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K Hordnes

Publications and source records attributed to K Hordnes.

18 recordsLinked to original sources
PubMed1998

Self-sampled and air-dried cervicovaginal secretions can be used for analyses of mucosal antibodies.

Cervicovaginal secretions were collected from 26 women (13 premenopausal and 13 postmenopausal) using a new sampling device (MucoSafeTM) with an absorbent which was introduced into the vagina and retrieved by the women themselves, after which it was air-dried and stored for months at room temperature until extraction of immunoglobulins. Cervical secretions were also collected by absorbent cylindrical wicks (Polyfiltronics) which were introduced into the cervical canal during speculum examination and thereafter kept frozen until extraction. The concentrations of specific IgA and IgG antibodies (to group B streptococci) in extracts from both methods were corrected by reference to total immunoglobulin levels. Three pairs of samples, all from postmenopausal women, were excluded from analysis due to undetectable levels of antibodies in the MucoSafeTM specimen. In the remaining 23 pairs, corrected concentrations of IgA and IgG antibodies in samples obtained by MucoSafeTM correlated well with the corresponding concentrations in wick samples, R = 0.84 (p < 0.0001) and R = 0.69 (p = 0.0002), respectively. Thus, cervicovaginal secretions for antibody measurements can be obtained by this novel method for self-sampling, obviating the need for speculum examination and storage of frozen samples.

Absorption↗
PubMed1998

Cervical secretions in pregnant women colonized rectally with group B streptococci have high levels of antibodies to serotype III polysaccharide capsular antigen and protein R.

Group B streptococci (GBS) colonizing the female genital tract will often infect newborn infants during delivery. In 200 pregnant women studied, 14% were colonized with GBS in the cervix, 12% in the rectum, and 9% in both cervix and rectum. We have previously reported that antibody levels to GBS serotypes Ia, II, and III in sera and cervical secretions were increased in women colonized in the rectum and/or cervix, when analyzed by a whole-cell ELISA. Here, we report the levels of antibodies to GBS serotype III capsular polysaccharide antigen (CPS III) and to protein antigen R4, which are present in most GBS III strains. Compared to culture-negative women, the group of women colonized rectally had markedly elevated levels of immunoglobulin (Ig)A and IgG antibodies in cervical secretions to both CPS III and protein R4 (P < 0.01 and P < 0.001, respectively). In sera, the corresponding differences between culture-negative and culture-positive women were less pronounced, or not present. In contrast to antibody levels to whole-cell GBS, antibody levels to CPS III and protein R4 in cervical secretions were not significantly increased in women colonized only in the cervix, except that IgA antibodies to protein R4 were slightly elevated (P < 0.05). These findings suggest that capsular type-specific polysaccharides and protein R4 in a mucosal vaccine might induce protective antibodies against GBS colonization of the uterine cervix.

Antibodies, Bacterial↗
PubMed1997

[What is the purpose of mucosal antibodies? Relevance to colonization with group B streptococci].

The surface area of the mucosae is extremely large and its contact with the external environment is of vital importance. Most infectious agents use the mucosae as their portal of entry. Some microorganisms, however, colonize the mucosal surfaces without causing disease, and may even be beneficial by contributing to the digestion of food or by excluding pathogens. An important part of the immune system operates in the mucosae, the principal mediator substance of this local immune system being secretory IgA. Other antibody isotypes are usually found in small amounts in exocrine fluids, but IgG predominates in secretions of the uterine cervix. These mucosal antibodies may eliminate microbes, or they may coexist with persistent colonization. In a recent study, we found increased levels of IgA and IgG antibodies to group B streptococci in the cervical secretions of women colonized with these bacteria. Group B streptococci are often transmitted to the infant during delivery, and are a major cause of severe infection in newborns. We have used this study as a background for discussing the role of mucosal antibodies. Presumably, group B streptococci may be eradicated by reenforcing the local antibody response, and a mucosal vaccine will be evaluated in the near future.

Antibodies, Bacterial↗
PubMed1997

Nasal immunization with group B streptococci can induce high levels of specific IgA antibodies in cervicovaginal secretions of mice.

We have studied the cervicovaginal antibody responses in mice, by ELISA, following mucosal immunizations with group B streptococci (GBS) serotype III/R4. Immunizations were carried out either: (1) rectally with GBS alone; (2) rectally with GBS plus cholera toxin (CT); (3) nasally with GBS alone; (4) nasally with GBS+CT; or (5) nasally under general anesthesia with GBS+CT. Nasal immunizations with GBS alone led to at least tenfold higher levels of specific IgA-antibodies to GBS in cervicovaginal secretions than with any other immunization. These mucosal antibody levels were higher than after rectal immunizations, and 2-17 times higher than the corresponding IgA antibody levels in sera. Markedly lower cervicovaginal antibody levels were found in mice which had received GBS together with CT as a mucosal adjuvant than in mice immunized by the same routes with GBS alone. Our observations indicate that a nasal vaccine consisting of GBS might induce sufficient antibody levels to protect against genital colonization of these bacteria.

