bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural analysis of 5‐[thiazol‐2‐yldiazenyl]pyrimidine‐2,4,6(1H,3H,5H)‐trione in both solid state and solution
Authors: Seferoğlu Zeynel , Hökelek Tuncer , Şahin Ertan
Published: March 2008

The synthesis, crystal structure analysis and characterisation of 5‐[thiazol‐2‐yldiazenyl]pyrimidine‐2,4,6(1H,3H,5H)‐trione are reported. This dye was characterised by ultraviolet–visible, Fourier Transform–infrared, proton nuclear magnetic resonance spectroscopy, mass spectrometry techniques and elemental analysis. Both the effects of pH value and solvent polarity upon the absorption properties of the dye have been presented. In addition, the structure of the dye has been determined by a single crystal X‐ray diffraction method. The dye was triclinic in P‐1 with a = 8.2419(2) Å, b = 10.6225(3) Å, c = 12.5106(3) Å, α = 90.543(1)°, β = 102.79(3)°, γ = 103.858(1)°, V = 1035.26(5) Å3, Dcalc = 1.634 g/cm3 and Z = 2. The asymmetric unit contains two crystallographically independent C7H5N5O3S molecules, alongside one half of the solvent C2H6O2 molecule. In the crystal structure, intramolecular N–H…N and intermolecular N–H…N, N–H…O, O–H…N, C–H…O and C–H…N hydrogen bonds link the molecules to form a supramolecular network in which they seem to be effective in the stabilisation of the structure.
One‐bath dyeing of polyester/cotton blends with disperse and bis‐3‐carboxypyridinium‐s‐triazine reactive dyes. Part 2: Application of substantive reactive dyes to cotton at 130 °C and neutral pH†
Authors: Bone J A , Le T T , Phillips D A S , Taylor J A
Published: March 2008

An earlier paper reported that the reactive dyes (not the disperse dyes) were responsible for the inability to achieve heavy depths of shade, when dyeing polyester/cotton blends by a one‐bath process at 130 °C and neutral pH using reactive dyes containing a 3‐carboxypyridinium‐s‐triazinyl group. It was shown that the poor colour yield of the bis‐3‐carboxypyridinium‐s‐triazine reactive dyes was because of their low exhaustion level at 130 °C and pH of 7.0–7.5. We now report the synthesis and evaluation of some bis‐3‐carboxypyridinium‐s‐triazine reactive dye structures, possessing highly substantive chromophores, as a means of obtaining high colour yield, on 100% unmercerised cotton, under the specified dyeing conditions. The technical performance of these dyes under such conditions was compared with that of selected Novacron (Cibacron) LS and Procion H‐E dyes, applied under their recommended (atmospheric) dyeing conditions.
Variation in the decisions of observers regarding the ordering of white samples
Authors: Jafari R , Amirshahi S H
Published: March 2008

The variations in the ordering of white samples by different observers have been investigated. Twenty white samples with low to high CIE whiteness indices were prepared and ranked by 22 amateur observers and the variations in the ordering decisions of the observers were compared. Results show a significant consistency between the assessments of the observers for the white samples with low indices of whiteness. However, a large level of disagreement was found between the observers for the whiter samples. In fact, the range of ranks assigned by viewers for each sample increases with an increase in the whiteness of the specimens. Distributions of the assigned orders for the samples are interpreted by considering the CIE whiteness as well as the tinting indices.
A Trial of Simple versus Intensified Dietary Modification for Prevention of Progression to Diabetes Mellitus in Women with Impaired Glucose Tolerance
Authors: Wein Peter , Beischer Norman , Harris Claire , Permezel Michael
Published: March 2008

Summary: Women with impaired glucose tolerance are at high risk of developing noninsulin dependent diabetes mellitus (NIDDM). The Mercy Hospital for Women has a long‐term follow‐up programme for women with gestational diabetes, which identifies many women with impaired glucose tolerance. Two hundred of these women were entered into a randomized controlled trial of intensive versus routine dietary advice. Seven women were lost to follow‐up. The annual incidence rates of diabetes mellitus for the 2 groups were 6.1% (intervention) and 7.3% (control), an incident rate ratio of 0.83, 95% confidence interval 0.47–1.48, p = 0.50. Overall, there was a return to normal glucose tolerance in 44% of patients. Multivariate analysis showed that body mass index, fasting and 2‐hour plasma glucose levels at trial entry were significantly associated with an increased risk of diabetes mellitus. Impaired glucose tolerance is an important condition that should be treated with advice about lifestyle modification (diet and/or exercise). We consider that future trials in the management of women with previous gestational diabetes who have impaired glucose tolerance should investigate the effect of pharmacological intervention in addition to diet and/or exercise, the latter providing a therapy that it would be unethical to exclude on the evidence presently available.
Eating Disorders and Reproduction
Authors: Morgan J.F.
Published: March 2008

