bluuebunny/crossref_metadata_2025 huggingface dataset:
Lidocaine treatment in pediatric convulsive status epilepticus
Authors: Yildiz Bilal , Çitak Agop , Uçsel Raif , Karaböcüoğlu Metin , Aydinli Nur , Uzel Nedret
Published: February 2008

Background: Convulsive status epilepticus (CSE) may end fatally or leave serious sequelae. CSE treatment, invariably an emergency case, is based upon i.v. benzodiazepines as well as phenytoin, barbiturates or both. The present paper reports efficiency of lidocaine in CSE.

Methods: The effects of lidocaine on patients with CSE due to infectious and non‐infectious reasons were compared. Lidocaine was given in 29 episodes of CSE to 49 patients having failed to respond to first‐line anticonvulsive drugs, such as diazepam, phenobarbital and phenytoin therapy. Lidocaine was given in doses of 2 mg/kg bolus i.v., and then in 4 mg/kg per h infusion.

Results: Mean duration of lidocaine infusion was 14.6 ± 7.8 h. Effectiveness of lidocaine in patients with CSE was found to be 44.4%. Also, 11 patients responded to a single dose of lidocaine (37.9%), while another two (6.9%) required another dose to suppress their seizures. Patients with seizures attributable to infections were observed to have responded favorably to lidocaine when compared to those with seizures due to epilepsy (37.9% vs 6.8%; P < 0.05). Subsequent epilepsy was found to occur more frequently in patients with a poor response to lidocaine than in patients with a good response (P < 0.05). Adverse reactions to lidocaine were observed in three patients (10.3%), two of them having ventricular arrhythmia. As for the other patient, the focal seizure developed into a generalized one.

Conclusions: Lidocaine seems to be useful for the management of CSE as a rapid‐acting anticonvulsant, particularly in patients with CSE due to infections. But further studies with larger number of patients are needed.
Hepatitis C virus infection and interferon therapy in patients with Down syndrome
Authors: Miyoshi Yoko , Tajiri Hitoshi , Okaniwa Mariko , Terasawa Sousuke , Fujisawa Tomoo , Iizuka Toshiyuki , Ozono Keiichi
Published: February 2008

Background:The clinical features of hepatitis C virus (HCV)‐associated liver diseases, or the efficacy of interferon (IFN) therapy in children with Down syndrome (DS) remain to be elucidated. The purpose of the present paper was to survey the features of liver diseases in this subset of children and evaluate the efficacy of IFN treatment in those patients.

Methods:A questionnaire was sent to 41 members of the Japan Society of Pediatric Hepatology. Ten of them reported on 11 patients with DS who had concomitant chronic HCV infection, providing information on liver disease and the response to IFN treatment.

Results:Interferon therapy of 24 weeks duration using natural IFN‐α was instituted in six of the 11 patients with DS, but none of the six patients cleared HCV‐RNA from their serum. Among 12 age‐ and sex‐matched control children who were treated with IFN using the same regimen against chronic HCV infection, half of them had a favorable response to IFN therapy with a sustained clearance of HCV‐RNA from their serum. The major baseline features including alanine aminotransferase levels, HCV genotype and viral load were not apparently different between the six patients with DS and the 12 controls.

Conclusions:IFN therapy for HCV infection in patients with DS may be unfavorable as compared with non‐DS children.
Developmental characteristics of very low‐birthweight infants at 18 months’ corrected age according to birthweight
Authors: Kono Yumi , Mishina Jun , Sato Noriko , Watanabe Toyoko , Honma Yoko
Published: February 2008

Background: The objective of the present study was to describe developmental profiles of very low‐birthweight (VLBW) infants compared by birthweight, because those of infants with birthweight <750 g might be different from other VLBW infants.

Methods: VLBW infants from four medical centers were followed at each site with the same protocol at 18 months’ corrected age. The protocol by the Society for the Study of Follow up for High‐Risk Infants, which includes a standardized developmental test, the Kyoto Scale of Psychological Development (KSPD), was used. Five hundred and sixty‐four VLBW infants without neurological or neurosensory impairment were divided into four groups using 250 g birthweight intervals and outcomes were compared between the four groups.

Results: Developmental characteristics of extremely low‐birthweight infants (birthweight <750 g) in comparison with other VLBW infants were as follows: (i) more infants were judged clumsy in their fine motor skills; (ii) fewer were able to speak meaningful words although they were able to understand oral simple orders; (iii) developmental quotients (DQ) of KSPD was significantly lower; and (iv) more infants were judged as hyperactive.

Conclusion: Developmental profiles of VLBW infants without major handicaps at 18 months’ corrected age correlated significantly with their birthweight sequence. These results provide useful information on developmental outcomes of VLBW infants.
Transient tachypnea of the newborn: Predictive factor for prolonged tachypnea
Authors: Kasap Belde , Duman Nuray , Özer Esra , Tatli Mansur , Kumral Abdullah , Özkan Hasan
Published: February 2008

Background: Because there is a lack of well‐established criteria, the aim of the present paper was to determine risk factors to predict the duration of tachypnea in transient tachypnea of the newborn (TTN).

Methods: Data from 95 newborns with TTN were evaluated retrospectively. Clinical and laboratory findings were compared between patients in whom tachypnea lasted <72 h (group 1) or >72 h (group 2).

