bluuebunny/crossref_metadata_2025 huggingface dataset:
Viruses and the immune system: their roles in seizure cascade development
Authors: Getts Daniel R. , Balcar Vladimir J. , Matsumoto Izuru , Müller Marcus , King Nicholas J. C.
Published: February 2008

Viral encephalitis affects approximately 7.5 people/100 000 and carries a high rate of morbidity and mortality. Most patients with viral encephalitis will develop some form of seizure during the infectious process, and of those who survive encephalitic disease, approximately 4–20% will develop epilepsy. Arthropod‐borne (arbo)viruses are the leading cause of viral encephalitis in the world today, with between 10% and 35% of patients infected with these viruses displaying some form of seizure. Several neurotropic DNA viruses, including Herpes and cytomegalovirus also commonly cause seizures in infected patients. In the clinical setting, the cause of seizures seen during viral encephalitis is usually attributed to acute febrile responses. However, it has become apparent that the mechanisms behind seizure generation during viral encephalitis are likely to be much more complicated. For example, CD4+and CD8+T cells possibly through their secretion of interferon‐γ, appear to play an important role in determining neuronal responses when challenged with kainic acid. In addition, the ability of the human immunodeficiency virus, transactivating protein to modulate NMDA signaling possibly triggering seizures, highlights the fact that elements of the antiviral response and even virally derived proteins are capable of directly manipulating neuronal function. Understanding the complex relationships between the CNS, the immune system, and invading pathogens is a critical step in understanding the pathogenesis of seizures seen during viral infections and informing the development of novel therapies.
Dysregulation of intracellular calcium homeostasis is responsible for neuronal death in an experimental model of selective hippocampal degeneration induced by trimethyltin
Authors: Piacentini Roberto , Gangitano Carlo , Ceccariglia Sabrina , Fà Aurora Del , Azzena Gian Battista , Michetti Fabrizio , Grassi Claudio
Published: February 2008

Trimethyltin (TMT) intoxication is considered a suitable experimental model to study the molecular basis of selective hippocampal neurodegeneration as that occurring in several neurodegenerative diseases. We have previously shown that rat hippocampal neurons expressing the Ca2+‐binding protein calretinin (CR) are spared by the neurotoxic action of TMT hypothetically owing to their ability to buffer intracellular Ca2+overload. The present study was aimed at determining whether intracellular Ca2+homeostasis dysregulation is involved in the TMT‐induced neurodegeneration and if intracellular Ca2+‐buffering mechanisms may exert a protective action in this experimental model of neurodegeneration. In cultured rat hippocampal neurons, TMT produced time‐ and concentration‐dependent [Ca2+]iincreases that were primarily due to Ca2+release from intracellular stores although Ca2+entry through Cav1 channels also contributed to [Ca2+]iincreases in the early phase of TMT action. Cell pre‐treatment with the Ca2+chelator, 1,2‐bis(2‐aminophenoxy)ethane‐N,N,N′,N′‐tetraacetic acid tetrakis(acetoxymethyl ester) (2 μM) significantly reduced the TMT‐induced neuronal death. Moreover, CR+neurons responded to TMT with smaller [Ca2+]iincreases. Collectively, these data suggest that the neurotoxic action of TMT is mediated by Ca2+homeostasis dysregulation, and the resistance of hippocampal neurons to TMT (including CR+neurons) is not homogeneous among different neuron populations and is related to their ability to buffer intracellular Ca2+overload.
Age‐related changes in Drosophila midgut are associated with PVF2, a PDGF/VEGF‐like growth factor
Authors: Choi Na‐Hyun , Kim Joong‐Gook , Yang Dong‐Jin , Kim Young‐Shin , Yoo Mi‐Ae
Published: February 2008

Age‐associated changes in stem cell populations have been implicated in age‐related diseases, including cancer. However, little is known about the underlying molecular mechanisms that link aging to the modulation of adult stem cell populations. Drosophila midgut is an excellent model system for the study of stem cell renewal and aging. Here we describe an age‐related increase in the number and activity of intestinal stem cells (ISCs) and progenitor cells in Drosophila midgut. We determined that oxidative stress, induced by paraquat treatment or loss of catalase function, mimicked the changes associated with aging in the midgut. Furthermore, we discovered an age‐related increase in the expression of PVF2, a Drosophila homologue of human PDGF/VEGF, which was associated with and required for the age‐related changes in midgut ISCs and progenitor cell populations. Taken together, our findings suggest that PDGF/VEGF may play a central role in age‐related changes in ISCs and progenitor cell populations, which may contribute to aging and the development of cancer stem cells.
Gathering in Thoreau's backyard: nontimber forest product harvesting as practice
Authors: Robbins Paul , Emery Marla , Rice Jennifer L
Published: February 2008

Understanding of the gathering of nontimber forest products (NTFPs) in woodlands has focused heavily on politics surrounding public lands and harvester communities. Yet forest gathering may be far more universal. This paper reports the results of a survey of residents in New England, querying whether people gather wild things and for what purposes. The results suggest that gathering in New England, and elsewhere in the developed world, is not restricted to a unique type of community or economy, but instead is a form of practice. Those analytical approaches to NTFPs that seek to produce ‘alternatives’ to the dominant economy may therefore ironically work to reinforce a capitalocentric view of daily life.
Pressure ulcer prevalence and incidence in intensive care patients: a literature review
Authors: Shahin Eman SM , Dassen Theo , Halfens Ruud JG
Published: February 2008

Background:  Pressure ulcers remain a common health problem worldwide within the different health‐care settings, especially in intensive care settings.

