bluuebunny/crossref_metadata_2025 huggingface dataset:
Antihypertensive drug prescribing in Grampian
Authors: Ross Sarah , Macleod Mary Joan
Published: August 2005

Aims

To assess the cost implications of changing prescribing patterns for antihypertensive drugs and to analyse adherence to guidelines and formulary in Grampian region over a 1 year period.

Methods

Data on all prescriptions for antihypertensive medicines between November 2001 and October 2002 were obtained from Grampian Health Board. The total quantity and cost of each drug prescribed was calculated and compared with November 1998 to October 1999. Adherence to the local formulary and 1999 British Hypertension Society guidelines for first line agents and prescribing of generic drug names were analyzed for each practice.

Results

There was an increase in the total number of prescriptions for antihypertensive drugs from 504929 in 1998/99 to 741620 in 2001/02, and a corresponding increase in total cost from £4.52 million to £6.79 million. Increases were seen in all drug classes, particularly angiotensin II antagonists (246.27%). Adherence to the local formulary was good, with an average of 91.25% (SD 5.94%) of prescribing consistent with recommended agents. This fell to 71.70% (SD 23.10%) for angiotensin II antagonists. Prescription using generic name was related to whether the practice dispensed medication or not: the mean level of generic prescribing in dispensing practices was 75.25% and in nondispensing practices was 89.02% (mean difference 13.76 (9.27, 18.26), P < 0.001).

Conclusions

There was a substantial increase in prescribing volume and cost of antihypertensives between 1998/99 and 2001/02. This trend is likely to have continued, given changing targets and indications for therapy. Although practices generally showed high concordance with formulary recommendations, newer agents such as angiotensin II antagonists were less consistent, possibly related to pharmaceutical influences on prescribing. Dispensing practices were more likely to prescribe branded drugs which may reflect current reimbursement policies. Changing prescribing practices by encouraging formulary based prescribing and prescribing of generic agents may help offset the cost implications of guideline driven increases in antihypertensive drug prescribing. Education, and reviewing payment practices in dispensing and smaller practices, may also have a role.
Population pharmacokinetics and association between A77 1726 plasma concentrations and disease activity measures following administration of leflunomide to people with rheumatoid arthritis
Authors: Chan Vivien , Charles Bruce G. , Tett Susan E.
Published: August 2005

Aims

To investigate the concentration‐effect relationship and pharmacokinetics of leflunomide in patients with rheumatoid arthritis (RA).

Methods

Data were collected from 23 RA patients on leflunomide therapy (as sole disease modifying antirheumatic drug (DMARD)) for at least 3 months. Main measures were A77 1726 (active metabolite of leflunomide) plasma concentrations and disease activity measures including pain, duration/intensity of morning stiffness, and SF‐36 survey. A population estimate was sought for apparent clearance (CL/F ) and volume of distribution was fixed (0.155 l kg−1). Factors screened for influence on CL/F were weight, age, gender and estimated creatinine clearance.

Results

Significantly higher A77 1726 concentrations were seen in patients with less swollen joints and with higher SF‐36 mental summary scores than in those with measures indicating more active disease (P < 0.05); concentration‐effect trends were seen with five other disease activity measures. Statistical analysis of all disease activity measures showed that mean A77 1726 concentrations in groups with greater control of disease activity were significantly higher than those in whom the measures indicated less desirable control (P < 0.05). There was large between subject variability in the dose‐concentration relationship. A steady‐state infusion model best described the pharmacokinetic data. Inclusion of age as a covariate decreased interindividual variability (P < 0.01), but this would not be clinically important in terms of dosage changes. Final parameter estimate (% CV interindividual variability) for CL/F was 0.0184 l h−1 (50%) (95% CI 0.0146, 0.0222). Residual (unexplained) variability (% CV) was 8.5%.

Conclusions

This study of leflunomide in patients using the drug clinically indicated a concentration‐effect relationship. From our data, a plasma A77 1726 concentration of 50 mg l−1 is more likely to indicate someone with less active disease than is a concentration around 30 mg l−1. The marked variability in pharmacokinetics suggests a place for individualized dosing of leflunomide in RA therapy.
Population pharmacokinetics of vancomycin in patients receiving extracorporeal membrane oxygenation
Authors: Mulla Hussain , Pooboni Suneel
Published: August 2005

Aims

Extracorporeal membrane oxygenation (ECMO) is a life support system used during severe respiratory or cardiorespiratory failure. The objective of this study was to characterize the population pharmacokinetics of vancomycin during ECMO.

Methods

A population model was developed using WinNonMix (Version 2.0.1) from a total of 366 plasma observations in 45 patients, including term neonates, older children and adults. The study utilized both rich prospective and sparse retrospective data. Prospective samples were drawn at baseline and then 30, 60,90, 120, 180, 240, 300, 360 and 420 min postinfusion. Steady state concentrations were obtained retrospectively from an assay database, cross‐referencing with the patients’ medical records.

Results

Data were examined using a two‐compartment model with an additive and proportional residual error. Model fit improved substantially when clearance, CL (l kg−1 h−1) was modelled as a nonlinear function of serum creatinine (Cr) µmol l−1. There was a linear relationship between CL and age up to 1000 days: CL (Age < 1000 days) = [2.4 + 0.0018 × Age (days)]/Cr; CL (Age > 1000 days) = 4.3/Cr. Age also influenced central volume (V1) when included in the model as a dichotomous variable: V1 (Age < 4000 days) = 0.45 l kg−1; V1 (Age > 4000 days) = 0.36 l kg−1. Intercompartmental clearance and tissue volume were estimated to be 0.09 l kg−1 h−1 and 0.25 l kg−1, respectively. Model validation in a separate group of 20 patients revealed a bias of −7.7% and a precision of 26.7%.

