bluuebunny/crossref_metadata_2025 huggingface dataset:
Caesarean Section and Perinatal Mortality in South Western Nigeria
Authors: Ezechi OC , Loto OM , Ndububa VI , Okogbo FO , Ezeobi PM , Nwokoro CA
Published: June 2010

Aim: Caesarean section carries a substantial hazard to the unborn fetus, especially if done as an emergencyprocedure. In our environment fetal loss following a caesarean delivery is usually attributed to the procedureby patients and relations who do not readily accept caesarean section as a delivery option.Method: A 10 year descriptive study of caesarean section related perinatal mortality in four tertiary hospitalsin South western Nigeria.Results: Nineteen thousand one hundred and seventy nine deliveries were conducted in the hospitalsduring the study period; five thousand one hundred and ninety five (27.1 %) of which were caesareandeliveries. Two hundred and thirty five of the caesarean deliveries were associated with perinatal death (6.9%.). Majority of these deaths were among the unbooked (73.8%), multiparous (69.0 %) patients and emergencycaesarean delivery (83.4%). Prolonged/ obstructed labour (45.4%), preeclampsia/eclampsia (18.8%) andfetal distress (11.5%), were the commonest indication for caesarean deliveries. While majority of the perinataldeath were still born (60.3%), (39.7%) were early neonatal deaths. The common causes of early neonataldeath in these patients were severe birth asphyxia (37.4 %), neonatal sepsis (22.0%) and prematurity (16.4%).Conclusion: The cause of perinatal mortality associated with caesarean delivery in our environment arepreventable with public enlightenment, provision of affordable and accessible prenatal and neonatal care,discipline, behavioural and attitudinal change of health workers, and the political will on the part of policymakers to maternal and child health delivery care more effective.DOI: 10.3126/njog.v4i1.3332Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 46-48
Unilateral torsion of fallopian tube at 32 of weeks of pregnancy followed by a normal delivery
Authors: Upadhyaya Indira , Sharma Richa
Published: June 2010

A 24 year primi gravida at 32 weeks pregnancy presented with acute abdomen simulating torted ovariantumor that underwent laparatomy/unilateral salpingectomy with the diagnosis of fallopian tube torsion ispresented because of uneventful term vaginal delivery despite postoperative complication like gaped abdominalwound needing secondary suture.Keywords: acute abdomen in pregnancy; acute abdomen due to fallopian tube torsion.DOI: 10.3126/njog.v4i1.3336Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 58-59
Bilateral tubercular ovarian cyst presenting with vertigo
Authors: Bose Chinmoy K
Published: June 2010

DOI: 10.3126/njog.v4i1.3337Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 60
MICHAEL TREBILCOCK AND THE PAST AND FUTURE OF LAW AND ECONOMICS
Authors: Priest George L.
Published: June 2010

In the revised text of his keynote address delivered at the Symposium in Honour of Michael Trebilcock held at the Faculty of Law, University of Toronto, 1–2 October 2009, Professor Priest traces the history of the law and economics movement, starting with Aaron Director and Ronald Coase, founders of the Journal of Law & Economics (‘Stage i’); proceeding to Richard Posner, Guido Calabresi, and the emergence of the efficiency theory of the common law (‘Stage ii’), and concluding with Michael Trebilcock, whose scholarship characterizes what Priest argues is the emerging third stage. The distinguishing feature of Trebilcock's scholarship is that he does not relentlessly promote market, as opposed to government, solutions to economic problems, although, in common with his intellectual predecessors, he does seek to determine the actual effects of legal policy on behaviour and views legal rules and institutions as means of shaping behaviour to achieve desirable social outcomes.
LAW AND ECONOMICS IN THE LEGAL ACADEMY, OR, WHAT I SHOULD HAVE SAID TO DISCIPULUS
Authors: Ogus Anthony
Published: June 2010

Is there a future for law and economics scholarship within the legal academy that does not involve formal modelling? To reach a positive answer to this question, I provide a brief sketch of the development of the subdiscipline, showing how, in the most recent period, the dominance of economists, working with their own agenda and career motivations, has created obstacles for the dissemination of law and economics within the legal academy and to legal policy makers more generally. I argue that drawing out and communicating to this broader readership the major insights of law and economics remain important tasks. So also, from a normative perspective, to relate efficiency analysis to whatever non-economic goals may also influence particular areas of law. Across the huge range of his publications, Michael Trebilcock has provided a model for the law and economics scholarship that I am advocating.
ACCESS TO JUSTICE AND BEYOND
Authors: Roach Kent , Sossin Lorne
Published: June 2010

This essay examines Michael Trebilcock's access to justice scholarship from his work on consumer protection in the 1970s to his 2008 Legal Aid Review. Trebilcock's approach over the years has consistently been informed by a consumer welfare perspective, including a concern that the middle class be included in access to justice initiatives, and by a broad concern with access to markets and regulatory regimes as well as to adjudication. Trebilcock's use of public choice analysis, however, has made him more sceptical about the use of regulatory regimes to lessen or simplify disputes. The authors argue that the increased resources that would be required to add the middle class to legal aid might be better directed at the replacement of a costly court-based system in areas such as family law with a more efficient and holistic tribunal structure and by a return to the political process to produce regulation to limit and simplify disputes.
GIVING VOICE TO REALITY: MICHAEL TREBILCOCK AND PENSION GOVERNANCE ISSUES
Authors: Davis Ronald B. , Sarra Janis P.
Published: June 2010

