[Long-term outcome after endovascular treatment of high-risk patients with recurrently symptomatic intracranial stenoses of the posterior circulation]. / Langzeitergebnisse nach endovaskulärer Behandlung von Hochrisiko-Patienten mit mehrfach symptomatischen intrakraniellen Stenosen der vertebrobasilären Strombahn.

PURPOSE: We present long-term clinical and duplex data from high-risk patients with severe, recurrent symptomatic stenoses of the vertebrobasilar circulation. We hypothesized that despite the greater risk of periprocedural complications in this patient group, interventional treatment would reduce the risk of recurrent strokes relative to the expected natural risk. We also predicted that the long-term treatment outcome would be positively influenced by the use of stents and by the periprocedural technical success rate. MATERIALS AND METHODS: An analysis of our patient data base yielded 45 cases of stenosis of the vertebrobasilar circulation treated endovascularly in 42 patients between 1998 and 2006. Clinical and vascular diagnostic tests, both periinterventionally and during follow-up, were performed independently by experienced neurologists. RESULTS: The technical success rate was 93%. Stents were used in 67% of the procedures. After 30 days, 24% of the patients showed post-procedural clinical deterioration. After an average period of 26.3 months, 17.8 % of the patients had deteriorated. 11.1% of the patients suffered severe permanent damage as a result of the procedure (mRs 3 - 6). Restenosis was found in 9.5% of the cases. There were no instances of a recurrent stroke during follow-up. CONCLUSION: For this population of high-risk patients with recurrently symptomatic intracranial stenoses of the vertebrobasilar axis, endovascular treatment reduced the risk of stroke and death relative to the expected natural risk. The use of stents had no significant effect on the long-term results.

Is diathermy safe in women with copper-bearing IUDs?

Ultrasound and short-wave diathermy are widely used in physiotherapy to induce heating of deep tissues, since this causes a concomitant increase in local blood flow. A metallic implant in the treated field is generally regarded as a contra-indication to diathermy because of the risk of thermodamage to surrounding tissues. It is not certain, however, if copperbearing IUDs contain sufficient metal as to constitute a risk. In order to exclude the possibility that diathermy might lead to intra-uterine burns in women using copperbearing IUDs a technique was devised of measuring temperatures in the copper wire of an IUD in situ during short-wave an ultrasonic therapy. The results indicate diathermy to be perfectly safe in women whit copper-bearing IUDs.

PIP: Physicians at the hospital in Tonder, Denmark performed a dilation and curettage (D&C) procedure on 8 44-58 year old women who were experiencing perimenopausal bleeding problems. Prior to the D&C, the physicians 1st inserted a glass/ethanol thermometer with a Multiload copper 250 IUD attached then a thermometer with no copper IUD attached into the uterus to measure the temperature during short wave or ultrasonic diathermy. Since diathermy induces therapeutic tissue temperatures and increases blood flow, it is used to treat several conditions in women of childbearing age. So the physicians wanted to determine if diathermy in women bearing copper IUDs results in thermogenic damage to the uterine lining. Short wave diathermy at recommended dose intensity of minode 3 (maximum 400 W) resulted in a small increase in intrauterine temperature when a noncopper bearing thermometer was used (36.4 degrees Celsius-37 degrees Celsius). The corresponding temperatures for the thermometer with a copper bearing IUD attached were slightly higher (36.8 degrees Celsius-37.6 degrees Celsius) perhaps due to the metallic content of the thermometer. Ultrasonic diathermy at recommended dose intensity of 1.5 W/square cm) resulted in an insignificant increase in intrauterine temperature (patient 1, 36.1 degrees Celsius-37 degrees Celsius; patient 2, 36.5 degrees Celsius-37.3 degrees Celsius.) The physicians suggested that this minute rise may reflect ultrasonic diathermy's insufficient penetration of the uterine cavity. None of these temperatures reached the level needed to induce a protective increase in blood flow (38.1 degrees Celsius). Indeed none reached harmful levels. Therefore diathermy at dose intensities within the normal therapeutic range can be safely used to treat women with copper bearing IUDs.

Ovulation in uremic women: the reproductive cycle in women on chronic hemodialysis.

We studied five uremic women of fertile age and on chronic intermittent haemodialysis over a 3-month period. The purpose of this investigation was to establish how often the hormonal pattern indicated ovulation in uremic women and, thereby, the possibility of an inexpedient pregnancy. The pituitary ovarian axis was estimated by analyzing the serum concentrations of follicle-stimulating hormone, luteotropic hormone, progesterone, estradiol, and prolactin. Forty percent of the investigated cycles seemed to be ovulatory, though with a slightly atypical hormonal pattern. Because of these factors, it is recommended that sexually active women of fertile age and on chronic intermittent hemodialysis consider the use of contraception in order to avoid unwanted pregnancies.