Conclusions

The clearance of vancomycin was decreased and its volume of distribution increased in patients receiving ECMO, suggesting altered drug disposition during this treatment.
The functional significance of genetic variation within the β1‐adrenoceptor
Authors: Sandilands A. J. , O'Shaughnessy K. M.
Published: August 2005

The β‐1 adrenoceptor is an archetypal G‐coupled protein receptor that controls sympathetic responses in the heart, kidney and adipocytes. It has been widely exploited as a drug target with the development of antagonists to treat cardiovascular diseases such as hypertension, angina and heart failure. Signalling through the receptor is modulated by desensitization and β1‐ adrenoceptor down‐regulation. It is also affected by in vitro substitution of specific amino acid residues within the β‐1 adrenoceptor. Amino acid substitutions also occur naturally due to polymorphic variation within the human β‐1 adrenoceptor gene itself. Since these variants are common (typically being present in > 5% of the population), the pharmacogenetic implications are enormous. A number of these variants have been identified, although two have been the particular focus of recent publications: a serine to glycine substitution at position 49 (49S > G) and an arginine to glycine at position 389 (389R > G). The data on the in vitro behaviour of these two receptor variants is reviewed here, along with the evidence that they may affect both the risk of cardiovascular disease and the therapeutic response to β‐1 adrenoceptor antagonists.
Cyclin D1 overexpression in thyroid papillary microcarcinoma: its association with tumour size and aberrant β‐catenin expression
Authors: Lantsov D , Meirmanov S , Nakashima M , Kondo H , Saenko V , Naruke Y , Namba H , Ito M , Abrosimov A , Lushnikov E , Sekine I , Yamashita Sh
Published: August 2005

Aims : Cyclin D1 is a target molecule transcriptionally activated by aberrant β‐catenin in Wnt signalling. Thyroid papillary microcarcinoma (PMC) may be considered a precursor of papillary thyroid cancer (PTC). Ki67 is widely used as a proliferation marker. The aim of this study was to determine whether cyclin D1 overexpression is involved in early thyroid carcinogenesis.

Methods and results : Thirty‐five cases of PMC were examined immunohistochemically, including 11 cases less than 5 mm (PMC < 5) and 24 cases more than 5 mm (PMC > 5), and 18 PTC cases (size 11–15 mm). Cyclin D1 expression was significantly lower in PMC < 5 than in PMC > 5, while there was no significant difference between PMC > 5 and PTC. Statistical analysis revealed significant correlations between cyclin D1 labelling index (LI) and Ki67 LI (P = 0.0272)/cytoplasmic β‐catenin expression (P < 0.001) in PMC and PTC. Four of five PMC > 5 cases with lymph node (LN) metastases displayed a high cyclin D1 LI and strong cytoplasmic β‐catenin expression.

Conclusions : Cyclin D1 overexpression and correlation with aberrant β‐catenin expression were demonstrated in PMC. Cyclin D1 expression was significantly associated with tumour size and LN metastases in PMC. Cyclin D1 may be up‐regulated at an early stage of thyroid carcinogenesis and promote tumour growth and metastatic potency in PMC through activation of the Wnt/β‐catenin pathway.
Expression and prognostic implications of cell cycle regulatory molecules, p16, p21, p27, p14 and p53 in germinal centre and non‐germinal centre B‐like diffuse large B‐cell lymphomas
Authors: Paik J H , Jeon Y K , Park S S , Kim Y A , Kim J E , Huh J , Lee S‐S , Kim W H , Kim C W
Published: August 2005

Aims : To evaluate the different expression patterns and the prognostic significance of cell cycle regulatory molecules in diffuse large B‐cell lymphomas (DLBCLs) of germinal centre (GC) and non‐GC phenotypes.

Methods and results : Tissue microarray slides composed of 126 extranodal and 88 nodal DLBCLs were immunostained for p16, p21, p27, p14 and p53. DLBCLs were classified into GC and non‐GC phenotype according to the immunohistochemical expression of bcl‐6, CD10, and MUM1. Aberrant expression of p53 was more frequent in the GC phenotype in nodal cases (P = 0.038), and the loss of p16, p21 and p14 expression was significantly more common in the non‐GC phenotype (P = 0.004, P = 0.001, P < 0.001). Concurrent disruptions of the p16‐Rb and p14‐p53 pathways as represented by the immunoprofile of p16/p14/p53 (–/–/+) were associated with a poor prognosis in the GC phenotype [mean survival 31 months in the p16/p14/p53 (–/–/+) group versus 62 months in the other groups, P =0.0485].

Conclusions : The expression and prognostic implications of cell cycle regulatory molecules differ between GC and non‐GC phenotypes in DLBCLs. The immunoprofile of p16/p14/p53 (–/–/+) within the GC phenotype of DLBCLs can be defined as a poor prognostic subgroup.
Expression of type V secretory phospholipase A2 in myocardial remodelling after infarction
Authors: Ishikawa Y , Komiyama K , Masuda S , Murakami M , Akasaka Y , Ito K , Akishima‐Fukasawa Y , Kimura M , Fujimoto A , Kudo I , Ishii T
Published: August 2005

Aims : Secretory phospholipase A2 is associated with ischaemic injury in the human heart, but the distribution of type V secretory phospholipase A2 (sPLA2‐V) remains unknown. The significance of sPLA2‐V in myocardial infarction was investigated histopathologically.

