bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐Specific Prevalence of Hepatitis B Surface and e Antigenemia in Pregnant Women in Taiwan
Authors: Lin Ho‐Hsiung , Hsu Hong‐Yuan , Lee Tzu‐Yao , Hsieh Rhong‐Phong , Chen Pei‐Jer , Chen Ding‐Shinn
Published: August 2010

To investigate the age‐specific prevalence of hepatitis B surface and e antigens (HBsAg and HBeAg) in pregnant women, we studied all the parturients encountered in National Taiwan University Hospital between 1985 and 1990. Serum HBsAg and HBeAg were checked by radioimmunoassay. The prevalence rate of HBsAg in pregnant women was 13.2%, 12.7%, 11.4%, 11.7%, 12.9% and 14.2%, respectively for each year. The figures seemed stable. The positive rate of HBeAg in HBsAg‐positive pregnant women was 32.8%, 39.9%, 42.6%, 30.8%, 32.0% and 31.7%, respectively during the past 6 years. We also analyzed the results in different age‐grouped pregnant women. The positive rate of HBsAg was 12.8%, 13.1%, 11.6% and 11.5% respectively in 21–25 year‐old, 26–30 year‐old, 31–35 year‐old and 36–40 year‐old groups. The positive rate of HBeAg in HBsAg‐positive pregnant women was 49.4%, 36.5%, 31.5% and 20.0% respectively in these 4 age groups, with a prevalence declining with the advanced age. We conclude that HBsAg‐positive rate was 11–14% in the pregnant women who visited our hospital, and their HBeAg‐positive rate was 31–43%. No decrease of HBsAg carriage or HBeAg prevalence was seen in the past 6 years.
A Case of Ovarian Brenner Tumor with Stromal Estrogenic Activity
Authors: Morimura Yutaka , Ohishi Mari , Hoshi Kazuhiko , Sato Akira , Munakata Satoru , Azuma Tatuo
Published: August 2010

An 88‐year‐old menopausal Japanese female suffering from atypical genital bleeding received a left oophorectomy for a tumor of the left ovary. A vaginal smear before removal of the tumor revealed high estrogenic activity. The patient's ovarian tumor was a benign Brenner tumor and contained theca‐like cells in its stroma. The pathological findings relating to these theca‐like cells suggested their estrogenic activity, and a vaginal smear after removal of the tumor revealed that estrogenic activity had disappeared.
The ABC of Shoulder Dystocia Management
Authors: Lurie Samuel , Ben‐Arie Alon , Hagay Zion
Published: August 2010

In this retrospective study we analyzed our experience in management of 76 consecutive cases of shoulder dystocia. In most cases (N = 67, 88.2%) McRoberts' maneuver was sufficient in order to deliver the impacted shoulders. In 2 cases (2.6%) in addition to McRoberts' maneuver suprapubic pressure was applied. In 7 cases (9.2%) Woods' maneuver was performed after the McRoberts' maneuver and the suprapubic pressure. Based on our experience and upon careful review of the literature we propose the optimal “ABC” for the management of shoulder dystocia. It includes A) McRoberts' maneuver, B) Suprapubic pressure, C) Woods' maneuver, D) Delivery of posterior arm. We emphasize that the shoulder dystocia situation is a major emergency in obstetrics and that its management requires prompt resuscitation of the fetus during the process of its delivery.
Enzyme‐Cytochemistry of Human Chorion Laeve at Term: Enzyme Localization on the Chorionic Trophoblast
Authors: Matsubara Shigeki , Sayama Masaaki , Sato Ikuo , Tamada Taro
Published: August 2010

Is the chorion laeve merely a remnant of the chorion frondosum in placental development? Or is it metabolically active, having something to do with materno‐fetal interactions? In order to answer these questions at least in part, we determined the ultracytochemical localizations of some important enzymes such as nonspecific phosphatase (alkaline phosphatase), specific phosphatase (Ca++‐ATPase and 5′‐nucle‐otidase) and adenylate cyclase in the human chorion laeve at term. Strong activities of these enzymes were localized by ultracytochemistry on the plasma membrane of the trophoblast in the chorion laeve. These enzyme activities were confirmed by a series of cytochemical‐control experiments, i.e., substrate‐free control, heat‐stability control, and inhibition control by inhibitors of alkaline phosphatase. These observations indicate that the chorionic trophoblast is probably metabolically active and that it might play an important role in the physiology of the fetal membrane.
Clinical Usefulness of Low‐Dose Oral Contraceptives for the Treatment of Adolescent Hyperandrogenemia
Authors: Yamamoto Takara , Okada Hiroji
Published: August 2010

In the early stage of adolescence, irregular menstruation and an anovulation often occurs. During this period, some adolescent women suffer from hyperandrogenemia, which results in acne, adiposity, and hirsutism. If adequate treatment is not given to these hyperandrogenic young women, severe hirsutism and polycystic ovary (PCO), which could be a proximate cause of juvenile endometrial carcinoma, might occur.

