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Objective To assess trends for hysterectomy methods in the Nordic countries and to compare outcomes of hysterectomies in Finland done by trainees with those done by specialists. Design Register-based study. Setting NOMESCO database for the Nordic countries and the Finnish Hospital Discharge Register. Population National prospective cohort of 5279 hysterectomies in Finland. Methods Numbers of hysterectomies in the Nordic countries were collected in 1995-2011 and in Finland in 1990-2012. The Finhyst study to collect data on hysterectomies for benign indications was carried out in Finland in 2006. Information concerning patients, surgeons, and hysterectomy outcome was analysed. Main outcome measures Hysterectomy numbers and methods. Operating time, blood loss, and complications in hysterectomies done by trainees and specialists. Results In Finland, the rate of hysterectomies has been reduced by approximately 50% since the 1990s and is now similar to that in the other Nordic countries. The laparoscopic method is twice as common in Finland as in other Nordic countries, constituting 35-40% of all hysterectomies. The operating time for all hysterectomy methods was 16-25% longer among trainees than specialists. For the abdominal or laparoscopic methods there were no significant differences in the complication rates between the groups. In the vaginal approach, blood loss of ≥1000 mL was slightly more common in operations done by trainees (1.3% vs. 2.6%, p = 0.037). Conclusions Laparoscopic hysterectomy is more common in Finland than in the other Nordic countries. Although trainees need more time to operate, there were no differences between the trainees and the specialists with regard to major complication rates. [ABSTRACT FROM AUTHOR]

Objective To study the possible association between menopausal hot flushes and bone mineral density. Design Observational study. Setting University clinic. Population Healthy women ( n = 143) with or without hot flushes, 6-36 months postmenopausal after participating in a 6-month hormone therapy trial. Methods The women prospectively recorded the number and severity of hot flushes for 2 weeks. Bone mineral density in lumbar and hip bones was measured with dual-energy X-ray absorptiometry at recruitment and reassessed in 114 women approximately 6.2 years later. Main outcome measures Hot flushes and bone mineral density. Results At recruitment, hot flushes were absent in 22 women, mild in 32, moderate in 28, and severe in 61. Lumbar bone mineral densities in non-flushing women (1.130 ± 0.022 g/cm2; mean ± SEM), and in those with mild (1.088 ± 0.024 g/cm2), moderate (1.082 ± 0.030 g/cm2) or severe (1.102 ± 0.019 g/cm2) hot flushes did not differ, nor were there differences in hip bone mineral densities between the four study groups. During the follow-up, lumbar bone mineral density decreased by a mean of 0.4 ± 0.1% a year in women not using hormone therapy, and increased by 0.1 ± 0.2% a year in hormone therapy users ( p = 0.019). The respective non-significant changes in left and right total hip bone mineral densities were - −0.6 ± 0.01 and −1.0 ± 0.1 for the non-users, and −0.4 ± 0.1 and −0.6 ± 0.2 for hormone therapy users. These changes in bone mineral density bore no relation to the hot flush status at baseline. Conclusion In recently menopausal women, hot flushes do not appear to determine bone mass density. [ABSTRACT FROM AUTHOR]

Objective To compare in controlled cardiovascular autonomic function tests the effects of hormone therapy ( HT) on heart rate variability ( HRV) responses in postmenopausal women with and without pretreatment hot flushes. Design A randomized placebo-controlled trial. Setting Finland, Helsinki University Central Hospital. Population A total of 150 recently postmenopausal and healthy women with prospectively evaluated hot flushes. Methods Women (72 with and 78 without hot flushes) were randomized to receive estradiol alone or in combination with medroxyprogesterone acetate or placebo for 6 months. Time and frequency domain measures of HRV were assessed at baseline and after HT with short-term recordings during paced quiet and deep breathing and with active orthostatic tests, both under carefully controlled laboratory conditions to avoid confounding factors present in long-term ambulatory HRV measurements. Main outcome measures Responses of time and frequency domain measures of HRV to HT. Results At baseline HRV was similar in women with and without hot flushes. Pretreatment hot flushes did not associate with changes in time domain parameters of HRV during controlled quiet or deep breathing or active orthostatic tests after different types of HT. However, HT reduced HRV in very low frequency power in women with pretreatment hot flushes (from 371 ± 40 to 258 ± 28 ms2, p = 0.018). HT did not have an effect on other frequency domain measures during quiet breathing or active orthostatic tests. Conclusions Hormone therapy did not significantly modify the HRV responses in women with or without hot flushes under controlled short-term measurements of the cardiovascular autonomic nervous system. [ABSTRACT FROM AUTHOR]

