bluuebunny/crossref_metadata_2025 huggingface dataset:
Distension of painful structures in the treatment for chronic pelvic pain in women
Authors: Heyman J. , Öhrvik J. , Leppert J.
Published: December 2009

Background. There is a lack of established treatment for Chronic pelvic pain (CPP), defined as acyclic pain of at least six months duration. We decided to study the pain‐alleviating effects of stretching on defined structures in women with CPP, and the treatment's impact on quality of life variables.

Design of study. An open, randomized study.

Setting. Primary Health Care Centre, Kolbäck, Sweden.

Methods. Fifty women, median age 33 years (range 19–54), complaining of CPP for a median duration of 25.5 months (range 6–264) were randomly assigned to either a treatment or a control group. A short questionnaire containing 17 questions was administered before randomization and two to three weeks after a second treatment of distension of pelvic structures. Visual analog scales were used for questions concerning intensity of pain and quality of life. Five‐point scales were used for questions dealing with duration and frequency of pain.

Results. Intensity, frequency and duration of pelvic pain, painful intercourse, lower back pain, sleep disturbance, sleep quality, mental fatigue, depression, mood and anger improved significantly more in the treatment group than in the control group. Treatment proved more effective than counseling as reflected by self‐rating scales: pain intensity (OR 18.37, 95% CI 3.39–99.64) and pain during intercourse (OR 8.59, 95% CI 1.57–46.68).

Conclusion. In this open, randomized study, distension of painful pelvic structures in women with CPP resulted in significant relief of pain and improvement in quality of life measures.
Hysterectomy and incontinence: a study from the Swedish national register for gynecological surgery
Authors: Ellström Engh Marie A. , Otterlind Lena , Stjerndahl Jan‐Henrik , Löfgren Mats
Published: December 2009

Background. Hysterectomy is one factor that has been suggested to be a risk factor for developing stress incontinence. In Sweden, with a population of 8.86 million, a national register was set up in 1997 in order to have data for assessing the quality of gynecological surgery for benign disorders. Methods. Data in the Swedish national register for gynecological surgery during the period 1997–2002 were investigated. Surgical methods compared during this time period were: total hysterectomy (abdominal/laparoscopic, n=198/116), subtotal hysterectomy (abdominal/laparoscopic, n=163/86), and total hysterectomy (vaginal/laparoscopic assisted vaginal, n=265/7). Patients who underwent endometrial destruction (endometrial ablation, endometrial balloon treatment, n=187) were used as a control group. Only patients with no preoperative complaints were included. Outcome measures were answers to subjective questions asked pre‐ and postoperatively regarding urinary problems and incontinence. Results. De novo symptoms of stress incontinence, urgency and urgency incontinence, and/or mixed incontinence were noted in all groups. No differences were found among the groups. Conclusion. Factors other than hysterectomy should be discussed causing stress incontinence in women.
Prevalence and impact of premenstrual syndrome in adolescent schoolgirls in the United Arab Emirates
Authors: Rizk Diaa E.E , Mosallam Moza , Alyan Syfian , Nagelkerke Nico
Published: December 2009

Background. Our objective was to determine the prevalence, sociodemographics, and impact of premenstrual syndrome in adolescent schoolgirls in the United Arab Emirates, as there are no national data on this subject.

Methods. Adolescent girls aged 12–18 years who were at least 1 year postmenarchal were selected from five private and five public schools (n=70×10 = 700) in Al‐Ain city using a multistage stratified cluster‐sampling technique. Subjects were interviewed about cyclic and recurrent behavioral and somatic premenstrual symptoms during the last 3 months based on the American College of Obstetricians and Gynecologists’ criteria and their impact on quality of life using a structured and validated questionnaire.

Results. The prevalence of premenstrual syndrome was 16.4% (n=115). On logistic regression analysis, premenstrual syndrome was significantly associated with Emirati nationality (p=0.001), presence of the condition in sister(s) (p=0.002), and dysmenorrhea (p<0.001). Only 52 affected subjects (45.2%) were currently taking treatment for premenstrual syndrome and the majority (60%) used pharmacological therapy. Premenstrual syndrome had a moderate but significant negative impact (p<0.001) on the quality of life of affected girls, particularly school performance, social interactions, lifestyle, and emotional well‐being. Difficulty in performing school functions and decrease in stigma were the two most adversely affected parameters.

Conclusion. Premenstrual syndrome is a prevalent, yet undertreated, disorder in adolescent schoolgirls in the United Arab Emirates, which adversely affects their emotional well‐being and educational performance, representing a significant public health problem. Premenstrual syndrome is significantly associated with ethnicity, family history, and dysmenorrhea in this group.
Association of maternal protein intake before conception and throughout pregnancy with birth weight
Authors: CUCÓ G. , ARIJA V. , IRANZO R. , VILÀ J. , PRIETO M. T. , FERNÁNDEZ‐BALLART J.
Published: December 2009

Background.The aim of this study is to analyze how the maternal intake of macronutrients before conception and in the 6th, 10th, 26th, and 38th weeks of pregnancy affects birth weight.

