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Biomedical subjects

M Hahlin

Publications and source records attributed to M Hahlin.

At least 37 records · Page 2Linked to original sources
PubMed1996

Using a logistic model to identify women with first-trimester spontaneous abortion suitable for expectant management.

OBJECTIVE: To design a method to identify women with first trimester spontaneous abortion suitable for expectant management. DESIGN: A stepwise logistic regression analysis based on retrospective analysis of clinical and biochemical variables. SETTING: Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS: One hundred and three women with inevitable or incomplete spontaneous abortion at < 13 weeks of gestation were chosen for expectant management. Eighty-one women with complete spontaneous abortion (i.e. complete expulsion and/or resolution of pregnancy products within three days of expectant management) were compared with those (n = 22) who underwent surgical evacuation of the uterus, most commonly owing to retained products of conception after three days. RESULTS: Employing a stepwise logistic regression procedure, five diagnostic variables possessing prognostic power were identified: serum progesterone, daily serum hCG change, serum CA125, serum alpha fetoprotein and intrauterine diameter. The logistic regression analysis was also applied to three diagnostic variables chosen for routine clinical use: serum progesterone, serum hCG and intrauterine diameter. The probability of complete spontaneous abortion within three days of expectant management in each woman could be calculated. CONCLUSION: We have used a logistic model to calculate the probability of complete spontaneous abortion within three days in women with first trimester miscarriages. Such information may be of clinical use in caring for women, as well as for development of management guidelines for those with miscarriages.

Abortion, Spontaneous↗
PubMed1996

A randomised prospective trial comparing laparoscopic and abdominal hysterectomy.

OBJECTIVE: To compare short term clinical results in a prospective randomised trial of laparoscopic hysterectomy compared with abdominal hysterectomy. METHODS: One hundred and forty-three women scheduled for total abdominal hysterectomy, with or without salpingo-oophorectomy and with a maximum uterine width of less than ll cm, were prospectively randomised to undergo the procedure by laparoscopic hysterectomy (n = 71) or abdominal hysterectomy (n = 72). During laparoscopic hysterectomy, the uterine arteries as well as the upper portion of the cardinal ligaments were transected laparoscopically. The perioperative and post-operative courses of the groups were compared. RESULTS: The number of women with a complication did not differ significantly between laparoscopic hysterectomy (27%) and abdominal hysterectomy (33%) groups. The post-operative fall in erythrocyte volume fraction was significantly greater following abdominal hysterectomy (5.6% compared with 4.1% median value, P < 0.001). Post operative pain, assessed by the patients two days after surgery on a visual analogue scale, was significantly higher following abdominal hysterectomy (4.2 compared with 3.6 units median value, P < 0.05). Although laparoscopic hysterectomy took longer (148 min compared with 85 min median value, P < 0.001), the women undergoing this procedure had a shorter post-operative time in hospital (two compared with four days median value, P < 0.001) and a shorter convalescence (16 compared with 35 days median value, P < 0.001). CONCLUSIONS: Laparoscopic hysterectomy is a safe procedure for selected patients scheduled for abdominal hysterectomy, and offers benefits to the patients in the form of less operative bleeding, less post-operative pain, shorter time in hospital and shorter convalescence time.

Adult↗
PubMed1996

Regulation of corpus luteum function in early human pregnancy.

