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Biomedical subjects

L F Andersen

Publications and source records attributed to L F Andersen.

At least 19 recordsLinked to original sources

Ampicillin-metronidazole treatment in idiopathic preterm labour: a randomised controlled multicentre trial.

OBJECTIVE: To determine whether treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour will prolong the gestation and reduce maternal and neonatal infectious morbidity. DESIGN: Randomised controlled double-blind trial. SETTING: Six obstetric departments in the Copenhagen area. POPULATION: One hundred and twelve women with singleton pregnancies, with threatened idiopathic preterm labour and intact amniotic membranes at 26 to 34 weeks of gestation. METHODS: Random allocation to eight days intravenous and oral treatment with ampicillin and metronidazole, or placebo. MAIN OUTCOME MEASURES: Number of days from admission to delivery, gestational age at delivery, rates of preterm delivery, low birthweight, maternal infections and neonatal infections. RESULTS: Treatment with ampicillin and metronidazole was associated with a significant prolongation of pregnancy (admission to delivery 47.5 days versus 27 days, P < 0.05), higher gestational age at delivery (37 weeks versus 34 weeks, P < 0.05), decreased incidence of preterm birth (42% versus 65%, P < 0.05), and lower rate of admission to neonatal intensive care unit (40% versus 63%, P < 0.05), when compared with placebo treatment. Antibiotic treatment had no significant effects on infectious morbidity. CONCLUSIONS: Treatment with ampicillin and metronidazole in women with threatened idiopathic preterm labour significantly prolonged the gestation, but had no effects on maternal and neonatal infectious morbidity.

Administration, Oral

No influence of proinsulin and insulin on plasma levels of plasminogen activator inhibitor type 1 and tissue plasminogen activator in young women before and during intake of contraceptive steroids.

Clinical observations in patients predisposed to cardiovascular disorders and recent experimental observations suggest that proinsulin and insulin participate in the regulation of fibrinolysis in vivo. In the present study, we examined if proinsulin and insulin affect the constitutive (fasting) secretion of plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen activator (t-PA) in young healthy women (N = 17). We also measured the antigen concentrations of PAI-1 and t-PA during slow and fast changes in proinsulin and insulin levels induced by oral (OGTT) and intravenous (IVGTT) glucose tolerance tests. The assessments were performed before and after 6 months of treatment with contraceptive steroids, which have a well-defined influence on the fibrinolytic variables. We observed no consistent correlations between fasting values of proinsulin, insulin, PAI-1, and t-PA either before or during hormonal treatment. Before hormonal treatment, PAI-1 and t-PA antigen levels decreased (P < .05) during the hyperproinsulinemia and hyperinsulinemia induced by the OGTT and IVGTT. After hormonal intake for 6 months, a decrease only in t-PA concentrations during the OGTT was observed despite similar proinsulin and insulin responses to the glucose loads. Our findings suggest that proinsulin and insulin have no influence on the regulation of plasma levels of PAI-1 and t-PA in young healthy women, irrespective of intake of contraceptive steroids.

Adult

Very-long-chain n-3 fatty acids as biomarkers for intake of fish and n-3 fatty acid concentrates.

We examined how supplementation with very-long-chain n-3 fatty acids was reflected in the concentration of these fatty acids in plasma phospholipids of 363 Norwegian men and women. The concentration of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma phospholipids was significantly higher among individuals supplemented with n-3 fatty acids after the supplementation period than before. We also examined the relation between dietary intake of fatty acids measured with a 180-item quantitative food-frequency questionnaire and the concentration of the same fatty acids in plasma phospholipids in 579 men and women. Correlation coefficients between plasma phospholipid fatty acids and dietary intake of fatty acids were 0.51 and 0.49 for EPA and DHA, respectively. The correlation between fish intake and n-3 fatty acids in plasma phospholipids was 0.37. These results suggest that dietary intake measured with our food-frequency questionnaire may be used to predict the biological availability of some of the essential n-3 fatty acids.

Adolescent

Effects of the non-peptide inhibitor OPC-21268 on oxytocin and vasopressin stimulation of rat and human myometrium.

