Exploring the Diagnosis and Management of Bouveret's Syndrome.

Bouveret's syndrome is an unusual cause of gastric outlet obstruction secondary to gallstone impaction. It is so rare that it is commonly missed in clinical practice if it is not considered in differential diagnoses of intestinal obstruction more specifically in man who does not report the history of gall stone. Furthermore, there are no definitive guidelines on approach and management of this condition. We present a seventy eight year old man who developed acute abdominal symptoms due to impaction of a gallstone in the duodenum. He did not have history of gall stone. The diagnosis was supported via CT abdomen and Endoscopy. The patient was successfully managed by exploratory laparotomy followed by anterior pylorotomy to remove the stone without cholecystectomy and fistula repair.

An experimental helical-tubular photobioreactor for continuous production of Nannochloropsis sp.

An experimental helical-tubular photobioreactor has been designed for controlled, continuous production of Nannochloropsis sp. Its main advantages are: (1) combination of large ratio of culture volume to surface area along with the optimised light penetration depth, (2) easy control of temperature and contaminants, (3) effective spatial distribution of fresh air and CO(2), (4) better CO(2) transfer through extensive interface surface between fresh air and culture-liquid medium and (5) novel automated flow-through sensor providing continuous cell concentration monitoring. Nannochloropsis sp. population density reached maximum value under rather high temperatures and combined natural and artificial light conditions. An average daily increase of 30 x 10(6)cells ml(-1) was obtained at population densities above 350 x 10(6)cells ml(-1) allowing daily harvesting rates of at least 10% the total volume. Measured cellular density productivity data and estimated volumetric productivity range of 1.10-3.03 g l(-1)day(-1), are among the highest Nannochloropsis sp. productivities reported in the literature.

Legislated right for donor-insemination children to know their genetic origin: a study of parental thinking.

BACKGROUND: In Sweden, a child born as a result of donor insemination (DI) has the right to receive information both about the DI and the identity of the donor. The present study aimed to elucidate parents' thoughts regarding these possibilities, and whether, how and when they had told their offspring about the DI. An additional aim was to examine the parents' experiences of the attitudes of healthcare providers. METHODS: A follow-up study using semi-structured telephone interviews with 19 couples, including 19 women and 17 men. RESULTS: More than half of the parents (61%) had told all their child/ren about the DI, but almost everyone had told another person. Mean age for disclosure was 5 years for the first child. Reasons given for disclosure were to avoid accidental discovery, a desire for openness and a persons' fundamental right to know his/her genetic origin. Parents who did not intend to tell their child/ren considered DI a private matter and were afraid of other people's attitudes. Sixty-one percent of the parents had not yet told their children about the possibility of identifying the donor. Healthcare staff had impacted on the parents' thinking, and a majority of those who had been encouraged to tell their child/ren about the DI had done so. CONCLUSIONS: There was a discrepancy between the intentions of the legislation and how parents act in relation to them. To improve compliance, it is crucial to organize education, support and ethical discussion among professionals, and to offer parents, and parents-to-be, counselling, support and group sessions with other DI families.

Life 20 years after unsuccessful infertility treatment.

BACKGROUND: This study explores the long-term experience of involuntary childlessness among 14 Swedish women 20 years after their infertility treatment. METHODS: In-depth interviews were conducted. RESULTS: The childlessness had had a strong impact on all the women's lives and was for all a major life theme. The effects were experienced both on a personal level and on interpersonal and social levels. Half of the women were separated, and in all but one, sexual life was affected in negative and long-lasting ways. The effects of childlessness were especially increased at the time the study was conducted, as the women's peer group was entering the 'grandparent phase'. Many coped with their childlessness by caring for others, such as the children of friends or relatives, elderly parents or animals. CONCLUSION: These findings represent a small sample, but they point towards the need for developing models of counselling and support that stimulate self-reflection and strengthen personal resources and empowerment for individuals and couples experiencing involuntary childlessness.

Adverse mood effects during postmenopausal hormone treatment in relation to personality traits.

