bluuebunny/crossref_metadata_2025 huggingface dataset:
Low levels of vitamin B12 and venous thromboembolic disease in elderly men
Authors: DÍAZ DE TUESTA A. M. , RIBÓ MA. D. R. , BELINCHÓN O. , MARCHENA P. J. , BRUSCAS MA. J. , VAL E. , CORTÉS A. , NIETO J. A.
Published: August 2005

Abstract.  Díaz de Tuesta AM, Ribó MaDR, Belinchón O, Marchena PJ, Bruscas MaJ, Val E, Cortés A, Nieto JA (Virgen de la Luz Hospital, Cuenca, Spain). Low levels of vitamin B12 and venous thromboembolic disease in elderly men. J Intern Med 2005; 258: 244–249.

Objectives.  Hyperhomocysteinaemia is a well‐known risk factor for venous thromboembolic disease (VTD). However, it is not clear whether homocysteine (Hc) itself or a related metabolite or a cofactor is primarily responsible for VTD. We carried out a case–control study to investigate whether vitamin concentrations that are involved in the Hc metabolism are associated or not with an elevated risk of VTD.

Design.  Case–control study.

Methods.  We measured serum vitamin B12, folate, creatinine and albumin concentrations and plasma Hc concentrations in 101 consecutive patients with VTD, diagnosed by image tests and 101 control subjects, matched for age and sex.

Results.  Serum vitamin B12 concentrations were significantly lower in VTD patients than in the control subjects. There were no differences in plasma Hc or serum folate concentrations between the groups. Among the male subgroup aged more than 70 years, serum vitamin B12 concentrations were significantly lower (240.88 ± 103.07 vs. 421.20 ± 314.31 pmol L−1; P = 0.03) and plasma Hc concentrations were significantly higher (13.1 ± 4.18 vs. 10.56 ± 3.06 μmol L−1; P =0.04) in VTD patients than in the control group. On multivariate analysis, in patients aged more than 70 years, serum vitamin B12 concentrations were independently associated with VTD. Compared with the highest quartile of vitamin B12 (>512.6 pmol L−1) the odds ratio (OR) for VTD in the lowest quartile (<230.9 pmol L−1) was 3.8 (95% CI 1.44–10.18; P = 0.01).

In the VTD group, lowest vitamin B12 concentrations (percentile 10 <152.8 pmol L−1) were associated with the factor V Leiden mutation (OR = 6.07, 95% CI 0.93–38.55; P = 0.04).

Conclusions.  Measuring vitamin B12 concentrations in elderly males may help in identifying people at risk of venous thromboembolism in our population.
Unwounded plants elicit Agrobacterium vir gene induction and T‐DNA transfer: transformed plant cells produce opines yet are tumour free
Authors: Brencic Anja , Angert Esther R. , Winans Stephen C.
Published: August 2005

Agrobacterium tumefaciens is well known to cause crown gall tumours at plant wound sites and to benefit from this plant association by obtaining nutrients called opines that are produced by these tumours. Tumourigenesis requires expression of the vir regulon in response to chemical signals that are thought to be released from wound sites. Here, we examine chemical interactions between A. tumefaciens and unwounded plants. To determine whether unwounded plants can release significant amounts of vir gene inducers, we constructed an A. tumefaciens strain carrying a PvirB–gfp fusion. This fusion was strongly induced by co‐culture with tobacco seedlings that have been germinated without any intentional wounding. The release of phenolic vir gene inducers was confirmed by GC/MS analysis. We also constructed a strain containing the gfp reporter located on an artificial T‐DNA and expressed from a plant promoter. A. tumefaciens efficiently transferred this T‐DNA into cells of unwounded plants in the absence of exogenous vir gene inducers. Many cells of seedlings colonized by the bacteria also produced octopine, which was detected using a Pocc‐gfp reporter strain. This indicates transfer of the native T‐DNA. However, these transformed plant cells did not form tumours. These results suggest that successful colonization of plants by A. tumefaciens, including T‐DNA transfer and opine production, does not require wounding and does not necessarily cause cell proliferation. Transformation of plant cells without inciting tumours may represent a colonization strategy for this pathogen that has largely been overlooked.
Transcriptional regulation of flhDC by QseBC and σ 28 (FliA) in enterohaemorrhagic Escherichia coli
Authors: Clarke Marcie B. , Sperandio Vanessa
Published: August 2005

Enterohaemorrhagic Escherichia coli (EHEC) serotype O157:H7, the causative agent of haemorrhagic colitis, has been shown to utilize a cell‐to‐cell signalling system to regulate gene expression. We have previously reported that the quorum sensing E. coli regulators B and C (QseBC) may act as a two‐component system in EHEC to transcriptionally regulate the expression of flagella and motility through flhDC, the master regulator of flagella and motility genes. Here, we performed deletion analyses using the flhDC promoter in order to determine the minimal promoter regions necessary for QseBC transcriptional activation. We also performed electrophoretic mobility shift assays, competition experiments and DNaseI footprints, which suggest that QseB directly binds the flhDC promoter at high‐ and low‐affinity binding sites. These analyses have allowed us to determine the potential consensus sequence to which QseB binds in order to regulate transcription. Additionally, we mapped the transcriptional start site of flhDC responsive to QseBC, leading to the identification of a conserved FliA (σ 28) consensus sequence. These results suggest that FliA (σ 28), a class 2 flagellar gene, may be aiding in the transcriptional initiation of class 1 genes (flhDC) in EHEC. In order to further characterize the role of FliA (σ 28) in transcription of the flhDC promoter, we constructed a fliA isogenic mutant in EHEC. The flhDC::lacZ transcriptional fusion showed decreased activity in the fliA mutant compared with wild‐type and complemented strains. Taken together, these results indicate that transcriptional initiation at the flhDC promoter by QseBC appears to be complex and dependent on the presence of FliA (σ 28).
Transposition is modulated by a diverse set of host factors in Escherichia coli and is stimulated by nutritional stress
Authors: Twiss Erin , Coros Abbie M. , Tavakoli Norma P. , Derbyshire Keith M.
Published: August 2005

