bluuebunny/crossref_metadata_2025 huggingface dataset:
Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation
Authors: BU LING‐NAN , CHANG MEI‐HWEI , NI YEN‐HSUAN , CHEN HUEY‐LING , CHENG CHIA‐CHI
Published: June 2007

Background: The purpose of the present paper was to evaluate the efficacy of probiotics (Lactobacillus casei rhamnosus, Lcr35) for treating children with chronic constipation and to compare its effect with magnesium oxide (MgO) and placebo.

Methods: This double‐blind placebo‐controlled, randomized study enrolled 45 children under 10 years old with chronic constipation. They were randomly assigned to receive Lcr35 (8 × 108 c.f.u./day; n = 18), MgO (50 mg/kg/day; n = 18), or placebo (n = 9) orally twice daily for 4 weeks. Lactulose use (1 mL/kg per day) was allowed when no stool passage for 3 days was noted. Glycerin enema was used only when no defecation was noted for >5 days or abdominal pain was suffered due to stool impaction. Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora. Comparisons of the frequency of defecation, consistency of stool and the use of lactulose or enema during the period of treatment were made among the three groups.

Results: The patients who received MgO or probiotics had a higher defecation frequency (P = 0.03), higher percentage of treatment success (P = 0.01), less use of glycerin enema (P = 0.04) and less hard stool (P = 0.01) than the placebo group. There was no significant difference between MgO and probiotic groups in the aforementioned comparisons. The first effect of MgO (second week) on constipation was slightly earlier than that of probiotic (second to third week). Abdominal pain occurred less frequently in the probiotic group than in both the MgO and the placebo groups (P = 0.03). There was no statistically significant difference among the three groups in the use of lactulose, episodes of fecal soiling, and change of appetite. No adverse effect was noted in probiotic and placebo groups. Only one patient in the MgO group suffered from mild diarrhea.

Conclusion: Lcr35 was effective in treating children with chronic constipation. There is no statistically significant difference in efficacy between MgO and Lcr35, but less abdominal pain occurred when using Lcr35. Study with larger case number and longer follow up is needed in the future.
ENDOSCOPIC MICROVASCULAR ARCHITECTURE OF THE PORTAL HYPERTENSIVE GASTRIC MUCOSA ON NARROW BAND IMAGING
Authors: Hayashi Seishu , Saeki Shunichi
Published: June 2007

Background:  We evaluated the endoscopic microvascular architecture of the gastric mucosa in portal hypertension patients using the prototype of narrow band imaging (NBI).

Material and Methods:  The study included 103 Helicobacter pylori‐negative patients with chronic liver disease (22 without portal hypertension (group 1), 81 with portal hypertension (group 2)).

Results:  (i) Abnormality of collecting venules, reddening mucosa, red spots, a mosaic‐like pattern, and gastric antral vascular ectasia (GAVE) were observed on the gastric mucosa, and an obscure change in collecting venules (73% vs 14%; P < 0.001), reddening mucosa (49% vs 5%; P < 0.001), red spots (36% vs 5%; P < 0.01) and a mosaic‐like pattern (40% vs 5%; P < 0.01) were more frequently observed in group 2 than in group 1. (ii) On magnifying endoscopy with NBI, the mucosa with an obscure change in collecting venules was demonstrated as dilation of the capillaries surrounding the gastric pits in various degrees, and reddening mucosa was observed as extended and swollen gastric pits and various degrees of dilated and convoluted capillaries surrounding the gastric pits. Red spots were demonstrated as extended and swollen gastric pits, dilated and convoluted capillaries surrounding the gastric pits, and intramucosal hemorrhage around these capillaries. GAVE was recognized as partial and marked dilatation of the capillaries surrounding the gastric pits.

Conclusion:  Abnormality of collecting venules, swelling of gastric pits, dilatation of capillaries surrounding the gastric pits, intramucosal hemorrhage around capillaries, and partial and marked dilatation of the capillaries were observed on the gastric mucosa in portal hypertension patients.
EFFICACY AND SAFETY OF PROPHYLACTIC PANCREATIC DUCT STENT (PIT‐STENT) PLACEMENT IN PATIENTS AT HIGH RISK OF POST‐ERCP PANCREATITIS
Authors: Ito Kei , Fujita Naotaka , Noda Yutaka , Kobayashi Go , Horaguchi Jun , Takasawa Osamu , Obana Takashi
Published: June 2007

Background:  The usefulness of prophylactic pancreatic stent placement for preventing post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been reported. We developed a new pancreatic duct stent, which was a 5 Fr, 4 cm‐long stent with a single duodenal pigtail (Pit‐stent).

Patients and Methods:  Pancreatic duct stenting using a Pit‐stent was attempted in 76 patients (40 men, 36 women; mean age, 65 years; age range, 42–91 years) at high risk of post‐ERCP pancreatitis. The frequency of post‐ERCP pancreatitis and spontaneous passage of the stent were investigated.

Results:  Pancreatic duct stent placement was successfully performed in 93% of the patients. One patient developed mild pancreatitis after ERCP (1.4%). Spontaneous passage of the stent was observed in 92%. There were no other complications or procedure‐related deaths in this group.

