bluuebunny/crossref_metadata_2025 huggingface dataset:
Exchange bias in Fe/EuTe(111) bilayers
Authors: Macedo W. A. A. , Martins M. D. , Pires M. J. M. , Oliveira R. B. , Pombo C. J. S. M. , Nunes W. C. , Knobel M. , Rappl P. H. O. , Motisuke P.
Published: August 2007

We report on the investigation of the exchange bias effect in Fe layers on EuTe(111), an antiferromagnetic semiconductor. For this ferromagnet (FM)/semiconducting antiferromagnet (AFM) exchange bias system, we have found positive and negative exchange bias effect (EB). Fresh samples exhibit positive EB, independently of the applied cooling field, indicating antiferromagnetic coupling between the FM and the AFM layers at the Fe/EuTe(111) interface. The change in EB with time, from positive EB for fresh samples to negative EB after short time,is attributed to aging effects at the Fe/EuTe interface.
Interference method for the determination of the complex refractive index of thin polymer layers
Authors: Moulé Adam J. , Meerholz Klaus
Published: August 2007

The optical properties of thin-film layers are described by the complex index-of-refraction (N) and are commonly measured using spectroscopic ellipsometry. Once determined, they can be used to predict the optical reflection and transmission from films of any thickness. Fitting of the spectroscopic ellipsometry data for thin-film polymers and polymer-blends is difficult because numerous numerical assumptions are necessary and optical birefringence must be accounted for. Ellipsometric fitting techniques fail for thin films with strong absorption and high surface roughness. The authors present a simple method to measure N, perpendicular to the sample plane, of optically homogeneous films using a UV/Vis spectrometer and partial transmission substrates.
Composition dependence of structural and optical properties for sol-gel derived (100)-oriented Ba1−xSrxTiO3 thin films
Authors: Wang G. S. , Zhang Y. Y. , Mao C. L. , Dong X. L. , Chu J. H.
Published: August 2007

Highly (100) oriented Ba1−xSrxTiO3 (BST) thin films were grown on LaNiO3 coated silicon substrate by modified sol-gel process. X-ray diffraction analysis shows that the out-of-plane lattice constant decreases linearly with increase of Sr concentration. The energy band gaps (Eg) of BST thin films exhibit strong dependence on Sr content by analyzing the results of the spectroscopic ellipsometer (SE) measurement. The smallest Eg has been obtained at x=0.3, which is at the phase boundary of cube phase and tetragonal phase. The refractive index and thickness of BST thin films were obtained by fitting SE data with a multiphase model.
Simple lithographic approach for subwavelength structure antireflection
Authors: Wang Sen , Yu Xiao Zheng , Fan Hong Tao
Published: August 2007

A simple lithographic method is developed to generate large-area antireflective subwavelength structures (SWSs), in which the metal island films are used as masks. Using magnetron sputter deposition, stochastically arranged Ag islands were fabricated on Si substrates with dimensions controlled in the range of 50∼400nm. After reactive ion etching with CF4, Si SWSs were formed, with the same arrangement and density as those of Ag islands. The measured reflectivity was decreased from ∼40% for polished Si to ∼5% for Si SWS surfaces. The residual reflection was thought to be mainly from the bottoms of “U”-shape grooves.
Reduction of mosaic spread using iridium interlayers: A route to improved oxide heteroepitaxy on silicon
Authors: Gsell S. , Fischer M. , Brescia R. , Schreck M. , Huber P. , Bayer F. , Stritzker B. , Schlom D. G.
Published: August 2007

Using epitaxial SrTiO3 and yttria-stabilized zirconia (YSZ) buffer layers deposited on silicon as a starting point, epitaxial iridium layers were grown by electron-beam evaporation using a two-step growth process with an extremely low initial deposition rate. The iridium layers had in-plane (twist) and out-of-plane (tilt) full widths at half maximum as narrow as 0.08° and 0.15°, respectively, up to an order of magnitude narrower than the underlying SrTiO3 and YSZ layers. SrTiO3 and ZnO films grown on the iridium showed significantly narrower twist and tilt values than without the iridium interlayer, demonstrating a route to improved oxide heteroepitaxy on silicon.
Increasing the operating temperature of boron doped silicon terahertz electroluminescence devices
Authors: Xuan G. , Kim S. , Coppinger M. , Sustersic N. , Kolodzey J. , Lv P.-C.
Published: August 2007

High power electroluminescence near 8THz was observed from boron doped silicon devices operating at heat sink temperatures up to 118K. This represents the highest emission temperature yet observed for silicon dopant-based terahertz devices, and is a significant increase from previous reports. This letter compares the temperature dependence of the emission mechanism to the dopant occupation function and describes an empirical model that fits the variation of output power with temperature, and that can guide the design of future terahertz devices.
Mechanism of catalyst diffusion on magnesium oxide nanowire growth
Authors: Yanagida Takeshi , Nagashima Kazuki , Tanaka Hidekazu , Kawai Tomoji
Published: August 2007