OBJECTIVE: When postmenopausal women are treated with sequential hormone therapy (HT), cyclical mood swings similar to symptoms seen in the premenstrual dysphoric disorder (PMDD) are described. Women with a history of premenstrual symptoms (PMS) seem to respond differently to the addition of a progestin to estrogen than women without previous PMS. This study aimed to investigate personality traits and daily mood symptoms in women with a history of PMS and women without, while treated with estrogen and sequential progestin. METHODS: A total of 106 women, who participated in clinical trials designed to evaluate mood and physical responses to sequential estrogen and progestin therapy, filled out the Karolinska Personality Scale (KSP) form, before entering the studies. The treatment consisted of 2 mg estradiol valerate continuously, with an addition of 10 mg medroxyprogesterone acetate (MPA) during the last 12 days of the 28-day cycle. Subjects kept daily symptom ratings using a validated symptom scale during these two treatment cycles, and these were used for the analyses. The study-groups were stratified for a history of PMS or not, appearance of progestin-induced adverse mood effects or not, and symptom cyclicity or not. RESULTS: There was a significant co-variation between the women who reported the highest negative mood scores during the addition of progestin to estrogen and a history of PMS. Women with PMS history reported different personality characteristics as having higher scores of anxiety symptoms of muscular tension, feeling more indirect aggression and lack of impulse control, and being less satisfied with their lives or childhood, compared to women without a PMS history. Women who reported the most intense negative mood symptoms during the progestin phase reported more somatic anxiety, an aim to avoid monotony, a lower satisfaction with life or childhood, and higher scores of indirect aggression and irritability. CONCLUSIONS: Women with a history of PMS and women with a high anxiety-related personality might respond with adverse mood effects to a combination of estrogen and sequential progestin and therefore a thorough evaluation should be made, at the consultation for hormone therapy, of mood benefits or disadvantages before initiation of treatment and there should be a close follow-up after.

Increased contraceptive use one year post-abortion.

BACKGROUND: The aim of the study was to investigate the impact of abortion on contraceptive use, partner relationship and sexual satisfaction. METHODS: In a longitudinal study, 58 women answered a pre-abortion questionnaire and participated in two interviews, one in connection with the abortion and a second 1 year later. RESULTS: Most women (40/58) had retained the same partner 1 year after the abortion. More than half of these (22/40) experienced no change in the quality of the partner relationship, while the rest (18/40) had deepened their relationship. Furthermore, the majority of the women (45/58) had not experienced any negative influence on their sexual satisfaction. Most women who were sexually active 1 year post-abortion (42/47) used some contraceptive method; the number who used hormonal methods or intrauterine devices had, for example, increased from four to 35, although one-third of them had been doubtful about these methods before abortion. Conversely, 15 women had tried these methods during the follow-up year but had not continued because of negative effects. Overall, contraceptive use 1 year post-abortion had increased. CONCLUSIONS: To achieve well-founded decisions about contraceptives, counsellors should be aware of women's ambivalence about the use of modern, effective contraceptive methods. In order to prevent abortion it is important to discuss gender differences in sexual behaviour and encourage communication with both sexes about the pros and cons of coitus-dependent and coitus-independent methods.

Semen providers and their three families.

BACKGROUND: In 1985 the Swedish government introduced legislation that required all semen providers to furnish identifying information on themselves which would then be made available to their biological/provider offspring when they are deemed to have 'sufficient maturity'. The purpose of the legislation was to protect the child's rights and needs. The aim of this paper is to examine the degree to which semen providers have considered the implications of their decision to donate upon their three families; their birth family, the family they form with their partner, and the recipient family. METHODS: Thirty semen providers from two Swedish clinics were sent self-completion questionnaires collecting both quantitative and qualitative information. The initial response rate was 100%. Questions requested demographic information; the degree to which semen providers had consulted with or advised their partners, family, existing offspring and acquaintances about their semen donation; views and attitudes of semen providers towards donor offspring, anonymity, information sharing, payments to semen providers, community acceptance of DI and semen providers, experience of donation, recruitment/screening procedures. RESULTS: Almost all respondents had told their partners that they were providing semen, however, a much smaller proportion had told their birth families. Almost two thirds of semen providers were positive or very positive about the prospect of meeting their offspring at some time in the future, with older men expressing more enthusiasm. CONCLUSIONS: The findings suggest that semen providers have only partially considered and addressed the full implications of having semen provider offspring. The age of semen providers could be influential in determining some attitudes and views.

