Supporting young women with menstrual pain - Experiences of midwives working at youth clinics.

BACKGROUND: Menstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems. OBJECTIVE: The objective of the study was to describe midwives' experiences of supporting girls with menstrual pain. METHODS: This is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held inSeptember 2021. The recordings were transcribed and analyzed using thematic analysis. RESULTS: Two main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young women's knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed. CONCLUSION: The results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young women's knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals.

Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment.

BACKGROUND: The aim of the present study was to evaluate the subjective outcome of primary repair of obstetric anal sphincter injury (OASIS) at 6 months, the factors associated with the symptoms of anal incontinence (AI), and the role of a simple survey consisting in one question with three answer choices, combined with the Wexner incontinence score for the assessment of this patient population. METHODS: A retrospective cohort study was conducted on patients with third- or fourth-degree OASIS operated on between January 2007 and December 2013 inclusive at Tampere University Hospital, Finland. At 6 months, the patients were asked to report their Wexner's score as well as the three-choice assessment regarding AI symptoms. Based on this assessment, the patients were divided into three groups: those, asymptomatic, those with mild symptoms who did not want further treatment and those with severe symptoms who were willing to undergo further evaluation and treatment. RESULTS: There were 325 patients (median age 30 years). A total of 310 patients answered the questionnaire. Of which, one hundred and ninety-eight (63.9%) patients were asymptomatic, 85 (27.4%) had mild AI, and 27 (8.7%) experienced severe symptoms. There was no statistical difference in the results between the two techniques used (overlapping vs. end-to-end), or the stage of specialization of the operating physician. Persistent symptoms were associated with instrumental vaginal delivery (OR 2.12, 95% CI 1.32-3.41), severity of the injury (OR 1.64, 95% CI 1.20-2.25), and increased maternal age (OR 1.07, 95% CI 1.02-1.13). The correlation between the three-choice symptom evaluation and the Wexner score was good (Spearman's rho 0.82). CONCLUSIONS: After 6 months, severe symptoms after OASIS repair were present in 9% of women and were more frequent in older women, women with high-degree tears and after instrumental vaginal delivery. A three-choice assessment of AI symptoms correlated well with the Wexner score and might be useful to triage patients who need further evaluation.

Transcription factors PRE3 and WOX11 are involved in the formation of new lateral roots from secondary growth taproot in A. thaliana.

The spatial deployment of lateral roots determines the ability of a plant to interact with the surrounding environment for nutrition and anchorage. This paper shows that besides the pericycle, the vascular cambium becomes active in Arabidopsis thaliana taproot at a later stage of development and is also able to form new lateral roots. To demonstrate the above, we implemented a two-step approach in which the first step leads to development of a secondary structure in A. thaliana taproot, and the second applies a mechanical stress on the vascular cambium to initiate formation of a new lateral root primordium. GUS staining showed PRE3, DR5 and WOX11 signals in the cambial zone of the root during new lateral root formation. An advanced level of wood formation, characterized by the presence of medullar rays, was achieved. Preliminary investigations suggest the involvement of auxin and two transcription factors (PRE3/ATBS1/bHLH135/TMO7 and WOX11) in the transition of some vascular cambium initials from a role as producers of xylem/phloem mother cells to founder cells of a new lateral root primordium.

Understanding the role of water in the interaction of ionic liquids with wood polymers.

Hemicellulose lean pulps are a raw material source for numerous high value products. We have previously presented the IONCELL-P(ulp) process, a hemicellulose extraction method, based on a binary mixture of ionic liquid and water. The IONCELL-P process does not suffer from yield losses or polymer degradation and retains the Cellulose I crystalline form. In this paper, a selection of cellulose dissolving ionic liquids is tested, in order to compare their applicability in the process. We demonstrate that the extraction selectivity towards low molar mass polymers is related to the anion's ability to accept hydrogen bonds (Kamlet-Taft ß-value), if divided by the water molar fraction of the solvent system. Pulp consistency, solvent system viscosity and pH are investigated in order to identify the factors affecting the extraction efficiency. The results show that all the tested ionic liquid-water mixtures were able to dissolve hemicelluloses, but there were differences in their efficiency, selectivity and the ability to process high pulp consistencies.

Nulliparous pregnant women's narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study.

OBJECTIVE: To describe the expectations concerning imminent childbirth before and after 8 weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth. DESIGN: Qualitative study of nulliparous pregnant women's narratives before and after CBT. SETTING: The first ICBT programme for treating severe fear of childbirth. SAMPLE: Fifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme. METHODS: Semi-structured open-ended questions over the internet before and after 8 weeks of ICBT. The data were analysed using thematic analysis. MAIN OUTCOME MEASURES: The participants' narratives pertaining to five different situations during labour and delivery before and after ICBT. RESULTS: After therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth. CONCLUSIONS: Following the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.

