bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol‐based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics
Authors: Winn Robert D. , Laura Sharon , Douglas Charles , Davidson Patricia , Gani Jon S.
Published: May 2004

Background:  There is evidence that antibiotics can be used as primary treatment for appendicitis, however, delayed surgical treatment might still be associated with perforation. Most patients at risk of perforation have high Alvarado scores. We designed a protocol‐based approach to suspected appendicitis, in which the Alvarado score was used to select patients for early treatment with surgery or outpatient antibiotics.

Methods:  Patients included in the present study were adults and children referred to the surgical service at John Hunter Hospital (Newcastle, Australia) with suspected appendicitis in the 12 months from July 2000. Treatment groups: no treatment (Alvarado score 1−4); antibiotics alone (Alvarado 5−7); early surgery (Alvarado 8−10). Outcome measures: time to operation; duration of hospital stay; non‐therapeutic operations; delayed treatment in association with perforation; recurrent appendicitis (for those treated with antibiotics). Comparison group: 142 patients managed with ‘best clinical practice’ as part of an earlier trial.

Results:  One hundred and twenty‐two patients were enrolled. Median time to operation was 3.9 h (comparison group 7.3 h, P = 0.014). Median length of stay was 38.5 h (comparison group 44.2 h, P = 0.041). There were two cases of delayed treatment in association with perforation (2/122 = 1.6%, comparison group 2/142 = 1.4%, P = 0.88) and 10 non‐therapeutic operations (10/122 = 8.1%, comparison group 15/142 = 10.6%, P = 0.51). Of those whose initial illness was treated successfully with antibiotics, 2/42 (4.8%) subsequently required appendicectomy.

Conclusions:  This protocol‐based approach to suspected appendicitis is feasible. A prospective controlled study would be required to confirm potential benefits (in terms of short hospital stay) and to confirm that there is not an increase in adverse outcomes.
Submental intubation in complex craniomaxillofacial trauma
Authors: Davis Charles
Published: May 2004

The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re‐establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. A submental intubation has been used in 11 selected cases amongst 190 consecutively treated patients with craniomaxillofacial trauma over a 3‐year period. These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described.
Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review
Authors: Woodfield John C. , Windsor John A. , Godfrey Catherine C. , Orr David A. , Officer Neil M.
Published: May 2004

The increased reporting of tuberculosis of the pancreas is related to a worldwide increase in tuberculosis and an increase in emigration from countries where tuberculosis is endemic into countries where more sophisticated healthcare and radiological imaging are available. Three recent cases of pancreatic tuberculosis in Auckland, New Zealand, emphasize that tuberculosis should now be included in the differential diagnosis of a pancreatic mass. Diagnostic indicators include emigration from, or recent travel to, a country where tuberculosis is endemic, the association of a pancreatic mass with fever, the presence of abdominal pain and a cystic pancreatic mass in a younger male. Radiological appearances might be similar to a mucinous cystic neoplasm or could show a pancreatic mass with involvement of peripancreatic lymph nodes or a mass centred in a peripancreatic lymph node. When the diagnosis is suspected an human immunodeficiency virus test and a comprehensive screening for tuberculosis at other sites should be performed. If tuberculosis is unable to be diagnosed then pancreatic biopsy and culture is indicated. Endoscopic ultrasound with fine needle aspiration for cytology is likely to become the preferred technique. Most patients have an excellent clinical response to standard antituberculosis regimens.
Surgical fires and alcohol‐based skin preparations
Authors: Tooher Rebecca , Maddern Guy J. , Simpson John
Published: May 2004

Alcohol‐based skin preparations are known to be flammable. Their use continues despite a significant level of risk. Two cases of fires resulting from ignition of pooled alcohol‐based skin preparations are reported. Both cases were associated with use of electrocautery for haemostasis. The literature is reviewed and recommendations are made to reduce the risk of further similar occurrences.
Waiting for elective general surgery: physical, psychological and social consequences
Authors: Oudhoff Jurriaan P. , Timmermans Danielle R. M. , Bijnen Arnold B. , Van Der Wal Gerrit
Published: May 2004

Background:  Long surgical waiting lists are common and receive serious consideration. To evaluate the positive and negative effects of waiting lists, insight into the consequences of waiting is needed. The present study aims to assess what insight the current literature provides into the effects of delayed surgery for varicose veins, inguinal hernia in adults, gallstones, and breast cancer in terms of physical, psychological and social aspects.

Methods:  Searches of Medline and Embase, for the period January 1985−September 2003, were performed to identify articles providing direct or indirect insight into the consequences of waiting for surgery for each disorder. Reference lists of retrieved reports were examined for relevant articles.