Results: Male gender, prematurity and delivery by cesarean section were the major risk factors for TTN. Parenteral furosemide had no effect on the clinical course. Peak respiratory rate (RRpeak) at the first 36 h was significantly higher in group 2 (P > 0.000). The cut‐off for RRpeak during the first 36 h (RRpeak36) was 90/min and RRpeak36 > 90/min caused a 7.04‐fold risk of prolonged tachypnea. White blood cell count and hematocrit levels were lower whereas duration of hospitalization and antibiotic treatment were longer in group 2.

Conclusions: Assessment of RRpeak36 may be useful in predicting clinical course of TTN.
Computational significance of transient dynamics in cortical networks
Authors: Durstewitz Daniel , Deco Gustavo
Published: February 2008

In the published paper of Durstewitz & Deco (2007), there was an error in the Abstract (in the first sentence, the words ‘are correlated’ should have been moved to the end). In the same paper, as Fig. 6 was not printed in colour, the words ‘black’ and ‘red’ should have been replaced by ‘middle’ and ‘top and bottom’, respectively. The publishers apologize for these errors, and reproduce the corrected Abstract and Fig. 6 legend below.

Neural responses are most often characterized in terms of the sets of environmental or internal conditions or stimuli with which their firing rate increases or decreases are correlated. Their transient (nonstationary) temporal profiles of activity have received comparatively less attention. Similarly, the computational framework of attractor neural networks puts most emphasis on the representational or computational properties of the stable states of a neural system. Here we review a couple of neurophysiological observations and computational ideas that shift the focus to the transient dynamics of neural systems. We argue that there are many situations in which the transient neural behaviour, while hopping between different attractor states or moving along ‘attractor ruins’, carries most of the computational and/or behavioural significance, rather than the attractor states eventually reached. Such transients may be related to the computation of temporally precise predictions or the probabilistic transitions among choice options, accounting for Weber's law in decision‐making tasks. Finally, we conclude with a more general perspective on the role of transient dynamics in the brain, promoting the view that brain activity is characterized by a high‐dimensional chaotic ground state from which transient spatiotemporal patterns (metastable states) briefly emerge. Neural computation has to exploit the itinerant dynamics between these states.
Projections from basal forebrain to prefrontal cortex comprise cholinergic, GABAergic and glutamatergic inputs to pyramidal cells or interneurons
Authors: Henny Pablo , Jones Barbara E.
Published: February 2008

The present study was undertaken to characterize the pre‐ and postsynaptic constituents of the basal forebrain (BF) projection to the prefrontal cortex in the rat, and determine whether it includes glutamatergic in addition to established γ‐aminobutyric acid (GABA)ergic and cholinergic elements. BF fibres were labelled by anterograde transport using biotin dextran amine (BDA) and dual‐stained for the vesicular transporter proteins (VTPs) for glutamate (VGluT), GABA (VGAT) or acetylcholine (VAChT). Viewed by fluorescence microscopy and estimated by stereology, proportions of BDA‐labelled varicosities were found to be stained for VGluT2 (and not VGluT1 or 3), VGAT or VAChT (representing, respectively, ∼15%, ∼52% and ∼19% within the infralimbic cortex). Each type was present in all, though commonly most densely in deep, cortical layers. Material was triple‐stained for postsynaptic proteins to examine whether BDA+VTP+ varicosities might form excitatory or inhibitory synapses, respectively, labelled by postsynaptic density‐95 kDA (PSD‐95) or gephyrin (Geph). Viewed by confocal microscopy, a majority of BDA+/VGluT2+ varicosities were found to be apposed to PSD‐95+ elements, and a majority of BDA+/VGAT+ varicosities to be apposed to Geph+ elements. Other series were triple‐stained for cell marker proteins to assess whether the varicosities contacted interneurons or pyramidal cells. Viewed by confocal microscopy, BDA‐labelled VGluT2+, VGAT+ and VAChT+ BF terminals were all found in contact with calbindin+ interneurons, whereas VGAT+ BF terminals were also seen in contact with parvalbumin+ interneurons and non‐phosphorylated neurofilament+ pyramidal cells. Through distinct glutamatergic, GABAergic and cholinergic projections, the BF can thus influence cortical activity in a diverse manner.
Neonatal inflammation produces selective behavioural deficits and alters N‐methyl‐d‐aspartate receptor subunit mRNA in the adult rat brain
Authors: Harré E.‐M. , Galic M. A. , Mouihate A. , Noorbakhsh F. , Pittman Q. J.
Published: February 2008

Peripheral inflammation causes production of central cytokines that alter transmission at the N‐methyl‐d‐aspartate receptor (NR). During development, NRs are important for synaptic plasticity and network connectivity. We therefore asked if neonatal inflammation would alter expression of NRs in the brain and behavioural performance in adulthood. We gave lipopolysaccharide (LPS) (100 µg/kg, i.p.) or saline to male rats on postnatal day (P)5, P14, P30 or P77. Subsequently we assessed mRNA levels of the NR1, NR2A, B, C and D subunits in the hippocampus and cortex either acutely (2 h) or in adulthood using real‐time reverse transcriptase‐polymerase chain reaction. We explored learning and memory behaviours in adult rats using the Morris water maze and contextual fear conditioning paradigms. Hippocampal NR1 mRNA was acutely increased in the P5‐ and P77‐treated rats but was reduced in adults treated with LPS at P5, P30 and P77. P14 LPS‐treated rats showed few acute changes but showed pronounced increases in NR2A, B, C and D subunit mRNA later in adulthood. The cortex displayed relatively few acute changes in expression in the neonatal‐treated rats; however, it showed robust changes in NR2B, C and D mRNA in all groups given LPS in adulthood. Behavioural deficits were observed specifically in the P5 and P30 LPS‐treated groups in the water maze probe trial and fear conditioning tests, consistent with hippocampal NR1 mRNA down‐regulation. Thus, a single bout of inflammation during development can programme specific and persistent differences in NR mRNA subunit expression in the hippocampus, which could be associated with behavioural and cognitive deficits in adulthood.
Differential electrophysiological properties of dopamine D1 and D2 receptor‐containing striatal medium‐sized spiny neurons
Authors: Cepeda Carlos , André Véronique M. , Yamazaki Irene , Wu Nanping , Kleiman‐Weiner Max , Levine Michael S.
Published: February 2008

