Jan Brundin

Changes of Bone Mineral Content During Pregnancy and Lactation

Abstract. In order to study changes in the calcium depots of the body during pregnancy and lactation, bone mineral determinations were performed on fourteen pregnant women and eighteen mothers post partum by X‐ray spectrophotomeyry. Pregnant women exhibited a loss in trabecular bone but not in cortical bone when measured once during late first or early second trimester and again one week post partum. Lactating women who nursed less than three months lost mineral during the first three months and than regained it while those who nursed for longer than three months had no losses during six months of study.

Transcervical sterilization in the human female by hysteroscopic application of hydrogelic occlusive devices into the intramural parts of the Fallopian tubes: 10 years experience of the P-block☆

The development of the hydrogelic occlusive device called the P-block is described including developmental steps of the design of the device as well as the experience gained concerning the hydrogel of the device, shelf life, animal and human toxicology, insertion techniques, analgesia, check-up for retention in situ, actual efficacy of the method, mode of action of the device, complication rates, patient acceptance, continuation rates, possible reversibility and future perspectives of the method. Over a period of 10 years more than 900 woman years were observed. The gross Pearl Index for the total series of nine different designs of P-blocks is 5, due to rejection of the device on either or both sides. The corresponding value for intact P-blocks in situ is 0.3. With the latest version of P-blocks--Mark 9--a total of 191 women have been observed over 637 woman years during a mean of 21 months with a maximum time of observation of 88 months in the single case. The continuation rate, when no pregnancy occurs is 99% over 10 years. After unilateral expulsion and intra-uterine pregnancy 48% return for reinsertion of P-blocks. The rate of complications, including extra-uterine pregnancies was neglectable as was the loss for follow-up. Life table analysis revealed that no pregnancy occurred after 30 months from the insertion of P-blocks.

Salpingitis; aspects of diagnosis and etiology: a 4-year study from a Swedish capital hospital.

359 patients underwent laparoscopy to verify the diagnosis of salpingitis. Pelvic inflammatory disease (PID) was found in 187 (52%) cases. Laparoscopy revealed normal conditions in 136 (37%) cases. Other diseases were diagnosed in 36 (10%) cases. Bacteriological cultures from the fimbrial lumen were positive in 24% of the PID cases. Chlamydia trachomatis (CT) was detected in 12%, Bacteroides species (BS) in 5%, Actinomyces israelii (AI) in 3%, Gardnerella vaginalis (GV) in 2%, Neisseria gonorrhoeae (NG) in 1%, and Ureaplasma urealyticum (UU) in 1%. Cervical cultures were positive for NG and/or CT in 71% of the PID cases but only in 19% of the non-PID cases. From these no positive intra-abdominal cultures were detected. Serological tests for CT were carried out. A positive acute titre of greater than or equal to 1/64 was noted in 37%, a seroconversion (X4) 2-3 weeks later was found in 14%. Positive serology despite a negative culture was registered in 19%.

Cardiac gas embolism during carbon dioxide hysteroscopy: risk and management

A relatively high number of fatal complications during hysteroscopy, where carbon dioxide was used as the uterine distension medium, plus a recent report on heart embolism during dog experiments with venous carbon dioxide infusion, audible by simple stethoscopic surveillance during the infusion, prompted the present study. Seventy women with no history of cardiac valvular disease or failure were observed during carbon dioxide hysteroscopy for the occurrence of the characteristic metallic heart sound caused by the intracardiac presence of free carbon dioxide during the heart contractions. In seven cases (10%) the typical metallic heart sounds appeared during the hysteroscopy, leading to immediate interruption of the hysteroscopy and withdrawal of the hysteroscope. This caused the pathological heart sounds to disappear, after which the hysteroscopy could continue. Heart auscultation should always be performed during carbon dioxide hysteroscopy in order to avoid serious cardiovascular complications. This simple precaution turns carbon dioxide hysteroscopy into a versatile and safe method for intra-uterine diagnosis and therapy.

Observations on the mode of action of an intratubal device, the P-block.

A hydrogelic intratubal device, called P-block, Mark 9, was inserted hysteroscopically with local anesthesia in the intramural part of the fallopian tube of 25 women referred for the procedure as an alternative to abdominal sterilization. Hysterosalpingography revealing bilateral oviductal patency was followed by hysteroscopic checkup verifying bilateral presence of P-blocks, except in three patients who had expulsion of the P-blocks on one side. All of the 22 patients had retention of the P-blocks 6 to 7 months after insertion. None became pregnant. Thus it is suggested that an intratubal device in the isthmic part of the human fallopian tube acts as an intrauterine contraceptive device, preventing intratubal and intrauterine pregnancies. Endeavors to explain the contraceptive effect of a nonocclusive intratubal device are discussed on the basis of our present knowledge of tubal physiology. Distension of part of the human isthmus is likely to disturb normal gamete transport through the isthmus.