Evaluation of fungal extracts to determine immunomodulatory properties.

BACKGROUND: Immunoglobulin E-mediated allergies have doubled in prevalence during recent decades in developed countries.This increase has been attributed, in part, to high hygiene standards, which have reduced exposure to microbes. The capacity of microbes to induce type 1 helper T cell (TH1) responses may imply suppression of TH2 responses. However, little research has been performed with fungal extracts. OBJECTIVES: To evaluate the TH1-inducing properties of fungal extracts. METHODS: A total of 24 fungal extracts, including Cetavlon-precipitated polysaccharides from different yeasts, molds, and mushrooms were prepared.The extracts were screened for production of interferon (IFN)gamma in human peripheral blood mononuclear cells. The active compounds were further purified by mild acid hydrolysis and by column chromatography and studied in human peripheral blood mononuclear cells. RESULTS: Expression of IFN-gamma was induced by several extracts. The strongest expression of IFN-gamma was induced by Candida albicans. The Cetavlon-precipitated mannans of fungi induced cytokine responses that were similar or superior to those induced by whole extracts, C albicans being the most potent inducer of IFN-gamma. Column chromatography-fractionated mild acid hydrolysis of Calbicans mannan was performed. Fractions containing oligosaccharides of 12-16 mannoses induced production of tumor necrosis factor. CONCLUSIONS: Several fungal extracts induce IFN-gamma. The most promising preparations were yeast-derived oligosaccharides. Further research should be focused on purification and eventual synthesis of the extracts.

Evaluation of Fungal Extracts to Determine Immunomodulatory Properties

Antecedentes: En los países desarrollados, la prevalencia de las enfermedades alérgicas mediadas por la inmunoglobulina E se han duplicado en las últimas décadas. Este aumento ha sido, en parte, atribuido a pautas de higiene excesivas que han reducido la exposición a microbios. La capacidad de los microbios para inducir la respuesta Th1 puede dar lugar a la supresión de la respuesta Th2. En este sentido, la investigación que se ha realizado con extractos fúngicos es escasa. Objetivos: Evaluar las propiedades inmunomoduladoras Th1 que inducen los extractos de hongos. Métodos: Se evaluaron un total de 24 extractos de hongos, incluyendo polisacáridos de diferentes levaduras, mohos y hongos. Se estudió la capacidad de estos extractos de inducir la producción de interferón- ƴ (IFN- ƴ) en células mononucleares de sangre periférica (PBMC) humanas. Los extractos fueron posteriormente sometidos a una hidrólisis ácida suave y a cromatografía en columnas. Resultados: Los extractos procedentes de diferentes levaduras, mohos y hongos indujeron un incremento en la expresión de la producción de IFN- ƴ. La expresión más enérgica fue la provocada por Candida albicans (C. albicans). Los mananos fueron también capaces de conseguir un incremento de la expresión de IFN- ƴ similar o superior a la inducida por los extractos enteros, siendo el manano de C. albicans el más potente de todos ellos. Mediante los estudios de estimulación celular, con fracciones obtenidas por cromatografía del manano C. albicans, se observó que aquellas que contenían oligosacáridos de 12-16 manosas indujeron una mayor producción de TNF. Conclusiones: Son varios los extractos fúngicos capaces de inducir la producción de IFN- ƴ. Los productos más potentes fueron los oligosacáridos derivados de las levaduras. Las investigaciones futuras deberían centrarse en la purificación y síntesis final de los mismos (AU)

Background: Immunoglobulin E–mediated allergies have doubled in prevalence during recent decades in developed countries. This increase has been attributed, in part, to high hygiene standards, which have reduced exposure to microbes. The capacity of microbes to induce type 1 helper T cell (TH1) responses may imply suppression of TH2 responses. However, little research has been performed with fungal extracts. Objectives: To evaluate the TH1-inducing properties of fungal extracts. Methods: A total of 24 fungal extracts, including Cetavlon-precipitated polysaccharides from different yeasts, molds, and mushrooms were prepared. The extracts were screened for production of interferon (IFN) ƴ in human peripheral blood mononuclear cells. The active compounds were further purified by mild acid hydrolysis and by column chromatography and studied in human peripheral blood mononuclear cells. Results: Expression of IFN- ƴ was induced by several extracts. The strongest expression of IFN-􀁡 was induced by Candida albicans. The Cetavlon precipitated mannans of fungi induced cytokine responses that were similar or superior to those induced by whole extracts, C albicans being the most potent inducer of IFN- ƴ. Column chromatography–fractionated mild acid hydrolysis of C albicans mannan was performed. Fractions containing oligosaccharides of 12-16 mannoses induced production of tumor necrosis factor. Conclusions: Several fungal extracts induce IFN- ƴ. The most promising preparations were yeast-derived oligosaccharides. Further research should be focused on purification and eventual synthesis of the extracts (AU)

Pro-inflammatory and Th2-type cytokine responses in PBMC in infants are associated with parental smoking.