The role of host factors in regulating bacterial transposition has never been comprehensively addressed, despite the potential consequences of transposition. Here, we describe a screen for host factors that influence transposition of IS903, and the effect of these mutations on two additional transposons, Tn10 and Tn552. Over 20 000 independent insertion mutants were screened in two strains of Escherichia coli; from these we isolated over 100 mutants that altered IS903 transposition. These included mutations that increased or decreased the extent of transposition and also altered the timing of transposition during colony growth. The large number of gene products affecting transposition, and their diverse functions, indicate that the overall process of transposition is modulated at many different steps and by a range of processes. Previous work has suggested that transposition is triggered by cellular stress. We describe two independent mutations that are in a gene required for fermentative metabolism during anaerobic growth, and that cause transposition to occur earlier than normal during colony development. The ability to suppress this phenotype by the addition of fumarate therefore provides direct evidence that transposition occurs in response to nutritional stress. Other mutations that altered transposition disrupted genes normally associated with DNA metabolism, intermediary metabolism, transport, cellular redox, protein folding and proteolysis and together these define a network of host proteins that could potentially allow readout of the cell's environmental and nutritional status. In summary, this work identifies a collection of proteins that allow the host to modulate transposition in response to cell stress.
Early life predictors of adolescent smoking: findings from the Mater‐University study of pregnancy and its outcomes
Authors: Lawlor Debbie A. , O'Callaghan Michael J. , Mamun Abdullah A. , Williams Gail M. , Bor William , Najman Jake M.
Published: August 2005

In this study we have examined the early life predictors of smoking at age 14 in a birth cohort of individuals born in Brisbane, Australia between 1981 and 1984. In stratified and multivariable analyses maternal smoking throughout pregnancy and when the child was aged 14 were both associated with the child smoking: fully adjusted odds ratio [95% confidence interval] comparing maternal smoking throughout pregnancy with never smoking was 1.40 [1.25, 1.65] and that comparing maternal smoking when the child was aged 14 with not smoking was 1.57 [1.19, 2.06]. The association of maternal smoking throughout pregnancy was specific for adolescent smoking and was not associated with alcohol consumption, TV viewing or self‐report of poor school performance at age 14. Maternal and paternal educational attainment were also associated with smoking at age 14, with these associations attenuating towards the null with adjustment for childhood behavioural problems and cognitive function. There was no association of family income with smoking at age 14 once other explanatory variables were taken into account.
Male reproductive strategy in Trichogramma evanescens: sperm production and allocation to females
Authors: Damiens David , Boivin Guy
Published: August 2005

Abstract.  The production and allocation of sperm among successive mates during a male's life largely determine its fitness. The sperm production pattern and sperm allocation to females is studied in Trichogramma evanescens, a short‐lived egg parasitoid of several lepidopteran species. At emergence, virgin males have an average of 1607 ± 249 sperm stored in the seminal vesicles and no further production occurs during adult life. These males are able to mate with at least 20 females in rapid succession. During the first 10 matings, the males transfer approximately 100 sperm each time and then transfer fewer and fewer sperm per mating. The number of sperm stored in spermathecae of successively mated females remains relatively constant for the first 10 females, and decreases slowly for the subsequent females. The relationship between male reproductive strategy and some life‐history traits are discussed.
Evolution of larval foraging behaviour in Drosophila and its effects on growth and metabolic rates
Authors: Mueller Laurence D. , Folk Donna G. , Nguyen Ngoc , Nguyen Phuong , Lam Phi , Rose Michael R. , Bradley Timothy
Published: August 2005

Abstract.  The evolution of foraging in Drosophila melanogaster (Meigen) is studied using outbred populations that had been differentiated using laboratory selection. The foraging behaviour of Drosophila larvae is measured using the foraging path length of 72‐h‐old larvae. The foraging path length is the distance travelled by foraging larvae over 5 min. Populations of Drosophila selected for rapid development show significantly greater path lengths than their controls. Populations of Drosophila selected for resistance to ammonia and urea in their larval food have shorter path lengths than their controls. Individuals in the ammonia‐resistant populations are smaller than those in the control populations, but the size‐adjusted metabolic rates are not significantly different. A simple model is proposed suggesting that changes in larval foraging behaviour may be a means for Drosophila larvae to adapt to new environments that require additional maintenance energy. In the ammonia‐selected populations, crucial tests of these ideas will have to be conducted in environments with ammonia.
Predictive genetic testing in young people for adult‐onset conditions: Where is the empirical evidence?
Authors: Duncan RE , Delatycki MB
Published: August 2005

