bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrauterine Sonographic Visualization of Embryonic Genital Tubercle
Authors: Hata Toshiyuki , Tanaka Hirokazu , Hayashi Keiji , Yamashiro Chizu , Ohnishi Yohichi , Akiyama Masashi , Yanagihara Toshihiro
Published: April 2003

Objective: To visualize embryonic genital tubercle using intrauterine sonography with a 20-MHz flexible catheter-based high-resolution real-time miniature transducer in early first-trimester pregnancy. Design: Randomized prospective study. Methods: A total of 39 women about to undergo therapeutic abortion from 7 to 10 weeks’ gestational age were studied with specially developed catheter-based high-resolution real-time miniature (2.4 mm in outer diameter) ultrasound transducer (20 MHz). Before the intrauterine sonographic procedure was performed, transvaginal sonographic assessment of the embryo was conducted. The percentage of embryonic genital tubercle (or phallus) visualized at each gestational age using intrauterine and transvaginal sonography is presented. Results: The genital tubercle could not be identified at 7 weeks of gestation with intrauterine sonography. The genital tubercle was visualized in 30% of embryos at 8 weeks’ gestation, and in 100% of embryos at 9 and 10 weeks. The genital tubercle was situated somewhat cranially to the sacral prominence at this gestational age. The genital tubercle could not be depicted with transvaginal sonography between 7 and 10 weeks of gestation. Conclusions: Intrauterine sonography provides a novel means for visualization of genital tubercle of the embryo. These results suggest that intrauterine sonography can become an important modality in future embryological research and in detection of embryonic developmental disorders in the early first-trimester pregnancy.
Evaluation of Fetal Heart Rate Patterns during the Second Stage of Labor through Fetal Oximetry
Authors: Salamalekis E. , Vitoratos N. , Loghis C. , Panayotopoulos N. , Kassanos D. , Creatsas G.
Published: April 2003

The purpose of this study was to assess the feasibility and accuracy of fetal pulse oximetry during the second stage of labor in cases with abnormal fetal heart rate (FHR) patterns with reference to postpartum acid-base status and Apgar scores. Forty-eight parturients with normal and 20 parturients with abnormal FHR tracings during the second stage of labor were monitored by fetal pulse oximetry and postpartum umbilical artery pH, pO2, pCO2 values and 1- and 5-min Apgar scores. The mean SpO2 value was 55.47 ± 9.95% in cases with normal and 52.55 ± 16.42% in cases with abnormal FHR patterns. A significant correlation was noted between fetal SpO2 and umbilical artery pH in cases with normal (r = 0.76, p < 0.05) as well as in cases with abnormal FHR patterns (r = 0.78, p < 0.05). No significant correlation was found between fetal SpO2 and Apgar scores at 1 and 5 min in cases with normal FHR patterns. On the contrary a significant correlation was noted in cases with abnormal FHR patterns. A normal FHR pattern alone is reassuring. In cases with abnormal FHR, fetal pulse oximetry is an objective method for distinguishing a hypoxic fetus.
Anticardiolipin Antibodies and the Severity of Preeclampsia-Eclampsia
Authors: Martínez-Abundis Esperanza , González-Ortiz Manuel , Cortés-Llamas Verónica , Salazar-Páramo Mario
Published: April 2003

Objective: To identify and compare anticardiolipin antibodies (aCL) in patients with eclampsia, different grades of preeclampsia and women with normotensive pregnancy. Methods: A cross-sectional study was conducted in 13 patients with eclampsia, 39 with preeclampsia (13 severe, 26 mild), and 52 normotensive pregnant women. All of them were studied in the 3rd trimester of pregnancy. The aCL were determined by an ELISA method. Results: There were no significant differences in IgG aCL (F = 0.33, p = 0.80) and IgM aCL (F = 1.64, p = 0.18) between patients with eclampsia (6.9 ± 3.9 U/GPL and 4.0 ± 2.0 U/MPL), severe preeclampsia (5.7 ± 3.5 U/GPL and 2.9 ± 1.3 U/MPL), mild preeclampsia (6.8 ± 3.9 U/GPL and 2.8 ± 1.0 U/MPL) and normotensive pregnant women (6.4 ± 3.4 U/GPL and 3.0 ± 1.8 U/MPL). None of the values of the aCL were considered as positive. Conclusion: Serum aCL levels were similar in patients with different grades of preeclampsia-eclampsia and women with normotensive pregnancy.
Obstetric Uterine Rupture: A Four-Year Clinical Analysis
Authors: Ziadeh Saed M. , El-Jallad Mohammad F. , Sunn’a Elias I.
Published: April 2003