Summary: Eating disorders are common and characteristically affect young women at what would otherwise be their peak of reproductive functioning. Anorexia nervosa and bulimia nervosa impinge on reproduction both behaviourally and physiologically, with effects on menstruation, ovarian function, fertility, sexuality and pregnancy. This review presents a summary of current knowledge and makes suggestions for future research, along with some clinical recommendations for the management of eating disorders in pregnancy.
Adnexal Torsion
Authors: Yamashita Yoshiki , Sowter Martin , Ueki Minoru , Gudex Guy
Published: March 2008

Summary: We performed a retrospective audit of 24 cases of adnexal torsion managed at National Women's Hospital from 1996 to 1997 inclusive. There have been several reports in the recent literature of ovarian conservation in cases of ovarian infarction secondary to torsion in women desiring further fertility (1–3). In our review 50% (12 of 24) of patients were treated by oophorectomy or salpingo‐oophorectomy and most of these women desired further fertility. In spite of torsion being suspected in 73% (17 of 24), the time interval between admission and operation varied from 0.5 to 52 hours with a mean of 8 hours; 46% (11 of 24) were treated laparoscopically without recourse to laparotomy. As expertise increases, we consider that adnexal torsion will be increasingly managed laparoscopically. These results suggest that more urgent surgery should be scheduled if ovarian torsion is suspected, and in view of recent reports in the literature greater consideration should be given to conservation of infarcted ovaries if further fertility is required.
Tubal Ectopic Pregnancy: An Evaluation of Laparoscopic Surgery Versus Laparotomy in 614 Patients
Authors: Lo Leslie , Pun Ting Chung , Chan Sammy
Published: March 2008

Summary: We performed a prospective nonrandomized multicentre study to compare laparoscopic surgery and laparotomy in the immediate surgical outcome of tubal ectopic pregnancy (TEP), at 9 teaching hospitals in Hong Kong with a laparoscopic surgical service, on all patients with the operative diagnosis of tubal ectopic pregnancy between July 1, 1996 and June 30, 1997. In the period studied, 630 patients were recruited of which 614 were suitable for analysis. In them, 382 (62.2%) had laparoscopic surgery while the rest had laparotomy with or without diagnostic laparoscopy. Significantly more cases of shock ended in laparotomy (86.1% versus 13.9%). After exclusion of patients with shock, laparoscopic surgery offered a significantly shorter postoperative hospital stay (mean 2.7 days versus 5.3 days), a slightly lower perioperative complication rate (8.1% versus 13.9%) and more conservative surgery (90.1% of all salpingotomies) than laparotomy. A longer operating time was needed for laparoscopic surgery (1.2 hours versus 1.01 hours).
Catheterization Prior to Evacuation of Uterus and Diagnostic Curettage
Authors: Trivedi A.N.
Published: March 2008

Dilatation and curettage and evacuation of the uterus are the 2 most common minor gynaecological procedures that trainees perform. Some trainees are taught to catheterize the patient before these procedures. This study was carried out with 2 aims, firstly to establish the prevalence of significant residual urine volume prior to these procedures and secondly to gain information on the practices among members and fellows of the RNZCOG residing in New Zealand with regard to catheterization prior to these operations. The measured residual urine volume was greater than 50 mL in 37.5% of patients and greater than 100 mL in 12.1%. About 92% of those surveyed did not catheterize prior to either procedure. The risk of infection does not appear to be a valid argument for not catheterizing. Routine urinary catheterization before these procedures is unnecessary.
Phaeochromocytoma in Pregnancy
Authors: Huddle K.R.L. , Nagar A.
Published: March 2008

The diagnosis of phaeochromocytoma during pregnancy requires a high index of suspicion and is essential for the favourable outcome of mother and offspring. Delayed diagnosis is associated with considerable morbidity and mortality. The cases of 4 patients presenting with phaeochromocytoma during pregnancy over an 11‐year period are presented.
Patient Preference the Leading Indication for Elective Caesarean Section in Public Patients‐Results of a 2‐year Prospective Audit in a Teaching Hospital
Authors: Quinlivan Julie A. , Petersen Rodney W. , Nichols Christopher N.
Published: March 2008

In response to a Western Australian Ministerial enquiry into the levels of intervention in childbirth, a 2‐year prospective audit was undertaken of the indication and timing of all public Caesarean section deliveries at King Edward Memorial hospital. During the study period, a total of 9,138 deliveries were performed at the hospital, of which 1,624 were by Caesarean section, an overall rate of 17.8%. Of these, 633 (39%) were elective and 911 (61%) were nonelective. The most common primary indication for elective Caesarean section was maternal choice, largely due to a refusal of the patient to consent to a trial of scar following a single previous Caesarean section or a refusal to attempt a trial of vaginal breech delivery. The most common indications for nonelective Caesarean section birth were an intrapartum diagnosis of suspected fetal distress or failure to progress in labour. Strategies to reduce the incidence of Caesarean section birth need to focus on the pathways involved with maternal decision‐making in the birth process, and on improving the diagnosis of intrapartum fetal compromise.
Registrar Experience in Vaginal Breech Delivery. How Much is Occurring?
Authors: Robson Stephen , Ramsay Bruce , Chandler Karen
Published: March 2008