The electrophysiological properties of distinct subpopulations of striatal medium‐sized spiny neurons (MSSNs) were compared using enhanced green fluorescent protein as a reporter gene for identification of neurons expressing dopamine D1 and D2 receptor subtypes in mice. Whole‐cell patch‐clamp recordings in slices revealed that passive membrane properties were similar in D1 and D2 cells. All MSSNs displayed hyperpolarized resting membrane potentials but the threshold for firing action potentials was lower in D2 than in D1 neurons. In voltage clamp, the frequency of spontaneous excitatory postsynaptic currents was higher in D2 than in D1 cells and large‐amplitude inward currents (> 100 pA) were observed only in D2 cells. After tetrodotoxin this difference was reduced, suggesting that sodium conductances contribute to the increased frequencies in D2 cells. After pharmacological blockade of GABAA receptors, a subset of D2 cells also displayed large spontaneous membrane depolarizations and complex responses to stimulation of the corticostriatal pathway. To further characterize ionotropic glutamate receptor function, α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionate (AMPA) was applied onto dissociated MSSNs. Application of AMPA alone or in the presence of cyclothiazide (an AMPA receptor desensitization blocker) evoked larger currents in D1 than in D2 cells. Together, these data demonstrate significant differences in electrophysiological properties of subpopulations of MSSNs defined by selective expression of D1 and D2 receptors. D2 cells display increased excitability and reflect ongoing cortical activity more faithfully than D1 cells, an effect that is independent of postsynaptic AMPA receptors and probably results from stronger synaptic coupling. This could help to explain the increased vulnerability of D2 MSSNs in neurodegenerative disorders.
Genetic background influences the behavioural and molecular consequences of neurokinin‐1 receptor knockout
Authors: McCutcheon J. E. , Fisher A. S. , Guzdar E. , Wood S. A. , Lightman S. L. , Hunt S. P.
Published: February 2008

Genetic background affects animal phenotype and therefore is of particular relevance to studies using genetically manipulated mice. Strain differences in hypothalamic–pituitary–adrenocortical (HPA) axis activity may contribute to background‐specificity of some mutations. Here, we analysed components of the HPA axis in mice lacking a functional neurokinin‐1 receptor (NK1–/–) on two backgrounds: backcrossed C57BL/6 (B6) and mixed C57BL/6 × 129/sv (129B6). We hypothesized that HPA axis activity would vary between these strains, leading to differences in the NK1–/– phenotype. We compared levels of plasma corticosterone between the groups, and found 129B6 mice exhibited elevated levels of stress‐induced corticosterone compared with B6 mice, regardless of genotype. Although the level of basal corticotrophin‐releasing factor and stress‐induced c‐fos mRNAs did not differ between the genotypes of either strain, examination of glucocorticoid receptor immunoreactivity within the hippocampus revealed that NK1–/– mice on the 129B6 background had elevated expression compared with wild‐type, whilst there was no difference between genotypes in the B6 strain. Similarly, hippocampal neurogenesis in NK1–/– mice was greater than in wild‐type on the 129B6 strain, and did not differ between genotypes on the B6 background. Finally, novelty‐ and morphine‐induced locomotion were assessed. NK1–/– mice on the 129B6 background exhibited hyperlocomotion in response to novelty and greater sensitivity to the locomotor‐stimulating properties of morphine than wild‐type. In contrast, in B6 mice, no differences were observed between genotypes for either locomotor behaviour. In summary, we find that HPA axis activity differs between the strains and that there are profoundly background‐specific effects of the NK1 receptor mutation.
The effect of rTMS over left and right dorsolateral premotor cortex on movement timing of either hand
Authors: Pollok Bettina , Rothkegel Holger , Schnitzler Alfons , Paulus Walter , Lang Nicolas
Published: February 2008

It has been suggested that the left dorsolateral premotor cortex (dPMC) controls timing abilities of either hand. To further clarify its functional significance for movement timing, low‐frequency repetitive transcranial magnetic stimulation (rTMS) was applied over the left and right dPMC, respectively, while subjects performed an auditorily paced finger‐tapping task with each hand. rTMS over the left dPMC decreased tapping accuracy of both hands, whereas no behavioural effects occurred following right dPMC stimulation. To elucidate the time window in which left dPMC TMS disturbs synchronization abilities, pairs of TMS pulses were applied over the left dPMC and the left anterior parietal cortex serving as control condition. TMS pulses were applied randomly at 40 ms, 80 ms, 120 ms, 160 ms, 200 ms and 240 ms before pacer onset, as taps precede the pacing signal for about 20–60 ms. Again, the analysis revealed that TMS over the left dPMC disturbed synchronization abilities of either hand; however, this effect was shown at different times suggesting that the left dPMC affects the right M1 via at least one additional relay station. The present data support the hypothesis that the left dPMC is crucial for accurate timing of either hand. Additionally, they reveal a piece of evidence that the left dPMC affects the left hand not via a direct left dPMC–right M1 connection.
Long‐term results of palliative stenting or surgery for incurable obstructing colon cancer
Authors: Faragher I. G. , Chaitowitz I. M. , Stupart D. A.
Published: February 2008