Predictive genetic testing in young people for severe, adult‐onset conditions is advised against in current guidelines. Despite this, there has been considerable debate regarding the issue. Some perceive such testing as too potentially harmful to allow. Others perceive it as an opportunity for the promotion of benefit, an opportunity even for the prevention of harm. The only way to resolve this theoretical debate is to collect empirical data related to the effects of such testing when it occurs. However, more than 15 years after the debate began, there is virtually no such empirical evidence available. The reasons for this lack of evidence appear to relate to the rarity of such testing, which when it occurs is not studied systematically. Additionally, clinicians performing such tests may feel vulnerable in sharing the outcomes, given that such testing is contrary to current recommendations. We propose a way forward that entails the provision of tests to mature minors, where clinicians deem this appropriate. These tests should be performed as part of an international research collaboration, facilitated by one leading group.
What's wrong with rights? Rethinking human rights and responsibilities
Authors: Flynn David
Published: August 2005

This paper examines the relationship between social work and human rights. It argues that the concept of human rights, as it is currently understood, is insufficient as a framework for social work theory and practice. Human rights are inherently individualistic – a problem that a focus on collective rights does little to rectify. What is absent from the human rights discourse, and what is directly relevant to social work, is a corresponding discourse on human responsibilities. This paper addresses the major criticisms of a human rights discourse by proposing a developmental model of human rights and responsibilities. The model establishes its applicability to social work theory and practice by demonstrating the counterbalancing forces of individual rights and collective responsibilities operating on the person in the environment.
Measurement of placental alkaline phosphatase in maternal plasma as an indicator of subsequent low birthweight outcome
Authors: BROCK DAVID J.H. , BARRON LILIAS
Published: August 2005

Summary. Placental alkaline phosphatase (P‐ALP) was measured by a specific monoclonal antibody‐based immunoassay in plasma samples of 117 women who subsequently were delivered of an infant of birthweight less than 2·5 kg. P‐ALP values > twice the normal median were found in 32% of maternal plasma samples from low birthweight cases in one scries and in 35% in another series, while in normal outcome controls the corresponding value was 8%. The differences were highly significant. The proportion of low birthweight cases with elevated maternal P‐ALP values appears to be very similar between 15 and 34 weeks gestation. At 16–18 weeks gestation there is a significant positive correlation (r = 0·40) between P‐ALP and maternal plasma alpha‐fetoprotein (AFP) values in low birthweight cases. The use of P‐ALP assay in combination with AFP assay appears to improve the detection of pregnancies with subsequent low birthweight outcome.
Obesity and urinary incontinence in women
Authors: DWYER P. L. , LEE E. T. C. , HAY D. M.
Published: August 2005

Summary. In a series of 368 incontinent women who presented to our urodynamic clinic for assessment, 232 (63%) were diagnosed as having genuine stress incontinence, and 136 (27%) as having detrusor instability. Obesity (>20% more than average weight for height and age) was significantly more common in women with genuine stress incontinence and detrusor instability than in the normal population. In those with detrusor instability the body mass index was found to increase with age and parity. In women with genuine stress incontinence the body mass index increased with age and the number of previous incontinence operations; it was higher in nulliparous than in parous women. There was no significant difference between obese and nonobese women in any of the urodynamic variables measured in the two incontinence groups.
The management of the patient with abnormal vaginal cytology following hysterectomy
Authors: IRELAND DAVID , MONAGHAN JOHN M.
Published: August 2005

Summary. Thirty‐two patients presenting with abnormal vaginal cytology following hysterectomy were studied. Seven (21·8%) had had hysterectomy for benign conditions whilst 25 (78·1%) had cervical intraepithelial neoplasia (CIN) or invasive cervical carcinoma. Twenty‐five patients had partial or total vaginectomy (15 as the primary procedure), and one required laser treatment following vaginectomy. Of 11 (34·3%) patients treated primarily by laser, five subsequently required vaginectomy because of persistent or recurrent cytological abnormality. All four patients treated with topical 5‐fluorouracil or dinitrochlorobenzene subsequently required surgery. Nine of the 32 patients (28·1%) proved to have invasive carcinoma of the vagina on histological examination of the vaginectomy specimen. At the time of writing all patients in the study are well with no evidence of disease.
Comparison of four continuously administered progestogen plus oestradiol combinations for climacteric complaints
Authors: SPORRONG T. , HELLGREN M. , SAMSIOE G. , MATTSSON L. Å.
Published: August 2005

Summary. Sixty women with climacteric complaints who had not menstruated for at least 1 year were randomly allocated to receive one of four hormonal replacement regimens. All four formulations were administered daily and continuously and each contained 2 mg of micronized oestradiol‐17β in combination with either norethisterone acetate 1 mg (group A) or 0·5 mg (group B) or megestrol acetate 5 mg (group C) or 2·5 mg (group D). The clinical efficacy was the same although the alleviation of vasomotor symptoms was somewhat slower in those women receiving preparation A. The endometrium was atrophied in nearly all biopsies. Irregular uterine bleeding was almost entirely confined to the earlier phase of the study and was substantially less with the formulation containing 1 mg norethisterone acetate. It is concluded that a continuous oestradiol‐progestogen combination can be used for longterm treatment of climacteric complaints in postmenopausal women and that after 4 months the clinical efficacy is the same irrespective of the type and dose of progestogen administered.
Neurophysiological abnormalities in genuine female stress urinary incontinence
Authors: VARMA J. S. , FIDAS A. , SMITH A. N. , CHISHOLM G. D. , McINNES A.
Published: August 2005

