bluuebunny/crossref_metadata_2025 huggingface dataset:
Serous borderline tumours of the ovary
Authors: Kurman R J , Seidman J D , Shih I‐M
Published: August 2005

In this Expert Opinion we have invited articles from two leading groups, to discuss serous borderline tumours (serous tumours of low malignant potential) of the ovary from their own perspectives. Controversy remains over heterogeneity within this group of tumours and their relationship to ovarian cancer. Our authors discuss the histopathological classification of these tumours in relation to morphological appearances, molecular and clinical data. The significance of a micropapillary pattern is discussed, and issues related to extra‐ovarian implants.
Cytokeratin 7 and 20 expression in intestinal metaplasia of the distal oesophagus: relationship to gastro‐oesophageal reflux disease
Authors: Shearer C , Going J , Neilson L , Mackay C , Stuart R C
Published: August 2005

Aims : Intestinal metaplasia and gastro‐oesophageal reflux disease typify classical Barrett's oesophagus. Cytokeratin (CK) 7 and 20 phenotypes differentiate intestinal metaplasia in long segment Barrett's oesophagus from gastric intestinal metaplasia. This study examines the relationship between CK7/20 phenotypes and reflux disease in intestinal metaplasia of the distal oesophagus.

Methods and results : Eighty patients with oesophageal pH studies included 30 with long segment Barrett's, 16 with short segment Barrett's and 34 with intestinal meatplasia of the gastro‐oesophageal junction. Representative biopsy specimens were immunostained for CK7 and CK20. All 30 long segment patients demonstrated a Barrett's CK7/20 phenotype. All nine short segment patients with gastro‐oesophageal reflux had a Barrett's CK7/20 phenotype, while four of seven short segment patients without reflux had a gastric CK7/20 phenotype (P = 0.019). Of 14 patients with intestinal metaplasia of the gastro‐oesophageal junction and reflux, 10 (71%) had a Barrett's CK7/20 phenotype, compared with 11 (55%) of the 20 non‐reflux patients.

Conclusions : CK7/20 immunoreactivity for patients with intestinal metaplasia of the distal oesophagus without long segment Barrett's oesophagus suggests a heterogeneous group, with an association between Barrett's CK7/20 pattern and gastro‐oesophageal reflux disease in both short segment Barrett's and intestinal metaplasia of the gastro‐oesophageal junction.
Pinus cembra L. (arolla pine), a common tree in the inner French Alps since the early Holocene and above the present tree line: a synthesis based on charcoal data from soils and travertines
Authors: Ali Adam A. , Carcaillet Christopher , Talon Brigitte , Roiron Paul , Terral Jean‐Frédéric
Published: August 2005

Aim  In this study, charcoal‐based data for Pinus cembra L. (arolla pine) were gathered from soil and travertine sequences in order to reconstruct its historical biogeography at the landscape level in the inner western Alps during the Holocene.

Location  The study sites are located between 1700 and 2990 m a.s.l., in the southern (Queyras Massif and Ubaye Valley) and the northern (Maurienne Valley) parts of the inner French Alps.

Methods  Charcoal fragments were extracted from sediments by water sieving, using meshes of 5, 2, 0.8 and 0.4 mm. The charcoal mass of P. cembra was determined in each charcoal assemblage. Accelerator mass spectrometry and conventional 14C measurements were used to date the fragments.

Results  Supported by 40 14C datings, the fragments show that, over 2000 m a.s.l., P. cembra accounts for around 40% (mean value) of identified fragments. Data reveal that arolla pine once extended between 260 and 375 m above the present‐day local tree lines. It was established in the southern and the northern French Alps from at least c. 9000 and 6000 cal yr bp, respectively.

Main conclusions  While present‐day populations of P. cembra are very fragmented in the inner French Alps, charcoal records indicate large past occurrences of this tree since the early Holocene. Human disturbance since the Neolithic seems to be the main reason for the regression of the arolla pine woodlands. On the south‐facing slopes of the study sites, currently deforested, this species extended up to 2800 m a.s.l. In the northern areas, charcoal records of the P. cembra expansion are consistent with the regional pollen archives, but in the southern massifs charcoal records indicate its presence c. 2600 years earlier than other palaeobotanical studies suggest. This discrepancy highlights the necessity to crosscheck data using several different proxies in order to assess the validity of conclusions regarding tree development in space and time.
Swiss Atherothrombosis Survey: a field report on the occurrence of symptomatic and asymptomatic peripheral arterial disease
Authors: HAYOZ D. , BOUNAMEAUX H. , CANOVA C. R.
Published: August 2005

Objectives.  To investigate the Ankle/Brachial Pressure Index (ABI) for its suitability in daily practice to identify patients at atherothrombotic risk. To collect data on the prevalence of atherothrombotic events [coronary artery disease (CAD), stroke/transient ischaemic attack (TIA)], of ‘hidden’ (asymptomatic) versus ‘known’ (symptomatic) peripheral arterial disease (PAD) and treatment in the general practice population.

Design.  Field survey from everyday Swiss practice. On five consecutive workdays, 276 doctors documented all patients, recording gender, age, history of atherothrombotic events, risk factors and family history. In the case of a previous stroke/TIA and/or CAD, or two or more risk factors were present at age >55, the ABI was determined. A total of 25 351 patients were included and 3921 ABI measurements were performed in eligible patients.

Setting.  Practices of primary care doctors.