The debate surrounding the safety of vaginal breech delivery compared to Caesarean delivery may be close to resolution, with a large randomized trial underway. However, trends in the management of vaginal breech delivery over recent years have led to suggestions that training in the technique of such deliveries may be inadequate. We have attempted to quantify the level of training in vaginal breech delivery available to registrars. This was accomplished by surveying obstetric training schemes in comparable regions of England and South Australia. Our findings suggest that registrar exposure to this important obstetric skill may be insufficient to guarantee expertise.
Problems in the Detection of Intrapartum Fetal Asphyxia with Intermittent Auscultation
Authors: Menticoglou Savas M. , Harman Christopher R.
Published: March 2008

Summary: We present 4 cases of severe intrapartum fetal asphyxia occurring during spontaneous unaugmented labours at term in low‐risk women. In each case the baseline heart rate was completely normal, and the only indication of asphyxia was markedly decreased variability detected with electronic fetal heart rate monitoring. Correct action was taken in 3 cases that probably prevented fetal death or reduced neonatal morbidity. In no case would intermittent auscultation have been able to identify the compromised fetus.
Vulval Perineal Haematomas in the Immediate Postpartum Period and their Management
Authors: Morgans David , Chan Norman , Clark Catherine A.
Published: March 2008

EDITORIAL COMMENT: We accepted this paper for publication because there are surprisingly few papers in the literature about how best to deal with vaginal lacerations and pelvic haematomas. It is generally agreed that postpartum haemorrhage from the uterus cannot be dealt with effectively by packing the uterus because the uterus distends, bleeding continues and the pack becomes dislodged. However bleeding from vaginal lacerations, with or without an associated episiotomy, is a different matter because the vagina lies within the bony basin of the pelvis and this can be effectively packed to give rapid haemostasis, if the blood is clotting normally, although the ribbon gauze pack must be long and wide (200 ± 10cm) and in the editor's experience 2 such packs need to be tied together to do the job properly. The pack should be moistened with obstetric cream so it can be introduced without causing trauma to the vagina. Since such packing occludes the urethra, an indwelling (Foley) catheter is required until the pack is removed, usually 12 hours later; healing of any unsutured vaginal lacerations is usually quite satisfactory (A). The editor has the indelible memory of a patient who in 1964, following a difficult mid‐forceps delivery, was seen to have large bilateral vaginal tears which bled profusely. There was no possibility of dealing with the problem with sutures and 2 packs as mentioned above were quickly inserted, together with an indwelling catheter, and the patient was given a 2‐pint blood transfusion. The pack was removed the next day without any further problems. At the 6 weeks postnatal visit the vagina was well healed but somewhat distorted. However at the patient's first antenatal visit in her next pregnancy, the vagina appeared normal and she proceeded to term and had an uneventful, safe delivery. Following this experience and throughout his obstetric lifetime, the editor always used a gauze pack in any patient who had a large episiotomy as a prophylaxis against a paravaginal or vulval haematoma. Cases of vulval haematoma reoccurring after an episiotomy has been repaired, sufficient to take the patient to theatre, as described in the 5 cases reported here, is a major surgical exercise which can probably be avoided, in many cases, by routinely packing the vagina when a large episiotomy repair has been necessary, as outlined above. During the subsequent 30 years of obstetric practice the editor was certainly not taking 1 in every 290 patients he delivered, the incidence herein reported, to theatre to deal with a vulval haematoma. This pack, catheter plus antibiotic regimen avoids serious morbidity and probably also mothers’lives.
Home Within 24 Hours of Laparoscopic Hysterectomy
Authors: Chou Danny C.Y. , Rosen David M.B. , Cario Gregory M. , Carlton Mark A. , Lam Alan M. , Chapman Michael , Johns Chris
Published: March 2008

We assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow‐up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30–65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85–150 minutes) and the average blood loss was 97 mL (20–250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20–24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time was 53.5 hours. The study showed that laparoscopic hysterectomy can be associated with a reduction in length of in‐patient stay compared to traditional laparotomy. Furthermore this reduction could be safely reduced to 24 hours following laparoscopic hysterectomy. There was also an associated cost saving in terms of inpatient bed days. Patient satisfaction with this protocol was high in this selected and motivated group.
Fertility and Ovarian Function After Conservative Surgery for Germ Cell Tumours of the Ovary
Authors: Pen‐in Lewis C. , Low Jeffrey , Nicklin James L. , Ward Bruce G. , Crandon Alex J.
Published: March 2008

