bluuebunny/crossref_metadata_2025 huggingface dataset:
Pseudoaneurysm of the Y‐graft/iliac artery anastomosis following pancreas transplantation: a case report and review of the literature
Authors: Verni Michael P , Leone John P , DeRoover Arnaud
Published: March 2003

Transplant‐related aneurysms are an unusual complication following pancreas transplantation. We present a case of a pseudoaneurysm developing in a recipient 6 months after bladder‐drained pancreas transplantation. The pseudoaneurysm was incidentally found during ultrasonographic evaluation in preparation for a pancreas biopsy. Angiography demonstrated that the origin of the pseudoaneurysm was located near the base of the Y‐graft/iliac artery anastomosis. Surgical repair was performed using standard vascular techniques. The patient subsequently recovered without loss of graft exocrine or endocrine function. Review of the literature revealed that aneurysms of various types associated with pancreas transplantation have a high incidence of graft loss and contribute significantly to patient morbidity. However, with prompt diagnostic and surgical management, non‐infected pseudoaneurysms can be repaired without loss of pancreatic function.
Eurotransplant Senior Program ‘old for old’: results from 10 patients
Authors: Schlieper G , Ivens K , Voiculescu A , Luther B , Sandmann W , Grabensee B
Published: March 2003

More frequently there is the need for renal transplantation of older patients. Against the background of an increasing number of old donors and recipients, Eurotransplant Leiden started the Eurotransplant Senior Program (ESP) ‘old for old’ in 1999. The ESP works with donors and recipients both over 65 yr. The kidneys are transplanted with short cold ischaemia time regardless of the human leukocyte antigen (HLA) compatibility. Compatibility of blood groups, negative crossmatch and less than 5% cytotoxic antibodies are required. First experiences from 10 patients at Heinrich Heine University hospital are reported here. The course of 10 transplanted patients is described from January 1999 until November 1999 (28.4±15.8 wk). Age of donor and recipient, cause of dialysis and concomitant diseases from recipients, function of the transplanted kidney and complications are analysed. Immunosuppression consisted initially of cyclosporin A, mycophenolic acid and steroids. The results of these 10 patients were compared to 14 patients who were transplanted according to the ordinary Eurotransplant criteria (Eurotransplant Kidney Allocation System) in the same period of time. Kidneys from six donors (70.5±3.3 yr) were transplanted to 10 different recipients (66.9±2.2 yr). The control group consisted of 14 patients (47.6±14.4 yr) who received kidneys from 14 donors (48.3±10.1 yr). One double kidney transplantation was performed in the senior group, i.e. two kidneys from a marginal donor were transplanted to one recipient (‘two in one’). In the ESP group, cold ischaemia time was reduced by 5 h and mean of HLA mismatches was more than doubled. Mean length of hospitalisation of ESP and control groups was 47.2±28.2 and 34.2±11.6 d, respectively. Intraoperatively, no complications were seen, post‐operative care was performed on a normal ward. ESP patients suffered more often from delayed graft function, which led to further need for haemodialysis for 11.2 d. Finally, 9 of 10 patients acquired a satisfactory renal graft function. A total of 13 biopsies were performed in eight cases. Altogether seven acute rejections in 6 patients were found (four interstitial, one vascular, one interstitial+vascular, one clinical). The 9 patients with sufficient renal graft function were discharged with a mean serum creatinine level of 2.3±0.5 mg/dL (control: 1.9±0.8 mg/dL). Comparing these 10 recipients to a control group consisting of 14 patients, the results are comparable and encouraging. In conclusion, the short‐term results of the ESP are promising. Nevertheless, the post‐operative care requires more attention due to several complications. Though the HLA compatibility was not considered, all rejections were coped with effectively. Quality of life was improved.
The effect of G‐CSF‐stimulated donor marrow on engraftment and incidence of graft‐versus‐host disease in allogeneic bone marrow transplantation
Authors: Ji Shu‐quan , Chen Hui‐ren , Xun Chang‐qing , Wang Hang‐xiang , Pan Shi‐ping , Xiao Ming‐hua
Published: March 2003

Graft‐versus‐host disease (GVHD) and infection are major obstacles to successful allogeneic bone marrow transplantation (allo‐BMT). In an attempt to improve the results of HLA‐identical sibling BMT, we investigated the effect of accelerating hemopoietic reconstitution and reducing acute GVHD (aGVHD) in allo‐BMT receiving G‐CSF‐stimulated donor marrow and the preliminary biological mechanism. The donors of 30 patients (study group) with leukemia were given G‐CSF 3–4 μg/kg/d for 7 doses prior to marrow harvest. The results of subsequent engraftment in the recipients were compared with those of 18 patients without G‐CSF (control group). Five donors themselves were studied to assess the effects of G‐CSF on the hematopoietic progenitor cells and lymphocyte subsets in the bone marrow (BM). We observed that the stimulated BM yielded higher numbers of nucleated cells as well as CFU‐GM and CD34+ cells (p<0.01), and that hemopoietic reconstitution was accelerated. The median number of days of granulocyte count exceeding 0.5×109/L and platelet count exceeding 20×109/L was 16 (range 10–23 d) and 18.5 (range 13–31 d), respectively (control group: median 22 d, range 13–29 d and median 23 d, range 17–34 d; p=0.001). The incidence of grade II–IV severe aGVHD was very low, with only 1 case (3.3%) with acute grade II aGVHD limited to the skin in the study group. Five of 18 patients in the control group manifested grade II–IV severe aGVHD (27.8%, p=0.02). The number of T‐lymphocyte subsets in the harvested BM using G‐CSF stimulation was changed. In the G‐CSF‐stimulated marrow group, CD4+ decreased and CD8+ increased significantly (p=0.02). The changes of progenitor cells and T‐lymphocyte subsets in donors’ BM from pre‐ and post‐G‐CSF stimulation showed that the percentage of CD4+ reduced (p=0.04) and that of CD8+ increased (p=0.06), while that of CD34+ also increased (p=0.002). The incidence of chronic GVHD and relapse had no significant difference between both groups. These results indicate that allo‐BMT in BM G‐CSF priming can accelerate engraftment and minimize the incidence of severe aGVHD. There is a trend in favor of improved transplantation‐related mortality.
Correlation between carotid intima–media thickness and hematocrit and hemoglobin values in renal transplant recipients
Authors: Brzósko Szymon , Łebkowska Urszula , Małyszko Jolanta , Hryszko Tomasz , Pawlak Krystyna , Myśliwiec Michał
Published: March 2003

