bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV and AIDS among adolescents in the United States: increasing risk in the 1990s
Authors: Bowler Suzanne , Sheon Amy R. , D'angelo Lawrence J. , Vermund Sten H.
Published: April 2004

Acquired immunodeficiency syndrome (AIDS) and human immuno‐deficiency virus (HIV) are growing problems among U.S. adolescents. By examining recent data on AIDS surveillance and HIV seroprevalence, surveys on teenagers' knowledge, beliefs, and behaviors related to HIV/AIDS, key treatment issues, and barriers to prevention, this manuscript reviews the problem and proposes possible ways of combating it. African American youth have the highest rates of AIDS and white youth the lowest. However, the largest number of AIDS cases overall has been recorded in white males, reflecting relatively high case rates in boys with hemophilia and in young male homosexuals. Predominant HIV risk factors for adolescents are unprotected sex and/or sharing injection drug equipment with an infected partner. Relatively high rates of HIV infection in adolescent females may indicate their greater physiological vulnerability than adult females to sexually transmitted diseases (STDs). Data from HIV seroprevalence studies suggest a substantially increased heterosexual epidemic in the 1990s, especially in large east coast cities and southeastern rural areas where drug use and/or STDs are highly prevalent. More comprehensive prevention and treatment services are needed to prevent on‐going expansion of HIV infection and AIDS in the adolescent age group.
The effect of phalloidin and jasplakinolide on the flexibility and thermal stability of actin filaments
Authors: Visegrády Balázs , Lőrinczy Dénes , Hild Gábor , Somogyi Béla , Nyitrai Miklós
Published: April 2004

In this work the effect of phalloidin and jasplakinolide on the dynamic properties and thermal stability of actin filaments was studied. Temperature dependent fluorescence resonance energy transfer measurements showed that filaments of Ca‐actin became more rigid in the presence of phalloidin or jasplakinolide. Differential scanning calorimetric data implied that the stiffer filaments also had greater thermal stability in the presence of phalloidin or jasplakinolide. The fluorescence and calorimetric measurements provided evidences that the extent of stabilization by jasplakinolide was greater than that by phalloidin.
Bacteriologic studies in second‐trimester pregnancy termination: A comparison of intra‐ and extra‐amniotic methods
Authors: Reichman Judith , Ashkenazi Jack , Elian Inge , Goldman Jack A.
Published: April 2004

Vaginal and cervical cultures were obtained in 20 women undergoing intra‐amniotic saline infusion and 20 women having extraamniotic saline infusion for second‐trimester abortion. Following expulsion intrauterine cultures were taken and the patients were followed for signs of clinical infection.

Sixty percent of the patients had pathogenic bacteria cultured prior to abortion, 40% has positive intrauterine cultures after abortion and 7.5% had clinical infection. There was a positive correlation between injection‐abortion time and pathogenic intrauterine cultures. No significant differences in the incidence of positive intrauterine cultures or clinical infection between the two groups were found. Of those patients with positive preabortion cultures 70% had identical pathogens cultured from the uterus after expulsion suggesting that most postabortal pathogens arise from endogenous vaginal and cervical sites rather than from exogenous sources.
Post‐cesarean section endomyometritis: Significance of transcervical endometrial cultures in bacteremic patients
Authors: diZerega Gere S. , Yonedura M. Lynn , Ledger William J.
Published: April 2004

Pelvic infection following cesarean section is the most common hospital acquired infection facing the obstetrician‐gynecologist today. In order to prescribe the optimal antibiotic therapy, clinicians must know which organisms generate the infection. This study assessed the utility of transcervical endometrial swab cultures in the isolation of organisms from post‐cesarean section patients. Results of blood cultures obtained from the same patients are used as the standard of comparison.
The influence of lumbar epidural analgesia in labor on mode of delivery
Authors: Chandler Christopher J. , Davidson Brian A.
Published: April 2004

A retrospective analysis of the use of lumbar epidural analgesia in the Leeds Maternity Hospital between 1969 and 1978 has been carried out. The percentage of patients with epidural blocks has been compared with the instrumental delivery and cesarean section rates for each of the 10 years.

The data shows that while the epidural rate has risen from 0% to almost 40%, the operative delivery rates have remained almost constant.
Ovarian tumors complicating pregnancy
Authors: Hasan Adnan , Amr Samir , Issa Abdulla , Bata Majed
Published: April 2004

Between the years 1977 and 1981, 9037 patients gave birth at Jordan University Hospital (JUH). Among these ten patients were found to have an associated ovarian tumor, an incidence of one in 900 deliveries. Benign cystic teratomas were the most common ovarian tumors found, followed by mucinous cystadenomas. All of the tumors were benign except one case of Burkitt's lymphoma.
A prospective randomized study of induction of labor
Authors: Sande H.A. , Tuveng J. , Fønstelien T.
Published: April 2004

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.
Episiotomy pain: Efficacy and safety of fluproquazone compared to aspirin and placebo
Authors: London Robert , Sundaram G.S. , Feldman Susan , Goldstein Phillip
Published: April 2004

