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- Prostaglandin F2α 10 mg was administered intravesically in a double-blind placebo-controlled study to promote micturition in cases of urinary retention after operative treatment of urinary stress incontinence in women. Fifteen of 18 patients (83%) succeeded in voiding after treatment with prostaglandin F2α, but the placebo was ineffective in all 18 patients ( P<0.001). Although the effect of prostaglandin F2α on bladder muscle contraction was short-lived, it seemed to enhance the restoration of bladder motor function with no serious side effects, and thus to be clinically useful in the treatment of post-operative urinary retention. [ABSTRACT FROM AUTHOR]

- To evaluate urodynamic effects of modified Burch colposuspension, 24 patients with stress urinary incontinence were investigated before and 6 to 9 months after the operation. A new method of urodynamic evaluation was performed using a multitransducer-catheter, 5 microtransducers inside the urethra and 1 in the bladder, connected to a computer and graphic plotter. Single coughs were analysed with the catheter in a fixed position and the patient in the standing position. The operation, which was successful, in all but 1 patient, did not alter urethral pressure at rest, but urethral closure pressure at stress after the operation (mean 45.0 cm H2O (SD 21.6)) was significantly higher ( P < 0.005) than the - 3.6 cm H2O (SD 10.2) recorded before the operation. The pressure transmission ratio was less than 100% in 22 patients before the operation and more than 100% in 18 patients afterwards, the pre-and post-operative mean values being 78.9% (SD 11.9) and 109.5% (SD 17.2) respectively ( P < 0.0005). Burch colposuspension markedly improves urethral closure function as evaluated by this method, which analyses the pressure data at different points of the urethra and bladder during one single cough. [ABSTRACT FROM AUTHOR]

Objective: To compare a local injection of hyperosmolar glucose and salpingostomy for the laparoscopic treatment of tubal pregnancy in terms of immediate success and postoperative tubal patency., Design: Prospective. PATIENTS, SETTING: Forty women with an unruptured tubal pregnancy were enrolled from among 117 women with ectopic pregnancies (EPs) admitted consecutively to the university clinic. The inclusion criteria were as follows: [1] concentration of beta-hCG in the serum < or = 5,000 IU/L; [2] no living fetus in the EP; and [3] unruptured tubal pregnancy at laparoscopy., Interventions: After randomization, 20 of these patients were treated with a local injection of hyperosmolar (50%) glucose solution and 20 women by salpingostomy. Tubal patency was evaluated at relaparoscopy or by hysterosalpingography 6 to 13 months after the primary treatment., Results: The mean decrease in beta-hCG concentration from the preoperative value to the first postoperative day was 37% and 52% in the glucose and salpingostomy groups, respectively, and the mean resolution time was 13 and 12 days, respectively. Human chorionic gonadotropin showed a persistent EP in 4 women (20%) in the glucose group and 2 (10%) in the salpingostomy group. A patent treated tube was found in 9 of 13 women in the glucose group and 9 of 10 in the salpingostomy group at re-examination. During a follow-up of 6 to 20 months 4 women in the glucose group and 4 women in the salpingostomy group had an intrauterine pregnancy., Conclusion: A local injection of hyperosmolar glucose is a reasonable method treating tubal pregnancy in selected cases but does not seem to offer any advantage over salpingostomy concerning persistent trophoblastic disease rate.

The effects of the new progestagen desogestrel on the changes induced by ethinyloestradiol (EE) on the serum levels of sex hormone binding globulin (SHBG), transcortin, ceruloplasmin and haptoglobin were studied in healthy female volunteers. Desogestrel (0.125 mg or 0.250 mg) administered in combination with 0.050 mg EE was compared with 0.050 mg EE alone. After 7 and 14 days the three regimens induced similar changes in the serum levels of transcortin, ceruloplasmin and haptoglobin. Desogestrel at a dose level used in oral contraceptives did not inhibit the EE-induced increase in SHBG capacity while its influence on this parameter at twice the clinical dosage (0.250 mg) used was still minor. It can be concluded that with respect to the parameters studied desogestrel in the clinical dosage used has no detectable oestrogenic or androgenic effect.