Background: Cardiovascular diseases are the main causes of morbidity and mortality in kidney transplant recipients. Blood viscosity plays an important role in the development of arteriosclerosis in the general population. Since hematocrit (Ht) and hemoglobin (Hb) values are determinants of blood viscosity, we decided to perform a study to check the possible relevance between these hemorheological factors and carotid intima–media thickness (IMT) in renal transplant recipients.  Patients and methods: The study was performed on 33 clinically stable renal transplant recipients and 19 healthy persons. All subjects underwent ultrasonographic measurements of IMT. Analyzed clinical parameters included: age, sex, body mass index (BMI), mean arterial blood pressure (MAP), pulse pressure (PP) time from renal transplantation, and time on dialysis. The following biochemical parameters were assessed: Hb, Ht, fibrinogen (Fbg), and homocysteine (tHcy) concentrations (estimated by enzyme immunoassay).  Results: The two analyzed groups did not differ in respect to age and BMI. Mean concentrations of Hb and Ht values were lower in the patients group. Mean carotid IMT, Fbg, tHcy, MAP, and PP were significantly higher in the renal transplant recipients group when compared to the control group. IMT was positively correlated with age (r=0.55; p=0.001), Hb (r=0.36; p=0.04), Ht (r=0.34; p<0.05), PP (r=0.35; p<0.05), Fbg (r=0.4; p=0.02), and time on dialysis prior to transplantation (r=0.50; p=0.003) in the patients group. Multiple regression analysis in renal transplant recipients showed that the IMT was independently related to age, Hb or Ht values, and Fbg.  Conclusions: The results for the first time show positive association between IMT and Ht and Hb values in renal transplant recipients. The results may implicate the role of these rheological factors in progression and acceleration of arterial remodeling in renal transplant recipients.
Analysis of portal venous waveform after living‐related liver transplantation with pulsed Doppler ultrasound
Authors: Tang Shao‐Shan , Shimizu Tadashi , Kishimoto Riwa , Kodama Yoshihisa , Miyasaka Kazuo
Published: March 2003

We evaluate the portal venous waveform (PVW) with pulsed Doppler ultrasound (US) after living‐related liver transplantation (LRLT) and correlate it with subsequent abnormalities. In the first 2 wk after LRLT, pulsed Doppler US demonstrated three types of PV waveform (PVW) in 33 recipients: non‐phasic PVW in 19 patients, pulsatile in 10, and turbulent in 4. In the pulsatile PVW group, arterio‐portal (A‐P) shunt was confirmed in three grafts by either arteriograhy or computed tomography during hepatic arteriography. A severe stenosis in the grafted vein was confirmed in one case by both US and venography. The pulsatile PVW in the remaining six cases spontaneously disappeared and turned to the non‐phasic PVW without treatment. The graft volume/liver standard volume (GV/SV) ratio was significantly smaller in the pulsatile PV waveform group than in the non‐phasic PVW group (p<0.01). In the turbulent PVW group, aneurysmal‐like dilatation of the portal vein at the umbilical portion was formed in 3 of the 4 patients. The pulsatile waveform in the PV is frequently observed with pulsed Doppler after LRLT, especially in patients that received small grafts. We should keep in mind that they often disappear without any treatment, although some examples of pulsatile waveforms represent vascular complications.
Influence of dialysis on post‐transplant events
Authors: Joseph JT , Jindal RM
Published: March 2003

Introduction: We examined the effect of haemodialysis (HD) or peritoneal dialysis (PD) on acute rejection, delayed graft function (DGF), graft and patient survival after cadaveric renal transplantation. Materials and methods: We carried out a retrospective analysis of 325 patients (cyclosporin [CyA]‐based therapy) who had their first cadaver renal transplant between January 1991 and December 1996 and followed up for a mean of 61 ± 26 months. They were divided into three groups: HD, PD and CD (where both PD and HD was used for at least 3 months). Delayed graft function was diagnosed if the patient needed dialysis in the first week post‐transplant while primary non‐function (PNF) was diagnosed if the kidney never achieved function. Graft rejection was confirmed by biopsy; early acute rejection (EAR) was defined as acute rejection occurring before 90 days and late acute rejection (LAR) as one after 90 d

