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- Gustafsson, Rita, et al.
(författare)
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The Lactobacillus flora in vagina and rectum of fertile and postmenopausal healthy Swedish women
- 2011
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Ingår i: BMC Women's Health. - : Springer Science and Business Media LLC. - 1472-6874. ; 11:Article. nr 11
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Lactobacillus species are the most often found inhabitants of vaginal ecosystem of fertile women. In postmenopausal women with low oestrogen levels, Lactobacillus flora is diminishing or absent. However, no studies have been performed to investigate the correlation between oestrogen levels and the lactobacilli in the gut. The aim of the present study was to investigate the relation in healthy women between vaginal and rectal microbial flora as well as possible variations with hormone levels. Methods: Vaginal and rectal smears were taken from 20 healthy fertile women, average 40 years (range 28-49 years), in two different phases of the menstrual cycle, and from 20 postmenopausal women, average 60 years (range 52-85 years). Serum sex hormone levels were analyzed. Bacteria from the smears isolated on Rogosa Agar were grouped by Randomly Amplified Polymorphic DNA and identified by multiplex PCR and partial 16S rRNA gene sequencing. Results: Lactobacillus crispatus was more often found in the vaginal flora of fertile women than in that of postmenopausal (p = 0.036). Fifteen of 20 fertile women had lactobacilli in their rectal smears compared to 10 postmenopausal women (p = 0.071). There was no correlation between the number of bacteria in vagina and rectum, or between the number of bacteria and hormonal levels. Neither could any association between the presence of rectal lactobacilli and hormonal levels be found. Conclusion: Lactobacillus crispatus was more prevalent in the vaginal flora of fertile women, whereas the Lactobacillus flora of rectum did not correlate to the vaginal flora nor to hormonal levels.
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- Karlsson, Caroline, et al.
(författare)
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5-Hydroxytryptamine contracts human uterine artery smooth muscle predominantly via 5-HT2 receptors
- 1997
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Ingår i: Human Reproduction. - 0268-1161. ; 12:2, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- Serotonergic receptors were classified in the isolated human uterine artery with intact endothelium, using agonists and antagonists for 5-hydroxytryptamine (5-HT) receptors. The efficacy for different agonists rated: alpha-methyl-5-HT (5-HT2) = 5-HT (non-selective) = 2-methyl-5-HT (5-HT3) >> sumatriptan (5-HT1), and the potency as: sumatriptan = 5-HT > 5-HT > alpha-methyl-5-HT > 2-methyl-5-HT. The contractile effects of 5-HT and alpha-methyl-5-HT were antagonized by the 5-HT2 receptor antagonist ketanserin and the non-selective antagonist methiothepin. The efficacy of sumatriptan was comparatively low. No interaction was encountered between 2-methyl-5-HT and MDL72222, suggesting an absence of 5-HT3 receptors. The results indicate that the contractile serotonergic receptor population in the human uterine artery mainly comprises 5-HT2 receptors, although a minor contribution of contractile 5-HT1 receptors cannot be excluded.
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| 6. |
- Karlsson, Caroline, et al.
(författare)
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Characterization of 5-hydroxytryptamine receptors mediating circular smooth muscle contraction in the human umbilical artery
- 1999
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Ingår i: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 1423-002X .- 0378-7346. ; 47:2, s. 102-107
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Tidskriftsartikel (refereegranskat)abstract
- The study was performed to characterize pharmacologically the contractile 5-hydroxytryptamine (5-HT) receptors in the circular smooth muscle of the isolated human umbilical artery. Effects of agonists and antagonists for different 5-HT receptor subtypes were studied in intact endothelium vessel segments. All agonists induced concentration-dependent circular smooth muscle contractions. The potency was in declining order 5-HT > alpha-methyl-5-HT > sumatriptan >/= 2-methyl-5-HT. The effects of 5-HT and alpha-methyl-5-HT were antagonized by ketanserin, as well as methiothepin. The contractile effect of sumatriptan was antagonized by methiothepin but not by ketanserin. The 5-HT3 receptor antagonist, MDL 72222, did not affect the contraction by any of the agonists, including 2-methyl-5-HT. It is concluded that the 5-HT-induced contraction in the circular smooth muscle of the human umbilical artery seems to be mediated by a mixed population of 5-HT1-like receptors and 5-HT2 receptors.
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- Karlsson, C, et al.
