[More women in the medical profession--a benefit?]. / Er flere kvinner i legeyrket en berikelse?

More than a hundred years have passed since the first woman graduated in medicine in Norway. Today, more than 30% of doctors and 20% of specialists are women. In some specialties there are still few women: in general surgery 5%, in otorhinolaryngology 9%; only in some 10% of the specialties are there a little above 30% female doctors. There are also few women in positions of leadership. A better balance between men and women would be a benefit to the medical profession, to the patients, to the working environment and in the shaping of the politics of healthcare. There is a change going on, but a slow one. At present, 50% of medical students are women. It is to be hoped that they will be able to make their career choices on the basis of their skills and preferences rather than their gender. Women doctors make a positive contribution to a male-dominated profession; indeed, they may contribute to a development and expansion of the doctor's role. This calls for changes in attitudes, good support and role models--and satisfactory working conditions. Project groups within the Norwegian Medical Association as well as its Equal Opportunity Committee will be working for this in the new millennium.

Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair. A randomised controlled trial.

OBJECTIVE: To assess the effect of preoperative local anaesthesia with ropivacaine and find out if there was a dose-response relationship with postoperative pain after inguinal hernia repair. DESIGN: Randomised, double-blind, placebo-controlled trial. SETTING: Two Swedish and two Norwegian hospitals. SUBJECTS: 131 Male patients undergoing elective inguinal hernia repair. INTERVENTION: Infiltration of the inguinal field before operation with 0.5% ropivacaine 40 ml (200 mg), 0.25% ropivacaine 40 ml (100 mg) or saline 40 ml. MAIN OUTCOME MEASURES: Wound pain at rest and during mobilisation, pressure exerted to reach pain threshold and maximum pain tolerance after 3, 6, 10, and 24 hours, and after 7 days; consumption of analgesics; and Quality of Life assessed by two independent questionnaires before and after operation. RESULTS: Pain scores after 3 hours were significantly lower in the ropivacaine groups compared with the saline group for all variables (p < 0.05). At 6 hours pain scores were significantly lower for ropivacaine 0.5% compared with saline for wound pain during mobilisation and pressure exerted to reach maximum pain tolerance. Patients given saline made their first request for analgesics significantly sooner than in the other two groups (p < 0.05), and a significantly larger percentage of them requested analgesics during the first 24 hours (p < 0.05). Evaluation of the Quality of Life questionnaires showed no significant differences between the groups. CONCLUSION: Ropivacaine has a significant, dose-related pain-reducing effect in the immediate postoperative period but we could find no support for the theory that preoperative infiltration analgesia reduces long term pain.

The effect of a meal on cardiac output in man at rest and during moderate exercise.

Cardiac output at rest increased by 11-63% in a group of healthy individuals after the consumption of a medium-sized, mixed meal. The maximum post-prandial levels of cardiac output were reached from 10 to 30 min after termination of the meal. Cardiac output values at rest fluctuate around a mean level, and this fluctuation was considerably more marked after a meal, when changes in cardiac output from one 15-s period to another could be of the order of 1-1.5 l min-1. Recording of flow in the superior mesenteric artery before and also after a meal was successful in two subjects in whom anatomical conditions were favourable. Flow in the artery was approximately doubled from the fasting to the post-prandial situation, an augmentation that accounted for about 50% of the concomitant increase in cardiac output. The increases in cardiac output caused by 2-min bouts of standardized, moderate and rhythmic exercise were consistently larger in the post-prandial than in the fasting situation. It thus appears that any tendency for redistribution of blood flow, for example from the gastrointestinal tract to the working muscles, during moderately intense exercise is less marked after a meal than before.

Doppler measurements on branches of the uterine artery in normal, hypertensive and growth-retarded pregnancies.

The quality and reliability of pulsed Doppler recordings from branches of the uterine artery were tested by studying 37 normotensive pregnancies and 14 complicated by pregnancy-induced hypertension (PIH) lasting for several minutes. The coefficients of variation of mean velocity and A/B ratio (= peak systolic/end diastolic velocity) were 0.06 and 0.08, respectively. Thus, calculations of A/B ratio from a limited number of heart beats should be reliable. Calculations were then made from uterine artery Doppler recordings in 65 normotensive pregnancies and 32 with PIH. A significantly higher A/B ratio was found in the PIH group. Among the normotensives, no statistically significant difference in A/B ratio was found between those who gave birth to appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA: less than 10th centile) infants. In the PIH group a significant difference was found; A/B: 1.95 versus 1.78 in the SGA and AGA groups, respectively. The latter was still significantly higher than the normotensive (= 1.60). Two PIH subgroups with equivalent blood pressures and proteinuria, but who gave birth to AGA or SGA infants, were compared. A/B ratio from the latter was significantly higher. These findings show that PIH is associated with increased uteroplacental vascular resistance; increased vascular pathology is associated with fetal growth retardation.

The effect of dihydralazine on blood velocity in branches of the uterine artery in pregnancy induced hypertension.

Dihydralazine is frequently used in severe pregnancy induced hypertension (PIH). Little is known about its effect on the human uteroplacental circulation. In this study, Doppler ultrasound recordings were made from branches of the uterine artery in 5 women with PIH and blood pressure (BP) greater than or equal to 150/100 who received either 7.5 or 10 mg dihydralazine, as repeated intravenous doses of 2.5 mg, before obtaining near-normal/normal BP values. The measurements started 5-10 min prior to the injections and continued as undisrupted as possible during injections and the subsequent 30 min. When the reduction in BP was obtained, the median blood velocity was reduced by 23% (range 10-29%). A/B ratio was calculated at the same time as an indicator of peripheral vascular resistance. The ratio increased, compared with pre-experiment values, in 3 subjects (5, 26 and 31%) but decreased in 2 (4 and 6%). Maternal tachycardia was noted in all but one woman. Continuous fetal heart rate (FHR) recording showed no signs of fetal distress. The uteroplacental circulation does not seem to benefit from the vasodilatory effects of dihydralazine, the response to the decreased perfusion pressure being a reduction in blood velocity and unchanged peripheral resistance.