Adjuvants, Immunologic↗
PubMed1997

Immune responses in mice after gastric and subcutaneous immunization with BCG.

Mucosal immunization can induce immune responses different from those induced by systemic immunization. In this study, murine immune responses were analysed after immunization through gastric and subcutaneous routes with Mycobacterium bovis BCG. The number of circulating cells secreting antigen-specific immunoglobulins (Ig), and the number of gamma interferon (IFN-gamma) secreting cells in spleen-cell cultures after in vitro stimulation with mycobacterial antigens were analysed at the single cell level by the ELISPOT method. Levels of antigen-specific antibodies in sera were determined by ELISA. In the subcutaneously immunized mice the authors found approximately 100 times more splenic cells secreting antigen-specific IgG than in gastrically immunized mice or control mice. Their levels of antigen-specific IgG in sera were 66-6700 times higher than in sera from gastrically immunized mice or control mice. In contrast, the numbers of IFN-gamma producing cells in spleen-cell cultures after in vitro activation with BCG were equally high in the immunized groups of mice, and for both groups higher than in non-immunized controls. Furthermore, IFN-gamma producing cells could be demonstrated in gastrically immunized animals even without in vitro activation. The results demonstrate that gastric immunization with the BCG vaccine can induce a systemic T cell-mediated immune response against mycobacterial antigens.

Animals↗
PubMed1996

Emergency McDonald cerclage with application of stay sutures.

OBJECTIVE: To evaluate the efficiency of emergency cervical cerclage, and the use of stay sutures. STUDY DESIGN: Retrospective review of patients who were treated with emergency cervical cerclage at our department between January 1984 and April 1994. McDonald cerclage, after traction of the cervix with 6-10 stay sutures, was inserted in 16 women between 16 and 28 weeks gestation, presenting with dilated cervix and protruding membranes. Tocolytics and prophylactic antibiotics were given to most patients. RESULTS: All cerclage operations were primarily performed without complications, except in one case where membranes ruptured during operation. Two reoperations were necessary, and were successfully performed. The median duration of pregnancy after the procedure was 4.5 weeks (range 1 day-18 weeks), and the median birth weight was 1250 g (range 130-4330 g). In 10 of 16 patients (63%), the duration of pregnancy prolongation was between 2.5 and 18 weeks (median 7.0 weeks) following cerclage, with a median birth weight of 2145 g (range 995-4330 g). Four of these patients (25%) delivered at term. In the other six patients, pregnancy lasted seven days or less, resulting in four abortions, and two surviving infants. Eleven of the 16 pregnancies (69%) resulted in live infants. CONCLUSION: Pregnancy can be significantly prolonged following emergency cervical cerclage, and the procedure may contribute to improved neonatal outcome.

Adolescent↗
PubMed1996

Colonization in the rectum and uterine cervix with group B streptococci may induce specific antibody responses in cervical secretions of pregnant women.

We have studied the relationships between genital or rectal carriage of group B streptococci (GBS) with the levels of systemic and mucosal antibodies to GBS in 200 women at about week 17 of pregnancy. Secretions from the uterine cervix were collected with absorbent cylindrical wicks for quantification of antibody levels with whole cell enzyme-linked immunosorbent assay. GBS were cultured from the cervix (with or without concomitant rectal colonization) of 13.5%, from the rectum (with or without concomitant cervical colonization) of 12%, and from both culture sites of 8.5% of the women. Serotypes Ia, II, and III were predominant. Compared with culture-negative women, the group of women colonized rectally had markedly elevated levels of both immunoglobulin A (IgA) and IgG antibodies to GBS in cervical secretions and also had a moderate but significant elevation of IgA antibodies in sera. Women colonized only in the cervix had increases of specific IgA and IgG antibodies in cervical secretions, but their serum antibody levels were not elevated. In cervical secretions, the increase in antibody levels in the groups of colonized women was most pronounced for the IgG isotype, indicating a mucosal immune response involving IgG as well as IgA. A close correlation was found among the levels of antibodies to each of the three GBS serotypes tested. Evidence for such cross-reacting antibodies to different serotypes of GBS, as well as to group A streptococci, was also obtained from absorption experiments. Altogether, our results show that undiluted secretions for antibody determination can be easily collected from the uterine cervix with absorbent wicks and demonstrate that colonization of GBS in the rectum and the uterine cervix may induce a systemic as well as a pronounced local immune response in the female genital tract. The findings may have implications for the development of a mucosal vaccine against GBS disease.

Adolescent↗
PubMed1995

Systemic and mucosal antibody responses to group B streptococci following immunization of the colonic-rectal mucosa.