Objective  Self‐expanding metal stents are an effective means of relieving left‐sided malignant colonic obstruction, and in the setting of incurable disease may provide palliation while allowing the patients to avoid surgery altogether. With modern chemotherapy regimes, patients may have a long‐life expectancy, even in the presence of metastases. The purpose of this study was to investigate the long‐term results of palliative stent placement, compared with patients undergoing palliative surgery.

Method  This is a retrospective study of 55 consecutive patients who underwent colonic stenting or palliative surgery for incurable, obstructing adenocarcinoma of the left colon.

Results  Twenty‐nine patients underwent colonic stenting, and 26 had surgery during the study period. Survival was similar in the two groups (14 months in the stent group, 11 months in the surgery group). Median hospital stay was shorter in the stent group (4 vs 13.5 days), and fewer patients in the stent group had complications (2 vs 14). Only four patients in the stent group went on to require later surgery. The median time to failure of the stents was 14 months.

Conclusion  Colonic stenting provides effective and durable palliation for patients with incurable, obstructing adenocarcinomas of the left colon. It can be performed with less morbidity than palliative surgery, and offers similar long‐term survival.
Global Trade Models and Economic Policy Analyses: Relevance, Risks and Repercussions for Africa
Authors: Ben Hammouda Hakim , Osakwe Patrick N.
Published: February 2008

Computable general equilibrium models are widely used for trade policy analyses and recommendations. There is, however, increasing discomfort with the use of these models, especially in Africa. This article demonstrates that the results of several such studies of the impact of trade reforms in Africa differ drastically in terms of both magnitude and direction, failing to take account of key features of African economies. It also outlines potential consequences of the misuse of CGE models for policy evaluation and suggests pitfalls to be avoided.
SHORT REVIEWS AND NOTICES
Authors: Hoskins W. G.
Published: February 2008

G. E. Fussell. Farming Systems from Elizabethan to Victorian Days in the North and East Ridings of Yorkshire.

Ernest Barker. The Development of Public Services in Western Europe

The Letters of John McLoughlin, Second Series, 1839–44; Third Series, 1844–6. Ed. by E. E. Rich with an introduction by W. Kaye Lamb.

R. H. Snape. Britain and the Empire

Robert Machray. The Problem of Upper Silesia

Economic Problems of Latin America, edited by Seymour E. Harris.
HUDSON'S BAY COMPANY
Authors: Glover Richard
Published: February 2008

Peter Skene Ogden's Snake Country Journals: 1824–5 and 1825–6. Edited by E. E. Rich, with an introduction by Dr Burt Brown Barker. (London: the Hudson's Bay Record Society, 1950. Pp. lxxix f 233 + xv.)
Reviews
Authors: Holt J. C. , Titow J. Z. , Beresford M. W. , Hoskins W. G. , Hill Christopher , Outhwaite R. B. , Finch Mary , Colvin H. M. , Jones E. L. , Horsefield J. Keith , Wilson Charles , Cranfield G. A. , Green E. R. R. , Colvin H. M. , Mathias Peter , Pollard Sidney , Checkland S. G. , Musson A. E. , Payne Peter L. , Payne Peter L. , Boehm E. A. , Vincent J. R. , Baker Alan R. H. , Ashworth W. , Miller Edward , Hobsbawm E. J. , Bergier Jean‐François , Rich E. E. , Fieldhouse D. K. , Feltham R.
Published: February 2008

Book Reviews in This Article:

W. E. Wightman. The Lacy Family in England and Normandy, 1066‐1194.

H. S. Bennett. Life on the English Manor: A Study of Peasant Conditions, 1150‐1400.

Margaret Wood. The English Mediaeval House.

D. Portman. Exeter Houses, 1400‐1700.

Patrick Collinson. The Elizabethan Puritan Movement.

Calendar of the Patent Rolls. Preserved in the Public Record Office. Elizabeth I.

Margaret Cash (Ed.). Devon Inventories of the Sixteenth and Seventeenth Centuries.

P. E. Jones (Ed.). The Fire Court: Calendar to the Judgments and Decrees of the Court of Judicature appointed to determine differences between landlords and tenants as to rebuilding after the Great Fire.

G. E. Fussell. The English Dairy Farmer, 1500‐1900.

A. Andréadès. History of the Bank of England, 1640‐1903.

P. G. M. Dickson. The Financial Revolution in England. A Study in the Development of Public Credit, 1688‐1756.

Robert Munter. The History of the Irish Newspaper, 1685‐1760.

W. A. McCutcheon. The Canals of the North of Ireland.

J. D. Williams. Audley End. The Restoration of 1762‐1797.

W. E. Minchinton (Ed.). Politics and the Port of Bristol in the Eighteenth Century.

Stanley D. Chapman. The Early Factory Masters. The Transition to the Factory System in the Midlands Textile Industry.

Phyllis Deane. The First Industrial Revolution.

