bluuebunny/crossref_metadata_2025 huggingface dataset:
Colposcopic analysis of genital human papillomavirus infections during an 8‐year prospective follow‐up
Authors: Ji H.X. , Yliskoski M. , Väyrynen M. , Hippeläinen M. , Syrjänen S. , Syrjänen K.
Published: April 2004

A long‐term prospective follow‐up program has been conducted for genital human papillomavirus (HPV) infections in 532 women in Kuopio since 1981. By regular examinations (at 6‐month intervals) using colposcopy, cytology and/or punch biopsy, 426 of these women have been followed up for the minimum of 48 months (mean 71 ± 19 months). These 426 women were included in the present report. The colposcopic data of all women at the first and the latest visits were recorded from the colpophotographs, analysed and correlated with cytology, histology, HPV DNA detection and clinical behavior (i.e. prognosis) of the disease. Colposcopic abnormalities were found in 313 (73.5%) women at the first visit and in 138 (32.4%) patients at the latest visit. HPV infections were diagnosed in 368 (86.4%) women at the first visit and in 75 (17.9%) at the latest visit on light microscopy (i.e. biopsy and/or PAP smear). CIN was found in 54.7% of the women at the first visit. HPV DNA was detected by in situ hybridization in 38.2% of the biopsies assayed. Colposcopical multicentric lesions were found in one third of the women upon examination of the entire lower genital tract. The majority of the lesions were situated within the transformation zone. HPV infection and CIN were most frequently encountered in women with multiple lesions. Progression to CIN III was most frequent in large lesions (28.6%). No colposcopic pattern was able to distinguish HPV infections from CIN lesions, or predict the progression of the former. The results implicate that: (1) colposcopy is an essential method to disclose abnormalities due to CIN and HPV infections, but histological changes cannot be predicted on a single colposcopy; (2) HPV infection is a multicentric disease, making the careful examination of the entire lower genital tract mandatory on every colposcopy; and (3) the HPV progressors cannot be predicted on the basis of the colposcopic patterns.
A case‐control study of stillbirths in Northeast Brazil
Authors: Ferraz E.M. , Gray R.H.
Published: April 2004

An institution based case‐control study to determine risk factors for stillbirths was conducted in the city of Natal, NE Brazil, where 90% of deliveries take place in health facilities. Two hundred thirty‐four singleton stillborn cases were compared to 2555 liveborn singleton control infants of normal birthweight and gestational age. Information was obtained by postnatal interview and anthropometry, and review of medical records. Univariate analyses revealed a large number of potential risk factors, but after adjustment by logistic regression only six factors remained significantly associated with stillbirth. These were low maternal weight, ⩽50 kg and a history of pregnancy loss, both with odds ratios (OR) of 1.8, inadequate prenatal care defined as less than five visits (OR = 1.9), gestational complications (OR = 14.2), intrapartum complications (OR = 2.0), and congenital malformations (OR = 8.7). There was also an increased risk of stillbirth among older mothers who smoked (OR = 1.4), and evidence of an interaction between smoking and complications of pregnancy. From the public health perspective, the most important factors amenable to intervention were inadequate prenatal care and antenatal or intrapartum complications which were associated with substantial attributable risks (23.8%, 35.2%, and 10.2%, respectively). Thus, in this population, future reductions of the high stillbirth rate (27.2 per 1000 births) will largely depend on the coverage, utilization, and quality of antenatal and intrapartum care.
Low‐dose aspirin and vascular response in pregnant patients sensitive to angiotensin II
Authors: Caruso A. , Ferrazzani S. , De Carolis S. , Lanzone A. , Mancuso S.
Published: April 2004

The angiotensin sensitivity test was performed in 25 high risk pregnant women before and after administration of low‐dose aspirin (100 mg/day for 7 days). After aspirin administration there was a significant decrease in AII sensitivity in sensitive patients with no change in nonsensitive patients. Low‐dose aspirin favorably affects sensitivity to AII in sensitive patients, thus indicating a reduced vascular reactivity as a consequence of this regimen.
Fewer accelerations and decreased long term variability in the heart rate of small for gestational age fetuses
Authors: D'Hooghe T.M. , Odendaal H.J.
Published: April 2004

Two hundred newborns delivered after decelerative antenatal fetal heart rate tracings were divided retrospectively into two groups, one that was small for gestational age (SGA) and another that was appropriately grown for gestational age (AGA). Analysis of the tests showed a lower prevalence of good long term variability in the SGA group when compared with the AGA group. In addition, fetal heart rate accelerations occurred less frequently in the SGA group, even in the presence of good long term variability.
Life‐saving skills training for midwives: report on the Ghanaian experience
Authors: Taylor J.E.
Published: April 2004

The shortage of rural‐based physicians in Ghana has led to a decision to provide short term courses to rural midwives on the treatment of those obstetric conditions that are the main causes of maternal mortality. A description of this ongoing training is provided.
Hysteroscopy in the diagnosis of suspected interstitial pregnancy
Authors: Kabukoba J.J. , de Courcy‐Wheeler R.H.B.
Published: April 2004

Three cases are reported in which interstitial pregnancy was suspected on ultrasound scan. The first was managed by scans and laparoscopy, but resulted in rupture of the uterus and hysterectomy at 20 weeks. In the following cases hysteroscopy was used to refute the diagnosis in one patient and confirm it in another within the first trimester. A case is made for the use of hysteroscopy in the assessment of patients with suspected interstitial pregnancy.
Presentation and management of eclampsia
Authors: Konje J.C. , Obisesan K.A. , Odukoya O.A. , Ladipo O.A.
Published: April 2004