This article explores how Michael Trebilcock's multidimensional and pragmatic approach to the governance issues arising from limited liability in corporate law and the problems of assigning the task of protecting corporate employees to private contracting have widespread application in many areas where parties’ relationships are not confined to a single isolated transaction, including employment-based pension plans. Observations about the potential for opportunistic behaviour in the endgame of a long-term contractual relationship and the moral hazards that accompany limited liability for corporate managers are extended into the problems of pension-plan governance. The sources of moral hazards in funding assumptions and the agency costs in pension investment policy decisions are analysed and illustrated. The article suggests a role for the ‘voice’ of plan members in the governance of pension plans as a means of controlling conflicts of interest and moral hazard in these relationships, echoing some of Trebilcock's suggestions for addressing such conflicts in other aspects of the employment relationship.
TREBILCOCK ON TAX AVOIDANCE
Authors: Alarie Benjamin
Published: June 2010

Michael J. Trebilcock is by all accounts one of his generation's most prolific and important scholars of law and economics. Through more than 200 articles, book chapters, books, edited volumes, and other academic publications, Trebilcock has made lasting contributions to many fields, including contracts, torts, consumer protection, antitrust, international trade, immigration, regulation, and law and development. In recognition of his teaching and research, he has received awards and distinctions from students, universities, governments, and scholarly societies. The symposium for which this essay was prepared is only the latest token of appreciation for Trebilcock's profound and prominent contributions to the intellectual depth and breadth of legal thought. And yet, despite the accolades, the attention, and the richly deserved scholarly fame, there is a comparatively unlit corner of Trebilcock's oeuvre: the part dealing with income-tax law. Most readers of Trebilcock's more discussed work will not be aware that his scholarly career began, inauspiciously as it might seem, nearly five decades ago with a 224-page llm thesis at the University of Adelaide. Almost unbelievably, this substantial piece of work was dedicated to analysing just a single provision of Australian income-tax law: a general anti-avoidance rule aimed at combating tax avoidance. This essay seizes control of the spotlight that has been trained on Trebilcock's other work and redirects it to his early tax scholarship.
‘TO HEAP DISTRESS UPON DISTRESS?’ COMPARATIVE REFLECTIONS ON INTEREST-RATE CEILINGS
Authors: Ramsay Iain
Published: June 2010

Interest-rate ceilings are often proposed as a protection for lower-income consumers in the credit market. Economists are generally sceptical of the protective role of ceilings, arguing that they often have undesirable substitution and exclusionary effects, may be circumvented, and hurt most those whom they are intended to protect. More competition, better information, and financial literacy are proposed as alternative policies, together with more effective redistribution through the social system. This was the conclusion of David Cayne and Michael Trebilcock in 1973 in their examination of the problem that ‘the poor pay more.’ Notwithstanding these economic critiques of ceilings, many European countries retain ceilings, and Japan recently lowered its existing ceiling. There does not seem to be an ‘end of history’ as nations converge on a ‘modern’ understanding of ceilings. This article sketches recent debates in the United Kingdom (no ceilings) and France (ceilings) where both countries view their policies as protection against financial exclusion. The author outlines the role of empirical knowledge and the value assumptions in these debates, raises the question of whether the differences represent distinct national cultural preferences, and suggests that explanations of consumer credit regulation should be sought in the dynamics of political interest-group influence and its institutional setting in both countries.
Editorial
Authors: Kockel Ullrich
Published: June 2010

With this issue, AJEC returns to its original format as a journal with, for the time being, two issues per year. When the first issue was published in 1990 by the European Centre for Traditional and Regional Cultures (ECTARC), Europe was a different place. As the director of ECTARC, Franz-Josef Stummann (1990: 7), explained in his introduction to that issue, the ‘magical date of 1992’, heralding the Single European Market as a significant step towards European integration, had ‘a substantial bearing’ on the foundation of the journal. Moreover, the Berlin Wall, symbol of the political divide that cut right through Cold War Europe, had crumbled the previous year. German unification was imminent, but very little else seemed predictable. Eighteen years and two Gulf Wars later, not only has the European Union acquired fifteen new member states, ten of them former Communist countries, but we have also been told to perceive a new divide – between a ‘new’ Europe and an ‘old’ one.
Books Available for Review
Authors: Craith Máiréad Nic
Published: June 2010

Books Available for Review
Kyrgyzchylyk
Authors: Aitpaeva Gulnara
Published: June 2010

