Finn Lauszus | Aarhus University (original) (raw)
Books by Finn Lauszus
Type 1 Diabetes: Causes, Treatment and Potential Complications. Page 25-40., 2013
The aim of this short review is an introduction to the field of ambulatory blood pressure measure... more The aim of this short review is an introduction to the field of ambulatory blood pressure measurements in pregnancy and in particular in women with type 1 diabetes. Estimates of risk by blood pressure evaluation in these women are influenced by pregnancy per se and diabetes vasculopathy. Several factors have to be considered as few monitors are validated for use in pregnancy and not many of the different methodologies have undergone thorough investigation. Using the absolute values of blood pressure have the advantage that fewer assumptions are necessary of how blood pressure behaves due to modes of evaluation and biological rhythm.
Monitors should be chosen carefully with consideration as the clinical setting, timing, and population influences the outcome, thus, the monitors ought to be validated for the specific condition they are applied for.
Inherent characteristics of the measurements to be considered are reproducibility, consistency, precision, and trend over scale of measurement. Studies on these issues suggest that consistency and precision depend on which monitor is used. During pregnancy, the reproducibility and specificity depend on the timing and whether measurements are performed repeatedly. Diabetes mellitus itself seems not to play a major role during pregnancy in the performance of the measurements. Over- and underestimation of blood pressure are typical for 24-h monitors in high- as well as low risk pregnancies.
Preeclampsia is associated with urinary albumin excretion rate, reduced night/day ratio, and elevated diurnal blood pressure from first trimester and onwards. However, due to blunting of the diurnal variation, the night/day rhythm provides no good prediction of preeclampsia. Diurnal measurement is a valuable estimate of blood pressure in terms of sensitivity, specificity, and predictive values. Obviously, well-known risk factors like hypertension, urinary albumin excretion rate, glycemia, and parity must still be considered in women with type 1 diabetes.
Granulosa cell tumour by Finn Lauszus
A 68-year-old woman noticed deepening of her voice over three years, a moderate growth of facial ... more A 68-year-old woman noticed deepening of her voice over three years, a moderate growth of facial hair and major head hair loss. A high testosterone level of 15 nmol/L was found in plasma (normal range <2.4 nmol/L) while values of androstendione, dehydro-epiandrosterone sulfate, estradiol, estrone and sexual hormone binding globulin were normal. A CT- and a transvaginal ultrasound scan found normal adrenal glands and ovaries. The woman had a bilateral ooforectomy. A solid yellow area was found in the right ovary, which under microscopy was a tumor process of 14 mm of trabecular growing cells with eosinophilic cytoplasm, uniform core and few mitoses. Staining confirmed the diagnosis of a granulosa cell tumor (GCT). The testosterone level dropped to 0.67 nmol/L ten days postoperatively.
GCT occurs in Denmark at an incidence of 1.37 per. 100,000 women. Most often, the tumors are of low malignancy and diagnosed in early stages due to symptomatic hormonal activity. Virilism, as in this case, is rarely seen. Most often, the tumor produces excess estrogen and GCT is associated with breast cancer at an odds ratio of 3.3, and an odds ratio of 138 for endometrial cancer
A case of a granulosa-theca-cell tumour of the ovary in a 39-year-old woman is reported. Despite ... more A case of a granulosa-theca-cell tumour of the ovary in a 39-year-old woman is reported. Despite benign histology and apparently radical operation, tumor growth relapsed twice before apparent cure. Oestradiol in serum proves valuable as a tumour marker and correlates well with tumour relapse.
Gynecologic Oncology
Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical pr... more Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with stage I granulosa cell tumor.
![Research paper thumbnail of [Granulosa cell tumors: a population-based study from two counties]](https://attachments.academia-assets.com/41239560/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 8, 2004
Gynecologic Oncology, 2001
Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical pr... more Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with stage I granulosa cell tumor.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
Acta Obstetricia et Gynecologica Scandinavica, 2013
Granulosa cell tumor of the ovary (GCT) is a rare neoplasm. The tumor often secretes estrogens an... more Granulosa cell tumor of the ovary (GCT) is a rare neoplasm. The tumor often secretes estrogens and then presents at an earlier stage due to hormone-related symptoms. GCT women are at increased risk of endometrial carcinoma, but there is only limited information about GCTs and potential association to other hormone-related neoplasms such as breast cancer. We conducted a retrospective follow-up study on 163 women with GCT. Medical records and histological sections were reviewed and a search in the pathology registry performed. Eight [95% confidence interval (CI); 3.4-15.8] GCT women were diagnosed with a breast neoplasm; one with Paget's disease of the nipple and seven with breast carcinoma. Based on calculations using incidence rates on breast cancer among Danish women, we would have expected 2.5 cases of breast cancer. The odds ratio was 3.3 (95% CI, 1.6-6.6), suggesting an increased risk of breast cancer in GCT women.
![Research paper thumbnail of [Granulosa cell tumor. A 30-year material from a central hospital]](https://attachments.academia-assets.com/41239572/thumbnails/1.jpg)
](Diabetes and pregnancy by Finn Lauszus
Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal... more Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and –II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and-3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.
Aim: Few data on insulin-like growth factor 1 (IGF-1) and preterm delivery are reported in type 1... more Aim: Few data on insulin-like growth factor 1 (IGF-1) and preterm delivery are reported in type 1 diabetes mellitus while cross-sectional studies with regulators of
IGF-1 indicate association with preterm delivery and fetal growth. We evaluated time-course relationship between the maternal serum IGF-1 and the subsequent
obstetrical outcome.
Setting and design: Consecutive follow-up study of 130 pregnant women with type 1 diabetes recruited for measurement of growth factors and evaluated for diabetes
status and adverse perinatal outcome. Serum was drawn for measurement of IGF-1 at every fourth week during pregnancy until week 30, then every second week.
Preterm was defined as delivery before week 36. Arterial stiffness index was calculated from diurnal blood pressure measurements. Birth weight was adjusted for
gender and gestational age by calculating a birth weight ratio.
Results: Diabetic women who delivered preterm had lower IGF-1 levels throughout pregnancy. Measured consecutively with all data present, IGF-1 in week 14 to
32 was consistently lower compared with women who delivered after gestational week 35 adjusted for albumin excretion rate preeclampsia, arterial stiffness index,
duration of diabetes, and parity (p<0.05). Low birth weight in terms of birth weight ratio (<1.22) was associated with lower IGF-1 from week 14 to 32; also, when
adjusted for preterm delivery, albumin excretion rate, and preeclampsia (p<0.05). Birth weight ratio was higher in women delivering preterm compared to women
delivering at term.
Conclusion: Preterm delivery showed an association with consecutive IGF-1 values from week 14 to 32. Fetal growth was not impeded in preterm delivery in diabetic
pregnancy.
Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal... more Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and –II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and-3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.
Prepregnancy counselling for diabetics includes an assessment of the metabolic condition,-and if ... more Prepregnancy counselling for diabetics includes an assessment of the metabolic condition,-and if present-angiopathy and nephropathy. Complications in previous pregnancies worsen the prognosis, particularly if they involve the kidneys. A case story is presented of a diabetic woman (White group F/R), who in her first pregnancy had shown several signs of increasing nephropathy. At the beginning of her third pregnancy her diabetes is badly regulated and her kidneys show signs of nephrosclerosis. Nevertheless, the pregnancy runs relatively smoothly until the thirty-third week where she delivers prematurely. The case story shows the difficulties in predicting the course of present and future pregnancies in a diabetic with angio- and nephropathy.
Aim. The arterial wall elasticity and genetic setting is a potential risk factor for dysfunction ... more Aim. The arterial wall elasticity and genetic setting is a potential risk factor for dysfunction of vas¬cular endothelial cells and the clinical expression of retinopathy. The prevalence was evaluated of polymorphism in the genes of methylene-tetrahydro-folate-reductase (MTFHR), Factor V, glycoprotein IIb/IIIa (Gp 2b3a), and prothrombin in a cohort of pregnant women with type 1 diabetes. The role of hyperhomo¬cysteinemia in microangiopathy in diabetes mellitus has been debated and is mainly seen with reduced activity of the MTHFR gene. The arterial resistance index (AASI) has been used to detect arterial dysfunction and correlate with cardiovascular morbidity and mortality in patients with hypertension.
Design. Two-hundred-and-thirty-three women with type 1 diabetes mellitus were analyzed for MTHFR gene polymorphism and Factor V Leiden. In 176 of these women AASI was further evaluated. In a sub-cohort of 40 women with preeclampsia, mutations in glycoprotein IIb/IIIa (Gp2b3a) and prothrombin was measured. The pregnancy and ophthalmological examination data charts were reviewed retrospectively.
Results. Retinopathy was associated with higher AASI during pregnancy (p < 0.01, in all three trimesters) and preeclampsia (p < 0.05). The stiffness increased with higher grades of retinopathy. AASI in women with simplex and proliferative retinopathy followed different patterns during the three trimesters, even when adjusted for age, BMI, and glycemic regulation (p < 0.01). None of the studied coagulation genes (MTHFR, Factor V, Gp2b3a, and prothrombin) were found associated with retinopathy or preeclampsia.
Conclusion. Retinopathy showed a strong association with AASI during pregnancy and not outside pregnancy in women with type 1 diabetes. This suggests a pregnancy-related functional change in the vascular bed.
Glomerular structural changes in pregnant, diabetic and pregnant-diabetic rats. APMIS 2005;113:46... more Glomerular structural changes in pregnant, diabetic and pregnant-diabetic rats. APMIS 2005;113:465–72. Kidneys enlarge both during pregnancy and in diabetes. The enlargement and morphology of glomer-uli was studied during pregnancy and in diabetes in order to examine possible similarities, differences, and interactions in the growth in these conditions. Morphometric investigations were performed on glomeruli in pregnant rats, in rats with 2 weeks' diabetes, and in pregnant-diabetic rats. Kidneys were enlarged 22% in the midterm pregnant rats compared with controls, 74% in diabetic rats, and a further 21% in pregnant-diabetic rats. Glomerular volume was enlarged by 26% during midterm pregnancy in normal animals. Diabetes induced an enlargement in glomerular volume of 58% and a further 18% in midterm diabetic animals due to pregnancy. Within the glomerulus, pregnancy in normal animals induced minor non-significant changes. Diabetes induced significant increase in several parameters: mesangial volume and cell volume, capillary and glomerular basement membrane volume, capillary wall surface area, foot process width, filtration slit length, and nuclear number. Pregnancy in diabetic animals induced no significant additional changes. In conclusion, kidney enlargement in pregnancy shows very few glomerular changes in either normal or diabetic animals. Enlargement of glomeruli in diabetes involves hypertrophy and hyperplasia concurrent with several morphological changes within the glomerulus.
Objective: To determine the possible relation between maternal serum insulin-like growth factor I... more Objective: To determine the possible relation between maternal serum insulin-like growth factor I and II (IGF-I and IGF-II) in women with insulin-dependent diabetes mellitus and fetal macrosomia. Methods: This was a prospective, observational study of 45 pregnant women with insulin-dependent diabetes mellitus without overt nephropathy, examined in an outpatient, antenatal diabetic clinic. Maternal venous serum samples were collected from week 14 every fourth week until week 30, and every other week until delivery. Levels of IGF-I and-II were measured in maternal serum by immunoassays. The repeated measurements were tested with two-way analysis of variance. The outcome measures were birth weight and serum IGF-I, IGF-II, IGF binding protein (BP)-3, and IG-FBP-3 proteases. Before the study, minimum sampling size was calculated as 14 subjects in each group if a difference in IGF-I of 50 g/L was to be detected with an estimated standard deviation of 40, a two-sided P value () of .05, and a power of 90 (.1). Results: Increasing levels of IGF-I and-II were significantly associated with the birth-weight groups: The higher the birth-weight ratio, the higher the levels of IGF-I and-II (P < .01). Conclusion: Macrosomia in diabetic pregnancy is associated with high levels of maternal IGF-I and-II. (Obstet Gynecol 2001;97:734 – 41.
Background. The relation between retinopathy and the parameters: 24-h blood pressure, glucose con... more Background. The relation between retinopathy and the parameters: 24-h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin-dependent diabetes mellitus on tight metabolic control during pregnancy. Methods. Prospective study of 112 pregnant women with insulin-dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Århus University Hospital. Changes in retinopathy were related to 24-h blood pressure, blood glucose, albumi-nuria, and adverse perinatal outcome. Results. There was an association between grade of retinopathy and HbA1c before (Spear-man's rhoΩ0.49, p∞0.04) and after pregnancy (Spearman's rhoΩ0.42, p∞0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14∫8 years, range 1–27) than those women with improvement or no progression of retinopathy (19∫8 years, range 1–36, p∞0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied. Conclusions. Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.
Objective: The aim of this study was to examine the importance of glycemic regulation on the risk... more Objective: The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoalbuminuria and no preeclampsia later in pregnancy. Study design and methods: A prospective study of 71 women with type 1 diabetes mellitus where complete data were collected on HbA1c, insulin dose, and albumin excretion rate from week 12 and every second week hereafter. Fundus photography was performed and diurnal blood pressure measured three times during pregnancy. Results: The preterm rate was 23% and women delivering preterm showed higher HbA1c throughout pregnancy. At regression analysis HbA1c was the strongest predictor for preterm delivery from week 6 to 32, also when including insulin dose, BMI, age, duration of diabetes, and diurnal blood pressure. The risk of delivering preterm was more than 40% when HbA1c was above 7.7% in week 8. Diurnal blood pressure was not found associated with preterm delivery. Conclusion: The quality of glycemic regulation in the early and mid-pregnancy is a major, independent risk factor for preterm delivery in normoalbuminuric diabetic women without preeclampsia.