In nanowire growth using vapor-liquid-solid (VLS) mechanism, controlling catalyst diffusion has been a key issue since VLS growth is essentially no longer feasible in the absence of catalyst on the tip. Here the authors demonstrate the controllability of catalyst diffusion on MgO nanowire growth by ambient pressure and discuss the underlying physical mechanism. Drastic enhancement of oxide nanowire growth was found when increasing the ambient pressure under oxygen atmosphere, and surprisingly even under argon atmosphere. This indicates that the ambient pressure rather than the amount of ambient oxygen dominates the oxide nanowire growth via suppressing the catalyst diffusion.
Molecular Epidemiology of Rhodococcus equi Based on traA, vapA, and vapB Virulence Plasmid Markers
Authors: Ocampo-Sosa Alain A , Lewis Deborah A , Navas Jesús , Quigley Frances , Callejo Raquel , Scortti Mariela , Leadon Desmond P , Fogarty Ursula , Vázquez-Boland José A
Published: August 2007

Molecular typing of the actinomycete Rhodococcus equi is insufficiently developed, and little is known about the epidemiology and transmission of this multihost pathogen. We report a simple, reliable polymerase chain reaction typing system for R. equi based on 3 plasmid gene markers: traA from the conserved conjugal transfer machinery and vapA and vapB, found in 2 different plasmid subpopulations. This “TRAVAP” typing scheme classifies R. equi into 4 categories: traA+/vapA+B−, traA+/vapA−B+, traA+/vapAB−, and traA−/vapAB− (plasmidless). A TRAVAP survey of 215 R. equi strains confirmed the strong link between vapA (traA+/vapA+B− plasmids) and horse isolates and revealed other host-related plasmid associations: between traA+/vapA−B+ and pigs and between traA+/vapAB−—a new type of R. equi plasmid—and cattle. Plasmidless strains were more frequent among isolates from nonpathological specimens. All plasmid categories were common in human isolates, which possibly reflects the predominantly opportunistic nature of R. equi infection in this host and a zoonotic origin.
Infants who drink cows milk: A cohort study
Authors: Binns Colin W , Graham Kathleen I , Scott Jane A , Oddy Wendy H
Published: August 2007

Aim:  The aim of this study was to document current practice in an Australia city regarding the introduction of whole cows milk to children under the age of 12 months.

Methods:  A cohort study of mothers and infants, recruited at birth was undertaken in Perth, Australia. A total of 587 mothers were interviewed on seven occasions over a period of 12 months using a structured questionnaire. At each interview infant feeding methods were recorded in detail. At 12 months 453 mothers (78%) remained in the study.

Results:  In this study the median age of introduction of cows milk was 41.5 weeks, a behaviour that has not changed in the past 8 years. Infants who were given solids earlier than 4 months were more likely to be introduced to cows milk before 12 months (odds ratio (OR) 2.06, confidence interval (CI) 1.4–3.1). Mothers who had a lower score on the IOWA Infant Feeding Attitudes Scale were more likely to give cows milk earlier (OR 1.83, CI 1.21–1.77). Where fathers did not support breastfeeding or were ambivalent infants were more likely to be given cows milk (OR 1.70, CI 1.23–2.58)

Conclusions:  Despite recommendations that cows milk should not be given before 12 months of age, the majority of infants were given cows milk before this age. This suggests the need for further education programs.
Outcome and hospital cost for infants weighing less than 500 grams: A tertiary centre experience in Taiwan
Authors: Hsieh Wu‐Shiun , Jeng Suh‐Fang , Hung Yi‐Li , Chen Pau‐Chung , Chou Hung‐Chieh , Tsao Po‐Nien
Published: August 2007

Aim:  To determine the outcome and hospital cost for infants weighing ≤500 g at a tertiary centre in Taiwan.

Methods:  We retrospectively reviewed the medical records of infants who were born alive with birthweight ≤500 g at the National Taiwan University Hospital from 1997 to 2004. Their outcome and hospital cost were analysed.

Results:  A total of 168 infants were included for analysis that 146 of them died after compassionate care in the delivery room and 22 received postnatal resuscitation. The infants who received resuscitation were more likely to have higher birthweights, older gestational ages and multiple births compared with those who received compassionate care. After resuscitation, five of the infants died and 17 were admitted to neonatal intensive care unit (NICU) for further management. Subsequently, 12 infants died and five infants survived to discharge. Two infants were discharged against advice and died within days. After exclusion of those receiving compassionate care, the NICU survival rate was 22.7% and the long‐term survival rate was 13.6%. The most common early morbidities were respiratory distress syndrome, intraventricular haemorrhage and patent ductus arteriosus, whereas the late morbidities included cholestatic jaundice, retinopathy of prematurity and chronic lung disease. The average total hospital costs for the NICU survivors with birthweight ≤500 g was US$ 42 411 and the average hospital cost per day was US$ 350.

Conclusion:  Exclusive compassionate care was given to the majority of the infants weighing ≤500 g in Taiwan. The survival rate remained low in these marginally viable infants.
DTPa‐HBV‐IPV vaccine for primary vaccination of infants
Authors: Nolan Terry , Lambert Stephen , Roberton Don , Marshall Helen , Richmond Peter , Streeton Catherine
Published: August 2007

Aim:  Combined vaccines have an increasingly important role to play in delivering these antigens acceptably. We describe the immunogenicity and reactogenicity of a combined DTPa‐HBV‐IPV vaccine (diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated poliovirus (DTPa‐HBV‐IPV: Infanrix penta) ) when administered for the primary vaccination of infants resulting from a study where the primary objective was to demonstrate non‐inferiority of the immune response induced by DTPa‐HBV‐IPV using an industrial‐scale IPV production process.

Methods:  Three hundred and fourteen infants received primary immunisation with DTPa‐HBV‐IPV at 2, 4 and 6 months of age. Routine Haemophilus influenzae immunisation was performed at 2 and 4 months of age at a separate injection site. Blood samples were taken at 2 and 7 months of age. Reactogenicity was assessed using diary cards for 7 days after each dose.