Young women with hyperandrogenemia show increased levels of luteinizing hormone (LH) levels and free testosterone (T)/total T ratio, and a decreased level of steroid hormone binding globulin (SHBG) in serum. Low‐dose oral contraceptives might reduce the hormone unbalance and hyperandrogenemia without leading to negative effects in the ovarian function of adolescent women.
Ultrasound Diagnosis of Rudimentary Uterine Horn Pregnancy in Fourteen Weeks of Gestation: A Case Report
Authors: Chang Wen‐Feng , Lin Ho‐Hsiung , Ho Hong‐Nerng , Sheu Bor‐Ching , Huang Su‐Cheng , Lee Tsu‐Yao
Published: August 2010

Pregnancy in a rudimentary uterine horn is rare. Rupture tends to occur in the second trimester, and results in maternal morbility and mortality. Although the diagnosis prior to rupture is difficult, early detection is essential in avoiding a fatal outcome. An asymptomatic case of pregnancy in the rudimentary horn of a bicornu‐ate uterus prior to rupture is presented. This report is to emphasize the important value of sonography for early detection of the prerupture of the rudimentary pregnancy.
The Influence of Obstetric Workload on Cesarean Section Rate
Authors: Chung Tony K.H. , Haines Christopher J. , Rogers Michael S. , Chang Allan M.Z.
Published: August 2010

The cesarean section rate in a busy obstetric unit was studied in relation to the monthly confinement rate. A total of 30,825 births over a period of 5 years were analyzed. There was a negative correlation between the emergency cesarean section rate and the unit workload (correlation = — .498, 2 tailed p = 0.0001) whilst there was no relationship between workload and the elective cesarean section rate. This suggested that the unit may reach a certain saturation level as far as the emergency cases were concerned during the busy periods. However, there was no evidence that the perinatal outcome was affected by this variation in emergency cesarean section rate.
1C5 Antigen: Cancer‐Associated Protein Expressed by Cervical Adenocarcinomas and β‐Casein
Authors: Horimoto Emi , Uede Toshimitsu , Koizumi Motoiki , Kikuchi Kokichi , Kudo Ryuichi
Published: August 2010

The monoclonal antibody 1C5 reacts with an antigenic determinant present in 90% of the cases of adenocarcinoma of the uterine cervix. The antigen denned by the 1C5 antibody exhibits immunological characteristics similar to those of skim milk (bovine buttermilk). lC5‐defined antigen obtained from tumor extract and skim milk binds specifically to wheat germ agglutinin (WGA) lectin. The lC5‐defined antigenic activity of a WGA lectin‐bound fraction was eluted at 0.7‐0.8 m NaCl off a Mono Q column. Use of an inhibition assay and a dot immunobinding assay revealed that the antigenic epitope defined by the 1C5 MoAb from skim milk exists within the first 28 amino acids of the β‐casein peptide.
The Effects of Patients' Sera with Sperm‐Immobilizing Antibodies on Sperm of the Japanese Monkey
Authors: Kameda Kinu , Fukuda Hiroshi , Shigeta Minoru , Tsuji Yoshiyuki , Koyama Koji , Torii Ryuzo , Isojima Shinzo
Published: August 2010

In order to study the interspecies cross‐reactivity of sperm‐immobilizing antibodies found in sera of women who were infertile for unknown reasons, we used the sperm‐immobilization test to examine the effects of patients' sera with or without sperm‐immobilizing antibodies on the sperm of the Japanese monkey (Macaca fuscata).

Fourteen of 17 antibody‐positive sera and 7 of 14 antibody‐negative sera showed sperm‐immobilizing activity with regard to monkey sperm. The sperm‐immobilizing antibody that was active against both human and monkey sperm could be absorbed only by sperm from each corresponding species. The periodate treatment of human or monkey sperm markedly diminished their antibody‐absorbing capabilities. Human and mouse monoclonal antibodies having sperm‐immobilizing activity with regard to human sperm showed no sperm‐immobilizing activity with regard to monkey sperm.