Objective: The purpose of our study was to identify the risk factors of uterine rupture during labour, to report maternal and neonatal outcome, and to propose preventive measures. Study Design: A retrospective study with review of patients’ files and monitor strips was performed. Results: Between January 1, 1994 and November 30, 1998, there were 21 cases of uterine rupture at our institution. Of these, 6 patients had complete rupture, and 15 had incomplete rupture. The risk of uterine rupture was increased in patients who had a history of one or more Caesarean sections, obstructed labour, dysfunctional labour, and those who had injudicious use of uterine stimulants. There was no maternal death and fetal loss was 7 (33.3%). Conclusions: The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high-risk patients outside hospital because of declining economy, and more patients with two or more previously scarred uterus. The maternal and neonatal complications have remained very high in the developing countries. We recommend that all patients with a history of Caesarean delivery should be delivered in hospital and observed closely for progression of labour, recognition of an active phase arrest requires operative delivery.
Timing of Sonohysterography in Menstruating Women
Authors: Wolman Igal , Groutz Asnat , Gordon David , Kupferminc Michael J. , Lessing Joseph B. , Jaffa Arial J.
Published: April 2003

A prospective, blind study was carried out on 44 patients to evaluate the most suitable time to perform transvaginal sonohysterography. On the day of arrival at our unit, regardless of their cycle day, the women underwent sonohysterographic evaluation, which was repeated during the first 10 days of the next cycle. Patients with sonohysterographic findings underwent hysteroscopy. According to the timing of the first examination, they were divided into two groups, i.e. group 1 for the first 10 days of the cycle, and group 2 for days 16 through 28. At the end of the study the groups were compared. The results showed a false-positive rate of 27% in group 2, while no false-positive was found in group 1. We concluded that the best time for sonohysterography in patients who still have their menstrual period is during the first 10 days of the cycle.
Salpingectomy for Unilateral Hydrosalpinx May Improve in vivo Fecundity
Authors: Choe Jung , Check Jerome H.
Published: April 2003

The objective of this study was to determine whether unilateral salpingectomy for hydrosalpinx could improve fecundity in women with an apparently normal contralateral tube. Two women with unilateral hydrosalpinx and with an apparently normal contralateral tube, and a long history of infertility, including failure to conceive despite several cycles of in vitro fertilization (IVF), had unilateral salpingectomies prior to considering subsequent IVF cycles. Case 1 conceived after 1 month following surgery and case 2 after 8 months without the use of assisted reproductive technology. Though the ensuing pregnancies may have been fortuitous, the possibility exists that in cases of unilateral hydrosalpinx, the performance of salpingectomy may improve fecundity without the need for IVF. Hopefully the outcome of these 2 case reports may generate interest in a larger cooperative prospective study.
Three-Dimensional Sonographic Visualization of Fetal Skeleton in the Second Trimester of Pregnancy
Authors: Yanagihara Toshihiro , Hata Toshiyuki
Published: April 2003

Purpose: To demonstrate the potential of using three-dimensional (3D) sonography to reveal anomalies of fetal skeleton. Materials and Methods: Forty-two normal fetuses and 3 anencephalic fetuses from 14 to 27 weeks’ gestation were studied with a specially developed abdominal 3D transducer (3.5 MHz). This imaging system provided conventional two-dimensional (2D) sonographic images and also generated within seconds high-quality 3D images in the surface and transparent mode with no need for an external workstation. Results: Using this imaging system, we obtained 2D and 3D images of fetal skeleton (skull, scapula, spine, rib, humerus, ulna/radius, pelvis, femur, and tibia/fibra) at two gestational ages. The percentages of fetal skeletal visualization at less than 20 weeks of gestation using 3D sonography were 78–100%, whereas those with 2D sonography were all 100%. The percentages of skeletal structures revealed after 20 weeks’ gestation using 3D sonography were 82–100%, whereas those with 2D sonography were all 100%. We found no significant differences in detection rates of the fetal skeleton between 2D and 3D sonography. However, 3D sonographic images generally provided a more comprehensive view of the fetal skeleton than did conventional 2D sonography. In 2 cases with anencephaly, 3D sonography clearly revealed the defect of cranium. Conclusion: The new 3D sonographic technology can generate within seconds high-quality 3D images of the fetal skeleton. The 3D technology seems to perform at least as well as conventional 2D sonography. Our results suggest that 3D sonography has the potential to supplement 2D sonography and might be useful in identifying malformations of the fetal skeleton and chromosomal abnormalities in utero.
Immunohistochemical Study of Annexin V Expression in Placentae of Preeclampsia
Authors: Shu Fang , Sugimura Motoi , Kanayama Naohiro , Kobayashi Hiroshi , Kobayashi Takao , Terao Toshihiko
Published: April 2003

We investigated the clinical significance of annexin V in the placentae with preeclampsia and found: (1) annexin V was detected on trophoblasts in the placentae and the staining intensity of annexin V in the placentae from such patients was reduced when compared to normal placentae; (2) as expression of annexin V was reduced, the gestosis index from patients with preeclampsia was elevated and the standard deviation value in the infant’s standard weight was decreased; plasma level of the fibrin degradation products and thrombin-antithrombin III complex from patients were elevated as the expression of anexin V was reduced. These results suggest that the reduced expression of annexin V in the placentae from patients with preeclampsia may lead to a hypercoagulable state in the intervillous space and may be associated with the development of intrauterine growth restriction.
Can Women’s Cognitive Appraisals Be Registered throughout Childbirth?
Authors: Alehagen Siw , Wijma Klaas , Wijma Barbro
Published: April 2003