OPC-21268 (1-[-1-[4-(3-acetylaminopropoxy)benzoyl]-piperidyl]-3,4- dihydro-2(1H)-quinolinone), a non-peptide vasopressin V1 receptor antagonist, inhibited oxytocin- and vasopressin-induced contractions of myometrial strips from rats and from full-term pregnant women. Administered intravenously in rats the drug also inhibited uterine contractions caused by infusion of oxytocin. When incubated with purified plasma membranes from rat or human myometrial tissue, OPC-21268 inhibited the specific receptor binding of tritiated oxytocin and vasopressin in a dose-dependent and reversible way.

Anesthesia

Evaluation of a quantitative food frequency questionnaire used in a group of Norwegian adolescents.

OBJECTIVE: The study was conducted to assess the reproducibility and validity of a 190-item self-administered quantitative food frequency questionnaire, used in a nation-wide study of adolescents. DESIGN AND SUBJECTS: Reproducibility study; 103 11th grade students (18 years) completed the questionnaire twice, with a 6-week interval. Validation study; 49 11th grade students filled in the questionnaire and kept 7-day weighed food records. RESULTS: Spearman rank correlations between the nutrient intakes from the two questionnaires varied from 0.63 (sugar energy percentage) to 0.91 (alcohol). The median coefficient was 0.85. The first questionnaire produced generally higher nutrient intake estimates than the second. Correlations between nutrient intake values from the records and the questionnaire ranged from 0.14 (vitamin D, non-significant, cod liver oil not included) to 0.66 (monounsaturated fatty acids). The median coefficient was 0.52. Adjustment for energy intake did not materially affect the correlations. On average 41% of the subjects were classified in the same quartile in the questionnaire and the records, and 2% in the opposite quartiles. However, the percentage of subjects in the same/opposite quartiles for vitamin D and fibre were 33/12 and 22/6, respectively. CONCLUSIONS: It is concluded that the questionnaire is able to rank subjects according to the tested nutrients, except vitamin D and fibre.

Adolescent

Dietary intake among Norwegian adolescents.

OBJECTIVE: The aim of the nationwide study on dietary behaviour of adolescents was to describe and evaluate dietary habits, and relate that to other lifestyle factors. DESIGN AND SUBJECT: 1564 students in secondary schools completed a self-administered quantitative food frequency questionnaire in a school setting. RESULTS: The questionnaire showed an average energy intake of 15.8 and 9.9 MJ among boys and girls, respectively. Nearly 31% of the energy was supplied by fat and 11.4% by sugar. The average daily intake of micronutrients exceeded the Norwegian recommendations, except for vitamin D and iron in girls. 13.4% of the students had breakfast twice a week or less. These students had a higher percentage of energy from fat and sugar, and a lower intake of micronutrients, than students eating breakfast more often. Students who were daily smokers or fairly inactive had higher energy percentage from fat and sugar and lower intake of fibre, than non-smokers or physically active students. CONCLUSION: Half of the students consumed a diet with too much fat and two-thirds consumed too much sugar as compared to the recommendations. The girls had a diet with a higher nutrient density and a lower fat energy percentage than the boys. Finally, it seemed as if a healthy lifestyle was associated with a healthy diet.

Adolescent

[Relation between cervical conization, microbial colonization and threatening preterm labor].

UNLABELLED: The relationship between prior cervical conization, the cervical microbial colonization and threatening preterm delivery was investigated in 35 women with preterm premature rupture of the membranes (PPROM), 38 women with idiopathic preterm labor and 75 normal pregnant women at 26-34 weeks of gestation. Prior cervical conization occurred with a significantly higher frequency in PPROM patients than in patients with preterm labor (p < 0.01) and normal pregnant women (p < 0.001). The prevalence of lactobacilli was lower in patients with PPROM than in patients with preterm labor (p < 0.05) and control patients (p = 0.05)--and lower in patients with prior cervical conization than in patients without prior conization (p < 0.05). All other microorganisms occurred with the same frequencies in all groups. CONCLUSIONS: Prior conization was associated with PPROM. Women with prior conization and women with PPROM had a reduced prevalence of lactobacilli in the cervix. The "absence" of lactobacilli may indicate changes in the cervical microflora, which could be of importance for PPROM.

Adult

Uro-genital microbial colonization and threatening preterm delivery.