A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect t... more A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect to reproducibility and variations on precision and consistency. Some 133 women with type 1 diabetes mellitus and 59 non-diabetic women were recruited. During pregnancy, systolic BP was between 6 and 12 mmHg higher in the oscillometric than the auscultatory readings, and diastolic BP was between 1 and 2.6 mmHg. The association of difference with the mean BP disappeared with progression of pregnancy and the repetition of measurements in diabetic pregnancy. The precision, reproducibility, and trend of association over the scale of measurement were improved in the repeated compared to individual measurements, whereas consistency did not improve.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights
Type 1 Diabetes: Causes, Treatment and Potential Complications. Page 25-40., 2013
The aim of this short review is an introduction to the field of ambulatory blood pressure measure... more The aim of this short review is an introduction to the field of ambulatory blood pressure measurements in pregnancy and in particular in women with type 1 diabetes. Estimates of risk by blood pressure evaluation in these women are influenced by pregnancy per se and diabetes vasculopathy. Several factors have to be considered as few monitors are validated for use in pregnancy and not many of the different methodologies have undergone thorough investigation. Using the absolute values of blood pressure have the advantage that fewer assumptions are necessary of how blood pressure behaves due to modes of evaluation and biological rhythm.
Monitors should be chosen carefully with consideration as the clinical setting, timing, and population influences the outcome, thus, the monitors ought to be validated for the specific condition they are applied for.
Inherent characteristics of the measurements to be considered are reproducibility, consistency, precision, and trend over scale of measurement. Studies on these issues suggest that consistency and precision depend on which monitor is used. During pregnancy, the reproducibility and specificity depend on the timing and whether measurements are performed repeatedly. Diabetes mellitus itself seems not to play a major role during pregnancy in the performance of the measurements. Over- and underestimation of blood pressure are typical for 24-h monitors in high- as well as low risk pregnancies.
Preeclampsia is associated with urinary albumin excretion rate, reduced night/day ratio, and elevated diurnal blood pressure from first trimester and onwards. However, due to blunting of the diurnal variation, the night/day rhythm provides no good prediction of preeclampsia. Diurnal measurement is a valuable estimate of blood pressure in terms of sensitivity, specificity, and predictive values. Obviously, well-known risk factors like hypertension, urinary albumin excretion rate, glycemia, and parity must still be considered in women with type 1 diabetes.
A 68-year-old woman noticed deepening of her voice over three years, a moderate growth of facial ... more A 68-year-old woman noticed deepening of her voice over three years, a moderate growth of facial hair and major head hair loss. A high testosterone level of 15 nmol/L was found in plasma (normal range <2.4 nmol/L) while values of androstendione, dehydro-epiandrosterone sulfate, estradiol, estrone and sexual hormone binding globulin were normal. A CT- and a transvaginal ultrasound scan found normal adrenal glands and ovaries. The woman had a bilateral ooforectomy. A solid yellow area was found in the right ovary, which under microscopy was a tumor process of 14 mm of trabecular growing cells with eosinophilic cytoplasm, uniform core and few mitoses. Staining confirmed the diagnosis of a granulosa cell tumor (GCT). The testosterone level dropped to 0.67 nmol/L ten days postoperatively.
GCT occurs in Denmark at an incidence of 1.37 per. 100,000 women. Most often, the tumors are of low malignancy and diagnosed in early stages due to symptomatic hormonal activity. Virilism, as in this case, is rarely seen. Most often, the tumor produces excess estrogen and GCT is associated with breast cancer at an odds ratio of 3.3, and an odds ratio of 138 for endometrial cancer
A case of a granulosa-theca-cell tumour of the ovary in a 39-year-old woman is reported. Despite ... more A case of a granulosa-theca-cell tumour of the ovary in a 39-year-old woman is reported. Despite benign histology and apparently radical operation, tumor growth relapsed twice before apparent cure. Oestradiol in serum proves valuable as a tumour marker and correlates well with tumour relapse.
Gynecologic Oncology
Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical pr... more Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with stage I granulosa cell tumor.
Ugeskrift for laeger, Jan 8, 2004
Gynecologic Oncology, 2001
Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical pr... more Objectives. The goal of this work was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with stage I granulosa cell tumor.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
Acta Obstetricia et Gynecologica Scandinavica, 2013
Granulosa cell tumor of the ovary (GCT) is a rare neoplasm. The tumor often secretes estrogens an... more Granulosa cell tumor of the ovary (GCT) is a rare neoplasm. The tumor often secretes estrogens and then presents at an earlier stage due to hormone-related symptoms. GCT women are at increased risk of endometrial carcinoma, but there is only limited information about GCTs and potential association to other hormone-related neoplasms such as breast cancer. We conducted a retrospective follow-up study on 163 women with GCT. Medical records and histological sections were reviewed and a search in the pathology registry performed. Eight [95% confidence interval (CI); 3.4-15.8] GCT women were diagnosed with a breast neoplasm; one with Paget's disease of the nipple and seven with breast carcinoma. Based on calculations using incidence rates on breast cancer among Danish women, we would have expected 2.5 cases of breast cancer. The odds ratio was 3.3 (95% CI, 1.6-6.6), suggesting an increased risk of breast cancer in GCT women.
Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal... more Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and –II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and-3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.
Aim: Few data on insulin-like growth factor 1 (IGF-1) and preterm delivery are reported in type 1... more Aim: Few data on insulin-like growth factor 1 (IGF-1) and preterm delivery are reported in type 1 diabetes mellitus while cross-sectional studies with regulators of
IGF-1 indicate association with preterm delivery and fetal growth. We evaluated time-course relationship between the maternal serum IGF-1 and the subsequent
obstetrical outcome.
Setting and design: Consecutive follow-up study of 130 pregnant women with type 1 diabetes recruited for measurement of growth factors and evaluated for diabetes
status and adverse perinatal outcome. Serum was drawn for measurement of IGF-1 at every fourth week during pregnancy until week 30, then every second week.
Preterm was defined as delivery before week 36. Arterial stiffness index was calculated from diurnal blood pressure measurements. Birth weight was adjusted for
gender and gestational age by calculating a birth weight ratio.
Results: Diabetic women who delivered preterm had lower IGF-1 levels throughout pregnancy. Measured consecutively with all data present, IGF-1 in week 14 to
32 was consistently lower compared with women who delivered after gestational week 35 adjusted for albumin excretion rate preeclampsia, arterial stiffness index,
duration of diabetes, and parity (p<0.05). Low birth weight in terms of birth weight ratio (<1.22) was associated with lower IGF-1 from week 14 to 32; also, when
adjusted for preterm delivery, albumin excretion rate, and preeclampsia (p<0.05). Birth weight ratio was higher in women delivering preterm compared to women
delivering at term.
Conclusion: Preterm delivery showed an association with consecutive IGF-1 values from week 14 to 32. Fetal growth was not impeded in preterm delivery in diabetic
pregnancy.
Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal... more Introduction: Macrosomia in diabetic pregnancy is an ubiquitous finding and implies both maternal and fetal issues. Its incidence surpasses other critical obstetrical morbidity in diabetic pregnancy with increased placental size and polyhydramnios as comorbidity. The studies on the underlying factors contributing to macrosomia have focused on growth stimuli like IGF, glycemia, and insulin and their effects on regional organ function. IGF-I and –II in maternal serum are associated with birth weight and the bioavailabiliy is modulated by IGF-binding-proteins (IGFBP) and phosporylated isoforms of IGFBP and the presence of proteases and IGF split products. Human placental growth hormone regulates the effect of IGF-I in pregnancy. Methods: The literature on the IGF system′s possible effect on fetal growth in diabetic pregnancy is reviewed before our current studies and updated with respect to later findings. Regulation on bioavailability by proteolysis and phosporylation is described. The review discusses briefly the studies on pregnant women with type 1 diabetes with respect to vasculopathy. Results: The data show good correlation of IGF-1/2 levels with birth weight. No such correlation with IGFBP-1 and-3 is found. Fetal growth deviation in diabetic pregnancy is not uniform. In first trimester, growth delay is documented in fetal growth curves compared to non-diabetic controls. Accordingly, a shift in IGF-IGFBP regulation in second trimester is found with less proteolysis of IGFBPs and relative increase in total binding capacity. In third trimester, free IGF further increases as IGFBP binding decreases by proteolysis and modulation. The first trimester values may be used as predictor of fetal weight at term. Diabetic women show a two-to threefold increase in the in vitro IGFBP-3 proteolytic activity during pregnancy as compared to post-partum values. Conclusions: Prominent proteolysis of binding proteins and the modulation by insulin account for the mechanism leading to macrosomia. The two factors combined guarantee the stimulation by more bioavailable IGF and the glycemic levels reveal whether insulin dose are optimal. Structural factors of diabetes i.e. microangiopathy further modulate the sum of effects on fetal growth. In contrast to macrosomia, fetal growth restriction is associated with prominent maternal vascular endothelial complications, such as overt nephropathy, proliferative retinopathy, preeclampsia, and hypertension. In parallel to the growth inhibition, stimulatory effects are exerted by the GH axis including the placental growth hormones and occur probably as compensatory mechanism, similar to the increased IGFBP-3 proteolysis in late pregnancy found in growth retardation. This influence may in part explain the disproportionate growth in different tissue components occurring in the various stages of diabetic pregnancy.
Prepregnancy counselling for diabetics includes an assessment of the metabolic condition,-and if ... more Prepregnancy counselling for diabetics includes an assessment of the metabolic condition,-and if present-angiopathy and nephropathy. Complications in previous pregnancies worsen the prognosis, particularly if they involve the kidneys. A case story is presented of a diabetic woman (White group F/R), who in her first pregnancy had shown several signs of increasing nephropathy. At the beginning of her third pregnancy her diabetes is badly regulated and her kidneys show signs of nephrosclerosis. Nevertheless, the pregnancy runs relatively smoothly until the thirty-third week where she delivers prematurely. The case story shows the difficulties in predicting the course of present and future pregnancies in a diabetic with angio- and nephropathy.
Aim. The arterial wall elasticity and genetic setting is a potential risk factor for dysfunction ... more Aim. The arterial wall elasticity and genetic setting is a potential risk factor for dysfunction of vas¬cular endothelial cells and the clinical expression of retinopathy. The prevalence was evaluated of polymorphism in the genes of methylene-tetrahydro-folate-reductase (MTFHR), Factor V, glycoprotein IIb/IIIa (Gp 2b3a), and prothrombin in a cohort of pregnant women with type 1 diabetes. The role of hyperhomo¬cysteinemia in microangiopathy in diabetes mellitus has been debated and is mainly seen with reduced activity of the MTHFR gene. The arterial resistance index (AASI) has been used to detect arterial dysfunction and correlate with cardiovascular morbidity and mortality in patients with hypertension.
Design. Two-hundred-and-thirty-three women with type 1 diabetes mellitus were analyzed for MTHFR gene polymorphism and Factor V Leiden. In 176 of these women AASI was further evaluated. In a sub-cohort of 40 women with preeclampsia, mutations in glycoprotein IIb/IIIa (Gp2b3a) and prothrombin was measured. The pregnancy and ophthalmological examination data charts were reviewed retrospectively.
Results. Retinopathy was associated with higher AASI during pregnancy (p < 0.01, in all three trimesters) and preeclampsia (p < 0.05). The stiffness increased with higher grades of retinopathy. AASI in women with simplex and proliferative retinopathy followed different patterns during the three trimesters, even when adjusted for age, BMI, and glycemic regulation (p < 0.01). None of the studied coagulation genes (MTHFR, Factor V, Gp2b3a, and prothrombin) were found associated with retinopathy or preeclampsia.
Conclusion. Retinopathy showed a strong association with AASI during pregnancy and not outside pregnancy in women with type 1 diabetes. This suggests a pregnancy-related functional change in the vascular bed.
Glomerular structural changes in pregnant, diabetic and pregnant-diabetic rats. APMIS 2005;113:46... more Glomerular structural changes in pregnant, diabetic and pregnant-diabetic rats. APMIS 2005;113:465–72. Kidneys enlarge both during pregnancy and in diabetes. The enlargement and morphology of glomer-uli was studied during pregnancy and in diabetes in order to examine possible similarities, differences, and interactions in the growth in these conditions. Morphometric investigations were performed on glomeruli in pregnant rats, in rats with 2 weeks' diabetes, and in pregnant-diabetic rats. Kidneys were enlarged 22% in the midterm pregnant rats compared with controls, 74% in diabetic rats, and a further 21% in pregnant-diabetic rats. Glomerular volume was enlarged by 26% during midterm pregnancy in normal animals. Diabetes induced an enlargement in glomerular volume of 58% and a further 18% in midterm diabetic animals due to pregnancy. Within the glomerulus, pregnancy in normal animals induced minor non-significant changes. Diabetes induced significant increase in several parameters: mesangial volume and cell volume, capillary and glomerular basement membrane volume, capillary wall surface area, foot process width, filtration slit length, and nuclear number. Pregnancy in diabetic animals induced no significant additional changes. In conclusion, kidney enlargement in pregnancy shows very few glomerular changes in either normal or diabetic animals. Enlargement of glomeruli in diabetes involves hypertrophy and hyperplasia concurrent with several morphological changes within the glomerulus.
Objective: To determine the possible relation between maternal serum insulin-like growth factor I... more Objective: To determine the possible relation between maternal serum insulin-like growth factor I and II (IGF-I and IGF-II) in women with insulin-dependent diabetes mellitus and fetal macrosomia. Methods: This was a prospective, observational study of 45 pregnant women with insulin-dependent diabetes mellitus without overt nephropathy, examined in an outpatient, antenatal diabetic clinic. Maternal venous serum samples were collected from week 14 every fourth week until week 30, and every other week until delivery. Levels of IGF-I and-II were measured in maternal serum by immunoassays. The repeated measurements were tested with two-way analysis of variance. The outcome measures were birth weight and serum IGF-I, IGF-II, IGF binding protein (BP)-3, and IG-FBP-3 proteases. Before the study, minimum sampling size was calculated as 14 subjects in each group if a difference in IGF-I of 50 g/L was to be detected with an estimated standard deviation of 40, a two-sided P value () of .05, and a power of 90 (.1). Results: Increasing levels of IGF-I and-II were significantly associated with the birth-weight groups: The higher the birth-weight ratio, the higher the levels of IGF-I and-II (P < .01). Conclusion: Macrosomia in diabetic pregnancy is associated with high levels of maternal IGF-I and-II. (Obstet Gynecol 2001;97:734 – 41.
