bluuebunny/crossref_metadata_2025 huggingface dataset:
SURGICAL OUTCOME OF CHRONIC SUBDURAL HAEMATOMA: A 5‐YEAR AUDIT *
Authors: Man Fan Joe King , Ka Kit Leung Gilberto , Yiu Wah Fan
Published: August 2010

Chronic subdural haematoma (CSDH) is a common neurosurgical condition that has been studied extensively.1–3 Unlike acute post‐traumatic subdural haematoma, there is often minimal associated parenchymal brain injury with CSDH and surgical outcome is satisfactory in most cases. However, the fact that CSDH affects primarily elderly people means that operative mortality and morbidity is by no means uncommon.4,5 In this review, we report the surgical outcome of CSDH at a local neurosurgical centre over the course of 5 years, with emphasis on treatment‐related morbidity and mortality.

A retrospective analysis was performed on 108 patients who underwent operation for CSDH at Queen Mary Hospital, Hong Kong, between January 1995 and December 1999. The diagnosis of CSDH was made on computerized tomography (CT) in all cases and confirmed at operation. Patients with acute post‐traumatic subdural haematoma and subdural effusion were excluded.

There were 108 patients. The male to female ratio was 3 : 1. The mean age was 73 years. The majority of patients presented with limb weakness. History of head injury could be identified with certainty in less than half of the patients. Eight patients had bleeding tendency who required delayed operations—six were taking salicylate, one was taking ticlopidine and one was on warfarin.

Two patients underwent craniotomy—one for a heavily loculated CSDH and the other had a solid mass of organized CSDH. Both recovered uneventfully. For those who underwent burr hole drainage, more than half did not have any postoperative drainage.

One 55‐year‐old female developed subdural empyema. One 64‐year‐old male suffered from postoperative tonic‐clonic seizure. There were five recollections of haematoma which required re‐operations. There were four deaths, giving rise to a hospital mortality rate of 4%.

This series is an audit of the surgical outcome of chronic subdural haematoma at a local neurosurgical centre and shows that the mortality and morbidity rates are compatible with current standard of care. The nature of a retrospective study is such that detailed assessment of postoperative clinical and functional improvement is severely hampered by suboptimal documentation and recall bias. It is hoped that a prospective study in the near future will revisit the issue in more positive light.
ASSOCIATION OF APOLIPOPROTEIN E POLYMORPHISM WITH OUTCOME IN PATIENTS WITH SUBARACHNOID HAEMORRHAGE
Authors: Leung C.H.S. , Ng H.K. , Poon W.S.
Published: August 2010

Background variation in outcome after subarachnoid haemorrhage (SAH) patients is not fully explained by the known prognostic factors. Traditionally poor World Federation of Neurological Surgeons (WFNS) or Hunt and Hess grade SAH patients were labelled as unsuitable for surgical intervention. But more often we observed favourable outcome from this group of poor grade SAH patients. The decision becomes complicated especially when the patient is young but has a poor grade subarachnoid haemorrhage. Decision on whether to intervene or not may be easier if there is an additional prognostic indicator on the prognosis of this group of patients. Also this may improve the survival of this group of patients whom we have labelled not for surgery.

The gene Apolipoprotein E (APOE) had been widely studied in animal models which indicates it has an important role in response to nervous system injury. * From the Glasgow group we learnt that APOE has a prognostic value in head injured patients.
† One of the Apolipoprotein—APOE4 was studied specifically for its adverse effect on the outcome of head injured patients. So far there is no clinical study investigates the genetic predisposing factors relating to the outcome of subarachnoid haemorrhage patients. We report a prospective clinical study testing the hypothesis that patients with APOE epsilon4 have a worse clinical outcome than those without APOE4. Preliminary results and possible implications will be discussed.
The Treatment of Intoed Gait in Spina Bifida Patients by Lateral Transfer of the Medial Hamstrings
Authors: Golski A. , Menelaus M. B.
Published: August 2010

The operation of lateral transfer of the medial hamstring muscles is described. Its application in the management of intoed gait in spina bifida is discussed, and the results of eight such operations, performed on four children, are recorded. The operation was effective in correcting the intoed gait in all; however, there was no activity in the transferred muscles in one child.

1. The transferred tendons were active in three of four children subjected to bilateral lateral transfer of the medial hamstrings.

2. There was some diminution of knee flexion power, but no back knee or knee flexion contracture, as a result of the surgery. In one case there was no activity in the transferred muscles on either side.

3. The intoed gait was corrected in all cases.
Chronic Subdural Haematoma in the Elderly
Authors: So S. C.
Published: August 2010

A series of 20 patients over the age of 60 years, all suffering from chronic subdural hematoma, is reviewed. Factors leading to diagnostic errors are emphasized. Burr‐hole aspiration supplemented by adequate measures to aid in reexpansion of the brain remains the primary choice of treatment in this condition.
Thymectomy for Myasthenia Gravis
Authors: Farnsworth A. , Pories W. , Mendelsohn H.
Published: August 2010

A group of 71 patients with myasthenia gravis is reviewed. All were initially managed medically, and 18 underwent thymectomy. Twenty‐three responded poorly to drug treatment, and seven died from respiratory failure. In contrast, thymectomy was beneficial in 16 of the 18 who were subjected to operation. Seven patients had significant postoperative respiratory complications, and nine required a tracheostomy. Thymectomy appears to be effective and safe and to be indicated in young patients with early disease, and in patients who do not respond to drug treatment. The transcervical approach to thymectomy zvas satisfactory on two occasions.
Properties of Strain Cells of the Uterine Invasive Mole and of Its Metastatic Choriocarcinomas
Authors: Nakamoto Osamu
Published: August 2010

No report could be found concerning the strain cells of the invasive mole. We could establish the three strain cells from materials which were histologically diagnosed as invasive mole. At the same time, five strain cells were obtained from a cerebral metastatic choriocarcinoma focus. The present work was designed to elucidate the nature and genesis of this mole by repeating the analysis on the cell level.