Results:  Seven studies were identified with direct data on consequences of delay in elective surgery. Relevant indirect data were found in 32 reports. Results indicated that delayed varicose vein surgery or inguinal hernia repair involves marginal physical, psychological or social suffering, and that severe deterioration is unlikely. The impact of delayed cholecystectomy seems more profound by suffering on all three health aspects. Complications while waiting do occur, with a higher risk for patients with previous complications. Longer delays for breast cancer surgery seem to adversely affect prognosis, although it is unclear which interval is associated with such an effect. Moreover, having breast cancer undoubtedly affects psychological health.

Conclusions:  There is a remarkable paucity of studies addressing the consequential impact of waiting for elective surgery on patients’ health for each of the four studied disorders. Current literature permits merely general estimation of this consequential impact. As specific assessment of these consequences is important for daily practice and for policy, further research is required.
Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia
Authors: Bilgin Tufan , Özuysal Sema , Ozan Hakan , Atakan Türkan
Published: May 2004

Aim: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH).

Methods: Forty‐six consecutive women who underwent hysterectomy for AEH were analyzed.

Results: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC.

Conclusion:  A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.
Ultrasound‐guided local injection of methotrexate to treat an invasive hydatidiform mole
Authors: Tsukihara Satoru , Harada Tasuku , Terakawa Naoki
Published: May 2004

A 28‐year‐old Japanese woman had an invasive hydatidiform mole which was diagnosed by means of transvaginal ultrasonography. After the two initial courses of systemic methotrexate (MTX) therapy given over a period of weeks, the tumor was 14 mm in diameter and the surrounding blood supply remained rich. In addition to the two initial courses of systemic MTX therapy, local ultrasound‐guided injection of MTX therapy was given three times, once per week. After the local MTX treatment, the βhCG level, which had been as high as 240 ng/mL, dropped to less than 0.1 ng/mL. We then gave two additional courses of systemic MTX therapy (once per week). More than 3 years have passed since the final systemic MTX therapy, and the patient's serum βhCG levels continue to be less than 0.1 ng/mL. An invasive mole can be treated with an ultrasound‐guided local injection of MTX in addition to the established systemic MTX treatment.
Stavudine effects on rat pregnancy outcome
Authors: Barreto Regina Lúcia Braga , De Jesus Simões Manuel , Amed Abes Mahmed , Soares Júnior José Maria , Oliveira‐Filho Ricardo Martins , Luiz Kulay
Published: May 2004

Objective: Stavudine is an inhibitor of HIV reverse transcriptase and acts as a chain terminator during DNA synthesis. The aim of the study presented here was to evaluate the effects of stavudine during rat pregnancy.

Methods: Female rats were randomly divided into four treatment groups: GI (treated with the drug vehicle); GII; GIII; and GIV (treated with 1, 3 or 9 mg/kg of stavudine, respectively) (n = 25 pregnant rats for every group). Rats were treated by gavage once daily. The treatment period extended from day 0 until the 20th day of pregnancy. Body weights were recorded weekly during this period. At term, the rats were sacrificed, and the implantation sites and number of fetuses and resorptions were recorded. The fetuses were evaluated for external abnormalities under a stereomicroscope.

Results: No differences in body weight gain between the groups were observed. The mean number of implantations per dam in stavudine‐treated groups was higher than in the control group (P < 0.05); however, only GIII presented an increase in the mean number of resorptions compared to the other groups (P < 0.01). The resorption/implantation rate was higher in the GII group and lower in the GIV group as compared to the other groups. Neither the mean fetal weights nor the placental weights differed significantly among the groups. No external anomalies were observed at dissection in rat fetuses, placentae or uteri.

Conclusion: Rat pregnancy outcome seems to be affected by stavudine, mainly with respect to the mechanisms of intrauterine concept survival.
Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan
Authors: Shimano Satoshi , Nishikawa Akira , Sonoda Tomoko , Kudo Ryuichi
Published: May 2004

Aim: Our aims were to evaluate the prevalence of bacterial vaginosis (BV), Chlamydia trachomatis (C. trachomatis) infection and Mobiluncus spp. infection among pregnant women in Otaru, Hokkaido, Japan according to the month and year of the first prenatal visit, and to evaluate their risk factors.

Methods: Six thousand and eighty‐three pregnant women who were seen consecutively at our hospital between 1993 and 2000, were enrolled in the study. Vaginal and endocervical swabs were subjected to Gram stain and detection of C. trachomatis. Univariate and multivariate methods were used to investigate the association between each infection and potential risk factors including age, gravidity, parity, history of dilatation and curettage (D & C), and history of natural abortion.

Results: The annual rate of BV increased from 13.6% in 1993 to 21.4% in 2000. The annual rate of C. trachomatis infection was relatively constant. The prevalence of bacterial vaginosis, C. trachomatis infection and Mobiluncus spp. infection over the 8‐year period was 18.2%, 4.2%, and 4.1%, respectively. The prevalence of the three infections was significantly higher among teenagers and among women with a history of D & C. The prevalence of C. trachomatis and Mobiluncus spp. infections was significantly higher among women with no history of delivery. BV was not associated with parity on multivariate analysis. The monthly prevalence of BV was significantly higher in May than in December, and the monthly prevalence of C. trachomatis infection was high in August.

