bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between anger and pruritus perception in patients with chronic idiopathic urticaria and psoriasis
Authors: Conrad R , Geiser F , Haidl G , Hutmacher M , Liedtke R , Wermter F
Published: March 2008

Background  There is evidence that chronic idiopathic urticaria (CIU) and psoriasis are associated with personality based difficulties in emotional regulation particularly with regard to the feeling of anger. This deficit in emotional awareness could lead to the phenomenon that emotions are rather experienced in bodily symptoms such as pruritus.

Aim  We investigated whether there is a relationship between pruritus as major symptoms in CIU and psoriasis and the experience of negative emotions.

Setting  Forty‐one CIU patients and 44 psoriasis patients treated at Bonn University Hospital and 49 healthy controls were included.

Method  Patients and controls were compared on questionnaires measuring alexithymia (TAS‐20), emotional distress (SCL‐90‐R) and anger (STAXI). In skin‐disordered patients, separate stepwise regressions with pruritus severity as dependent variable and questionnaires, skin status, duration, sex and age as independent variables were calculated.

Results  CIU and psoriasis patients showed higher alexithymia, emotional distress, depression, anxiety and state anger compared with controls. State anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. Depression was the only significant predictor of pruritus severity in psoriasis explaining 12% of variance.

Conclusions  Our findings suggest a relationship between pruritus severity and anger in CIU. Furthermore, our results indicate a relationship between pruritus severity and depression in psoriasis.
Cancer and Intellectual Disability: A Review of Some Key Contextual Issues
Authors: Hogg James , Tuffrey‐Wijne Irene
Published: March 2008

Research into the health of people with intellectual disabilities has increasingly focused on the occurrence of cancer in this population. Information on the incidence and prevalence of cancer is reviewed in both institutional and community settings. Examples of environmental causation are considered including Helicobacter pylori. Gender‐specific issues are considered with respect to both women and men, and screening services discussed. The overall issue of timely diagnosis of cancer in members of this population is reviewed with special reference to avoidable deaths. The need for methodologically sound studies to clarify the epidemiology of cancer in people with intellectual disabilities is discussed.
Eyewitness Memory and Eyewitness Identification Performance in Adults with Intellectual Disabilities
Authors: Ternes Marguerite , Yuille John C.
Published: March 2008

Background  Since individuals with intellectual disabilities are often the only witnesses to alleged crimes, it is important to know their capacity to provide eyewitness testimony.

Methods  Twenty‐two participants with intellectual disabilities and 23 comparison group participants had their photographs taken by a confederate. One to two weeks following the photography session, participants were interviewed about the event and were asked to identify the photographer. Two misleading questions, to test for suggestibility, were asked at the end of the interview.

Results  Comparison group participants performed significantly better than participants with intellectual disabilities with a target‐present lineup, but no significant differences were found between participant groups with a target‐absent lineup. Comparison group participants performed significantly better than chance with the target‐absent lineup, but participants with intellectual disabilities did not. In the interview, participants with intellectual disabilities provided significantly fewer details than comparison group participants, and the details provided by both groups were mainly accurate. Participants with intellectual disabilities were significantly more likely to acquiesce to one of the suggestive questions than comparison group participants, but the two participant groups did not differ in likelihood of acquiescence for the other suggestive question.

Conclusions  It seems that individuals with intellectual disabilities may make adequate witnesses if they are interviewed in a non‐leading manner. Future research should examine methods to improve their eyewitness identification performance.
My heart is on my tongue: the untranslated self in a translated world
Authors: Krog Antjie
Published: March 2008

Abstract:  The South African Truth and Reconciliation Commission (TRC) was the first body to provide translation in all the languages of the country, setting people free from groping around with distorted tongues, unable to see, talk or hear one another … After three centuries of silence South Africans could daily hear the black voice talking and being translated; for the first time white South Africans could hear and listen. Through translation we could access our deepest emotions and feelings.

But among the two thousand testimonies there were some that were incomprehensible, that confirmed every racial stereotype built up over many years of apartheid. What does one do with these ‘untranslatable’ narratives? This paper looks at one TRC testimony and one Bushmen story, both of them translated from indigenous languages and both posing enormous moral dilemmas. Read in a particular way, the Bushmen story seems to say that they had no sense of responsibility. I will look at the story in its cultural context as revealed through translation to see if another conclusion is possible. In the TRC testimony, I and two colleagues looked at the slippages between the original Xhosa testimony and the interpreted version and explore the consequences thereof.

I want to make the point that a narrative can be experienced as discriminatory and ethically problematic when read through a particular, in this case a western, perspective. But the moment there is an attempt to interpret the narrative via its embeddedness in an indigenous worldview, it becomes breathtakingly ethical, fair and logical.
Cost‐effectiveness analysis of different embryo transfer strategies in England
Authors: Dixon S , Faghih Nasiri F , Ledger WL , Lenton EA , Duenas A , Sutcliffe P , Chilcott JB
Published: March 2008

Objective  The objective of this study was to assess the cost‐effectiveness of different embryo transfer strategies for a single cycle when two embryos are available, and taking the NHS cost perspective.

