bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Transcutaneous Electric Nerve Stimulator for Pain Relief in Labour
Authors: Chia Y. T. , Arulkumaran S. , Chua S. , Ratnam S. S.
Published: August 2010

The effectiveness of transcutaneous electric nerve stimulation (TENS) for pain relief in labour was compared to inhalation analgesia consisting of 50% nitrous oxide and 50% oxygen (ENTONOX). In the first part of the study 101 patients in early labour were allocated to using TENS (Group A) or ENTONOX (Group B) for pain relief. Our results did not show any beneficial effect on pain relief in labour with the use of TENS over ENTONOX; 18.8% of patients in Group A went through labour without any further form of analgesia as opposed to 17.0% in Group B. In the second part of the study 20 nulliparous patients having induced labour were randomly allocated to use TENS (Group C) or ENTONOX (Group D) as the first modality of pain relief. A switchover was made when labour pains were no longer tolerable. The results showed that both TENS and ENTONOX could be used in early labour up to 5–6 cm cervical dilatation till the frequency of contractions was nearly 5 in 10 min or the first 3–4 hr from the time patients first requested pain relief in labour when frequency of contractions was nearly 4 in 10 min. TENS could be used in early labour for patients who wish to be ambulant and is as effective as ENTONOX. Either modality of pain relief was not adequate for pain relief throughout labour.
A New Therapy for Pelvic Endometriosis and Uterine Adenomyosis: Local Effect of Vaginal and Intrauterine Danazol Application
Authors: Igarashi Masao
Published: August 2010

In order to investigate the effect of the local direct action of danazol upon endometriosis, intravaginal and intrauterine application were tried. A vaginal danazol ring containing 2 g to 3.5 g danazol not only reduced both dysmenorrhea and the extent of pelvic endometriosis in all 35 infertile women, but also resulted in conception in 13 out of 35 infertile women while the vaginal ring was in place. Uterine adenomyosis usually fails to respond to oral danazol therapy, but an intrauterine device containing 175 mg of danazol was effective in reducing the size of the uterus and in inducing pregnancy in 66.6% cases. It is noteworthy that this vaginal or intrauterine danazol therapy did not inhibit ovulation, but still effected atrophy of endometriosis and aided in the establishment of pregnancy. These results clearly demonstrate that the main mode of action of danazol is its direct action on endometriotic cells.
Carcinoma of the Vulva in Pregnancy: A Rare Occurrence
Authors: Sivanesaratnam V. , Pathmanathan R.
Published: August 2010

A rare case of squamous cell carcinoma diagnosed in early pregnancy in a 28‐year‐old woman is described. At the time of radical surgery, which was carried out in the puerperium, the growth had already advanced to Stage IV disease. The rapid growth of the tumor seen in this patient suggests that although treatment needs to be individualised, the definitive radical surgery should not be delayed.
The Role of Transcutaneous Electrical Nerve Stimulation in Management of Labour in Obstetric Patients
Authors: Lee Edwin W. C. , Chung Ivis W. Y. , Lee Janet Y. L. , Lam Pansy W. Y. , Chin Robert K. H.
Published: August 2010

The study evaluated the effect of transcutaneous electrical nerve stimulation (TENS) in the management of labour. It comprised of 125 subjects with 93 primiparae and 32 multiparae. They were divided into 3 groups. The first group received electrical stimulation from the TENS unit (TENS); the second group (placebo group) had the TENS machine connected but with no current from the TENS unit (TPL); whereas the third group had no machine application (control group).

Analgesic requirements, pain assessment, labour duration, Obstetric outcome, and the comments from mother and midwife were analysed. No negative effects on the mothers and babies were reported. Neither was there any objective clinical significant differences demonstrated among the 3 groups.
Management of Cyclical Menorrhagia with Prostaglandin Synthetase Inhibitor
Authors: Grover Vimal , Usha R. , Gupta Usha , Kalra S.
Published: August 2010

A well controlled double blind prospective trial was undertaken to determine the efficacy of mefenamic acid in the treatment of menorrhagia. Eighty patients who had unexplained cyclical menorrhagia with secretory endometrium received mefenamic acid orally in a dose of 500 mg 8 hourly or a placebo tablet thrice daily starting from day‐one of the cycle for 5 days or till cessation of menses.

Mefenamic acid administration caused a statistically significant reduction in the number of days of bleeding from 9.7±3.1 days before treatment to 4.1±0.6 days after treatment. It also brought about significant reduction in the amount of bleeding in terms of number of pads used per day, that is from 15.2±3.1 before treatment to 6.5±0.02 after treatment. Eighty‐six percent patients in the treatment group had control of menorrhagia with the drug compared to 20% in the control group without drugs and this difference was statistically significant. Mefenamic acid proved to be a potent and efficacious agent in the control of unexplained menorrhagia.
Pregnancy Suppression by a Structurally Related Antagonist for Platelet Activating Factor, CV‐6209, in Mice
Authors: Ando Masaaki , Suginami Hiroshi , Matsuura Shumpei
Published: August 2010

The effects of CV‐6209, a structurally related antagonist for platelet activating factor (PAF), on pregnancy were investigated in mice, so that the physiologic significance of PAF production by and secretion from preimplantation embryos could be elucidated. When it was repeatedly administered to pregnant mice during days 1–6 of pregnancy, CV‐6209 prevented preimplantation thrombocytopenia and reduced the number of implantation sites dose‐dependently, CV‐6209 suppression of pregnancy was eliminated by concomitant administrations of PAF. When it was administered on various fractional days of pregnancy, CV‐6209 suppressed pregnancy most effectively in mice treated during days 4–5 of pregnancy, the days of implantation. CV‐6209 treatment exhibited no apparent effect on embryonic development. Implantation was suppressed when day 4 embryos from saline‐treated donor mice were transferredin uteroto CV‐6209‐treated recipient mice. Once implanted, however, theirin uterogrowth was normal. The results indicate that PAF is prerequisite to pregnancy by promoting embryonic implantation.
Silastic Cup Vacuum Extractor of Forceps: A Comparative Study
Authors: Svigos John M. , Cave Don G. , Vigneswaran Rasiah , Resch Annie , Christiansen Jane
Published: August 2010

A retrospective analysis over a 2‐year period was carried out to compare the limitations in the use of the Silastic Cup vacuum extractor and forceps as the preferred instrument for operative vaginal delivery.