Methods : Sequential changes in the localization of sPLA2‐V and its mRNA in myocardial tissues obtained from 30 autopsied hearts were examined by immunohistochemistry and in situ hybridization and compared with those of fibronectin, vascular endothelial growth factor (VEGF), interleukin (IL)‐1β, tumour necrosis factor (TNF)‐α, and cyclooxygenase‐2 (COX‐2).

Results : No expression of sPLA2‐V was observed in normal heart, but it was promptly expressed in wavy myofibres positive for fibronectin just after the onset of infarction. sPLA2‐V was subsequently expressed in ischaemic cardiomyocytes around the lesion. The expression decreased at the granulation tissue and disappeared at the chronic stage with scar formation. The distribution of the signal for sPLA2‐V mRNA paralleled that of the protein. Ischaemic myocytes around the lesion expressed VEGF, IL‐1β, TNF‐α and COX‐2 at all stages.

Conclusions : sPLA2‐V production in myocardium is limited to the acute phase of infarction. sPLA2‐V may play a dual role, acting both to remove degraded cell‐membrane through cooperative activity with COX‐2 in necrotic areas and to attack ischaemic myocytes around the lesion via degradation of membrane phospholipids.
Phytogeography of the bryophyte floras of oak forests and páramo of the Cordillera de Talamanca, Costa Rica
Authors: Holz Ingo , Robbert Gradstein S.
Published: August 2005

Aim  Central America is a biogeographically interesting area because of its location between the rich and very different biota of North and South America. We aim to assess phytogeographical patterns in the bryophyte floras of oak forests and páramo of the Cordillera de Talamanca, Costa Rica.

Location  Tropical America, in particular the montane area of Cordillera de Talamanca, Costa Rica.

Methods  The analysis is based on a new critical inventory of the montane bryophyte flora of Cordillera de Talamanca. All species were assigned to phytogeographical elements on the basis of their currently known distribution. Absolute and percentage similarities were employed to evaluate floristic affinities.

Results  A total of 401 species [191 hepatics (liverworts), one hornwort, 209 mosses] are recorded; of these, 251 species (128 hepatics, one hornwort, 122 mosses) occur in oak forests. Ninety‐three per cent of all oak forest species are tropical in distribution, the remaining 7% are temperate (4%) and cosmopolitan (3%) species. The neotropical element includes almost 74% of the species, the wide tropical element (pantropical, amphi‐atlantic, amphi‐pacific) only 19%. A significant part of the neotropical species from oak forests are species with tropical Andean‐centred ranges (27%). As compared with bryophyte species, vascular plant genera in the study region are represented by fewer neotropical, more temperate and more amphi‐pacific taxa. Bryophyte floras of different microhabitats within the oak forest and epiphytic bryophyte floras on Quercus copeyensis in primary, early secondary and late secondary oak forest show a similar phytogeographical make‐up to the total oak forest bryophyte flora. Comparison of oak forest and páramo reveals a greater affinity of the páramo bryophyte flora to temperate regions and the great importance of the páramo element in páramo. Surprisingly, oak forests have more Central American endemics than páramo.

Main conclusions  (1) Providing first insights into the phytogeographical patterns of the bryophyte flora of oak forests and páramo, we are able to confirm general phytogeographical trends recorded from vascular plant genera of the study area although the latter were more rich in temperate taxa. (2) Andean‐centred species are a conspicuous element in the bryophyte flora of Cordillera de Talamanca, reflecting the close historical connection between the montane bryophyte floras of Costa Rica and South America. (3) High percentages of Central American endemics in the bryophyte flora of the oak forests suggest the importance of climatic changes associated with Pleistocene glaciations for allopatric speciation.
FAREAST: a forest gap model to simulate dynamics and patterns of eastern Eurasian forests
Authors: Xiaodong Yan , Shugart H. H.
Published: August 2005

Aim  This paper describes the forest gap model, FAREAST, its testing and its application to simulating the distribution, composition and dynamics of forests in eastern Eurasia.

Location  The FAREAST model is tested in north‐eastern China, initially for forests on the elevational gradient of Changbai Mountain, which is located on the border of the People's Republic of China and the Democratic People's Republic of Korea. Subsequently, the model is inspected regionally for other northern Chinese mountains and, finally, it is applied to predict subcontinental forest communities in the Russian Far East. Boreal larch (Larix spp.) forests cover much of the 6 million km2 of eastern Eurasia. Mixed broad‐leaved tree species/Korean pine (Pinus koraiensis) forests and spruce/fir (Picea/Abies) forests also occupy considerable areas.

Methods  The model is tested using three types of information: (1) direct species composition comparisons between simulated and observed mature forests at the same locations; (2) forest type comparisons between simulated and observed forests along altitudinal gradients of several different mountains; and (3) comparison with forest stands in different succession stages of simulated forests.

Results  Model comparisons with independent data indicate that the FAREAST model is capable of representing many of the broad features of the forests of north‐eastern China. After regional model validation in the north‐eastern region of China, geographical model applications were developed for the forests of the Russian Far East. In simulations at 31 different sites distributed across the entire Russian Far East and including a wide variety of natural forests, the model demonstrates an ability to reproduce observed vegetation pattern. The model simulations are correct with respect to our criteria for 23 of the 31 sites, and there are close results for three other sites. Among the five sites that are incorrectly predicted, four simulations can be corrected by adding a simple assumption to the model for permafrost effects on water balance.

