bluuebunny/crossref_metadata_2025 huggingface dataset:
The relation between plasma urate and placental bed vascular adaptation to pregnancy
Authors: McFADYEN I. R. , GREENHOUSE P. , PRICE A. B. , GEIRSSON R. T.
Published: August 2005

Summary. Placental bed biopsies were obtained at caesarean section from 34 women. Their plasma urate was directly related to maximum mean arterial pressure and inversely to adjusted birthweight; but it was related most closely to the histological appearances of the spiral arteries in the placental bed. Nine women had physiological changes in the spiral arteries: their mean urate (233, SD 28·9 μmol/l) was significantly (P <0·00l) lower than the mean urate in those who did not have adequate physiological changes (339, SD 90·3 μmo1/l) or that in the nine women who had atherosis (397, SD 153·2 μmol/l). Raised plasma urate appears to be better related to maternal vascular pathology than to the clinical condition or infant birthweight.
Primary infertility in women exposed to diethylstilboestrol in utero
Authors: MENCZER JOSEPH , DULITZKY MORDECHAI , BEN‐BARUCH GILAD , MODAN MICHAELA
Published: August 2005

Summary. In a selected group of 40 women who had been exposed to diethylstilboestrol in utero, 18 conceived without difficulty and 22 had primary infertility. Among those with primary infertility there was a significantly higher rate of anatomical structural defects and a greater tendency for menstrual disorders than in those without infertility. Thirteen (59%) of the women with primary infertility conceived, most after treatment with ovulation stimulating drugs. Spontaneous abortion and tuba1 pregnancy were frequent (47% and 10% respectively) and similar in both fertility groups. Of 13 infertile women examined, 4 (31%) had mild hyperprolactinemia—a hithero unreported finding for such women.
Estimating the probability of spontaneous delivery conditional on time spent in the second stage
Authors: KADAR NICHOLAS , CRUDDAS MARIE , CAMPBELL STUART
Published: August 2005

Summary.The duration of second stage labour was studied, retrospectively, among 410 primigravidas who received epidural analgesia in the first stage of spontaneous labour at term (>37 weeks). Survival analysis was used to investigate how the likelihood of a spontaneous delivery was related to time spent in the second stage, and how some maternal and fetal factors influenced this relationship. The proportion of spontaneous deliveries that had occurred by any given time was greatly influenced by maternal age and infant birthweight. However, the women who were least likely to have been delivered by any given time after full dilatation, were also the ones who were least likely to be delivered within any given subsequent time interval. If delivery had not occurred by 3h, the probability that it would take place in the next 3 h was well under 30% in most cases. We conclude that second stage labour in excess of 3 h is likely to be beneficial only if certain criteria, which are defined in the paper, are met.
Antibacterial activity in human amniotic fluid: dependence on divalent cations
Authors: SCANE T. M. N. , HAWKINS D. F.
Published: August 2005

Summary. Antibacterial activity, tested against Bacillus subtilis, was present in all 34 samples of human amniotic fluid collected between 37 and 41 weeks gestation. High‐molecular–weight (β‐lysin) antibacterial activity was reduced after treatment with ethylene diamine tetra–acetic acid (EDTA), but not after treatment with 1, 10‐phenanthroline or diphenylthiocarbazone. The activity was restored following incubation with magnesium, calcium, or zinc. Low‐molecular‐weight antibacterial activity (<1000 daltons) in acid–alcohol extracts was reduced after treatment with dithizone, but not after treatment with EDTA or 1, 10 phenanthroline. Activity was restored after treatment with manganese, cobalt or zinc. High‐molecular‐weight (β‐lysin) activity was therefore biochemically similar to serum p‐lysin but biochemically different from the low‐molecular‐weight antibacterial component of amniotic fluid.
Do obstetric intranatal interventions make birth safer?
Authors: TEW MARJORIE
Published: August 2005

Summary. Impartial analyses of the evidence from official statistics, national surveys and specific studies consistently find that perinatal mortality is much higher, when obstetric intranatal interventions are used, as in consultant hospitals, than when they are little used, as in unattached general practitioner maternity units and at home. The conclusion holds even after allowance has been made for the higher predelivery risk status of hospital births as a result of the booking and transfer policies. It holds even more strongly for births at high than at low predicted risk. It follows that the increased use of interventions, implied by increased hospitalization, could not have been the cause of the decline in the national perinatal mortality rate over the last 50 years and analysis of results by different methods confirms that the latter would have declined more in the absence of the former. Data are presented which point to the deleterious effect of interventions on the incidence of low birthweight and short gestation and their associated mortality. Also presented are data supporting the alternative explanation of the decline in perinatal mortality, namely the improvement in the health status of mothers built up over several generations. The organization of the maternity service stands indicted by the evidence. Despite the beliefs of those responsible, it has not promoted, and cannot promote, the objective of reducing perinatal mortality.
Perinatally related wastage—a proposed classification of primary obstetric factors
Authors: WHITFIELD C. R. , SMITH N. C. , COCKBURN F. , GIBSON A. A. M.
Published: August 2005

