant women at delivery, and in eight lactating women 3 and 16 days after delivery, were compared with those in a postpartum hypoparathyroid patient treated with 1 alpha-hydroxyvitamin D (1 alpha-OHD). The mean concentration of 1,25-dihydroxyvitamin D [1,25-(OH)2 D] was 203 (SD 61) pmol/l in the pregnant, and 86 (SD 27) pmol/l in the non-pregnant women (P less than 0.0005). The levels 3 and 16 days after delivery were similar [57 (11) compared with 62 (19) pmol/l], and lower than the non-pregnant value (P less than 0.01). The 25-hydroxyvitamin D (25-OHD) concentration remained unchanged between the 3rd and 16th days after delivery, whereas the 24,25-dihydroxyvitamin D [24,25-(OH)2D] level increased from 2.7 (SD 1.8) to 3.7 (SD 2.3) nmol/l (P less than 0.025). The patient temporarily required an increased supplement of l alpha-OHD during pregnancy, but a dose which was appropriate before pregnancy resulted in marked hypercalcaemia and a rise of 1,25-(OH)2D concentration within 16 days of delivery despite lactation. The results suggest that the metabolic need for the active vitamin D metabolite 1,25-(OH)2D is increased during pregnancy and rapidly reduced during early lactation in healthy and hypoparathyroid women.
Pulsed Doppler technique was combined with real-time B-mode ultrasonography for non-invasive measurement of human fetal blood flow in utero. The fetal vessel, e.g. aorta or umbilical vein, was identified in the real-time image and the real-time transducer put parallel to the vessel. The 2 MHz pulsed Doppler transducer insonated the vessel at a known angle, as the transducers were firmly attached to each other at an angle of 52 degrees. The Doppler instrument processed the Doppler shift signals and estimated the mean and maximum blood velocity. For calculation of blood flow, fetal vessel diameter must be measured. Three ultrasonic techniques (real-time B-mode, TM-mode, Time-distance recording) were applied for diameter measurements. The accuracy of the real-time B-mode technique was tested in vitro on 8 glass tubes with various diameters; the ultrasonically measured diameter was within +/- 0.4 mm of the diameter measured with vernier calipers. The reproducibility of diameter measurement was tested in vivo; the standard deviation of the difference between measurement was 0.15 mm for the fetal aorta and 0.20 mm for the umbilical vein. Fetal blood flow was measured in 38 normal late pregnancies. Blood flow in the thoracic part of the descending fetal aorta ws 185 ml min-1 kg-1 when based on mean blood velocity, and 261 ml min-1 kg-1 when based on maximum blood velocity. In the intra-abdominal part of the umbilical vein the mean blood flow was 115 ml min-1 kg-1.
Scanning electron microscopy and a capillary tube sperm penetration test were used to study the cervical mucus of women using a triphasic oral contraceptive supplying a varying dosage of estrogen and gestagen during the cycle. The findings were compared with those of healthy women having regular cycles and not using contraception. Generally speaking, the ultrastructure of the cervical mucus was dense during medication, like that found in normal luteal phase. No conspicuous changes occurred with different dosages of estrogen and gestagen. For the control cycles a loose structure of the cervical mucus was found on the days prior to the temperature rise, after which a dense structure was predominant. The sperm penetration of the cervical mucus was low during medication, being less than 6 mm/h. For the controls, a high sperm penetration rate was found on the days prior to the temperature rise, while it was low in the luteal phase. The progestogenic type of cervical mucus produced by the medication at all dosages, probably contributes to contraceptive effect.
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Serum HCG-beta has been assayed in 100 cases of ectopic pregnancy. Results above 10 IU/l were considered positive. Positive values were found in 97 cases, of which 23 were within the range of a normal pregnancy, one was above and 73 below the normal range. In the 3 cases with a negative HCG-beta value, devitalized ectopic pregnancies were found at operation. The routine urine pregnancy test was negative in 53, positive in 29 and not performed in 18 cases.
A total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin. Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 low-dose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis. There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.
Marked lymphocyte responses to PHA, ConA and PWM were demonstrated in the first week of life. Prematurity up to 30 weeks gestational age did not influence the results. There were only small variations in the responses from day to day, no sex differences, and no differences between infants who were small for gestational age of appropriate weight. Newborn infants with high serum IgM-concentrations had reduced lymphocyte responses to ConA, possibly through the influence of ConA on B-lymphocytes. Infants of mothers who had received corticosteroids prior to delivery had lower mean responses to all 3 mitogens, but the differences between the steroid- and comparable non-steroid groups were not significant. The results suggest that newborn infants have functioning cellular immune mechanisms.
