Helle V. Clausen

Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long-pulsed diode laser vs. intense pulsed light

Background  Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels.

Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial

OBJECTIVE To disclose a clinical and histopathological effect of local low-dose oestradiol treatment on the vagina. DESIGN A randomised, double-blind trial. SETTING Two gynaecological departments at University Hospitals. SUBJECTS Forty-eight postmenopausal women scheduled for surgery because of genital prolapse. INTERVENTION 25 micrograms oestradiol or placebo, administered as vaginal pessaries daily, 3 weeks prior to surgery. MAIN OUTCOME MEASURES Cytological, histological and clinical changes of the vaginal mucosa. RESULTS The thickness of the vaginal wall increased as did the oestrogenic index. No clinical effect was seen apart from decreased incidence of recurrent cystitis postoperatively. CONCLUSIONS Preoperative oestrogen treatment has been shown to reduce the incidence of recurrent cystitis and may be needed for stimulation of vaginal mucosa; the short-term clinical effect is not convincing, however.

Heart rate response and fitness effects of various types of physical education for 8- to 9-year-old schoolchildren.

Abstract The present study investigated the heart rate (HR) response to various types of physical education (PE) activities for 8- to 9-year-olds (five school classes, n = 93) and the fitness effects of a short-term PE training programme (three of the five classes, n = 59) with high compared to low-to-moderate aerobic intensity. HR was recorded during small-sided indoor soccer (SO), basketball (BB), unihockey (UH), circuit training (CT), walking (W) and Nintendo Wii Boxing (NWB) and Nintendo Wii Tennis (NWT). Maximal HR (HRmax) and physical fitness was determined by the Yo-Yo Intermittent Recovery Level 1 Childrens test (YYIR1C) test. Following cluster randomisation, three classes were tested before and after 6 wks with 2 × 30 min/wk SO and UH lessons [high-intensity (HI), 2 classes, n = 39] or low-to-moderate intensity PE lessons (CON, 1 class, n = 20). Average HR in SO (76 ± 1% HRmax), BA (77 ± 1% HRmax) and UH (74 ± 1% HRmax) was higher (P < 0.05) than in CT (62 ± 1% HRmax), W (57 ± 1% HRmax), NWB (65 ± 2% HRmax) and NWT (57 ± 1% HRmax). Time with HR > 80% and 90% HRmax, respectively, was higher (P < 0.05) in SO (42 ± 4 and 12 ± 2%), BB (41 ± 5 and 13 ± 3%) and UH (34 ± 3 and 9 ± 2%) than in CT, W and NW (0–5%), with time >80% HRmax being higher (P < 0.05) in SO than UH. After 6 wk, YYIR1C performance was increased (P < 0.05) by 22% in HI (673 ± 57 to 821 ± 71 m), but unaltered in CON (674 ± 88 to 568 ± 81 m). HR 2 min into YYIR1C was lowered (P < 0.05) in HI after 6 wks (92.4 ± 0.8 to 89.1 ± 0.9% HRmax), but not in CON. In conclusion, ball games elicited high aerobic loading for young schoolchildren and a short-term, low-volume ball game PE-intervention improved physical fitness. Traditional PE sessions had no effects on intermittent exercise performance.

The use of Yo-Yo intermittent recovery level 1 and Andersen testing for fitness and maximal heart rate assessments of 6- to 10-year-old school children.