Phase contrast microscopy revealed two types of proliferation, one was single‐layered and the other multi‐layered. In the latter, the cells were piled up one on another resembling cancer cells. Electron microscopic observation revealed there were two kinds of cells, one having papillary processes grown on the free surface and designated as syncytiotrophoblast, the other type resembled a cytotrophoblast. The growth curve was established and doubling time based on it was calculated as 2.2 days. The chromosome count, fell in the higher polyploid zone. Both strains produced glycoprotein hormones (hCG, ACTH), and steroid hormones (progesterone, estrogen) in large amounts.

Both series of strain had many similarities and a few differences suggesting the possibility that cancerous cells may be mingled in some invasive moles under pathological conditions.
A Study on the Existence and Localization of the Testis‐Determining Substance in Early Fetal Rat by Organ Culture
Authors: Koresawa Mitsuhiko , Jimbo Toshiharu , Mizuno Masahiko , Sakamoto Shoichi
Published: August 2010

The combined organ culture was performed in vitro using rats of the Wister strain. During the experiment combinations of the following organs were used: the fetal ovarian primordium at the 14th day of gestation and fetal testes at the 14th, 16th, and 19th day of gestation and the 2nd day after birth, or the fetal liver at the 14th day of gestation. Cultivation was carried out on a glass fiber filter (METRICEL mebrane filter) placed on a mesh in a small culture vessel (Falcon No. 3037), using 0.5 ml of synthetic medium 199 containing 25% of fetal calf serum at 37°C with 5% CO2 in air. Histological sections of 5 μ were made 2 or 3 days after cultivation and stained with hematoxyline‐eosin.

It was observed that the differentiation of the fetal testis and ovarian primordium took place in vitro during cultivation. The former exhibited the seminiferous tubule‐like structures. In the case of the ovarian primordium, its differentiation was influenced to the various extents depending on the tissues with which it was combined. In combination with the fetal testis up to day 16 of gestation, it showed a testis‐like development in close relation with the distance to the border of the testis, but neither the testis after day 19 of gestation nor the fetal liver exerted any influence on ovarian differentiation, indicating that the testis‐determining substance(s) exists specifically in the early fetal testis and is secreted therefrom.
Myomectomy: A Reappraisal and Post‐Operative Reproductive Performance
Authors: Omu A.E. , Ehigiegba A.
Published: August 2010

Seventy‐two out of 108 patients that had myomectomy at the University of Benin Teaching Hospital from April 1973 to March 1979 are reviewed. Myomectomy was a more favoured method of surgical treatment of uterine fibroid in the community than hysterectomy, (X2 = 13, P/0.02). The commonest indications for myomectomy included infertility (69.4%), menorrhagia (58.3%) and dysmenorrhoea (56.94%). There was associated tubal blockage of 33.3%, and 56.9% had pelvic adhesions at operation. Recurrent myoma was recorded in 13.9% of the patients. The gross pregnancy rate was 15.4%. Sixty percent of the patients were delivered by caesaren section.
The Effect of Intra ‐ Uterine Device on the Endometrial Pattern
Authors: Nayel Sayed A. , Elgazaierly Samir A. , Fahmy Sohir M.
Published: August 2010

Endometrial biopsies were taken from fifty asymptomatic Lippes loop users with regular cycles on days, 16, 20 and 24 to study the endometrial pattern. Maturation was delayed in 58% of biopsies on day 16, in 80% on day 20 and in 88% on day 24.
Kielland's Forceps for Deep Transverse Arrest
Authors: Rodrigues Camilla , Singh Padamjit M. , Gupta Amar Nath
Published: August 2010

This is a retrospective analysis of 165 deliveries conducted for deep transverse arrest at the Postgraduate Institute of Medical Education and Research, Chandigarh over a period of five years from January, 1974 to December, 1978. The maternal and foetal outcome in 109 cases following a Kielland's forceps delivery were compared with 56 cases delivered by manual rotation and forceps. However, there was no significant difference in the maternal and foetal outcome in the two groups, except for a significantly higher incidence of cephalohaematoma with manual rotation and a forceps delivery as compared to a Kielland's forceps delivery (p < 0.01).
Rupture of The Pregnant Uterus
Authors: Ezem B. U. , Otubu J. A. , Barnes B.
Published: August 2010

123 cases of uterine rupture treated at the Ahmadu Bello University Hospital, Zaria, are reviewed. The incidence is 1 per 148 deliveries. Mean age was 27 while mean parity was 4.3. The commonest etiologic factor was cephalopelvic disproportion. The commonest clinical feature were tachycardia, abdominal pain and pallor.

Scar rupture was associated with more vesical injuries while vaginal injuries were more common in the unscarred ruptures. Fetal and maternal mortality were 82.9% and 14.6%, respectively. Fetal prognosis was better in the scarred than unscarred uterine rupture.

