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Biomedical subjects

P Wølner-Hanssen

Publications and source records attributed to P Wølner-Hanssen.

At least 19 recordsLinked to original sources
PubMed2001

An ultra-short perineal pad-test for evaluation of female stress urinary incontinence treatment.

We assessed the reproducibility and feasibility of a rapid perineal pad-test designed for evaluation of stress urinary incontinence treatment. In an experimental study, we included 34 women with genuine stress incontinence, 13 with urge incontinence and 10 non-incontinent volunteers for a repeated pad-test with a standardized bladder volume (300 mL) and a standardized physical activity during one minute. The pad was weighed before and after the exercise to estimate the volume of any leaked urine. In order to find out the percentage of unselected, incontinent women who had been able to perform a preoperative pad-test, we identified all 120 women operated on for stress incontinence during a one-year period in a separate retrospective analysis. In another retrospective analysis, we compared the subjective outcome of laparoscopic colposuspension with the outcome of the test performed before and after the procedure among 93 women with genuine stress incontinence. Among stress incontinent women, the median of the differences in leakage between the first and the second test was 8.5 mL (range 0-60 mL) and the repeatability coefficient was 33.6 mL. None of the 13 women with urge incontinence leaked during the tests. One of the 10 controls leaked (during both tests). Of the unselected women, 104/120 (87%) were able to perform the test. Reduction of leaking after surgery was significantly associated with subjective report of outcome (P < 0.0001). In conclusion, the described pad-test has an acceptable reproducibility and feasibility making it suitable for follow-up studies.

Bandages↗
PubMed2000

Laparoscopic Burch colposuspension for stress urinary incontinence: a randomized comparison of one or two sutures on each side of the urethra.

OBJECTIVE: To compare 1-year cure rates after laparoscopic Burch colposuspension using one double-bite or two single-bite sutures on each side of the urethra. METHODS: Consecutive women with primary stress urinary incontinence at one university hospital were included. Preoperative clinical and urodynamic evaluation included cystoscopy, cystouretrometry at rest and stress, and a standardized pad test. Immediately before surgery, the patients were randomized to have one or two polytetrafluoroethylene (GoreTex CV 2; W. L. Gore Inc., Flagstaff, AZ) sutures placed on each side of the urethra. During surgery, access to the space of Retzius was achieved by transperitoneal videolaparoscopic technique. Women were scheduled for postoperative interview and pad test 1 year after surgery. RESULTS: We included 161 women in the study; 78 were randomized to one suture (group A) and 83 to two sutures (group B). Median time for surgery was significantly shorter for group A than for group B (60 compared with 77 minutes; P < .001). We examined 158 women 1 year after surgery, at which time 148 performed a pad test. Objective cure rate was significantly higher in group B than in group A (83% compared with 58%; P = .001). CONCLUSION: Two single-bite sutures resulted in a significantly higher objective short-term cure rate than one double-bite suture on each side of the urethra.

Aged↗
PubMed2000

Laparoscopic colposuspension: a short term urodynamic follow-up and a three-year questionnaire-study.

BACKGROUND: The purpose of the study was to evaluate outcome, urodynamic correlates and adverse effects of laparoscopic colposuspension using polytetrafluoroethylene sutures. METHODS: Eighty-five consecutive women with primary stress urinary incontinence at one university hospital were included in this prospective non-controlled study. During videolaparoscopic surgery, two polytetrafluoroethylene sutures were placed on each side of the urethra and fixed to the Cooper ligaments. Pre- and postoperative clinical and urodynamic evaluations, including pad-test, were performed. A mailed questionnaire was used to evaluate cure-rate and complication-rate three years after surgery. RESULTS: At follow-up examination, we considered 62 of 76 women (82%) as being cured, ten (13%) improved, and four (5%) as being failures. The questionnaires were returned by 80 women; 41 (51%) considering themselves as cured and 31 (39%) improved, and eight women (10%) as unimproved or minimally improved. Clinical outcome was not associated with alterations in urethral functional length or in urethral closing pressure. Short preoperative urethral functional length was associated with failure (p=0.04).The incidence of new onset urge symptoms and of new onset recto/enterocele was 13% and 9% respectively. CONCLUSIONS: Laparoscopic colposuspension resulted in acceptable cure rate in short-, and medium long term evaluation. However, a decline in cure rate was observed. Cured women had significantly longer preoperative urethral functional length than women still leaking after surgery.