Conclusions:  Pancreatic duct stent insertion may reduce the incidence of post‐ERCP pancreatitis in patients at high risk of post‐ERCP pancreatitis. Spontaneous migration of a pancreatic stent that contributes to a lessening of the need for additional ERCP can be expected with the use of a Pit‐stent.
CURRENT STATUS OF DOUBLE BALLOON ENDOSCOPY
Authors: Kita Hiroto , Yamamoto Hironori
Published: June 2007

Yamamoto and colleagues have developed a novel insertion method of the endoscope, the ‘double balloon method’ for enteroscopy and, recently, a specialized system for the ‘double balloon method’ has been commercialized by Fujinon. The double balloon endoscopy enables visualization of the entire small bowel and also allows for interventional therapy in the small intestine. This method could be used either from the oral or anal approach. Observation of an affected area with controlled movement of the endoscope enables interventions, including biopsies, hemostasis, balloon dilatation, stent placement, polypectomy, and endoscopic mucosal resection. The procedure is safe and useful, and it provides high diagnostic yields and therapeutic capabilities.
Effect of treatment with biological agents for arthritis in Australia: the Australian Rheumatology Association Database
Authors: Buchbinder R. , March L. , Lassere M. , Briggs A. M. , Portek I. , Reid C. , Meehan A. , Henderson L. , Wengier L. , Van Den Haak R.
Published: June 2007

Background: The Australian Rheumatology Association Database (ARAD), a voluntary national registry, has been established to collect health information from Australian patients with inflammatory arthritis for the purpose of monitoring the benefits and safety of new treatments, in particular the biological disease‐modifying anti‐rheumatic drugs (bDMARDs). These drugs are proving to be very effective, yet little is known of their long‐term effectiveness or safety. Patient registries that systematically gather data on large cohorts of unselected patients are increasingly believed to be an essential means of answering questions of the long‐term effectiveness and safety of new drugs. The aim of this report is to describe the role, development and structure of ARAD and provide some preliminary data.

Methods: As of 1 August 2006, 563 patients with rheumatoid arthritis prescribed a bDMARD have been enrolled in ARAD, involving 105 rheumatologists from across Australia.

Results: The data collected will enable examination of multiple domains of patient responses to bDMARDs, including quality of life, health‐care utilization, incidence of adverse events and the effects of therapy switching.

Conclusion: Evidence‐based information about the long‐term outcome of bDMARD therapy is essential for clinicians, consumers, policy‐makers, drug development companies and approval agencies, to enable better care and improved outcomes for patients with inflammatory arthritis.
Hypermethylation of the COX‐2 gene is a potential prognostic marker for cervical cancer
Authors: Jo Hoenil , Kang Sokbom , Kim Jae W. , Kang Gyeong H. , Park Noh H. , Song Yong S. , Park Sang Y. , Kang Soon B. , Lee Hyo P.
Published: June 2007

Aim:  The aim of the present study was to evaluate the DNA hypermethylation profiles of 14 genes known to be associated with tumor behavior and their clinical significance in cervical cancer.

Method:  The clinical features of 82 patients with stage IB cervical cancer were analyzed in terms of DNA hypermethylation of 14 genes (hMLH1, p16, COX‐2, CDH1, APC, DAPK, MGMT, p14, RASSF1A, RUNX3, TIMP3, FHIT, THBS1, and HLTF).

Results:  Of 14 genes investigated, only hypermethylation of COX‐2 showed significant association with poor disease‐free survival (P = 0.001). To further investigate an alteration in COX‐2 expression by DNA hypermethylation, immunohistochemistry for COX‐2 protein was performed in the cervical cancer tissues. We found no significant association between hypermethylation and expression patterns of the COX‐2 gene.

Conclusions:  The present results suggest that DNA hypermethylation of the COX‐2 gene may be a potential prognostic marker in early stage cervical cancer, the underlying mechanism of which is independent of gene silencing.
Expression of epidermal growth factor, fibroblast growth factor‐2, and platelet‐derived growth factor‐A in the eutopic endometrium of women with endometriosis
Authors: Lee Sa‐Ra , Kim Sung‐Hoon , Lee Young‐Jin , Hong Seok‐Ho , Chae Hee‐Dong , Kim Chung‐Hoon , Kang Byung‐Moon , Choi Young‐Min
Published: June 2007

Aim:  The objective of the present study was to compare the levels of expression of epidermal growth factor (EGF), fibroblast growth factor‐2 (FGF‐2), and platelet‐derived growth factor‐A (PDGF‐A) mRNA in the eutopic endometrium of women with and without endometriosis.

Methods:  Thirty‐five women with advanced stage endometriosis and 31 control women were recruited. Following isolation of total RNA from endometrial tissue and reverse transcription, cDNA samples were amplified to quantify the level of expression of EGF, FGF‐2, PDGF‐A.

Results:  While the levels of mRNA of EGF and FGF‐2 were not different between the two groups, the PDGF‐A mRNA level was significantly lower in the endometriosis group than in the control group during the secretory phase (6.12 ± 0.51 vs 12.50 ± 0.99, mean ± SEM, P < 0.05).

Conclusion:  The expression level of PDGF‐A, but not EGF and FGF‐2, might be decreased during the secretory phase in the eutopic endometrium of women with advanced stage endometriosis.
Tocolysis and delayed delivery versus emergency delivery in cases of non‐reassuring fetal status during labor
Authors: Briozzo Leonel , Martinez Alma , Nozar Maria , Fiol Veronica , Pons Jose , Alonso Justo
Published: June 2007

Aim:  To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non‐reassuring fetal heart‐rate (FHR) pattern using conventional heart rate monitoring.