Three hundred forty‐seven cases of eclampsia were managed at the University College Hospital (UCH), Ibadan, Nigeria from 1977 to 1986 (9.3 per 1000 deliveries). Thirty‐one percent of seizures occurred antenatally, 46.2% during labor and 23.2% postnatally. Only 5% first occurred in the hospital. Seizures were controlled with diazepam, lytic cocktail (chlorpromazine, pethidine and phenergan), sodium amylobarbitone, paraldehyde and bromethol. Maternal mortality was 2.9%, and perinatal mortality 193 per 1000, respectively. Prevention of avoidable factors (absent or poor antenatal care and prolonged labor) by the provision of comprehensive antenatal care will reduce the incidence of eclampsia. Improvement in management facilities prior to transfer to referral centers, the use of magnesium sulfate or diazepam to control seizures and the avoidance of hypotonic solutions and 50% glucose during therapy will reduce morbidity and mortality.
A ten‐year review of encephalocele in a teaching hospital
Authors: Adetiloye V.A. , Dare F.O. , Oyelami O.A.
Published: April 2004

A 10‐year review of infants with encephalocele was carried out in a multicentered teaching hospital. Out of 23 438 infants seen within the period, only 12 cases of encephalocele were seen, giving an incidence of 0.5/1000 births. Nine (75%) of patients had occipital encephalocele, two (16.7%) occipitoparietal and one (8.3%) fronto‐nasal. Two patients had spina bifida as an associated neural tube defect while occular abnormalities were seen in another two. None had neurological defects at birth but some showed evidence of hydrocephalus and delayed milestones after surgery. Ultrasonic diagnosis was made in one case only. The etiologic, prognostic and descriptive characteristics, in addition to obstetric management of encephalocele are discussed.
Ovarian pregnancy
Authors: Al‐Meshari A.A. , Chowdhury N. , Adelusi B.
Published: April 2004

Ovarian ectopic pregnancy occurs very rarely; the reported incidence is only 1:7000–40 000 deliveries, despite various reports in recent years. We present four cases of primary ovarian pregnancy which were managed in the King Khalid University Hospital (KKUH) over a 5‐year period representing a prevalence rate of 19.9 per 100 000 deliveries. All four cases complied with the four criteria of Spiegelberg. None of the patients were known to have used an intrauterine contraceptive device which had been suggested as the cause of ovarian pregnancies in several studies. Fertility after surgery in these cases was unaffected.
Influence of work on pregnancy outcome
Authors: De A. Seneviratne S.R. , Fernando D.N.
Published: April 2004

OBJECTIVES: To study the effect of working in health services on complications of pregnancy, preterm deliveries and low birthweight (LBW). METHODS: These indices were studied in 130 pregnancies that occurred within the preceding 5 years in 100 nursing officers (NOs) and 126 pregnancies in 100 clerical workers (CWs). Risk was assessed by calculating odds ratios. Confounding and interaction effects were studied by stratification. RESULTS: Socio‐economic background and antenatal care utilization in the two groups were similar. Occurrence of LBW was not significantly different (OR = 1.04; 0.57 < OR < 1.89; P = 0.89) although complications of pregnancy (OR = 2.18; 1.09 < OR < 4.38; P = 0.017) and preterm deliveries (OR = 5.64; 1.15 < OR < 37.73; P = 0.013) were higher in NOs. Further analysis showed that employment in health services has a positive effect in prevention of LBW among NOs in the presence of other risk factors. CONCLUSIONS: Working in the health services had a negative effect on some of the indices while benefits of such employment had a positive effect on birth‐weight.
Endometriosis and tamoxifen therapy
Authors: Morgan M.A. , Gincherman Y. , Mikuta J.J.
Published: April 2004

Tamoxifen is an estrogen antagonist/agonist often associated with antiestrogenic effects such as hot flushes and vaginal dryness in premenopausal women. Estrogenic side‐effects, such as thromboembolic phenomena and endometrial proliferation has been reported in postmenopausal women. Paradoxically, tamoxifen has also been shown to be capable of increasing estrogen levels in premenopausal women. Since tamoxifen is being used more frequently in this group of women, potential adverse effects are only now being recognized. Two cases of premenopausal women who developed symptomatic endometriomas while on tamoxifen for breast cancer, are reported. Stimulation of endometriosis should be considered when pain and an ovarian mass develops in a woman on tamoxifen. The unique effects of tamoxifen in premenopausal women may contribute to this even in the presence of regular ovulation.
Relativity of chronological age and level of awareness in crystallization of choice of career among Nigerian undergraduates
Authors: Eyetsemitan Frank
Published: April 2004

This study attempts to assess the relative influence of chronological age and level of awareness on the crystallization of choice of discipline or career among Nigerian University undergraduates. Crystallization is defined as the ability to know or choose a discipline or vocational environment with characteristics congruent with one's personality or implementing one's vocational self‐concept in the appropriate vocational environment. Level of awareness is the amount of information or data one has about a discipline. Seventy‐six freshers of the University of Jos, Nigeria in two categories of disciplines—old/professional disciplines (medicine and law) and new disciplines (sociology and psychology) with different levels of awareness about them in Nigerian society were used. It was hypothesized that students in the old/professional disciplines of law and medicine would have better crystallization about their disciplines than students in the newer disciplines of psychology and sociology. This hypothesis was supported at P < 0.01. Also supported was the hypothesis that crystallization would not increase with chronological age.