Main conclusions  Continental‐scale forest cover can be simulated using a forest gap model to represent individual–plant interactions with one another, and their environment, and with parameters that describe the biology of each tree species. It appears that such a model, validated relatively locally (in this case, in north‐eastern China), can then be applied over a much larger region. These results further imply that the Russian Far East forests can be regarded as a natural geographical expansion of north‐eastern Chinese forests. In both regions, forests share not only similar species compositions, but also similar underlying causes of forest successional dynamics.
Biogeography of mammals on tropical Pacific islands
Authors: Carvajal Alejandra , Adler Gregory H.
Published: August 2005

Aim  We examine the influence of geography on species richness and endemism of mammals on tropical Pacific archipelagos to determine the importance of intra‐ and inter‐archipelago speciation in promoting local and regional species richness.

Location  Thirty tropical Pacific archipelagos.

Methods  A distributional list of mammals on 30 archipelagos was compiled, and values for 10 geographical variables were estimated for each archipelago. Mammal species were placed in three different categories (continental, Pacific and endemic) based on their distribution. The total number of species and numbers of species within each category were related to the geographical variables using Poisson regression analysis.

Results  Species richness was related positively to variables describing land area, numbers of large islands and elevation; and negatively to variables describing isolation. Levels of endemism did not differ between volant and non‐volant species, but differed between mega‐ and microchiropterans.

Main conclusions  Variation in species richness of mammals in the tropical Pacific region can be accounted for by a combination of intra‐archipelago speciation within archipelagos composed of large islands, and inter‐archipelago speciation, particularly among more isolated archipelagos. Mammals were less widely distributed throughout the study area than previously found for butterflies, skinks or birds. However, the level of endemism was similar to that of skinks and birds on the same archipelagos, and was higher than that of butterflies.
The distribution of the ectoparasite fauna of Sebastes capensis from the southern hemisphere does not correspond with zoogeographical provinces of free‐living marine animals
Authors: González M. T. , Moreno C. A.
Published: August 2005

Aim  We examined the ectoparasite fauna of Sebastes capensis over almost all its geographical distribution range (Chilean, Argentinean and South African coasts) to determine (1) whether the ectoparasites of this host show a zoogeographical pattern and, if so, (2) how this pattern is related to known zoogeographical patterns for free‐living organisms.

Location  Fish were captured from 20, 24, 30, 33, 36, 40, 45 and 52° S along the Chilean coast; 11° S on the Peruvian coast; 43° S on the Argentina coast; and 34° S on the South African coast.

Methods  From April to September 2003 and from April to August 2004, 626 fish were captured. The parasites were collected using standard parasitological techniques. At the component community level, zoogeographical distribution patterns were evaluated using cluster analysis. At the infra‐community level, patterns of similarity in parasite composition among localities were investigated with multivariate discriminant analyses.

Results  The ectoparasite fauna of S. capensis consists of six species distributed along the whole of the Chilean coast. Four other species are distributed only within the transitional zone between the northern warm temperate region (Peruvian faunistic province), extending from Peru to the northern Chilean coast up to c. 30° S, and the cold temperate region (Magellanic faunistic province). The component communities from latitudes 30 to 40° S showed higher ectoparasite species richness, while localities on the margins of the geographical range showed lower species richness. Cluster analysis indicated a grouping of localities consistent with the transitional zone. Argentina and South Africa always emerged as separate localities.

Main conclusions  The ectoparasite communities of S. capensis do not follow a distributional pattern concordant with the known biogeographical zones for invertebrates and/or fish along the south‐eastern Pacific. Therefore their ectoparasite fauna is not useful as a zoogeographical indicator, although it does allow us to distinguish the transitional zone of the south‐eastern Pacific. On a more extended geographical scale, it is possible to distinguish the ectoparasite communities of S. capensis in the south‐eastern Pacific (as a whole) from those of Argentina and South Africa.
Insulin resistance in an 18‐year‐old patient with Down syndrome presenting with hyperglycaemic coma, hypernatraemia and rhabdomyolysis
Authors: HOORN E. J. , DE VOGEL S. , ZIETSE R.
Published: August 2005

Hoorn EJ, de Vogel S, Zietse R (Erasmus Medical Center, Rotterdam, The Netherlands). Insulin resistance in an 18‐year‐old patient with Down syndrome presenting with hyperglycaemic coma, hypernatraemia and rhabdomyolysis (Case report). J Intern Med 2005; 258: 285–288.
Self‐reported smoking, cotinine levels, and patterns of smoking in pregnancy
Authors: Pickett Kate E. , Rathouz Paul J. , Kasza Kristen , Wakschlag Lauren S. , Wright Rosalind
Published: August 2005

Non‐pregnant adult smokers generally exhibit fairly stable smoking behaviour over time. In studies of this population, cotinine assays are considered a ‘gold standard’ measure of exposure to cigarette smoke; current smoking status can be validated with high sensitivity and specificity. In contrast, there is substantial within‐person fluctuation in pregnancy smoking, as women try repeatedly to quit or cut down. As a result, cotinine measures may be of limited use for validation of amount smoked, as they are informative only about recent exposure, vary with individual smoking topography and are dependent on time lapsed since the last cigarette smoked. Thus, in reproductive epidemiology, where timing, intensity and duration of exposure are critical, self‐reported history of cigarette consumption may be a more relevant fetal exposure than current smoking status. If there were substantial within‐person variation over the course of pregnancy, numerous measures of cotinine would be needed to characterise patterns of fetal exposure and would not be feasible in many studies.