Malignant ovarian germ cell tumours (MOGCT) principally occur in girls and young women and are generally unilateral. Effective combination chemotherapy with conservative surgery has seen a dramatic improvement in survival rates. This increase has shifted the focus to long‐term fertility and reproductive outcome. The present study describes 45 patients with MOGCT treated with conservative surgery to preserve fertility, with or without the addition of chemotherapy. The age range was 10 to 32 years with a mean of 20 years. The majority of the subjects had Stage 1 tumours; 44 underwent unilateral salpingo‐oophorectomy and 1 patient ovarian cystectomy. Adjuvant chemotherapy was administered in 29 patients. Overall mean follow‐up was 58.7 months. There were 4 recurrences and 2 deaths. Survival of those with Stage 1 disease was 97% and for advanced stages 87%. During chemotherapy 50% became amenorrhoeic but 96% resumed normal menstrual function on completion. Seven healthy babies were recorded in the chemotherapy group and no documented birth defects occurred in any of these. There was no case of persistent infertility; 3 patients experienced temporary problems. It is concluded that conservative fertility‐sparing surgery is the treatment of choice in these young women and advanced disease is not necessarily a contraindication. The majority can anticipate normal menstrual function and fertility.
Splenic Infarction in Pregnancy
Authors: Siva Sashi , Smoleniec John
Published: March 2008

We present a case of splenic infarction in pregnancy, secondary to acute bacterial endocarditis. Left upper quadrant pain in pregnancy can be due to a variety of causes and in the septic or unwell patient, splenic infarct should be considered in the differential diagnosis. The diagnosis of splenic infarct should be considered especially in those at increased risk of bacterial endocarditis. Acute bacterial endocarditis can occur even in patients without any risk factors. Bacterial endocarditis is rare in pregnancy and splenic infarction is even rarer. However when it occurs, rapid diagnosis and management are necessary to minimize embolic phenomena. With the increasing use of intravenous drugs and with increasing numbers of Pacific Islanders in our pregnant population, it is important to be alert to the risk of bacterial endocarditis and to avoid serious sequelae. Patient education to the importance of medical follow‐up in order to prevent such a life‐threatening condition, and to avoid more complicated acute treatment, is imperative.
Streptococcus Viridans Intra‐amniotic Infection Associated with Antecedent Cunnilingus
Authors: Gherman Robert B. , Browning Joseph , Tramont John , Eggleston Maurice K.
Published: March 2008

Introduction of bacteria into the amniotic cavity has been associated with oral sex through an ascending infectious route. Previous reports have implicated both Capnocytophaga and Fusobacterium nucleatum via this process. We report a case of Streptococcus viridans intra‐amniotic infection occurring at 25 weeks’gestation. Patient questioning revealed a close temporal relationship between the onset of symptoms and previous episodes of cunnilingus. The diagnosis of subclinical bacterial colonization of the amniotic fluid should be considered in patients presenting with preterm labour and no apparent aetiology. A history of recent cunnilingus may be associated with the presence of Streptococcus viridans in the amniotic fluid.
Anterior Sacral Meningocele as a Pelvic Complication of Marfan Syndrome
Authors: Voyvodic Frank , Scroop Rebecca , Sanders Robin R.
Published: March 2008

Anterior sacral meningocele (ASM) is well recognized in Marfan syndrome as a consequence of dural ectasia. Two cases presenting as non‐gynaecological pelvic masses are described highlighting the clinical difficulty in diagnosis and the classical radiological findings. The classification of ASM and associated anomalies of the sacrum are reviewed.
Extremely Elevated Serum CA125 Due To Endometriosis
Authors: Kashyap Ravi James
Published: March 2008

Summary: Endometriosis can mimic cancer in a pre‐menopausal woman (1). In this case an ultrasound showed a complex ovarian cyst with a low resistance blood flow and the serum CA 125 level was 6,114 iu/mL (normal <35), more than twice the highest level previously reported due to benign disease.
A Case of Massive Fetomaternal Haemorrhage at Term Associated with Choriocarcinoma
Authors: Lee K.W. , Ho L.C.
Published: March 2008

EDITORIAL COMMENT: We accepted this case for publication because of its rare anecdotal interest and to remind readers that a choriocarcinoma can present after a normal pregnancy and indeed can do so very soon after delivery. We would respectfully suggest that the fetomaternal haemorrhage is not necessarily due to the choriocarcinoma since this condition occurs in pregnancies with an apparently normal placenta. Another extraordinary case was reported in this journal 30 years ago in which the diagnosis of choriocarcinoma with pulmonary and vaginal metastases was made at 21 weeks’gestation in a 16‐year‐old primigravida who soon thereafter died undelivered from respiratory failure and haemoptysis (A). At autopsy, macroscopic examination of the placenta showed no evidence of mole or myometrial invasion. However, serial sections of the placenta revealed an area of trophoblastic hyperplasia and sections from the corresponding area of the uterine wall showed‘much trophoblast in the myometrial venous spaces'. When it comes to choriocarcinoma, in particular, there is nothing new under the sun!
Prenatal Diagnosis and Management of Nonimmune Hydrops Fetalis
Authors: Swain S. , Cameron A.D. , McNay M.B. , Howatson A.G.
Published: March 2008