Objective Both smoking and the release of nitric oxide ( NO) in the uterine cervix are determinants for high-risk human papillomavirus (hr HPV) infection. We compared the cervical NO release between smoking and non-smoking women with and without hr HPV infection. Design Open clinical cohort study. Setting University Hospital in Finland. Population One hundred and twenty-five smoking and 301 non-smoking women, with ( n = 244) and without ( n = 182) hr HPV infection. In total, 264 women showed cytological and/or histological cervical epithelial changes. Methods The presence of hr HPV was tested by an HPV DNA test and the release of NO was assessed from NO metabolites in the cervical fluid by the Griess reaction. Main outcome measures The difference in cervical NO release between smoking and non-smoking women with and without hr HPV. Results Infection with hr HPV in smokers (70%) was more frequent ( p = 0.001) than in non-smokers (52%). As a whole, smoking was accompanied by a 35% decrease ( p = 0.04) in NO release in hr HPV-infected women (35.9 μmol/L, 95% confidence interval 27.0-44.2) compared with non-smoking hr HPV- infected women (48.3 μmol/L, 95% confidence interval 38.0-56.2). No difference in NO release between smokers and non-smokers was seen in women with healthy cervical epithelium, but smoking was accompanied by a suppressed (26%) NO release ( p = 0.03) in women with either cytological or histological changes. Conclusions Smoking may suppress NO release in the uterine cervix in women with hr HPV infection. [ABSTRACT FROM AUTHOR]

Objective. To compare cervical fluid nitric oxide release in women with and without Chlamydia trachomatis and high-risk human papillomavirus infection (hrHPV). Design. An open clinical study. Setting. University Hospital of Helsinki. Population. Thirty-nine women with ( n=21) and without C. trachomatis ( n=18). Methods. Chlamydia trachomatis and/or hrHPV were studied by using specific RNA- and DNA-based tests. Levels of cervical fluid nitric oxide metabolite (NOx) were assessed by the Griess reaction. Main Outcome Measures. The difference in cervical fluid NOx between women with and without C. trachomatis and hrHPV. Results. Fourteen (67%) C. trachomatis-infected women and three (17%) noninfected women had concomitant hrHPV. The level of cervical fluid NOx in women with C. trachomatis (median 37.5μmol/l, 95% confidence interval 26.1-50.9) was higher ( p=0.02) than that in C. trachomatis-noninfected women (median 19.7μmol/L, 95% confidence interval 5.6-30.0). The presence of hrHPV did not associate with any difference in NOx levels between C. trachomatis-infected or -noninfected women. Conclusions. Chlamydia trachomatis was associated with increased release of nitric oxide metabolites in the uterine cervix. This stimulus was stronger than that of hrHPV, because no additional rise in NOx was seen in women with concomitant C. trachomatis and hrHPV infection. [ABSTRACT FROM AUTHOR]

The article discusses a study on the levels of cervical fluid nitric oxide metabolite (NOx) in women with or without high-risk (hr) human papillomavirus (HPV) and the value of which in the prediction of HPV persistence. The study involved women aged 18 to 64 years old in Finland. The study found that hr HPV persisted in 64% of the women and disappeared in 36%. Women with persistent hr HPV had higher median basal levels of NOx than those with eradicated hr HPV.

