bluuebunny/crossref_metadata_2025 huggingface dataset:
Direct intracellular injections for studying human myometrial gap junctions prior to labor
Authors: Nadir Çiray H. , Persson Bo‐Eric , Bäckstrom Torbjörn , Roomans Godfried M. , Ulmsten Ulf
Published: November 2007

Direct intracellular microinjection of a fluorescent dye (Lucifer Yellow) was performed on ex‐situ muscle strips from term pregnant women not in labor. The aim was to characterize the intracellular distribution of LY to obtain criteria for an intracellular injection in whole mounts and ultimately to study the gap junctional communication between myometrial cells in those tissues. Fifteen injections performed on biopsies from ten cases snowed a well‐bordered fusiform shape and were considered to be intracellular. The intercellular spread of the dye into an adjacent cell was observed in three injections (three cases). The average cell dimension was 284 ± 95 μm for length and 5±1.5 μrn for width (n=17). The intracellular injection was confirmed by light microscopy of cross sections. It is concluded that limited coupling exists between myometrial cells of women prior to labor.
Anterior placental location predisposes for occiput posterior presentation near term
Authors: Gardberg Mikael , Tuppurainen Marketta
Published: November 2007

325 sonographies were performed in singleton pregnancies past 36 weeks with the fetus in a vertex position in order to examine a possible association between placental localization and occiput posterior presentation (OP). OP was found in 11.6% of all cases. The distribution of the placental locations in the OP group differed significantly from the occiput anterior (OA) group. Also, an anterior placental location was seen significantly more often in the OP group.
Routine revision of uterine scar after prior cesarean section
Authors: Kaplan B. , Royburt M. , Peled Y. , Hirsch M. , Hod M. , Ovadla Y. , Neri A.
Published: November 2007

Up until the early seventies fear of uterine rupture led to the widespread practice of ‘once a section, always a section’. Nowadays, there is a consistent trend toward vaginal birth after a prior cesarean delivery, making early detection of uterine scar dehiscence at delivery important. However. the need for routine transcervical revision of the uterine scar following vaginal deliver) is controversial in the medical literature. The present study reviewed 467 women who underwent vaginal delivery following a previous cesarean section. In 414 patients the scar Was examined transcervically, and not one case of dehiscence of the scar was detected. The patients included four with twin pregnancies, and four with breech presentations (two underwent external cephalic version). Intrauterine pressure was monitored in 17 cases; Prostaglandin E2, vaginal tablets were used in 46 patients. and in 14 cases labor was augmented by Pitocin. Our results suggest that routine revision of a uterine scar at the time of a subsequent vaginal delivery is usually unnecessary.
Sonographic evaluation of fetal head extension and maternal pelvis in cases of breech presentation
Authors: Rojansky Nathan , Tanos Vasilios , Lewin Aby , Weinstein Daniel
Published: November 2007

Background. To investigate whether sonographic examination of the fetal head extension, pelvic adequacy and fetal position, could replace the traditional x‐ray method in the evaluation of t he breech in labor. Methods. Seventy‐two parturients admitted in labor with a breech presentation were prospectively evaluated by a newly proposed ultrasonographic approach. The head extension, obstetric conjugate and fetal attitude obtained were further compared 10 the gold standard radiologic measurements. Results. A highly significant correlation between ultrasonic and x‐ray measurements for the fetal head extension (r = 0.8696; p<0.00011. obstetric conjugate (r = 0.8931 p<0.0001), as well as high reliability (95.5%)) in diagnosing the breech variant by ultrasound have been found. Conclusions. Ultrasonic evaluation of breech presentation, as performed by the proposed method. is simple, easy to perform aid compares well with the standard radiologic studies. It is suggested that modern ultrasonic technique. which carries no risk of ionizing radiation, may replace traditional x‐ray examination of the breech in labor.
Changes in risk factors for unfavorable pregnancy outcome among singletons over twenty years
Authors: Sipilä Pirkko , Hartikainen Anna‐Liisa , Von Wendt Lennart , Oja Hannu
Published: November 2007

Objectives. To examine the change in the prevalence and relative effect of pre‐pregnancy risk factors for low birthweight and/or stillbirth and/or neonatal mortality over a period of twenty years.

Design. Two prospectively collected one year birth cohorts.

Setting. The two northernmost administrative districts of Finland.

Patients. A birth cohort for 1966 comprising I1905 singleton births and a cohort for 1985‐86 containing a further 9247.

Main outcome measures. Risk factors for poor pregnancy outcome.

Results. In twenty years the prevalence of low birthweight infants among singletons decreased from 4.2%, to 3.1% and that of stillbirths and neonatal deaths from 2.4%) to 0.9%. The impact of single marital status decreased and while maternal age < 19 years was not an independent risk factor. the age ≥35 years related more to poor pregnancy outcome. The proportion of multiparous women was halved but multiparity had a protective influence on pregnancy outcome meanwhile the impact of primiparity decreased markedly. In spite of more effective health education. the prevalence of heavy smokers was 4 times higher in the 1980s as compared with the 1960s. and its impact on adverse outcomes increased. with odds ratio (OR) 1.72 (confidence interval (CI) 1.14‐2.61) in 1966 and OR 2.15 (CI 1.61‐2.88) in 1985‐86. The number of mothers with a previous low birthweight baby was halved but the impact of low birth weight was still great in the latter cohort (OR 2.47; CI 1.64‐3.71). The impact of an earlier stillbirth and/or neonatal death increased significantly. with an OR 1.53 (CI 1.10‐7.14) in 1966 and OR 2.95 (CI 1.814.81) in 1985‐86, but the number of mothers concerned was halved from that in 1966.

