[Treatment of benign paroxysmal postural vertigo in a department of otorhinolaryngology]. / Behandling af benign paroksysmatisk positionssvimmelhed i øre-naese-halspraksis.

Benign paroxysmal positional vertigo can be succesfully treated by means of the Epley manoeuvre and vibration. This is a simple, non-invasive and economic procedure for this group of patients, who are greatly affected by vertigo in their daily life and therefore have many sick days.

Clinical effects of preoperative oestradiol treatment before vaginal repair operation. A double-blind, randomized trial.

The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation. In a double-blind randomized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus, it was found that 7 patients suffered from concomitant urinary stress incontinence. Vagifem (25 micrograms oestradiol) or placebo was administered as vaginal pessaries daily, 3 weeks prior to surgery and the clinical effects evaluated. One month postoperatively the prevalence of bacteriuria (> 100,000 CFU/ml urine) was significantly lower when using oestradiol than in the placebo group. At follow-up 3 years later 40 women (93%) answered the questionnaires. None received hormone replacement therapy. Nineteen percent in the preoperative oestradiol group and 11% in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics. This difference is not statistically significant (p > 0.05). Recurrent cystitis was not correlated to bacteriuria postoperatively. Seventy-nine percent of the women with genital prolapse but only 29% of the women with concomitant urinary stress incontinence were cured (p < 0.05). Neither preoperative oestradiol treatment nor body weight had any influence on relapse. Preoperative low-dose vaginal oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen. Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects.

The value of peroperative ultrasound examination in first trimester legally induced abortion.

A prospective study was carried out based on 117 first trimester legally induced abortions. Abdominal ultrasound examination was performed immediately after aspiration. The predictive value of an empty uterus at ultrasound examination was 97.3%. The rate of retained tissue was not reduced compared to studies where peroperative ultrasound was not used.

PIP: Despite curettage after vacuum aspiration of induced first trimester abortions, some patients experience signs and symptoms of retained placental tissue. A prospective study was conducted to evaluate the use of postoperative ultrasound examination in the prediction of an empty uterus in induced abortion and to study the effect of preoperative ultrasound on the rate of complications after legal termination in the first trimester. The study was conducted among 117 women, 18-48 years old, who were referred for legally induced first trimester abortion with their consent. The abortions were performed under general anaesthesia by vacuum aspiration followed by blunt curettage of the cavity, by surgeons with varying experience. 10 iu of oxytocin were given intravenously to each women at the end of the operation. Abdominal ultrasound examination was performed after the completion of the procedure. The uterus was examined longitudinally and transversely using an Ultrasound Scanner type 1846 equipped with a 3 mhz abdominal transducer. Dense echoes in the uterus cavity indicated retained tissue and the procedure with aspiration and/or curettage was performed repeatedly until a clearly defined echo cavity was found. The women were discharged the same day. Complications requiring readmission within the first month were registered. No preoperative complications were registered. 6 women were readmitted within one month after abortion because of bleeding and pain, and recurettage was performed in 5 women because of clinical signs of retained tissue. Retained pregnancy products were demonstrated histopathologically only in 3 patients, while another 2 patients were treated with antibiotics because of asymptomatic positive chlamydia culture. The study demonstrated a predictive value of an empty uterus of 97.3% at ultrasound examination. The rate of retained tissue was not reduced compared to other studies that did not use ultrasound examination. The findings of the study therefore suggest that ultrasound examination is valuable when retention of products is suspected, but it cannot be recommended as routine for all patients.

Postpartum eclampsia. Impossible to eradicate?

Two cases of post partum eclampsia in previously healthy women are presented. Prior to the onset of eclamptic seizures, which occurred, one respectively eight days after delivery, the patients had no symptoms and were without signs of preeclampsia. Prevention of eclampsia is further discussed.

[Postoperative morbidity after hysterectomy is related to alcohol consumption]. / Postoperativ morbiditet efter hysterektomi er relateret til alkoholforbruget.

Postoperative morbidity after hysterectomy was studied prospectively in 229 consecutive patients in our departments. The incidence of alcohol abuse (> or = 60 gm of alcohol daily) and moderate drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the moderate drinkers and the control group, the alcohol abusers developed significantly more complications (80% versus 27% and 80% versus 13% respectively). Preoperative history of alcohol consumption may define a group of patients at particular risk for increased postoperative morbidity.

Mast cells in the placenta. Is there a relation to the development of atopic disease in infants before 18 months of age?

OBJECTIVE: To disclose a relation between the amount of mast cells in placenta and the development of atopic disease in children before 18 months of age. DESIGN: A prospective, descriptive study. SETTING: Two obstetric departments at university hospitals. SUBJECTS: 67 pairs of mothers and their newborn infants. MAIN OUTCOME MEASURES: Family history of atopic disease was taken. The amount of mast cells in placenta was counted. Follow-up questionnaires of the children were evaluated after 18 months. RESULTS: The follow-up rate was 84%. The number of mast cells in placenta did not differ between atopic and non-atopic children. CONCLUSION: A new predictor, the amount of mast cells in placenta was evaluated. In this study the amount of mast cells, in placenta was not predictive of the development of atopic disease before 18 months of age.