We examined self‐reported smoking patterns and compared them to patterns of urinary cotinine levels in a prospective study of 998 pregnant women, recruited 1988–92. Fluctuations in smoking were considerable and, while cotinine measures and self‐reported number of cigarettes were highly correlated at any given time point across women (r = 0.70), the within‐person correlation between the patterns of self‐reported number of cigarettes and cotinine levels was weaker (r = 0.33). For researchers interested in fetal outcomes in which intensity and timing of exposure are critical, we conclude that self‐reported variations in smoking during pregnancy may be a valid way to characterise detailed patterns of fetal exposure in epidemiological studies.
Equivocating on reconciliation
Authors: Galloway Greta
Published: August 2005

This critical discourse analysis of welfare workers’ responses to reconciliation demonstrates the ways in which language operates to maintain Indigenous people's disenfranchisement and oppression within the Australian polity. It cautions against welfare personnel assuming more liberation within their ranks than found within general society.
Help or hindrance? Outcomes of social work student placements
Authors: Barton Heather , Bell Karen , Bowles Wendy
Published: August 2005

This paper discusses the findings of a pilot project exploring the benefits and costs of social work student placements to host agencies. In this qualitative study, 43 supervisors were interviewed about their experiences of the costs and benefits of having a student on placement. Overall, the benefits were assessed as outweighing the costs. The main benefit identified was the work undertaken by students, such as counselling, research projects, evaluations, group work and staff training. Importantly, enhancement of the supervisors’ own professional development and reflection on practice was the second most frequently identified benefit. An unanticipated benefit was that placements appear to function as pre‐employment trials, with 60% of respondents reporting that students were subsequently employed by the practicum agency. The major costs included time spent in student supervision and student use of agency resources.
The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials
Authors: PRENDIVILLE WALTER , ELBOURNE DIANA , CHALMERS IAIN
Published: August 2005

Summary. Recent claims that routine active management of the third stage of labour increases rather than decreases maternal and neonatal morbidity have prompted us to conduct a systematic review of the relevant controlled trials. In this paper we have analysed data derived from a total of nine published reports of controlled trials in which an oxytocic drug was compared with either a placebo or no routine prophylactic. Oxytocic drugs used routinely appear to reduce the risk of postpartum haemorrhage by about 40% (typical odds ratio 0·57, 95% confidence interval 0·44–0·73) implying that for every 22 women given such an oxytocic, one postpartum haemorrhage could be prevented. The available data are insufficient to assess the possible effects of this policy on the incidence of retained placenta, hypertension and other possible adverse effects.
Gestational diabetes and impaired glucose tolerance of pregnancy in Riyadh
Authors: AL‐SHAWAF T. , ARIEL A. , MOGIIRABY S. A. S.
Published: August 2005

Summary. A total of 1088 pregnant women was screened for abnormalities in glucose metabolism at the initial antenatal visit; those with specific risk factors were screened again after 28 weeks gestation. In 210 (19·3%) plasma glucose measured 2 h after a 75 g glucose load was ≤7·8 mmol/1 (140 mg/dl). Follow‐up glucose tolerance tests revealed an overall prevalence of abnormal tests of 10·3% (112 of 1088) according to the WHO criteria, of which 21 (1·9%) were diagnosed as gestational diabetes, and 91 (8·4%) as impaired glucose tolerance. This high prevalence was significantly related to age, parity and body mass index. Screening and diagnosis using criteria set by the WHO were found acceptable and are recommended to help resolve the international disagreement on diagnostic criteria of glucose metabolism abnormalities in pregnancy.
Massive feto‐maternal haemorrhage: effect of passively administered anti‐D in the prevention of Rh sensitization and haemolytic disease of the newborn
Authors: MILLS L. , NAPIER J. A. F.
Published: August 2005

Summary. Fourteen mothers carrying ABO compatible but Rh D incompatible pregnancies experienced large feto‐maternal haemorrhages (estimated 188 ml, range 50–400 ml red cells). These were all treated with infusions of fresh frozen plasma containing anti‐D at a mean immunoglobulin to fetal cell ratio of 129 i.u. (25·8 μg)/ml of fetal cells. At 48 h after the infusion 95% of fetal cells had been removed but 3 to 4 days were required for complete removal. The passively administered anti‐D was detectable for up to 6–9 months but not after that time. Four of the 14 women had successful pregnancies subsequently although in two of these anti‐C + D was present. Of these, one resulted in a clinically affected baby who survived exchange transfusion.
Closed suction wound drainage and lower‐segment caesarean section
Authors: SAUNDERS N. J. ST. G. , BARCLAY C.
Published: August 2005

Summary. In a randomized controlled study of wound suction drainage after transverse suprapubic incision for lower‐segment caesarean section no significant advantages could be demonstrated for routine drainage in terms of wound infection, haematoma formation, duration of hospital stay or analgesic requirements.
Relapsing fever in pregnancy: analysis of high‐risk factors
Authors: MELKERT P. W. J.
Published: August 2005