Conclusions. The prevalence of pregnancies with an adverse outcome decreased markedly, as did the prevalence of many of the risk factors. The proportion of ≥35 years old parturients and of heavy smokers increased. The impact of primiparity decreased, while that of a previous poor pregnancy outcome increased. Identification of pregnancies with a risk of a poor outcome as assessed from pre‐pregnancy factors has not improved in these twenty years, especially where primiparous parturients are concerned.
The relationshp of clinical‐pathologic status and adiuvant treatment with natural hller cell activity in stage I and II endometrial carcinoma
Authors: Garzetti Giuseppe Gioele , Ciavattini Andrea , Muzzioli Mario , Goteri Gaia , Fabris Nicola , Valensise Herbert , Romanin Carlo
Published: November 2007

Objective. The aim of our study was to evaluate the basal immune reactivity in patients with locally advanced endometrial carcinoma, and the immune modulating effect of adjuvant treatment in cancer population randomized to endocrine or radiation therapy.

Material and methods. Forty‐three patients with FIGO stage I and II endometrial carcinoma, treated with primary radical surgery, were randomly selected to receive endocrine (medroxy‐progesterone acetate 30 mg weekly and Tamoxifen 300 mg weekly, given consecutively) or radiation adjuvant treatment (external beam photon treatment of the whole pelvis, with an average total dose of 3680 cGy rad). The immune assay included the evaluation of natural killer cell activity by target cell retention of the fluorescent dye carboxyfluoresceyn diacetate. using sensitive cell line K 562. The immunological monitoring was performed before surgery, and then before, during, and after adjuvant treatment. Nine patients, who refused any adjuvant treatment, were recruited as controls.

Results. Patients, matched for age and demographic characteristics. with locally advanced endometrial carcinoma had significantly lower mean values of natural killer activity than in henlthy controls: the decrease of natural cytotoxicity was significantly related to the depth of inyometrial invasion. The adjuvant treatment was associated with a significant immune modulation: patients in endocrine therapeutic regimen showed an increase of natural killer activity. while patients in radiation therapy had a reduction; in the control group there was no significant modification of natural cytotoxicity during negative follow up.

Conclusions. Natural killer cell activity of peripheral blood is significantly reduced in local advanced endometrial carcinoma patients. The natural cytotoxicity evaluation, as a function of therapeutic modality, may be useful in establishing a relationship between adjuvant treatment and immune status in endometrial carcinoma.
Kindermann G, Lampe B, eds. Immunohistochemische Diagnostik gynäcologischer Tumoren. Diagnostic immunohistopathology of Gynecologic Tumors
Authors: Sandvei Roar
Published: November 2007

167 pp., tables, figures. Georg Thieme Verlag Stuttgart ‐ New York: 1992. Price. DM 98.00.
Pulsatile fluctuations of plasma‐gonadotropin‐releasing hormone and corticotropin‐releasing factor levels in healthy pregnant women
Authors: Petraglia Felice , Genazzani Alessandro D. , Aguzzoli Lorenzo , Gallinelli Andrea , de Vita Davide , Caruso Alessandro , Genazzani Andrea R.
Published: November 2007

Several data emphasize the neuroendocrine aspects of human placenta. Classical hypophyseo‐tropic neurohormones are produced and secreted by the human placenta. Indeed, in contrast with non pregnant subjects, gonadotropin‐releasing hormone (GnRH) and corticotropin‐releasing factor (CRF) are measurable in maternal plasma during pregnancy. The aim of the present study was to investigate the characteristics of the secretory pattern of maternal plasma GnRH and CRF levels. A total of 25 healthy pregnant women participated in the present cross‐sectional study. Plasma levels of the two neurohormones were measured according to three different time‐intervals: 1) every five minutes for eight hours (n=4), 2) every ten minutes for four hours (n= 15), 3) every four hours for 24 hours (n =7). Following an acidic extraction plasma GnRH and CRF levels were measured by specific radioimmunoassay. Using two different algorithms (Detect and Cluster) a pulsatile pattern for both plasma GnRH and CRF levels was observed. Specific pulse frequency, amplitude, and duration were found. In the groups of women studied with a longer sampling interval, pulse frequency of GnRH or CRF levels did not differ between first and third trimester of gestation. However, amplitude of CRF pulses were significantly higher at term than at early stages of pregnancy (p≤0.01), while GnRH pulse amplitude was highest in women at first trimester of gestation. Evaluating the degree of concordance in all subjects, GnRH pulses significantly correlated with CRF pulses at 30 min. lag (p≤0.01). No significant circadian changes were found for any circulating neurohormone measured. The present study showed that maternal circulating neurohormone levels change according to a pulsatile pattern, probably reflecting the placental secretory events.
Factors associated with abruptio placentae in preterm deliveries
Authors: Spinillo Arsenio , Capuzzo Ezio , Colonna Laura , Solerte Laura , Nicola Sabrina , Guaschino Secondo
Published: November 2007

Objective. To evaluate risk factors associated with occurrence of abruptio placentae in preterm deliveries.

Methods. Risk factors were evaluated in 55 consecutive index cases of abruptio placentae and 726 control patients delivered between 24‐36 weeks' gestation.