Participants.  All patients who visited one of the 276 participating doctors on one of five consecutive workdays were included in the survey.

Intervention.  Data recording and measurement of the ABI on those patients who qualified.

Results.  Of the patients 3.7% had symptomatic PAD. An additional 2.7% of hitherto asymptomatic patients were identified as being at high atherothrombotic risk by having an ABI value <0.9. Exactly 93.9% of the participating doctors considered the ABI measurement easy to incorporate into the diagnostic routine of patients presenting with risk factors.

Conclusions.  The ABI measurement is an easy‐to‐use, noninvasive and reliable means to identify patients at risk of atherothrombotic events. Identification of asymptomatic PAD leads to intensified targeted prophylactic atherothrombotic treatment that can reduce morbidity and mortality.
A dichotomous epigenetic mechanism governs expression of the LlaJI restriction/modification system
Authors: O'Driscoll Jonathan , Fitzgerald Gerald F. , van Sinderen Douwe
Published: August 2005

The LlaJI restriction/modification (R/M) system is comprised of two 5mC MTase‐encoding genes, llaJIM1 and llaJIM2, and two genes required for restriction  activity, llaJIR1  and llaJIR2.  Here,  we  report the molecular mechanism by which this R/M system is transcriptionally regulated. The recognition sequence for the LlaJI MTases was deduced to be 5′GACGC′3 for M1.LlaJI and 5′GCGTC′3 for M2.LlaJI, thus together constituting an asymmetric complementary recognition site. Two recognition sequences for both LlaJI MTases are present within the LlaJI promoter region, indicative of an epigenetic role. Following in vivo analysis of expression of the LlaJI promoter, we established that both LlaJI MTases were required for complete transcriptional repression. A mutational analysis and DNA binding studies of this promoter revealed that the methylation of two specific cytosines by M2.LlaJI within this region was required to trigger the specific and high affinity binding of M1.LlaJI, which serves to regulate expression of the LlaJI operon. This regulatory system therefore represents the amalgamation of an epigenetic stimulation coupled to the formation of a MTase/repressor:promoter complex.
Tris stimulates ecdysteroid secretion via Ca2+ messenger system in the prothoracic glands of Locusta migratoria
Authors: Neuwirth Aleš , KodríK Dalibor , Birkenbeil Heiner , Sehnal František
Published: August 2005

Abstract.  Secretion of ecdysteroids by the prothoracic glands of the migratory locust, Locusta migratoria L., is enhanced in vitro by tris(hydroxymethyl)aminomethane (tris) in a dose‐dependent manner. Glands from larvae on the second day of the penultimate stadium are most sensitive. This action of tris depends on the uptake of calcium; increased production of ecdysteroid does not occur in the presence of cadmium, verapamil or TMB‐8, or in calcium‐free media. The concentration of unbound Ca2+, [Ca2+]i, in the cytoplasm is measured with the aid of FURA 2/AM. Tris causes a rise of [Ca2+]i that is fully suppressed by lanthanum and partially by nitrendipine. Two antagonists of IP3 receptors elicit mutually opposite effects: heparin blocks, whereas 2‐APB accelerates, the rise in [Ca2+]i. Ryanodine exerts only a slight effect. It is proposed that tris activates locust prothoracic glands in a Ca2+‐dependent manner that exhibits many similarities to the transduction pathway of prothoracicotropic hormone.
The hemoglobinopathies and malaria
Authors: Richer J , Chudley AE
Published: August 2005

With philatelic illustrations, we review sickle cell anemia, some of the common hemoglobinopathies, and their relevance to malaria. We discuss the mechanism by which hemoglobinopathies arise, the progress made with pre‐natal screening, as well as innovative therapies. We review recent developments in the pathophysiology of malaria and discuss innovations in the effort against this parasite.
Doppler echocardiographic assessment of atrioventricular velocity waveforms in normal and small‐for‐gestational‐age fetuses
Authors: RIZZO GIUSEPPE , ARDUINI DOMENICO , ROMANINI CARLO , MANCUSO SALVATORE
Published: August 2005

Summary. A prospective longitudinal study determined the physiological patterns of blood flow velocity waveforms in normal and in small‐for‐gestational‐age (SGA) fetuses. Using a Pulsed Doppler Duplex system, 125 normally grown fetuses and 35 SGA fetuses were studied longitudinally at between 27 and 42 weeks gestation. In normal fetuses the ratio between the E velocity (early passive ventricular filling) and the A velocity (active ventricular filling during atrial contraction) increased progressively during pregnancy in both transmitral and transtricuspid waveforms, approaching 1 at term. In SGA fetuses, the E/A ratios did not increase during pregnancy and the values obtained were significantly lower than in normal fetuses. The ratio between the transtricuspid and transmitral mean temporal velocities remained almost constant throughout pregnancy in the normal fetuses with transtricuspid velocity slightly exceeding the transmitral velocity. On the other hand, in SGA fetuses the ratio between the mean temporal velocities was inversed with the transmitral velocity progressively greater than the transtricuspid velocity suggesting the existence of intracardiac hacmodynamic changes in these fetuses.
Retrieval of intrauterine contraceptive devices with missing tails, using Lamicel
Authors: JOHNSON NICHOLAS , MOODLEY JACK
Published: August 2005