The aims of the present study were: (a) to examine whether it was possible to measure women’s cognitive appraisals hourly during the whole process of labor and delivery, and (b) to explore how the appraisals varied during labor. Measurements from 12 nulliparous women are presented. The findings indicate that it is possible to study psychological appraisals directly, in detail and continuously during the process of labor and delivery. The women’s cognitive appraisals varied throughout labor both per individual woman and between the participating women.
Effects of Inflammatory Cytokines on Prostaglandin E2 Production from Human Amnion Cells Cultured in Serum-Free Condition
Authors: Furuta Itsuko , Yamada Hideto , Sagawa Tadashi , Fujimoto Seiichiro
Published: April 2003

The effects of five inflammatory cytokines, i.e. interleukin(IL)-1α, IL-1β, IL-6, IL-8 and tumor necrosis factor-α (TNF-α) on prostaglandin E2 (PGE2) production from amnion cells cultured in a serum-free condition was evaluated. After human amnion cells obtained from term placenta were incubated with the inflammatory cytokines at various concentrations, PGE2 production in the culture supernatant was determined using an enzyme immunoassay method. Under a serum-free culture condition, an increase in PGE2 production by IL-1α and IL-1β was observed at concentrations of 10 and 100 ng/ml compared to control cultures. However, the increases in PGE2 production by IL-6 and IL-8 were found at relatively high concentrations, i.e. at 100 and 200 ng/ml. TNF-α induced a significant increase in PGE2 production at 50 and 100 ng/ml, but not at 200 ng/ml. These data suggest that these inflammatory cytokines directly stimulate PGE2 production from amnion cells and may initiate premature labor if amniotic inflammatory cytokines are elevated, e.g. following intrauterine infection.
Magnetic Resonance Imaging Diagnosis of Metastasis of ChronicMyelocytic Leuk emia to the Uterus
Authors: Deguchi Masaaki , Ishiko Osamu , Hino Masayuki , Fukumasu Yasuko , Ogita Sachio
Published: April 2003

We report a case of chronic myelocytic leukemia (CML) in which the initial manifestation of blastic crisis was massive genital bleeding. The bleeding was diagnosed as being caused by CML metastasis to the uterus on the basis of the magnetic resonance imaging findings.
Skeletal Muscle Ultrastructure in Normal Pregnancy and Preeclampsia
Authors: Folgerø Terese , Lindal Sigurd , Øian Pål
Published: April 2003

The aim of this study was to assess by quantitative methods whether the assumed metabolic disturbance underlying preeclampsia would be reflected in muscle cell composition of lipid, mitochondria, or glycogen. We have reported mitochondrial dysfunction in preeclampsia, and since accumulation of lipid in skeletal muscle is a feature in mitochondrial disorders, our hypothesis was that preeclamptic women would have an increased content of triglyceride droplets. Quantitative investigation of the skeletal muscle ultrastructure was performed in 10 women with severe preeclampsia and in 6 normotensive pregnant women. Biopsy specimens from musculus rectus abdominis were taken during cesarean section and prepared for electron microscopy. Random pictures were taken by transmission electron microscopy, and point-counting stereology was performed. Preeclamptic women did not have a higher lipid volume fraction than normotensive pregnant women, and we had to reject our hypothesis. On the contrary, there was a tendency towards a lower triglyceride volume fraction in preeclampsia. We did not detect differences in relative volumes of mitochondria or glycogen in skeletal muscle between the two groups.
Transport and Metabolism of Serotonin in the Human Placenta from Normal and Severely Pre-Eclamptic Pregnancies
Authors: Carrasco Gonzalo , Cruz Maria Antonieta , Gallardo Victoria , Miguel Patricia , Dominguez Alejandra , González Clemente
Published: April 2003

We have attempted to elucidate the possible participation of serotonin as an etiological factor in pre-eclampsia. The transport of serotonin into vesicles from the maternal-facing brush border membrane was measured, as well as the metabolism induced by monoamine oxidase (MAO) in placental homogenate obtained from normal-term and severely pre-eclamptic placentas. Kinetic analysis of serotonin uptake by the placental brush border membrane of the syncytiotrophoblast between normally pregnant and severely pre-eclamptic subjects showed no significant difference (similar Vmax and Km values). However, the metabolism of serotonin was significantly higher in placental homogenate from normal pregnancies than in placentas from severely pre-eclamptic pregnancies. These findings suggest that the higher plasma-free serotonin levels observed in severe pre-eclampsia are mainly due to a reduction in MAO-A activity and not limited by the rate of serotonin uptake into the cells.
Maternal and Fetal Circulating Angiogenin Levels in Pregnancies with Small-for-Gestational-Age and Appropriate-for-Gestational-Age Infants
Authors: Yamashiro Chizu , Ohnishi Yohichi , Kanenishi Kenji , Hayashi Keiji , Yanagihara Toshihiro , Hata Toshiyuki
Published: April 2003

