Post-operative infections of osteoplastic compared with free bone flaps

A retrospective study was performed to evaluate the rate of infection in free and osteoplastic bone flaps after craniotomy. Two hundred and two craniotomies were performed in 98 cases of tumour, 35 cases of trauma and 69 cases of vascular disease. The overall incidence of infection was 6.4% (13 cases). The infectious agents were Staphylococcus aureus in four cases; Pneumococcus and gram-positive rods each in one case. In seven cases no infectious agent was identified. In 127 cases with free bone flaps eight (6.3%) were infected, and in 75 cases with osteoplastic bone flaps five (6.7%) were infected. One of five (20%) osteoplastic and four of eight (50%) free bone flaps had to be removed in order to accomplish healing, suggesting that an osteoplastic bone flap may be preserved more often in cases of infection.     

The selection of antibodies with defined desorption properties from precipitated immune complexes for use in immunoadsorption procedures

A general method for preparing immunosorbents with preselected antibody avidity is described. The method, which is a modification of a method described previously, also includes immunospecific purification of the ligand prior to coupling on the gel matrix. Polyclonal anti-alpha-1-fetoprotein antibodies in precipitated immune complexes were separated according to their avidity (low, intermediate and high) by dissociation with agents of increasing efficiency. After solid-phase coupling the antigen binding activity of the separated antibody preparations was examined according to recovery, capacity and binding strength. Antibodies of intermediate avidity derived from the immune complexes demonstrated optimal properties for preparative affinity chromatography.     

Open randomized comparison of prostaglandin E2 given by intracervical gel or vagitory for preinduction cervical ripening and induction of labor.

Intracervical application of prostaglandin E2 (PGE2) in a viscous gel was compared with conventional wax-based PGE2 vagitories (pessaries) for ripening of the cervix prior to induction of labor. A total of 226 healthy pregnant women at term were randomly allocated to receive intracervical gel with an effective dose of 0.5 mg (n = 116) or vagitories containing 2.5 mg PGE2 (n = 110). All women had a modified cervical score of less than or equal to 4. The numbers of cases contributed by each of the three centers were similar. There was no significant difference in parity, gestational length, maternal characteristics, indications for induction or preinduction cervical scores between the treatment groups. The rate of spontaneous birth was 71% in the gel group, compared with 69% in the vagitory group. Successful treatment was defined as active labor within 24 h or a change in cervical dilatation allowing artificial rupture of the membranes with subsequent progressive labor. The success rate was not significantly different in the gel group (82%) compared with the vagitory group (80%). There were no differences in the frequency of fetal distress, outcome of labor, assisted delivery rates or maternal side effects. The cervical scores were not different at 12 and 24 h after application. Intracervical gel and intravaginal application of PGE2 were similar in their efficacy and safety for ripening of the cervix and inducing labor at term.     

The effect of human menopausal gonadotrophin and highly purified, urine-derived follicle stimulating hormone on the outcome of in-vitro fertilization in down-regulated normogonadotrophic women

It has been suggested that the luteinizing hormone (LH) activityof human menopausal gonadotrophin (HMG) preparations used forovarian stimulation in in-vitro fertilization (IVF) may haveadverse effects on reproductive outcome. In the present prospective,randomized trial of 218 infertile couples this notion was investigated.A total of 114 women were treated with Pergonal (HMG group)and 104 with Fertinorm HP (HP-FSH group). The two groups werecomparable with regard to duration of infertility, cause ofinfertility, age and number of previous IVF attempts and allhad normal basal gonadotrophin concentrations before treatmentwas started. A standard hormonal treatment consisting of pituitarydown-regulation with gonadotrophin-releasing hormone analogue(GnRHa) for 14 days starting on cycle day 21, followed by eitherHMG or highly purified follicle stimulating hormone (HP-FSH),three ampoules (225 IU) per day for 7 days, was used in allcases. The daily hormone dose was thereafter individualizedaccording to the ovarian response. A maximum of two pre-embryoswere transferred after 3 days of culture. Luteal support withprogesterone (300 mg per day intravaginally) was used in allcases. Serum concentrations of oestradiol, FSH and LH were measuredon days 1 and 8 of stimulation and on the day of oocyte retrieval.The mean number of days of stimulation, mean number of ampoulesof HMG or HP-FSH used, mean total motile sperm count on theday of oocyte retrieval and mean numbers of oocytes retrieved(13.4 versus 13.7) or pre-embryos transferred (1.8 versus 1.8)were similar for both groups. Significantly (P < 0.05) morecycles in the HP-FSH group (17 = 16%) were cancelled due tocomplete failure of fertilization than in the HMG group (7 =6%). The mean fertilization rate was significantly (P < 0.05)higher in the HMG group (56%) than in the HP-FSH group (50%),and significantly more transferable pre-embryos were obtainedin the HMG than in the HP-FSH group (mean: 4.0 versus 3.2; P< 0.01). Serum hormone concentrations were similar in thetwo groups on stimulation day 1, but differed significantlywith regard to FSH, LH and oestradiol on stimulation day 8.The clinical outcome was similar in the two groups, with anongoing pregnancy rate (>12 weeks of gestation) per startedcycle of 33% in the HMG group and 29% in the HP-FSH group. Theclinical abortion rates were similar(10 and 14%), and the implantationrate was 30% in each group. In conclusion, no detrimental effectof the LH activity of HMG on the clinical outcome of IVF inGnRHa down-regulated normogonadotrophic women was found. Tothe contrary, some beneficial effects of HMG on fertilizationrates and pre-embryo development as compared with HP-FSH weredemonstrated. These effects, as well as the differences in serumhormone concentrations during ovarian stimulation, may be causedby differences in LH content and/or in the composition of FSHisoforms of the HMG and HP-FSH preparations.     