Summary. Perineal sensory and motor function was investigated in 28 women with genuine stress incontinence of urine and compared with a matched control group. Electrosensitivity of the dorsal nerve of the clitoris and of the urethral mucosa was significantly diminished in these patients (eight measurements ‘insensitive’). Three different reflex latency measurements (dorsal nerve to external anal sphincter, dorsal nerve to urethral sphincter, urethral mucosa to external anal sphincter) were prolonged in incontinence (14 absent reflexes). Mean motor unit potential duration of the external anal sphincter was also prolonged, reflecting an early neuropathy. Anorectal manometry detected significantly weaker squeeze pressures in stress incontinence although other variables were unaffected.
Serial fetal blood sampling for the management of pregnancies complicated by severe rhesus (D) isoimmunization
Authors: MacKENZIE I. Z. , CASTLE B. M. , SELINGER M. , FERGUSON J. F. , BOWELL P. J.
Published: August 2005

Summary. Fifty‐one pregnancies complicated by rhesus (D) isoimmunization have been managed by serial fetal blood sampling between 17 and 36 weeks gestation as an alternative to amniocentesis for ΔOD453 measurements. In 36 pregnancies where the fetus was shown to be rhesus (D) positive and both measurements were made before any intrauterine fetal transfusions, the ΔOD453 value gave misleading predictions on 13 of 63 occasions (21%). Fetal haematocrit estimations provided a direct assessment of the haemopoietic compensation occurring, but fetal bilirubin and albumin concentrations did not correlate directly with disease severity. It is proposed that pregnancies complicated by severe isoimmunization can be more precisely managed by serial fetal blood sampling for haematocrit estimation than amniocentesis for ΔOD453 measurement thus avoiding unnecessary intervention or delayed treatment.
Antenatal fetal blood sampling for the management of alloimmunized pregnancies: effect upon maternal anti‐D potency levels
Authors: BOWELL P. J. , GILES JANE , SELINGER M. , FERGUSON JANE , MacKENZIE I. Z.
Published: August 2005

Summary. Increase in maternal anti‐D concentrations after intrauterine investigation has been studied retrospectively in 95 rhesus (D) alloimmunized pregnancies; 48 were managed by fetal blood sampling (FBS) procedures (using fetoscopy or ultrasound‐guided needle sampling) and 47 using amniocentesis. In those pregnancies where the fetus was rhesus (D) positive, the frequency of procedure‐related increases (>50%) in maternal anti‐D potency was estimated following single procedures and found to be similar for the two methods of FBS employed (28%) and for amniocentesis (31%). The proportion of pregnancies showing an increase in anti‐D potency was higher after ultrasound‐guided needle sampling (75%) than after fetoscopic FBS (40%) and after amniocen tesis (44%).
Energy supplementation in the last trimester of pregnancy in East Java: I. Effect on birthweight
Authors: KARDJATI SRI , KUSIN JANE A. , DE WITH C.
Published: August 2005

Summary. The effect of two levels of energy supplementation in the last trimester of pregnancy on birthweight was tested in a controlled randomized trial in three villages in Madura, East Java. The high and low energy supplements provided 1·95 MJ (465 kcal) and 218 kj (52 kcal) per day respectively. In the baseline period the home diet provided on average 6·28 MJ (1500 kcal) (SD 2·1 MJ (499 kcal)) and41g(SD 13 g) of protein. The mean birthweight was 2835 g and the rate of low birth‐weight 12·2%. In the experimental period the home diet was better. The average intake ranged from 6·45 to 7·19 MJ (1541–1717 kcal) and 41·4–44·2 g per day, depending on the degree of compliance. Mean birth‐weight increased by 100 g and the rate of low birthweight dropped to 9·5%. There was no difference between the high and low energy supplemented group as a whole, probably due to the masking effect of the better home diet in the experimental period. It is likely that a positive effect of energy supplementation on birthweight was restricted to the group of pregnant women with the lowest home dietary intake and/or a low prepregnant weight. In this community targeting of supplementation to lean seasons and/or to women with a low prepregnant weight may be cost‐effective.
Ovarian size in postmenopausal women
Authors: GOSWAMY R. K. , CAMPBELL S. , ROYSTON J. P. , BHAN V. , BATTERSBY R. H. , HALL V. J. , WHITEHEAD M. I. , COLLINS W. P.
Published: August 2005

Summary. Ovarian volumes have been determined by pelvic ultrasonography in 2246 apparently healthy postmenopausal women of whom 2221 were included in the statistical analysis. Factors associated with gonadal size have been identified, and reference ranges for derived indices have been determined for use (in association with criteria for abnormal morphology) in a screening programme for ovarian carcinoma. The right ovary was present in 98·9% of subjects and the left in 99 · 1 %. The mean (SD; range) of right and left ovarian volumes were 3·58 (1·40; 1·00–14.01) and 3·57 (1·37; 0·88–10·9) ml respectively. Significant predictors of ovarian volume were years since the menopause, weight, parity, age at menopause, a history of hormone replacement therapy, and previously diagnosed breast cancer. Abnormal ovarian volumes were assessed from a score equal to the (observed mean log volume (MLV) minus the predicted MLV)/0·327. A simplified nomogram has been prepared for routine clinical use. The relative abnormality of one ovary was assessed from a ratio score equal to loge (larger ovarian volume/smaller ovarian volume)/0·211 compared with the 99th centile for the Gaussian distribution.
Antenatal care; current practice in debate
Authors: HERINGA MARTIJN P. , HUISJES HENDRIK J.
Published: August 2005