Whilst the use of the vacuum extractor was associated with less maternal morbidity (54.9% episiotomy rate; 20.9% nil analgesia) and comparable neonatal problems, an increased failure rate (6.5%) was demonstrated in comparison to forceps delivery (0.7% failed vaginal delivery rate).

A comparison of their use for rotational vaginal delivery failed to reveal any significant difference in maternal or neonatal outcome apart from an increased failure rate (30%) to complete vaginal delivery after application of the vacuum extractor.

It is concluded that the vacuum extractor is a comparable instrument for midcavity or lift‐out instrumental delivery but Kielland's forceps may still be a more appropriate instrument for rotational vaginal delivery.
The Efficacy of a Combination Administration of Gonadotropin‐Releasing Hormone Agonist and Gonadotropins for Controlled Ovarian Hyperstimulation in IVF Program
Authors: Chang Yoon Seok , Kim Seok Hyun , Shin Chang Jae , Kim Jung Gu , Moon Shin Yong , Lee Jin Yong
Published: August 2010

In 105 patients with the past history of poor response to the previous controlled ovarian hyperstimulation (COH) due to poor follicular growth or premature LH surge, the efficacy of pituitary suppression with gonadotropin‐releasing hormone agonist (GnRHa) in IVF/GIFT program was evaluated in 112 cycles of COH using a combination regimen of leuprolide acetate (Lupron) and FSH/hMG or pure FSH from May to December, 1989. After suppression phase, serum E2 and progesterone levels decreased significantly, but there was no change in serum LH and FSH levels. There was no occurrence of premature LH surge during COH. Eleven cycles (9.8%) were cancelled, and 3 cycles (3.0%) failed in the transvaginal oocytes retrieval. The 7.00±3.32 follicles (FD ≥ 12 mm) were observed, and 6.11±4.15 oocytes were retrieved. The 3.59±2.57 oocytes were fertilized and cleaved with the cleavage rate of 55.7%. In 83 IVF patients, 4.08±2.39 embryos were transferred, and 16 pregnancies were obtained with the pregnancy rate per ET of 19.3%. In 6 GIFT patients, 7.83±3.31 oocytes were available for transfer. When compared with the previous 108 cycles, the cancellation rate during COH was decreased and all the parameters of the outcome of COH including the pregnancy rate were increased. These data suggest that GnRHa therapy for pituitary suppression is an effective adjunct to the current gonadotropin regimens for COH in IVF/GIFT and can increase the probability of oocytes retrieval and pregnancy, especially in the previous poor responders.
Mature Cystic Teratoma of the Uterine Cervix
Authors: Iwanaga Shigeaki , Ishii Hiroki , Nagano Hidetsugu , Shimizu Masahiko , Nishida Takashi , Yakushiji Michiaki
Published: August 2010

A rare case of extragonadal teratoma which occurred primarily in the uterus is described. The tumor developed in the uterine cervix to form a polypoid appearance, and consisted of ectodermal, mesodermal and endodermal derivatives. This is the 14th such tumor to be recorded in world literature. A review of the literature and its possible histogenesis are briefly described.
Genital Human Papillomavirus Infection among Women from Major Ethnic Groups in Singapore
Authors: Chow Vincent T. K. , Tham K. M. , Lim‐Tan S. K. , Sng Ivy T. Y. , Bernard H. U.
Published: August 2010

The close epidemiological relationships between specific genital human papillomavirus (HPV) types and neoplasia of the cervix uteri have been extensively documented worldwide, including Singapore. Cervical cancer incidence rates in Singapore show variations between the major ethnic groups. To ascertain the corresponding HPV infection rates among the various races in Singapore, we analysed the cervical smears of 225 women by filter in situ DNA hybridization, and compared the data with a previous similar study. Fourteen (6.2%) individuals were HPV‐positive, with HPV 16 and HPV 31 being the commonest types. No significant difference between HPV positivity rates in Chinese (5.0%) and in Malays (6.7%) was found, even though Chinese have a higher cervical cancer incidence than Malays. Furthermore, the cervical HPV carriage rate among women with normal cytology was 5.9%. In the light of reports of high genital HPV prevalence rates detected by DNA amplification, these data support the notion that HPV infection is commonly latent and requires the cooperation of other factors for cervical carcinogenesis.
Uterine Activity in Dysfunctional Labour and Target Uterine Activity to Be Aimed with Oxytocin Titration*
Authors: Arulkumaran S. , Chua S. , Chua T. M. , Yang T.M. , Piara S. , Ratnam S. S.
Published: August 2010