Summary. Adapting Sir Dugald Bairďs concept of primary obstetric causes of perinatal mortality, a revised clinico‐pathological classification has been evolved to take account of new knowledge and developments, and to direct attention to potentially avoidable deaths and to where intensified efforts and investigation are needed. Categories highlighting the importance of intrauterine growth retardation, unexplained intrauterine death and spontaneous premature labour have been introduced, intrapartum hypoxia is separated from birth trauma, and infection again has its own category. Regular perinatal audit at one obstetric hospital, since 1979, has shown that the new system provides a workable and useful means for classifying not only perinatal deaths, but also late abortions, late neonatal deaths and perinatally related infant deaths. The rate of total perinatally related wastage, defined in this way, was almost twice that for perinatal mortality (22–8 compared with 11.9 per 1000 births). The former is advocated as a more realistic index for the audit of perinatal care. The revised and extended system is put forward as a contribution to the current debate on classifying and reporting such wastage, in the hope that it may be tested as a model for regional as well as hospital surveys.
The measurement of cardiac output by electrical impedance plethysmography in pregnancy. Are the assumptions valid?
Authors: DE SWIET M. , TALBERT D. G.
Published: August 2005

Summary. The assumptions of the Kubicek technique for measurement of cardiac output by detection of changes in the chest wall electrical impedance have been re‐examined. The fall in cardiac output in the latter half of pregnancy which Crawforďs group calculated using the Kubicek technique can be almost entirely accounted for by a fall in the term dZ/dT of the Kubicek equation, as pregnancy progress. One key assumption of the Kubicek technique is a constant ejection flow rate equal to the initial flow as the pulmonary valve opens, which is multiplied by the estimated ejection time to obtain stroke volume. Initial flow rate is represented by the term dZ/dT in the Kubicek equation. Although this assumption has been shown to give a reasonable correlation with other techniques for measurement of cardiac output in the non‐pregnant state, this may not be so for longitudinal studies in pregnancy because of the changes in lung mechanics and in the circulation which occur in this state. Crawforďs data emphasizes the necessity for validating the Kubicek technique very critically during pregnancy.
Pain relief in labour using transcutaneous electrical nerve stimulation (TENS). A TENS/TENS placebo controlled study in two parity groups
Authors: HARRISON ROBERT F. , WOODS TERESA , SHORE MARY , MATHEWS GABRIEL , UNWIN ANTONY
Published: August 2005

Summary.The analgesic effects of transcutaneous electrical nerve stimulation (TENS) in labour and effects on outcome were investigated in a double‐blind TENS/TENS placebo controlled trial in 100 primigravidae and 50 women in their third labour. There were no differences between the TENS and the TENS placebo users in terms of pain concept or relief, and only 12 and 13% of primigravidae and 48 and 39% of the para 2 women completed labour without requiring other analgesia in their respective groups. The primigravidae who used either TENS or TENS placebo alone had shorter labours than those who required further analgesia. Although the outcome of labour for mother and infant were similar in the two groups, there was a higher operative delivery rate in women who also had epidural analgesia. There were highly significant differences between the TENS and the TENS placebo users in terms of favourable and unfavourable comments by the mothers and the midwives at 1 and 24 h after delivery. The evident consumer satisfaction for TENS suggests TENS has a part to play in analgesia in labour but the equivocal findings in terms of factors associated with pain relief points to the need for apparatus more specifically designed to cope with the special characteristics of the pain of labour.
Mast cells in the tubal wall in women using an intrauterine contraceptive device
Authors: SANDVEI ROAR , ANKER CARSTEN , WOLLEN ANNE‐LONE , FLOOD PER R.
Published: August 2005

Summary. The number of mast cells in the tubal wall of 33 healthy non‐pregnant women, 17 of whom had an intrauterine contraceptive device (IUCD), was investigated. Light microscopy showed that both the muscularis externa and the lamina propria of the tubal wall contained more mast cells in the 17 IUCD users than in the 16 non‐users (control group). In both patient groups the mast cell concentration was higher in the muscularis externa than in the lamina propria. Most mast cells of the muscularis externa were more closely related to smooth muscle cells than to blood vessels. The increased number of mast cells in IUCD users may be a factor in the pathogenesis of pelvic inflammatory disease and the ectopic pregnancies that occur in IUCD users.
A low voltage diathermy loop for taking cervical biopsies: a qualitative comparison with punch biopsy forceps
Authors: PRENDIVILLE WALTER , DAVIES ROY , BERRY P. J.
Published: August 2005

Summary. Twenty patients attending a colposcopy clinic because of a cytological suspicion of dyskaryosis were entered into a ‘paired’ biopsy study. A low voltage diathermy loop biopsy and a punch biopsy were taken from the cervix of each patient, In a second ‘unpaired’ study loop biopsies taken from 20 patients were compared with punch biopsies taken from 20 different patients. The length and depth of the loop biopsies were greater than those of the punch biopsies. There was no difference in the amount of artefactual damage. These findings held for both the paired and the unpaired studies. We conclude that biopsies taken with the low voltage diathermy loop are more likely to reveal microinvasive disease.
Complement activation, circulating protease inhibitors and pregnancy‐associated proteins in severe preeclampsia
Authors: ARMSTRONG N. P. I. , TEISNER B. , REDMAN C. W. G. , WESTERGAARD J. G. , FOLKERSEN J. , GRUDZINSKAS J. G.
Published: August 2005