Objective. The human uterine cervix is capable of producing nitric oxide (NO). We studied the impact of cytological changes on the release of cervical NO. Design. Population-based case-control study. Setting. City of Helsinki, Finland. Population. Cervical cytology tests and cervical fluid samples were collected in 297 women. Methods. Cervical cytology tests, classified according to Bethesda criteria, were specifically analyzed for changes typically seen in human papillomavirus (HPV) infection, and the level of NO metabolites (NOx) in cervical fluid was assessed by Griess reaction. Main outcome measures. The difference in cervical fluid NOx between normal and abnormal cytology. Results. Cervical cytology was normal in 219 women and abnormal in 78 women. Among women with abnormal cytology there was both a higher detection rate (89% vs. 71%) and a higher concentration of NOx (median 22.5 µmol/l, 95% CI 14.6-31.9 vs. 11.0 µmol/l, 95% CI 8.0-16.7) compared to women with normal cytology. Age, parity, use of oral contraceptives, phase of the menstrual cycle, or history of miscarriage or termination of early pregnancy were not linked to an increased cervical NOx level. Conclusions. Cervical cell changes (suggestive of HPV infection) are accompanied by an increased release of NO in the human cervix. The significance of this finding remains uncertain, but in theory, increased release of NO could modify the outcome of cervical infection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Vasoactive intestinal peptide (VIP) is a peptidergic neurotransmitter and a vasodilator with positive inotropic and chronotropic properties. Whether and how VIP contributes to the neuroendocrine response in heart failure (HF) is disputed, and there are no data on VIP in pressure overload-induced HF. Methods: We studied 129 adults with isolated aortic valve stenosis (AS). Blood was sampled from the aortic root and, in a subset of 48 patients, also from the coronary sinus for determination of VIP by radioimmunoassay. HF was diagnosed according to the European Society of Cardiology criteria. Results: Plasma VIP (mean±S.E.M.) was slightly higher in patients with HF (22.6±0.9 pmol/l, n =41) than in patients free of HF (21.1±0.5 pmol/l, n =88) or in 11 control patients without structural heart disease (20.0±1.3 pmol/l, n =11) (p =0.030 across the groups). VIP did not correlate with any measurement of cardiac structure or function in AS. The change in plasma VIP from aortic root to coronary sinus averaged +1.2±0.4 pmol/l in the 11 control patients (p =0.021), +1.2±0.2 pmol/l in 33 AS patients free of HF (p <0.001) and +0.8±0.3 pmol/l in 15 AS patients with HF (p =0.037). Conclusions: Both structurally normal and diseased hearts release VIP into the coronary sinus. Although marginally elevated in the systemic circulation, VIP is unlikely to contribute significantly to the neuroendocrine activation in HF due to pressure overload. [Copyright &y& Elsevier]

Abstract: Background: The pregnancy hormone relaxin has been raised as a new compensatory mediator of cardiac origin in heart failure (HF). We set out to assess the role of relaxin in pressure overload-induced human HF. Methods: We studied 129 adult patients undergoing cardiac catheterization for isolated aortic valve stenosis (AS). Blood was sampled from the aortic root and, in a subset of 49 patients, from the coronary sinus for the determination of plasma relaxin by enzyme immunoassay. HF was diagnosed when the patient had dyspnea or fatigue on ordinary effort in association with pulmonary wedge pressure >14 mm Hg at catheterization. Results: Forty-one patients had HF, which was systolic (ejection fraction <50%) in 16 patients and diastolic in 25 patients. The median plasma relaxin was 32 pg/ml (<12–297 pg/ml) in 88 AS patients without HF, 28 pg/ml (<12–825 pg/ml) in the 41 AS patients with HF, and 42 pg/ml (range, <12–100 pg/ml) in 11 control patients free of heart disease (p=0.82). Plasma relaxin did not correlate with any measurement of cardiac structure or function. The concentration gradients of relaxin from the aortic root to the coronary sinus indicated relaxin extraction by the heart in the control patients (median change, −5 pg/ml, p=0.038) vs. relaxin production in patients with systolic HF (median change, +6 pg/ml, p=0.028) (p=0.002 between groups). Conclusions: Although the heart may release relaxin into the circulation in certain forms of HF, this does not translate into elevated systemic concentrations. Relaxin is not a major player in human HF. [Copyright &y& Elsevier]

The article discusses the highlights of the training organized by the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) Educational Committee which was held in Copenhagen, Denmark on November 8-9, 2013, aimed at assessing the possible reconciliation and improvement of the Nordic training in obstetrics and gynecology. Some of the speakers include Professor Wendy Reid from Great Britain, Professor Juha Räsänen from Finland, and NFOG President Professor Göran Berg.