Prevalence and risk factors of adenomyosis at hysterectomy.

BACKGROUND: The present study was performed to evaluate the prevalence and possible associated risk factors for adenomyosis. METHODS: Medical records were retrieved and histo-pathological material re-examined for 549 consecutive women undergoing hysterectomy in a two-year period from 1990-1991. RESULTS: The prevalence of adenomyosis in the study varied from 10.0-18.2%, depending on different diagnostic criteria. The presence of endometrial hyperplasia at the time of hysterectomy was the only variable significantly associated with adenomyosis (OR = 3.0; 95% CI: 1.2-8.3). No statistically significant association was found between adenomyosis and previous caesarean section, endometrial curettage or evacuation of the uterus. Furthermore, we did not see any significant association between adenomyosis and pain-related symptoms, indication for hysterectomy, age, parity or number of myometrial samples. CONCLUSIONS: Our study stresses the need for precise diagnostic criteria for adenomyosis, and furthermore indicates that endometrial hyperplasia and adenomyosis may have a common aetiology.

[Failure of fluoroquinolone treatment in pneumococcal pneumonia]. / Svigt af fluorokinolonbehandling ved pneumokokpneumoni.

Based on a case story concerning the development of pneumococcal pneumonia in relation to treatment with a quinolone, use of such antibiotics in respiratory tract infections is discussed. In the light of in vitro results, animal experiments, and clinical reports of treatment failure of quinolones, we warn against the routine use of these antibiotics against respiratory tract infections. Quinolones may be useful in the treatment of verified Gram-negative respiratory tract infections, but should always be preceded by susceptibility testing.

Hormonal and menstrual changes after laparoscopic sterilization by Falope-rings or Filshie-clips.

OBJECTIVE: To evaluate the influence of laparoscopic sterilization by Falope-rings (Cabot Medical Corp., Langhorne, PA) or Filshie-clips (Femcare, Nottingham, United Kingdom) on menstrual pattern and ovulatory function. DESIGN: A prospective, nonrandomized study of women sterilized by Falope-rings (n = 6) or Filshie-clips (n = 5). Menstrual charts were kept. Serum follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) were measured by means of radioimmunoassay in one cycle before and 3, 6, and 12 months after the sterilization. Blood samples were drawn on day -6, -2, 0, +6, +10 of the menstrual cycle, ovulation corresponding to day 0. The women sterilized by Filshie-clips had abdominal ultrasonography of the ovaries measuring the leading follicle on day -6, -2, 0, +6 of the menstrual cycle. PATIENTS: Twelve women, 25 to 38 years old, with regular menstrual cycles and no use of oral contraceptives or intrauterine contraceptive device at least 6 months before sterilization. One woman was excluded. RESULTS: After the sterilization, all women reported unchanged menstrual pattern. The follicular rise in E2 unchanged, and FSH levels fell accordingly. Progesterone levels were ovulatory, but the midluteal P peak 3 months poststerilization was significantly decreased. Serial abdominal ultrasonography in women sterilized by Filshie-clips confirmed ovulation in all cycles except in one woman, who had an unruptured follicle in one cycle before and in the sixth cycle after sterilization. CONCLUSION: Laparoscopic sterilization by Falope-rings or Filshie-clips does not seem to interfere with menstrual pattern or ovulatory function.

PIP: Physicians evaluated the effect of laparoscopic female sterilization by Falope-ring and the Filshie-clip technique on the menstrual pattern, the ovarian endocrine function, and the ovulatory function on 6 women at the Rigshospitalet in Copenhagen, Denmark and on 5 women at Gentofte County Hospital in Denmark. They followed these women from 1-2 months before sterilization and at 3,6, and 12 months after sterilization. The physicians took blood samples on day -6, -2, 0 (menstrual cycle), 6, 10 of the menstrual cycle to measure follicle stimulating hormone (FSH), estradiol, and progesterone. Ultrasonography measured the leading follicle of women sterilized by Filshie-clips on day -6, -2, 0, 6, 10 of the menstrual cycle. None of the 11 25-38 year old women used oral contraceptives or an IUD before the surgery. All experienced regular menstrual cycles. The sterilization did not cause any changes in menstruation. Moreover peak estradiol levels rose during the follicular phase and peak FSH levels decreased as normal. Overall peak progesterone levels stayed within normal limits of the ovulatory cycle, but it fell considerably 3 months after sterilization (p.05) and somewhat significantly 12 months after sterilization. Ultrasonography revealed that only 1 women sterilized by Filshie-clips experienced an unruptured follicle in the cycle before and the 6th cycle after sterilization. All other women sterilized by Filshie-clips experienced normal valuation. Based on these results, the researchers concluded that laparoscopic female sterilization by Falope-rings and the Filshie-clips do not affect the menstrual pattern or ovulatory function.

