bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservative Management of a Case of Placenta Praevia Percreta
Authors: Otsubov Yasuo , Shinagawa Toshiya , Chihara Hiromitsu , Araki Tsutomu
Published: February 2008

Summary: Pregnancies complicated by placenta praevia and a history of caesarean section are associated with increased risk of placenta percreta (1). Placenta praevia percreta sometimes involves the bladder or other pelvic organ, invasion leading to genital bleeding or haematuria (2, 3). Bladder injury or uncontrollable profuse haemorrhage occasionally occurs in such patients during surgery. Examination of placental invasion is necessary as this clinical condition is severe. Treatment of placental myometrium invasion is required to prevent uncontrollable profuse haemorrhage during surgery. We present a multiparous patient who was diagnosed prenatally with placenta praevia percreta using magnetic resonance imaging (MRI) and who was treated conservatively with a good prognosis.
Pyomyoma: A Case Report
Authors: Gupta Bipin , Sehgal Alka , Kaur Ravinder , Malhotra Sarla
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because, although rare, it is interesting and has been associated with a high fatality rate unlike pyometra where the pus is usually sterile on culture. One of the reviewers wondered whether it was wise to aspirate such a tumour but since this patient survived treatment uneventfully it may be that the preoperative knowledge of the abscess provided an advantage at least in suggesting the need for antibiotic therapy. The editor has seen a number of cases of submucous fibroids associated with infection, especially when they have prolapsed through the cervix into the vagina, but he has never seen a case of a pyomyoma as described here. N.B.
A Severe Case of Post‐Antibiotic Clostridium difficile Colitis
Authors: Braniff K
Published: February 2008

Clostridium difficile infection is a common cause of post‐antibiotic diarrhoea. In the following case it caused severe disease, and the correct diagnosis was not considered at first.
Estimation of fetal weight by ultrasound prior to 33 weeks gestation
Authors: Hotcfain Anne , Bell Robin , Umstad Mark P , Robinson Hugh P , Doyle Lex W
Published: February 2008

Summary: The aim of this study was to develop an accurate formula for the ultrasonic prediction of fetal weight for infants < 33 weeks gestational age and s 1500 g birth‐weight. The subjects comprised live births free of lethal malformations or chromosomal anomalies, < 33 weeks gestational age and with birthweights s 1500 g born in the Royal Women's Hospital between January 1990 and March 1996. All subjects had accurate gestational age confirmed by ultrasound prior to 20 weeks gestation and ultrasound measurements within 72 hours of birth of biparietal diameter (BPD), femur length (FL) and abdominal circumference (AC). A formula with the highest explained variance was computed by linear regression analysis using the three fetal variables in various combinations from 54 infants born between January 1990 and December 1993. The optimal formula was:

Log10birthweight = 0.714627 + 0.077362.AC + 0.058758.BPD + 0.287037.FL ‐ 0.011274. AC. FL

The new formula was more accurate compared with existing formulae when tested in a separate cohort of 39 infants born between January 1994 and March 1996.
Spontaneous uterine perforation from uterine infarction: a rare case of acute abdomen
Authors: Tan Lay‐Kok , Busmanis Inny
Published: February 2008

Summary: A case of spontaneous uterine perforation from uterine infarction is presented. The authors believe that this is the first reported case.
Partial mole, triploidy and proteinuric hypertension: two case reports
Authors: Rahimpanah Farhad , Smoleniec John
Published: February 2008

Summary: We present two cases of proteinuric hypertension in This demonstrates the complementary nature of the early second trimester of pregnancy, associated ultrasound in the diagnosis and management of with partial mole and triploidy karyotyping. this rare association.
Vesicocervical fistula: an unusual presentation
Authors: Banerjee Neelam , Deka Deepika , Roy Kallol K , Takkar Deep
Published: February 2008

Summary: A rare case is presented of vesicocervical fistula that occurred in a woman who sought help for continuous dribbling of urine for nine years. The aetiological implications of her obstetric history are discussed in the context of previous reports in the literature. The management and outcome of this case is discussed.
Perimortem Caesarean section: two case reports and a management protocol
Authors: Tang Georgiana , Nada Wagdy , Gyaneshwar Rajat , Crooke David
Published: February 2008

Summary: Perimortem Caesarean section is a rare clinical event. Two cases are reported. Both cases had poor outcomes. The impact of this was traumatic for the trainee specialists who managed the two cases. The relevant literature has been reviewed and a protocol for the management of this rare emergency is presented.
Improving antenatal recognition of women at risk for postnatal depression
Authors: Webster Joan , Linnane John WJ , Dibley Linda M , Pritchard Margo
Published: February 2008

Summary: The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for postnatal depression. It was a prospective, hospital‐based, cohort study of 901 women (600 with and 301 without prenatal risk factors for postnatal depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for depression (25.9%) scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p ≤ 0.001). Low social support (p ≤ 0.001), a personal history of mood disorder (p ≤ 0.001) and a past history of postnatal depression (p = 0.002) were all strongly associated with postnatal depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for postnatal depression.
Pain relief following day case laparoscopic tubal ligation with intra‐peritoneal ropivacaine: a randomised double blind control study
Authors: Dreher JK , Nemeth D , Limb R
Published: February 2008

Summary: The aim of this study was to examine the effectiveness of ropivacaine administered by a simple intraperitoneal technique in relieving pain following laparoscopic application of Filshie clips.