Summary.Circulating protease inhibitors, pregnancy‐associated proteins and the split product of complement factor 3 (C3d) were measured in 14 women with severe pre‐eclampsia and their matched controls. Only the mean levels of antithrombin III were observed to be significantly lower in pre‐eclampsia (P<0.02).
Follicle growth patterns and endocrinological abnormalities in infertile women with minor degrees of endometriosis
Authors: THOMAS ERIC J. , LENTON ELIZABETH A. , COOKE IAN D.
Published: August 2005

Summary. Eighteen patients whose only demonstrable cause of infertility was a minor degree of endometriosis and whose partners were normal, were investigated prospectively for one menstrual cycle using ultrasonography and endocrine profiles. Twelve cycles appeared to be normal. A luteinized unruptured follicle (LUF) occurred in two cycles and one patient had a follicular cyst. In a further two patients there was inadequate or abnormal folliculogenesis whilst in the last patient the follicle ruptured prematurely. This study describes the variety of endocrinological abnormalities found in women with mild endometriosis, and concludes that, in this series at least, there is a low frequency of LUF.
Vaginal and abdominal delivery increases maternal urinary 6‐keto‐prostaglandin F1α excretion
Authors: YLIKORKALA O. , PAATERO H. , SUHONEN L. , VIINIKKA L.
Published: August 2005

Summary. To study the role of the antiaggregatory and vasodilatory prostacyclin (PGI2) during human delivery, serial urine samples collected from 13 women delivered vaginally and from eight delivered abdominally were assayed for 6‐keto‐prostaglandin F1α (6‐keto‐PGF1α a breakdown product of PGI2) by high‐performance‐liquid‐chromatography and radioimmunoassay. In women delivered vaginally the mean urinary 6‐keto‐PGF1α concentration was 41.9 (SE 8.3) ng/mmol creatinine, before the onset of labour and increased progressively to a maximum of 186.5 (SE 47.6) ng/mmol creatinine 2 h after delivery irrespective of the use of oxytocin and epidural analgesia. In women delivered by caesarean section under epidural anaesthesia, the urinary 6‐keto‐PGF1α rose from 33.4 (SE 4.2) ng/mmol creatinine to 2153 (SE 314) ng/mmol creatinine 2 h after section. In both groups the increased levels had fallen by 24 h postpartum to levels below those found before delivery. In neonatal urine 6‐keto‐PGF1α concentrations were some 12–30 times higher than those in postpartum urine. Thus, vaginal and abdominal delivery is accompanied by significant increases in maternal PGI2 release, perhaps in the myometrium and/or intrauterine tissues. This may be of significance in the regulation of fetoplacental blood flow and in the prevention of intra‐ and postpartum thrombosis.
Antenatal diagnosis of placental anastomosis in a twin pregnancy using Doppler ultrasound
Authors: ERSKINE R. L. A. , RITCHIE J. W. K. , MURNAGHAN G. A.
Published: August 2005

Summary. Qualitative analysis of blood velocity in the umbilical arteries of twin fetuses detected by pulsed Doppler ultrasound revealed discordant patterns which permitted an accurate antenatal diagnosis of an artery‐to‐artery anastomosis. One twin was consistantly larger than the other, had a normal umbilical artery impedance and survived; the other fetus was consistantly smaller, had persistantly high umbilical artery impedance and died in utero. The death of one fetus did not affect the blood flow patterns within the umbilical artery of the other up to delivery 24 h later. The case demonstrates that intrauterine morbidity due to vascular anastomoses is not confined to the transfusion of significant amounts of blood from one fetus to another.
A randomized trial of Citanest with Octapressin for relief of pain associated with laser vaporization of the cervix
Authors: LEE E. T. C. , OZUMBA E. N. , BEVAN J. R.
Published: August 2005

Summary. Fifty women undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. In one group the patients received no anaesthesia, in the other the ectocervix was infiltrated with 2 ml of Citanest with Octapressin (prilocaine 3% with 0.03 i.u./ml. of felypressin) immediately before the procedure. The pain experienced by each group was assessed immediately after treatment by visual analogue and verbal rating scales. The pain experienced by those women receiving local anaesthesia was significantly reduced as assessed by the visual analogue scale (P =0.011) and this reduction was not quite significant by the verbal rating scale (P =0.06). The Citanest group had less troublesome bleeding but the difference in bleeding between the two groups was not significant.
Oestriol with oestradiol verses oestradiol alone: a comparison of endometrial, symptomatic and psychological effects
Authors: PADWICK M. L. , SIDDLE N. C. , LANE G. , ENDACOTT J. A. , COOPER H. , PRYSE‐DAVIES J. , WHITEHEAD. M. I.
Published: August 2005

Summary. In a prospective, double‐blind, randomized, cross‐over trial, the effects of oral oestradiol, 2 mg daily, on the endometrial histology, frequency and severity of vaginal bleeding, and the symptomatic and psychological status of postmenopausal women were compared with those of oral oestradiol, 2 mg daily, plus oestriol, 1 mg daily. Both therapies were prescribed for 3 months on a cyclical basis. The addition of oestriol to oestradiol did not modify the endometrial response. The prevalence of proliferative/hyperplastic endometrium (64%: 9 of 14 biopsies) was similar after both treatments and there were no significant differences in either the frequency or heaviness of vaginal bleeding. Both therapies significantly reduced hot flushes, night sweats and vaginal dryness: no significant differences in effect on the symptomatic and psychological status were recorded. The addition of 1 mg of oestriol to 2 mg of oestradiol did not confer any benefit and the value of such an addition is challenged.
The role of second‐look laparotomy in the management of patients with Stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide
Authors: KIRWAN P. H. , NAFTALIN N. J. , KHANNA S. , AUKETT R. J.
Published: August 2005