These results indicate that the sperm‐immobilizing activity of the sera of infertile women against human and monkey sperm might be due to antibodies with different specificities, which recognize a unique carbohydrate antigen epitope expressed in the sperm of each species.
Feticide Followed by Successful Removal of Pregnancy Products in Early Abdominal Pregnancy
Authors: Qureshi Rahat N. , Chaudhuary Nasreen , Rizvi Imtiaz , Afzal Masood
Published: August 2010

Patient presented with an acute abdomen at 18 weeks gestation. Ultrasound and CT scan confirmed single extra uterine gestation. Considering the maternal hazards associated with surgical removal of viable abdominal pregnancy feticide was performed with ultrasound guided intracardial injection of KCl solution. Ten days after the procedure successful removal of pregnancy was achieved with no intra or post operative complications.
Prediction of First‐Trimester Miscarriage from Embryonic Bradycardia and Embryonic Growth Delay
Authors: Ikegawa Akira
Published: August 2010

Objective: The purpose of this study was to determine whether subsequent and simultaneous measurements of embryonic heart rate (EHR) and crown‐rump length (CRL) are useful in predicting miscarriage.

Study Design: A prospective cross‐sectional study was performed on miscarriages with detectable embryonic heart rate (n = 33). Chromosomal tests were carried out in 9 of 33 cases.

Result: In cases with embryonic bradycardia and/or embryonic growth delay, the mean CRL was 6.6 mm (n = 16), and embryonic death occurred at CRL values under 20 mm. In cases where neither bradycardia nor growth delay was detected, the CRL was 23.9 mm (n = 17) at embryonic death. Chromosomal abnormalities were present as triploidy (n = 5) and trisomy‐16 (n = 2) in both bradycardia and embryonic‐growth‐delay cases.

Conclusion: Subsequent and simultaneous measurements of EHR and CRL are useful in predicting miscarriage in the first trimester, especially when the CRL is under 20 mm.
Prevalence, Genotypes and Antibody Titer of Hepatitis C Virus in Pregnant Women in Taiwan
Authors: Lin Ho‐Hsiung , Kao Jia‐Horng , Huang Su‐Cheng , Lee Tzu‐Yao , Chen Pei‐Jer , Chen Ding‐Shinn
Published: August 2010

Objectives: To investigate the prevalence and genotypes of hepatitis C virus (HCV) in pregnant women in Taiwan, as well as to examine whether any correlation occurs between HCV genotype and anti‐HCV titer.

Methods: Forty‐three pregnant women with positive anti‐HCV and HCV‐ RNA were selected among 3,400 cases screened from January 1992 to March 1994. Each blood specimen was assayed for HCV genotypes by PCR method to detect HCV I, II, III and IV. Anti‐HCV titer was determined by a second‐generation EIA kit with serial dilutions.

Results: Twenty‐eight cases (65%) belonged to HCV II, 11 (26%) HCV III, 3 (7%) HCV IV and 1(2%) HCV II+III. Besides, the anti‐HCV titers in HCV II and HCV III groups were similar, ranging from 8x to 40,000x and revealing no statistical significance (p = 0.75).

Conclusions: Our data have verified that the prevalence rate of HCV infection in pregnant women is around 1.3% and no significant difference of anti‐HCV titer occurs between HCV II and HCV III pregnant women.
Clinical Usefulness of the Dye‐Injection Method for Diagnosing Premature Rupture of the Membranes in Equivocal Cases
Authors: Fujimoto Seiichiro , Kishida Tatsuro , Sagawa Tadashi , Negishi Hiroaki , Okuyama Kazuhiko , Hareyama Hitoshi , Makinoda Satoru
Published: August 2010

Objective: In 1981, we preliminarily reported on the clinical value and safety of the intra‐amniotic dye (Phenol‐sulfonphthalein, PSP)‐injection method for diagnosing PROM. In the current study, through examination of 64 equivocal cases in the midtrimester of pregnancy, we investigated the clinical efficacy of the PSP test.

Methods: In the present study we examined patients with equivocal PROM in their 14th week to 33rd week of gestation, whose findings were positive according to a combination of conventional diagnostic methods. The results of the PSP test and conventional diagnostic methods were compared with the final diagnosis of PROM.