Conclusion: The differences in the annual and monthly infection patterns between BV and C. trachomatis infection suggest that the etiologies of the two infections differ.
Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu‐T prevent endometrial cancer?
Authors: Guleria Kiran , Agarwal Neera , Mishra Kiran , Gulati Rachna , Mehendiratta Anita
Published: May 2004

Aims: To study changes in endometrial proliferative indices (i.e. cell mitosis and Ki67), endometrial steroid (estrogen and progesterone) receptors, and serum estradiol and progesterone level in women using copper intrauterine device (IUD) after 6 months of use.

Methods: Fifteen healthy women were recruited having no contra indication to IUD or endometrial biopsy. Endometrial biopsies and serum samples were taken on 10/11th day of menstrual cycle at recruitment and after six months. The endometrial samples were subjected to: (i) steroid receptor estimation by immunohistochemistry; (ii) cell mitosis and Ki67 estimation by morphology and proliferative indices.

Results: The mean glandular mitotic index was 1.69 ± (0.39) at first visit and 0.35 ± (0.15) at second visit after 6 months. Similarly, Ki‐67 count in glands was 11.79 ± (1.59) at first visit and 2.40 ± (0.54) at second visit. In the stroma, Ki67 decreased from a mean of 0.85 to 0.01 in six months. This suggested statistically significant reduction in proliferation and mitotic activity in endometrial glands and the stroma of women who used Cu‐T continuously for a long period.There was a significant reduction of estrogen receptor concentration in glands (from a mean of 51.67 down to 11.67) and the stroma (from a mean of 33.00 to 8.00) over this 6‐month period. The observed fall in progesterone receptor counts was less compared to other parameters studied, being marginally significant in stroma (from a mean of 32.00 down to 14.33), but not significant enough in glands (from a mean of 45.00 down to 25.00). No changes were observed in serum hormone levels in these two visits.

Conclusion: Continuous use of copper intrauterine device causes significant reduction in endometrial mitotic activity as well as estrogen receptor concentration without affecting serum estradiol or progesterone levels. This finding infers that Cu‐T may have a protective role against endometrial cancer.
Unsafe abortion: A neglected tragedy. Review from a tertiary care hospital in India
Authors: Jain Vanita , Saha Subhas C. , Bagga Rashmi , Gopalan Sarala
Published: May 2004

Aim: With 16% of the world's population, India accounts for over 20% of the world's maternal deaths. The maternal mortality ratio, defined as the number of maternal deaths per 100 000 live births is incredibly high at 408 per 100 000 live births for the country. Abortion has been legalized in India for the past three decades. However, the share of unsafe abortion as a cause of maternal mortality continues to be alarming. The objective of the present study is to identify the magnitude of problem of unsafe abortion in India.

Methods: Emergency gynecologic admissions to a tertiary care center in North India over a 15‐year period (1988–2002) were reviewed to evaluate the demographic and clinical profile of patients admitted as a result of unsafe abortion. The records were analyzed with regard to the age group, parity and marital status of the abortion seekers, the indication of abortion, the methods used, qualification of abortion providers, complications and fatality rate.

Results: The majority of women who were admitted with diagnosis of unsafe abortion were in the third decade of their lives. They were married, multiparous women living with their spouses. Sixty percent of the women had approached unqualified abortion providers who used primitive methods of pregnancy termination. All the women were admitted with serious complications of unsafe abortions and one‐fourth of them succumbed to the complications.

Conclusion: Unsafe abortion constitutes a major threat to the health and lives of women. This study highlights the need to focus more directly on the needs and preferences of women who seek abortion as well as on the accessibility of contraceptives and skills of the providers of abortion services, in order to improve the quality of abortion care.
Therapeutic termination of second trimester pregnancies with intrauterine fetal death with 400 micrograms of oral misoprostol
Authors: Pongsatha Saipin , Tongsong Theera
Published: May 2004

Objective: To assess the efficacy and maternal side‐effects of oral misoprostol for second trimester termination of pregnancies with intrauterine fetal death.

Methods: A prospective descriptive study was conducted on 63 pregnant women who had intrauterine fetal death with unfavorable cervix (Bishop scores ≤4). All received 400 µg of misoprostol orally every 4 h until favorable cervix was achieved. Main outcome measures included success rate of termination within 12, 24, 36 and 48 h, mean induction to delivery time and maternal side‐effects.

Results: The success rates of termination within 12, 24, 36, 48 h were 50.8%, 84.1%, 88.9% and 92.1%, respectively. Mean induction to delivery time in cases of delivery within 48 h was 13.2 ± 8.4 h, range 2.25–22.9 h. The most common maternal side‐effect was chill (33.3%). No serious maternal complication was detected.