Design  Cost‐effectiveness model.

Setting  Five in vitro fertilisation (IVF) centres in England between 2003/04 and 2004/05.

Population  Women with two embryos available for transfer in three age groups (<30, 30–35 and 36–39 years).

Methods  A decision analytic model was constructed using observational data collected from a sample of fertility centres in England. Costs and adverse outcomes are estimated up to 5 years after the birth. Incremental cost per live birth was calculated for different embryo transfer strategies and for three separate age groups: less than 30, 30–35 and 36–39 years.

Main outcome measures  Premature birth, neonatal intensive care unit admissions and days, cerebral palsy and incremental cost‐effectiveness ratios.

Results  Single fresh embryo transfer (SET) plus frozen single embryo transfer (fzSET) is the more costly in terms of IVF costs, but the lower rates of multiple births mean that in terms of total costs, it is less costly than double embryo transfer (DET). Adverse events increase when moving from SET to SET+fzSET to DET. The probability of SET+fzSET being cost‐effective decreases with age. When SET is included in the analysis, SET+fzSET no longer becomes a cost‐effective option at any threshold value for all age groups studied.

Conclusions  The analyses show that the choice of embryo transfer strategy is a function of four factors: the age of the mother, the relevance of the SET option, the value placed on a live birth and the relative importance placed on adverse outcomes. For each patient group, the choice of strategy is a trade‐off between the value placed on a live birth and cost.
Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasound
Authors: Fowler GE , Adams EJ , Bolderson J , Hosker G , Lowe D , Richmond DH , Alfirevic Z
Published: March 2008

Objective  To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter.

Design  A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed.

Methods  To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test‐retest analysis. Kappa agreement was calculated to assess intra‐observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans.

Main outcome measures  Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra‐observer and gold standard versus observer kappa values of experienced clinicians (A–E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations.

Conclusions  LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms.
Differential impact of conventional and low‐dose oral hormone therapy, tibolone and raloxifene on mammographic breast density, assessed by an automated quantitative method
Authors: Eilertsen AL , Karssemeijer N , Skaane P , Qvigstad E , Sandset PM
Published: March 2008

Objective  To evaluate impact of different postmenopausal hormone therapy (HT) regimens and raloxifene on mammographic breast density.

Design  Open, randomised, comparative clinical trial.

Setting  Women were recruited through local newspapers and posters. They were examined at the Departments of Haematology, Gynaecology, and Radiology in a University Hospital.

Population  A total of 202 healthy postmenopausal women between the age of 45 and 65 years.

Methods  Women were randomly assigned to receive daily treatment for 12 weeks with tablets containing low‐dose HT containing 1 mg 17 β‐estradiol + 0.5 mg norethisterone acetate (NETA) (n = 50), conventional‐dose HT containing 2 mg 17 β‐estradiol and 1 mg NETA (n = 50), 2.5 mg tibolone (n = 51), or 60 mg raloxifene (n = 51). Mammographic density was determined at baseline and after 12 weeks by an automated technique in full‐field digital mammograms.

Main outcome measures  Mammographic density was expressed as volumetric breast density estimations.

Results  Mammographic breast density increased significantly and to a similar degree in both the conventional‐ and low‐dose HT groups. A small reduction in mammographic breast density was seen in the raloxifene group, whereas those allocated to tibolone treatment only showed minor changes.

Conclusions  Our findings demonstrated a significant difference in impact on mammographic breast density between the regimens. Although these results indicate a differential effect of these regimens on breast tissue, the relation to breast cancer risk remains unresolved.
Rats that differentially respond to cocaine differ in their dopaminergic storage capacity of the nucleus accumbens
Authors: Verheij Michel M. M. , de Mulder Eric L. W. , De Leonibus Elvira , van Loo Karen M. J. , Cools Alexander R.
Published: March 2008

Cocaine (COC) inhibits the re‐uptake of dopamine. However, the dopamine response to COC also depends on dopamine inside storage vesicles. The aim of this study was to investigate whether rats that differentially respond to COC differ in their dopaminergic storage capacity of the nucleus accumbens. Total and vesicular levels of accumbal dopamine as well as accumbal vesicular monoamine transporter‐2 levels were established in high (HR) and low responders (LR) to novelty rats. Moreover, the effects of reserpine (RES) on the COC‐induced increase of extracellular accumbal dopamine were investigated. HR displayed higher accumbal levels of total and vesicular dopamine than LR. Moreover, HR displayed more accumbal vesicular monoamine transporters‐2 than LR. COC increased extracellular accumbal dopamine more strongly in HR than in LR. A low dose of RES prevented the COC‐induced increase of accumbal dopamine in LR, but not in HR. A higher dose of RES was required to inhibit the COC‐induced increase of accumbal dopamine in HR. These data demonstrate that HR were marked by a larger accumbal dopaminergic storage pool than LR. It is hypothesized that HR are more sensitive to COC than LR, because COC can release more dopamine from accumbal storage vesicles in HR than in LR.
Visceral adipose tissue modulates mammalian longevity
Authors: Muzumdar Radhika , Allison David B. , Huffman Derek M. , Ma Xiaohui , Atzmon Gil , Einstein Francine H. , Fishman Sigal , Poduval Aruna D. , McVei Theresa , Keith Scott W. , Barzilai Nir
Published: March 2008