This essay discusses the concept of kyrgyzchylyk (rather inadequately rendered in English as 'Kyrgyzness') as a way of transcending different boundaries: the Soviet past, Koran-based Islam, rational thinking. Several aspects of the concept and its meaning in everyday life are discussed; in particular the idea of kyrgyzchylyk as spirituality is examined. Moreover, the concept can be seen as transcending the boundaries between traditional beliefs and Islam. Traditional practitioners - healers, clairvoyants, epic storytellers, sacred sites custodians and others - are seen as becoming powerful people through their practices, and the role of kyrgyzchylyk in the context of the traditional worldview is assessed.
Tradition and Heritage in Ethnological Practice and Theory
Authors: Anttonen Pertti
Published: June 2010

All scholarly fields feed on rhetoric of praise and criticism, mostly self-praise and self-criticism. Ethnology and folklore studies are not exceptions in this, regardless of whether they constitute a single field or two separate but related ones. This essay discusses questions concerning ethnological practice and object formation, cultural theory and the theory of tradition (or the lack thereof), cultural transmission, cultural representation, and the ethics and politics of cultural ownership and repatriation. It draws on general observations as well as on work in progress. The main concern is with a discursive move: from tradition to heritage, from the ethnography of repetition and replication to cultural relativist descriptions and prescriptions of identity construction and cultural policy, from ethnography as explanation to ethnography as representation and presentation. In addition, the essay seeks to delineate other underlying tenets that appear to constitute our traditions and heritages - both as strengths and as long-term constraints and biases. Where is ethnology headed in its quest to transcend theories and practices? Less theory and more practice? More theory on practice? Or more practice on theory?
Mapping Europeanist Research
Authors: Barrera-González Andrés , Horolets Anna
Published: June 2010

There are two meanings attached to the concept ‘Europeanist’ when applied within the boundaries of our discipline. The term can be used to refer to the practice of anthropology in Europe (e.g. Grillo 1980; Macdonald 1993). This usage primarily indicates the region where fieldwork and research is carried out, as when we label other such fields of anthropological practice ‘Africanist’ or ‘Americanist’. It is thus a mere indication of the regional focus of interest. A more circumscribed usage would take Europeanist anthropology as the anthropology of Europe (e.g. Goddard, Llobera and Shore 1994; Barrera-González 2005). The broader object of study being Europe itself, the term could not be properly applied to whatever piece of research and writing done on some part of Europe. Instead, it would entail studies with a substantial comparative dimension and/or a regional outlook.
Reclaiming European Heritages of Transatlantic Migration
Authors: Čiubrinskas Vytis
Published: June 2010

This article provides a fieldwork-based case study for the application of identity empowerment through heritage as a research perspective for the analysis of East European transnationalism seen in Lithuanian immigration in the U.S.A. Two patterns of reclaiming European heritages, 'diasporic' and 'recognitionist', are discussed. The 'diasporic' pattern among more recent migrants embraces a transatlantic heritage in which culture stands for the nation. It is instrumentalised as a claim to retain essential Lithuanianness, and reinforced by the moral imperative to return to the homeland. The 'recognitionist' pattern is exemplified by descendants of earlier East European immigrants, and is focused on family roots, as well as on ethnic history and culture. Transatlantic roots and ethnic heritages of the Lithuanian 'Texas pioneers' are reinforced by belonging to the local United States as migrants strive to achieve re-inscription of that heritage as one that has long been rooted in the local history of Texas.
In a World of Migration
Authors: Quintero Elizabeth P.
Published: June 2010

This article has evolved from teaching future teachers about literacy and language in multilingual contexts. The examples are taken from contexts in the United States with learners from around the world. Professionals in the classrooms, in the teacher development programs, and in schools and colleges of education have been doing responsible research for many years, and have learned much regarding the learning of multilingual people who represent a multitude of histories. In this article the focus is on rethinking literacy, languages (home languages and target languages of host countries), the connections between personal and communal history and learning texts, and how all of the above relate to the curriculum in various learning arenas.
Contending "Historical" Identities in India
Authors: Nair Deepa
Published: June 2010

The controversy over rewriting history textbooks in India in 2000 not only revealed the divergent renditions of collective memory but also evoked decades of contention over self-representation and cultural identity. This article explores these "multiple" renderings of a "singular" past and contends the formation of "historical identities" by arguing that divergent use of reason and interpretation leads to a layered and uid Indian identity leaving it open for contestation. By situating the case of the Mughal ruler Aurangzeb within the milieu from which textbook controversies emanate, the article suggests an alternative dimension for looking at the controversy—instead of the usual binary concept of "secular" versus "communal" history. At the root of the controversy is not merely politicization but also divergent perspectives of looking at the past and the resultant rethinking and reworking of dominant notions of it.
Weapons of Mass Instruction
Authors: Ingrao Charles
Published: June 2010