Repair of the uterus with sterilization was the common method of treatment.
Effect of Gamma‐Aminobutyric Acid on the Release of Prolactin, Luteinizing Hormone and Follicle Stimulating Hormone in Spayed Rats
Authors: Ohkawa Tomi , Sato Naoki , Okinaga Shoichi , Arai Kiyoshi
Published: August 2010

The effect of Gamma‐Aminobutyric Acid (GABA) on the release of Prolactin (PRL), Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH) in spayed rats was studied. Adult female rats of the Wistar strain were ovariectomized 30 days prior to the experiments and various doses of GABA and/or picrotoxin (PCT) were injected into the third ventricle under Nembutal anesthesia. A dose of 10‐8 mole GABA produced a marked decrease in plasma PRL levels. On the other hand, the addition of 10‐8 mole PCT to 10‐8 mole GABA antagonized the inhibitory effect of GABA, whereby plasma PRL levels returned to pretreatment values. Plasma LH levels increased significantly after intraventricular administration of 10‐7 mole of GABA. FSH concentrations remained unchanged after the same treatment. Intraventricular injection of GABA interfered with central nervous system (CNS) function in the periventricular region and activated hypothalamic nerve cells. Participation of the hypothalamic inhibitory interneurons in inhibition of PRL release and the LH secretion stimulatory mechanism were discussed.
The Guinea Pig Hypothalamo‐Neurohypophyseal Complex in Organ Culture for Oxytocin Studies
Authors: Suzuki Hideaki , Makino Tsunehisa , Haginiwa Ichigen , Iizuka Rihachi
Published: August 2010

The guinea pig hypothalamo‐neurohypophyseal complex (HNC) was assessed as a possible in vitro model for oxytocin (OT) studies. The hypothalamus was incised in such a way as to contain intact supraoptic and paraventricular nuclei. The HNC was maintained for a week on a steel grid in Eagle's Minimum Essential culture medium (containing 10% fetal bovine serum and kanamycin 60 mg/1, pH 7.0) and incubated at 37°C under 95% air and 5% CO2. OT released from the HNC into the culture medium in a 20 minute period was measured every day. OT concentrations were fairly constant from Day 1 to Day 7 in culture.

The hypothalamus and the pituitary were also incubated in the same conditions as the HNC in culture for comparison. Our studies indicate that OT was released from the HNC in constant quantities.

Histological observations under light microscopy showed that the neurosecretory cells remained viable during the culture period.

We believe organ culture of the HNC could be a useful model for further OT studies.
C‐Reactive Protein in EPH Gestosis
Authors: Nayel Sayed A. , Kandil Kamal K. , Mustafa Essam M. Abu
Published: August 2010

C‐reactive protein (C R P) was measured in thirteen normal non pregnants, thirty four normal gravidas, and seventeen cases of EPH gestosis. No significant differences were found between the normal non pregnants and the normal pregnants. It was found to be significantly higher in EPH gestosis than in the other two groups.
Total Platelet Count, Adhesive Platelet Count, Platelet Adhesiveness in Normal Menstrual Cycle and Functional Uterine Bleeding: A Comparative Study
Authors: Abbott R. , Chandra M. , Chandra R.
Published: August 2010

The menstrual cycle is known to influence the haemodynamic and the thrombocytic elements in women.

All 100 cases in this study were investigated to exclude any bleeding disorder or severe anaemia.

In a control group of 50 women, with normal and regular menstrual cycle it was observed that the total platelet count (TPC) and adhesive platelet count (APC) increased gradually to a peak from menstrual to the mid cycle phase and subsequently declined to an intermediate level in the premenstrual phase. Platelet adhesiveness (PA) showed negligible change.

In other 50 cases of FUB (Group A: 25 cases of FUB with menorrhagia; Group B: 25 cases of FUB with continuous irregular bleeding), the mean values of TPC and APC were consistently lower but a phasis trend was maintained similar to control cases. However, PA was consistently elevated and declined only during the mid cycle. The above changes in FUB seem to be due to:

(a) reduced absorption of necrotic material into circulation

(b) deranged hormonal levels‐,

(c) acceleration of thrombin formation
The Establishment of Human Choriocarcinoma Cell Line in Vitro
Authors: Suzumori Kenji , Sugimoto Yoshie , Suzjmori Kaoru , Yagami Yoshiaki , Takeda Akihiro
Published: August 2010

A new tissue culture cell line, designated NUC‐1, has been established from human choriocarcinoma of the uterus. The cell line has now been growing in vitro for 28 months and has been subcultured 32 times. The cell grew in a monolayer sheet, showed a marked tendency to pile up, and released human chorionic gonadotropin (hCG) in media. During logarithmic growth in vitro, the doubling time for NUC‐1 was 36 hr. Light and electron microscopic observation showed that the cultured cells consist of various types of trophoblastic cells ranging from cytotrophoblasts to syncytiotrophoblasts. The chromosomal constitution of this cell line was hyperdiploid, and the marker chromosome could be identified in the A‐group. Cultured cells at the seventh passage were transplanted to nude mice; histological examination of the tumor which developed in nude mice showed close resemblance to the original tumor.
Effect of Ritodrine Hydrochloride on Uterine Activity and Maternal and Fetal Circulations in the Pregnant Sheep
Authors: Fujimoto Seiichiro , Akahane Masuo , Uzuki Katsuya , Inagawa Akira , Sakai Keiichiro , Ichinoe Kihyoe
Published: August 2010

The effects of ritodrine hydrochloride on uterine activity and maternal and fetal circulations were investigated in chronically prepared pregnant sheep. Ritodrine inhibited oxytocin‐induced uterine contractions in a dose‐dependent manner. The inhibition of uterine activity at 3 mcg/kg/min of ritodrine was about 70%, and greater infusion rates resulted in only minimal further inhibition of the uterine activity. Maternal tachycardia but no hypotension were observed during ritodrine infusion. There were no significant changes in fetal heart rate or blood pressure. Uterine arterial blood flow decreased remarkably at higher doses of ritodrine. These changes were, however, less pronounced when ritodrine was infused at a constant dose of 3 mcg/kg/min, which was sufficient to inhibit the uterine activity.

