Biomedical subjects
Publications and source records attributed to L Schierup.
Malignant transformation occurs in about 2% only of ovarian dermoid cysts. The clinical and histopathological findings in a rare case of primary ovarian malignant melanoma of amelanotic type are presented.
Two triphasic oral contraceptives containing the same amount of ethinyl estradiol in combination with gestodene or levonorgestrel were compared with respect to contraceptive effect, on lipid metabolism and coagulation. Serum concentrations of gestodene, levonorgestrel, ovarian and pituitary hormones, and sex hormone-binding globulin were measured. Thirty-five randomized into two groups receiving either of the preparations. Before treatment and in the third and sixth cycles, blood sample were drawn in the morning while subjects were still in bed to obtain basal conditions. The contraceptive effect and cycle control were good with both preparations, and there were only a few minor side effects. Sex hormone-binding globulin was elevated twofold in the levonorgestrel group and threefold in the gestodene group. The gestodene concentration in serum varied more than the levonorgestrel concentration, but with correction for variations in sex hormone-binding globulin binding, less variability in gestodene and levonorgestrel concentrations were seen. High-density lipoprotein2 cholesterol decreased in the levonorgestrel group but was unchanged in the gestodene group, whereas apolipoprotein A1 increased in the gestodene group but not in the levonorgestrel group. Antithrombin III decreased in the gestodene group but was unchanged in levonorgestrel-treated women. Factor VII increased in both groups but more in the gestodene group. We conclude that gestodene has a positive influence on lipid metabolism, probably because of its lower androgenicity, and a slightly negative influence on coagulation. The latter, however, probably has no clinical relevance.
Two triphasic oral contraceptives containing gestodene (GES) (a new progestogen) and levonorgestrel (LNG) were compared with respect to contraceptive effect, cycle control, acceptability and side effects. The serum concentrations of ingested hormones were measured together with ovarian, pituitary, and some adrenal hormones, as well as sex hormone binding globulin (SHBG). The contraceptive effect and cycle control were good with both preparations, and there were only a few minor side effects. SHBG was elevated 2-fold in the LNG group and 3-fold in the GES group. The GES concentration in serum varied more than the LNG concentration, but with correction for variations in SHBG binding, less variability in actual GES and LNG concentrations was seen. Serum levels of FSH, LH, estradiol and progesterone were all depressed with both preparations. The depression was more marked in the GES group, despite lower progestogen ingestion and similar serum concentrations. Equal decreases were found in testosterone, androstenedione and dehydroepiandrosterone sulfate (DHEA-S) with both preparations.
A material of 194 women sterilized laparoscopically using Filshie clips was followed for 16-51 months. The method is economical (short stay in hospital) and with little damage to the tube. Only few complaints and no complications were recorded. One woman became pregnant in the observation period, a failure rate of 0.5%. According to the literature the potential for reversal seems very good. The method seems to have some advantages over other methods in common use for female sterilization.
The effects of two triphasic oral contraceptives containing the same amount of ethinylestradiol (EE) in combination with levonorgestrel (LNG) or gestodene (GES), respectively, on lipid metabolism and coagulation were studied. Serum concentrations of GES and LNG were determined at the same time. Thirty-three healthy women were randomized into two groups receiving either of the preparations. Before treatment and in the 3rd and the 6th cycle, blood samples were drawn in the morning while subjects were still in bed to obtain basal conditions. HDL2-cholesterol decreased in the LNG group but was unchanged in the GES group, whereas apolipoprotein A1 increased in the GES but not in the LNG group. Antithrombin III decreased in the GES group but was unchanged in the LNG-treated women. Factor VII increased in both groups, but more in the GES group. It is concluded that GES has a positive influence on lipid metabolism, and has a slightly negative influence on coagulation but the latter is more likely to be without clinical relevance. The positive influence of GES compared to LNG on lipids is probably due to its lower androgenicity and not to differences in bioavailability.