Maternal febrile morbidity after cesarean section.

The frequency of puerperal febrile complications is considerably higher following cesarean section than after vaginal delivery. In a retrospective investigation of 234 planned operations and 506 emergency operations, a significantly different frequency of febrile morbidity (FM) was found following the two types of operation (7.7% vs. 20.9%). The development of FM following emergency operation was investigated in relation to factors such as age, parity, repeat cesarean section, surgeon's experience, peroperative bleeding, rupture of membranes, frequency of vaginal exploration, gestational weeks, pre- and postoperative anemia. We found some predisposing factors to FM and of these five, each was significant, but a multiple regression analysis showed that only rupture of the membranes, and pre- and postoperative anemia have an independent significant explanatory value (p less than 0.01).

Impaired insulin receptor binding and postbinding defects of adipocytes from normal and diabetic pregnant women.

To evaluate the relative contribution of insulin binding and postbinding defects of glucose utilization in peripheral tissue during normal and diabetic pregnancy, we have studied the in vitro insulin action of isolated adipocytes from eight nondiabetic pregnant women and nine pregnant women with insulin-dependent diabetes mellitus who were undergoing cesarian section. The pregnant women were compared with a matched group of normal nonpregnant women undergoing gynecologic surgery. Insulin binding to adipocytes measured at tracer insulin concentration was reduced by 45% (P less than 0.01) in normal pregnant women and by 30% (P less than 0.02) in pregnant women with diabetes. In contrast, no changes were found between the three groups in insulin binding to pure monocytes and erythrocytes. The glucose transport system in fat cells from both groups of pregnant women was characterized by impaired maximal (P less than 0.05) and half-maximal (P less than 0.05) response to insulin. When fat cell glucose metabolism was studied, pregnant diabetic women exhibited decreased basal lipogenesis (P less than 0.05) and decreased maximal responses of lipogenesis and glucose oxidation to insulin stimulation (P less than 0.05). Similar but less pronounced abnormalities were seen in glucose metabolism of adipocytes from nondiabetic pregnant women. In conclusion, both in late normal and diabetic pregnancy, insulin binding to adipocytes is significantly reduced and accompanied by decreased insulin sensitivity and reduced maximal insulin responsiveness of glucose transport and by impaired basal and maximally insulin-stimulated glucose metabolism.

Diabetes mellitus and pregnancy. A seven-year material of pregnant diabetics, where control during pregnancy was based on a centralized ambulant regime.

A 7-year survey of the outcome of pregnancy complicated by diabetes mellitus, carried out at the Aarhus center, is presented. The material comprised 344 diabetic pregnant women where the control was based mainly on a centralized ambulant regime. The latter half-period was moreover based on self-monitoring of the blood glucose level. This achieved a significantly better blood glucose regulation, with a reduction of the mean blood glucose level from 7.9 to 6.4 mmol/l. Furthermore, the introduction of self-monitoring halved the number of hospitalizations necessary for blood glucose regulation. Pregnancy was complicated in about 35%. The importance of screening for urinary tract infection is emphasized, since this, which was present in 20% of cases, might be a possible factor in ketoacidosis and/or intra-uterine growth retardation. In 19% of the vaginal births it was deemed necessary to give instrumental assistance; 5% had shoulder dystocia. The cesarean section frequency was 31%. The antenatal mortality rate was 1.2% and the uncorrected perinatal mortality was 3.5%, half of the neonatal mortality was due to fatal congenital malformations. About half of the newborn babies required immediate intensive neonatal treatment. Because of the high frequency of complications in pregnant diabetics, during childbirth and in the neonatal period, centralized monitoring by a highly specialized team is necessary in order to maintain the present relatively low perinatal mortality and morbidity rates and the low number of cesarean sections, together with the most convenient control regimen for this highly pathological group. Furthermore, centralization will facilitate research which, together with prepregnancy consultation, may reduce the frequency of major fetal malformations.

Heart frequency of the fetus at birth.

Heart frequency was recorded in 10 infants during the delivery and the following day. It was found that during vaginal birth, in cephalic presentation, heart frequency decreased during the last 3 minutes before delivery of the head. In breech presentation the initial deceleration was shorter, while with cesarean section there was no initial deceleration. Shortly after delivery of the head and in close connection with the first cry, a tachycardia lasting approx. 10 minutes was observed in all infants. On the day after birth, all infants had a normal heart frequency. It is concluded that the heart frequency changes correspond to the alterations expected on the basis of the caput compression and the relative fetal hypovolemia arising during the final stage of the vaginal delivery. These observations also indicate that the variable deceleration is caused partly by fetal hypovolemia. The neonatal tachycardia is presumably a response to the ordinary placental transfusion and neonatal adaptation to extra-uterine life.