Aims:  The aims of this were to systematically assess the recent prevalence and incidence of pressure ulcers in intensive care patients (2000–2005), the factors related to pressure ulcer prevalence and incidence and the methodological rigour of studies about pressure ulcer prevalence and incidence in intensive care patients.

Methods:  The research design involved a review of literature for the period of 2000 to 2005, focused on the prevalence and incidence of pressure ulcers in intensive care patients.

Results:  The analysis of published papers revealed variations in pressure ulcer prevalence in intensive care settings ranging from 4% in Denmark to 49% in Germany, while incidence ranged from 38% to 124%. There was a wide variation in the prevalence and incidence of pressure ulcers in intensive care patients as evidenced in the studies examined. There is also a gap between theory and practice in the prevention and treatment of pressure ulcers which needs to be addressed.

Conclusion:  Further research is needed regarding the effectiveness of nursing care on pressure ulcer development and into treatments that may successfully prevent their occurrence in intensive care patients.
Commentary: Brunker C. (2006). Assessment of sedated head‐injured patients using the Glasgow Coma Scale: an audit
Authors: Waterhouse Catheryne
Published: February 2008

The Glasgow Coma Scale (GCS) is widely used to assess head‐injured patients. However, patients with acute severe head injury are typically managed with varying doses of sedative drugs that may interfere with GCS assessments. There is a question as to whether GCS assessments are useful and justified when the patient is sedated. The limited literature available is briefly reviewed. The aim of the audit described in this paper was to gain an overview of current practice among the neuroscience intensive care units in the UK, in search of any consensus. Thirty questionnaires were distributed and 23 returned (a 77% response). The results show considerable variations in practice and, in particular, differences between those units that treat only neuroscience patients and those that manage general intensive care patients as well. This audit demonstrates a lack of clear consensus and highlights the need for more research.

Abstract reprinted from the British Journal of Neuroscience Nursing, volume 2, Brunker C, ‘Assessment of sedated head‐injured patients using the Glasgow Coma Scale: an Audit.’, pages 276–280. © 2006, reproduced with permission from MA Healthcare Limited.
Comparison of complications and procedural activities of pulmonary artery catheter removal by critical care nurses versus medical doctors*
Authors: Öztekin Deniz S , Akyolcu Neriman , Öztekin İlhan , Kanan Nevin , Göksel Onur
Published: February 2008

Background:  None of the nursing studies on PA catheter removal pointed out any differences in complications after removal and procedural activities for removal of PA catheter by CCNs vs MDs in Turkey.

Aims:  This quasi‐experimental study was conducted to determine the occurrence and type of complications and to indicate the differences between CCNs and medical doctors’ (MDs) activities for removal of PA catheter.

Methods:  Totally, 60 critical care unit patients were scheduled as a sample, and they were assigned randomly to the CCN (n = 30) or to the MD (n = 30) groups. For the comparison purposes of the different activities and complications of PA catheter removal procedure between the two groups, ‘Instruction Form’ was followed step by step. The differences in the prevalence of variables were tested using Student’s t statistics. For categorical data, Fisher’s exact test was used. Significance was declared by P value of <0·05.

Results:  Preprocedural activities like patient positioning (P < 0·001) and instructing the patient for breathing (P = 0·001) demonstrated statistically significant differences between the two groups. The PA catheters were removed properly in both groups (P > 0·05). The majority of postprocedural activities were completed successfully. The complications of the catheter removal were documented more carefully by nurses compared with doctors (P < 0·01). Additionally, singular premature ventricular complexes were observed on electrocardiogram in both groups (P > 0·05).

Conclusion:  Instructing CCNs to remove a PA catheter has been highlighted in keeping the number of complications associated with removal procedure of PA catheter.
Foetal Electrocardiography Using a Suction Electrode
Authors: Ross Heather J.
Published: February 2008

1. An electrode arrangement for obtaining a pure foetal electrocardiogram is described.

2. The advantages of the electrode used are listed.

3. The electroencephalograph amplifier and pen recorder used in this study are briefly described.
Adenomyosis and Carcinoma of the Endometrium*
Authors: Anderson B. H. , Bettinger H. F.
Published: February 2008

1. Adenomyosis and cancer of the body of the uterus are frequently associated. In 249 cases of endometrial carcinoma, adenomyosis was present in greater or less degree in 96 or 38.5 per cent.

2. The presence of adenomyosis does not appear to influence the type of malignant growth, the extent of invasion of the uterine wall, or the prognosis of the associated carcinoma.

3. The frequent association probably results from excessive or prolonged stimulation of oestrogens acting in a genetically susceptible individual.
Hydronephrosis and Hydro‐ureter in Genital Prolapse
Authors: Corkill Brian
Published: February 2008

1. Three patients with hydro‐ureter and hydronephrosis associated with genital prolapse have been presented. This complication is more common than usually believed.