Background. The relation between retinopathy and the parameters: 24-h blood pressure, glucose con... more Background. The relation between retinopathy and the parameters: 24-h blood pressure, glucose control, albuminuria, and outcome of pregnancy was studied before, during, and after pregnancy in women with insulin-dependent diabetes mellitus on tight metabolic control during pregnancy. Methods. Prospective study of 112 pregnant women with insulin-dependent diabetes mellitus followed with fundus photography at the Department of Ophthalmology, Århus University Hospital. Changes in retinopathy were related to 24-h blood pressure, blood glucose, albumi-nuria, and adverse perinatal outcome. Results. There was an association between grade of retinopathy and HbA1c before (Spear-man's rhoΩ0.49, p∞0.04) and after pregnancy (Spearman's rhoΩ0.42, p∞0.02), but no such correlation was found at any examination during pregnancy where glycemia was kept tight. Those women who had progression of retinopathy during or after pregnancy had significantly earlier onset of diabetes mellitus (14∫8 years, range 1–27) than those women with improvement or no progression of retinopathy (19∫8 years, range 1–36, p∞0.04). No association was found between progression of retinopathy and HbA1c, blood pressure, adverse perinatal outcome or any of the other variables studied. Conclusions. Tight glycemic control during pregnancy is recommendable to avoid progression of retinopathy. Attention should be given to the period after delivery where the tight regulation may be difficult to achieve. IDDM women should be encouraged to plan pregnancies early in life.
Objective: The aim of this study was to examine the importance of glycemic regulation on the risk... more Objective: The aim of this study was to examine the importance of glycemic regulation on the risk of preterm delivery in women with normoalbuminuria and no preeclampsia later in pregnancy. Study design and methods: A prospective study of 71 women with type 1 diabetes mellitus where complete data were collected on HbA1c, insulin dose, and albumin excretion rate from week 12 and every second week hereafter. Fundus photography was performed and diurnal blood pressure measured three times during pregnancy. Results: The preterm rate was 23% and women delivering preterm showed higher HbA1c throughout pregnancy. At regression analysis HbA1c was the strongest predictor for preterm delivery from week 6 to 32, also when including insulin dose, BMI, age, duration of diabetes, and diurnal blood pressure. The risk of delivering preterm was more than 40% when HbA1c was above 7.7% in week 8. Diurnal blood pressure was not found associated with preterm delivery. Conclusion: The quality of glycemic regulation in the early and mid-pregnancy is a major, independent risk factor for preterm delivery in normoalbuminuric diabetic women without preeclampsia.
A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect t... more A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect to reproducibility and variations on precision and consistency. Some 133 women with type 1 diabetes mellitus and 59 non-diabetic women were recruited. During pregnancy, systolic BP was between 6 and 12 mmHg higher in the oscillometric than the auscultatory readings, and diastolic BP was between 1 and 2.6 mmHg. The association of difference with the mean BP disappeared with progression of pregnancy and the repetition of measurements in diabetic pregnancy. The precision, reproducibility, and trend of association over the scale of measurement were improved in the repeated compared to individual measurements, whereas consistency did not improve.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/authorsrights
Background. To examine retinal and pregnancy outcome in insulin-dependent diabetic women with pro... more Background. To examine retinal and pregnancy outcome in insulin-dependent diabetic women with proliferative retinopathy and assess the effect of albuminuria on morbidity. Methods. The records of 26 women with known proliferative retinopathy before pregnancy were studied retrospectively in the prepregnancy period, during pregnancy, and after delivery. Perinatal and maternal morbidity was studied using ophthalmic, obstetric and pediatric records. Results. Seven pregnancies were delivered preterm (27%). Serious neonatal morbidity occurred in five pregnancies (19%). Perinatal survival was 88%. Laser treatment was given prior to pregnancy to 54%, during pregnancy to 27% and after delivery to 31% of the women. Laser treatment during pregnancy was more common in those with no prior photocoagulation and in White class F/R. Low birthweight was more frequently associated with nephropathy and proliferative retinopathy compared to retinopathy alone (p∞0.05). Recent hemorrhage, macul-opathy or glaucoma was found in 14 (54%) of the women. Blindness developed unilaterally in two women. Conclusions. Perinatal morbidity was associated with nephropathy rather than retinopathy. The incidence of hemorrhage, maculopathy or glaucoma was similar in White classes R and F/R.
Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angio-genic factor normally absent fro... more Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angio-genic factor normally absent from the adult circulation. We have previously shown that it appears in normal maternal serum and that circulating FGF-2 levels are elevated in pregnancies complicated by diabetes. This study was performed to determine whether serum
Retinopathy is of outmost importance in relation to conservation of the visual function and the q... more Retinopathy is of outmost importance in relation to conservation of the visual function and the quality of life. Diabetes mellitus is one of the main causes of blindness in the Western world. The mechanism by which pregnancy, diabetes, and retinopathy interact is by higher retinal flow and by circulating and vitreous IGF-1. Similar pathways may be suspected due to coexistence of vascular morbidity in the kidney and retina. Given the encouraging development of methods of diagnosing vascular morbidity, the aim is early to detect factors, which are responsible for further deterioration.
Aim: No data on IGF-1 and either preterm or preeclampsia have been reported so far in diabetic p... more Aim:
No data on IGF-1 and either preterm or preeclampsia have been reported so far in diabetic pregnancies. We evaluated consecutive measurements of IGF-1 for preeclampsia, preterm delivery and birth weight in type 1 diabetic pregnancy.
Setting:
In an outpatient university clinic, 97 pregnant women were consecutively recruited for evaluation of indicators for deterioration of diabetes status and adverse perinatal outcome. At every visit, a blood sample for measurement of IGF-1 was drawn.
Results:
IGF-1 levels from week 14 to 32 was consistently lower in women who delivered preterm compared with women whose delivered after gestational week 36; the increase in 2nd and 3rd trimester was steeper in those delivering at term than in women delivering preterm (p = 0.032). IGF-1 in preeclampsia did not show the same relation in diabetic women (p = 0.74). The lowest tertile of birth weight ratio (0.8-1.2) was associated with lower IGF-1 from week 14 to 32 (p = 0.047, adjusted for preterm delivery and preeclampsia).
Conclusion:
We found low IGF-1 levels associated with preterm delivery and low birth weight.
The most recent Cochrane reviews on oral antihypertensive drugs in pregnancy conclude that no sub... more The most recent Cochrane reviews on oral antihypertensive drugs in pregnancy conclude that no substantial benefits for the mother or fetus are demonstrated so far. Whether this applies for a high-risk and diabetic pregnancy is doubtful. The aim of this short review is an introduction to the field of ambulatory blood pressure measurements in pregnancy and in particular in women with type 1 diabetes. Diabetic pregnancy is complicated with a 50% risk of hypertension/preeclampsia. In the nonpregnant, diabetic women minute increases in blood pressure as well as in albuminuria are forerunners for incipient and overt nephropathy. Medication is essential and can conserve renal function, modifying the risk of renal insufficiency. During pregnancy, renal insufficiency in women with diabetes leads to termination of pregnancy. Therefore, detection of minute changes based on reliable measurements in this high-risk population is invaluable to protect the mother’s kidney function and, if possible, prolong pregnancy for the benefit of the fetus.
Estimates of risk by blood pressure evaluation in these women are influenced by pregnancy per se and diabetes vasculopathy. Several factors have to be considered as few monitors are validated for use in pregnancy and not many of the different methodologies have undergone thorough investigation. The use of absolute values of blood pressure have the advantage that fewer assumptions are necessary on how blood pressure behaves due to modes of evaluation and biological rhythm. Monitors should be chosen with care considering the clinical setting, timing, and population, which influences the outcome, thus, the monitors ought to be validated for the specific condition they are applied for. The strategy for the studies used for safe conclusions in this brief review was chosen with priority of the papers with the best, validated methodology on BP measurements, which is by no way guaranteed in numerous recent publications.
Inherent characteristics of the measurements to be considered are reproducibility, consistency, precision, and trend over scale of measurement. Studies on these issues suggest that consistency and precision depend on which monitor is used. During pregnancy, the reproducibility and specificity depend on the timing and whether measurements are performed repeatedly. Over- and underestimations of blood pressure are typical for 24-h monitoring in high- as well as low risk pregnancies.
Preeclampsia is associated with urinary albumin excretion rate, reduced night/day ratio, and elevated diurnal blood pressure from first trimester and onwards. However, due to blunting of the diurnal variation, the night/day rhythm provides no good prediction of preeclampsia. Diurnal measurement is a valuable estimate of blood pressure in terms of sensitivity, specificity, and predictive values.
Journal of Clinical Endocrinology & Metabolism, 1997
Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angiogenic factor normally absent from... more Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angiogenic factor normally absent from the adult circulation. We have previously shown that it appears in normal maternal serum and that circulating FGF-2 levels are elevated in pregnancies complicated by diabetes. This study was performed to determine whether serum FGF-2 is more abundant in pregnant diabetic women with retinopathy than in those without. Serum was collected monthly between 14 -30 weeks gestation and every 2 weeks from then until delivery (35-38 weeks) from 36 women with type 1 diabetes. FGF-2 was extracted by heparin-Sepharose affinity chromatography and quantified by specific RIA. Patients were divided according to the White classification of diabetes. In 17 women without retinopathy (White groups B, C, and D 0 ), immunoreactive FGF-2 was detectable at 14 weeks (mean Ϯ SEM, 154 Ϯ 39 pmol/L), was maximal after 26 weeks (306 Ϯ 38 pmol/L), after which values steadily declined to term (212 Ϯ
Gynecology & Obstetrics, 2013
This study was designed to test umbilical indices and establish a reference in pregnancies compli... more This study was designed to test umbilical indices and establish a reference in pregnancies complicated by type 1 diabetes mellitus, and to correlate the pulsatility index to other clinical parameters.
Obstetrics & Gynecology, 2001
Methods: This was a prospective, observational study of 45 pregnant women with insulin-dependent ... more Methods: This was a prospective, observational study of 45 pregnant women with insulin-dependent diabetes mellitus without overt nephropathy, examined in an outpatient, antenatal diabetic clinic. Maternal venous serum samples were collected from week 14 every fourth week until week 30, and every other week until delivery. Levels of IGF-I and -II were measured in maternal serum by immunoassays. The repeated measurements were tested with two-way analysis of variance. The outcome measures were birth weight and serum IGF-I, IGF-II, IGF binding protein (BP)-3, and IG-FBP-3 proteases. Before the study, minimum sampling size was calculated as 14 subjects in each group if a difference in IGF-I of 50 g/L was to be detected with an estimated standard deviation of 40, a two-sided P value (␣) of .05, and a power of 90 ( ؍ .1).
The Journal of Clinical Endocrinology & Metabolism, 1997
Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angiogenic factor normally absent from... more Fibroblast growth factor-2 (FGF-2) is a potent mitogen and angiogenic factor normally absent from the adult circulation. We have previously shown that it appears in normal maternal serum and that circulating FGF-2 levels are elevated in pregnancies complicated by diabetes. This study was performed to determine whether serum FGF-2 is more abundant in pregnant diabetic women with retinopathy than in those without. Serum was collected monthly between 14 -30 weeks gestation and every 2 weeks from then until delivery (35-38 weeks) from 36 women with type 1 diabetes. FGF-2 was extracted by heparin-Sepharose affinity chromatography and quantified by specific RIA. Patients were divided according to the White classification of diabetes. In 17 women without retinopathy (White groups B, C, and D 0 ), immunoreactive FGF-2 was detectable at 14 weeks (mean Ϯ SEM, 154 Ϯ 39 pmol/L), was maximal after 26 weeks (306 Ϯ 38 pmol/L), after which values steadily declined to term (212 Ϯ
Aim: Reports are rare on sexual knowledge associated with consumption of pornography in adolescen... more Aim: Reports are rare on sexual knowledge associated with consumption of pornography in adolescence. Methods: A questionnaire was presented to all pupils in 9 th grade in the municipality of Viborg without prior notice to teachers or pupils. We wanted to explore the knowledge on sexual matters with focus on pornography and what media was used. Pornography was divided according to five media subcategories. Knowledge on sexually transmitted infection (STI), pregnancy and abortion and their associations with pornography were explored. Results: Pornography was reported as the second largest source of knowledge on sex (61%) only surpassed marginally by closest of friends as source (63%). Girls reported more use of pornographic written media as source of knowledge than boys (p=0.002). Sixty-eight percent (218 of 320) of the girls reported having their knowledge on sex from magazines without explicit photographs; thus, these magazines constituted a major source for adolescent girls. Girls knew the gestational age of legal abortion in Denmark and had their knowledge from non-explicit magazines while this was not the case for boys (p=0.004). Pupils who stated their knowledge on sex from these magazines knew the first sign of pregnancy (menostasia), the correct facts of legal abortion, and STI. Conclusions: Pornography in different media is used in the vast majority of adolescents and its use is sex-specific. Knowledge on STI, pregnancy, legal abortion was variably associated with the type of media.