Jet-washing of the uterine cavity for cytological examination has been performed in 200 patients. The results were compared with the histological diagnoses obtained by curettage. In 24 patients with endometrial carcinoma, both methods showed one specimen to be 'not adequate' while the other showed malignancy. A combination of jet-wash and curettage gave a diagnosis in 96% of patients while curettage alone gave a diagnosis in 82%, and cytology alone in 90%. The method is simple and may be of special value in postmenopausal patients.
Perinatal mortality in 700 cases of breech delivery was studied retrospectively and results were compared with those of controls. Cases were matched with those of cephalic presentation for maternal age and parity, foetal gestational age, and birthweight. The perinatal mortality was more than twice as high in the breech group. The difference remained significant after intrauterine foetal death and malformations were excluded. Neonatal death was most frequently caused by the respiratory distress syndrome and prematurity, and in the breech group also by intracranial haemorrhage. The difference in perinatal mortality was more pronounced in the low weight and low gestational age groups. At term the differences in mortality between the two groups were small. Neonatal distress assessed as low Apgar score and the need for special care was far more frequent for the breech group. Special care in premature breech deliveries and a liberal use of caesarean section in recommended. Delivery before the 36th week of gestation should be performed by caesarean section.
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Concentrations of total estriol, progesterone, cortisol, human placental lactogen and alpha-fetoprotein were measured in maternal venous plasma at regular intervals from the seventh week of pregnancy until term in a woman with an anencephalic fetus. Except for the first trimester, during which the values were in the lower normal range, the concentration of estriol was constantly subnormal. The "physiological" rise in cortisol levels was absent. Progesterone and HPL were both within the low normal range. The levels of alpha-fetoprotein were transiently raised during the 13th--25th weeks of pregnancy.
The Hb level during pregnancy was followed in 113 non-anaemic women with uncomplicated pregnancy and birth weight of the baby above the 2.5th percentile. There was an inverse correlation close to statistical significance between the birth weight of the baby and the lowest Hb level reached during pregnancy as well as the Hb level in late pregnancy (38th week). A group of seven non-anaemic women with birth weight of the baby below the 2.5th percentile had a significantly higher (p less than 0.001) Hb level in late pregnancy than the normal group. Four of these cases had a statistically significant higher Hb level already in the second trimester. Trends in the reproductive history, complaints in the present pregnancy as well as results of hormone assays and the condition of the baby indicated that the seven cases represented a pathological group with fetal growth retardation. None of the women in the two groups were treated with diuretics. All had iron supplementation in high doses.
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The myofibrillogenesis in the human embryonic heart is described. The synthesis of thin filaments, which are the first to appear, takes place in close proximity to smooth surfaced SR tubules. Z-band material is closely related to the thin filaments and appears first as irregularly distributed patches in the filamenteous mass. Further cellular differentiation includes an organization of the thin filaments/Z-band material. The synthesis of thick filaments, which follows that of the thin filaments, takes place in ribosome rich areas of the cell. They are rapidly incorporated into the strings of organized thin filaments/Z-band material. The periodic binding sites on both kinds of filaments are believed to play an important role in the precise ordering of the filaments. The formation of myofilaments in the adult hypertrophied human heart is also described. The similarities between this process and that observed in the embryonic heart are striking, and we believe it to be the same process.
Primary 9 + 0 cilia have been found in the embryonic and the adult human heart. Proximally the cilia show the typical 9 + 0 filament arrangement. Rearrangement of the filaments occur in their distal regions. The cilia are usually found in deep invaginations of the cell membrane, but can also be found in a superficial position. Close connections are frequently found between cilia and thin cytoplasmic extensions from neighbouring cells.
A new staining method for differentiating WBCs from immature germ cells in seminal fluid has been studied. It is a combination of Bryan's sperm stain, which particulary stains the acrosomal cap of the spermatozoa and the spermatid, and Leishman's blood stain which stains the WBCs in the same way as found in blood smears. The peroxidase positive granules in the cytoplasm of the PMN leukocytes are seen clearly. Thus, it is possible to differentiate PMN leukocytes from non-separated spermatids when they are present in a common cytoplasm. The staining of acrosomal cap permits differentiation between spermatids and lymphocytes.