OBJECTIVE: To examine whether there is a relationship between the uro-genital microbial colonization and threatening preterm delivery. STUDY DESIGN: The microflora in the urine and endocervix was studied in 43 women with preterm labor, 45 women with preterm premature rupture of the membranes (PPROM) and 80 normal pregnant women at 26-34 weeks of gestation. Amniotic fluid was examined in 20 of the patients with preterm labor. Data were analyzed by Fisher's exact test (two-tailed). RESULTS: The microflora in the urine was not significantly different in patients with preterm labor, PPROM and normal pregnant women. Compared with normal pregnant women, patients with preterm labor had significantly lower prevalences of corynebacteria (p < 0.05) and coagulase-negative staphylococci (p < 0.01) in the cervix, while patients with PPROM had significantly lower prevalences of lactobacilli (p < 0.05) and coagulase-negative staphylococci (p < 0.05) in the cervix. Positive amniotic fluid cultures were detected in three of the 20 patients with preterm labor who underwent transabdominal amniocentesis. Evidence of ascending colonization was found in two of these cases. CONCLUSIONS: The microbial colonization of the urine was not associated with threatening preterm delivery. Reduced prevalences of lactobacilli, corynebacteria and coagulase-negative staphylococci in the cervix were associated with threatening preterm delivery.

Adolescent

The relationship between prior cervical conization, cervical microbial colonization and preterm premature rupture of the membranes.

The occurrence of prior cervical conization and the cervical microbial colonization was investigated in 38 women with idiopathic preterm labor, 35 women with preterm premature rupture of the membranes (PPROM) and 75 normal pregnant women at 26-34 weeks of gestation. Data were analyzed by Fisher's exact test (two-tailed). The frequency of prior cervical conization was significantly higher in PPROM patients compared to normal pregnant women (P < 0.001) and to patients in preterm labor (P < 0.01). Lactobacilli occurred with a lower frequency in patients with PPROM compared to patients in preterm labor (P < 0.05) and control patients (P = 0.0543)-and with a lower frequency in patients with prior cervical conization (P < 0.05). All other microorganisms occurred with the same frequencies in all groups. The absence of lactobacilli may indicate changes in the cervical flora, which could increase the risk of PPROM. Prior cervical conization may impair the antimicrobial defense-mechanisms in the cervix, which could facilitate ascending microbial colonization. This may lead to a release of prostaglandins and proteolytic enzymes and subsequently preterm labor and rupture of the membranes.

Adult

[Hysteroscopically guided endometrial destruction in the treatment of menorrhagia].

Until recently, hysterectomy has been the alternative method of treatment in cases of premenopausal menorrhagia where it has not proved possible to obtain satisfactory regulation of the haemorrhage by medical means. Within recent years, a series of hysteroscopic methods have been developed for selective destruction of the endometrium by means of neodymium-laser, electroresection and coagulation. Compared with hysterectomy, hysteroscopic destruction of the endometrium appears to be a much more rapid, simpler and cheaper form of treatment of menorrhagia and appears to be associated with considerably fewer complications. The duration of hospitalization and the period of convalescence can be reduced considerably but, primarily, a large group of women can avoid hysterectomy. As yet, no controlled investigations of selective destruction of the endometrium as compared with conventional hysterectomy are available. There are no comparative investigations of the different methods nor of the long-term sequelae after destruction of the endometrium. This method of treatment has hitherto only been employed to a limited extent in Denmark. Coordination of the activities in this field in connection with establishing this form of treatment in Denmark should be encouraged.

Dilatation and Curettage

[Idiopathic preterm delivery and subclinical genital infection].

Investigations from abroad suggest that idiopathic preterm delivery may be due to ascent of microorganisms from the cervix. These may then colonize the decidua, foetal membranes and amniotic fluid and may thus precipitate preterm contractions or rupture of the membranes. In subclinical urogenital infections, antibiotic treatment appears, in some cases, to be capable of reducing the risk of preterm birth. In cases of treated premature delivery, antibiotic treatment may possibly prolong the pregnancy and prevent neonatal and puerperal infections. Further investigations are, however, recommended before introduction of routine antibiotic treatment in cases of threatened premature birth.

Amniotic Fluid

Group B streptococcal chorioamnionitis and neonatal septicemia following 8 days pivampicillin and metronidazol prophylaxis after premature rupture of membranes; a case report.