In conclusion, it is suggested that level of awareness as against chronological age is a more potent determiner of crystallization of career choice in Nigeria.
Diminished responsibility as a mitigating circumstance in juvenile offenders' legal judgments
Authors: Siegal Michael
Published: April 2004

The legal judgments of 20 juvenile offenders and 20 non‐offenders were examined for three types of crimes: assault, arson and treason. Mitigating circumstances cast in the form of an inability to control events consisted of brain damage, passion and economic need, in contrast to a situation in which no mitigating circumstances were offered. The results indicated that despite the often‐made legal argument, neither group regarded passion and economic need as circumstances warranting the reduction of sentencing. Compared to the non‐offender group, offenders rated brain damage as less mitigating. While non‐offenders rated passion and economic need more severely than brain damage, offenders' ratings of the three circumstances did not differ significantly. The findings are discussed in terms of perceptions of control and structural‐developmental approaches to socialization.
A comparison of the psychological evaluation of adolescents with anorexia nervosa and of adolescents with conduct disorders
Authors: Gordon Donna P. , Halmi Katherine A. , Ippolito Paula M.
Published: April 2004

Cognitive and projective psychological tests were administered to ten inpatient adolescents with anorexia nervosa and ten inpatient adolescents with conduct disorders. All subjects were selected on the basis of race, sex and overall intelligence. Results indicate that there are high numbers of neuropsychological deficits in both groups, but that neuropsychological deficiets are especially numerous in the anorexia group. The two groups showed striking similarities in terms of some psychological functions, but results indicate that some aspects of personality style in the two groups are significantly different. A significant finding was that there were far more suicidal indicators on the Rorschach records of the anorectic group as compared with those found on the records of the conduct disorder group.
The use of analogy in individual psychotherapy with young and pre‐adolescents: “Superman, Bimbo and the big, grey wolf”
Authors: Baird Frank
Published: April 2004

For various reasons, youngsters often have difficulty in discussing important issues in individual psychotherapy. Therapists, also, may find it hard to uncover underlying issues and dynamics. This paper describes three separate techniques for using analogy in individual therapy with the 10 to 15‐year‐old age group. These techniques were developed while the author was a member of a multi‐disciplinary team operating within an out‐patient, adolescent psychiatric clinic.
The dangers of ill‐health through recreation
Authors: Zwingmann Ch. , Gunn Alexander D.G.
Published: April 2004

Healthy recreation for adolescents is discussed in its physical, psychological, educational and social dimensions. The medical and psychological dangers, in many current practices, are highlighted. Contemporary changes that have occurred in conceptions of pleasure and recreation are examined and the emerging evidence of the hazards involved is emphasised. Proposals for the prevention of these hazards to health are made.
West Indian adolescents' perceptions of family functioning
Authors: Payne Monica A. , Furnham Adrian
Published: April 2004

A total of 424 Barbadians aged 13–15 years completed the Family Functioning in Adolescence Questionnaire, developed in Australia by Roelofse and Middleton (1985). Findings revealed most adolescents, like their Australian peers, reported fairly favourable perceptions of their families. However, neither total nor sub‐scale scores served to discriminate between sub‐groups based on sex, age or household structure to any great extent. A re‐grouping of items based on results of Varimax analysis also failed to yield many significant group differences, although some directions for future research were indicated. Adolescents not living with their fathers seemed to have a somewhat lower sense of personal security, but in other respects did not report their family life any less favourably than did those living with both natural parents.
Adolescents' dropout from individual psychotherapy—is it true?
Authors: Suzuki Ryu
Published: April 2004

Although adolescent patients are said to have a propensity to drop out from psychotherapy, and clinical experiences seem to support this view, few studies have systematically examined this issue. However, a review of researches on adults' dropout shows that dropout is a serious problem for psychotherapy with adult patients. Moreover, available evidence on adolescents' dropout suggests that there is no significant difference in the rates of dropout from psychotherapy between adolescent patients and adult ones. In order to understand the specific quality of adolescents' dropout, the termination of psychotherapy with an adolescent patient is described and discussed. The view is put forward that it is because of the strong counter‐transference feelings evoked in the therapist, when his adolescent patient leaves him prematurely, tends to maintain the impression of adolescents' proclivity to drop out from psychotherapy.
Self‐destructive tendencies and depression as predictors of suicidal ideation in teenagers
Authors: Lester David , Gatto Jeri‐Lynn
Published: April 2004

In male teenagers, scores on a self‐destructive inventory were more strongly associated with the presence of suicidal ideation than scores on a depression inventory. For female teenagers, scores on the depression inventory were more strongly associated with suicidal ideation.
Transitions in the nuclear age: late adolescence to early adulthood
Authors: Van Hoorn Judith , Le Veck Paula , French Perrin
Published: April 2004

