Biomedical subjects

Erik Qvigstad

Publications and source records attributed to Erik Qvigstad.

12 recordsLinked to original sources

PubMed2007

Laparoscopic occlusion compared with embolization of uterine vessels: a randomized controlled trial.

OBJECTIVE: To compare clinical outcome 6 months after treatment with bilateral laparoscopic occlusion of the uterine artery versus uterine leiomyoma embolization. METHODS: Sixty-six premenopausal women with symptomatic uterine leiomyomata were randomized to treatment with either laparoscopic occlusion of uterine arteries or uterine leiomyoma embolization. The primary outcome was reduction of blood loss from pretreatment to 6 months postoperatively, measured by a Pictorial Bleeding Assessment Chart. Secondary outcomes included patients' own assessment of symptom reduction, postoperative pain assessed using visual analog scales, ketobemidone used postoperatively, complications, secondary interventions, and failures. RESULTS: Fifty-eight women were included; 6-month follow-up data were available for 28 participants in each group. The percentage reduction in Pictorial Bleeding Assessment Chart scores did not differ between the treatment groups (52% after uterine leiomyoma embolization and 53% after laparoscopy, P=.96). The study had 52% power to detect a 20% difference on the Pictorial Bleeding Assessment Chart. Fewer participants in the group treated with uterine leiomyoma embolization complained of heavy bleeding after 6 months (4% compared with 21%, P=.044). The postoperative use of ketobemidone was higher after uterine leiomyoma embolization (46 mg compared with 12 mg, P<.001). CONCLUSION: Both laparoscopic occlusion of uterine vessels and embolizaton of uterine leiomyoma improved clinical symptoms in the majority of patients. Participants with the laparoscopic procedure had less postoperative pain but heavier menstrual bleeding 6 months after treatment. A larger study and longer follow-up is necessary before a definite conclusion can be made regarding the most effective treatment. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00277680 LEVEL OF EVIDENCE: I.

Adult↗

PubMed2006

Differential effects of conventional and low dose oral hormone therapy (HT), tibolone, and raloxifene on coagulation and fibrinolysis.

INTRODUCTION: We have recently reported that different hormone regimens given to healthy post-menopausal women had markedly different effects on activation of coagulation. Low-dose hormone therapy (HT) and raloxifene, as opposed to conventional-dose HT and tibolone, were associated with no or minor activation of coagulation. The aim of this study was to elucidate the mechanism(s) for differences in coagulation activation by analysing clotting and fibrinolytic factors and coagulation inhibitors. MATERIALS AND METHODS: 202 healthy women were randomly assigned to receive treatment for 12 weeks with either low dose HT containing 1 mg 17 beta-estradiol+0.5 mg norethisterone acetate (NETA) (n=50), conventional dose HT containing 2 mg 17 beta-estradiol and 1 mg NETA (n=50), 2.5 mg tibolone (n=51), or 60 mg raloxifene (n=51) in an open-label design. RESULTS: The conventional-and low-dose HT groups generally showed similar effects, i.e., reductions in both clotting factors and inhibitors, but the effects were markedly more pronounced in the conventional-dose HT group. Compared with the low-dose HT group those treated with tibolone showed more pronounced decreases in factor VII, less reduction of antithrombin and protein C and even increased levels in protein S and tissue factor pathway inhibitor. As opposed to the low-dose HT group the reductions in inhibitors in the raloxifene group were smaller. Moreover in those allocated to raloxifene reduced levels of fibrinogen were seen. CONCLUSIONS: Our study demonstrates that the different HT regimens and raloxifene exert differential effects on coagulation factors, inhibitors and fibrinolytic factors.

Administration, Oral↗

PubMed2006

[Requested abortions in Oslo 2000-2003].