Methods.A longitudinal study of food consumption to assess the nutritional status of 77 healthy female volunteers (age range: 24–36) who were planning immediate pregnancy was performed in Reus between 1992 and 1996. A seven‐consecutive‐day dietary record was used in order to evaluate the dietary intake. We fitted multiple linear regression models of macronutrients on birth weight adjusted for energy intake, maternal age, pre‐conceptional body mass index, sex of the newborn, length of pregnancy, parity, physical activity in leisure time, and smoking.

Results.In the 6th, 10th, and 26th weeks of pregnancy, 7.2–12.7% of the variability of the birth weight can be explained by the intake of macronutrients. In the protein and fat model, a 1 g increase in maternal protein intake during preconception and in the 10th, 26th, and 38th weeks of pregnancy leads to a significant increase of 7.8–11.4 g in birth weight.

Conclusions.The diet of well‐nourished women in the preconception period and throughout most of pregnancy has a significant effect on birth weight, and proteins are the macronutrient that has the greatest influence.
Predictions for the decision‐to‐delivery interval for emergency cesarean sections in Norway
Authors: Kolås Toril , Hofoss Dag , Øian Pål
Published: December 2009

Background. To explain the variation in decision‐to‐delivery intervals in emergency cesarean sections in Norway. Methods. A seven‐month prospective registration of all emergency cesareans provided by 24 maternity units. The clinician in charge filled in a predesigned form for each delivery that obtained detailed information about obstetric history, the pregnancy, indication, the date and time of delivery, decision‐to‐delivery interval, seniority of the surgeon, and neonatal outcome until hospital discharge. To take account of the clustered nature of our observations, data were analyzed by multilevel regression. Results. 1,511 singleton emergency cesarean sections with known decision‐to‐delivery interval were included. The average decision‐to‐delivery interval for all emergency cesarean sections was 52.4 min, for acute cesarean sections 58.7 min, and for urgent emergency operations 11.8 min. Most of the decision‐to‐delivery interval variation was at patient level, not between departments. Several significant decision‐to‐delivery interval predictors were identified: 1. abruptio placentae (−54 min), umbilical cord prolapse (−37 min), and fetal stress (−35 min); 2. general anesthesia (versus regional) (−15 min), 3. cesarean sections performed during night‐time (−10 min), 4. seniority of the surgeon (−6 min), and 5. cervical opening (for each cm: −6 min). Conclusions. The variance in the decision‐to‐delivery interval was mainly explained by the different nature of the cesarean sections. The most important predictors, which all acted to reduce decision‐to‐delivery interval, were the three indications abruptio placentae, cord prolapse, and fetal stress. Sections performed during night‐time had significantly reduced decision‐to‐delivery interval. The size of the maternal units as measured by number of deliveries per year was not a significant predictor.
Maternal smoking predicts the risk of spontaneous abortion
Authors: Nielsen Ann , Gerd Hannibal Charlotte , Eriksen Lindekilde Bodil , Tolstrup Janne , Frederiksen Kirsten , Munk Christian , Bergholt Thomas , Buss Lisbeth , Ottesen Bent , Grønbaek Morten , Krüger Kjaer Susanne
Published: December 2009

Background. Few studies have examined smoking prior to pregnancy and the occurrence of spontaneous abortion, as most studies have addressed the risk of spontaneous abortion in relation to smoking during pregnancy. However, results are not entirely consistent. The aim of the present study was to assess the risk of spontaneous abortion considering smoking prior to pregnancy. Methods. We performed a nested case–control study using prospective data from a population‐based cohort comprising 11,088 women aged 20–29 years. From this cohort, women who experienced either a spontaneous abortion (n=343) or who gave birth (n=1,578) during follow‐up were selected. Associations between self‐reported smoking at enrolment and subsequent spontaneous abortion were analyzed by means of multiple logistic regression. Results. The risk of spontaneous abortion in relation to pre‐pregnancy smoking showed a clear dose–response effect. The adjusted odds ratio (95% confidence interval) for spontaneous abortion among current smokers prior to conception was 1.20 (1.04–1.39) per every extra five cigarettes smoked per day. The increased risk was only present for current smokers. The duration of smoking prior to pregnancy was not a significant predictor for subsequent spontaneous abortion. Conclusions. The amount of daily smoking prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas the duration of smoking does not seem to be related to an increased risk of spontaneous abortion.
Oral misoprostol for induction of labor in prelabor rupture of membranes (PROM) at term: a randomized control trial
Authors: Cheung Peter C. , Yeo Evelyn L. K. , Sun Wong Kin , Tang Lawrence C. H.
Published: December 2009