Results. In logistic regression analysis abruptio placentae was associated with a low number of antenatal visits, smoking in pregnancy, hypertension, intravenous drug abuse and a history of recent abdominal trauma. Among hypertensive disorders of pregnancy, preeclampsia superimposed on chronic hypertension was associated with the highest risk of premature placental separation. Finally, there was a significant trend relating duration of premature rupture of membranes with abruptio placentae (chi‐square for trend =3.93, p =0.047).

Conclusions. Several risk factors seem strongly associated with abruptio placentae in preterm deliveries; the presence of these risk factors should dictate intensive surveillance.
CO2‐laser excision of endometriosis does not improve the decreased natural killer activity
Authors: Oosterlynck Dldier J. , Meuleman Christel , Waer Mark , Koninckx Philippe R.
Published: November 2007

Objective. We recently described a decreased lymphocyte‐mediated cytotoxicity to autologous endometrium and to natural killer‐sensitive targets in women with endometriosis. The purpose of the present study was to investigate whether the defect remained after COylaser excision of the endometriotic lesions.

Design. In 15 women with endometriosis the cytotoxicity assays were performed before and three to four months after complete removal of the endometriotic lesions with COylaser excision. CA‐125 serum levels were measured before and after laser laparoscopy, in order to confirm that endometriosis had been treated properly.

Results. After removal of the endometriotic lesions the decreased natural killer activity (K562‐assay) and the impaired cytotoxicity of autologous and even heterologous lymphocytes to the endometrium remained unchanged, and those cytotoxicity assays were still significantly decreased compared to the women without endometriosis. CA‐125 serum concentrations, however, were still significantly decreased three to four months after CO,‐laser excision of the endometriosis, (paired Student's t‐test p< 0.007).

Conclusions. These data suggest a primary deficiency in natural killer activity in women with endometriosis and are in accordance with our clinical experience as endometriosis is relapsing frequently after treatment.
Vaginal ultrasonography versus colpo‐cysto‐urethrography in the evaluation of female urinary incontinence
Authors: Mouritsen Lone , Strandberg Charlotte
Published: November 2007

To compare the information of bladder neck suspension given by colpo‐cysto‐urethrography (CCU) and vaginal ultra‐sonography (US), 44 women with various grades of incontinence were examined by both methods. The criteria for evaluation of incontinence for each method were applied on both procedures. CCU‐diagnoses of type of bladder neck descent were compared as well as US‐measurements of bladder neck position and mobility in relation to the symphysis pubis during rest, Valsalva and withholding. The interobserver agreement of diagnoses was 58%, which is comparable to interobserver agreement for CCU. The measurements of bladder neck suspension by bladder to symphysis (BS)‐distance and rotation‐angle in relation to the symphysis pubis, revealed almost identical results for the two procedures. The US‐measurements had a better accuracy than the CCU measurements. Furthermore, hypermobility of the bladder neck was related to grade of incontinence and to diagnoses including anterior suspension defects. Presence of a cysto‐ or rectocele affected the size of the rotation angles. Patients with a cystocele had a 16o larger rotation angle by both procedures. Presence of a rectocele increased the rotation angle, measured by US, but decreased the angles, measured by CCU. Furthermore, the ability to withhold was decreased, when the patient had a rectocele. Since the same information of bladder neck suspension is provided by the two methods, and since the US‐criteria revealed a better accuracy and a good clinical reliability, ultrasonography is recommended for evaluation of bladder neck anatomy ‐ also for practical and economical reasons.
Laparoscopic sterilization under local anesthesia
Authors: Munk Torben , Kjer Jens Jørgen
Published: November 2007

Fifty‐two women were sterilized through laparoscope under local anesthesia with Filshie‐clips. The majority (94%) were satisfied with the method. During the operation three patients were submitted to general anesthesia due to adhesions (two) and inadequate relaxation (one). Admission period and sick leave were reduced to a minimum.
Malignant mixed miillerian tumor of the fallopian tube
Authors: Zorlu C. Gürkan , Clobanolu Ömer , Kuscu Esra , Aribas Duygu
Published: November 2007

Primary malignant mixed miillerian tumor of the fallopian tube is uncommon. Only 37 cases of malignant mixed miillerian tumor of the fallopian tube have been reported to date and of these only 16 contained heterologous components (mesodermal mixed tumor). This rarity made us report a case of malignant mixed miillerian tumor of the fallopian tube containing heterologous components which was operated on in our gynecologic oncology department. Postoperatively the patient was placed on six courses of adjuvant chemotherapy consisting of cis‐platinum, adriamycin and cyclophosphamide (PAC). Second look laparotomy was performed after completion of chemotherapy. Presently, she is doing well, at two months follow‐up, with no evidence of disease.
Assessment of estrogen receptor distribution in human endometrium by direct immunofluorescence
Authors: Ben‐Hur Herzl , Mor Guillemor , Insler Vasclav , Blickstein Isaac , Amir‐Zaltsman Yehudit , Kohen Förtüne
Published: November 2007

Objective. To use a direct immunofluorescence technique employing a fluorescein labeled anti‐idiotypic antibody that recognizes the estrogen receptor (ER) order to assess the distribution of ER in the uteri of normal women throughout the normal menstrual cycle and of a woman exposed prenatally to diethylstilbestrol (DES).

Subjects. Included in the study were 25 women aged between 35 and 50 years and an amenorrheic patient diagnosed as “DES Syndrome”.

Localization. Localization of ER expression in frozen sections of uterine tissue was achieved by direct immunofluorescence using a fluorescein labeled anti‐idiotypic antibody that interacts with ER.