Caloric restriction (CR) can delay many age‐related diseases and extend lifespan, while an increase in adiposity is associated with enhanced disease risk and accelerated aging. Among the various fat depots, the accrual of visceral fat (VF) is a common feature of aging, and has been shown to be the most detrimental on metabolic syndrome of aging in humans. We have previously demonstrated that surgical removal of VF in rats improves insulin action; thus, we set out to determine if VF removal affects longevity. We prospectively studied lifespan in three groups of rats: ad libitum‐fed (AL‐fed), CR (Fed 60% of AL) and a group of AL‐fed rats with selective removal of VF at 5 months of age (VF‐removed rats). We demonstrate that compared to AL‐fed rats, VF‐removed rats had a significant increase in mean (p < 0.001) and maximum lifespan (p < 0.04) and significant reduction in the incidence of severe renal disease (p < 0.01). CR rats demonstrated the greatest mean and maximum lifespan (p < 0.001) and the lowest rate of death as compared to AL‐fed rats (0.13). Taken together, these observations provide the most direct evidence to date that a reduction in fat mass, specifically VF, may be one of the possible underlying mechanisms of the anti‐aging effect of CR.
IN‐SITU ELEMENTAL AND Sr ISOTOPE INVESTIGATION OF HUMAN TOOTH ENAMEL BY LASER ABLATION‐(MC)‐ICP‐MS: SUCCESSES AND PITFALLS*
Authors: SIMONETTI ANTONIO , BUZON MICHELE R. , CREASER ROBERT A.
Published: March 2008

Trace element and Sr isotope data were obtained by laser ablation‐ and solution mode‐(MC)‐ICP‐MS analysis for tooth enamel from remains excavated at the New Kingdom period Egyptian colonial and Nubian cemetery site of Tombos (Sudan). Elemental abundances determined by both methods of ICP‐MS analysis yielded comparable values; however, 87Sr/86Sr values obtained by laser ablation were higher compared to their solution mode counterparts. This discrepancy is related to the production of a molecular interference—Ca + P + O (overlaps 87Sr); hence the higher 87Sr/86Sr values recorded during ablation analyses. Laser ablation studies of enamel may provide relatively precise 87Sr/86Sr values rather quickly but cannot be used for accurately deciphering historical population migrations.
COINS, ARTEFACTS AND ISOTOPES—ARCHAEOMETALLURGY ANDARCHAEOMETRY*
Authors: REHREN TH. , PERNICKA E.
Published: March 2008

Archaeometallurgy is one of the earliest manifestations of archaeometric research, using science‐based approaches to address cultural–historical questions. This review first outlines the extent of the field, defining in some detail the main branches of archaeometallurgy, and their specific methodological approaches. It then looks at some of the early publications pioneering archaeometallurgical research, to set the scene for the publication pattern of archaeometallurgy in general, and the role thatArchaeometryplayed in publishing archaeometallurgical research. The analysis of archaeometallurgy‐themed publications inArchaeometry, their change over time and their relationship to the total range of work done in the field indicates that there is a rather narrowly defined and specific type of archaeometallurgy that gets published inArchaeometry, initially with a strong focus on coin and object analysis, often combined with method developments. The more recent developments in isotope‐based studies in archaeometallurgy find only a limited representation in the journal, despite the leading role that the Isotrace Laboratory played in this discipline, for some considerable length of time. More recently, thisArchaeometry‐specific ‘flavour’ of archaeometallurgy seems to weaken, with an increase of papers on iron and on primary production in general, subjects still much under‐represented.
Money for Science? The Impact of Research Grants on Academic Output*
Authors: Chudnovsky Daniel , López Andrés , Rossi Martín A. , Ubfal Diego
Published: March 2008

This paper evaluates the impact of subsidies on the academic performance of researchers in Argentina. Academic performance is measured in terms of number of publications and in terms of impact factors in peer‐reviewed journals. The performance of researchers with financially supported projects is compared with that of a control group of researchers who submitted projects accepted in terms of quality but not supported because of shortage of funds. We use non‐experimental data and a difference‐in‐differences approach along with propensity score matching techniques, where we control for pre‐programme observable attributes as well as for researchers’ time‐invariant unobservable characteristics. Our findings suggest a positive and statistically significant effect of subsidy on academic performance, especially for young researchers.
The Actuarial Balance Sheet for Pay‐As‐You‐Go Finance: Solvency Indicators for Spain and Sweden*
Authors: Boado‐Penas María del Carmen , Valdés‐Prieto Salvador , Vidal‐Meliá Carlos
Published: March 2008