The condom in relation to prevention of sexually transmitted infections and as a contraceptive method in Sweden.

OBJECTIVE: To analyze in detail the latest Swedish population survey regarding condom use in order to gain a deeper knowledge of the characteristics of women and men using or not using condoms at a time when the number of sexually transmitted infections (STIs) had started to increase. METHODS: From a population-based survey of sexual life in Sweden among men and women aged between 18 and 74 years (n = 2810), we investigated the use of condoms in relation to social demographic, lifestyle, sexual and behavioral characteristics. RESULTS: In the age group 18-49 years, every third person had experience of a legal abortion and every fourth had had an STI. Overall, use of condoms was 12% in the whole population and 15% in the age group 18-49 years. Using a condom as a method of contraception, as opposed to other methods, was found to be less frequent in six subgroups: when coitus was less frequent, age above 25 years, among those who had had many partners and those with earlier experience of abortion or STI, as well as having a risky behavior. Using a condom as a preventive against contracting an STI occurred less often in women and men older than 25 years and among those having coitus more frequently. CONCLUSION: Even with good information and easy accessibility to condoms, there are still obstacles to their use. To achieve the aim of safer sexual practice, it is a challenge for the couple as well as for counselors to reason about the advantages and disadvantages of not using a condom. Discussions about attitudes, behavior and gender differences must be continued and emphasized in coming generations, both on the individual and on a societal level, in order to achieve safer sexual practice.

Wellbeing and mental growth-long-term effects of legal abortion.

The present study aims to increase knowledge about coping with legal abortion by studying women's reasoning, reactions and emotions over a period of 1 year. The study comprises interviews focusing on the experiences and effects of abortion in 58 women, 4 and 12 months after the abortion. The women also answered a questionnaire before the abortion concerning their living conditions, decision-making process and feelings about the pregnancy and the abortion. Majority of the women did not experience any emotional distress post-abortion and almost all the woman reported that they had coped well at the 1-year follow-up, although 12 had had severe emotional distress directly post-abortion. Furthermore, almost all described the abortion as a relief or a form of taking responsibility and more than half reported only positive experiences such as mental growth and maturity of the abortion process. Those without any emotional distress post-abortion stated clearly before the abortion that they did not want to give birth since they prioritised work, studies and/or existing children. The study shows that women generally are able to make the complex decision to have an abortion without suffering any subsequent regret or negative effects, as ascertained at the 1-year follow-up.

Reactions and reflections in men, 4 and 12 months post-abortion.

BACKGROUND: in general, men involved in legal abortion constitute an invisible group and there is scarcely any knowledge about their experiences and opinions. Therefore, the aim of the present study was to increase knowledge about reactions and reflections by means of a prospective study of men's attitudes and feelings towards abortion. METHODS: twenty-six men answered a questionnaire before abortion, and participated in interviews at the time of abortion and 4 and 12 months post-abortion. RESULTS: nearly all of the men were happy with the women's decision to have an abortion at both follow-ups. They experienced the abortion as a relief and a responsible act. Simultaneously, abortion could also be experienced as a painful and ethically problematic act. Overall, most men had only positive experiences post- abortion, such as a feeling of maturity. More than half of those who accompanied their partners to the hospital felt that the staff did not have a welcoming attitude. It was also found that 1-year post-abortion, more than a third consistently did not use a reliable contraceptive method. CONCLUSIONS: there is a need for further studies concerning men's experiences and reactions in the context of abortion and it is of fundamental importance that a gender perspective is incorporated into this specific field of reproductive health research.

Recruitment and motivation of semen providers in Sweden.

BACKGROUND: Legislation in Sweden requires that semen providers are prepared to be identified to offspring (at maturity) should this be requested. This study presents views of semen providers in Sweden regarding factors associated with their recruitment and motivation. METHODS: All semen providers (n = 30) in two clinics in different parts of Sweden participated in a questionnaire survey and both quantitative and qualitative data are reported. RESULTS: While there were some important demographic differences between the two clinic populations, there was total agreement that the desire to assist infertile couples was the sole or main motivating factor in becoming a semen provider. Monetary reward was not reported by respondents to be an important motivator, although at least 50% of the providers in both clinics thought that payment should be made and reimbursement of expenses was reported as being important. Men responded to both advertising and personal experiences or contacts they had with infertile couples. The involvement and support of the semen provider's partner was regarded as important. CONCLUSIONS: Semen providers can be recruited within a system that requires them to be prepared to be identified to offspring in the future. The characteristics of such providers vary, but are typified by a strong desire to assist infertile couples.

