摘要:

There is no doubt that some of our colleagues at least in some parts of the world take part in the implementation of this harmful practice. They do so with the best intentions, trying to reduce the harm done by traditional practitioners in back streets and with unhygienic tools. And some do it just to earn money, or because people request it. They do, however, provide surgical approaches, anesthetics, aseptic procedures and sutures as opposed to what is known to occur in the back rooms with unsterile razor blades, thorn stitches and a screaming child. In some countries it is illegal to do this in private or public hospitals, in other countries it is permitted. Irrespective of how it was done, there are probably around 85‐115 million mutilated women around the world today, mainly in a belt of 40 countries throughout Africa (1). Although some people associate the tradition with Islam, this is not a Muslim practice. Many Muslims are affected anyway, even if the tradition is older than the Islamic influence in the region. Some women from other religions, including Christianity, are also exposed, whereas most Asian Muslims do not do it (2). Some European and American girls also underwent clitoridectomy a hundred years ago, mainly because their custodians identified them to practice ‘harmful masturbation’. Some of us have also cut the labia minora of modern women, on cosmetic rather than medical d

ISSN:0001-6349    

DOI:10.3109/00016349609054662

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.Vasopressin seems to be an important etiological factor for the myometrial hyperactivity and reduced blood flow in primary dysmenorrea. Substances which block the action of vasopressin on the uterus are therefore of interest.Methods.The effect of an orally active, non‐peptide vasopressin V1areceptor antagonist, SR 49059, as well as its enantiomer, SR 49770, which is 50 to 100 fold less potent in binding studies, were testedin vitroon myometrium from 14 subjects. Two doses of the compounds, 2 nmol/L and 10 nmol/L, were used for counteracting the contractile effect of arginine vasopressin in a concentration of 0.7 nmol/L.Results.SR 49059, in the lower concentration, significally decreased the response to arginine vasopressin, measured as area under the recording curve, to 48 per cent of that to the agonist alone, and in the higher dose to 28 per cent. SR 49770 was much less potent in reducing the response to vasopressin.Conclusion.The myometrial action of arginine vasopressin is exerted via V1areceptors. The potent stereospecific inhibitory effect of SR 49059 on arginine vasopressin‐induced myometrial activity indicates that the compound acts specifically through V1areceptors and may have a therapeutic potential in primary dysmenor

ISSN:0001-6349    

DOI:10.3109/00016349609054663

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.To determine fetal fibronectin in vaginal fluid from healthy women during uncomplicated pregnancy and to investigate possible relationships to gestational age and the vaginal microflora.Materials and methods.Samples of vaginal fluid were collected for fetal fibronectin determination and for quantitative aerobic and anaerobic microbiological culture from 22 women followed longitudinally at 12, 28 and 37 weeks gestation and cross‐sectionally in women at 12 weeks (n=10), 28 weeks (n=10), 37 weeks (n=10), and 39 weeks (n=30) gestation, respectively. Fetal fibronectin was determined by a quantitative enzyme immunoassay (Adeza Biomedical).Results.There were no significant differences between the concentrations of fetal fibronectin in vaginal secretions at any of the four measurement points (12, 28, 37 and 39 weeks gestation). Women with elevated fetal fibronectin concentration (0.05 mg/L) had less often hydrogen peroxide‐producing facultative lactobacilli (p<0.0001), and more often bacterial vaginosis (p<0.02) andPeptostreptococcus species(p<0.002). Bacterial vaginosis (p<0.01) andCandida albicans(p<0.01) were more frequently found in women lacking hydrogen peroxide‐producing lactobacilli.Conclusion.Fetal fibronectin in vaginal fluid was more associated with the vaginal microflora than with the gestational age of the pregnancy. Presence of hydrogen peroxide‐producing lactobacilli seems to be the most important factor for a stable vaginal mic

ISSN:0001-6349    

DOI:10.3109/00016349609054664

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.Congenital nephrotic syndrome of the Finnish type [CNF] is an autosomal recessive disorder leading to death in early childhood, if treated conservatively without early renal transplantation. Prenatal screening at midtrimester is feasible by measuring maternal serum alpha‐fetoprotein [MSAFP], elevated amniotic fluid [AF] AFP being the only diagnostic test in population screening. We studied whether concentrations of other pregnancy‐related markers offer any ancillary procedure for screening.Methods.In a prospective case‐control study, the concentrations of maternal serum human chorionic gonadotropin [hCG], unconjugated estriol [uE3], human placental lactogen [hPL]and placental protein 14 [pp14] were measured in samples from six singleton pregnancies associated with fetal CNF and from 18 matched controls at 15 weeks of gestation.Results.In the CNF group, mean hCG and pp 14 concentrations were slightly elevated, whereas uE3and hPL concentrations were within the lower normal range. None of these differences were statistically significant and the distribution of these values was too wide to use them for screening.Conclusions.Low unconjugated E3and elevated hCG concentrations were expected, since newborns with CNF are growth‐retarded and have large placentas. The extent of these alterations was not sufficient to identify high risk pregnancies. Substantial differences in the maternal serum concentrations of hPL and pp 14 were not observed. Hence, MSAFP screening at midtrimester is the strategy of choice for prenatal detection