Results: A total of 183 patients had PD, 117 HD and 25 CD. The mean time period in which the patients were on dialysis for PD was 24 months, HD 34.5 months and CD 50.6 months (p < 0.01). The recipients were matched for age and gender. The donor variables (age, gender and cold ischaemia time) did not differ between the groups. The mean time for the development of first acute rejection following renal transplant in each group was as follows: PD group: 68.8 d, HD group: 81.3 d and CD group: 105 d (p=0.08). The number of patients who developed EAR was 90 (49.2%) in PD group, 51 (43.6%) in HD group and 11 (56%) in CD group (p=0.6); the number who developed LAR was nine in PD group (4.9%), six in HD group (5.1%) and one in CD group (4%) (p=0.9). Fifty‐six patients with PD had DGF compared with 58 with HD (p=0.01). There was no difference in the number and severity of rejection episodes or DGF based on the duration of dialysis. The 5‐yr survival of patients was 79% for PD, 81% HD and 78% CD groups (p=n.s), while the graft survival for PD group was 61%, HD group 63% and CD group 74% (p=n.s). Summary: We could find no difference in the patient or graft survival between patients who had pre‐transplant HD, PD or CD. There was no difference in the incidence of acute rejection episodes between the three groups of patients as well. However, we found a significantly higher rate of DGF in the HD versus PD patients.
Infectious disease prophylaxis in renal transplant patients: a survey of US transplant centers
Authors: Batiuk Thomas D , Bodziak Kenneth A , Goldman Mitch
Published: March 2003

Definitive approaches to most infectious diseases following renal transplantation have not been established, leading to different approaches at different transplant centers. To study the extent of these differences, we conducted a survey of the practices surrounding specific infectious diseases at US renal transplant centers.

A survey containing 103 questions covering viral, bacterial, mycobacterial and protozoal infections was developed. Surveys were sent to program directors at all U.S. renal transplant centers.

Responses were received from 147 of 245 (60%) transplant centers and were proportionately represented all centers with respect to program size and geographical location. Pre‐transplant donor and recipient screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and cytomegalovirus (CMV) is uniform, but great discrepancy exists in the testing for other agents. HCV seropositive donors are used in 49% of centers. HIV seropositivity remains a contraindication to transplantation, although 13% of centers indicated they have experience with such patients. Post‐transplant, there is wide variety in approach to CMV andPneumocystis carinii(PCP) prophylaxis. Similarly divergent practices affect post‐transplant vaccinations, with 54% of centers routinely vaccinating all patients according to customary guidelines in non‐transplant populations. In contrast, 22% of centers indicated they do not recommend vaccination in any patients.

We believe an appreciation of the differences in approaches to post‐transplant infectious complications may encourage individual centers to analyse the results of their own practices. Such analysis may assist in the design of studies to answer widespread and important questions regarding the care of patients following renal transplantation.
Prevention of de novo hepatitis B virus infection in living donor liver transplantation using hepatitis B core antibody positive donors
Authors: Chen Yaw‐Sen , Wang Chih‐Chi , De Villa Vanessa H , Wang Shih‐Hor , Cheng Yu‐Fan , Huang Tung‐Liang , Jawan Bruno , Chiu King‐Wah , Chen Chao‐Long
Published: March 2003

Abstract: Exclusion of liver grafts from hepatitis B core antibody (anti‐HBc) positive donors to prevent de novo hepatitis B virus (HBV) infection after liver transplantation is not feasible in areas highly endemic for HBV virus like Taiwan, where approximately 80% of adults are anti‐HBc(+). The efficacy of lamivudine monotherapy to prevent de novo HBV infection after living donor liver transplantation (LDLT) using grafts from anti‐HBc(+) donors remains to be elucidated. From June 1994 to August 2000, LDLT was performed in 42 recipients. Twenty‐four of the 42 donors were anti‐HBc(+) (57%). Pre‐transplant HBV vaccination was given to all recipients irrespective of anti‐HBc status at monthly intervals for 3 months. Until December 1997, eight recipients received liver grafts from anti‐HBc(+) donors without prophylaxis. Since January 1998, prophylaxis with lamivudine monotherapy was given to 16 recipients receiving liver grafts from anti‐HBc(+) donors. De novo HBV infection occurred in three of the eight recipients (37.5%) who did not receive prophylaxis, while none of the 16 recipients given lamivudine developed de novo HBV infection after a mean follow‐up of 25 months. Two of the three recipients with de novo HBV infection were anti‐HBs(–) and one recipient was anti‐HBs(+). Lamivudine was well tolerated, and no side effects were noted. These results suggest that lamivudine monotherapy for recipients receiving anti‐HBc(+) liver grafts is a simple, relatively inexpensive and effective prophylactic regimen for prevention of de novo HBV infection. The additive protection provided by vaccine‐induced or natural immunity is uncertain.
Serotonin in mania and in the mechanism of action of mood stabilizers: a review of clinical studies
Authors: Shiah I‐Shin , Yatham Lakshmi N
Published: March 2003

Objectives:

Serotonin (5‐hydroxytryptamine, 5‐HT) was implicated in the pathophysiology of manic‐depressive illness as early as 1958. Although extensive evidence has accumulated since then to support 5‐HT's role in depression, relatively fewer studies examined its role in mania. The purpose of this paper was to review and summarize the current state of knowledge on the role of 5‐HT in mania and its treatment.   Methods: We systemically reviewed clinical studies of 1) 5‐HT function in mania and 2) 5‐HT in the mechanism of action of mood stabilizers, including lithium and anticonvulsants.   Results: Review showed that cerebrospinal fluid, postmortem, platelet, neuroendocrine challenge, and tryptophan depletion studies provided some evidence to support the hypothesis that a 5‐HT deficit is involved in mania and that enhancement of 5‐HT neurotransmission exerts a mood‐stabilizing effect.   Conclusions: There is some evidence from clinical studies for the contribution of 5‐HT in mania and in the mechanism of action of mood stabilizers. However, it is very likely that other neurotransmitters also play important roles. Future directions for research include 1) in vivo study of 5‐HT receptor subtypes using positron emission tomography, 2) investigation of the interaction between 5‐HT and other neurotransmitter systems, and 3) determination of the relationships between diagnostic subtypes of mania and 5‐HT function and other neurotransmitter systems.
Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry
Authors: Chengappa Kn Roy , Levine Joseph , Gershon Samuel , Kupfer David J
Published: March 2003

Objective:

To evaluate the prevalence of substance abuse dependence and/or alcohol abuse dependence among subjects with bipolar I versus bipolar II disorder in a voluntary registry.   Method: One hundred randomly selected registrants in a voluntary case registry for bipolar disorder were interviewed, using the Structured Clinical Interview for DSM‐IV Axis I Disorders, to validate the diagnosis of this registry. Corroborative information was obtained from medical records, family members and the treating psychiatrist. Eighty‐nine adults (18–65 years) met criteria for bipolar disorder (bipolar I=71, bipolar II=18) and were included in this analysis.   Results: Forty‐one (57.8%) subjects with bipolar I disorder abused, or were dependent on one or more substances or alcohol, 28.2% abused, or were dependent on, two substances or alcohol, and 11.3% abused or were dependent on three or more substances or alcohol. Nearly 39% of bipolar II subjects abused or were dependent on one or more substances, nearly 17% were dependent on two or more substances or alcohol, and 11% were dependent on three or more substances or alcohol. Alcohol was the most commonly abused drug among either bipolar I or II subjects.   Conclusions: Consistent with other epidemiologic and hospital population studies, this voluntary bipolar disorder registry suggests a high prevalence of comorbidity with alcohol and/or substance abuse dependence. Bipolar I subjects appear to have higher rates of these comorbid conditions than bipolar II subjects; however, as the number of bipolar II subjects was rather small, this suggestion needs confirmation.
The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample
Authors: Bauer Mark S , Vojta Chris , Kinosian Bruce , Altshuler Lori , Glick Henry
Published: March 2003

Objective:
The Internal State Scale (ISS) is a self‐report instrument that has been validated for discriminating mood states in patients with bipolar disorder. This study a) extends investigation to a multisite public sector sample and b) tests a revised scoring algorithm that formally identifies patients in mixed states.   Methods: Eighty‐six patients with bipolar disorder from four Veterans Affairs medical centers were assessed in a cross‐sectional design. Physician‐conducted semi‐structured interviews used DSM‐IV criteria to identify subjects as meeting criteria for euthymia, mania or hypomania, depression, or mixed state (mania or hypomania plus depression). A revised ISS scoring algorithm independently assigned mood state. Mean subscale scores were analyzed across groups. Receiver‐operating characteristic (ROC) curve analysis was conducted to determine optimal algorithm structure.   Results: Analysis of mean scores for the ISS subscales replicated original results for Activation, Well‐Being, and Perceived Conflict, but indicated differences from the original results for the Depression Index. The ROC curve analysis identified optimal cut‐off scores for the revised algorithm. The overall kappa score indicated moderate agreement between ISS and physician ratings of mood state, including mixed states.   Limitations: The study used a sample consisting primarily of male veterans. Mood state was assigned by experts using expert clinician diagnosis, not structured interviews.   Conclusion: The performance of the ISS in this multisite, public sector sample was similar to the performance in the initial research clinic sample. This finding confirms the validity of the ISS as a discriminator of mood states in bipolar disorder. The development of a revised scoring algorithm makes feasible formal identification of mixed episodes with the ISS.
Present and future role of Mental Illness Advocacy Associations in the management of the mentally ill: realities, needs and hopes at the edge of the third millennium
Authors: Morselli Paolo Lucio
Published: March 2003

Objective:

The purpose of the present review is the analysis of the development and current status of the Mental Illness Advocacy Movement in the USA and in Europe, as well as of the role such a movement is playing in the management of the mentally ill.

  Methods: Information on the issue has been collected via literature search and several personal inquiries and contacts with different Mental Illness Advocacy Groups in the USA and in Europe.

  Results: The findings indicate that the Mental Illness Advocacy Movement is very alive and in full growth. Its role in the management of the mentally ill has become more and more important over the years. In several countries, it makes it possible to overcome some of the deficiencies of the National or Private Health Services. Thanks to the actions of the various Mental Illness Advocacy Groups, today, patients and families are more and better informed of their conditions and their rights. In many cases, this results in earlier diagnosis, better compliance and better outcomes. However, despite significant improvement in the status of the mentally ill patient, much still remains to be done.