Objective. To compare the efficacy of two different dosages of oral misoprostol (50 and 100 μg) with control, in medical induction of labor for patients with prelabor rupture of membranes (PROM) at term. Methods. One hundred women with PROM at term were randomized to receive placebo (vitamin B6 50 mg, control), 50 μg (treatment group 1), or 100 μg (treatment group 2) of oral misoprostol every 4 h to a maximum of six doses. The main outcome measures included time interval from onset of PROM to delivery, duration of first stage of labor, and occurrence of vaginal delivery within 24 h from PROM. Results. The time intervals from PROM to delivery were significantly reduced in both treatment groups compared to control (control, 25.1±10.5 h; treatment group 1, 14.5±6.2 h; and treatment group 2, 13.0±6.1 h, p<0.0001 for both). The duration of the first stage of labor was significantly shortened only in treatment group 2 compared to control (3.3±2.5 versus 6.2±3.4 h, p=0.01). Of those who delivered vaginally (93% in treatment group 1 and 97% in treatment group 2), significantly more women delivered within 24 h of PROM in the treatment group compared to the control group (50%, p<0.05). Conclusions. Oral misoprostol 50 μg every 4 h is safe, cheap, and as effective as 100 μg in reducing the PROM to delivery time interval and labor duration in primiparous women. The same effect is not observed in a multiparous group.
Quality of life in relation to TVT procedure for the treatment of stress urinary incontinence
Authors: Bakas Panagiotis , Liapis Angelos , Giner Maria , Creatsas Georgios
Published: December 2009

Background. The aim of the study was to assess the impact of tension‐free vaginal tape (TVT) procedure as anti‐incontinence surgery on patients’ urinary symptoms and quality of life. Methods. Ninety‐eight patients participated in the study. All patients were operated for urodynamic stress incontinence with the TVT procedure. Patients with prolapse more than first degree according to International Continence Society classification, previous anti‐incontinence surgery, detrusor overactivity, or intrinsic sphincter deficiency were excluded from the study. Patients’ quality of life assessment was performed with the use of the short form of Incontinence Impact Questionnaire and short form of Urinary Distress Inventory (UDI‐6). Results. Mean follow‐up time was 12.4 ±4.2 months (range: 6–18 months). The cure rate for TVT procedure was 87.6%. There was a statistically significant improvement of quality of life postoperatively. In addition, the domains of UDI‐6 concerning irritative symptoms and stress urinary incontinence symptoms showed statistically significant improvement postoperatively, while the domain concerning obstructive symptoms did not show statistically significant difference. Conclusions. Tension‐free vaginal tape procedure as anti‐incontinence surgery significantly improves the quality of life in female patients with urodynamic stress incontinence.
Pregnancy, delivery, and neonatal complications after treatment with antiepileptic drugs
Authors: Pilo Christina , Wide Katarina , Winbladh Birger
Published: December 2009

Aim. To study the risk for complications during pregnancy, delivery, and neonatal period after the use of antiepileptic drugs (AEDs) during pregnancy.

Methods. Women treated with AEDs during pregnancy and with singleton deliveries were identified from the Swedish Medical Birth Registry during the period July 1 1995 to and including 2001 (n = 1350). Risk estimates were made using the Mantel‐Haenszel procedure and comparisons with all singleton births in Sweden during this period (n = 559 491). Stratification was made for year of birth, maternal age, parity, and smoking habits.

Results. Most of the women (n = 1207, 89%) used AEDs in monotherapy. Carbamazepine was the most commonly used drug (n = 683), followed by valproic acid (n = 255). The rate of caesarean sections was significantly increased (OR = 1.64, 95% CI 1.43–1.89), but it was not possible to differentiate between elective and emergency sections. The risk for pre‐eclampsia (OR = 1.66, 95% CI 1.32–2.08) and for hemorrhage after vaginal delivery was increased (OR = 1.29, 95% CI 1.02–1.63). The neonates showed an increased risk for respiratory distress (OR = 2.06, 95% CI 1.62–2.63).

Conclusion. The study demonstrates a slightly increased risk only for preeclampsia, vaginal hemorrhage after delivery, and respiratory distress in the newborn after the use of AEDs during pregnancy.
Variation in Doppler indices along the length of the cord from the intraabdominal to the placental insertion
Authors: Khare Manjiri , Paul Sanjoy , Konje Justin C.
Published: December 2009

Aim. The aim of this study was to assess the feasibility of obtaining umbilical artery Doppler waveforms from the intraabdominal portion (perivesical) of the umbilical arteries and to compare the indices from this site to those from the free loop (FL) of cord placental insertion (PL) and abdominal insertion (AI). Methods. A cross‐sectional study of 71 singleton fetuses of 24–38 weeks of gestation. Umbilical artery Doppler waveforms were obtained from four sites by a single operator and their resulting indices — i.e. resistance index, pulsatility index, and systolic/diastolic ratio — were compared. Waveforms were also obtained from the two perivesical (PVC) arteries and the mean was used for analysis. Statistical analyses were performed using appropriate non‐parametric tests. Results. Doppler waveforms acceptable for inclusion in the study were obtained in 100% of cases from the FL site. There were failures to obtain waveforms that met the inclusion criteria in three (4%) cases at the PL site, three (4.2%) cases at the PVC site, and 12 (16.9%) cases at the AI. The three indices fell progressively with gestation from the PVC to the PL sites. There were no significant differences between the two PVC arteries using non‐parametric test of mean difference for related samples using Wilcoxon signed‐rank test (P>0.05) for all the indices. The relation between the differences at the two ends of the cord was fairly consistent across gestation. Conclusions. Doppler velocimetry at PVC site of the umbilical artery is feasible and easy to perform. The indices obtained at this site are higher than those at the other three sites. There is a need for standardization of the site of sampling in order to ensure consistency for clinical application.
Maternal and anthropomorphic risk factors for shoulder dystocia
Authors: Mazouni Chafika , Porcu Géraldine , Cohen‐Solal Emmanuelle , Heckenroth Helene , Guidicelli Beatrice , Bonnier Pascal , Gamerre Marc
Published: December 2009