Results: The conventional diagnostic methods showed an accuracy rate of 63.9%–70.5%, in contrast to the PSP test, which had a 100%‐accuracy rate (p < 0.001).

Conclusion: Using the PSP test in combination with amnioscopy, we have established a method of differentially diagnosing PROM. We have reconfirmed the clinical efficacy of the PSP test in 64 equivocal PROM cases.
Effect of Bronchial Asthma on the Course of Pregnancy, Labour and Perinatal Outcome
Authors: Jana Narayan , Vasishta Kala , Saha Subhas C. , Khunnu Bhawani
Published: August 2010

The course of pregnancy and labour, and perinatal outcome of 182 pregnancies complicated by bronchial asthma, over a 10‐year period were studied. Antiasthmatic medications included oral and/or parenteral β2‐agonists, theophylline, aminophylline, corticosteroids, and inhaled salbutamol and beclomethasone. A control group of 364 nonasthmatic gravidas was matched for age and parity.

In asthmatic gravidas, antenatal complications mean duration of pregnancy (38.5 weeks), mode of delivery, incidence of prematurity (13.2%) and low birth weight (LBW, 19.6%) and perinatal mortality (0.5%) were not significantly different compared to the controls (p > 0.05). However, uncontrolled severe asthma in 15 gravidas who required hospitalization, was associated with significant decrease in mean birth weight (2469 ± 571 g vs 2842 ± 494 g; p < 0.05) and a high incidence of LBW neonates (53.3% vs 20.5%; p < 0.01) at mean gestation of 38 weeks.

Bronchial asthma during pregnancy, when optimally controlled does not affect the course or pregnancy and labour, and perinatal outcome. However, uncontrolled severe asthma leads to fetal growth retardation.
Malignant Brenner Tumor of the Ovary: Two Cases of Unusual Histologic Features of Relapsed Tumors
Authors: Kataoka Akio , Nishida Takashi , Imaishi Kiyohisa , Sugiyama Toru , Yakushiji Michiaki
Published: August 2010

This study focused on unusual histologic features observed in 2 relapsed Brenner tumors. Case 1: A 67‐year‐old woman had a malignant Brenner tumor. The tumor relapsed was squamous‐cell carcinoma. Case 2: A 51‐year‐old woman had a proliferating and malignant Brenner tumor with mucinous metaplasia. The relapsed tumor was a well‐differentiated mucinous adenocarcinoma. These cases suggest that: (1) the relapsed tumor cells survived chemotherapy; and (2) the relapsed tumor cells transformed.
A Clinical Trial on Diagnostic Scoring System of Choriocarcinoma and Invasive Mole in Vietnam
Authors: Hoa Phan Trung , Phuong Nguyen Thi Ngoc , van Quyen Phan
Published: August 2010

Objectives: The aim was to discrimate preoperatively invasive mole (IM) and choriocarcinoma (CC) in patients with gestational trophoblastic neoplasm (GTN) for early and satisfactory treatment in Vietnam.

Methods: In 1990, 122 patients with GTN treated at TUDU Hospital were retrospectively analysed to make a differential diagnosis between CC and IM by using the JSOG scoring system and these results were later compared with postoperative histopathological findings. Furthermore, to raise the predictive diagnostic value for CC, the authors modified the JSOG system and devised a scoring system of TUDU hospital which results were compared with that of the JSOG ones.

From the end of 1990 to March 1993, in 151 patients with GTN who underwent surgery, preoperative and postoperative diagnoses of CC and IM were prospectively compared using the JSOG and the modified scoring system.

The comparative data were statistically analysed using the t‐test, X2 test and Fisher test. The sensitivity, specificity, and the positive and negative predictive value, and false positive and false negative were calculated and compared.

Results

Retrospective study: In making a predictive diagnosis of 122 patients with findings of trophoblastic tumors, the authors found some differences in possibility of CC of the following subfactors: latent period, primary lesion, pulmonary metastases, metastases except pulmonary metastases and hCG rerise. So, a modified scoring system of TUDU hospital was devised.

Prospective study: Of 151 Vietnamese patients with GTN using the JSOG scoring system and the modified system, a diagnostic probability in 108 cases predicted choriocarcinoma by JSOG scoring system was 61%, while that of invasive mole in 43 cases was 62.8%. Accordingly, the false positive rate for invasive mole of 64 cases predicted choriocarcinoma was 38.9%. According to the modified scoring system, of 75 patients predicted choriocarcinoma, 69 patients were histologically confirmed choriocarcinoma. Therefore, the diagnostic specificity was high (94.20%) and the false positive rate was low (5.3%), while of 76 patients predicted invasive mole, 13 patients were histologically diagnosed as choriocarcinoma. Accordingly, the false negative rate was low (13.1%).

