Stefan Fianu

PROPHYLACTIC EFFECT OF UVA-E IN WOMEN WITH RECURRENT CYSTITIS: A PRELIMINARY REPORT

Abstract The prophylactic effect of UVA-E on recurrent cystitis was evaluated in a double-blind, prospective, randomized study. A total of 57 women who had suffered at least three episodes of cystitis during the year preceding the study were treated with either UVA-E (n = 30) or placebo (n = 27) for 1 month. At the end of the 1-year follow-up period, a statistically significant difference between groups in the number of recurrences was seen. No side effects were reported. We conclude that UVA-E exerts a prophylactic effect on recurrent cystitis.

Absorbable Polyglactin Mesh for Retropubic Sling Operations in Female Urinary Stress Incontinence

Mesh of absorbable polyglactin 910 instead of human tissues or nonabsorbable synthetic materials was utilized for retropubic sling procedures in 21 women with urinary stress incontinence. The patients have been observed for a period ranging from 4 to 14 months. 20 of them are continent while there was 1 relapse after 2 months. The postoperative complications were minimal, and there has been no instance of foreign body reaction.

The site of placental attachment as a factor in the aetiology of breech presentation

Abstract. The frequency of cornu‐fundal implantation of the placenta in association with breech presentation was investigated in the following study. In a series of 124 women with breech presentation, and 125 women with cephalic presentation at or near term, the implantation site of the placenta was demonstrated by ultrasonography. It was found that with breech presentation the placenta was implanted in the cornual region in 72.6% of the cases, as compared with 4.8% in cephalic presentation. The placental implantation site may therefore have a determining effect upon the presentation of the foetus.

The effect of cervical dilatation by laminaria on the plasma levels of 15-keto-13,14-dihydro-PGF2α

Laminaria tents were inserted to induce cervical dilatation prior to suction abortion in 42 primigravidae. The plasma level of 15-keto-13,14-dihydro-PGF2 alpha, the principal metabolite of prostaglandin F 2 alpha, increased during the dilatation period. The gentle dilatation by laminaria tents probably induces an endogenous synthesis of prostaglandins causing a softening of the cervix.

Does the Hygroscopic Property of the Laminaria Tent Imply a Risk for Ascending Infection in Legal Abortions?: A microbiological study

In 53 women admitted for first‐trimester abortion, the cervical canal was dilated with laminaria tents prior to vacuum aspiration. Before insertion of the tents, endocervical specimens were taken for microbiological investigations, including Chlamydia trachomatis, and both aerobic and anaerobic microorganisms. The laminaria tents, widened by their hygroscopic properties, were removed just before the vacuum aspiration and sent for cultivation of aerobic and anaerobic microorganisms. The Grampositive aerobic cocci, Staph. epidermidis, Strept. faecalis and Strept. agalactiae as well as Escherichia coli and Klebsiella/Enterobacter were the most frequent microorganism among the aerobic isolates from the endocervices as well as from the laminaria tents. These microorganisms were identified on the tents in greater numbers than in the cervices. Staph. aureus was isolated from three laminaria tents, but only one of these 3 women was proved to be primarily colonized endocervically. Among the anaerobes, Bacteroidaceae followed by peptococci and peptostreptococci were the predominant genera found in the cervix as well as on the removed laminaria tents. These three groups of anaerobic microorganisms were found markedly less frequently on the laminaria tents than in the endocervix. On the other hand, Strept. intermedius, another anaerobe of possible enteric origin, was recovered from 9 laminaria tents but not in the cervices. Since no cases of clinically verified endometritis/salpingitis were registered in the present study it is concluded that the risk of a pelvic inflammatory disease (PID) due to the laminaria tent is negligible as long as the laminaria treatment does not exceed 24 hours.

SURGICAL TREATMENT OF POST ABORTUM ENDOMETRIOSIS OF THE BLADDER AND POSTOPERATIVE BLADDER FUNCTION

During the years 1953-1967, 17 women with endometriosis of the urinary bladder were treated with extirpation of the endometrial tissue, including partial or total resection of the trigone. In all cases the endometriosis had followed vaginal hysterotomy for legal abortion. Urethrocystoscopy was performed and the residual urine and bladder capacity were measured in all the patients one month and one year after the bladder operation. At follow-up in 1978 only 4 of the 17 women were available for urodynamic studies. Combined urethrocystometry, recording of the urethral pressure profile and measurement of the maximal urethral pressure in supine and standing positions were performed in these four patients, using the technique of Ulmsten et al. In all cases in the series, including those with trigone extirpation, all the tested parameters were normal. The writers therefore conclude that even total trigone resection can be done without disturbance to the bladder function.

External cephalic version in the management of breech presentation with special reference to the placental location.

In a series of 74 primary breech presentations, regularly followed up at the antenatal care unit at the University Department of Obstetrics and Gynecology at Sabbatsberg Hospital in Stockholm during the period January 1976December 1977, the result of attempts at cephalic versions were studied. Roentgenologic pelvimetry, prenatal estimation of the fetal weight and placental localization by ultrasonography were carried out in all the patients examined, representing cases from consecutive hospital admissions. Only pregnancies complicated by some disorder in either mother or child e.g. placenta praevia, contracted pelvis, accidental hemorrhage, toxemia, elderly primipara and cases when elective cesarean section was intended. have been excluded. External version was attempted when the fetus presented as a breech in patients of 35 (or more) weeks of gestation. There were 39 primiparae and 35 multiparae. All the 74 attempts at external version were made without anesthesia and in each case only one attempt was performed. No maternal or fetal death followed the attempted versions. In no case did spontaneous version take place after the attempted version. To analyze satisfactorily the results obtained in this series the breech presentations have been divided into two groups, according to the localization of the placenta. In Group I the placenta was located in one of the cornuo-fundal regions, while in Group I1 it was located on the anterior or posterior wall of the uterus.

Retropubic Urethrocystopexy with Fibrin Sealant: a Long-Term Follow-Up

Transabdominal urethrocystopexy by using a two-component fibrin sealant as a substitute for sutures was performed in 99 women suffering from proved urinary stress incontinence. All were assessed preoperatively, both clinically and by urodynamic tests. This report deals with the results after a follow-up period not shorter than 1 year and up to 4 years. We found it essential not to report postoperative results concerning observation periods shorter than 1 year, as most relapses are observed more than 1 year after operation. Success was defined as absence of objective urine loss at coughing or straining with full bladder in upright position. The results imply that this simple technique is worthy of trial in correcting urinary stress incontinence in women.

Maternal Mortality in Sweden 1955–1974

Abstract. A survey of the causes of maternal death in Sweden during the years 1955–74 is presented. 296 cases, where autopsy has been performed in 94%, have been reviewed. 219 have been classified as obstetrical deaths and 77 as non‐obstetrical. During the period an almost uniform lowering of the maternal death rate occurred. The explanation is a probable improvement in the quality of the medical care given in the hospitals and the antenatal clinics.

The influence of an early diagnosis on the results of surgical treatment of ectopic pregnancy

The postoperative fertility of 292 cases of ectopic pregnancy treated 1972–1979 was studied. Of these 156 were operated upon during 1972–1976, when only determinations of HCG in urine were available and 136 during 1977–1979, when RIA‐determinations of HCG in serum made an earlier pregnancy diagnosis possible. In spite of the fact that the time of observation was shorter in the second group the pregnancy rate was 41% compared to 31% in the first one (P < 0.05). The rate of childbirth among the pregnancies in the second group was 72% compared to only 55% in the first one (P < 0.05).