Summary. Preliminary cervical dilatation using Lamicel, followed by relatively painless uterine probing was successful in removing 30 of 31 contraceptive devices that had not been removable in the outpatient clinic. This technique is simple, safe, inexpensive and well tolerated. It can be utilized to retrieve intrauterine contraceptive devices with missing tails when other conventional clinic procedures fail.
Plasma corticotrophin‐releasing factor (CRF) in normal pregnancy
Authors: WOLFE C. D. A. , PATEL S. P. , CAMPBELL E. A. , LINTON E. A. , ANDERSON J. , LOWRY P. J. , JONES M. T.
Published: August 2005

Summary. Corticotrophin‐releasing factor (CRF) was measured directly in maternal plasma using an immunoradiometric assay (IRMA). In the first and second trimester CRF levels were within the non‐pregnant range (mean 15 pg/ml). A total of 72 women was followed sequentially from 28 weeks until delivery and CRF levels rose from a median of 20 pg/ml at 28 weeks to 1320 pg/ml at 40 weeks and 1732 pg/ml during labour. There was a strong correlation (rs= 0·81, P<0·001) between gestational age and CRF levels. The rate of rise of CRF (pg/ml) per week was associated with weight gain (rs= 0·36, P<0·05) but with no other obstetric variable. There was an association between umbilical cord and maternal plasma CRF levels (rs= 0·54, P<0·01).
Tape measurement of symphysis‐fundal height in twin pregnancies
Authors: NEILSON J. P. , VERKUYL D. A. A. , BANNERMAN C.
Published: August 2005

Summary. We hypothesized that tape measurement of symphysis‐fundal height could be useful in detecting multiple pregnancies, and in such cases in predicting preterm labour and identifying small‐for‐gestationalage (SGA) fetuses. Although mean fundal height is substantially greater in twin than in singleton pregnancies, the value of the technique to detect multiple pregnancies may be limited because combined birthweight is less and the frequency of SGA fetuses is greater in undiagnosed than in diagnosed twin pregnancies. We found no evidence that the measured fundal height is greater in pregnancies going on to preterm delivery, and we suggest that the commonly accepted theory that the high rate of preterm labour in twin pregnancies results simply from uterine overdistension be reappraised. Nevertheless, fundal height measurement was of value in identifying pregnancies in which both babies were SGA and is therefore recommended as a simple, inexpensive and non‐invasive technique.
Short‐term reproductive prognosis when no cause can be found for recurrent miscarriage
Authors: PARAZZINI FABIO , ACAIA BARBARA , RICCIARDIELLO ORIETTA , FEDELE LUIGI , LIATI PAOLA , CANDIANI G. BATTISTA
Published: August 2005

Summary. The short‐term reproductive prognosis of recurrent miscarriage for which no cause was found has been evaluated in 95 couples investigated between 1980 and 1986 at the First Obstetric and Gynaecological Clinic of the University of Milan. The actuarial overall 3‐year livebirth delivery rate was 64%, increasing constantly with time. The reproductive success rate decreased with the number of previous miscarriages from 80% in women with two, to 60% with three and 46% with four or more miscarriages. No effect of age and socio‐economic status emerged. There was a positive association between the number of previous miscarriages and the risk of miscarriage in the next pregnancy. Compared with women with two miscarriages the relative risk of another miscarriage was 2·3 for those with three previous miscarriages and 5·0 for those with four or more (χ21 for trend adjusted for age = 5·2, P= 0·02).
Chlamydia trachomatis among sexually active teenage girls. Lack of correlation between chlamydial infection, history of the patient and clinical signs of infection
Authors: RAHM VIVI‐ANNE , GNARPE HÅKAN , ODLIND VIVECA
Published: August 2005

Summary. Cultures for Chlamydia trachomatis were obtained from 1012 teenage girls attending an adolescence clinic mainly for family planning; C. trachomatis was isolated from 174 (17·2%). The proportion of chlamydia‐positive girls varied between 15·7% and 28·5% depending whether or not there were symptoms and signs of infection. Neither the history nor the finding at pelvic examination offered conclusive evidence for or against the presence of an infection with C. trachomatis. Of the chlamydia‐positive, untreated, asymptomatic girls, 17·5% developed symptoms of a genital infection within 3 months. There was a statistically significant difference in the proportion of positive cultures by the two investigators, suggesting that the procedure for specimen collection is of great importance.
A prospective study of colposcopy in women with mild dyskaryosis or koilocytosis
Authors: BOLGER B. S. , LEWIS B. V.
Published: August 2005

Summary. Colposcopy was performed in 91 women who had cervical cytology suggesting mild dyskaryosis or showing koilocytosis, all previous cytology having been normal. The final histological diagnosis was C1N III in 22%, CINII in 18%, CINI in 31%, koilocytosis alone in 14% and no abnormality in 15%. These results indicate that even with mild cytological atypia, a high proportion of patients will have more advanced disease when colposcopy‐directed punch biopsy is performed.
Bladder drainage: a survey of practices among gynaecologists in the British Isles
Authors: HILTON PAUL
Published: August 2005