Nineteen patients were randomised to receive either ropivacaine (200 mg) or normal saline through the umbilical port following clip application. Using a visual analogue scale women receiving ropivacaine had significantly lower pain scores 2 hours post operatively (0.97 vs 2.03 p < 0.05). The mean total postoperative fentanyl use was also significantly lower on the ropivacaine group (40 μg vs 104 μg p < 0.02).

Only 10% (1/10) of the women in the ropivacaine group complained of nausea compared with 44o (4/9) in the control group. Furthermore, 80% (8/10) of women in the ropivacaine group were either very or totally satisfied with their pain relief. Only 56% (5/9) of the women in the control group were very or totally satisfied with their pain relief.

Ropivacaine administered by a simple intraperitoneal technique following laparoscopic sterilisation significantly reduces postoperative pain and parenteral analgesic requirements. It would be reasonable to consider this method as standard practice following laparoscopic tubal ligation.
Tissue kallikrein activity in pregnancy
Authors: Khedun S M , Naicker T , Moodley J
Published: February 2008

Summary: To determine tissue kallikrein (TK) activity in black African women with hypertensive disorders of pregnancy; 140 women were recruited and divided into the following groups: group A – 35 preeclamptic women, group B – 35 mild to moderate hypertensive pregnant women and group C – 35 normotensive pregnant women, and group D – 35 normotensive non‐pregnant healthy women. The activity of tissue kallikrein was determined from a random untimed urine sample using a selective, synthetic chro‐mogenic tripeptide substrate having the sequence H‐D‐Val‐Leu‐Arg‐pNA (S‐2266). Urinary sodium and potassium levels was determined by flame photometry. Tissue kallikrein activity was decreased in women with preeclampsia (1.54 ± 0.95 vs 3.05 ± 0.83 ngTK/μg protein; p < 0.0001) and mild to moderate hypertensive group (2.03 ± 0.76 vs 3.05 ± 0.83 ngTK/μg protein; p < 0.0001) compared with normotensive pregnant women. There was also a significant difference in tissue kallikrein activity between the pregnancy groups (1.54 ± 0.95 vs 2.03 ± 0.76 ngTK/μg protein; p < 0.001). No difference in tissue kallikrein activity was observed between normotensive pregnant and normotensive non‐pregnant healthy women (3.05 ± 0.83 vs 3.14 ± 0.88 ngTK/μg protein; p = 0.51). There was no difference in the excretion of urinary sodium and potassium in pregnancy groups compared to normotensive pregnant group. Tissue kallikrein activity is decreased in hypertensive disorders of pregnancy.
Birth of twins using in vitro matured oocytes and cryopreserved semen from a male with carcinoma of the penis
Authors: Chiu Tony T Y , Briton‐Jones Chris M , Rogers Michael S , Haines Christopher J
Published: February 2008

Summary: Semen cryopreserved from a male prior to treatment for carcinoma of the penis was used for intra‐cytoplasmic sperm injection (ICSI) of in vitro matured (IVM) oocytes, resulting in the birth of healthy, non‐identical twin girls.
Management of essential thrombocythaemia during pregnancy
Authors: Cincotta Robert , Higgins John R. , Tippett Christine , Gallery Eileen , North Robyn , McMahon Lawrence P. , Brennecke Shaun P.
Published: February 2008

Essential thrombocythaemia is a rare myeloproliferative disorder that often presents with haemorrhagic or thrombotic complications. It may be detected incidentally in an asymptomatic younger adult and there are only a few case reports of essential thrombocythaemia in pregnant women. The risks posed by essential thrombocythaemia during pregnancy and its optimal management are uncertain. To determine if there is increased incidence of obstetric complications seen in women who have essential thrombocythaemia, we collected a large case series from a number of tertiary obstetric units in Australia and New Zealand.

There were 30 pregnancies in 12 women who had essential thrombocythaemia. There were 17 live births (57%). 7 stillbirths (23%), 5 miscarriages (17%) and 1 ectopic (3%). Five pregnancies were complicated by placental abruption. When the outcomes of those women who received treatment with aspirin or interferon were compared to those that did not receive any treatment, there was a trend towards a higher livebirth rate (79% v 38%, p = 0.06). Seven women were treated with aspirin and 5 had successful outcomes with no fetal complications. Four women were treated with α‐interferon which reduced their platelet counts and all had successful outcomes with no fetal complication. These findings suggest that there is a high incidence of miscarriage, stillbirth and abruption in women with essential thrombocythaemia. Their pregnancies should be carefully monitored. Treatment with low dose aspirin and/or the use of α‐interferon may be associated with an improved pregnancy outcome.
Single dose oral azithromycin versus seven day doxycycline in the treatment of non‐gonococcal mucopurulent endocervicitis
Authors: şendaǧ Fatih , Terek Coşan , Tuncay Güngör , özkinay Erdinç , Güven Melih
Published: February 2008

The aim of this study was to compare single dose oral azithromycin versus seven‐day doxycycline in the treatment of non‐gonococcal mucopurulent cervicitis (MPC). One hundred and thirty‐one women with non‐gonococcal MPC were enrolled in a prospective‐randomised study to compare the efficacy and safety of a single oral dose of 1 g azithromycin and a seven‐day course of 100 mg doxycycline twice daily Clinical examination and culture samples for Chlamydia trachomatis and other microorganisms were performed before and approximately 14 days after starting the treatment.

