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Biomedical subjects

M Hahlin

Publications and source records attributed to M Hahlin.

At least 55 records · Page 3Linked to original sources
PubMed1991

Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy.

OBJECTIVE: Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial. DESIGN: One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy. To evaluate adhesion formation and tubal status, 73 patients with strong desire of pregnancy underwent a second-look laparoscopy. The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy. RESULTS: Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy (P less than 0.001). Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group. Tubal patency did not differ between the groups. CONCLUSIONS: Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery.

Fallopian Tubes↗
PubMed1991

Laparoscopic surgery in ectopic pregnancy. A randomized trial versus laparotomy.

A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment with conventional conservative abdominal surgery for tubal pregnancy. Entry criteria were: size of the ectopic gestation less than 4 cm, hemodynamic stability, accessibility for laparoscopic treatment and a trained laparoscopist on duty. There was no difference between the groups regarding gestational duration, size and location of the ectopic gestation, or the mean preoperative hCG values. The groups differed with respect to total operation time (73 min for the laparoscopy group vs. 88 min for the laparotomy group), hospital stay (2.2 vs. 5.4 days) and convalescence period (11 vs. 24 days). The rates of elimination of hCG was similar in the groups, and there were no statistical difference in the rate of second intervention.

Chorionic Gonadotropin↗
PubMed1991

Local luteolytic effect of prostaglandin F2 alpha in the human corpus luteum.

OBJECTIVE: To evaluate the effects of prostaglandin (PG)F2 alpha on human corpus luteum (CL) function in vivo. DESIGN: The effects of a single injection of PGF2 alpha into the CL was studied. SETTING: The patients underwent elective surgery at the Department of Obstetrics and Gynecology, Sahlgrenska Hospital, University of Göteborg, Sweden. PARTICIPANTS: Twenty women with regular menstrual cycles undergoing laparoscopy for legal sterilization with tubal clips volunteered for the study. INTERVENTIONS: Prostaglandin F2 alpha (3 mg) was injected through the abdominal wall into the CL. In control cases, vehicle was injected into the CL or PGF2 alpha into the contralateral ovary. MAIN OUTCOME MEASURE: After the injections, serum was analyzed for progesterone (P) and luteinizing hormone using fluoroimmunoassay and enzyme-immunoassay, respectively. Menstrual data were recorded. RESULTS: In contrast to control cases, intraluteal injection of PGF2 alpha caused both an immediate fall of greater than 30% in serum P and a shortening of the luteal phase by 2 to 5 days. Luteinizing hormone varied independently of the changes in serum P levels. CONCLUSION: The results suggest a local role for PGF2 alpha in human luteolysis.

Adult↗
PubMed1991

Persistent trophoblast after conservative treatment of tubal pregnancy: prediction and detection.

The incidence of persistent trophoblast and risk of second surgical intervention after conservative treatment of tubal pregnancy are substantial. The preoperative and postoperative hCG patterns in patients with tubal pregnancy were studied to see whether this information could predict and detect persistent trophoblast at an early stage. Ninety-eight women with tubal pregnancy underwent conservative surgical treatment by laparoscopy or laparotomy. Eight developed postoperative complications necessitating a second operation, and seven of them had both biochemical and histologic evidence of persistent trophoblastic activity. In seven of 31 patients with preoperative hCG above 3000 IU/L, a second operation was necessary, whereas in 67 with preoperative hCG levels below 3000 IU/L, only one such intervention was necessary. Eight of the 22 patients with hCG above 1000 IU/L on the second day after surgery and seven of 11 patients with hCG above 1000 IU/L on the seventh day after surgery later needed a second surgical procedure. In contrast, 86 of 87 women with hCG below 1000 IU/L on the seventh day after surgery had an uneventful convalescence. We conclude that pre- and postoperative hCG measurements can identify patients at risk of developing persistent trophoblast. Further, in patients with preoperative hCG titers below 3000 IU/L, we recommend conservative surgery followed by measurement of hCG 1 week postoperatively.

Chorionic Gonadotropin↗
PubMed1990

Treatment of tubal pregnancy by laparoscope-guided injection of prostaglandin F2 alpha.