College students, subjects in a 1983 study on reaction to the threat of nuclear war, participated in a follow‐up study to investigate the changes that occur from late adolescence to early adulthood. The 41 subjects again completed the Nuclear War Attitude Survey (NWAS II) and, additionally, a second questionnaire and a 1 to hour individual interview during which they were asked to explain changes in their answers to the NWAS II. Compared to their previous responses to the NWAS II, the responses of these young adults showed statistically significant decreases in the frequency they reported thinking about the possibility of nuclear war, their estimation of the likelihood of a nuclear war, and their intention to contact the news media to express their views. The researchers hypothesize that the major reasons for changes in response were (1) developmental differences, (2) the campus culture, (3) the political climate, (4) the media climate and (5) lack of engagement with the democratic process.
The measurement of adolescent adaptive processes in the clinical interview
Authors: Tansey L. , Fitzgerald M. , Kinsella A.
Published: April 2004

A study is described measuring the clinical usefulness of Adolescent Adaptive Process Scales. These processes are measured in three groups of adolescents in which psychopathology is also measured using a standardized psychiatric interview. Inter‐rater reliability is calculated between two raters and mean score comparisons are made between the groups using the t‐test method. In the study a higher inter‐rater reliability and some preliminary evidence of construct validity are found for these scales. The findings indicate that these scales could constitute a useful clinical tool in pyschotherapy, research and teaching. They also provide scope for future work in the field.
17α‐Hydroxylase deficiency in a genetic male and female sibling pair
Authors: Sills Irene N. , MacGillivray Margaret H. , Amrhein James A. , Migeon Claude J. , Peterson Ralph E.
Published: April 2004

The diagnosis of congenital adrenal hyperplasia due to a deficiency of the enzyme 17α‐hydroxylase was made in a genetic male and female sibling pair born of parents who were first cousins. The genetic male was a phenotypic female who presented with primary amenorrhea and mild hypertension. The genetic female exhibited absence of secondary sexual characteristics and severe hypertension. The plasma steroid data confirmed the diagnosis of 17α‐hydroxylase deficiency in both subjects: low 17α‐hydroxyprogesterone, elevated desoxycorticosterone, elevated corticosterone and elevated progesterone. These are the first case reports of 17α‐hydroxylase deficiency in a male‐female sibling pair, and they add support to the hypothesis that this is an autosomal recessive disorder.
Testosterone secreting adrenal cortical adenomas
Authors: Imperato‐McGinley Julianne , Young Iven S. , Huang Theresa , Dreyfus Joseph C. , Reckler Jon M. , Peterson Ralph E.
Published: April 2004

We report the hormonal and radiological evaluation of two cases of adrenal cortical adenomas that secreted testosterone exclusively. We discuss some of the pitfalls in the diagnosis of this lesion, and summarize the current knowledge of the characteristic hormonal features in the two cases and the 12 cases previously reported.
Cytomegalovirus infection of the uterine cervix: Local cervical infection and antibody response
Authors: Chiang Wen Tsuo , Chen Hong‐Ming , Hsieh Chang Yao , Tsai Wey Siong , Wei Ping Yen , Alexander E. Russell
Published: April 2004

Thirty‐three women were examined on three or more occasions, each at 2‐month intervals. The overall recovery rate of cytomegalovirus (CMV) was 28% (60/215). CMV was recovered from 53% of the cases where the local antibody was 1: 64 or greater but the greatest difference occurred below titers of 1: 32. Below that level virus was recovered in less than 5%, compared to a prevalence of 35% for cases with a titer of 1: 32 (P < 0.001). Twenty‐eight cases in whom CMV was sought underwent colposcopic examination and had cytologic smears examined by the papanicolaou method. The external uterine cervix with columnar cells only yield a CMV prevalence of 3/17 (18%). However, if colposcopy showed either atypical transformation or metaplasia the prevalence was 4/11 (36%). Similarly, it is provocative that the prevalence of CMV appears to increase with abnormal cytologic findings to 33% recovery in severe dysplasia or carcinoma in situ.
Antibody to hepatitis B core antigen, e‐antigen and its antibody in menstrual blood and semen
Authors: Ayoola E.A. , Ladipo O.A. , Odelola H.A.
Published: April 2004

Fifty male and fifty female healthy Nigerians were screened for hepatitis B surface antigen (HBsAg). Results were positive in five men and four women. HBsAg was detected in samples of semen of three male HBsAg carriers and in menstrual blood of four female carriers. Seven of the carriers had detectable hepatitis B core antibody in their serum; of these carriers, two semen and two menstrual blood samples were also positive for this antibody. In none of these subjects did we detect e‐antigen or its antibody in either the serum, semen or menstrual blood. It is concluded that the presence of the antibody to hepatitis B core antigen, which is a marker of persistent viral replication and of infectivity, further reinforces the role of sexual transmission in the propagation of hepatitis B virus infection in the tropics.
Vaginal evisceration
Authors: Cheong Choo Yew , Martin Lindenauer S.
Published: April 2004

A patient with vaginal evisceration due to prior radiation treatment of cervical carcinoma is presented, together with a review of reported cases. The salient features, predisposing causes and management of this unusual problem are discussed.
Testicular morphology in the 47XXY fetus at 16 weeks gestation
Authors: Rock John A. , Rock William A. , Rary Jack
Published: April 2004