J. Child. Industrial Relations in the British Printing Industry. The Quest for Security.

Werner von Siemens. Inventor and Entrepreneur: Recollections of Werner von Siemens.

Kurt Grunwald. Türkenhirsch: A Study of Baron Maurice de Hirsch, Entrepreneur and Philanthropist.

J. D. Bailey. A Hundred Tears of Pastoral Banking. A History of the Australian Mercantile Land and Finance Company, 1863‐1963.

F. B. Smith. The Making of the Second Reform Bill.

W. R. Powell (Ed.). A History of the County of Essex.

Peter Mathias. Retailing Revolution. A History of Multiple Retailing in the Food Trades based upon the Allied Suppliers Group of Companies.

Marc Bloch. French Rural History: an Essay on its Basic Characteristics.

J. P. Nettl. Rosa Luxemburg.

Erich Gruner and Karl Frei. Die schweizerische Bundesversammlung, 1848‐1920 L'Assemblée fédérale suisse, 1848‐1920.

Richard Colebrook Harris. The Seigneurial System in Early Canada. Geographical Study.

Ashin Das Gupta. Malabar in Asian Trade, 1740‐1800.

David Birmingham. Trade and Conflict in Angola.
Sources of Capital and Capitalization in the Scottish Brewing Industry, c. 1750—1830
Authors: DONNACHIE IAN
Published: February 2008

The formative years in the development of the Scottish brewing industry coincided with the classic Industrial Revolution between 1770 and 1830. The industry was well established by the middle of the eighteenth century, a number of important firms being founded about 1750. Capital found its way into Scottish brewing from various sources, mainly from agriculture and commerce. Merchants were among the leading groups of investors, which also included lawyers, accountants, and excisemen. Related trades, like malting, distilling, and corn‐milling also provided capital. Brewing maintained close contact with the countryside, for many farmers invested in the industry in a modest way; and the waste products of the brewery (called “draff” in Scotland) were returned to the farm for fattening purposes. Most breweries were small, serving only local markets. But in the cities and growing towns, where a more concentrated market existed and transport was a lower proportion of costs, larger units quickly emerged. Urban brewers began to make inroads into country markets during the Industrial Revolution, and also to sell further afield by developing coastal and foreign trades. At the close of the period with which this study is concerned the Scottish brewing industry was becoming increasingly urban in character, dominated by large‐scale production units, such as those in Edinburgh, Alloa, Falkirk, and Glasgow. This article examines two aspects of the Scottish brewing trade during the century 1750‐1850 through, (i) an analysis of the main sources of capital, and (ii) a breakdown of the size of firms from legal records and insurance valuations.
T cells in amyotrophic lateral sclerosis
Authors: Holmøy T.
Published: February 2008

The inflammatory process in ALS involves infiltration of T cells and activation of antigen presenting cells co‐localizing with motor neuron damage in the brain and spinal cord. The role of T cells in the pathogenic process is not settled. T cells may damage motor neurons by cell‐cell contact or cytokine secretion, or contribute indirectly to motor neuron damage through activation of microglia and macrophages. Alternatively, T cell infiltration may be an epiphenomenon related to clearance of dead motor neurons. Lessons from animal models of neuroinflammation and neurodegeneration have shown that T cell responses can be neuroprotective or even enhance neurogenesis. Therefore, it is possible that T cells can be induced to slow motor neuron destruction and facilitate repair in ALS. The T cell modulating drug glatiramer acetate has shown promising results in animal models, and is being currently investigated in a phase II trial in ALS. This paper reviews the evidence for T cells as pathogenic players and therapeutic targets in ALS.
Abdominopelvic tuberculosis in gynaecology: Laparoscopical and new laboratory findings
Authors: TINELLI Andrea , MALVASI Antonio , VERGARA Daniele , MARTIGNAGO Roberta , NICOLARDI Giuseppe , TINELLI Raffaele , PELLEGRINO Marcello
Published: February 2008

Introduction:  Tuberculosis (TB) is a rare curable infective disease, caused mainly by Mycobacterium tuberculosis, which in abdominopelvic (AP) localisation, can mimic a disseminated carcinomatosis. Symptoms of AP‐TB are non‐specific, so diagnosis is difficult and elusive as the affected patients have normal chest X‐ray and elevated levels of CA125. Female ultrasonographic features of AP‐TB mimic peritoneal carcinomatosis, and the computed tomography has also been suggested to be helpful, but the final diagnosis was reached by histology and serology.

Aim of the study:  To propose the validity of the combination of laparoscopy (LPS), histopathology and enzyme‐linked immuno‐spot (ELIspot) in the diagnosis of AP‐TB.

Methods:  In the last two years, we had six women with suspect of AP‐TB, who, after the routine exams, were referred for a diagnostic LPS that revealed turbid‐free fluid in pelvis or ascites (collected for serology), multiple peritoneal and/or bowel tubercles (randomly sampled), fibrous bands, adhesions, hyperaemic and oedematous bowel loops.

Results:  LPS diagnosis was confirmed by intra‐LPS biopsy of nodules and histological examination of specimens: epithelioid granulomas with central caseous necrosis in five patients (83.3%) and a non‐caseating granulomatous inflammation in the last one. An outer layer of epithelioid histiocytes and Langhans cells was present in all patients. Using the ELIspot technique performed on free fluids, the final diagnosis of TB was made in all patients.