. Twenty‐eight patients underwent a second‐look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulking procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumour had no effect on survival rates. Eighteen patients were surgically free of disease at the second‐look procedure and of these, all are alive and disease free with a mean survival time of 39 months. Of the 10 patients with positive second‐look procedures, four are dead. The mean survival for patients with positive second look laparotomies was 30.7 months. Second‐look laparotomy may contribute to increased survival if pelvic clearance was not attempted at initial staging laparotomy but should primarily be used to assess new agents and new combinations of chemotherapeutic agents and to define the optimum number of courses of chemotherapy.
The measurement of cardiac output by electrical impedance plethysmography in pregnancy. Are the assumptions valid?
Authors: De Swiet M. , Talbert D. G.
Published: August 2005

Summary. The assumptions of the Kubicek technique for measurement of cardiac output by detection of changes in the chest wall electrical impedance have been re‐examined. The fall in cardiac output in the latter half of pregnancy which Crawforďs group calculated using the Kubicek technique can be almost entirely accounted for by a fall in the term dZ/dT of the Kubicek equation, as pregnancy progress. One key assumption of the Kubicek technique is a constant ejection flow rate equal to the initial flow as the pulmonary valve opens, which is multiplied by the estimated ejection time to obtain stroke volume. Initial flow rate is represented by the term dZ/dT in the Kubicek equation. Although this assumption has been shown to give a reasonable correlation with other techniques for measurement of cardiac output in the non‐pregnant state, this may not be so for longitudinal studies in pregnancy because of the changes in lung mechanics and in the circulation which occur in this state. Crawforďs data emphasizes the necessity for validating the Kubicek technique very critically during pregnancy.
Fetal sympatho‐adrenal mediated metabolic responses to parturition
Authors: FALCONER A. D. , POYSER L. M.
Published: August 2005

Summary. Plasma cortisol and noradrenaline were measured in 15 mothers and babies following vaginal delivery and in 17 following elective caesarean section and related to blood concentration of glucose and glycerol. Significant elevations in umbilical artery cortisol and noradrenaline concentration were found in the vaginal delivery group. Blood glucose and glycerol concentrations were significantly higher in the vaginal delivery group for maternal venous, umbilical artery and vein samples. However, when allowances were made for placental transfer of these substances, little evidence was found to support sympatho‐adrenal mediated mobilization of glycerol and glucose in the fetus. The possible explanation for the apparent dissociation between marked sympatho‐adrenal activity and metabolic responsiveness during parturition in the fetus is discussed.
Absorption of menstrual discharge by tampons inserted during menstruation: quantitative assessment of blood and total fluid content
Authors: LEVIN ROY J. , WAGNER GORM
Published: August 2005

Summary. The simultaneous absorption of genital secretions and blood was assessed in 61 intravaginal tampons from eight young, healthy, nulliparous volunteers during menstruation. The tampons were selfinserted over the first 3 days of menstruation according to the habit of each subject. Wide variations in the amount of blood and fluid absorbed were noted within and between subjects. The mean amount of genital secretion absorbed was 0·31 g/h and that of menstrual blood was 0·76 g/h. The average tampon absorbed 65% blood and 35% genital secretion.
Obstetric hysterectomy—an 11‐year experience
Authors: THONET R. G. N.
Published: August 2005

Summary. A total of 31 women had obstetric hysterectomy at St Mary's Hospital, Manchester, between 1972 and 1982. Elective caesarean hysterectomy was performed on nine occasions mainly because of preexisting gynaecological problems such as fibroids or menorrhagia. Emergency hysterectomy most frequently followed uterine rupture, postpartum bleeding and major degrees of placenta praevia. The majority of patients required blood transfusion but postoperative problems were few. Late complications included infected discharge and cyclical bleeding after subtotal hysterectomy. There was one neonatal death but no maternal deaths. Although the operation is usually straightforward, and no major technical problems, such as urinary tract injury occurred, the decision to perform it as an emergency must be made before the patienťs condition is extreme; the availability of senior staff is important.
Use of LHRH analogue to obtain reversible castration in a patient with benign metastasizing leiomyoma
Authors: HAGUE W. M. , ABDULWAHID N. A. , JACOBS H. S. , CRAFT I.
Published: August 2005

Summary. The use of superactive LHRH analogue to provide a reversible form of castration is discussed in the context of the management of a patient with benign metastasizing leiomyoma. The aetiology and prognosis of this rare disease are briefly considered.
Fetal volume blood flow and umbilical artery flow velocity waveform analysis: a comparison
Authors: GILES WARWICK B. , LINGMAN GÖRAN , MARŠÁL KAREL , TRUDINGER* BRIAN J.
Published: August 2005