(författare)
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Endothelium-derived prostanoids reduce 5-hydroxytryptamine-induced contraction in the human uterine artery
- 1998
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Ingår i: Human Reproduction. - 0268-1161. ; 13:7, s. 1947-1951
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Tidskriftsartikel (refereegranskat)abstract
- The contribution of endothelium-linked mechanisms to the contraction induced by 5-hydroxytryptamine (5-HT) was investigated in the isolated human uterine artery. 5-HT contracted the uterine artery concentration-dependently. Removal of the endothelium or treatment with the cyclooxygenase inhibitor indomethacin potentiated the contractile response to 5-HT. The nitric oxide synthase inhibitor L-N(G)-monomethyl-arginine (L-NMMA) did not influence the contraction induced by 5-HT. Indomethacin did not affect the response to 5-HT in endothelium-denuded vessels. The 5-HT1 receptor agonist 5-carboxyamidotryptamine (5-CT) did not relax precontracted arteries. Removal of the endothelium did not change the response to 5-HT in the presence of the 5-HT(1B/D) receptor antagonist GR127935 and the 5-HT1A and 5-HT1B receptor antagonist -pindolol. The 5-HT1B receptor antagonist SB224289 did not affect the contraction induced by 5-HT. The results indicate that the 5-HT-induced contraction in the human uterine artery is accompanied by the release of an endothelium-derived relaxing factor (EDRF). This EDRF seems to be a prostanoid, probably prostacyclin (PGI2). The endothelium-linked mechanism seems to be mediated via a 5-HT1 receptor, but it is not possible to further classify the receptor subtype by the information obtained in this study.
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- Nilsson, Margareta, 1957-
(författare)
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Female urinary incontinence : impact on sexual life and psychosocial wellbeing in patients and partners, and patient-reported outcome after surgery
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Urinary incontinence (UI) and urgency are common conditions and can have a profound influence on many aspects of life. Approximately one in four women has UI and one in ten has daily symptoms. Knowledge is lacking, however, on the impact of UI and urgency on the lives of affected women and their partners and on the situation of women with urinary leakage one year postoperatively. Aims: To study the consequences of female UI and urgency for patients and their partners on quality of life (QoL), the partner relationship, and their sexual lives. Also to evaluate the success rates of three operation methods: tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and transobturator tape (TOT) for stress urinary incontinence (SUI), with a particular focus on women who still have urinary leakage one year after surgery. Methods: Women seeking healthcare for UI and/or urgency and their partners were invited to answer questionnaires. The women completed disease-specific questionnaires and both the women (n = 206) and their partners (n = 109) answered questions about their psychosocial situation, partner relationship, and sexual life. Patient-reported outcomes one year after surgery with TVT, TVT-O, or TOT (n = 3334) were derived from the Swedish National Quality Register for Gynaecological Surgery. Results: Most of the women reported that their urinary problems negatively affected their physical activities, and almost half reported negative consequences for their social life. Women aged 25–49 years were less satisfied with their psychological health, sexual life, and leisure than women aged 50–74 years. One third of both the women and their partners (all the partners were men) experienced a negative impact on their relationship, and sexual life was negatively affected in almost half of the women and one in five of their men. Coital incontinence was reported in one third of the women. Most of their men did not consider this a problem, but the majority of the affected women did. Satisfaction with outcome of the operation did not differ between TVT, TVT-O, and TOT, but TVT showed a higher success rate for SUI than TOT did. Higher age, higher body mass index, a diagnosis of mixed urinary incontinence, and a history of urinary leakage in combination with urgency each constitute a risk for a lower operation success rate. After one year, 29% of the women still had some form of UI, but half of these were satisfied with the outcome and most reported fewer negative impacts on family, social, working, and sexual life than before the operation. Conclusions: Female UI and/or urgency impaired QoL, particularly in young women, and had negative effects on partner relationships and on some partners’ lives. Sexual life was also affected, more often in women with UI and/or urgency than in their partners. At one-year follow-up after surgery, about one third of the women still had some form of UI, but the negative impact on their lives was reduced. A challenge for health care professionals is to initiate a dialogue with women with urinary symptoms about sexual function and what surgery can realistically be expected to accomplish.