The analgesic efficacy of fluproquazone at 100 mg and 200 mg doses, was measured in 160 patients with episiotomy pain and was compared to that of aspirin (650 mg) and placebo. The 100‐mg dose of fluproquazone was more effective in relieving episiotomy pain than the 200‐mg dose of fluproquazone, aspirin or placebo in terms of mean pain intensity scores after 1 h. All active compounds were more effective than placebo by all criteria.
Daily rhythm of serum human chorionic gonadotropin and human chorionic somatomammotropin in normal pregnancy
Authors: Ayala Aquiles R. , Bustos Hugo , Aguilar Rosa Ma.
Published: April 2004

We have quantified the human chorionic gonadotropin (HCG) and human chorionic somatomammotropin (HCS) serum levels in normal pregnant women at 1‐h intervals during 24 h, through radioimmunoassay procedures. The HCG levels were higher during the first trimester, although no circadian variations were detected. Some variations exceeded by ten fold: these variations decreased with advanced periods of gestation. No diurnal fluctuations in serum HCS were apparent; in a case nearly at term, there was an increase from 05:00 h to 09:00 h simulating a circadian pattern, although it was not statistically significant. These data indicate that the placental protein secretion is autonomous and that HCG levels of fluctuation during early stages of pregnancy might be regulated by factors other than the trophoblast.
Serum prolactin profiles of normal human conceptual cycles
Authors: Adejuwon Christopher A. , Faundes Anibal , Segal Sheldon J. , Alvarez‐Sanchez Francisco
Published: April 2004

Commencing on day 10 of the menstrual cycle through onset of subsequent menses, or confirmation of pregnancy, daily sera collected from 15 women planning pregnancy were analyzed by radioimmunoassays (RIA) for prolactin (hPRL), estradiol‐17β and luteinizing hormone (hLH). Two of the observed subjects became pregnant in the single cycles studied. The profiles of these hormones during the early gestation following spontaneous ovulation were established. No distinct midcycle peaks of hPRL were observed in either subject. Enormous spikes were observed in daily prolactin values, with wide variations between subjects.
Continuous twenty‐four hour recording of the fetal cardiac rhythm during normal pregnancies
Authors: Lecoutour X. , Treisser A. , Renaud R.
Published: April 2004

Recording the fetal cardiac rhythm (FCR) is currently the technique most widely used to assess the well being of the fetus. In view of the importance of the decisions taken on the modifications of the FCR, the authors have recorded and analysed over 24 consecutive hours 10 resting women manifesting a strictly normal pregnancy. They observed no modification in the basal cardiac frequency, very few declarations and above all, never any signs of a flat or sinusoidal rhythm. Flattening of the FCR is invariably pathological. It must not be interpreted as “fetal sleep” period, but it should intensify the surveillance.
Placental hemorrhagic endovasculitis: Risk factors and impact on pregnancy outcome
Authors: Stevens Nancy G. , Sander Charles H.
Published: April 2004

Two hundred and eighteen cases of hemorrhagic endovasculitis (HEV), a recently recognized abnormality of human placentas, were identified from placentas submitted to the Michigan Placental Tissue Registry over a 2.5‐year period. HEV appears to focus on fetal placental blood vessels with resultant fragmentation and destruction of fetal RBCs, hemorrhage into villous stroma, microthrombi in villous capillaries and non‐exudative necrosis of medium sized chorionic vessels. Placentas without HEV submitted for evaluation from the same hospitals were selected for comparison. Women with HEV placentas were of similar age, race and parity as control women. The sex of the fetus of HEV cases was somewhat more often female (57% vs 48%, P = 0.05). The presence of HEV appeared to have a deleterious effect on the outcome of pregnancy: 52% (112/218) of the HEV placentas were associated with stillborn infants, in contrast to only 22% (89/400) of control placentas. The difference in the proportion of still‐births was greatest when the gestational age was 25 weeks or greater. Other significant positive associations with HEV included the presence of meconium staining, intrauterine growth retardation, smaller placentas, and maternal hypertension or toxemia. Pathologic findings associated with HEV were chronic villitis, erythroblastosis, thrombosis and cord abnormalities. No association was found with infant Apgar score or fetal anomalies. The association of HEV with a high proportion of stillbirths in the registry suggests that further understanding of this lesion might shed light on the problem of unexplained stillbirths.
Vaginal contraception: An overview
Authors: Edelman David A.
Published: April 2004

Some of the more recent advances in vaginal contraception (suppositories, diaphragms, cervical caps, contraceptive sponges) are reviewed, and, when available, data relating to their safety and effectiveness are presented.
Plasma volume in normal pregnant Nigerian primigravidae
Authors: Abudu O.O. , Sofola O.A.
Published: April 2004

Plasma volume was measured in 10 non‐pregnant, healthy nulliparous Nigerian and 30 normal primigravid Nigerians at various times of gestation by the Evans blue dye dilution technique. The mean plasma volume of 2098 ml for the non‐pregnant Nigerians was statistically different (P < 0.001) from values in non‐pregnant caucasian primigravidae of comparable status. A mean maximum plasma volume increase of 1387 ml above non‐pregnant value was found. Essentially, pregnancy imposed a much higher physiological load on Nigerian primigravidae compared to caucasian primigravidae. There was a significant negative correlation between plasma volume and packed cell volume (PCV) in pregnancy (r = −0.51, P < 0.001), which may be related to excessive hemodilution in the primigravid Nigerian. Differences found may be due to geographical and/or racial factors.
Craniofacial defects associated with amniotic band syndrome: A case report
Authors: Ito Masaharu , Onitsuka Yoshio , Matsui Kazuo , Fujisaki Syunichi , Maeyama Masao
Published: April 2004