Uterine activity was quantified using a transducer tipped intrauterine catheter in 75 nulliparous women with dysfunctional labour. The active contraction area profiles in these women were below the median levels reported for those who had normal progress of labour from our institution. When uterine activity was augmented with oxytocin, 90.7% progressed in labour and delivered vaginally. Six patients (8%) showed poor progress despite good uterine activity and had to be delivered by caesarean section (CS) for failure to progress and signs of cephalopelvic disproportion. The pre‐ and post‐augmentation uterine activity were similar in those who delivered vaginally or by CS and was not helpful in identifying those who had cephalopelvic disproportion. Of the 75 women who had slow progress of labour, 50 had a contraction frequency of less than 1 in 3 min whilst 25 had a minimum frequency of 1 in 3 min or more. All except one in the latter group delivered vaginally when oxytocin was titrated to achieve a contraction frequency of 1 in 2 to 2 1/2 min which were clinically judged to be adequate based on a duration >40 sec. Oxytocin should be titrated to achieve a target contraction frequency of 1 in 2 to 2 1/2 min lasting >40 sec to achieve good obstetric outcome in those with dysfunctional labour.
Prenatal Diagnosis of Rubella Infection by Fetal Blood Sampling
Authors: Suzumori Kaoru , Iida Tadashi , Adachi Ritsuko , Okada Setsuo , Yagami Yoshiaki
Published: August 2010

Prenatal diagnosis of rubella infection was attempted at 21 to 23 weeks of gestation by measuring rubella‐specific IgM by ELISA in blood obtained from 16 fetuses whose mothers had been confirmed rubella infection during pregnancy. Specific IgM was detected in 9 fetuses. In 1 case, the time of the appearance of the rash was 20 weeks of gestation and this pregnancy went to term resulting in a healthy baby without clinical evidence of congenital rubella. The remaining 8 patients had their pregnancies terminated, and fetal infection was confirmed by blood tests after the abortion. No specific IgM was detected in the 7 other fetuses. However, in 2 IgM fetal blood negative cases whose mothers had had the rash at 17 and 20 weeks of gestation, the neonates showed positive IgM findings, but were apparently healthy. The reasons for the false‐negative findings are discussed.
Low Birth Weight in Kuala Lumpur
Authors: Tahir Hashim M. , Ismail Nik N. , Gebbie Donald A. M.
Published: August 2010

Low birth weight babies are defined as those weighing under 2,500 g. They make 13.5% of all births at the Maternity Hospital, Kuala Lumpur but contribute to 74.8% of all deaths. They are most likely to be Indian babies and least likely to be Chinese. Among all 3 communities, the primigravidae tend to produce smaller babies than multiparae but this is also true for the Indian of parity more than 3. The Malay teenager is more likely to produce small babies than their older counterparts but not so with the Indian and Chinese. There are definite clinical factors associated with or causing the births of small babies and the lighter the baby, the more influential are these factors. Maternal hypertension, antepartum haemorrhage, multiple pregnancy and unexplained intrauterine death are the 4 outstanding associations with both low birth weight and perinatal death. Although the spontaneous (often premature) onset of labour was the commonest preceding factor, it was much less important in the lowest birth weight groups of babies and was a less important contributor to perinatal death.
Effect of Estrogen and Progesterone on the Growth of Human Ovarian Dysgerminoma Heterotransplanted to Athymic Nude Mice
Authors: Ochiai Kazunori , Isonishi Seiji , Hirama Yoshiaki , Yasuda Makoto , Terashima Yoshiteru
Published: August 2010

The effects of estrogen and progesterone on the growth of dysgerminoma of ovary heterotransplanted to ovariectomized athymic nude mice (OVX‐NUs) were examined. OVX‐NUs were divided into 6 groups and a subcutaneous injection of either 1 μg or 10 μg of estradiol (E1 or E10), 0.1 mg or 1 mg of progesterone (P0.1 or P1), or a combination treatment of E1 and P1 (E1+P1), or sesame oil as a vehicle control (oil) was given every other day for 2 weeks. Tumor size was recorded every day and the volume doubling time (VDT) was calculated. Tumor bearing OVX‐NUs were killed on day 21 and tumor tissue was excised for retransplantation, histological examination and cytosol receptor assay.

E10 treatment accelerated tumor growth and shortened VDT to 25 hours compared to 44 hours for the control group. P1 treatment delayed the tumor growth (VDT: 71 hrs) and E1+P1 treatment further inhibited it (VDT: 197 hrs). E1 or P0.1 did not have any effect on the tumor growth.

The levels of both the estrogen receptor (ER) and progesterone receptor (PR) of the original tumor were 5 fmol/mg protein, respectively. Hormone treatment had no remarkable effect, except for a significant increase in PR after estrogen treatment and this result seems to be responsible for the enhanced inhibitory effect of E+P on tumor growth. These effects were also observed histologically.

In conclusion, the dysgerminoma used in this study was sex steroid hormone dependent and P alone or in combination with E could be a choice for the treatment of such ovarian dysgerminoma.
Cervical Adenocarcinoma Metastasizing to the Skin Incision: A Case Report
Authors: Dhall Rajiv , Grant Kenneth A.
Published: August 2010

In a patient previously operated upon for cervical adenocarcinoma, an abdominal wall swelling of identical histology developed in the surgical incision line. The skin involved was the site of external irradiation. The case is discussed and the literature reviewed.
Prevention by Urinastatin ofCis‐Diamminedichloroplatinum‐Induced Nephrotoxicity in Rabbits: Comparison of Urinary Enzyme Excretions and Morphological Alterations by Electron Microscopy
Authors: Kobayashi Hiroshi , Ohi Hidekazu , Terao Toshihiko
Published: August 2010