BACKGROUND: During infancy, a disturbed cytokine balance leads to an atopic immune response. Many risk factors have been associated with the development of atopy. These include parental smoking, elevated cord blood IgE, early exposure to pets and family history of atopy, but the knowledge of their impact on cytokine balance is limited. OBJECTIVE: To assess the cytokines induced by mitogen in peripheral blood mononuclear cells (PBMC) of infants at 3 months and 12 months of age and their potential association with fatty acid (FA) intervention, parental atopy, atopic dermatitis and parental smoking. METHODS: Infants from an intervention study using black currant seed oil (BCSO, n = 34) or placebo (n = 34) were included. PBMC samples were taken at the age of 3 and 12 months. Signs of atopic dermatitis and parental smoking were registered. PBMC were isolated from heparinized blood samples, stimulated with ConcanavalinA mitogen and the cytokine responses were detected at 72 h of stimulation by Luminex technology. RESULTS: Children of smoking parents had elevated levels of IL-4 (P = 0.0004), IL-5 (P = 0.0002), IFN-γ (P = 0.039) and TNF (P = 0.0003) at 12 months of age. Children who had atopic dermatitis by the age of 3 months showed elevated levels of IL-5 at 3 months (P = 0.0027) and 12 months of age (P = 0.022). The production of TNF at the age of 3 months was higher (P = 0.010) and the production of IL-12 at the age of 12 months was lower (P = 0.025) in infants whose parents were atopic. BCSO intervention did not have any effect on any cytokine production or mRNA expression. CONCLUSION: Children of smoking parents had highly significantly elevated levels of Th2-type cytokines IL-4, IL-5 and pro-inflammatory cytokine TNF. The detrimental effects of parental smoking on the child's immune function should lead us to pay more attention to supporting parents to stop smoking.

Stem cell function during plant vascular development.

While many regulatory mechanisms controlling the development and function of root and shoot apical meristems have been revealed, our knowledge of similar processes in lateral meristems, including the vascular cambium, is still limited. Our understanding of even the anatomy and development of lateral meristems (procambium or vascular cambium) is still relatively incomplete, let alone their genetic regulation. Research into this particular tissue type has been mostly hindered by a lack of suitable molecular markers, as well as the fact that thus far very few mutants affecting plant secondary development have been described. The development of suitable molecular markers is a high priority in order to help define the anatomy, especially the location and identity of cambial stem cells and the developmental phases and molecular regulatory mechanisms of the cambial zone. To date, most of the advances have been obtained by studying the role of the major plant hormones in vascular development. Thus far auxin, cytokinin, gibberellin and ethylene have been implicated in regulating the maintenance and activity of cambial stem cells; the most logical question in research would be how these hormones interact during the various phases of cambial development.

Three-year follow-up study of allergen-induced in vitro cytokine and signalling lymphocytic activation molecule mRNA responses in peripheral blood mononuclear cells of allergic rhinitis patients undergoing specific immunotherapy.

BACKGROUND: Allergen-specific immunotherapy (SIT) is known to affect the allergen-specific T helper cell (Th2/Th1) balance and to induce T regulatory (Treg) cells. These observations have usually been made during the first treatment year and often without symptom monitoring. This study was performed to investigate allergen-induced Th2 (IL-4, IL-5)-, Th1 [IFN-gamma, IL-18, signalling lymphocytic activation molecule (SLAM)]- and Treg (IL-10)-type immune responses in peripheral blood mononuclear cells (PBMC) and their association with symptom improvement in allergic rhinitis patients after 3 years of SIT. METHODS: Twenty patients were treated with SIT and 8 patients were studied as untreated controls. PBMC were collected before and after 1 and 3 years of SIT and stimulated with specific allergen. Cytokine and SLAM mRNA expression was determined by TaqMan(R) RT-PCR. Symptoms were recorded yearly using visual analogue scale (VAS) scoring. RESULTS: IL-18, SLAM and IL-10 mRNA expression increased after 3 years of SIT, with a peak at 1 year, whereas IL-5 mRNA expression transiently decreased and IFN-gamma mRNA expression transiently increased after 1 year of SIT. The increases in IL-18 and SLAM expression were not associated with symptom improvement, whereas decreases in both IL-4 expression and the IL-4/IFN-gamma ratio after 1 year of SIT were found in patients with a good therapeutic outcome (>40 percentage unit reduction in VAS). CONCLUSIONS: SIT has long-term effects on allergen-specific immune responses. The induced Treg- and Th1-type responses persist over 3 years of SIT, whereas Th2-type responses are transiently decreased only during early therapy.