Adult↗
PubMed1998

Cost-effectiveness analysis of in-vitro fertilization: estimated costs per successful pregnancy after transfer of one or two embryos.

Standard protocols for in-vitro fertilization (IVF) include transfer of two or three embryos. Not surprisingly, the rate of twin pregnancy after IVF is high (about 24% of all pregnancies). Routine transfer of one, rather than two, embryos would be expected to result in a much lower rate of twin pregnancies at the cost of a lower take-home baby rate. The aim of this study was to compare hypothetical costs to society incurred by pregnancies achieved with IVF protocols based on the transfer of one or two embryos. We compared actual (for two-embryo transfers) and hypothetical (for one-embryo transfers) take-home baby rates; risks of twin pregnancies; and costs of sick leave and hospitalization during pregnancy, deliveries, neonatal intensive care, and handicap care after transfer of one or two embryos. The study showed that even when more treatments might be needed to achieve similar baby take-home rates after transfer of one compared with two embryos, the lower twin pregnancy rate of the former approach caused it to be more cost-efficient than the latter. In conclusion, IVF costs are the sum of fertilization treatment costs and the costs for health care of the pregnant women and their offspring. Considering the association of the latter costs with numbers of embryos transferred, studies of one-embryo transfer protocols are urgently needed.

Adult↗
PubMed1996

Infections after hysterectomy. A prospective nation-wide Swedish study. The Study Group on Infectious Diseases in Obstetrics and Gynecology within the Swedish Society of Obstetrics and Gynecology.

BACKGROUND: An increased use of prophylactic antibiotics to avoid postoperative infections in women undergoing hysterectomy has been observed in Sweden. This investigation was performed a) to study the infection rate to enable future evaluation of the effect of prophylactic antibiotic regimens and b) to identify subgroups suitable for intervention. METHOD: A prospective study comprising all women undergoing pelvic surgery with hysterectomy during a two month period at forty-two Departments of Obstetrics and Gynecology in Sweden. Relevant information regarding the surgical procedure and the postoperative course was included in a standardized form at discharge from hospital and at a follow-up visit 4 to 6 weeks after surgery. RESULTS: Of the 1060 women included in the study, 23% developed postoperative infections: 9.4% had wound-, cuff-, and/or deep infections, 13% urinary tract infections, and 4% other infections unrelated to the surgical site. Only half of the wound/cuff-/deep infections were diagnosed before discharge from the hospital. Wertheim-Meigs procedures, bleedings per-operatively exceeding 1000 ml, and presence of bacterial vaginosis (BV) were associated with an increased risk of postoperative infections. Among women undergoing abdominal hysterectomy for benign reasons, (n = 159), wound-cuff/deep infection was significantly associated with preoperative BV, i.e. 7 of 28 (25%) vs. 11 of 131 (8%), respectively (relative risk = 3.0, p = 0.01). Infection was associated with prolonged postoperative hospital stay. Antibiotics were given pre- or postoperatively to 236 (22%) of the 1060 women. Reduction in the postoperative infection rate was seen among women undergoing vaginal hysterectomy who were given pre- or postoperative antibiotics. CONCLUSION: The postoperative infection rate after hysterectomy was clinically significant in this population. Wertheim-Meigs procedures, peroperative bleeding > 1000 ml and BV were identified as risk factors for postoperative infections after hysterectomy.

Anti-Bacterial Agents↗
PubMed1995

Silent pelvic inflammatory disease: is it overstated?

OBJECTIVE: To determine the relationship between a history of abdominal pain and laparoscopic findings in infertile women. METHODS: From September 1993 through December 1994, consecutive infertile women were interviewed approximately 1 hour before diagnostic laparoscopy. A standardized questionnaire was used. The questions focused on medical history. Laparoscopic findings were recorded on a standardized form. RESULTS: One hundred twelve women were prospectively studied. Thirty-six women (32.1%) had one or more of the following: adnexal adhesions, distal tubal occlusions, perihepatic adhesions. A history of pelvic inflammatory disease (PID) was related to distal tubal occlusion (odds ratio [OR] 2.6, 95% confidence interval [CI] 0.7-10.0), tubal adhesions (OR 1.9, 95% CI 0.7-5.1), ovarian adhesions (OR 2.3, 95% CI 0.9-6.5), and perihepatic adhesions (OR 6.8, 95% CI 1.1-43.9). However, only 11 of the 36 (30.6%) women with adhesions and/or distal tubal occlusion had a history of PID. By contrast, 29 of 36 (80.6%) of those with adhesions and/or distal tubal occlusion had a history of lower abdominal pain. This was true for 32 of the 76 (42.1%) remaining women (OR 5.7, 95% CI 2:0-14.6). Only four women with adhesions and/or distal tubal occlusion had no history of abdominal pain and no evidence of endometriosis at laparoscopy, and therefore qualified for a possible diagnosis of silent PID. CONCLUSION: Silent PID does not seem to be as common among infertile women as previously thought. This study suggests that in the future, more extensive questions about medical history are needed than have been asked in the past.