Summary. The antenatal screening practice of 67 teaching hospitals in the European Community was assessed by use of a written questionnaire. There were minor differences in mean numbers of tests performed in different countries, but only limited agreement was found on the selection of tests that were performed. There was no unity of practice within the countries. No correlations were found between the number of screening tests performed and the size of the units, or the composition of the attending staff.
Pregnancy complicated by maternal heart disease. A review of 519 women
Authors: McFAUL P. B. , DORNAN J. C. , LAMKI H. , BOYLE D.
Published: August 2005

Summary. Between 1970 and 1983, 519 pregnancies in 405 women with heart disease were managed at the Royal Maternity Hospital, Belfast, Northern Ireland, a rate of 1·3 per 100 deliveries. In 312 (60%) the heart disease was of rheumatic origin, in 161 (31%) congenital, and the remaining 46 (9%) were a miscellaneous group that included arrhythmias, ischaemic heart disease and cardiomyopathies. The New York Heart Association (NHYA) grading was no greater than 1–2 in 445 (86%) pregnancies antenatally. Three maternal deaths occurred, all in the group whose antenatal NYHA grade was 3–4. Heart failure was present in 96 (18%) pregnancies antenatally, and six others developed failure during labour or in the puerperium. Prophylactic antibiotics were not used routinely and infective endocarditis did not occur. The perinatal mortality rate was 19/1000, and the rate of congenital malformations was not raised in the reviewed group.
The influence of method of contraception and cigarette smoking on menstrual patterns
Authors: BROWN SUSAN , VESSEY MARTIN , STRATTON IRENE
Published: August 2005

Summary. Self‐perceived menstrual patterns have been investigated in a sample of 2115 women aged 18–9 years using a postal questionnaire. Seven aspects of ‘abnormal’ menstruation were denned: prolonged periods, heavy periods, frequent periods, irregular periods, intermenstrual bleeding, painful periods and severe premenstrual syndrome. Women who used oral contraceptives were less likely than other women to report any of the seven menstrual abnormalities except for intermenstrual bleeding and severe premenstrual tension. Women who used an intrauterine contraceptive device (IUCD) reported prolonged, heavy, and frequent periods and intermenstrual bleeding more often than other women, but they did not report painful periods with undue frequency. Women who had had a tubal sterilization generally reported menstrual patterns similar to, or slightly less favourable than, women using no contraception or contraceptive methods other than the pill or the IUCD. There was a significant association between smoking habits and each of the abnormal menstrual patterns except for severe premenstrual tension. In every case, the effect of smoking was unfavourable and in almost every case, current smokers reported the worst experience, with ex‐smokers occupying an intermediate position. We believe that these data are of considerable clinical significance and that they offer a basis for a conservative approach to managing menstrual disorders in some women.
Trophoblast membrane infusion for unexplained recurrent miscarriage
Authors: JOHNSON P. M. , CHIA K. V. , HART C. A. , GRIFFITH H. B. , FRANCIS W. J. A.
Published: August 2005

Summary. A novel protocol is described which has been developed for immunotherapy in unexplained recurrent miscarriage. This is based on a single intravenous infusion with isolated placental trophoblast plasma membrane vesicle preparations. Clinical experience gained with this approach is described. A total of 16/21 (76%) patients who subsequently had pregnancies have now achieved a live birth or are currently pregnant at greater than 28 weeks gestation.
Fetal outcome in obstetric cholestasis
Authors: FISK NICHOLAS M. , BRUCE STOREY G. N.
Published: August 2005

Summary. Obstetric cholestasis has been associated with a high incidence of stillbirth and perinatal complications. Between 1975 and 1984, 83 pregnancies were complicated by cholestasis. Meconium staining occurred in 45%, spontaneous preterm labour in 44%, and intrapartum fetal distress in 22%. Of 86 infants two were stillborn and one died soon after birth. Perinatal mortality fell from 107 in a previous series from this hospital (1965–1974) to 35/1000 in this series. Cardiotocography, estimations of oestriol, liver function tests and ultrasonic assessment of amniotic fluid volume failed to predict fetal compromise, whereas amniocentesis revealed meconium in 8 of 26 pregnancies. Early intervention was indicated in 49 pregnancies, 12 because of fetal compromise. This study suggests that intensive fetal surveillance, including amniocentesis for meconium, and induction of labour at term or with a mature lecithin/sphyngomyelin ratio, may reduce the stillbirth rate in this ‘high‐risk’ condition.
Fetomaternal macrotransfusion in the Yorkshire region. 2. Perinatal outcome
Authors: LI T. C. , BROMHAM D. R.
Published: August 2005