Conclusions:  Even if gynaecological LPS appearance of the peritoneum can mimic other conditions, ELIspot and histopathological exam can confirm the suspect of AP‐TB.
Avoidable risk factors in perinatal deaths: A perinatal audit in South Australia
Authors: DE LANGE Titia E. , BUDDE Marenne P. , HEARD Adrian R. , TUCKER Graeme , KENNARE Robyn , DEKKER Gus A.
Published: February 2008

Objectives:  To analyse risk factors of perinatal death, with an emphasis on potentially avoidable risk factors, and differences in the frequency of suboptimal care factors between maternity units with different levels of care.

Methods:  Six hundred and eight pregnancies (2001–2005) in South Australia resulting in perinatal death were described and compared to 86 623 live birth pregnancies.

Results:  Two hundred and seventy cases (44.4%) were found to have one or more avoidable maternal risk factors, 31 cases (5.1%) had a risk factor relating access to care, while 68 cases (11.2%) were associated with deficiencies in professional care. One hundred and four women (17.1% of cases) presented too late for timely medical care: 85% of these did have a sufficient number of antenatal visits.

The following independent maternal risk factors for perinatal death were found: assisted reproductive technology (adjusted odds ratio (AOR) 3.16), preterm labour (AOR 22.05), antepartum haemorrhage (APH) abruption (AOR 6.40), APH other/unknown cause (AOR 2.19), intrauterine growth restriction (AOR 3.94), cervical incompetence (AOR 8.89), threatened miscarriage (AOR 1.89), pre‐existing hypertension (AOR 1.72), psychiatric disorder (AOR 1.85) and minimal antenatal care (AOR 2.89). The most commonly found professional care deficiency in cases was the failure to act on or recognise high‐risk pregnancies/complications, found in 49 cases (8.1%).

Conclusion:  Further improvements in perinatal mortality may be achieved by greater emphasis on the importance of antenatal care and educating women to recognise signs and symptoms that require professional assessment. Education of maternity care providers may benefit from a further focus on how to recognise and/or manage high‐risk pregnancies.
Chlamydia and associated factors in an under 20s antenatal population
Authors: CHENEY Kate , WRAY Lynne
Published: February 2008

Introduction:  Detection and treatment of genital chlamydia trachomatis infections in pregnancy have been shown to reduce the risk of premature rupture of membranes, and post‐partum endometritis and reduce the risk to the newborn of conjunctivitis and pneumonitis. Identification of factors associated with chlamydial infection in pregnancy could be used to develop criteria for routine chlamydia screening for some pregnant women. No national screening strategy exists around genital Chlamydia trachomatis infection.

Methods:  We undertook a review of the medical records of all young women (aged 20 years or younger) attending the RPA Women and Babies Young Parents Clinic for antenatal care between January 2003 and June 2006. This group was chosen as RPA Women and Babies routinely offers testing for C. trachomatis to women attending the Young Parents Clinic. Data extracted included age, country of birth, language spoken at home, postcode of usual residence, marital status, educational level, change of sexual partners within the past 12 months, consistency of condom use and history of sexually transmissible infections.

Results:  Two hundred and twelve of the 365 eligible pregnant women were screened for genital C. trachomatis, of whom 29 were positive. A rate of 13.7% genital chlamydia infection was found in this population of young pregnant women.

Conclusions:  Results from this study indicate that the rate of chlamydia infection (13.7%) is high in women aged 20 years or younger and that the most important risk factor is young age. These findings support recent recommendations that all women 25 years and younger are screened for C. trachomatis in pregnancy.
Soluble Flt‐1 as a diagnostic marker of pre‐eclampsia
Authors: WOOLCOCK Jane , HENNESSY Annemarie , XU Bei , THORNTON Charlene , TOOHER Jane , MAKRIS Angela , OGLE Robert
Published: February 2008

Backgound: Serum levels of soluble fms‐like tyrosine kinase (sFlt‐1) increase in pre‐eclampsia (PE).

Aims: To determine whether concentrations of serum sFlt‐1 can differentiate PE or superimposed PE (SPE) from gestational hypertension (GH) or chronic hypertension (CH).

Methods: Blood was collected from pregnant women being investigated for hypertension (blood pressure of  > 140 and/or 90 mmHg). Normotensive (NP) and pre‐eclamptic (PE‐C) control ranges were measured.

Results: Patients with evolving hypertension in pregnancy eventually fell into four groups: GH (n = 14), PE (n = 7), CH (n = 9) and SPE (n = 9). Patients who later developed pre‐eclampsia had a higher sFlt‐1 (PE: 2.61 ng/mL and SPE: 2.77 ng/mL, respectively) than GH (P < 0.001) or CH (1.05 ng/mL, P = 0.11). Women with established PE at recruitment (PE‐C; (n = 18) (3.13 ng/mL; interquartile range (IQR): 2.14–4.17 ng/mL) had a median sFlt‐1 higher than NP (n = 18) (0.47 ng/mL; IQR: 0.11–0.89) (P < 0.0008). Patients with GH compared to NP had a slight increase (1.33 ng/mL, P < 0.003). Using a sFlt‐1 cut‐off of ≥ 1.9 ng/mL yielded a sensitivity of 94% (95% confidence interval (CI) 73–100%) and specificity of 78% (95% CI 64–82%).