Cervical koilocytosis and high risk HPV types: the benefit of laser vaporization.

Forty-six patients with biopsy-proven cervical koilocytosis, which in 19 cases was associated with CIN I, were randomized to treatment by cervical laser vaporization or to follow-up without therapy. The polymerase chain reaction was used to examine the paraffin-embedded cervical biopsies for human papillomavirus (HPV) types 6, 11, 16, 18 and 33 by polymerase chain reaction and molecular hybridization technique. Twenty biopsies contained HPV DNA, in 17 cases of the putatively oncogenic types HPV 16 and HPV 18. During a mean follow-up of 28 months, the lesions resolved in 37 women, 5 women had progression to CIN III lesions, and 4 women had persisting disease. Lesions not harboring any of the 5 HPV types showed a high spontaneous regression rate of 88%, which was not improved by the laser therapy. In the HPV-positive lesions, resolution occurred in only 29% of untreated lesions, but in 92% of those treated by laser. The difference is significant (P = 0.007). It is concluded that in patients with cervical koilocytosis, the HPV diagnosis could be of practical value in identifying patients who might benefit from treatment.

Preoperative treatment with oestradiol in women scheduled for vaginal operation for genital prolapse. A randomised, double-blind trial.

OBJECTIVE: To disclose a clinical and histopathological effect of local low-dose oestradiol treatment on the vagina. DESIGN: A randomised, double-blind trial. SETTING: Two gynaecological departments at University Hospitals. SUBJECTS: Forty-eight postmenopausal women scheduled for surgery because of genital prolapse. INTERVENTION: 25 micrograms oestradiol or placebo, administered as vaginal pessaries daily, 3 weeks prior to surgery. MAIN OUTCOME MEASURES: Cytological, histological and clinical changes of the vaginal mucosa. RESULTS: The thickness of the vaginal wall increased as did the oestrogenic index. No clinical effect was seen apart from decreased incidence of recurrent cystitis postoperatively. CONCLUSIONS: Preoperative oestrogen treatment has been shown to reduce the incidence of recurrent cystitis and may be needed for stimulation of vaginal mucosa; the short-term clinical effect is not convincing, however.

Influence of alcohol intake on postoperative morbidity after hysterectomy.

Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in our departments. The incidence of alcohol abuse (greater than 60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social drinkers and the control group, the alcohol abuse group had significantly more complications (80% vs 27% and 80% vs 13%, respectively).

Retroperitoneal abscess and vena cava thrombosis following normal pregnancy and delivery.

A 24 year old primigravida underwent a normal pregnancy and delivery, and developed a retroperitoneal abscess and thrombosis of the vena cava late in the puerperium. A transvaginal drainage of the abscess was performed and the thrombosis of the vena cava treated with Heparin and thrombectomy. Full recovery was obtained.

CO2 laser vaporization in the treatment of cervical human papillomavirus infection in women with abnormal Papanicolaou smears.

In a randomized study, we have evaluated the treatment of cervical human papillomavirus (HPV) lesions by CO2 laser vaporization. Fifty patients with abnormal Papanicolaou smears and histological evidence of cervical HPV infection associated or not with cervical intraepithelial neoplasia (CIN) grade I were randomized to either a treatment or a control group. The cervical swabs were obtained every 3 months in both groups and examined for HPV type 16 DNA by the polymerase chain reaction. After a follow-up period of 12 months no significant differences were found between the laser treatment and the control groups in relation to the disappearance of the abnormal Papanicolaou smear. Two patients in the treatment group and 3 in the control group had a conization because of development of CIN I or aggravation of the concomitant CIN found at the initial visit. The percentage of women who demonstrated HPV in their cervical smears at 12 months' follow-up was identical in the two groups, supporting the hypothesis that HPV is a persistent infection during which the virus is widespread in the vaginal epithelium.

Uni- and bilateral torsion of the testes in the neonate; a report of two cases.

One case of unilateral and one case of bilateral torsion of the testes in the neonate are presented together with a review of the literature for bilateral cases. Finally some recommendations are made for the dealing with this rare but important illness of the neonate.

CO2-laser vaporization of human papillomavirus (HPV)-induced abnormal cervical smears. A simple and effective solution to a recurrent clinical problem.

Fifty women with human papillomavirus (HPV)-induced abnormal cervical smears were randomly allocated to either CO2-laser vaporization or routine control. The success rate at the 6 months check was 100% after laser treatment compared to that of 72% in the control group (p less than 0.05). Although longer follow-up is needed to fully establish the efficacy of the treatment, the method seems appropriate to this large group of women at risk of developing cervical intraepithelial neoplasia.