Conclusion: 400 µg oral misoprostol every 4 h is effective for pregnancy termination in cases of intrauterine fetal death and may be an alternative regimen because of its ease and convenience.
Auto antibodies against oxidized low density lipoprotein in severe preeclampsia
Authors: Jain Meenakshi , Sawhney Harjeet , Aggarwal Neelam , Vashistha Kala , Majumdhar Siddarth
Published: May 2004

Background: To study autoantibody titres against oxidized low density lipoprotein in preeclamsia.

Methods: Ten millimeters of heparinized blood samples were collected from 20 primigravidae with severe preeclamsia (study group) and 20 gestation‐matched normotensive primigravidae (control group). Concentration of malondialdehyde, metabolite of lipid peroxidation were measured in sera by HPLC and autoantibodies against oxidized low density lipoproteins (obtained after oxidation with 2 mm CuSO4) were determined by ELISA. Statistical analysis was performed by Student's t‐test and χ2 test.

Results: Mean triglyceride levels were significantly (P < 0.001) higher in the study group (193.20 ± 31.16 mg/dL) compared to the control group (170.60 ± 23.2 mg/dL). Mean plasma lipid per oxide levels were not significantly different between the study (4.45 ± 1.28 mmol/mL) and control (3.88 ± 0.99 mmol/mL) groups. The majority of women in both groups had low antibody titres (<1.32) against low density lipoprotein. Six women (30%) of the study group and four (20%) of the control group had high autoantibody titres (≥1.32). In preeclamptic women, diastolic blood pressure, the amount of urinary protein excretion and the plasma level of urea were significantly higher (P < 0.05) in patients with higher auto antibody titre.

Conclusion: Titres of autoantibodies to oxidized low density lipoprotein were similar in normotensive and preeclamptic women. In preeclamptic women, titres correlated positively with the severity of preeclampsia.
Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance
Authors: Modanlou Houchang D. , Murata Yuji
Published: May 2004

Objectives: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology.

Background: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh‐sensitized and dying fetuses. This FHR pattern was called ‘sinusoidal’ because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death.

Undulating FHR pattern: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre‐mortem FHR pattern; (4) pseudo‐SHR pattern; and (5) equivocal FHR patterns.

Fetal conditions associated with SHR pattern: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth.

Definition of true SHR pattern: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120–160 bpm; (b) amplitude of 5–15 bpm, rarely greater; (c) frequency of 2–5 cycles per minute; (d) fixed or flat short‐term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity.

Physiopathology: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology.

Conclusion: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics.
Evaluation of the Pyruvate Kinase isoenzyme tumor (Tu M2‐PK) as a tumor marker for cervical carcinoma
Authors: Kaura Babita , Bagga Rashmi , Patel Feruza D.
Published: May 2004

Various isoforms of the glycolytic enzyme pyruvate kinase are expressed in different cell types. One of these isoforms, Tu M2‐PK, is over‐expressed in tumor cells and released into body fluids. Plasma determination of Tu M2‐PK has been shown to discriminate between benign and malignant lesions. Tu M2‐PK was quantitated in the plasma of 50 patients with cervical carcinoma, 10 patients with chronic cervicitis and 10 healthy controls. The concentration of Tu M2‐PK was determined by commercial kits using a sandwich enzyme linked immunosorbent assay based on two monoclonal antibodies (clone I and II) specific for Tu M2‐PK. The sensitivity of the test for discrimination of malignant from non‐malignant condition was 82% with a specificity of 60%. Highly significant statistical difference was found in the means of three groups (P = 0.0002). The present results indicate that Tu M2‐PK can be used as a tumor marker in follow‐up of patients with cervical carcinoma.
Primary omental ectopic pregnancy
Authors: Wong Wai Chung , Wong Bonnie Pui Yee , Kun Ka Yan , Ng Tai Keung , Kwok Shek Yuen , Lee Chun Kit
Published: May 2004

Omental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed.
Prediction of successful menorrhagia treatment after thermal balloon endometrial ablation
Authors: Shaamash Ayman H. , Sayed Ezzat H.
Published: May 2004

Background: Thermal balloon endometrial ablation (TBEA) is a non‐hysteroscopic technique, which relies on a combination of heat and pressure within the uterine cavity to destroy endometrium and superficial myometrium. It is a simple, easy and minimally invasive procedure with an equivalent effectiveness to hysteroscopic endometrial ablation.

Objectives: To evaluate the effectiveness of TBEA in the treatment of menorrhagia and to identify the possible predictive factors for a successful outcome after 2‐year follow‐up.

