Annales chirurgiae et gynaecologiae. Supplementum最新文献

A randomized study was undertaken to compare the effect of vaginal (1 mg of dinoprostone/2.5 ml gel) and intracervical (0.5 mg of dinoprostone in 2.5 ml of two different vehicles) on induction of labor and perinatal outcome. Sixty women (n = 20/20/20) who presented with an unfavorable cervix and a specific indication for the induction of labor participated in the study. There were no significant differences between the groups with respect to maternal age, weight, parity, gestational length or Bishop scores before prostaglandin E2 preinduction. Labour was induced with prostaglandin gel alone in twenty-two patients and with oxytocin infusion on the following morning after gel application in seven patients; altogether the rate of successful induction was 48.3%. The rate of uterine hyperstimulation was 16.7% with most cases in the groups receiving intracervical prostaglandin E2. Neonatal asphyxia diagnosed with umbilical vein and artery blood gas analysis was seen in eleven neonates who were delivered by labor induced with prostaglandin gel alone (50%). Prostaglandin pre-induction decreases the need for Cesarean sections in complicated pregnancies, but because of the risk of uterine hyperstimulation and neonatal asphyxia prostaglandins should be used only with specific indications.

A retrospective review of the 289 women over the age of 40 years and delivering at the Turku University Central Hospital between 1986-1990 is presented. Forty-seven women were nulliparous and 242 multiparous. The proportion of women over 40 of all parturients during this time period was 2.1%. Infertility was treated in 12% of couples. There were three multifetal pregnancies, all spontaneous. 88% of the women had a first trimester amniocentesis or chorion villus biopsy for fetal chromosomal analysis. The most common pregnancy-related complications were prematurity (11%), gestational diabetes (8%), pre-eclampsia (7%) and infectious diseases (11%). The rate of Caesarean section was high, 26% (among the primipara 36%). The perinatal mortality rate was very low, 3.4 per thousand, and neonatal mortality rate 6.8 per thousand. The incidence of congenital anomalies was 2%, and most of these anomalies were cardiac. Large-for-date babies were overpresented in this population and primipara had a higher rate of small-for-gestational age babies than in the normal population. Although advanced maternal age alone does not carry major risks of abnormal pregnancy outcome, the higher frequency of complications among some subgroups may explain the high rate of Caesarean sections in this population.

Three rare epithelial ovarian tumours, one malignant Brenner tumour, one transitional cell carcinoma and one Brenner tumour of borderline malignancy, are presented with special emphasis on the diagnostic, prognostic and therapeutic modalities. Because the prognosis of transitional cell carcinoma of the ovary is worse, as in our case, than that of the malignant Brenner tumour, this classification is justified.

The exercise- and drug-induced potassium shifts in pregnant women was studied. Six healthy nonpregnant women, six healthy pregnant women and four hypertensive, pregnant women on labetalol performed a bicycle exercise test. Blood samples for plasma potassium concentrations were drawn before, during and after the exercise. The exercise-induced plasma potassium increase was 0.9 +/- 0.2 mmol/l in healthy control women and 0.8 +/- 0.1 mmol/l in healthy pregnant women. In hypertensive pregnant women on labetalol the increase was 0.3 +/- 0.3 mmol/l (P < 0.01). There was a negative correlation (r = 0.941, P = 0.05) between the plasma potassium and labetalol concentration. Our results suggest that the potassium exchange during normal pregnancy is not changed. Labetalol reduced the exercise-induced plasma potassium increase which contrasts to other beta-blocking agents which usually augment the plasma potassium increase caused by exercise.

In order to study the contribution of the vasoconstrictory peptide endothelin-1 (ET-1) to the elevation of the pulmonary vascular resistance in the neonatal respiratory distress syndrome (RDS) seven preterm infants were studied at 2, 24 and 48 hours of age for plasma ET-1 concentrations and systolic pulmonary artery pressure (PAP), measured by Doppler sonography. Plasma ET-1 levels were high during the first day after birth, but declined soon to normal levels thereafter. During the study period, the systolic PAP also decreased, whereas the systemic pressure remained unchanged. There were no correlations between plasma ET-1 and vascular pressures, but there was a significant association between ET-1 and the requirement of supplemental oxygen and the arterial-alveolar oxygen tension ratio. Our results thus suggest that high plasma ET-1 levels in the acute phase of RDS reflect the severity of the pulmonary disease, but may not significantly contribute to the elevation of the pulmonary vascular resistance in the RDS.