Of the 131 women recruited (67 in the azithromycin group and 64 in the doxycycline group), Ureaplasma urealyticum was isolated from 21 (16%); Chlamydia trachomatis from 15 (11.5%); and Mycoplasma hominis from 3 (2.3%) of the patients at the initial examination. The eradication rate of baseline culture‐positive cases at the follow‐up visit in the azithromycin group was 71.4%, and 77.3% in the doxycycline group. There was no statistically significant difference in efficacy between the single dose azithromycin and seven‐day course of doxycycline in the treatment of culture‐positive cases. Azithromycin 1 g appears to be an effective and safe alternative to doxycycline for the treatment of non‐gonococcal MPC.
The relationship of physical trauma and surgical stress to menstrual dysfunction
Authors: To William W K. , Wong Margaret W N.
Published: February 2008

To evaluate the incidence and pattern of menstrual dysfunction in reproductive age group women suffering acute musculoskeletal trauma, 198 women between 15 and 50 years of age admitted consecutively into an acute orthopaedic unit were recruited over a 6‐month period. The patients were then followed up for 6 months with menstrual diaries to compare their menstrual pattern with their preadmission status. Excluding those with significant menstrual problems before admission, the menstrual pattern remained normal in 135 (68%) (EM), while 12 (6%) developed polymenorrhoea (PM), and 51 (25%) had oligomenorrhoea or amenorrhoea (OAM) within the 6‐month observation.

The three groups did not differ in their mean age, body mass index, parity or age of menarche, but previous cycle lengths were shortest in the PM group (25.4 days, SD 7.64) (p<0.05) and history of amenorrhoea in the previous one year was most common in the OAM group (p<0.025). Univariate analysis showed the incidence of moderate to major trauma, operative treatment, longer operative time, general anaesthesia, blood transfusion and immobilisation were significantly higher in the PM and OAM groups compared to the unchanged group (p<0.05).

A logistic regression model showed that general anaesthesia and longer surgical operations remained significantly related to the development of menstrual dysfunction. We conclude that the pattern of menstrual dysfunction after acute orthopaedic trauma appeared to be dictated by the woman's pre‐existing menstrual characteristics and the stress of surgical treatment.
Referral patterns for gynaecological radiotherapy in Victoria
Authors: Gard Gregory B. , Quinn Michael A. , Narayan Kailash , Bernshaw David M. , Planner Robert S. , Taylor Mandy
Published: February 2008

A retrospective chart review was undertaken on all patients in Victoria who were referred for radiotherapy for a gynaecological cancer from February 1997 to January, 1998. Three hundred and ten patients were identified which represents less than one‐third of all gynaecological cancers diagnosed in Victoria each year. Ninety‐two of the 310 patients (30%) referred for radiotherapy were managed without the prior involvement of a certified gynaecological oncologist. The 310 patients included 95 patients with cervical cancer, 33 patients with ovarian cancer and 142 patients with endometrial cancer. The initial management strategies employed for patients with the major gynaecological cancers varied depending on the source of referral. This difference was most marked in endometrial cancer due mainly to differing indications for full surgical staging and subsequent referral for radiotherapy both between types of specialists and also between gynaecological oncology units.

The development of evidence based guidelines in the major gynaecological cancers should lead to a more uniform approach to the care of women with gynaecological malignancies.
Validation of women's self‐reported smoking status in a Sydney colposcopy clinic
Authors: Donnelly Neil J. , Ward Jeanette E. , Dalrymple Chris
Published: February 2008

This study validated a self‐reported smoking prevalence questionnaire against urinary cotinine levels among women referred to a Sydney based public hospital colposcopy clinic over the period November 1997 to June 1998. Of 213 eligible women, 160 (75%) agreed to participate. Of these, 151 (94%) completed the smoking prevalence item and 130 (86%) also provided a urine specimen. 40% (95% CI: 33%‐49%) of respondents self‐reported as current smokers.

Observed agreement between self‐reported and biochemically validated smoking status was 94% compared with 52% chance agreement (kappa = 0.87, p < 0.001). This high level of agreement was also robust to sensitivity analyses using a more conservative cutoff for the urinary cotinine levels. We conclude that self‐reported smoking status provides valid estimates of actual rates of smoking among women referred with abnormal cervical smears.
A RACOG sponsored pilot study of a quality assurance program regarding management of labour by provincial Fellows
Authors: Humphrey Michael D. , Maher Claire F. , Panjari Mary
Published: February 2008

Objective

To develop an effective and practical self‐administered obstetric audit program for use by clinicians within their own practice.

Setting

The private and public practices of specialists in provincial practice.

Sample

Two periods of 3 months in each Fellow's practice, separated by a period of 3 months to allow for data review, resulting in the review of management of 6708 singleton births.

Methods

All provincial Fellows in active practice in Australia in early 1998 were invited to take part in a voluntary ‘quality cycle’ obstetric practice audit. The data from the first 3 month period was fed back to participating Fellows for review before a second 3‐month audit period was undertaken.

Results

One hundred and twenty provincial Fellows were invited to take part; 62 registered for the study, 58 commenced the project, and 52 completed the entire cycle.