OBJECTIVE: To investigate the capacity of the human corpus luteum (CL) of pregnancy to form cyclic adenosine-3',5'-monophosphate (cAMP) and P in vitro in response to hCG and prostaglandin (PG) E2. DESIGN: Six women undergoing sterilization concomitant with legal abortion and eight women undergoing surgery for ectopic pregnancy were included. Human chorionic gonadotropin was analyzed preoperatively in two serum samples. The CL were excised and luteal specimens were incubated for 2 hours in the presence or absence of hCG or PGE2. The tissue concentrations of cAMP and P concentrations in the incubation media were measured. The in vitro results were correlated to the preoperative daily change in serum hCG. RESULTS: In CL from pregnancies with normally rising serum hCG levels, the addition of hCG in vitro did not affect luteal cAMP or P production. In pregnancies with plateauing and/or decreasing serum hCG levels, the addition of hCG in vitro significantly stimulated cAMP and P formation, and this stimulatory effect correlated significantly with the preoperative daily change in serum hCG. In contrast to hCG, PGE2 had the same stimulatory effect in vitro on CL specimens from both normal and pathological pregnancies. This effect did not correlate with the preoperative daily change in serum hCG. CONCLUSIONS: Prostaglandin E2 stimulates all CL, irrespective of any changes in preoperative serum hCG levels. In contrast, the stimulatory effect of hCG in vitro does not correlate with changes in serum hCG, and thus CL from pregnancies with normally rising serum hCG levels are refractory to hCG in vitro.

Chorionic Gonadotropin↗
PubMed1996

Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy: measurements of neutrophil activation and release of interleukin-6, cortisol, and C-reactive protein.

BACKGROUND: Trauma and major surgery stimulate a cascade of events that mediate the inflammatory response. The aim of our study was to determine whether or not hysterectomy leads to release of cytokines, cortisol, and C-reactive protein (CRP), activation of neutrophils, and activation of the complement cascade. A further aim was to compare laparoscopic and abdominal hysterectomy with regard to the same parameters. STUDY DESIGN: Twenty-four consecutive patients were randomized to either abdominal (n = 12) or laparoscopic hysterectomy (n = 12). Blood samples were drawn preoperatively, intraoperatively, and then at one minute, 24 hours, and seven days postoperatively. Interleukin-6 (IL-6) levels were used to evaluate cytokine release, cortisol and CRP to evaluate the inflammatory response, and polymorphonuclear (PMN) elastase to detect neutrophil activation. To evaluate complement activation, the terminal C5b-9 complement complex (TCC) was determined. RESULTS: Interleukin-6 concentrations were significantly elevated one minute and 24 hours postoperatively in both groups. Independent of the surgical technique or operative time, the highest IL-6 concentration was reached four hours after beginning the operation. Cortisol levels were significantly elevated during and after the operation in both groups. C-reactive peptide levels were significantly elevated in both groups 24 hours and seven days after the operation. Polymorphonuclear elastase was elevated 24 hours postoperatively in both groups. There were no signs of complement activation during the operative period or postoperatively in either patient group. CONCLUSIONS: Our results indicate serious tissue trauma during both laparoscopic and abdominal hysterectomy. The extent of surgical trauma did not differ between the two operative methods.

C-Reactive Protein↗
PubMed1996

Ultrasound studies of vascular and morphological changes in the human corpus luteum during the menstrual cycle.

OBJECTIVE: To determine changes in corpus luteum (CL) volume, echogenicity, vascularity, and P production relative to a positive test result for urinary LH and day 1 of next menses. SUBJECTS: Thirteen healthy volunteers (age 23 to 32 years). INTERVENTIONS: All women underwent transvaginal ultrasonography on cycle day 11 and a urinary LH self-test was used daily. The plan was to rescan all women immediately after a positive test result and then at least every 48 hours (until day 6 of the next cycle); samples of peripheral blood were taken for analysis. MAIN OUTCOME MEASURES: The times of follicular rupture, a positive urinary LH test, and the start of menses; CL volume and echogenicity, maximum peak systolic velocity and minimum impedance, the circulating levels of serum P, E2, LH, and FSH. RESULTS: Nine women fulfilled criteria for an ovulatory cycle. There was a good correlation between peak systolic velocity, CL volume, and the concentration of serum P from day 4 to 10 after a positive LH test. Peak systolic velocity reached a maximum value between days 7 and 9 relative to a positive urinary LH test and started to decline from day 1 of menses minus 3, 4 days. CONCLUSION: Changes in peak systolic velocity from the time of a positive urinary LH self-test might be a useful adjunct for monitoring CL function.