Summary. The perinatal outcome associated with fetomaternal macrotransfusion (FMMT), defined as fetomaternal haemorrhage ≥10 ml, was investigated in a study group of 179 cases of FMMT and compared with the outcome in 322 controls selected from the same population. Perinatal mortality and morbidity occurred more frequently in the case group (P<0.01). The mean Apgar score at 1 min and the cord haemoglobin level differed significantly between the case and control groups (P<0.01) and showed a significant inverse correlation with the estimated volumes of FMMT (P<0.0001). There was no significant difference in birth weight between the case and control groups. The mean estimated volumes of FMMT associated with perinatal mortality and with low cord haemoglobin (≤9.0 g/dl) were significantly higher than the mean volume in the case group as a whole, which suggests the possibility of adapting these observations to a screening procedure.
The effect of the antiprogestin RU 486 on uterine contractility and sensitivity to prostaglandin and oxytocin
Authors: SWAHN M. L. , BYGDEMAN M.
Published: August 2005

Summary. The effect of RU 486, a steroid acting as an antiprogestin at the receptor level, on uterine contractility and sensitivity to the prostaglandin analogue, 16‐phenoxy‐PGE2 methyl sulfonylamide (16‐phe‐noxy‐PGE2) and to oxytocin was studied in 29 women in early pregnancy. Seven untreated women at the same stage of pregnancy served as controls. In the untreated women no spontaneous uterine contractility was recorded and the response to 0.25 mg 16‐phenoxy‐PGE, was characterized by an increase in uterine tonus with superimposed irregular contractions of low amplitude. Treatment with 25 mg RU 486 twice daily resulted in the appearance of regular uterine contractions at 24 h in two out of five patients and in all patients at 36, 48 and 72 h after the start of RU 486 treatment. The withdrawal of progesterone influence changed the inactive early pregnant uterus into an active organ. Administration of 16‐phenoxy‐PGE2 caused an obvious stimulation of both frequency and amplitude of the contractions. In addition, the significantly increased sensitivity to the prostaglandin analogue, but not to oxytocin, was already apparent 24 h after the start of RU 486 treatment. We have previously shown that the addition of one intramuscular injection of 16‐phenoxy‐PGE2 on the fourth day of treatment with RU 486 (25 mg twice daily) significantly increased the abortifacient effect of the antiprogestin during early pregnancy. The present study suggests that a shorter treatment may be possible.
Correlation of urethral physiology and skin collagen in postmenopausal women
Authors: VERSI EBOO , CARDOZO LINDA , BRINCAT MARK , COOPER DEREK , MONTGOMERY JULIA , STUDD JOHN
Published: August 2005

Summary. Connective tissue collagen is thought to contribute to the generation of urethral pressure. It has been previously shown that skin collagen and urethral pressure are oestrogen dependent. This study demonstrates a correlation between urethral pressure measurements and skin collagen content. It is suggested that the beneficial effect of oestrogens on urethral function may be mediated by collagen.
Clinical features of women with chronic lower abdominal pain and pelvic congestion
Authors: BEARD R. W. , REGINALD P. W. , WADSWORTH JANE
Published: August 2005

Summary. The clinical features of 35 women with pelvic pain and demonstrable congestion on pelvic venography have been characterized by comparing their symptoms and signs with those of 22 women with pelvic pain due to classical pathology. Women with pelvic pain and congestion had a mean age of 32·4 years, were more often multiparous and had had symptoms for 6 months to 20 years. The pain was dull and aching with sharp exacerbations. In individual women it commonly occurred on one side of the abdomen but unlike the pain due to‘classical pathology’, it could occur on the other side. The pain was exacerbated by postural changes, and walking. Congestive dysmenorrhoea, deep dyspareunia and postcoital ache were common findings in women with pelvic congestion and 60% had evidence of significant emotional disturbance. The combination of tenderness on abdominal palpation over the ovarian point and a history of postcoital ache was 94% sensitive and 77% specific for discriminating pelvic congestion from other causes of pelvic pain.
Increased uterine prostaglandin E receptors in menorrhagic women
Authors: ADELANTADO JUAN MARIA , REES MARGARET C. P. , BERNAL ANDRÉS LÓPEZ , TURNBULL ALEXANDER C.
Published: August 2005

Summary. PGE receptor concentrations were measured in myometrial samples collected from 10 women at hysterectomy. Five women had normal measured menstrual blood loss (35–44 ml) and the remainder had unexplained menorrhagia occurring in the absence of any uterine, pelvic or general pathology, with losses ranging from 85 to 925 ml. Median PGE receptor concentrations were significantly higher in the women with menorrhagia (1077 fmol/mg protein) than in the women with normal menstrual blood loss (625 fmol/mg protein) and correlated with menstrual blood loss (P<0·02). These findings suggest that unexplained menorrhagia may simply be a constitutional variant in some women and that specific and potent PGE uterine receptor antagonists would furnish effective non‐surgical treatment for unexplained menorrhagia.
Disposal arrangements for fetuses lost in the second trimester
Authors: BATCUP G. , CLARKE J. P. , PURDIE D. W.
Published: August 2005

Summary. In 1986, 28 consultant pathologists with a special paediatric or perinatal interest in the UK and Irish Republic supplied information on current disposal methods for fetuses lost in the second trimester (12–28 weeks gestation) and the facilities available to parents. In over half the hospitals surveyed no single method of disposal was employed, but most of the fetuses were incinerated. In six hospitals all fetuses were either buried or cremated; 25 hospitals had facilities for photography and 24 made special religious services available. Other facilities available in some centres included the provision of blessing cards and a‘remembrance book’and the appointment of a bereavement counsellor. In five of the local crematoria or cemeteries a special plot of land was reserved for stillbirths and younger fetuses. The relative costs of these facilities are discussed.
Doppler ultrasound waveform indices: A/B ratio, pulsatility index and Pourcelot ratio
Authors: THOMPSON ROSEMARY S. , TRUDINGER BRIAN J. , COOK COLLEEN M.
Published: August 2005