Summary. All 2836 members and fellows of the Royal College of Obstetricians and Gynaecologists were circulated with a questionnaire concerning catheterization practices; 1229 replies were received, an overall response rate of 43%; the response rate from practitioners of consultant and senior registrar status was 67%. Practices varied considerably, some aspects of management apparently relating to the age or experience of the surgeon, some to their level of interest or surgical commitment in gynaecological urology, and some showing regional variation. Of the 960 respondents in active gynaecological practice, 84.93% (depending on the operation) drained the bladder before routine abdominal procedures, 52–54% (depending on the route) drained the bladder before incontinence surgery, and 62–70% routinely used continuous bladder drainage for periods between 1 and 12 days following these procedures. Overall, 51% of respondents preferred urethral. and 39% suprapubic catheters for postoperative bladder drainage; this showed a marked regional‐ and experience‐related variation. Prophylactic antibiotics were used by 32% of gynaecologists overall, and a wide variety of other measures were employed in the management of catheter‐associated infection, and other problems of catheter management.
Pregnancy outcome in elderly primigravidae with and without a history of infertility
Authors: TUCK SUSAN M. , YUDKIN P. L. , TURNBULL A. C.
Published: August 2005

Summary. The pregnancy outcome of 196 primigravidae aged 35 years or over, with no history of involuntary infertility, was compared with that of 196 matched primigravidae aged 20–25 years, and also with 72‘elderly’ primigravidae (35 years) whose pregnancies had followed a period of involuntary infertility of at least 1 year. The older primigravidae with no history of infertility had a four‐fold risk of preterm (<37 weeks) delivery, a five‐fold risk of caesarean section and significantly increased rates of vaginal operative delivery, chronic hypertension and fibroids, when compared with the primigravidae between 20 and 25 years of age. They also showed a greater tendency to severe preeclampsia and perinatal death, but these differences were not statistically significant. Elective caesarean section was twice as common in the older women with a history of infertility than in those without such a history (20.8% compared with 10.7%) although this difference was not statistically significant. No other differences in pregnancy outcome were found between the two‘elderly’ groups.
Alcohol counselling of 85 pregnant problem drinkers: effect on drinking and fetal outcome
Authors: HALMESMÄKI ERJA
Published: August 2005

Summary. Eighty‐five pregnant problem drinkers were given intensive counselling throughout gestation to persuade them to reduce or stop their alcohol intake. Nevertheless, 7% of their blood specimens collected at follow‐up visits contained ethanol. Fifty‐five women (65%) were able to reduce their alcohol consumption by at least 50%. Alcohol abuse was associated in a dose‐dependent manner with fetal growth retardation detectable by uftrasonography from 27 weeks gestation. Twenty infants (24%) had a complete fetal alcohol syndrome and 22 (26%) had some features of‘fetal alcohol effects’ (FAE). In addition, the rate of structural malformations was high (13%). Of the women with continuous alcohol abuse 89% gave birth to infants with at least one feature of FAE compared with only 40% of those who decreased their alcohol consumption.
Early pregnancy termination: a comparison between vacuum aspiration and medical abortion using prostaglandin (16,16 dimethyl‐trans‐Delta;2‐PGE, methyl ester) or the antiprogestogen RU 486
Authors: CAMERON I. T. , BAIRD D. T.
Published: August 2005

Summary. Three different regimens for termination of early pregnancy by medical means were compared to vacuum aspiration. Women seeking therapeutic abortion of pregnancy (56 days amenorrhoea) were allocated to one of four treatment groups: (1) vacuum aspiration (n= 28); (2) 1 mg vaginal pessary of a prostaglandin analogue (gemeprost) every 3 h for up to 5 pessaries (n=30); (3) the antigestogen (RU 486 mefipristone) 150 mg per day for 4 days by mouth (n=20); (4) RU 486 in the same dose as group 3 together with 1 mg gemeprost on day 3 (n= 19). Complete abortion occurred more often in women treated with vacuum aspiration (96%), gemeprost alone (97%) and RU 486 plus gemeprost (95%) than in those treated with RU 486 alone (60%). In women receiving up to five gemeprost pessaries alone vomiting occurred in 7 (23 %) and diarrhoea in 10 (33%); 16 (53%) required parenteral opiates for relief of pain. Side‐effects and analgesic requirements were much reduced in the women who received RU 486 alone or in combination with a single gemeprost pessary. There was no difference in the number of days of vaginal bleeding after abortion between the four groups although there was wide individual variation (mean 10 days, range 1–34). These results confirm that medical induction of abortion in early pregnancy with prostaglandin vaginal pessaries is as effective as vacuum aspiration and that the dose can be reduced five‐fold without loss of efficacy when used in combination with RU 486.
Doppler assessment of the cardiac and uteroplacental circulations in normal and complicated pregnancies
Authors: AL‐GHAZALI W. , CHAPMAN M. G. , ALLAN L. D.
Published: August 2005

Summary. Blood flow velocity waveforms were recorded in four sites in the fetal circulation in a series of 271 normal and 71 complicated pregnancies. The sites were the umbilical artery, the uterine artery branches in the placental bed, and distal to the two arterial valves in the heart. The blood flow through the arterial valves was added to estimate combined cardiac output. Normal ranges for values in all sites were established in our own series, and were similar to other published results. Abnormality of the waveform in the umbilical artery proved the most useful predictor of perinatal morbidity. Reversal of the normal pattern of increasing diastolic flow in the umbilical artery with advancing gestation was an important prognostic finding in the pregnancies studied serially. The combined cardiac output did not fall until late in the course of fetal compromise, and low values were seen only with an abnormal umbilical artery tracing.
The effect of pelvic floor exercises in the treatment of genuine urinary stress incontinence in women at two hospitals
Authors: HENALLA S. M. , KIRWAN P. , CASTLEDEN C. M. , HUTCHINS C. J. , BREESON A. J.
Published: August 2005