The testis from two 47XXY fetuses (20 weeks) revealed histologic features not dissimilar from that observed in a normal 46XY fetus of similar gestational age. These findings support the observation that the loss of germ cells in patients with Klinefelter's syndrome is an event which begins in infancy and not in utero and progresses through early childhood and the prepubertal period. At puberty germinal aplasia may be complete with clinical evidence of testicular atrophy.
A successful pregnancy in transfusion dependent homozygous β‐thalassemia: A case report
Authors: Goldfarb A.W. , Hochner‐Celnikier D. , Beller U. , Menashe M. , Dagan I. , Palti Z.
Published: April 2004

A rare case of successful pregnancy in a 26‐year‐old woman with transfusion dependent homozygous β+‐thalassemia is described. Following the delivery she became amenorrheic with no evidence of ovarian or pituitary failure. Transient fertility is most unusual in female patients who otherwise present with a severe clinical course of the disease.
Mixed Mullerian tumors of the uterus: Clinical and pathologic correlations
Authors: Lotocki Robert , Rosenshein Neil B. , Grumbine Francis , Dillon Michael , Parmley Tim , Woodruff J. Donald
Published: April 2004

The 10‐year experience at The Johns Hopkins Hospital with 61 cases of mixed Mullerian tumors were reviewed. The patients had a mean age of 63.7 years and the similar constitutional factors of diabetes mellitus, hypertension and nulliparity of endometrial adenocarcinoma. Only one patient had estrogen exposure. Eighteen percent had had prior exposure to pelvic radiation. The life table survival of the 61 patients was 41.1% at 5 years. The 2‐year life table survival was 76% for disease confined to the uterus and 16.5% for extrauterine disease. There was no difference in survival between homologous and heterologous tumors. The surgical staging and the autopsies reviewed documented widely disseminated disease even when the tumor appeared to be confined to the uterus. It thus appears essential in order to improve survival these patients require aggressive staging and consideration of systemic adjuvant chemotherapy.
Influence of maternal levels of blood glucose on fetal outcome
Authors: Raman Leela , Rao Veena A. , Kumar S.
Published: April 2004

The effect of maternal levels of fasting blood glucose on fetal outcome was studied in 500 women with normal and toxemic pregnancies. Forty percent of the mothers with low glucose levels gave birth to low birth weight infants. In cases of severe preeclamptic toxemia, low fasting glucose levels were associated with a higher incidence of low birth weight, prematurity and stillbirths. Thus, in a population subsisting on poor caloric and protein intake, maternal levels of fasting blood glucose may be an important index in predicting high‐risk pregnancy.
Hypergonadotropic ovarian failure in young women
Authors: Bateman Bruce G. , Nunley Wallace C. , Kitchin James D.
Published: April 2004

The purpose of this study is to evaluate 13 patients with primary ovarian failure (POF). All patients were less than 35 years of age. Serum FSH, performed by RIA, was in the post‐menopausal range in all patients. Karyotype with Q‐banding was performed on peripheral leukocytes and/or ovarian tissue. All patients had 46XX karyotype. Eleven patients had laparoscopy or laparotomy and ovarian biopsy. Two of the 11 patients had ovarian follicles. One patient had Graves' disease. Based on our data, we offer these conclusions. A thorough evaluation of patients with premature ovarian failure is essential. Testing for autoimmune endocrinopathies should be considered in POF patients who exhibit any signs of endocrine dysfunction. A peripheral karyotype with banding should be performed on all patients. The resistant ovary syndrome may occur with greater frequency than has previously been reported and a review of the literature on the resistant ovary syndrome is presented.
Micrognathia—prenatal ultrasonographic diagnosis
Authors: Shalev Eliezer , Weiner Ehud , Feldman Ester , Cohen Hana , Zuckerman Henryk
Published: April 2004

The first case of prenatal real‐time ultrasonographic diagnosis of micrognathia is presented. Diagnosis was made at 17 weeks' gestation in the fetus of a patient with previous infant affected with the syndrome of thrombocytopenia with absent radii (TAR). Recognition of micrognathia as a part of TAR syndrome and the easy visualization of fetal facial bones in the second trimester made diagnosis possible.
Induction of ovulation with clomiphene citrate followed by LH‐RH in women
Authors: Maia H. , Barbosa I.C. , Maia H. , Hirsch C. , Tironi E. , Coutinho E.M.
Published: April 2004

Luteinizing hormone‐releasing hormone (LH‐RH) was used to induce ovulation following clomiphene priming to stimulate follicular growth. Ovulation was assumed to have occurred following LH‐RH injection when progesterone levels started to rise within 48 h following treatment and LH pretreatment levels were below 8 mIU/ml. Ovulation occurred in eight of 10 patients following the administration of LH‐RH and six pregnancies were achieved in the first 4 months of treatment.
Deliveries after cesarean birth in two Asian university hospitals
Authors: Chi I‐Cheng , Saifuddin Abdul Bari , Gunatilake D.E. , Wallace Sylvia L.
Published: April 2004

The task force of the consensus conference on cesarean birth of the National Institutes of Health, USA, has recommended substituting a trial of labor and vaginal delivery for elective repeat cesarean section in selected women. This paper assesses the benefits and risks associated with that recommendation using data from two Asian teaching hospitals, one in Jakarta, Indonesia and the other in Colombo, Sri Lanka. Data recorded on the Maternity Record Form designed by the International Fertility Research Program and the International Federation of Gynecology and Obstetrics were used for analysis. Consistent findings were derived from the two hospitals, in spite of the different medical care delivery systems in their countries. No significant increase in maternal and infant mortality and morbidity were associated with women having vaginal delivery subsequent to cesarean birth as compared to those with repeat cesarean section. Savings in medical cost were considerable in the former group.
Prenatal diagnosis of placental hemangioma — clinical implication: A case report
Authors: Shalev Eliezer , Weiner Ehud , Feldman Ester , Zuckerman Henryk
Published: April 2004

Placental hemangioma is considered to be associated with a high rate of maternal and fetal complications. We report a case where ultrasonography revealed the placental tumor at 28 weeks gestation. The patient was kept under strict surveillance which permitted diagnosis of pre‐eclampsia at 34 weeks gestation with successful termination of pregnancy at 37 weeks.