Objective: The objective of the present study was to evaluate whether maternal and fetal circulating angiogenin levels in pregnancies with small-for-gestational- age (SGA) infants are different from those in pregnancies with appropriate-for-gestational-age (AGA) infants. Methods: Maternal and fetal circulating angiogenin concentrations were compared at birth between 16 pregnancies with SGA (7 delivered vaginally and 9 delivered by elective cesarean section) and 46 pregnancies with AGA (27 delivered vaginally and 19 delivered by cesarean section). Serum angiogenin level was measured with an enzyme-linked immunosorbent assay. Results: There were no significant differences in maternal and fetal serum angiogenin levels between the two groups. However, maternal serum angiogenin levels were significantly higher than those in fetal serum within both SGA and AGA infant pregnancies. There were no significant differences in maternal and fetal serum angiogenin levels between vaginal and cesarean delivered pregnancies in both SGA and AGA groups. Conclusion: These results suggest that there is no difference in angiogenin synthesis between SGA and AGA pregnancies.
Small Bowel Herniation through Subumbilical Port Site following Laparoscopic Surgery at the Time of Reversal of Anesthesia
Authors: Leung Tak Yeung , Yuen Pong Mo
Published: April 2003

Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. Two cases of small bowel herniation at subumbilical port site occurred at the time of withdrawal of the trocar sheath at the end of the laparoscopic procedure are reported. The herniations were precipitated by the coughing movements of the patients as a result of too early reversal of the general anesthesia. Awareness of the complication, precaution at time of sheath withdrawal and a well-timed reversal of the general anesthesia are important in avoiding such a complication.
Activation of Ca2+-Activated K+ Channels in Human Myometrium by Nitric Oxide
Authors: Shimano Miho , Nakaya Yutaka , Fukui Rijin , Kamada Masaharu , Hamada Yoko , Maeda Kazuhisa , Aono Toshihiro
Published: April 2003

To investigate the mechanism of human uterine smooth muscle relaxation, the activation of Ca2+-activated K+ channels in cultured myometrial cells obtained from human pregnant myometrium at term by nitric oxide was evaluated at the single cell level using the patch-clamp technique. The open probability of the K+ channel after the addition of 3 × 10–3 M isosorbide dinitrate, a nitric oxide donor (0.116 ± 0.048) was significantly higher than that before the addition (0.059 ± 0.032; n = 9, p < 0.01). In myometrial cells pretreated with lipopolysaccharide, activation of K+ channels was also noted after the addition of L-arginine (10–4 M; open probability increased from 0.179 ± 0.076 to 0.380 ± 0.105, n = 9, p < 0.01: 10–3 M; open probability increased from 0.073 ± 0.050 to 0.242 ± 0.098, n = 12, p < 0.01). Either 10–3 M N-nitro-L-arginine-methyl-ester, an inhibitor of nitric oxide synthase, or 10–6 M methylene blue, an inhibitor of guanylate cyclase, abolished activation of the K+ channel by 10–3 M L-arginine in pretreated myometrial cells with lipopolysaccharide. Application of 10–3 M L-arginine to the intracellular surface of an excised inside-out patch in the myometrial cells pretreated with lipopolysaccharide failed to increase Ca2+-activated K+ channel activity, suggesting that the activation was mediated by intracellular messengers. These results indicate that nitric oxide should control human myometrial relaxation during pregnancy via activation of Ca2+-activated K+ channels.
Coexistence of a Heterotopic Pregnancy Associated with a Homolateral Ovarian Cyst in a Patient Submitted to Elective Abortion
Authors: Dessole Salvatore , Ruiu Giovanni Antonio , Cherchi Pier Luigi
Published: April 2003

The authors describe the case of a right tubal pregnancy of delayed diagnosis in a 31-year-old nullipara, who was submitted to voluntary termination during the 7th week of pregnancy and who presented a homolateral ovarian cyst. Two weeks later the patient presented pelvic pain and intraperitoneal fluid layer, while plasma β-hCG was 1,262 IU/ml. The case history was complicated by recent termination surgery and presence of an ovarian cyst, but a plasma β-hCG assay and transvaginal ultrasonography oriented the diagnosis towards a previously unrevealed heterotopic pregnancy. The fallopian tube and the ovarian cyst were removed by laparoscopy. The case points out to the fact that, though rare, heterotopic pregnancy must always be considered one of the possible complications of spontaneous pregnancy.
Excessive Use of Cesarean Section for the Second Twin?
Authors: Wolff Kerstin
Published: April 2003

