Karsten Petersen

Postoperative morbidity among symptom-free alcohol misusers

Retrospective studies suggest that there is an increased postoperative morbidity among alcohol misusers. We have prospectively studied the risk of alcohol intake among patients undergoing surgery. We investigated 15 symptom-free subjects who required colorectal surgery and who were drinking at least 60 g of alcohol per day. These patients were matched for sex, nutrition, age, weight, cardiovascular and pulmonary disease, diagnosis, anaesthesia, and surgery to 15 control subjects who were consuming below 25 g of alcohol daily. Those drinking at least 60 g of alcohol per day developed more postoperative complications than controls (67% vs 20%, p less than 0.05) and hospital stay was prolonged (20 vs 12 days, p less than 0.05). Preoperatively, alcohol misusers had reduced left ventricular ejection fraction (median, 54% vs 68%, p less than 0.01). Delayed hypersensitivity responses were smaller in the alcohol group before (53 mm2 vs 78 mm2, p less than 0.05) and after (18 mm2 vs 55 mm2, p less than 0.01) surgery. Alcohol misusers had longer bleeding times during the first postoperative week (p less than 0.01). Surgical stress responses, as assessed by changes in plasma cortisol and catecholamines, were higher among alcoholics (p less than 0.05). Postoperative morbidity is increased in symptom-free alcohol misusers. The mechanism is probably subclinical cardiac insufficiency, immunosuppression, and decreased haemostatic function. Preoperative alcohol consumption may be a more important risk factor than previously thought.

Embryo quality and developmental potential is compromised by age

Aims. The aim of this retrospective study was to assess whether and how the age of the woman affects the quality and developmental potential of the oocytes and embryos in an ART program.

Perinatal outcome after in vitro fertilisation

A prospective series of 90 consecutive pregnancies (70 singleton, 16 twin and 4 triplet pregnancies) resulting in births of 114 infants after in vitro fertilisation (IVF) at Rigshospitalet were compared to a control group of pregnancies and deliveries in 70 non‐IVF infertility patients with singleton pregnancies and 20 women with normal fertility with twin (n=16) or triplet (n=4) pregnancies. No differences in the incidence of third trimester pregnancy complications, abnormal fetal karyotypes or malformations were found. The number of women with spontaneous onset of labor and the gestational age at delivery were similar in the IVF and control groups. In singleton deliveries, the birth weight was lower (p<0.025) in the IVF group (median 3145 g, range 8904300 g) than in the control group (3399 g, 2592–4850 g), whereas in multiple gestation similar birth weights were found in the IVF and control groups. We conclude that the birth weight in singleton deliveries after IVF is lower than the birth weight in infertility patients treated differently. The cause of this difference remains obscure.

Influence of Zona Pellucida Thickness of Human Embryos on Clinical Pregnancy Outcome Following In Vitro Fertilization Treatment

AbstractPurpose: To evaluate the correlation between the degree ofzona pellucida thickness variation (ZPTV) of transferredembryos with identical morphologies and subsequent clinicalpregnancy rates during 141 intracytoplasmic sperminjection (ICSI) treatment cycles. Methods: A total of 141 women participating in the studygroup comprising mostly male factor infertilities and somerepeat in vitro fertilization (IVF) failures were transferred,2 days after ovum pickup, with two to three embryos withidentical grades created by fertilization with ICSI. Allselected embryos were subjected to zona pellucida thicknessmeasurements immediately prior to transfer using a computerizedembryo measurement program from videocinematographyrecordings. Results: A total of 326 identical-grade transferredpre-embryos resulted in 70 clinical pregnancies with live-bornimplantation rate of 27.6%. A highly significant correlationwas observed between ZPTV of transferred embryos andthe IVF outcome with 77.1% and 83.64% of the clinicalpregnancies resulting from transferred embryos with ZPTVvalues greater than 20 and 25, respectively. The mean ZPTVvalues for 70 conceptual cycles and 62 nonconceptual cycleswere 28 ± 6.43 and 17.85 ± 8.11, respectively. No significantcorrelation between ZP thickness and number of blastomeresin the transferred embryos was evident, though embryoswith better scores had significantly thinner zonae and higherZPTV values. Though average zona thickness of embryosdeclined with age, the mean ZPTV value for women lessthan 30 years old was significantly higher (25.84 ± 8.57)as compared with those from women older than 35 years(20.72 ± 8.45). Conclusions: The degree of ZPTV of the transferred embryosexhibits a strong correlation with clinical pregnancy outcome following IVF treatment. This potentially reliable indicatorof IVF success rate could be used as a criteria forembryo selection during clinical transfers.