Summary. The diagnosis of tick‐borne relapsing fever was established in 27 pregnant patients by demonstration of Borrelia spirochaetes in a thick blood smear and the borrelia index was estimated to calculate the density of the spirochaetaemia. Clinical findings are described and compared with those reported from Rwanda. The results suggest that the density of the spirochaetaemia and the gestational age are the main high‐risk factors.
Genetic control of susceptibility to eclampsia and miscarriage
Authors: COOPER DESMOND W. , HILL JOSEPH A. , CHESLEY LEON C. , BRYANS C. IVERSON
Published: August 2005

Summary. An analysis has been made of 48 pedigrees selected (ascertained) through an affected mother in the first generation. These pedigrees mainly involve cases of eclampsia which occurred before its recent decline in incidence. The data confirm the genetic determination of susceptibility indicated by published data on eclampsia/preeclampsia. There is a suggestion that the fetal genotype can contribute to susceptibility to eclampsia in its mother, in contrast to previous findings that susceptibility to pre‐eclampsia is controlled solely by the maternal genotype. An association between eclampsia and miscarriage is shown in the data. We argue that this suggests that the primary mode of action of the gene(s) involved is to affect the interaction between uterine and placental tissue.
Assessment of trace metal intake and status in a Gujerati pregnant Asian population and their influence on the outcome of pregnancy
Authors: WARD ROBERTA J. , ABRAHAM RACHEL , McFADYEN I. R. , HAINES A. D. , NORTH W. R. S. , PATEL M. , BHATT R. V.
Published: August 2005

Summary. Dietary assessments and biochemical indices including plasma zinc and copper were determined in pregnant vegetarian and non‐vegetarian Gujerati women in India at 28 weeks gestation, and the results were contrasted with those of a comparable group of Gujerati pregnant women living in Harrow. Even though the dietary intake of energy, protein and zinc was significantly lower in the Indian vegetarian Gujerati group when compared to the equivalent group in Harrow, the birthweights of the babies delivered at term were similar. The intake of zinc in the diet of the Gujerati Indian vegetarian and non‐vegetarian groups was only one quarter of the US recommended intake during pregnancy and was approximately one half in the Harrow Indian groups. Even so, the plasma concentrations of zinc were similar in all dietary groups in either India or Harrow. The albumin content in the plasma of both the Gujerati Indian vegetarian and non‐vegetarian was significantly reduced when compared to the equivalent Harrow dietary groups. The plasma concentrations of both calcium and sodium were significantly correlated with the albumin concentration but not with the plasma content of zinc. Copper levels were elevated to the normal range in both dietary groups of the Gujerati and were similar to the concentrations found in the Harrow groups.
Intrauterine pressure studies in multigravid patients in spontaneous labour: effect of oxytocin augmentation in delayed first stage
Authors: REDDI KOGIE , KAMBARAN SUNDER R. , PHILPOTT R. HUGH , NORMAN ROBERT J.
Published: August 2005

Summary. Uterine activity was assessed by measuring the uterine activity integral (UAI) in 116 black multigravid patients in spontaneous active labour at term. Although individual patients showed a wide range of mean UAI levels, normal labour (group I, n= 54) was associated with a mean UAI level of 1640 kPas/15 min which was higher than the mean level observed in patients in whom delay in cervical dilatation occurred in active labour. The patients who failed to progress in labour were treated with oxytocin infusion and 32 of them made good progress in labour and achieved vaginal delivery (group IIa: mean UAI pre‐oxytocin treatment 1040 (SD424) kPas/15min, post‐oxytocin 1890 (SD 559) kPas/15min). The other 23 patients required operative delivery (group IIb) despite correction of uterine activity after oxytocin treatment (pre‐oxytocin mean UAI 1230 (SD570) kPas/15min, post‐oxytocin 1815 (SD650) kPas/15min). The rate of oxytocin infusion varied between patients from 2 to 16 mU/min but in 75% uterine activity was corrected to normal levels by a dose of ≤8 mU/min. It is concluded that delay in progress in labour is associated with lower intrauterine pressures than are present in normal labour, and that management of patients presenting with inefficient uterine action may benefit from the use of uterine activity integral measurements.
Bone histology and mineral homeostasis in human pregnancy
Authors: PURDIE DAVID W. , AARON JEAN E. , SELBY PETER L.
Published: August 2005

Summary.Mineral homeostasis was studied biochemically and histologically in patients in early pregnancy and at term. In early pregnancy there was evidence of increased and reversible resorption of bone, whereas in late pregnancy bone demonstrated active formation and rapid mineralization with minimal resorption. Gut absorption of calcium was not increased in early pregnancy. The overall findings were consistent with calcium liberation from bone in early pregnancy, and with enhanced conservation of bone calcium at term. It is proposed that the additional calcium required during pregnancy is derived largely from the skeleton during early gestation and from dietary absorption at term.
Poor maternal weight gain between 28 and 32 weeks gestation may predict small‐for‐gestational‐age infants
Authors: LAWTON FRANK G. , MASON GERALD C. , KELLY KRYSTYNA , RAMSAY IAN N. , MOREWOOD GEOFFREY A.
Published: August 2005

Summary. In a retrospective analysis of 158 women considered to have had normal, low‐risk pregnancies, 30 gave birth to infants with a birth‐weight less than the 10th centile for gestation. These 30 women had a significantly poorer mean increase in weight (0·99 kg) between 28 and 32 weeks gestation than the other 128 women (1·95 kg) who gave birth to infants with birthweights above the 10th centile for gestation. There was no statistically significant difference in booking weight, overall weight gain or other variables associated with low birthweight between the two groups of women which suggests that poor maternal weight gain specifically between 28 and 32 weeks gestation may predict small‐for‐gestational‐age infants.
Uterine blood flow and myometrial activity at menstruation, and the action of vasopressin and a synthetic antagonist
Authors: HAUKSSON ARNAR , ÅKERLUND MATS , MELIN PER
Published: August 2005