  Conclusions: We need an improved dialogue with mental heath providers, public administrators, mental health policy makers, mass media and politicians. The dialogue between primary care team and the specialist must also be improved. A global alliance for action is needed to ensure better and more available services to those who suffer from mental disorders.
Psychotherapy for bipolar depression: a phase‐specific treatment strategy?
Authors: Swartz Holly A , Frank Ellen
Published: March 2003

Objectives: The depressive phase of bipolar disorder is particularly difficult to treat. Pharmacologic strategies for bipolar depression are often inadequate. We therefore review the literature on the role of psychotherapy as an adjunct to medication in the treatment of bipolar depression.   Methods: With one exception, there are no descriptions of psychotherapies employed specifically for the treatment of bipolar depression. We therefore reviewed published reports of psychotherapy for bipolar disorder in general and extracted from these reports relevant data or impressions about the specific effects of the therapies on the depressive phase of the disorder.   Results: Described psychosocial approaches to bipolar disorder include psychoeducation, group therapy, cognitive‐behavioral therapy, couples therapy, family therapy, and interpersonal psychotherapy. Only cognitive‐behavioral therapy has been tested in a pilot study for the treatment of bipolar depression specifically. Results from randomized controlled trials of family therapy and interpersonal and social rhythm therapy suggest that these treatments may be more efficacious in the treatment and prevention of depression relative to mania.   Conclusions: A limited number of well‐designed studies and preponderance of case reports limit definitive conclusions about the role of psychotherapy in the treatment of bipolar depression. However, converging reports suggest that cognitive‐behavioral therapy, family therapy, and interpersonal and social rhythm therapy may be particularly useful for bipolar depression. We propose a novel approach to the treatment of bipolar disorder that includes the use of phase‐specific sequenced psychotherapies delivered in variable patterns and linked to fluctuating mood states.
Suicidal behavior: is there a genetic predisposition?
Authors: Turecki Gustavo
Published: March 2003

Objectives:To review the data that support the role of genetic factors in the predisposition to suicidal behavior and to examine whether or not these factors are part of the genetic liability to mood disorders. To review molecular genetic studies carried out in suicidal behavior.   Methods:A review of the literature was carried out by means of systematic bibliographic database searches and complemented by searches in the references of relevant publications.   Results:There is consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide and suicidal behaviors. Although there is important overlap between suicide and mood disorders, a common genetic liability seems unlikely. It is possible that part of the predisposition to suicide may be transmitted via the presence of impulsive and impulsive‐aggressive behaviors. An increasing number of molecular genetic studies have been carried out in subjects with suicidal behavior. There is some support for a role of some genes that code for components of the serotonergic pathway in the etiology of suicidal behavior, but these studies are still preliminary.   Conclusions:Further studies are needed at the epidemiological, clinical and molecular level to better characterize the genetics of suicide. These should control for the presence of behaviors that are considered as part of the phenotypic spectrum of suicide.
A pilot study of concordance therapy for individuals with bipolar disorders who are non‐adherent with lithium prophylaxis
Authors: Scott Jan , Tacchi Mary Jane
Published: March 2003

Objectives:  To assess the acceptability and feasibility of concordance therapy (CCT) in improving adherence with lithium prophylaxis in individuals with bipolar disorder.

Methods:  Ten subjects with bipolar I disorder and self‐reported problems with lithium adherence were recruited. Eight participated in a 6‐month study of CCT delivered by an expert in cognitive therapy. Reliable and valid assessments of self‐reported adherence with lithium, attitudes towards, and knowledge of lithium and serum plasma lithium levels were measured pre‐ and post‐intervention. Subjects' views of CCT were also recorded.

Results:  Statistically significant improvements in attitudes towards lithium (mean score baseline = 6.8; follow up = 4.1; Effect size = 1.6) were associated with improvements in self‐reported adherence. Laboratory results demonstrated statistically significant increases in serum plasma lithium levels (mean increased from 0.41 to 0.6; effect size 1.7). Subjects viewed CCT as an acceptable intervention. However, only four of the 10 subjects completed all seven half‐hour therapy sessions and homework tasks.

Conclusions:  This small open study suggests that CCT may represent a useful addition to the ‘stepped care’ package of treatment for individuals with bipolar disorders. Research is underway to assess its efficacy and to establish whether novice therapists can also apply the model effectively.
The case for completing the lymphadenectomy when positive lymph nodes are found during radical hysterectomy for cervical carcinoma
Authors: KENTER GEMMA G. , HELLEBREKERS BART W. J. , ZWINDERMAN KOOS H. , VAN DE VIJVER MARK , PETERS LEX A. W. , TRIMBOS JEAN BAPTIST
Published: March 2003

Background. In the present study we report on the results of a retrospective study on the effect on survival of the pelvic lymphadenectomy in a group of 294 patients with stage Ia2‐IIa cervical carcinoma treated by radical hysterectomy from 1984 through 1996 at the Leiden University Medical Center.

Methods. Lymphadenectomy was called ‘complete’ when lymph node bearing tissue had been removed from 5 or 6 lymph node stations and ‘not‐complete’ when this was the case in 1–4 stations.