This paper provides the first estimate of the actuarial balance of the Spanish contributory pension system for the old‐age contingency, based on official data. The main accounting entries are developed from the principles of double‐entry bookkeeping. The novel entry in the balance sheet, entitled the ‘contribution asset’ or ‘hidden asset’, is at the centre of the theoretical discussion. A comparison between the official balance sheet for the Swedish notional account system and our balance sheet for the Spanish contributory pension system is also provided. The main finding is that the Spanish pension system has an insolvency rate of 31.4 per cent. The policy implication is that unless current legislation is reformed, Spanish taxpayers (the plan sponsor) should count on making transfers to the pension system with a present discounted value of 31.4 per cent of current liabilities. Moreover, a comparison of the consecutive balance sheets for 2001‐06 shows that the degree of insolvency is growing over time, even though the cash‐flow outcome has improved over the same period. Taking steps to reverse this trend and restore solvency is in Spanish taxpayers' interest, and possibly also in the interest of those in the European Union who recognise that there is a chance that they may have to support the Spanish budget in the future.
Effect of nanoclays on the dyeability of polypropylene nanocomposite fibres
Authors: Razafimahefa Lova , Chlebicki Sabine , Vroman Isabelle , Devaux Eric
Published: March 2008

Polypropylene clay fibres loaded with different alkylammonium‐modified montmorillonite were prepared using a melt spinning technique and relationships between the structure and properties of the nanopolypropylene fibres are discussed. Experiments carried out using transmission electron microscopy showed that the chemical structure of the organic modifier and the interlayer spacing of the clay induced different dispersions of the clay, thus improving accessibility of the nano fibre. It is known that nanoclays are effective and efficient sorbents for dyes. Therefore, the dyeing behaviour of the nano polypropylene fibres with two distinct acid dyes and a disperse dye was studied and the build‐up of dyes, measured as colour yield, reported. The best results were obtained when the clay was well dispersed in nanopolypropylene fibres; that is, when maleated polypropylene was added as a compatibiliser and when disperse dye was used. Good wash fastness was then obtained.
Effects of atmospheric plasma treatment on the dyeability of cotton fabrics by acid dyes
Authors: Karahan H A , Özdoğan E , Demir A , Ayhan H , Seventekin N
Published: March 2008

Cotton fabrics were treated with air and argon atmospheric plasma for surface activation. Activated surfaces were grafted with two different amine compounds: ethylenediamine and triethylenetetramine. Pretreated cotton was dyed with acid dye and the effects of pretreatment on the colour strength, as well as the washing, rubbing and the light fastness of the dyeings, were investigated. Colour yield results showed that grafted ethylenediamine and triethylenetetramine enhance the dyeability of cotton fabric with acid dyes. Fourier transform infrared spectra confirmed the formed groups on the surface and scanning electron microscopy showed the etching effect of plasma.
Asphyxia, Cerebral Palsy and Litigation
Authors: Beavis E.L.G.
Published: March 2008

This contribution was submitted for consideration for publication as a letter to the editor. The author is one of Australia's most senior obstetricians. The editor has known him well for 45 years and considers him to be both an impressive scholar and formidable iconoclast. In addition he is writing on his favourite subject, concerning which he has analyzed the relevant literature for many years, often in relation to providing opinions in cases being considered for litigation. He also has the distinction of usually providing opinions from the point of view of patients rather than defendants (obstetricians, hospitals) in such cases. We have not invited the authors whose papers are mentioned to respond to his comments. The editorial committee of the journal and our other reviewers agreed that this material should be offered to our readers as it stands for their consideration.
Maternal Height as a Risk Factor for Caesarean Section Due to Failure to Progress in Labour
Authors: McGuinness B.J. , Trivedi A.N.
Published: March 2008

Summary: We examined for a regional sample of the New Zealand population, the relationship between maternal height and an increased risk of emergency Caesarean section due to arrested labour, to identify a height below which the risk of Caesarean section increases markedly and to quantify the risk of a Caesarean section for a range of maternal heights. The data of nulliparous singleton pregnancies over the period 1994–1998 was sorted into 2 study groups, one resulting in emergency Caesarean section for arrested labour and the other a group of women who had normal vaginal delivery requiring no intervention. The means and standard deviations of these 2 groups were found and 99% confidence intervals calculated. They were analysed for statistical difference and then a logistical regression calculation tried to identify a height at which the risk of a Caesarean section increased suddenly. There were 81 women in the Caesarean section group and 997 in the normal vaginal delivery group. Mean heights and confidence intervals were 161.0 cm (158.9–163.1) and 164.6 cm (164.0–165.2) respectively. There was a statistically significant difference between these means (p < 0.001) but logistic regression analysis showed that risk of Caesarean section increased gradually with decreasing height, and even then did not reach more than 30% risk until a height of less than 140 cm. Low maternal height was associated with increased risk of Caesarean section due to labour arrest. Because the likelihood of having a normal vaginal delivery was still very good (> 80%) at modest degrees of short stature, this risk factor alone is unlikely to affect management. However the combination of other risk factors with maternal height may be of clinical use.
Incidence and Management of Gynaecological‐Related Ureteric Injuries
Authors: Asian Peter , Brooks Andrew , Drummond Malcolm , Woo Henry
Published: March 2008