The ultrasonic features of the tumor are described and the clinical implication discussed.
Characteristics of contraceptive acceptors in an urban Nigerian setting
Authors: Ayangade Okun
Published: April 2004

Intensive efforts in promoting family planning concepts and contraceptive delivery in the third world over the past two‐ and one‐half decades have yielded only token dividends. This has occurred in Nigeria, despite the favorable government attitude. A study of the characteristics of current contraceptive acceptors showed an overwhelming percentage of acceptors are uneducated, married and from the lower socioeconomic class, a striking departure from usual expectations. Most acceptors prefer oral contraceptives. The status of acceptance of modern contraception by the educated population is still underermined. Contraceptives appeared to be used primarily by women aged 30 and older in our population.
A study of delta intrauterine devices in Ankara, Turkey
Authors: Kisnisci Husnu , Champion Cheryle B.
Published: April 2004

Delta devices, modifications of standard Lippes Loop D and TCu 220C IUDs, were designed for postpartum insertion. A study of the Delta T and the Delta Loop was conducted at Hacettepe University School of Medicine in Ankara, Turkey. The IUDs were randomly allocated to 246 immediately postpartum women (<10 min postplacenta). Twelve‐month expulsion rates were low for both devices; 3.7 for Delta Loop users and 7.6 for Delta T users.
Intracervical administration of prostaglandin E2 prior to vacuum aspiration a prospective double‐blind randomized study
Authors: Iversen Torbjørn , Skjeldestad Finn Egil
Published: April 2004

Two‐hundred and ninety‐three patients without a previous vaginal delivery were randomized to intracervical/extra‐amniotic application of 0.5 mg prostaglandin E2 (PGE2) or to gel only. Of the patients who received PGE2, 18.7% were admitted before the next morning due to spontaneous abortion, bleeding or pains. No other side‐effect was observed. A statistically significant dilatation of the cervical canal was found in the prostaglandin group. Thirty percent of the treated patients did not need further dilatation of the cervix 25.4% were non‐responders to PGE2 and 7.7% were hyper‐responders. The number of uterine perforations, pelvic inflammatory disease (PID) or retained pregnancy products were not influenced by the pretreatment with PGE2.
Diagnosis and management of tubal pregnancy: Effect on fertility outcome
Authors: Paavonen J. , Varjonen‐Toivonen M. , Komulainen M. , Heinonen P.K.
Published: April 2004

We analysed 188 ectopic pregnancies seen during a 2‐year period. They represented 2.2% of the live births that occurred during the same time interval. Overall, 53% of the tubal pregnancies had ruptured at the time of examination. Location was ampullary in 51% of the cases, isthmic in 28%, and 10% had aborted. Sixty‐nine (38%) patients had an IUD. Diagnostic sensitivity was 58%–93% for pregnancy tests, 79% for culdocentesis, 41% for ultrasound examination, 43% for dilatation and curettage, and 100% for laparoscopy. Salpingectomy was performed in 47% of the cases, salpingotomy in 27%, and tubal resection in 19%. During a follow‐up of 116 women (mean 1.5 years, range 0.5–3 years) 49% delivered, 10% had repeat ectopic pregnancy, 10% had abortion, 17% were infertile and 15% practised birth control. Among those who delivered no difference was found between those who underwent salpingectomy and those who underwent conservative surgery.
Effect of copper T intrauterine device on cervico‐vaginal flora
Authors: Wahab S.A. , Altaieb S. , Senity A. , Saleh A. , Sakr E. , Hamly A.K. , Hegab M.
Published: April 2004

The effect of the Copper T intrauterine device (IUD) insertion on vaginal and cervical flora was studied in thirty cases. The vaginal and cervical cultures showed a significant increase (P < 0.01) in some of the anaerobic bacteria. Some of the aerobic organisms showed a statistically significant increase in the cervical cultures (P < 0.01). Strict asepsis during insertion of the device is recommended.
Childbearing among the Igbos of Nigeria
Authors: Egwuatu V.E.
Published: April 2004

Traditional Obstetric care among women of the Igbo tribe in Nigeria is described. The role of traditional birth attendants, antenatal care, management of delivery complications, postnatal care and traditional community practices surrounding birth are discussed.
Endometriosis in diagnostic laparoscopy in Isfahan, Iran
Authors: Sarram M. , Rezazadeh A.
Published: April 2004

In 200 consecutive routine diagnostic laparoscopies, 31 cases (15.5%) of endometriosis were found. Of these 200 cases, 131 patients (65.5%) were referred for laparoscopy because of infertility. In 22 (71.0%) out of 31 patients with endometriosis infertility was the indication for laparoscopy. In the remainder of the patients laparoscopy was performed because of other indications. Half of the patients with endometriosis showed moderate or severe degrees of the disease. Seventy‐one percent of the patients were below the age of 29.