History schoolbooks are part of a much broader legitimation process through which every society's ruling elite secures the uncritical acceptance of the existing political, social and economic system, together with the cultural attributes that re ect its hegemony. In central Europe, the need to justify the creation of nation-states at the beginning and end of the twentieth century has generated proprietary accounts that have pitted the region's national groups against one another. Post-communist democratization has intensi ed these divisions as political leaders feel obliged to employ hoary myths—and avoid inconvenient facts— about their country's history in order to survive the electoral process. In this way they succumb to the "Frankenstein Syndrome" by which the history taught in the schools destroys those who dare to challenge the arti cial constructs of the past. The article surveys history teaching throughout central Europe, with special emphasis on the Yugoslav successor states.
New Trends in History Textbook Research
Authors: Repoussi Maria , Tutiaux-Guillon Nicole
Published: June 2010

This article traces the developments within history textbook research as presented at the 2009 conference of the International Society for History Didactics (ISHD), held in cooperation with the Georg Eckert Institute for International Textbook Research in Braunschweig, Germany. The article claims that significant developments reveal school historiography to be a challenged area for history didactics. Key concepts and theoretical frames require further discussion in order to develop history didactics not only as an area for social and political responsibilities but also as a theoretical discipline.
Poly(glycolide) multi-arm star polymers: Improved solubility via limited arm length
Authors: Wolf Florian K , Fischer Anna M , Frey Holger
Published: June 2010

Due to the low solubility of poly(glycolic acid) (PGA), its use is generally limited to the synthesis of random copolyesters with other hydroxy acids, such as lactic acid, or to applications that permit direct processing from the polymer melt. Insolubility is generally observed for PGA when the degree of polymerization exceeds 20. Here we present a strategy that allows the preparation of PGA-based multi-arm structures which significantly exceed the molecular weight of processable oligomeric linear PGA (<1000 g/mol). This was achieved by the use of a multifunctional hyperbranched polyglycerol (PG) macroinitiator and the tin(II)-2-ethylhexanoate catalyzed ring-opening polymerization of glycolide in the melt. With this strategy it is possible to combine high molecular weight with good molecular weight control (up to 16,000 g/mol, PDI = 1.4–1.7), resulting in PGA multi-arm star block copolymers containing more than 90 wt % GA. The successful linkage of PGA arms and PG core via this core first/grafting from strategy was confirmed by detailed NMR and SEC characterization. Various PG/glycolide ratios were employed to vary the length of the PGA arms. Besides fluorinated solvents, the materials were soluble in DMF and DMSO up to an average arm length of 12 glycolic acid units. Reduction in the Tg and the melting temperature compared to the homopolymer PGA should lead to simplified processing conditions. The findings contribute to broadening the range of biomedical applications of PGA.
Detection ofMycobacterium avium ss. Paratuberculosisin Blau Syndrome Tissues
Authors: Dow C. Thomas , Ellingson Jay L. E.
Published: June 2010

Background and Aim of the Work. Blau syndrome is an inherited granulomatous inflammatory disorder with clinical findings of uveitis, arthritis, and dermatitis. Although rare, Blau syndrome shares features with the more common diseases sarcoidosis and Crohn's disease. The clinical findings of Blau syndrome are indistinguishable from juvenile sarcoidosis; the mutations of Blau syndrome are on the same gene of chromosome 16 (CARD15) that confers susceptibility to Crohn's disease. The product of this gene is part of the innate immune system.Mycobacterium avium ss. paratuberculosis(MAP) is the putative cause of Crohn's disease and has been implicated as a causative agent of sarcoidosis.Methods. Archival tissues of individuals with Blau syndrome were tested for the presence of MAP.Results. DNA evidence of MAP was detected in all of the tissues.Conclusions. This article finds that MAP is present in Blau syndrome tissue and postulates that it has a causal role. The presence of MAP in Blau syndrome—an autosomal dominant, systemic inflammatory disease—connects genetic and environmental aspects of “autoimmune” disease.
The vegetation and floristics of the Letaba exclosures, Kruger National Park, South Africa
Authors: Siebert Frances , Eckhardt Holger C. , Siebert Stefan J.
Published: June 2010

The construction of exclosures along two of the most important rivers in the Kruger National Park was done to investigate how patterns of spatial and temporal heterogeneity of the riparian zone is affected by fire, flood and herbivory. To assist this research programme, vegetation surveys were conducted within exclosures along the Letaba River to classify and map the vegetation of the area. The history and experimental design of the Letaba exclosures are similar to that of the Nkhuhlu exclosures along the Sabie River, which is directly related to questions surrounding elephant management. The main difference between the Nkhuhlu and Letaba exclosures is local heterogeneity, since the latter lies within the Mopaneveld, which is floristically and physiognomically much more homogenous than the vegetation of the southern Kruger National Park. Nevertheless, four plant communities, eight sub-communities and six variants were recognised and mapped for the Letaba exclosures. The vegetation description was done in relation to prevailing soil forms, differences in species richness, diversity and community structure, and therefore should serve as a basis for further detailed and broad-based botanical studies. Vegetation mapping was done to sub-community level and, where possible, to variant level. As expected in Mopaneveld vegetation, the plant communities could broadly be related to soil types, although smaller-scale variations correspond to soil moisture availability because the Mopaneveld is considered ‘event-driven’, especially in the herbaceous layer.Conservation implications: Floristic surveying and vegetation mapping of a long-term monitoring site, such as the Letaba exclosures, is seen as a baseline inventory to assist natural resource management. Linking mapping units to biodiversity strengthens the understanding needed to maintain biodiversity in all its natural facets and fluxes.
Modifications of Thyroid Cancer Surgical Diagnosis and Treatment: 33 Years of Experience at Saint-Petersburg Center of Endocrine Surgery and Oncology
Authors: Romanchishen Anatoly F
Published: June 2010