Summary: We report a 5‐year review of all ureteric injuries at a major Sydney teaching hospital as a result of gynecological procedures. A retrospective analysis was made of all hospital medical records and consultant follow‐up notes from January, 1990 to May, 1995. Injuries were recorded in 22 patients with a mean age 52 years (range 31–88). Of these, 17 occurred at our institution, while 5 were referred from peripheral hospitals. Two injuries were bilateral, and 6 were discovered intraoperatively. Patients were managed acutely where possible. Treatment options included cystoscopy and retrograde stenting, deligation, neoureterocystostomy, transureteroureterostomy or nephrectomy. Follow‐up imaging was available in 16 patients, of those, 15 were normal, and 1 showed bilateral obstruction secondary to radiotherapy. The overall risk of ureteric injury for all methods of hysterectomy was 0.44% (0.24% for total abdominal hysterectomy).
Laparoscopically‐Assisted Vaginal Hysterectomy for Fibroid Uteri Weighing at Least 500 Grammes
Authors: Salmanli Nesrin , Maher Peter
Published: March 2008

Summary: We retrospectively reviewed the medical records of 13 women who underwent laparoscopically‐assisted vaginal hysterectomy (LAVH) where the uterus weighed 500 g or more. LAVH was successfully performed in 10 of these 13 women for whom the mean uterine weight was 619 g, mean operating time 99 minutes, and mean postoperative hospital stay 3.7 days. One of the 3 women who underwent abdominal hysterectomy required blood transfusion for intraoperative bleeding. There was no febrile or other operative morbidity associated with any patient. As up to 75% of hysterectomies are performed abdominally, LAVH may replace many abdominal hysterectomies for large fibroid uteri when vaginal hysterectomy is not feasible.
A Case Report and Review of Pregnancies in Rudimentary Noncommunicating Uterine Horns
Authors: McCarthy Elizabeth
Published: March 2008

A liveborn and subsequently thriving child was delivered abdominally from a pregnancy in a rudimentary noncommunicating uterine horn. This is the 13th English language report of neonatal survival from such an unusual and life‐threatening situation. The case presents some‘clues’in the history and a review of the literature suggests that the previously reported bleak outlook for these pregnancies can now be tempered with cautious optimism. Ultrasound diagnosis of Müllerian abnormalities during pregnancy remains difficult but has been reported in several other cases in the literature and may become more common in the future.
Treatment of Acute Myocardial Infarction in Pregnancy with Coronary Artery Balloon Angioplasty and Stenting
Authors: Craig Simon , Eton Marcus
Published: March 2008

Acute myocardial infarction in pregnancy is a rare condition with substantial risk of maternal and fetal mortality. We present a case of myocardial infarction during pregnancy which was treated by percutaneous coronary artery balloon angioplasty and stenting with excellent pregnancy outcome.
Influence of Seasonal Variation on Pregnancy‐induced Hypertension and/or Preeclampsia
Authors: Makhseed Ma'asoumah , Musini Vijaya Manav , Ahmed Mohammad Abrar , Monem Rawiya Abdul
Published: March 2008

Seasonal variation of temperature and humidity are said to influence the incidence of hypertensive disorders of pregnancy. The aim of this study was to determine if temperature and humidity exert any influence on the incidence of pregnancy‐induced hypertension and preeclampsia in Kuwait. This is a retrospective study performed in the Maternity Hospital, Kuwait (MHK) in the years 1992–1994. Monthly distribution of all deliveries and those in which the patients had pregnancy‐induced hypertension and preeclampsia were recorded. There are some studies including ours which do not show any significant correlation between meteorological factors and hypertensive disorders of pregnancy. We found that the incidence of pregnancy‐induced hypertension per 1,000 deliveries was high in June when the temperature was very high and the humidity at its lowest. The reverse was true for the incidence of preeclampsia per 1,000 deliveries, which was high in November when the temperature was low and the humidity high.
The Effects of Abdominal Hysterectomy on Bladder Neck and Urinary Incontinence
Authors: Demirci Fuat , Ozden Selcuk , Alpay Zeynep , Demirci Elif Tozkir
Published: March 2008

We assessed the bladder neck (BN) by perineal ultrasonography of 39 patients before and 1 year after hysterectomy, and we compared them with 30 control cases in terms of stress urinary incontinence. We evaluated the BN position and mobility in the downwards and backwards directions. The bladder neck was found to be significantly lower at rest, in the downwards direction, in the postoperative period. The stress position of the BN was not significantly different. Its downwards mobility decreased, but not significantly. There was no significant difference in the location of the BN with respect to the pubis, at rest and during stress, in the backwards direction, between the preoperative and postoperative periods. Backwards mobility of the BN decreased significantly following hysterectomy. Stress incontinence was not significantly different between the study group and the control group after one year. We concluded that hysterectomy did not weaken urethral support and did not increase the rate of stress incontinence.
Uterine Leiomyosarcoma‐A Singapore Experience
Authors: Soh L.T. , Chew S.H. , Ang L.
Published: March 2008