Background: In Sweden, the frequency of cesarean section of the second twin after vaginal birth of the first twin has increased in recent years. Methods: To investigate the indications for second twin cesarean sections, all twin deliveries at Huddinge University Hospital from 1995 to 1997 were reviewed retrospectively. The rates of cesarean section for the second twin were compared with figures from the whole country, based on the Swedish medical birth register. Results: Thirty-one percent of all twin deliveries had a spontaneous onset and spontaneous vaginal delivery. The total twin cesarean section rate, including cesarean section for the second twin, was 45% at Huddinge University Hospital in 1995–1997 and 44% in Sweden in 1995. Cesarean section for the second twin after vaginal delivery of the first twin occurred in 11%. On review, 2/3 of the cesarean sections for the second twin were considered potentially avoidable. Conclusion: In normal twin pregnancies with vertex/nonvertex presentation, the favorable fetal outcome and also the maternal risks associated with cesarean section support vaginal delivery as the recommended delivery route. Extraction or version of a second nonvertex twin should be attempted before cesarean section for this twin is performed.
Prostacyclin Deficiency and Reduced Fetoplacental Blood Flow in Pregnancy-Induced Hypertension and Preeclampsia
Authors: Klockenbusch Walter , Goecke Tamme W. , Krüssel Jan S. , Tutschek Boris A. , Crombach Gerd , Schrör Karsten
Published: April 2003

Background: Low endothelial generation of prostacyclin (PGI2) is a typical feature of pregnancy-induced hypertensive disorders. The aim of the current study was to establish whether changes in PGI2 are accompanied by alterations in fetoplacental blood flow and to test the hypothesis that PGI2 deficiency contributes to reduced fetoplacental perfusion in pregnancy-induced hypertension (PIH) and preeclampsia. Methods: The study included 11 women with normal pregnancies, 12 with PIH/preeclampsia, and 7 with otherwise complicated pregnancies. Fetoplacental blood flow was assessed both by umbilical artery Doppler sonography measuring the resistance index (RI) and by means of neonatal birth weight. PGI2 formation was measured in umbilical arteries prepared immediately after birth. PGI2, RI and birth weight were correlated with and without correction for gestational age. Furthermore, data from patients with PIH/preeclampsia were compared with normal pregnancies as controls. Results: A significant inverse correlation was found between umbilical PGI2 formation and umbilical RI and between birth weight and RI, whereas PGI2 and birht weight were directly related. Patients with PIH/preeclampsia showed reduced PGI2 formation, markedly increased gestational age-corrected RI and significantly reduced percentile birth weight. Conclusions: These results provide evidence showing that PGI2 is a relevant mediator of fetoplacental blood flow and suggest an important role of PGI2 deficiency in PIH/preeclampsia.
Human Papillomavirus Genotypes in Cervical Cancer with Different Histological Features
Authors: Jakob Christiane , Schlotter Claus Martin , Bosse Ulrich , Füzesi László
Published: April 2003

We report the case of a 32-year-old woman having developed two cervical cancers synchronously, an adenocarcinoma and a squamous cell carcinoma. Polymerase chain reaction with the general primers GP5/GP6 and a subsequent enzyme-linked immunosorbent assay to detect human papillomaviruses (HPV) resulted in isolation of HPV 33 in the squamous cell carcinoma and HPV 18 in the adenocarcinoma. This is the first reported case of two histologically different synchronous cervical cancers with this distinct HPV expression pattern, and further confirms the association of certain ‘high-risk’ HPV genotypes to different histological features of carcinoma. Furthermore, the important role of microdissection for gaining tumor tissue of different areas in molecular diagnostics is supported.
Vascular Reactivity to Angiotensin II and Eicosanoid Production in the Human Placenta from Term and Preterm Pregnancy
Authors: Cruz M.A. , Domínguez A. , Gallardo V. , Carrasco G. , Miguel P. , González C.
Published: April 2003

Isolated human placental cotyledons from normal term (37–40 weeks of gestation) and preterm (26–36 weeks of gestation) labor were perfused in vitro, and the effect of angiotensin II (ANG II) and its interaction with prostanoids was measured. In the preterm group, ANG II caused greater maximal increases in perfusion pressure than in normal term pregnancies without affecting sensitivity. Also, preparations from normal term pregnancies showed a marked development of tachyphylaxis compared to placentae from preterm pregnancies. Indomethacin (10–6 M) increased the maximum pressor response to ANG II by 33.6% in normal term, however, in preterm placentas a 39.2% reduction was observed. Infused ANG II 10–6 M) decreased the concentrations of thromboxane B2 and 6-keto-PGF1α in both pregnancy groups, but this effect was not statistically different from the baseline values. In the current study, we show that the placenta of preterm pregnancies in basal conditions produce 7.6 times as much thromboxane as the normal term placenta (2,800 ± 470 vs. 366.5 ± 62 pg/min, respectively), without significant change in prostacyclin levels (preterm 88.6 ± 11.0 vs. Term 100.6 ± 30.7 pg/min). These observations provide evidence that the contribution of basally released thromboxane from placental tissue appears to contribute to abnormalities in the regulation of fetoplacental hemodynamics in premature pregnancies.
Conization by Harmonic Scalpel for Cervical Intraepithelial Neoplasia: A Clinicopathological Study
Authors: Akahira Jun-ichi , Konno Ryo , Moriya Takuya , Yamakawa Hiromitsu , Igarashi Tsukasa , Ito Kiyoshi , Sato Shinji , Yajima Akira
Published: April 2003

