A new surgical technique for repairing cystocele in hysterectomized women.

No satisfactorily efficient surgical procedure for correction of cystocele subsequent to hysterectomy has so far been described. Anterior colporrhaphy generally is associated with risk of relapse, since no fibrous tissues or ligaments are available for sufficient fixation to the anterior pelvic wall. In the present study, a new surgical procedure was used, simultaneously performed transabdominally and vaginally by two surgeons. The elevated bladder was fixed without sutures to the posterior retropubic periosteum and to the lower abdominal wall by a two-component fibrin sealant (Tisseel, Immuno AB, Stockholm, Sweden) after invagination of the cystocele. Postoperatively, the vagina was tamponed for 12 hours, and a Foley catheter was used for 4-5 days. Antibiotics were administered for 7 days. This technique has been evaluated in nine patients. The procedure was found easy to perform and well tolerated by the patients. During the observation time 0.5-4 years, no relapse has been registered. This surgical procedure also proved to prevent postoperative stress incontinence, previously concealed by the cystocele.

Serum levels of apolipoprotein A-I, A-II and HDL-cholesterol in second half of normal pregnancy and in pregnancy complicated by pre-eclampsia.

Serum concentrations of Apolipoprotein A-I and A-II, (Apo A-1 and Apo A-II) HDL-cholesterol (HDL-C), Total Cholesterol (TC), triglycerides (TG) and lipoprotein electrophoresis were assayed serially in the second half of normal pregnancy (21 women), in pre-eclampsia (26 women) and in both groups one and six weeks after delivery. In the normal group we found increased concentrations of Apo A-I and HDL-C, which remained unaltered during pregnancy. Apo A-II was unchanged. Correlation coefficients for Apo A-II vs HDL-C and Apo A-I vs Apo A-II decreased gradually towards delivery while it remained at an elevated and unaltered level for Apo A-I vs HDL-C. The Apo A-I/HDL-C ratio was unaltered during the whole study while the Apo A-I/A-II ratio was elevated during pregnancy and the Apo A-II/HDL-C ratio was reduced. These results may indicate a gradual change in the surface structure of the HDL particle or its subfractions. In pre-eclampsia Apo A-I and HDL-C concentrations were reduced, TG was increased and Apo A-II and TC were unchanged when compared with the normal pregnancy group. A more pronounced correlation coefficient was recorded for Apo A-I vs HDL-C than for Apo A-II vs HDL-C and Apo A-I vs Apo II. The results indicate that from an atherogenic point of view normal pregnancy seems more beneficial than pre-eclampsia.

Endometrial content of prostaglandin precursors during the menstrual cycle.

Fractionated curettage was performed in 18 women with cervical intraepithelial neoplasia. Otherwise all appeared to be healthy. The histological examination showed 9 of them to have been sampled in the follicular phase and the other 9 in the luteal phase. Endometrial specimens were simultaneously taken for analysis of the fatty acid pattern of lecithin (PC) and phosphatidylethanolamine (PE) by means of gas-liquid chromatography (GLC). In the luteal phase we found increased concentrations of the total sum of essential fatty acids of the linoleic acid series both in PC and PE (p less than 0.01 in both cases). All the main fatty acid components within this series showed increased mean levels in the luteal phase but only arachidonic acid (20:4) in PE was significantly elevated (p less than 0.01). The total sum of the alpha-linolenic acid series was unaffected by the phase of menstrual cycle. These results seem to indicate that the endometrium accumulates prostaglandin precursors towards the time for menstruation.

Serum cholic and chenodeoxycholic acids during pregnancy and puerperium in normal and pre-eclamptic women.

Serum cholic acid (CA), chenodeoxycholic acid (CDCA) and other biochemical markers of liver diseases were determined during pregnancy and in the puerperium in 19 normal and 16 pre-eclamptic women. In one-third of the cases, either CA or CDCA or both increased to values above the reference limits 6 weeks after delivery.

Serum levels of unconjugated and total oestrogens and dehydroepiandrosterone, progesterone and urinary oestriol excretion in pre-eclampsia.