In addition, propranolol blocked the effect of ritodrine on uterine activity and maternal heart rate. This supports the view that ritodrine produces its effects through activation of adrenergic β‐receptor.
Management of Hydatidiform Mole in Women over 45 Years Old*
Authors: Soma Hiroaki , Takayama Masaomi , Saito Toshiki , Isaka Keiichi
Published: August 2010

In order to estimate the incidence of hydatidiform mole in older women, the records of 369 cases of hydatidiform mole including 27 patients over 45 years of age were investigated and compared with total numbers and distributions of 4964 pregnancies by maternal age during a 6‐year period (1975 – 1980) at Tokyo Medical College Hospital.

The incidence of hydatidiform mole in women over 45 years of age was extremely high, in spite of the low rate of pregnancy for that age. The increase was 45‐fold in such older patients. Eighteen of 27 cases over 45 years of age developed subsequently into malignant changes. The rate of such malignant progressions as choriocarcinoma or invasive mole was 66% in women over the age of 45 as compared with around 15% in those under 44 years of age. Thus, women aged 45 years or more are subject to a 4.4‐fold increase in the risk of choriocarcinoma or invasive mole.
Pregnancy Gingivitis and Estimation of Oxygen Consumption in Gingival Tissue
Authors: Saleh F.M. , Abd‐El‐Gawad A.H. , Ragheb A. , Nour Z.M. , El‐Negoumi I.A. , El‐Bassyouni A.M.
Published: August 2010

Forty females were included for the clinical dental examination and estimation of oxygen consumption in the gingival tissue using the Warburg manometrictechnique. In the twenty pregnant females there were no significant difference in the plaque and retention indices as compared to the non‐pregnant females. However the gingival index was significantly higher in pregnant women. The oxygen consumption in the gingival tissue showed a statistically significant increase in the pregnant women. Explanation for these changes were discussed.
On‐line Computer System for Storage and Retrieval of Perinatal Records
Authors: Kitazoe Yasuhiro , Yamamoto Koji , Hashimoto Hiroshi , Ogura Hisakazu , Furutani Hiroshi , Takeda Yoshihiko
Published: August 2010

An on‐line computer system for easy entry and retrieval of perinatal records is described. Using this on‐line system, physicians without any knowledge of computer language can make simple statistical calculations. Originally developed as a data entry system for perinatal records gathered by the Committee on Perinatal Statistics of the Japan Society of Obstetrics and Gynecology, this system was then merged into IMIS, the Integrated Medical Information System of Kochi Medical School. 448 cases of perinatal deaths were registered by the end of 1982. Using these death cases, dependence of main clinical causes of death on gestational week and birth weight is shown as an example of the results obtained using this computer system.
Relation of the Site of Congenital Upper Gastrointestinal Obstruction to Amniotic Fluid Bilirubin Concentration
Authors: Hisanaga Sachio , Shimokawa Hiroshi , Kurokawa Tatsuro , Maesato Soei , Nakano Hitoo
Published: August 2010

In order to ascertain relative amniotic fluid bilirubin concentrations and to assess their value in antenatal diagnosis of upper gastrointestinal obstruction, amniotic fluid samples obtained from eight women who gave birth to infants with congenital upper gastrointestinal obstruction were analyzed spectrophotometrically.

Types of congenital upper gastrointestinal obstruction in the study included esophageal atresia (1), pyloric atresia (1), high jejunal atresia (1), annular pancreas (2), and duodenal atresia (3).

Amniotic fluid bilirubin concentration of the six women who gave birth to infants with intestinal obstruction distal to Vater's ampulla increased above the mean + 2 S.D. of the control. By contrast, the two who gave birth to infants with esophageal atresia or pyloric atresia had normal levels of amniotic fluid bilirubin.

These findings suggest that when the obstruction is distal to Vater's ampulla, bile is regurgitated into the amniotic fluid by the fetus, resulting in a significant increase in amniotic bilirubin concentration. However, amniotic fluid bilirubin doesn't originate from the upper gastrointestinal tract in normal pregnancies: its concentration was within the normal range in the two fetuses with esophageal or pyloric atresia who couldn't regurgitate bile into the amniotic fluid.
Effects of Domperidone on Serum Prolactin Levels in Rats with Hypothalamic Deafferentation
Authors: Kato Hiroshi , Ueda Kazuyuki , Tamura Haruyo , Fujino Toshio , Toyoshima Hiroyuki , Hiratsuka Keisuke , Mano Takafumi , Torigoe Tadashi
Published: August 2010

The sites of action of domperidone, a dopamine antagonist, in stimulating prolactin secretion were studied in female rats subjected to one of the following treatments: Hypophysectomy and pituitary‐autotransplantation beneath the kidney capsule; hypothalamic deafferentation at the medial hypothalamus between the anterior hypothalamic area and the nucleus dorso‐medialis hypothalami (MHD); hypothalamic deafferentation in the posterior part of the hypothalamus just caudal of the nucleus mamillaris (PHD); MHD plus PHD. In the hypophysectomized pituitary‐auto‐transplanted rats, intravenous injections of domperidone (200 μg/100 g body weight) neither increased serum prolactin levels nor reversed the inhibition caused by bromocriptine. On the other hand, domperidone caused significant increases in serum prolactin levels in all groups of rats with hypothalamic deafferentation. These results indicated that domperidone, at least at high concentrations, acts through the caudal part of the hypothalamus to stimulate prolactin secretion.
Pivmecillinam in Treatment of Complicated Urinary Tract Infections during Initial Prophylactic Therapy after Radical Hysterectomy
Authors: Tamaya Teruhiko , Tsurusaki Toshihide , Kusanishi Hiroshi , Okada Hiroji
Published: August 2010

The clinical efficacy of pivmecillinam was evaluated in the treatment of complicated urinary tract infections occurring during prophylactic initial therapy immediately after radical hysterectomy with pelvic lymphadenectomy in 29 patients with uterine cervical cancer. Pivmecillinam was administered 400mg daily for 2 weeks. Overall clinical evaluation was done in 24 cases. The result was excellent in 5, good in 10, and a failure in 9 cases, for an overall efficacy rate of 62.5%, based on the assessments of pyuria and bacteriuria. Side effects in patients who received pivmecillinam were not remarkable.