The biochemical and immunohistochemical estrogen (ER) and progesterone receptor (PR) content and flow cytometric DNA ploidy was analyzed in five semimalignant and 35 malignant epithelial ovarian tumours. By biochemical assay, 67% of the tumours were ER-positive (> or = 5 fmol/mg protein) and 56% were PR-positive (> or = 10 fmol/mg protein). The corresponding values by immunohistochemical assay (with a HSCORE of 10 as the cutoff level) were 22% and 27%, respectively. DNA histogram measured from paraffin embedded specimens were diploid in 20% (7/35) and aneuploid in 80% (28/35) of the malignant tumours. All semimalignant tumours were diploid. The mean receptor values in the diploid and aneuploid tumours did not differ significantly and receptor-positive and receptor-negative tumours were evenly distributed in all stages and grades. In contrast, flow cytometric DNA ploidy was clearly associated with tumour stage (G2 = 10.52, Df = 3, P = 0.015) and histological differentiation (G2 = 20.57, Df = 3, P = 0.0001).

Diagnostic transabdominal amnioinfusion was performed at 32 weeks of gestation in a case of anhydramnion. Before saline infusion, no exact fetal structures could be identified by sonography. Also, there was a total diastolic block in the fetal aorta (FA) and umbilical artery (UA). After infusion of 270ml of saline, the diastolic blocks in the FA and UA disappeared, and, after another infusion of 410ml of saline, severe fetal congenital kidney abnormalities were identified. Transabdominal amnioinfusion is a practical aid to fetal sonography in severe oligohydramnion and anhydramnion.

Ten mothers at normal term pregnancy were rendered mildly hypoxic by allowing them to breathe a gas mixture of 10% oxygen and 90% nitrogen. The fetuses were studied with Doppler ultrasound and computer assisted cardiotocography. There was vasodilatation in the cerebral vasculature while the utero-placental blood flow decreased. No changes in fetal haemodynamics occurred. The fetal heart rate was correlated inversely to the heart rate variation. There was a positive correlation between the heart rate variation and the umbilical flow velocity waveform index. In a group of 30 subjects with severe pre-eclampsia and/or severe intrauterine growth retardation, the fetal heart rate variation was inversely correlated to the umbilical blood flow. Hence, the study shows a clear physiological difference in fetal heart function during short-term hypoxia compared to that during long term placental insufficiency.

We present three patients with advanced carcinoma of the uterine cervix treated with full pelvic irradiation followed by surgery 21-37 weeks after the radiation therapy. In two cases chemotherapy was given after radiotherapy due to clinical or radiological residual disease. Postoperative treatment was dependent on histological examination of the surgical specimens. If indicated chemotherapy was started or continued after surgery. No major operative complications were noticed in these three patients in spite of full preoperative pelvic radiation. The information obtained from these operations was valuable in determining the further treatment of the patients. All three patients are clinically disease free at the moment, but longer follow-up will show if this treatment modality can increase survival of advanced carcinoma of the uterine cervix.

Sixteen patients with urinary tract fistulas (14 vesicovaginal and two ureterovaginal) following simple abdominal hysterectomy were treated over a period of 17 years. Most vesicovaginal fistulas were treated by a transvesical technique, which proved to be a comfortable and successful method in our hands. Closure of the fistula followed usually more than four weeks after diagnosis. Earlier repair, which has been forwarded as an alternative therapy, might give equally good results and would save the patient from the severe hygienic problem of continuous urinary leakage. Conservative treatment with an indwelling urinary catheter led to spontaneous closure of the fistula in one patient. Two ureterovaginal fistulas were corrected by an anti-reflux ureteroneocystostomy.