60.1% of the 6708 women studied laboured spontaneously, 25.8% had labour induced, and 14.1% had elective Caesarean sections. 87.8% of the 5759 women who laboured gave birth vaginally. There was little change in the incidence of intervention in labour between the first and second study periods.

Conclusions

It is possible to design a worthwhile self‐administered clinical audit in obstetric practice with which specialists in full‐time practice can cope and which provides useful personalised feedback for the specialist.
Transvaginal cervico‐isthmic cerclage: a simple approach
Authors: Bennett MJ , Duncombe GJ
Published: February 2008

Summary: In this article, we describe a relatively simple surgical option that we believe is indicated for use in cases of cervical incompetence. We discuss the advantages of this procedure to the surgeon and patient, and give details of 59 patients who have undergone this procedure one or more times over a 13‐year period. A short review of the history of treatment of cervical incompetence and of recent trends for its management is also presented.
Laparoscopic presacral neurectomy ‐ retrospective series
Authors: Kwok Adrian , Lam Alan , Ford Robert
Published: February 2008

Summary: A retrospective audit of medical records was conducted for one surgeon (AL). All patients who underwent laparoscopic presacral neurectomy for severe midline dysmenorrhoea were identified. Details of the preoperative symptoms, clinical findings and operative records were studied. Improvement of dysmenorrhoea was assessed according to a pain scale. Twelve patients who had a laparoscopic presacral neurectomy performed were identified. Eight patients reported significant improvement of symptoms, with a further two reporting mild improvement. Two patients failed to show any improvement of symptoms. We believe that the role of laparoscopic presacral neurectomy should be limited to patients with severe midline dysmenorrhoea not responding to the medical therapy. It may be a supplementary procedure to laparoscopic resection of endometriosis or adhesiolysis.
Is the irritable bladder associated with anterior compartment relaxation? A critical look at the ‘integral theory of pelvic floor dysfunction’
Authors: Dietz HP , Clarke B
Published: February 2008

Summary: The ‘integral theory of pelvic floor dysfunction’, first proposed by Petros and Ulmsten in 1990, claims that anterior vaginal wall relaxation is associated with symptoms of urgency, frequency, nocturia and urge incontinence. A retrospective study was designed to test this hypothesis. Imaging data and urodynamic reports from 272 women suffering from symptoms of lower urinary tract dysfunction were evaluated. Opening of the retrovesical angle, bladder neck descent, urethral rotation and descent of a cystocele during Valsalva were used to quantify anterior vaginal wall laxity.

None of the tested parameters were associated with symptoms and signs of detrusor overactivity. On the contrary, patients with higher grades of urethral and bladder descent were less likely to suffer from nocturia and urge incontinence and were less likely to have sensory urgency and detrusor instability diagnosed on urodynamic testing. The findings of this study therefore do not support this hypothesis of the ‘integral theory’.
How long does it take to deliver a baby by emergency Caesarean section?
Authors: Spencer Michael K , MacLennan Alastair H
Published: February 2008

This audit documented the current range of decision‐to‐delivery reaction times for 464 emergency Caesarean sections performed in maternity hospitals with differing levels of facilities, and examined the reasons for any perceived delay.

The median (with 10th‐90th percentile) times from when the decision was made to perform an emergency Caesarean section to the delivery of the child were: 69 (37–114), 54 (28–94) and 42 (17–86) minutes in Level 1, 2 and 3 maternity hospitals respectively when the indication for delivery was urgent. Less urgent emergency Caesarean sections took 70 (42–125), 66 (38–141) and 67 (35–164) minutes respectively. The main perceived reasons for delay in the delivery were staff unavailability in Level 1 hospitals, theatre access in Level 2 hospitals and anaesthetic complications in Level 3 hospitals. Therefore the decision‐to‐delivery reaction times in the majority of urgent emergency Caesarean sections are, in practice, much longer than the times commonly advocated and are influenced by the facilities and staff available.
Seroprevalence of varicella zoster virus, parvovirus B19 and Toxoplasma gondii in a Melbourne obstetric population: implications for management
Authors: Karunajeewa Harin , Siebert David , Hammond Rachel , Garland Suzanne , Kelly Heath
Published: February 2008

At an antenatal clinic at a Melbourne obstetric hospital, 308 women were questioned about a known past history of infection with varicella zoster virus (VZV), human parvovirus B19 and Toxoplasma gondii. Immunoglobulin G (IgG) concentrations were determined for the 3 infectious agents and a recalled history of infection was compared with the presence of specific antibody. Exactly 66% of women recalled being infected with chickenpox (VZV) and 94% showed serological evidence of past exposure. Although 64% of women had parvovirus specific IgG, only one gave a definite history of past parvovirus infection. None of the 23% of women with evidence of previous exposure to Toxoplasma gondii recalled a past infection. The proportion of antenatal women at risk in this study was used to estimate the potential burden of disease from congenital infections in Australia and to examine implications for management of pregnancies complicated by these 3 infections.
Prognostic value of baseline serum oestradiol in controlled ovarian hyperstimulation of women with unexplained infertility
Authors: Costello Michael F , Hughes Graeme J , Garrett Don K , Steigrad Stephen J , EkangaM Abie
Published: February 2008

This study aimed to evaluate the prognostic value of the baseline serum oestradiol E2 level on the cycle pregnancy rate (PR) in women with unexplained infertility (UI) undergoing controlled ovarian hyperstimulation (COH). This study is unique in that it evaluates the effect of cycle day 1 (rather than day 3) E2 levels on cycle PR in a COH setting (without IVF) in women with UI (rather than multiple causes of infertility).