Coitus-dependent and coitus-independent contraceptive methods in women and men.

OBJECTIVE: To study the use of contraceptives in Sweden. METHODS: Analysis of the population-based survey 'Sex in Sweden. On the Swedish sexual life 1996'. The survey was analyzed in relation to socio-demographic, lifestyle, sexual and behavioral characteristics as well as attitudes to, and evaluation of, personal experiences. The data included 2810 men and women between 18 and 74 years of age. The results were compared with a similar survey carried out in 1967. RESULTS: During the 30-year period between the 1967 and 1996 surveys, condom use more than halved and use of oral contraceptives increased by 6 percentage points. The decline in the use of condoms did not occur among teenagers but among all other age groups in both men and women. In 1996 the majority (72%) used a reliable contraceptive method, but 29% did not. Coitus-dependent methods were more frequently used by men and women who were below the age of 21, smoked, used alcohol simultaneously with coitus, had casual partners, were more highly educated, were breastfeeding, had coitus less frequently and among those who were most satisfied with their sexual life and their partner relationship. CONCLUSION: In order to increase the use of more reliable contraceptive methods, three crucial factors should be focused on in counselling and media campaigns: gender, age and the use of coitus-dependent/coitus-independent methods.

Legal abortion: a painful necessity.

This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion.

Impact of urinary and climacteric symptoms on social and sexual life after surgical treatment of stress urinary incontinence in women: a long-term outcome.

AIM: The aim of the present study was to evaluate the long-term results of surgical treatment of stress urinary incontinence (SUI) using both subjective and objective methods. BACKGROUND: Few studies have focused on the influence of biological and social changes in a woman's life on the long-term outcome of surgical treatment of stress urinary incontinence. METHODS: The study included 45 women with genuine SUI treated with either retropubic urethrocystopexy (n=30) or puboccocygeal repair (n=15). The assessment included interviews, questionnaires, urinary diary, pad test, continence test and urodynamic investigation. RESULTS: The results were evaluated at intervals of 3 months, 1 year and 5--7 years after the treatment. One year after the surgical treatment 71% of the women in the urethrocystopexy group and 80% in the pubococcygeal repair group were subjectively cured, while 5--7 years after surgery the corresponding values were 43% vs. 60%. However, according to pad test a 67% of the women in the urethrocystopexy group and 47% in the pubococcygeal repair group had ceased to leak urine 1 year after the operation whereas at the long-term follow-up the corresponding values were 64% vs. 71%. According to the questionnaire at the long-term follow-up only 35% of the women in the whole group had genuine SUI whereas 21% had urge-incontinence. Moreover, 37% experienced sweating, 23% flushing and 44% vaginal dryness. The number of women with adiposity had increased significantly (P < 0.001) at the long-term follow-up. Twenty-eight per cent of the women decreased their activities whereas the majority experienced no impediment. Seventy-nine per cent reported that they were sexually active and the majority reported satisfaction with their sexual lives. CONCLUSIONS: Accurate assessment of postoperative results of SUI demands rigorous recording of subjective and objective data taking into consideration psychological and social factors, otherwise there is a high risk of bias in the interpretation of the results of the treatment for SUI. This study indicates that, in order to give women with SUI adequate treatment the nursing care should comprehend the women's divergent experiences of urinary incontinence and its impact on social and sexual life.

Contraceptive risk-taking in women and men facing legal abortion.