Summary. The estimation of fetal umbilical vein and aortic volume blood flow was compared with umbilical artery flow velocity‐time waveform analysis in 42 pregnancies. The volume blood flow measurements were made with a combined linear array B‐mode and pulsed Doppler ultrasound system. The umbilical artery flow velocity‐time waveform analysis was made with either pulsed or continuous wave 2 MHzDoppler ultrasound and the systolic/diastolic (A/B) ratio was used as an index of flow resistance. There was no difference when continuous wave was compared to pulsed Doppler ultrasound as a method of recording flow velocity waveforms. Analysis of the umbilical artery flow velocity‐time waveform was more sensitive (100%‐50%) than the measurement of umbilical vein volume blood flow (ml/kg/min) in the detection of the small‐for‐gestational age (SGA) fetus. The predictive value of a positive test was higher (71%‐45%) while specificity was similar (88%‐81%). Descending aortic volume flow was reduced in only one SGA fetus. The increase in umbilical placental downstream resistance (high systolic/ diastolic ratio) was associated with a reduction in the percentage of fetal aortic blood flow directed to the umbilical placental circulation.
The relation of birthweight to histological appearances in vessels of the placental bed
Authors: McFADYEN I. R. , PRICE A. B. , GEIRSSON R. T.
Published: August 2005

Summary. Biopsy of the placental bed was attempted at caesarean section in 109 patients: 77 consecutive and 32 selected because of the maternal or fetal condition. Forty‐seven (44%) of these biopsies were from the placental bed and contained spiral arteries suitable for comment. Histological examination separated the patients into four groups: comprising 11 whose vessels showed normal physiological changes, 20 who showed inadequate physiological change, 12 with acute atherosis, and four with a mixed pattern. There was no relation between these changes and maternal age, parity, race or smoking habit, but no physiological change and atherosis were more common in association with maternal hypertension. Mean adjusted birthweight was greatest in those with physiological changes, less in those without physiological changes or the mixed pattern, and least in those with atherosis. The four patients in the mixed group did not have any unifying clinical characteristics.
The actions of prostaglandins and their interactions with angiotensin II in the isolated perfused human placental cotyledon
Authors: GLANCE D. G. , ELDER M. G. , MYATT L.
Published: August 2005

Summary. The prostaglandins PGE1, PGE 2, PGD 2, PGF 2α., U46619 and 6β‐PGIl were administered as bolus injections both separately and in combination with angiotensin II into the fetal circulation of isolated human placental cotyledons perfused in vitro. PGF2α, and PGD2, caused small dosedependent increases in fetal perfusion pressure when compared with U46619 which acted as an extremely potent vasoconstrictor of the fetal‐placental vasculature. PGE1, caused very small dose‐dependent decreases in fetal perfusion pressure when injected on its own. In combination with angiotensin 11, PGE1, PGD2, and 6β‐PG11, caused significant, dose‐related attenuations of the angiotensin II vasoconstrictive response whereas PGE2, PGF2α, and U46619 potentiated the response. Injections of angiotensin II after the infusion of indomethacin into the fetal circulation resulted in a potentiation of angiotensin II induced vasoconstriction. The results indicate that prostaglandins exert their effects on the fetal‐placental circulation by modulating the actions of angiotensin II.
Postpartum haemorrhage—a continuing problem
Authors: GILBERT L. , PORTER W. , BROWN V. A.
Published: August 2005

Summary. The factors responsible for postpartum haemorrhage (PPH) in singleton vaginal deliveries, not complicated by a retained placenta, were identified by comparing labour characteristics in 86 women who had a PPH (blood loss > 500 ml) with 351 women whose blood loss at delivery was < 350 ml. Primiparity, induction of labour by amniotomy/ oxytocin, forceps delivery, long first and second stages, oxytocin com‐pared with syntometrine (oxytocin plus ergometrine maleate), as a prophylactic oxytocic, were identified as significant risk factors. Epi‐dural analgesia contributed indirectly to an increase in the risk of postpartum haemorrhage. The changes in labour ward practice over the last 20 years have resulted in the re‐emergence of PPH as a significant problem.
Nifedipine as a second line antihypertensive drug in pregnancy
Authors: CONSTANTINE G. , REYNOLDS A. L. , LUESLEY D. M. , BEEVERS D. G.
Published: August 2005

Summary. Slow‐release nifedipine has been used in the treatment of severe hypertension in 23 pregnant women. In 22 this was in combination with other drugs, in 18 including atenolol. Good control of blood pressure was achieved in 20 women. The perinatal mortality of the group was 130/1000, with a high caesarean section rate (71% of live‐births), a high rate of abnormal CTGs, a high rate of premature delivery, and a high rate of infants who were small‐for‐dates. Whether this is due to the disease process or the medication is uncertain. For the present time these combinations should only be used in severe hypertensives or in the context of a controlled trial.
Energy intake and physical activity during pregnancy in relation to maternal fat accretion and infant birthweight
Authors: LANGHOFF‐ROOS JENS , LINDMARK GUNILLA , KYLBERG ELISABETH , GEBRE‐MEDHIN MEHARI
Published: August 2005

Summary.During the second pregnancy of 56 Swedish women resulting in a term birth, energy intake and physical activity were measured for 3 days at weeks 17 and 33. The values were related to maternal lean body mass, pregnancy weight gain, maternal fat accretion and infant birth‐weight by multiple linear regression analyses. A significant regression coefficient was found for energy intake at week 17 on maternal fat accretion. Energy intake was not significantly correlated with infant birthweight, not even when physical activity and maternal lean body mass were taken into account. Thus in a well‐nourished Swedish population, energy intake is positively related to maternal fat accretion but not to the birthweight of term infants.
A comparison of symphysis‐fundal height and ultrasound as screening tests for light‐for‐gestational age infants
Authors: PEARCE J. MALCOLM , CAMPBELL STUART
Published: August 2005