Results. A radical hysterectomy was carried out in 294 patients. In 63 patients positive lymph nodes were found. Patients with positive nodes showed poorer 5 year survival: 64.5% compared to 90% in patients with negative nodes. In the univariate analysis the following factors were found to affect the presence of node metastases in a statistically significant way: age, tumor size, depth of infiltration, vaso‐invasion, surgical margins, parametrial infiltration, stage and place of referral. In 63 patients with positive nodes, a complete lymphadenectomy was carried out in 23 patients, and in 40 patients the procedure was incomplete. All 63 patients were treated by adjuvant radiation therapy; those with complete lymphadenectomy had significantly less recurrences (25%) compared to those with incomplete lymphadenectomy (56%): the relative risk (RR) was 2.9 (95% ci: 1.3–6.7), p=0.012. After adjustment for other prognostic factors including tumor size, depth of infiltration and parametrial involvement, the complete lymphadenectomy showed an independent effect on disease free survival: RR=3.2 (95% ci:1.3–7.7), p=0.011. Prognostic factors were not significantly different for patients with complete or incomplete lymphadenectomy.

Conclusions. From the results of this study, although retrospective and non randomized, it can be concluded that to complete removal of lymph nodes in combination with radical hysterectomy seems to have a beneficial effect on prognosis in case of positive nodes. The policy of aborting the procedure when lymph node metastases are found in frozen section should be questioned.
Perinatal deaths in a Norwegian county 1986–96 classified by the Nordic‐Baltic perinatal classification: Geographical contrasts as a basis for quality assessment
Authors: HOLT JAN , VOLD INGAR NIKOLAI , ODLAND JON ØYVIND , FØRDE OLAV HELGE
Published: March 2003

Background. Quality assessment of perinatal care can be carried out by classifying perinatal deaths. In the following we have analyzed the geographical contrasts in perinatal deaths according to the Nordic‐Baltic perinatal death classification in a sparsely populated Norwegian county.

Material and methods. All stillbirths (≥28 weeks of gestation) and neonatal deaths (gestational age ≥22 weeks; death ≤28 days) in 1986–96 from Nordland county (240 000 inhabitants) were classified. For comparison the county was geographically divided into six general local hospital areas and one central hospital area.

Results. The classification showed a well acceptable inter and intra observer variation. One hundred and seventy‐one stillbirths and 155 neonatal deaths were analyzed. The death rate (pr 1000 births) for single, non‐malformed, antenatal stillbirths was higher in the central hospital area than in the local hospital areas (3.22 vs. 2.02). The death rate for extreme preterm infants (22–27 weeks of gestation) was on the other hand higher in the local hospital areas (2.45 vs. 1.05). One of the general local hospital areas was singled out with an especially high neonatal death rate among extreme preterm infants. This was to some extent explained by the death of extreme preterm twins and triplets.

Conclusion. The Nordic‐Baltic perinatal death classification system is a consistent and reproducible tool also for studying perinatal death in restricted geographical areas. The observed contrasts in perinatal deaths were used as basis for programs aimed at improving perinatal care. The observation of an unexplained increased number of antenatal stillbirths in the central hospital area resulted in a program for prospective recording and better characterization of the placenta and umbilical cord. Proposals for a better antenatal program preventing extreme preterm birth of twins for the whole county has been launched. In utero transfer to a hospital with a neonatal intensive care unit seems crucial in improving the prognosis for these infants.
The frequency of salpingitis and ectopic pregnancy as epidemiologic markers of Chlamydia trachomatis
Authors: BJARTLING CARINA , OSSER STELLAN , PERSSON KENNETH
Published: March 2003

Background. To study the incidence of non‐gonococcal salpingitis, gonococcal salpingitis and ectopic pregnancy in a defined population over a 28‐year period on the assumption that the frequency of salpingitis and ectopic pregnancy may indirectly illustrate the epidemiological pattern of Chlamydia trachomatis.

Design. A retrospective epidemiological study.

Setting. University hospital with an urban catchment area.

Patients. Five thousand two hundred and thirty‐three patients admitted to the hospital between 1969 and 1996 with a diagnosis of ectopic pregnancy, non‐gonococcal salpingitis, or gonococcal salpingitis.

Results. The frequencies of both non‐gonococcal and gonococcal salpingitis increased steeply early in the period under study, rising to a peak in the early 1970s, then decreasing throughout the period except for the last 3 years when a slight increase was seen again. The frequency of ectopic pregnancy showed a steady increase, peaking in the late 1980s and early 1990s and then declining at the end of the study period. While the introduction of more sensitive pregnancy tests and programs for assisted fertility would increase the rate of ectopic frequency the decline during the ŉineties cannot be accounted for in this way. The peak of salpingitis cases in the early 'seventies seems to be mirrored exactly by the peak of ectopic pregnancies fifteen years later in the late 'eighties.

Conclusion. The frequencies of salpingitis and of ectopic pregnancy can probably be used to estimate the incidence of preceding Chlamydia trachomatis. Thus the incidence of C. trachomatis has probably declined since the early 'seventies like that of N. gonorrheae.
Oxytocin‐induced oscillations of cytoplasmic Ca2+ in human myometrial cells
Authors: FU XIN , LIU YI‐JIA , CIRAY NADIR , OLOVSSON MATTS , ULMSTEN ULF , GYLFE ERIK
Published: March 2003

Background. To investigate the mechanisms of oxytocin (OT) induced oscillations of the cytoplasmic Ca2+ concentration ([Ca2+]i) in cultured human myometrial cells.

