Søren Stampe Sørensen

Endometrial polyps and associated factors in Danish women aged 36-74 years

OBJECTIVE To identify factors associated with endometrial polyps. STUDY DESIGN Case-control study of 140 women with endometrial polyps and 367 controls. Information on potentially associated factors was obtained by a validated questionnaire. RESULTS In an age-adjusted logistic regression model, the following was positively associated with endometrial polyps: current use of hormone therapy (odds ratio, 2.81; 95% CI, 1.29-6.13) and being overweight (body mass index > 25 kg/m(2)) (odds ratio, 2.06; 95% CI, 1.12-3.79) (postmenopausal women). Negatively associated was use of oral contraceptive pills (odds ratio, 0.20; 95% CI, 0.06-0.66). Histopathology diagnosed benign endometrial polyps (n = 137), polyp with premalignant disease (n = 3), and benign polyp with concomitant complex hyperplasia/endometrial cancer (n = 3). CONCLUSION Being overweight and current use of hormone therapy in postmenopausal women were positively associated, whereas the use of oral contraceptive pills was negatively associated with endometrial polyps. Hypertension and cervical polyps were not associated with endometrial polyps. Endometrial polyps were infrequently related to premalignant and malignant disease.

Müllerian duct anomalies diagnosed by saline contrast sonohysterography: prevalence in a general population

OBJECTIVE To estimate the prevalence of uterine müllerian duct anomalies in a general population. DESIGN Cross-sectional study. SETTING University hospital in collaboration with the Danish Civil Registry. PATIENT(S) A total of 1,654 women randomly recruited from a general population; 686 women were eligible and accepted inclusion (429 pre- and 257 postmenopausal). Saline contrast sonohysterography (SCSH) was finally performed in 622 women (aged 20-74 years) (the procedure was impossible owing to cervical stenosis in 58, contraindicated in 2, other patient-related factors in 4). INTERVENTION(S) The shape of the uterus was dynamically evaluated in the transversal and longitudinal planes during SCSH and classified in accordance with American Fertility Society as normal, arcuate, septate (partial, complete), bicorn (partial, complete), or unicorn. History of previous miscarriage and menstrual cycle was obtained by a questionnaire. MAIN OUTCOME MEASURE(S) Prevalence of müllerian anomalies, miscarriage, and oligomenorrhea. RESULT(S) The overall prevalence of müllerian anomalies was 9.8% (61 of 622) (95% confidence interval [CI] 7.5-12.1). The majority had arcuate uteri (n=42, 6.8%), 17 partial septate (2.7%), 1 complete septate (1.6%), and 1 unicorn uterus (1.6%). Müllerian anomalies were significantly more frequently diagnosed in nulliparous (20% [26 of 128]) compared with parous women (7% [35 of 494]). Müllerian anomalies were more frequent in women with oligomenorrhea compared with women with normal menstrual periods (19% [15 of 79] vs. 10% [34 of 339]). One first-trimester miscarriage or multiple miscarriages (more than one) were not significantly more frequent in premenopausal women with müllerian anomalies compared with women with normal-shaped uteri (24% [6 of 25] vs. 22% [57 of 265]). CONCLUSION(S) In a general population examined by SCSH the prevalence of Müllerian anomalies is estimated at 9.8%. Müllerian anomalies were more frequent in nulliparous women. Both impaired fertility and a pregnancy-associated modulation of the uterine corpus are among explanations. Müllerian anomalies were associated with oligomenorrhea in premenopausal women. In this general population there was no association between miscarriage and müllerian anomalies; however, the number of cases was limited.

Termination of second trimester pregnancy with gemeprost vaginal pessaries and intra-amniotic PGF2α. A comparative study

152 women admitted for legal abortion in the second trimester of pregnancy were included in an open, randomized, controlled six-centre study. 75 patients received gemeprost 1 mg vaginal pessaries at 3 hours intervals up to a maximum of 5 mg and 66 patients were treated with a single 40 mg intra-amniotic dose of PGF2 alpha. The 24-hour success rate was 81% (n = 61/75) in the gemeprost and 64% (n = 42/66) in the PGF2 alpha group (p less than 0.02). The mean abortion times were 14.3 and 14.8 hours in the gemeprost and the PGF2 alpha groups, respectively. The mean time to onset of pain was shorter and more patients experienced blood loss over 100 ml during the induction in the PGF2 alpha group than in the gemeprost group (p less than 0.02). Apart from that, the nature and severity of side effects were comparable between the two groups. Besides significantly better efficacy, the non-invasive gemeprost treatment was found to be easier and safer as compared to the PGF2 alpha treatment.

Pre- and postoperative therapy with GnRH agonist for endometrial resection : A prospective, randomized study

Background. To assess the value of endometrial preparation, with preoperative and pre‐ and postoperative GnRH agonist therapy in transcervical endometrial resection.