Methods:  This was a prospective and randomized study, conducted between 2001 and 2004 at Pereira Rossell Hospital, Montevideo, Uruguay. The population consisted of 390 fetuses, in which intrauterine distress was diagnosed using electronic FHR monitoring. Of these, 197 were randomly assigned to the emergency delivery group and 193 to the fetal intrauterine resuscitation group. The inclusion criteria were: term singleton pregnancy, in labor, cephalic presentation, and no placental accidents.

Results:  The time between randomization and birth was 16.9 ± 7.6 min (mean ± SD) for the emergency delivery group, and 34.5 ± 11.7 min (mean ± SD) for the resuscitation group. The relative risk (RR) of acidosis in the umbilical artery (pH < 7.1) in the emergency delivery group was 1.47 (0.95–2.27). The RR of base deficit ≤12 mEq/L in the emergency delivery group was higher than in the resuscitation group (RR = 1.48 [1.0–2.2], P = 0.04). When considering the need for admission to the neonatal care unit, the relative risk was higher in the emergency delivery group than in the resuscitation group (RR = 2.14 [1.23·3.74], P = 0.005). No maternal adverse effects were reported.

Conclusion:  Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non‐reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side‐effects.
Comparison of maternal and cord blood nucleated red blood cell count between pre‐eclamptic and healthy women
Authors: Aali Bibi Shahnaz , Malekpour Reza , Sedig Fatemeh , Safa Abbas
Published: June 2007

Aim:  The aim of this study was to evaluate the influence of pre‐eclampsia on the cord and maternal nucleated red blood cell (NRBC) count.

Methods:  Immediately after delivery, 1 mL of maternal venous blood and 1 mL of cord blood from 50 pre‐eclamptic and 150 healthy pregnant women were collected separately in tubes containing 1.5 mg ethylene diamine tetra‐acetic acid. Blood smears were prepared and stained using the Giemsa method. The number of NRBC per 100 leukocytes in maternal and cord blood was counted and compared between the two groups using SPSS software package for Windows. Any correlation of the NRBC count in maternal and umbilical cord blood was also evaluated. P‐values < 0.05 were considered significant.

Results:  The mean (±SD) NRBC per 100 white blood cell (WBC) level in cord blood of newborns in the pre‐eclamptic group (18.2 ± 31.8, range 0–142) was significantly greater than in the control group (6.2 ± 8.1, range 0–36). Low birth weight and intrauterine growth restriction showed a statistically significant relationship with abnormal NRBC count in pre‐eclamptic patients. A significant correlation was found between the maternal and cord blood NRBC count in the pre‐eclamptic group.

Conclusion:  Fetal response to utero–placental insufficiency in pre‐eclampsia leads to elevated NRBC in the cord blood, particularly in the presence of low birth weight and intrauterine growth restriction. The positive correlation between maternal and cord blood NRBC counts in pre‐eclamptic patients indicates that maybe the hypoperfused placenta plays a role in the correlated alteration of the maternal and fetal NRBC count.
Why do mothers die in Dakahlia, Egypt?
Authors: Abdel‐Hady El‐Said , Mashaly Abdel‐Maguid , Sherief Lotfy S. , Hassan Mostafa , Al‐Gohary Alaa , Farag Mohamed K. , El‐Khoeriby Fouad
Published: June 2007

Aim:  To investigate the causes of maternal mortality in the Dakahlia Governorate in Egypt.

Methods:  A confidential enquiry for each case of maternal mortality during the years 2004–2005 was carried out.

Results:  One hundred and seventy‐nine maternal deaths were reported, giving a maternal mortality rate (MMR) of 71.3/100 000 live births. 140 (78.2%) women died due to direct obstetric causes, 24 (13.4%) due to indirect causes and 15 (8.4%) due to accidental or unexplained causes. 44 (24.6%) women died during or following delivery by cesarean section and 91 (50.8%) during labor or within 24 h following delivery. Complications during cesarean delivery, postpartum hemorrhage and hypertensive disorders were the leading causes of maternal mortality. Death due to substandard care was encountered in 85% of cases. Obstetricians were responsible for 51% of causes of avoidable maternal death.

Conclusion:  Maternal mortality in Dakahlia, although declining, is still relatively high. To further reduce maternal mortality, deliveries should be conducted at well‐equipped hospitals.
Comparison of the efficacy and safety of a new recombinant human follicle‐stimulating hormone (DA‐3801) with follitropin‐α (Gonal‐F®) in women undergoing controlled ovarian hyperstimulation for assisted reproductive technology
Authors: Moon Shin Yong , Choi Young Sik , Ku Seung‐Yup , Kim Seok Hyun , Choi Young Min , Kang Inn Soo , Kim Chung Hoon
Published: June 2007

Aim:  To compare the efficacy and safety of a new recombinant human follicle‐stimulating hormone (FSH; DA‐3801) with follitropin‐α (Gonal‐F®) in women undergoing controlled ovarian hyperstimulation (COH) for assisted reproductive technology (ART).

Methods:  This was a phase III, multicenter, randomized, non‐inferiority study. A total of 97 women were randomized to receive COH using DA‐3801 (DA‐3801 group, n = 49) or Gonal‐F® (Gonal‐F group, n = 48). All subjects underwent COH using a gonadotropin‐releasing hormone (GnRH) antagonist protocol. The primary efficacy endpoint was the number of oocytes retrieved, and the secondary efficacy endpoints included the total dose of FSH, the duration of stimulation, the serum estradiol levels on the day of human chorionic gonadotropin (hCG) administration, and the fertilization, implantation and pregnancy rates. Safety was evaluated using pre‐ and post‐treatment laboratory tests and all adverse events were recorded.

