Lars Svanberg

Primary and secondary maternal cytomegalovirus infections and their relation to congenital infection. Analysis of maternal sera.

ABSTRACT. 4382 new mothers were examined retrospectively with the enzymelinked immunosorbent assay (ELISA) for IgG activity to cytomegalovirus (CMV) during pregnancy. Some of them were also studied with the indirect immunofluorescence (IIF) test for CMV‐IgM antibodies. All the infants had been studied for CMV excretion within the first week of life. Nineteen of them had been shown to be congenitally infected with CMV. 1218 (28 %) women lacked CMV‐IgG activity at their first antenatal visit (usually in months III‐IV). Fourteen of them seroconverted before parturition (primary infection). Thirteen of the seroconverters were shown to develop CMV‐IgM activity. In 6 (43 %) cases the primary infection was transmitted to the offspring. The remaining 13 congenitally infected infants were born to mothers with a positive IgG‐test at their first antenatal control. Only one of these mothers had a clearly positive IgM‐test. She was shown to lack CMV‐antibodies before conception (primary infection during the first trimester). Preconceptional sera were obtained from further 4 of the 13 seropositive mothers of congenitally infected infants; all 4 had CMV antibodies before pregnancy (secondary infection during pregnancy). The combined studies of the mothers and infants revealed that 21–63 % of the congenital infections could have been caused by secondary maternal infections. Prospectively performed, the study would only have disclosed one of the three fetal CMV infections that resulted in neurological sequelae.

Congenital Cytomegalovirus Infection and Sensorineural Hearing Loss

In a prospective study still in progress, infants with congenital cytomegalovirus (CMV) infection were followed with audiological, ophthalmological, neurological, and psychological tests; 10,328 infants were investigated within a 5-year period (1977-1982) by virus isolation in urine within the first week of life. Fifty (0.5%) had a congenital CMV infection. In this group four children turned out to have total deafness and a fifth possibly a mild hearing disorder. In one case the deafness was associated with severe mental retardation and spastic tetraplegia. The mother of the child had a primary CMV infection in the first trimester. In one of the other cases of severe deafness it could be proven that the mother had had a secondary CMV infection and in further two cases, presumed secondary infections. Prospective serological tests of the mothers would not have revealed more than one of the high risk pregnancies. The value of vaccination against congenital CMV infection is questioned. Screening of newborn infants for congenital CMV infection is recommended in order to reveal infants at high risk for deafness and make an early habilitation possible.

On some Late Effects of Bilateral Oophorectomy in the Age Range 15–30 Years

Abstract. Between 1910 and 1940, 146 young females, aged 15–30 years, underwent bilateral salpingo‐oophorectomy as part of a radical operation for salpingo‐oophoritis. These women or their records were reviewed in 1971. 42 women had died in the meantime. More than half (22) of them had died from cardiovascular diseases, 5 from carcinoma of the uterus and 4 had committed suicide. None had died from carcinoma of the breast. Of 68 who were still alive, information by questionnaire was obtained and 32 were admitted to hospital for extensive examination. 32 age‐matched women to be operated on for prolapse but with no other known disease of the reproductive tract served as controls. A further control group was added as 11 of the 68 were found to have menstruated again after the operation which had evidently not completely removed the gonads. Complete oophorectomy was found to have been followed by: (a) an increased incidence of cardiac symptoms and nervous diseases as well as an increased use of drugs; (b) a significant increase in the frequency of coronary vascular diseases in ages up to 70 years; (c) an increase in the serum cholesterol and triglycerides, most significantly in the ages below 60‐65 years. Women with symptomatic coronary disease had a higher serum cholesterol level than women without and women with signs of peripheral vascular diseases had a significantly higher concentration of serum triglycerides: (d) an increased frequency of fractures (radius and femoral neck), increased osteoporosis and thinner cortical bone. The brittleness of the skeleton was correlated with low excretion of oestrogens in the urine. No vertebral compression or abnormal decrease in height was observed, (e) an increased adrenocortical activity with significantly increased excretion of 17‐ketosteroids, 17‐OH‐ketosteroids and low polar total oestrogens. This activity abated in women above 65 years. (f) a traumatic psychological experience of the accompanying sterility while sexuality seemed to be largely unaffected in many of them. Almost half of the women examined by the psychiatrist were unusually mentally active and agile and they had a lower excretion of estriol than the rest.

Coagulative and fibrinolytic properties of ascitic fluid associated with ovarian tumors.