Summary. The results of the pelvic floor exercises for the treatment of genuine stress incontinence of urine were compared between two different hospitals geographically 50 miles apart. A perineal pad weighing test was used to assess the quantity of urine lost during exercise before and after treatment. A similar percentage of patients in the two studies responded to treatment and became either completely dry or significantly improved at the end of 3 months interval; 69% at LCH and 65% at LGH. Overall, 67% of patients achieved complete continence or a significant improvement as a result of pelvic floor exercises alone.
The blood flow velocity waveform in the fetal internal carotid and umbilical artery; its relation to fetal behavioural states in the growth retarded fetus at 37–38 weeks gestation
Authors: VAN EYCK J. , WLADIMIROFF J. W. , NOORDAM M. J. , VAN DEN WIJNGAARD J. A. G. W. , PRECHTL H. F. R.
Published: August 2005

Summary. In eight women whose fetuses showed evidence of intrauterine growth retardation (IUGR), the relation was examined between the blood flow velocity waveform in the fetal internal carotid and umbilical artery and fetal behavioural states at 37–38 weeks gestation. In both vessels there was a virtual overlap of pulsatility index values originating from state IF and 2F, reflecting behavioural state independency. In the internal carotid artery this state independency is associated with moderately reduced pulsatility index values.
A randomized controlled trial of the provision of a social support service during pregnancy: the South Manchester Family Worker Project
Authors: SPENCER BRENDA , THOMAS HELEN , MORRIS JANE
Published: August 2005

A pilot scheme was introduced in Manchester to provide additional social support to pregnant women at above average risk of giving birth to a low‐birthweight baby. The help of lay workers, known as family workers, was made available to eligible women. The effect on infant birthweight of offering the help of a family worker was assessed by a randomized controlled trial. No significant differences were observed between the experimental and control group, but on a number of grounds the interpretation of this finding is not straightforward, and further research is recommended.
Socio‐economic Status and pregnancy outcome. An Australian study
Authors: MORRISON J. , NAJMAN J. M. , WILLIAMS G. M. , KEEPING J. D. , ANDERSEN M. J.
Published: August 2005

A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers' Hospital in Brisbane was examined to consider the impact of socio‐economic Status on pregnancy outcome. The indicators of socio‐economic Status selected were family income, maternal education and paternal occupational Status. Pregnancy out‐comes considered were preterm delivery, low birthweight, low birth‐weight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational Status of the father and three measures of perinatal morbidity. Initial adjustment for the mother's socio‐demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variations between the three Status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed dass differences in pregnancy outcome are attributable to the mother's personal characteristics (height/weight2, parity) and her lifestyle.
Induction of abortion in early first trimester human pregnancy using epostane
Authors: WEBSTER MICHAEL A. , GILLMER MICHAEL D. G.
Published: August 2005

The role of epostane (Sterling Winthrop, Guildford, UK), a competitive inhibitor of the 3β hydroxysteroid dehydrogenase enzyme system (3β‐HSD), as an abortifacient agent in early human pregnancy has been studied in 54 women. All were less than 49 days from their last menstrual period. Thirty were treated with 200 mg of epostane every 8 h for 7 days and 24 were given 200 mg every 6 h for 7 days. This caused a sustained reduction in circulating progesterone concentrations, a smaller fall in 17 β‐oestradiol and no effect on serum cortisol. Abortion occurred in 21 women (70%) in the lower dosage group and in 20 women (87%) in the higher dosage group. Abortion was incomplete in 6 of these 41 women. A worsening of pregnancy nausea and vomiting was noted by 66% of women in the first group and 84% in the second. There was no delay in the resumption of normal menstruation following abortion. This study confirms the potential of epostane as an effective inhibitor of ovarian and placental steroidogenesis and as a potent abortifacient agent in early human pregnancy.
Absorption of irrigating fluid during laser photocoagulation of the endometrium in the treatment of menorrhagia
Authors: MORRISON L. M. M. , DAVIS J. , SUMNER D.
Published: August 2005

Twelve women undergoing laser ablation of the uterus for menorrhagia were studied by haemodynamic, biochemical and haematological indices including radioisotope dilution studies of plasma volume to assess the degree of fluid absorption into the circulation during laser surgery. There was a significant rise in central venous pressure and serum chloride and a significant decrease in plasma protein, albumin and haematocrit. Absorption of the irrigating fluid used was demonstrated and in one woman whose case history is illustrated this was excessive.
The excretion of 5‐oxoproline in urine, as an index of glycine status, during normal pregnancy
Authors: PERSAUD C. , McDERMOTT J. , DE BENOIST B. , JACKSON A. A.
Published: August 2005

The urinary excretion of 5‐oxoproline, which may be used as an index of glycine status, was investigated in 30 normal pregnant women during different stages of pregnancy and in 18 non‐pregnant female volunteers. During an 18‐h study there was little variation in the 5‐oxoproline/creatinine index, and a single sample gave a representative value. The excretion of 5‐oxoproline/creatinine (μmol/mmol) rose progressively as pregnancy advanced (non‐pregnant mean 10, SD5, first trimester mean 46, SD 12, second trimester mean 150, SD 180, and third trimester mean 280, SD 320) and by the third trimester was over 20 times greater than in non‐pregnant women. The data suggest that as pregnancy advances the endogenous production of glycine may be insufficient to satisfy the increasing demands.
The relation between daily salivary progesterone profile and endometrial development in the luteal phase of fertile and infertile women
Authors: LI T. C. , LENTON E. A. , COOKE I. D. , DOCKERY P. , ROGERS A. W.
Published: August 2005