Peripheral serum levels of unconjugated (E1) and total (tE1) oestrone, unconjugated oestradiol-17 beta, unconjugated (E3) and total (tE3) oestriol, progesterone, unconjugated dehydroepiandrosterone (DHA) and dehydroepiandrosterone sulphate (DHAS), and urinary tE3 excretion were determined in pre-eclamptic patients at gestational weeks 32 and 36 and in women with normal pregnancy at the corresponding length of gestation. DHA and DHAS were also analyzed in samples taken 6 weeks after delivery. There were no differences between pre-eclamptic and normal subjects in unconjugated oestrogens and progesterone. Serum tE1 and tE3 levels and urinary tE3 were significantly lower, and the E1/tE1 and E3/tE3 ratios significantly higher in the pre-eclampsia patients. Serum DNA and the DHA/DHAS ratio were significantly elevated in the pre-eclampsia patients during pregnancy, while no differences in these respects were found in the samples taken 6 weeks after delivery. There were no differences in serum DHAS levels. The findings are thought to reflect a general decrease in fetoplacental oestrogen production in combination with a reduced hepatic steroid conjugation in pre-eclamptic subjects.

Atenolol and metoprolol. A comparison of their excretion into human breast milk.

The transfer of atenolol and metoprolol to human breast milk was studied in 7 lactating women with hypertension. Concentrations of atenolol and metoprolol in maternal plasma and milk and in plasma of the nursed infants were determined. Blood samples were obtained from the women and from the infants during a dose interval. Milk was collected repeatedly from the left breast but only twice from the right breast. The ratio between the area under the milk concentration versus time curve ( AUCm ) and the area under the plasma concentration versus time curve ( AUCp ) in the mother varied between 2.0 and 3.1 for metoprolol and 1.1 and 3.1 for atenolol. The milk concentrations of metoprolol in the right breast were similar to those in the left breast, although the latter had been emptied more frequently. For atenolol the milk concentrations in the right breast were lower than in the left breast. The plasma concentrations of metoprolol and atenolol in the infants were negligible or below the limit of detection. Our results show that exposure of the infant to metoprolol can be minimized if nursing is not undertaken earlier than 3-4 hours after dose intake.

The fatty acid composition of serum lecithin after pregnancy complicated by pre-eclampsia.

Using gas-liquid chromatography the relative fatty acid composition of serum lecithin was measured in 22 women, during and after pregnancies complicated by pre-eclampsia, and the results were compared with those in 21 "normal" puerperal women. The increased values of 22:6 in the linolenic acid series found during pregnancy in women who had pre-eclampsia were also noted in the puerperium and the 22:6 value fell to normal more slowly. This might be due to an enhanced activity of the deacylation-reacylation cycle in this group of patients. All other fatty acids showed a rapid return to normal with values comparable to those of "normal" puerperal women 1 week after delivery. The differences in essential fatty acid distribution between normal and pre-eclamptic women did not seem to have a dietary cause. The prostaglandin precursors (arachidonic and dihomo-gamma-linolenic acids) were not reduced during pre-eclampsia or in the puerperium. Neither breast-feeding nor treatment of hypertension with hydralazine seemed to influence the fatty composition of serum lecithin.

Relative fatty acid composition of lecithin during postmenopausal replacement therapy--a comparison between ethinyl estradiol and estradiol valerate.

The relative fatty acid composition of serum lecithin was followed in groups of women during postmenopausal replacement therapy. The effects of estradiol valerate and ethinyl estradiol in two different doses, and the modulating influence of various progestogens and antiestrogens were compared. Unopposed estrogen treatment enhanced liver lecithin synthesis along pathway I, i.e. reduced the amount of stearic acid and increased the amount of palmitic acid. The effect was clearly dose-dependent and even the low dose of 10 micrograms of ethinyl estradiol was more potent than 2 mg of estradiol valerate. No qualitative difference between the two estrogens was recorded. The sequential addition of the antiestrogen tamoxifen significantly reduced the influence of ethinyl estradiol. Liver lecithin synthesis along pathway I may be stimulated by all estrogens and not only by 17C-alkylated compounds. The prostaglandin precursors, dihomogammalinolenic and arachidonic acid, showed a seemingly dose-dependent increase during estrogen treatment. The comparatively weaker effects of estradiol valerate on lipid metabolism should make this non-alkylated estrogen the first choice in clinical practice.