Summary. The clinical efficiency of serial measurement of symphysisfundal height (SFH) for the prediction of light‐for‐gestational age (LGA) infants was compared with that of a single measurement of fetal abdominal circumference (AC) by ultrasound in the third trimester. To make the tests comparable the lower cut‐off point of AC was altered until the specificity matched that of SFH. The sensitivity of the AC measurement (83%) was slightly better than that of the SFH measurement (76%) but this difference was not statistically significant. Each test had a false positive rate of about 60% which is comparable with clinical assessment. Screening with both tests and predicting LGA with abnormal results from either test improved the sensitivity to 93% but, as expected, decreased the specificity to 67% and the positive predictive value to 32%. If ultrasound facilities permit both tests should be used otherwise SFH measurements only could screen for LGA with ultrasound back‐up for those with low SFH results.
Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement
Authors: BRINCAT M. , O'DOWD T. , MAGOS A. L. , MONTGOMERY J. , STUDD J. W. W. , MONIZ C. F. , VERST E. , KABALAN S.
Published: August 2005

Summary. The thigh skin collagen content and the metacarpal index were measured in 69 untreated postmenopausal women and in 37 postmenopausal women who had been receiving oestradiol and testos terone implants for 2–10 years. There was a significant positive correlation between the skin collagen content and the metacarpal index in both groups of patients. In the untreated group, there was a statistically significant decrease both in the thigh skin collagen content and in the metacarpal index with the years since the menopause. This decrease was preventable in women who were on sex hormone replacement therapy.
Outcome of pregnancies progressing beyond 28 weeks gestation in women with a history of recurrent miscarriage
Authors: REGINALD P. W. , BEARD R. W. , CHAPPLE J. , FORBES P. B. , LIDDELL H. S. , MOWBRAY J. F. , UNDERWOOD J. L.
Published: August 2005

Ninety‐seven women who had had three or more miscarriages had also had at least one pregnancy with a singleton birth that had reached 28 weeks gestation. Information was available on these 118 babies; 30% were small‐for‐gestational age (birthweight ≤ 10th centile using figures from Scotland 1973–79), 28% were born preterm, and the perinatal mortality rate (excluding babies of <28 weeks gestation) was 161/1000 births, all of which are significantly increased above the prevalence for a normal obstetric population. These observations may serve to alert the clinician to the increased risk of these complications when dealing with women who have a history of recurrent miscarriage.
Natural killer cells in cervical intraepithelial neoplasia and human papillomavirus infection
Authors: JENKINS D. , TAY S. K. , SINGER A. , TAY S. K.
Published: August 2005

Summary. A semiquantitative immunocytochemical study of natural killer (NK) cells in cervical mucosa was performed by the immuno‐peroxidase technique using anti‐Leu‐7 and anti‐Leu‐11 monoclonal antibodies. NK cells were present in two of the five normal controls and five of six specimens showing human papillomavirus (HPV) infection. Of the 12 CIN studied, six were positive for both Leu‐7 and Leu‐11 staining and three were positive for Leu‐11 alone. NK cells were found predominantly in the subepithelial stroma. The frequency and pattern of distribution of these cells were similar in all grades of CIN. The number of NK cells present was usually small but the degree of infiltration by Leu‐11 positive cells was pronounced in two HPV infections and in one CIN 1. NK cells may have a role in surveillance against HPV infection and the development and progression of CIN.
Levonorgestrel‐releasing intrauterine device in the treatment of menorrhagia
Authors: ANDERSSON J KERSTIN , RYBO GÖRAN
Published: August 2005

Summary. In 20 women with menorrhagia (>80 ml blood loss per menstrual period) a levonorgestrel‐releasing intrauterine device (Lng‐IUCD) was inserted. Menstrual blood loss (MBL) was measured in two consecutive cycles before the device was inserted and after 3, 6 and 12 months of use. MBL was significantly reduced after 3 months (86%) and after 12 months the reduction was 97%. There was a significant increase (P< 0.001) in serum ferritin during the first year of Lng‐IUCD use. The Lng‐IUCD seems to be an important alternative to oral medication and to hysterectomy in the treatment of menorrhagia.
C‐reactive protein and serum amyloid A protein in pregnancy and labour
Authors: de VILLIERS WILLEM J. , LOUW JOHANN P. , STRACHAN ALISTAIR F. , ETSEBETH SUSEL M. , SHEPHARD ENID G. , de BEER FREDERICK C.
Published: August 2005

Summary. Serum levels of C‐reactive protein (CRP) and amyloid A protein (SAA) were measured prospectively using immunoradiometric assays in normal pregnant women, newborn infants and women with prelabour rupture of membranes (PROM), focusing on the peripartum period. CRP levels in 50 healthy women at 38 weeks gestation did not differ significantly from previously established normal values. CRP levels in 67 healthy women sampled serially in labour from admission to 96 h postpartum confirm the physiological occurrence of a major acute phase response. The serial CRP levels of 16 women with PROM did not differ significantly from the wide range of CRP levels found in the normal postpartum period. This complicates the use of CRP as an early predictor of clinical chorio‐amnionitis. Serial SAA levels in 17 women at 38 weeks gestation, immediately postpartum and 24 h postpartum showed a parallel rise to CRP in the peripartum period. Significant differences between maternal and neonatal CRP and SAA levels were demonstrated, implying a lack of transplacental transfer during labour.
Assessment of menstrual blood loss using a pictorial chart
Authors: HIGHAM JENNY M. , O'BRIEN P. M. S. , SHAW R. W.
Published: August 2005