Structured as a retrospective cohort study, the setting was the Ovulation Induction Clinic at an academic tertiary care hospital. One hundred and forty‐five patients with UI underwent 374 cycles of COH with either human menopausal gonadotrophin (hMG) alone or hMG and clomiphene citrate.

Outcome was measured as cycle pregnancy rate (PR) according to the cycle day 1 level of E2. Patients with an E2 level > 150 pmol/1 on cycle day 1 of COH achieved a significantly lower PR (4%) compared with those with E2 levels ≤ 150 pmol/1 (13%). Logistic regression analysis demonstrated that women with day 1 E2 levels below 150 pmol/1 were 3.2 times more likely to conceive than those with day 1E2 levels above 150 pmol/1. Also, the impact of day 1E2 levels on the chance of pregnancy was independent of day 1 serum FSH levels.

Women with UI undergoing COH in our unit with an elevated baseline serum E2 > 150 pmol/1 have a significantly lower PR and should be counselled regarding the decreased likelihood of pregnancy.
Guideline use for gestational diabetes mellitus and current screening, diagnostic and management practices in Australian hospitals
Authors: Rumbold Alice R , Crowther Caroline A
Published: February 2008

A postal questionnaire investigating screening, diagnosis and management practices for gestational diabetes mellitus (GDM) and guidelines use for GDM, was sent to 544 Australian hospitals providing maternity care. Of these, 360 (66%) responded. Guidelines for GDM were available in 127 (39%) hospitals. Screening for GDM was undertaken by 284 (87%) hospitals and of these, 151 (53%) screened all women and 63 (22%) selectively screened women. Half (143, 50%) of the hospitals surveyed screened women using a 50 g oral glucose challenge test (OGCT) and 70 hospitals (25%) used a 75 g OGCT.

A 75 g oral glucose tolerance test was most commonly used to diagnose GDM (207; 81%) and 126 hospitals (60%) recommended a 2 hour blood glucose level of ≥ 8.0 mmol/1 as diagnostic for GDM. In the management of women with GDM, levels for optimal glycaemic control varied. Postpartum testing for diabetes mellitus was recommended by the majority of hospitals (202; 72%). This study has shown the majority of Australian hospitals providing maternity care screening for GDM, but there is little consensus in screening practices.
Obstetric and neonatal outcomes associated with maternal naltrexone exposure
Authors: Hulse GK , O'Neill G , Pereira C , Brewer C
Published: February 2008

Poor maternal and neonatal outcomes are associated with the pregnant heroin user. These include increased antepartum haemorrhage, decreased neonatal birthweight and increased neonatal mortality. Medically supervised withdrawal from heroin during pregnancy has, however, been discouraged due to possible risk to the fetus and because of the high incidence of return to regular illicit heroin use by the mother. In recent years, however, a number of withdrawal procedures using anaesthesia, oral sedation, or intravenous sedation, precipitated by naloxone and/or naltrexone have been developed and carried out successfully on pregnant heroin users.

We have now collated information on 18 cases (19 detoxifications) from three countries (Portugal, Australia and the United Kingdom). These case study data, although limited, indicate that detoxification of the pregnant heroin user is possible without significant risk to the neonate or mother, with many women not returning to dependent heroin use following detoxification. Naltrexone maintenance has also been used in the non‐pregnant heroin user to discourage illicit heroin use.

Similarly to methadone, stabilisation on naltrexone may be associated with conception and pregnancy, i Over the past three years, 26 women have conceived j while on the Western Australia naltrexone pro‐ i gram. Due to the unknown teratogenic effects, most have ceased naltrexone intake at approximately seven or eight weeks gestation. In a number of ! instances, however, naltrexone maintenance has : been recommenced following return to a dependent pattern of heroin use. As a consequence, neonates have had different periods of naltrexone exposure. building from the initial seven or eight weeks.

We now report on seven women who have delivered and three who are well into their third trimester. Neonatal and obstetric features were unremarkable with good Apgar scores, birthweight and head cir cumference observed. In the three cases still in third‐term gestation, normal fetal development has been observed at recent ultrasound examinations. These case data indicate that naltrexone maintr nance may have a role in the management of the pregnant heroin user.
Pregnancy after Fontan repair of complex congenital heart disease
Authors: Hoare Jane V , Radford Dorothy
Published: February 2008

We describe four successful pregnancies in three women who had previously had a Fontan repair for congenital heart disease. Each pregnancy resulted in a live birth and there was no maternal mortality. The infants were premature, being delivered at 26, 30 and 35 weeks, and weighing 1020, 1333 and 1930 g respectively. The fourth infant was born at 32 weeks and no birthweight is available.