Results:  One month after the primary course, at least 98.9% of subjects achieved seroprotective antibody concentrations/titres against diphtheria, tetanus, hepatitis‐B and polio types 1, 2 and 3. More than 97% had a vaccine response to pertussis antigens. The incidence of local injection site reactions after DTPa‐HBV‐IPV was similar to that for the Haemophilus influenzae vaccine site. General reactions of Grade 3 intensity were uncommon.

Conclusions:  The DTPa‐HBV‐IPV vaccine is a new combination of vaccines previously available separately, with established effectiveness and safety profiles. Combined vaccines reduce storage requirements and minimise the number of injections required, thereby reducing distress for infants and parents. DTPa‐HBV‐IPV was immunogenic with an acceptable safety profile and could replace separate administration of DTPa, HBV and IPV vaccines in infants.
Twin pregnancy with a coexisting hydatiform mole and liveborn infant: Complicated by maternal hyperthyroidism and neonatal hypothyroidism
Authors: True Deanna K , Thomsett Michael , Liley Helen , Chitturi Sridhar , Cincotta Robert , Morton Adam , Cotterill Andrew
Published: August 2007

Abstract:  A twin pregnancy with a coexisting complete hydatiform mole and a healthy fetus is rare. Associated with this condition are potentially serious maternal and fetal complications. We describe a case of a woman, 23/40 pregnant, who was diagnosed with a twin pregnancy complicated by a hydatiform mole, vaginal bleeding, hyperthyroidism and preterm labour at 26/40. Her hyperthyroidism was successfully treated with propylthiouracil. The preterm labour resulted in the livebirth of a healthy male infant. The baby developed biochemical hypothyroidism post‐natally. The baby’s thyroid function tests were unexpected, revealing a low T4 and a low‐normal thyroid stimulating hormone. This is the first case reported in the literature to describe an infant’s clinical and biochemical thyroid status after gestational trophoblastic disease complicated by hyperthyroidism.
Human rights and child health
Authors: Raman Shanti , Woolfenden Susan , Williams Katrina , Zwi Karen
Published: August 2007

Abstract:  Human rights are those basic standards without which people cannot live in dignity.

Children are at risk of human rights violations because of their vulnerability in society. The Convention on the Rights of the Child (CRC), a United Nations (UN) treaty acknowledges that addressing children’s human rights requires special attention. In Australia groups such as children seeking asylum, Aboriginal and Torres Strait Islander children, children with disabilities, children in care and children living in poverty are identified to be at particular risk. As individuals and collectively, we have had a long history of gathering information, advocacy and tailoring training to improve children’s health and well‐being. A human rights approach and the use of the CRC provide an additional framework to do this.
Early intervention for the ocular and neurodevelopmental sequelae of Fetal Valproate Syndrome
Authors: Carrim Zia I , McKay Lorna , Sidiki Sikander S , Lavy Timothy E
Published: August 2007

Abstract:  The established teratogenicity of antiepileptic drugs raises important issues in women of child‐bearing age. While the association between neural tube defects and antiepileptic drugs is well recognised, other congenital malformations are known to occur. We report two siblings with characteristic craniofacial features of Fetal Valproate Syndrome who also had associated ocular and neurodevelopmental problems which would benefit from early recognition and intervention.
BARIATRIC SURGERY IN AUSTRALIA: WHO, WHY AND HOW?
Authors: Kitto Simon C. , Borradale David , Jeffrey Carol A. , Smith Julian A. , Villanueva Elmer V.
Published: August 2007

A review of published reports was conducted to identify gaps in the research regarding bariatric surgery. Much of the research that has been conducted is clinical outcome based; however, little research has been conducted in many key areas. Data on the demographics of the bariatric surgery group are patchy at best. The role of best practice and evidence‐based medicine in bariatric surgery seems to be poorly understood, and equity issues and the role of clinical pathways in bariatric surgery need to be clarified. Significant gaps were identified in the published reports regarding pathways to bariatric surgery and multidisciplinary team use. Additionally, much of the published report and research data were from US studies, as few Australian studies have been conducted. Further research and policy and practice developments in bariatric surgery are needed, especially with regard to the Australian context.
TRENDS IN PREVALENCE OF FATAL SURGICAL DISEASES AT FORENSIC AUTOPSY
Authors: Acosta Stefan , Krantz Peter
Published: August 2007

Background:  In 1992, there were major changes in Swedish law of the deceased, which had led to a dramatic decrease in autopsy rates. The aim of this study was to investigate the prevalence of fatal or potential fatal surgical diseases within a Swedish forensic autopsy cohort, before and after this change in legislation.

Methods:  Deaths referred for forensic autopsy at the Institution of Forensic Medicine, Lund University Hospital, Sweden, between 1970–1982 and 2000–2004, were studied regarding the prevalence of aorto‐iliac diseases, acute abdomen and abdominal cancer.

Results:  The forensic autopsy rates in the population during the two time periods were 14.0% (29 399 patients) and 5.3% (4487 patients), respectively. The total prevalence of surgical diseases has increased significantly from 67.3 (95% confidence interval 64.3–70.2) to 83.4 (74.9–91.8) per 1000 autopsies, respectively. The cause‐specific mortality ratios in patients with fatal acute abdomen increased significantly from 16.5 (15.1–18.0) to 39.0 (33.2–44.8) per 1000 autopsies, respectively, and there was almost a three‐time increase in patients with fatal gastrointestinal haemorrhage and acute alcohol‐related pancreatitis.