Summary. This study analysed the relation between daily salivary progesterone profiles in the luteal phase and endometrial development as assessed by morphometric studies of endometrial biopsies that were timed by luteinizing hormone surge. Among 34 fertile women studied, a threshold relation was noted between cumulative salivary progesterone concentration and 11 of the 17 morphometric features measured, as well as the results of the histological dating. Above the observed threshold, a significant linear correlation was found between cumulative salivary progesterone and the results of histological dating. Among 55 women, the progesterone profile in the first half of the luteal phase, but not the second half, was found to be significantly lower in those with retarded endometrial development than in those with normal development. Overall, 50% of retarded endometrial development was associated with a subnormal progesterone profile, but the other 50% was associated with a normal progesterone profile, in keeping with an abnormal response of the endometrium due to progesterone receptor deficiency. Retarded endometrial development was more likely to be associated with a subnormal progesterone profile in the first half of the luteal phase than in the second half.
Prostaglandin E production by the fetal membranes in unexplained preterm labour and preterm labour associated with chorioamnionitis
Authors: BERNAL A. LÓPEZ , HANSELL D. J. , KHONG T. Y. , KEELING J. W. , TURNBULL A. C.
Published: August 2005

The production of prostaglandin E (PGE) by amnion, choriodecidua and placenta was measured in 45 women delivered after spontaneous preterm labour, in 10 women delivered electively preterm, in 30 women at elective caesarean section at term, and in 28 women after spontaneous labour at term. In the preterm labour group 24 women had normal placental histology, and gestational age was 34 (31–36) weeks (median and range); 18 women had evidence of chorioamnionitis and gestational age was significantly shorter, 30 (24–36) weeks; three other patients had placental abruption. In the absence of inflammatory infiltration of these tissues the highest PGE output (fmol/mg dry weight/2 h) was found after labour at term and the lowest after uncomplicated preterm labour: 2640 (360–15 580) (median and range) compared with 1414 (164–11 045) in amnion, 677 (100–3245) compared with 308 (39–1086) in choriodecidua, and 1200 (520–3022) compared with 578 (150–1859) in placenta, respectively. Tissues showing chorioamnionitis produced much higher outputs of PGE from amnion (12278, 1799–82 617) and from choriodecidua (1018, 216–11 768), but not from placenta (616, 89–4131). Chorioamnionitis seems to cause very early preterm labour by increasing PG production in the amnion and choriodecidua.
Alternative positions in the second stage of labour: a randomized controlled trial
Authors: GARDOSI JASON , SYLVESTER SHARON , B‐LYNCH CHRISTOPHER
Published: August 2005

A controlled clinical trial involving 151 primigravidae and 18 midwives assessed the acceptability and outcome of second‐stage labour in upright positions. Women who had no specific antenatal preparation and preferences regarding labour positions were managed either conventionally (semi‐recumbent and lateral), or encouraged to adopt upright positions (squatting, kneeling, sitting or standing) according to individual preference. Of the women allocated to the upright position 74% completed the second stage upright, with kneeling being the most favoured position, but squatting was, despite all assistance, too difficult to maintain. Adoption of upright positions resulted in a higher rate of intact perineums. There was a clinically apparent reduction of forceps deliveries in the upright group which influenced midwives' attitudes. Moving the parturient from recumbent to upright positions was often perceived to be beneficial when there was slow progress. Estimated blood loss was similar in the two groups, as was the condition of the newborn (Apgar score and umbilical artery pH). Alternative positions in the second stage of labour, in particular kneeling, are achievable even without specific birth aids and antenatal preparation. They appear safe, acceptable to most parturients and their midwives, and arc easily integrated into modern labour ward practice; they may have clinical advantages which need further investigation.
Doppler time velocity waveform studies of the uterine artery and uterus
Authors: LONG M. G. , BOULTBEE J. E. , HANSON M. E. , BEGENT R. H. J.
Published: August 2005

Summary. This study describes a reliable and reproducible method of obtaining Doppler frequency shift waveforms from the uterine artery based on observations in 26 non‐pregnant women. The waveforms were detected easily but direct display of the vessel was inconsistent. The values of the pulsatility index calculated from the waveforms had a mean of 3·25 (SD 0·83). The standard error of the mean was 0·16 and based on this, the 95% reference range was 1·21 to 5·29. The stage of the menstrual cycle did not affect the pulsatility index nor was there any significant difference between subjects who were nulliparous and those who had had previous pregnancies. These results show that Doppler ultrasound can be applied to the non‐pregnant uterus and the data presented may be used as a baseline for the study of uterine pathology.
The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body‐weight
Authors: GJØNNÆSS HALVARD
Published: August 2005