Results. Analysis of the immunofluorescence staining indicated that in the normal human endometrium the intensity of ER staining varied according to the phase of the cycle as well as according to the cell type. On the other hand, endometrial ER evaluation of the patient with DES syndrome showed minimal expression of ER and after treatment with conjugated estrogens, endometrial biopsy revealed a significant increase in ER expression.

Conclusions. These findings indicate that the fluorescein labeled anti‐idiotypic antibody can be used to detect ER in normal and pathological human endometrium and to monitor changes in ER expression in the endometrium during hormonal therapy.
Perinatal outcome after in vitro fertilisation
Authors: Petersen Karsten , Hornnes Peter J. , Ellingsen Susanne , Jensen Flemming , Brocks Vibeke , Starup Jørgen , Jacobsen Joes Ramsøe , Andersen Anders Nyboe
Published: November 2007

A prospective series of 90 consecutive pregnancies (70 singleton, 16 twin and 4 triplet pregnancies) resulting in births of 114 infants after in vitro fertilisation (IVF) at Rigshospitalet were compared to a control group of pregnancies and deliveries in 70 non‐IVF infertility patients with singleton pregnancies and 20 women with normal fertility with twin (n=16) or triplet (n=4) pregnancies. No differences in the incidence of third trimester pregnancy complications, abnormal fetal karyotypes or malformations were found. The number of women with spontaneous onset of labor and the gestational age at delivery were similar in the IVF and control groups. In singleton deliveries, the birth weight was lower (p<0.025) in the IVF group (median 3145 g, range 8904300 g) than in the control group (3399 g, 2592–4850 g), whereas in multiple gestation similar birth weights were found in the IVF and control groups. We conclude that the birth weight in singleton deliveries after IVF is lower than the birth weight in infertility patients treated differently. The cause of this difference remains obscure.
Pulmonary edema in association with an intravenous infusion of sulprostone
Authors: Stock Anthony , Jones Robert , Chung Tony , Fung Hedy Yun Mei
Published: November 2007

We encountered a patient with pre‐eclampsia who developed pulmonary edema whilst receiving an infusion of sulprostone. Recent evidence suggests that pulmonary hypertension following the administration of prostaglandins may result from stimulation of an EP3 or thrombox‐ane receptor in the pulmonary artery, This has implications for therapeutic use of prostaglandins.
β‐HCG concentration in peritoneal fluid and serum in ectopic and intrauterine pregnancy
Authors: Oettinger Moshe , Odeh Marwan , Tarazova Lidia , Snitkovsky Tamara , Ophir Ella
Published: November 2007

Objective. To evaluate the significance of P‐HCG levels in peritoneal fluid and serum in the diagnosis of ectopic pregnancy.

Study design setting. Obstetrics and Gynecology department of a regional general hospital.

Subjects. Sixty‐two women who presented with a differential diagnosis of ectopic pregnancy vs. nonviable intrauterine pregnancy.

Interventions. All patients underwent D & C and culdocentesis. P‐HCG was measured in simultaneously obtained peritoneal fluid (PF) and serum (S), and the PFiS ratio calculated.

Results. Twenty‐three patients had an ectopic pregnancy (Group I). All 23 had higher β‐HCG concentrations in the PF than in the serum, with a mean PFiS ratio of 19.1 ± 16.9. Twenty‐four patients had an intrauterine pregnancy (Group II). The β‐HCG levels in the PF and serum were similar (mean PF/S 1.1 ±0.2). The difference in PFiS ratio between groups I and II was statistically significant (p<0.001).

Conclusion. The measurement of P‐HCG in peritoneal fluid and serum is a useful diagnostic tool in differentiating ectopic from intrauterine pregnancy.
Sterility of the uterine cavity
Authors: Møller Birger R. , Kristiansen Frank V. , Thorsen Poul , Frost Lars , Mogensen Søren C.
Published: November 2007

In a prospective open study the sterility of the uterine cavity was evaluated in 99 women admitted for hysterectomy. The indications for hysterectomy were in most cases persistent irregular vaginal bleeding and fibromyomas of the uterus. Samples for both aerobic and anaerobic bacteria, Chlamydia trachomatis, yeasts and viruses were taken preoperatively from the apex of the vagina and cervical of. Immediately after hysterectomy the uterus was opened under sterile conditions and samples obtained from the isthmus and fundus of the uterine cavity for microbiological examination. Wet smears were taken from the same sites.

Nearly a quarter of all the patients harbored one or more microorganisms in the uterus, mostly Gardnerella vaginalis, Enterobacter and Streptococcus agalactiae.

We found that in a significant number of cases, the uterine cavity is colonized with potentially pathogenic organisms which may play a causative role in endometritis. The results indicate that inflammation of the uterine cavity should be evaluated by hysteroscopic examination before hysterectomy is undertaken in patients with persistent irregular vaginal bleeding.
Malignant fibrous histiocytoma of the uterus: Some immunohistochemical and ultrastructural observations
Authors: Isaksen Christina V. , Lindboe Christian F. , Hagen Bjørn
Published: November 2007

Hysterectomy was performed in a 64‐year‐old woman because of a uterine malignant tumor which extensively involved both the endometrium and the myometrium. Histological examination revealed a malignant fibrous histiocytoma (MFH) of the pleomorphic‐storiform type. The presence of epithelial or heterologous mesenchymal tumor components or cells of smooth muscle derivation was ruled out by immunohistochemistry and electron microscopy. The patient developed pulmonary metastases and died six months after surgery. MFH is a rare primary tumor of the uterus, but it should be considered in cases of malignant mesenchymal tumors without heterologous elements or signs of smooth muscle derivation.
Paternal influences on birthweight
Authors: Wilcox Mark A. , Newton Carol S. , Johnson Ian R.
Published: November 2007

Objective. To assess the influence of paternal size on birthweight after suitable control for maternal and fetal factors.