Results:  The number of oocytes retrieved was 13.0 ± 6.2 (DA‐3801) versus 10.6 ± 6.7 (Gonal‐F) in the intention‐to‐treat (ITT) population, and 12.7 ± 6.4 (DA‐3801) versus 11.0 ± 7.1 (Gonal‐F) in the per‐protocol (PP) population. The non‐inferiority of DA‐3801 was demonstrated with differences of 2.3 ± 6.5 (95% confidence interval [CI] = 0.13, ∞) and 1.7 ± 6.7 (95% CI = −0.74, ∞), respectively, in the ITT and PP populations. The total dose of FSH used (1789.8 ± 465.5 vs 2055.6 ± 646.7 pg/mL, P = 0.027) and duration of stimulation (8.3 ± 1.4 vs 9.1 ± 1.9 days, P = 0.036) in the ITT population were significantly lower in the DA‐3801 group. Other secondary efficacy endpoints, including pregnancy and implantation rates and the incidence and severity of adverse events, were comparable between the two groups.

Conclusions:  The results of this study demonstrate that DA‐3801 is not inferior to follitropin‐α in terms of its efficacy and safety in women undergoing COH for ART.
Kampo therapy for premenstrual syndrome: Efficacy of Kamishoyosan quantified using the second derivative of the fingertip photoplethysmogram
Authors: Kimura Yoko , Takamatsu Kiyoshi , Fujii Asami , Suzuki Mayumi , Chikada Naoko , Tanada Rie , Kume Yumi , Sato Hiroshi
Published: June 2007

Aim:  Premenstrual syndrome (PMS) affects 40–80% of women. Japanese herbal medicine, known as Kampo, is frequently prescribed for PMS, so we examined the efficacy of Kamishoyosan using two methods: first, the second derivative of the fingertip photoplethysmogram (SDPTG) evaluating vascular age (VA), and second, a self‐assessment questionnaire on subjective symptoms.

Methods:  The SDPTG was recorded in 45 patients with PMS (mean ± SD = 32 ± 6 years of age) before (0 M), on the first (1 M) and third (3 M) month of therapy. Patients answered a questionnaire (44 questions) on their complaints every month. The reproducibility of the SDPTG was confirmed with 15 normal volunteers (33 ± 9 years of age).

Results:  In patients with older VA than their chronological age (Age) before therapy, we found linear correlations of the VA–Age differences at 1 M versus 0 M (y = 0.45x + 1.59, standard error of estimate [SEE] = 6.13 years), and at 3 M versus 0 M (y = 0.18x + 4.09, SEE = 6.03 years). The VA–Age decreased from 11.3 ± 6.4 (0 M) to 6.6 ± 6.7 (1 M) and 6.1 ± 6.0 years (3 M) (P < 0.01). The score on the self‐assessment questionnaires for the five most frequent symptoms significantly improved from 13.4 ± 3.3 (0 M) of 20 to 10.7 ± 3.9 (1 M) and 8.2 ± 4.6 (3 M) (P < 0.01).

Conclusion:  The improvement of PMS symptoms as a result of using Kamishoyosan was quantified by means of SDPTG and the self‐assessment questionnaire.
Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomy
Authors: Demirturk Fazli , Aytan Hakan , Caliskan Ahmet C.
Published: June 2007

Aim:  The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications.

Methods:  A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo‐oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared.

Results:  Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 ± 3.71 vs 90.95 ± 5.73 min, P < 0.001; 87.76 ± 25.48 vs 152.63 ± 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group.

Conclusion:  EBVS was found to be less time‐consuming and caused less bleeding when compared with HS.
Do different delivery systems of estrogen therapy influence serum lipids differently in surgically menopausal women?
Authors: Baksu Başak , Davas Inci , Agar Eser , Akyol Atıf , Uluocak Aygul
Published: June 2007

Aim:  To compare the influence of different delivery forms of estrogen therapy (ET) on serum lipid levels.

Methods:  For this prospective, randomized, controlled study, 132 surgically menopausal women were assigned to 12 months of therapy with oral conjugated estrogen 0.625 mg/day (n = 35), intranasal 300 μg/day estradiol hemihydrate (n = 33), percutaneous gel 1.5 mg/day estradiol hemihydrate (n = 32) or no treatment (control group, n = 32). Total cholesterol (t‐Chol), triglycerides, high‐, low‐, and very low‐density lipoprotein (HDL‐Chol, LDL‐Chol, and VLDL‐Chol, respectively) levels were determined at baseline, and cycles 6 and 12. Data were analyzed using repeated measures ANOVA.

Results:  All delivery forms significantly decreased t‐Chol and LDL‐Chol while increasing HDL‐Chol after 6 and 12 cycles. The oral route significantly increased whereas other modalities significantly decreased serum triglycerides after cycle 6 and 12. VLDL‐Chol levels were significantly increased using the oral route after cycle 12 while intranasal and percutaneous gel forms decreased the level after cycles 6 and 12.