Abstract Bendiksen, M, Ahler, T, Clausen, H, Wedderkopp, N, and Krustrup, P. The use of Yo-Yo intermittent recovery level 1 and Andersen testing for fitness and maximal heart rate assessments of 6- to 10-year-old school children. J Strength Cond Res 27(6): 1583–1590, 2013—We evaluated a submaximal and maximal version of the Yo-Yo intermittent recovery level 1 children’s (YYIR1C) test and the Andersen test for fitness and maximal heart rate assessments of children aged 6–10 years. Two repetitions of the YYIR1C and Andersen tests were carried out within 1 week by 6- to 7-year-olds and 8- to 9-year-olds (grade 0, n = 17; grade 2, n = 16) and 6 weeks apart by 9- to 10-year-olds (grade 3, n = 49). Grade 0–2 pupils also performed an incremental treadmill test (ITT). Grade 2 pupils had a better (p < 0.05) YYIR1C (84%; 994 ± 399 m (±SD) vs. 536 ± 218 m) and Andersen test performance (10%; 1,050 ± 71 m vs. 955 ± 56 m) than grade 0 pupils. For grade 0–2 pupils, YYIR1C, Andersen, and ITT peak heart rates were 205 ± 11, 207 ± 9, and 203 ± 7 b·min−1, respectively (Andersen > ITT, p < 0.05), and for grade 3 pupils, YYIR1C and Andersen peak heart rates were 208 ± 9 and 204 ± 9 b·min−1, respectively (YYIR1C > Andersen, p < 0.05). Submaximal YYIR1C heart rate (HR) was inversely correlated (p < 0.05) with YYIR1C test performance (r = −0.54 to −0.67) and V[Combining Dot Above]O2peak (r = −0.42). The 6-week change in submaximal HR correlated with the change in YYIR1C test performance (r = −0.42 to −0.53, p < 0.05). In conclusion, YYIR1C and Andersen tests are simple and inexpensive intermittent field tests that can detect differences in fitness levels and determine maximal HR of 6- to 10-year-old children. Additionally, submaximal YYIR1C testing can be used for frequent nonexhaustive fitness assessments.

Patterns in expression of insulin-like growth factor-II and of proliferative activity in the normal human first and third trimester placenta demonstrated by non-isotopic in situ hybridization and immunohistochemical staining for MIB-1.

The expression of insulin-like growth factor-II (IGF-II) in normal human first and third trimester placental tissue was investigated by non-isotopic in situ hybridization (ISH). This is the first ISH study on IGF-II expression in placenta using an alkaline phosphatase-labelled probe. The expression was correlated with the proliferative activity of the cells using the proliferative marker MIB-1. In first trimester tissue, IGF-II was expressed in the cytotrophoblast, the extravillous trophoblast, the fetal endothelial cells and the mesenchymal fetal cells in the villi. In third trimester tissue, IGF-II expression was found in the amnion, the extravillous trophoblast and the mesenchymal fetal cells especially in the endothelial cells and the outer contractile sheet in the stem villi. In areas with perivillous fibrin deposits, strong expression of IGF-II was found in the cytotrophoblasts invading the fibrin. In first trimester tissue, the proliferative activity of the villous cytotrophoblast correlated well with the degree of IGF-II expression whereas in third trimester tissue, there was a discrepancy between MIB-1 positivity and the IGF-II expression. Expression of IGF-II does not seem to be correlated exclusively to the mitogenic activity of cells.

Comparison between local anaesthesia with remifentanil and total intravenous anaesthesia for operative hysteroscopic procedures in day surgery

BACKGROUND This study aimed at comparing total i.v. anaesthesia (TIVA) with monitored anaesthesia care (MAC) during day-surgery operative hysteroscopy regarding: operation time, time to mobilization and discharge, and patient satisfaction. METHODS Ninety-one healthy women were randomized to MAC with paracervical local anaesthesia and remifentanil or to TIVA with propofol and remifentanil. Time from arrival to leaving the operating theatre, time from arrival in the recovery room to mobilization and discharge readiness, and patient satisfaction with MAC and TIVA were observed. RESULTS Time from arrival to leaving the operating theatre showed no significant difference between groups (P=0.6). The time to mobilization {MAC: 53 min [inter-quartile range (IQR) 40-83], TIVA: 69 min (IQR 52-96) (P=0.017)} and the total time from arrival to discharge readiness [MAC: 118 min (IQR 95-139), TIVA: 138 (IQR 120-158) (P=0.0009)] were significantly reduced for patients in the MAC group. More patients in the MAC group 45 (91.8%) than in the TIVA group 24 (64.9%) responded positively to the question: would you like to receive the same kind of anaesthesia for a similar procedure in the future? (P=0.003). CONCLUSIONS Paracervical local anaesthesia combined with remifentanil is suitable for operative hysteroscopy in day surgery.