Design. Prospective observational study.

Setting. Delivery state, City Hospital. Nottingham.

Subjects. 571 husbands/partners of unselected women delivering August 1992 to February 1993.

Main outcome methods. Individualised birthweight ratio and thereby an adjusted birthweight for a cypical mother. The results of a multiple regression analysis with the individualised birthweight ratio as the dependent variable.

Results. When considered in isolation both paternal height and weight are significantly positively associated with crude and adjusted birthweight (p<0.01, analysis of variance). Due to correlations of paternal size with maternal size and smoking habit, only paternal height is significant in the multiple regression analysis (p = 0.01).

Conclusion. If the partner of an average woman is short (mean—2s.d.) then the baby will be 183 g lighter than if he is tall (mean+2s.d.). This effect of paternal height on birthweight must be genetic arid therefore should be taken into account when defining intra‐uterine growth retardation and macrosomia.
Effects of long‐term administration of an oral contraceptive containing ethinylestradiol and cyproterone acetate on lipid metabolism in women with polycystic ovary syndrome
Authors: Falsetti Leopoldo , Pasinetti Edda
Published: November 2007

Background. The effects of an oral contraceptive pill containing cyproterone acetate on lipid metabolism in women with polycystic ovary syndrome (PCOS) was studied.

Materials and methods. Seventy‐two women with PCOS were treated for 36 consecutive cycles with an oral contraceptive containing 0.035 mg of ethinylestradiol and 2 mg of cyproterone acetate. Hormonal. lipid and glucose profiles were studied before and after 12 and 36 cycles of treatment. Lipid, lipo‐and apolipoprotein values were compared to a healthy control group. Statistical analysis was by one way analysis of variance and Bonferroni's t tests.

Results. The treatment suppressed gonadotropin and androgen values and increased the levels of sex hormone binding globulin. After 12 and 36 cycles a significant increase in triglycerides, high density lipoprotein (HDL) cholesterol system, and apoprotein B levels was seen. Low density lipoprotein (LDL) cholesterol and LDL cholesterol/HDL cholesterol ratio were reduced. Insulin and glucose plasma concentrations did not change. During treatment triglycerides, total cholesterol and apoprotein B values were higher than in the control group. There were no differences in plasma levels of LDL‐C and HDL‐C in PCOS and in the control group.

Conclusion. Lipid and lipoprotein changes observed after treatment could be due to the estrogen dominance of the treatment. The plasma concentration of triglycerides and total cholesterol during treatment does not change appreciably and the LDL‐CIHDL‐C ratio improved.
Detection of bacterial vaginosis in wet mount, Papanicolaou stained vaginal smears and in Gram stained smears
Authors: Platz‐Christensen Jens Jörgen , Larsson Per‐Göran , Sundström Ewa , Wlqvlst Nils
Published: November 2007

In a prospective study of 107 women, bacterial vaginosis was clinically diagnosed in 34 women. Compared with clinical diagnosis of bacterial vaginosis, detection of clue cells in Papanicolaou stained vaginal smears showed a sensitivity of 88.2%, a specificity of 98.6%, a positive predictive value of 96.8% and a negative predictive value of 94.7%. The corresponding values for detection of bacterial vaginosis in Gram stained smears compared with the clinical diagnosis were 100%, 97.3%, 94.4% and 100%, respectively. Compared with clue cells in wet smears, identification of clue cells in Papanicolaou stained vaginal smears showed a Kappa index of 0.87 and compared with Gram stain criteria a Kappa index of 0.94. The correlation between Gram stain and Papanicolaou stained vaginal smears showed a Kappa index of 0.89. In contrast to the results of earlier investigators our studies indicate that the demonstration of clue cells in Papanicolaou stained vaginal smears correlate reasonably well with the conventional clinical criteria. However, the Gram stain method may be more reliable than the Papanicolaou method.
Serial antenatal monitoring compared with labor induction in post‐term pregnancies
Authors: Almström Harald , Granström Lena , Ekman Gunver
Published: November 2007

Objective. In view of the increased risk of obstetric and perinatal complications in post‐term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks.

Materials and methods. A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 gravidae admitted for induction of labor at 42 weeks. A third, high‐risk, group comprised gravidae (from either of the foregoing groups) who had to be admitted for emergency induction of labor owing to increased fetal risk (i.e., the presence of oligohydramnios or a small‐for‐gestational‐age fetus).

Results. The frequency of labor induction was significantly lower in the study group than among controls (p < 0.001), but the two groups did not differ in obstetric or perinatal outcome. As compared with these two low‐risk groups, the high‐risk group was characterized by significantly higher frequencies of instrumental delivery (p < 0.01), operative delivery for fetal distress (p < 0.001) and infants requiring neonatal intensive care (p < 0.001).