Conclusion:  Forensic autopsy data continues to be invaluable, despite changes in legislation in Sweden, for epidemiological studies on fatal or potential fatal surgical diseases.
PULMONARY HYDATIDOSIS: CLINICAL PROFILE AND FOLLOW UP FROM AN ENDEMIC REGION
Authors: Fatimi Saulat H. , Naureen Sameera , Moizuddin Sonia S. , Puri Mohammad M. , Yousuf Mian A. , Javed Muhammad A. , Ahmad Usman
Published: August 2007

Objectives:  The aim of this case series was to study the clinical presentation, treatment and outcome of pulmonary hydatid cyst disease at a tertiary care centre.

Methods:  A retrospective review of case records was carried out to collect demographic, clinical and outcome data on patients with pulmonary hydatid disease, treated over a 10 year period.

Results:  A total of 49 cases were included in the series. The most common presenting complaint was cough. Twenty‐four per cent had bilateral lung involvement whereas 38% had both lung and liver involvement. Surgery was carried out in 38 cases. Surgical treatment was supplemented by pre‐op and post‐op chemotherapies. Muscle‐preserving thoracotomy and cystectomy were most commonly carried out. Nineteen (39%) patients had post‐op complications; however, there was no death. Ten patients were lost to follow up. Mean follow up was for 18 months without any recurrence.

Conclusion:  Pakistan is an endemic area for the disease. The patients in our series were relatively younger as compared with those in other reports. Surgery is the treatment of choice for hydatid disease and has good results. Pre‐op and post‐op chemotherapies decrease the risk of intraoperative infection and recurrence. Chest X‐ray and abdominal ultrasound should be carried out in case of even minimum clinical suspicion, especially in endemic areas.
AMERICAN SOCIETY OF ANESTHESIOLOGISTS CLASSIFICATION OF PHYSICAL STATUS AS A PREDICTOR OF WOUND INFECTION
Authors: Woodfield John C. , Beshay Nagy M. Y. , Pettigrew Ross A. , Plank Lindsay D , Van Rij Andre M.
Published: August 2007

Background:  Wound infection occurs when bacterial contamination overcomes the hosts’ defences against bacterial growth. Wound categories are a measurement of wound contamination. The American Society of Anesthesiologists (ASA) classification of physical status may be an effective indirect measurement of the hosts’ defence against infection. This study examines the association between the ASA score of physical status and wound infection.

Methods:  A retrospective review of a prospective study of antibiotic prophylaxis was carried out. Patients with a documented ASA score who received optimal prophylactic antibiotics were included. The anaesthetist scored the ASA classification of physical status in theatre. Other risk factors for wound infection were also documented. Patients were assessed up to 30 days postoperatively.

Results:  Of 1013 patients there were 483 with a documented ASA score. One hundred and one may not have received optimal prophylaxis, leaving a database of 382 patients. There were 36 wound infections (9.4%). Both the ASA classification of physical status (P = 0.002) and the wound categories (P = 0.034) significantly predicted wound infection. The duration of surgery, patient’s age, acuteness of surgery and the organ system being operated on did not predict wound infection. On logistic regression analysis the ASA score was the strongest predictor of wound infection.

Conclusion:  When effective prophylactic antibiotics were used the ASA classification of physical status was the most significant predictor of wound infection.
FACTORS AFFECTING FLUID REQUIREMENT ON THE FIRST DAY AFTER SEVERE BURN TRAUMA
Authors: Csontos Csaba , Foldi Viktor , Fischer Tamas , Bogar Lajos
Published: August 2007

Background:  Parkland formula (PF) is the most often used schema for calculating intravenous resuscitation fluid requirement in burn patients. Some studies have reported that PF underestimates the fluid requirement in 45–63% of patients. The aim of this retrospective study was to analyse factors influencing first‐day intravenous fluid replacement set for a targeted urinary output in severely burnt patients.

Methods:  Data of 47 patients with burn injury affecting equal or more than 15% of body surface area were retrieved from the archived files. The local intensive care protocol rendered the infusion rate of lactated Ringer’s solution to achieve a urinary output of 0.5–1.0 mL/kg per hour in the first 24 h after burn trauma.

Results:  First‐day i.v. infusion volume was significantly higher than PF preferred. In the first 24 h the hourly volume of intravenous fluid resuscitation per bodyweight per burnt surface area showed significant negative correlation to the burnt body surface area and body mass index, (r = −0.553, P < 0.001; r = −0.570, P < 0.001, respectively) no correlation was found to bodyweight, height or patient age. Patients having deep‐burn injury required higher intravenous fluid resuscitation rate than patients having superficial injury only (P < 0.01).

Conclusion:  Our data suggest that fluid requirement is higher than predicted by PF if the extent of burn or body mass index is low and less if the extent of burn or body mass index is high. The presence of deep burn increases fluid requirement.
LAPAROSCOPIC GASTRIC RESECTION FOR BENIGN AND MALIGNANT CONDITIONS: LESSONS LEARNED FROM 35 CONSECUTIVE CASES
Authors: Liew Victor , Taylor Craig , Ghusn Michael , Jamnagerwalla Murtaza , Layani Laurent
Published: August 2007

Introduction:  Despite significant advances in laparoscopy, gastric surgery is still generally carried out by conventional open techniques. The aim of the study was to report the short‐ and medium‐term outcomes of gastric surgery when carried out laparoscopically for a variety of benign and malignant conditions.