The Harmonic Scalpel® (HS) is a new surgical tool that cuts and coagulates by converting electrical energy into ultrasonic mechanical vibrations. The purpose of our study was to compare HS conization and the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) with respect to both clinical and pathological features. Fifty-one consecutive women conservatively treated (29 with LEEP and 22 with HS conization) for CIN III were retrospectively reviewed. The background of the patients was similar. Operative time, intra- and postoperative blood loss were not significantly different. With HS conization all specimens were removed in one piece, but with LEEP the median number of specimens obtained per patient was 3.3 (p < 0.0001) with a maximum of 5. The depth of thermal artifacts at the endocervical margin was significantly less with HS conization (0.20 mm) than with LEEP (0.30 mm; p = 0.0006). This new method produced an ideal-shaped specimen without increasing complications and thermal artifacts compared with LEEP.
The French Version of the Defense Style Questionnaire
Authors: Bonsack Ch. , Despland J.N. , Spagnoli J.
Published: April 2003

Background: Bond et al. developed the Defense Style Questionnaire (DSQ), a self-questionnaire that aims at empirically measuring conscious derivatives of defense mechanisms. The original analysis yielded 4 factors called Defense Styles (DS). DSQ discriminates between mature and immature defense styles. Objectives: Determine if the French version of DSQ has (a) face validity, (b) a similar structure to the original version, (c) internal consistency, (d) grouping of defense mechanisms into clinically pertinent defense styles, (e) evidence of nonpatients using more mature defense styles, (f) correlation with Defensive Functioning Scale (DFS) (DSM-IV) [2]. Methods: Reliability and validity study on 82 control subjects and 140 patients, 59 among them evaluated for defensive level. Results: Factor analysis of controls sample yielded 4 factors ranging from immature to mature defense styles. DSQ scores on factor I (maladaptive style) are significantly higher in outpatients than in controls. Maladaptive style score correlates with clinical evaluation of defensive level of functioning (DFS). Conclusion: Psychometric features of the French version are similar to the original scale, although minor differences in individual defense mechanisms are present. Factor I (maladaptive defense style) remains more stable than other factors, accounts for most of variance contribution, has high internal consistency and applies to behaviors, i.e. conscious derivatives of defense mechanisms that can be easily identified. The French version of DSQ is (a) an easy and economical way to rate immature defense style in populations of ‘neurotic’ and borderline patients and (b) further provides a hierarchical grouping of defense mechanisms in defense styles.
Psychiatric Symptoms and Psychological Profile of Patients with Near Fatal Asthma:Absence of Positive Findings
Authors: Rocco Pier Luigi , Barboni Enrico , Balestrieri Matteo
Published: April 2003

Background: We examined the presence of psychiatric symptoms and personality characteristics in patients with asthma and near fatal asthma (NFA). An NFA attack is defined by the presence of one or more of the following symptoms: respiratory arrest, alteration in consciousness, need for mechanical ventilation, Pa CO2 > 50 mm Hg. Methods: To assess the relevance of a specific psychiatric profile or the difference in personality characteristics existing in patients that survived an NFA attack and asthmatic patients. The authors interviewed a sample of 17 asthmatic patients who experienced one or more NFA attacks. A control group of 17 control patients with asthma who never experienced NFA attacks was enrolled. After a baseline assessment, the patients underwent an interview concerning their personal and familiar psychiatric history and a psychodiagnostic investigation using Hamilton scales for anxiety and depression, Zung scales for anxiety and depression, and Minnesota Multiphasic Personality Inventory. The study was performed in a 6-month period. Results: No significant differences in the results of psychodiagnostic tests between NFA patients and the control group were reported. Psychiatric history was similar in the two groups. Conclusions: Our results suggest that psychiatric symptoms and personality characteristics are not related to the presence of asthma with or without NFA.
Diagnosis and Treatment of Pituitary Disease
Authors: Shimon Ilan , Melmed Shlomo
Published: April 2003

Critical issues in diagnosis and treatment of pituitary disease are surveyed. The most relevant clinical aspects of hyperprolactinemia, acromegaly, Cushing’s disease, secondary hyperthyroidism, syndrome of inappropriate ADH secretion, panhypopituitarism, growth hormone deficiency, gonadotropin deficiency, ACTH deficiency, TSH deficiency, and diabetes insipidus are discussed. Diagnostic and therapeutic issues in the approach to pituitary adenomas, craniopharyngiomas and pituitary apoplexy are analyzed.
Neuropsychiatry and Pituitary Disease: An Overview
Authors: Weitzner Michael
Published: April 2003