Twenty-six cases of unruptured tubal pregnancy were treated by laparoscope-guided injection of prostaglandin (PG) F2 alpha into the affected tube and the ovary containing the corpus luteum. Preoperative serum human chorionic gonadotropin (hCG) levels were 22 to 2,050 IU/L (mean 328 IU/L). The procedure was successful in 24 patients (92%), as indicated by reduction of hCG values to less than 20 IU/L. The remaining 2 cases showed an initial fall in hCG after injection and thereafter a plateau phase indicating the persistence of trophoblast. In both cases, a second surgical intervention was necessary. The total subsequent conception rate among 19 women desiring pregnancy was 90% (17/19). The intrauterine conception rate was 58% (11/19), and the repeat rate of ectopic pregnancy was 32% (6/19). Two-thirds (12/19) of the subsequent pregnancies occurred within 6 months "at risk" for conception. It is concluded that local injection of PGF2 alpha represents an attractive method for termination of selected cases of tubal pregnancy, preferentially in subjects with low trophoblastic activity.

Abortion, Legal↗
PubMed1990

Evaluation of time-resolved fluoroimmunoassay for analysis of sex steroids in serum.

The performance characteristics of time-resolved fluoroimmunoassays (FIAs) for oestradiol and progesterone were evaluated in an in-vitro fertilization/embryo transfer (IVF/ET) programme and for use in differential diagnosis of early pregnancy. Comparisons were made with commercially available radioimmunoassays (RIAs) and the correlations between the results obtained were analysed. The possible clinical impact of the differences was assessed in 30 women undergoing ovarian stimulation for IVF/ET and also in 68 women presenting with suspected pathological gestation. There was good agreement between the performance characteristics observed in the present study and those claimed by the manufacturer. There was also a strong correlation between RIA and FIA within the working ranges of the assays. The differences in the results obtained with the two methods were within the normal limits of variation of the assays, and, consequently, the clinical relevance was minimal. In conclusion, for the clinical purposes in question, the FIAs perform at least as well as commercially available RIAs, and may, therefore, be regarded as an alternative to RIAs for many laboratories.

Embryo Transfer↗
PubMed1990

Single progesterone assay for early recognition of abnormal pregnancy.

Serum progesterone and human chorionic gonadotrophin (HCG) were analysed using a time-resolved fluoroimmunoassay in an unselected group made up of 158 women with clinical suspicions of abnormal early gestation. Only cases in which endovaginal sonography had failed to localize the pregnancy were included. A single HCG determination had no diagnostic value. On the other hand, a critical progesterone level of 30 nM was determined below which no viable intrauterine pregnancies were found. Eighty-eight per cent of the ectopic pregnancies (n = 97) and 83% of the spontaneous abortions had progesterone levels below this limit. The discriminatory efficacy of one single progesterone determination was independent of the actual HCG level and serial determinations of progesterone did not increase the discriminatory power.

Abortion, Spontaneous↗
PubMed1990

Luteotropic effects of prostaglandins I2 and D2 on isolated human corpora luteum.

Human corpora lutea (CL) of the menstrual cycle or early pregnancy were excised at operation, cut into pieces, and incubated in the presence of human chorionic gonadotropin or prostaglandin (PG) I2 and D2. After incubation, the tissue levels of 3',5' cyclic adenosine monophosphate (cAMP) and the medium concentration of progesterone (P) was determined. Prostaglandin I2 and PGD2 stimulated cAMP production in the CL of both the menstrual cycle and early pregnancy. This stimulatory effect was maximal for PGI2 after 5 minutes and for PGD2 after 10 minutes. Repeated addition of the PGs during 120 minutes in the CL from the menstrual cycle resulted in a persistent cAMP elevation and stimulated P formation. The stimulatory effects of PGI2 and PGD2 on cAMP and P production in vitro indicate that these local hormones play a role in the normal development of human menstrual CL and in the persistence of the CL of early pregnancy.

Corpus Luteum↗
PubMed1989

Serial human chorionic gonadotropin determinations by fluoroimmunoassay for differentiation between intrauterine and ectopic gestation.

A new means for differentiation between ectopic and early intrauterine pregnancy--the human chorionic gonadotropin score--is described. The score relates the rate of serum hCG rise per day to the initial human chorionic gonadotropin level. The positive predictive value for ectopic pregnancy was 94.7%, based on human chorionic gonadotropin scores from 41 women with increasing human chorionic gonadotropin levels in the range of 10 to 4000 IU/L. The method may be useful for identification of ectopic pregnancy in a category of women in whom ultrasonography is of limited diagnostic value.

Chorionic Gonadotropin↗
PubMed1989

Characterization of a monoclonal antibody inhibiting the biological activity of human chorionic gonadotrophin.