We examined the incidence, aetiological factors and outcome in 40 cases of nonimmune hydrops fetalis (NIH) and suggest a rational approach to management. The incidence of NIH was 1 in 830 deliveries during the last 10‐year period. In spite of extensive antenatal and postnatal investigation no cause could be established in 14 (35%) cases. A probable aetiological factor was found in 65% of cases. These included viral infection (7), cardiovascular (6), twin‐to‐twin transfusion (3), chromosomal abnormality (3), other malformation syndromes (4), renal dysplasia (1), laryngeal atresia (1) and severe fetomaternal haemorrhage (1). Five of the 40 fetuses survived, 2 treated antenatally for tachyarrhythmia, 2 had spontaneous resolution and the fifth fetus had repeated intrauterine transfusions because of human parvovirus B19‐induced anaemia. After diagnosis of nonimmune hydrops fetalis, early referral to a tertiary centre is to be encouraged for investigation and provision of intensive perinatal care. Investigation allows parents to be counselled appropriately that the mortality is no longer 100% and a steadily growing number may be amenable to some form of fetal therapy.
Prelabour Rupture of the Membranes at Term‐No Advantage of Delaying Induction for 24 Hours
Authors: Akyol Didem , Mungan Tamer , Ünsal Aydm , Yüksel Kutlugül
Published: March 2008

Summary: We performed a prospective randomized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes (PROM) at term with early induction of labour or expectant management, 126 women with singleton pregnancy, cephalic presentation and gestational duration > 37 weeks, were randomized either to immediate induction of labour with oxytocin (Group 1) (n= 52), or conservative management (Group 2) (n=74). Women who constituted Group 2 were divided into 2 groups. The first group (Group 2A) (n=25) included women in whom spontaneous labour did not begin after a waiting period of 24 hours, in which case labour was induced with oxytocin i.e. expectant management. The second group consisted of women (Group 2B) (n=49) in whom labour began spontaneously within 24 hours. The base Caesarean section rate was significantly higher in Group 2 (28.4%) (p<0.05). The rates of Caesarean section in the Groups 1–2A‐2B were 19.2%, 60%, and 12.2%, respectively for nulliparous and parous women together. The rate of fetal distress was significantly higher in Group 2 (p<0.05). For determining maternal outcomes, the other parameters such as clinical chorioamnionitis, fever before or during labour, receiving antibiotics before or during labour, postpartum fever, analgesia, anaesthesia did not differ in Groups 1 and 2. Women in Group 1 went into active labour sooner, had fewer digital vaginal examinations, had a shorter interval between membrane rapture and delivery, and spent less time in the hospital before delivery than those in Group 2 (p<0.05). Babies in Group 2 were more likely to receive antibiotics, and more likely to stay in an intensive care nursery for more than 24 hours, and more likely to receive ventilation after initial resuscitation than those babies in Group 1. For developing apnoea and hypotonia, there was no significant difference between Groups 1 and 2. However, for babies in Group 2A there was a significant difference. We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section, compared with a practice of expectant management. Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity.
Is the Vacuum Extractor Really the Instrument of First Choice?
Authors: Chan C.C.T. , Malath I. , Yeo G.S.H.
Published: March 2008

This study was a retrospective analysis of the pattern of usage of both the forceps and vacuum extractor as well as the neonatal outcome on all the instrumental deliveries conducted in 1995 at the Kandang Kerbau Hospital, Singapore. There were a total of 927 forceps deliveries and 495 vacuum extractions but neonatal data was available for only 481 forceps and 255 vacuum extractor babies. (There were 2 neonatal units which accepted admissions on alternate days; all of the data were collected from 1 of the units only). Demographic data were comparable in most aspects except that vacuum deliveries were significantly associated with higher parity and shorter labours. There was a trend towards using the vacuum extractor in less difficult cases. Almost all the instrumental deliveries were conducted by specialists. Birth trauma was significantly more likely to occur with the vacuum extractor. Almost all the deliveries were conducted with similar expertise in both groups, yet the use of the vacuum extractor resulted in more birth trauma even in the presence of ‘easier’ cases. This may suggest an inherent risk in using the vacuum extractor.
Successful Zavanelli Manoeuvre for Shoulder Dystocia With An Occipitoposterior Position
Authors: Buist Robert , Khalid Omar
Published: March 2008

EDITORIAL COMMENT: Readers are referred to a recent review(A) of reported results of the Zavanelli manoeuvre in 103 partially‐born but undeliverable fetuses (92 cephalic, 11 podalic presentations). Although 7 mothers suffered trauma, including cases of lacerations to the lower uterine segment, and of uterine rupture, there were ‘no maternal deaths or fetal injuries ascribed to the manoeuvre’.
Back to Basics Midwifery in Arawa, Bougainville, During 1998
Authors: Jones I.S.C.
Published: March 2008