Objective. To study maternal and anthropomorphic parameters as potential risk factors for shoulder dystocia. Material and method. From a series of 9667 vaginal deliveries between January 1998 and December 2003, a total of 138 cases complicated by shoulder dystocia were retrospectively identified and compared with a control group of 138 uncomplicated vaginal deliveries. In addition to maternal age, parity, diabetes, body mass index (BMI), and ethnicity, anthropometric factors including maternal height‐to‐infant weight ratio, characteristics of labor, management techniques, and outcome were evaluated as possible risk factors for shoulder dystocia. Results. The overall incidence of shoulder dystocia in this retrospective series of vaginal deliveries was 1.4%. In univariate analysis, maternal obesity (OR; 95% CI: 3.6; 2.1–6.3), diabetes (OR: 19.4; 2.5–145.7), parity greater than 2 (OR: 2.5; 1.4–4.4), maternal height‐to‐infant weight ratio (OR: 1.02; 1.01–1.04; P < 0.001), and infant weight‐to‐maternal BMI ratio (OR: 1.02; 1.01–1.03; P < 0.001) were predictive of shoulder dystocia. In multiple regression analysis, obesity and multiparity were the most significant maternal risk factors for shoulder dystocia. The only anthropometric factors associated with shoulder dystocia in multiple regression analysis were maternal height <1.55 m (OR: 6.6; 1.3–34.9) and maternal height‐to‐infant weight ratio (OR: 1.02; 1.01–1.05). Conclusion. Shoulder dystocia may be anticipated in cases involving short women and discrepancy between maternal height or weight and infant weight.
A novel method of ninth‐intercostal microlaparoscopic approach for patients with previous laparotomy
Authors: Kumakiri Jun , Takeuchi Hiroyuki , Sato Yuichi , Kitade Mari , Kikuchi Iwaho , Shimanuki Hiroto , Kinoshita Katsuyuki
Published: December 2009

Background. To evaluate the availability of a primary laparoscopic approach for a patient with previous laparotomy and to assess postoperative adhesion to the abdominal wall. Methods. A total of 172 patients with a history of laparotomy who were undergoing laparoscopic surgery in our hospital were evaluated. The primary trocar insertion was performed via the ninth‐intercostal microlaparoscopic approach for these patients. Results. This procedure could be performed on all patients and there were no complications. Postoperative abdominal wall adhesion was found in 53 (30.8%) of 172 patients, and periumbilical adhesion was found in 16 patients (9.3%). Among the 172 patients, 150, 19, and three patients had undergone laparotomy once, twice, and thrice, respectively, prior to this study. Considering the number of previous laparotomies, the frequency of periumbilical adhesion was 5.3% (eight of 150 patients), 36.8% (seven of 19 patients), and 33.3% (one of three patients), respectively. Among 150 patients who had undergone laparotomy once, the type of laparotomy was an obstetric‐and‐gynecologic surgery in 126 patients and other surgeries in 24 patients. There was no significance in the frequency of adhesion between types of previous laparotomies. Surgical incisions were classified as median infra‐umbilical incision (94 patients), median supra‐umbilical incision (three patients), Pfannenstiel's incision (33 patients), para‐rectal incision (15 patients), and peri‐rectal incision (five patients). A high frequency of periumbilical adhesion was recognized in the all three median supra‐umbilical incisions. Conclusion. Ninth‐intercostal microlaparoscopic approach is safe for laparoscopic surgery in patients who have undergone laparotomy previously, and this procedure could prevent the risk of bowel injury.
Recurrence rate of endometriomas following a laparoscopic cystectomy
Authors: Kikuchi Iwaho , Takeuchi Hiroyuki , Kitade Mari , Shimanuki Hiroto , Kumakiri Jun , Kinoshita Katsuyuki
Published: December 2009

Background. The objectives were to observe the clinical course of patients who underwent laparoscopic cystectomy (LC) using transvaginal ultrasonography. Method. The definition of “recurrence” was to detect a diffuse, hypoechoic area whose long axis was at least 2 centimeters (cm) on the transvaginal ultrasonogram during the postoperative follow‐up period. Using the Cox regression test, we analyzed each patient's background variables, namely, patient's age, the revised American Society of Reproductive Medicine score (r‐ASRM score), use of gonadotropin releasing hormone analogues (GnRHa), and pregnancy during the observation period. Next, cyst size and multi‐lobularity of each of the 417 cysts were also analyzed as recurrence risk factors per cyst. Results. The mean postoperative observation period was 21.4±16.8 months. During the observation period, 50 (15.9%) out of 315 patients experienced recurrence and 51 (16.2%) out of 315 patients became pregnant. The cumulative recurrence rate per patient was 31.7% over 60 months. Among prognostic factors per patient, age and showed negative and r‐ASRM scores positive correlations with cyst recurrence. On the other hand, we did not identify any cyst factors associated with recurrence. The patients who underwent hemilateral LC showed a 5.2% cyst recurrence rate in the ovary that appeared to be normal at the time of the initial surgery. Conclusion. Young age and severe endometriosis appeared to be the factors associated with high recurrence risk. Recurring ovarian endometrimas probably include cysts occurring spontaneously and those recurring from the cyst residues in the lesions where cystectomy has been performed.
New ultrasonographic criteria for the prenatal diagnosis of Chiari type 2 malformation
Authors: FUJISAWA HIDETOSHI , KITAWAKI JO , IWASA KOICHI , HONJO HIDEO
Published: December 2009