Methods:  A retrospective review was carried out for all patients who underwent a laparoscopic gastric resection between January 2000 and September 2006. Follow up was carried out at the private consulting rooms and by telephone interview.

Results:  Thirty‐five consecutive laparoscopic gastric resection were carried out in 31 patients for a variety of benign lesions, six early gastric cancer and 13 adenocarcinomas. The totally intracorporeal laparoscopic procedures included four total, eight distal and 21 partial gastrectomies. There were two open conversions (6%). There was one in‐hospital mortality (3%) and one non‐fatal anastomotic leak. Median operative duration and length of stay were 75, 205 and 252 min and 5, 6.5 and 8 days for laparoscopic partial, distal and total gastrectomy, respectively. After malignant resections, there were six recurrences; however, 15 patients remained disease‐free at up to 60 months follow up.

Conclusion:  Laparoscopic gastric resection is feasible with good short‐ and medium‐term results and may be an appropriate treatment option in selected cases.
OUTCOMES OF LAPAROSCOPIC ADRENALECTOMY FOR HYPERLADOSTERONISM
Authors: Pang Tony C. , Bambach Chris , Monaghan Judith C. , Sidhu Stan B. , Bune Alex , Delbridge Leigh W. , Sywak Mark S.
Published: August 2007

Background:  Primary hyperaldosteronism is a frequent cause of resistant hypertension and is amenable to surgical intervention when caused by a unilateral aldosterone‐producing adenoma. The aim of this study was to investigate the long‐term results of laparoscopic adrenalectomy in the control of hypertension caused by primary hyperaldosteronism.

Methods:  A prospective case series of patients undergoing laparoscopic adrenalectomy for hyperaldosteronism was studied. Blood pressure (BP), serum aldosterone levels, plasma renin activity, serum potassium and antihypertensive requirement were measured before and after adrenalectomy.

Results:  Sixty‐two patients with hyperaldosteronism underwent laparascopic adrenalectomy in the period from December 1995 to August 2005. The median follow up was 59 months. There was a significant decrease in both systolic blood pressure and diastolic blood pressure at final follow up compared with that before operation. Systolic blood pressure decreased from 149 mmHg to 129 mmHg at final follow up (P < 0.0001). Diastolic blood pressure decreased from 89 mmHg to 80 mmHg (P < 0.0001). Antihypertensive requirement was decreased from an average of 2.6 separate medications preoperatively to 1.4 medications at final follow up (P < 0.0001). Serum aldosterone levels were significantly lower (698 (confidence interval 534–862) pg/mL vs 181 (confidence interval 139–225) pg/mL, P < 0.0001). Overall, 34% of patients had cure of hypertension and did not require any antihypertensive agent. A further 51% had improvement in BP control, whereas 5% had no change or had worsening hypertension. Multivariate regression analysis showed that age and gland size were independent factors predicting sustained hypertension after surgery.

Conclusion:  In appropriately selected patients with primary hyperaldosteronism, laparoscopic adrenalectomy is effective in improving long‐term BP control. Larger adrenal gland size and older age at time of surgery are predictors of persisting hypertension.
IS LAPAROSCOPIC COLECTOMY FOR CANCER COST‐EFFECTIVE RELATIVE TO OPEN COLECTOMY?
Authors: Hayes Julian L. , Hansen P.
Published: August 2007

Background: Laparoscopic‐assisted colectomy (LAC) for cancer has been shown to be safe, with equivalent long‐term survival rates to conventional open colectomy (OC) and better short‐term patient outcomes. However, LAC tends to require more operating theatre time and disposable equipment. This study investigated, in the context of the New Zealand public hospital system, the extent to which LAC for cancer is cost‐effective relative to OC.

Methods: Estimates of the hospital resources used and patient recovery times for LAC and OC for colorectal cancer were obtained from a meta‐analysis of published international randomized controlled trials. Using prices from a representative New Zealand public hospital, the additional resources for LAC (relative to OC) were summed to obtain an estimate of LAC’s total incremental (additional) cost. The recovery time savings from LAC were also represented in quality‐adjusted life years (QALY), enabling a cost‐utility analysis of LAC, which was subjected to a one‐way sensitivity analysis.

Results: On average, a LAC costs New Zealand public hospitals $1267 (range: $259–$3808; all dollars referred to are New Zealand dollars) more than an OC. Average recovery time savings of 12 and 33 days (from two randomized controlled trials) translate into QALY gains of 0.018 and 0.049. Thus, relative to an OC, an LAC costs $38 and $106 per recovery day saved, or $70 389 and $25 857 (combined range: $14 389–$211 556) per QALY gained.

Conclusion: LAC for cancer appears to be cost‐effective relative to OC (per recovery day saved and QALY gained, respectively) for the lower of the average cost estimates and is probably not cost‐effective for the higher estimate. Expected future reductions in operating times, conversion rates and postoperative stays will further improve cost‐effectiveness.
MINIMALLY INVASIVE APPROACH IN THE MANAGEMENT OF CHILDHOOD INTUSSUSCEPTION
Authors: Cheung Sing T. , Lee Kim H. , Yeung Tse H. , Tse Cheong Y. , Tam Yuk H. , Chan Kin W. , Yeung Chung K.
Published: August 2007

Background:  Intussusception is one of the most common causes of intestinal obstruction in infancy. Non‐operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non‐operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception.