Uterine leiomyosarcoma is an aggressive tumour. In our retrospective series of 27 patients, there were 25 with nonmyxoid high‐grade leiomyosarcoma of the uterus. The stage distribution was Stage 1, 16; Stage 3, 5 and Stage 4, 4. In the patients with Stage 1 disease, 3 of the 8 patients who received adjuvant chemotherapy subsequently developed recurrent disease. In contrast, 6 of the 8 patients who did not receive adjuvant chemotherapy subsequently developed recurrent disease; 2 of the patients in the latter group also received adjuvant radiotherapy. Six of the 9 women with recurrences were distant‘failures’alone, 2 were both distant and pelvic‘failures’and 1 was pelvic‘failure’alone. All the patients with advanced‐stage disease eventually succumbed to the disease despite the therapies given. This study is small and retrospective but it suggests that there might be a role for adjuvant chemotherapy in the management of the early stage of this disease.
Can Examination of the Cervix Provide Useful Information for Prediction of Cervical Incompetence and Following Preterm Labour?
Authors: Rocco Broso Pasquale , Garrone Carla
Published: March 2008

Summary: Diagnosing cervical incompetence is difficult because there are no specific tests or criteria that confirm or exclude the diagnosis, and the accurate prediction and diagnosis of preterm labour continue to frustrate the clinician. To evaluate the condition of the cervical canal, when dilatation of the internal os is identifiable by digital examination, cervical ripening has advanced considerably. Measurement of cervical length by ultrasonography offers the possibility of confirming cervical canal shortening before it is evident by digital examination. Transabdominal observations require a full urinary bladder, and the uterus is consequently deformed from the lower part to the fetal head. Measurement of cervical length by transvaginal ultrasonography has made it possible to resolve the problems associated with transabdominal observation and to assess the condition of the cervical canal in more detail. Application of transfundal pressure during transvaginal ultrasound evaluation of the cervix and its internal os may assist in detecting the asymptomatic incompetent cervix.
Have Kielland Forceps Reached Their ‘Use By’ Date?
Authors: Robson Stephen , Pridmore Brian
Published: March 2008

Summary: Kielland forceps have long been used in Australian hospitals for rotation and delivery from occipitolateral and occipitoposterior positions. We have studied the pattern and use of these forceps in our hospital, and conducted a statewide survey of obstetric trainees about their experience with Kielland forceps. We conclude that current obstetric training programmes are unlikely to provide registrars with sufficient skill in their safe use.
A Randomized Controlled Trial of a Smoking Cessation Intervention During Pregnancy
Authors: Panjari Mary , Bell Robin , Bishop Sue , Astbury Jill , Rice Greg , Doery Jim
Published: March 2008

This study was a randomized controlled trial of a smoking cessation intervention for pregnant smokers. Women who reported smoking at their first antenatal visit and satisfied the inclusion criteria were asked to participate in the trial. Analysis was restricted to 393 evaluable women in the control group (received usual antenatal care) and 339 women to the study group (received usual antenatal care plus the intervention). The primary hypotheses were that the intervention would result in a higher proportion of quitters and that the mean birth‐weight of babies born to women receiving the intervention would be greater than that of babies born to women in the control group. The outcome measures were smoking status based on self‐report combined with a urinary cotinine level of <115 ng/mL, and birth‐weight. There was no significant difference in quit rate between women receiving the intervention and women in the control group (11.9% versus 9.8% p=0.41). Babies born to women receiving the intervention were on average 84 g heavier than babies born to controls (p=0.04). The factors that contribute to the lack of a significant increase in smoking cessation in the intervention group and the possible explanation for the changes in birth‐weight are discussed.
Modern Antioestrogens and the Coming Revolution in Women's Health Care
Authors: Evans Amanda , Vollenhoven Beverley , Healy David
Published: March 2008

This review will focus on antioestrogens and selective oestrogen receptor modulators (SERMS). The more traditional SERMS, clomiphene citrate and tamoxifen, will be reviewed along with such modern drugs as raloxifene and faslodex, with emphasis upon their actions on breast, uterus, bone and lipids. The future potential of these medications, in the management of oestrogen‐dependent gynaecological conditions such as endometriosis, dysfunctional uterine bleeding, fibroids and breast cancer will be discussed.
The Use of Family Planning Services by Non‐English Speaking Background (NESB) Women
Authors: Mirza Tanjina , Kovacs Gabor T. , McDonald Peter
Published: March 2008

Summary: This study was undertaken to determine the proportion of family planning organization clients who are from a non‐English speaking background (NESB), to analyse the services they used, and to compare it to the services used by other clients. Analysis of clinic data sheets from the 8 State/Territory family planning organizations (FPO) was conducted. From a total of 185,879 client visits in FPO clinics between July, 1996 and June, 1997, 27,349 (14.7%) were from NESB. The proportion of clients with NESB was quite similar to that in the community. This means that in general, FPOs are reaching their share of clients with NESB. The patterns of reproductive health services used varied between NESB women compared to English speaking women.
Outcome After a Pap Smear Report of Low‐Grade Abnormality: a Longitudinal Comparative Study
Authors: Mitchell Heather
Published: March 2008