It has been recognized for some time that psychiatric symptoms, such as depression, anxiety, and behavioral alterations, may occur in patients who have pituitary disease. From other research focused on endocrine abnormalities seen in patients with psychiatric illness, it is understood that there is a significant interrelationship between the endocrine system and mental health. More recent research focusing on neural circuits in the brain and the impact of alterations in neurotransmission and neurohormonal modulation has shown that the prefrontal cortex can be affected by perturbations in functioning occurring in distant sites. Such is the situation with the hypothalamic-pituitary axis. Through its rich connections with other limbic structures, the hypothalamic-pituitary axis may affect the behavioral control exerted by the prefrontal cortex, causing mood and personality alterations. In the more severe cases, an apathy syndrome may develop which must be carefully differentiated from depression and other cognitive disorders. This report will review: (1) the neuroanatomical components that cause the behavioral changes observed in many patients with pituitary disease; (2) the current concept of apathy syndrome; (3) the differentiation of apathy syndrome from major depression; (4) the underlying neurobiology of apathy, and (5) potential treatments.
Emotional Aspects of Hyperprolactinemia
Authors: Sobrinho L.G.
Published: April 2003

Patients with hyperprolactinemia often present with emotional difficulties. These occasionally persist even after successful treatment. Insight into the roots of their diseased state makes a difference in the handling of all cases, but becomes crucial in the not-so-rare situations in which the normalization of hormonal levels is not followed by a feeling of cure. This chapter attempts to provide details, discuss and situate in context the following blocks of pertinent information: (1) prolactin acts upon the central nervous system and variations in its concentrations do affect mood, emotions and behavior; (2) most actions of prolactin are directed to metabolical and behavioral adaptation to pregnancy and the care of the young; (3) even in the absence of pregnancy prolactin secretion responds to environmental stimuli under specific conditions. Whether adaptive, as in the case of surrogate maternity, or pathological, as in the case of pseudopregnancy, prolactin responds to a perceived need to take care of a child; (4) the facts that the clinical onset of prolactinomas often follows life-events and that these tumors occur preferentially in women brought up under specific conditions suggest the possibility that psychological factors may predispose to prolactinomas; (5) dealing with individual cases requires the perception that the relations between prolactin, emotions and feelings are circular, i.e., prolactin affects the brain and mood but, on the other hand, personality traits and environmental factors may stimulate the secretion of prolactin and may play a role in the genesis of the disease.
Validation of the French Translation of the Agoraphobic Cognitions Questionnaire
Authors: Bouvard Martine , Cottraux Jean , Talbot Frédéric , Mollard Evelyne , Duhem Stéphanie , Yao Sai-Nan , Arthus Murielle , Note Ivan , Cungi Charly
Published: April 2003

Background: The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). Methods: Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. Results: The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. Conclusions: These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9–20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.
A Preventive Intervention Program in Adolescent Schoolgirls:A Longitudin al Study
Authors: Santonastaso Paolo , Zanetti Tatiana , Ferrara Silvia , Olivotto Maria C. , Magnavita Nicola , Favaro Angela
Published: April 2003

Background: To explore the impact of a prevention program on the eating and body attitudes of a sample of adolescent schoolgirls. Methods: The program involved lessons and group discussions of general adolescent problems and eating disorders. A total of 254 16-year-old schoolgirls were evaluated, of whom 154 participated in the program and a further 154 subjects formed the control group. Variations in weight, Eating Attitudes Test and Eating Disorders Inventory at a 1-year follow-up were compared for the two groups. Results: Among high-risk subjects, no significant differences were found between the prevention and the control group. The preventive program appeared to reduce significantly body dissatisfaction and to decrease the risk of bulimic attitudes in low-risk subjects. Conclusions: Providing schoolgirls with the correct information about eating disorders did not encourage unhealthy attitudes to eating and weight regulation practices. However, for high-risk subjects more intensive and specific intervention may be required, for which further research is needed.
Individual Prognosis for Changes in Sperm Quality on the Basis of Perceived Stress
Authors: Pook Martin , Röhrle Bernd , Krause Walter
Published: April 2003

Background: In this study we examined whether stress has a negative influence on sperm quality. To investigate this issue we developed a scale assessing perceived stress resulting from infertility. Methods and Results: The Infertility Distress Scale was constructed based on the data of 158 infertility patients contacting an andrological clinic for the first time. The Infertility Distress Scale consists of items assessing self-reported stress, different appraisals of infertility and cognitive involvement in infertility. The scale was shown to have good psychometric properties. Changes in sperm quality were predicted by this scale for 69 patients. Changes in sperm concentration and sperm motility were predicted correctly 75.4 and 65.6% of the time, respectively. While these prediction accuracies were significantly better than chance prediction, the Infertility Distress Scale had no predictive value for changes in morphology. Conclusion: Results indicate that distress caused by infertility is a risk factor for a decrease in sperm quality.
The Amsterdam Alexithymia Scale: Its Psychometric Values and Correlations with Other Personality Traits
Authors: Bermond Bob , Vorst Harrie C.M. , Vingerhoets Ad J.J.M. , Gerritsen Welmoet
Published: April 2003

