Hospital records of all women operated on for ectopic pregnancy (EP) in four Swedish towns during 1970-72 and 1980-82 were elaborated. The gynecological and obstetrical background was noted and the clinical picture and management was recorded and analysed. The incidence of EP more than doubled between the two periods. There was no major change in classical background factors between the periods, but the proportion of IUCD users rose from 4 to 16 percent. The use of hCG assays, curettage and ultrasound in establishing the diagnosis increased markedly and the proportion of women with ruptured tubes and heavy intra-abdominal bleeding decreased. Moreover there was a clear tendency towards a more conservative surgical approach in the latter period.
Two hundred and five patients with ectopic pregnancy in a well-defined Swedish population were interviewed with respect to prior disease and pregnancy histories as well as various constitutional and socioeconomic factors. The results were compared with those of two control groups, i.e. 110 early pregnant women intending to continue the gestation to term as well as 101 women seeking voluntary interruption of pregnancy. The results provide evidence that several may be involved in the etiology of ectopic pregnancy, including abdominal (or pelvic) surgery, previous ectopic pregnancy and pelvic inflammatory disease. Furthermore, a history of infertility is strongly correlated to ectopic pregnancy. On the other hand, there is no evidence that uncomplicated spontaneous or induced abortion, parity or marital status are important factors.
Based on the frequency distribution in a previous case-control study of ectopic pregnancy in Sweden, the prognostic value of a number of risk factors was analysed. A logistic procedure was applied in a stepwise manner, resulting in a risk-scoring model in which the probability of ectopic pregnancy can be determined on the basis of four background factors.
PURPOSE: To evaluate concordance between results obtained with the Heidelberg Retina Tomograph (HRT) (Heidelberg Engineering GmbH, Heidelberg, Germany) and those obtained with the high-pass resolution perimeter (HRP) in glaucoma diagnosis. METHODS: A total of 217 patients from the glaucoma services at St. Erik Eye Hospital, Stockholm, Sweden (n = 107) and Sahlgrenska University Hospital, Göteborg, Sweden (n = 110) were included in the study. All patients were examined because of known or suspected glaucoma in at least one eye. The conventional indices presented by the instruments were used, i.e., glaucoma index from the HRT (negative values = abnormal, positive = normal) and combined deviation (upper normal limit 2.1 dB) from the HRP. RESULTS: The concordance regarding the classification of normal or glaucomatous by the two instruments was 71% (153/217 eyes). The HRT indicated glaucoma but HRP findings were normal in 47 patients, and the reverse occurred in 17 patients. There was a significant difference in optic disc area between patients with abnormal HRT findings and normal HRP findings and in patients with normal HRT findings and abnormal HRP findings. The concordance could not be improved by adjusting for disc size. The correlation between combined deviation on HRP and the HRT glaucoma index was r = -0.53. CONCLUSION: A significant correlation was found between the combined index given by HRP and the HRT glaucoma index in 217 patients examined for known or suspected glaucoma. Discordant findings were observed in 64 patients; in 22 this discordance was explained by the influence of disc size. No other reasons for differences in examination results could be detected.
We compared the cost-effectiveness of therapeutic laparoscopy and open laparotomy for treatment of laparoscopically diagnosed ectopic pregnancy. Clinical outcomes of ectopic pregnancy treatment were based on results of a randomised trial done between 1987 and 1989 at Sahlgrenska University Hospital (Göteborg, Sweden). We estimated costs for inpatient and follow-up care of ectopic pregnancy by the two methods. Observed resource use (eg, procedure duration) was multiplied by 1992 estimates of resource unit cost (eg, cost per minute of laparoscopy time), based on detailed internal cost accounting data from Huddinge University Hospital. By specified criteria, the initial procedure eliminated trophoblastic activity without major complications in 81% (95% CI: 68-90) of 52 laparoscopy patients, versus 95% (85-99) of 57 laparotomy patients. Residual trophoblast or complications were successfully treated in all remaining patients. Mean simulated costs (standard error) for the overall laparoscopy strategy were 28,058 (1780) Swedish kronor versus 32,699 (1080) kronor for laparotomy (p = 0.03). In the baseline simulation and most sensitivity analyses, laparoscopy produced final outcomes equivalent to those of laparotomy at lower costs. As laparoscopic outcomes improve, this newer approach should become increasingly preferable.