Methods: A prospective study was conducted, including 45 patients suffering from serious menorrhagia. Under local anesthesia with i.v. sedation, the Therma‐Choice™ (Gynecare, Somerville, NJ, USA) balloon was inserted transcervically and after inflation in the endometrial cavity with 5% dextrose, it was heated to 87°C for an 8‐minute treatment cycle.

Results: There were no intraoperative complications and postoperative morbidity was minimal. At 2‐year follow‐up the overall improvement of menstrual pattern was 85%; with reported 29% amenorrhea, 23.5% hypomenorrhea and 32.5% euomenorrhea. Menorrhagia persisted in 15% of patients. Multiple logistic regression analysis of the factors that could affect the outcome showed that the chance for a successful treatment increased significantly with increased age (P = 0.044), shorter uterine depth (P = 0.049) and adequate balloon pressure (P = 0.027). These were the predictive factors for successful outcome. However, parity, uterine volume and endometrial thickness were not predictive factors.

Conclusion: At 2‐year follow‐up, thermal balloon endometrial ablation is effective in menorrhagia treatment. Increased age, shorter uterine depth and adequate balloon pressure can be predictive factors for successful treatment.
Vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women: A randomized controlled trial
Authors: Bunnasathiansri Soysuwan , Herabutya Yongyoth , O‐Prasertsawat Pratak
Published: May 2004

Aim: To investigate the efficacy of vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women.

Methods: Forty‐four postmenopausal women with indication for dilatation and curettage were randomly assigned to receive either 400 µg of misoprostol or placebo vaginally 6 h before dilatation and curettage. The main outcome measures were the number of women who required cervical dilatation, cervical width, time taken to dilate to Hegar 6 and other complications.

Results: The mean cervical diameter (4.59 millimeters in the misoprostol group vs 4.41 millimeters in the placebo group) was comparable between the two groups. A similar number of women in the misoprostol group and in the placebo group required cervical dilatation (12 vs 16, P = 0.35). The operative times for both groups were similar. The incidence of side‐effects was comparable in both groups. There were two uterine perforations in the misoprostol group (2 vs 0).

Conclusion: There was no significant benefit from applying 400 µg vaginal misoprostol 6 h prior to dilatation and curettage in postmenopausal women.
Chromosome abnormalities identified in 347 spontaneous abortions collected in Japan
Authors: Nagaishi Masaji , Yamamoto Tatsuo , Iinuma Kazuso , Shimomura Katsunori , Berend Sue Ann , Knops Judith
Published: May 2004

Objective: We determined the incidence of specific chromosome abnormalities in this Japanese population so that comparisons could be made to the incidence of chromosome abnormalities reported for other populations.

Methods: A total of 423 cases of products of conception aborted spontaneously were collected for cytogenetics analysis from various medical sites located in Japan. The cytogenetic results, along with clinical information including gestational age at the time of the miscarriage and maternal age, were compiled in a database. The incidence of specific chromosome aberrations was determined. The abnormalities were separated by gestational age at the time of the miscarriage and by maternal age.

Results: The total number of specimens available for cytogenetic analysis was 407. Cytogenetic results were obtained for 347 cases (85.3%), of which 196 (56.5%) showed chromosome abnormalities. Autosomal trisomy was detected in 120 cases (61.2% of the abnormal cases). Trisomy for each autosome, with the exception of chromosomes 1, 5, 6, 11, 12, and 19, was identified. The most common autosomal trisomy was that of chromosome 16 (30 cases), followed by trisomy 21 (13 cases), and trisomy 22 (13 cases). Eight cases showed double trisomies, and one case showed trisomy for three different chromosomes. Two cases showed monosomy 21, and 24 cases showed 45,X. Triploidy was identified in 27 cases and tetraploidy was detected in five cases. Unbalanced structural rearrangements were found in 11 cases, and balanced translocations were identified in two cases. Six cases showed mosaicism: three cases showed a normal cell line; and three cases had multiple abnormal cell lines. Separating the trisomies by the gestational age at which time the miscarriage occurred revealed that trisomies 7, 8, 14, 15, 16 and 22 occurred exclusively during the first trimester and fetuses with trisomies 4, 13, 18 and 21 survived late into the second trimester.

Conclusion: Overall patterns of chromosome abnormalities detected in spontaneous abortions in Japan were similar to those reported in the literature.
Proposal to transfer ‘Aegyptianella ranarum’, an intracellular bacterium of frog red blood cells, to the family Flavobacteriaceae as ‘CandidatusHemobacterium ranarum’ comb. nov.
Authors: Zhang Chunbin , Rikihisa Yasuko
Published: May 2004