Hormonal characteristics of follicular fluid from women receiving either GnRH agonist or hCG for ovulation induction

BACKGROUND: A recent prospective randomized study from our groupcompared GnRH agonist (0.5 mg buserelin) and hCG (10 000 IU)for triggering of ovulation following a flexible antagonistprotocol. The agonist group showed a poor reproductive outcomedespite luteal phase support with progesterone and estradiol(E₂). In the present prospective observational study, the healthstatus of follicles from the above study was monitored by analysingthe hormonal content of frozen/thawed follicular fluid samples.The aim was to test whether the poor reproductive outcome couldbe related to a defective pre-ovulatory follicular maturationresulting in oocytes with a compromised developmental competence.METHODS: Hormone concentrations were measured in two individualfollicular fluid samples from each of 32 women receiving buserelinand 37 receiving hCG, thus representing a subset of the folliclesretrieved. RESULTS: Follicular fluid levels of LH in the agonistgroup as compared with the hCG group was 11.1 ± 0.5 versus3.6 ± 0.3 IU/l (mean ± SEM; P < 0.001); FSH,6.3 ± 0.6 versus 3.3 ± 0.2 IU/l (P < 0.001);hCG, not determined versus 139±8 IU/l; E₂, 1.9 ±0.2 versus 1.8 ± 0.2 µmol/l (P > 0.10); progesterone,70 ± 4 versus 93 ± 6 µmol/l (P < 0.001);inhibin-A, 36.9 ± 3.1 versus 37.1 ± 2.5 ng/ml(P > 0.10) and inhibin-B, 35.6 ± 2.8 versus 40.1 ±3.1 ng/ml (P > 0.10). Thus, pronounced hormonal differencesexist in follicular fluid, and the collective concentrationof all three gonadotropins and the follicular fluid concentrationof progesterone were much higher in the group of women receivinghCG for ovulation induction. CONCLUSION: The study suggeststhat GnRH agonist results in proper pre-ovulatory follicularmaturation, but the ovulatory signal – probably in synergywith the resulting pituitary down-regulation – is toolow to support appropriate corpus luteum (CL) function.     

Type 1 diabetes and multiple sclerosis: A Danish population-based cohort study

BACKGROUND: Type 1 diabetes mellitus (T1D) and multiple sclerosis (MS) contribute considerably to the burden of autoimmune diseases in young adults. Although HLA patterns of T1D and MS are considered mutually exclusive, individual and familial co-occurrence of the 2 diseases has been reported. OBJECTIVE: To assess the co-occurrence of T1D and MS by estimating the risk for MS in patients with T1D and the risk for T1D in first-degree relatives of patients with MS. DESIGN, SETTING, AND PARTICIPANTS: Two population-based disease registers, the Danish Hospital Discharge Register and the Danish Multiple Sclerosis Register were used to identify patients with T1D, defined as patients in whom diabetes was diagnosed before age 20 years (N = 6078), and patients with MS (N = 11 862). First-degree relatives (N = 14,771) of patients with MS were identified from family information in the Danish Civil Registration System. MAIN OUTCOME MEASURE: Patients with T1D and first-degree relatives of patients with MS were followed up for occurrence of MS and T1D, respectively, and the relative risks were expressed as standardized incidence ratios, that is, ratios of observed to expected numbers of outcomes based on national age, sex, and period-specific MS and T1D incidence rates. RESULTS: Patients with T1D were at more than 3-fold increased risk for development of MS (relative risk, 3.26; 95% confidence interval, 1.80-5.88; n = 11). First-degree relatives of patients with MS were at 63% increased risk (relative risk, 1.63; 95% confidence interval, 1.26-2.12; n = 56) for development of T1D. However, adjusting for familial relationship to patients with T1D reduced the excess risk to 44% (relative risk, 1.44; 95% confidence interval, 1.11-1.88; n = 56). CONCLUSION: The present nationwide cohort study demonstrates an intraindividual and, to a lesser degree, an intrafamilial co-occurrence of MS and T1D.     