OBJECTIVE: The aim of the study was to gain knowledge about contraceptive use, reproductive risk-taking and sexuality in Swedish women seeking abortion and their partners. METHODS: Two hundred and eleven women and 75 men answered a questionnaire before the abortion. The data have been divided into six subgroups: women with and without previous experience of abortion, single women and women with a partner relationship, and women whose partner participated in the study and the male partners. RESULTS: The main findings showed that there are more similarities than differences between the subgroups. Overall, there were no differences regarding use of contraceptives, sexual life and psychosocial characteristics. However, women with previous abortion experience were found to be older, had longer partner relationships and more often had children. Some gender differences were also found, i.e. women favored coitus-dependent contraceptives to a larger extent and took more responsibility for preventing unwanted pregnancies. At the time of conception, half the participants had not used any contraceptive methods and one-fifth had relied on 'natural family planning'. The most common reasons for not using contraceptives were related to risk-taking and/or to strong sexual desire. Twelve per cent of the women had felt pressure/threat from their partner in connection with the conception. CONCLUSION: In efforts to prevent undesired pregnancies, this study highlights the need to incorporate a gender perspective both in communication about risk-taking and in counselling about contraceptives.

Ambivalence--a logical response to legal abortion: a prospective study among women and men.

The aim of the study was to elucidate ambivalence in relation to legal abortion by studying emotions, attitudes, motives for abortion and ethical reasoning in a strategic sample of women and men who, 1 year after abortion, expressed both positive and painful feelings in relation to the abortion. The study shows that social perspectives legitimate the decision to have an abortion whilst ethical perspectives complicate the decision. Nearly all women and men described having the abortion as an expression of responsibility. Almost one-half also had parallel feelings of guilt, as they regarded the abortion as a violation of their ethical values. The majority of the sample expressed relief while simultaneously experiencing the termination of the pregnancy as a loss coupled with feelings of grief/emptiness. In spite of the ambivalence, only one woman regretted the abortion. For the vast majority, the impact of the abortion had led to increased maturity and deepened self-knowledge. Thus, ambivalence might be regarded not only as problematic but also as indicating openness to the complexity of the abortion issue. Since incompatible values clash in connection with abortion, experiences of ambivalence become both logical and understandable.

Reproductive outcome after surgical treatment of ectopic pregnancy.

OBJECTIVES: Reproductive outcome after laparoscopy or laparotomy performed for treatment of ectopic pregnancy. METHODS: Data of 104 women were collected by a questionnaire and from medical records. RESULTS: No differences in pregnancy rate were found comparing the two different operative procedures. Women with a normal contralateral fallopian tube had a better pregnancy rate compared with those with a damaged contralateral tube. CONCLUSIONS: The crucial factor for future reproductive outcome after surgical treatment of ectopic pregnancy is the status of the contralateral tube.

The male partner involved in legal abortion.

This study comprises 75 men who have been involved in legal abortion. The men answered a questionnaire concerning living conditions and attitudes about pregnancy and abortion. Most men were found to be in stable relationships with good finances. More than half clearly stated that they wanted the woman to have an abortion while 20 stressed that they submitted themselves to their partner's decision. Only one man wanted the woman to complete the pregnancy. Apart from wanting children within functioning family units, the motivation for abortion revealed that the desire to have children depended on the ability to provide qualitatively good parenting. More than half the men had discussed with their partner what to do in event of pregnancy and half had decided to have an abortion if a pregnancy occurred. More than half expressed ambivalent feelings about the coming abortion, using words such as anxiety, responsibility, guilt, relief and grief. In spite of these contradictory feelings, prevailing expectations concerning lifestyle make abortion an acceptable form of birth control. A deeper understanding of the complexity of legal abortion makes it necessary to accept the role of paradox, which the ambivalence reflects. Obviously, men must constitute a target group in efforts to prevent abortions.

Psychosocial determinants of well-being in gynecologic cancer patients.

The purpose of this study was to investigate the well-being of women with endometrial versus cervical cancer before treatment, and its determinants at 12 to 15 months follow-up. The subjects were interviewed before treatment, then 6 and 12 to 15 months after initiation of treatment. Simultaneously, they completed questionnaires on psychological symptoms and social support. It appeared that well-being at baseline and at the follow-ups were highly correlated. Furthermore, cervical cancer patients reported significantly more symptoms on all occasions. After discriminant function analysis, the following three variables remained in the analysis: (a) well-being before treatment, (b) diagnosis, and (c) children at home. This allowed 81% of the patients to be classified as having a favorable versus an unfavorable outcome. The results of this study highlight the importance of well-being before treatment as a predictor of well-being after treatment. The necessity of individualized intervention measures is warranted.