Methods:  We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed.

Results:  Over a 6‐year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure‐related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t‐test, P < 0.0001).

Conclusion:  The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay.
Role of vasoactive substances on endometrial and ovarian function
Authors: KUBOTA TOSHIRO
Published: August 2007

In this review, it is proposed that the vasoactive agents endothelin (ET), nitric oxide (NO)/NO synthase (NOS) and carbon monoxide(CO)/heme oxygenase(HO) act directly on human endometrial functions and on ovarian functions in the normal menstrual cycle and in implantation periods. These vasoactive substances are likely to be important autocrine/paracrine factors that regulate a variety of physiological and pathological processes. The main actions of these agents are differentiation and implantation in the endometrial functions, and follicular growth, luteinization and atresia in the ovarian functions, in the tight connection between endometrial and ovarian systems during normal menstrual periods and during implantation (Reprod Med Biol 2007; 6: 157–164)
Sperm retention site and its influence on pronucleus stage evaluation following intracytoplasmic sperm injection
Authors: NEGISHI MOMOKO , YANAIHARA ATSUSHI , IWASAKI SHINJI , SUZUKI NORIO , HASEGAWA JUNICHI , YORIMITSU TAKESHI , OKAI TAKASHI
Published: August 2007

Aim:  It has been suggested that the position of the sperm after intracytoplasmic sperm injection (ICSI) has an effect on the development and quality of the embryo. In this study, we retrospectively examined whether pronucleus stage evaluation used through clinical studies in recent years has relevance with regard to sperm location.

Methods:  From 2003 to 2005, 1285 oocytes from 459 patients (average age: 36 years) were retrospectively analyzed. The 459 patients underwent ICSI because of fertilization disorders and oligozoospermia. Follicle stimulation was via either Clomid or the long protocol. Human chorionic gonadotropin was administered to induce ovulation and oocyte retrieval was conducted 35 h later. After confirming the presence of a polar body, we immobilized the ovum at the 6 o’clock position, introduced the injection pipette at the 3 o’clock position and carried out ICSI.

Results:  When a sperm was located at a position that was opposite to the polar body, both classifications of Scott and Tesarik regarding embryo quality were distinctly low. Furthermore, a good embryo classification ensued when the sperm was located adjacent to the polar body.

Conclusion:  The zone in which the sperm was located did not always correlate with embryo quality; however, our study suggested that sperm location affects the synchronization of the nucleolus. When carrying out ICSI, it is important to take into consideration the insertion point of the sperm. (Reprod Med Biol 2007; 6: 171–174)
Uterine rupture during pregnancy soon after a laparoscopic adenomyomectomy
Authors: MORIMATSU YUKAKO , MATSUBARA SHIGEKI , HIGASHIYAMA NOBUHIKO , KUWATA TOMOYUKI , OHKUCHI AKIHIDE , IZUMI AKIO , SHIBAHARA HIROAKI , SUZUKI MITSUAKI
Published: August 2007

Although laparoscopic adenomyomectomy may be a possible risk factor for uterine rupture in subsequent pregnancy, few reports have described it. A 35‐year‐old woman became pregnant 1 month after laparoscopic adenomyomectomy. At the 28th week, uterine contraction occurred, leading to intravenous ritodrine infusion. Severe abdominal pain and a non‐reassuring fetal heart rate occurred abruptly and an emergency cesarean section was carried out. The uterus ruptured at the site of previous surgery of the uterine body, which was reconstructed. The mother and the infant did well postoperatively. We report the second case of uterine rupture during pregnancy subsequent to laparoscopic adenomyomectomy. A history of adenomyomectomy and a short interval to subsequent pregnancy may be risk factors for uterine rupture. (Reprod Med Biol 2007; 6: 175–177)
Single inherited thrombophilias and adverse pregnancy outcomes
Authors: Larciprete Giovanni , Gioia Stefano , Angelucci Piero A. , Brosio Federica , Barbati Giulia , Angelucci Giulio P. , Frigo Maria G. , Baiocco Federico , Romanini Maria Elisabetta , Arduini Domenico , Cirese Elio
Published: August 2007

Introduction:  Inherited thrombophilia is believed to be a multiple gene disease with more than one defect. We aimed to determine the association between single thrombophilic patterns and a variety of pregnancy diseases.

Methods:  284 pregnant women were recruited for the present study and were divided in two groups: A group (176 controls) and B group (108 cases). Patients belonging to the B group had one of the following: severe pre‐eclampsia, hemolysis, hepatic enzymes increase, hypertension and low platelet count (HELLP) syndrome, gestational hypertension, fetal growth restriction, intrauterine death, abruptio placentae and disseminated intravascular coagulopathy. To detect methylenetetrahydrofolate reductase (MTHFR) A1298C, MTHFR C677T, factor V Leiden, PAI‐1, mutant prothrombin G20210A, an inverse hybridization technology was used. Plasma homocysteine, antithrombin (AT) III and protein S were determined. A modified functional activated protein C resistance was detected.

Results:  MTHFR C677T and hyperhomocysteinemia were more prevalent than other thrombophilias. Deficiency in AT III was significantly linked with pre‐eclampsia (relative risk 0.88; 95% CI 0.83–0.94). Activated protein C resistance (APCR) was significantly related to the abruptio placentae (relative risk 0.71; 95% CI 0.61–0.82).