Summary. Local endometrial blood flow was measured by a thermistor technique and myometrial activity by intrauterine pressure recording in 10 women before and during menstruation. The effect of lysine vasopressin infusion (1 pmol/kg body‐weight per min) and of bolus injection of a synthetic oxytocin analogue, l‐deamino‐2‐d‐Tyr(OEt)‐4‐Thr‐8‐Orn‐oxytocin (10 nmol/kg body‐weight), were studied. Spontaneous variations in blood flow were seen synchronous with clearly demarcated uterine contractions, the myometrial activity being significantly increased in early (day – 1 to day +2) compared with late (day +3 to day +5) menstrual phase. The vasopressin infusion decreased blood flow, stimulated uterine activity and caused slight to moderate dysmenorrhoea‐like pain. These effects were completely inhibited by the injection of the oxytocin analogue. In‐vitro studies on uterine arteries confirmed that the analogue also inhibited the vasopressin‐induced constriction of the uterine arteries. This antagonist was more effective than two other analogues, l‐deamino‐2‐d‐Tyr(OEt)‐4‐Val‐8‐Orn‐oxytocin and l‐deamino‐2‐Tyr(OEt)‐oxytocin. The counteracting effect of l‐deamino‐2‐D‐Tyr(OEt)‐4‐Thr‐8‐Orn‐oxytocin on the vasopressin‐induced decrease of blood flow and increase of contractions supports the therapeutic value of the drug in primary dysmenorrhoea and preterm labour.
A comparison of gemeprost (Cervagem) pessaries and Lamicel tents for cervical preparation for abortion by dilatation and suction
Authors: HELM C. W. , DAVIES N. , BEARD R. J.
Published: August 2005

Summary. In a randomized, single‐blind trial, 78 women having vaginal termination of pregnancy were treated with either a 1‐mg gemeprost (Cervagem) pessary or a Lamicel tent inserted 3–4 h before operation. Both agents produced satisfactory cervical softening but dilatation was significantly easier after gemeprost. Pre‐operative side‐effects were more frequent after gemeprost but did not increase the need for analgesia. There were no differences between the two groups with regard to either postoperative symptoms and analgesic requirements or pre‐operative and postoperative temperature, pulse rate and blood pressure. Gemeprost pessaries are easier, faster and less uncomfortable to administer.
The treatment of normospermic infertility by gamete intrafallopian transfer (GIFT)
Authors: YOVICH JOHN L. , MATSON PHILLIP L. , BLACKLEDGE DAVID G. , TURNER SIMON R. , RICHARDSON PETER A. , YOVICH JEANNE M. , EDIRISINGHE W. ROHINI
Published: August 2005

Summary. Gamete intrafallopian transfer (GIFT) was applied in 207 treatment cycles in 73 couples. The pregnancy rate in cycles with only one (2/21, 9·5%) or two (2/29, 6·9%) oocytes transferred was significantly less than that in which four oocytes (36/116, 31·0%) were replaced. The collection of more than four oocytes did not influence the pregnancy rate in that treatment cycle. The overall pregnancy rate was 24·2% (50 of 207) and was similar in the four infertility groups studied (non‐occlusive tubal disorders, endometriosis, cervical factor and unexplained infertility) with 28 (56%) of the pregnancies delivered at 20 weeks. The pregnancy wastage included 4 (8%) ectopic pregnancies and 3 (6%) late pregnancy losses. The 12 multiple pregnancies occurred following the transfer of three and four oocytes.
Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom
Authors: HILTON PAUL
Published: August 2005

Summary. A total of 400 women referred consecutively to a gynaecological urology clinic was questioned with regard to their sexual activity and were subsequently investigated by cystometry to establish the prevalence of urinary incontinence occurring during intercourse, and to define the urodynamic background of sufferers. Of the 400 women 324 were sexually active, and of these 79 (24%) experienced incontinence during intercourse; in two thirds of sufferers incontinence occurred on penetration, whereas in the remaining one third urine leakage was restricted to orgasm. Of the former group 70% were shown to have genuine stress incontinence and 4% detrusor instability; of the latter, 42% had genuine stress incontinence and 35% detrusor instability. A comparison of cystometric variables in these two index groups and matched controls failed to identify any specific abnormality of bladder function associated with these symptoms.
A further assessment of the gauze hammock sling operation in the treatment of stress incontinence
Authors: KERSEY J. , MARTIN M. R. , MISHRA P.
Published: August 2005

Summary. A further series of 100 consecutive gauze hammock sling operations for urinary stress incontinence is presented with preliminary urodynamic assessment in all cases and follow‐up from 6 months to 5 years. In 63 women the operation was a primary procedure. Modification to the operation included redesign of the shape of the sling, use of increased tension where minor degrees of bladder detrusor instability exist, and use of a suprapubic catheter postoperatively. Of the 100 women 87 were reviewed directly and 12 indirectly; only one was lost to follow‐up. After operation, 78% were continent, 17% showed improvement and there were 4% failures. The only serious complication was a pulmonary embolus in one woman but 15 had some voiding difficulty during the follow‐up period which responded to urethral dilatation in all but three. There were no fistulas. This improved technique should overcome many of the objections to the sling procedure and is a suitable primary procedure for stress incontinence or for treatment of recurrence after previous alternative procedures.
Programmed gamete intrafallopian transfer (GIFT)
Authors: BATES ROBERT G. , FIELDING PAUL M. , LINDSAY KEVIN S. , WHITE NICKI , KEITH EDMONDS D.
Published: August 2005