First-trimester legally induced abortions. The amount of aspirated tissue in relation to gestational age.

A possible method for reducing complications after legally induced first-trimester abortions was sought. One hundred-seventeen patients participated in the study and had the gestational age determined by ultrasound before evacuation. The aspirated amount of tissue was measured and a definite correlation was made to the seventh to twelfth week of gestation respectively. It is concluded that at least 15 ml tissue should be evacuated in the seventh to eight week, 25 ml in the ninth to tenth week, and 35 ml in the eleventh to twelfth respectively.

PIP: A method for reducing complications from retained tissue requiring readmission after a legally induced 1st trimester abortion is evaluated. Prior attempts had been made to ascertain the reason for an annual 6% of 22,000 readmission rate. 117 women ages 18-42 years requesting legal abortion participated in this study at Bispebjerg Hospital, Copenhagen, Denmark. 47% were primagravida and the median age was 29.5 years. This study determined gestational age of 77-12 weeks by ultrasound for measuring crown-rump length. The abortion was performed by vacuum aspiration, followed by curettage and iv administration of oxytocin 10. Aspirated tissue was measured, after removal of blood clots, in a tube contain g 50 ml of water to eliminate air bubbles. Readmission due to infection or bleeding within the nest month was recorded. Tissue removed in a reevacuation was examined microscopically to ascertain placental or decidua tissue. The results of the analysis using Mann- Whitney's rank sum test for unpaired data revealed a significant difference in amount of aspirated tissue between 7-8 and 9-10 weeks (p.01) and also between 9-10 and 11-12 weeks (p.01). 5% or 6 patients were readmitted of whom 4.2% or 5 required a recurettage because of excessive bleeding. In 3 cases (2.5%) villi chorii were found on histological examination. 2 had a retroverted uterus and all 3 were 8-9 weeks gestation, 25 years, and primagravida. The retroversion would create more difficulty in emptying. It is recommended that retained tissue should be suspected when the amount of tissue after aspiration is 15 ml in the weeks 7-8, 25 ml in the weeks 9-10 and 35 ml in the weeks 11-12 of gestation.

[Testicular torsion in neonates. With special emphasis on bilateral cases]. / Testestorsion hos nyfødte. Med speciel vaegt på bilaterale tilfaelde.

The literature concerning torsion of the testis in neonates is reviewed with special reference to bilateral cases. The incidence, pathogenesis, diagnosis, differential diagnoses and treatment are discussed. The importance of immediate surgical intervention is emphasized in order to avoid necrosis of spermatogenic tissue and subsequent infertility.

Comparison of urinary human follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in polycystic ovarian syndrome.

A randomized, double-blind, crossover study was carried out to compare purified urinary follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) for ovarian stimulation in polycystic ovarian syndrome (PCOS). Twelve patients were stimulated with FSH and hMG in three alternate cycles. FSH, luteinizing hormone (LH), estradiol, dihydroepiandrosterone sulphate, free and total testosterone, delta 5-androstenedione, sex hormone binding globulin, and ovarian volume were monitored during the stimulation. There was no difference between the dose of FSH and hMG necessary to induce preovulatory follicles in the individual patients. The mean increase of ovarian volume during stimulation with FSH and hMG was 120% and 129% respectively (no significant difference). Two patients became pregnant in the first cycle. Two other patients had delayed bleeding and positive serum-human chorionic gonadotropin. No significant difference was found in the endocrine changes during the two different stimulation methods. The LH/FSH ratio was normalized after a few days of treatment regardless of the type of stimulation. The size of the material does not permit a comparison of the efficacy of the two treatment schedules. Our clinical and ultrasonic observations do not support the theory that treatment of infertility in PCOS with FSH is more safe than with hMG.

Laparoscopy and ultrasound examination in women with acute pelvic pain.

The results of preoperative pelvic examination and eventual ultrasound examination were correlated with the laparoscopic findings in 316 women with acute pelvic pain. The predictive values of normal and abnormal findings at pelvic examination were 46.9 and 82.1%, respectively. 42.1% of the women had ultrasound examination performed. This investigation showed to be helpful especially in patients with normal findings at pelvic examination. If ultrasonic findings were abnormal the results at laparoscopy were also abnormal in 90%. On the contrary, normal findings at ultrasound examination did not exclude abnormal pelvic findings. The predictive value of normal results at ultrasound examination was 50.0%. This discrepancy between ultrasonic and pelvic findings can be explained by the size of the pelvic masses. Ultrasound examination is a valuable tool in the evaluation of patients with acute pelvic pain, but it cannot replace laparoscopy.

Endometriosis of the round ligament.

A case of endometriosis of the extraperitoneal part of the round ligament is presented. The incidence, symptoms, diagnostic possibilities as well as treatment are discussed.