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Biomedical subjects

T Espersen

Publications and source records attributed to T Espersen.

17 recordsLinked to original sources

Is diathermy safe in women with copper-bearing IUDs?

Ultrasound and short-wave diathermy are widely used in physiotherapy to induce heating of deep tissues, since this causes a concomitant increase in local blood flow. A metallic implant in the treated field is generally regarded as a contra-indication to diathermy because of the risk of thermodamage to surrounding tissues. It is not certain, however, if copperbearing IUDs contain sufficient metal as to constitute a risk. In order to exclude the possibility that diathermy might lead to intra-uterine burns in women using copperbearing IUDs a technique was devised of measuring temperatures in the copper wire of an IUD in situ during short-wave an ultrasonic therapy. The results indicate diathermy to be perfectly safe in women whit copper-bearing IUDs.

Body Temperature

Maternal febrile morbidity after cesarean section.

The frequency of puerperal febrile complications is considerably higher following cesarean section than after vaginal delivery. In a retrospective investigation of 234 planned operations and 506 emergency operations, a significantly different frequency of febrile morbidity (FM) was found following the two types of operation (7.7% vs. 20.9%). The development of FM following emergency operation was investigated in relation to factors such as age, parity, repeat cesarean section, surgeon's experience, peroperative bleeding, rupture of membranes, frequency of vaginal exploration, gestational weeks, pre- and postoperative anemia. We found some predisposing factors to FM and of these five, each was significant, but a multiple regression analysis showed that only rupture of the membranes, and pre- and postoperative anemia have an independent significant explanatory value (p less than 0.01).

Adult

Impaired insulin receptor binding and postbinding defects of adipocytes from normal and diabetic pregnant women.

To evaluate the relative contribution of insulin binding and postbinding defects of glucose utilization in peripheral tissue during normal and diabetic pregnancy, we have studied the in vitro insulin action of isolated adipocytes from eight nondiabetic pregnant women and nine pregnant women with insulin-dependent diabetes mellitus who were undergoing cesarian section. The pregnant women were compared with a matched group of normal nonpregnant women undergoing gynecologic surgery. Insulin binding to adipocytes measured at tracer insulin concentration was reduced by 45% (P less than 0.01) in normal pregnant women and by 30% (P less than 0.02) in pregnant women with diabetes. In contrast, no changes were found between the three groups in insulin binding to pure monocytes and erythrocytes. The glucose transport system in fat cells from both groups of pregnant women was characterized by impaired maximal (P less than 0.05) and half-maximal (P less than 0.05) response to insulin. When fat cell glucose metabolism was studied, pregnant diabetic women exhibited decreased basal lipogenesis (P less than 0.05) and decreased maximal responses of lipogenesis and glucose oxidation to insulin stimulation (P less than 0.05). Similar but less pronounced abnormalities were seen in glucose metabolism of adipocytes from nondiabetic pregnant women. In conclusion, both in late normal and diabetic pregnancy, insulin binding to adipocytes is significantly reduced and accompanied by decreased insulin sensitivity and reduced maximal insulin responsiveness of glucose transport and by impaired basal and maximally insulin-stimulated glucose metabolism.

Adipose Tissue

Diabetes mellitus and pregnancy. A seven-year material of pregnant diabetics, where control during pregnancy was based on a centralized ambulant regime.

A 7-year survey of the outcome of pregnancy complicated by diabetes mellitus, carried out at the Aarhus center, is presented. The material comprised 344 diabetic pregnant women where the control was based mainly on a centralized ambulant regime. The latter half-period was moreover based on self-monitoring of the blood glucose level. This achieved a significantly better blood glucose regulation, with a reduction of the mean blood glucose level from 7.9 to 6.4 mmol/l. Furthermore, the introduction of self-monitoring halved the number of hospitalizations necessary for blood glucose regulation. Pregnancy was complicated in about 35%. The importance of screening for urinary tract infection is emphasized, since this, which was present in 20% of cases, might be a possible factor in ketoacidosis and/or intra-uterine growth retardation. In 19% of the vaginal births it was deemed necessary to give instrumental assistance; 5% had shoulder dystocia. The cesarean section frequency was 31%. The antenatal mortality rate was 1.2% and the uncorrected perinatal mortality was 3.5%, half of the neonatal mortality was due to fatal congenital malformations. About half of the newborn babies required immediate intensive neonatal treatment. Because of the high frequency of complications in pregnant diabetics, during childbirth and in the neonatal period, centralized monitoring by a highly specialized team is necessary in order to maintain the present relatively low perinatal mortality and morbidity rates and the low number of cesarean sections, together with the most convenient control regimen for this highly pathological group. Furthermore, centralization will facilitate research which, together with prepregnancy consultation, may reduce the frequency of major fetal malformations.

Ambulatory Care

Heart frequency of the fetus at birth.

Heart frequency was recorded in 10 infants during the delivery and the following day. It was found that during vaginal birth, in cephalic presentation, heart frequency decreased during the last 3 minutes before delivery of the head. In breech presentation the initial deceleration was shorter, while with cesarean section there was no initial deceleration. Shortly after delivery of the head and in close connection with the first cry, a tachycardia lasting approx. 10 minutes was observed in all infants. On the day after birth, all infants had a normal heart frequency. It is concluded that the heart frequency changes correspond to the alterations expected on the basis of the caput compression and the relative fetal hypovolemia arising during the final stage of the vaginal delivery. These observations also indicate that the variable deceleration is caused partly by fetal hypovolemia. The neonatal tachycardia is presumably a response to the ordinary placental transfusion and neonatal adaptation to extra-uterine life.

Blood Pressure

Self-monitoring of blood glucose in pregnant diabetics. A comparative study of the blood glucose level and course of pregnancy in pregnant diabetics on an out-patient regime before and after the introduction of methods for home analysis of blood glucose.

Sixty-one pregnant patients with insulin-dependent diabetes mellitus completed a self-monitoring program consisting of five daily blood glucose tests at least twice weekly during the ambulatory periods of their pregnancies. Either a reflectometer method, Eyetone, glucometer--reflectometer, or Haemoglucotest 1-44 test strips were used. Of 1 834 glucose profiles, 45% were optimal, with all blood glucose values between 3.9 and 8.3 mmol/l. The 61 pregnancies were compared with 62 pregnancies where the diabetic control and therapy principles were identical, but where self-monitoring blood glucose methods were not employed. The self-monitoring regime resulted in a significant drop in mean blood glucose levels, from 7.8 +/- 1.3 to 6.4 +/- 1.0 mmol/l, compared with the period before the self-monitoring program was introduced. Furthermore, a decline in the number of diabetes-conditioned extra hospitalizations during pregnancy in the self-test group could be registered.

Ambulatory Care

Ovulation in uremic women: the reproductive cycle in women on chronic hemodialysis.

We studied five uremic women of fertile age and on chronic intermittent haemodialysis over a 3-month period. The purpose of this investigation was to establish how often the hormonal pattern indicated ovulation in uremic women and, thereby, the possibility of an inexpedient pregnancy. The pituitary ovarian axis was estimated by analyzing the serum concentrations of follicle-stimulating hormone, luteotropic hormone, progesterone, estradiol, and prolactin. Forty percent of the investigated cycles seemed to be ovulatory, though with a slightly atypical hormonal pattern. Because of these factors, it is recommended that sexually active women of fertile age and on chronic intermittent hemodialysis consider the use of contraception in order to avoid unwanted pregnancies.

Adolescent