Conclusion:  Oral, intranasal and transdermal gel delivery modes of ET have beneficial effects on serum lipids, as shown by decreased t‐Chol and LDL‐Chol, and increased HDL‐Chol levels in surgically menopausal women. The oral form should be used with care in women with hypertriglyceridemia and with increased VLDL‐Chol levels. However, the oral route seems to be more effective in decreasing LDL‐Chol levels than the percutaneous gel form.
Women's douching practices and related attitudes in eastern Turkey
Authors: Ege Emel , Timur Sermin , Zincir Handan , Egri Mucahit , Sunar Reeder Bulbin
Published: June 2007

Aim:  Vaginal douching is a common hygiene practice for many women all over the world, but it is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the objective of the present study was to evaluate the status of vaginal douching practices of women in the Malatya province of eastern Turkey.

Methods:  This was a cross‐sectional study. A sample of 465 Muslim women was interviewed to ascertain the status of vaginal douching practices. All participants were between 15 and 49 years of age and all were married. Data were collected by using a questionnaire in the process of conducting face‐to‐face interviews in June 2004. Data analysis included descriptive statistics and logistic regression modeling.

Results:  The present study revealed that the frequency of douching was 61.5% among women. The participants were frequently douching for feminine hygiene (47.6%). Vaginal douching practices were associated with several factors including education level (odds ratio [OR] = 1.991, 95% confidence interval [CI] = 1.154–3.434), family income (OR = 0.996, 95% CI = 0.994–0.998), marital age (OR = 0.402, 95% CI = 0.223–0.715), frequency of sexual intercourse (OR = 2.335, 95% CI = 1.532–3.554), and presence of genital syndromes/infections (OR = 1.813, 95% CI = 1.215–2.739).

Conclusion:  This study provides preliminary information about women's douching practices and attitudes in the Malatya region of Turkey. It may also provide information to health‐care practitioners in their efforts to educate women on the adverse effects of vaginal douching.
Severe secondary postpartum hemorrhage 3 weeks after cesarean section: Alternative etiologies of uterine scar non‐union
Authors: Pollio Fabrizio , Staibano Stefania , De Falco Marianna , Buonocore Ugo , De Rosa Gaetano , Di Lieto Andrea
Published: June 2007

A case of secondary postpartum hemorrhage that occurred 3 weeks after cesarean section requiring total abdominal hysterectomy is reported. The patient's history and pathologic features of the removed uterus did not allow the authors to clearly recognize a previous reported cause of this potentially life‐threatening complication. Alternative causes of the non‐union of the uterine incision are suggested.
Polypoid endocervical adenomyoma: A case report with clinicopathologic analyses
Authors: Ota Shunichiro , Ushijima Kimio , Nishio Shin , Fujiyoshi Naoki , Takemoto Shuji , Terada Atsumu , Kamura Toshiharu
Published: June 2007

A case of polypoid endocervical adenomyoma (PEA) in the uterine cervix was encountered in the uterine cervix of a 56‐year‐old woman. Grossly, a well‐circumscribed polypoid tumor was observed protruding from the uterine cervix. Based on the findings of imaging studies, it was assumed to be an adenoma malignum in the uterine cervix. The tumor was composed of a mixture of proliferating glands of endocervical type and fascicles of smooth muscle. No distinct nuclear anaplasia, architectural abnormality or any evidence of destructive stromal invasion was observed. Adenoma malignum, which shows a gastric phenotype with immunoreactivity for HIK‐1083, was a serious diagnostic possibility. In the present case, the tumor was a well‐circumscribed polypoid lesion, with no cytologic or architectural abnormality; however, focal immunoreactivity was shown for HIK‐1083, which thus suggested it to be PEA. Therefore, the results of these ancillary diagnostic modalities should be interpreted with caution and combined with the gross and light microscopy findings.
Ectopic ovary: A case of autoamputated ovary with mature cystic teratoma into the cul‐de‐sac
Authors: Kusaka Masumi , Mikuni Masato
Published: June 2007

An ovary with a mature cystic teratoma which was autoamputated into the cul‐de‐sac and confirmed by laparoscopy is described. A 24‐year‐old woman with a history of chronic pelvic pain for 5 years presented with left abdominal pain. Magnetic resonance imaging revealed a left ovarian mass of 5 cm in diameter. The pain was relieved spontaneously after a few weeks. Laparoscopy was performed 5 months later. The mass was identified in the cul‐de‐sac partly enveloped in the omentum without any ligamentous or direct connection with the pelvic organs. There was no left ovary in its proper anatomical location. Histopathologic study revealed a mature cystic teratoma with viable ovarian tissue. These findings suggested autoamputation of the ovary either by inflammation or torsion, which is one of the mechanisms for the formation of an ectopic ovary.
Schwannoma in the retroperitoneum
Authors: Song Jae Yen , Kim Sue Yeon , Park Eun Gyung , Kim Chan Joo , Kim Do Gang , Lee Hye Kyung , Park In Yang
Published: June 2007

Schwannoma (neurilemmoma) is a peripheral nerve sheath tumor and commonly occurs singularly on the head, neck, and trunk. Giant schwannoma is rarely located on the retroperitoneum and pelvic cavity. The majority of symptoms caused by the tumor are due to the effect of its mass. Surgical resection is enough to treat the tumor. Schwannoma is reported usually as benign, and despite incomplete resection of the tumor, the risk of recurrence and metastasis is low. A schwannoma on the retroperitoneum that was preoperatively misdiagnosed as a malignant adnexal mass in a 60‐year‐old menopausal woman is presented, with a brief review of the literature.
Corpus luteum hemorrhage: Rare complication of congenital and acquired coagulation abnormalities
Authors: Gupta Nupur , Dadhwal Vatsla , Deka Deepika , Jain Sunesh Kumar , Mittal Suneeta
Published: June 2007