Conclusions: sFlt‐1 was elevated in women with PE compared to NP. The sFlt‐1 also differentiated women destined to develop PE among those who presented with a diagnostic rise in maternal blood pressure. The sFlt‐1 test is a useful diagnostic test for PE.
Contraceptive use and associations with intimate partner violence among a population‐based sample of New Zealand women
Authors: FANSLOW JANET , WHITEHEAD Anna , SILVA Martha , ROBINSON Elizabeth
Published: February 2008

Aim:  To outline the use of contraception among a representative sample of New Zealand women, and explore associations with intimate partner violence (IPV), and contraception and condom use.

Methods:  Face‐to‐face interviews were conducted with a random sample of 2790 women who had ever had sexual intercourse, aged 18–64 years old in two regions (urban and rural) in New Zealand. Analyses were conducted using logistic regression and Wald χ2 tests.

Results:  Almost all women had used contraception at some point in their life, and almost one half of all women 18–49 years were currently using methods of contraception. Contraceptive use and methods varied significantly by location. Women who had ever experienced IPV were significantly more likely to report having ever used contraception, compared with women who had not experienced IPV (91% vs 85.2%). While having a partner who refused to use or tried to stop women from using a method of contraception was rare, it was significantly more common among women who had ever experienced IPV (5.4% vs 1.3%).

Conclusions:  Most women have used contraception at some point. Women who have ever experienced IPV were: more likely to have used contraception than women who have not experienced IPV, and to have had partners who refused to use condoms or prevented women from using contraception. Partner refusal may be a key indicator of IPV. These findings emphasise the importance of family violence screening at routine health consultations.
Hospital‐based interventions at and following miscarriage: Literature to inform a research‐practice initiative
Authors: STRATTON Katrina , LLOYD Libby
Published: February 2008

Background:  It is estimated that up to one in five pregnancies will result in miscarriage, the spontaneous loss of pregnancy up to 20 weeks gestation. Miscarriage is such a common form of reproductive loss that it is often under acknowledged by the community, including health professionals. Dissatisfaction with care following miscarriage is well noted despite evidence that the care provided in hospital can have a significant effect on the experience of and the emotional and physical recovery from a miscarriage.

Aims:  The aim of this literature review was to determine any evidence‐based guidelines for hospital‐based medical and psychosocial services following a miscarriage.

Methods:  A search was made of medical and psychosocial databases for key terms. Further searches were then carried out using references. Articles were critically analysed and implications for service delivery derived.

Results:  Indications for service delivery at the time of miscarriage and follow up are clear from the reported experiences of women and the psychological sequelae of miscarriage. However, there is little evidence to support the efficacy of follow up postdischarge. There are implications for service delivery and research in six domains: staff care, assessment, information, phone follow up, risk assessment and care during subsequent pregnancies.

Conclusions:  Further research is needed to establish the impact on women and staff of routine follow‐up care after a miscarriage.
Laparoscopic management of adnexal tumours in post‐hysterectomy women
Authors: LEE Jung Hun , KYUNG Min Sun , JUNG Un Suk , CHOI Joong Sub
Published: February 2008

Background:  Laparoscopy is becoming common for the management of complex benign gynaecological diseases, in which considerable adhesions are expected, thus making the laparoscopic surgery more difficult to perform.

Aims:   To evaluate the efficacy and safety of laparoscopic surgery for adnexal tumours in post‐hysterectomy women.

Methods:  In a retrospective study, we reviewed and analysed 40 post‐hysterectomy women who were treated surgically for benign ovarian tumours at Kangbuk Samsung Hospital, from May 1999 to April 2007. Twenty women received laparotomic surgery and 20 were treated by laparoscopic surgery. Operating time, haemoglobin changes, complication rates, return of bowel activity, and duration of hospital stay were evaluated.

Results:  Operating time, haemoglobin changes, and complication rates were similar for both groups. For the laparoscopy group, the return of bowel activity was significantly faster (33 vs 45 h; P = 0.0131) and hospital stay was significantly shorter (four vs eight days; P = 0.0005) than for the laparotomy group.

Conclusions:  Laparoscopic surgery for adnexal tumours in post‐hysterectomy women might be an effective and safe alternative to laparotomic surgery. Surgical experience in this procedure and a thorough understanding of retroperitoneal anatomy from a laparoscopic view are mandatory to ensure low morbidity.
Oral celecoxib versus oral diclofenac for post‐perineal repair analgesia after spontaneous vaginal birth: A randomised trial
Authors: LIM Soo Soo , TAN Peng Chiong , SOCKALINGAM Jayanthi Karen , OMAR Siti Zawiah
Published: February 2008

Objective:  To compare oral celecoxib with oral diclofenac as pain reliever after perineal repair following normal vaginal birth.

Methods:  One hundred and sixty‐four and 165 women, respectively, were randomised to 200 mg celecoxib or to 100 mg diclofenac orally 12 hourly for 24 h after perineal repair. A ten‐point visual analog scale (VAS) for pain recorded at one, two, four, eight, 12 and 24 hours at rest and when mobilising was the primary outcome.

Results:  Repeated measures analysis of variance showed a larger reduction of VAS pain score at rest with celecoxib compared to diclofenac (P = 0.044). Mean VAS pain score at rest was 2.2 versus 2.7, 2.1 versus 2.5, 1.8 versus 2.2, 1.6 versus 1.6, 1.3 versus 1.4 at one, two, four, eight, 12 and 24 hours, respectively, for celecoxib versus diclofenac. The difference in pain score when mobilising was not significant (P = 0.75). Univariate analyses with the Student's t‐test indicated significantly lower pain score at rest only at one, two and four hours with celecoxib.