Maternal complications occurred and were those anticipated after a Fontan repair. Two mothers required treatment for supraventricular arrhythmias (atrial flutter and fibrillation). Ventricular failure was present in two mothers and required ongoing drug treatment. Raised systemic venous pressures caused peripheral oedema in two mothers and hepatomegaly and ascites in one mother. The physiology, potential complications, anaesthetic concerns and drug treatment in pregnancy after Fontan repair are discussed.
Bioactivity and stability of endogenous fibrogenic factors in platelet‐rich fibrin
Authors: Lundquist Rasmus , Dziegiel Morten H. , Ågren Magnus S.
Published: February 2008

Platelet‐rich fibrin (PRF®) is an autologous fibrin sealant (FS) enriched with a platelet concentrate (>1,000,000 platelets/μL) produced by the automated Vivostat® system and used to enhance wound healing. The effects of PRF were compared with supernatant from thrombin‐activated platelet concentrate, recombinant human platelet‐derived growth factor (rhPDGF) isoforms, and a homologous FS in cultured normal human dermal fibroblasts. Also, the release of selected endogenous growth factors from PRF and their stability against proteolytic degradation were studied. The proliferative effect of PRF exceeded that of FS and rhPDGF‐BB, although it was lower than thrombin‐activated platelet concentrate possibly due to sustained growth factor release from platelets in PRF. Anti‐PDGF antibody blocked the mitogenic effect of rhPDGF‐BB but not that of PRF in growth‐arrested fibroblasts. PRF promoted secretion of carboxyterminal propeptide of type I collagen into conditioned medium while rhPDGF‐AB had no significant effect on collagen biosynthesis. Limited proteolysis of PDGF‐AB and no proteolysis of transforming growth factor‐β1 (TGF‐β1) in PRF were observed with trypsin treatment, whereas rhPDGF‐AB and rhTGF‐β1 in bovine serum albumin, matching the total protein concentration of PRF, were almost completely degraded after 24 hours at 37 °C. To conclude, PRF provides sustained release and protection against proteolytic degradation of endogenous fibrogenic factors important for wound healing.
Tissue profiling MALDI mass spectrometry reveals prominent calcium‐binding proteins in the proteome of regenerative MRL mouse wounds
Authors: Caldwell Robert L. , Opalenik Susan R. , Davidson Jeffrey M. , Caprioli Richard M. , Nanney Lillian B.
Published: February 2008

MRL/MpJ‐Faslpr mice exhibit the ability to regenerate ear tissue excised by dermal punches. This is an exceptional model to identify candidate proteins that may regulate regeneration in typically nonregenerative tissues. Identification of key molecules involved in regeneration can broaden our understanding of the wound‐healing process and generate novel therapeutic approaches. Tissue profiling by matrix‐assisted laser desorption ionization mass spectrometry is a rapid, powerful proteomic tool that allows hundreds of proteins to be detected from specific regions of intact tissue specimens. To identify these candidate molecules, protein expression in ear punches was examined after 4 and 7 days using tissue profiling of MRL/MpJ‐Faslpr mice and the nonregenerative mouse strain C57BL/6J. Spectral analysis revealed distinct proteomic differences between the regenerative and nonregenerative phenotypes, including the calcium‐binding proteins calgranulin A and B, calgizzarin, and calmodulin. Spatial distributions for these differentially expressed proteins within the injured regions were confirmed by immunohistochemistry.
Anatoxin‐a occurrence and potential cyanobacterial anatoxin‐a producers in Spanish reservoirs1
Authors: Carrasco David , Moreno Enrique , Paniagua Thamar , Hoyos Caridad de , Wormer Lars , Sanchis Daniel , Cirés Samuel , Martín‐del‐Pozo Delia , Codd Geoffrey A. , Quesada Antonio
Published: February 2008

The presence of anatoxin‐a (ANA) in Mediterranean region freshwaters has been reported only recently, and this work presents the first survey for ANA on a national scale in such waters. Fourteen reservoirs were sampled over a distance of 550 km from northeast to southwest Spain. Genera of cyanobacteria with ANA‐producing members in other countries were present in all of the Spanish reservoirs, but this toxin was detected in only one reservoir. The maximum ANA concentration detected was 0.31 μg · L−1, and the most probable producer was Anabaena flos‐aquae (Lyngb.) Bréb. ex Bornet et Flahault. These findings suggest that in spite of the abundant cyanobacterial populations, ANA may be of lower occurrence in the Spanish reservoirs investigated than in other European freshwaters, and different strains of potential ANA producers occur in different ecoregions.
Distinct patterns of nitrate reductase activity in brown algae: light and ammonium sensitivity in Laminaria digitata is absent in Fucus species1
Authors: Young Erica B. , Dring Matthew J. , Berges John A.
Published: February 2008

Fucus and Laminaria species, dominant seaweeds in the intertidal and subtidal zones of the temperate North Atlantic, experience tidal cycles that are not synchronized with light:dark (L:D) cycles. To investigate how nutrient assimilation is affected by light cycles, the activity of nitrate reductase (NR) was examined in thalli incubated in outdoor tanks with flowing seawater and natural L:D cycles. NR activity in Laminaria digitata (Huds.) Lamour. showed strong diel patterns with low activities in darkness and peak activities near midday. This diel pattern was controlled by light but not by a circadian rhythm. In contrast, there was no diel variation in NR activity in Fucus serratus L., F. vesiculosus (L.) Lamour., and F. spiralis L. either collected directly from the shore or maintained in the outdoor tanks. In laboratory cultures, transfer to continuous darkness suppressed NR activity in L. digitata, but not in F. vesiculosus; continuous light increased NR activity in L. digitata but decreased activity in F. vesiculosus. Furthermore, 4 d enrichment with ammonium (50 μmol · L−1 pulses), resulted in NR activity declining by >80% in L. digitata, but no significant changes in F. serratus. Seasonal differences in maximum NR activity were present in both genera with activities highest in late winter and lowest in summer. This is the first report of NR activity in any alga that is not strongly regulated by light and ammonium. Because light and tidal emersion do not always coincide, Fucus species may have lost the regulation of NR by light that has been observed in other algae and higher plants.
Different strategies of photoacclimation by two strains of Emiliania huxleyi (Haptophyta)1
Authors: Suggett David J. , Le Floc’H Emilie , Harris Gayle N. , Leonardos Nikos , Geider Richard J.
Published: February 2008