Acute nephrotoxicity was produced by 3 mg/kg intramuscular administrations ofcis‐diamminedichloroplatinum (CDDP) in rabbits. Urinary enzyme excretions of arylamidase and γ‐glutamyl transpeptidase, and morphological alterations by electron microscopy were used as endopoints to quantitate the severity of nephrotoxicity. The preventive effect of urinastatin (US), a trypsin inhibitor, on CDDP‐induced nephrotoxicity was evaluated. The alteration of urinary enzyme excretions did not parallel the severity of renal morphological changes. In proximal tubular cells, the morphological alterations consisting of nuclear irregularity, brush border disruption, and lysosomal membrane destruction were observed. In contrast, in rabbits treated concurrently with CDDP and 10,000 unit/kg of US, CDDP‐induced morphological changes observed in rabbits without US were completely absent. The differences in urinary enzyme excretions and morphological alterations between US‐treated rabbits and the US‐nontreated group were enough to fully account for the drastic protective effect of US against CDDP nephrotoxicity.
Grandmultiparity in Malaysian Women
Authors: Tai Christina , Urquhart Rennie
Published: August 2010

Grandmultiparity is an ill defined term, but it is generally believed that increasing parity after the fifth delivery increases the risks of child bearing for both the mother and fetus. Four hundred seventy‐seven women aged less than 35 years of parity 5 and above who delivered during one year period at the University Hospital, Kuala Lumpur were studied. There were 406 women of parity 5 and 6 and 71 women of parity 7 and above. The 2 groups as a whole comprised 7.5% of the obstetric population for that year. Obstetric performance in the 2 groups of grandmultipara was compared with 1,135 women, aged 25 to 34 years, having their second baby during the same period. Women of parity 7 and above were significantly more likely to be from lower socioeconomic groups, and suffer from anaemia, hypertension and preeclampsia. They were also significantly at risk of preterm delivery and delivering infants weighing less than 2.5 kg. In addition, the perinatal mortality rate was significantly greater in the highly parous group (Para >7) than in women of parity 5 and 6 or the control group. Apart from a significant increase in the incidence of anaemia, women of parity 5 and 6 had a similar obstetric performance and perinatal outcome to that of the control group. We conclude that grandmultiparity per se is not an obstetric risk factor until after the seventh delivery. These findings have implications for those who plan the provision of obstetric services for the community.
Bilateral Ovarian Cysts in a Newborn: A Case Report
Authors: Lira C. T. , Wong K. K. , Yap Y. F. , Sivanesaratnam V.
Published: August 2010

Large ovarian cysts in the fetus are uncommon. Ultrasonography has helped in the detection of these cysts antenatally and in the newborn female infant. A case of bilateral ovarian cysts in a newborn is presented. The choice of management between conservative measures and surgical approaches remains controversial.
A Study on the Placental Transport Mechanism of Vitamin K2 (MK‐4)
Authors: Iioka Hideaki , Akada Shinobu , Hisanaga Hiroyasu , Shimamoto Takako , Yamada Yoshihiko , Moriyama Ikuko S. , Ichijo Motohiko
Published: August 2010

The present study was primarily concerned with in vitro investigation of vitamin K2 (MK‐4) transport using human placental villous tissues, with the objective of elucidating the placental transport mechanism of vitamin K2.

 When vitamin K2 (MK‐4) was not administered to gravidae, the observed concentrations of vitamin K2 were 0.32±0.07 ng/ml in the maternal venous blood, undetectable in umbilical venous blood, and 1.01 ±0.37 ng/g wet tissue in the placental villous tissue.

 When vitamin K2 was administered to gravidae, (20 mg/day X 7 days per os), the corresponding concentrations were 0.89±0.21 ng/ml in the maternal venous blood, 0.18±0.06 ng/ml in umbilical venous blood, and 5.38± 1.05 ng/g wet tissue in the placental villous tissue.

 In vitro studies using placental villous tissue indicated that vitamin K2 transport into villous tissue is not active, but suggested the existence of a highly vitamin K2 specific transport system in the human placenta. On the other hand, the results of comparison studies of transport of vitamin K2 and vitamin K1 into villous tissue indicated that transport activity with respect to the former vitamin was higher. Moreover, comparison of vitamin K2 transport into villous tissue at the end of the first trimester and at full term revealed that transport was somewhat higher during the final stage.

In summary, the above results indicated that whereas transport of vitamin K1 into the fetus is not especially pronounced, transport into the placental villous tissue is comparatively good.
Malakoplakia of the Omentum and Endometrium
Authors: Koetsawang Amorn , Senapad Sumrit , Boriboonhiransarn Dittakarn , Robertson Donald Ian
Published: August 2010

A rare case of malakoplakia involving the omentum and endometrium is presented. This is the first documented case of malakoplakia in the Thai population.
Sonographic Evaluation of Clinical Suspicion for Ectopic Pregnancy
Authors: Tongsong Theera , Wanapirak Chanane , Siriwattanapa Pannee , Pongsuthirak Pallop
Published: August 2010

Abstracts

Analysis of transabdominal ultrasonic findings of 167 patients presented with clinical suspicion of extrauterine pregnancies (EUP), all with measurable serum HCG, has been undertaken. Patients were divided into two main groups, namely those with demonstrable typical intrauterine gestational sac (46.7%), and those without (53.3%). This later group of patients, i.e., without intrauterine sac, was further subdivided into four other groups depending on whether or not they have adnexal mass and/or fluid in cul‐de‐sac. In this first subgroup of patients (21 cases), without any demonstrable mass or fluid, a positive predictive value (PPV) for EUP of only 28.6% was obtained. With ultrasound showing fluid but no mass, the PPV was 55.6%, while those with both mass and fluid, the PPV as high as 95.7% was possible.

Characterization of the adnexal mass or cul‐de‐sac findings among those with empty uterus may further improve PPV.

