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PubMed1994

[Information routines in HIV screening of pregnant women].

HIV-antibody testing has been carried out as a routine among pregnant women in Norway since September 1987. Up to September 1991 (later information is incomplete) 339,823 women have been tested. 25 of these were positive. In this survey we interviewed by questionnaire 55 physicians and nurses who had been asked for a second blood sample from their patients. None of the physicians who had tested the 25 HIV-positive women were included. Among these 55, nine stated that the women had suffered psychological distress after the second testing, and one reported that the woman in question had chosen to have an abortion. The study demonstrates possible opportunities for improving the handling of information, both between laboratories and physicians/nurses and between physicians/nurses and the women who are asked to give a second blood sample. We also interviewed 290 physicians who had asked for a HIV-test for pregnant women but had received no false positive results (the number of respondents was 258). Among a total of 379 physicians and nurses, one third stated that they seldom or never asked explicitly if the woman wanted to be tested. 88% were in favour of routine testing and 97% reported a positive or very positive attitude among the pregnant women towards screening. Nearly one third stated that they had insufficient knowledge about the significance of a false positive test result.

AIDS Serodiagnosis↗

PubMed1999

Randomised trial comparing expectant with medical management for first trimester miscarriages.

OBJECTIVE: To compare the efficacy of antiprogesterone (mifepristone) in combination with a synthetic prostaglandin E1 analogue (misoprostol) for outpatient treatment of miscarriages. PARTICIPANTS: One hundred and twenty-two women with first trimester miscarriages. METHODS: The women were randomised to treatment with mifepristone 400 mg orally followed by a single oral dose of 400 microg misoprostol 48 hours later (n = 60) or expectant management (n = 62). Women were re-evaluated five days later. If retained intrauterine products of conception were found with an antero-posterior diameter above 15 mm on transvaginal ultrasound, surgical evacuation was performed. RESULTS: Eighty-two percent of the women randomised to pharmacological treatment and 76% of those randomised to expectant management had an empty uterine cavity after five days. Convalescence time was 1.8 days longer for women randomised to pharmacological treatment. Pain, bleeding, complications, and satisfaction with the treatment did not differ between the groups. CONCLUSIONS: Most cases of spontaneous incomplete miscarriage will become a complete miscarriage without intervention. This study shows that outpatient treatment with a combination of antiprogesterone and a prostaglandin E1 analogue did not increase the rate of complete miscarriage, compared with expectancy alone, by a clinical important degree.

Abortifacient Agents, Steroidal↗

PubMed1997

Simplified therapy for Asherman's syndrome.

OBJECTIVE: To evaluate a technique that converts a blind hysteroscopic procedure to a "septum" division. DESIGN: Open noncomparative clinical study. SETTING: Tertiary care center. PATIENT(S): Six women with Asherman's syndrome; five with complete and one with incomplete obliteration of the uterine cavity. INTERVENTION(S): The patients underwent recreation of the uterine cavity by the hysteroscopic-laparoscopic technique described to establish the correct dissection plane. MAIN OUTCOME MEASURE(S): The ability to reestablish the uterine cavity; postoperative resumption of menses and fertility. RESULT(S): In all patients, the cavity of the uterus was restored; menses resumed in all women who were previously amenorrheic; and 5 women conceived, of whom four had live births and one a missed abortion. At hysteroscopy, two women incurred perforations and in another hemorrhage occurred. CONCLUSION(S): This technique appears to be effective and safe for the reconstruction of a functional endometrial cavity in women with Asherman's syndrome.

Adult↗

PubMed2006

[From the Cochrane Library: both expectant management and curettage are suitable options in case of miscarriage].

A Cochrane systematic review of 5 randomised clinical trials compared the safety and efficacy of expectant management versus curettage for early foetal loss. The expectant-care group was more likely to have an incomplete miscarriage, a need of unplanned curettage, and bleeding. In contrast, curettage was associated with a significantly higher risk ofinfection. Given the lack of clear superiority of either approach, the woman's preference should play a dominant role in reaching a decision.