2. When urinary symptoms are present in patients with uterine prolapse, full urological investigation should be instituted. with repair would appear to be the most logical form of treatment.
The Failure to Obtain “Early Stage Diagnosis” in Malignant Disease*
Authors: Donaldson Malcolm
Published: February 2008

AS this is my first visit to New Zealand, I am not in a position to say how many patients are seen for treatment of cancer when the growth is already advanced, but judging by experience in other countries every surgeon and gynaecologist sees a number of patients in whom the disease is so far advanced that any radical treatment with the idea of “cure” is impossible. Some statistics suggest it is over 50 per cent. In a great many cases this is the fault of nobody, because it is due to the disease failing to produce any symptoms before it has become disseminated to other parts of the body. But this is not always true, and among the 100,000 deaths in England and Wales each year due to malignant disease there are approximately 25,000 “accessible cancers” which do as a rule show signs of the disease whilst the growth is in an early stage, but which are neglected.
Serological Tests on Rh‐Immunized Mothers*
Authors: Krieger Vera I.
Published: February 2008

Serological tests for detection and estimation of Rh antibodies are briefly reviewed.

Results of serial indirect Coombs titres on Rh‐immunized mothers investigated during 1958 are presented.

The value of graphs of serial indirect Coombs titres in prediction of the likelihood of the baby developing erythroblastosis and the severity to be expected are discussed.
The Diagnosis of the Position of the Foetal Skull*
Authors: Cox L. Woodrow
Published: February 2008

The anatomy of the occipital bone, including its ossification at the time of birth, is described.

The relationship of the obstetrical hinge joint of Budin to the changes in shape of the foetal skull in labour is shown.

The prominence of the occipital protuberance and the superior curved lines of the occipital bone become useful landmarks due to moulding of the foetal head.

This landmark is of great value in the diagnosis of foetal position.
Some Observations on the Use of Bretylium Tosylate in Pregnancy
Authors: Whiley Warren , Shearman Rodney , Robinson Colleen
Published: February 2008

The use of bretylium tosylate in hypertensive pregnant women is discussed. Using C‐14 labelled material there is evidence of placental transfer but this does not appear to affect the foetus adversely. In 12 patients, Darenthin adequately controlled the blood pressure of both essential hypertension complicating pregnancy and pre‐eclampsia. There is insufficient evidence to show whether or not this control improves foetal prognosis or modifies other manifestations of toxaemia. In 1 patient, therapy was discontinued because of severe urticaria.
Prolapse of the Umbilical Cord: A Report of 50 Cases
Authors: Hammouda A. A.
Published: February 2008

A review of 50 cases of prolapse of the umbilical cord is presented.

The important aetiological factors are: malpresentations, prematurity, multiple pregnancy, hydramnios and placenta praevia. Parity is a relatively unimportant aetiological factor.

The degree of cervical dilatation is of prime importance in determining the method of treatment.

The foetal mortality in this series was 50%. When the foetal heart was present on admission the mortality was 35.9%. There were no maternal deaths.

Proper antenatal care, early diagnosis and the more liberal use of Caesarean section will help in the reduction of foetal loss.
A Case of Spontaneous Evolution of Transverse Lie
Authors: Childers C.
Published: February 2008

A case of spontaneous evolution of a transverse lie is presented with a review of the literature showing its rarity. It is considered that the mechanism involved in the case reported is similar to that described by Douglas (1819). The antenatal course was complicated by repeated bleeding per vaginam and premature labour: these were probably related to a circumvallate formation of the placenta.
Perinatal Mortality*
Authors: MacGregor T. N.
Published: February 2008

The data presented indicate the trend in perinatal mortality rates and show not only where improvement has occurred, but also where further improvement can be anticipated. The national figures emphasize very clearly that the death rates rise rather sharply in primigravidae over the age of 35 and in multi‐gravidae who have had 5 or more children. It is essential, therefore, that if the perinatal mortality associated with these 2 groups is to be further reduced, particular care must be given to these mothers during pregnancy and labour. Furthermore, it has been shown conclusively that the lower the social class of the father, the higher the foetal loss. Every effort must therefore be made to improve the living standards of this class.

A study of hospital statistics indicates that the known causes of perinatal mortality can be divided into 3 main groups:

(a) Prematurity: Foetal loss associated with prematurity in the past has been high, but methods of controlling infection in the newborn have saved many lives. Nevertheless, prematurity is the largest single cause of death within the first 7 days of life. It accounts for some 20% of all foetal deaths and, when those associated with toxaemia are added, the total is quite appreciable. A number of factors are involved in premature labour, so that it can rarely be prevented, but nonetheless every effort should be made. Hospitalization of those with multiple pregnancies at the 28th‐30th week of gestation and the maintenance of a strict hospital régime until the 36th week reduces the incidence of premature labour in the majority of cases. Furthermore, added rest at this stage of pregnancy not only lowers the incidence of prematurity, but also diminishes that of toxaemia.

(b) Congenital abnormalities: This is an important group. Our knowledge, however, of the genetic defects in the human is so scanty that it is unlikely that there will be improvement in this group in the immediate future.

(c) Toxaemia: Although the data indicate that the perinatal mortality associated with toxaemia has been reduced, this condition still accounts for some 20% of foetal deaths. Prematurity is undoubtedly a factor, but this would be partially overcome if the incidence of toxaemia could be reduced. This can only be accomplished by a more intensified scheme of antenatal supervision.