Adult↗
PubMed1995

Expectant management of first-trimester spontaneous abortion.

Approximately 15% of registered pregnancies end in spontaneous abortion, and for 50 years or so dilatation and curettage (D&C) has been the usual management. In a prospective randomised trial we compared the clinical results after either expectant management or D&C, for miscarriages of less than 13 weeks' gestation in which transvaginal ultrasound examination showed intrauterine tissue and/or blood clots with a diameter 15-50 mm. 103 patients were randomised to expectant management and spontaneous resolution of pregnancy occurred within 3 days in 81 cases (79%). 52 patients were randomised to D&C. 3 infections were diagnosed among patients who underwent expectant management (3%); 5 infections and 1 case of postoperative anaemia were observed among patients randomised to D&C (11%). The duration of vaginal bleeding was a mean of 1.3 days longer in the expectant management group (p < 0.02). Convalescence time, time during which patients experienced pain, and packed-cell volume 3 and 14 days after inclusion did not differ significantly between the groups. This study shows that expectant management of selected cases of spontaneous abortion has a similar outcome to D&C.

Abortion, Spontaneous↗
PubMed1995

The expectant management of early pregnancies of uncertain site.

The role of expectant management was evaluated in 80 women in whom clinical examination, including vaginal ultrasound, had failed to identify the location of an early pregnancy. In 45 cases, spontaneous resolution of the pregnancy products occurred. A normal intra-uterine pregnancy was diagnosed in 12 patients. A total of 23 patients underwent active therapeutic measures due to an ectopic pregnancy (n = 16) or a spontaneous abortion (n = 7). The effectiveness of different diagnostic measures to identify patients suitable for expectant management was analysed. In 33/34 patients (97%) with a relative daily human chorionic gonadotrophin (HCG) change of < -5%, and a serum progesterone concentration of < 20 nmol/l, spontaneous resolution of the pregnancy products occurred. Among 46 cases, with a relative daily HCG change of > -5% and/or serum progesterone > 20 nmol/l, active therapeutic measures were carried out in 22 cases (48%), a normal intra-uterine pregnancy was diagnosed in 12 cases (26%) and spontaneous resolution of the pregnancy products occurred in 12 cases (26%). In conclusion, the combination of a single progesterone assay and serial HCG determinations retrospectively identified early pregnancies of uncertain location in whom expectant management was a safe management option.

Abortion, Spontaneous↗
PubMed1995

Interaction between oxytocin and prostaglandin F2 alpha in human corpus luteum?

The effect of a single injection of oxytocin into the corpus luteum, with or without pretreatment with a prostaglandin synthetase inhibitor, was studied in order to investigate possible local interactions between prostaglandin (PG)F2 alpha and oxytocin in the regulation of the human corpus luteum. Oxytocin (4 IU) was injected through the abdominal wall into the corpus luteum in women undergoing laparoscopy for legal sterilization. In the control cases, saline was injected into the corpus luteum, or oxytocin was injected into the contralateral ovary. Oxytocin injected into the corpus luteum caused a fall in serum progesterone and shortened the luteal phase. These effects were not seen following injection of saline into the corpus luteum, or following injection of oxytocin into the contralateral ovary. After the injection of oxytocin into the corpus luteum a rise in 15-keto-dihydro-PGF2 alpha, a PGF2 alpha metabolite, was seen. The changes in serum progesterone caused by injection of oxytocin into the corpus luteum could be prevented if a PG synthetase inhibitor was given before the injection. These findings suggest that local interaction between oxytocin and PGF2 alpha plays a role in the regulation of the human corpus luteum.

Adult↗
PubMed1995

In vitro production of cyclic AMP and steroids from an ovarian Sertoli-Leydig cell tumor. Notes on clinical management.