Comments:  Apart from the linkage between AT III deficiency and the occurrence of pre‐eclampsia, and apart from the increased risk of abruptio placentae in pregnant women with altered APCR, we obtained findings in contrast with some of the published literature. In our case series, no association of pre‐eclampsia with factor V Leiden or with prothrombin gene mutation was found.
TNF‐α from monocyte of patients with pre‐eclampsia‐induced apoptosis in human trophoblast cell line
Authors: Seki Hiroyuki , Matuoka Kikumi , Inooku Hiroki , Takeda Satoru
Published: August 2007

Objective:  In pre‐eclampsia, fetal growth restriction is frequently observed, and the possible involvement of inhibitory substances on trophoblast cell proliferation and differentiation has been suggested. The objective of this study was to investigate the effects humoral factors, such as cytokines, produced in immune cells on proliferation of an immortalized trophoblastic cell line (TCL) that we established.

Methods:  Serum and lymphocyte layers were isolated from the blood of normal pregnant and preeclamptic women. The lymphocyte layer was further fractionated into different immune cell populations by the Stem Sep method. Immortalized trophoblastic cells were cultured with the sera diluted. The cytokine concentrations in the supernatants of lymphocyte cultures were compared between normal pregnancy and pre‐eclampsia. The number, DNA content and induced apoptosis were examined on the immortalized trophoblastic cells at the end of culture.

Results:  The sera from preeclamptic women significantly inhibited the immortalized trophoblastic cell proliferation in comparison with those from normal pregnancy. Among the lymphocyte fractions, monocytes significantly inhibited the immortalized trophoblastic cell proliferation. The monocytes from preeclamptic women were found to produce higher levels of tumor necrosis factor‐α (TNF‐α) in the culture supernatant than those from normal pregnant women. The coculture with the monocytes from preeclamptic women increased the frequency of TUNEL‐positive TCL cells. TNF‐α inhibited immortalized trophoblastic cell proliferation in a dose‐dependent manner and induced apoptosis.

Conclusion:  The present results suggest that monocytes are activated and that cytokines, such as TNF‐α, which is produced by monocytes, induce apoptosis and inhibit proliferation of trophoblast cells in pre‐eclampsia.
Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clinical indicators of hyperemesis severity
Authors: Tan Peng C. , Jacob Reena , Quek Kia F. , Omar Siti Z.
Published: August 2007

Objective:  To determine pregnancy outcome in hyperemesis gravidarum and the effect of metabolic, biochemical, hematological and clinical indicators of disease severity on outcome.

Study Design:  A retrospective study based on 166 women hospitalized for confirmed hyperemesis gravidarum from January 2004 to January 2005. For each woman, three controls matched for age, parity and ethnicity were obtained from our 2004 birth register. The effects of laboratory indicators of hyperemesis severity were separately analyzed within the hyperemesis gravidarum study group. Outcome measures include stillbirths, Apgar score, mode of delivery, low birthweight, preterm delivery, labor induction, pregnancy induced hypertension and gestational diabetes. Analysis was by t‐test, Fisher's exact test and multivariable logistic regression analysis.

Results:  Women with hyperemesis had similar pregnancy outcome compared to controls. In the analysis of laboratory indicators of hyperemesis severity and pregnancy outcomes, hypokalemia (adjusted odds ratio [AOR] 2.7: 95% confidence interval [CI] 1.0–6.8) was associated with emergency operative delivery, high creatinine (odds ratio 4.4: 95% CI 1.3–15) with labor induction and raised gamma glutamyltransferase (AOR 7.5: 95% CI 1.2–46) with the development of gestational diabetes.

Conclusions:  Hyperemesis gravidarum per se was not associated adverse pregnancy outcome. Hypokalemia, high creatinine and raised gamma glutamyltransferase in women with hyperemesis gravidarum were associated with adverse pregnancy outcome.
Cervical varix with placenta previa totalis
Authors: Kumazawa Yukiyo , Shimizu Dai , Hosoya Naoko , Hirano Hideto , Ishiyama Koichi , Tanaka Toshinobu
Published: August 2007

A cervical varix during pregnancy is a very rare complication. It can lead to hemorrhage and may result in significant morbidity. Furthermore, appropriate management has not yet been established. We present a case of a cervical varix with placenta previa totalis. A 30‐year‐old woman with placenta previa totalis also had a cervical varix without bleeding. At 32 weeks' gestation, massive hemorrhage from the cervical varix occurred. A vaginal pack controlled the bleeding, and a cesarean section was subsequently carried out because of uncontrollable uterine contractions. A 1655 g female infant was delivered; the estimated blood loss was 1814 mL. The cervical varix decreased dramatically in size. In conclusion, presented herein is a rare case of a cervical varix, which had a successful outcome.
Metastasis of lobular breast carcinoma to the cervix
Authors: Perišić Dragan , Jančić Snežana , Kalinović Dragoslav , Čekerevac Milica
Published: August 2007

Breast cancers without previous dissemination occasionally result in hematogenous metastases in gynecologic organs, particularly in the cervix. This case report examines a multimodally treated lobular breast cancer patient who was 52 months later diagnosed with malignancy in the uterus. After a tumor was detected at the endocervical and isthmic part of the uterus, a complete hysterectomy with bilateral salpingo‐oophorectomy was carried out. The malignant cells were highly positive for carcino‐embrional antigen and gross cystic disease fluid protein‐15, sensitive breast cancer markers. In conclusion, as breast carcinoma can metastasize to atypical places (cervix, endometrium, etc.), regular surveillance of patients should include gynecologic control.
Decrease and dysfunction of endothelial progenitor cells in umbilical cord blood with maternal pre‐eclampsia
Authors: Xia Liang , Zhou Xin P. , Zhu Jun H. , Xie Xu D. , Zhang Hao , Wang Xing X. , Chen Jun Z. , Jian Sun
Published: August 2007