BACKGROUND: Women of non-Western origin are over-represented among women requesting induced abortion before the end of the 12th week of pregnancy, in Oslo, Norway. Our aim was to find out if that was also the case for women requesting induced abortion after week 12. MATERIAL AND METHODS: We assessed differences between Western and non-Western women in duration of pregnancy at request for induced abortion and the proportion accepted for abortion. All women requesting induced abortion after the 12th week of pregnancy at Ullevål University Hospital, Oslo from January 2000 to September 2003 (n = 378) were included. Information about the number of fertile women in Oslo according to ethnic background was found in the municipality of Oslo's statistical office. Other data were obtained from patient medical records. RESULTS: 23% (87/378) of all women requesting late induced abortion and 15.5% (20,636/132,843) of women aged 15-50 years in Oslo had non-Western background (p < 0.05). The mean gestational age at the time of requested abortion among non-Western women was 16.4 weeks and among Western women it was 15.6 weeks (p = 0.01). There was a non-significant increased risk of having the abortion request rejected for non-Western as compared to Western women (adjusted odds ratio 1.6; 95% CI 0.5-5.5), after control for gestational age and maternal age. INTERPRETATION: It is known that non-Western women in Oslo are over-represented among women giving birth and women requesting induced abortion in general. This study shows that non-western women are also over-represented among women requesting induced abortion after the 12th pregnancy week.

Abortion, Legal↗

PubMed2006

Endoscopic treatment of deep infiltrating endometriosis (DIE) involving the bladder and rectosigmoid colon.

BACKGROUND: To study the feasibility, complications and symptom relief of laparoscopic treatment in patients with deep infiltrating endometriosis. METHODS: From January 2004 to March 2005, 24 patients with deep infiltrating endometriosis were treated with laparoscopic techniques. Preoperative symptoms, staging, involvement of the disease, and surgical procedures were recorded. Operating time and perioperative complications were also registered, as well as follow-up of the patients. RESULTS: The surgical treatment was individualized with removal of deep infiltrating endometriosis in all 24 patients, additional bladder resection in five patients and colorectal resection in eight patients. In two cases laparoconversion was performed, and one patient had a temporary loop ileostomy. We observed no major peri- or postoperative complications. Median operating time was 3.4 h (range 1.4-8.0 h). All patients with bladder involvement were relieved of their urinary dysfunction, while all except three patients were successfully treated for their pain problems, and also these three patients had symptom relief. CONCLUSIONS: Patients with deep infiltrating endometriosis represent a challenge to surgical procedures. Our results show that radical laparoscopic surgery including colorectal and bladder resection is feasible, safe, and effective in almost all patients.

Adult↗

PubMed2006

Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial.

OBJECTIVE: To compare the impact of 400 mug oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion. DESIGN: Randomised controlled trial. SETTING: Norwegian University Teaching Hospital. SAMPLE: Three hundred and thirty-eight women undergoing surgical abortion between 7 and 12 weeks of gestation. METHODS: The women were randomised to either 400 microg of oral misoprostol the evening before or 400-microg of self-administered vaginal misoprostol at home the same day as vacuum aspiration. Main outcome measures Pre-operative cervical dilatation, complications and acceptability. RESULTS: The median cervical dilatation was 6.2 mm (range 0-11 mm) for the women in the 400 mug oral misoprostol and 6.5 mm (range 0-11 mm) in the 400-microg vaginal misoprostol groups. The median pre-operative dilatation was larger in multigravidae (6.4 and 6.7 mm for the oral and vaginal routes, respectively) than in primigravidae (5.8 and 6.0 mm, respectively). In primigravidae, 19% achieved a pre-operative dilatation of > or = 7 mm, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre-operative dilatation of > or = 7 mm with vaginal dosage, compared with 36% with oral dosage (P = 0.03). There was no difference between non-immigrant versus immigrant women in pre-operative cervical dilatation. The 400-microg oral dosage group had a higher risk of bleeding, compared with the group receiving 400-microg vaginal misoprostol [odds ratio (OR) = 10.4; confidence interval (CI) 5.2-20.8]. There was no difference between non-immigrant and immigrant women in acceptability of self-administered vaginal misoprostol; almost all women found this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups. CONCLUSIONS: The vaginal route will result in a satisfactory dilatation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilatation in either group and is associated with a higher occurrence of pre-operative bleeding. Self-administered vaginal misoprostol at home is highly acceptable.