The importance of an autopsy in all cases of perinatal death has been emphasized. Thereby not only may much maternal distress be allayed but also prognosis for the future may be assessed. The significance of precise knowledge cannot be overstated.

A considerable further reduction in perinatal mortality is of immediate concern and is a challenge to all of us.
Inlet Contraction of the Pelvis
Authors: Glenning P. P. , Bond A. G.
Published: February 2008

1. A series of 159 patients with contraction of the pelvic inlet has been analysed, and the literature reviewed.

2. The over‐all incidence of caesarean section was 53%, and 43% if a trial of labour had been conducted.

3. There was no maternal death in the series.

4. The foetal mortality (corrected) was 4%. There was no mortality with caesarean section. Earlier resort to caesarean section in some patients would have increased foetal salvage.

5. Elective caesarean section is advocated when the obstetrical conjugate is below 9.0 cm.

6. The efficiency of uterine action is a major factor in determining the method of delivery. A labour lasting longer than 50 hours is unlikely to terminate in vaginal delivery, and the trial should be discontinued unless delivery seems certain within a few hours.

7. Premature rupture of the membranes is a poor prognostic sign; it was associated with a caesarean section rate of 75%.

8. A previous vaginal delivery in a patient with a contracted pelvis is not necessarily indicative of a successful vaginal delivery in a subsequent pregnancy. Greater use of caesarean section in such multi‐gravidae who have had a previous difficult delivery seems indicated.

9. The incidence of caesarean section in women over 5 feet in height (152 cm.) with a contracted pelvis was increased and was related to the larger size of their babies.

10. The incidence of contracted pelvis was greater in Southern European than in Anglo‐Saxon stock, but there was no concomitant increase in the caesarean section rate in such patients.
Obstructed Labour in Papuan Hospital Practice
Authors: Ryan B. P. K.
Published: February 2008

Forty patients with obstructed labour seen the General Hospital, Port Moresby, are described.

The commonest cause of this complication was cephalopelvic disproportion at the pelvic brim. Other common causes were transverse lie and occipito‐posterior positions and transverse arrest of the head.

There was no maternal mortality and the possible reasons for this are discussed.
Some Observations on the Height of the Fundus Uteri in Pregnancy
Authors: Smibert James
Published: February 2008

“It is crucial in measuring to know the error of the method; to have but an inaccurate measure may be regrettable, but to have it and not to know it is deplorable.”–Sir Thomas Lewis.
Pregnanediol Excretion in Pregnancy
Authors: Krieger Vera I.
Published: February 2008

1. Average normal, maximal and minimal curves for the 24‐hour urine excretion of pregnanediol by normal pregnant women are very similar, irrespective of the modifications of the original Somerville, Gough and Marrian method (1948) used by 5 groups of workers.

2. The average pregnanediol excretion curve for normal pregnant women has now been firmly established.

3. Approximately 3 times as many abortions occur in abortion‐prone patients whose pregnanediol excretion is not maintained near the average normal level – that is, above the “critical level” of Rawlings and Krieger (1958), or the “lower limit of normal” of Robson and Gornall (1955).
Maternal Mortality – With Special Reference to the Mechanisms of Death in the Toxaemias of Pregnancy
Authors: Green G. H.
Published: February 2008

Fifty‐six maternal deaths in 35,159 deliveries have been studied, with special regard to the mode of death in patients with severe toxaemia of pregnancy.

Toxaemia (23), haemorrhage (11), infection (10), and cardiac disease (5), were the commonest causes of death.

Maternal mortality was 1.62 per 1,000 live births.

The mechanisms of death in patients with toxaemia were:

(a) Acute circulatory failure– 11 patients.

Evidence is presented to show that these patients exhibited features similar to those in patients dying from septic abortion, intra‐uterine infection in labour, and premature placental separation without toxaemia.

It is suggested that all these deaths resulted from the manifestations of the generalized Shwartzman reaction in pregnancy.

(b) Vascular accidents– 9 patients.

These deaths were due mainly to disruption of major blood vessels. The wider use of hypotensive drugs to avoid such accidents is advocated.

(c) Miscellaneous– 4 patients.

This group consists of 2 patients with respiratory complications due to over‐treatment, 1 with pyaemia from a suppurative pyelonephritis and 1 sudden death after termination of pregnancy in a near‐uraemic patient.
Iniencephalus: A Report of Two Cases and a Review of the Obstetrical Aspects
Authors: Campbell J. M. , Miller M. D.
Published: February 2008

Two cases of iniencephalus have been presented; one was an example of iniencephalus apertus, the other, iniencephalus clausus.

The condition is an unusual one, since there were 10,000 deliveries separating these 2 cases.

Obstetrical aspects of the condition have been discussed and the literature has been briefly reviewed.
Bilateral (Simultaneous) Tubal Pregnancy
Authors: Kneale. Barry
Published: February 2008

1. A case of bilateral, simultaneous tubal prgenancy is reported.

2. The types and incidence of the condition are noted.

3. Absolute diagnosis rests on the finding of chorionic villi in each tube.

4. The importance of inspecting all pelvic viscera at laparotomy is stressed.
Complications Associated with the Use of the Gräfenberg Ring
Authors: Wren Barry G.
Published: February 2008

The case‐records of 12 patients admitted to a metropolitan hospital with complications resulting from the insertion of the Grafenberg ring are reviewed.