Summary. Three different indices, the A/B ratio, the pulsatility index (PI) and the Pourcelot ratio (PR), are in common use for quantitative analysis of umbilical artery Doppler ultrasound waveforms. A detailed examination of the similarities and differences between these indices, together with the expected errors for each, was undertaken to enable informed comparisons and choices to be made. The indices were calculated from 133 last trimester recordings using an objective and very reliable computer analysis technique. The PI is more difficult to calculate than the other two quantities and the extra computation does not provide any extra information. The A/B ratio appears the simplest index to use but the values are not normally distributed. With the PR a normal distribution of values can be assumed. A theoretical consideration of errors showed that none of the indices is intrinsically less error prone for last trimester waveforms overall. The errors in the A/B ratio increase as the value of the index increase, whereas the converse holds for the PI and PR.
The effect of epostane, a 3‐beta hydroxy steroid dehydrogenase inhibitor, on maternal and fetal steroid levels during mid‐gestation
Authors: SELINGER MARK , MACKENZIE IAN Z. , GILLMER MICHAEL D. , PHIPPS SUE L. , FERGUSON JANE
Published: August 2005

Summary. A double‐blind, placebo‐controlled trial was conducted to assess the maternal and fetal endocrine effects of epostane, an inhibitor of progesterone synthesis, in mid‐pregnancy. Although present in the maternal circulation, epostane was not detected in cord blood or amniotic fluid. Maternal and fetal progesterone levels fell by 80% and 95% respectively with maintenance of the fetal arterio‐venous difference while oestradiol and aldosterone levels were affected to a lesser extent. The mechanism of 3‐beta hydroxy steroid dehydrogenase suppression and the relation between fetal and maternal progesterone levels are discussed.
Umbilical artery flow velocity waveforms in fetuses dying with congenital anomalies
Authors: HSIEH FON‐JOU , CHANG FONG‐MING , KO TSANG‐MING , CHEN HSI‐YAO , CHEN YUAN‐PING
Published: August 2005

Summary. Absent or reversed diastolic component in umbilical artery (UA) flow velocity waveform was observed in eight fetuses with major malformations. Because of the uncorrectable fetal conditions or the parents' reluctance to terminate the pregnancy, no interventions were undertaken and eventually all eight fetuses died in utero. The interval between the abnormal waveform recording and fetal death was between 1 and 7 days (mean 3.6 days). In two fetuses with abnormal diastolic flow, analysis of umbilical vein blood obtained by ultrasound‐guided sampling revealed moderately severe acidosis and hypoxia (pH 7.228 and 7.241, Pco2 47.5 and 46.9 mmHg; Po2 14.6 and 14.7 mmHg, respectively). Our observation suggests that once the diastolic component of UA flow velocity waveforms becomes absent or reversed, the fetus is in a state of hypoxia and acidosis and fetal death is impending. This limited experience may help in formulating clinical management when using UA flow velocity waveforms in the monitoring of high‐risk fetuses.
The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study
Authors: GILPIN S. A. , GOSLING J. A. , SMITH A. R. B. , WARRELL D.W.
Published: August 2005

Summary. Histological and histochemical analysis of biopsy samples of pubococcygeus muscle obtained from asymptomatic women and from women with stress incontinence of urine, with or without genitourinary prolapse, have been coinpared. In the asymptomatic women both age and parity appeared to be related to the morphological features of the samples and in particular those obtained from the posterior part of the pubococcygeus. In the symptomatic women there was a significant increase in the number of muscle fibres showing pathological damage which were obtained from the posterior part of the pelvic floor. The ränge of diameters of both Type I and Type II fibres obtained from this region was significantly different between symptomatic and asymptomatic women. These findings may be attributable to partial denervation of the pelvic floor in patients with urinary stress incontinence with or without genital tract prolapse.
Problems of peritoneal access in intraperitoneal treatment and monitoring of ovarian cancer
Authors: REDMAN C. W. E. , LAWTON F. G. , LUESLEY D. M. , BUXTON E. J. , BLACKLEDGE G.
Published: August 2005

Summary. A total of 154 peritoneal lavages was attempted through either a permanent (17) or a temporary percutaneous cannula (137) in 59 ovarian cancer patients undergoing intraperitoneal treatment or monitoring. Seven of the eight permanent catheters were removed because of complications; intraperitoneal adhesions were a major problem in this group. Overall, 137 temporary catheters were inserted (14G Venflon i. v. cannula in 119, Verres needle in 15, and a Trocath peritoneal dialysis catheter in 3 instances) but it was not possible to perform a peritoneal lavage in 42 (30%). Access to the peritoneal cavity was unsatisfactory on 29 (34%) occasions when a Venflon cannula was used, either because there was inadequate flow of lavage fluid into the peritoneal cavity or this was limited by pain. Perforation of the bowel occurred in 12 (9%) cases but there was no significant morbidity. Problems with achieving reliable peritoneal access using either permanent or temporary catheters may limit the potential advantages of the intraperitoneal route for treatment and monitoring.
Clinical characteristics of subfertile men with antisperm antibodies
Authors: IQBAL P. K. , ADEGHE A. J. H. , HUGHES YVONNE , SAMRA J. S. , OBHARI M. S. , CUTHBERT J.
Published: August 2005