Abortifacient Agents, Nonsteroidal↗

PubMed2004

Deep vein thrombosis after elective cesarean section.

INTRODUCTION: Pregnancy is associated with an overall 5-10 fold increased risk of venous thromboembolism (VTE). The absolute risk is highest during and shortly after delivery. Although operative delivery further increases the risk of VTE, there is no consensus on thromboprophylaxis after an elective cesarean. The aim of the present study was to investigate the frequency of symptomatic and asymptomatic deep venous thrombosis (DVT) in a low risk cesarean section population. MATERIALS AND METHODS: Fifty-nine women undergoing elective cesarean section were screened for DVT using triplex Doppler sonography 3-5 days after delivery. Markers of activated coagulation were also followed and all women were screened for thrombophilia. Postoperative thromboprophylaxis was not given. During the same period all cases of symptomatic VTE were also recorded. RESULTS: No DVT was detected by ultrasonography and no women developed symptomatic VTE during the six weeks follow-up period after delivery. Six women had thrombophilia. During the study period, a cesarean section was performed in 1067/5364 (20%) deliveries. Five of these women (0.47%) developed symptomatic pulmonary embolism, and all of these women had additional risk factors for VTE. CONCLUSION: The risk of DVT among healthy pregnant women undergoing elective cesarean section is low, and general medical thromboprophylaxis is probably not justified.

Adult↗

PubMed2004

Multiple myomas treated with a temporary, noninvasive, Doppler-directed, transvaginal uterine artery clamp.

A 43-year-old woman with menorrhagia, dysmenorrhea, and pelvic pain of several years' duration had a uterus enlarged by myomas to the size of a 16-week pregnancy. Her uterine arteries were noninvasively transvaginally identified and occluded for 6 hours with a clamp that was guided by audible Doppler ultrasound. Following removal of the clamp, blood flow in the uterine arteries returned immediately. Menorrhagia symptoms diminished. Three months following treatment, uterine volume decreased by 48.9%, and dominant myoma volume decreased by 77.2%.

Adult↗

PubMed2003

[Intractable postpartum haemorrhage treated with selective arterial embolization].

BACKGROUND: Postpartum haemorrhage is a major contributor to maternal morbidity and mortality. MATERIAL AND METHODS: In this case report we present a patient with intractable postpartum haemorrhage, successfully treated with selective arterial embolisation of the uterine arteries. RESULTS AND INTERPRETATION: In most cases, primary postpartum haemorrhage can be managed with conservative treatment involving uterine massage, uterotonic drugs and uterine/vaginal packing. With persistent bleeding, vascular ligation or hysterectomy may be needed. Surgical treatment may be technically difficult and may fail to control haemorrhage. For these reasons, selective arterial embolisation of the uterine arteries represents an interesting alternative that allows preservation of future fertility.

Adult↗

PubMed2003

Low molecular weight heparin (dalteparin) for the treatment of venous thromboembolism in pregnancy.