Conclusion. As the wait‐and‐see policy with serial monitoring resulted in a lower rate of labor induction, but not in a lower rate of instrumental delivery or perinatal complication, medically the two routines would appear to be comparable. However, an individual approach with intensified fetal surveillance is to be recommended, as it is vital to identify post‐term pregnancies where the fetus is at increased risk. The use of such new techniques as umbilical artery flow velocimetry would no doubt improve the management of high‐risk post‐term pregnancies.
Laser endometrial ablation with the neodynium: Yttrium‐aluminium garnet (Nd‐YAG) laser: A review of ninety consecutive patients
Authors: Osei Edward , Tharmaratnam Suresh , Opemuyi Isaac , Cochrane Geoffrey
Published: November 2007

Objective. To assess the effectiveness of laser endometrial ablation in women with dysfunctional bleeding.

Design. A retrospective analysis of 90 patients.

Setting. Department of Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex IG3 8YB, U.K.

Subjects. Ninety patients with dysfunctional uterine bleeding who were hysteroscopically suitable for laser endometrial ablation.

Interventions. Endometrial laser ablations using the neodynium‐yttrium‐garnet laser at 70 watts power output.

Main outcome measures. Patient satisfaction/dissatisfaction at 6 months follow‐up and response to repeat ablation.

Results. A total of 117 procedures were carried out on the 90 patients. There was one suspected perforation which was not confirmed at subsequent hysterectomy and one primary hemorrhage which required tamponade with Foley catheter. There were three cases of fluid overload with no clinical evidence of fluid over‐load syndrome. All five major complications occurred in the first six months or ‘learning phase’ of the study. During this period, there were proportionately more treatment failures after one attempt (52.8% versus 42.6%) than the second six months of the study. Overall. 53.3% of the patients were satisfied with the initial ablation and 73.3% were satisfied after repeat ablations.

Conclusion. Endometrial laser ablation is a major advance in the management of dysfunctional uterine bleeding, especially in patients who would otherwise have had a hysterectomy.
Maternal And Fetal Serum Levels Of Organochlorine Compounds In Cases Of Premature Rupture Of Membranes
Authors: Ron M. , Cucos B. , Rosenn B. , Hochner‐Celnikier D. , Ever‐Hadani P. , Pines A.
Published: November 2007

Blood residue levels of some organochlorine pesticides (DDT and its analogues, lindane, dieldrin, heptachlor epoxide) and polychlorinated biphenyls were measured in maternal and cord blood in 20 cases of premature rupture of fetal membranes at term and in 15 matched controls. No evidence of a possible organochlorine compounds role in the pathogenesis of premature rupture of the membrane was found.
The Effect Of Flurbiprofen And Naproxen Sodium On Intra‐Uterine Pressure And Menstrual Pain In Patients With Primary Dysmenorrhea
Authors: Milsom Ian , Andersch Björn , Sundell Gunilla
Published: November 2007

The effects of flurbiprofen (100 mg) and naproxen sodium (500 mg) on intrauterine pressure and menstrual pain were assessed in 8 women with primary dysmenorrhea using a double‐blind parallel study technique. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles, and the area under the curve were analysed in 30 min periods. Prior to medication all the patients displayed signs of uterine hyperactivity as judged by a high resting pressure 55.3±3.8 mm Hg, high active pressure 175.0±6.1 mm Hg and a high frequency of pressure cycles 12.3±0.7 contractions per 0.5 h. Oral administration of flurbiprofen and naproxen sodium significantly suppressed uterine activity and was associated with a significant reduction in pain intensity. However no significant differences were recorded between the two drugs regarding their effects on intrauterine pressure and pain intensity.
Intravascular Fetal Blood Transfusion Under Ultrasonic Guidance In A Case Of Severe Rh Isoimmunization
Authors: Westgren Magnus , Stangenberg Magnus , Sasidharan Ponthenkandath , Schifano Joseph
Published: November 2007

A severely Rh‐affected fetus with an initial hematocrit value of 7% and a hemoglobin value of 2.3 g/dl was transfused three times by the intravascular route into the umbilical cord under ultrasonic guidance. After the second transfusion, fetal movements recurred and the non‐stress test became reactive. Neonatal outcome was favorable. The implications of this procedure are discussed.
Ruptured Uterine Sacculation: A Rare Presentation Of Ectopic Implantation
Authors: Saha Arabinda , Bhargava Vijay Laxmi
Published: November 2007

Pregnancy growing in the uterine sacculation following medical termination of pregnancy is a rare occurrence. We present one such case in which rupture occurred on the ward while the patient was waiting for diagnostic laparotomy.
Sex Differences in Dually Diagnosed Severely Mentally III Clients in Dual Diagnosis Outpatient Treatment
Authors: Comtois Katherine Anne , Ries Richard K.
Published: November 2007

The authors explored gender differences among clients enrolled in an integrated outpatient program for dually diagnosed severely mentally ill patients. A total of 338 clients (36% women) were evaluated in several clinical areas. Women were more often diagnosed with affective disorders and men with schizophrenia. Women were more often single vs. polydrug users, showed lower levels of substance use, and had higher overall functioning. Women, however, attended groups less often than men despite comparable individual attendance and compliance. The authors discuss results in terms of program evaluation and future research.
Fluidization of fine and ultrafine particles using nitrogen and neon as fluidizing gases
Authors: Valverde Jose Manuel , Quintanilla M. A. S. , Castellanos Antonio , Lepek Daniel , Quevedo Jose , Dave Rajesh N. , Pfeffer Robert
Published: November 2007