Working in a country, which is suffering the aftermath of war, is a very professionally rewarding and at the same time, humbling experience. It highlights so many things that we in Australia take for granted. The importance of a safe water supply and an efficient sewerage system is vital for the well‐being of a community. Illnesses that were important in Australia 30 or more years ago, were commonplace on Bougainville in 1998 and 1999. I was also reminded of how much reliance we place on modern technology as we practise obstetrics in Australia in 1999. In Bougainville clinical skills and common sense were all that the midwives had and they used them to great effect. Tribute should be paid to the men and women of the PMG (Peace Monitoring Group) for without their dedication and professionalism the improvement in the health of the people in Bougainville during the last 18 months would not have been possible.
Serum Insulin and Lipid Profile in Normal Pregnant and Pregnancy‐Induced Hypertensive Women from North India
Authors: Tripathy Chandana , Malik Sunita , Shah Pankaj , Lakshmy R. , Tripathy Devjit
Published: March 2008

High serum insulin and lipoproteins have been reported in pregnancy‐induced hypertension. Little is known about the insulin and lipoprotein profile in Indian women. To address this question we compared serum insulin and lipoproteins of women with pregnancy induced hypertension (PIH) and normotensive pregnant women. The serum insulin, triglycerides, total cholesterol and HDL cholesterol of 104 women with PIH were compared with 99 control women. Hypertensive women had significantly higher insulin (53.94 ± 29.58 versus 37.69 ± 17.39 pmol/L, p=0.0004) and triglyceride (3.27 ± 1.2 versus 2.66 ± 0.6, p=0.0001). There was no significant difference in total cholesterol and HDL cholesterol levels. Insulin levels had a positive correlation with systolic blood pressure (r=0.64) and diastolic blood pressure (r=0.55) in women with PIH. These differences persisted even after adjusting for possible confounding variables such as age, body mass index and the period of gestation. We conclude that elevated serum insulin values or insulin resistance may contribute to the pathogenesis of PIH in Indian women.
The Comparison of Uterine Artery Doppler Velocimetry with the Histopathology of the Placental Bed
Authors: Sagol S. , Özkinay E. , Öztekin K. , Özdemir N.
Published: March 2008

We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.
The Struggle for Surrogacy
Authors: Leeton John
Published: March 2008

EDITORIAL COMMENT: We accepted this communication for publication as a special report because the author is presenting a medical lifetime's experience and frustration produced by restrictive legislation in the State of Victoria concerning the practice of surrogacy. The editorial committee agrees with the opinion expressed that the existing legislation in Victoria requires urgent review. Incidentally, the editor confesses an inability to name any 'strict medical indication’ for so‐called traditional surrogacy!
Medium‐term Follow‐up of the Intravaginal Slingplasty Operation Indicates Minimal Deterioration of Urinary Continence With Time
Authors: Petros Pe Papa
Published: March 2008

An assessment of the medium term efficacy of stress incontinence cure in a group of patients who had undergone the intravaginal slingplasty (IVS) operation is presented. Eighty‐five unselected patients, aged 27 to 83 years at the time of surgery, 12 with pure stress symptoms, and 73 with mixed incontinence symptoms underwent the IVS procedure between 31 and 57 months previously (mean 3.9 years). The patients were assessed with the same self‐administered semiquantitative questionnaire used in the initial assessment. The results were compared with the original cure rate which was 88% at 1.75 years with another 2.5% more than 70% improved (total 90.5%). The cure rate in the 75 patients assessed at 3.9 years was 81%, with another 8% reporting more than 70% improvement (total 89%). Included in the latter were 2 patients who, though originally designated as failures, gradually achieved almost 100% continence within 2 years of surgery. Deterioration of continence following the IVS operation appears more like the Burch colposuspension than needle suspensions. It is possible to explain deterioration of continence with time in terms of age‐related connective tissue laxity of the vaginal hammock. Improvement in 2 women with time can be explained by tightening of the hammock via paraurethral scar contraction with time. Whether the IVS operation improves or deteriorates in the longer term may depend on which process predominates.
The Integrity of Surgical Gloves During Gynaecological Operations
Authors: Khoo S.K. , Isbester Anne
Published: March 2008

Summary: The study was designed to evaluate the integrity of all surgical gloves, worn as single‐gloving, used in 100 consecutive gynaecological operations. Glove perforations were tested by a standardized hydrosufflation technique. Of the 326 pairs of gloves used, 46 were found to have perforations (an overall rate of 7.1 %) and about 30% had more than 1 perforation. The rate of glove perforation was 19% among charge nursing sisters, 16% among surgeons and 13% among first assistants‐these differences were not statistically significant. The duration of the operation and degree of operative difficulty strongly influenced the rate of perforation. We recommend that surgeons, charge sisters and first assistants should change their gloves after every hour of the operation and use double‐gloving in anticipation of a difficult operation.
Extreme Torsion of the Pregnant Uterus
Authors: Mustafa M.S. , Shakeel F. , Sporrong B.
Published: March 2008