A 27 year old nulliparous woman with a history of chronic anovulation and signs of virilization with a markedly elevated serum level of testosterone, underwent a laparotomy with peroperative bilateral ovarian vein catheterization and bilateral bisection of both ovaries. A solid, 1.5 cm, well delimited tumor located centrally in the right ovary, was excised. Testosterone levels in ovarian venous blood from the tumor bearing side, were 88.4 nmol/l and from the contralateral ovary 3.9 nmol/l. Histopathological examination showed a Sertoli-Leydig cell tumor which was radically extirpated. Postoperatively, the serum levels of androgen normalized, the woman had regular cycles, became pregnant and delivered a normal female baby. Pieces of tumor tissue were incubated for 2 h, with and without addition of gonadotropins and adrenocorticotropic hormone (ACTH). Human chorionic gonadotropin (CG), follicle stimulating hormone (FSH) and adrenocorticotropic hormone (ACTH) caused significant increases in cyclic monophosphate (cAMP) production in tumor tissue in vitro, as compared to controls. Furthermore, ACTH also significantly stimulated 17 beta-estradiol production. In tumor cells cultured for 48 h, FSH slightly, but not significantly, increased the production of progesterone. In the cell culture, [3H]-thymidine incorporation into deoxyribonucleic acid (DNA) was stimulated by IGF1 alpha but not by hCG and FSH. It is concluded that Sertoli-Leydig cell tumors may be sensitive to gonadotropins and ACTH and that their small size, solid shape and intra-ovarian localization can cause diagnostic difficulties.

Adrenocorticotropic Hormone↗
PubMed1994

Prediction of persistent trophoblastic activity after local prostaglandin F2 alpha injection for ectopic pregnancy.

A total of 60 patients underwent injection of prostaglandin (PG)F2 alpha into the affected tube and corpus luteum. Two serum samples, with a mean interval of 2.1 days, were taken pre-operatively and human chorionic gonadotrophin (HCG) and progesterone were determined by fluoroimmunoassay retrospectively. Cases requiring a second intervention (n = 8) were compared with uncomplicated cases (n = 52). The receiver-operator characteristic curve was used to determine optimal discriminatory levels of each diagnostic test. Among the complicated cases, 75% had progesterone values > 20 nmol/l and 100% had a daily HCG increase > 50 IU/l. The corresponding figures for the uncomplicated cases were 17% and 23% respectively. A 'high-risk' group representing 12% of the patient material was identified, and was biochemically profiled by serum progesterone values > 20 nmol/l, together with daily HCG changes > +50 IU/l/day. These patients had an 86% risk for a second intervention. Conversely, 88% of patients had only a 4% risk for such an intervention. We conclude that the combined use of two sequential serum HCG samples and one serum progesterone sample, the last of each taken not more than 24 h pre-operatively, can predict the risk for a complicated course following local injection of 15-methyl-PGF2 alpha for small tubal pregnancies.

Chorionic Gonadotropin↗
PubMed1994

Prediction of persistent ectopic pregnancy after laparoscopic salpingostomy.

OBJECTIVE: To evaluate whether preoperative measurements of progesterone and hCG in serum can predict the risk of needing a second therapeutic intervention after laparoscopic salpingostomy. METHODS: In 158 patients with unruptured tubal pregnancies smaller than 4 cm, serum progesterone and hCG levels were measured in two venous blood samples taken preoperatively. Fourteen complicated cases, in which a second therapeutic intervention was necessary, were compared with 144 uncomplicated cases. RESULTS: Eleven of the 14 complicated cases (79%) had preoperative progesterone values exceeding 35 nmol/L, whereas this was true for only 15 (10%) of the uncomplicated cases. Among the complicated cases, 12 (86%) had preoperative daily hCG changes above 100 IU/L, compared to 44 (31%) of the uncomplicated cases. Cases with a progesterone level above 35 nmol/L and a daily hCG change exceeding 100 IU/L had a 61% risk for a second therapeutic intervention, whereas with a progesterone value below 35 nmol/L and/or a daily hCG change of less than 100 IU/L, the risk was only 2%. CONCLUSION: The risk for a second therapeutic intervention after laparoscopic salpingostomy for ectopic pregnancy can be predicted by the combined use of two sequential serum hCG samples and one serum progesterone sample, the last of each taken within 24 hours preoperatively.