Abortion, Spontaneous↗

PubMed2006

Differences and similarities in viral life cycle progression and host cell physiology after infection of human dendritic cells with modified vaccinia virus Ankara and vaccinia virus.

Modified vaccinia virus Ankara (MVA) is an attenuated strain of vaccinia virus (VV) that has attracted significant attention as a candidate viral vector vaccine for immunization against infectious diseases and treatment of malignancies. Although MVA is unable to replicate in most nonavian cells, vaccination with MVA elicits immune responses that approximate those seen after the administration of replication-competent strains of VV. However, the mechanisms by which these viruses elicit immune responses and the determinants of their relative immunogenicity are incompletely understood. Studying the interactions of VV and MVA with cells of the human immune system may elucidate these mechanisms, as well as provide a rational basis for the further enhancement of the immunogenicity of recombinant MVA vectors. Toward this end, we investigated the consequences of MVA or VV infection of human dendritic cells (DCs), key professional antigen-presenting cells essential for the generation of immune responses. We determined that a block to the formation of intracellular viral replication centers results in abortive infection of DCs with both VV and MVA. MVA inhibited cellular protein synthesis more rapidly than VV and displayed a distinct pattern of viral protein expression in infected DCs. MVA also induced apoptosis in DCs more rapidly than VV, and DC apoptosis after MVA infection was associated with an accelerated decline in the levels of intracellular Bcl-2 and Bcl-X(L). These findings suggest that antigen presentation pathways may contribute differentially to the immunogenicity of VV and MVA and that targeted modifications of virus-induced DC apoptosis may further increase the immunogenicity of MVA-vectored vaccines.

Apoptosis↗

PubMed1987

Toxoplasmosis in sheep. I. Effect of a killed vaccine on lambing losses caused by experimental challenge with Toxoplasma gondii.

A total of 50 two-tooth ewes were immunized pre-tupping using a killed vaccine of disintegrated Toxoplasma tachyzoites with Freunds incomplete adjuvant. At mid-pregnancy, the ewes were challenged intravenously with 1 x 10(4) live T. gondii tachyzoites. There was no difference in the lambing percentage between ewes vaccinated once and unvaccinated ewes. The lambing percentage for ewes vaccinated twice was significantly lower (p<0.05 normal score) than unvaccinated ewes. The serological response to vaccination and challenge was measured by the Toxoplasma dye test. The level of dye test antibodies at the time of challenge suggests that effective immunity to Toxoplasma n abortion is not dependent on dye test antibody titre. These results suggest that a killed vaccine would Toxoplasma on fertility and lambing performance in not be an effective tool to estimate the effects of commercial flocks.

Journal Article↗

PubMed1995

Epidemiologic Evidence of Radiofrequency Radiation (Microwave) Effects on Health in Military, Broadcasting, and Occupational Studies.

In this opinion piece, the author brings together and discusses the collective relevance of possible health effects of microwave or radar exposure in military, broadcasting, and occupational circumstances, with a view to assuring optimal protective practices. Sources of the information presented include 1) historical data, 2) experiences of Polish soldiers, 3) a study of U.S. naval personnel using radar in the Korean War, 4) preliminary findings of exposures to the Skrunda, Latvia, transmitter, 5) data obtained near Hawaiian broadcasting facilities, 6) occupational studies of electronic and electrical workers, including ham radio operators, 7) reproductive outcomes among physiotherapists using short-wave and microwave diathermy, and 8) U.S. foreign service personnel exposed at Embassies in Eastern Europe. Some of the data are available in the peer-reviewed literature, others in abstracts, reports, or other non-peer-reviewed forms. Some were obtained under Freedom of Information statutes and are incomplete. For some of these, there is reason to believe that further evidence desired by the investigator was not obtained. Some are case-referent studies, but most are not. Some are ecological, and all are retrospective. Few have reliable dose estimations, and none has accurate dosage information on each subject. None includes evidence of tissue heating or any short-term effect. Possible outcomes considered included 1) blood count changes, 2) evidence of somatic mutation, 3) impairment of reproductive outcomes, especially increased spontaneous abortion, and 4) increase in cancer incidence and mortality, especially of the hematopoietic system, brain, and breast. The author presents evidence that sufficient microwave exposures are associated with all four of these outcomes, concluding that the possible effects and their timings with respect to exposure are qualitatively similar to those on ionizing radiation. A prudent course of action would be to provide more protection for those exposed than required by present regulations. No systematic effort to include negative studies is made; thus this review has a positive reporting bias.