Women taking anticoagulants or those with a clotting factor deficiency are at increased risk of corpus luteum rupture due to coagulation abnormalities and three such cases are described here. Case 1 was a 35‐year‐old woman with prosthetic mitral valve replacement who was on anticoagulant therapy, in whom hemoperitoneum secondary to ruptured corpus luteum was seen. Emergency laparotomy revealed 1.2 L of massive hemoperitoneum. Left salpingo‐oophorectomy was performed. Case 2 was two episodes of hemoperitoneum from luteal cyst rupture in a young patient with the rare congenital factor X deficiency. This patient was managed conservatively with fresh frozen plasma and blood transfusion. This is the first case of congenital factor X deficiency manifested as luteal rupture to be managed conservatively. Case 3 was two episodes of hemoperitoneum from luteal cyst rupture in a patient with antiphospholipid antibody syndrome who was on oral anticoagulants. Laparotomy was done twice with left salpingo‐oophorectomy in the first instance and partial excision of the right ovary in the second instance. Hemoperitoneum secondary to rupture of the corpus luteum should be considered in the differential diagnosis of acute abdominal pain in women with congenital and acquired coagulation deficiencies.
Endometrioid adenocarcinoma with a functioning stroma
Authors: Hayasaka Tadashi , Nakahara Kenji , Kojimahara Takanobu , Saito‐Sekiguchi Maki , Motoyama Teiichi , Kurachi Hirohisa
Published: June 2007

A case of a 70‐year‐old woman with endometrioid adenocarcinoma of the ovary with functioning stroma is presented. The symptom was postmenopausal bleeding. The preoperative level of serum estradiol was as high as 162.4 pg/mL, and serum gonadotropin levels were suppressed. The endometrial tissue showed hyperplastic changes. The surgical specimens consisted of a multilocular cystic ovarian tumor of 95 mm in diameter and an enlarged uterus. Histologically, the tumor was composed of proliferating, atypical, columnar cancer cells resembling early secretory endometrial cells, and condensation of plumed stromal cells resembling theca lutein cells. The diagnosis of endometrial adenocarcinoma of the ovary with functioning stroma was made. After surgery, the serum levels of estradiol decreased and of follicle‐stimulating hormone increased. Almost all types of ovarian tumor have been reported to be associated with endocrine abnormalities. Mucinous epithelial ovarian tumors most commonly present with estrogenic stroma, although the frequency of endometrioid adenocarcinoma with functioning stroma is very low. Here, a rare case with the patient's clinical course and histopathologic findings is reported.
Isolated adenomyotic cyst associated with severe dysmenorrhea
Authors: Kamio Masaki , Taguchi Shuuhei , Oki Toshimichi , Tsuji Takahiro , Iwamoto Ichiro , Yoshinaga Mitsuhiro , Douchi Tsutomu
Published: June 2007

A case of a 23‐year‐old, nulliparous female with a very rare isolated adenomyotic cyst inducing severe dysmenorrhea was seen. Transvaginal ultrasonographic tomography and magnetic resonance imaging (MRI) showed a 3 × 3‐cm cystic mass within the left anterior wall of the uterine corpus. The cystic space was filled with hyperintense fluid on T1‐weighted images, which was surrounded by hypointense tissue beside the right uterine corpus on T2‐weighted images. The case was preliminarily diagnosed using MRI as having cavitated rudimentary uterine horn. However, hysterosalpingography excluded the possibility of uterine anomaly. A hemorrhagic adenomyotic cyst measuring 3 cm within the left anterior wall of the uterine corpus was surgically removed. There was no evidence of diffuse adenomyosis uteri. Dysmenorrhea completely disappeared postoperatively.
Epithelioid trophoblastic tumor of the lung
Authors: Urabe Satoshi , Fujiwara Hisaya , Miyoshi Hiroshi , Arihiro Koji , Soma Hiroaki , Yoshihama Isao , Mineo Shoichiro , Kudo Yoshiki
Published: June 2007

Epithelioid trophoblastic tumor (ETT) is a rare type of gestational trophoblastic disease and only 25 cases have been reported so far. It was first proposed by Mazur and Kurman in 1994 as an unusual type of trophoblastic tumor that is distinct from placental site trophoblastic tumor and choriocarcinoma and has features resembling carcinoma. A case of ETT of the lung in a 38‐year‐old Japanese woman is reported. The patient had suffered from a hydatidiform mole at the age of 27 years, and had four normal deliveries at the ages of 24, 31, 35 and 37 years. Because no tumor lesions were detected in the uterus, the patient was suspected of having metastatic choriocarcinoma with multiple lesions in the lung accompanied by an elevated level of human chorionic gonadotropin (hCG). In order to make an exact diagnosis, a partial resection of metastatic foci in the lung was performed. Microscopically, the tumor showed hemorrhagic necrotic foci and was composed of mainly mononuclear tumor cells and some giant tumor cells resembling trophoblastic cells. Immunohistochemical examination showed that a few large cells were stained positively for hCG, and that other cells were positive for human placental lactogen, pregnancy‐specific β1‐glycoprotein, cytokeratin 7 and inhibin‐α. In the ultrastructure, the tumor cells contained large nuclei and rich organella with desmosomes and well‐formed filaments. The diagnosis of ETT was confirmed from the findings as described above.
A novel formulation of the theory of critical distances to estimate lifetime of notched components in the medium‐cycle fatigue regime
Authors: SUSMEL L. , TAYLOR D.
Published: June 2007