Danish medical journal, 2012
The aim of the present study was to reveal any association of sexual practice with knowledge abou... more The aim of the present study was to reveal any association of sexual practice with knowledge about sex education, reproductive physiology and abortion. The study was performed in a non-intervention setting to minimize information bias. A cross-sectional questionnaire was handed out without prior notice to all ninth grade pupils in the Municipality of Viborg, Denmark, in 2007. We found that sexual debut was associated with a greater probability of knowing that chlamydia is the most common sexually transmitted infection (STI). Knowledge of chlamydia was strongly associated with knowledge about the first symptom of pregnancy. A high general level of knowledge of STI was associated with the father being the source of the knowledge among pupils who had not yet had their sexual debut (p < 0.04) and among girls (p < 0.04). The general of knowledge of STI was associated with knowing the first signs of pregnancy and the criteria for legal abortion. A high level of knowledge of STI was ...
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](Ugeskrift for laeger, Jan 30, 2009
A study on knowledge of venereal diseases, opinions on sexual matters, and satisfaction with sex ... more A study on knowledge of venereal diseases, opinions on sexual matters, and satisfaction with sex education at school. A questionnaire was handed out on the same day in all ninth grade classes in the municipality of Viborg without prior notification of teachers and pupils. A total of 394 of 398 questionnaires were answered and returned. Only 36% were fully satisfied with the sex education imparted at school, while 70% of the teenagers were satisfied with the quantity. Satisfaction was similar between genders, but more marked among those without sexual debut as 66% were satisfied, while just 47% of those with sexual debut thought sex education was satisfactory (p < 0.006). Knowledge of venereal disease like hiv/aids, chlamydia and herpes simplex was high (> 80% of pupils). A total of 58% of boys and 76% of girls identified chlamydia as the most common venereal disease (p < 0.0001, girls vs. boys), while 26% of the boys and 27% of the girls answered AIDS/HIV (p < 0.75). Fin...
![Research paper thumbnail of [Knowledge of contraception, pregnancy, and sexuality in ninth grade pupils in the municipality of Viborg during a 21-year-period]](https://attachments.academia-assets.com/41243458/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 30, 2009
A study of the sources of and the changes in the knowledge about contraception, pregnancy, and se... more A study of the sources of and the changes in the knowledge about contraception, pregnancy, and sexuality during a 21-year-period. A questionnaire was handed out on the same day in all ninth grade classes in the Municipality of Viborg without prior notice to teachers or pupils. The results were compared with similar studies performed in 1986, 1993, and 2000. In all 394 of 398 questionnaires were answered. The answers revealed that forty-three percent knew at which time in the cycle pregnancy can occur; boys with sexual debut scored lowest. The time limits for legal abortion were known by 64%, the girls had a higher level of knowledge on this item than the boys. The abortion limits for 16-year-old girls were known by 58%, but here the boys, who had made sexual debut, scored highest and the girls with no prior sexual experience scored lowest. The sources of knowledge changed over the years; screen-based media (TV, internet) now cover more than 30% of both gender's sources, and maga...
![Research paper thumbnail of [Sexual activity and use of contraception in ninth grade pupils during the last 21 years]](https://attachments.academia-assets.com/41232034/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 30, 2009
The study surveys sexual activity, use of contraception at sexual debut and changes in sexual hab... more The study surveys sexual activity, use of contraception at sexual debut and changes in sexual habits during a 21-year period. A questionnaire was handed out on the same day in all ninth grade classes in the Municipality of Viborg. Neither teachers nor pupils were given prior notice. The results were compared with similar studies performed in 1986, 1993 and 2000. A total of 394 of 398 questionnaires were answered and returned. In both genders, 40% had had debuted sexually. The frequency among the boys had increased in comparison with the previous 21 years. The amount of sexual debuts before the legal age of consent at 15 years was 18%, which is similar to previous years. In both genders an increased proportion had experienced coitus within the last week. Condoms were used by 76% and the pill by 15% at sexual debut. Subsequently, 27% shifted from condom use to pill use alone or in combination with a condom at the latest coitus; thus, 34% used the pill at their latest coitus. Practical...
Archives of Gynecology and Obstetrics, 2011
Purpose The sexual activity and contraceptive use is evaluated over 21 years amongst Danish adole... more Purpose The sexual activity and contraceptive use is evaluated over 21 years amongst Danish adolescents in ninth grade. Methods A repeated, cross-sectional questionnaire study in the municipality of Viborg, comparing the results of four consecutive surveys between 1986 and 2007. Results In 2007, 40% of the pupils had sexual debut at an average age of 15.3 § 1.5 years. At sexual debut condoms were used in 77% of the adolescents and the contraceptive pill in 15%. At their latest coitus 34% used any contraceptive pill as 27% of pupils changed from use of condom to the pill. Practical experience with condoms was found in 90% of both sexes at sexual debut. Fourteen percent of the adolescents used no contraception at all at debut in 2007, which is similar to 1986, 1993, and 2000. Eighteen percent of the pupils used no contraception at all at their last intercourse in 2007 and 2000. Conclusion Knowledge about and use of condoms is substantial amongst adolescents already at sexual debut. A shift is conWrmed from condoms at Wrst coitus to more frequent use of the pill later on. A considerable number of pupils (10-20%) are neither protected against sexually transmitted infections nor pregnancy at Wrst or later intercourse.
Archives of Gynecology and Obstetrics, 2011
Purpose A study of what sources of knowledge on sex education, reproductive physiology and aborti... more Purpose A study of what sources of knowledge on sex education, reproductive physiology and abortion was sought by adolescents at school. Methods A cross-sectional questionnaire study of 9th grade pupils in the municipality of Viborg, Denmark in 2007 compared with similar studies performed in 1986, 1993 and 2000. Results A total of 394 of 398 questionnaires were answered in 2007. The age of the pupils was 15.3 ± 1.5 years. In 2007, the limits for legal abortion were known by 64% of the pupils. The boys, who had had sexual debut, answered the question most correctly and the girls with no prior sexual experience the least correctly. The legal aspects of abortion in a 16-yearold girl were known by 58% of the pupils. The school was the most important source of information for the pupil without sexual debut. The adolescents who had sex indicated more use all other sources of information than those without debut. Half of the girls indicated they used magazines as a source of information, whilst only 40% of the boys mentioned pornography and magazines. The contents of girls' choice of magazines suggest that the use of written pornography as substantial source of information on sexual education. Friends/peers play a major role in sexual knowledge for both genders.
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](Ugeskrift For Laeger, Mar 1, 2009
Introduktion: Undersøgelse af 9. klasses elevers viden om kønssygdomme samt deres mening om og vu... more Introduktion: Undersøgelse af 9. klasses elevers viden om kønssygdomme samt deres mening om og vurdering af skolens seksualundervisning. Materiale og metoder: Spørgeskemaundersøgelse af alle 9. klasser i Viborg Kommune. Resultater: I alt 394 ud af 398 spørgeskemaer blev besvaret. Kun 36% af eleverne var fuldt tilfredse med seksualundervisningen, mens 70% syntes, at omfanget af undervisningen var god nok. Tilfredsheden var ligeligt fordelt over kønnene, mens de, der havde ikke haft samleje, var mest tilfredse. Disse angav for 66% vedkommende at vaere tilfredse, mens kun 47% af dem, der havde prøvet samleje, syntes, at undervisningsmaengden var god nok (p < 0,006). Kendskabet til kønssygdomme som hiv/aids, klamydia og herpes fandtes højt (> 80% af eleverne). Som hyppigste kønssygdom svarede 58% af drengene og 76% af pigerne, at det var klamydia (p < 0,0001, piger vs. drenge). I alt 26% af drengene og 27% af pigerne svarede aids/hiv (p < 0,75), mens 13% af drengene og 6% af pigerne svarede ved ikke eller blankt. Samlejedebut øgede kendskabet til klamydia som hyppigste kønssygdom til 85% hos pigerne (p < 0,03). Viden om klamydias symptomer og følgetilstande kan karakteriseres som noget usikker. Pigerne var i højere grad klar over, at det kunne medføre sterilitet (p < 0,001, piger vs. drenge), og at det ikke nødvendigvis gav symptomer (p < 0,02). Niendeklassernes skøn over, hvor stor en andel af pigerne, der havde debuteret seksuelt, var ikke delt efter køn, men efter samlejedebut. Dem, der ikke havde debuteret, skønnede bedst, idet hhv. 77% af drengene og 81% af pigerne skønnede i overensstemmelse med det rigtige svar. Konklusion: Man burde overveje, om man ved at give seksualundervisningen et indhold og en form, der tager hensyn til, om man var debuteret, kunne mindske utilfredsheden med denne undervisning og samtidig øge skolens bidrag til en bedre viden og hensigtsmaessig adfaerd. UGESKR LAEGER 171/14 | 30. MARTS 2009
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](Ugeskrift For Laeger, Apr 1, 2009
Introduktion: Artiklens formål var at belyse unges seksuelle aktivitet og brug af praevention ved... more Introduktion: Artiklens formål var at belyse unges seksuelle aktivitet og brug af praevention ved seksuel debut. Desuden sammenlignes aendringer med erfaringer fra en 21-års periode. Materiale og metoder: Spørgeskemaundersøgelse af alle 9. klasseselever i Viborg Kommune og sammenligning med tilsvarende undersøgelser fra 1986, 1993 og 2000. Resultater: I alt 394 ud af 398 spørgeskemaer blev besvaret. Andelen af dem, der havde haft debut var 40%, og den var nogenlunde den samme for begge køn. Der var i perioden en signifikant stigning hos drengene. Andelen med debut før det 15. år var 18% af alle, hvilket er uaendret i forhold til tidligere. Hos både drenge og piger sås en øget andel i de senere år med samleje inden for den seneste uge. Ved debut brugte 76% kondom og 15% p-piller. I alt 27% havde skiftet fra kondom-til p-pille-brug alene eller som supplement ved seneste samleje, således at i alt 34% brugte p-piller ved deres seneste samleje. Erfaring med kondom hos elever med seksuel erfaring angives af 90% af drengene og pigerne, mens p-pille-erfaring angives af 56% af drengene og 68% af pigerne. Konklusion: Kendskab til og brug af kondom og p-piller er udbredt blandt unge allerede ved den seksuelle debut. Der finder et reelt skifte sted fra udbredt kondombrug ved debut til mere udbredt anvendelse af p-piller ved senere samlejer. Der er dog fortsat en del unge (10-20%), der hverken beskytter sig mod kønssygdomme eller graviditeter ved første eller ved seneste samleje.
A 24-year-old nurse student referred because of oligo-menorrhea and elevated plasma testosterone ... more A 24-year-old nurse student referred because of
oligo-menorrhea and elevated plasma testosterone
was enrolled in a double-blind, randomized study of
the effect of metformin on PCOS. The study was
designed as a crossover study with treatment periods
of 6 months separated by a 3-month washout period.
Before entering the study, she received general
information about PCOS and the importance of being
physically active and losing weight was emphasized.
Conclusions on the effect of metformin on circulating anti-M€ ullerian hormone (AMH) levels in wo... more Conclusions on the effect of metformin on circulating anti-M€ ullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are ambiguous. We performed a secondary analysis of a randomized, double-blind, placebo controlled cross-over trial. Fifty-six women with hyperandrogenemic PCOS were included. Each woman served as her own control receiving a daily dose of either 1700 mg metformin or placebo for 6 months. After a 3-month wash-out period they received the opposite treatment. The decrease in AMH from a median of 49.5 to 46.9 pmol/L after 6 months on metformin was overall not significant (p = 0.81), nor were changes in obese women (from 49.5 to 38.2 pmol/L; p = 0.53). Comparing individual metformin/placebo AMH values, a small absolute decrease of 9.3 pmol/L (p = 0.03) was observed in obese women after 6 months relative to baseline, suggesting a trend towards decreasing values after metformin treatment, mainly in obese women. Abbreviations: AMH, anti-M€ ullerian hormone; BMI, body mass index; PCOS, polycystic ovary syndrome.
Treatment with the anti-diabetic drug metformin is followed by a decline in plasma cobalamin, but... more Treatment with the anti-diabetic drug metformin is followed by a decline in plasma cobalamin, but it is unsettled whether this denotes an impaired cobalamin status. This study has explored changes in the markers of cobalamin status in women with Polycystic Ovary Syndrome treated with metformin (1.5–2.5 g per day) (n = 29) or placebo (n = 23) for six months. Serum samples were collected before and after two, four, and six months of treatment. We found serum cobalamin to decline and reach significant lower levels after six months of treatment (p = 0.003). Despite the decline in serum cobalamin, we observed no reductions in the physiological active part of cobalamin bound to transcobalamin (holotranscobalamin), or increase in the metabolic marker of cobalamin status, methylmalonic acid. Instead, the non-functional part of circulating cobalamin bound to haptocorrin declined (p = 0.0009). Our results have two implications: The data questions whether metformin treatment induces an impaired cobalamin status in PCOS patients, and further suggests that serum cobalamin is a futile marker for judging cobalamin status in metformin-treated patients.
Objective: We sought to determine whether metformin affects the rate of first trimester spontaneo... more Objective: We sought to determine whether metformin affects the rate of first trimester spontaneous abortions and congenital malformations in women with PCOS. Design. Consecutive series of metformin treated women with a questionnaire follow-up. Setting. Department of Gynecology and Obstetrics at Herning and Holstebro Hospital. Population. 117 women with PCOS treated with metformin prior to and during early pregnancy. Methods. The women answered a questionnaire about the first pregnancy on metformin and background data. The data were compared with the corresponding medical charts. Main outcome measures. First trimester spontaneous abortions and congenital malformations. Results. Of the 117 women 20 (17 %) had spontaneous abortions and one induced abortion. Two minor fetal malformations were reported. The response rate on the questionnaire was 65 %. Conclusion. Our spontaneous abortion rate is comparable with the risk in the general population. Our low incidence of malformations warrants further investigation on adverse and beneficial effects of metformin during pregnancy.