Bile acid malabsorption

Opinion statement Patients with bile acid malabsorption typically present with chronic, watery diarrhea. Bile acids recirculate between the liver and small intestine in the enterohepatic circulation. They are reabsorbed in the distal small intestine, and normally only a small fraction of the bile acid pool is lost to the colon during each cycle. In patients with bile acid malabsorption, a larger amount of bile acids is spilled into the colon, where the acids stimulate electrolyte and water secretion, which results in loose to watery stools. The common causes of bile acid malabsorption are ileal resection and diseases of the terminal ileum (Crohn’s disease and radiation enteritis), which result in a loss of bile acid transporters and, consequently, diminished reabsorption. Bile acid malabsorption also has been documented in a small group of patients with chronic, watery diarrhea who have no demonstrable ileal disease (idiopathic bile acid malabsorption). The amount of bile acid loss to the colon determines the clinical presentation. Patients with mild to moderate bile acid malabsorption present with watery diarrhea and generally respond very well to treatment (with abolishment of diarrhea) with bile acid binders such as cholestyramine. Patients with more severe bile acid malabsorption have both diarrhea and steatorrhea. Treatment with cholestyramine is of no benefit in this group of patients and may, in fact, worsen steatorrhea. These patients are best treated with a low-fat diet supplemented with medium-chain triglycerides.     

Prenatal risk indicators of a prolonged pregnancy. The Danish Birth Cohort 1998-2001

BACKGROUND: Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. METHODS: Data from the Danish Birth Cohort in Denmark were used. Interview data from 53,392 participants with live-born singleton deliveries in the period 1998-2001 were available at the time of this study. The participants were interviewed by telephone at 12 and 30 weeks' gestation, and 6 and 18 months after delivery. Statistical analyses were done using logistic regression. RESULTS: Women with a pre-pregnancy body mass index of 25 kg/m2 or more had a high risk of prolonged pregnancy. If the pre-pregnancy body mass index was 35 kg/m2 or more the odds ratio was 1.52 (95% CI 1.28-1.82). Nulliparity also increased the risk of prolonged pregnancy (OR (95% CI) = 1.35 (1.27-1.44)). CONCLUSIONS: The risk of post-term delivery was high in women with a pre-pregnancy body mass index of 25 kg/m2 or more, and in nulliparous women.     

Risk factors in developing pregnancy-related pelvic girdle pain

BACKGROUND: In this prospective epidemiologic cohort study the aim was to identify possible risk factors for developing four different syndromes of pelvic girdle pain during pregnancy. METHODS: Over a one-year period a total of 2,269 consecutive pregnant women -- at week 33 of gestation -- responded to a structured questionnaire and underwent a thorough physical examination. Women who at baseline reported daily pain from pelvic joints and had corresponding objective findings were allocated, according to symptoms, into one of four classification groups, and followed up with questionnaires and physical examinations up to two years after delivery. RESULTS: Multivariate analysis could distinguish the four pelvic pain sub groups from the "Pelvic healthy" group with respect to 13 of 24 variables. The pelvic girdle syndrome group revealed a history of previous low back pain, trauma of the back or pelvis, multiparae, had a relatively higher weight, a higher level of self reported stress and of job At a higher risk of developing symphysiolysis were women who were multiparae, had a relatively higher weight, and were smokers. If a woman had vocational training or a professional education, was stressed, had a poorer experience of previous delivery, had previous low back pain, trauma of back, or previous salpingitis, she had an increased risk of developing one-sided sacroiliac syndrome. The risk factors for developing double-sided sacroiliac syndrome were previous low back pain and trauma of the back or pelvis, multiparae, poorer relationship with spouse, and less job satisfaction. CONCLUSIONS: This study demonstrates no single dominant risk factor for developing pelvic girdle pain in pregnancy, but reveals a set of physical and psychosocial factors. The risk factors for developing pelvic girdle pain in general are: history of previous low back pain, trauma of the back or pelvis, multivariate, higher level of stress, and low job satisfaction.