OBJECTIVE: To evaluate the effect and dose of dalteparin given to pregnant women with acute venous thromboembolism. DESIGN: An observational study of pregnant women in Norway. SETTING: Delivery and haematological departments in Norway. POPULATION: Twenty women, aged 22-41 years, with acute venous thromboembolism verified by objective means. METHODS: Patients were treated with dalteparin from diagnosis until delivery. Treatment was monitored with anti-activated factor Xa (anti-Xa) activity, and the dose was adjusted to achieve target 0.5-1.0 U/mL 2-3 hours post-injection. MAIN OUTCOME MEASURES: Anti-Xa activity and side effects. RESULT: None of the patients suffered recurrent venous thromboembolism or major bleeding complications. In 9 of 13 women starting with conventional dose of dalteparin (100 iu/kg bd), dose escalation was necessary to reach target anti-Xa activity. None of the six women who started with 105-118 iu/kg bd required dose escalation. One woman who started with 133 iu/kg bd required dose reduction. Bioaccumulation of dalteparin was not observed. CONCLUSION: Our study suggests that dalteparin may be used for the treatment of acute venous thromboembolism in pregnancy. Approximately 10-20% higher doses of dalteparin may be needed as compared with non-pregnant individuals.

Acute Disease↗

PubMed2002

[Induced abortion among women with foreign cultural background in Oslo].

BACKGROUND: A large proportion of women requesting induced abortion in Oslo, Norway are of non-Western origin. The aim of this study was to investigate whether non-Western immigrant women are over-represented among women requesting induced abortion. For comparative purposes the proportion of non-Western women with deliveries was also assessed. MATERIAL AND METHODS: Included in the study were all women 16-50 years of age, living in Oslo in 1999. Age specific data on the number of female residents and the number of women with deliveries according to immigrant status were obtained from the City of Oslo's Statistical Office. Information on the number of induced abortions according to age and immigrant status was obtained from the medical records of all women requesting induced abortion in Oslo during a four-months period. RESULTS: 25% of all women requesting induced abortion (262/1,069) and 15.5% (20,637/132,843) of the general population were non-Western (ratio between proportions = 1.6, p < 0.05 chi square test). Non-Western women were over-represented in all age groups of women requesting induced abortion; this was most pronounced in the age groups > 35 years. Non-Western women were also over-represented in all age groups of women who had delivery. Half of all deliveries in women < 25 years were among non-Western women. INTERPRETATION: Non-Western immigrant women seem to represent a risk group for induced abortion.

Abortion Applicants↗

PubMedDate not supplied

Severe complications caused by retained tissue in laparoscopic supracervical hysterectomy.

In our department, laparoscopic supracervical hysterectomy has gradually replaced hysterectomy by laparotomy in patients with a benign condition and no history of cervical dysplasia. During the last year, we experienced serious complications in two patients because of inadequate removal of the tissue in the morcellator procedure. These cases are presented and discussed in this case report.

Female↗

PubMedDate not supplied

Changing hysterectomy technique from open abdominal to laparoscopic: new trend in Oslo, Norway.

STUDY OBJECTIVE: To evaluate the change in hysterectomy technique. DESIGN: Retrospective study (Canadian Task Force classification XXX). SETTING: University tertiary referring center in Norway. PATIENTS: A total of 1963 women treated with hysterectomy over a 5-year period in Oslo. INTERVENTIONS: The operative records and techniques were investigated in all treated patients. MEASUREMENTS AND MAIN RESULTS: A total of 1963 hysterectomies were performed from 2001 through 2005. The operative patient records were investigated with the main focus on indication for surgery and the technique used in the operative procedure. In 2001, 62 (17.7%) laparoscopic hysterectomies were performed, while 256 (73.1%) of the hysterectomies were done with laparotomy. The operative technique has gradually changed during the last 5 years. In 2005, 220 (53.5%) of the surgical procedures were laparoscopic, 177 (43.1%) were done by laparotomy, while the vaginal approach in all these years was less than 10%. CONCLUSION: From 2001 to 2005, a trend shift of the operative technique has been observed in Oslo, increasing the endoscopic hysterectomy rate from approximately 18% to 54%. During the same time, enlarged uteri with myomas equivalent to 10 to 12 weeks' gestation and endometrial cancer were more often treated by laparoscopic hysterectomy instead of open abdominal hysterectomy. With modern equipment and trained staff, more routine hysterectomies can be managed with laparoscopy.

Female↗