Objective: Evaluation of the incidence of gestational diabetes in PCOS women treated with metform... more Objective: Evaluation of the incidence of gestational diabetes in PCOS women treated with metformin before and during early pregnancy and to ascertain their family history of diabetes. Design: Follow-up on all women with PCOS and infertility who received treatment with metformin prior to pregnancy (=index pregnancy) during 10 years. Data on diabetes was retrieved by questionnaire and hospital charts. Main outcome measures: Incidence of gestational diabetes, pregnancy outcome, and fetal size Results: In 18 % of the women GDM was diagnosed at some stage. The clinical and obstetrical outcome of the women showed no association with family history of diabetes or GDM. No neonatal anthropometric feature was different with respect to family history of diabetes or GDM and no fetal malformations were found Conclusion: GDM and family history of diabetes seem not to be associated with unfavourable pregnancy outcome in PCOS women.
Background. Women with polycystic ovary syndrome (PCOS) are reported to be at risk for glucose in... more Background. Women with polycystic ovary syndrome (PCOS) are reported to be at risk for glucose intolerance. The aim of the study was to describe these risk factors in a population of Danish PCOS women attending a gynecologic clinic and to identify the parameters with the strongest correlation to the fasting blood glucose levels. In addition, we studied whether the oral glucose tolerance test (OGTT) diagnosed more cases of glucose intolerance in this PCOS population than the fasting plasma glucose value (FPG) alone. Methods. Cross-sectional study of 91 women with oligomenorrhea or amenorrhea and elevated serum testosterone, followed by an OGTT in 27 of the women. Results. Women with a FPG above normal were older and had a higher body mass index (BMI), cholesterol, and triglycerides and a lower sexual hormone binding globulin (SHBG). Of the 21 women older than 34, eight (38%) had a FPG above normal. The OGTT study showed that one of five with abnormal glucose tolerance would not have been diagnosed, if the FPG alone had been performed. Conclusions. In this study, 38% of women with symptoms of PCOS over the age of 34 had abnormal blood glucose values. These women should receive blood glucose testing regardless of BMI, testosterone levels and family history of type 2 diabetes mellitus. An OGTT may be necessary to find all cases of impaired glucose intolerance.
Background: Data are sparse on medical treatment of hirsutism with metformin. The extent of the t... more Background: Data are sparse on medical treatment of hirsutism with metformin. The extent of the treatment effects may affect the women's quality of life, as low self-esteem and higher rates of depression are associated with the severity of the PCOS condition.
Acta obstetricia et gynecologica Scandinavica, Jan 7, 2015
Conclusions on the effect of metformin on circulating anti-Müllerian hormone (AMH) levels in wome... more Conclusions on the effect of metformin on circulating anti-Müllerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) are ambiguous. We performed a secondary analysis of a randomized, double-blind, placebo-controlled cross-over trial. Fifty-six women with hyperandrogenemic PCOS were included. Each woman served as her own control receiving a daily dose of either 1700 mg metformin or placebo for 6 months. After a 3-month wash-out period they received the opposite treatment. The decrease in AMH from a median of 49.5 to 46.9 pmol/L after 6 months on metformin was overall not significant (p = 0.81), nor were changes in obese women (from 49.5 to 38.2 pmol/L; p = 0.53). Comparing individual metformin/placebo AMH values, a small absolute decrease of 9.3 pmol/L (p = 0.03) was observed in obese women after 6 months relative to baseline, suggesting a trend towards decreasing values after metformin treatment, mainly in obese women.
Nutrients, 2013
Treatment with the anti-diabetic drug metformin is followed by a decline in plasma cobalamin, but... more Treatment with the anti-diabetic drug metformin is followed by a decline in plasma cobalamin, but it is unsettled whether this denotes an impaired cobalamin status. This study has explored changes in the markers of cobalamin status in women with Polycystic Ovary Syndrome treated with metformin (1.5-2.5 g per day) (n = 29) or placebo (n = 23) for six months. Serum samples were collected before and after two, four, and six months of treatment. We found serum cobalamin to decline and reach significant lower levels after six months of treatment (p = 0.003). Despite the decline in serum cobalamin, we observed no reductions in the physiological active part of cobalamin bound to transcobalamin (holotranscobalamin), or increase in the metabolic marker of cobalamin status, methylmalonic acid. Instead, the non-functional part of circulating cobalamin bound to haptocorrin declined (p = 0.0009). Our results have two implications: The data questions whether metformin treatment induces an impaire...
Human Reproduction, 2007
BACKGROUND: Our aim was to assess the effects of metformin on menstrual frequency, fasting plasma... more BACKGROUND: Our aim was to assess the effects of metformin on menstrual frequency, fasting plasma glucose (FPG), insulin resistance assessed as HOMA-index, weight, waist/hip ratio, blood pressure (BP), serum lipids, and testosterone levels in women with polycystic ovary syndrome (PCOS) METHODS: In a randomized, controlled, doubleblinded setup, 56 women aged 18 -45 with PCOS were treated with either metformin 850 mg or placebo twice daily for 6 months. After a wash-out period of 3 months participants received the alternate treatment for 6 months. The changes in the measured parameters were analysed by intention-to-treat and per protocol RESULTS: There were no changes in menstrual frequency. In the intention-to-treat analysis, weight and systolic BP were reduced on metformin treatment (p50.009 and 0.047, respectively), while high-density lipoprotein (HDL) increased (p50.001). On placebo, weight and FPG increased (p<0.05). Post-hoc subgrouping according to BMI revealed reductions in testosterone (p50.013), FPG (p50.018), insulin (p50.045) and HOMA-index (p50.022) in obese women. Per protocol analysis showed the following differences between the changes on placebo and metformin (mean (5 -95 % percentiles): weight (-4.2 (-7.0, -1.9) kg, p<0.001), FPG (-0.23 (-0.44, -0.01) mmol/l, p50.041), insulin (-4.17 (-8.10, -0.23) mIU/l, p50.039) and HOMA index (-1.50 (-2.53, -0.47) mIU/l*mmol/l, p50.006). Weight, FPG and HOMA index were lower after metformin than after placebo. CONCLUSIONS: Metformin treatment lowered weight and systolic blood pressure and increased HDL in women with PCOS. In post-hoc analysis it increased insulin sensitivity and lowered testosterone in obese women. Non-obese women did not benefit from metformin.
Fertility and Sterility, 2010
Objective: To evaluate the effect of metformin in polycystic ovary syndrome (PCOS). As follow-up ... more Objective: To evaluate the effect of metformin in polycystic ovary syndrome (PCOS). As follow-up on a previous paper describing hormonal and metabolic factors, this paper focuses on correlations between adiponectin and anthropometric, hormonal, and metabolic factors in PCOS and the effect of metformin. Design: Randomized, double-blind, placebo-controlled crossover study. Setting: District and university hospital. Patient(s): Fifty-two women with PCOS. Three groups were defined according to baseline adiponectin. Intervention(s): Metformin or placebo for 6 months, followed by 3 months' washout before switching to opposite treatment. Blood tests and measurements were performed before and after treatment periods. Main Outcome Measure(s): Adiponectin, insulin, homeostasis model assessment (HOMA) index, and testosterone. Result(s): Waist-hip ratio (WHR), insulin, and HOMA index were significantly higher in the lower adiponectin group than in the upper and middle group, and high-density lipoprotein (HDL) cholesterol was higher in the upper than in the lower adiponectin group. Multiple regression analysis with adiponectin as the dependent variable and HOMA index, HDL cholesterol, testosterone, and WHR as independent variables showed an R 2 of 0.43 with b-coefficients of À0.12 for the HOMA index, 0.72 for HDL cholesterol, and À1.49 for WHR. Testosterone did not contribute to the prediction of adiponectin levels. Metformin had no effect on adiponectin in spite of significant decreases in weight, fasting glucose, and insulin resistance. Conclusion(s): In PCOS, adiponectin levels are closely linked to insulin resistance, HDL cholesterol, and abdominal adiposity and unaffected by metformin. (Fertil Steril Ò 2010;-:---.
Objective: To determine prevalence, incidence proportion, and changes of urinary incontinence (UI... more Objective: To determine prevalence, incidence proportion, and changes of urinary incontinence (UI) 10– 13 years after hysterectomy compared to two control groups. Study design: A longitudinal cohort study of 661 women with follow-up for ten years. Originally, 866 women answered a questionnaire on continence status preoperatively. Ten years postoperatively the queries were repeated in 371 with a hysterectomy, 89 with laparoscopic cholecystectomy (LC), and 201 with transcervical endometrial resection (TCRE). Significant incontinence was UI at least once a week. The main outcome measures were prevalence and incidence proportions of UI. Results: The overall prevalence of stress UI ten years after surgery was 23% compared to 12% preoperatively. Urge UI was prevalent in 12% compared to 5% preoperatively. Incidence proportions of stress UI were in hysterectomies 21%, in LC 15%, and in TCRE 18%. Similarly, incidence proportions of urge UI were in hysterectomies 11%, in LC 11%, and in TCRE 8%. No significant differences between surgical procedures were found; however, we found substantial amount of changes in continence status from continent to incontinent and vice versa in all three groups. Conclusions: No significant difference was found after hysterectomy compared to controls in the prevalence or incidence proportions of UI after 10 years follow-up. Hysterectomy is not a risk factor of UI.
The aim of this study was to determine the short-term prevalence of de novo urinary symptoms afte... more The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9–45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.
The aim of the study is to investigate the changes in continence status in a population of women ... more The aim of the study is to investigate the changes
in continence status in a population of women hysterectomized
in 1998–2000. Four hundred fifteen hysterectomized
women who participated in a questionnaire study on
continence status in September 2001 were retested with
the same questionnaire on actual continence status in
January 2005. As controls we used 97 women who had a
laparoscopic cholecystectomy in 1999–2000 and were
tested and retested similarly. Urinary incontinence was
defined as involuntary urinary leakage at least once a week.
Stress incontinence was defined as leakage when coughing,
laughing, or lifting heavy weights. Urge incontinence was
defined as an uncontrollable desire to void with leakage
before reaching the toilet. Stress incontinence was reported
by 30% of the hysterectomized women in 2005 vs 28% in
2001. The similar prevalences of urge incontinence were 15
and 13%, respectively. Women who had a subtotal
hysterectomy significantly more often had stress incontinence
compared to controls in 2005 and 2001. No other
significant differences were found. However, the similar
prevalences of incontinence reflected that 16% of the
hysterectomized women changed from continent in 2001
to stress incontinent in 2005, while 32% changed from
stress incontinent to continent. For urge incontinence the
similar changes were 8 and 35%, respectively. A large
proportion of women change from continent to incontinent
or from incontinent to continent during the 3 years of
investigation, which should be born in mind when
prevalence studies on urinary incontinence are evaluated.
Previous hysterectomy does not seem to be of great
importance for the development of de novo incontinence
or remission.
a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to ... more a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. Conclusion: Hysterectomy is significantly associated with stress urinary incontinence in women , who previously had a TCER.
Aim of study. To investigate the association between obesity and peri-or postoperative complicati... more Aim of study. To investigate the association between obesity and peri-or postoperative complications after hysterectomy for nonmalignant bleeding disorders. Material and methods. Data from 444 vaginal hysterectomies and 503 abdominal hysterectomies indicated by benign bleeding disorders were drawn from a regional database. Data on peri-or postoperative complications and postoperative stay were related to preoperative body mass index (BMI). Results. Obesity was related to longer operation time for vaginal as well as abdominal hysterectomy and to large perioperative blood loss for vaginal hysterectomy only. No association was found between BMI and serious complications such as ileus, infection or hematomas except for a higher prevalence of wound hematoma after abdominal hysterectomy in underweight and normal weight patients. Neither was any association found between BMI and use of blood transfusion, reoperation or prolonged postoperative stay. Conclusion. Vaginal and abdominal hysterectomy have a significant risk of complications, but obese patients did not experience an increased risk of serious morbidity compared to normal weight women. Obesity per se is not a contraindication of vaginal or abdominal hysterectomy in otherwise healthy women.
![Research paper thumbnail of [Vaginal hysterectomy in cases of enlarged, non-descended uterus].](https://attachments.academia-assets.com/46589540/thumbnails/1.jpg)
](Introduktion: En forstørret uterus angives ofte som en kontraindikation ved vaginal hysterektomi ... more Introduktion: En forstørret uterus angives ofte som en kontraindikation ved vaginal hysterektomi på ikkedescenderet uterus. Vi har derfor i et regionalt materiale fundet det af interesse at undersøge, i hvilken grad uterus' størrelse har betydning for komplikationsfrekvensen og indlaeggelsestiden ved vaginal hysterektomi. Materiale og metoder: Kvinder, der fik foretaget vaginal hysterektomi ved ikkedescenderet uterus og på benign indikation på de gynaekologiske afdelinger på Silkeborg, Herning og Holstebro Sygehuse i perioden fra den 1. oktober 1997 til den 1. marts 2003 indgik i undersøgelsen. Data vedrørende uterus' vaegt, perioperative komplikationer og indlaeggelsestid blev udtrukket fra en regional hysterektomidatabase. Data tilhørende kvinder, hvis uterus vejede under 300 g blev efterfølgende sammenlignet med data tilhørende kvinder, hvis uterus vejede mindst 300 g. Resultater: Der blev indberettet 2.909 hysterektomier til databasen. Af disse opfyldte 694 inklusionskriterierne. Hos 94 af disse vejede uterus mere end 300 gram. Kun operationstiden fandtes signifikant større i gruppen med tunge uteri, mens komplikationsfrekvensen og indlaeggelsestiden var uden signifikante forskelle. Der var dog signifikant tungere uteri i den gruppe, hvor man måtte konvertere operationen til abdominal hysterektomi. Diskussion: En uterusvaegt på mere end 300 g øgede ikke komplikationsfrekvensen ved vaginal hysterektomi på ikkedescenderet uterus, men muligvis risikoen for konvertering til abdominal operation. Under i øvrigt optimale forhold kan en uterusvaegt på 300 g eller mere ikke anses for en kontraindikation for vaginal hysterektomi.