Abdominal Pain↗
PubMed1995

Risk factors for fever in labor.

OBJECTIVE: To identify risk factors for fever in labor. METHODS: A retrospective case-control study was conducted. Maternal sublingual temperature was measured every 2-4 hours during labor in 3109 of 3860 consecutive term parturients presenting from September 1992 through December 1993. Women who had fever (at least one recorded temperature of 38C or more, n = 72) during labor were compared with those who remained afebrile (n = 3037). Furthermore, a matched-pair case-control study was conducted, involving 250 women at term who developed fever in labor and 250 controls matched for parity and duration of labor; all delivered between January 1989 and December 1993. A conditional multiple logistic regression analysis was used to identify independent risk factors for fever during labor. RESULTS: In the case-control study, fever was associated with epidural analgesia, nulliparity, and a long duration of labor. These three variables were also related among themselves. However, multiple regression analysis showed that all three variables were independently associated with maternal temperature. In the matched-pair study, epidural analgesia, rupture of membranes longer than 24 hours, latency phase exceeding 8 hours, and a temperature in the upper normal range (37.5-37.9C) at admission were independent risk factors for developing fever in labor. CONCLUSION: Epidural analgesia, duration of labor, and a long interval from rupture of membranes to delivery were independent risk factors for maternal fever in labor.

Adult↗
PubMed1991

Assessing risk for pelvic inflammatory disease and its sequelae.

To assess the risk for pelvic inflammatory disease (PID), a practitioner must evaluate the likelihood that a woman has PID or will be exposed to a sexually transmitted disease causing PID. Successful risk assessment depends on accurate information about variables influencing risk of PID. To determine the current state of knowledge about PID risk variables, we examined data in published reports. Data on each risk variable were scrutinized to discern which link(s) in the PID risk chain it affects (acquisition of a sexually transmitted disease, development of PID, or development of PID sequelae) and whether it is a risk marker or a risk factor. Most PID risk variables, particularly sexual behaviors, are associated with acquisition of a sexually transmitted disease, rather than development of PID itself. With the exception of age, demographic and social indicators of risk appear to be risk markers, while contraceptive practices appear more often to be risk factors than risk markers. Additional data are needed for most PID risk variables confidently to categorize them as risk factors. Enough information is available, however, to begin assessing risk for PID, so that appropriate counseling can ensue and timely diagnosis can be made.

Age Factors↗
PubMed1991

Pelvic inflammatory disease.

Two studies compared and showed equal efficacy of the two intravenous treatment regimens recommended by the Centers for Disease Control: cefoxitin plus doxycycline and aminoglycoside plus clindamycin. The increased risk of pelvic inflammatory disease (PID) among users of an intrauterine device was confirmed in a reanalysis of the Oxford Family Planning Study. However, a prospective study showed that prophylactic, single-dose oral doxycycline significantly reduced the risk of post-insertion gonococcal, but not chlamydial, PID. According to Canadian investigators, laparoscopy is not very specific for PID diagnosis when tubal and endometrial histopathology is used as the gold standard. Two studies showed that vaginal douching is significantly associated with PID and with ectopic pregnancy. The risk of PID increased with frequency of douching. Data from the Women's Health Study suggest increased risk of PID among cigarette smokers. However, the risk of PID was unrelated to the number of cigarettes smoked.

Anti-Bacterial Agents↗
PubMed1990

Association between vaginal douching and acute pelvic inflammatory disease.

The vaginal douching habits of 100 consecutive municipal hospital patients with verified pelvic inflammatory disease (cases) were compared with those of 762 randomly selected controls (random controls) and 119 women thought to have pelvic inflammatory disease but in whom the diagnosis was not confirmed by laparoscopy and/or endometrial biopsy specimen (internal controls). Because patients had been symptomatic for no more than 3 weeks, current douching was arbitrarily defined as any douching during the previous 2 months. Current douching was more common among those with pelvic inflammatory disease than among random controls or internal controls. Among current douchers, pelvic inflammatory disease was significantly related to frequency of douching. For example, when cases were compared with random controls, those who douched three or more times per month were 3.6 times more likely than those who douched less than once per month to have confirmed pelvic inflammatory disease. A logistic regression model was used to adjust for demographic, behavioral, and other possible confounding variables. Even after adjustments, douching during the previous 2 months remained associated with pelvic inflammatory disease. These data suggest that among these women vaginal douching may be a risk factor for pelvic inflammatory disease.