Pivmecillinam appears to be useful for maintenance therapy against complicated urinary tract infection in gynecology. Clinical considerations concerning the bacteriological findings are also discussed.
Evaluation of Male Infertility by Penetrability (or Penetration Assay) of the Human Spermatozoa through Zona‐Free Hamster Ova
Authors: Tang Lawrence C. H. , Chan Steven Y. W. , Ma Ho‐kei
Published: August 2010

The human spermatozoa zona‐free hamster ova penetration assay (SPA) and seminal fluid analysis (SFA) were performed on 44 infertile and 35 fertile couples. The mean penetration rate for semen samples from fertile males (44% ± 3%) was significantly higher (p<0.05) than that of semen samples from infertile males (10% ± 1%). Penetration rates below 20% were not observed with fertile semen samples. No correlation (p>0.05) was observed between the spermatozoal density, total spermatozoal count, percentage of motile spermatozoa, or percentage of normal morphology and the penetration rate. The sensitivity of the SPA was 91% and the specificity was 100% as compared to 73% and 83% respectively for the SFA. These findings indicate that the SPA is useful in the assessment of the fertility potential of human semen samples in the evaluation of male fertility and infertility.
Uterine Contractile Effect of an Oxytocin‐like Substance in the Human Placenta
Authors: Nakazawa Kazumi , Makino Tsunehisa , Nagai Takashi , Lizuka Rihachi , Lshii Kunio
Published: August 2010

Abstracts

The bioactivity of an oxytocin‐like substance in human term placental tissue was examined using rat uterine muscle obtained during diestrus.

The human term placental tissue extract contracted the rat uterine muscle on a Magnus apparatus. Placental tissue extract incubated with oxytocin antiserum did not induce significant contraction of the muscle, whereas placental tissue extract incubated with normal rabbit serum induced a significant effect on the rat uterine muscle. Synthetic oxytocin caused contraction similar to that caused by placental tissue extract in rat uterine muscle. This contraction was also inhibited when synthetic oxytocin was incubated with anti‐oxytocin serum for 24 hr at 4°. Normal rabbit serum and anti‐oxytocin serum alone did not cause contraction. These results suggest that the oxytocin‐like substance in the human placenta may possess uterine contractile activity.
Surgical Induction of Labour
Authors: Wong P. C. , Ratnam S. S.
Published: August 2010

Six hundred and forty‐one patients who underwent induced labour over a 12 month period were analysed. The ethnic group distribution was similar to that in the obstetric population. 54.6% of these were primiparous patients. The common indications of induced labour were hypertensive disorder of pregnancy, static weight and post‐term pregnancy. The mean induction delivery interval was 8.52 hours in primiparous and 5.18 hours in multi‐parous patients. The caesarean section rate was 15% and this was statistically more than those with spontaneous labour. The rate of complication was very low.
The Effect of Electro‐cutting and Diathermy Coagulation on Wound Healing in Gynecological Surgery
Authors: Nayel Sayed A. , Habashy Mostaf A. El , Osman Ahmed M. , Gawad Aly A.
Published: August 2010

Thirty patients were enrolled in this study. In half of the group, electrocutting was used in transecting the abdomen, while in other half, the conventional scalpel was used. From our observations; diathermy incisions showed some impairment of the healing, but no serious complications has occurred. The observation of the wound healing and complications of the procedures used were discussed in the light of the available data.
Clinical Significance of Antithrombin III, Plasminogen and Alpha2‐plasmin Inhibitor in Perinatal Period
Authors: Fuse Yoji , Fuse Kozue
Published: August 2010

We studied changes in antithrombin III, plasminogen and alpha2‐plasmin inhibitor levels in the maternal and cord blood by a newly developed fluorescent substrate assay method. Correlations between bleeding on parturition and weight of the newborn were also studied.

No marked changes in antighrombin III, plasminogen and alpha2 ‐plasmin inhibitor levels were noted before or after parturition in either the normal bleeding or the abnormal bleeding group, but preparturient plasminogen and alpha2‐plasmin inhibitor values correlated with amount of bleeding on parturition, and could therefore be used to predict intrapartal bleeding.

The SGA (small for gestational age) group showed a significant decrease of plasminogen and alpha2‐plasmin inhibitor compared with the AGA (appropriate for gestational age) and LGA (large for gestational age) group, which was understood to be due to mild acidosis caused by stress in pregnancy and on parturition and immaturity of the neonatal liver.
Some Characteristics of Breech Deliveries
Authors: Wong P.C. , Widjaya Kusuma , Heng S.H. , Ratnam S.S.
Published: August 2010

Two hundred and forty‐four patients with breech presentation occurring in a one year period of a total of 7676 deliveries were analysed. The incidence of breech deliveries was 3.2%. 57.4% of breeches occurred in primiparous patients and a quarter of them were delivered premature. 80% went into spontaneous labour whilst a third were delivered abdominally. 10.2% of the babies were less than 2270 g. The overall perinatal mortality rate of breeches over 1000 g was 55 per 1000. Some of the factors affecting the perinatal mortality were discussed.
The Management of Female Hirsutism with the Anti‐Androgen Agent Cyproterone
Authors: Kwok Peter C. , Correy Joseph F. , Senator Gordon B.
Published: August 2010