In vitro induction of murine suppressor t‐cells by human chorionic gonadotropin

Human chorionic gonadotropin (HCG) has previously been considered to be immunosuppressive and, thus, by prohibiting maternal rejection of the fetal transplant, to be one of the factors responsible for the successful outcome of pregnancy. The mechanisms by which HCG exerts its pregnancy retaining effect is, however, as yet unknown. The present study shows that HCG has the capacity in mice of inducing lymphocytes which are subsequently competent to depress a polyclonal antibody response induced by different B cell mitogens. It is therefore suggested that HCG may exert its feto‐protective action by inducing suppressor T cells. These lymphocytes would thus prevent the activation of cells which are responsible for transplant rejection.

Second look laparoscopy; evaluation of two different antibiotic regimens after treatment of acute salpingitis

Abstract In order to have their diagnoses verified, etiology determined and treatment evaluated, 64 patients with suspected acute salpingitis (AS) underwent laparoscopy during which specimens were taken. The patients were referred to groups of either a mild ( 16 64 ), a moderate ( 26 64 ), or a severe ( 22 64 ) form of salpingitis. They were then randomized to one of two groups for treatment with either doxycycline/bensylpenicillin-procain (DC/BP) or trimethoprim-sulfamethoxazole (TMP-SMZ). The results were evaluated by second-look laparoscopy 3–6 months later when adhesions and tubal passage were looked for. Isolates from the cervix were culture positive for Chlamydia trachomatis (CT) in 36 64 (56%) ( 9 16 with a mild form, 13 26 with moderate form and 14 22 with a severe form of salpingitis). Neisseria gonorrhoeae (NG) was isolated from the cervix in 15 64 (23%) ( 5 16 with a mild form, 4 26 with a moderate form and 6 22 with a severe form of the disease). Oviductal cultures for CT were found in 12 64 (19%) ( 1 16 with a mild form, 4 26 with a moderate and 7 25 with severe form of salpingitis). Oviductal isolates for NG were found in 2 64 (13%) ( 2 16 from the group with a mild form of the disease). Second-look laparoscopy revealed totally occluded oviducts in two patients from the group with a severe form of salpingitis (one from each treatment group).

Radionuclide hysterosalpingography for measurement of human oviductal function

A clinical method is described and claimed to evaluate the active transportation capacity of the luminal epithelium lining the human uterus and fallopian tube. After intracervical application of technetium‐labelled human albumin spheres at 1–2 days before ovulation this radioactivity could be followed by gamma‐camera when moved in ad ovarian direction. This method is called radionuclide hysterosalpingography (RN‐HSG). The results were compared to the findings at normal hysterosalpingography (HSG). By use of this method it was possible to verify active passage in cases of tubal spasm at HSG, lack of transport in cases of normal patent oviducts at HSG as well as presence or absence of active transport through sactosalpinges with or without fimbrial passages to the abdominal cavity as seen at normal HSG. Congruent findings between HSG and RN‐HSG was observed in 49%. The studied oviducts were found to be patent with normal HSG but lacked transportation capacity when studied by RN‐HSG in 41%. The clinical use of this method is discussed in view of the selection of patients for different forms of in vitro fertilization and egg transfer (IVF‐ET).

In Vivo Suppression of Uterine Lymphocytes During Early Human Pregnancy

The immunological acceptance of the foetus being an allogeneic homograft is still a perplexing phenomenon. How can the foetal trophoblast engraft into the endometrium and survive while exposed to the maternal immunological defense? It has been postulated previously that a mucoprotein, masking trophoblastic antigens, (1) or an anatomical foetomaternal separation ( 2 ) should be essential in the engrafting process. A number of soluble substances, have also been suggested to be responsible for this successful transplantation, by inhibition of the maternal lymphocyte transformation. Thus, in vitro studies have demonstrated that human chorionic gonadotropin (HCG) ( 3 4 , human chorion somatomammatrophin (HCS) (4) and progesterone (7) inhibit lymphocyte transformation as induced by different antigens and mitogens. In addition IgG, possibly locally produced, eluated from placental tissue has been shown to possess a similar inhibitory effect (8, 9). The underlying mechanism is still unclear but these antibodies are most likely not directed towards any as yet specified surface component, since antibodies directed against known T or B cell antigens do not significantly inhibit the mitogen-induced proliferative response of lymphocytes. During pregnancy a factor has been demonstrated in maternal plasma that suppresses the reactivity of peripheral blood lymphocytes (10, 11) . As this factor is probably produced by the placenta, the lymphocytes adjacent to the uterus should be functionally more suppressed than those in the peripheral circulation. To elucidate this postulation lymphocytes were

Thyroxine-Binding Globulin in Spontaneous Abortion

Thyroxine-binding globulin (TBG), thyroxine-binding prealbumin (TBPA), thyroxine (T4), free T4, triiodothyronine (T3) and thyroid-stimulating hormone (TSH) were studied in 144 apparently healthy, euthyroid pregnant women displaying miscarriages. In an additional group of 18 aborting women a frozen blood sample drawn in early pregnancy was similarly analyzed for the thyroid components as well as for human chorionic gonadotropin (HCG). The values were compared to those of normal pregnancies (n = 228) at corresponding intervals. Significantly lower values of TBG were found in the spontaneously aborting group. A significantly lower value of TBG was found to be more predictive concerning spontaneous abortion than that of HCG.