Conclusion: The modified JSOG scoring system is of more diagnostic value in the preoperative differentiation between CC and IM in Vietnam.
Familial Risk Factors for a Second Primary Malignancy in Endometrial or Ovarian Carcinoma
Authors: Shiromizu Kenji , Araki Joji , Onda Takashi , Nishimura Toshinobu , Takahashi Michiko , Matsuzawa Masumi
Published: August 2010

Objective: To elucidate the risk factor for a second primary carcinogenesis in endometrial or ovarian carcinoma patients.

Methods: Endometrial and ovarian carcinoma patients treated from 1975 through 1990 were analyzed clinicopathologically.

Results: The incidence of patients with a second primary malignancy was 10.5% (28/267) in endometrial carcinoma cases, and 9.0% (13/144) in ovarian carcinoma cases. Endometrial carcinoma patients whose parents, siblings, and/or children had developed malignant diseases were at risk for a second primary malignancy. This familial factor is also believed to be a risk factor for ovarian carcinoma patients, but the results lacked statistical significance. There also was no statistical significance with respect to smoking and/or alcohol consumption. More than one‐half of the second primary carcinomas were breast, colon, or stomach carcinomas.

Conclusions: Cancer patients with this familial high‐risk factor should be carefully and regularly followed up by monitoring at every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations.
Tissue Expression of Sialyl Tn Antigen in Gynecologic Tumors
Authors: Numa Fumitaka , Tsunaga Nagato , Michioka Toru , Nawata Shugo , Ogata Hidenobu , Kato Hiroshi
Published: August 2010

Objective(s): To investigate tissue expression of Sialyl Tn antigen (STN) in gynecologic tumors, and to compare with its appearance in blood circulation.

Methods: Surgical specimens were obtained from 24 patients with malignant gynecologic diseases, including 7 ovarian cancers, 13 cervical cancers, 3 endometrial cancers, and 1 vulval cancer. Control tissues were also obtained at surgery from 28 patients with benign tumors of the ovary or uterus.

Results: Anti‐STN monoclonal antibody (TKH‐2) positively identified 6 (86%) of 7 ovarian cancers, 11 (85%) of 13 cervical squamous‐cell carcinomas, but none of 3 endometrial cancers. None of the 28 benign tissues, including 11 ovarian benign tumors, showed positive immunostaining for STN, except 1 with an ovarian chocolate cyst which showed weak staining for STN. No expression was found in normal squamous epithelium distant from the lesion. Serum STN antigen was positive in 4 of 7 ovarian cancers (cutoff = 39 U/ml), but only in 2 of 13 cervical cancers, and none in the 3 endometrial cancers.

Conclusion(s): These findings indicate different behaviors in the appearance of STN in tumor tissue and blood circulation, and also suggest the possible applicability of STN to immunohistochemical diagnosis of squamous‐cell carcinomas.
Maternal and Perinatal Mortality/Morbidity Associated with Cesarean Section in Indonesia
Authors: Wirakusumah Firman F.
Published: August 2010

Objectives: To compare the frequencies of maternal mortality and perinatal mortality, and severe morbidity among cases of cesarean delivery.

Study Design: A cohort study, the outcome of major interest (cesarean section) being evaluated retrospectively and the cohort being hospital‐based and actually covering a 10‐year period.

Subjects: Six hundred sixty‐three cesarean deliveries out of a total of 7,128 births in the period 1981–1983 and 761 out of 8,534 in 1988–1990 were analyzed.

Statistical Analysis: Chi‐square statistical analysis and Linear regression analysis were used.

Results: The maternal mortality was 985.7/100,000 live births and 757.5/100,000 live births in period I and II, respectively. Perinatal mortality in the two periods was 125.6 per 1,000 live births and 90.8 per 1,000 live births, respectively. Although the cesarean birth rate did not increase, there was a decrease in maternal and perinatal mortality.

The study demonstrated that although overall maternal mortality was high, the fatality rate in cesarean delivery was low: 4.5 and 2.6 per 1,000 cesarean sections in period I and II, respectively.