A pathological study was made of a female infant with amniotic band syndrome. At birth, the 1450‐g female infant was noted to have craniofacial defects such as anencephaly, cleft lip, severe nasal deformity and asymmetric microphthalmia. The fetal membrane was focally adhered to the scalp, and histological examinations revealed that the connecting area of the fetal head to the membrane resembled a serial architecture from keratinized squamous cells to amniotic layer without any inflammatory findings. These observations suggested that the etiology in the present case may be consistent with Torpin's mesodermic band theory.
Fertility after the demonstration of intravasation during hysterosalpingography
Authors: Ron M. , Menashe M. , Aviad I. , Palti Z. , Mogle P.
Published: April 2004

Intravasation of contrast medium was found in 28 women out of 450 women (6.25%) who underwent hysterosalpingography (HSG). Ten of these women had an otherwise normal uterine cavity and patent tubes. In six patients (66%) out of nine who underwent a repeated HSG within 2 months no intravasation was demonstrated. Seven of the 28 patients with intravasation (25%) of whom four were among the 10 patients with normal uterine cavity and patent tubes (40%) conceived and delivered later.

It is concluded that in cases in which no other uterine pathology is demonstrated on HSG intravasation is not a persistent occurrence, and by itself does not affect the prognosis of fertility.
Advanced papillary adenocarcinoma of unknown origin as tumor previa during late pregnancy
Authors: Levin S. , Zuker N. , Grishkan A. , Ezra Y. , Rizel S.
Published: April 2004

A 41‐year‐old woman with advanced abdominal adenocarcinoma presented at term pregnancy. The tumor was presented as previa and obstructed the delivery. A cesarean section was performed and a healthy child was born. At surgery diffuse metastatic disease was detected throughout the pelvis and abdomen and was partially resected. Combined chemotherapy consisting of cis‐platinum, adriamycin and cytoxan was administered for 5 months. At second‐look laparotomy no residual disease was found. We present an unusual presentation of metastatic abdominal undifferentiated carcinoma treated as ovarian cancer.
Long term follow‐up of women with hypertension in pregnancy
Authors: Selvaggi L. , Loverro G. , Schena F.P. , Manno C. , Cagnazzo G.
Published: April 2004

The reproductive history and the present health status of 66 patients who had had a pregnancy complicated by hypertension during the period 1972–1982 were retrospectively studied. Hypertension in pregnancy is a poor prognostic factor not only for the future development of hypertension but, also, as it is associated to a very poor reproductive history. Such complications are more frequent in pregnant women with very high blood pressure (160/100). In fact, in the case of a previous pregnancy, this group of patients had experienced a high rate of abortions (31.7%), premature deliveries (17.8%) and perinatal mortality (21.4%). Moreover, these women are subject to a higher risk (56.5%) of developing hypertension in successive pregnancies. Risk factors for determining the future development of hypertension are: familiar hypertension, the severity of hypertension during pregnancy and pluriparity.
Maternity care monitoring: A contrast at two levels of health care delivery in Ibadan, Nigeria
Authors: Otolorin E.O. , Marinho A.O. , Ojengbede O. , Odukoya A.O. , Palmer C.K.
Published: April 2004

The obstetric performance of women delivering at two hospitals in Ibadan is compared in this study. The prevalence of high‐risk pregnancies at the tertiary level hospital (University College Hospital) was higher than that of the secondary level hospital (Oluyoro Catholic Hospital). Consequently, the cesarean section rate of the UCH (21.8%) was higher than that at the OCH (2.3%). Similarly, the maternal mortality (3.5 per 1000) and perinatal mortality (60.2 per 1000) at the UCH were significantly higher than at the OCH, 2.0 per 1000 and 9.8 per 1000, respectively. The need for a national birth survey based on a representative sample of all the different types of health establishments in Nigeria was stressed.
Peer review through perinatal statistics
Authors: Rooth G.
Published: April 2004

The purpose here is to demonstrate that perinatal statistics serve as a powerful tool for peer review, thereby improving the standard of maternity care. These data were used as an instrument for peer review, first by comparing perinatal mortality between one country and another. More detailed statistics, rapidly fed back to the delivery units, acted as a strong inducement to practitioners at all levels who wanted to do at least as well as their neighbors. Examples are given from Sweden, Scotland and Germany.
Conjoined twins and abdominal pregnancy
Authors: Offringa P.J. , Wildschut H.I.J. , Tutein Nolthenius‐Puylaert M.C.B.J.E. , Leon S. , Boersma E.R.
Published: April 2004

Abdominal pregnancy is rare; conjoined twins are also rare. The diagnosis of abdominal pregnancy is easily missed and often not made until near full‐term. Similarly conjoined twins are not diagnosed until late in gestation or during parturition. In this case, the diagnosis of conjoined twins and abdominal pregnancy was only made during laparotomy.
Biomagnetic measurements of the brain activity of preeclamptic pregnant women using a superconducting quantum interference device
Authors: Anninos Ph. , Anastasiadis P. , Liberis V. , Galazios G. , Koutsougeras G.
Published: April 2004