Methods. [Ca2+]i was measured in individual myometrial cells by dual wavelength spectrophotofluorometry using the fluorescent indicator fura‐2. Myometrium was obtained at abdominal hysterectomy (n=8) and during cesarean section (n=7).

Results. OT (10–300 nM) typically induced [Ca2+]i oscillations with frequencies in the 0.6–0.8/min range. There were no obvious differences in the responses of cells taken from non‐pregnant and term pregnant women. The frequency and amplitude of the oscillations were not significantly affected by OT concentrations up to 300 nM. The amplitude of the oscillations decreased in the presence of the voltage‐dependent Ca2+ channel antagonist verapamil and gradually disappeared in Ca2+‐free medium. The oscillations were further blocked by the inorganic Ca2+ antagonist La3+ and by the intracellular Ca2+‐ATPase inhibitor 2.5‐di‐tert‐butylhydroquinone (DTBHQ). Caffeine inhibited the OT‐induced oscillations in a concentration‐dependent manner. DTBHQ and high concentrations of OT made [Ca2+]i remarkably sensitive to changes in the external Ca2+ concentration.

Conclusions. The results indicate that OT‐induced [Ca2+]i oscillations in human myometrial cells are due to inositol 1,4,5‐trisphosphate‐mediated release of intracellular Ca2+ combined with capacitative as well as voltage‐dependent influx of the ion.
Stratified rates of cesarean sections and spontaneous vaginal deliveries
Authors: BREDAHL RASMUSSEN OLE , PEDERSEN BETH LILJA , WILKEN‐JENSEN CHARLOTTE , VEJERSLEV LARS O.
Published: March 2003

Background. A fundamental point when auditing labor management is to ensure present and stratified process data.

Method. Stratification of deliveries into ten mutually exclusive groups enabled comparisons of rates of cesarean sections and rates of spontaneous vaginal deliveries between labor wards.

Results. Data from five labor wards in Denmark in 1996 were included in the study comprising a total of 11,287 women. The overall cesarean section rates were between 13.2 and 15.2% which was not a significant difference, whereas cesarean section rates in several of the ten groups and the rates of spontaneous vaginal delivery in group 1 and 3 were significantly different between the labor wards.

Discussion. The method presented here is simple and can be used as an integrated part of the daily work and quality assurance. We advocate that stratification of the delivering women into ten groups should take place in every labor ward with focus on both the cesarean section rate and the rate of spontaneous vaginal delivery. Stratification provides data for periodical evaluation of the outcome within a department and for comparison between departments with different populations and policy.
Cervical intraepithelial neoplasia in pregnancy
Authors: PALLE CONNIE , BANGSBØLL SUSANNE , ANDREASSON BENNY
Published: March 2003

Objective. To determine the progression/regression rate of cervical intraepithelial neoplasia in pregnancy and to describe the number of patients requiring treatment for cervical neoplasia during or following the pregnancy.

Methods. A retrospective analysis of 305 pregnant women with abnormal cervical cytology was performed. The colposcopic, cytologic and histologic findings of repeated examinations during pregnancy and of the subsequent examination eight weeks postpartum were registered and compared. All smears were obtained by cotton bud and Cytobrush. Colposcopy was performed using standard techniques and cervical biopsies were taken in case of colposcopic abnormalities. Endocervical curettage was omitted during pregnancy. At postpartum evaluation colposcopy, directed biopsies and endocervical curettage were performed in all cases.

Results. One hundred and two patients (33%) were followed only by cytology and colposcopy. The remaining 203 patients (67%) had one to four colposcopically directed biopsies during the pregnancy. Comparing the initial histology in pregnancy to the postpartum histologic evaluation 25% showed spontaneous regression while 75% of the women exhibited progression (28%) or persistence (47%) in the severity of cervical neoplasia. Two patients were treated by cervical conization in early pregnancy and 143 women (53%) were treated within the first year after the pregnancy. In the postpartum period microinvasive carcinoma was diagnosed in two patients, but no women advanced to more serious stages of cervical cancer.

Conclusions. The high persistence rate of cervical intraepithelial neoplasia in pregnancy leads us to recommend a liberal use of colposcopically directed biopsies during pregnancy and to ensure a high follow‐up rate in the postpartum period.
Danish National IVF Registry 1994 and 1995. Treatment, pregnancy outcome and complications during pregnancy
Authors: WESTERGAARD HANNE BRIX , JOHANSEN ANNE METTE TRANBERG , ERB KARIN , ANDERSEN ANDERS NYBOE
Published: March 2003

Subject. Data from the compulsory Danish National IVF Registry from 1994 and 1995 regarding treatments, abortions and complications following assisted reproductive technologies.

Methods. Data were generated through registries and compared to pregnancies in Denmark in 1995. Those pregnancies that resulted in a delivery were compared to a matched control group.

Results. In 1994 and 1995 5219 women were treated in 9471 initiated cycles. The numbers increased over the period. The overall delivery rate per initiated cycle was 19%, egg donation 24%, IVF 20%, ICSI 16% and frozen egg replacement 10%. The rates increased over the period. The rate of spontaneous abortions was highest for ICSI (25%) and egg donation (27%). For IVF and ICSI the birth rates per transfer of 1 embryo was 13, 1%, 2 embryos 25, 4%, 3 embryos 25, 8% and 4 or more 3, 8%. Transfer of 2 embryos resulted in 75% singleton, 25% twin and 0.2% triplet deliveries. After transfer of 3 embryos the corresponding rates were 68%, 29% and 4%. No quadruplet deliveries occurred. Totally, 1.4% reported complications to the treatment, the most frequent being ovarian hyperstimulation syndrome. In the study group 5.8% of the women who gave birth were diagnosed with imminent abortion vs. 3.0% in the control group (OR 1.98, CI 1.41–2.78).