‘Aegyptianella ranarum’ (order Rickettsiales), an ultrastructurally defined small, Gram‐negative rod, is known to replicate in the red blood cells of frogs. Heretofore, this bacterium has not been characterized genetically. We cloned and sequenced the 16S rRNA (1310 bp) andgyrB(718 bp) genes of ‘A. ranarum’ from a Canadian frog blood specimen.In situhybridization (with an ‘A. ranarum’ 16S rRNA gene polymerase chain reaction product as probe) and electron microscopy confirmed that ‘A. ranarum’ forms cytoplasmic inclusions in frog erythrocytes.blastcomparisons with GenBank 16S rRNA andgyrBsequences showed that both ‘A. ranarum’ genes were most similar (91% and 67% identity) to those ofChryseobacterium meningosepticum, a bacterium in the family Flavobacteriaceae.In contrast, ‘A. ranarum’ 16S rRNA shared only 61% identity withAegyptianella pullorum. Phylogenetic analyses of these genes usingphylipsupported ‘A. ranarum’ as a member of Flavobacteriaceae, but suggested that its cladistic sibling may beBergeyella zoohelcumorWeeksella virosa, rather thanC. meningosepticum.We propose to classify ‘Aegyptianella ranarum’ as ‘CandidatusHemobacterium ranarum’ in the family Flavobacteriaceae.Our results provide a starting point for studies of related intraerythrocytic bacterial infections in frogs.
Application and validation of DNA microarrays for the 16S rRNA‐based analysis of marine bacterioplankton
Authors: Peplies Jörg , Lau Stanley Chun Kwan , Pernthaler Jakob , Amann Rudolf , Glöckner Frank Oliver
Published: May 2004

An oligonucleotide probe‐based DNA microarray was evaluated for its ability to detect 16S rRNA targets in marine bacterioplankton samples without prior amplification by polymerase chain reaction (PCR). The results obtained were compared with those of quantitative fluorescence in situ hybridization (FISH). For extraction and direct labelling of total RNA, a fast and efficient protocol based on commercially available kits was established. A set of redundant and hierarchically structured probes was applied, and specificity of hybridization was assessed by additional control oligonucleotides comprising single central mismatches. The protocol was initially tested by microarray analysis of bacterial pure cultures. Complete discrimination of all control oligonucleotides was achieved, indicating a high degree of hybridization specificity. In a co‐culture, abundant members were detected by microarray analysis, but signal ratios of positive probes did not correlate well with quantitative data from FISH experiments. A marine picoplankton sample from the German Bight was analysed. Bacterial populations with relative abundances of at least 5% were detected by hybridizing 0.1 µg of total RNA extracted from a sample of 375 ml equivalent to 4.1 × 108 cells. Our results demonstrate that major populations of marine bacterioplankton can be identified by microarray analysis in a fast and reliable way, even in relatively low volumes of sea water.
Repression of Pseudomonas putida phenanthrene‐degrading activity by plant root extracts and exudates
Authors: Rentz Jeremy A. , Alvarez Pedro J. J. , Schnoor Jerald L.
Published: May 2004

The phenanthrene‐degrading activity (PDA) of Pseudomonas putida ATCC 17484 was repressed after incubation with plant root extracts of oat (Avena sativa), osage orange (Maclura pomifera), hybrid willow (Salix alba × matsudana), kou (Cordia subcordata) and milo (Thespesia populnea) and plant root exudates of oat (Avena sativa) and hybrid poplar (Populus deltoides × nigra DN34). Total organic carbon content of root extracts ranged from 103 to 395 mg l−1. Characterization of root extracts identified acetate (not detectable to 8.0 mg l−1), amino acids (1.7–17.3 mg l−1) and glucose (1.6–14.0 mg l−1), indicating a complex mixture of substrates. Repression was also observed after exposure to potential root‐derived substrates, including organic acids, glucose (carbohydrate) and glutamate (amino acid). Carbon source regulation (e.g. catabolite repression) was apparently responsible for the observed repression of P. putida PDA by root extracts. However, we showed that P. putida grows on root extracts and exudates as sole carbon and energy sources. Enhanced growth on root products may compensate for partial repression, because larger microbial populations are conducive to faster degradation rates. This would explain the commonly reported increase in phenanthrene removal in the rhizosphere.
Pathogenic potential of environmental Klebsiella pneumoniae isolates
Authors: Struve Carsten , Krogfelt Karen Angeliki
Published: May 2004

Klebsiella pneumoniae is an important opportunistic pathogen and a frequent cause of nosocomial infections. K. pneumoniae infections can occur at nearly any body site; however, urinary tract infections and infections of the respiratory tract predominate. Infections are frequently preceded by gastrointestinal colonization, and the gastrointestinal tract is believed to be the most important reservoir for transmission of the bacteria. In contrast to many other bacterial pathogens, K. pneumoniae is ubiquitous in nature. Several studies have described Klebsiella isolates of environmental origin to be nearly identical to clinical isolates with respect to several phenotypic properties. However, the pathogenic potential of environmental K. pneumoniae isolates is essentially unknown. We have evaluated the virulence of K. pneumoniae strains of environmental and clinical origin directly in animal models, i.e. in urinary tract infection and intestinal colonization models. Furthermore, the ability to adhere to and invade human epithelial cell lines was examined. Although strain‐to‐strain differences were observed in the individual infection models, overall, strains of environmental origin were found to be as virulent as strains of clinical origin. The ubiquity of K. pneumoniae in nature and the general ability of K. pneumoniae strains to infect susceptible hosts might explain the high frequency of opportunistic infections caused by this species.
Isolation of haloarchaea that grow at low salinities
Authors: Purdy K. J. , Cresswell‐Maynard T. D. , Nedwell D. B. , McGenity T. J. , Grant W. D. , Timmis K. N. , Embley T. M.
Published: May 2004