Time-related decrease in diffusion capacity in HIV-infected patients with impaired immune function.

The purpose of this study was to investigate acute and time-related changes in lung function, i.e. forced expiratory volume in 1 second (FEV1), vital capacity (VC) and transfer factor (KCO) in HIV-infected patients with CD4 cell counts less than 400 x 10(6)/l. 66 males with no history of HIV-related pulmonary symptoms participated in a prospective lung function study for 9 months with 3-month intervals between examinations. 15/66 patients (23%) developed acute pulmonary symptoms, i.e. dyspnea (n = 12), cough (n = 13), fever greater than 38 degrees C (n = 13) and interstitial infiltrates on the X-ray (n = 9). Among the 51 asymptomatic patients, a significant time-related decrease in KCO (median decrease of 7%) was found, whereas no significant change in FEV1 or VC was observed during the study. Baseline KCO, i.e. KCO at entry, was found to be significantly higher in the asymptomatic patients (102% predicted (pred.) than in those patients who developed pneumonia (88% pred.). Development of pulmonary symptoms was both followed by a significant decrease in KCO (median decrease 17%), FEV1 and VC. We therefore conclude that HIV-infected patients with impaired immune function have in the absence of pulmonary symptoms a decrease in KCO. In case of pneumonia an acute decrease in both KCO, FEV1 and VC occurs.

Antibody response to whole cells and teichoic acid of Staphylococcus aureus strain E 1369 in human sera.

A whole cell Staphylococcus aureus enzyme-linked immunosorbent assay (ELISA) using the protein A-deficient strain E 1369 as antigen was compared to an ELISA with cell-wall teichoic acid, extracted from the same strain, as antigen for the detection of IgG antibodies against S. aureus in human sera. A total of 178 serum samples from 119 patients with S. aureus endocarditis, complicated and uncomplicated septicaemia, non-S. aureus endocarditis and septicaemia were investigated together with sera from 155 healthy controls. The sensitivity in diagnosing S. aureus endocarditis was better for the whole cell-ELISA (83%) as compared to the teichoic acid-ELISA (61%), and the same was true for complicated septicaemia (41% vs 29%). The whole cell ELISA was also more specific for S. aureus infections with only 3.6% false positive test values compared to 7.1% for the teichoic acid-ELISA. The differences were however, not statistically significant. None of the assays were able to distinguish between complicated and uncomplicated S. aureus septicaemia.

Interaction between limulus amoebocyte lysate and soluble antigens from Pseudomonas aeruginosa and Staphylococcus aureus studied by quantitative immunoelectrophoresis.

To investigate the interaction of Limulus amoebocyte lysate (LAL) with gram-negative bacteria, soluble antigens from sonicated Pseudomonas aeruginosa were studied by various crossed-immunoelectrophoresis methods before and after reaction with LAL. Of 64 possible, at least 7 antigens were affected, as indicated by precipitin pattern, after the reaction with LAL. The precipitates corresponding to lipopolysaccharide and Pseudomonas "common antigen" disappeared. This reaction was inhibited when LAL was pretreated with lipopolysaccharide or by heating. Several of the reacting antigens have been shown to cross-react with many other strains of both gram-negative and gram-positive bacteria. Soluble antigens from a protein A-deficient strain of Staphylococcus aureus were also studied. LAL reacted with at least four of these antigens, including the teichoic acid complex. It is concluded that LAL is highly reactive with lipopolysaccharide, but it can react with other antigens from gram-negative and gram-positive bacteria as well. It is suggested that LAL interacts with biologically important antigens from the bacterial membrane. It is proposed that the reactivity and specificity of LAL for various microbial antigens can be studied by immunoelectrophoretic techniques.

Antibody response against whole Staphylococcus aureus in patients with staphylococcal septicaemia and endocarditis investigated by ELISA.

A whole cell Staphylococcus aureus enzyme-linked immunosorbent assay (ELISA) for the detection of IgG antibodies against S. aureus has been developed. To avoid non-specific binding of IgG to protein A, the protein A-poor strains of S. aureus, E 1369 and Wood 46, were used as antigens. One-hundred and eighty serum samples from 120 patients with S. aureus endocarditis, non S. aureus endocarditis, S. aureus septicaemia and non S. aureus septicaemia were tested together with sera from 155 healthy controls. The sensitivity was similar for the E 1369 ELISA and the Wood 46 ELISA and positive test values were detected in 84.2% of patients with S. aureus endocarditis and 41.2% of patients with complicated S. aureus septicaemia. No distinction could be found between complicated and uncomplicated S. aureus septicaemia. The E 1369 ELISA was more specific showing cross reactions with sera from patients infected with other bacteria than S. aureus in 3.6%. Furthermore, the reproducibility was better for the E 1369 ELISA with a coefficient of variation at 0.054. The absence of need for purified antigens makes the whole S. aureus ELISA easy, rapid and cheap. Therefore, we suggest the whole S. aureus ELISA as a good alternative to previously reported assays using purified cell wall antigens.