Summary. This study investigated the clinical features which could serve as markers to identify subfertile men with antisperm antibodies including age, duration of infertility, history of abdominal or perineal surgery and previous genital trauma. Of the 162 men studied, 43 had a positive test for antisperm antibodies. A significantly greater number of these patients had a history of genital trauma and appendicectomy. Whereas the aetiological role of genital trauma in spcrmatozoal autoimmunity is readily explicable, that of appendicectomy is not. It can only be postulated that inflammation of the appendix may sometimes affect the vas deferens or that there is some inadvertent injury to the vas deferens during appendicectomy.
Genital cancer among wives of men with penile cancer. A study between 1958 and 1982
Authors: HELLBERG DAN , NILSSON STAFFAN
Published: August 2005

Summary. Previous studies have suggested an association between penile cancer and cervical cancer but the results have been difficult to interpret. The current study includes 1064 cases of penile cancer reported to the National Swedish Cancer Registry between 1958 and 1980. One matched control for each living case was chosen randomly from the Swedish Population Registry, and for cases who had died, from the National Death Registry. Details about the men, their marriages and each wife or wives were obtained from the population registry in the parish in which the men lived or had died. The personal identification number and name of each wife or wives were matched against the cancer registry. All genital cancers, including 15 cervical cancers, were distributed equally among the wives of the cases and those of the controls. The expected rate of cancers among the population of wives of cases was also calculated and there was no difference between the observed and the expected number of women with cancer. The results did not show an association between penile cancer in men and cervical cancer in their sexual partners.
A meta‐analysis of randomized control trials of progestational agents in pregnancy
Authors: GOLDSTEIN PETER , BERRIER JAYNE , ROSEN SCOTT , SACKS HENRY S. , CHALMERS THOMAS C.
Published: August 2005

The continued use of progestational agents in attempts to achieve a normal outcome of pregnancy in women with a ‘high‐risk’ pregnancy (previous miscarriage, stillbirth or present preterm labour) prompted this meta‐analysis of randomized control trials of such therapy. Of 20 trials of a progestogen 15 had combinable data. Combined comparisons, using odds ratios with confidence intervals, were made of the rates of livebirths at term or preterm and the sum of term and preterm deliveries, miscarriages, stillbirths and neonatal deaths. All but one comparison failed to show a significant benefit. Only the preterm delivery versus the term delivery comparison approached statistical significance. There were average deficiencies of quality apparent in the studies, and a test for heterogeneity among the studies was positive, but these caveats do not diminish the conclusion that progestogens should not be used outside of randomized trials at present. If trials are done, they should include only women with demonstrated hormonal abnormalities who are carrying a live fetus as shown by ultrasonography.
Unemployment and reproductive outcome. An Australian study
Authors: NAJMAN J. M. , MORRISON J. , WILLIAMS G. M. , KEEPING J. D. , ANDERSEN M. J.
Published: August 2005

The Mater‐University of Queensland Study involves the follow‐up of 8556 pregnant women who were enrolied at their first clinic visit. This analysis compares four groups of women categorized according to their own and their partners' employment Status. Group l comprised women unemployed, partners not unemployed. Group 2 comprised women not unemployed with unemployed partners. Group 3 comprised women and partners who were both unemployed. In group 4 ncither partner was unemployed. Initial analysis showed that there was a significant association between birthweight and birthweight for gestational age, and unemployment as reported by mothers. After adjustment for lifestyle variables (principally smoking) there were no remaining statistically significant associations.
Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial
Authors: GAMSU H. R. , DONNAI P. , MULLINGER B. M. , DASH C. H.
Published: August 2005

In a prospective, randomized, double‐blind, multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome (RDS) in preterm infants. The dose of betamethasone was 4 mg every 8 h for six doses, unless delivery occurred. The 251 women who were enrolled gave birth to 262 liveborn infants, 130 in the betamethasone and 132 in the placebo group; the two groups were evenly matched in most respects. The diagnosis of RDS in the newborn was confirmed by two independent assessors. Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo group developed RDS. In infants whose mothers had received at least three injections, RDS was also less frequent in the steroid group than in the placebo group (3/104 and 10/104 respectively; P<0·05). There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial (0/30 and 8/45 respectively; P<0·05). The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation, within 8 days of trial entry, and whose mothers had received at least three injections (0/27 steroid group and 7/32 placebo group; P=0·03), and there were also significantly fewer neonatal deaths (2/27 and 13/32, respectively; P<0·01) in this subgroup. Betamethasone did not provoke earlier delivery. Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids: there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group. Neonatal jaundice was significantly less frequent in the steroid (55/129) than in the placebo group (81/127; P<0·01) but not in the subgroups born before 34 completed weeks gestation.
Screening donors for sexually transmitted disease in donor insemination clinics in the UK. A survey
Authors: BARRATT C. L. R. , CHAUHAN M. , COOKE S. , COOKE I. D. , MONTEIRO E. F.
Published: August 2005

Summary. A survey conducted amongst the 40 donor insemination centres in the UK registered by the Royal College of Obstetricians and Gynaecologists (RCOG) showed that most of the clinics had no structured policy for control of common (non‐HIV) sexually transmitted diseases within their programmes.