Archaea, the third domain of life, were long thought to be limited to environmental extremes. However, the discovery of archaeal 16S rRNA gene sequences in water, sediment and soil samples has called into question the notion of Archaea as obligate extremophiles. Until now, none of these novel Archaea has been brought into culture, a critical step for discovering their ecological roles. We have cultivated three novel halophilic Archaea (haloarchaea) genotypes from sediments in which the pore‐water salinity was close to that of sea water. All previously reported haloarchaeal isolates are obligate extreme halophiles requiring at least 9% (w/v) NaCl for growth and are typically the dominant heterotrophic organisms in salt and soda lakes, salt deposits and salterns. Two of these three newly isolated genotypes have lower requirements for salt than previously cultured haloarchaea and are capable of slow growth at sea‐water salinity (2.5% w/v NaCl). Our data reveal the existence of Archaea that can grow in non‐extreme conditions and of a diverse community of haloarchaea existing in coastal salt marsh sediments. Our findings suggest that the ecological range of these physiologically versatile prokaryotes is much wider than previously supposed.
Graphite electrodes as electron donors for anaerobic respiration
Authors: Gregory Kelvin B. , Bond Daniel R. , Lovley Derek R.
Published: May 2004

It has been demonstrated previously that Geobacter species can transfer electrons directly to electrodes. In order to determine whether electrodes could serve as electron donors for microbial respiration, enrichment cultures were established from a sediment inoculum with a potentiostat‐poised graphite electrode as the sole electron donor and nitrate as the electron acceptor. Nitrate was reduced to nitrite with the consumption of electrical current. The stoichiometry of electron and nitrate consumption and nitrite accumulation were consistent with the electrode serving as the sole electron donor for nitrate reduction. Analysis of 16 rRNA gene sequences demonstrated that the electrodes supplied with current were specifically enriched in microorganisms with sequences most closely related to the sequences of known Geobacter species. A pure culture of Geobacter metallireducens was shown to reduce nitrate to nitrite with the electrode as the sole electron donor with the expected stoichiometry of electron consumption. Cells attached to the electrode appeared to be responsible for the nitrate reduction. Attached cells of Geobacter sulfurreducens reduced fumarate to succinate with the electrode as an electron donor. These results demonstrate for the first time that electrodes may serve as a direct electron donor for anaerobic respiration. This finding has implications for the harvesting of electricity from anaerobic sediments and the bioremediation of oxidized contaminants.
Pseudomonas putida mutants in the exbBexbDtonB gene cluster are hypersensitive to environmental and chemical stressors
Authors: Godoy Patricia , Ramos‐González María‐Isabel , Ramos Juan L.
Published: May 2004

The genes in the exbBexbDtonB cluster of Pseudomonas putida DOT‐T1E are co‐transcribed. We have generated non‐polar mutants in each of the genes by inserting an aphA3 cassette encoding kanamycin resistance. All three mutants show similar phenotypes: the mutants are unable to grow on minimal medium under iron deficiency conditions. Furthermore, regardless of iron conditions, all mutants are hypersensitive to antibiotics, p‐hydroxybenzoate and toluene, chemicals that are extruded from the cell by efflux pumps. These findings are discussed in terms of the involvement of the TonB system in the energization of outer membrane functions necessary for the import or export of different compounds in P. putida.
Hydrogen threshold concentrations in pure cultures of halorespiring bacteria and at a site polluted with chlorinated ethenes
Authors: Luijten Maurice L. G. C. , Roelofsen Wim , Langenhoff Alette A. M. , Schraa Gosse , Stams Alfons J. M.
Published: May 2004

Halorespiring microorganisms are not only able to oxidize organic electron donors such as formate, acetate, pyruvate and lactate, but also H2. Because these microorganisms have a high affinity for H2, this may be the most important electron donor for halorespiration in the environment. We have studied the role of H2‐threshold concentrations in pure halorespiring cultures and compared them with mixed cultures and field data. We have found H2‐threshold values between 0.05 and 0.08 nM for Sulfurospirillum halorespirans, S. multivorans and Dehalobacter restrictus under PCE‐reducing and nitrate‐reducing conditions.