Photoacclimation involves the modification of components of the light and dark reactions to optimize photosynthesis following changes in available light. All of the energy required for photosynthesis comes from linear electron transport through PSII and PSI and is dependent upon the amount of light harvested by PSII relative to PSI (a*PSII and a*PSI). The amount of light harvested is determined by the effective absorption cross‐sections (σPSII, σPSI) and cellular contents of the PSII and PSI reaction center complexes (RCII, RCI). Here, we examine the effective absorption cross‐sections and reaction center contents for calcifying (B11) and noncalcifying (B92) strains of the globally important coccolithophorid Emiliania huxleyi (Lohmann) W. H. Hay et H. Mohler when grown under various photon flux densities (PFDs). The two strains displayed different “strategies” of acclimation. As growth PFD increased, B11 preferentially changed σ and the cellular content of chl a per cell over PSU “size” (the total cellular chl a content associated with the reaction center complexes); strain B92 preferentially changed PSU size over the cellular content of reaction complexes. Neither strategy was specifically consistent with the majority of previous studies from other microalgal species. For both strains, cellular light absorption for PSII and PSI was maintained close to unity across the range of growth PFDs since changes of σPSII and σPSI were reciprocated by those of RCIIs and RCIs per cell. Our results demonstrate a significant adaptive flexibility of E. huxleyi to photoacclimate. Finally, we calculated the amount of chl a associated with either photosystem to consider our interpretations of photoacclimation based on conventional determinations of PSU size.
Parthenogenesis in the brown alga Lessonia nigrescens (Laminariales, Phaeophyceae) from central Chile1*
Authors: Oppliger L. Valeria , Correa Juan A. , Peters Akira F.
Published: February 2008

Parthenogenesis, the development of female gametes without fertilization, is relatively common in brown algae, although limited quantitative information on the phenomenon is available. Its occurrence is reported for the first time in Lessonia nigrescens Bory, a member of the Laminariales and a key ecological component of the benthic algal communities along the Chilean coast. Isolated female gametophytes developed into parthenosporophytes throughout the year, with a maximum in spring to early summer. Isolated male gametophytes, on the other hand, never developed fronds. Parthenosporophytes obtained in the laboratory developed normally when cultivated under greenhouse conditions, and the resulting individuals were indistinguishable in size, shape, texture, and color from heterozygous sporophytes. Quantification of DNA of various tissues demonstrated that early during their development, parthenosporophytes duplicated their DNA content, displaying levels similar to heterozygous sporophytes and almost twice the level found in gametophytes. One out of 45 individuals from a field population yielded only female gametophytes, strongly suggesting that parthenogenesis does occur in wild stands of L. nigrescens.
Origins of the secondary plastids of Euglenophyta and Chlorarachniophyta as revealed by an analysis of the plastid‐targeting, nuclear‐encoded gene psbO1
Authors: Takahashi Fumio , Okabe Yugo , Nakada Takashi , Sekimoto Hiroyuki , Ito Motomi , Kataoka Hironao , Nozaki Hisayoshi
Published: February 2008

Because the secondary plastids of the Euglenophyta and Chlorarachniophyta are very similar to green plant plastids in their pigment composition, it is generally considered that ancestral green algae were engulfed by other eukaryotic host cells to become the plastids of these two algal divisions. Recent molecular phylogenetic studies have attempted to resolve the phylogenetic positions of these plastids; however, almost all of the studies analyzed only plastid‐encoded genes. This limitation may affect the results of comparisons between genes from primary and secondary plastids, because genes in endosymbionts have a higher mutation rate than the genes of their host cells. Thus, the phylogeny of these secondary plastids must be elucidated using other molecular markers. Here, we compared the plastid‐targeting, nuclear‐encoded, oxygen‐evolving enhancer (psbO) genes from various green plants, the Euglenophyta and Chlorarachniophyta. A phylogenetic analysis based on the PsbO amino acid sequences indicated that the chlorarachniophyte plastids are positioned within the Chlorophyta (including Ulvophyceae, Chlorophyceae, and Prasinophyceae, but excluding Mesostigma). In contrast, plastids of the Euglenophyta and Mesostigma are positioned outside the Chlorophyta and Streptophyta. The relationship of these three phylogenetic groups was consistent with the grouping of the primary structures of the thylakoid‐targeting domain and its adjacent amino acids in the PsbO N‐terminal sequences. Furthermore, the serine‐X‐alanine (SXA) motif of PsbO was exactly the same in the Chlorarachniophyta and the prasinophycean Tetraselmis. Therefore, the chlorarachniophyte secondary plastids likely evolved from the ancestral Tetraselmis‐like alga within the Chlorophyta, whereas the Euglenophyte plastids may have originated from the unknown basal lineage of green plants.
Generation and analysis of 5318 expressed sequence tags from the filamentous sporophyte of Porphyra haitanensis (Rhodophyta)1
Authors: Xiaolei Fan , Yongjun Fang , Songnian Hu , Guangce Wang
Published: February 2008