The treatment of female hirsutism with a combination of the anti‐androgen agent Cyproterone Acetate and Ethinyl Oestradiol is discussed in 53 patients of whom 37 have completed 12 months' treatment. Assessment was carried out by serial scoring using the Ferriman and Gallwey method. The majority of patients experienced satisfactory subjective improvement, and objective improvement was recorded in approximately half of the patients who completed the full course of 12 months' treatment. Side effects of treatment were experienced by 27 of the 37 patients completing 12 months' treatment but in most instances were mild and related to the oestrogen. Minimal disturbances of liver function tests and lipids were noted which did not reach significance. The maximum response to treatment was noted after 6 months of therapy, and it is recommended that this be the standard initial course of treatment.
Duplication of Ileum in Fetus: A Case Report
Authors: K‐ozuka Mitsuo , Sato Akira , Tanigawara Shingo , Suzuki Toshiaki , Kimura Kazuhiko
Published: August 2010

Fetal abdominal c‐st different from the urinar‐ bladder was detected b‐ real‐time ultrasonograph‐.

The c‐st, which had grown to approximatel‐ 60 mm in diameter at the 29th week of gestation, was punctured under real‐time ultrasonographic guidance. Fetograph‐ revealed no distinctive external malformation.

Examination of the fluid from the c‐st did not reveal the c‐st̂s origin.

Laparotom‐ conducted on the 19th da‐ after birth revealed duplication of the ileum at approximatel‐ 95 cm from the end of ileum.

Indications for intra‐uterine treatment are discussed.
Postoperative Arterial Thrombosis
Authors: Pal S. K. , Chowdhur‐ N. N. Ro‐
Published: August 2010

Arterial thrombosis following pelvic surger‐ is a rare phenomenon. In the present communication unilateral thrombosis of common iliac and external iliac arter‐ is reported in the postoperative period in a case of carcinoma cervix who had bilateral internal iliac arter‐ ligation done, as an emergenc‐ procedure to control vaginal bleeding. Patient developed evidence of arterial obstruction of right leg on third postoperative da‐ and the level of obstruction was determined b‐ doppler ultrasonic velocit‐ detector. Right external arteriotom‐ was done and thrombi were removed b‐ Fogart‐ balloon catheter. Unfortunatel‐ patient died of postoperative shock.

It is highl‐ probable that thrombosis superimposed on a preexisting atheromatous patch in the iliac vessel. The exiciting factors in the present case were slowing of circulation which occurred during the last bout of vaginal haemorrhage and also handling of the arteries during the operation which might have initiated arterial spasm thus favouring thrombus formation.
Collaborative Stud‐ on Preterm Breeches: Vaginal Deliver‐ Versus Caesarean Section
Authors: Viegas Osborn A. C. , Ingemarsson Ingemar , Sim Low Poh , Singh Kuldip , Cheng Mark , Ratnam S. S. , Chow K. K. , Ho T. H. , Vengadasalam D.
Published: August 2010

Perinatal outcome and infant development in 73 preterm breech deliveries is described in relation to mode of deliver‐.

32 such cases were delivered b‐ caesarean section and 41 b‐ the vaginal route between April 1982 and December 1983 at the 5 major government deliver‐ units in Singapore ‐ all with comparable neonatal services.

Vaginal deliver‐ was associated with a higher intrapartum and neonatal mortalit‐ and morbidit‐ when compared with infants delivered b‐ caesarean section (mortalit‐ rate in vaginal deliver‐ group = 17.1% compared with 6.3% in caesarean section group). Furthermore, amongst the 25 children assessed at 12 months of age, there was a tendenc‐ to better performance in gross motor function and language abilit‐ in those delivered abdominall‐. The present results suggest that the preterm breech might benefit from caesarean section even if variables other than the mode of deliver‐ influence the outcome. These findings are consistent with previous reports which have also been briefl‐ reviewed.

However, the higher maternal morbidit‐ associated with caesarean deliver‐ and the risk for unnecessar‐ surgical intervention (eg in cases of malformed fetuses) make a careful preoperative assessment imperative.
Recurrence of Invasive Moles and Choriocarcinomas
Authors: Hirokawa Kiyoji , Tomoda Yutaka , Kaseki Shigeaki , Ishizuka Takao , Nishikawa Yoshiki , Goto Setsuko
Published: August 2010

Prevention of the recurrence is the most important issue to be considered for improving the results of treatment of trophoblastic disease. The authors strictly differentiated choriocarcinoma and invasive mole and studied problems related to their recurrence. There were 17 recurrent cases out of 320 invasive moles treated until 1979. Among them histologically confirmed cases were all found to be choriocarcinoma at the time of recurrence. By applying strict criteria for judgement of complete remission, a drop of 7.7 — 1.8% in the recurrence rate was achieved.

Regarding 159 choriocarcinoma cases treated until 1979, the remission rate was remarkably improved, but decrease in the recurrence rate could not be achieved. The risk factors involved in the recurrence of the disease were investigated, and factors such as history of hydatidiform mole, tumor localization, alteration of platelet count, and number of chemotherapeutic courses needed after hCG dropped to minimum level were found to be related. Since 1980, observance of the risk factors and improved treatment regimen has decreased the recurrence rate of choriocarcinoma.
A Case of Urachal Carcinoma with Meigs's Syndrome
Authors: Kidera Yoshiro , Uchiyama Yoh‐ichi , Iwasaka Tsuyoshi , Ohkuma Yoshinari , Yoshimura Takahiro , Sugimori Hajime
Published: August 2010