The results of this study indicates that ultrasonic examination can help to provide a more correct diagnosis in the investigation of EUP. EUP can be easily excluded, in the great majority of cases, with sonographic visualization of intrauterine pregnancy. In the case of empty uterus with no mass nor fluid, patients should be closely followed up with HCG titer and ultrasonic examination. For those with empty uterus with fluid, culdocentesis may be indicated; whereas in the case of empty uterus with mass, laparoscopy should be considered as additional investigative procedures.
Analysis of Urinary Protein by Immunoblot Method Using Unconcentrated Urine in Preeclampsia
Authors: Yamamoto Tatsuo , Yoshimura Sachiko , Sasamori Yukifumi , Sakamoto Takako , Ogino Masahiro , Kambegawa Akira , Okinaga Shouichi , Arai Kiyoshi
Published: August 2010

In order to investigate the renal change in preeclampsia, molecular weight and specific protein analyses in unconcentrated urine were performed by the immunoblot method. Urine samples were taken from 34 preeclamptic cases (pure type), including 20 severe cases. Polypeptide profiles of urine consisted of four patterns: low MW (L) pattern (tubular damage), high MW (H) pattern (glomerular damage), high and low MW (HL) pattern, and middle MW (M) pattern. The incidences of the HL, H, L, and M patterns were 26.5%, 14.7%, 11.8%, and 47.1%, respectively. The HL pattern was found more frequently in severe proteinuria than in mild proteinuria. High incidences of the HL and H patterns were found in the hypertensive group. Larger amounts of IgM, fibronection, IgG, and β2 microglobulin in urine were confirmed using specific antibodies. Our results suggest that the immunoblot method makes it possible to differentiate glomerular and tubular damages and to evaluate the severity of renal damage in preeclampsia using unconcentrated urine.
Bone Metastasis in Ovarian Cancer
Authors: Kumar Lalit , Bhargava V. L. , Rao R. C. Keshav , Rath G. K. , Kataria S. P.
Published: August 2010

Bone involvement in carcinoma of ovary occurs rarely. In a review of 103 patients over last 3 years we have seen 4 such patients (serous‐2, mucinous‐1, mixed germ cell tumour‐1). Patients presented with severe localized bone pain, bony swelling and difficulty in walking. The common sites of involvement were vertebrae, pelvic bones and skull. Radiologically the osteolytic lesions were commonest. Bone lesions were associated with abdomino‐pelvic disease in 3 patients. Cisplatinum based chemotherapy in addition to local radiation resulted in significant response in 2 patients; one complete and one partial response. The median survival was 7.5 months (range 6–39 months) after bone metastasis. We conclude bone involvement in cancer ovary is associated with poor prognosis.
Effect of Menstruation on Serum CA125 Levels
Authors: Kan Yuen‐Yee , Yeh Shin‐Hwa , Ng Heung‐Tat , Lou Ching‐Mee
Published: August 2010

CA125 levels were measured in the sera of 54 women with normal menstrual cycle and without infectious, benign and malignant gynecologic disorders. In 54 subjects studied, 13 (24%) had no significant variations in serum CA125 levels throughout the menstrual cycle. In contrast, there 41 (76%) had significant variations in serum CA125 with peak levels (51.8±6.5 U/ml, mean±SEM) during menstruation. The concentration reached a normal value (17.7±1.6 U/ml, mean±SEM) at proliferative phase, and remained low throughout the rest phases of the cycle. The mean peak level was significantly higher than that at proliferative phase (P<0.001), where as no significant difference in mean concentration was detected between sequential phases from proliferative phase to premenstrual phase (P>0.1). Among 41 with variable CA125 levels in the menstrual cycle, more than half of them, namely 39% of the total (21/54), had the levels of the upper limit or normal values.
A Case Report: Cervical Pregnancy with Placenta Percreta an Ultrasonic Assisted Diagnosis
Authors: Monks Peter L. , Catalano Salvatore , Close Peter J.
Published: August 2010

A rare cervical pregnancy is reported, discussing the difficulty differentiating this condition from the cervical phase of an incomplete abortion. Placenta percreta further complicates this case.

Ultrasound will give a firm diagnosis of cervical pregnancy and associated placenta percreta.

Conservative and radical surgical care determined by vital signs are discussed.
Estradiol Administered in a Percutaneous Gel for the Prevention of Postmenopausal Bone Loss
Authors: Ng Heung‐Tat , Chang Sheng‐Ping , Yang Tzay‐Shing , Cho Min‐Ping , Wei Tzann‐Chyang
Published: August 2010

Sixty‐one postmenopausal women were randomized into 3 groups. Two groups of women were treated with estrogen replacement therapy (ERT) by percutaneous administration of estradiol gel at a dosage of 1.25 g and 2.5 g, respectively. The third group of women, receiving no treatment except placebo, was studied concurrently as a control group. Bone mineral density (BMD) was measured by quantitative computed tomography (QCT) in the vertebrae from T12‐L3 and hormones (E1, E2, FSH, LH and testosterone) were determined by radioimmunoassay at baseline, then at 6 monthly intervals thereafter. One year of the study has been completed thus far.

The results of this study indicate that: (1) loss of BMD in the control group was observed significantly only in surgical menopausal women and no significant loss of BMD was observed in women receiving ERT treatment regimens; (2) decrease of E1 in control group and increase of E1 in the treatment group were both significant.