Pudendal block with 20 ml 1% mepivacaine with and without epinephrine was performed in 151 patients during the second stage of labor. No differences in efficacy of the block or in Apgar scores between the two groups were found. The maternal mepivacaine concentration was higher in the plain group than in the epinephrine group (p less than 0.01), but toxic levels were never reached. In the infants, no difference in mepivacaine concentration was found between the groups (p greater than 0.05, type II error 9%) and toxic levels were not reached. The time elapsed from the pudendal block until delivery was prolonged when epinephrine was added (p less than 0.02). We found no effect on blood pressure in either of the groups, with or without oxytocin and/or methergin. Twenty ml 1% mepivacaine (plain) is a safe choice for pudendal block without the possible disadvantages of adding epinephrine.
Blood samples were collected in peripheral venous blood of ten postpartum women before, during and after breast-feeding. Vasoactive intestinal polypeptide (VIP) and prolactin (PRL) were measured radioimmunochemically. A parallel significant increase in the VIP and PRL concentrations was observed following breast-feeding. VIP increased from a median control value of 4.5 pmol . 1(-1) to 18 pmol . 1(-1), and PRL increased from 2.8 U . 1(-1) to 5.2 U . 1(-1). A positive but insignificant correlation between corresponding PRL and VIP values was found.
Sixty patients were prospectively studied with respect to the volume and pH of their gastric contents after allocation to one of three preoperative treatments. All patients received diazepam (Apozepam) 5 mg the night before operation and 10 mg at 06.30 on the morning of operation. One group received sodium citrate solution 50 ml perorally at 06.30, 75-370 min before operation. A second group received water 50 ml perorally at 06.30, 100-405 min before operation. The third group received 50 ml water at 06.30 and 50 ml sodium citrate solution perorally just before admission to the operation theatre, 15-50 min before aspiration. Statistical analysis showed elevated pH and volume of gastric contents in the group receiving water in the morning and sodium citrate solution just before admission to the operating theatre immediately after induction of anaesthesia. There was no statistically significant difference of pH and aspirated volume between the group receiving water and the group receiving sodium citrate at 06.30.
Recently, vasoactive intestinal polypeptide (VIP) has been localized in nerve fibers in the human female genital tract. In the present investigation, the effect and concentration of VIP was studied in uterine tissue from pregnant and nonpregnant women, and the plasma concentration of VIP was measured in relationship to diurnal rhythm, intake of food, menstrual cycle, pregnancy, labor, age, and sexual arousal. In vitro VIP inhibited the contractions of the nonpregnant but not of the pregnant uterus. The median concentration of VIP in myometrium from pregnant women (less than 0.1 pmole/gm) was significantly lower than that in myometrium from nonpregnant women (1.6 pmoles/gm). The venous plasma concentrations of VIP during labor (10.5 to 13.0 pmoles/L) were significantly higher than those during pregnancy (2.0 to 5.0 pmoles/L) and the menstrual cycle of VIP increased significantly during sexual arousal, from 4.0 to 8.5 pmoles/L. The median arterial and venous concentrations in the umbilical cord (12.5 and 14.5 pmoles/L, respectively) were significantly higher than the concentration in maternal peripheral venous blood (5.2 pmoles/L). The plasma concentrations of VIP were not related to intake of food, diurnal rhythm, menstrual cycle, or age. The conclusion is that the function of VIP may be related to pregnancy, delivery, and sexual stimulation.
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Laparoscopic chromoperturbation in superior to hysterosalpingography in the evaluation of infertile women. Referring women to both investigations is therefore cost ineffective and unacceptable for the patient. To estimate the magnitude of this problem, the records of all women referred to hysterosalpingography in our department during 1989-92 were reviewed. We registered the result of the hysterosalpingography, whether or not she later had laparoscopic chromoperturbation and the results of this procedure if done. One hundred and eighteen women were included. Fifty eighty had a laparoscopic chromoperturbation (49%). The fertility prognosis obtained at hysterosalpingography was different from the fertility prognosis found by laparoscopic chromoperturbation in 34 percent of the women. Women with an abnormal hysterosalpingography had significantly more often a complicated gynecologic history. It is suggested that testing for tubal patency as a primary infertility investigation should be reserved for women with an adverse gynecologic history. Laparoscopic chromoperturbation is the method of choice.