Conclusions. Transfer of three embryos did not result in higher pregnancy rates as compared to transfer of two embryos. The first data from the Danish IVF Registry support data from other registries regarding treatment, pregnancy outcome and complications during pregnancy.
Doppler ultrasound of the maternal uterine arteries: disappearance of abnormal waveforms and relation to birthweight and pregnancy outcome
Authors: CAMPBELL STUART , BLACK REBECCA S. , LEES CHRISTOPH C. , ARMSTRONG VALERIE , PEACOCK JANET L.
Published: March 2003

Background. To assess whether the gestation at which abnormal uterine artery waveforms disappear is related to birthweight and complications of pregnancy.

Methods. A prospective study of outcome of pregnancy after a uterine artery Doppler screening program set in an inner city teaching hospital. One thousand five hundred and twenty‐four consecutive women attending the Obstetric Department for a routine anomaly scan at between 19 and 21 weeks gestation had maternal uterine arteries assessed using color wave Doppler. Those women in whom the flow was deemed abnormal were recalled for a further scan at 24–26 weeks gestation. The main outcome measures were birthweight, gestation at delivery and incidence of pre eclampsia.

Results. The women in whom the uterine artery blood flow was normal at 20 weeks had babies with significantly higher mean birthweight than those who normalized between 20 and 24–26 weeks gestation (‘late normalizers’) after adjustment for confounding factors; gestational age, maternal height, parity, ethnic group and smoking (mean difference=173 g, 95% confidence intervals 42 to 303 g).

Conclusions. The timing of trophoblast invasion, as reflected by abnormal uterine artery waveforms, may have an effect on birthweight.
Child rate, pregnancy outcome and ovarian function in females with classical 21‐hydroxylase deficiency
Authors: JÄÄSKELÄINEN JARMO , HIPPELÄINEN MARITTA , KIEKARA OLAVI , VOUTILAINEN RAIMO
Published: March 2003

Background. Ovulatory disorders and decreased fertility rates have been found in females with classical 21‐hydroxylase deficiency (21‐OHD). We analyzed the pregnancies of 29 females with classical 21‐hydroxylase deficiency and examined 16 of these women in a cross‐sectional study.

Methods. The child rate of the 29 patients was compared with that in the general Finnish female population with equal age distribution.The cross‐sectional study of the 16 patients included a standardized questionnaire, clinical examination, ultrasonography of the internal genitalia, basal measurements of serum steroids, sex hormone binding globulin, PRL, gonadotropins and plasma ACTH.

Results. The child rate was significantly lower than that in the general population (0.34 vs 0.91; p<0.001). A total of 13 pregnancies could be registered. From these pregnancies, ten healthy children were born, all for females with a simple virilizing disease. None of the nine females with salt wasting 21‐OHD had any children or had sought treatment for infertility. In the cross‐sectional study, females with regular menses (5/16; 31%) had well controlled adrenal androgen secretion and they had normal serum progesterone concentrations whereas the females with irregular menses (11/16; 69%) were often undersubstituted and presented with high serum progesterone concentration in the follicular phase. Polycystic ovaries could not be detected in any of these patients.

Conclusions. Females with simple virilizing 21‐OHD often have irregular menses but their final prognosis for fertility seems to be better than previously reported. On the contrary, our study confirms the extremely low child rate in the salt wasting group.
The diagnosis of urinary tract infections among pregnant women in rural Tanzania; prevalences and correspondence between different diagnostic methods
Authors: OLSEN BJØRG EVJEN , HINDERAKER SVEN GUDMUND , LIE ROLV TERJE , GASHEKA PETRO , BAERHEIM ANDERS , BERGSJØ PER , KVÅLE GUNNAR
Published: March 2003

Background. To assess the prevalence of dysuria, dipsticks positive on nitrite and leukocyte esterase and positive Uricult® dip slides among pregnant women in rural Tanzania.

Methods. 3715 pregnant women were examined for dysuria and had their urine tested with nitrite and leukocyte esterase dipsticks and Uricult® dipslides, at their first antenatal visit in 1995–96.

Results. The prevalences of positive symptoms and tests were as follows: dysuria 32%, nitrite 40.3%, leukocyte esterase 65.6%, and Uricult® dip slides 16.4%. A general log‐linear model where all four variables were analyzed simultaneously showed poor correspondence between the diagnostic methods. Odds ratio with 95% confidence intervals were as follows: dysuria vs. nitrite [1.6 (1.4–1.8)], dysuria vs. leukocyte esterase [1.2 (1.0–1.4)], nitrite vs. leukocyte esterase [4.2 (3.6–4.9)], and leukocyte esterase vs. Uricult®[1.4 (1.1–1.7)]. Dysuria and nitrite were not associated with Uricult® dipslide.

Conclusion. A high prevalence of positive tests, but a poor correspondence between the methods was found, emphasizing the need for more attention to the problem of urinary tract infections among pregnant women in developing countries, and the need for better screening tests for urinary tract infections in these countries.