Ascitic fluid samples from 19 patients with ovarian carcinoma, 3 with a benign ovarian tumor, and 5 with cirrhosis of the liver were examined for their content of coagulation factors and components of the fibrinolytic system. The concentration of trypsin inhibitors in the ascitic fluid was significantly higher in the presence of carcinoma. Large amounts of FDP were found in the ascitic fluid in all patients with malignant tumors, but not in the other two groups. Determination of FDP may therefore make it possible to differentiate between malignant and nonmalignant ascitic fluid.

The incidence of primary dysmenorrhea in teenagers

SummaryBy means of a questionaire we studied the menstrual patterns of 502 adolescent girls aged 10–19 years in 1979. The incidence of occasional or consistent primary dysmenorrhea was 43%. The incidence of dysmenorrhea increased considerably with increasing age and the interval between the menarche and the onset of dysmenorrhea was less than one year in 72% of subjects investigated. The occurrence of severe dysmenorrhea resulting in absence from school varied between 8 and 18% in various age groups.

The Prevalence of Type 1 Diabetes Mellitus at Follow‐up of Swedish Infants Congenitally Infected with Cytomegalovirus

In a Swedish prospective study of congenital cytomegalovirus (CMV) infection, 76 infants were shown to be infected among 16474 newborns screened by virus isolation in urine. Seventy‐three of the excreters were followed up and one developed Type 1 diabetes, as compared to 38 of the 19483 children born during the same period (p = 0.14, Fishers one‐tailed test). Thus we found no evidence that the combined finding of congenital CMV infection and Type 1 diabetes mellitus was related.

Abruptio Placentae—Treatment with the Fibrinolytic Inhibitor Tranexamic Acid

Abruptio placentae is known to have a bad prognosis for the fetus. Pathologic proteolysis, e.g. a pathologic activation of the coagulation mechanism and/or the fibrinolytic system is known to be a common complication in such cases. Analysis of the coagulation factors and components of the fibrinolytic system in the acute stage of 14 cases confirmed the earlier finding of mainly an activation of the fibrinolytic system, which argues for the use of a specific fibrinolytic inhibitor. 73 consecutive cases of abruptio placentae were treated with tranexamic acid in the acute stage, 67 of the patients were immediately delivered by cesarean section. The remaining six patients were in early gestational age and were treated for a prolonged period. The perinatal mortality of the entire group was only 8 per cent and the maternal mortality nil. None of the cases were complicated by hemorrhagic diathesis or thromboses. We believe that routine immediate treatment with tranexamic acid can reduce the perinatal mortality in cases of abruptio placentae.

Surgery for fulminating colitis during pregnancy

Two cases of fulminating colitis presenting during pregnancy are described. In both cases, resectional surgery was performed. In the first case, cesarean section was combined with subtotal colectomy and ileostomy during the 32nd week of gestation. In the second case, cesarean section was performed during the 33rd week of gestation and proctocolectomy in the puerperium. In both cases, histopathologic examination showed colitis more consistent with Crohns disease. It is concluded that if fulminating colitis appears during pregnancy it should be treated in the same manner as in the nonpregnant state.

BROMOCRIPTINE TREATMENT OF THE PREMENSTRUAL SYNDROME

Abstract. Bromocriptine, 2.5 mg twice a day was tested for its effect on premenstrual tension in a random double‐blind cross‐over trial.

A Prospective Study of Rotavirus Infections in Neonatal and Maternity Wards

ABSTRACT. The occurrence and symptomatology of rotavirus infections was studied at three maternity wards and one neonatal unit. Rotavirus was identified in 12.7% of 553 infants and 1.3% of 542 mothers at the maternity wards. Infections were more frequent in a mixed obstetric/ gynecology ward than in the pure obstetric wards. Only 10% of the infants had symptomatic infections. Subgroups of rotavirus was determined in 41 infants: 22 of subgroup I and 19 of subgroup II, which is the subgroup accounting for the majority of childhood gastroenteritis. Rotavirus was found in faecal samples from 37% of the infants at the neonatal unit during an eight‐month survey. A seasonal variation with most infections during colder months was seen. Subgroup determination was possible in 29 cases, 14 subgroup I and 15 subgroup II. Fifteen per cent of the infections demonstrated diarrheal symptoms. No significant difference among other clinical data registered was seen among rotavirus infected compared to the non‐infected infants. We conclude that neonatal rotavirus infections occur as an endemic infection at our maternity wards possibly combined with infections due to external sources of virus in mixed wards and neonatal units