Background. During prenatal ultrasonography, characteristic malformations including the lemon sign, the banana sign, and obliteration of the cisterna magna are widely used for diagnosis of Chiari type 2 malformation (Arnold Chiari malformation). However, these signs are often obscured by 25 weeks’ gestation. Here, we report an investigation of ultrasonographic markers of Chiari type 2 malformation for diagnosis after 24 weeks’ gestation. Methods. Twenty‐two cases of 24–37 weeks’ gestation referred as fetal ventriculomegaly were analyzed prospectively. Fetuses were examined with ultrasonography by axial section of the head to detect conventional signs, and then by coronary section of the posterior horn of the lateral ventricle to detect two prospective new signs: bilateral downward‐triangle shape (triangle sign) and quadrilateral angular shape (square sign). Results. From the axial sections, three cases were diagnosed with holoprosencephaly, but the remaining 19 cases did not show the lemon sign. In the coronar sections, the eight cases that showed the triangle sign were associated with open spina bifida at the lower vertebral site. The four cases that displayed the square sign showed upper spinal lesions. Chiari type 2 malformation was suspected in these 12 cases. Four of the other seven cases were suspected to be agenesis of the corpus callosum, and the remaining three were normal. All ultrasonographic findings were consistent with the subsequent MRI and postpartum definitive diagnoses. Conclusions. At 24 weeks’ gestation or later, Chiari type 2 malformation can be precisely and efficiently diagnosed by two new characteristics detected during ultrasonography: triangular shape and quadrilateral angular shape.
Using Veronikis ligature carrier to simplify transvaginal sacrospinous colpopexy
Authors: Chang Wen‐chun , Huang Su‐cheng , Sheu Bor‐ching , Hsu Wen‐chiung , Torng Pao‐ling , Chow Song‐nan , Chang Daw‐yuan
Published: December 2009

Background. Pelvic organ prolapse is a common problem in women and often requires surgical management. Sacrospinous colpopexy (SSC) requires significant expertise, especially in placement of the suture into sacrospinous ligament (SSL).

Methods. Veronikis ligature carrier (VLC) designed for SSC was used to facilitate suture placement and retrieval under direct visualization within the confines of the pararectal space. From December 2003 through March 2004, SSC was performed in 20 patients with VLC as part of their site‐specific reconstructive pelvic surgery (group A). The historic control group (group B) included 15 patients who underwent SSC with a straight needle holder between March 1999 and March 2001.

Results. There was no significant difference in age, gravity, parity, body mass index, blood loss, and hospital stay in both groups with the diagnosis of uterovaginal prolapse or posthysterectomy vaginal vault prolapse. The median operation time for group A and group B was 35min (range 25–40min) and 75min (range 45–128min), respectively (P<0.001). It took less than 5min to introduce two sutures through the SSL by VLC in group A but 20–40 min by straight needle holder in group B. There was no injury to the bladder, rectum, pudendal nerve, or major pelvic vessels.

Conclusions. VLC allows rapid and safe introduction of the suspending suture through the SSL and makes SSC easy to perform.
Ultrasound screening for fetal anomalies in Southern Sweden: a population‐based study
Authors: Nikkilä Annamari , Rydhstroem Hakan , Nikkilä Annamari , Rydhstroem Hakan , Källén Bengt , Jörgensen Connie
Published: December 2009

Background. The accuracy of ultrasound in the diagnosis of congenital malformations has been the subject of many studies. Most of these are hospital‐based studies over a limited period of years presenting high detection rates and also relatively high incidence of major malformations. We present here a large population‐based study over a long period of years. Methods. The prenatal diagnoses are compared with the diagnoses of the newborns and aborted fetuses, including autopsy results. The detection rate of some common structural malformations is studied. Results. The overall detection rate of malformations in our study was 28.4%. We noticed an improved detection rate of heart defects and cleft lip during the study period. The prevalence of malformations in the population was 2.6%. The false positive diagnoses were few, 54 cases, and mainly of a mild nature. Conclusions. Ultrasound screening of fetal malformations in our population has a low false positive rate and even though the overall sensitivity is low, 28.4%, the detection rate for many common structural malformations is relatively good.
Pregnancy‐induced changes in insulin‐like growth factor I (IGF‐I), insulin‐like growth factor binding protein 3 (IGFBP‐3), and acid‐labile subunit (ALS) in patients with growth hormone (GH) deficiency and excess
Authors: Wiesli Peter , Zwimpfer Cornelia , Zapf Jürgen , Schmid Christoph
Published: December 2009