Summary: The rate of subsequent diagnosis of high‐grade cervical abnormality was studied among women whose first Pap smear in 1994 was reported as being negative or from the category of low‐grade abnormality (excluding CIN 1). Regardless of the degree of low‐grade abnormality reported on the entry smear, the rate of subsequent high‐grade disease was 3.3 cases per 100 years of follow‐up. The rate of subsequent high‐grade disease among women with negative Pap smear reports was 0.23 to 0.45 cases per 100 years of follow‐up. Within each cohort, a small number of cases of invasive cervical cancer were diagnosed in the 2 years after the entry smear. These data indicate that Pap smear reports which are coded to the registry squamous cell code of ‘mild atypia’ (with or without evidence of human papillomavirus effect) have a significantly higher risk of emerging high‐grade cervical disease than negative Pap smear reports (including those with minor reactive and/or inflammatory change). It is suggested that the former have a uniform recommendation of repeating the smear in 1 year and the latter in 2 years.
Uterine Perforation During Surgical Abortion: A Review of Diagnosis, Management and Prevention
Authors: Pridmore Brian R. , Chambers Dennis G.
Published: March 2008

We analysed results of 13,907 women who underwent termination of pregnancy over a 6‐year period in a public day‐surgery clinic in South Australia to determine possible risk factors and preventive measures for known perforation of the uterus in surgical abortion. The perforation rate in the first trimester was 6 in 12,040 (0.05%) and in the second trimester (13–20 weeks), 6 in 1,867 (0.32%). Previous gynaecological surgery had been performed in 11 of 12 (92%) women sustaining perforation and was the main risk factor identified. No second trimester perforations occurred in the 2 years following identification of the risk factor and the introduction of precautionary protocols, and there was only 1 first trimester perforation. The overall reduction in perforation rate was from 0.13% to 0.02% (p=0.022). We conclude that previous gynaecological surgery including termination of pregnancy, lower segment Caesarean section and the large loop excision of transformation zone of the cervix (LLETZ) procedure, which may have resulted in scarring of the internal cervical os is a previously unreported risk factor for tearing of the internal os leading to perforation of the uterus during subsequent surgical abortion procedures. Dilatation of the cervix particularly for these ‘at risk’ procedures should be predominantly passive by the use of oral prostaglandins such as misoprostol and osmotic dilators.
Uterine Torsion with Shock
Authors: Kovavisarach Ekachai , Vanitchanon Pisanu
Published: March 2008

EDITORIAL COMMENT: We accepted this case report of uterine torsion with shock for publication, although this issue of the journal carries another case report of this condition, because it is easy to believe that the placental abruption that occurred in this woman was precipitated by the uterine torsion causing an increase in venous pressure. It has been stated over the years that vena caval occlusion due to the supine position can increase venous pressure and cause placental abruption, an observation that has been supported by experimental vena caval ligation in animals resulting in retroplacental haemorrhage. Torsion of the uterus through 180 degrees could surely cause similar vascular complications. The lesson provided by this case is that a patient who suffers sudden onset of abdominal pain and shock in late pregnancy, together with fetal death in utero, may have torsion of the uterus with or without concealed placental abruption as occurred in this case.
10% Maltose Infusion Therapy for Oligohydramnios
Authors: Suzuki Shunji , Mine Katsuya , Sawa Rintaro , Yoneyama Yoshio , Araki Tsutomu
Published: March 2008

EDITORIAL COMMENT: We accepted this case report for publication because any method that may be successful in the treatment of fetal growth retardation, with or without oligohydramnios, must be of interest to obstetricians who manage these high‐risk pregnancies. There are now many methods that have been used in the antenatal management of uteroplacental insufficiency and this topic has been briefly reviewed in a previous editorial comment (A). It is interesting that this paper from Japan using an intravenous infusion of 10% maltose refers to this technique being used 17 years ago in Japan. Similarly at the Mercy Hospital for Women in Melbourne, Victoria, there was great commitment to the treatment of these high‐risk pregnancies with intravenous infusion of 25% dextrose and more recently of 10% dextrose and amino acids. These studies were first reported in the 1970's (B) and were in favour for about 15 years. The regimen has largely been discontinued because controlled trials did not show superiority of one fluid over another (C). In the studies reported from the Mercy Hospitut for Women the regimen was based on the philosophy of continuing the pregnancies until, fetal viability, then considered to be about 37 weeks' gestation, in the absence qf maternal complications, such as preeclampsia and uncontrollable hypertension, so long as the, fetal cardiotocograph remained normal. It is possible that more modern ultrasonographic techniques are a better way to evaluate fetal condition. Hopefully this editorial comment will encourage some readers to consider reintroducing this very simple, safe therapy for both mother and child. Follow‐up studies of surviving infiints, from these pregnancies showed a satisfactory long‐term prognosis (D, E). One of the problems in cases of severe, fetal growth retardation, especially when the mother has a past history of intrauterine deaths, is that management is anecdotal because it is dificult to set up controlled trials of such extreme high‐risk pregnancies.
Giant Myoma and Erythrocytosis Syndrome
Authors: Özsaran A. Aydm , Itil Ismail Mete , Terek Coşan , Kazand Mert , Dikmen Yilmaz
Published: March 2008