Comment In: Lancet. 1995 May 6;345(8958):1127-87723539
A total of 261 women in early pregnancy, either with mild symptoms of ectopic pregnancy (EP) or being at an increased risk for this condition, were included in a longitudinal study. The effectiveness of different diagnostic measures in obtaining correct final diagnoses was analyzed. In addition to clinical findings and symptoms, the use of serum human chorionic gonadotropin, serum progesterone, endovaginal sonography and a risk score for EP were all proven to be valuable in distinguishing normal intrauterine pregnancies from pathological pregnancies.
OBJECTIVE--To find out whether a 10-14 days' course of antibiotics early in the course of reactive arthritis associated with enteric infections could reduce the severity and duration of the disease and whether the antibody response in patients with reactive arthritis associated with yersinia infection differed between those treated and those not treated with the antibiotics. DESIGN--Prospective multicentre trial in which patients were randomised to treatment or no treatment with antibiotics. Patients were seen at three and six weeks and three, six, nine, 12, and 18 months after their first visit. SETTING--Departments of infectious diseases in three hospitals in Linköping, Malmö, and Stockholm, Sweden. PATIENTS--40 Consecutive patients who had had symptoms of reactive arthritis associated with enteric infection for less than four weeks. INTERVENTIONS--20 Patients were allocated to treatment with antibiotics and 20 patients did not receive antibiotics. All patients received non-steroidal anti-inflammatory drugs, and four also received intra-articular steroid injections after at least six weeks' observation. MAIN OUTCOME MEASURES--Arthritic symptoms assessed clinically and by using Ritchies' index; blood measurements reflecting inflammatory activity; serum IgG, IgM, and IgA antibody titres; HLA tissue type. RESULTS--No difference was observed concerning duration of arthritis, grade of inflammation, and number of joints affected between patients treated and those not treated with antibiotics. Furthermore, there was no significant difference between the two groups in erythrocyte sedimentation rate and haptoglobin, IgG, and IgA concentrations. All values had returned to normal within three months. No patient developed chronic arthritis, but sustained slight arthralgia occurred in three patients. The HLA-B27 antigen was found in 23 (58%) of the patients, and its presence did not affect clinical outcome. The IgG, IgM, and IgA antibody responses were similar in patients treated with antibiotics and those not treated. CONCLUSION--Short term antibiotic treatment has no beneficial effect on the clinical outcome of reactive arthritis associated with enteric infection.
Campylobacter jejuni and C. coli strains were collected during three different years from adult patients with enterocolitis in Sweden (n = 372) from 49 patients in Kuwait, and Campylobacter strains from hens from Mexico, Pakistan and Sweden (n = 107) and Swedish pigs (n = 47). C. jejuni was the predominant species in human and hen isolates, and C. coli in pigs C. coli was significantly more common in human isolates from Sweden, and more common in hen isolates from Pakistan, than in hens from Sweden and Mexico. C. laridis was only isolated from pigs (17%) and was in no case enterotoxigenic. Both in human and hen isolates, C. jejuni strains were more enterotoxigenic than C. coli strains. C. jejuni strains from Swedish hens were less enterotoxigenic than those from Pakistan and Mexico (P less than 0.001), and strains from pigs were less enterotoxigenic than those from hens (P less than 0.001). We conclude that C. jejuni are more often enterotoxigenic and possibly more virulent than c. coli and C. laridis. The relative frequency of C. jejuni and C. coli in humans and animals differs from one country to another.
Many commonly used pharmaceuticals, such as antidepressants and neuroleptics as well as some illegal drugs, are metabolised by the cytochrome P450 enzyme debrisoquine 4-hydroxylase (CYP2D6). Of Caucasians, 7-10% lack this enzyme, which can, upon administration of drugs in normal therapeutic doses, lead to adverse reactions and unexpected intoxication, leading in turn even to a fatal outcome in some cases.
Individuals (n=242) who had died due to intoxication by pharmaceuticals were genotyped for CYP2D6 and CYP2C19 and compared with a reference group of 281 blood donors. A single nucleotide polymorphism (SNP) method was used to identify five CYP2D6 alleles: *1 (wt), *2, *3, *4 and *6. The allele *5, a complete gene deletion, was identified by a multiplex amplification of long DNA fragments. Four CYP2C19 alleles *1 (wt), *2, *3 and *4 were also identified by SNP analysis.
The prevalence of the CYP2D6 poor metaboliser (PM) genotypes in individuals with fatal intoxication was lower (4.7%) than expected from the frequencies of these genotypes in the blood donors (8.5%). A significantly lower frequency P