Objective identification of recurrences and application of radioactive iodine for the treatment of cancers of the thyroid have now been available in Russia over the last 10 years. This has improved results of the treatment of thyroid cancers. Central neck dissection has also been crucial in the treatment of cancer of the thyroid.
Fibrous Dysplasia of the Temporal Bone
Authors: Singh Baldev , Duggal Prahlad , Grover Ruchika
Published: June 2010

We report a case of monostotic fibrous dysplasia of temporal bone in a 15-year-old male which presented with mass in the temporomastoid region. There was no associated complaint and patient came only for cosmetic correction of the asymmetry of skull. Conductive hearing loss was an incidental finding on audiogram. Computed tomography showed increased bone thickness with ground glass appearance. Shaded surface display of the skull was used in assessing the external bony deformity. Patient was operated for contouring of the bone and canalplasty which improved the cosmetic appearance as well as corrected the hearing loss thereby avoiding an extensive surgery. Patient is under regular follow-up with good cosmetic and functional results. This case highlights the importance of conservative surgery and regular follow-up in selective cases of temporal bone fibrous dysplasia along with use of shaded surface display for planning the correction of external deformity.
Is Prophylactic Central Compartment Lymph Node Dissection Necessary for Papillary Thyroid Carcinoma?
Authors: Doherty Gerard M , McKenzie Travis J , Lillegard Joseph B , Grant Clive S , Hay Ian D , Fisher James E , Thompson Geoffrey B
Published: June 2010

The need for prophylactic central compartment lymph node dissection in patients with papillary thyroid carcinoma continues to be a subject of ongoing debate. Regional lymph node metastases are a common finding with papillary thyroid carcinoma, with an incidence as high as 50% or more. With the widespread use of high resolution ultrasound and sensitive thyroglobulin assays, lymph node metastases, not appreciated at the time of surgery, are showing up in the follow-up period, creating significant angst amongst patients, endocrinologists, and their surgeons. It was previously thought that lymph node metastases in papillary thyroid carcinoma had little bearing on survival, but this has more recently been challenged. Opponents of prophylactic central compartment node dissection cite high perioperative morbidity as a word of caution in performing prophylactic central neck dissections. The following review will look at the most up-to-date literature and best evidence for arriving at logical and sensible recommendations. This review will also look at specific definitions of what is a central compartment lymph node dissection. In the hands of experienced thyroid surgeons, prophylactic central compartment lymph node dissection, performed in a meticulous manner, can limit persistent or recurrent disease in the central compartment, and can diminish the need for routine administration of radioactive iodine, with acceptable perioperative morbidit
Assessment of an Ultrasound-based Scoring System for Triaging Ovarian Tumors in Symptomatic Women
Authors: Alcázar Juan Luis , Royo Pedro , Galván Rosendo , Mínguez José Ángel , Manero Manuel García , Laparte Carmen , García Guillermo López
Published: June 2010

Objective

To evaluate prospectively an ultrasound-based scoring system as a method for triaging symptomatic women presenting with an adnexal mass for surgical treatment.

Methods

151 symptomatic women scheduled for surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound prior to surgery. Patients were classified as low-risk or high-risk for malignancy according an ultrasound-based scoring system. Patients with low risk for malignancy were scheduled for laparoscopy and patients for high risk for malignancy were scheduled for laparotomy. Some patients with high-risk were scheduled for advanced oncologic laparoscopic surgery. Patients with low risk but tumor size > 10 cm were scheduled for laparotomy.

Results

82 women presented with pelvic pain, 8 had uterine bleeding and 61 referred symptoms suggestive for ovarian malignancy, such as abdominal swelling, bloating and abdominal discomfort. 75 (49.7%) masses were considered as “low-risk” and treated by laparoscopy in 58 cases and by laparotomy in 7 cases, because emergency or associated pathology (All tumors were benign). 76 (50.3%) masses were considered as “high-risk” and all treated by laparotomy (56 malignant and 4 benign tumors) or by advanced laparoscopy (16 malignant tumors). Ten (6.7%) tumors were considered as “low-risk” but scheduled for primary laparotomy because of size > 10 cm (9 benign and 1 malignant). Sensitivity, specificity, PPV and NPV for this scoring system were 98.6%, 94.9%, 94.7% and 98.7%, respectively. The scoring system were more sensitive than patient's complaints (98.6% vs 79.5%, p < 0.0001) and more specific than physical examination (94.9% vs 85.9%, p < 0.0001)