According to our findings, the presumption that endometriosis is a rare disease in Iran is considered to be erroneous.
Acceptance of contraceptive practice by grandmultiparae in Benin City, Nigeria
Authors: Omu A.E. , Unuigbe J.A.
Published: April 2004

Five hundred sixty grandmultiparous women were interviewed as to their contraceptive awareness, desirability and use in the three major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was high level of awareness of contraceptive availability and usefulness (65%), but low level of practice (27.1%). The main causes of the low practice level included opposition from husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. We believe that with more concerted effort at family planning counseling, the community will be rid of the hazards and menace of grandmultiparity.
Periodic acid‐Schiff stain as a prognostic indicator in serous and mucinous ovarian tumors
Authors: Aalto Marja‐Leena , Collan Yrjó
Published: April 2004

The prognostic significance of periodic acid‐Schiff (PAS) stain in 112 serous: 43 benign, 25 borderline and 44 malignant cystadenomas; and in 106 mucinous: 60 benign, 32 borderline and 14 malignant cystadenomas of the ovary were investigated. The amount of positively stained mucin was estimated morphometrically. The outcome of most patients with benign or borderline lesion was good. One patient with benign mucinous cystadenoma died, however, of pseudomyxoma peritonei and another patient with borderline mucinous cystadenoma died of peritoneal carcinosis. Other patients were alive and free of the disease after a follow‐up of 1–14 years, or had died of causes unrelated to the ovarian disease. Abundant PAS positive mucin predicted a longer survival both in serous and in mucinous malignant tumors. The 5‐year survivals for the serous cystadenocarcinomas with and without PAS positive mucin were 21% and 13%, respectively (not statistically significant). For mucinous cystadenocarcinomas with mucin value over and below the median, the 5‐year survival rates were 57% and 14%, respectively (P < 0.10).

High PAS positivity in both serous and mucinous cystadenocarcinomas clearly indicated better prognosis, although statistical significance was not achieved. Thus, further studies are needed for final evaluation of the prognostic significance of the PAS stain in these ovarian tumors.
A prospective comparison of clinical and ultrasonic methods of predicting normal and abnormal fetal growth
Authors: Okonofua F.E. , Ayangade S.O. , Chan R.C.W. , O'Brien P.M.S.
Published: April 2004

Charts of symphysial‐fundal height (SFH) and ultrasound growth of fetal biparietal diameter (BPD) and abdominal circumference (FAC) were used simultaneously for the antenatal diagnosis of altered fetal growth in 100 patients. After delivery, infants were classified as small‐for‐gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) by birthweight and the postnatal diagnoses compared to antenatal diagnoses. The results indicate that although SFH is as good as ultrasound in predicting normal fetal growth, it is less sensitive than ultrasound for the diagnosis of SGA infants and even less so for macrosomia.

It is concluded that SFH should be retained or instituted as a routine screening test for abnormal fetal growth.
Severe hypoglycemia during pregnancy: Its frequency and predisposing factors in diabetic women
Authors: Rayburn W. , Piehl E. , Jacober S. , Schork A. , Ploughman L.
Published: April 2004

Severe hypoglycemic episodes, as defined as altered consciousness to the extent that self treatment is impossible, were sought prospectively in pregnant diabetic women. One or more episodes were found in none of 21 gestational onset, insulin‐requiring women during their 28 pregnancies but were present in 19 (33%) of the 57 already insulin dependent (Type 1) women during 26 (36%) of their 72 pregnancies. The most common predisposing factors included strict glucose control, anorexia, early morning hours (1200‐0900), lack of an adrenergic response and time shortly before the next anticipated meal.
Mortality associated with sterilization: Preliminary results of an international collaborative observational study
Authors: Rochat R.W. , Bhiwandiwala P.P. , Feldblum P.J. , Peterson H.B.
Published: April 2004

Sterilization is the contraceptive method most widely used worldwide, yet the case‐fatality rate of deaths attributable to sterilization is not known. We used data collected from 1971–1979 from 28 countries by Family Health International to estimate case‐fatality rates. We adjusted these rates for individuals lost to follow‐up.

Of 41,834 sterilizations, 23 resulted in deaths temporally associated with the procedure used. The adjusted attributable case‐fatality rates were 13.4 per 100,000 for interval procedures, 53.3 per 100,000 for postabortion procedures, and 43.4 per 100,000 sterilizations after vaginal delivery.

Multiple factors contributed to the deaths, including pre‐existing health problems, infection and anesthesia. Prevention of deaths resulting from sterilization depends on complete ascertainment of deaths associated with sterilization and careful investigation to determine preventable risk factors.