Self-monitoring of blood glucose in pregnant diabetics. A comparative study of the blood glucose level and course of pregnancy in pregnant diabetics on an out-patient regime before and after the introduction of methods for home analysis of blood glucose.

Sixty-one pregnant patients with insulin-dependent diabetes mellitus completed a self-monitoring program consisting of five daily blood glucose tests at least twice weekly during the ambulatory periods of their pregnancies. Either a reflectometer method, Eyetone, glucometer--reflectometer, or Haemoglucotest 1-44 test strips were used. Of 1 834 glucose profiles, 45% were optimal, with all blood glucose values between 3.9 and 8.3 mmol/l. The 61 pregnancies were compared with 62 pregnancies where the diabetic control and therapy principles were identical, but where self-monitoring blood glucose methods were not employed. The self-monitoring regime resulted in a significant drop in mean blood glucose levels, from 7.8 +/- 1.3 to 6.4 +/- 1.0 mmol/l, compared with the period before the self-monitoring program was introduced. Furthermore, a decline in the number of diabetes-conditioned extra hospitalizations during pregnancy in the self-test group could be registered.

Course and treatment of milk stasis, noninfectious inflammation of the breast, and infectious mastitis in nursing women.

In nursing women with inflammatory symptoms of the breast, it has been possible on the basis of leukocyte counts of the milk and quantitative cultivation for bacteria to classify these cases into milk stasis (counts of less than 10(6) leukocytes and less than 10(3) bacteria per milliliter of milk), noninfectious inflammation (counts of greater than 10(6) leukocytes and less than 10(3) bacteria), and infectious mastitis (counts of greater than 10(6) leukocytes and greater than 10(3) bacteria). In the present study the duration and outcome of these cases were observed, and those without intervention were compared to those with treatment that consisted of systematic and intensive emptying of the breast, supplemented in some cases by antibiotic therapy as directed by susceptibility tests of the bacteria. The course of milk stasis was of short duration and the outcome was good independent of treatment. In cases of noninfectious inflammation the symptoms persisted for several days without treatment, and half of the patients developed infectious mastitis. Emptying of the breast resulted in a significant decrease in the duration of symptoms and a significantly improved outcome. Infectious mastitis without treatment was followed by a good result in only 15% of the cases, and 11% developed abscesses. Emptying of the breast increased the rate of a good outcome to 50% and significantly decreased the duration of symptoms. The addition of antibiotic therapy resulted in a good outcome in 96% of the cases and a further significant reduction of the persistence of symptoms.

Controlled study of bromocriptine and placebo for induction of ovulation in normoprolactinemic secondary amenorrhea.

In order to evaluate the effect of bromocriptine in the treatment of secondary amenorrhea, a double-blind placebo-controlled study including 30 women with normo-prolactinemic normo-hypogonadotropic hypogonadism was carried out. The patients were given either 5 mg bromocriptine or placebo every day for 12 weeks and observed during the following 3 months. A biphasic basal body temperature curve and serum progesterone levels exceeding 25 nmol/l during the expected midluteal phase were considered an indication of ovulation. Restoration of ovulation was observed in 2 of 17 women given bromocriptine and 4 of 13 women given placebo. Bromocriptine was found to have no specific effect on the restoration of ovulation in women with secondary amenorrhea and normoprolactinemic normo-hypogonadotropic hypogonadism.

[Ovulation determined by basal temperature curves]. / Ovulation bedømt ved basaltemperaturkurve.

PIP: 64 regular menstrual cycles with either normal diphasic or monophasic basal temperature curves were assessed hormonally by means of serum estradiol and serum progesterone analyses twice weekly. A 2-humped normal serum estradiol course with serum progesterone values in the normal range is considered indicative of the occurrence of ovulation. In 53 cases, good agreement was found between hormonally verified ovulation/anovulation and diphasic/monophasic temperature curves. In 6 patients, normal diphasic temperature curves were found in cycles which were anovulatory as estimated by hormone analysis. In 5 cases, the temperature curves were monophasic in cycles which were ovulatory as judged by hormone analysis. (author's)^ieng

[Liver tumor and prolonged oral contraception]. / Leuertumor og langvargt p-pilleforbrug.

PIP: A case of focal nodular hyperplasia of the right hepatic lobe was discovered during the hysterectomy operation of a 40 year old woman. The patient had used oral contraceptives almost continuously for 15 years to treat metrorrhagia. The patient had been using a preparation consisting of .5 mg norgestrel and .05 mg ethinyl estradiol for 6 years prior to the operation; the other preparations were unknown. The relationship between oral contraceptive use and developing benign hepatic tumors is discussed.^ieng