Background:  The pre‐eclampsia is characterized by placental defective angiogenesis and maternal vascular/endothelial dysfunction. Recently, the decrease and senescence of endothelial progenitor cells (EPC) has been observed in maternal circulation with pre‐eclampsia. Given the essential involvement of EPC in neovascularization and reendothelialization, we investigate whether or not the depletion of EPC is existent in placental/fetal circulation with maternal pre‐eclampsia.

Methods:  Samples of venous cord blood were collected during the labor of preeclamptic mothers (n = 14) and normotensive controls (n = 10). Circulating EPC were enumerated as AC133+/KDR+ cells via fluorescence‐activated cell sorting (FACS) analysis. Additionally, EPC were expanded in vitro and identified by DiI‐acLDL uptake and lectin staining by direct fluorescent staining under a laser scanning confocal microscope. EPC proliferation, migration and vasculogenesis activities were determined by MTT, modified Boyden chamber assay and in vitro vasculogenensis assay.

Result:  The placental/fetal circulating EPC numbers were significantly decreased in the pre‐eclampsia group compared with the control (median, 200; range, 100–440 cells/mL vs 390; 270–440 cells/mL, P < 0.001), and after in vitro cultivation the numbers of EPC also decreased in pre‐eclampsia group (19.5; 5.0–32.0 vs 39.5; 31.2–52.0 EPC/×200 field; P < 0.001). Both circulating EPC and cultivated EPC were inversely correlated with cord blood level of soluble fms‐like tyrosine kinase 1 (sFlt‐1). In addition, the EPC from patients with pre‐eclampsia were significantly impaired in their proliferation, migration and vasculogenesis capacities.

Conclusion:  The present study documented the decrease and dysfunction of placental/fetal circulating EPC in patients with pre‐eclampsia. The alteration is probably associated with the increased sFlt‐1 levels in the umbilical cord blood.
Iniencephaly: Prenatal diagnosis with postmortem findings
Authors: Tugrul Semih , Uludoğan Mehmet , Pekin Oya , Uslu Hüsamettin , Çelik Cem , Ersan Fırat
Published: August 2007

Iniencephaly is a rare but almost always lethal neural tube defect with the following cardinal features: occipital bone defect, partial or total absence of cervicothoracal vertebrae and fetal retroflexion. Iniencephaly is associated with malformations of the central nervous system, gastrointestinal and cardiovascular system. Prenatally diagnosed cases of iniencephaly are rare because careful and early ultrasonographic evaluation is necessary. The present cases of iniencephaly were found to carry associated malformations such as atrioventricular septal defect and club foot. We present an iniencephaly prenatally diagnosed by sonography, in which therapeutic abortion was induced, with a review of the published literature.
Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection
Authors: Cupisti Susanne , Mueller Andreas , Strauss Richard , Dittrich Ralf , Beckmann Matthias W. , Binder Helge
Published: August 2007

A 35‐year‐old woman developed bilateral jugular thrombosis in the seventh gestational week in a twin pregnancy after severe ovarian hyperstimulation syndrome (OHSS) and intracytoplasmic sperm injection (ICSI). Due to progressive thrombosis and further complications despite anticoagulation therapy, the pregnancy was terminated in the ninth gestational week. Thromboembolic events are a serious complication associated with OHSS after assisted reproduction techniques. In these cases, a pregnancy can usually be protected by administering anticoagulation therapy, but our case shows that there may be exceptions to this. Screening for thrombophilia should be considered in patients who are at risk for OHSS and deep vein thrombosis.
Definitive diagnosis of primary adenocarcinoma of the appendix by laparoscopic appendectomy
Authors: Umemoto Masahiko , Shiota Mitsuru , Shimaoka Masao , Hoshiai Hiroshi
Published: August 2007

We report a 62‐year‐old woman with a primary adenocarcinoma of the appendix mimicking ovarian tumor. We had diagnosed it definitively by laparoscopic appendectomy, and additional surgery was required in this case. However, the present case suggests that, in some cases, if cancer of the appendix can be diagnosed early, laparotomy can be avoided and the cancer treated with minimally invasive laparoscopic surgery alone.
Mechanical ileus in a pregnant woman at term pregnancy accompanied by labor pains
Authors: Kuwahata Tomoki , Iwamoto Ichiro , Fujino Toshinori , Douchi Tsutomu
Published: August 2007

Intestinal obstruction in pregnancy is a rare, but serious complication of pregnancy with significant maternal and fetal mortality. We herein report a case of intestinal strangulation in a pregnant woman with a history of pelvic surgery due to an ectopic pregnancy. Epigastric pain occurred at term pregnancy with concomitant onset of labor pains. The epigastric pain disappeared transiently, and she gave a birth to a healthy child. However, the pain appeared again after the vaginal delivery. She immediately underwent ileo‐ileostomy with a diagnosis of mechanical ileus, and the postoperative course was uneventful. Mechanical ileus should be considered when examining epigastric pain in a pregnant woman with a history of abdominal or pelvic surgery even after the onset of labor pains.