We conclude that, overall, sterilization in these programs was conducted with very low attributable mortality.
Outcome of pregnancy following investigation and treatment of infertility
Authors: Varma T.R. , Patel R.H.
Published: April 2004

We studied 500 women who conceived after investigation and treatment for different infertility problems and compared the outcome of the 5 infertility groups (Group 1 to 5), the ovulatory dysfunction (Group 1), male infertility (Group 2), A.I.D. (Group 3), tubal surgery and IVF (Group 4) and no treatment (Group 5) with the outcome in the hospital group during a period of 3 years. The incidence of abortion in Group 3 is significantly higher (13.8%), the incidence of ectopic pregnancy is significantly higher in Group 4 (21.7%) as compared with the incidence in the hospital group (P < 0.01). The rate of pre‐existing hypertension and gestational diabetes is significantly higher in all the 5 infertility groups as compared with the incidence in the hospital group (P < 0.05). The incidence of preterm labor in general is less in the infertility group as compared with the incidence in the hospital group (P > 0.05). The incidence of older women, multiple pregnancy, induction of labor, operative deliveries, fetal distress, low Apgar score, babies with birth weight below the tenth centile were higher in the infertility groups (P < 0.05). But the perinatal mortality or major or minor fetal anomalies were not significantly different in the infertility groups as compared with the rate in the hospital groups (P > 0.05).
Intracervical administration of prostaglandin E2‐gel prior to therapeutic abortion: a prospective randomized double‐blind study
Authors: Shalev E. , Tsabari A. , Edelstein S. , Weiner E. , Zuckerman H.
Published: April 2004

Forty primigravid women due to undergo first trimster termination of pregnancy were randomly selected for intracervical application of 1 mg prostaglandin E2 in gel or gel only as placebo. In the PGE2‐gel group, a marked dilatation of the cervical canal was obtained, with post‐gel treatment mean Hegar dilatation of 11.18 mm in that group, compared to 4.4 mm in the control group (P 0.001). Moreover, 16 (80%) patients in the PGE2‐gel group had a complete abortion, one (5%) patient had an incomplete abortion and in the remaining three (15%) patients, fetal demise was observed. The mean induction‐abortion interval in this group was 7.5 h. In the placebo group, none of the above effects were observed. The only side effect noted was vomiting, which occurred in five (25%) of the patients in the PGE2‐gel group. Termination of pregnancy was found to be easier in the PGE2‐gel group, compared to the placebo group.
The incidence of urogenital Chlamydia trachomatis infections among patients in Kumasi, Ghana
Authors: Drescher C. , Elkins T.E. , Adkeo O. , Akins‐Bekoe P. , Agbemadzo T. , Foster R.L. , Martey J.O.
Published: April 2004

The incidence of urogenital chlamydia infections among selected patients in Kumasi, Ghana was evaluated using an immunofluorescent monoclonal antibody technique. Chlamydia trachomatis was identified in 4 of 110 patients presenting for prenatal care, 2 of 55 female patients with infertility and 6 of 15 males with acute urethritis. The findings demonstrate that C. trachomatis is a frequently identified pathogen among male patients presenting with symptoms of acute urethritis; however, the incidence of chlamydia infections among asymptomatic patients is relatively low.
Sonographic study of the endometrial responses to ovarian hormones in patients receiving ovarian stimulation
Authors: Sakamoto C. , Yoshimitsu K. , Nakamura G. , Ootsuka H. , Yoshida K.
Published: April 2004

A total of 486 endometrial sonograms from 60 cases were reviewed to study the endometrial responses. There was a significant change in the proportion of each sonographic criterion between the pre‐ and post‐ovulatory phases. After ovulation endometrial image showed distinct changes, and its thickness increased. These results suggest that classification of endometrial sonograms according to criteria and thickness measurements provides useful information.
Virilization due to a rare ovarian tumor in a postmenopausal woman
Authors: Varma T.R. , Patel R.H. , Burke M.
Published: April 2004

A 60‐year‐old postmenopausal woman presented with evidence of hirsutism, alopecia and mild virilization. Clinical examination and biochemical abnormalities suggested that the source of androgen excess was ovarian, and an ovarian tumor was confirmed and removed at laparotomy followed by normal endocrine profile in the postoperative period.
Endoscopic suspension of vaginal prolapse
Authors: Palma P.C.R. , Pinotti J.A.
Published: April 2004

A new alternative for the surgical treatment of vaginal prolapse is presented in which the prolapse vagina is brought towards the abdominal wall using an extraperitoneal abdomino perineal approach with endoscopic control. The technique consists of a small suprapubic transverse incision to expose the abdominis rectus muscle aponeurosis. A Stamey needle is passed retropubically to the vagina and the extremity of a helicoidal suture previously made in the vaginal wall is introduced in the eye of the needle. It is then withdrawn to bring the thread to the suprapubic region. The maneuver is repeated on the other side and the threads are tied up over the aponeurosis of the rectus abdominis muscles, bringing the vagina to its original position. Endoscopic control is important to avoid bladder perforation.
Serum lactic dehydrogenase and its isoenzymes in patients with ovarian dysgerminoma
Authors: Yoshimura T. , Takemori K. , Okazaki T. , Suzuki A.
Published: April 2004

Lactic dehydrogenase (LDH) is a glycolytic enzyme that may be elevated in the serum of patients with gonadal and extragonadal germinomas. In this report, a case of unilateral ovarian pure dysgerminoma with remarkably elevated levels of serum LDH is presented. After complete excision of the tumor, serum LDH levels promptly returned to normal levels. Although an electrophoretic pattern of serum LDH isoenzymes was within normal limits pre‐operatively, an increase in LDH‐1 and 2 was found 1 week after operation. Seventeen additional examples of ovarian dysgerminomas with elevated serum LDH levels have been reported in the English literature including five cases who had high levels of two fast fractions of LDH. These data suggest that serum LDH levels and its isoenzymes pattern are useful tumor markers for diagnosis and post‐therapy surveillance in patients with ovarian dysgerminomas.