The bladder is a common site of injury during hysterectomy for benign disorders 123. Investigatio... more The bladder is a common site of injury during
hysterectomy for benign disorders 123. Investigations
have shown that endometriosis and previous
surgery such as cesarean section are risk
factors, as well as some operative methods, for
instance laparoscopic assisted vaginal hysterectomy
(23). However, few studies have focused
primarily on bladder injuries. The aim of the
present study was to investigate the risk factors
for peroperative bladder injury during hysterectomy
for benign disorders.
![Research paper thumbnail of [Analysis of need for sick leave after hysterectomy]](https://attachments.academia-assets.com/41243167/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 21, 2008
The recommended sick leave after hysterectomy varies among operating wards and depends on many no... more The recommended sick leave after hysterectomy varies among operating wards and depends on many non-medical issues. The recommendation is rarely validated scientifically and is often without any connection to the women's actual handling of the leave if this is not recorded as part of a project. We analysed the postoperative period for a group of hysterectomised women who kept a diary over eight weeks. Between July 2005 and June 2006 all hysterectomised women entered the diary project if they fulfilled the following criteria: the operation was indicated by meno-metrorrhagia, dysplasia, pressure symptoms or pain, she was under 60, she was Danish-speaking and in full-time work which was to be recommenced after operation. Women were excluded if they were operated for descended uterus, if a major re-operation was performed or, unexpectedly, endometriosis or malignancy was found. Our ward's recommendation on sick leave was four weeks for vaginal hysterectomy and six weeks for abdom...
![Research paper thumbnail of [Survival rate after radical hysterectomy for cervical cancer performed in a central hospital]. Ugeskr Laeger 167: 4367-4371](https://attachments.academia-assets.com/41243819/thumbnails/1.jpg)
](Ugeskrift for laeger
No recent Danish data exist on survival rate by stage for cervical cancer. Further centralization... more No recent Danish data exist on survival rate by stage for cervical cancer. Further centralization of cancer treatment is presently being discussed, and this report aims to discuss and broaden the view on the issues of survival, centralization and quality of treatment. During the period 1982-2002, 123 women were diagnosed with cervical cancer and operated on by two gynaecologists in a central hospital in Denmark, using a modification of Okabayashi's operation. Stage 1b cancer was found in 111 women. The hospital charts were reviewed retrospectively, and data on survival rates were drawn from hospital records and registers. The occurrence of lymph gland metastasis was associated with the stage of the cancer. Relapse of tumor occurred in 29 women, with 21 women subsequently succumbing to the disease. No difference was found in survival rate in stage 1 according to treatment of relapse. The five- and ten-year survival rates in stage 1b were 87% and 82%, respectively. Similarly to wh...
![Research paper thumbnail of [Survival rate after radical hysterectomy for cervical cancer performed in a central hospital]](https://attachments.academia-assets.com/44256092/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 14, 2005
No recent Danish data exist on survival rate by stage for cervical cancer. Further centralization... more No recent Danish data exist on survival rate by stage for cervical cancer. Further centralization of cancer treatment is presently being discussed, and this report aims to discuss and broaden the view on the issues of survival, centralization and quality of treatment. During the period 1982-2002, 123 women were diagnosed with cervical cancer and operated on by two gynaecologists in a central hospital in Denmark, using a modification of Okabayashi's operation. Stage 1b cancer was found in 111 women. The hospital charts were reviewed retrospectively, and data on survival rates were drawn from hospital records and registers. The occurrence of lymph gland metastasis was associated with the stage of the cancer. Relapse of tumor occurred in 29 women, with 21 women subsequently succumbing to the disease. No difference was found in survival rate in stage 1 according to treatment of relapse. The five- and ten-year survival rates in stage 1b were 87% and 82%, respectively. Similarly to wh...
Acta Obstetricia et Gynecologica Scandinavica, 2011
Objective. To determine transfusion rates, risk factors for transfusion and the prevalence of une... more Objective. To determine transfusion rates, risk factors for transfusion and the prevalence of unexpected red blood cell alloantibodies in women undergoing hysterectomy for benign disease. In addition, we aimed to evaluate the necessity of the pretransfusion testing for red blood cell alloantibodies. Design. Retrospective cohort study. Setting. The Danish Hysterectomy Database and a regional computerized blood bank register. Population. The 4 181 hysterectomies in 2004 reported to the Hysterectomy Database. The blood bank registers 2 603 hysterectomies performed between 1997 and 2005. Methods. From the hysterectomy database, information about indications for the hysterectomy, surgical procedures, re-operations, number of blood transfusions, and demographic, descriptive and clinical characteristics were extracted. Urgency of the transfusion episodes was evaluated by a retrospective review of the patients' medical records. From the regional blood bank register, results of the screening for red blood cell alloantibodies were extracted. Main Outcome Measures. Transfusion rates, prevalence of unexpected red blood cell alloantibodies. Results. In all, 242 women (5.8%) received blood transfusions, but only 32 of the 4 181 women (0.77%) were urgently transfused. Re-operations were frequently associated with urgent blood transfusions. Nine of the 2 603 women from the regional register (0.35%) had newly detected, clinically significant red blood cell alloantibodies. Conclusions. The risk of a hemolytic transfusion reaction was estimated to be less than 1 in 17 000 hysterectomies (upper confidence limit) if the routine pretransfusion test were to be omitted. We suggest that reconsideration of the necessity for routine preoperative pretransfusion testing for women undergoing hysterectomy for benign disease is indicated.
![Research paper thumbnail of [Analysis of need for sick leave after hysterectomy]](https://attachments.academia-assets.com/41233380/thumbnails/1.jpg)
](Ugeskrift For Laeger, Apr 21, 2008
INTRODUCTION: The recommended sick leave after hysterectomy varies among operating wards and depe... more INTRODUCTION: The recommended sick leave after hysterectomy varies among operating wards and depends on many non-medical issues. The recommendation is rarely validated scientifically and is often without any connection to the women's actual handling of the leave if this is not recorded as part of a project. We analysed the postoperative period for a group of hysterectomised women who kept a diary over eight weeks.MATERIALS AND METHODS: Between July 2005 and June 2006 all hysterectomised women entered the diary project if they fulfilled the following criteria: the operation was indicated by meno-metrorrhagia, dysplasia, pressure symptoms or pain, she was under 60, she was Danish-speaking and in full-time work which was to be recommenced after operation. Women were excluded if they were operated for descended uterus, if a major re-operation was performed or, unexpectedly, endometriosis or malignancy was found. Our ward's recommendation on sick leave was four weeks for vaginal hysterectomy and six weeks for abdominal hysterectomy, but with emphasis on the necessary individualization of sick leave. Once a week, the women answered eight questions on their well-being and activities in the diary and returned the diary.RESULTS: In total, 71 women entered the study, 27 with vaginal hysterectomy and 44 with abdominal hysterectomy. After one week, none of the women suffered from nausea or discomfort, while 20% were still complaining of pain. Less than half of the women had commenced work one week after the recommended sick leave. At that time, two thirds had recommenced their former leisure activities but less than half of the women's sex lives were as before the operation.CONCLUSION: The majority of women extend their sick leave beyond the recommended period on their own initiative, despite the ward's long recommended period of sick leave. It is questionable whether the actual period of sick leave can be cut by shortening the recommended sick leave.
Purpose Information is limited on the early postoperative rehabilitation following hysterectomy. ... more Purpose Information is limited on the early postoperative rehabilitation following hysterectomy. Our purpose was to evaluate the different perioperative modalities of fatigue, pain, quality of life, and physical performance and their time-related. Methods A prospective, follow-up study of a cohort of women undergoing abdominal and vaginal hysterectomy at the Gynecology Department at Herning Hospital, Den-mark. Data from 108 women with elective hysterectomy were compared pre-and postoperatively. The fatigue level was scored on a visual analogue scale and SF-36. Objective measurements were performed by dynamometer of hand grip, knee extension strength, and postural stability; further , by ergometer cycle work capacity and by impedance lean body mass. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. Results Women lost lean body mass 13 and 30 days after their hysterectomy (p \ 0.01). Strength in hand (p \ 0.05) and knees (p \ 0.01) increased compared to preoperative values but no change in postural stability and work capacity was noted. Fatigue resumed to preoperative levels after 30 days. SF-36 revealed that the modality of 'physical functioning' and 'role limitations due to physical problems' remained significantly decreased at the end of the study (p \ 0.01) Conclusion Hysterectomy was associated with reduction in physical function assessed by SF-36 30 days after surgery. No impairment of performance was found in physical tests at days 13 and 30 postoperatively.
Introduction: Good metabolic control is important in type 2 diabetes mellitus to improve quality... more Introduction:
Good metabolic control is important in type 2 diabetes mellitus to improve quality of life, work ability and life expectancy, and the use of telemedicine has proved efficient as an add-on to the usual treatment. However, few studies in type 2 diabetes patients have directly compared telemedicine with conventional outpatient treatment, and we wanted to evaluate whether telemedicine, compared with standard care, provides equivalent clinical outcomes.
Methods:
Forty patients with type 2 diabetes mellitus allocated from October 2011-July 2012 were randomized to either treatment at home by video conferences only or standard outpatient treatment. Primary outcomes were HbA1c and blood glucose levels and secondary outcomes were 24-hour blood pressure, cholesterol levels and albuminuria. The video-telephone was a broadband solution installed and serviced by the Danish Telephone Company (TDC).
Results:
The improvements in the two treatments, given as changes in percentage of telemedicine vs standard, showed significant differences in HbA1c (-15 vs -11%), mean blood glucose (-18 vs -13%) and in cholesterol (-7 vs -6%). No differences in LDL (-4 vs -6%), weight (-1 vs 2%), diastolic diurnal blood pressure (-1 vs -7%), and systolic diurnal blood pressure (0 vs -1%) were found. Nine consultations were missed in the standard outpatient group and none in the telemedicine group.
Conclusions:
In the direct comparison of home video consultations vs standard outpatient treatment in type 2 diabetes mellitus, telemedicine was a safe and available option with favourable outcomes after six months treatment.
American Journal of Clinical Nutrition
To compare the metabolic effect of coingestion of saturated and monounsaturated fats with potato,... more To compare the metabolic effect of coingestion of saturated and monounsaturated fats with potato, 12 subjects large amounts of butter also increase fatty acid and triacylglycerol concentrations.
![Research paper thumbnail of [A survey of research funding at Danish regional hospitals]](https://attachments.academia-assets.com/41232100/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 7, 2009
According to recently passed Danish legislation, all Danish hospitals are obliged to take part in... more According to recently passed Danish legislation, all Danish hospitals are obliged to take part in scientific research. As data on financial support for research activities are lacking, we assessed the resources allocated to research from the budget of the central hospital management as a percentage of the total budget at Danish regional hospitals in 2007. A postal survey was conducted at 13 hospitals in the Western part of Denmark. The questionnaire comprised items in the following major categories: 1) budget allocated specifically for research and travel grants; 2) employment of scientific and technical support staff; 3) facilities and equipment for research; and 4) research dissemination. Questionnaires were returned from 11 hospitals. Six hospitals reported to have dedicated fixed amounts on the budget for research, exact figures were reported in four cases only equivalent to 0.1%, 0.3%, 0.3% and 0.6% of the total budget. Most hospitals had associate professors, but only five had...
Danish medical bulletin, 2011
As we found no recent published reports on the amount and kind of research published from Danish ... more As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Public...
![Research paper thumbnail of [Research at regional hospitals in Denmark can be reinforced]](https://attachments.academia-assets.com/41233118/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 4, 2013
We examined the conditions for health research at regional hospitals in Denmark. The study was co... more We examined the conditions for health research at regional hospitals in Denmark. The study was conducted as an interview-based case study containing interviews with key persons at the governing level as well as medical doctors at the operating level. The results showed that the settings and opportunities regarding health research vary between university hospitals and non-university regional hospitals. However our findings indicate, that focusing on a long-term strategy to implement health research in regional hospitals will enable these to be more active in health research.
![Research paper thumbnail of [Research in regional hospitals in two Danish regions]](https://attachments.academia-assets.com/41232862/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 4, 2013
The quantity of interest, experience, and barriers to research in non-university hospitals in Den... more The quantity of interest, experience, and barriers to research in non-university hospitals in Denmark is undocumented. Therefore, a questionnaire was distributed to all employees at non-university hospitals in two Danish regions. The results showed that a substantial number of medical doctors were engaged in ongoing research. 24% of the respondents were supervisors in research projects, and 19% conducted contract research. Thus, Danish non-university hospitals have employees with both interest and experience in medical research. The four most commonly stated barriers for research were lack of time, funding, supervision, and training courses.
Ugeskrift for laeger
Denne sygehistorie illustrerer det problematiske ved brug af et nyt stof, som ikke har en antidot... more Denne sygehistorie illustrerer det problematiske ved brug af et nyt stof, som ikke har en antidot, og hvor der endnu ikke er solid evidens eller klinisk erfaring for behandlingen af akut blødning. I overvejelsen om antikoagulationsbehandling til patienter med atrieflimren bør man derfor inddrage dette aspekt, i saerdeleshed hos patienter, som ikke ønsker blodtransfusion, såsom Jehovas Vidner. Der findes ca. 7 mio. Jehovas Vidner i 230 lande, hvorfor ovenstående problemstilling er yderst relevant for mange laeger [5].
![Research paper thumbnail of [Research in regional hospitals in two Danish regions]](https://attachments.academia-assets.com/41233607/thumbnails/1.jpg)
](Ugeskrift For Laeger, Feb 4, 2013
The quantity of interest, experience, and barriers to research in non-university hospitals in Den... more The quantity of interest, experience, and barriers to research in non-university hospitals in Denmark is undocumented. Therefore, a questionnaire was distributed to all employees at non-university hospitals in two Danish regions. The results showed that a substantial number of medical doctors were engaged in ongoing research. 24% of the respondents were supervisors in research projects, and 19% conducted contract research. Thus, Danish non-university hospitals have employees with both interest and experience in medical research. The four most commonly stated barriers for research were lack of time, funding, supervision, and training courses.