A case of preterm premature rupture of the membranes (PPROM) in the 31st week of gestation is reported. Initial cultures from the cervix and urine were without pathogenic microorganisms. After 8 days of prophylactic pivampicillin and metronidazol, culture from the cervix showed profuse growth of Group B Streptococci (GBS) and the patient developed symptoms of chorioamnionitis. Cesarean section was performed and the infant presented GBS-septicemia. In spite of continued treatment with pivampicillin, culture from the cervix on day 6 post partum still showed profuse growth of GBS. Prolonged prophylactic per oral administration of broad-spectrum antibiotics after PPROM may not always protect against infectious complications. Literature is reviewed, and it is discussed whether the applied regimen in some cases even may favour the occurrence of serious infections.

Adult

Maternal-fetal listeriosis: 2 case reports.

Two cases of maternal-fetal infection with Listeria monocytogenes are reported. Both women were admitted with influenza-like symptoms and preterm labor at 32 and 34 weeks of gestation, respectively. The infants were delivered within a few days of onset of maternal symptoms. One infant was seriously ill with meningitis and subsequently developed hydrocephalus. The other infant suffered from septicemia, but had no sequelae. It is recommended always to consider the diagnosis listeriosis in pregnant women with fever of unknown origin and preterm labor.

Adult

[Condylomata acuminata in children].

During the period 1.1.1967 to 31.12.1986, a total of 34 children with condylomata acuminata were treated in the County Hospitals in Copenhagen. Nineteen of these were treated during the last five years of the period. A retrospective study revealed that 12 of the children were under the age of two years when the condylomata appeared. In eight of these, one or both of the parents had condylomata at the time of the child's birth suggesting that infection of the child may have occurred during delivery. Among the remaining 22 children, a possible source of infection was revealed in only one case. In the children, condylomata were much more frequently localized perianally or anally than in adults. There was no evidence of sexual abuse in any of the children but systematic investigation with this in mind was not undertaken. The finding of condylomata in children raises the suspicion of sexual abuse but does not prove this. Investigation and treatment should, as a rule, be undertaken by a multidisciplinary team preferably in a paediatric department.

Adolescent

Termination of second trimester pregnancy with gemeprost vaginal pessaries and intra-amniotic PGF2 alpha. A comparative study.

152 women admitted for legal abortion in the second trimester of pregnancy were included in an open, randomized, controlled six-centre study. 75 patients received gemeprost 1 mg vaginal pessaries at 3 hours intervals up to a maximum of 5 mg and 66 patients were treated with a single 40 mg intra-amniotic dose of PGF2 alpha. The 24-hour success rate was 81% (n = 61/75) in the gemeprost and 64% (n = 42/66) in the PGF2 alpha group (p less than 0.02). The mean abortion times were 14.3 and 14.8 hours in the gemeprost and the PGF2 alpha groups, respectively. The mean time to onset of pain was shorter and more patients experienced blood loss over 100 ml during the induction in the PGF2 alpha group than in the gemeprost group (p less than 0.02). Apart from that, the nature and severity of side effects were comparable between the two groups. Besides significantly better efficacy, the non-invasive gemeprost treatment was found to be easier and safer as compared to the PGF2 alpha treatment.

Abortifacient Agents

Oxytocin receptor blockade: a new principle in the treatment of preterm labor?

The concentration of myometrial and decidual oxytocin receptors increases dramatically in normal women in late pregnancy, causing enhanced uterine sensitivity to physiologic levels of oxytocin. Similar increase in myometrial oxytocin receptors has been found in women in preterm labor, indicating a role for oxytocin also in idiopathic preterm labor. A newly synthesized oxytocin analogue, 1-deamino-2-D-Tyr-(OEt)-4-Thr-8-Orn-oxytocin, has been found to be a competitive inhibitor of oxytocin. The present study was conducted to test its efficacy in suppressing uterine contractions during preterm labor in women. Twelve patients with established, uncomplicated preterm labor between 27 and 33 weeks of gestational age were given intravenous infusions of the analogue for 1.5 to 13 hours during continuous external cardiotocographic monitoring. In nine patients inhibition of uterine contractions was achieved and further progression in cervical scores was arrested. In three patients, all at 27 weeks of gestational age, no significant tocolytic effect was observed during a 1.5-hour infusion of the analogue and the patients were then given ritodrine intravenously. No side effects were observed in any of the patients. These preliminary findings support the concept that an increased concentration of uterine oxytocin receptors is an important etiologic factor in uncomplicated preterm labor and therefore oxytocin receptor blockade may be a therapeutic alternative for this condition.

Adult