Conclusions

Ultrasound based triage of symptomatic women diagnosed, as having an adnexal mass is effective for selecting surgical approach.
3D PD Imaging of Ovarian Pathology— Advantages and Limitation of the Method: How can We Standardize the Results?
Authors: Alcázar Juan Luis , Kudla Marek
Published: June 2010

Three-dimensional Power Doppler ultrasound is a new imaging modality for assessing tissue vascularization, which is being introduced into clinical practice and it is being increasingly used. In the last years a number of papers assessing the role of this method for assessing adnexal masses vascularization have been published. The aim of this work is to address some technical aspects of 3D US, to review critically its current status in clinical practice and to address future perspectives of its use.
Web Based Interactive Tutorials in Obstetrics and Gynecology
Authors: Patham Bhargavi , Guerra Martha
Published: June 2010

The challenge of integrating basic science and clinical knowledge contents has become an educational imperative at Paul L Foster School of Medicine clinical presentation based curriculum. During the first two years of our curriculum, students are introduced to clinical applications of basic science knowledge. For better understanding and appreciation of the important links between the basic science principles and clinical medicine, students return to basic science topics. To support such a progression of students' knowledge and skills, the curriculum should allow and support individual learning. Interactive tutorials created by authors of different backgrounds and expertise facilitate clinical application of basic science knowledge and provide multiple pathways in learning and inductive reasoning. Web based learning modules do not supplement traditional lectures, small groups sessions and team based learning activities, but they may significantly enrich students' learning experience.

Physical and content boundaries between basic science and clinical departments are sometimes difficult to breach. In virtual space, thematically organized modules and collective approach of interdisciplinary teaching teams allow full integration of core content. This concept of distance learning contributes to educational continuity, longitudinal experience and educational mobility.
Ultrasound—A Clinical Procedure to Motivate Preclinical Medical Students to Learn Embryology
Authors: Azumendi Guillermo , Beale Elmus G
Published: June 2010

A fundamental understanding of human embryology is an essential skill for the majority of practicing physicians. However, its perceived difficulty, in context of the constant competition for time needed to learn other basic science disciplines, makes teaching embryology in undergraduate medical education a universal challenge. Sonography is now commonly used in standard prenatal care because it allows safe, noninvasive imaging of early embryos and fetuses. Two-, three- and four-dimensional and Doppler ultrasound provide an astonishing arsenal of techniques to evaluate a pregnancy and screen for abnormalities. We are developing an international collaboration with ultrasound experts to introduce sonography into the teaching of embryology to preclinical medical students. The objective is to motivate students and facilitate learning by providing clinical relevance and online images that will help them visualize embryonic development. We invite members of the Ian Donald School of Ultrasound and editors and readers of the Journal to participate in this project.
Ultrasound Imaging of the Menstrual Cycle
Authors: Janssen Herbert F
Published: June 2010

The menstrual cycle is nature's repeating preparation for pregnancy. Each month, the uterine lining develops in anticipation of implantation by a fertilized ovum. If this occurs, hormones from the reproductive organs stabilize the vascular tissue of the endometrium which provides an environment for the developing embryo. If the awaited implantation does not occur, the endometrium is sloughed due to a rapid drop in circulating levels of progesterone. This process starts during the early teenage years of a female's development (menarche) and repeats 400-500 times over the next 40 years. Normally, this process is interrupted only by pregnancy; however, other factors can certainly influence both the cycle length, volume, and the duration of each menses. Ultrasound imaging provides a noninvasive method to visualize the internal reproductive organs, the endometrium, and the embryo if implantation occurs. This relatively inexpensive evaluation provides an easy and cost effective method to examine potential problems associated with the female reproductive organs. Advances in computer software and hardware coupled with new ultrasound equipment has provided exciting 3-D and 4-D images that generate near life-like images. In the guiding hand of a trained physician or sonographer, ultrasound enhances diagnostic capability and gives reassurance to the patient.
The Role of Ob/Gyn Ultrasound in Medical Student Education: Immunological Disorders of Pregnancy Assessed by Ultrasound
Authors: Piskurich Janet F
Published: June 2010

To learn immunology in the absence of visual images would be an onerous and tedious chore. Most immunology textbooks use a large number of illustrations and diagrams to assist students as they endeavor to grasp the semantics and fundamentals of immunology, which are exacting and can be confusing to the uninitiated. Likewise, ultrasound imaging can be used to elucidate the consequences of an immune incompatibility between the mother and child during pregnancy in a manner that brings both clarity and clinical relevance to the medical students' understanding of this basic concept. Here we illustrate in the context of medical student education the use of ultrasound in the assessment of immunological disorders of pregnancy.
Using Ultrasound to Teach Female Reproductive Physiology
Authors: Janssen Herbert F
Published: June 2010