Objective: The effect of a diet rich in monounsaturated fatty acids (MUFA) on blood pressure, gly... more Objective: The effect of a diet rich in monounsaturated fatty acids (MUFA) on blood pressure, glycemic control, lipids and insulin sensitivity was evaluated in women with gestational diabetes mellitus. Design and methods: A randomized, unpaired diet intervention was performed in 27 women with gestational diabetes mellitus in an outpatient clinic. After randomization the women received either a high-carbohydrate diet (H-CHO) or a high-MUFA diet (H-MUFA) from the 33rd gestational week of pregnancy. Outcome measures were 24 h ambulatory blood pressure, blood lipids, glycemic control and insulin sensitivity estimated by an intravenous glucose tolerance test. Results: The 24 h diastolic blood pressure increased more in the H-CHO group than in the H-MUFA group (P < 0.04). Conclusions: After 5 weeks of treatment with a MUFA-enriched diet, no increase in 24 h diastolic blood pressure and no adverse effects on blood lipids were seen. The favorable effect on the blood pressure by the MUFA diet is a possible non-medication treatment. The H-MUFA diet had no advantage to the H-CHO diet in ameliorating the decline of insulin sensitivity in third term of pregnancy in GDM. Sponsorship: Sources of support were grants from the Mimi and Victor Larsens Foundation, Nordisk Insulin Foundation, Novo Nordisk Foundation, and the
The American journal of clinical nutrition, 1996
To compare the metabolic effect of coingestion of saturated and monounsaturated fats with potato,... more To compare the metabolic effect of coingestion of saturated and monounsaturated fats with potato, 12 subjects with non-insulin-dependent diabetes mellitus (NIDDM) received 300 g mashed potato alone or in combination with 40 g olive oil, 80 g olive oil, 50 g butter, or 100 g butter, respectively. The blood glucose response area to potatoes with 100 g butter (448 +/- 68 mmol.240 min/L) was significantly lower than after the four other meals: 596 +/- 63 (potato alone), 649 +/- 82 (potato + 40 g olive oil), 587 +/- 80 (potato + 50 g butter), and 604 +/- 81 (potato + 80 g olive oil) nmol.240 min/L, P < 0.05, respectively. The insulin response was significantly increased by adding 50 and 100 g butter, whereas addition of 40 and 80 g olive oil had no effect. The fatty acid concentration was higher when 100 g butter was added to the potato meal than when it was not (0.67 +/- 0.05 compared with 0.48 +/- 0.07 mmol/L, P < 0.05). Fatty acid concentrations were similar to those found for t...
![Research paper thumbnail of [Saturated and monounsaturated fats in patients with insulin-dependent diabetes. Different effects on blood glucose and insulin response in NIDDM]](https://attachments.academia-assets.com/41232260/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 2, 1998
To compare the metabolic effect of co-ingestion of saturated and monounsaturated fat with potato,... more To compare the metabolic effect of co-ingestion of saturated and monounsaturated fat with potato, 12 NIDDM subjects received 300 g mashed potato alone or in combination with 40 g olive oil, 50 g butter or 100 g butter, respectively. Blood glucose response area to potatoes with 100 g butter (448 +/- 68 mmol/L x 240 min) was significantly lower than to the four other meals: 596 +/- 63 (potato alone), 649 +/- 82 (potato + 40 g olive oil), 587 +/- 80 (potato + 50 g butter), and 604 +/- 81 (potato + 80 g olive oil) mmol/L x 240 min, p < 0.05, respectively. The insulin response was significantly increased by adding 50 g and 100 g butter, whereas no effect after addition of 40 g and 80 g olive oil was found. The free fatty acid (FFA) level was higher when 100 g butter was added to the potato meal than without (0.67 +/- 0.05 vs 0.48 +/- 0.07 mmol/L, p < 0.05). The triglyceride response increased dose-dependently with the fat content of the meals irrespective of the type of fat. In con...
Diabetes Care, 1994
OBJECTIVE -To determine the influence of postprandial exercise on blood glucose responses in insu... more OBJECTIVE -To determine the influence of postprandial exercise on blood glucose responses in insulin-dependent diabetes mellitus (IDDM) subjects.
Diætbehanlding af patienter med gestationel diabetes mellitus
Diet is the cornerstone in the treatment of gestational diabetes mellitus (GDM) and in principle ... more Diet is the cornerstone in the treatment of gestational diabetes mellitus (GDM) and in principle follow recommendations on diet treatment in diabetes mellitus. Several studies show that a diet rich in monounsaturated fatty acids (MUFA) hasda beneficial influence on blood pressure and glucose and lipid metabolism compared to the recommended carbohydrate-rich, low-fat diabetes diet. The purpose of this thesis was to show whether and to what extent these beneficial effects of a MUFA-rich diet can be reproduced in GDM.
Twenty-seven pregnant women with GDM were randomized into two groups, treated respectively with a MUFA-rich diet (MUFA group, n = 13) and a carbohydrate-rich diet (CHO group, n = 14). The diagnosis of GDM was confirmed before 34th week by an oral glucose tolerance test. Intake of medicine was a criterion for exclusion. In the 33rd, 36th and 38th week, the pregnant had an intravenous glucose tolerance test, diurnal blood pressure was measured, blood samples taken, and 24-h urine collected. Diurnal blood pressure was measured by a monitor.
The CHO group had the recommended diabetes diet containing 50% carbohydrate and 30% fat (13% as saturated fat). The MUFA group had a diet with 46% carbohydrates, 37% fat (22% as MUFA). The actual food intake was recorded over four days in the 33rd and 36th week.
We found that the MUFA group increased MUFA intake about 2 times and reduced carbohydrate intake as planned. The CHO group continued with the diabetes diet unchanged. No significant difference was found between the trial groups in the 33rd week; however, there was a trend towards higher weight in the MUFA group.
Diastolic ambulatory blood pressure was lower in the MUFA group compared with the CHO group. In the MUFA group the expected increase was not seen in diurnal blood pressure in the third trimester, whereas the blood pressure in the CHO group rose significantly.
No difference was found in glucose and lipid metabolism between the two diets. The MUFA group increased its insulin secretion from 33rd to 38th week compared to the CHO group, while fasting insulin in the CHO group decreased from 33rd to 38th weeks. Levels of glucose, fructosamine, and HbA1c were similar in the two trial groups.
A high-fat diet rich in MUFA had no negative effect on lipid metabolism in GDM. No difference between the groups was found in creatinine clearance, excretion of electrolytes, and albumin. Birth weight was similar in the trial groups and no different from a group with normal OGTT who had similar weight, diabetes history, and parity. Birth weight was higher in the GDM women than children born to normal women.
We conclude that a diet rich in MUFA content may have beneficial effects on blood pressure GDM compared with a diet rich in carbohydrates. The MUFA diet displayed no influence on glucose and lipid metabolism. The MUFA diet apparently did not affect birth weight or the newborn's glucose and lipid values.
Purpose The cornerstone in treatment of gestational diabetes mellitus (GDM) is medical nutrition ... more Purpose The cornerstone in treatment of gestational diabetes mellitus (GDM) is medical nutrition therapy (MNT), but the effect on birth weight is disputed. The birth weight was evaluated with respect to length of MNT and adherence to diet. Methods We performed a cohort study on 436 women with GDM and 254 non-diabetic women. Women with a normal oral glucose tolerance test were included as controls as they had similar background predisposition as the women with GDM. The GDM women were subdivided according to MNT and the nutritional status was further stratified according to adherence to the current dietary guidelines. Results Birth weight above 4 kg was more prevalent in the non-diabetic women compared to the diet-treated GDM women (27 vs. 18%, p = 0.012) but similar to the GDM women who had no MNT (24%). Lower birth weight was associated with longer duration of MNT (r =-0.13, p = 0.021). The birth weight was 1.2 g lower per day of treatment. Conclusions Medical nutrition therapy was associated with reduction of the fetal weight in women with GDM and the weight decreases with length of treatment. Birth weight above 4 kg was as prominent in the non-diabetic women as in the women with GDM without MNT.
Formål: At undersøge glukosemetabolismen ved gestationel diabetes mellitus til identifikation af ... more Formål: At undersøge glukosemetabolismen ved gestationel
diabetes mellitus til identifikation af gravide
med størst risiko for udvikling af abnorm glukosemetabolisme
efter graviditeten.
Design: Prospektiv undersøgelse af glukosemetabolismen
hos gravide med gestationel diabetes med
abnorm oral glukosetolerancetest før 34. uge som
indgangskriterium.
Regi: Gynækologisk/obstetrisk afdeling Y, Århus
Universitetshospital, i perioden 1.12.1991-1.6.1993.
Materiale: Niogtyve gravide med gestationel diabetes.
Variabler: Intravenøs glukosetolerancetest i 33., 36.
og 38. uge og oral glukosetolerancetest post partum.
Resultater: Gravide med normal oral glukosetolerancetest
post partum udviste et signifikant fald under
graviditeten i fasteblodglukose fra 33. til 38. uge
(4,8 !4,0 mmol/l, p<0,05), mens kvinder med en
patologisk oral glukosetolerancetest havde uændrede
fasteblodglukoseværdier (5,1!5 mmol/l). K-værdi
(fald i blodglukose) målt ved i.v. glukosetolerancetest
i 38. uge var signifikant lavere for kvinder med
diabetisk/borderline oral glukosetolerancetest i puerperiet
i forhold til kvinder med normal oral glukosetolerancetest
(1,0550,07 mod 1,3250,08 --
1023mmol/l3min--1, p<0,05). Diabetisk eller borderline
diabetisk oral glukosetolerancetest i puerperiet
fandtes signifikant associeret med et fald i K-værdi
fra 33. til 38. uge (p<0,05). Tidligt diagnosetidspunkt
af gestationel diabetes fandtes associeret med patologisk
oral glukosetolerancetest post partum (p<0,05).
Konklusioner: Høje og uændrede fasteblodglukoseværdier
i sidste trimester ved gestationel diabetes
kan identificere de kvinder, der har størst risiko for
diabetisk/borderline oral glukosetolerancetest efter
graviditet. Enkelte fasteblodglukosemålinger post
partum synes ikke velegnet til dette formål.
Twenty-nine pregnant women with gestational diabetes mellitus (GDM) diagnosed before the 34th ges... more Twenty-nine pregnant women with gestational diabetes mellitus (GDM) diagnosed before the 34th gestational week had three intravenous glucose tolerance tests (IVGTT) performed during pregnancy and a follow-up with OGTT post partum. The women with a normal OGTT post partum had a significant decrease in fasting serum glucose from the 33rd to the 38th week in pregnancy (4.8-->4.0 mmol/l, p < 0.05). However, the women with a diabetic/borderline OGTT showed no decrease in fasting serum glucose during the same period (5.1-->5.0 mmol/l). The K-value (the diminution rate of blood glucose) of the IVGTT in week 38 was significantly lower in women with puerperal diabetic/borderline OGTT compared with women with a normal post partum OGTT (1.05 +/- 0.07 vs. 1.32 +/- 0.08 -10(2) x mmol/l x min-1, respectively, p < 0.05). Diabetic or borderline diabetic OGTT in the first week post partum was significantly associated with a decrease in the K-value from week 33 to 38 (p < 0.05). Early diagnosis of GDM was found to be associated with a pathological OGTT post partum (p < 0.05). Five of 22 women (23%) with previous GDM had a diabetic and one (5%) a borderline OGTT at follow-up four to thirteen months post partum. High fasting serum glucose levels during the last trimester in GDM can identify the women at risk of diabetic/borderline OGTT post partum.
Background. The purpose was to compare the influence of varying levels of glycemia on the perinat... more Background. The purpose was to compare the influence of varying levels of glycemia on the perinatal outcome. Methods. The data charts of 383 women screened for gestational diabetes mellitus with an oral glucose tolerance test during two birthyears were retrospectively evaluated. In 55 women gestational diabetes mellitus was diagnosed and treated with diet. The non-diabetic women (nΩ328) were subdivided into a borderline diabetes group (nΩ74) and a normal group (nΩ 254) on the basis of the oral glucose tolerance test result. The birth registry of 8196 singleton pregnancies from The Perinatal Research Unit at Skejby University Hospital served as the background population. Results. Birthweight was highest in the borderline group. Weight increase during pregnancy was larger in the non-diabetic than the gestational diabetic women (15 vs. 8 kg p∞0.01). The women with less increase of body weight delivered neonates with lower birthweight than those with higher increase. Birthweight was associated with maternal weight during pregnancy (p∞0.01). Birthweight ratio increased with increasing glucose intolerance. Vaginal delivery rate was less and cesarean section rate higher in women with gestational diabetes mellitus compared to the non-diabetic women. No significant difference was found in the incidence of hypertensive disorders during pregnancy or neonatal morbidity. Conclusions. Even minor hyperglycemia is associated with increasing birthweight. Birthweight is reduced in GDM when dietary treatment is instituted and effect on weight gain is achieved.
Gestational diabetes mellitus (GDM) increases the risk for diabetes in the next pregnancy and lat... more Gestational diabetes mellitus (GDM) increases the risk for diabetes in the next pregnancy and later in life. Thus, estimating the risk of GDM in further pregnancies provides a time frame for possible preventive measures. We aimed to calculate the recurrence rate of GDM in primiparous women and evaluate the factors involved such as age, body mass index, weight gain, time between pregnancy and postpartum OGTT results.
We established a prospective cohort during a five-year period at the Department of Obstetrics at Kolding Hospital. Women with diet-treated GDM in their first pregnancy and a subsequent pregnancy constituted our study population. Multiparity and insulin-treated GDM were exclusion criteria.