ISSN:0001-6349    

DOI:10.3109/00016349609054665

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.The relationship between physical activity at work and risk of fetal growth restriction is controversial. For the most part, previous studies investigated the effect of work activity on birthweight alone. We evaluated the impact of type of occupation and physical effort at work on the risk of ultrasonographically confirmed fetal growth retardation among nulliparous women.Methods.We compared the characteristics of work and the intensity of occupational fatigue (work posture, weekly working hours, physical effort at work) in 349 patients with ultrasonographically confirmed fetal growth retardation and 698 control pregnancies with appropriate fetal growth. Physical demands at work were evaluated by interview at birth. Logistic regression analysis was used to evaluate the association of employment status, type of occupation, and intensity of occupational fatigue with the risk of fetal growth retardation, correcting for potential confounders (maternal age, pre‐pregnancy body mass index, mean weight gain in pregnancy, education, partner's social status, smoking in pregnancy, alcohol use, illicit drug use, time of stopping work, and hypertension).Results.After adjusting for confounding, the risk of fetal growth retardation was similar between unemployed and formally employed women at the beginning of pregnancy (OR=1.26; 95% confidence interval=0.86‐1.83). However, manual workers were at slightly higher risk of IUGR than not formally employed women (OR=1.81; 95% CI=1.15‐2.85). Among formally employed women, standing or walking at work, and working 30 hours a week were not significantly associated with IUGR. Finally, the risk of IUGR was significantly higher (OR=2.4; 95% CI=1.36‐1.21) among women reporting moderate‐to‐heavy as compared to light physical effort at work.Conclusion.Formal employment at the beginning of pregnancy is not associated with an increased risk of IUGR. However, moderate‐to‐heavy physical effort at work seems to increase the risk of sonographically confirmed fetal gro

ISSN:0001-6349    

DOI:10.3109/00016349609054666

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.To investigate the guidelines for patient selection and drug regimens for application of antibiotic prophylaxis in relation to cesarean section in the maternity clinics in Denmark.Methods.A questionnaire to all the Danish maternity clinics that perform cesarean section, concerning indications for application of antibiotic prophylaxis and antibiotic regimens to patients undergoing acute and elective cesarean section.Results.All departments (n=48) returned the questionnaire. Twenty departments (46%) provided written guidelines for antibiotic prophylaxis. Four departments (8%) used antibiotic prophylaxis to elective cesarean sections, 25 departments (52%) applied antibiotics to all emergency sections. In the presence of the rupture of membranes or prolongation of labor (>12hrs) 58% and 63% of the departments applied antibiotic prophylaxis, respectively. The most frequent first choice drug was cefuroxim, employed by 27 departments (56%). Concerning timing, 21 departments (44%) applied antibiotics after cord clamping and 13 departments (27%) before incision.Conclusion.We propose a nation‐wide prospective investigation on the rate of infections associated with cesarean section to set up rational guidelines for antibiotic prophylaxi

ISSN:0001-6349    

DOI:10.3109/00016349609054667

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.A major goal of Finnish family planning policy since the 1970s has been to minimize unintended pregnancies by providing equal contraception and abortion services throughout the country. This report looks at how this policy has succeeded among teenagers.Methods.The data on childbirths, induced abortions and mean populations were collected from the national abortion and population registers. Regional and age‐specific rates were calculated for fertility, abortions and pregnancies in girls aged 15‐19.Results.In 1993, the teenage pregnancy rate was 20/1000 and the abortion rate 9.5/1000 in the whole country. Although the pregnancy rate had dropped by half since the 1970s, the regional differences were still there: the lowest rate was 18/1000 and the highest 29/1000 (in Lapland) in 1991‐93. The abortion rate ranged from 8/1000 to 14/1000. Childbirths decreased, particularly at the beginning of the study period, while abortions declined sharply towards the end of the period. In 1986‐88, the abortion ratio exceeded 100 in all provinces except two. In the 1990s, it dropped below 100 again except in the capital province. In 16‐17 year‐olds, the trends were quite equal in different provinces. In 18‐19 year‐olds, pregnancies remained more frequent in the north and were more often carried to term, while the choice of abortion was more likely in the south.Conclusions.Equally declining trends in pregnancies in all provinces suggest that teenage family planning services have a comprehensive coverage. However, regional differences still remain and imply a detailed analysis o