Biomagnetic brain activity was studied in 17 full‐term pregnant women with symptoms of pre‐eclampsia using the biomagnetometer SQUID. The results show obvious differences both in the waveforms and in the spectra that obtained from statistical Fourier analysis by comparing them with the corresponding results from 87 pregnant women with normal full‐term pregnancies. Specifically, in the pathological pregnancies the high magnetic field activity emitted from points of the mother's brain is distributed in the 2–7 Hz band frequency range whereas in normal pregnancies we found low magnetic field activity distributed over the 7 Hz band frequency.
Breastfeeding and health care services
Authors: Jolly R.
Published: April 2004

Breastfeeding can help prevent the 38,000 daily deaths of infants and young children through its nutritional, immunologic, and sanitary aspects. Nevertheless, it is on the decline in most countries. The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) have combined to issue guidelines on the role of maternity services in promoting breastfeeding, such as, a hospital breastfeeding policy with rooming‐in, demand‐feeding, and the elimination of bottles and breast milk substitutes. These practices have succeeded in programs around the world and have increased the breastfeeding rate at the same time that infection rates decreased.
Technical Working Group B Report: Government and donor support for breastfeeding promotion in hospitals and maternity care institutions
Authors: Belsey Mark , McGuire Judith , Greaves Peter
Published: April 2004

The purpose of this workshop was to design a general strategy for government and donor support for breastfeeding promotion in hospitals and maternity care institutions. The overall success of the oral rehydration therapy (ORT) campaign to attract attention and funding was examined as a model. Several components were identified as leading to its success: a lobby of dynamic individuals; simple packages to “sell”; arguments that ORT was necessary and technically understandable; arguments couched in the language of either policy leaders and/or scientists; and detailed plans of action.
Technical working group C report: Breastfeeding promotion in health and health‐related programs
Authors: Spieler Jeff , Aumack Kimberly , Nathusius Dina
Published: April 2004

The purpose of this working group was to design a general strategy for the development of activities in non‐maternity health settings and in health‐related programs. The working group proposed that all sectors of society, which have any direct or indirect contact with women of childbearing age, should be approached to advocate breastfeeding. Seven sectors were outlined with suggestions for action.
Severe hemolytic disease of the newborn due to anti‐c
Authors: Appelman Z. , Lurie S. , Juster A. , Borenstein R.
Published: April 2004

Two cases of severe hemolytic disease of the newborn due to c‐isoimmunization are presented. Both women were multiparous, had previous blood transfusion and high maternal tites of anti‐c (1:1024 and 1:4036, respectively).
Peripartum cocaine use: estimating risk of adverse pregnancy outcome
Authors: Cohen H.R. , Green J.R. , Crombleholme W.R.
Published: April 2004

Pregnancy outcome of 83 patients with a positive urine toxicology screen for cocaine in the third trimester were reviewed. The outcomes of pregnancies complicated by cocaine abuse were compared to those of matched controls selected from our general obstetric population. We observed a statistically significant increase in the incidence of premature separation of the placenta, low birthweight infants, preterm deliveries, and the incidence of fetal distress requiring cesarean section. On admission, 55% of patients denied recent cocaine use. These observations have implications for planning perinatal services.
Shoulder dystocia: Anticipation and outcome
Authors: El Madany A.A. , Jallad K.B. , Radi F.A. , El Hamdan H. , O'deh H.M.
Published: April 2004

Shoulder dystocia is a serious obstetric emergency with several cases of permanent disability and fetal deaths each year. Ninety‐eight cases of shoulder dystocia, an incidence of 0.45%, occurred in Farwania Hospital, Kuwait during 1985–1987. Of these 54.1% had one or more birth trauma. The perinatal mortality rate was 71.4 per thousand, with a considerable increase in the rate of maternal complications. Macrosomia, maternal diabetes, augmentation and induction of labor, vacuum extraction, post‐term and malposition, were identified risk factors. We found that if all babies weighing ⩾4.5 kg are delivered by cesarean section, dystocia can be significantly reduced.
Hysteroscopic hydrotubation for treatment of tubal blockage
Authors: Lei Z.W. , Xiao L. , Xie L. , Li J. , Chen Q.X.
Published: April 2004

In order to increase the effectiveness of hydrotubation, a plastic cannula was inserted into the fallopian tube under hysteroscopic control. Fifty women with tubal blockage confirmed by HSG were selected for treatment. Hydrotubation solution consisted of hydrocortisone (20 mg), gentamicin (160,000 IU) and procaine (80 mg) in 20 ml distilled water. Repeat HSG was performed. After three treatments, tubal patency (one or both tubes) was achieved in 20 women (40%), and seven pregnancies resulted within 1–18 months. Hysteroscopic hydrotubation may be an alternative treatment for tubal blockage.
Adenocarcinoma of the supernumerary ovary
Authors: Barik S. , Dhaliwal L.K. , Gopalan S. , Rajwanshi A.
Published: April 2004

A rare case of adenocarcinoma of the supernumerary ovary is reported. This rarely encountered gynecological entity posed difficulty in diagnosis and management. However, the behavior is similar to adenocarcinoma of ovary originating from a normal site.
Menstruation: symptoms, management and attitudes in university students
Authors: Cronjé H.S. , Kritzinger I.E.
Published: April 2004

The aim of the study was documentation of the attitude towards and management of menstruation in Afrikaans speaking university students. Of 130 questionnaires issued, 102 (78.5%) were analysed. Severe symptoms occurred in 23% of the women. Premenstrually, the major symptoms were irritability, moodiness, breast tenderness, skin changes and increased appetite. During menstruation, dysmenorrhea was the most important symptom. Although only 17.6% of the women consulted a physician during the 2 years preceding the study, 47.1% used medication for symptoms. Seventy‐six (74.5%) of the women accepted menstruation as an integral part of a woman's life whereas 19.6% preferred not to menstruate. In this latter group, the majority reported severe symptoms. Fear of consulting a physician for menstrual symptoms was documented.
Delegation of obstetric care in Indonesia
Authors: Thouw J.
Published: April 2004

An intervention and a control area were selected. Results of the intervention, which consisted of training TBAs, midwives, and health center doctors, were positive inasmuch as there was an increase in referrals of breech presentation, prolonged labor and intrapartum fever in the intervention area. Pregnant women in general were also more often referred in the intervention area as compared to the control area. The same outcome was seen in referrals of neonates weighing under 2000 or more than 4000 g. At the district hospital level, a great number of procedures were left to general practitioners with quite satisfactory results. Conclusions drawn from our experience are that: (1) obstetric care must of necessity be delegated to TBAs, midwives, and general practitioners; (2) TBAs can be taught to recognize danger signs; (3) general practitioners are able to do such procedures as curettage, vacuum or forceps deliveries, and manual removal of placenta.
Appropriate training for maternal health and the attributes of the trainer
Authors: Parry E.H.O.
Published: April 2004

This review describes the qualities which those who are trainers in safe motherhood and other programs should display. The educational principles and objectives for maternal health workers, based on the tasks which they have to do and expressed in the skills and competences they must attain, are related to practical methods of training. Problem‐based learning is advocated and the value of distance education for rural workers is discussed.
The effect of desogestrel for hormone replacement therapy on the blood lipid profiles of postmenopausal women
Authors: Tadmor O.P. , Kleinman Y. , Goldstein R. , Diamant Y.Z.
Published: April 2004

Objective: To determine the effect of a hormone replacement protocol containing conjugated equine estrogens and desogestrel (which has a highly selective progestogenic and low androgenic effect) as the progestogen, on the plasma lipid profile, as compared with two other hormone replacement treatments (HRT). Method: Eighty‐nine healthy post‐menopausal women were divided prospectively into four groups. A control group of 24 women did not receive HRT. Twenty‐nine women received conjugated equine estrogen and medroxyprogesterone, and 13 women received a protocol containing estradiol, estriol and norethisterone acetate. Fasting blood lipid was taken at the end of each third cycle. The cumulative therapeutic response was calculated in each group as compared with initial values and between groups. Significance was analyzed by t‐tests. Results: A protocol containing desogestrel significantly decreased low‐density lipoprotein cholesterol (27%; P < 0.05) and increased high‐density lipoprotein cholesterol (HDL‐C) by 30% (P < 0.05%) after 9 months. The ratio of total cholesterol to HDL‐C also decreased significantly (44%; P < 0.05). Conclusion: The most beneficial effect on plasma lipid profile was obtained with an HRT protocol containing desogestrel as the progesterone.
Female voluntary surgical contraception via minilaparotomy under local anesthesia
Authors: Jack K.E. , Chao C.R.
Published: April 2004

Objective: To examine changes in prevalence and acceptance of sterilization methods in a developing country from 1986 to 1990. Method: Data from 5182 voluntary female sterilizations performed at 52 service sites in Nigeria were retrospectively reviewed for sterilization method, anesthesia technique, demographic factors, and patient acceptance. Results: The annual number of sterilization procedures increased dramatically over this period from 688 in 1986 to 1911 in 1989. Overall, 74.3% of the procedures were performed by minilaparotomy under local anesthesia (ML/LA), 6% by laparascopy/general anesthesia, and 19.7% by laparatomy/general anesthesia. ML/LA was found to be a very safe method, with a complication rate of 1.4% 98.6% of ML/LA patients expressed complete satisfaction with the procedure. Conclusion: Female sterilization increased in acceptance in Nigeria over the period 1986–1990 concomitant with the increased use of ML/LA. This approach is safe, cost‐effective, and appropriate for the developing world.
The treatment of female urethral diverticulum with calculus through ultrasonic lithotripsy
Authors: Guidi H.G.C. , Montelatto N.I.D. , Ribeiro R.M. , Pinotti J.A.
Published: April 2004

A case report is presented of a large urethral diverticulum with calculus. We proposed the use of transurethral ultrasonic lithotripsy, followed by conventional surgical reconstruction 3 months later, when the condition had improved. The patient was completely cured.
Community care for late adolescents
Authors: Aldrich Anne
Published: April 2004

This paper describes supportive accommodation for late adolescents in Cambridge provided by the Castle Project in conjunction with the Young People's Psychiatric Service. It outlines the characteristics of young people referred to the Project over the first years of its existence, their lengths of stay and next moves, and suggests that there are members of two groups, those with schizophrenic‐type disorders and those with pronounced antisocial behaviour, who present long‐term problems of care and accommodation and whose needs are not yet catered for appropriately.
Adolescent fantasy and self‐fulfilment: the problem of female passivity
Authors: Humphrey Michael , Lenham Christine
Published: April 2004

A detailed analysis is reported of essays written by teenagers from two independent schools (120 of each sex) in response to the opening sentence: “Today is my eightieth birthday and I look back to the day I left school.” Predictably the girls were orientated toward marriage and family life, and were somewhat less career‐minded than the boys. They were also less politically aware, and saw hobbies as a luxury for their retirement and not as an integral part of life. Essentially they differed from the boys in being ready to live through others rather than on their own terms. These findings are interpreted in the light of Freud's distinction between passivity and the pursuit of a passive aim, which may call for well directed activity.
Implications of criminal career research for the prevention of offending
Authors: Farrington David P.
Published: April 2004

In the Cambridge Study of Delinquent Development, 411 London males have been followed up from age 8 to age 32. Offending was only one element of a general syndrome of antisocial behaviour, which showed significant continuity from childhood to adulthood. The most important childhood (age 8–11) predictors of offending up to age 32 were: socio‐economic deprivation, poor parenting, family deviance, school problems, hyperactivity‐impulsivity‐attention deficit, and antisocial child behaviour. A theory was proposed to explain these results, including criminal motivation, internalized beliefs about offending, and rational decision‐making. It was concluded that the most hopeful methods of preventing offending were behavioural parent training and pre‐school intellectual enrichment programmes.
Leisure activities of adolescent school students: predictors of participation and interest
Authors: Garton Alison F. , Pratt Chris
Published: April 2004

Frequency of participation and levels of interest in more than 60 leisure pursuits were measured via a questionnaire administered to 1248 adolescent high school students. The relationship between participation and levels of interest was measured by correlation as well as by asking the students to nominate up to three activities they would like to participate in but cannot and to indicate the reason for their non‐participation. Factor analyses reduced the Participation and Interest items to six factors each. Multiple regressions were then conducted on the derived factor‐score variables. Sex was the major predictor of participation in sports and vocational activities and of interest in sporting and gregarious activities. Age, school location, ethnicity and SES were lesser predictors for groups of activities such as the social and outdoor pursuits. The results are discussed in terms of the theoretical and practical implications of the relationship between participation and interest as well as the prediction of participation and interest levels by developmental and social factors.
Five year clinical experience with the copper 7 intrauterine device
Authors: Gobeaux‐Castadot Marie‐Jeanne , Boria Maria C. , Chervenak Frank A. , Aubert Jose M.
Published: April 2004

The clinical observation of 1547 patients who had a Copper 7 IUD inserted in a municipal hospital in New York City during the period August 1, 1974 to July 31, 1979, is presented. Despite the extreme mobility of this lower socio‐economic population, complete followup was possible for 79% of the insertions.

The demographic characteristics of the patients are presented, as well as the number of events and closures for the first segment of use and for all segments. The events are analyzed by patient's age, gravidity, parity and duration of use. Net annual rates for accidental pregnancies, expulsions and removals, as well as continuation rates are presented for the first 3 years of use. Net cumulative rates for the same events are presented for the 5 years of the study.
Prediction of time to delivery from start of contractions in induced labor: A life table analysis approach
Authors: Bremme K. , Nilsson B.
Published: April 2004

Labor was induced in a total of 200 patients. Outcome of treatment was compared with respect to time to delivery from start of contractions. Prognostic variables compared here were, e.g. dilatation, parity and Bishop score. All comparisons were performed with a life table technique, both bivariate and multivariate. Parity showed a strong relation to prognosis and so did cervical dilatation. The degree of cervical dilatation as in spontaneous labor is the factor in the Bishop index that correlated best to the outcome of treatment. With the two predictors parity and dilatation, a scoring system was constructed.
Is Lactation A Risk Factor of IUD‐ and Sterilization‐related Uterine Perforation? ‐ A Hypothesis
Authors: Chi I‐Cheng , Kelly Elizabeth
Published: April 2004

A recent article reported a high risk of IUD‐related uterine perforation in lactating women in the U.S. This article prompted the authors to examine the large international datasets on IUDs and tubal sterilizations collected by Family Health International. The findings are somewhat suggestive of such a positive association in IUD users as well as in women undergoing laparoscopic or minilaparotomy sterilization. More definitive studies are urged.
Strangulated prolapse of the urethra in the elderly female
Authors: Golomb J. , Merimsky E. , Braf Z.
Published: April 2004

Circular prolapse of the urethral mucosa in the elderly female is rarely reported in the literature, but is a common clinical entity. During the years 1972–1983 thirteen women with urethral prolapse were operated upon in our department, in all of whom differentiation of the benign lesion from malignancy could not be done on clinical grounds only. The following survey is meant to draw attention to the entity and its clinical implications.
Perinatal factors in twin mortality in Nigeria
Authors: Fakeye O.
Published: April 2004

The results of a retrospective study involving 622 twin‐pairs born over an 18‐month period among 17,726 births at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, are presented with particular reference to four variables: birthweight, presentation, parity, and intertwin delivery time interval. The twinning incidence was 35.1 per 1000. Monozygous and dizygous rates are 7 and 28 per 1000, respectively. Overall perinatal mortality (PNM) was 15.5%. Mortality was higher in second than in first twin (19.5% vs. 11.6%), and consistently higher when divided into birthweight groups. Corrected PNM increased with breech presentations: 16.3% in breech: breech compared with 3.9% in vertex: vertex presentations. The twinning rate increased with parity; PNM is low in parity 1, of little variation in birth‐ranks 2–5, and high in para 6 and above. Delivery of the second twin within 15 min seems optimal, giving a corrected PNM 3.6% in contrast to rates of 10.1%, 14.0% and 19.1%, respectively when delivery occurred between 16 and 30, 31 and 60 and greater than 60 min, respectively.

Prevention of preterm delivery, increased use of cesarean section delivery for malpresentation, active management of delivery of second twin within an optimal time of 15 min, and family planning are suggested in order to decrease twin PNM.
Advanced abdominal pregnancy in Muhimbili Medical Centre, Tanzania
Authors: Mbura J.S.I. , Mgaya H.N.
Published: April 2004

A prospective study was conducted at Muhimbili Medical Centre (MMC) over a 2‐year period on 16 patients with advanced abdominocyesis. The incidence of 1 in 3259 deliveries was higher than that of previous years. Infertility prior to index pregnancy was a significant antecedent factor (P < 0.001).

The most consistent symptom both in early and late pregnancy was abdominal pain. Difficulty in fetal palpation and abnormal lies were the most significant signs. The sensitivity of clinical suspicion was 68%, ultrasound 85% and X‐ray diagnosis 93%. Sepsis was the leading maternal complication, especially when the placenta was left in situ. Perinatal mortality was 87.5% and maternal mortality was 6.4%.

Abdominal pregnancy remains a diagnostic challenge and certain aspects of fetal mortality are ill‐understood. Early diagnosis of abdominal pregnancy can be improved upon by more detailed history taking, a high index of suspicion and meticulous interpretation of sonagraphic and radiological signs. It is suggested that the placenta be removed except in the rarest trying cases and that pregnancy be terminated on diagnosis.
Maternal mortality — a twelve‐year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria
Authors: Adetoro O.O.
Published: April 2004

This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin over a 12‐year period (1972–1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50 per 1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the third stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity services in our hospital, health education programs for the public and particularly the expectant women and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.
Fetal heart rate changes following external cephalic version under tocolysis near term
Authors: Rabinovici J. , Barkai G. , Shalev J. , Mashiach S.
Published: April 2004

Fifty eight gravidas near‐term underwent external cephalic version using tocolytic treatment and continuous fetal monitoring by cardiotocograph and real‐time ultrasound. No unfavorable maternal or fetal effects were recorded. Fetal heart rates showed a significant decline at 10 and 30 min after the procedure with complete recovery at 1 h after external version, but no pathologic tracing was recorded. No uniform heart rate patterns due to external cephalic version could be found.
Advanced and unsuspected secondary abdominal pregnancy misdiagnosed before laparotomy
Authors: Acien P. , Milla A. , Segarra F. , Piñero J.L.
Published: April 2004

A case of advanced secondary abdominal pregnancy is presented. It happened in a multiparous patient, a heroin addict and with a previous secondary amenorrhea. In spite of having been controlled through the whole pregnancy, the ectopic pregnancy was not diagnosed until a laparotomy was performed, several days after fetal death. After full extraction of the fetus and placenta, followed by left adnexectomy, the postoperatory evolution was normal. Hormonal and echographic studies and fetal monitorings are provided, and the diagnosis and treatment are discussed.
Randomised trial comparing combinations of cyclophosphamide and cisplatin without or with doxorubicin or 4′‐epi‐doxorubicin in the treatment of advanced ovarian cancer
Authors: Hernádi Z. , Juhász B. , Póka R. , Lampé L.G.
Published: April 2004

Forty‐eight patients with FIGO stage III and IV epithelial carcinomas of the ovary were entered in this randomised trial. Radical surgery was performed and no residual tumor with a diameter greater than 2 cm was left behind. Of these patients 62.5% (10/16) had a complete or partial response on cyclophosphamide + cisplatin (CP) 87.5% (14/16) on cyclophosphamide + doxorubicin + cisplatin (CAP) and cyclophosphamide + 4′‐epi‐doxorubicin + cisplatin (CEP). The median time to progression was 3.5 months on CP, 12.5 months on CAP and 11.0 months on CEP. Patients treated with CAP combination chemotherapy had generally longer progression‐free survival (log rankχ2= 5.4; P = 0.04). No significant difference was found, however, between patients on CAP and CEP. The median survival times were 12.5 months on CP, 26.5 months on CAP and 14.0 months on CEP. Patients treated with CAP combination chemotherapy had generally longer survival (logrankχ2= 9.08; P = 0.0099). No significant difference was found, however, between patients on CAP and CEP in terms of survival. Asymptomatic mild‐to‐moderate laboratory test toxicity occurred in 6–12% of patients on CP, 6–12% on CAP and no toxicity of this type and grade on CEP. Nausea and vomiting were also less severe and less frequent in the CEP group. Cardiotoxicity was seen in 12.5% (2/16) only in the CAP group.
Criteria for the oral glucose tolerance test in pregnant and non‐pregnant Nigerian women
Authors: Okonofua F.E. , Amole F.A. , Ayangade S.O. , Nimalaraj T.
Published: April 2004

In order to establish diagnostic criteria for detection of abnormal oral glucose tolerance test (OGTT) in pregnant and non‐pregnant Nigerian women, the test was performed in 25 non‐pregnant and 60 pregnant non‐diabetic women at various trimesters of pregnancy. The upper limit of normal plasma glucose was the same as that from caucasian populations with respect to the fasting values but much less at 60 and 120 min. When compared to the non‐pregnant controls, fasting plasma glucose was significantly lower during pregnancy, however, there was no change in glucose tolerance during pregnancy. The possible reasons for these observations are discussed and it would appear that our criteria would be the ideal ones to use for clinical purposes in Nigerian women.
Cervical encerclage — a stitch in time: Analysis of 23 cases
Authors: Nalini V. , Urmila P.K. , George E. , Dasan J. , Thomas M.
Published: April 2004

Cervical incompetency has been recognized as a cause of repeated reproductive loss. Currently many surgeons cast doubt on the existence of cervical insufficiency and the efficiency of encerclage to salvage the situation. Over a period of 3 years we did cervical encerclage for 23 patients with recurrent pregnancy loss in whom all other causes were ruled out. Twenty‐one patients benefitted by the procedure, only one ended in missed abortion and one patient had preterm delivery with early neonatal loss. We had a fetal salvage of 91.3%. Birth weights of the babies were above 2500 g in 65.2%. In our experience, with proper selection, patients benefitted from encerclage performed at the appropriate time.
Study of serum copper and zinc in cases of hyperemesis gravidarum
Authors: El Tabbakh G. , Darwish E. , El Sebaie F. , Galal S. , El Maradny E. , Loutfi I.
Published: April 2004

The dehydration, electrolyte and metabolic changes which occur in hyperemesis gravidarum are well recognized. The aim of this paper was to study the changes in serum copper and zinc and their correlation with the changes in serum electrolytes that occur in patients with hyperemesis gravidarum. Serum copper, zinc, sodium and potassium and urinary chloride were measured in 30 patients suffering from hyperemesis gravidarum and compared to the levels in 10 normal pregnant women in their first trimester. There was no significant change in serum copper or zinc in patients with hyperemesis compared to normal pregnant women. Also, there was no significant correlation between the changes in the level of these trace elements and the decrease which occurred in serum sodium and potassium and urinary chloride.
Enhanced pre‐ovulatory progesterone levels in fertile cycles during clomiphene citrate treatment
Authors: Fedele L. , Brioschi D. , Marchini M. , Dorta M. , Baglioni A.
Published: April 2004

We compared ovulatory changes in fertile and preceding infertile cycles in 21 patients with unexplained infertility conceiving after clomiphene citrate treatment. No significant differences were observed in follicular growth, cervical score and follicle stimulating hormone (FSH) levels. Progesterone was higher (P < 0.05) in the 2 days preceding ovulation in fertile cycles, luteinizing hormone (LH) higher (P < 0.05) the day before, and 17‐β‐estradiol lower (P < 0.05) 4 days before. Stimulating progesterone secretion by systematic LH administration before ovulation could improve secretory endometrial transformation and thus reproductive prognosis.
Use of prostaglandin E2 vaginal suppositories in third‐trimester fetal demise
Authors: Martin R.W. , Helman N.S. , Martin J.N. , Morrison J.C.
Published: April 2004

A retrospective analysis of eight cases of third‐trimester fetal demise managed with prostaglandin E2 vaginal suppositories (PGE2) is presented. Management included laminaria insertion prior to induction and an initial lower dosage of PGE2. No cases of uterine rupture or cervicovaginal lacerations were encountered. A summary of the literature as it relates to PGE2 vaginal suppository use in third‐trimester fetal demise is included.
Successful pregnancies of two patients with relapsing thrombotic thrombocytopenic purpura
Authors: Ezra Y. , Mordel N. , Sadovsky E. , Schenker J.G. , Eldor A.
Published: April 2004

Thrombotic thrombocytopenic purpura is a severe multisystemic disorder of unknown origin. The association of relapsing TTP with pregnancy is rare but well documented and high mortality rates of mothers and fetuses have been reported so far. Since the introduction of plasma therapy for treating the acute exacerbations of the disease, overall mortality rates have decreased significantly. It is now evident that the manifestations of the disease may reappear even after long disease‐free intervals and as many as a third of the recovering patients may develop a relapse. Presented are two TTP patients with relapsing TTP complicating their pregnancies. Prophylactic treatment with aspirin and dipyridamole during their last three successful pregnancies prevented or minimized the severity of TTP relapses. The course of these pregnancies and the management of such patients is discussed.
Interstitial pregnancy: a diagnostic challenge
Authors: Weissman A. , Fishman A. , Gal D.
Published: April 2004

A case report which illustrates the clinical problems and sonographic difficulties that accompany the diagnosis of interstitial pregnancy are reported. Non‐specific clinical symptoms and normal sonographic findings do not always preclude interstitial pregnancy.