Relative fatty acid composition of serum lecithin in the normal puerperium.

21 women who had been followed regularly during their normal pregnancies were examined in the puerperium. The relative fatty acid composition of serum lecithin was analyzed by means of gas-liquid chromatography. Palmitic acid decreased and stearic acid increased, which indicates a shift to more pathway II-synthesized lecithin in the puerperal period. Linoleic acid increased and the longer polyunsaturated fatty acids decreased. These changes were slow as compared to the changes in the saturated fatty acids. No correlations were found between the saturated fatty acids and linoleic acid dominating the polyunsaturated fatty acids. The results indicate different incorporational ways into the lecithin molecule of these fatty acid groups. It is suggested that the deacylation-reacylation cycle is responsible for the high content of longer polyunsaturated fatty acids still 1 week after delivery. 6 weeks after delivery normal values were recorded. Breast-feeding did not seem to influence the fatty acid pattern of serum lecithin.

Relative fatty acid composition of serum lecithin in the second half of the normal pregnancy.

Fasting vein blood samples from 21 apparently normal pregnant women were collected in 4-week intervals from the 24th week of gestation until delivery. The relative fatty acid composition of serum lecithin was analyzed by gas-liquid chromatography. Palmitic acid increased successively concomitant with a decrease in stearic acid which indicates that serum lecithin is predominantly synthesized along pathway I. Linoleic acid decreased successively parallel to an increased incorporation of longer polyunsaturated fatty acids and non-essential monoenoic (palmitoleic and oleic) acids. The increased incorporation of longer polyunsaturated fatty acids is suggested to be associated with the increased activity of the deacylation-reacylation cycle. The increase of nonessential monoenoic fatty acids is suggested to be associated with a reduced de novo incorporation of linoleic acid.

The relative fatty acid composition of serum lecithin in one woman with essential hypertension superimposed by severe preeclampsia.

A hospitalized woman with essential hypertension complicated by severe preeclampsia was serially studied in the end of her pregnancy and in the puerperal period. The relative composition of serum lecithin fatty acids was analyzed by gas-liquid chromatography. In the present case, the main finding during pregnancy was a dramatic decrease of the linoleic acid parallel to a vast increase of nonessential fatty acids. Of these fatty acids, 20:3 of the oleic acid series was found in an extremely high quantity which may suggest a compensatory mechanism to reduced levels of essential polyenoic fatty acids. It was suggested that the linoleic acid decrement was mainly associated with the disease. These changes were found to be enhancements of differences earlier found between preeclamptic and normal pregnant women.

The relative fatty acid composition of serum lecithin in preeclampsia.

Fasting vein blood samples were drawn from 12 women with an early, and from 14 women with a late, onset of preeclampsia and, in addition, from 21 normal pregnant women at comparable gestational length. The relative fatty acid composition of serum lecithin was an analyzed by gas-liquid chromatography. There seemed to be more pronounced fatty acid changes between early and late start of preeclampsia than between severe and mild preeclampsia as defined in terms of maternal symptoms. In the preeclamptic groups, palmitic acid increased and stearic acid decreased as among the normal pregnant women, suggesting a similar amount of lecithin synthesized along pathway. 1. Linoleic acid was reduced in preeclamptic patients as compared to normal pregnant women. This finding seems to be associated partly with the increased incorporation of longer polyunsaturated fatty acids and partly with the increased incorporation of nonessential monoenoic fatty acids. The increased content of longer polyunsaturated fatty acids in serum lecithin might indicate a further reinforcement of the deacylation-reacylation cycle in preeclampsia. Linoleic acid reduction may be associated with intrauterine growth retardation.