Porphyra haitanensis T. J. Chang et B. F. Zheng (Bangiales, Rhodophyta) is cultivated in China and widely consumed in Asia. To gain more insight into its physiological and biochemical properties, we generated 5318 expressed sequence tags (ESTs) from the sporophyte of P. haitanensis, and upon assembling into a nonredundant set, 2535 sequences were obtained, among which only 32.2% (816) shared certain similarity with published sequences (Nr and KOG). Functional classification of such ESTs revealed that most of the transcripts were related to its conservative biological metabolism, and P. haitanensis most likely possesses cyanide‐resistant respiration and a C4‐like carbon‐fixation pathway, both of which have never been reported in a rhodophyte before. Twenty‐eight percent of the nonredundant gene clusters exhibited significant similarity to those from P. yezoensis Ueda sporophytes, and 16 genes up‐regulated in P. yezoensis sporophytes were also expressed abundantly in P. haitanensis. Codon usage analysis indicated that exposure to high GC pressure might occur during evolution of P. haitanensis. These findings represent the most extensive collection of ESTs from P. haitanensis to date, and all the ESTs in this study have been submitted to GenBank (accession nos. DN604790–DN608469, EG016226–EG018540).
Extent of Implementation of Evidence‐Based Fall Prevention Practices for Older Patients in Home Health Care
Authors: Fortinsky Richard H. , Baker Dorothy , Gottschalk Margaret , King Mary , Trella Patricia , Tinetti Mary E.
Published: February 2008

This study determined the extent to which fall risk assessment and management practices for older patients were implemented in Medicare‐certified home health agencies (HHAs) in a defined geographic area in southern New England that had participated in evidence‐based fall prevention training between October 2001 and September 2004. The standardized in‐service training sessions taught home health nurses and rehabilitation therapists how to conduct assessments for five evidence‐based risk factors for falls in older adults—mobility impairments, balance disturbances, multiple medications, postural hypotension, and home environmental hazards—using techniques shown to be efficacious in clinical trials. Twenty‐six HHAs participated in these in‐service training sessions; 19 of these participated in a survey of nurses and rehabilitation therapists between October 2004 and September 2005. Self‐reported assessment and management practices implemented with older patients during home healthcare visits were measured in this survey, and HHA‐level measures for each fall risk factor were constructed based on proportions of clinicians reporting assessment and management practices that were recommended in the fall prevention training sessions. For all fall risk factors except postural hypotension, 80% or more of clinicians in all HHAs reported implementing recommended fall risk management practices. Greater variation was found regarding fall risk assessment practices, with fewer than 70% of clinicians in one or more HHAs reporting recommended assessment practices for all risk factors. Results suggest that evidence‐based training for home healthcare clinicians can stimulate fall risk assessment and management practices during home health visits. HHA‐level comparisons hold the potential to illustrate the extent of diffusion of evidence‐based fall prevention practices within and between agencies.
Toward the Development of an Interdisciplinary Information Assurance Curriculum: Knowledge Domains and Skill Sets Required of Information Assurance Professionals*
Authors: Cegielski Casey G.
Published: February 2008

Since the ratification of the Sarbanes‐Oxley Act of 2002, both publicly traded companies and their respective financial statement auditors have struggled to comply with the requirements of the legislation. Utilizing three individual Delphi studies, separately, I surveyed partners, managers, and staff associates in the United States from each of the “Big 4” international accounting firms to ascertain from each respective group what knowledge domains and technical skills are most important in the practice of Sarbanes‐Oxley–related information assurance compliance. Analysis of the data collected provided the basis for the development and subsequent implementation of a new interdisciplinary business curriculum in information assurance.
Enhancing Undergraduates' Capabilities Through Team‐Based Competitions: The Edward Jones Challenge
Authors: Umble Elisabeth J. , Umble Michael , Artz Kendall
Published: February 2008

The Edward Jones Company recently initiated financial sponsorship of team‐based competitions in six undergraduate business core classes at Baylor University. The challenges were chosen to take place in an introductory freshman business class, Managerial Accounting, Principles of Marketing, Corporate Finance, Operations Management, and Strategic Management. Teams of students in each course competed for monetary awards ranging up to $1,000 per team member. This article describes the rationale behind the Edward Jones Challenge, reviews the literature as to the expected benefits of the group projects involved in the competition, summarizes the projects used in the various classes, analyzes the results of a student survey, tests a set of hypotheses relating project structure to the expected benefits, examines the positive results derived from the Edward Jones initiative, and discusses the lessons learned from the experience.
Classroom Questioning with Immediate Electronic Response: Do Clickers Improve Learning?
Authors: Yourstone Steven A. , Kraye Howard S. , Albaum Gerald
Published: February 2008

A number of studies have focused on how students and instructors feel about digital learning technologies. This research is focused on the substantive difference in learning outcomes between traditional classrooms and classrooms using clickers. A randomized block experimental design involving four sections of undergraduate Operations Management classes was used to determine if clicker systems increase student learning of both quantitative and conceptual material in Operations Management. Learning was measured using the difference between the scores on an entrance examination and the final examination. The findings of this research provide evidence that the use of immediate feedback using a technology like clickers can have a positive impact on student learning as measured by test scores.