Blood velocities in the dorsal pedis and radial arteries during labour.

To detect evidence of aortic compression by the uterus in the supine position during labour, blood velocity in the dorsal pedis artery was recorded using Doppler ultrasound. Twenty-seven women in labour, 16 with an epidural block (epidural group) and 11 with painful contractions (non-epidural group) were studied through several contractions in the lateral and supine position. In the non-epidural group, blood velocities showed large fluctuations, typical of temperature regulation, between contractions. During contractions, velocities were reduced by 80% in both positions, most likely due to vasoconstriction caused by pain. Radial artery measurements illustrated the same fluctuations between, and reductions during, contractions. In the epidural group, blood velocities were steadily high without fluctuations between contractions, illustrating sympathetic nerve blockade. In 14 of the 16 women, velocities remained high during contractions; in the remaining two women velocities decreased, mainly in systole, during contractions in the supine but not in the lateral position without concomitant fetal heart rate pathology.

Uterine artery blood velocities during contractions in pregnancy and labour related to intrauterine pressure.

Doppler recordings from branches of the uterine artery were made simultaneously with intrauterine pressure measurements in eight women in labour. Blood velocities fell and pulsatility index (PI) increased during all 22 contractions studied. Velocities were reduced almost linearly by up to 60% when pressure increased from 0 to 50 mmHg. To study the effect of uterine contractions before labour on uterine blood flow, simultaneous Doppler recordings from branches of the uterine artery and external tocodynamometry were made in seven women during the last trimester. Velocities fell during 18 of the 20 contractions studied (median 35%, range 19-71%). Extrapolating from labour contractions, this corresponds to a pressure increase of 30-40 mmHg. Fetal heart rate (FHR) recordings were normal during all contractions.

Blood velocities to the female breast during lactation and following oxytocin injections.

A heterodyne pulsed doppler velocitymeter was used to measure blood velocities in the mammary branch of the lateral thoracic artery during breast-feeding and after oxytocin injections. A few heart beats before the mother felt the milk-ejection reflex, blood velocities fell rapidly by 40-50%, and then increased during the next 1-2 min. Synthetic oxytocin was given intravenously to lactating women, both in doses believed to be physiological in milk-ejection and larger, and the same velocity changes occurred. Synthetic oxytocin was also given to non-lactating women who had never been pregnant or who had breast-fed previously and to one man. In these a rapid increase in velocity was observed after about a half a minute, lasting for 1-2 min. In addition to the short-term effects of breast-feeding, blood velocity increased rapidly towards the end of nursing or a few minutes afterwards, with a maximal increase of 25-50%. It then slowly returned to pre-nursing values during the following 30-60 min. This pattern was seen in both breasts, independent of which breast the infant had been sucking.

Blood velocities in the uterine artery in humans during labour.

Blood velocities in the uterine arteries were measured during labour in humans, by means of the pulsed ultrasound Doppler velocity meter (UNIDOP). The uterine arteries were approached through the abdominal wall at the lateral border of the uterus and through the lateral vaginal fornix. At a depth of 0.5-1.5 cm from the lateral vaginal fornix there were three different arteries in each woman. One of these arteries had similar velocity spectra to the uterine artery as measured through the abdominal wall higher up along the uterus, and the velocities were in the same range. The mean velocities were high and the velocities in diastole were high compared to those in systole. During uterine contractions the velocities were reduced during diastole, reducing mean velocities by 20-40% as measured through the vagina and by 50-60% when measured higher up through the abdominal wall. A second artery, which we believe is a branch of the uterine artery traversing the myometrium, had lower mean velocities and a greater difference between systole and diastole. During contractions the velocities were reduced by 100%. A third artery, which we believe is the descending branch of the uterine artery, supplying the cervix and vagina, had the lowest mean velocities, with backflow during diastole. During contractions the velocities increased 100-140%.

Effect of acetylsalicylic acid, paracetamol and placebo on pain and blood loss in dysmenorrheic women.

The analgesic effect of paracetamol, acetyl-salicylic acid, and placebo on dysmenorrhea were compared in a double-blind cross-over study of 30 women. There was a moderate placebo effect, but no significant difference was found between the three treatments. Blood loss was also measured and it did not vary, with the type of drug ingested. It is concluded that paracetamol and acetylsalicylic acid in the doses used (0.5 g x 4 for 3 days) were not effective against heavy dysmenorrhea, and that none of the drugs influenced the amount of blood lost.

Effect of acetylsalicylic acid, paracetamol, and placebo on pain and blood loss in dysmenorrhoeic women.

The analgesic effect of paracetamol, acetylsalicylic acid, and placebo on dysmenorrhoea were compared in a double-blind crossover study of 30 women. There was a moderate placebo effect, but no significant difference was found between the three treatments. Blood loss was also measured and it did not vary with the type of drug ingested. It is concluded that paracetamol and acetylsalicylic acid in the doses used (0.5 g X 4 for 3 days) were not effective against heavy dysmenorrhoea, and that none of the drugs influenced the amount of blood lost.