A case of urachal carcinoma observed in a 41‐year‐old female is reported. Her complaints were easy fatigability, abdominal distention and dyspnea. Ascites, right‐sided pleural effusion and pelvic tumor were observed. Culdo‐centesis and pleural aspiration proved the fluid to be bloody. Because the pelvic tumor was found at laparotomy to arise from the juxta‐vesical region, the tumor was considered to originate in the urachus. Very slow bleeding from the tumor vessels was noted, which accounted for hemoperitoneum and bloody effusion in the right pleural cavity. Resection of the pelvic tumor with a small metastatic nodule on the Douglas' pouch peritoneum, simple total hysterectomy and right salpingo‐oopholectomy were performed. Histopathologic examination of the tumor revealed a poorly differentiated transitional cell carcinoma. Postoperatively the patient was put on a combination chemotherapy of Cisplatin, Adriamycin and cyclophosphamide. She is free from disease at 8 months.
Maternal Mortality Yet to Be Minimized
Authors: Yam A. , Ghosh A.
Published: August 2010

The changes in the causes of maternal deaths in a major referral hospital over a span of 39 years from 1945 to 1983 have been reviewed. There were 235,319 deliveries and 118 maternal deaths. The overall maternal mortality rate per 100,000 total births was 50. The rate declined from 89 during the period 1945 to 1954 to 10 in the last decade. There has been a significant decline in direct maternal deaths from infection, haemorrhage and preeclampsia–eclampsia since the first half of the studied period. Pulmonary embolism and general anaesthesia were not found to be an important cause of maternal death. Heart disease and amniotic fluid embolism were the two major causes of maternal death in the last 19 years. During the past 9 years non‐obstetric causes have almost approached direct causes of maternal death in frequency. Continued vigilance is still needed to eliminate death resulting from haemorrhage, infection and preeclampsia–eclampsia. Risk of maternal death due to other causes can be minimized only if a greater effort is made to identify the at‐risk patients particularly those with medical disorders so that an adequate pre‐conceptional advise and a multi‐disciplinary approach to the patient care can be provided.
Secretion of the β‐subunit of Luteinizing Hormone in Dispersed Rat Anterior Pituitary Cells
Authors: Seki Takashi , Makino Tsunehisa , Tanimoto Satoshi , Izumi Shunichiro , Iizuka Rihachi
Published: August 2010

Enzymatically dispersed rat anterior pituitary cells were perifused in order to investigate the secretion pattern of luteinizing hormone (LH) and its β‐subunit (LH‐β) by luteinizing hormone‐releasing hormone (LH‐RH) in vitro.

Intermittent stimulations with LH‐RH induced marked release of LH and LH‐β. The self‐priming effect on either LH or LH‐β release by LH‐RH was not significant; in contrast, a desensitization effect produced by this decapeptide hormone was clearly observed in the release of these two peptide hormones. The perifusion technique was revealed to be useful in analyzing the temporal secretion of the gonadotro‐pins from the anterior pituitary cells, and the data suggest that LH‐β is released concomitantly with native LH by LH‐RH in vitro.
Immunocytological Distribution of the Tumor Antigen
Authors: Hoshina Makoto , Kimura Azusa , Shibata Kazuo , Maruo Takeshi , Mochizuki Matsuto
Published: August 2010

Serum levels of the cervical cancer associated antigen (TA‐4) have been well correlated with clinical staging of cervical cancer and the response to surgery or radiation therapy. We studied immunohistologically the distribution of TA‐4 in normal and neoplastic cervical tissue. TA‐4 was localized to epithelial tissue of the uterine cervix. During squamous maturation of the cervix, TA‐4 was expressed first in the nucleus and then in the cytoplasm of the original epithelium or the columnar epithelium with squamous metaplasia. Therefore, TA‐4 seems to be associated with squamous maturation or metaplasia. The intensity of TA‐4 staining in neoplastic regions was greater than in normal epithelium. Thus TA‐4 might be related to carcinogenesis of the cervix.
Antenatal Diagnosis and in Utero Treatment of Fetal Arrhythmia
Authors: Hata Toshiyuki , Iida Kohji , Hata Kohkichi , Moriyama Masashi , Kitao Manabu
Published: August 2010

An antenatal diagnosis was made in six fetuses with supraventricular premature beats, and in two with supraventicular and ventricular premature beats, using fetal echocardiography, electrocardiography, and pulsed Doppler ultrasound. Coenzyme Q10 was given to the mother to treat the fetal arrhythmias, in two fetuses. In the first fetus with supraventricular premature beats and severe deceleration, the arrhythmia disappeared during gestation, and in the second fetus with severely irregular supraventricular premature beats and paroxysmal supraventricular tachycardia, the arrhythmia had practically disappeared just before labor. These findings suggest that Coenzyme Q10 warrants further investigation for the treatment of fetal arrhythmia, in utero.
A Scoring System for Toxemia of Pregnancy
Authors: Ichijo Motohiko , Ushioda Etsuo , Oku Masataka , Hiraoka Katsutada , Moriyama Ikuko S. , Nakanishi Akira , Saitoh Shigeru , Iioka Hideaki
Published: August 2010

A total of 1026 cases of toxemia of pregnancy were chosen from some 1500 cases collected in cooperation with many hospitals and medical facilities in Japan, and examined for the purpose of devising an appropriate scoring system for toxemia of pregnancy. We prepared various scoring methods relating to toxemia of pregnancy and compared them to determine their value in predicting intrauterine growth retardation, fetal death, and maternal persistent hypertension at 30 days after delivery. A scoring method taking edema, proteinuria, and hypertension (EPH) was found to be better and easier to use than other methods.
Sequential Therapy with Clomiphene Citrate and Human Menopaus‐al Gonadotropin for Induction of Ovulation and Pregnancy
Authors: Yasuda Motoi , Miyake Akira , Aono Toshihiro , Tanizawa Osamu
Published: August 2010