Summary: Extreme uterine torsion of 180 degrees at term is a rare obstetric event and raises several critical management considerations. We report such a case detected at laparotomy for a repeat Caesarean section. The existing literature on uterine torsion is reviewed and a plan of management is suggested, based on previous reports and our own experience.
Evaluation of Serum Creatine Kinase as a Diagnostic Marker for Tubal Pregnancy
Authors: Saha P.K. , Gupta I. , Ganguly N.K.
Published: March 2008

Forty women comprising of 20 each in study and control groups had their serum creatine kinase (CK) estimated. The study subjects were proven cases of ectopic pregnancy and the controls were either medical termination of pregnancy seekers or antenatal cases matched for gestational age and with a confirmed intrauterine pregnancy. Total serum creatine kinase levels were found to be significantly higher in the study group i.e. 34.15 ± 1.17 IU/L compared to the controls 18.72 ± 1.25 (p < 0.001). Creatine kinase is estimated routinely in cardiac patients even on an emergency basis. Our findings indicate that when in doubt the test could be used as a marker for the diagnosis of ectopic pregnancy.
Herpes Zoster During Pregnancy Near Term: to Treat or Not to Treat?
Authors: Thami Gurvinder P. , Kanwar Amrinder J.
Published: March 2008

EDITORIAL COMMENT: We accepted this short report for publication since the case will interest readers and our editorial committee considers that the treatment described was correct, Acyclovir and similar drugs are widely used in pregnancy for herpes simplex, and as stated in this paper there is clear benefit to the patient of early treatment of herpes zoster.
Massive Bilateral Phaeochromocytomas in Association with Von Hippel Lindau Syndrome in Pregnancy
Authors: Kothari Alka , Bethune Michael , Manwaring Janine , Astley Nicole , Wallace Euan
Published: March 2008

We report a rare case of large bilateral phaeochromocytomas in pregnancy, found coincidentally by ultrasonography at 26 weeks' gestation, in a woman with a family history of Von Hippel Lindau syndrome. Further, we report maternal and fetal serum and amniotic fluid phenoxybenzamine levels from this case.
Labial Fusion Causing Voiding Difficulty and Urinary Incontinence
Authors: Ong Nicole C.S. , Dwyer Peter L.
Published: March 2008

EDITORIAL COMMENT: We accepted this case for publication because it gives a good account of urinary problems due to extreme labial agglutination in a postmenopausal woman. The editor was the Senior Gynaecologist in the Repatriation General Hospital, Melbourne from 1976 to 1996, where he saw a number of elderly‐women with partial labial agglutination. Occasionally, when the condition was more extreme, the patients presented with spraying of the urine when the urinary stream hit the bridge of fused labia minora. However the editor has not seen a patient such as the woman reported here who required surgery, possibly because of routine administration of oestrogen cream to the vagina in these women. One would imagine that the process of urination would maintain a degree of labial patency in these women! It is an unfortunate fact that, even in major teaching hospitals, gynaecological conditions that are dealt with purely on an outpatient basis are never coded and so it is virtually impossible to do a hospital audit on the prevalence of these so‐called ‘minor’ gynaecological disorders. This probably applies to agglutination of the labia minora in asymptomatic, elderly, postmenopausal women.
Is Surgical Salvage of Arteriovenous Grafts Feasible after Unsuccessful Percutaneous Mechanical Thrombectomy?
Authors: Maya Ivan D. , Smith Tamorie , Young Carlton J. , Allon Michael
Published: March 2008

Treatment of thrombosed dialysis ateriovenous (AV) grafts in the radiology interventional suite requires percutaneous mechanical thrombectomy, along with angioplasty of the underlying stenotic lesion. We analyzed the anatomic reasons for unsuccessful percutaneous thrombectomy of AV grafts, and assessed the feasibility of surgical salvage. The radiologic reports of all thrombosed AV grafts undergoing unsuccessful percutaneous mechanical thrombectomy during a 5‐year period were analyzed for the specific problem precluding restoration of graft patency. We also compared the features of patients with unsuccessful graft thrombectomy to those with successful thrombectomy. Of 77 AV grafts undergoing unsuccessful percutaneous thrombectomy, only six (or 8%) could be revised surgically. Inability to salvage the graft surgically was because of: severe draining vein occlusion or stenosis (30 patients); severe central vein lesion (12); multiple intragraft stenoses (11); large pseudo‐aneurysms (six); venous anastomotic occlusion (six); and arterial anastomotic occlusion (four). When compared with 211 patients with successful graft thrombectomy, those with unsuccessful thrombectomy were more likely to have a forearm graft (53% vs. 27%, p < 0.001), and more likely to have a lesion in the draining vein (42% vs. 10%, p < 0.001), the central vein (17% vs. 3%, p < 0.001), or within the graft itself (23% vs. 1%, p < 0.001). An unsuccessful percutaneous graft thrombectomy is more likely in forearm than in upper arm grafts, and more likely if there is a lesion in the draining vein, central vein, or within the graft itself. Surgical salvage of a thrombosed AV graft after an unsuccessful percutaneous intervention is rarely feasible. Most patients have a severe anatomic lesion that cannot be repaired, and require creation of a new vascular access.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: A Sufficient Reason to Avoid Gadolinium‐Based Contrast in All Patients with Renal Impairment?
Authors: Willicombe Michelle , Cunningham John
Published: March 2008