Background. Under most circumstances with altered growth hormone (GH) secretion, the changes of insulin‐like growth factor I (IGF‐I), insulin‐like growth factor binding protein 3 (IGFBP‐3), and acid‐labile subunit (ALS) are in parallel. The aim of the present study was to compare the effects of pregnancy in a hypopituitary patient with those of pregnancy in an acromegalic patient on IGF‐I, IGFBP‐3, and ALS. Methods and results. IGF‐I and ALS were low before pregnancy in the hypopituitary patient under glucocorticoid and thyroxine treatment. Gonadotropin treatment allowed her to become pregnant; IGF‐I and ALS levels rose in the second half of pregnancy and fell again after delivery. IGF‐I concentrations were elevated in the patient with persistent acromegaly before and dropped into the normal range during the first half of pregnancy. In the second half of pregnancy and following delivery, IGF‐I levels increased again. IGFBP‐3 levels (as assessed by immunoblot analysis as well as by 125I‐IGF II ligand blotting) decreased markedly during pregnancy in both patients, suggesting that the placenta rather than pituitary GH regulates IGFBP‐3 proteolysis in human pregnancy. The increase of IGF‐I (and ALS) during the second half of pregnancy in the individual with pituitary GH deficiency may be attributed to placental GH. The fall of IGF‐I (and ALS) into the normal range in the acromegalic patient during the first trimester of pregnancy may be related to decreased production or decreased half‐life of these proteins. Conclusion. Our data suggest that measures to continuously replace GH or to suppress GH secretion during pregnancy in patients with GH deficiency or excess, respectively, may not be warranted.
Prenatal risk indicators of a prolonged pregnancy. The Danish Birth Cohort 1998–2001
Authors: OLESEN ANNETTE W. , WESTERGAARD JES G. , OLSEN JØRN
Published: December 2009

Background. Few prenatal risk factors of prolonged pregnancy, a pregnancy of 42 weeks or more, are known. The objective was to examine whether sociodemographic, reproductive, toxicologic, or medical health conditions were associated with the risk of prolonged pregnancy. Methods. Data from the Danish Birth Cohort in Denmark were used. Interview data from 53,392 participants with live‐born singleton deliveries in the period 1998–2001 were available at the time of this study. The participants were interviewed by telephone at 12 and 30 weeks’ gestation, and 6 and 18 months after delivery. Statistical analyses were done using logistic regression. Results. Women with a pre‐pregnancy body mass index of 25 kg/m2 or more had a high risk of prolonged pregnancy. If the pre‐pregnancy body mass index was 35 kg/m2 or more the odds ratio was 1.52 (95% CI 1.28–1.82). Nulliparity also increased the risk of prolonged pregnancy (OR (95% CI) = 1.35 (1.27–1.44)). Conclusions. The risk of post‐term delivery was high in women with a pre‐pregnancy body mass index of 25 kg/m2 or more, and in nulliparous women.
Fertility preserving surgical treatment of ovarian borderline tumour: long‐term consequence for fertility and recurrence
Authors: MARCICKIEWICZ JANUSZ , BRÄNNSTRÖM MATS
Published: December 2009

Background. Borderline tumours of the ovary comprise >10% of all epithelial ovarian tumours, and about one‐quarter of these tumours are seen in women of fertile age. In the present study, the outcomes with regard to fertility and recurrence were followed in patients with borderline tumours, who were treated with ovarian and uterus preserving surgery. Methods. Of 101 women surgically treated for borderline tumours in our institution, 22 underwent fertility preserving surgery, defined as the preservation of at least part of one ovary and the uterus. A retrospective follow up of these patients was conducted. Results. The 22 patients (mean age 30.5 years) underwent surgery with either unilateral salpingoophorectomy (USO; n = 14) or USO combined with cystectomy of the contralateral ovary (n = 8). All these patients had tumours of FIGO‐stage 1 (1a = 13; 1b = 3; 1c = 6). No recurrence was seen during the follow up time (mean 8.1 years; range 5–12 years). Thirteen of the 22 patients have, since the surgery, been given a chance of pregnancy (10 actively aimed to achieve pregnancy; 3 with no contraceptive during the follow up period), and 9 of the 13 patients have become pregnant. Seven patients conceived spontaneously and 2 became pregnant through IVF. Eight of the 9 pregnant patients have given birth to a total of 14 infants, all born at term. Conclusion. This study shows that borderline ovarian tumours in patients of fertile age can be successfully treated conservatively to preserve fertility with no apparent risk of recurrence.
Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration
Authors: LARSSON CHRISTINA , SALTVEDT SISSEL , WIKLUND INGELA , PAHLEN SARA , ANDOLF ELLIKA
Published: December 2009

Background. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter‐individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over‐estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2 = 0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2 = 0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over‐estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions.
The Use of Multiple Psychotropic Medication in the Treatment of Mental Disorders
Authors: Jacob K. S.
Published: December 2009

The concurrent use of multiple psychotropic medication has been reported to be widely prevalent in the treatment of mental disorders, and is considered inferior practice [1]. However, the complexity of the issues demands reappraisal. This paper attempts to discuss the conceptual and practical issues involved.
Approaches to Delivering Child and Adolescent Mental Health Services: The South Australian Experience
Authors: Sawyer Michael Gifford , Kosky Robert John
Published: December 2009