The objective of this study is to discuss the myomatous erythrocytosis syndrome in a patient with a giant subserous uterine myoma. She presented with plethora and an abdominal mass. After venesection of 4 units of blood, the preoperative haematocrit value of 53.3% and haemoglobin value of 17.5 g/dL had decreased to 48.6% and 16.8 g/dL levels, respectively. After the operative extraction of the giant subserous myoma with attached uterus weighing 14.2 kg, the haematocrit and the haemoglobin values had regressed to 40.3% and 14.3 g/dL levels, respectively. The findings indicated that the giant subserous myoma was the cause of the myomatous erythrocytosis syndrome in this patient.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Early Recognition and Treatment
Authors: Knopp Eleanor A. , Cowper Shawn E.
Published: March 2008

Nephrogenic systemic fibrosis (NSF) is a progressive, debilitating, and emotionally distressing disease that can affect patients with renal dysfunction. Prevention, early recognition and early treatment are essential to limiting its impact. The most significant risk factors for developing NSF are chronic or significant acute kidney disease (usually necessitating dialysis) and the administration of gadolinium‐containing contrast agents (GCCA). Early symptoms include swelling, redness, pruritus, and pain in the limbs, sometimes with muscle weakness. Early signs are edema, erythema, and occasionally palpable warmth of the involved extremities; there may be florid scleral telangiectasia resembling conjunctivitis. We must redouble our efforts to avoid the administration of GCCA to patients with renal insufficiency. The most effective treatment for NSF to date is maximization of renal function via medical therapy or transplantation. There are data to support a beneficial effect from extracorporeal photopheresis, and all patients can gain from physical therapy.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Recommendations for Gadolinium‐Based Contrast Use in Patients with Kidney Disease
Authors: Perazella Mark A. , Reilly Robert F.
Published: March 2008

Nephrogenic systemic fibrosis is a systemic disorder characterized by widespread tissue fibrosis. Gadolinium‐based contrast (GBC) was recently noted as a possible trigger for this disease. The vast majority of cases occur in patients with ESRD receiving hemodialysis or peritoneal dialysis. However, approximately 10% of cases develop in patients with AKI (many requiring dialysis), advanced CKD stage 4, and CKD stage 5 not receiving renal replacement therapy. Recommendations to guide the use of GBC in patients with underlying kidney disease are presented. These clinical practice guidelines should be individualized and considered in consultation with the ordering physician, radiologist, and nephrologist.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Tissue Deposition of Gadolinium and Development of NSF: A Convergence of Factors
Authors: Perazella Mark A.
Published: March 2008

Gadolinium‐based contrast (GBC) exposure has recently been linked to the development of nephrogenic systemic fibrosis (NSF) in patients with underlying kidney disease and may in fact be the previously unrecognized trigger for the fibrosing process. As NSF is fairly rare in this patient population, a number of permissive factors are likely required for GBC exposure to initiate fibrosis. Advanced kidney disease is an absolute requirement whereas vascular injury and an inflammatory state, and a mix of co‐factors including increased serum phosphate and calcium concentrations and iron overload further enhance risk. The combination of these events allows excess circulating gadolinium, which dissociates from its chelate to leak out of vessels and deposit in tissues. Free or bound tissue gadolinium, a rare earth metal of the lanthanoid series, promotes fibrosis via either direct binding to the collagen helix or, once the metal has been engulfed by macrophages, through the production of free oxygen radicals, cytokines, and other profibrotic factors that attract circulating fibrocytes to tissues. These fibrocytes then differentiate into fibroblast‐like spindle cells that produce connective tissue matrix and other angiogenic and growth factors that further enhance tissue fibrosis. Direct gadolinium activation of transglutaminases on these tissue fibroblast‐like cells may also promote fibrosis.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis and Gadolinium‐Based Contrast: Medico‐Legal Implications
Authors: Houck Cara M. , Pristave Robert J. , Kannensohn Kimberly J.
Published: March 2008

The epidemiologic link between exposure to gadolinium‐based contrast (GBC) agents and the development of nephrogenic systemic fibrosis (NSF) in patients with moderate to severe end‐stage renal disease (ESRD) has caused concern among physicians, particularly radiologists and nephrologists. The concerns of manufacturers of GBC agents and the U.S. Food and Drug Administration (FDA) have led to the publication of product label warnings and a Public Health Advisory. As more cases of NSF associated with GBC agent exposure have surfaced, manufacturers and physicians have become increasingly concerned about the potential for litigation. To date, litigation has been directed primarily at manufacturers of GBC agents and has focused on package warnings. Thus, physicians should stay abreast of FDA warnings, keep an open line of communication with manufacturers of GBC agents, and review package warnings.