Nephrogenic systemic fibrosis (NSF) was recently linked to gadolinium‐based contrast (GBC) exposure in patients with renal failure. As result, the U.S. Food and Drug Administration (FDA), the UK Commission on Human Medicines (CHM) and the European Pharmacovigilance Working Party Committee for Medicinal Products for Human Use (CHMP) recommended that GBC should be avoided in patients with advanced renal failure (GFR < 30 ml/minute/1.73 m2). Ones initial reaction is to advise avoidance of GBC exposure in patients with any level of kidney disease to prevent this awful complication. However, this approach is not based on data nor is it practical for patients who would benefit from this diagnostic modality. Thus, while complete avoidance cannot currently be advocated, GBC‐enhanced MRI in renal impairment should be reserved for neurological and vascular cases where the quality of information gained is sufficient to justify the risk of potential devastating adverse effects of NSF.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Non‐Gadolinium Options for the Imaging of CKD/ESRD Patients
Authors: Dawson Peter , Punwani Shonit
Published: March 2008

Nephrogenic systemic fibrosis (NSF) is a severe systemic disorder developing apparently exclusively in patients in advanced renal failure who receive a gadolinium chelate contrast‐enhancing agent for magnetic resonance imaging. Some other apparent risk factors have been identified but their status remains uncertain. Physicians are frequently confronted with patients at risk of NSF who need imaging. An approach to planning imaging in patients at risk to develop NSF is outlined.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Dialytic Therapies to Prevent NSF Following Gadolinium Exposure in High‐Risk Patients
Authors: Rodby Roger A.
Published: March 2008

Prolonged exposure to gadolinium‐based contrast (GBC) appears to be the core pathophysiologic factor in the development of nephrogenic systemic fibrosis (NSF). As the GBC is renally excreted, this condition is predominantly seen only following exposure in patients with severe reductions in renal function. Fortunately, GBC is easily hemodialyzed with 95% of an administered dose removed after two hemodialysis sessions. Peritoneal dialysis, on the other hand, is not an efficient means of GBC removal. This has led to recommendations to hemodialyze a high‐risk patient immediately following GBC administration and to repeat the treatment the following day. Although this approach seems logical and is more aggressive than the usual thrice‐weekly hemodialysis schedule that most patients were receiving when they developed this devastating condition, there are no data to support the supposition that this approach will reduce the risk of NSF. Therefore, although an aggressive hemodialysis strategy postexposure is not unreasonable, it is probably best at this point to try to avoid GBC administration altogether in these high‐risk patients.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Patient Characteristics and Risk Factors for Nephrogenic Systemic Fibrosis Following Gadolinium Exposure
Authors: Grobner Thomas , Prischl Friedrich C.
Published: March 2008

Nephrogenic systemic fibrosis (NSF) is a systemic illness, which only affects patients with kidney failure. NSF risk increases with progressively lower levels of kidney function. It is characterized by red skin areas or plaques that develop over several weeks to painful thickened skin with a “woody” texture, resembling “peau d’orange.” It may ultimately cause flexion contractures of joints. Skin biopsy reveals thickened collagen bundles, mucin deposition, proliferation of fibroblasts and elastic fibers, without inflammation. Originally described as nephrogenic fibrosing dermopathy (NFD), because of its primarily cutaneous manifestation, it was renamed NSF because of the involvement of various organs like the lungs, myocardium, or striated muscles. The pathogenesis of the disease is not known yet, but recently we suggested a strong association between development of NSF and exposure to gadolinium‐based contrast (GBC) agents, thereafter confirmed by other authors. As a consequence of our recent observations, medical authorities imposed restrictions that exclude patients with advanced levels of renal insufficiency from potentially important magnetic resonance imaging studies with gadolinium. Unfortunately, the only alternatives in many situations (examination of brain, lungs, vasculature) are imaging modalities using iodinated radiocontrast agents. Thus, clinicians are faced with weighing the potential risk of NSF from GBC exposure against the risk of acute kidney injury‐associated with radiocontrast media. In this dilemma, clinicians must identify patients at high‐risk to develop NSF. Known risk factors critical for the development of NSF after exposure to GBC agents (certain chelates and higher doses) are end‐stage renal disease requiring dialysis, especially those with little or no residual renal function, and advanced kidney disease not on dialysis. Other potential risk factors include metabolic acidosis, iron overload/intravenous iron, divalent ion disturbances, endothelial/vascular injury, and high erythropoietin doses. Further studies are required.