Allergen-induced in vitro expression of IL-18, SLAM and GATA-3 mRNA in PBMC during sublingual immunotherapy.

BACKGROUND: Signalling lymphocytic activation molecule (SLAM) and interleukin (IL)-18 induce interferon (IFN)-gamma production from Th1 cells. The allergen-induced SLAM and IL-18 mRNA expressions are increased during subcutaneous immunotherapy (SCIT), but nothing is known about their role during sublingual immunotherapy (SLIT). Transcription factor GATA-3 is associated with Th2 cells but its role in SCIT and SLIT is yet unexplored. This study was undertaken to analyse the allergen induced in vitro mRNA expression of IL-18, SLAM and GATA-3 in peripheral blood mononuclear cells (PBMC) of children with allergic rhinitis (AR) during SLIT. METHODS: Ten patients with AR undergoing pollen SLIT with a weekly dose of 200,000 SQ-U, 10 with 24,000 SQ-U of mixture of Betula verrucosa, Corylus avellana and Alnus glutinosa and 10 with placebo were included. Peripheral blood mononuclear cell were stimulated with birch extract prior to, after 1 and 2 years of the treatment. The mRNA expression was assessed using kinetic real-time RT-PCR (TaqMan); Applied Biosystems, Foster City, CA, USA). RESULTS: The expression of IL-18 mRNA was increased in the high-dose group in comparison to the placebo group after 1 year of therapy (P = 0.028) and had an inverse correlation with the late phase skin reaction after the second study year (r = -0.41, P = 0.041). SLAM mRNA expression increased in the high-dose group from baseline to 1 year (P = 0.028) and correlated with IL-10 (r = 0.96, P < 0.0001) and transforming growth factor-beta (r = 0.80, P = 0.0037) mRNA expression. No significant changes were seen in GATA-3 mRNA expression. CONCLUSIONS: During SLIT, IL-18 and SLAM are upregulated, suggesting that the Th2 type inflammatory response is downregulated during SLIT by increased Th1 type response.

Sevoflurane anaesthesia in children after induction of anaesthesia with midazolam and thiopental does not cause epileptiform EEG.

BACKGROUND: Sevoflurane is a methyl ether anaesthetic commonly used for induction and maintenance of general anaesthesia in children. Sevoflurane is a non-irritant and acts quickly so induction is usually calm. However, inhalation induction with high concentrations of sevoflurane can cause convulsion-like movements and seizure-like changes in the electroencephalogram (EEG). Little is known about the EEG during maintenance of anaesthesia with sevoflurane, so we planned a prospective trial of sevoflurane maintenance after i.v. induction with benzodiazepine and barbiturate, which is another common induction technique in children. METHODS: EEG recordings were made before premedication with midazolam (0.1 mg kg(-1) i.v.), during induction of anaesthesia with thiopental (5 mg kg(-1)), and during maintenance with sevoflurane (2% end-tidal concentration in air/oxygen without nitrous oxide) in 30 generally healthy, 3- to 8-year-old children having adenoids removed. Noise-free EEG data of good quality were successfully recorded from all 30 children. RESULTS: Two independent neurophysiologists did not detect epileptiform discharges in any of the recordings. CONCLUSION: Premedication with midazolam, i.v. induction with thiopental and maintenance of anaesthesia with 2% sevoflurane in air does not cause epileptiform EEG patterns in children.

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years.

OBJECTIVE: To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. DESIGN: Retrospective observational study with long term follow up. SETTING: Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. SAMPLE: and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. MAIN OUTCOME MEASURES: Intra- and post-operative morbidity, mortality and recurrence of prolapse. RESULTS: Sixteen of the 25 women (64 %) had no major intra- or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. CONCLUSION: Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.

Modelling aerosol processes related to the atmospheric dispersion of sarin.