Journal Article↗

PubMed1989

A 45,X/69,XXY fetus.

Post-mortem examination of a 20-week fetus showed incompletely masculinised external genitalia, hypoplastic adrenal glands and minor physical stigmata suggestive of a chromosome abnormality. Gonad and skin were karyotyped and both were found to contain two cell lines, 45,X and 69,XXY. It appears this fetus is a true 45,X/69,XXY mosaic.

Abortion, Induced↗

PubMed2004

Mutation site-specific differences in arrhythmic risk and sensitivity to sympathetic stimulation in the LQT1 form of congenital long QT syndrome: multicenter study in Japan.

OBJECTIVES: We sought to compare the arrhythmic risk and sensitivity to sympathetic stimulation of mutations located in transmembrane regions and C-terminal regions of the KCNQ1 channel in the LQT1 form of congenital long QT syndrome (LQTS). BACKGROUND: The LQT1 syndrome is frequently manifested with variable expressivity and incomplete penetrance and is much more sensitive to sympathetic stimulation than the other forms. METHODS: Sixty-six LQT1 patients (27 families) with a total of 19 transmembrane mutations and 29 patients (10 families) with 8 C-terminal mutations were enrolled from five Japanese institutes. RESULTS: Patients with transmembrane mutations were more frequently affected based on electrocardiographic (ECG) diagnostic criteria (82% vs. 24%, p < 0.0001) and had more frequent LQTS-related cardiac events (all cardiac events: 55% vs. 21%, p = 0.002; syncope: 55% vs. 21%, p = 0.002; aborted cardiac arrest or unexpected sudden cardiac death: 15% vs. 0%, p = 0.03) than those with C-terminal mutations. Patients with transmembrane mutations had a greater risk of first cardiac events occurring at an earlier age, with a hazard ratio of 3.4 (p = 0.006) and with an 8% increase in risk per 10-ms increase in corrected Q-Tend. The baseline ECG parameters, including Q-Tend, Q-Tpeak, and Tpeak-end intervals, were significantly greater in patients with transmembrane mutations than in those with C-terminal mutations (p < 0.005). Moreover, the corrected Q-Tend and Tpeak-end were more prominently increased with exercise in patients with transmembrane mutations (p < 0.005). CONCLUSIONS: In this multicenter Japanese population, LQT1 patients with transmembrane mutations are at higher risk of congenital LQTS-related cardiac events and have greater sensitivity to sympathetic stimulation, as compared with patients with C-terminal mutations.

Adolescent↗

PubMed1989

Lymphatic abnormalities in fetuses with posterior cervical cystic hygroma.

We studied the structure and number of lymph vessels in 12 spontaneously aborted previable fetuses with posterior cervical cystic hygroma and generalized edema of variable origin (monosomy X, trisomy 21, trisomy 13, suspected Noonan syndrome, and lethal multiple pterygium syndrome) and compared them to 5 therapeutically aborted, apparently normal fetuses. We found that in the non-45,X fetuses with cystic hygroma and edema the lymphatic vessels at all studied sites were dilated and appeared increased in number. The 45,X fetuses had no recognizable lymphatic vessels in the edematous cutaneous tissue of the limbs, and only occasional dilated vessels in the wall of the nuchal cystic hygroma and in the lungs. These findings may be useful in differentiating between monosomy X and other conditions causing nuchal cystic hygroma in specimens in which the fetus was incomplete and/or cytogenetic study could not be done.

Aorta↗

PubMed1989

Reproductive hazards related to perchloroethylene. A review.