In the present paper, the theory of critical distances (TCD) is reformulated in order to make it suitable for predicting fatigue lifetime of notched components in the medium‐cycle fatigue regime. This extension of the TCD takes as its starting point the idea that the material characteristic length, L, changes as the number of cycles to failure, Nf, changes. In order to define the L versus Nf relationship two different strategies were investigated. Initially, we attempted to determine it by using the L values calculated considering material properties defined at the two extremes, namely static failure and the fatigue limit. This strategy, though correct from a philosophical point of view, contained some problems in its practical application. We subsequently attempted to determine the L versus Nf relationship by means of two calibration fatigue curves; (one generated by testing plain specimens and the second one generated by testing notched specimens). This second strategy was found to be much more simple to apply to practical problems, resulting in estimations characterized by a higher accuracy. The reliability of the devised method was systematically checked by using experimental results generated by testing notched specimens of low‐carbon steel containing different geometrical features and tested using various loading types, stress ratios and specimen thicknesses. The accuracy of the method was further verified by using several data sets taken from the literature. Our method was seen to be successful giving predictions falling always within the scatter band of the data from the parent material. These results are very interesting, especially considering that the TCD is very easy to use because it requires only a linear‐elastic stress analysis.
Crack closure in fibre metal laminates
Authors: PLOKKER H.M. , ALDERLIESTEN R.C. , BENEDICTUS R.
Published: June 2007

GLARE is a fibre metal laminate (FML) built up of alternating layers of S2‐glass/FM94 prepreg and aluminium 2024‐T3. The excellent fatigue behaviour of GLARE can be described with a recently published analytical prediction model.

This model is based on linear elastic fracture mechanics and the assumption that a similar stress state in the aluminium layers of GLARE and monolithic aluminium result in the same crack growth behaviour. It therefore describes the crack growth with an effective stress intensity factor (SIF) range at the crack tip in the aluminium layers, including the effect of internal residual stress as result of curing and the stiffness differences between the individual layers. In that model, an empirical relation is used to calculate the effective SIF range, which had been determined without sufficiently investigating the effect of crack closure.

This paper presents the research performed on crack closure in GLARE. It is assumed that crack closure in FMLs is determined by the actual stress cycles in the metal layers and that it can be described with the available relations for monolithic aluminium published in the literature.

Fatigue crack growth experiments have been performed on GLARE specimens in which crack growth rates and crack opening stresses have been recorded. The prediction model incorporating the crack closure relation for aluminium 2024‐T3 obtained from the literature has been validated with the test results.

It is concluded that crack growth in GLARE can be correlated with the effective SIF range at the crack tip in the aluminium layers, if it is determined with the crack closure relation for aluminium 2024‐T3 based on actual stresses in the aluminium layers.
Stress intensity factors for surface fatigue crack in a round bar under cyclic axial loading
Authors: YANG F. P. , KUANG Z. B.
Published: June 2007

In this paper, the surface fatigue crack growth shape for an initial straight‐fronted edge crack in an elastic bar of circular cross‐section is determined through experiments under pure fatigue axial loading. Three different initial notch depths are discussed. The relations of the aspect ratio (b/c) and relative crack depth (b/D) are obtained, and it is shown that there is a great difference in the growth of cracks with different initial front shapes and crack depths. Further, using the three‐dimensional finite element method, the stress intensity factors (SIFs) are determined under remote uniform tension loading. Since the relationship of b/c and b/D changes during the fatigue crack growth, the SIFs are determined for different surface crack configurations.
Mixed‐mode fatigue crack growth of thin aluminium panels with single‐side repair using experimental and numerical methods
Authors: HOSSEINI‐TOUDESHKY H. , MOHAMMADI B. , BAKHSHANDEH S.
Published: June 2007

In this paper, experimental and numerical fatigue crack growth of thin aluminium panels containing a central inclined crack of 45° with single‐side glass/epoxy composite patch are performed. Effects of patch lay‐up configuration on the restarting crack growth (crack re‐initiation) life and crack growth rate of the repaired panels are investigated. The obtained experimental results are compared with those predicted using finite element analysis based on both mid‐plane and unpatched surface fracture parameters. In the finite elements analyses, it is assumed that the crack‐front remains perpendicular to the panel's surfaces during its propagation. It is shown that the finite element crack re‐initiation and propagation lives predictions using the unpatched surface results are too conservative. However, the finite element mid‐plane results lead to a non‐conservative life prediction. It is experimentally shown that, the most effective patch lay‐up configurations to retard the crack growth of the repaired panels is [−45/+45]2; however, the most life extension including the crack propagation cycles belongs to the patch lay‐up of [904]. It is also shown that using the asymmetric patch lay‐up configuration similar to [902/02] with a proper bonding process may lead to a very slow crack growth rate, even slower than the patch lay‐up of [904].
Fatigue crack growth of filled rubber under constant and variable amplitude loading conditions
Authors: HARBOUR RYAN J. , FATEMI ALI , MARS WILL V.
Published: June 2007