Simple and efficient stereological quantitation of some placental structures

Summary This paper provides practical examples of basic stereological methods applied to the human planceta. Systematic random sampling gives all parts the same probability of being represented in the sections obtained for microscopical examination. Isotropy and vertical design are described and formulas provided for calculating volume, surface area, length and number. The importance of counts of particles/cells as a fraction of the reference volume is emphasized, but for unambiguous conclusions, results must be expressed as total quantities. If sampling is correct and optimal, the efficiency of the stereological methods provides unbiased and precise estimates, made from counting no more than about 200 counts in one organ.

Minimal impairment in pulmonary function following laparoscopic surgery

Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head‐down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic cholecystectomy. We hypothesised that arterial oxygenation would be more impaired after hysterectomy performed in the head‐down position than after cholecystectomy in the head‐up position.

Effects of liraglutide on ovarian dysfunction in polycystic ovary syndrome: a randomized clinical trial

Polycystic ovary syndrome (PCOS) encompasses an ovarian and a metabolic dysfunction. Glucagon-like peptide-1 (GLP-1) analogues facilitate weight loss and ameliorate metabolic dysfunction in overweight women with PCOS, but their effect on ovarian dysfunction is scarcely reported. In a double-blind, randomized trial, 72 women with PCOS were allocated to intervention with the GLP-1 analogue liraglutide or placebo (1.8 mg/day), in a 2:1 ratio. At baseline and 26-week follow-up, bleeding pattern, levels of AMH, sex hormones and gonadotrophins were assessed and ovarian morphology evaluated. Liraglutide caused 5.2 kg (95% CI 3.0 to 7.5, P < 0.0001) weight loss compared with placebo. Bleeding ratio improved with liraglutide: 0.28 (95% CI 0.20 to 0.36, P < 0.001); placebo: 0.14 (95% CI 0.02 to 0.26, P < 0.05); between-group difference: 0.14 (95% CI 0.03 to 0.24, P < 0.05). In the liraglutide group, SHBG increased by 7.4 nmol/L (95% CI 4.1 to 10.7) and free testosterone decreased by 0.005 nmol/L (95% CI -0.009 to -0.001). Ovarian volume decreased by -1.6 ml (95% CI -3.3 to 0.1) with liraglutide versus placebo. Nausea and constipation were more prevalent in the liraglutide group. Liraglutide improved markers of ovarian function in overweight women with PCOS, and might be a possible intervention.

Ovarian morphology in polycystic ovary syndrome: estimates from 2D and 3D ultrasound and magnetic resonance imaging and their correlation to anti-Müllerian hormone:

Background Due to improved ultrasound scanners, new three-dimensional (3D) modalities, and novel Anti-Müllerian hormone (AMH)-assays, the ultrasound criteria for polycystic ovarian morphology are under debate and the appropriate thresholds are often requested. Purpose To quantify the differences in estimates of ovarian volume and antral follicle count (AFC) from two-dimensional (2D) and 3D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Material and Methods A cross-sectional study on 66 overweight women with polycystic ovary syndrome (PCOS) according to Rotterdam criteria. Ovarian volume and AFC were estimated from MRI, 2D TVUS, and 3D TVUS, and serum AMH levels were assessed. Bland–Altman statistics were used for comparison. Results Participants had a median age of 29 years (age range, 19–44 years) with a mean BMI of 32.7 kg/m2 (SD 4.5). Ovarian volume from 2D TVUS was 1.48 mL (95% confidence interval [CI], 0.94–2.03; P < 0.001) and 1.25 mL (95% CI, 0.62–1.87; P < 0.001) smaller than from 3D TVUS and MRI, respectively. AFC from 2D TVUS was 18% (95% CI, 13–23; P < 0.005) and 16% (95% CI, 6–25; P < 0.005) smaller than estimates from 3D TVUS and MRI, respectively. Correlations between AMH and AFC from 2D TVUS, 3D TVUS, and MRI were 0.67, 0.78, and 0.70, respectively (P < 0.001 for all). Conclusion In an overweight PCOS population, 2D TVUS underestimated ovarian volume and AFC as compared with 3D TVUS and MRI. Serum AMH correlated best with AFC from 3D TVUS, followed by MRI and 2D TVUS. The advantage of 3D TVUS might be of minor clinical importance when diagnosing PCOS, but useful when the actual AFC are of interest, e.g. in fertility counseling and research.