Effects of leptin on basal and FSH stimulated steroidogenesis in human granulosa luteal cells

Background. Body weight influences fertility and studies in mice have indicated that leptin is one of the mediators of this effect. Leptin is believed to centrally stimulate the hypothalamic‐pituitary axis resulting in increased gonadotropin release. Moreover, leptin is present in follicular fluid and the receptor is expressed in the human ovary. The aim of this study was to evaluate the direct effect of leptin on cultured human granulosa cell steroidogenesis.

Gonadotropin secretion before and during acute and chronic dopamine-receptor blockade in insulin-dependent diabetic patients with amenorrhea*

The dopaminergic influence on luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL) was studied in 12 diabetic patients with amenorrhea (DMAM) and in 10 normal menstruating diabetic patients (DM). DMAM patients had a reduction in LH pulsatility (P less than 0.05) and basal LH levels (P less than 0.02), compared with DM patients, whereas they had an LH and FSH response to intravenous metoclopramide (MTC) at 30, 45, and 60 minutes and at 30 minutes, respectively (P less than 0.05). Basal (P less than 0.05) and MTC-stimulated (P less than 0.05) PRL levels were lower in DMAM than in DM patients. Serum PRL and FSH increased significantly (P less than 0.02) in six DMAM patients during 10 weeks of oral MTC administration, whereas no significant (P greater than 0.05) alterations occurred in serum LH and estradiol levels. These data point toward increased dopaminergic activity in DMAM patients.

Are ultrasonic-guided follicular aspiration and flushing safe for the oocyte?

Oocyte collection was carried out in 53 patients by ultrasonically guided abdominal puncture under local or epidural anesthesia. Follicles were aspirated and flushed two to six times using a syringe with culture medium. A total of 196 oocytes was collected and 84 of those (42.9%) were found in the flushes. Mechanical damage was observed in 5.1% of the oocytes. Cleavage rates in mature oocytes (157) after 48 hr in culture were similar in the aspirate group (56.5%) and in the flush group (54.2%). Ten clinical pregnancies were obtained, corresponding to a pregnancy rate of 18.9%.

Prolonged dopamine receptor blockade in normoprolactinemic amenorrhea: a double-blind placebo study *

Patients with functional amenorrhea may have a raised central dopaminergic activity, leading to inhibition of pituitary-ovarian function. In a double-blind placebo trial, ten patients with amenorrhea received metoclopramide (MTC) orally in daily doses from 20 to 7.5 mg in a sequential form for 10 weeks. Six patients received placebo. Serum levels for luteinizing hormone (P less than 0.02), follicle-stimulating hormone (P less than 0.05), and prolactin (P less than 0.001) increased significantly during MTC administration, and no (P greater than 0.05) hormonal changes occurred in the placebo group. Six patients observed vaginal bleedings during MTC administration but without postovulatory progesterone levels. Dopamine receptor blockade may activate the hypothalamic-pituitary axis of amenorrheic patients, although an ovulatory response is not achieved.

Abnormal conjugated dopamine levels in patients with normoprolactinaemic amenorrhoea and in insulin-dependent diabetic patients

We determined the circulating dopamine levels in 17 patients with insulin-dependent diabetes mellitus (IDDM), of whom eight had amenorrhoea (DM-AM) and nine were normally menstruating (DM). Seven non-diabetic women with normoprolactinaemic, normogonadotrophic secondary amenorrhoea (AM) and nine normally menstruating women (controls) were studied. In all subjects basal blood concentrations of free dopamine (f-DA), conjugated dopamine (c-DA), epinephrine (E), norepinephrine (NE), prolactin (PRL), luteinizing hormone (LH), thyroid-stimulating hormone (TSH) and oestradiol-17 beta were determined and all subjects, except for three AM patients, had a Metoclopramide test performed for measurements of f-DA, c-DA, PRL, LH and TSH. Plasma c-DA was significantly (p less than 0.05) increased in patients with amenorrhoea compared to the respective control groups. In diabetic patients c-DA levels were significantly (p less than 0.05) lower compared to controls. The ratio between basal f-DA and c-DA concentrations was significantly (p less than 0.01) higher in diabetic patients compared with non-diabetic patients. After Metoclopramide stimulation DM-AM patients showed a significant (p less than 0.05) rise in c-DA, whereas this was not seen in other groups. DM-AM patients had significantly (p less than 0.05) lower basal PRL and LH levels than DM patients and controls. In addition DM-AM patients had a significantly (p less than 0.05) lower PRL response to Metoclopramide compared with DM patients. There were no significant correlations between catecholamines and basal as well as Metoclopramide stimulated pituitary hormones. This study suggests that the abnormal pituitary hormone secretion in patients with amenorrhoea may in part be caused by an increased dopaminergic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Life-Threatening Hemorrhage due to Uterine Vascular Abnormality

A case is reported of a 25‐year‐old woman stricken with prolonged and life‐threatening menorrhagia from abnormal uterine vessels resembling hemangioma cavernosum. The condition was suspected at ultrasonic investigation. Hysterectomy was performed as an emergency operation.