Physiology ties together many related disciplines including anatomy, histology, biochemistry, and cell biology. Mastering the concepts of physiology is essential to understanding the principles of medicine. Learning physiology requires acquisition of facts, but this alone provides little in the way of useful knowledge. Currently, educators are challenged with the task of presenting physiology in a manner that encourages students to actively learn the required material. Didactic lectures were considered antiquated a century ago by Abraham Flexner when he reported on the status of medical education in the United States and Canada. Unfortunately, his comments did little to dissuade the use of lecture as a primary teaching method in medical education. Today we have the opportunity to develop new methods to present material in a manner that encourages active learning and understanding of concepts. Ultrasound imaging is a tool useful in presenting many organ systems in physiology. This is especially true of the female reproductive system. Ultrasound equipment can be used to develop still images of the ovaries, fallopian tubes, uterus, and the developing fetus. It can also provide video clips showing the reproductive organs in juxtaposition with the surrounding tissue or images of the fetus complete with heart sounds and vascular flow. During more advanced training, the students can develop hands-on skills using the ultrasound to identify and evaluate structures.
3-D and Power Doppler Ultrasound in Translational Research
Authors: Rajkumar Lakshmanaswamy
Published: June 2010

At Texas Tech University Health Sciences Center in El Paso we have developed an animal model to study mammary carcinogenesis and neovascularization. Seven-week-old female Sprague Dawley rats are injected with N-methyl-N-nitrosourea (MNU) intraperitoneally at a concentration of 50 mg/kg bodyweight. The rats are palpated twice a week for development of mammary gland tumors. On the appearance of the first palpable tumor, the animals are divided into the groups treated with aromatase inhibitor, ethanolic neem leaf extract and control group, receiving vehicle treatment. Using a high-resolution 16 MHz linear array transducer mammary glands are imaged before and every two weeks following the introduction of the therapy. 3-D US coupled with 3-D power Doppler imaging is used for evaluation of the volume and vascularity of the mammary gland lesions. Pulsatility and resistance index and vascularity, flow and vascularity flow indices are evaluated longitudinally. Our preliminary data indicate that 2-D and 3-D power Doppler ultrasound may be efficiently used for evaluation of the mammary gland tumor volumes and vascularity. 2-D and 3-D power Doppler ultrasound may also be used for evaluation of the response of mammary gland tumors to different lines of medication therapy.
Ultrasound Screening in Low-risk Obstetrical Population: Effect on Perinatal Outcome
Authors: Theodora M , Antsaklis A
Published: June 2010

The issue of routine sonography for low-risk pregnant women continues to be controversial since randomized trials have not been able to demonstrate a clear benefit especially in prenatal outcome in the past. Ultrasonography early in pregnancy can be definitely used for accurate gestational age determination and detection of multiple gestations. Additionally ultrasound scan is the best method for detecting fetal malformation as well as fetuses in high-risk for growth restriction. Since fetal chromosomal and structural anomalies, prematurity and poor placentation account for 90% of poor perinatal outcome, ultrasound could theoretically help in decreasing perinatal mortality and severe perinatal morbidity.
Doppler Evaluation of the Ovary: Clinical Applications and Challenges
Authors: Zalud Ivica
Published: June 2010

Transvaginal sonography has been shown to be an accurate technique for discriminating between benign and malignant adnexal masses. Accurate preoperative differential diagnosis of adnexal masses is essential for optimizing patients’ treatment. The advancement and wider availability of therapies of assisted conception have occurred to a large extent as a result of developments in ultrasonography. Transvaginal color Doppler has opened up exciting new possibilities for the better understanding of the physiology and pathophysiology of ovarian blood flow, resulting in a number of completely new diagnostic parameters.
Three-dimensional Ultrasound for Assessing Uterine Pathology
Authors: Alcázar Juan Luis
Published: June 2010

Two-dimensional ultrasound is commonly used for assessing uterine pathology. Three-dimensional ultrasound is a new imaging modality, which is being introduced into clinical practice. The aim of this paper is addressing the current status of three-dimensional ultrasound in the assessment of uterine pathology.
Bioeffects and Safety of 2D and 3D/4D Ultrasound in Obstetrics—Is there a Place for “Parental Bonding” Scans?
Authors: Abramowicz Jacques S
Published: June 2010

Ultrasound is widely used in daily clinical obstetrical practice. Many medical indications exist for performing a sonographic examination but, in addition, several researchers have published information on the importance of patients watching the ultrasound monitor during the examination, particularly during three- and fourdimensional (3D/4D) scanning, for maternal-fetal bonding. Furthermore, a certain form of ultrasound, called “entertainment” or “keepsake” ultrasound has flourished, particularly in the United States. While ultrasound is assumed to be completely safe, it is a form of energy and, as such, has effects in tissues it traverses (= bioeffects). The two most important mechanisms for effects are thermal and non-thermal. Nonthermal mechanisms include cavitation, streaming, and even release of free radicals. These two major mechanisms are indicated on-screen by two indices: The thermal index (TI) and the mechanical index (MI). It is important to be aware of these effects to be able to prevent potential harm. Ultrasound machine controls can alter the instrument acoustic energy and hence the exposure but different machines behave differently. Therefore each clinician should know how this occurs in his/her own machine. Unfortunately, it appears the general knowledge in this area is poor and an effort should be made to educate the endusers. Whether 3D/4D enhances parental-fetal bonding is still a matter of discussion.
3D/4D Echocardiography—STIC
Authors: Szymkiewicz–Dangel Joanna
Published: June 2010