The literature of perchloroethylene (PER) was scrutinized to find answers to the following questions: (1) is an effect of PER on reproduction to be expected, and (2) if so, has such an effect actually been shown in animal experiments and/or in epidemiological studies? From this review it can be concluded that the first question should be answered in the affirmative, considering the various mechanisms capable of leading to defects in the reproductive processes and the information about how PER can interact (and in fact does interact) with these mechanisms. The few studies in which the effects of PER exposure on reproductive outcome have been studied are, however, not very conclusive. Some suggest an effect, others do not. In view of the incompleteness of the experimental results and the methodological shortcomings especially of the epidemiological studies, there is a need for a suitably designed epidemiological investigation on the reproductive consequences of exposure to PER. In order to avoid the methodological problems of the above-mentioned studies, the design should be a prospective one.

Abortion, Spontaneous↗

PubMed1995

Early abortifacient action of RU 486 by continuous intravenous infusion in rat.

RU 486 administered through constant intravenous infusion at 20 mg/kg dose on day 8 of pregnancy induced frank vaginal bleeding and resorption of all implantations in 100% rats. This was associated with an almost 4-fold reduction in progesterone secretion rate by the dispersed luteal cells ex-vivo. At 12 mg/kg dose, an incomplete resorption of implantations was observed in all treated animals. Results indicate that slow and continuous intravenous infusion of this antiprogestin was highly effective in terminating pregnancy shortly after implantation in the rat and this could, at least partially, be related to its luteolytic action in this species.

Abortion, Induced↗

PubMed1987

Reproductive outcome after fimbrial evacuation of tubal pregnancy.

Thirty-one ectopic pregnancies were manually expressed (i.e., "milked out") by the tubal fimbria during a 13-year period. Reproductive histories and operative findings were unremarkable when compared with the general population with ectopic gestation. The subsequent reproductive performance was evaluated in 27 patients who attempted conception. Twenty-five (92%) of the 27 patients subsequently conceived, 23 (85%) had at least one successful term pregnancy, and the remaining 2 (7%) had abortions only. There was no repeat ectopic pregnancy. Average follow-up time was 38.5 months. Previous experience with this technique has been disappointing with low postoperative rates of successful term pregnancies. Favorable outcomes after fimbrial expression have been reported only in small numbers of patients. It is suggested that the procedure is appropriate for distal tubal gestations that are loosely adherent within the tubal lumen; these are usually expressed with minimal efforts. However, if the gestational mass does not yield to gentle milking of the tube or evacuation has been incomplete, the surgeon can always use a linear salpingotomy. More experience is obviously needed to verify these preliminary results, suggesting that fimbrial evacuation is simple, safe, and advantageous in properly selected cases.

Adult↗

PubMed1983

A Sertoli-Leydig cell tumor and pregnancy. Clinical, endocrine, radiologic, and electron microscopic findings.

An extremely rare case of a conception occurring in a 26-year-old patient with a small virilizing Sertoli-Leydig cell tumor (diameter: 0.6 cm), bilateral polycystic ovaries and non-tumorous adrenal hyperandrogenism is presented. Prepregnancy findings included hirsutism, clitoromegaly, secondary amenorrhea, and elevated peripheral plasma testosterone (T; 5.7 ng/ml). Extensive basal steroid screening, dynamic function tests, conventional radiologic procedures, selective glandular vein catheterization, and laparoscopy failed to localize unequivocally the source of androgen excess, but suggested bilateral adrenal involvement. The patient conceived during the diagnostic work-up; peripheral T levels increased to 12.1 ng/ml within the first trimester. An exploratory laparotomy with left adrenalectomy, right adrenal biopsy and left ovarian wedge resection revealed an incompletely removed Sertoli-Leydig cell tumor, but normal adrenal histology. The pregnancy was terminated, a left oophorectomy and right ovarian wedge resection were performed at 14 weeks' gestation. Subsequently, peripheral androgens returned to normal, regular menses resumed, and hirsutism disappeared. Three years later the patient delivered a healthy female infant.

Abortion, Therapeutic↗

PubMed1991

Epidemiologic characteristics of preterm delivery: etiologic heterogeneity.