The reduction of PCE and TCE can proceed at H2 concentrations of below 1 nM at a polluted site. However, for the reduction of lower chlorinated ethenes a higher H2 concentration is required. This indicates that the measured H2 concentration in situ can be an indicator of the extent of anaerobic reductive dechlorination.
Lentisphaera araneosa gen. nov., sp. nov, a transparent exopolymer producing marine bacterium, and the description of a novel bacterial phylum, Lentisphaerae
Authors: Cho Jang‐Cheon , Vergin Kevin L. , Morris Robert M. , Giovannoni Stephen J.
Published: May 2004

Two phylogenetically distinct marine strains producing transparent exopolymers (TEP), designated HTCC2155T and HTCC2160, were cultivated from Oregon coast seawater by dilution to extinction in a high throughput culturing format. When cultured in low‐nutrient seawater media, these strains copiously produced Alcian Blue‐stainable viscous TEP. Growing cells were attached to each other by the TEP in a three dimensional network. Polymerase chain reaction employing 16S rDNA primers specific for the novel isolates indicated that they are indigenous to the water column of the Atlantic and Pacific oceans. The abundance of the isolates as determined by 16S rRNA dot blots, however, indicated that they are less than 1% of the total bacterial community. In phylogenetic analyses, the strains consistently formed a new phylum‐level lineage within the domain Bacteria, together with members of the candidate phylum VadinBE97, which consists of Victivallis, the first cultured genus in the candidate phylum, and 16S rRNA gene clones from DNA extracted from marine or anaerobic terrestrial habitats. Five putative subgroups were delineated within this phylum‐level lineage, including a marine group and an anaerobic group. The isolates are Gram negative, strictly aerobic, chemoheterotrophic, and facultatively oligotrophic sphere‐shaped bacteria. The DNA G+C content of strain HTCC2155T was 48.3 mol% and the genome size was 2.9 mb. It is proposed from these observations that the strains be placed into a new genus and a new species named Lentisphaera araneosa (type strain HTCC2155T = ATCC BAA‐859T = KCTC 12141T) gen. nov., sp. nov., the cultured marine representative of the Lentisphaerae phyl. nov., and the phylum be divided into two novel orders named the Lentisphaerales ord. nov. and the Victivallales ord. nov.
Biofilm formation by the small colony variant phenotype of Pseudomonas aeruginosa
Authors: Häußler Susanne
Published: May 2004

Pseudomonas aeruginosa is an ubiquitous environmental bacterium and an opportunistic human pathogen. Not only in most natural habitats but also within the human host, e.g. within the chronically infected cystic fibrosis lung, P. aeruginosa is associated with surfaces in structures known as biofilms. These functional communities represent a unique mode of bacterial growth where bacteria display particular phenotypes that are fundamentally different from planktonic cells. In this review the issue of the molecular mechanisms underlying the emergence of small colony variant (SCV) P. aeruginosa morphotypes that are especially capable of forming biofilms is addressed. It is assumed that the expression of the chaperone usher pathway (cup) genes encoding putative fimbrial adhesins is responsible for the phenotypic switch to an autoaggregative SCV phenotype. The elucidation of phenotypic switching in response to environmental stimuli will significantly increase our understanding of regulatory processes during bacterial adaptation and might be the basis for the initiation of the development of new antimicrobial treatment strategies.
Vertical and temporal shifts in microbial communities in the water column and sediment of saline meromictic Lake Kaiike (Japan), as determined by a 16S rDNA‐based analysis, and related to physicochemical gradients
Authors: Koizumi Yoshikazu , Kojima Hisaya , Oguri Kazumasa , Kitazato Hiroshi , Fukui Manabu
Published: May 2004

The vertical and temporal changes in microbial communities were investigated throughout the water column and sediment of the saline meromictic Lake Kaiike by PCR‐denaturing gradient gel electrophoresis (DGGE) of 16S rDNA. Marked depth‐related changes in microbial communities were observed at the chemocline and the sediment–water interface. However, no major temporal changes in the microbial community below the chemocline were observed during the sampling period, suggesting that the ecosystem in the anoxic zone of Lake Kaiike was nearly stable. Although the sequence of the most conspicuous DGGE band throughout the anoxic water and in the top of the microbial mat was most similar to that of an anoxic, photosynthetic, green sulphur bacterium, Pelodyction luteolum DSM273 (97% similarity), it represented a new phylotype. A comparison of DGGE banding patterns of the water column and sediment samples demonstrated that specific bacteria accumulated on the bottom from the anoxic water layers, and that indigenous microbial populations were present in the sediment. The measurements of bicarbonate assimilation rates showed significant phototrophic assimilation in the chemocline and lithoautotrophic assimilation throughout the anoxic water, but were not clearly linked with net sulphide turnover rates, indicating that sulphur and carbon metabolisms were not directly correlated.