Chorionic Gonadotropin↗
PubMed1992

Distinction between early normal intrauterine pregnancies and pathological pregnancies by means of a logistic model.

The probability of an unclear very early pregnancy being a normal intrauterine pregnancy was estimated using a logistic model. Five diagnostic measures of prognostic value were identified in the model: (i) daily change in human chorionic gonadotrophin (HCG), (ii) results of transvaginal ultrasound, (iii) vaginal bleeding, (iv) serum progesterone level and (v) risk score for ectopic pregnancy. With the use of this model, the probability of a normal intrauterine pregnancy has been estimated as 96.7%.

Chorionic Gonadotropin↗
PubMed1992

Differential diagnosis of early human pregnancies: impact of different diagnostic measures.

A total of 261 women in early pregnancy, either with mild symptoms of ectopic pregnancy (EP) or being at an increased risk for this condition, were included in a longitudinal study. The effectiveness of different diagnostic measures in obtaining correct final diagnoses was analyzed. In addition to clinical findings and symptoms, the use of serum human chorionic gonadotropin, serum progesterone, endovaginal sonography and a risk score for EP were all proven to be valuable in distinguishing normal intrauterine pregnancies from pathological pregnancies.

Chorionic Gonadotropin↗
PubMed1991

Human granulosa cell tumor: stimulation of steroidogenesis by gonadotropins in vitro.

A 59-year-old previously oophorectomized woman underwent surgery for a recurrent malignant granulosa cell tumor. Specimens and dispersed cells from the tumor tissue were incubated for 2 hr and cultured for 48 hr, respectively, with and without gonadotropins. Steroids and cyclic AMP (cAMP) concentrations were measured in the incubation and culture media. Incubated specimens from the tumor tissue released measurable amounts of cAMP, progesterone, and estradiol into the medium. Human follicle-stimulating hormone (FSH) 1 microgram/ml significantly stimulated the formation of cAMP and both steroids. Human luteinizing hormone (LH) 1 microgram/ml stimulated cAMP and progesterone but not estradiol release. Human chorionic gonadotropin (hCG) 10 micrograms/ml stimulated cAMP and progesterone formation in tumor tissue but was totally devoid of effect on estradiol release. In the tissue culture experiments progesterone and estradiol were formed in considerable amounts, with a higher capacity for progesterone than for estradiol. Progesterone formation was stimulated by FSH and hCG, while estradiol release was stimulated only by hCG. The addition of testosterone significantly enhanced estradiol formation in both incubation and culture experiments. It is concluded that the steroidogenesis of this granulosa cell tumor is sensitive to gonadotropins.

Chorionic Gonadotropin↗
PubMed1991

Combined use of progesterone and human chorionic gonadotropin determinations for differential diagnosis of very early pregnancy.

Progesterone (P) level and daily change in human chorionic gonadotropin (hCG) were determined in the serum of 307 patients with suspected ectopic pregnancy (EP). Of the viable intrauterine pregnancies (IUP), 99% had P values above 30 nmol/L, whereas 75% of the EP and 81% of the spontaneous abortions had P values less than 30 nmol/L. Among the viable IUP, 95% had normal hCG increases, whereas 89% of the EP and 99% of the spontaneous abortions had abnormal hCG increases. A P value less than 30 nmol/L combined with an abnormal hCG increase had a positive predictive value for pathological pregnancy of 1.0. Consequently, in such cases, further invasive diagnostic or therapeutic measures can be taken with a low risk of jeopardizing a viable IUP.

Abortion, Spontaneous↗