These data suggest that percutaneous ERT may be used in prevention of postmenopausal bone loss, particularly in surgical menopausal women and the increased E1 may play a beneficial role in inhibiting loss of bone mass and relieving menopausal syndrome. Different dosages of estradiol gel which did not create any significant difference between the 2 treatment groups, need a longer period of follow‐up.
Cisplatin, Vinblastine and Bleomycin in Advanced and Relapsed Germ Cell Tumours of Ovary
Authors: Kumar Lalit , Bhargawa V. L. , Kumar Sunesh
Published: August 2010

Seventeen patients with germ cell tumours of ovary were treated with 4 cycles of cisplatin, bleomycin and vinblastine (PVB) chemotherapy (CT). All patients had undergone prior surgery: hysterectomy + bilateral salpingoophorectomy + omentec‐tomy—5, salpingoophorectomy + debulking surgery—10 and biopsy alone in 2 patients. Four of seventeen patients had relapsed earlier and received PVB as second line therapy. FIGO staging revealed: stage IIB in one, III C in 12 and stage IV in 4 patients. Gross residual disease (>2 cm) was present in 13 patients. The most common cell types were dysgerminoma—5, endodermal sinus tumour—5, immature teratoma—5, choriocarcinoma and mixed germ cell tumour in one patient each. Twelve patients (70.5%) achieved significant response; complete response—11, partial response in one patient. The common side effects of CT were nausea/vomiting, myelosuppression, fever, mucositis, diarrhoea and alopecia. One patient died due to CT toxicity. Three complete responders underwent second look surgery and were found free of disease.

This study confirms that PVB is an effective combination in the treatment of ad‐vancecd and recurrent germ cell tumours of ovary and can be given over brief period. The toxicity of the regimen is moderate.
The Value of Transabdominal Pelvic Ultrasonography in Monitoring of Ovulation Induction with Gonadotropins
Authors: Chan Yuen‐Fai , So William W. K. , Ho Pak‐Chung , Tang Grace W. K.
Published: August 2010

Seventy‐five patients with a total of 306 human menopausal gonadotropin treatment cycles over the period 1984–1989 were analysed retrospectively to evaluate the value of transabdominal pelvic ultrasonography in prevention of complications arising from ovulation induction with human menopausal gonadotropins. There were 60 pregnancies giving a pregnancy rate of 19.6% per cycle. There was positive correlation between the number of follicles ≥ 14 mm in mean diameter and the incidence and degree of hyperstimulation (p<0.005) as well as the incidence of multiple pregnancies (p<0.01). Ultrasonography is a useful adjunct for monitoring in such a program.
Abdominal Nerve Blockade for Postoperative Analgesia after Caesarean Section
Authors: Kuppuvelumani P. , Jaradi Hema , Delilkan Alex
Published: August 2010

A prospective study of blocking T10‐L1 with local anaesthetic, bilaterally in 30 patients undergoing caesarean section under general anaesthesia has been shown to provide effective postoperative analgesia thus requiring significantly less narcotics (mean 66.6 mg of pethidine) compared to the 30 patients in the control group (mean 163 mg of pethidine). A cocktail of 0.5% of bupivacaine with adrenaline and xylocaine 1% produced analgesia for the duration ranging from 8 to 12 hours (mean 8.4 hours). Patients with abdominal field block were awake, alert and comfortable during the immediate postoperative period. They were pain‐free sufficiently to put the babies to the breast early and frequently.
Endometriosis and Luteal Phase Defect
Authors: Moeloek F. A. , Moegny Endy
Published: August 2010

It has been reported that there exists a correlation between endometriosis and the luteal phase defect (LPD) as one of the determinants in infertility. In some theories, the hampered maturation of the corpus luteum is believed to be caused by the reduction of LH receptors, increase in prolactin, prostaglandin and macrophages in endometriosis.

The purpose of this clinical study is to prove the hypothesis that there exists a significant correlation between endometriosis and the luteal phase defect in infertility.

The samples were taken at random from 150 women with infertile marriages on whom ovulation was assumed to have occurred, from January 1981 to December 1985. The assumption that there might have occurred ovulation is determined through the observation of their basal body temperature (BBT) chart. Endometrium biopsies to diagnose the LPD were taken at the end of their luteal phase. A laparoscopy examination to diagnose the pelvic endometriosis was done in the following cycle.

Of 84 patients with endometriosis, 44 (55.4%) had luteal phase defects, while the remaining 40 (47.6%) patients had no luteal phase defects. Of the 66 patients without endometriosis, 27 (40.9%) had luteal phase defects, while the remaining 39 (59.1%) did not have luteal phase defects. These differences were not significant (p > 0.05).

In summary, this clinical study fails to show the existence of significant correlation between endometriosis and the luteal phase defect.
The Effect of Nicardipine on Maternal and Fetal Hemodynamics and Uterine Blood Flow in Chronically Instrumented Pregnant Goats
Authors: Matsuda Yoshio , Ikenoue Tsuyomu , Matsuda Kazuhiro , Sameshima Hiroshi , Ibara Satoshi , Hokanishi Hisahiko , Sakamoto Hiroshi
Published: August 2010

This study was designed to clarify the maternal and fetal hemodynamics of nicardipine (0.02 mg/kg) administered intravenously to unanesthetized, chronically instrumented pregnant goats. Nicardipine produced a significant increase in maternal heart rate and cardiac output, and a significant decrease in maternal mean arterial blood pressure and systemic vascular resistance. These changes persisted for about 30 minutes. There were no consistent changes in maternal pulmonary hemodynamics. Uterine arterial blood flow (UBF) decreased significantly (about 15%) after 5 minutes of the injection and returned to the control value within 30 minutes. A significant correlation between the decreases in UBF and maternal diastolic blood pressure was observed after 5 minutes of the injection. The fetal heart rate, blood pressure and acid‐base status did not change after the injection of nicardipine. These observations of pregnant goats suggest that nicardipine might be a useful agent for the treatment of acutely hypertensive crises in pregnant patients.
Pharmacological Characteristics of Contractile Responses of Rabbit Uterine Cervices to Electrical Field Stimulation
Authors: Okawa Toshiaki , Suzuki Yosuke , Endo Chikara , Hoshi Kazuhiko , Sato Akira , Nakanishi Hironori
Published: August 2010