Among 15 735 deliveries, 535 women were diagnosed with GDM (3.4%); 209 (39.1%) were nulliparous women, treated with diet only. Seventy-two of these women had a subsequent pregnancy and they all attended the recommended screening procedure, namely a 75g oral glucose tolerance test at 14-20 (early) or 27-30 (late) weeks gestation. The recurrence rate of GDM was 47.2%. The risk of recurrence was less in women who lost weight between the first and the subsequent pregnancy.
Recurrence of diet-treated GDM was 47.2% in primiparous women with previous GDM and the recurrence was associated with weight gain between pregnancies.
Sexual & Reproductive Healthcare, 2014
We evaluated the use of curettage in second trimester medical induced abortions retrospectively i... more We evaluated the use of curettage in second trimester medical induced abortions retrospectively in 186 women at Herning Hospital, Denmark. Curettage was carried out in a total of 55% of the women. The incidence of curettage was associated with low gestational age (r = 0.32, p < 0.001) but not with age, parity, and BMI. The average incidence of curettage dropped from 62% to 25% at the time before 2007 compared with the time after 2007 (p < 0.001). The indications for abortion were not associated with subsequent use of curettage.
![Research paper thumbnail of [Uterine rupture in a primigravid woman at 31st gestational week]](https://attachments.academia-assets.com/41239544/thumbnails/1.jpg)
](Ugeskrift for laeger, Jan 16, 2009
Spontaneous uterine rupture is a very rare obstetric complication. This case report describes spo... more Spontaneous uterine rupture is a very rare obstetric complication. This case report describes spontaneous uterine rupture in a healthy 28-year-old primigravid woman at the 31st gestational week. The woman was hospitalized due to contractions, which eased after rest. Later she had acute abdominal pain followed by an abnormal cardiotocography. An acute caesarean section was performed and a longitudinal posterior uterine wall rupture found. She had no known risk factors explaining the rupture.
![Research paper thumbnail of [Strategy for delivery in breech presentations. A retrospective study]](https://attachments.academia-assets.com/41232261/thumbnails/1.jpg)
](![Research paper thumbnail of [Uterine rupture in a primigravid woman at 31st gestational week]](https://attachments.academia-assets.com/41239550/thumbnails/1.jpg)
](Ugeskrift For Laeger, Mar 1, 2009
Resume Spontan uterusruptur er en meget sjaelden obstetrisk komplikation. Vi beskriver et tilfael... more Resume Spontan uterusruptur er en meget sjaelden obstetrisk komplikation. Vi beskriver et tilfaelde af spontan uterusruptur hos en 28årig rask førstegangsgravid kvinde i 31. uge. Patienten blev indlagt til observation pga. plukkeveer, som havde aendret karakter inden for det seneste døgns tid. Efter 12 timers observation udviklede patienten voldsomme smerter i maven, og der blev registreret et patologisk kardiotokografi. Ved hyperakut sectio fandt man en laengdegående ruptur i bagvaeggen af uterus. Det var ingen kendte risikofaktorer for uterusruptur, og uterus samt placenta fandtes uden anomalier.
Introduction: In Chinese traditional medicine, the stimulation of acupuncture point no. 67 – the ... more Introduction: In Chinese traditional medicine, the stimulation
of acupuncture point no. 67 – the bladder meridian –
is recommended to favour cephalic version in case of foetal
breech presentation. The point can be stimulated by an
acupuncture needle, ginger application, fingertip pressure,
laser or moxibustion; moxibustion is heat generated by a
burning stick containing the herb Artemisia vulgaris.
A Cochrane review concluded that more research on the effectiveness
of moxibustion is needed. This study aimed to
estimate the effectiveness of moxibustion for version of
breech presentation.
Methods: We included 200 women in gestational week 33
who had a singleton foetus in breech position. They were
randomised to moxibustion treatment daily for two weeks
or control without moxibustion. The randomisation was
performed for nulliparous and parous women separately.
Results: After the trial, which lasted on average 16 days,
the breech position was confirmed in 68 of the 92 nulliparous
and in 50 of the 108 parous women (74% versus 46%,
p < 0.01); furthermore, cephalic position was verified in 76
women and other positions in six women. No significant
difference regarding the incidence of breech position was
found in the moxibustion group compared with the control
group (risk ratio (RR) = 1.05, 95% confidence interval (CI):
0.8-1.38); nor in nulliparous (RR = 1.17, 95% CI: 0.77-1.76)
or in parous women (RR = 1.0, 95% CI: 0.69-1.46); an RR
> 1 favours moxibustion).
ConclusionS: No significant effects of moxibustion were
found in correcting the breech position in primiparous and
parous women after their 33rd gestational week.
The highly sensitive pregnancy test, Tandem ICON HCG-urine, was compared with OPCO "One-step" Pac... more The highly sensitive pregnancy test, Tandem ICON HCG-urine, was compared with OPCO "One-step" Pacific Biotech in the gynecological and obstetrical department of Randers Hospital. The purpose was to determine the test specificity and sensitivity of the pregnancy tests in women with possible pregnancies. The test sensitivities were found to be 0.83 and 0.63 for ICON and ONE, respectively. We experienced one and four cases of negative pregnancy tests and ectopic pregnancies with ICON and ONE, respectively. In all cases, the diagnosis of ectopic pregnancy was suspected by other means and the patients submitted to operation. The ICON test showed its supremacy in diagnosis while ONE was easier and cheaper.
Background:Evaluation of histopathological factors for women with radical hysterectomy a.m. Okaba... more Background:Evaluation of histopathological factors for women with radical hysterectomy a.m. Okabayashi for cervical cancer in stage 1bwith similar pre- and postoperative treatment
Methods: Data on 141 women with cervical cancer stage 1b were revised. The local patient registry, data charts, and post mortem sections provided follow-up on survival, relapse, and re-admittance. Histopathological evaluation was performed by the same pathologist.
Results: Histological evaluation showed that adenosquamous cervical cancer in stage 1b was associated with poorer sur- vival than the pure squamous and adenomatous type (p<0.001, mixed versus pure type). Five year’s survival rate was 40 % (2-78 %) for mixed type and 92 % (87-97 %) for pure type. The mixed type was associated with glandular metastasis (p<0.02). The relapse free survival after 5 and 10 years was 88 % (82-94 %) and 83 % (75-91 %), respectively, while survival was found to be 89 % (83-95 %) and 86 % (79-93 %), respectively. The women’s age at diagnosis showed no association with histology type or survival.
Background: Evaluation of histopathological factors for women with radical hysterectomy a.m. Okab... more Background: Evaluation of histopathological factors for women with radical hysterectomy a.m. Okabayashi for cervical cancer in stage 1bwith similar pre- and postoperative treatment
Methods: Data on 141 women with cervical cancer stage 1b were revised. The local patient registry, data charts, and post mortem sections provided follow-up on survival, relapse, and re-admittance. Histopathological evaluation was performed by the same pathologist.
Results: Histological evaluation showed that adenosquamous cervical cancer in stage 1b was associated with poorer survival than the pure squamous and adenomatous type (p<0.001, mixed versus pure type). Five year’s survival rate was 40 % (2-78 %) for mixed type and 92 % (87-97 %) for pure type. The mixed type was associated with glandular metastasis (p<0.02). The relapse free survival after 5 and 10 years was 88 % (82-94 %) and 83 % (75-91 %), respectively, while survival was found to be 89 % (83-95 %) and 86 % (79-93 %), respectively. The women’s age at diagnosis showed no association with histology type or survival.
Seven cases with childhood ovarian tumors are presented. All underwent an ultrasound scan which g... more Seven cases with childhood ovarian tumors are presented. All underwent an ultrasound scan which gave the the preliminary diagnosis of ovarian tumor. Treatment differs according to the status of the child and whether malignity is involved. The numerous differential diagnoses must be kept in mind. The management of children with an unexplained abdominal mass should include an ultrasound scan.
Setting: A case study of a woman with presumed premature menopause is presented. Results: After m... more Setting: A case study of a woman with presumed premature menopause is presented. Results: After more than 4 years of premature menopause judged by subjective symptoms, bleeding history, and postmeno-pausal levels of gonadotropins, a woman conceived spontaneously 2 months after the start of hormone replacement treatment (HRT). Previously, ovarian stimulation with clomifen citrate had failed. She delivered prematurely due to preeclampsia and intrauterine growth retardation. Conclusions: Reviewing the literature finds that pregnancy is reported in woman with premature ovarian failure after the use of birth-control pills, HRT, ovarian stimulation, and in spontaneous cycles. Lack of oocyte donors and prohibition of the donor technique in some countries make other options valuable when optimal infertility treatment cannot be offered.
Acta Obstet Gynecol Scand 1994; 73: 6749. zyxwvut 0 Acta Obstet Gynecol Scand 1994
abstRact IntroductIon: Endometrial cancer is the most common gynaecological cancer in Denmark, an... more abstRact IntroductIon: Endometrial cancer is the most common gynaecological cancer in Denmark, and its incidence peaks in the postmenopausal years. The aim of the present study was to evaluate the effectiveness of vacuum aspirator (vabrasio) for the detection of endometrial cancer in terms of sensitivity, specificity and predictive value.
Archives of Gynecology and Obstetrics, 2009
Purpose Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type... more Purpose Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type 1 diabetes mellitus (T1DM) and in non-diabetic women was evaluated for its association with preeclampsia, retinopathy, HbA1c, and birth weight. Methods One hundred and sixty-one women were recruited for AMBP performed with a Spacelab 90207 monitor. The pregnant women were 50 non-diabetic women and 111 T1DM women with normoalbuminuria and no hypertension. ANOVA, regression, and ROC curves analysis were applied. Results Women with simplex retinopathy had higher night/day ratio and lower birth weight than those without retinopathy. Women who developed preeclampsia had night/day ratio similar to those with simplex retinopathy. In Wrst trimester they had higher blood pressure than those who did not develop preeclampsia. Conclusions Simplex retinopathy and preeclampsia are associated with a reduced night/day ratio even with normal blood pressure but night/day ratio provides no better prediction of preeclampsia than the absolute values.
Acta Obstetricia et Gynecologica Scandinavica, 2007
A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect t... more A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect to reproducibility and variations on precision and consistency. Some 133 women with type 1 diabetes mellitus and 59 non-diabetic women were recruited. During pregnancy, systolic BP was between 6 and 12 mmHg higher in the oscillometric than the auscultatory readings, and diastolic BP was between 1 and 2.6 mmHg. The association of difference with the mean BP disappeared with progression of pregnancy and the repetition of measurements in diabetic pregnancy. The precision, reproducibility, and trend of association over the scale of measurement were improved in the repeated compared to individual measurements, whereas consistency did not improve.
Archives of Gynecology and Obstetrics, 2009
Purpose Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type... more Purpose Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type 1 diabetes mellitus (T1DM) and in non-diabetic women was evaluated for its association with preeclampsia, retinopathy, HbA1c, and birth weight. Methods One hundred and sixty-one women were recruited for AMBP performed with a Spacelab 90207 monitor. The pregnant women were 50 non-diabetic women and 111 T1DM women with normoalbuminuria and no hypertension. ANOVA, regression, and ROC curves analysis were applied. Results Women with simplex retinopathy had higher night/day ratio and lower birth weight than those without retinopathy. Women who developed preeclampsia had night/day ratio similar to those with simplex retinopathy. In Wrst trimester they had higher blood pressure than those who did not develop preeclampsia. Conclusions Simplex retinopathy and preeclampsia are associated with a reduced night/day ratio even with normal blood pressure but night/day ratio provides no better prediction of preeclampsia than the absolute values.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014
Acta Obstetricia et Gynecologica Scandinavica, 1998
Background. To examine retinal and pregnancy outcome in insulin-dependent diabetic women with pro... more Background. To examine retinal and pregnancy outcome in insulin-dependent diabetic women with proliferative retinopathy and assess the effect of albuminuria on morbidity.
Acta Obstetricia et Gynecologica Scandinavica, 2001
Aim. The genetic setting is a potential risk factor for dysfunction of vascular endothelial cells... more Aim. The genetic setting is a potential risk factor for dysfunction of vascular endothelial cells. The prevalence of polymorphism in the methylene-tetrahydro-folate-reductase (MTHFR) gene (677C»T) was evaluated in diabetic pregnancy complicated by preeclampsia, nephropathy, retinopathy, and preterm delivery. The role of hyperhomocysteinemia in microangiopathy in diabetes mellitus has been debated and is mainly seen with reduced activity of the MTHFR gene. A polymorphism in the gene for MTHFR is identified causing this phenomenon. Design. Two hundred and sixty-eight pregnant women with type 1 diabetes mellitus were recruited. Two hundred and thirty-three women were successfully analyzed for MTHFR gene polymorphism 677C»T and compared to the incidence of the polymorphism in the background population (nΩ1084). The pregnancy data charts were reviewed retrospectively.
Background: Evaluation of histopathological factors for women with radical hysterectomy a.m. Okab... more Background: Evaluation of histopathological factors for women with radical hysterectomy a.m. Okabayashi for cervical
cancer in stage 1bwith similar pre- and postoperative treatment
Methods: Data on 141 women with cervical cancer stage 1b were revised. The local patient registry, data charts, and post
mortem sections provided follow-up on survival, relapse, and re-admittance. Histopathological evaluation was performed
by the same pathologist.
Results: Histological evaluation showed that adenosquamous cervical cancer in stage 1b was associated with poorer survival
than the pure squamous and adenomatous type (p<0.001, mixed versus pure type). Five year’s survival rate was 40
% (2-78 %) for mixed type and 92 % (87-97 %) for pure type. The mixed type was associated with glandular metastasis
(p<0.02). The relapse free survival after 5 and 10 years was 88 % (82-94 %) and 83 % (75-91 %), respectively, while survival
was found to be 89 % (83-95 %) and 86 % (79-93 %), respectively. The women’s age at diagnosis showed no association
with histology type or survival.