The effects of 0.125 mg daily doses of the new progestagen, desogestrel, 0.125 mg of levonorgestrel or 5 mg of lynestrenol on serum sex hormone binding globulin (SHBG), cortisol binding globulin (CBG), ceruloplasmin and HDL-cholesterol were studied in 30 healthy female volunteers to compare the possible androgenic and oestrogenic effects of these contraceptive steroids in vivo. All the progestagens in the applied dosages decreased SHBG and HDL-cholesterol concentrations, suggesting some androgenicity. Lynestrenol increased ceruloplasmin and CBG concentrations, indicating weak oestrogenic effects of the steroid. During desogestrel treatments, CBG and ceruloplasmin concentrations remained unchanged. After 30 days treatment with levonorgestrel there was a slight decrease (P less than 0.05) in ceruloplasmin concentrations. Thirty days after finishing the progestagen treatments serum protein concentrations were normal. In conclusion, at the doses used and under the present test conditions the progestagens studied had a weak androgen-like effect and lynestrenol also showed weak oestrogenic activity, as determined by their effects on serum proteins.

Intervillous blood flow (IVBF) was measured intravenously with a new quantitative 133Xe method in 50 normal and 74 complicated late pregnancies between the 35th and 42nd weeks. The distribution of individual flow rates seemed to be fairly wide in both the normal and the pathological groups. The mean rate of IVBF in normal pregnancies was 140 ml/100 ml of intervillous space/min. The lowest mean flow values were observed in pregnancies complicated by diabetes mellitus (class B-E), cholestasis of pregnancy and severe pre-eclampsia, a highly significant difference (p less than 0.001) from the mean IVBF observed in normal pregnancies. The significance of the results in the different groups has been discussed in detail. This method may open up a new diagnostic area in the management of high-risk pregnancies.

A new method for measuring regional distribution of placental blood flow is presented. After 2-5 mCi of 133Xe saline has been injected intravenously, the counts over the placenta are registered with a scintillation camera interfaced with a digital data storage and television readout system. Using "area of interest" technique, time activity curves are obtained for different regions. Analysis of the curves is based on two-exponential curve fitting. In normal pregnancy the mean intervillous flow in 16 healthy women was 125 ml/min/100 ml and myometrial flow 17 ml/min/100 g. The intervillous flow in the central part of the placenta was 55% higher than in the marginal parts. The myometrial flow in the placental area was nearly the same as outside the placenta.

The effects of low-dose segmental epidural analgesia on fetal heart rate (FHR) patterns, uterine activity, and some clinical features were examined in a series of 105 normal parturients. The aim of the analgesic technique was to relieve pain during the first stage of labour by blocking the sensory nerve fibres at the spinal level of T 10 to T12, with either 0-5 per cent bupivacaine or bupivacaine with adrenaline 1 : 200 000, the dose varying from 10 to 25 mg. Obvious pathological changes (late decelerations, prolonged fetal bradycardia, variable deceleration, or loss of beat to beat variation) in FHR patterns within the first 30 minutes after the beginning of analgesia were noted in 9 per cent of the patients. Addition of adrenaline to the analgesic agent seemed to reduce uterine activity for 60 minutes after the analgesia and this was reflected in a longer interval between the block and delivery. A 25 per cent fall in systolic blood pressure was recorded in 11 per cent of the patients. Nine patients required vacuum extractions. Our results show that the epidural technique employed has distinct advantages over the previous methods, which require larger doses of the analgesic, agent, and is therefore safer for the fetus; the addition of adrenaline to the analgesic agent is contraindicated.

Prostaglandin F2 alpha 10 mg was administered intravesically in a double-blind placebo-controlled study to promote micturition in cases of urinary retention after operative treatment of urinary stress incontinence in women. Fifteen of 18 patients (83%) succeeded in voiding after treatment with prostaglandin F2 alpha, but the placebo was ineffective in all 18 patients (P less than 0.001). Although the effect of prostaglandin F2 alpha on bladder muscle contraction was short-lived, it seemed to enhance the restoration of bladder motor function with no serious side effects, and thus to be clinically useful in the treatment of post-operative urinary retention.