A mouse monoclonal antibody (MCA), raised against human chorionic gonadotrophin (HCG) and coded 130A, was characterized with several types of immunoassay and with in-vitro and in-vivo bioassays. MCA 130A binds strongly to the intact HCG molecule but less so to either alpha- or beta-subunit; The dissociation constant of the MCA-HCG complex was found to be in the order of 70 pmol/l. MCA 130A inhibits the biological activity of HCG very effectively, both in vitro and in vivo. In a competitive immunoassay MCA 130A binds 30 x better to HCG than to human luteinizing hormone (HLH). The selectivity in the bioassays was much higher, e.g. in vitro, 50% inhibition of HLH-stimulated testosterone production requires 2600 x as much MCA as is needed for inhibiting HCG-stimulated production. Possible reasons for this difference in selectivity are discussed.

Animals↗
PubMed1989

Characterization of a monoclonal antibody which inhibits the biological activity of human chorionic gonadotrophin in human corpora lutea.

In the present study a murine monoclonal antibody (MCA), directed against human chorionic gonadotrophin (HCG), was investigated in vitro utilizing human corpora lutea (CL). The CL were excised from women of fertile age undergoing various gynaecological operations. The CL specimens were cut into pieces and incubated in standard medium for 2 or 4 h in the presence of HCG, luteinizing hormone (HLH) or prostaglandin (PG) E2 alone or in combination with the MCA directed against HCG. After incubation, the tissue levels of cyclic adenosine 3',5' monophosphate (cAMP) and the media contents of progesterone (P) were determined. HCG, HLH and PGE2 stimulated both cAMP and P formation in CL of all ages, while the MCA alone had no effect on these parameters. The MCA, however, effectively counteracted the stimulatory effect of HCG on both cAMP and P formation on a 1:1 molar basis. This antagonistic effect was clearly reversible and could be overcome by increasing the HCG concentrations. The stimulatory effect of HLH and PGE2, on the other hand, was not influenced by the antibody, even when administered at high concentrations. These in-vitro data show that the MCA studied effectively counteracts the stimulatory effect of HCG on human luteal tissue with high specificity.

Adult↗
PubMed1988

Luteotropic effects of prostaglandin E2 on the human corpus luteum of the menstrual cycle and early pregnancy.

Human corpora lutea (CL) of the menstrual cycle and early pregnancy were excised at operation, cut into pieces, and incubated or superfused in the presence of hCG or prostaglandin (PG) E2. After incubation, the tissue levels of cAMP and the medium concentrations of progesterone (P) were determined, while the concentration of P was analyzed after superfusion. PGE2 stimulated cAMP formation in CL from all phases of the menstrual cycle as well as from early pregnancy and caused an increase in P formation in CL from the early and midluteal phases of the menstrual cycle as well as from early pregnancy. A difference was found in the latency, the lag phase until maximal response, and the duration of response between the effects of PGE2 and hCG on both cAMP and P formation. Thus, the effect of PGE2 started more rapidly and was of shorter duration than that of hCG. The stimulatory effect of PGE2 on CL from early pregnancy was of the same magnitude as that of CL from the menstrual cycle. On the other hand, hCG had less stimulatory effect on cAMP and P formation in CL from early pregnancy compared to CL from the menstrual cycle. We conclude that PGE2 stimulates P and cAMP formation in isolated human CL from all phases of the menstrual cycle as well as in early pregnancy, indicating a luteotropic effect of this PG.

Adult↗
PubMed1987

Local prostaglandin F2 alpha injection for termination of ectopic pregnancy.

In nine women with unruptured ectopic pregnancy, prostaglandin F2 alpha was injected under laparoscopic control into the affected oviduct and in eight patients also into the ovary containing the corpus luteum. Termination of the pregnancy was achieved in all cases (in one at the second attempt), without complications. Fertility after this procedure needs to be compared with that after conventional surgery.

Abortifacient Agents↗
PubMed1987

Antigonadotropic effect of oxytocin on the isolated human corpus luteum.

From each of 43 women who had gynecologic laparotomy at different and well-classified stages of the luteal phase of the cycle, the corpus luteum (CL) was excised, cut into pieces, and incubated for short time periods (30 to 240 minutes). Incubations were performed in the absence and presence of human chorionic gonadotropin (hCG) and different concentrations of oxytocin ([OT], 0.1 to 1000 mIU/ml). After incubation, the tissue levels of cyclic adenosine 3',5'-monophosphate (cAMP) and the media concentrations of progesterone (P) were determined. Although hCG stimulated both cAMP and P formation in CL of all ages, OT alone had no effect on the basal production of these parameters. However, under certain experimental conditions, OT counteracted the stimulatory effect of hCG on both cAMP and P formation. Because the maximal antigonadotropic effect was found for concentrations of OT in the magnitude of the physiologic intraluteal concentration, these in vitro data suggest a role for OT in the luteolytic process of humans.

Adult↗