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- Nüssler, Emil, 1990-
(författare)
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Vaginal prolapse surgery : an epidemiological perspective : studies of native tissue repair versus implants, surgeons´ practical experiences and five year follow-up in the swedish national quality register for gynecological surgery
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pelvic organ prolapse (POP) is a common condition that impacts on quality of life for many women. The mean age of Swedish women operated for POP is 60 years, and with a life expectancy of approximately 84 years this means that the average patient will live 24 years subsequent to the operation. Therefore, sustainable long-term results of POP surgery are essential. In an effort to improve long-term outcomes of vaginal prolapse surgery, mesh materials have been developed for this purpose. In Sweden, synthetic mesh is used in 7.4% of all primary operations without any coherent consensus about their use. Prolapse surgery is regarded as a routine procedure performed at almost every hospital in Sweden, but a large proportion of the surgeons are inexperienced. In actuality, 73% of them perform the procedure once a month or less frequently. Simultaneously, surgery for POP has been reported to have a highfailure rate internationally. For most surgeons, the operation is a low-frequency procedure, and outcomes have been reported as unsatisfactory. The specific aims of these thesis were to examine:- Mesh-augmented repairs impact on operative results compared to nativetissue repair.- Surgical experience in performing a specific operation and utilize this knowledge in analysing how it may (or may not) affect operative results.- Long-term (5 year) national follow up of POP operations, regarding both the objective epidemiological data and the patient-reported outcomes.Methods: The studies in this thesis are based on data from the Swedish National Quality Register for Gynaecological Surgery (GynOp), which covers approximately 90% of all gynaecological operations in Sweden. The comparative follow-up of POP surgery using non-absorbable polypropylene mesh versus colporrhaphy using native tissue was analysed in two different cohorts, of women with a primary cystocele and women with a relapse after surgery for a rectocele. Both surgeon reported results and patient-reported outcomes (PROMs) were analysed 1 year post-surgery. Information about surgeons’ experience in performing POP operations was extracted from GynOp over 9 years. Inclusion criteria were otherwise healthy patients who underwent anterior or posterior native tissue repair, or both. The operations were divided into four groups according to the operative experience of the surgeon (measured as average number of operations per active year). Both PROM results and surgeon-reported outcomes after 1 year were investigated. For the long-term follow-up 5 years after any operation for a vaginal prolapse, a new questionnaire to capture PROM data was designed, validated and nationally distributed. Information about re-operations was extracted directly from GynOp.Results: Mesh-augmented repair of a primary cystocele had a significantly better outcome in terms of absence of symptoms, compared with native tissue repair, OR 1.53(95% CI 1.10-2.13), but also had more complications directly related to the procedure (OR 1.51, RD=6.6%). For recurrent rectocele, mesh was superior to native tissue repair, OR 2.06 (95% CI 1.03-4.35); the number of postoperative complications was equal in the two groups. Among the 1,092 surgeons who were active POP surgeons during the study, 803(73%) participated in POP operations once a month or less frequently in their active years. No differences in patient or surgeon-reported outcomes were seen between the “experience groups”. Kaplan-Meier curves for re-operation after a primary POP operation showed an overall retreatment rate of 11.2% after 5 years. The response rate for the patient questionnaire was 74.9%. Overall, 70% of the patients reported no symptoms, and around 72% and 82% were satisfied with the operative results and felt that their symptoms had improved, respectively.Discussion: Mesh use was, after 1 year of follow-up, generally characterized by a high cure rate and varying degrees of complications, such as postoperative pain. However, for recurrent rectocele, we found no immediate drawbacks of the method compared with native tissue repair, with the same high cure rate as seen in other compartments. Surgeon experience had no impact on the native tissue operation, and any inconsistency of outcome is more likely inherent in the method than attributable to a surgeon’s lack of experience.The 5-year results indicate that native tissue repair produces much better results, judging from overall Swedish results, than previously thought. This is backed up both by objective data indicating a minimal number of re-operations within 5 years for the most common cases (i.e. primary rectocele and cystocele) and by the outcomes reported by the patients themselves.Conclusions: Mesh-augmented repair is more effective than native tissue repair forrecurrent rectocele, and without increased risk of complications. Drawbacks of mesh repair vary for other compartments, and for primary operations.- Surgeons’ operative experience in routine POP operations using native tissue has no impact on outcome after 1 year.- Long-term results of POP repair with native tissue are excellent, with a low risk of re-operation and a persistent absence of subjective symptoms.
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| 10. |
- Siwe, Karin, et al.
(författare)
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Medical students learning the pelvic examination : Comparison of outcome in terms of skills between a professional patient and a clinical patient model
- 2007
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 68:3, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare two models of learning the pelvic examination (PE) for medical students, with professional patients (PP) or with clinical patients (CP), by measuring perceived distress and learning outcome in terms of skills. Methods: Prospective longitudinal study. Assessments of self-perceived distress on four occasions at the prospect of performing a PE. Evaluation of the learning session (LS) and clinical clerkship concerning outcome of palpation skills. Results: During the LS, students in the PP model (PP students) received enough guidance from their coaches, were certain they had palpated the uterus and at least one ovary, and were less distressed afterwards compared with students who were instructed using the CP model (CP students). During the clinical clerkship, the PP students performed twice as many PEs as CP students did and had more often confirmed palpating the uterus and an ovary. Conclusion: PP students were more skilful in palpating the uterus and ovaries and performed more PEs during the clinical clerkship than did CP students. Practice implications: Engaging healthy and voluntary women as PPs takes time and effort. It is, however, worthwhile as it increases the confidence of students who perform PEs, makes them more competent, and ultimately improves their skills in performing the examination during their clinical clerkship.
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