Preterm delivery (less than 37 weeks completed gestation) is known to result from diverse etiologic pathways, which can be grouped into idiopathic preterm labor, preterm premature rupture of the membranes, and medical complications. Data from publications providing sufficient detail to subdivide preterm delivery cases into these groups were tabulated. In spite of inconsistent terminology and incomplete reporting, patterns were identified. Black women have a markedly higher risk of preterm delivery, which is especially pronounced for preterm premature rupture of the membranes. Idiopathic preterm labor is predominant in lower-risk, white populations. These observations encourage consideration of subcategories of preterm delivery in studies of etiology and prevention.

Abortion, Induced↗

PubMed1988

The endometrium in natural and artificial luteal phases.

The normal human endometrium reacts precisely and sensitively to any hormonal stimulation with predictable changes. If the corpus luteum develops normally after ovulation, the progesterone secreted induces specific changes in endometrial glandular and stromal cells that can be dated by daily fine-structural alterations. With corpus luteum deficiency the endometrial differentiation is delayed and remains incomplete. The defect in the differentiation of glands and stroma varies in their distribution and intensity and may be dissociated or coordinated depending upon the cause of the corpus luteum deficiency. The administration of natural progesterone in the second half of the cycle prolongs the luteal phase and may result in hypersecretion of glands. In contrast, therapy with synthetic gestagens depresses glandular secretion, induces glandular atrophy and decidualization of the stroma. The various synthetic gestagens differ both quantitatively and qualitatively in their action; depending upon the dosage given the endometrium remains in abortive or arrested secretion. Clomiphene depresses normal secretion by its antioestrogenic effect which causes deficient oestrogen priming. On the other hand, clomiphene counteracts excessive oestrogen and will normalize the secretion in a deficient luteal phase that was preceded by follicular persistency. In the artificial cycle, depending upon the state of endogenous hormonal stimulation, the patients will benefit either from clomiphene or gonadotrophin to maintain or normalize their secretory endometrium.

Corpus Luteum↗

PubMed1969

Control of gene function in bacteriophage T4. I. Ribonucleic acid and deoxyribonucleic acid metabolism in T4rII-infected lambda-lysogenic hosts.

Deoxyribonucleic acid (DNA) synthesis in T4rII-infected, lambda-lysogenic strains of Escherichia coli proceeds with one-half the rate of T4 wild-infected bacteria and stops 16 min after infection at 37 C. The rates of ribonucleic acid (RNA) synthesis, however, are the same with T4rII and T4 wild. The turnover of pulse-labeled RNA is slow in K strains (half-lives 10 to 20 min) as compared with B strains (half-lives 2.5 to 6 min). Lambda-lysogeny increases the apparent messenger (m) RNA half-lives in pulse-chase experiments. The shutoff of host RNA synthesis in T4rII infected K(lambda) is incomplete. Moreover, the preferential transcription of T4 DNA ceases 13 min after infection, and transcription of host and prophage lambda DNA is resumed. The T4 RNA synthesized in rII-infected K(lambda) contains no late T4 mRNA. The early portion of the T4 genome, however, is transcribed completely. The T4-induced early modification of bacterial RNA polymerase does occur. Resumption of host DNA transcription at 13 min after infection is not associated with a reversal of the above polymerase modification. It is concluded that in lambdalysogenic bacteria T4rII infections are abortive because RNA polymerase is prevented from transcribing late T4 genes.

Centrifugation, Density Gradient↗

PubMed1980

Termination of molar pregnancy by intramuscular administration of 15(S)-15-methyl-prostaglandin F2 alpha.

Eleven patients entered a multicentre trial of repeated intramuscular injections of 15(S)-15-methyl-prostaglandin F2 alpha (15-me-PGF2 alpha) for terminating molar pregnancy. Duration of pregnancy ranged from 9 to 24 (median: 16) weeks and uterine size from 15 to 24 (median: 19) weeks. Complete (n=5) or incomplete (n=4) expulsion of molar tissue occurred in 9 patients (82%) after a median duration of 15.7 hours. In the remaining 2 patients treatment was interrupted after 8 hours at a cervical dilatation of 1 cm or more. Gastro-intestinal side effects were prominent in 64%. The use of prostaglandins in the management of hydatidiform mole is discussed.

Abortion, Therapeutic↗