Percutaneous Treatment with a Mucopolysaccharide Polysulphate of Experimentally Induced Subcutaneous Haematomas in Man

In a double blind trial on ten healthy volunteers, the efficacy of a topically applied mucopolysaccharide polysulphate* in the treatment of subcutaneous haematomas was assessed. Standardized haematomas were induced by subcutaneous injection of a mixture of autogenous blood and 125I-fibrinogen. The absorption of the haematoma, expressed as the removal of the labelled fibrin(ogen), could thus be objectively measured by the decrease in radioactivity.

The results show an exponential absorption of these haematomas. The absorption time was reduced to about half compared with placebo, when treated topically with mucopolysaccharide polysulphate. The difference is statistically highly significant and is also considered clinically relevant.

A new surgical technique for repairing cystocele in hysterectomized women

No satisfactorily efficient surgical procedure for correction of cystocele subsequent to hysterectomy has so far been described. Anterior colporrhaphy generally is associated with risk of relapse, since no fibrous tissues or ligaments are available for sufficient fixation to the anterior pelvic wall. In the present study, a new surgical procedure was used, simultaneously performed transabdominally and vaginally by two surgeons. The elevated bladder was fixed without sutures to the posterior retropubic periosteum and to the lower abdominal wall by a two-component fibrin sealant (Tisseel, Immuno AB, Stockholm, Sweden) after invagination of the cystocele. Postoperatively, the vagina was tamponed for 12 hours, and a Foley catheter was used for 4-5 days. Antibiotics were administered for 7 days. This technique has been evaluated in nine patients. The procedure was found easy to perform and well tolerated by the patients. During the observation time 0.5-4 years, no relapse has been registered. This surgical procedure also proved to prevent postoperative stress incontinence, previously concealed by the cystocele.

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.

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 Gram-positive 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.

Percutaneous treatment with a mucopolysaccharide polysulphate of experimentally induced subcutaneous haematomas in man

In a double blind trial on ten healthy volunteers, the efficacy of a topically applied mucopolysaccharide polysulphate in the treatment of subcutaneous haematomas was assessed. Standardized haematomas were induced by subcutaneous injection of a mixture of autogenous blood and 125I-fibrinogen. The absorption of the haematoma, expressed as the removal of the labelled fibrin(ogen), could thus be objectively measured by the decrease in radioactivity. The results show an exponential absorption of these haematomas. The absorption time was reduced to about half compared with placebo, when treated topically with mucopolysaccharide polysulphate. The difference is statistically highly significant and is also considered clinically relevant.

The effect of cervical dilatation by laminaria on the plasma levels of 15-keto-13,14-dihydro-PGF2 alpha

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.

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 less than 0.05). The rate of childbirth among the pregnancies in the second group was 72% compared to only 55% in the first one (P less than 0.05).

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.

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.

Minimal brain dysfunction in children born in breech presentation

The influence of delivery in breech presentation on the occurrence of minimal brain dysfunction (MBD) has been studied. Parents of 8--15 year old children were asked to account for behavioral and educational deficits and needs of their children from birth until the date of investigation. It was found that among prematurely delivered children, the frequency of MBD, defined as hyperkinesia and learning disability, amounted to about 20 per cent and was similarly distributed between children , however, the average frequency of hyperkinesia and learning disability amounted to 8 per cent; in children born in breech presentation it was 14 per cent, while in those born in vertex presentation the corresponding figure was 2 per cent. MBD was more common in boys (16 per cent) than in girls (12 per cent).

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

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.

Maternal mortality in Sweden 1955-1974

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.