Loop diathermy or laser excisional conization for cervical intraepithelial neoplasia

BACKGROUND Cervical intraepithelial neoplasia (CIN) can be managed by ablative or excisional procedures. We have compared the excision time, effectiveness, and safety of loop diathermy (loop) against laser conization. METHODS In a prospective study in two hospital departments 222 women were randomized to loop or laser conization. Data were collected by questionnaires after operation and at two follow-up examinations. RESULTS At department A (122 women), two physicians performed 27% of the loop and 35% of the laser excisions; at department B (100 women), the corresponding figures were 69% and 59%. Loop was quicker than laser conization in both departments (median 3-4 min versus 10-20 min), while laser conization was more time consuming in department A (median A/B = 20/10 min). Peroperative bleeding dominated during the laser procedure in both departments and complicated the loop procedure more frequently in department A. Postoperative bleeding occurred with equal frequency in the four groups (41.8%, 52.7%, 59.2%, 64.7%). At both departments, bleeding for more than two weeks was reported twice as often after laser conization (A:13.8%, B:24.2%), when compared to loop excision (A:7.1%, B:13.7%). Residual CIN was found in all of three re-conizations and in one of eight hysterectomy specimens. CONCLUSIONS Loop was quicker than laser excision, per- and postoperative bleeding diminished, and the success rates were comparable. Physicians mastered Loop excision after a few attempts. However, the results improved, when performed by a restricted number of physicians. Histological incomplete excision indicates close colposcopic and cytologic follow-up to identify residual CIN.

Autologous fibrin sealant in reconstructive rabbit oviduct microsurgery

A simple method for preparing concentrated fibrinogen for use in a tissue adhesive system is described. Approximately 75% to 80% of the plasma fibrinogen can be separated and concentrated within 45 to 60 minutes from a small blood sample collected from the patient before the operation. Autologous fibrinogen prepared by this method was evaluated in reconstructive microsurgery of the rabbit oviduct.

Outcome of Repeated Hysteroscopic Resection of the Endometrium

STUDY OBJECTIVE To evaluate the efficacy and safety of repeated endometrial resection. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING University teaching hospital. PATIENTS Women with a failed primary endometrial resection. INTERVENTION Repeated endometrial resection, roller-ball coagulation, or both. MEASUREMENTS AND MAIN RESULTS In all, 65 women had a repeated endometrial resection during the period from January 1995 through December 2002. Data were collected from standardized data sheets, hospital records, and the National Patient Registry of the National Board of Health. The primary outcome measurement was subsequent hysterectomy, and secondary, perioperative complications. The median follow-up time was 56 months (range 40-110 months). In all, 28 (43%) women required a hysterectomy eventually. Six (9%) women had operative complications. CONCLUSION Repeat endometrial resection is a relatively safe, minimally invasive operation and approximately 60% of women operated on will avoid hysterectomy. The operation should be performed by an experienced hysteroscopic surgeon.

Surgical management of tubal infertility

Objective. To investigate an unselected group of patients in a regional area undergoing tubal surgery for infertility and to identify those women who would benefit from surgery and those who should be referred directly to in vitro fertilization (IVF). Design. A retrospective study based on medical records and questionnaires. Setting. The Departments of Obstetrics and Gynecology, Gentofte, Glostrup and Herlev Hospitals, University of Copenhagen, Denmark.

Ovarian Cysts in Women with Inflammatory Bowel Disease

Abstract. The frequency of ovarian cysts in patients with Crohns disease (CD) or ulcerative colitis (UC) is believed to be higher than in the normal population, but this aspect has not been studied hitherto. The prevalence of ovarian cysts in the normal population is unknown. By ultrasonic scanning, we studied the frequency of ovarian cysts in 61 patients with CD, 64 with UC, and in 100 controls. The findings were positive in 3 out of 61 with CD, 5 of 64 with UC, and in 2 of 100 controls. There is a tendency to a higher frequency of ovarian cysts in patients with inflammatory bowel diseases than in the normal population, but no statistically significant difference.

Pregnancy outcome after metroplasty in women with müllerian anomalies.

Abstract. Pregnancy outcomes in 22 consecutively operated women with Mullerian anomalies are described. In 16 women the indication for metroplasty was two or more spontaneous abortions and/or premature deliveries The frequency of successful pregnancies increased from 5% before to 76% after operation. In 6 women metroplasty was performed on account of infertility. It is argued that infertility rarely constitutes an indication for metroplasty, and only when concurrent causes of infertility have been excluded. Several of the postoperative pregnancies and deliveries presented serious complications. Cesarean section is therefore recommended in some deliveries after metroplasty.