Premedication before day surgery. A double-blind comparison of diazepam and placebo.

Premedication with diazepam 0.25 mg kg-1 by mouth was compared with placebo in a double-blind trial in patients undergoing day-case surgery under general anaesthesia. Diazepam decreased significantly preoperative discomfort and apprehension. The patients were discharged on time regardless of the type of premedication, and complaints at the time of discharge and on the following day could be related only to the length of anaesthesia and not to the type of premedication. Premedication given early in the morning remained effective for up to 6 h.

The outcome of pregnancy after threatened abortion.

A prospectively collected group of 93 pregnancies complicated by threatened abortion was carefully monitored throughout pregnancy, during birth and in the perinatal period, and any deviation from a completely uneventful course was registered. Comparison was made with a selected group of 282 non-risk pregnant women. A significant association was found between threatened abortion and the overall number of complications in the second half of pregnancy requiring medical intervention and/or admission to hospital, impending pre-term birth requiring betamimetics, pre-term birth, retention of the placenta, birth weight below 2000 g, light-for-dates infants in case of pre-term birth or birth weight below 2000 g, and hyperbilirubinemia in infants with birth weight below 2000 g. The incidences of perinatal mortality and congenital malformations did not differ significantly from those of the control group. Pregnancies complicated by threatened abortion constitute a risk group requiring careful obstetric and perinatal supervision and follow-up.

Purification of Bordetella pertussis antigens using monoclonal antibodies.

Eleven monoclonal antibodies were produced using whole Bordetella pertussis cells as the immunizing antigen. All monoclonal antibodies reacted with components of Bordetella pertussis, as visualized in immunoblotting of SDS polyacrylamide gels. Selected antibodies were coupled to Sepharose columns and used for isolation of the corresponding antigen. In all cases complete accordance was found between SDS polyacrylamide gel electrophoresis of the eluted antigen and the bands found in immunoblotting of the original extract stained with the respective monoclonal antibody. One major problem in the interpretation of the results was the finding that some of the monoclonal antibodies stained a number of bands in immunoblottings of crude B.pertussis extract. This phenomenon was shown to be caused by proteolytic degradation of the antigens, since prior addition of protease inhibitors to the extract resulted in the staining of only one band. The monoclonal antibodies showed different reactivity patterns with various strains of B.pertussis, B.parapertussis, B.bronchiseptica and less closely related bacteria. Two of the antibodies were strictly specific for B.pertussis.

Purification and partial characterization of filamentous haemagglutinin from Bordetella pertussis using monoclonal antibodies.

Two monoclonal antibodies against filamentous haemagglutinin (F-HA) from Bordetella have been produced. In immunoblotting of a SDS-polyacrylamide gel electrophoresis (SDS-PAGE) of high ionic strength extracts of Bordetella pertussis, the two monoclonal antibodies both stained several high molecular weight bands. The two monoclonal antibodies were used for immuno-affinity column one-step purification of F-HA from high-ionic-strength extracts of Bordetella pertussis. In gradient SDS-PAGE, the eluted F-HA is present as a major double band with a molecular weight of approximately 240,000 daltons and several minor bands with molecular weights down to 90,000 daltons. The monoclonal antibodies were used in a monoclonal antibody catching enzyme linked immunosorbent assay (ELISA) for sensitive and specific detection of F-HA. This ELISA system proved valuable in optimizing the elution conditions for the monoclonal affinity columns.

Diagnostic procedures in threatened abortion.

In a prospective study of 177 women admitted consecutively to the hospital because of vaginal bleeding in the first half of pregnancy, the predictive values of seven hormonal parameters and ultrasound examination were evaluated. Generally, the prediction of abortion proved to be more accurate than that of successful outcome. A single low value for human chorionic gonadotropin (hCG) or progesterone at admission, regardless of gestational age, or an ultrasound examination without signs of fetal life after the ninth week, was unavoidably followed by abortion. Normal hormone values or fetal life detected at ultrasound scan signified successful outcome correctly in 64 to 88% and 79%, respectively. However, in weeks six to nine, a single normal reading of hCG, pregnancy-specific beta 1-glycoprotein, or estriol, or ultrasound scan showing fetal life signs, was followed by successful outcome in every case. The combination of ultrasound scan without fetal life and a low estradiol or human placental lactogen value was inevitably followed by abortion from the sixth and ninth weeks onward, respectively. If paired values of hCG + estradiol or hCG + estriol were low, abortion followed in every case from the sixth and eighth weeks on, respectively.