Clomiphene citrate (clomiphene) and human menopausal gonadotropin (hMG)‐human chorionic gonadotropin (hCG) were given sequentially to 18 patients who failed to ovulate with hMG‐hCG treatment alone. The rates of ovulation with clomiphene‐hMG‐hCG treatment were 94.4% per patient and 76.5% per course. Pregnancy was induced in 14 courses (16.5%) and in 12 patients (66.7%). The incidences of the ovarian hyperstimulation syndrome per patient and per course were 27.8% and 7.1% respectively. The rates of abortion and multiple pregnancy by treatment with clomiphene‐hMG‐hCG were 16.5% and 21.4%, respectively. The present findings suggest that treatment with clomiphene before hMG‐hCG induces ovulation and pregnancy in anovulatory patients who showed no response to hMG‐hCG treatment. Clomiphene‐hMG‐hCG therapy, however, requires careful monitoring of follicle maturation, because the ovarian hyperstimulation syndrome is apt to occur.
Natural Killer Cell Activity in Pregnancy and the Effects of Pregnant Womens' Sera
Authors: Kurashige Takanobu , Morita Hideo , Ogura Hideo , Kurashige Michi , Kitamura Isamu , Kamimura Osamu
Published: August 2010

Natural killer cell activity was found to significantly increase until the fifteenth week of gestation, then normalize from the sixteenth week to the end of pregnancy, and slightly increase at one month after delivery.

Maternal serum at the ninth week of pregnancy significantly suppressed natural killer cell activity, and sera at twenty and thirty‐six weeks of gestation, and after delivery, moderately suppressed natural killer cell activity, but nonpregnant womens' serum and autologous serum did not suppress natural killer cell activity.
Systemic Lupus Erythematosus in Pregnancy in Hong Kong Chinese
Authors: Yu Andrew , Wong Vivian C. W. , Lee Anthony K. Y. , Hung Beatrice K. M. , Ma H. K.
Published: August 2010

In 37 pregnancies, 28 patients with systemic lupus erythematosus managed in the Department of Obstetrics and Gynaecology of University of Hong Kong in 1973–1982 were reviewed. The abortion rate was much lower than expected. There was no perinatal loss in the series. Renal involvement does not give a worse prognosis, but active disease during pregnancy is associated with a significantly lower birth weight than the inactive disease.
Long‐Term Danazol Treatment for an Adolescent Girl with Aplastic Anemia
Authors: Nakamura Gen‐ichi , Yoshimitsu Kiyotaka , Ootsuka Haruo , Nakano Hitoo , Nagata Yukihiro
Published: August 2010

Danazol was administered for four years and ten months to control uterine bleeding in a 12‐year‐old girl who had had aplastic anemia. During treatment, ovulation was suppressed and the amount of uterine bleeding was much less than that of the usual monthly periods. After 58 months of danazol therapy, all the hematological findings became normal. At present, despite restoration of the normal menstrual cycles, she has normal hematological values without blood transfusions. There were few side effects during the ingestion of danazol. Danazol seems to be effective for the long‐term control of uterine bleeding.
Maternal Serum Diamine Oxidase Activity in the Third Trimester
Authors: Legge M. , Hammond E. M. , Ncwsomc B. J. , Duff G. B. , Aickin D. R.
Published: August 2010

Serum diamine oxidase activity was determined serially in 192 women in the third trimester of pregnancy. Maternal and fetal complications were absent in 74 of these women but 21 delivered light for dates infants, 18 delivered heavy for dates infants, 58 developed mild hypertension, 14 developed moderate hypertension and seven developed severe hypertension of pregnancy. In addition there were six women whose pregnancies were complicated by diabetes mellitus. Diamine oxidase activity was significantly lower among those pregnancies with light for dates infants and those pregnancies complicated by maternal hypertension. The pregnancies complicated by diabetes mellitus also demonstrated low diamine oxidase activity but the numbers were too few to assess statistically. Pregnancies with heavy for dates infants did not show any significant difference in diamine oxidase activity from normal pregnancies. The low diamine oxidase activity found in some pregnancy complications may indicate a failure of adequate substrate being available to initiate polyamine biosynthesis.
Obstetric Performance of Elderly Primiparae
Authors: Ho Pak‐Chung , So Wai‐Ki , Ma H. K.
Published: August 2010

The obstetric performance of 165 elderly primiparae was compared to that of 443 younger primiparae. The incidence of diabetes mellitus, antepartum haemorrhage, mild hypertension in pregnancy and uterine fibromyoma was increased in the elderly primiparae. The induction rate and caesarean section rate was also increased, but the perinatal mortality rate, though higher than the younger primiparae, was only 18.2/ 1000. The incidence of perinatal morbidity was also low. A history of involuntary sub‐fertility prior to conception did not affect the outcome.
Uterine Activity in Oxytocin Induced Labour
Authors: Arulkumaran S. , Gibb D. M. F. , Ratnam S. S. , Heng S. H. , Lun K. C.
Published: August 2010

Uterine activity measured by quantifying active contraction area in induced labour showed an initial significant steep increase (incremental phase) followed by a stable phase when the uterine activity was about 1750 k Pas/15 min in nulliparae and multi‐parae with poor cervical score; it was 1500 k Pas/15 min in multiparae with good cervical score. Once this was achieved, further increase in oxytocin dosage did not increase uterine activity but instead revealed a tendency to hypertonic uterine contractions. A marked rise in uterine activity was observed in the late first stage of labour (terminal phase) despite no increase in oxytocin in patients with good cervical scores (>6) at induction but not in those with poor cervical scores (<5). The uterine activity in the stable phase of oxytocin‐induced labour was not significantly influenced by parity and cervical score except multiparae with a cervical score of six or more who had significantly less uterine activity compared to multiparae with poor cervical score or nulliparae.