Summary. In 89 women with polycystic ovary syndrome (PCOS) who conceived after ovarian electrocautery, the pregnancy continued beyond 31 weeks in 62. In this group the frequency of pre‐eclampsia and diabetes was 12·9 and 8·1% respectively. The increased frequencies were confined to overweight women. The frequency of major and minor malformations was 1% and 3·8% respectively. The rate of early miscarriage of the first pregnancy after ovarian electrocautery was 15%, and when later pregnancies were included the rate reduced to 10·3%. These data do not indicate any impact upon the course or outcome of pregnancy from the state of PCOS per se or the ovarian electrocautery that induced ovulation in this series.
Fetal pathology in human parvovirus B19 infection
Authors: VAN ELSACKER‐NIELE A. M. W. , SALIMANS M. M. M. , WETLAND H. T. , VERMEY‐KEERS CHR. , ANDERSON M. J. , VERSTEEG J.
Published: August 2005

Summary. In a current Netherlands study on the effects on mother and child of infection with the human parvovirus B19 during pregnancy, 10 pregnancies have been reported. Three of them ended before term: two in fetal death and one by elective abortion. In two of these fetuses B19 infection in cells other than those of the erythroid series was demonstrated, and in the one terminated, ocular malformation and extensive inflammatory reactions in all fetal and placental tissues were found. The presence of B19 DNA was demonstrated by dot hybridization in placental and fetal tissues. In the third no gross fetal abnormalities were found, although B19 DNA was detected in several fetal tissues by in‐situ hybridization. Of the remaining seven pregnancies, six ended at term in the birth of apparently healthy babies. The other child was born near term with a low birthweight and multiple congenital malformations, but with no proof of intrauterine B19 infection. It is concluded that B19 infection in pregnancy can interfere with organ development and may lead to intrauterine fetal death.
The effects of oral contraceptives and parity on ovarian cancer trends in women under 55 years of age
Authors: VILLARD‐MACKINTOSH LAURENCE , VESSEY MARTIN P. , JONES LESLIE
Published: August 2005

Summary. Mortality from epithelial ovarian cancer is falling in women under 55 years of age in England and Wales. The decline does not appear to be a treatment effect nor to be attributable to changes in the rate of oophorectomy. Case‐control studies have shown that high parity and oral contraceptive use are protective against the disease. We suggest that the decrease in mortality is compatible in timing and magnitude with exposure to oral contraceptives. No obvious effect on mortality attributable to parity was apparent in this analysis. Oral contraceptives may prove to be a widely acceptable means of preventing ovarian cancer, providing they do not increase breast cancer risk.
The diagnosis of polycystic ovaries in subfertile women
Authors: EDEN JOHN A. , PLACE JAN , CARTER GRAHAM D. , JONES JULIA , ALAGHBAND‐ZADEH JAMSHID , PAWSON MICHAEL E.
Published: August 2005

Summary. Laparoscopy was used to identify the polycystic ovary (PCO) in a group of subfertile women. A third were found to have PCO. These patients had higher levels of luteinizing hormone (LH), testosterone (T) and a higher free androgen index (FAI) than those with normal ovaries. Only 15% of patients with laparoscopic evidence of PCO were obese, hirsute and oligomenorrhoeic. Within the PCO group, hirsutism was strongly associated with obesity and a high FAI. A group of subfertile women with PCO and regular cycles was found who had no other identifiable cause for their infertility. These women had higher follicular phase concentrations of LH and higher FAI than ovulatory women with normal ovaries.
Bladder neck electrical conductivity in the treatment of detrusor instability with biofeedback
Authors: HOLMES D. M. , PLEVNIK S. , STANTON S. L.
Published: August 2005

Summary. A new method for controlling the symptoms and objective signs of detrusor instability was investigated in a pilot study. The method uses the activity of the bladder neck, monitored by a conductivity catheter, as a biofeedback signal. Voluntary closure of the bladder neck mechanism abolishes abnormal detrusor activity. Ten severely symptomatic women with detrusor instability were assessed clinically and urodynamically before and after a course of biofeedback. Statistically significant improvements in the symptoms of urgency and urge incontinence were found. Five of the seven women who agreed to have repeat cystometry had stable cystometrograms. There was a statistically significant fall in the mean maximum deflection at rest from 41·5 to 16·5 μA (P<0·05) measured during bladder neck electrical conductivity tests before and after treatment.
Preterm labour in twin pregnancies: can it be prevented by hospital admission?
Authors: CROWTHER C. A. , NEILSON J. P. , VERKUYL D. A. A. , BANNERMAN C. , ASHURST H. M.
Published: August 2005

Summary. Women attending a twin pregnancy antenatal clinic underwent cervical palpation to calculate a cervical score by subtracting dilatation from length. Those with a score of −2 or less at or before 34 weeks are at especially high risk of preterm labour. A total of 139 such women were randomly allocated either to receive bed‐rest in hospital or to continue conventional outpatient management. No beneficial effect of bed‐rest could be identified in prolonging twin pregnancy or improving fetal outcome.
A protocol for the routine measurement of lactate and pyruvate in cord blood
Authors: PRENTICE A. , VADGAMA P. , APPLETON D. R. , DUNLOP W.
Published: August 2005

Summary. The influence of the site of sampling and the delay in sample collection on cord blood concentrations of lactate and pyruvate were investigated. A delay in sample collection of >1 min after cord clamping could invalidate the results obtained. Samples from umbilical artery had higher lactate values (mean 3·13 mmol/l) than paired vein samples (mean 2·32 mmol/1) but there were no significant differences in lactate values between different sites sampled within the umbilical vein. A calculation was devised to circumvent the need to take cord blood samples immediately after delivery.
Establishment of 22 pregnancies after oocyte and embryo donation
Authors: DEVROEY P. , CAMUS M. , VAN DEN ABBEEL E. , VAN WAESBERGHE L. , WISANTO A. , VAN STEIRTEGHEM A. C.
Published: August 2005