Summary. Objective menstrual blood loss measurements (in ml) were compared with the score obtained from a pictorial blood loss assessment chart (PBAC) which took into account the degree to which each item of sanitary protection was soiled with blood as well as the total number of pads or tampons used. Twenty eight women used the chart during 55 menstrual cycles and a single observer assessed 122 cycle collections in a similar manner. A pictorial chart score of 100 or more, when used as a diagnostic test for menorrhagia, was found to have a specificity and sensitivity of >80%. Demonstration of the relation between self assessed pictorial chart scores and the objective measurement of blood loss enables us to provide a simple, cheap and reasonably accurate method of assessing blood loss before embarking upon treatment.
Interdisciplinary Treatment of Failed Back Surgery Syndrome (FBSS): A Comparison of FBSS and Non‐FBSS Patients
Authors: Miller Brandy , Gatchel Robert J. , Lou Leland , Stowell Anna , Robinson Richard , Polatin Peter B.
Published: August 2005

Abstract:  Many patients enrolled in chronic pain centers suffer from failed back surgery syndrome (FBSS). However, there has been a paucity of research concerning how these patients differ from other chronic pain patients, and how to most effectively address their complex problems within an interdisciplinary chronic pain treatment environment. The current study represents the first large‐scale examination of these issues, with two major aims: (1) to elucidate the differences between FBSS patients and other chronic lumbar pain patients; and (2) to clarify the role of injections in interdisciplinary treatment, particularly with FBSS patients. A total of 128 chronic lumbar pain patients who presented for treatment at an interdisciplinary center were included in the study. Patients completed various measures at pre‐, mid‐, and post‐treatment intervals, including physical, functional, and psychosocial measures. Overall, both FBSS and Non‐FBSS patients reported significantly decreased pain and disability, and significant improvements in physical and psychosocial functioning after interdisciplinary treatment. However, Non‐FBSS patients were associated with greater reductions in self‐reported pain and disability than FBSS patients. On the other hand, FBSS patients were significantly more improved on physical therapy measures, including Activities of Daily Living, Strength, and Fear of Exercise. Statistical comparisons of Injection (INJ) and No‐Injection (No‐INJ) groups yielded few significant findings.
Intradiscal Electrothermal Coagulation and Percutaneous Neuromodulation Therapy in the Treatment of Discogenic Low Back Pain
Authors: Rozen Dima , Grass Gerald W.
Published: August 2005

Abstract:  Low back pain (LBP) is a major physical and socioeconomic entity. A significant percentage of LBP is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. Intradiscal electrothermal coagulation (IDET) and percutaneous neuromodulation therapy (PNT) are now being performed as an alternative to these therapies. Scientific data regarding the pathophysiology, biologic effects, and clinical results are relatively scarce. Early biomechanical and histologic investigations into the effects of IDET are conflicting. However, in early prospective human trials, IDET seems to provide some benefit with little risk. PNT represents a new less invasive technique for the treatment of discogenic pain, but limited research is available to determine long‐term clinical efficacy.

IDET and PNT are potentially beneficial treatments for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long‐term follow‐up evaluation is necessary.
Anterior Cervical Approach for Stellate Ganglion and T2 to T3 Sympathetic Blocks: A Novel Technique
Authors: Vallejo Ricardo , Plancarte Ricardo , Benyamin Ramsin M. , Santiago‐Palma Juan
Published: August 2005

Background:  Stellate ganglion block is used for the diagnosis and treatment of sympathetically maintained pain syndromes. Multiple anatomic variations and inaccurate sympathetic block may mislead the diagnosis and prevent patients from receiving potentially beneficial interventions. We describe a novel approach to blockade of the sympathetic chain at C7 and at T2 to T3 with a single‐needle injection.

Technique:  With the patient in supine position, the uncinate process of C7 is identified fluoroscopically as a target for insertion of a catheter through a Touhy needle. The catheter is directed caudally to the junction of T2 and T3. Contrast injection confirms the spread to the appropriate levels before injection of local anesthetic.

Conclusion:  This novel approach to blockade of the upper extremity sympathetic innervation may enhance diagnostic accuracy and therapeutic benefit as compared with traditional approaches to the stellate ganglion alone. This approach may be expected to decrease the risk of pneumothorax when compared with the posterior approach to T2 to T3.
Accuracy of Caudal Epidural Injection: The Importance of Real‐Time Imaging
Authors: Ergin Atilla , Yanarates Omer , Sizlan Ali , Orhan M. Emin , Kurt Ercan , Guzeldemir M. Erdal
Published: August 2005

Abstract:  Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure.