Service conditions experienced by rubber components often involve cyclic loads which are more complex than a constant amplitude loading history. Consequently, a model is needed for relating the results of constant amplitude characterization of fatigue behaviour to the effects of variable amplitude loading signals. The issue is explored here via fatigue crack growth experiments on pure shear specimens conducted in order to evaluate the applicability of a linear crack growth model equivalent to Miner's linear damage rule. This model equates the crack growth rate for a variable amplitude signal to the sum of the constant amplitude crack growth rates associated with each individual cycle. The variable amplitude signals were selected to show the effects of R‐ratio (ratio of minimum to maximum energy release rate), load level, load sequence, and dwell periods on crack growth rates. In order to distinguish the effects of strain crystallization on crack growth behaviour, two filled rubber compounds were included: one that strain crystallizes, natural rubber, and one that does not, styrene‐butadiene rubber. The linear crack growth model was found to be applicable in most cases, but a dwell effect was observed that is not accounted for by the model.
Fatigue strength of a typical ship structural detail: tests and calculation methods
Authors: RIZZO C. M. , TEDESCHI R. A.
Published: June 2007

In previous years, several large‐scale specimens have been fatigue tested in the Ship Structures laboratory of the Dipartimento di Ingegneria Navale e Tecnologie Marine (DINAV) of the University of Genova (Italy). They represent the crossing of a T‐shaped beam into deep web plates, simulating either a primary supporting member or bulkhead plating. Each specimen is characterized by two joints, both watertight but with different geometry.

The purpose of this paper is to review all the available test results using calculation methods for fatigue strength of welded structural details, namely: nominal stress approach, local stress approaches and the fracture mechanics approach.

Test results allow SN curves to be drawn which can be used for these and similar details, quite common in shipbuilding. Moreover, calibration of stress concentration factors and coefficients in the various fatigue life calculation methods is possible using the experimental data.
Coding of movement‐ and force‐related information in primate primary motor cortex: a computational approach
Authors: Guigon Emmanuel , Baraduc Pierre , Desmurget Michel
Published: June 2007

Coordinated movements result from descending commands transmitted by central motor systems to the muscles. Although the resulting effect of the commands has the dimension of a muscular force, it is unclear whether the information transmitted by the commands concerns movement kinematics (e.g. position, velocity) or movement dynamics (e.g. force, torque). To address this issue, we used an optimal control model of movement production that calculates inputs to motoneurons that are appropriate to drive an articulated limb toward a goal. The model quantitatively accounted for kinematic, kinetic and muscular properties of planar, shoulder/elbow arm‐reaching movements of monkeys, and reproduced detailed features of neuronal correlates of these movements in primate motor cortex. The model also reproduced qualitative spatio‐temporal characteristics of movement‐ and force‐related single neuron discharges in non‐planar reaching and isometric force production tasks. The results suggest that the nervous system of the primate controls movements through a muscle‐based controller that could be located in the motor cortex.
Dexmedetomidine for pediatric MRI sedation: a review of a series of cases
Authors: HEARD CHRISTOPHER M.B. , JOSHI PRASHANT , JOHNSON KRISTIN
Published: June 2007

Background:  The aim of this review was to determine whether dexmedetomidine alone provided satisfactory conditions for children undergoing magnetice resonance imaging (MRI).

Methods:  A retrospective review of 21 patients was undertaken, (age range: 1–8 years, weight 10–27 kg) who received dexmedetomidine to provide deep sedation for an MRI procedure.

Results:  In the initial eight patients who received dexmedetomidine (bolus 0.5–1.5 mg·kg−1 and infusion rate 1–1.5 mg·kg−1·h−1) by itself, movement occurred in five of them, even when the maximum suggested dose was used (1 μg·kg−1·h−1). Midazolam (0.1 mg·kg−1) i.v. was given as an adjunct to the following 13 patients (dexemdetomidine doses were lower: bolus 1 mg·kg−1, infusion 0.5–1 mg·kg−1·h−1). Only one patient moved within this group. The mean time to discharge postprocedure was 90 min. There were no differences with respect to recovery or discharge times between those who did or did not receive midazolam. No cardiac or respiratory complications were noted.

Conclusions:  The use of dexmedetomidine for MRI sedation by itself was more unpredictable than anticipated from the published case reports of its use.
How well do pediatric anesthesiologists agree when assigning ASA physical status classifications to their patients?1
Authors: BURGOYNE LAURA L. , SMELTZER MATTHEW P. , PEREIRAS LILIA A. , NORRIS ANGELA L. , ARMENDI ALBERTO J. DE
Published: June 2007

Background:  The scope and application of the American Society of Anesthesiologists Physical Status (ASA PS) classification has been called into question and interobserver consistency even by specialist anesthesiologists has been described as only fair. Our purpose was to evaluate the consistency of the application of the ASA PS amongst a group of pediatric anesthesiologists.

Methods:  We randomly selected 400 names from the active list of specialist members of the Society for Pediatric Anesthesia. Respondents were asked to rate 10 hypothetical pediatric patients and answer four demographic questions.

Results:  We received 267 surveys, yielding a response rate of 66.8% and the highest number of responses in any study of this nature. The spread of answers was wide across almost all cases. Only one case had a response spread of only two classifications, with the remaining cases having three or more different ASA PS classifications chosen. The most variability was found for a hypothetical patient with severe trauma, who received five different ASA PS classifications. The Modified Kappa Statistic was 0.5, suggesting moderate agreement. No significant difference between the private and academic anesthesiologists was found (P = 0.26).

Conclusions:  We present the largest evaluation of interobserver consistency in ASA PS in pediatric patients by pediatric anesthesiologists. We conclude that agreement between anesthesiologists is only moderate and suggest standardizing assessment, so that it reflects the patient status at the time of anesthesia, including any acute medical or surgical conditions.