Summary. Donated oocytes inseminated with partner's semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 alter the transfer of fresh embryos and nine after the transfer of frozen‐thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partner's semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies arc progressing normally and five miscarried.
Uterine activity during spontaneous labour after previous lower‐segment caesarean section
Authors: ARULKUMARAN S. , GIBB D. M. F. , INGEMARSSON I. , KITCHENER H. C. , RATNAM S. S.
Published: August 2005

Summary. Uterine activity was measured in three groups of labouring women who previously had a caesarean section (CS): group A included women with a previous elective CS before labour or in the early latent phase of labour and no previous vaginal delivery; group B included women with a CS in the active phase of labour and no previous vaginal delivery; group C included women with a CS and a vaginal delivery either before or after the abdominal delivery. The active contraction area profiles in the three groups were compared with those of matched control groups of nulliparae and multiparac without a uterine scar. Group A had a uterine activity profile similar to that in control nulliparae and significantly higher than that in control multiparae. The uterine activity in group B was less than that in matched nulliparae but was similar to that in matched multiparae. Group C had significantly less uterine activity than matched nulliparae but a similar profile to that in the matched multiparae. Progress of labour into the active phase in the previous pregnancy reduces the uterine activity profile in subsequent labour. Women who had had a vaginal delivery either before or after the CS (group C) exhibited uterine activity profiles similar to multiparae, suggesting that an intact scar did not affect the uterine function.
Pregnancy following simple repair of the ruptured gravid uterus
Authors: O'CONNOR R. A. , GAUGHAN B.
Published: August 2005

Summary. Eighteen pregnancies, occurring in 15 patients in whom a simple repair of a ruptured gravid uterus had been performed previously, are reviewed. Seventeen of these had a successful outcome. There was no case of recurrent rupture.
Transvaginal ultrasonic assessment of endometrial growth in spontaneous and hyperstimulated menstrual cycles
Authors: RANDALL J. M. , FISK N. M. , McTAVISH A. , TEMPLETON A. A.
Published: August 2005

Summary. Endometrial thickness and reflectivity were assessed by transvaginal ultrasound in both spontaneous and hyperstimulated menstrual cycles. Two groups of women with ovulatory cycles were examined; women in group 1 had unexplained infertility and women in group 2 were having artificial insemination by donor because of reduced spermatogenesis; a third group (group 3) comprised women with tubal infertility undergoing hyperstimulation for in‐vitro fertilization. There was no difference in endometrial thickness or reflectivity between the three groups. A basic pattern of endometrial appearance common to all cycles was found, consisting of hypoechoic, isocchoic and hyperechoic images, occurring in the early follicular, late follicular and luteal phases, respectively. In all three groups a positive correlation was found between proliferative phase plasma oestradiol concentration and endometrial thickness. Group 1 r= 0·403, P<0·01; group 2 r= 0·439, P<0·01; and group 3 r= 0·617, P<0·01. There was a progressive increase in endometrial growth throughout the normal cycle until a plateau was reached 5 days after the LH surge. This pattern was also seen without acceleration of the process in hyperstimulated cycles, despite supranormal levels of oestrogen. Assessment of endometrial thickness is not a useful variable in monitoring hyperstimulated cycles. No aberrations of endometrial growth or pattern were observed in the women with unexplained infertility.
A randomized controlled trial of extra‐amniotic ethinyloestradiol in ripening the cervix at term
Authors: PEEDICAYIL A. , JASPER P. , BALASUBRAMANIAM N. , JAIRAJ P.
Published: August 2005

Summary. A double‐blind randomized controlled trial investigated the use of extra‐amniotic ethinyloestradiol for ripening the unfavourable cervix at term. Twenty‐five primigravidae were treated with 150 mg ethinyloestradiol gel while 24 primigravidae were treated with gel alone. There was no statistical difference between the ethinyloestradiol and control groups in either mean change in Bishop score or the induction‐to‐delivery interval.
The effect of anorexia nervosa on skin thickness, skin collagen and bone density
Authors: SAVVAS M. , STUDD J. , MONIZ C. , BRINCAT M. , TREASURE J. , FOGELMAN I.
Published: August 2005

The effects of anorexia nervosa on skin thickness, skin collagen content and bone density were investigated in a cross‐sectional study of 36 women with anorexia nervosa with a 4‐year median duration of amenorrhoea and compared with a group of 33 women of comparable age without anorexia and with normal periods. The median skin thickness, assessed radiologically, was significantly reduced (P<0·01) from 0·88 mm in the comparison group to 0·70 mm in the anorectic group and the median collagen content was significantly reduced from 209 μg/mm2 in the comparison group to 164 μg/mm2 in the anorectic group (P<0·05). The median bone density in the comparison group was 0·93 gHA/cm2 at the lumbar spine and 0·84 gHA/cm2 at the proximal femur. These values were greatly reduced in the women with anorexia nervosa to 0·77 gHA/cm2 and 0·65 gHA/cm2 respectively (P<0·01). Our findings confirm the loss of bone mass with anorexia and demonstrate the coexistent loss of skin thickness and skin collagen content. This association supports the hypothesis that a generalized loss of collagen is a major factor in the causation of osteoporosis following oestrogen deficiency.