The cervico-vaginal mucosa is poorly designed for inducing a mucosal immune response, but it can effect such a response evoked at other mucosal sites. This study was undertaken to determine whether colonic-rectal immunization with group B streptococci (GBS) might induce a local cervico-vaginal immune response. Mice were immunized with either fragmented GBS rectally, whole GBS rectally, or whole GBS subcutaneously. Cholera toxin (CT) was used as an adjuvant for the rectal immunizations. Following colonic-rectal immunization with whole GBS, the mean anti-GBS IgA antibody level in vaginal secretions was 735 kU/ml, with individual values reaching 3480 kU/ml. Corresponding levels of IgA antibodies never exceeded 10 kU/ml in serum and intestinal secretions, or 90 kU/g in feces. In vaginal secretions IgA antibodies to GBS also constituted a much larger fraction of total IgA than in serum, intestinal secretions and feces. Immunizations with fragmented GBS produced much lower IgA responses. Anti-GBS IgA response at the inductive site in the colon-rectum was not significant, as opposed to a strong anti-CT IgA response. Except in serum, the anti-GBS IgG responses to colonic-rectal immunizations were generally low, or absent. The results may provide a basis for the development of mucosal vaccines against GBS-infection.

Administration, Rectal↗
PubMed1995

Evaluation of a rapid enzyme immunoassay for detection of genital colonization of group B streptococci in pregnant women: own experience and review.

We have compared an enzyme immunoassay (ICON Step B, Hybritech) with cultures for demonstration of genital carriage of group B streptococci (GBS) in pregnant women, and studied the relationship between vaginal and rectal carriage of this organism. Pertinent literature has also been reviewed. Two hundred pregnant women at gestational week 17 were included. Swabs from the uterine cervix were tested for GBS by ICON Strep B immunoassay and ordinary cultures on blood agar. Additional swabs from the rectum were tested by cultures. The percentage of women with GBS in cervical secretions was 13.5% (27/200) by cultures and 4% (8/200) by the ICON Strep B immunoassay. The overall sensitivity of the immunoassay was 7.4%, and the specificity 96.5%. In conclusion, the sensitivity of rapid enzyme immunoassays is too low for accurate screening of GBS in the genital tract of pregnant women.

Adolescent↗
PubMed1995

Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy.

OBJECTIVE: To study local treatment of ectopic pregnancy by injection of hyperosmolar (50%) glucose, guided either by transvaginal ultrasound or by laparoscopy. METHODS: Eighty women were randomized, 39 into the sonography and 41 into the laparoscopy group. Criteria for inclusion were 1) ectopic pregnancy < or = 4 cm seen by transvaginal ultrasound, 2) hCG < or = 3000 IU/l, and 3) little or no intraabdominal bleeding. In the sonography group, patients were treated by one skilled ultrasound investigator, whereas injections by laparoscopy were performed by several colleagues. The former group were offered a second glucose injection if hCG levels were rising. Those successfully treated were offered hysterosalpingography (HSG) for evaluation of tubal patency. RESULTS: Twenty-nine (74.4%) women were successfully treated in the sonography group by one single injection, compared to 21 (51.2%) in the laparoscopy group. Eight women in the sonography group received a second glucose injection because of a rising hCG, increasing the success rate in this group to 82.1% (32 of 39 women). Six patients in the laparoscopy group were not injected due to technical difficulties during the operation, and the success rate for those injected were 60% (21 of 35 women). The overall success rate was 66.3%. Of the 28 women investigated by HSG, both tubes were normal in 19 (67.8%), and in 25 patients (89.3%) the treated tube was open. CONCLUSIONS: Local injection of hyperosmolar glucose guided by transvaginal ultrasound by one skilled investigator is an effective treatment for ectopic pregnancy. Most women preserve tubal patency after treatment.

Administration, Topical↗
PubMed1994

[Episiotomy--an appeal for a more restricted use].

Episiotomy is one of the most widely performed surgical procedures, and episiotomy rates of 50-90% are common. The major presumed benefit of episiotomy is prevention of perineal lacerations, especially rupture of the anal sphincter. Prevention of damage to the pelvic floor, and the relief of harmful pressure on head of the foetus, have also been suggested. There is very little evidence to support these assumptions. On the contrary, the results of three randomized studies suggest that high rates of episiotomy are associated with increased risk of sphincter rupture. These and other studies are described. In view of the long term morbidity of sphincter rupture, a more selective use of episiotomy is recommended. A rate of 20-30% seems appropriate. Indications for episiotomy are discussed. These should include delivery by forceps, and perhaps delivery by ventouse. In other cases the use of episiotomy should be restricted.

Episiotomy↗
PubMed1994

[Group B streptococci in pregnancy--guidelines for routine examinations and treatment. American Academy of Pediatrics].

Group B streptococci are a major cause of serious infections in the newborn, and also cause chorioamnionitis, late abortions, puerperal infections and sepsis. Group B streptococci are harboured in the genital tract of 5-40% of pregnant women, and 50-70% of their infants are colonized. Severe perinatal infections caused by group B streptococci affect 1-5 infants per 1,000 live births. American Academy of Pediatrics (AAP) have issued guidelines for preventing group B streptococcal infections. These are described, and it is suggested that these should be adopted in Norway.

Female↗
PubMed1993

Severe lacerations after childbirth.

We have reviewed the literature on third and fourth degree perineal lacerations, with respect to occurrence, risk factors, repair, short and long term morbidity, and secondary treatment. Suggestions of delivery procedures aiming to reduce the extent of perineal trauma are given. The long term sequelae of severe lacerations are clearly underestimated.

Anus Diseases↗