Summary. Thirty‐three patients with unexplained infertility underwent a total of 42 programmed superovulation cycles in a gamete intrafallopian transfer (GIFT) programme. The date of oocyte retrieval was decided in advance and the cycle preceding oocyte collection was modified with norethisterone from mid‐cycle until 14 days before the scheduled laparoscopy. This was followed by a fixed schedule superovulation regimen. Serum oestradiol, progesterone and luteinizing hormone were monitored and the data analysed retrospectively. A single ultrasound scan was performed on the day of laparoscopy to exclude ovulation. Thirty‐eight GIFT procedures were performed, resulting in 11 (29%) clinical pregnancies of which four twin and four singleton pregnancies are continuing. There was a significant correlation between the oestradiol response pattern and the maturity of oocytes retrieved, the fertilization rate of supernumerary oocytes and the pregnancy rate. Programmed cycles may be conveniently combined with GIFT, and basic endocrinological monitoring can be used to identify cycles with a poor prognosis before laparoscopy.
Immunohistological localization of pregnancyassociated endometrial α2‐globulin (α2‐PEG) in endometrial adenocarcinoma and effect of medroxyprogesterone acetate
Authors: WOOD PAUL L. , WAITES GILLIAN T. , MacVICAR JOHN , DAVIDSON ALLAN C. , WALKER ROSEMARY A. , BELL STEPHEN C.
Published: August 2005

Summary. Endometrium from postmenopausal women with endometrial adenocarcinoma was examined immunohistochemically using a monoclonal antibody to pregnancy‐associated endometrial α2‐globulin (α2‐PEG), the major secretory protein of the glandular epithelium during the late luteal phase of the menstrual cycle and early pregnancy. Specimens were obtained at initial diagnostic curettage and at hysterectomy after medroxyprogesterone acetate (MPA) therapy. α2‐PEG was not detected in any malignant tissue irrespective of histological differentiation. Non‐malignant endometrium obtained in association with malignant tissue was negative for α2‐PEG before treatment although after MPA therapy all specimens obtained exhibited marked α2‐PEG localization in glands. In four specimens endogenous alkaline phosphatase was observed consistently only in the malignant endometrium. Malignant endometrium does not appear to synthesize α2‐PEG nor is its synthesis induced by an oral progestogen, so that it does not represent a useful marker for endometrial carcinoma. Non‐malignant endometrium in postmenopausal women appears to be fully capable of α2‐PEG production after stimulation with an oral progestogen.
Oligohydramnios and fetal cerebral blood flow
Authors: VAN DEN WIJNGAARD J. A. G. W. , WLADIMIROFF J. W. , REUSS A. , STEWART P. A.
Published: August 2005

Summary. Blood flow velocity waveforms in the fetal internal carotid artery were recorded in five pregnancies complicated by prolonged severe oligohydramnios due to bilateral renal agenesis. End‐diastolic flow velocity was reduced, absent or even reversed, resulting in a raised pulsatility index in all five cases. These data suggest that prolonged severe oligohydramnios may hamper cerebral blood flow through fetal head compression.
Does mother know best? Maternal assessment of relative fetal size in utero
Authors: WHITE DAVID R.
Published: August 2005

Summary. The accuracy of pregnant womens' impressions of the size of their babies in utero relative to their previous babies has been assessed in 140 parous women. The women who thought their babies would be bigger gave birth to babies weighing a mean of 0·30 kg more than their previous babies (P<0·01) and the women who thought their babies would be smaller were delivered of babies weighing a mean of 0·22 kg less than their previous babies (P<0·01).
Psychosexual trauma of an abnormal cervical smear
Authors: CAMPION M. J. , BROWN J. R. , MCCANCE D. J. , ATIA W. , EDWARDS R. , CUZICK J. , SINGER A.
Published: August 2005

Summary. The psychosexual sequelae of diagnosis and treatment of pre‐invasive cervical atypia were assessed in three groups of women. The first group included 30 women referred to a colposcopy clinic with an abnormal cervical smear indicating cervical intraepithelial neoplasia (CIN), the second comprised 50 women who were traced as sexual partners of men with penile human papillomavirus (HPV) infection; 26 of them had histologically proven cervical atypia and 24 had no such evidence. The third group included 25 women traced as partners of men with non‐specific urethritis and who did not have cervical disease. Before and after questionnaires assessed six aspects of sexual behaviour and responses before diagnosis and 6 months after treatment in women with cervical atypia. These were compared with answers given by women investigated and treated, if necessary, as partners of men with sexually transmitted disease (control group). There were statistically significant adverse psychosexual sequelae associated with diagnosis and treatment of pre‐invasive cervical epithelial disease.
Sex difference in fetal head growth
Authors: MOORE W. M. O. , WARD B. S. , JONES V. P. , BAMFORD F. N.
Published: August 2005

Summary. Growth of the fetal biparietal diameter (BPD) throughout the second and third trimesters was measured in a prospective longitudinal study. Linear‐cubic equations were fitted to the data of individual fetuses and from these equations mean growth curves were produced for males and females. The head growth trajectories of males and females were significantly different. The study illustrates why the practice of dating pregnancies by ultrasonic fetal BPD measurement at about 16 weeks gestation can lead to error.