We have developed mathematical models for evaluating the atmospheric dispersion of selected chemical warfare agents (CWA), including the evaporation and settling of contaminant liquid droplets. The models and numerical results presented may be utilised for designing protection and control measures against the conceivable use of CWA's. The model AERCLOUD (AERosol CLOUD) was extended to treat two nerve agents, sarin and VX, and the mustard agent. This model evaluates the thermodynamical evolution of a five-component aerosol mixture, consisting of two-component droplets together with the surrounding three-component gas. We have performed numerical computations with this model on the evaporation and settling of airborne sarin droplets in characteristic dispersal and atmospheric conditions. In particular, we have evaluated the maximum radii (r(M)) of a totally evaporating droplet, in terms of the ambient temperature and contaminant vapour concentration. The radii r(M) range from approximately 15-80 microm for sarin droplets for the selected ambient conditions and initial heights. We have also evaluated deposition fractions in terms of the initial droplet size.

Repetitive synchronized cyclical oscillations of multisystem parameters subsequent to high-dose thiopental therapy for status epilepticus secondary to herpes encephalitis.

We report a case of status epilepticus secondary to herpes encephalitis, treated with thiopental infusion and mechanical ventilation. The computerized storage and analysis of physiological data led to the detection of repetitive synchronized cyclical oscillations of arterial pressure, heart rate, EEG parameters, peripheral temperature and core temperature. Arterial pressure oscillations have been described in patients who are severely systemically unwell; cardiovascular and brain electrical activity may also oscillate in the presence of raised intracranial pressure. In contrast, this patient had no features of severe systemic illness or of raised intracranial pressure. Our hypothesis is that high-dose thiopental may have been a cause of our findings by producing autonomic dysfunction.

IBIS data library: clinical description of the Finnish database. Improved Monitoring for Brain Dysfunction during Intensive Care and Surgery.

Improved monitoring of brain function in intensive care and surgery is a project aiming to develop methods of biosignal processing and interpretation, in order to characterise critical events during anaesthesia and cardiac surgery, effect of anaesthesia regimen, neurophysiological findings of different sedation levels, arousal from post-anaesthesia sedation, post-cardiopulmonary bypass brain dysfunction and early brain dysfunction in patients with multiple organ failure. A data library was collected in the three participating hospitals. This is a description of the data library from the University Hospital of Kuopio, Finland, which includes data from 40 patients after cardiac surgery and from seven patients with multiple organ dysfunction. This project demonstrates that active neuromonitoring can be performed in the intensive care unit without interference with the normal treatment and care. The presented database may serve other scientific workers as a reference for a typical spectrum of perioperative data with respect to severity of disease, length of cardiopulmonary bypass, postoperative levels of sedation and length of hospital stay in cardiac surgery patients, and for types of diseases and outcome in patients with multiple organ dysfunction.

Single sweep analysis of event related auditory potentials for the monitoring of sedation in cardiac surgery patients.

Event-related potentials (ERPs) from the auditory system were investigated in 28 post-operative cardiac patients in order to assess their relevance in the monitoring of patient sedation level. Midazolam (17 patients) and propofol (11 patients) were the sedative agents used. The auditory ERP components of N100 (HAB100) and mismatch negativity (MMN) were considered. A single sweep method based on the AutoRegressive with eXogenous input (ARX) model, which is able to enhance the evoked responses to each single stimulus, was used to process each sweep and to compute traditional parameters on a sweep-by-sweep basis. Differences in the measured parameters were related to variations in the patient sedation levels classified through Ramsay score. Significant differences (P<0.05) in both MMN and HAB100 parameters were found between light sedation (LS) and deep sedation (DS) levels.

The effect of toremifene on bone and uterine histology and on bone resorption in ovariectomised rats.

The effect of the selective oestrogen receptor modulator, toremifene, to inhibit ovariectomy-induced bone loss was studied in rats. The oral doses were 0.3, 3.0 or 30 mg/kg/day for 2 months. 17beta-oestradiol (5 microg/kg/day, subcutaneously) was used as positive control. One group was also treated with a combination of 17beta-oestradiol (5 microg/kg) and toremifene (3.0 mg/kg). Biochemical markers were urinary hydroxyproline and calcium (adjusted with urinary creatinine levels) and the serum level of pyridinoline cross-linked carboxy terminal telopeptide, a bone specific collagen breakdown product. The femoral and sternal trabecular bone thickness served as histological parameters. Ovarectomy increased the levels of hydroxyproline and pyrodinoline and decreased the trabecular bone thickness compared to the sham-operated control group. This was inhibited by both test compounds but 17beta-oestradiol was more efficient. Toremifene did not reverse the ovariectomy-induced reduction of urinary calcium but inhibited the 17beta-oestradiol-related increase. When administered together with oestradiol, toremifene did not reverse the positive effect of 17beta-oestradiol on bone, however toremifene reversed the oestradiol-related uterothrophic effects. These findings indicate that the antagonistic features of toremifene dominate in the rat uterus the agonistic properties do in the bone.