When fluidized by a gas, some agglomerated fine and ultrafine particles display a regime of uniform, nonbubbling fluidization known as agglomerate particulate fluidization (APF). The agglomeration of micrometric sized particles, or simple pre‐existing agglomerates in the case of nanoparticles, is governed by the balance between hydrodynamic shear forces and interparticle attractive forces. From this balance the theoretical scaling law Bog ∼ kD+2 has been derived, where Bog, the granular Bond number, is the ratio of the interparticle attractive force to particle weight, k is the ratio of agglomerate to particle size, and D is the fractal dimension. In the experimental program the behavior of gas‐fluidized beds of fine and ultrafine particles as affected by the use of neon and nitrogen as fluidizing gas is studied. The experimental results indicate that there is no relevant distinction between the sizes of agglomerates fluidized with the different gases as theoretically predicted. However, it is seen that the relatively small increment of gas viscosity opens up a new window of highly expanded agglomerate particulate fluidization (APF) behavior with a delayed onset of bubbling. For a sufficiently high‐gas viscosity, and/or smaller particle size, full suppression of the bubbling regime is observed. For nanoparticles exhibiting agglomerate bubbling fluidization (ABF) behavior, where bed expansion is small, and bubbling occurs soon after minimum fluidization, we also observe a delayed onset of bubbling when fluidizing with a gas of higher viscosity. © 2007 American Institute of Chemical Engineers AIChE J, 54: 86–103, 2008
Hollow fiber membrane contactor for hydrogen sulfide odor control
Authors: Boucif Noureddine , Favre Eric , Roizard Denis , Belloul Mohamed
Published: November 2007

Hollow fiber membrane modules are extensively used as gas–liquid contactors for acid gas removal from waste gas streams. Hydrogen sulfide is an important indoor and outdoor contaminant, but, given its toxicity, a limited number of experimental results have been reported for this compound. Moreover, chemical absorption has been exclusively investigated. In this study, hydrogen sulfide odor control by absorption in water thanks to a hollow fiber contactor has been studied both experimentally and theoretically. The scrubbing of hydrogen sulfide from air gas mixture is investigated in two porous polypropylene (PP) hollow fiber modules of different contact area and fiber packing fraction. The gas phase is circulated in the lumen of the fiber bore and the liquid phase in the shell in a nonwetted mode, i.e. the membrane pores being filled with gas. The gas phase was run in countercurrent contact with the liquid phase at constant pressure. A laminar parabolic velocity has been employed to describe the convective diffusive mass transport equation which has been solved analytically and numerically. The calculated extents of hydrogen sulfide depletion reasonably compare with the generated experimental results for both membrane modules. Up to 85% of acid gas could be removed at gaseous flowrates of 200 cm3/min for the large module and removals as high as 89% at 10 cm3/min have been observed for the smaller one. The overall mass transfer coefficients calculated from the experimental data, agree satisfactorily with those generated by the mathematical model. The relation of the dimensionless Sherwood number to the Graetz number is in a good agreement with the Levêque semianalytical solution. © 2007 American Institute of Chemical Engineers AIChE J, 54: 122–131, 2008
Beckwith–Wiedemann‐like macroglossia and 18q23 haploinsufficiency
Authors: Lirussi Frédéric , Jonard Laurence , Gaston Véronique , Sanlaville Damien , Kooy R. Frank , Winnepenninckx Birgitta , Maher Eamonn R. , FitzPatrick David R. , Gicquel Christine , Portnoï Marie‐France , Couderc Rémy , Vazquez Marie‐Paule , Bahuau Michel
Published: November 2007

Beckwith–Wiedemann syndrome (BWS) is an overgrowth condition with tumor proclivity linked to a genetic imbalance of a complex imprinted region in 11p15.5. A female child with features fitting in with the BWS diagnostic framework and an apparent loss of imprinting (LOI) of the IGF2 gene in 11p15.5 was also reported to have a de novo chromosome 18q segmental deletion (Patient 1), thus pointing at the location of a possible trans‐activating regulator element for maintenance of IGF2 imprinting and providing one of the few examples of locus heterogeneity of BWS. A second child with de novo 18q23 deletion and features of macroglossia, nævus flammeus, bilateral inguinal hernia and transient neonatal hypoglycemia, thus also fitting in with the BWS diagnostic framework, is here fully reported (Patient 2). In this child, an analysis of the BWS1 locus precluded any paternal isodisomy and showed a normal imprinting pattern (mono‐allelic expression of IGF2 and normal H19 and CDKN1OT1/LIT1 methylation index). In Patients 1 and 2, deletions were shown to overlap, defining a minimal region of haplo‐insufficiency of 3.8–5.6 Mb in 18q23. We conclude that this region provides a candidate location for an original macroglossia condition with strong overlap with BWS, but without obvious upstream functional relationship with the BWS1 locus in 11p15.5. Because this minimal region of haplo‐insufficiency falls into a common region of deletion in 18q– syndrome, we inferred that this macroglossia condition would follow a recessive pattern of inheritance. © 2007 Wiley‐Liss, Inc.
Familial and genetic associations in Worster‐Drought syndrome and perisylvian disorders
Authors: Clark Maria , Neville Brian G.R.
Published: November 2007

Worster‐Drought syndrome (WDS) is a distinct clinical phenotype, comprising a congenital pseudobulbar palsy usually in association with a mild tetraplegia and often additional impairments. The phenotype is identical to that described in congenital bilateral perisylvian polymicrogyria syndrome (CBPS) and appears to have several different causes and a significant familial incidence. This study draws from a database of children with WDS phenotype or perisylvian polymicrogyria, held at a tertiary center. The findings suggest that genetic factors are important for a significant proportion of children and points to considerable genetic heterogeneity. There are grounds for considering WDS and perisylvian polymicrogyria as a spectrum of perisylvian malfunction. © 2007 Wiley‐Liss, Inc.
Brachymesomelic dysplasia with Peters anomaly of the eye results from disruptions of the X chromosome near the SHOX and SOX3 genes
Authors: Bleyl Steven B. , Byrne Janice L.B. , South Sarah T. , Dries David C. , Stevenson David A. , Rope Alan F. , Vianna‐Morgante Angela M. , Schoenwolf Gary C. , Kivlin Jane D. , Brothman Arthur , Carey John C.
Published: November 2007

We report on a mother and son affected with an unusual skeletal dysplasia and anterior segment eye abnormalities. Their skeletal phenotype overlaps with the SHOX‐related skeletal dysplasias and is intermediate between Leri–Weill dyschondrosteosis (LWD) and Langer Mesomelic dysplasia (LMD). The mother has bilateral Peters anomaly of the eye and was reported as having a new syndrome; the son had severe bilateral sclerocornea. Chromosome analysis showed that the mother has a pericentric inversion of the X chromosome [46,X,inv(X)(p22.3q27)] and the son, a resultant recombinant X chromosome [46,Y,rec(X)dup(Xq)inv(X)(p22.3q27)]. The observed skeletal and ophthalmologic abnormalities in both patients were similar in severity. The additional features of developmental delay, growth retardation, agenesis of the corpus callosum, cryptorchidism and hypoplastic scrotum in the son are consistent with Xq28 duplication. Analysis of the son's recombinant X chromosome showed that the Xp22.33 breakpoint lies 30–68 kb 5′ of the SHOX gene. This finding suggests that the skeletal dysplasia in both mother and son is allelic with LWD and LMD and results from a novel misexpression of SHOX. Analysis of the Xq27.1 breakpoint localized it to a 90 kb interval 3′ of the SOX3 gene, supporting a novel role of SOX3 misexpression in the development of Peters anomaly of the eye. © 2007 Wiley‐Liss, Inc.
Epidemiological association between isolated skin marks in newborn infants and single umbilical artery (SUA). Does it have biological plausibility?
Authors: Martínez‐Frías María Luisa ,   Grupo de trabajo del ECEMC
Published: November 2007

In a previous study on single umbilical artery (SUA) and its association with congenital defects, we observed a serendipitous association between isolated skin anomalies and the presence of SUA. Although this could be a spurious association, we considered that it deserved to be studied in detail. The aim of this study was to investigate, in an epidemiological setting, whether this association has any biological meaning or if it occurs just by chance. Using data from the Spanish Collaborative Study of Congenital Malformations (ECEMC), we analyzed “angiomas” (including all type of capillary skin marks, since it is not possible to distinguish it during the first 3 days of life), and nevi because they are the only defects detected in newborn infants as isolated skin defects. In the ECEMC methodology, infants with nevi or angiomas as the only congenital defect are considered as cases when they present with only one of these skin marks measuring at least 1 cm in diameter and within the first 3 days of life, or when they have three or more such marks of any size. A total sample of 1,832 consecutive newborn infants with isolated congenital skin marks was identified: 871 with nevi, 958 with angiomas, and 3 with both. Newborn infants with SUA and isolated angiomas displayed higher birth measurements, and older maternal and paternal ages than newborn infants with angiomas and three umbilical vessels. Similar results were observed when infants with angiomas and SUA were compared with control infants either with or without SUA. These associations were not observed in newborn infants with nevi with or without SUA or for control infants with or without SUA. The distribution of the angiomas by body areas, and sex preferences were also analyzed. After evaluating the limitations and advantages of the present study, the results suggest that newborn infants with angiomas (irrespective of their type), SUA, and higher centile measurements may have one of the syndromes that exhibit this type of skin mark. Although this observation requires confirmation, we do suggest close attention to newborns with these three signs. © 2007 Wiley‐Liss, Inc.
DOOR syndrome: Clinical report, literature review and discussion of natural history
Authors: James Aaron W. , Miranda Suzette G. , Culver Kathy , Hall Bryan D. , Golabi Mahin
Published: November 2007

DOOR syndrome (deafness, onychodystrophy, osteodystrophy, and mental retardation) is a rarely described disorder with less than 35 reports in the literature. The hallmarks of the syndrome, represented in the DOOR acronym, include sensorineural hearing loss, hypoplastic or absent nails on the hands and feet, small or absent distal phalanges of the hands and feet, and mental retardation. The purpose of our communication is to report on an additional patient with DOOR syndrome, delineate common as well as less frequent manifestations of DOOR syndrome, bring attention to the under appreciated facial features in DOOR syndrome, document the natural history of this disorder, and propose a suggested workup of those suspected of DOOR syndrome. DOOR syndrome is associated with characteristic, coarse facial features with large nose with wide nasal bridge, bulbous tip and anteverted nares, a long prominent philtrum and downturned corners of the mouth. The natural history is one of a deteriorative course, with progressive neurological manifestations including sensorineural deafness, seizures from infancy, optic atrophy, and a peripheral polyneuropathy. The majority of patients with DOOR syndrome have elevated levels of 2‐oxoglutarate in the urine and plasma. In this report, we present a newborn with manifestations consistent with DOOR syndrome and a progressive clinical course. A comprehensive literature review reveals 32 patients with DOOR syndrome. In conclusion, DOOR syndrome is a neurometabolic disorder with recognizable facial features and a progressive natural history. © 2007 Wiley‐Liss, Inc.