Approximately 10% of children and adolescents experience mental health problems, however only a small proportion receive specialised help. Identifying approaches which can provide a balanced and effective service for the large number of children and adolescents with problems is currently a major challenge for child and adolescent mental health services in Australia. In South Australia, following a review in 1983, child and adolescent services were reorganised into two separate but closely related services. This paper draws on experience in South Australia over the last decade to identify approaches which can be employed in six key areas that significantly influence the effectiveness of child and adolescent mental health services. The paper also describes the specific features which were included in the South Australian child and adolescent mental health service to address these issues.
Type a Behaviour in the Australian Working Population
Authors: Byrne D. G. , Reinhart M. I.
Published: December 2009

The Type A behaviour pattern (TABP) has been widely researched in Australian studies and, in view of its increasing prominence beyond its original association with risk of coronary heart disease, is likely to be as widely researched in this country well into the future. The Jenkins Activity Survey (JAS), being the most comprehensive self-report instrument used to assess the TABP, appears to be the instrument of choice for the measurement of the TABP in Australia, particularly in epidemiological studies where large samples are involved, or in other studies where either the interview method is impractical or the researchers are untrained in its application. This paper presents normative data on the use of the JAS in the Australian context, derived from a series of empirical studies undertaken by the authors over the past decade. Socio-demographic correlates of these data are presented, and refinements of the JAS for future use are suggested.
Pseudologia Fantastica and Gender Identity Disturbance in a Chinese Male
Authors: Leung C. M. , Lai K. , Shum K. , Lee G.
Published: December 2009

A Chinese patient with pathological lying (pseudologia fantastica) and gender identity disturbance is described. The stories “save face” and lack a truly self-aggrandising quality. The importance of keeping “face” and maintaining modest behaviour in the Chinese culture is central to the psychopathology.
Amniotic fluid neutrophil elastase and lactate dehydrogenase: association with histologic chorioamnionitis
Authors: Kidokoro Kumiko , Furuhashi Madoka , Kuno Naohiko , Ishikawa Kaoru
Published: December 2009

Background. Chorioamnionitis (CAM) is considered to be one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. The diagnosis of acute histologic CAM requires delivery and examination of the placenta. Although numbers of markers have been reported to predict histologic CAM before birth, it is unknown whether the levels of neutrophil elastase and lactate dehydrogenase (LDH) in amniotic fluid are associated with histologic CAM.

Methods. Sixty women at gestational age of 16–35 weeks underwent transabdominal amniocentesis within 48 hr before delivery. Amniotic fluid was analyzed for white blood cell count, glucose level, LDH level, and neutrophil elastase level. The levels of neutrophil elastase were measured by latex immunoassay. Following delivery, tissue samples were obtained from umbilical cord, chorionic plate, and placental membranes. Histologic CAM was diagnosed based on Blanc's criteria.

Results. Receiver‐operator characteristic curve analysis showed that the amniotic fluid neutrophil elastase had the best screening efficiency in predicting histologic CAM. Using amniotic fluid cut‐off levels of 0.15 μg/ml for neutrophil elastase and 250IU/l for LDH, the sensitivity, specificity, and positive and negative predictive values for predicting histologic CAM were 88.9% versus 84.1%, 73.3% versus 66.7%, 90.9% versus 88.1%, and 68.8% versus 58.8%, respectively.

Conclusion. Amniotic neutrophil elastase and LDH are useful markers in predicting histologic CAM.
Anxiety Disorders no More?
Authors: Starcevic Vladan
Published: December 2009

Objective: The aim of this article was to critically examine options for the future classification of the current Diagnostic and Statistical Manual (DSM) group of anxiety disorders.

Conclusions: There is a strong trend towards the narrowing of the current DSM group of anxiety disorders and to the adopting of a different name for it. A future conceptualization of the conditions currently classified as anxiety disorders will be useful to the extent that it espouses a longitudinal diagnostic approach and acknowledges a lack of clear boundaries between anxiety and related disorders.
Metaphor, Meaning and Psychiatry
Authors: Rosenman Stephen
Published: December 2009

Objective: The aim of this paper is to examine the scientific and cognitive role of metaphor and the use of metaphor in the conceptualization of depression as an example of mental illness.

Conclusions: Metaphors from the creative arts have been used to support existing psychiatric diagnostic concepts. The existing concepts are themselves built on embedded metaphors now treated as literal facts. The choice of metaphor dictates not only the description of the condition but also its treatment and research. The use of unacknowledged and unchanging metaphors in current diagnostic practice affects progress in knowledge and practice. Some alternative borrowings of basic metaphors are provided.
The Mental Health Literacy of Rural Adolescents: Emo Subculture and SMS Texting
Authors: Scott Lydia , Chur-Hansen Anna
Published: December 2009

Objective: This study sought to explore the mental health literacy of adolescents living in a rural area in Australia through in-depth, semi-structured interviews, with a view to identifying areas for further research and making recommendations for improved education programs around mental health.

Method: Nine Year 10 students (two boys and seven girls) from a rural secondary school in South Australia read two vignettes, one portraying depression and the other schizophrenia. Semi-structured individual interviews that focussed on the vignettes were audio-taped, transcribed and analysed for thematic content.