Except in occasional cases the use of the Gräfenberg ring is inadvisable.

It is recommended that smears should be taken at regular intervals from the cervix if Gräfenberg rings are in situ and that a ring biopsy should be taken from the cervix when the ring is permanently removed.

Mention is made of certain rules which should be adhered to if Gräfenberg rings are to be employed.
Cone Biopsy of the Cervix
Authors: Glenning P. P.
Published: February 2008

The procedure of cone biopsy of the cervix is described.

Its efficacy as a method of diagnosis of cervical epithelial abnormalities and its possible place as a method of treatment are discussed and the literature is reviewed.

A series of 30 cases is presented and analysed.
Advanced Skeletal Metastasis from Adeno‐acanthoma of the Uterine Body
Authors: Schweitzer G.
Published: February 2008

A case of advanced tibial metastasis from an adeno‐acanthoma of the uterus is reported.

The initial presentation was that of a pathological fracture, which healed readily with immobilization. The nature of the primary lesion was unsuspected until severe haemorrhage from the tumour in the leg necessitated admission to a general hospital.
The Vagal Factor in Foetal Heart Rate Change:II.–Some Experience with Anti‐Cholinergic Drugs
Authors: Bradfield Alan
Published: February 2008

The commonest type of heart rate pattern in clinically detectable foetal distress appears to result from umbilical cord complications.

It has a primary reflex basis. The efferent arc is the foetal vagus nerve.

The effect on foetal heart rate of drugs with anti‐vagal activity has been investigated during labour in 61 patients about term.

Atropine was given intravenously to 31 mothers who showed foetal heart rate patterns of the “cord” type. Within 15 minutes it consistently increased foetal heart rate and relieved bradycardia. When this effect was delayed there was clinical and electrocardiographic evidence to suggest an unusual degree of vagotonia.

Atropine was also injected directly into the foetal scalp on 14 occasions. Identical changes in heart rate were seen, except that their onset was more rapid. This is additional evidence of the specificity of action of the drug itself and of its transplacental passage.

Scopolamine, given to 8 mothers, altered the foetal heart rate in the same way as atropine. This action should not be overlooked when the drug is used as a sedative.

Scopolamine n‐butyl bromide (buscopan) injected intravenously to 8 mothers was not associated with any change in foetal heart rate.

Foetal heart rate is a single parameter of a complex physiological situation. Hence, the demonstrable relief of “cord” bradycardia by atropine and scopolamine must not yet be taken as licence for their use in clinically detectable foetal distress.
Two Types of Squamous Epithelium of the Human Ectocervix A Histological and Colposcopic Study
Authors: Reid B. L. , Garrett W. J. , Coppleson J. V. M.
Published: February 2008

The human ectocervix is divided into two zones, a circumoral regenerate epithelium and a more peripheral native epithelium. Each zone possesses a specific histological and colposcopic structure involving epithelial and subepithelial layers. Colposcopic examination reveals a difference in colour and texture of the two areas, whilst histological examination reveals differences in the type and arrangements of cells and tissues in both epithelial and subepithelial layers. These differences are manifest at a sharp junction represented by the line visible in the colposcope.

The significance of the occurrence of atypical epithelia on the more central (regenerate) portion of the cervix as it affects the problem of the origin of cancerous change is discussed. A homology is suggested concerning the sharp junction always found between native and regenerate epithelia and a similar junction sometimes found between atypical and native epithelium.
The Fern Phenomenon or Arborization Test
Authors: Heron H. J.
Published: February 2008

1. The literature on the arborization or ferning phenomenon has been briefly reviewed.

2. The presence of this phenomenon in liquor amnii has been demonstrated.

3. A crystalline structure synthesized to give the same characteristics has been shown to be composed of sodium chloride, minimal amounts of cholesterol and uric acid in the correct proportions.

4. Arborization is not restricted to the cervical mucus, but also may be found in sweat, tears and saliva of both the female and male.

5. In patients with threatened abortion, arborization may be due to the presence of liquor amnii.

6. In other instances it is felt that the phenomenon is the product of normal body fluids.
Uterine and Oxytocic Activity in Women in Labour
Authors: Hawker R. W. , Goodricke B. , Klemm G. H. , Pearson I. , Christie W. , Devietti A. , Cockburn K. G.
Published: February 2008

A series of 44 healthy women in labour has been studied.

It has been shown that blood O.A. and O.S. values are greater in late first‐stage and second‐stage labour than in the third trimester of pregnancy in both primiparous and multiparous women; that oxytocin is greater in second‐stage labour in the whole series than in women near term (due to increases in primiparous and not in multiparous women); and that the blood O.A., O.S. and oxytocin values do not change significantly throughout the subsequent course of labour after the cervix is about half dilated.

Uterine activity increases throughout labour in all women. Uterine tone increases throughout labour in multiparous women, and during second‐stage labour in primiparous women.

It has been postulated that O.S. acts as a trigger to the uterus.
Pregnancy Complicated by Torsion of a Unilateral Krukenberg Tumour
Authors: Alwyn John E. S. , Zacharin Robert F.
Published: February 2008

Torsion of a unilateral Krukenberg tumour complicating pregnancy and resulting in abortion is reported.