ISSN:0001-6349    

DOI:10.3109/00016349609054668

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.To review the experience of seven cases of gestational trophoblastic neoplasia with central nervous system involvement.Methods.Seven patients among 50 cases of malignant gestational trophoblastic neoplasia were analyzed retrospectively in a single institution.Results.The mean age of the patients at diagnosis was 28.7 years (range: 20‐34). While five of the patients presented initially with symptoms related to cranial involvement, the remaining two developed cerebral metastases during the therapy. In two patients, the presentation was so similar to a primary cranial pathology that craniotomy and biopsy revealed the trophoblastic involvement. The sites of involvement were the parietal lobe in three, temporal lobe in two and frontal lobe in two patients. Besides central nervous system involvement, four had additional lung and one had pelvic metastases. In terms of therapy, while five patients received methotrexate+actinomycin‐D+cyclophosphamide regimen for 3 to 5 courses, only two could be administered additional intrathecal methotrexate. Since one patient exhibited a fulminant clinical course, she could not be delivered a chemotherapy regimen and was lost in two months of initial diagnosis. The other patient was administered modified Bagshawe protocol (5 courses) which was switched to etoposide+methotrexate+actinomycin‐D+vincristine+cyclophosphamide (6 courses) due to development of resistance. She was still alive and free of disease after 24 months of initial diagnosis. Six of the patients were also delivered whole‐brain irradiation simultaneously with chemotherapy.Conclusions.The prognosis of brain metastases still seems to be poor despite combination chemotherapy and radiotherapy. Measures should be focused on early diagnosis and prop

ISSN:0001-6349    

DOI:10.3109/00016349609054669

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background.Endometrial stromal sarcoma is a rare neoplasm. We reviewed twenty cases to study the characteristics of this disease.Methods.Twenty cases of endometrial stromal sarcoma were treated at our hospital. The clinical stage, treatment and outcome were retrospectively analyzed.Results.Endometrial stromal sarcoma comprised 4.3% of corpus cancers and 46.4% of uterine sarcomas at our hospital. Seven cases were stage I, one was stage II, ten were stage III, and two were stage IV at the time of diagnosis. Histopathologically, seventeen cases were classified as low‐grade sarcoma and three were high‐grade sarcoma. Seven patients had recurrence and five of them had already died of disease. Among these recurrent patients, one was stage II and six were stage III. All three patients with high‐grade sarcoma and four with low‐grade sarcoma had recurrence.Conclusions.We think mitotic count is an important prognostic factor in low‐grade endometrial stromal sarcoma and high‐grade endometrial stromal sarcoma has a poor prognosis even with post‐operative adjuv

ISSN:0001-6349    

DOI:10.3109/00016349609054670

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective.The aim of this investigation was to study three groups of women presenting with possible HPV‐infection with regard to HPV‐types and cervical dysplasia.Methods.Eighty women were included. Eighteen of them were present partners to men with condylomas, 20 had clinical vulvar HPV‐lesions and 42 were referred due to an abnormal PAP‐smear. Samples for HPV‐analysis by PCR‐technique were taken from the vulva, the por‐tio and the cervical canal. A universal HPV‐primer as well as specific primers for HPV 6/11, 16,18, 31 and 33 were utilized. PAP‐smears were taken as well as biopsies from cervix/portio.Results.Seventy‐eight percent had HPV‐DNA identified. Sixty‐seven percent of those with HPV 16 and/or 18 had dysplasia verified by histopathology and 50% of those with 31 and/or 33. Twenty of 21 women with dysplasia had HPV 16, 18, 31 and/or 33 identified. One woman with dysplasia was HPV‐negative. Histopathologically verified CIN were diagnosed in all groups investigated. Women referred for suspicion of CIN significantly more often had HPV detected at the cervix/portio. HPV 6/11 was mostly found in women with condylomas. Apart from this the occurrence of the different HPV types were alike in the three groups.Conclusion.Infection with HPV is a process and the usefulness of different diagnostic methods seems to depend on when during the course of the disease they are used. HPV‐findings in women with dysplasia were all associated with oncogenic virus‐types. High‐risk virus was often found simultaneously with low‐risk virus indicating a covariation in the acqui

ISSN:0001-6349    

DOI:10.3109/00016349609054671

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY