Material and knot properties of braided polyester (Ticron) and bioabsorbable poly-L/D-lactide (PLDLA) 96/4 sutures.

The purpose of the present study was to investigate in vitro the biomechanical material and knot properties and histomorphometrical knot properties of 3-0 braided polyester suture (Ticron) and bioabsorbable poly-L/D-lactide (PLDLA) 96/4 suture. In Ticron five throws are needed to form a secure knot, and the 1 = 1 = 1 = 1 = 1 and the 2 = 1 = 1 = 1 configurations are recommended. For PLDLA several granny and square knots formed a secure knot, but the 1 = 1 and 1 = 1 = 1 knots were the best. These PLDLA knots had lower yield force and strain at yield point, but higher stiffness than the recommended Ticron knots. The ultimate force values did not differ, but PLDLA knots had significantly higher strain at ultimate point. In the histomorphometrical analysis of the recommended knots, the PLDLA knots had a significantly smaller knot surface area than the Ticron knots. According to these results, PLDLA suture proved to be suitable for flexor tendon repair.

A comparative analysis of the biomechanical behaviour of five flexor tendon core sutures.

Five core suture techniques were compared by static tensile testing in vitro. Fifty porcine tendons were used. The core sutures were performed with 3-0 or 4-0 braided polyester suture (Ticron) and the over-and-over running peripheral sutures with 6-0 monofilament polypropylene (Prolene). The core sutures were: (1) Pennington modified Kessler (3-0), (2) Double Pennington modified Kessler (3-0), (3) 4-strand Savage (3-0), (4) 4-strand Savage (4-0), and (5) 6-strand Savage (4-0). Repairs were compared as paired in regard to one variable: the number of core suture strands, the suture calibre, or the suture configuration. Biomechanical differences between the repair groups started during the linear region, with the yield force and stiffness increasing along with the number of core suture strands. All three variables influenced the strain at the yield point. Thus, the strength of the intact repair can be improved by modifying the core suture. In all repairs gap formation started near the yield point after failure of the peripheral suture. The yield force represents the strength of the intact repair composite and should be considered the strength of the tendon repair.

Gynecological problems of mentally retarded women. A case-control study from southern Finland.

Two hundred and fifty-five mentally retarded women (cases) and their age-matched control women with no mental retardation (controls) requiring the assistance of a gynecological consultant were studied. Reasons for consultation, heights, weights, blood pressures, smoking histories, medications, gynecological findings and therapeutic measures recommended after examination were recorded. In comparison to the group of non-mentally retarded control women the group of mentally retarded women had no deliveries at all, the number of pregnancies was 118.3 times less (p < 0.001), abortion 20 times less (p < 0.01), gynecological laparotomies 4.3 times less (p < 0.05) and diagnostic curettages 25.7 times less often (p < 0.001), but the number of lynestrenol induced therapeutic amenorrhea (TA) 123 times more (p < 0.001), anticonvulsive drug therapy 91 times more (p < 0.001), polypharmacy 22 times more (p < 0.01) and virginal gynecological status 11.7 times more often (p < 0.001). Further, among the mentally retarded cases than non-mentally retarded controls, contraception was 58 times less (p < 0.05), not smoking 1.2 times (p < 0.001), the incidence of genital infections 2.9 times and tumors of all kind 4.6 times less common (p < 0.001). Of the present mentally retarded women 67.5% had at least once in their life received lynestrenol for TA. Autopsy confirmed arterial diseases occurred in two out of four mentally retarded patients aged 44 and 45 years, who were current lynestrenol users and died during the study period. Therapeutic amenorrhea exhibited a clinical picture of depressed pituitary gonadal axis.

Lynestrenol induced therapeutic amenorrhea: effects of dose reduction on serum sex-hormones and lipids.

The effect of reducing the dose of peroral lynestrenol by half on serum sex-hormone, lipid and lipoprotein status was studied in 21 mentally retarded women with therapeutic amenorrhea (TA). They had previously received 5 or 10 mg peroral lynestrenol daily for periods ranging from 32 to 196 months. Dose halving of lynestrenol resulted in an increase in serum total testosterone (T) by 16% (p less than 0.05), sex-hormone binding globulin (SHBG) by 39% (p less than 0.01) and high-density lipoprotein cholesterol (HDL-C) by 28% (p less than 0.001). Both the mean serum total and free concentrations of norethisterone (NET and fNET) decreased by 60% (p less than 0.001). The serum concentrations of 17-beta-estradiol (E2), its free fractions (fE2) and free T (fT) were not significantly altered. Significant correlations were observed between the change in HDL-C and the change in T (r = 0.45, p less than 0.05), between the change in SHBG and the change in T (r = 0.62, p less than 0.01), fT (r = 0.43, p less than 0.05) and E2 (r = 0.51, p less than 0.05). The elevation of HDL-C was probably caused by the reduced serum NET concentrations. This also resulted in an increase in serum SHBG concentration, which is regarded as an indicator of the overall estrogen/androgen ratio.

Serum lipids and lipoproteins during therapeutic amenorrhea induced by lynestrenol and depot-medroxyprogesterone acetate.

Serum concentrations of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein A1 (Apo A1), and apolipoprotein B (Apo B) were determined in mentally handicapped subjects (n = 87). 33 women were on lynestrenol 5-10 mg for therapeutic amenorrhea (TA). 18 of them were randomly allocated to continue on lynestrenol and 15 were switched to intramuscular administration of medroxyprogesterone (DMPA). The switch to DMPA resulted in significant increases in HDL-C (33%), Apo A1 (12%), as well as in the HDL-C/LDL-C (48%) and Apo A1/Apo B (22%) ratios. The concentrations of HDL-C and Apo A1 were significantly greater in patients receiving DMPA, than in patients continuing with lynestrenol therapy. The amenorrhea incidence, however, did not differ between the two therapy groups. It is concluded that therapy with DMPA may be associated with smaller atherosclerosis risk than with peroral lynestrenol, because of its weaker effect on HDL-C and A1 levels.