This association is exceedingly rare.

Other cases of this combination have resulted in rapid death, and, in this case, a recurrence of the primary tumour at the site of origin was detected.

The relevant literature is reviewed
Recurrent Ectopic Pregnancy
Authors: Kloss M.
Published: February 2008

Thirty‐three patients with a second ectopic pregnancy have been presented, together with a brief review of the pertinent literature.
Amaurosis in Pregnancy
Authors: Radford A. J. , Dow Ruth
Published: February 2008

An interesting patient with convulsions and amaurosis is reported in whom hypertension, but not proteinuria was present.

The aetiology and treatment of amaurosis in pregnancy is presented. It is suggested that the following is the most efficacious treatment of amaurosis due to arterial spasm:

Amyl nitrite inhalation.

Intravenous administration of diuretics, and a vasodilator or local anaesthetic.

Stellate ganglion block should be performed if the condition persists.

Immediate termination of the pregnancy.

The value of ophthalmoscopy is emphasized.
Physiological Metaplasia on the Human Cervix Uteri
Authors: Reid B. L. , Coppleson Malcolm
Published: February 2008

The columnar epithelial‐covered portion of the cervix of 10 healthy women in the postpartum period was examined by a correlated study using colposcopy and histology (including electron microscopy). The aim of the study was an examination of the process of metaplasia. A further 43 cervices were studied by histological and electron microscopic methods alone. The subdivision of the columnar epithelium into rugae and villi is described. Colposcopic and histological alterations in the villi are described, leading to their fusion and conversion to a smooth epithelial sheet. The conversion is especially associated with areas of prominence as viewed from the vagina, for instance, adjacent to the portio and following the summits of rugae. The distribution of the process indicates that the final healed transformation zone is a union of such patches. The origin of the new squame cells is viewed as the original columnar epithelium with or without the addition of subepithelial cells.

The evidence supports the concept of the high incidence of metaplasia in the postpartum cervix and suggests that it is a purely physiological event resulting from an in situ alteration of the columnar epithelium.
Response of Myometrial Autografts in the Rabbit Ear chamber to Oxytocin during Pregnancy
Authors: Michael C. A. , Cliff W. J.
Published: February 2008

The changing sensitivity of myometrial autografts within rabbit earchambers to intravenous injections of oxytocin throughout the course of 6 normal pregnancies has been studied in a group of 5 female rabbits.

The myometrial autografts were shown to be sensitive to oxytocin from the 7th day of pregnancy.

The progressive reduction in the dosage of oxytocin necessary to produce myometrial contractions in the autografts has been shown to conform to a log hyperbolic curve.

The rather precise mathematical form relating minimum effective dose of oxytocin to day of pregnancy, obtained from these experiments, indicates that this preparation is of great potential value for the elucidation of the exact pattern of control of myometrial sensitivity throughout pregnancy.

The myometrial autografts increased very considerably in size during the progress of pregnancy and showed a rapid reduction in size post partum.

Associated with pregnancy, from as early as the 5th‐6th day, the vessels of the microcirculation, both in the grafts and in the earchamber fibrous tissue, developed very rapid pulsatile flow.
Ultrasonic Wave Diagnosis of Pelvic Tumours
Authors: Murooka H. , Ishihara M. , Uchida R.
Published: February 2008

In ultrasonic diagnosis in the field of gynaecology, it is our opinion that the crystal vibrator is best applied through the vagina.

We have devised special detectors for this purpose, a brief description of which has been given.

Pregnancy has been diagnosed at an early stage by this method. In addition, the technique is helpful in the differential diagnosis various intrapelvic turnours, such as uterine myomata.

No side‐effects have been noted and the manipulation can be done quite painlessly.
Cervical Carcinoma in Situ: True Cancer or Non‐Invasive Lesion?
Authors: Green G. H.
Published: February 2008

The commonly accepted view that cervical carcinoma in situ is necessarily a precursor of invasive cancer is questioned. Evidence to support the contention that carcinoma in situ may pursue a benign course in a large proportion of patients is presented.

(a) Clinical evidence. A series of 278 patients with carcinoma in situ dealt with in the years 1951‐62 is considered. Of these, 151 were treated by hysterectomy and 127 by conservative local excision. Fourteen of the latter were re‐coned because of positive cytology and 7 post‐hysterectomy patients showed evidence of vault recurrence. The follow‐up period for the conservative group ranged from 1 to

(i) Although many patients have shown positive follow‐up cytology, and cone biopsy has been found to be only about 80% effective in totally excising carcinoma in situ, no lesion has yet progressed to invasion. It is felt that one reason for this is that invasive cancer was, as adequately as possible, excluded at the outset.

(ii) None of 14 patients with carcinoma in situ to the biopsy margin, followed after cone biopsy only, have shown progression of the tumour to invasion for periods up to 5 years.

(iii) None of 17 patients with “microinvasive” lesions treated conservatively and followed for periods up to 5 years have shown progression of the tumour to invasion.

(b) Indirect statistical evidence. A series of 917 patients with invasive cervical carcinoma treated in 2 periods of 8 years each (before and after the advent of cytology in 1954) is presented. The incidence of invasive cervical cancer in gynaecological admissions was falling steadily in the 8 years before cytology was introduced and the rate of fall has not been accelerated since. Also the proportion of early (Stage 1) cases was rising before cytology was introduced and this rise has not obviously been thereby accelerated.