The pharmacological characteristics of contractile responses to electrical field stimulation (EFS) of uterine cervical muscular strips taken from non‐pregnant and pregnant rabbits were investigated,in vitro. The contractile responses to EFS of both non‐pregnant and pregnant muscular strips were markedly depressed by treatment with prazosin 1 μm, while the responses were only slightly depressed by treatment with atropine 1 μM. Propranolol 1 μM did not affect the responses. Guanethidine 10 μM and tetrodotoxin (TTX) 10 μm also depressed the contractile responses to EFS of both non‐pregnant and pregnant muscular strips. However, the depressive effects of the latter 2 drugs were more marked in non‐pregnant muscular strips than in pregnant ones. These findings indicate that the uterine cervical smooth muscle is predominantly innervated with adrenergic excitatory nerve fibers. The cholinergic innerva‐tion in uterine cervical smooth muscle seems minor. Futhermore, during pregnancy, a TTX‐resistant, non‐adrenergic, non‐cholinergic component might increase the contractile response of uterine cervical smooth muscle to EFS.
Contraceptive Practice before Female Sterilization*
Authors: Thike Katherine Ba , Wai Khin Thet , Oo Nan , Yi Khin Htar
Published: August 2010

The reproductive profile and contraceptive practice of 402 women undergoing female sterilization at the Central Women's Hospital are presented. Most (89%) of the interviewees were urban‐dwellers and housewives with primary school education. Fifty‐two percent were between 30 and 34 years with a mean of 4.2 living children. Sixty‐nine percent were past contraceptive users, of them; 29.9% had used more than one method. A considerable gap between knowledge and practice of different methods was found. Education level and employment had a significant effect on contraceptive practice (p<0.01 and p<0.5).

The majority knew and used combined oral contraceptive pills and injectable progestogens, whereas rhythm, withdrawal and barrier contraception were lesser known methods. Contraceptive use was primarily for child‐spacing whereas the main reasons for female sterilization were socioeconomic and achievement of desired family size.
Case Report: Spontaneous Pregnancy following Thymectomy for Myasthenia Gravis Associated with Premature Ovarian Failure
Authors: Chung Tony K. H. , Haines Christopher J. , Yip S. K.
Published: August 2010

We report the case of a 29‐year‐old woman who was diagnosed to have premature ovarian failure (POF) and myasthenia gravis at the age of 27 years. She was treated by thymectomy and pyridostigmine. Hormone replacement was started after the operation and she subsequently conceived spontaneously. We believe this is the first report of a spontaneous pregnancy after the diagnosis of POF associated with myasthenia gravis.
Treatment Failure in Malignant Gestational Trophoblastic Disease*
Authors: Byun Ji‐Soo , Yoon Young‐Don , Oh Sung‐Tack , Song Tae‐Bok , Choi Ho‐Sun , Lee Yu‐Ill
Published: August 2010

One hundred and thirty‐three patients with malignant gestational trophoblastic disease (GTD) were admitted. All patients (86/86) of the nonmetastatic and metastatic low‐risk groups and 89.4% (42/47) of the metastatic high‐risk group showed remission. The overall remission rate was 96.2%. Among 5 patients with brain metastases, however, only one (20%) survived. We arrived at two main conclusions. First, brain metastatic lesions did not successfully respond to therapy utilizing conventional chemotherapeutic regimens. Second, the key factors for successful outcome in brain metastases were early diagnosis and aggressive initial therapy. Therefore, early detection of brain metastases should be made with: (1) fine computerized tomography (CT) or magnetic resonance imaging (MRI), (2) measurement of the ratio of serum to cere‐brospinal fluid hCG concentration, and (3) early recognition of their clinical features.
Hormone Treatment Related Bone Mineral Content Changes in Japanese Women with Endometriosis
Authors: Fukushima Mineko , Shindo Masaaki , Sato Kozo
Published: August 2010

The effects of a GnRH agonist and danazol on bone mineral content (BMC) in Japanese women with endometriosis were investigated. Nineteen women with lap‐aroscopically confirmed endometriosis were treated with buserelin (900 μg/d administered intranasally, 10 cases) or with danazol (400 mg/d p.o., 9 cases) for 6 months. Trabecular BMC of the 3rd lumbar vertebra was measured using quantitative computerized tomography before treatment, at the end of treatment and 6 months after treatment by the same radiologist who was not informed about the drugs used. Serum estradiol and the biochemical parameters of bone metabolism were also measured. A significant decrease in BMC (10% on average; maximum 25.4%) was observed at the end of treatment with buserelin (p<0.01) and this loss was only partially recovered 6 months after treatment. In the danazol group, however, a slight gain in BMC was observed. Buserelin suppressed serum estrogen levels much more than danazol did. Parameters of bone resorption tended to increase in the buserelin group. Because treatment with buserelin, but not with danazol, was always associated with a significant decrease in BMC at L3, repeated usage of buserelin may lead to cumulative bone lpss in patients with endometriosis.
Megacystis Microcolon Intestinal Hypoperistalsis Syndrome: Antenatal Ultrasound Appearance. A Case Report
Authors: Gürgan Timur , Yarall Hakan , Zeyneloglu Hulusi , Develioglu Osman , Urman Bülent
Published: August 2010

We report a case of megacystis microcolon intestinal hypoperistalsis syndrome the diagnosis of which was established antenatally by ultrasonographic examination.
Serum Level of Magnesium Attained in Magnesium Sulfate Therapy for Severe Preeclampsia
Authors: Phuapradit Winit , Saropala Nopadol , Haruvasin Somchai , Thuvasethakul Pichai
Published: August 2010