Randomisation to celecoxib was associated with less upper gastrointestinal symptoms reported: 38 of 163 (23.3%) versus 57 of 165 (34.5%) (relative risk 0.67 95% CI 0.48–0.96: P = 0.029) but additional analgesia for breakthrough pain was not significantly different eight of 161 (5.0%) versus 18 of 165 (10.9%) (relative risk 0.46 95% CI 0.20–1.01: P = 0.065).

Conclusion:  Celecoxib was associated with a slightly lower VAS pain score at rest and less upper gastrointestinal symptoms were reported when compared to diclofenac.
Is incidental appendectomy necessary in women with ovarian endometrioma?
Authors: WIE He Jong , LEE Jung Hun , KYUNG Min Sun , JUNG Un Suk , CHOI Joong Sub
Published: February 2008

Background:  Several studies reported that pathology of the appendix is frequently detected alongside endometriosis, especially with chronic pelvic pain. Furthermore, ovarian endometriosis is a marker of more extensive pelvic and intestinal disease.

Aims:  To evaluate the feasibility and efficacy of incidental appendectomy in laparoscopic surgical treatment for ovarian endometrioma.

Methods:  One hundred and six women with ovarian endometrioma underwent laparoscopic surgery including laparoscopic appendectomy. Clinicopathological data were collected and analysed.

Results:  The main symptoms consisted of lower abdominal pain in 51 (48.1%) women, dysmenorrhoea in 23 (21.7%), left lower quadrant pain in 6 (5.7%), right lower quadrant pain in nine (8.5%), chronic pelvic pain in five (4.7%), and others in 12 (11.3%). Only three (3.3%) of the 106 women had abnormal findings on gross inspection during laparoscopic surgery: two women with endometriotic spots on the surface of their appendixes, and one with peri‐appendiceal inflammation with severe adhesions. Of the 106 resected appendixes, 37 (34.9%) had histopathologically confirmed pathology including lymphoid hyperplasia in 12 (11.3%), endometriosis in 14 (13.2%), peri‐appendicitis and serositis in five (4.7%), carcinoid tumour in three (2.8%), and others in three (2.8%).

Conclusions:  In all surgical treatments for ovarian endometrioma, surgeons need to preoperatively inform the patients of the fact that appendiceal pathology including endometriosis is found frequently regardless of concurrent symptoms or gross finding of the appendix. Furthermore, surgeons should take into account the possibility of appendiceal pathology during operation.
On thermobarometry
Authors: POWELL R. , HOLLAND T. J. B.
Published: February 2008

Thermobarometry, the estimation of the pressure–temperature (P–T) conditions of metamorphism, can be undertaken by using pseudosection calculations as well as by conventional methods. Conventional thermobarometry uses only the equilibrium thermodynamics of balanced reactions between end‐members of minerals, combined with the observed compositions of minerals. In contrast, pseudosections involve a forward calculation of mineral equilibria for a given rock composition. When related to observed rock data such as mineral assemblages, mineral proportions and mineral compositions, pseudosections have the power to provide valuable additional thermobarometric information. This is because the rock composition provides added constraints on P–T, unavailable in conventional thermobarometry, such as when minerals in the mineral assemblage are no longer stable, or when additional minerals join the mineral assemblage. Considering both conventional and pseudosection thermobarometry, a minimum requirement is that they use the same thermodynamic data and activity–composition models for the minerals involved. A new thermocalc facility is introduced that allows pseudosection datafile coding to be used for conventional thermobarometry. Guidelines are given and pitfalls discussed relating to pseudosection modelling and conventional thermobarometry. We argue that, commonly, pseudosection modelling provides the most powerful thermobarometric tools.
Thermobarometric modelling of zircon and monazite growth in melt‐bearing systems: examples using model metapelitic and metapsammitic granulites
Authors: KELSEY D. E. , CLARK C. , HAND M.
Published: February 2008

U–Pb age data collected from zircon and monazite are used to draw fundamental inferences about tectonic processes in the Earth. Despite the emphasis placed on zircon and monazite ages, the understanding of how to relate the timing of growth of zircon and monazite to an evolving rock system remains in its infancy. In addition, few studies have presented large datasets of geochronological data from zircon and monazite occurring in the same metamorphic rock sample. Such information is crucial for understanding the growth of zircon relative to monazite in a systematic and predictive manner, as per this study. The data that exist support the generally held conception that zircon ages tend to be older than monazite ages within the same rock. Here experimental data for zircon and monazite saturation in melt‐bearing rocks are integrated with phase diagram calculations. The calculations constrain the dissolution and growth behaviour of zircon and monazite with respect to evolving pressure, temperature and silicate mineral assemblages in high‐grade, melt‐bearing, metasedimentary rocks. Several key results emerge from this modelling: first, that in aluminous metapelitic rocks (i.e. garnet + cordierite + sillimanite assemblages), zircon ages are older than monazite ages in the same rock; second, that the growth rate of accessory minerals is nonlinear and much higher at and near saturation than at lower temperatures; and third, that the difference in zircon and monazite ages from the same rock may be ascribed to differences in the temperature(s) at which zircon and monazite grow rather than differences in closure temperature systematics. Using our methodology the cooling rate of granulites from the Reynolds Range, central Australia, have been constrained at ∼4 °C Myr−1. This study serves as a first‐pass template on which further research in applying the technique to a field study can be based.