Results: The data yielded a number of main themes, many of which have been previously identified in the literature. Two new findings also emerged. These were the role of Emo subculture and dealing with distress, and the value of confiding in another person through short message service (SMS) texting.

Conclusions: The impact of Emo subculture and SMS texting on mental health literacy requires further exploration. It is suggested that these two findings are not confined to rural youth, but may have national and international relevance.
Consumer-Clinician Co-Taught Training About Borderline Personality Disorder
Authors: Krawitz Roy , Jackson Wendy
Published: December 2009

Objective: The aim of this paper is to provide further outcome data on a novel consumer-clinician co-taught borderline personality disorder training program.

Method: Participants (n=216) who attended consumer-clinician co-taught borderline personality disorder training had their ratings of the training compared to ratings of participants who attended the previous clinician-only borderline personality disorder training.

Results: Mean training ratings of the consumer-clinician co-taught borderline personality disorder trainings were 37 percentile points higher (77th vs 40th percentile) than the ratings of the previous clinician-only borderline personality disorder training, which already had evidence of effectiveness.

Conclusion: Data confirm preliminary findings that adding a consumer-presenter to training adds considerable value.
Risk Assessment and Management in Practice: TheForensicareRisk Assessment and Management Exercise
Authors: Carroll Andrew
Published: December 2009

Objective: There is an emerging consensus that the assessment and management of adverse outcomes in mental health, such as violence and self harm, is best achieved by approaches which incorporate validated tools using “structured professional judgement”. Although several useful tools have emerged from the literature, there is no clear consensus on the best way to integrate these with clinical practice. This paper describes a framework, the Forensicare Risk Assessment and Management Exercise (F.R.A.M.E.), employed by a statewide community forensic mental health service, which incorporates two structured professional judgement tools, and explicitly integrates these into case management and psychiatric treatment. The potential benefits of the framework are discussed in the context of contemporary trends in risk assessment and management.

Conclusions: The F.R.A.M.E. appears to assist with the task of integrating risk assessment with clinical management. Formal evaluative research is indicated before it can be recommended for use by other services.
Changes to Inpatient Consultation-Liaison Psychiatry Service Delivery Over a 7-Year Period
Authors: Devasagayam Dhayanthi , Clarke David
Published: December 2009

Objective: The aim of this paper was to examine the effect of changes to a consultation-liaison (C-L) service at Maroondah Hospital on referral and service delivery patterns across a period of 7 years. There is no national benchmarking of C-L service. Local services respond to local political and service demands. There have been significant changes to the C-L service at Maroondah Hospital between 1999 and 2006. During the intervening years, psychogeriatric referrals have been included and gazetting of general hospital beds has resulted in detention of patients under the Mental Health Act (MHA).

Method: Clinical audit data from assessments by the C-L service during the above period were entered into a database and analysed.

Results: The annual referral rate increased as did the mean age of referred patients. The main reason for referral changed from suicide evaluation and history of psychotic symptoms to depression. Referral lag time did not change significantly. A higher proportion of patients received a single consultation and a greater number required psychiatric inpatient care.

Conclusion: The nature of referral changed towards older, sicker patients and away from younger, suicidal patients which, together with an increased referral rate, significantly increased demand on available resources.
Expensive Detour or a Way Forward? The Experience of Routine Outcome Measurement in an Aged Care Psychiatry Service
Authors: McKay Roderick , McDonald Regina
Published: December 2009

Objective: This paper describes and reflects upon the experience of a small, integrated aged care psychiatry service that has utilized the National Outcomes Casemix Collection (NOCC) routine outcome measurements within clinical practice, service management and evaluation. The goals of the NOCC initiative are reviewed in light of this experience.

Conclusion: Routine outcome measurement has the potential to significantly improve aged care psychiatric service delivery. The service described has developed a model that the authors believe demonstrates the potential for routine outcome measures to improve the monitoring of patient progress, care planning, team communication, management and the understanding of service effectiveness – goals that are consistent with NOCC philosophy. However, this requires both ongoing development of infrastructure support and the willingness of clinicians to explore their utility.
A Model for Consultation with Aboriginal Stakeholders About Young People's Mental Health and Wellbeing: the NSW School-Link Training Program
Authors: Hillin Anthony , McAlpine Rob , Bennett Bindi , Brideson Tom , Worral Vanessa , Montague Ros
Published: December 2009

Objective: The aim of this paper is to describe a model for consultation with Aboriginal stakeholders used in the development of a training course, by the NSW Institute of Psychiatry, about young people's mental health and wellbeing. Historical, social and political factors contribute to the elevated rates of mental distress and disorder experienced by many Aboriginal young people. However, these young people often do not receive the help they need. Knowledge, skills and attitudes of clinicians are associated with the uptake of services. Therefore, a training course for clinicians was developed utilizing a detailed consultation process with Aboriginal stakeholders.

Conclusions: The course was delivered as part of an ongoing comprehensive interagency training program for 2000 clinicians. The course was positively evaluated by participants and stakeholders, suggesting that the course development, including the consultation process with Aboriginal stakeholders, was effective in meeting participant and stakeholder needs. Agencies may be interested in the application of this model to consultation processes with Aboriginal communities and with other populations.