In this preliminary report, we demonstrate that fluoroscopic guidance for caudal epidural Tuohy needle placement without real‐time imaging may result in inadvertent intravenous injection of the drug. We detected intravenous leakage of the drug in 4 cases of 10 when real‐time fluoroscopic imaging was used. Thus, real‐time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.
Diagnosis and Management of Cervicogenic Headache
Authors: Sizer Phillip S. , Phelps Valerie , Azevedo Esteban , Haye Amy , Vaught Megan
Published: August 2005

Abstract:  Upper cervical pain and/or headaches originating from the C0 to C3 segments are pain‐states that are commonly encountered in the clinic. The upper cervical spine anatomically and biomechanically differs from the lower cervical spine. Patients with upper cervical disorders fall into two clinical groups: (1) local cervical syndrome; and (2) cervicocephalic syndrome. Symptoms associated with various forms of both disorders often overlap, making diagnosis a great challenge. The recognition and categorization of specific provocation and limitation patterns lend to effective and accurate diagnosis of local cervical and cervicocephalic conditions.
Urban Activism in a Downsizing World: Neighborhood Organizing in Postindustrial Chicago
Authors: Heathcott Joseph
Published: August 2005

In this article, I examine the origins and development of the National Training and Information Center (NTIC) in Chicago as part of a broader neighborhood organizing movement. I am particularly interested in the development of a philosophy and strategy of civic action in a postindustrial era. One of the most influential forms of grassroots urban activism in the 20th century was Saul Alinsky's community organizing movement. This movement, I argue, relied upon a relatively stable cadre of mass institutions including unions, the New Deal Democratic Party, and the Catholic Church. However, by the 1960s, these institutions fell into decline alongside the changing political, economic, and social conditions of the city wrought by deindustrialization. Neighborhood organizing arose in the late 1960s as one response to these changing conditions, and its emergence reflects an important shift in the methodologies of urban social action. Yet I conclude that the lack of a broad agenda for social change is a weakness of neighborhood organizing inherited from Alinsky, and that this weakness constitutes a major challenge for NTIC and like groups.
Glacial Sediment Causing Regional‐Scale Elevated Arsenic in Drinking Water
Authors: Erickson Melinda L. , Barnes Randal J.
Published: August 2005

In the upper Midwest, USA, elevated arsenic concentrations in public drinking water systems are associated with the lateral extent of northwest provenance late Wisconsin‐aged drift. Twelve percent of public water systems located within the footprint of this drift (212 of 1764) exceed 10 μg/L arsenic, which is the U.S. EPA's drinking water standard. Outside of the footprint, only 2.4% of public water systems (52 of 2182) exceed 10 μg/L arsenic. Both glacial drift aquifers and shallow bedrock aquifers overlain by northwest provenance late Wisconsin‐aged sediment are affected by arsenic contamination. Evidence suggests that the distinct physical characteristics of northwest provenance late Wisconsin‐aged drift—its fine‐grained matrix and entrained organic carbon that fosters biological activity—cause the geochemical conditions necessary to mobilize arsenic via reductive mechanisms such as reductive desorption and reductive dissolution of metal oxides. This study highlights an important and often unrecognized phenomenon: high‐arsenic sediment is not necessary to cause arsenic‐impacted ground water—when “impacted” is now defined as >10 μg/L. This analysis also demonstrates the scientific and economic value of using existing large but imperfect statewide data sets to observe and characterize regional‐scale environmental problems.
Demonstration experiments on nondiffracting beams generated by thermal light
Authors: Basano Lorenzo , Ottonello Pasquale
Published: August 2005

Nondiffracting (Bessel) beams are normally generated using fully coherent light (a laser). Yet their distinctive properties (nondiffraction and self-reconstruction) can be obtained using a common halogen lamp as the primary source. Other experiments, for example, the creation of periodic intensity modulations along the optical axis, require a source with a much narrower spectrum. We present demonstrations that show that thermal light is useful for explaining several properties of a Bessel-beam generator and may help students to understand some issues of modern coherence theory.
Increase in friction force with sliding speed
Authors: Cross Rod
Published: August 2005

A block sliding down an inclined plane normally accelerates. However, if the friction force increases with speed, then the block can slide at a constant terminal speed in a manner similar to the fall of an object through a fluid. Measurements of the increase in the coefficient of friction for tennis ball cloth sliding on a smooth surface are described over speeds varying by a factor of 9000. For the low speed measurements, the ball cloth was attached to the bottom of a weighted box and pulled along a horizontal surface by a constant horizontal force. Results at higher speeds were obtained by bouncing a tennis ball off the surface.
Flashback Teaching Technique Applied to a Block-and-Gap Physics Course
Authors: Hatch A. J. , Cope D. F.
Published: August 2005

A new method of teaching physics for general education is described. One principal feature of the method is to use the atom as the central theme of the course. The subject material is divided into three main topics, (1) background material, (2) the external atom, and (3) the nucleus. Organization of the subject material is analyzed with block-and-gap terminology. The other principal feature of the method is to introduce the Bohr model of the hydrogen atom at the beginning of the course and develop only the necessary background material such as Newton's laws of motion, electrostatics, wave motion, etc., as needed. This flashback approach has been found to be very helpful in providing the necessary motivation for the students. Other advantages of the method are the integration of subject material into one completely organized unit and the emphasis on modern physics which makes the course terminal in the desired sense for nonscience students.
A Simple Geometrical Proof of Buckingham's π-Theorem
Authors: Corrsin Stanley
Published: August 2005

By introduction of the concept of a “dimension space,” whose coordinates are the exponents of the basic dimensions of physical quantities, the proof of Buckingham π-theorem is transformed into a simple geometrical problem.