(c) Experimental evidence. The work of Saphir et al. (1959) and Kaminetzky (1960) in producing with podophyllin transient lesions of the cervix resembling carcinoma in ‘situ is referred to. Other local injurious influences which could conceivably produce such lesions, characterized by the picture of “frozen mitoses,” include inflammation, pregnancy, and irradiation.

A plea is made for the replacement of the various synonyms of carcinoma in situ (all of which contain the word “cancer”) by a term such as “suspicious cervical dysplasia.”

It is concluded that the virtual elimination of invasive cancer of the cervix by large‐scale cytology campaigns, as propounded especially by Boyes et al. (1962), is open to doubt.
The Pathology of the Mixed Carcinomas of the Cervix
Authors: McLean M. R.
Published: February 2008

An outline is presented of the pathology of the mixed carcinomas of the cervix, based on experience with these tumours at the National Women's Hospital.

A description is given of the histological features of the mature or differentiated group and of the immature or poorly differentiated group (including the two most undifferentiated variants of the latter group, the glassy cell type and the signet‐ring cell type).

A correlation of the histological types with the main clinical features of a group of patients with carcinoma of the cervix is presented, to allow a comparison of the mixed carcinomas with squamous carcinomas and adenocarcinomas.

Attention is drawn to the incidence of the mixed carcinomas in general, the high incidence of these types when the tumour occurs in pregnancy, and the poor prognosis of the immature mixed group, particularly the signet‐ring cell and the glassy cell types.

Distinctive features of this group of carcinomas are briefly discussed.
Primary Carcinoma of the Vagina
Authors: Blunt V. A. W.
Published: February 2008

A series of 44 patients with primary vaginal carcinoma has been reviewed and a comparison has been made with other published series.

Reasons are given for the need to adopt a more optimistic view of prognosis at the present time.

Different treatment modalities are discussed. Radical radiotherapeutic methods are considered to be the treatment of choice in most cases.

The need for cytological follow‐up in genital tract carcinoma is emphasized.
Bacteraemic Shock in Obstetrics
Authors: O'Neill James P.
Published: February 2008

THE occurrence of vascular collapse during the course of a severe infection by bacteria which do not produce an exotoxin was first described by Friderichsen in 1918, in cases of meningococcal septicaemia. He pointed out that such collapse could occur without haemorrhage into the adrenal glands, and, following the description of this “Syndrome”, it became recognized that shock could occur in a variety of infective conditions, Gram negative bacteria usually being demonstrable on blood culture. Thus, Stevens (1953) noted that profound hypotension could result from the transfusion of infected blood. In 1956, severe shock due to B. coli bacteraemia was reported by both Studdiford in 7 cases of septic abortion, and Dumoulin in 3 obstetrical patients—2 of these latter had developed an overt intrapartum infection.
Pregnancy in Leukaemia
Authors: Stevens F. R. T. , Fisher H. M.
Published: February 2008

THE association of pregnancy and acute leukaemia is rare. In 1943 McGoldrick and Lapp collected 34 such cases which had been recorded in the world literature. Yahia, Hyman and Phillips (1958) found reports of an additional 32'cases between 1943 and 1956. In most instances an acute onset of the leukaemia was observed during the course of an established pregnancy. Premature labour was common; the foetal mortality in the earlier reported group was 60%, whilst in the latter group it was below 40%. None of the babies developed leukaemia so far as is known. Although all mothers died during the pregnancy or within a few months post partum, survival time should improve in future with modern treatment.
Management of the Third Stage of Labour
Authors: Cunningham W. D.
Published: February 2008

To Summarize

Give an oxytocic agent with the birth of the head or anterior shoulder. Deliver the trunk of the foetus slowly.

Control the corpus uteri with the left hand while the right hand gains information by tension on the umbilical cord.

When the placenta is found lying in the cervix and vagina, pull downwards on the cord, keeping control of the corpus uteri with the left hand.

Examine the secundines carefully after delivery.
Surviving Korean Quadruplets
Authors: Mackenzie Helen P.
Published: February 2008

A further case of surviving female quadruplets is reported.

The mother died from eclampsia shortly after admission to hospital 24 hours post partum.

The placenta was injected via the umbilical veins with coloured solutions and communications between placental areas indicated that the quadruplets were uniovular.

The management of the infants is described.
Ligation of the Cervix — Its Place in Recurrent Abortion
Authors: Rawlings W. J.
Published: February 2008

1. The role of cervical ligation in the treatment of recurrent abortion has been studied in a series of 100 patients.

2. It is considered that in patients with late abortion and premature labour there is usually an active process of extrusion of the uterine contents, and only rarely is there a mechanical fault in the cervix.