Acute Disease↗
PubMed1990

Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use.

Studies have shown that oral contraceptive use may protect against pelvic inflammatory disease (PID), but it is not known whether oral contraceptives protect against the disease among women already infected with Chlamydia trachomatis or Neisseria gonorrhoeae. The relationship between oral contraceptive use and PID was analyzed in a case-control study of 141 women with verified PID and 739 randomly selected, sexually active women with no clinical evidence of the disease. Case and control subjects were stratified on the basis of infection with C trachomatis, N gonorrhoeae, or neither organism. Among women infected with C trachomatis alone, those with PID were less likely than control subjects to use oral contraceptives. The association was significant when oral contraceptive use was compared with nonuse (odds ratio, 0.22; 95% confidence interval, 0.08 to 0.64) and with noncontraception (odds ratio, 0.17; 95% confidence interval, 0.06 to 0.53) and remained so after adjusting for potential confounding variables by logistic regression analysis. Among women infected with N gonorrhoeae alone, no association was found between use of oral contraceptives and PID. These data suggest that oral contraceptive use protects against symptomatic PID among women infected with C trachomatis but not among those infected with N gonorrhoeae.

Adolescent↗
PubMed1990

Histopathology of endocervical infection caused by Chlamydia trachomatis, herpes simplex virus, Trichomonas vaginalis, and Neisseria gonorrhoeae.

We determined the histologic correlates of clinically identified mucopurulent cervicitis, culture-proven cervical infection with Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus (HSV), and vaginal infection with Trichomonas vaginalis by examining cervical biopsies from 83 women. Clinical mucopurulent cervicitis and culture-documented infection with one or more of these pathogens correlated histologically with intraepithelial neutrophils, reactive endocervical cells, edema, luminal neutrophils, and with several deeper tissue changes such as extensive and dense subepithelial inflammation, granulation tissue, and necrotic ulceration. Focal loss of surface columnar cells and spongiosis were also correlated with culture-confirmed infection. Well-formed germinal centers were seen in biopsies from 14 of 21 patients (67%) with C trachomatis infection alone, but in none of 17 patients with infections other than C trachomatis (P less than 0.001). A predominantly plasmacytic infiltrate was also significantly associated with chlamydial infection. Necrotic ulcers overlying a predominantly lymphocytic infiltrate were seen in six of nine patients (67%) with HSV infection alone but in only two of 40 patients (5%) with other infections (P less than 0.001). Marked inflammatory changes were not seen in the patients infected with N gonorrhoeae. The organism T vaginalis was not associated with any endocervical pathology. If these results are confirmed by prospective studies, they suggest that pathologists should alert clinicians to the possibility of recent or current infection with C trachomatis or HSV when cervical biopsies show the above changes. The loss of surface columnar epithelium with HSV, chlamydial, and gonococcal infection offers a possible explanation for the reported association of these infections with increased risk of acquiring human immunodeficiency virus infection.

Adolescent↗
PubMed1990

Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis.

To define and quantitate histologic changes in the endometrium that best correlate with documented upper genital tract infection (UGTI) and laparoscopically diagnosed acute salpingitis, we studied endometrial biopsy specimens from 69 consecutive patients with clinically suspected acute pelvic inflammatory disease (PID) who underwent microbiological evaluation for UGTI and laparoscopic examination for acute salpingitis. Both UGTI and acute laparoscopically confirmed salpingitis were present in 37 patients (54%), UGTI without salpingitis in 1 (1%), salpingitis without UGTI in 11 (16%), and neither UGTI nor salpingitis in 20 (29%). Chlamydia trachomatis or Neisseria gonorrhoeae UGTI was found in 34 women, Escherichia coli in two patients, Peptococcus magnus in one woman, and with Streptococcus agalactiae in one woman. The following features were correlated both with UGTI and with salpingitis: presence of any neutrophils in the endometrial surface epithelium; neutrophils within gland lumens; dense subepithelial stromal lymphocytic infiltration; any stromal plasma cells; and germinal centers containing transformed lymphocytes. The simultaneous presence of five or more neutrophils per X 400 field in endometrial surface epithelium, together with one or more plasma cell per X 120 field in endometrial stroma, was the best predictor of UGTI plus salpingitis. This combination had a sensitivity of 92% and a specificity of 87% for predicting the diagnosis of both UGTI and laparoscopically confirmable acute salpingitis. Prospective studies are needed to assess the usefulness of these criteria.