Current patterns of bacterial infection in myelomatosis.

Bacterial infections were registered in 39 patients with myelomatosis during 18 months in a prospective study. The infection incidence was 0.80 infections per patient year. 81% of a total of 32 isolates were gram-negative. Urinary tract infections due to Escherichia coli were the most frequent infections. Pneumonia due to Streptococcus pneumoniae were infrequently seen compared to previous studies. Hence, the etiologic spectrum has clearly shifted from gram-positive to gram-negative bacteria in these patients. 53% of all infections were hospital-acquired, and most of these were preceded by instrumentation of the urinary tract or indwelling venous catheters. The infections were nosocomial in 7/9 cases of septicemia registered. All 4 patients who died of infection, suffered from hospital-acquired infections. Patients who attracted infections had significantly higher serum creatinine levels and higher mortality compared to the rest of the patients.

Sex-hormone-binding globulin (SHBG) in serum in threatened abortion.

The binding capacity of the sex-hormone-binding globulin (SHBG) was determined by means of a new dihydrotestosterone-binding-capacity test in 73 pregnant women admitted to hospital because of vaginal bleeding between the 6th and 18th gestational week. In general, pregnancies ending in spontaneous abortion displayed lower SHBG-levels than pregnancies with a successful outcome, but a great deal of overlap in SHBG values was found between the abortive and the non-abortive cases. In the 6th to 9th weeks of pregnancy 'non-pregnant' SHBG levels were frequently found despite normal levels of oestradiol (E2) in patients continuing pregnancy until delivery. After the 9th gestational week a highly significant positive correlation was found between E2 and SHBG. The lack of correlation between these parameters before this gestational age indicates that the increased SHBG synthesis seen in pregnancy develops later than the rise in E2. Determinations of SHBG were found to be of limited value in evaluation of the prognosis is threatened abortion.

Antibody response to pneumococcal vaccination in patients with myelomatosis.

17 patients with myelomatosis were vaccinated with a 14-valent pneumococcal capsular polysaccharide vaccine. In comparison to 12 healthy controls, they had statistically significant lower combined geometric mean antibody concentrations (the geometric means of all 14 antigens), both before and 4 weeks after the immunization. Mean antibody increases, however, were remarkably similar in the 2 groups. After 18 months the geometric mean antibody concentrations of the patient group had returned to preimmunization levels or lower for 7 out of 14 antigens. 1 case of pneumococcal bacteraemia occurred in the patient group 8 1/2 months after vaccination in spite of a significant initial antibody response against the infecting serotype 23 F. Pneumococcal vaccination in patients with myelomatosis appears to yield subnormal antibody responses and therefore probably insufficient protection against pneumococcal infection.

Human placental lactogen, pregnancy-specific beta-1-glycoprotein and alpha-fetoprotein in serum in threatened abortion.

The predictive value of HPL, SP1 and AFP in serum were determined in 109 women admitted to hospital because of vaginal bleeding in the 6th to 19th gestational week. The prediction of abortion based on the initial analysis from the day of admission was found to be 91.7%, 75.9% and 81.8% for HPL, SP1 and AFP, respectively. The corresponding values for prediction of successful outcome were 68.7%, 73.6% and 65.4%. The HPL and AFP determinations were, however, found to be valid only after the 9th and 12th gestational week, respectively. A highly significant positive correlation (r = 0.84, P less than 0.001) was demonstrated between HPL and SP1 suggesting that SP1 measurements might replace HPL in the evaluation of the prognosis in threatened abortion.

Laparoscopic sterilization with the Falope-ring technique.

One hundred and sixteen women were admitted to hospital for laparoscopic sterilization by the Falope-ring technique. Up to the present, and with an average observation period of 20.8 months, no pregnancies have occurred. Bleeding from the distal site of puncture and tubal transection were the most common peroperative complications, occurring in 4.4 and 3.5% respectively. In 80 patients, hysterosalpingography was performed after 3 months as a control. Unilateral leakage was demonstrated in 6 patients; 5 of these were resterilized via a minilaparotomy. The Falope-ring technique is easy and quick to carry out and, when performed correctly, is encumbered with a low rate of complications and failures. The method is recommended as an alternative to sterilization via electrocautery of the tubes.