No abortion-inducing effect of the ulcer-healing dose of the synthetic prostaglandin E2 analogue enprostil in first trimester.

Milligram-range doses of E2 prostaglandins have long been used to induce labor or abortion in the second and third trimesters of pregnancy. Enprostil, a synthetic dehydroprostaglandin E2 structural analogue, is administered in microgram doses for the treatment of acute duodenal ulcer and acute gastric ulcer. This study examined the effect of the ulcer-healing dose and twice the ulcer-healing dose upon women in the first trimester of pregnancy. Two hundred and seven women who had requested legal abortion in the first trimester participated in two randomized, double-blind, placebo-controlled, parallel studies. They received two doses of enprostil 35 micrograms (the recommended dose for the treatment of duodenal and gastric ulcer) (n = 51), 70 micrograms (twice the recommended dose) (n = 53), or placebo (n = 103) 12 h apart. No drug-induced abortions occurred in any of the first-trimester pregnancies. Vaginal bleeding occurred in 4% of volunteers receiving the lower dose and 4% receiving the higher dose of enprostil. Vaginal bleeding occurred in up to 2% of volunteers on placebo. Although not recommended for pregnant women, if enprostil is given inadvertently to pregnant women with ulcers, it is unlikely to endanger the pregnancy during the first trimester.

The effect of peroral lynestrenol on serum lipids and lipoproteins in therapeutic amenorrhea of mentally retarded women.

Serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and triglyceride (TG) were measured and that of low density lipoprotein cholesterol (LDL-C) calculated in blood samples obtained from mentally handicapped women undergoing therapeutic amenorrhea (TA) induced by 5-10 mg of peroral lynestrenol, some receiving, some not receiving simultaneous anticonvulsant therapy (phenytoin, carbamazepine or barbiturate, alone or in combination). In addition, these analyses were carried out in women receiving only anti-convulsants and in controls (mentally handicapped women not receiving any of the above-mentioned medications). Significantly lower HDL-C, Apo A1, TG and cholesterol concentrations were measured in TA patients receiving lynestrenol only, than in those receiving anticonvulsants only, or in controls (p less than 0.001). With regard to HDL-C and Apo A1, patients receiving both lynestrenol and anticonvulsants were intermediate between lynestrenol only patients and controls, but the HDL-C/LDL-C and Apo A1/Apo B ratios were similar to those observed in lynestrenol only patients. Addition of 8 or 12 mg of estriol succinate to the lynestrenol regimen was virtually without an effect. However, halving of the lynestrenol dose resulted in a significant increase in HDL-C and in the HDL-C/LDL-C and Apo A1/Apo B ratios (p less than 0.001 or p less than 0.01), respectively. The lynestrenol dose was thus the most important determinant of lipoprotein pattern and should be kept as small as possible in order to reduce cardiovascular risk.

Peroral lynestrenol and arterial disease in mentally retarded women. A case-control study based on autopsy findings.

Autopsy findings from 170 non-smoking and mentally retarded women aged 12-51 years were analysed for any epidemiological association between the use of peroral lynestrenol for inducing therapeutic amenorrhea (TA) and arterial disease. Eighty-six women had received lynestrenol continuously for an average of 81 months (range 2-220 months) and the other 84 had not. After exclusion of 6 cases with known risk factors (diabetes, hypertension) predisposing to arterial disease, pathological arterial changes were found in 16 patients, 10 of them belonging to the TA group and 5 to the non-lynestrenol group. The incidence of arterial disease at autopsy at the age of 35 or more was 8/19 in TA patients and 1/15 in non-lynestrenol patients (p = 0.078). The benefits of prolonged TA induced by lynestrenol in this group of patients must be weighed very carefully against the possible risks involved.

Changes in placental intervillous blood flow measured by the 133xenon method during lumbar epidural block for elective caesarean section.

The effect of lumbar epidural block on placental intervillous blood flow (IBF) was estimated with the i.v. 133Xe method in 24 cases and in 14 controls. All parturients had uneventful pregnancies and were scheduled for elective caesarean section. Lumbar epidural block caused a significant decrease in maternal mean arterial pressure (MAP), when no preloading infusion with a plasma expander was given. In contrast, the MAP remained unchanged during lumbar epidural block when the parturients received a preloading infusion (Haemaccel, 100 ml/10 kg body weight within 10 min immediately before lumbar epidural block). The IBF decreased to some extent in the non-preloaded group, but increased temporarily in the preloaded group 15 min after the administration of lumbar epidural block. The mean changes of IBF in the non-preloaded and the preloaded groups differed statistically significantly from each other during lumbar epidural block. The IBF of the preloaded group did not differ significantly from the IBF of the control group receiving no lumbar epidural block.

Effect of maternal position on fetal heart rate during extradural analgesia.

Using continuous cardiotocography, the effect of maternal position on fetal heart rate (FHR) was studied during extradural analgesia (EA) with either 50 or 100 mg of etidocaine without adrenaline for labour and vaginal delivery. Of 70 healthy parturients, 39 were supine and 40 were in the lateral position. FHR was normal in all patients during the control period before EA, and remained normal during EA in 53. Transient abnormal patterns occurred in 26 patients, 22 (56%) in the supine group and four (10%) in the lateral group, a significant difference (P less than 0.001). The decrease in arterial pressure (AP) did not differ between the groups, but the frequency of abnormal FHR associated with a small or moderate decrease in AP (30% or less) was greater in the supine (51%) than in the lateral group (3%).