Fetal cardiac screening is an obligation for everybody performing prenatal ultrasound. The heart, as a small and always moving object, is still the most difficult part of the fetal anatomy evaluation. Knowing this, different methods of improving antenatal screening for congenital heart defects (CHD) were introduced. Spatial temporal image correlation (STIC) is the newest one. Its target was to automatic acquisition of the fetal scan from the abdomen, through 4 chamber view toward the three vessel view and off-line analysis of the anatomy of the fetal cardiovascular system. Is that really possible? Does STIC improve screening of CHD? Would it be helpful in the more precise diagnosis of complicated heart defects? These are still the open questions, which will be discussed in the article.
Three-dimensional Ultrasound in the Fertility Clinic
Authors: Deb Shilpa , Haoula Zeina , Raine-Fenning Nick
Published: June 2010

The management of subfertility involves a detailed assessment of the couple to identify factors that may affect or predict the outcome of treatment. Three-dimensional imaging is one of the recent advances in the field of ultrasound which has several obvious benefits that relate to an improved spatial orientation and the demonstration of additional image planes such as the coronal plane. Many clinicians remain unconvinced by its reputed advantages and three-dimensional ultrasound is not without disadvantages. These mainly relate to the cost involved and training requirements. Threedimensional ultrasound imaging is still at a relatively early stage in terms of its role as a day-to-day imaging modality in gynecology and reproductive medicine. Other than its application in the assessment and differentiation of uterine anomalies there is little evidence that three-dimensional ultrasound results in clinically-relevant benefit or negates the need for further investigation. Future work should ensure that three-dimensional ultrasound is compared to conventional imaging in randomized trials where the observer is blinded to the outcome such that its role in reproductive medicine can be truly evaluated in an evidence-based manner.
Prenatal Diagnosis and Management of Conjoined Fetuses
Authors: Mikos Themistoklis , Athanasiadis Apostolos , Zafrakas Menelaos
Published: June 2010

Conjoined twins have an estimated incidence of one in 50,000 to one in 100,000 births. The first cases of prenatal diagnosis of conjoined twins using B-mode ultrasound were reported in the 1970s, followed by prenatal real-time ultrasonographic diagnosis shortly thereafter. Since then, real-time ultrasound has been the most reliable method in establishing prenatal diagnosis of conjoined twins and in detecting associated anomalies. Moreover, recent improvements in real-time ultrasound technology - in some cases coupled with use of Magnetic Resonance Imaging (MRI) - have made early diagnosis of conjoined fetuses in the first trimester possible. Prenatal diagnosis of conjoined fetuses is considered essential for further management. Parents need detailed counseling in order to decide among various management options, which include the following: (a) pregnancy continuation and scheduled neonatal surgery, (b) termination of pregnancy, and (c) multifetal pregnancy reduction or selective fetocide in cases of high-order multifetal pregnancies with a component of conjoined fetuses. An interdisciplinary medical team, involving obstetricians, neonatologists, pediatric surgeons and anesthetists, should carefully approach and assist parents in their decisions. In special cases, additional consultation may be given by other specialists, even from specialized centers in other countries, depending on the area of conjunction, the involvement of other organ systems, and the presence of associated anomalies.
Vascular Ultrasound in Gynecology
Authors: Yoshida Atsushi , Tabata Tsutomu , Okugawa Toshiharu , Sugiyama Takashi , Sagawa Norimasa
Published: June 2010

The usefulness of the vascular ultrasound in the filed of gynecology is now well recognized. The intima-media thickness (IMT) and the elastic property of the common carotid artery are reported to be associated with the risk of cardiovascular diseases and are thought to be influenced by menopause. The assessment of the flow-mediated vasodilation (FMD) of the brachial artery is a noninvasive method for the evaluation of vascular endothelial function and is reported to be associated with menopause or hormone replacement therapy. Certain gynecological situations such as contraceptive use or hormone replacement therapy are reported to increase the risk of thrombosis. For the screening of deep vein thrombosis of the lower extremities in the gynecological diseases, compression ultrasonography (CUS) is useful.
Sonographic Diagnosis of Ovarian Masses
Authors: Hata Kohkichi
Published: June 2010

Transabdominal ultrasonography was initially used for the investigation of overt abdominal swellings and much later for the detection of early ovarian cancer in asymptomatic women. The technique was undoubtedly of value for detecting transient, persistent and overt ovarian cysts. Subsequently, the resolving power of pelvic ultrasonography was increased substantially by the advent of transvaginal probes. This revolutionary development was first applied to systemic studies of overt ovarian masses in patients awaiting surgery. Over the past decade, several ultrasound-based morphological scoring systems, color Doppler parameters, logistic regression models have been proposed and tested in order to try to predict the histology of ovarian tumors. On prospective testing, no standard criterion has been published. Therefore, it is important for each operator to establish their own criteria based on individual recognition potential.