Background: This article describes the construction and validation of the Amsterdam Alexithymia Scale (AAS) and explores some of the nomological net of alexithymia. Methods: Four correlational studies are presented. The internal structure of the AAS is explored by factor analyses on items. Correlations of the AAS with sex and (Guilford) intellectual abilities are established. Mean scores of three different professional groups are compared. Correlations between the AAS and several clinical and personality scales are determined. Students served as subjects in all studies (347<n<559). Results: The 20-item AAS has a stable 5-factor structure, covering 5 defining features of alexithymia: difficulties in, respectively, experiencing emotions, fantasizing, analyzing emotions, differentiating between emotions and verbalizing emotions. The AAS showed to be reliable. The AAS scores were independent of verbal and nonverbal IQ. As expected, the AAS scores turned out to be significantly lower in a group of dramatic art students and significantly higher in a group of math and artificial intelligence students, when compared to psychology students. The AAS scores correlated negatively with extroversion, positively with social inadequacy and not with neuroticism. Finally, correlations between the AAS and the Adjective Check List scores indicated that alexithymia is associated with, respectively, a neglect of own needs and impulses, a reduced capability to understand social situations and a tendency to stick to rules rigidly, to flee into social isolation, to be submissive, to avoid commitment and to experiences of lack of personal meaning in life. Conclusion: The AAS is the first instrument measuring the 5 defining features of alexithymia reliably and validly.
Blood Pressure Biofeedback Treatment, Organ Damage and Sympathetic Activity in Mild Hypertension
Authors: Nakao Mutsuhiro , Nomura Shinobu , Shimosawa Tatsuo , Fujita Toshiro , Kuboki Tomifusa
Published: April 2003

Background: Although biofeedback treatment is reported to be useful for patients with mild hypertension as an adjunct to medication, it is not certain whether the presence of organ damage affects its efficacy. The aim of this study is to clarify the clinical effects of biofeedback on mild hypertension in the absence and presence of organ damage. Methods: Eleven mildly hypertensive outpatients without damage to the heart, brain, retina or kidney (4 men and 7 women), aged 40–65 years, and 11 mildly hypertensive outpatients with target organ damage and matching variables for age, sex and medication were included in this study. They underwent biofeedback treatment once a week for a total of four sessions. Results: As a result of these sessions, mean blood pressures (MBP) in the organ-damage-negative (–) group and in the organ-damage-positive (+) group were significantly reduced by 12 ± 11 and 12 ± 8, respectively. The decrease was still significant 3 months after the treatment in the organ-damage (–) group, whereas no significant change was found 1 or 3 months after the treatment in the organ-damge (+) group. Throughout these sessions, the ratio of low frequency to high frequency of heart rate variance as well as systolic and MBP gradually decreased in each group (p < 0.01); this ratio of heart rate variance was smaller, and the α-wave amplitude on the electroencephalogram was larger in the organ-damage (–) group (p < 0.05). Conclusion: These results suggested that biofeedback intervention may be effective in mild hypertension, especially when the patient is organ damage (–). Sympathetic activity seems to play an important role in the differentiated response.
Cognitive-Behavioral Therapy for Somatization and Symptom Syndromes: A Critical Review of Controlled Clinical Trials
Authors: Kroenke Kurt , Swindle Ralph
Published: April 2003

Objective: Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials. Methods: A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. Results: A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months. Conclusion: CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated.
Reducing Relapse in Depressed Outpatients with Atypical Features: A Pilot Study
Authors: Jarrett Robin B. , Kraft Dolores , Schaffer Martin , Witt-Browder Amy , Risser Richard , Atkins Deborah H. , Doyle Jeanette
Published: April 2003

Background: Patients with major depressive disorder (MDD) and atypical features have reactive mood plus at least two sympoms: hypersomnia, hyperphagia, leaden paralysis or a lifetime sensitivity to rejection. These patients respond to cognitive therapy (CT) or phenelzine (PHZ) significantly more than pill placebo (PBO). The purpose of this report is to motivate research on tolerable continuation phase treatment designed to reduce the significant risk of relapse and recurrence which depressed patients with atypical features face. Methods: Outpatients with DSM-III-R MDD and atypical features who responded to acute-phase CT, clinical management plus PHZ or PBO (n = 31) were randomized to continue or discontinue treatment for 8 months and participate in 16 months or treatment-free follow-up. Results: A log-rank test showed that the relapse and recurrence-free survival over the 24 months after the acute phase was significantly greater for the responders who continued treatment than for those who discontinued treatment. Kaplan-Meier estimates of relapse and recurrence were significantly higher for patients whose treatment was discontinued than for those whose treatment continued (83 vs 49% based on unblinded ratings of the Research Diagnostic Criteria for MDD or of self/other referral for treatment of depressive symptoms). Conclusions: We note several important limitations of the design and analysis of these pilot data. We hypothesize that not only pharmacotherapy, but also CT used as a continuation phase threatment may reduce relapse in this population. This hypothesis warrants rigorous evaluation in samples of outpatients with MDD and atypical features that are large enough to allow comparative tests.