Acute Disease↗
PubMed1990

The effects of Chlamydia trachomatis on the female reproductive tract of the Macaca nemestrina after a single tubal challenge following repeated cervical inoculations.

The effects of repeated cervical infections followed by a single direct tubal inoculation with Chlamydia trachomatis, serovars D and F, were examined in 11 pig-tailed macaques to test the hypothesis that tubal inoculation after cervical priming causes a more severe disease than primary tubal inoculation alone. Animals were cervically inoculated between two and five times. Fallopian tubes were inoculated with serovar D or F 1 week after the last cervical challenge. Three control monkeys received only one direct tubal inoculation without previous cervical inoculation. Infection was confirmed by isolating the microorganism from the endocervix in 13 of 14 monkeys and from the endosalpinx in four only after the tubal inoculation. Antibody was detected in post-infection sera of all 14. Tubal edema occurred in seven of 11 animals after the first cervical inoculation, and uterine erythema occurred in 11 of 11 after the second cervical inoculation. Peritubal adhesions were induced before the tubal inoculation in zero of seven given three or fewer cervical inoculations and four of four given five cervical inoculations (P less than .01). After direct tubal inoculation, peritubal adhesions became more prominent, and the 11 hysterectomy specimens showed plasma cell endometritis in nine and salpingitis in nine. Two control monkeys developed minor adhesions, the other none. One tube in two of three controls showed mild plasma cell infiltrates, whereas no evidence of endometritis was observed in controls. Histopathology in these monkeys was characteristic of chlamydial endometritis and salpingitis. However, the pathogenesis of these changes is uncertain because C trachomatis was not isolated from the endosalpinx after cervical inoculations alone.

Animals↗
PubMed1989

Clinical manifestations of vaginal trichomoniasis.

Trichomonas vaginalis was detected by culture or wet-mount examination in 118 (15%) of 779 randomly selected women attending a sexually transmitted disease clinic. Vaginal trichomoniasis was significantly associated with symptoms of yellow discharge, abnormal vaginal odor, and vulvar itching and with signs of colpitis macularis ("strawberry cervix"), purulent vaginal discharge, and vaginal and vulvar erythema. A logistic regression model was used to adjust for coinfections, as well as for demographic, behavioral, and other possible confounding variables. Trichomonas vaginalis remained significantly associated with symptoms of yellow vaginal discharge (odds ratio [OR] = 2.4) and vulvar itching (OR = 3.0) and with signs of colpitis macularis (OR = 241), purulent vaginal discharge (OR = 8.0), vulvar erythema (OR = 2.5), and vaginal erythema (OR = 4.3). The sensitivity of symptoms and signs associated with trichomoniasis was relatively low. Nevertheless, clinical manifestations can be used to identify those patients for whom a wet-mount examination would likely have high yield. Careful clinical examination and selective use of wet-mount examination together with wider use of more sensitive tests for subclinical infection, such as culture or direct immunofluorescent staining of vaginal fluid, could lead to improved detection and control of this infection.

Adult↗
PubMed1989

Randomized treatment of mucopurulent cervicitis with doxycycline or amoxicillin.

A randomized trial of doxycycline versus amoxicillin was performed to treat mucopurulent cervicitis. Chlamydia trachomatis, the most common single agent associated with mucopurulent cervicitis, was isolated from 30 (47%) and Neisseria gonorrhoeae from five (8%) of 64 patients. Patients were followed up for 3 months, and the effect of treatment was assessed by clinical (presence of endocervical mucopus, cervicitis severity score, and number of polymorphonuclear leukocytes on Gram-stained smears of endocervical secretions) and microbiologic criteria. Doxycycline and amoxicillin were equally effective for treating chlamydial and nonchlamydial cervicitis. However, endocervical mucopus was still present in 18% of the patients in both treatment groups after 2 months and in 23% of the doxycycline group and 33% of the amoxicillin group after 3 months of therapy. The cause of persistent/recurrent mucopus after antimicrobial treatment was not explained by relapse or reinfection with Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, or Gardnerella vaginalis, but persistence was associated with the degree of cervical ectopy.

Amoxicillin↗