3. In these patients it is important that progesterone deficiency and anxiety states be treated adequately.

4. The course of subsequent pregnancies in these patients will establish the relative value of cervical ligation. This study and the conclusions will appear in Part II.
Christmas Island: Indian Ocean Obstetrics in an Isolated Community
Authors: Parker M. LeMoine
Published: February 2008

The obstetric service provided for the inhabitants of Christmas Island has been outlined and the records of the period 1950 to 1960 have been reviewed, in order to determine the overall pattern of obstetrics and the incidence of complications.
Studies of Nutrition in Pregnancy 4. Diet and Lactation
Authors: Hankin M. E. , Symonds E. M. , Cellier K. M.
Published: February 2008

1. A study of lactation and diet in a group of 174 primigravid and secundigravid women is presented.

2. The mean (geometric) length of lactaction was 4.8 weeks. Two weeks after delivery 70% of all subjects were breast feeding whilst at 6 weeks only 45% were breast feeding.

3. The length of lactation was greater in subjects with a higher antenatal dietary rating.

4. The length of lactation was greater in patients with better postnatal diets.

5. A diet of 70 g. protein/day, 800 mg. calcium/day and 2,500 calories/day seemed adequate for the maintenance of lactation.

6. The mean length of lactation in those subjects owning their own home was longer than that in those not owning their own home.

7. Parity was not related in this series to length of lactation. Subjects 19 years or younger were as successful in lactation as those 20 years and older.

8. The length of lactation of the mother did not seem to affect the weight of the infant at 6 and 12 months.

9. The mean maternal weight gain 12 months after delivery compared with pre‐conception weight was 0.45 kg. (1 lb.) and there was no relationship beween length of lactation and maternal weight gain at the end of 12 months.
Lymphography in Carcinoma of the Cervix
Authors: Biggs John S. G.
Published: February 2008

A study of patients with operable carcinoma of the cervix has shown lymphography to be a simple procedure with few complications.

The presence or absence of metastases in the pelvic lymph nodes was correctly predicted in 11 out of 22 patients studied. Lymphography was thus of limited assistance in diagnosing metastases.

The procedure was of value in making the lymph nodes more obvious at operation and in showing whether their dissection had been complete.
Massive Post Partum Haemorrhage
Authors: Mackay Eric V.
Published: February 2008

1. A 10‐year study of 120 patients with massive, primary post partum haemorrhage is presented.

2. The aetiological factors were as follows: retained placenta, 54 patients; birth canal trauma, 43 patients; coagulation defect, 11 patients; and uterine “atony”, 12 patients.

3. Although a major degree of control has been obtained over haemorrhages resulting from uterine atony and coagulation defect, the other 2 groups may fully tax the obstetrician's resources (as a result of morbid placental adherence and major vessel damage).

4. There were 5 maternal deaths in the series, 4 from birth canal trauma and 1 from an incompatible blood transfusion.
Ligation of Uterine Arteries, per Vaginam, in a Case of Recurrent Secondary Post Partum Haemorrhage Following Caesarean Section
Authors: Ross Ian C.
Published: February 2008

A case of recurrent post partum haemorrhage from the lower uterine segment wound of a Caesarean section is presented.

The facility of ligation of the uterine arteries per vaginam to control such haemorrhage is shown.

Eleven cases, both published and from the records of the Royal Women's Hospital, are reviewed with regard to the clinical features, aetiology, treatment and prognosis.
Face Presentation
Authors: Campbell J. M.
Published: February 2008

A series of 121 patients with face presentation is described. The incidence, aetiology, mechanism of labour, method of delivery and results are discussed.

A more conservative approach towards the management of complicated cases is suggested.
A Review of Carcinoma of the Cervix, Corpus Uteri and Vagina: From the Thirteenth Annual Report of the Cancer Committee of F.I.G.O.
Authors: McGarrity† K. A.
Published: February 2008

A short summary of the background and objectives of the Report of the Cancer Committee of F.I.G.O. is given,

Staging rules recommended by the Cancer Committee adopted by the General Assembly of National Societies of F.I.G.O. at Mar del Plata in 1964, are given in relation to cervical, uterine, and ovarian cancer.

A histological classification of the common primary epithelial tumours of the ovary adopted by the same General Assembly at Mar del Plata is given.

Stage distribution and 5‐year survival rates are given for 117,613 patients with cancer of the cervix, 13,125 patients with cancer of the corpus uteri, and 1,156 patients with cancer of the vagina.

Stability of recovery rates in carcinoma of corpus uteri and cervix uteri are compared.

Future proposals for collection of information on carcinoma of ovary and vulva and intraepithelial cancer are given.
Early Post‐operative Intestinal Obstruction After Gynaecological Surgery
Authors: Davis Neville
Published: February 2008

Always consider the possibility of mechanical obstruction in the early postoperative period, even though the symptomatology is atypical. Do not be misled into thinking it is a case of paralytic ileus just because pain is absent or insignificant.

Paralytic ileus does not recur. If there is recurrent vomiting or distension think of a mechanical cause. Check the serum electrolyte levels and give intravenous potassium if indicated.

Re‐examine the patient frequently and take particular note of the pulse.

Take repeated x‐rays of the abdomen, as they will often show whether the obstruction is progressing or not. Remember that oral Gastrografin will often reach the caecum in six hours if the bowel is not mechanically obstructed.

Strangulating obstruction is not uncommon, occurs particularly in the first week and carries a high mortality.

Use continuous suction in preference to intermittent suction because the former removes air as well as liquid. Do not imagine that suction decompression will be effective in all cases.

Remember the indications to re‐open the abdomen:

the slightest suspicion of strangulation;

signs that the obstruction is not relenting.

Decompression of the small bowel at operation is safe and effective.