Serum magnesium levels were determined in severe preeclampsia patients who were treated with magnesium sulfate infusion. Forty‐four patients with diagnosis of severe preeclampsia between 30–41 weeks gestation, given a conventional 5 g magnesium sulfate intravenous bolus infusion and 1 g/hr continous infusion and continued 24 hours postpartum, were prospectively studied. The mean pre‐treatment magnesium level was 2.3±0.3 mg/dl which was similar to those reports. The levels measured at 1/2, 1, 2, 4, 12 and 24 hours after initiation of magnesium infusion were 4.8±0.4, 4.7±0.4, 4.5±0.3, 4.7±0.3, 5.4±0.3 and 5.9±0.3 mg/dlrespectively. After delivery the levels were measured immediately, 12, and 24 hours and found to be 4.7±0.4, 4.9 ±0.4, and 5.2±0.3 mg/dl respectively. The serum magnesium levels were also varied with maternal weight, the dose regimen used in our study is appropriate for Asian pregnant women whose body weight usually less than 70 kg.
Serum Manganese Superoxide Dismutase (MnSOD) and Histological Virulence of Ovarian Cancer
Authors: Nishida Takashi , Sugiyama Toru , Kataoka Akio , Tashiro Masamichi , Yakushiji Michiaki , Ishikawa Mutsuo
Published: August 2010

The serum level of a scavenging enzyme, manganese superoxide dismutase (MnSOD), was examined in 78 patients with ovarian cancer. Tumors included 27 stage I, 6 stage II, 37 stage III and 8 stage IV diseases. They were classified as 43 serous, 18 mucinous, 10 clear cell and 7 endometrioid neoplasms, and grouped into 25 grade I, 27 grade II and 26 grade III cancers. Factors affecting the MnSOD level were estimated by analysis of variance and Bonferroni t‐test. From these, both the stage and histology were less‐effectively affected by the level, while the histological grade was estimated as effective with p<0.05. The MnSOD value increased significantly in accordance with the escalation of the tumor grade with p=0.02 for grade I vs II, 0.005 for II vs III, and 0.0001 for I vs III respectively. MnSOD determination may be unique as a predictor of the histological virulence of ovarian carcinoma.
Studies on the Permeability and Enzyme‐Cytochemistry of the Mouse Hemotrichorial Placenta*
Authors: Matsubara Shigeki , Tamada Taro , Sayama Masaaki , Saito Takuma
Published: August 2010

The permeability of higher molecular weight substances was investigated in mouse chorioallantoic labyrinthine hemotrichorial placenta, using horseradish peroxidase as a tracer. At the same time, ultrastructural localizations of some important enzymes, such as alkaline phosphatase (ALP), acid phosphatase (ACP), Ca++‐ATPase and guanylate cyclase were elucidated in this organ by means of the enzyme‐cytochemical technique.

Peroxidase easily entered the space between layers I and II, and no penetration of this tracer beyond layer II was observed. The reaction products for ALP activity were found mainly on the maternal side of the plasma membrane of the layer II tro‐phoblast. ACP activity was confined to the lysosomes of this layer II cell. In short, peroxidase stopped at the cell surface of the layer II trophoblast, and both ALP and ACP coexisted in this layer II cell. These observations strongly suggest that the layer II trophoblast, especially the surface plasma membrane of this cell, may have an important role in regulating the materno‐fetal transfer of substances in mouse chorioallantoic placenta.
Development and Evaluation of a Computer Expert System for the Management of Fetal Distress
Authors: Wong K. K. , Ng K. H. , Nah S. H. , Yusof K. , Rajeswari K.
Published: August 2010

Abstract

The general lack of specialist obstetricians in a developing country such as Malaysia prompted us to develop a computer expert system for the management of fetal distress in rural hospitals. It was based on accepted production rules and implemented on a microcomputer. The clinical prototype was evaluated by 8 specialist obstetricians and 21 non‐specialist doctors involved in obstetric care. The initial impression was that this type of expert system may help in diagnosis, decision‐making and teaching.
Intrauterine Pressure: Comparison of Extra vs Intra Amniotic Methods Using a Transducer Tipped Catheter
Authors: Chua Selina , Arulkumaran S. , Yang Mary , Steer Philip J. , Ratnam S. S.
Published: August 2010

Abstract

Fourteen women admitted in early labor, with intact membranes, were studied. In each woman, two catheters were inserted transcervically; one catheter was inserted into the extraamniotic space before rupture of membranes, and the second catheter was inserted, after artificial rupture of membranes into the intraamniotic cavity. The contraction to contraction difference in active pressure (pressure above the baseline) recorded by the two catheters, as well as the cumulative total active pressure generated (calculated be adding the active pressure of all contractions) throughout labor by the two catheters were compared. Of the 606 contractions analysed, 43.2% showed pressure difference of 0–5 mmHg between the intra amniotic and extraamniotic catheter; 21.3% showed 6–10 mmHg difference, 12.2% showed a difference of 11–15 mmHg, and 23.3% showed a difference greater than 15 mmHg. When total active pressure generated by each catheter for individual patients was calculated, the percentage difference varied from 2.3% to 53.7%. Intrauterine pressure measurements in labour using transducer‐tipped catheters inserted in the extraamniotic space may not provide comparable information to a similar catheter inserted intraamniotically when membranes are ruptured.
Transient Blindness in Pregnancy Induced Hypertension
Authors: Achanna Siva , Monga Deepika , Sivagnanam
Published: August 2010

Abstract

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject.

Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.