Conclusions: Maternal mortality and perinatal mortality following cesarean delivery were more related to maternal illness rather than the surgery.
Urokinase‐Type Plasminogen Activator (uPA) and Its Receptor (CD87): A New Target in Tumor Invasion and Metastasis
Authors: Schmitt Manfred , Wilhelm Olaf , Jänicke Fritz , Magdolen Viktor , Reuning Ute , Ohi Hidekazu , Moniwa Nobuhiko , Kobayashi Hiroshi , Weidle Ulrich , Graeff Henner
Published: August 2010

Extravasation and intravasation of tumor cells in solid malignant tumors is controlled by 3 steps: 1) attachment to and interaction of tumor cells with components of the basement membrane and the extracellular matrix, 2) local proteolysis, and 3) tumor cell migration. Evidence has accumulated that different types of tumor‐associated proteases, their inhibitors and receptors are involved in tumor invasion and metastasis. Four different classes of proteases are known to be correlated with the malignant phenotype: 1) Matrix metalloproteases; including collagenases, gelatinases and stromelysins. 2) Cysteine proteases; including cathepsins B and L. 3) Aspartyl protease cathepsin D. 4) Serine proteases; including plasmin and tissue‐type plasminogen activator (tPA) and urokinase‐type plasminogen activator (uPA). A strong independent prognostic value (relapse‐free and/or overall survival) has especially been demonstrated for uPA and its inhibitor PAI‐1 in patients with cancer of the breast, ovary, stomach, esophagus, colon, lung, and kidney thus predicting the course of the cancer disease. The strong correlation between elevated uPA and/or PAI‐I values in primary cancer tissues and the malignant phenotype of cancer cells has prompted to explore new tumor biology‐oriented concepts in order to suppress uPA or uPA receptor (CD87) expression or to abrogate interaction of uPA with CD87. Various very different approaches to interfere with the expression or reactivity of uPA or CD87 at the gene or protein level were successfully tested including antisense oligonucleotides, antibodies, inhibitors and recombinant or synthetic uPA and CD87 analogues.
The Imbalance of Plasminogen Activators and Inhibitor in Preeclampsia
Authors: Gao Meiyang , Nakabayashi Masao , Sakura Mari , Takeda Yoshihiko
Published: August 2010

Objective: To evaluate the role of plasminogen activators (tPA uPA) and inhibitor (PAI‐1) in the pathogenesis of preeclampsia.

Study Design: tPA uPA and PAI‐1 antigens were measured in amniotic fluid, maternal plasma, and placental homogenates in normal pregnancy by ELISA method and compared with that of preeclampsia.

Results: In normal pregnancy, tPA, uPA and PAI‐1 levels increase as the gestation advance, but the increment of PAI‐1 in amniotic fluid (28.3‐fold) is larger than that of tPA and uPA (1.8‐fold, 8.5‐fold) (p < 0.001). Decidua homogenates contained larger amount of PAI‐1 than villi. Whereas, villi had higher levels of tPA uPA than decidua (p < 0.01). In preeclampsia, the significantly higher levels of PAI‐1 were observed in AF and decidua tissue as compared to the normals (p < 0.01), and the increment of PAI‐1 in preeclampsia is larger than that of tPA, uPA.

Conclusions: The elevated PAI‐1 level is associated with the preeclampsia and the imbalance between the plasminogen activators (tPA, uPA) and the inhibitor (PAI‐1) might be involved in the pathogenesis of preeclampsia.
Clinical Utility of Calculated Creatinine Clearance as a Guide to Chemotherapy in Patients with Gynecologic Malignancies*
Authors: Kang Soon‐Boem , Kim Byoung‐Gie , Song Yong‐Sang , Lee Hyo‐Pyo
Published: August 2010

Objective: To examine the relationship between calculated and measured creatinine clearance, and also to evaluate the clinical utility of calculated creatinine clearance before administration of chemotherapy in patients with gynecologic malignancies.

Methods: In 38 patients with gynecologic malignancies, a total‐69 paired creatinine clearance measured by 24‐hour urinary creatinine clearance and calculated were compared.

Results: The significant correlation (r = 0.597, p < 0.0001) was observed between creatinine clearances determined by both methods. There were 26 (37.7%) 24‐hour urine collections. The correlation between two methods improved when these inaccurate samples were excluded (r = 0.876, p < 0.0001). In addition, if a creatinine clearance of 50 ml/min is set as a threshold for dose modification, only 2.9% of the patients would have received reduced doses inappropriately, by using the calculated creatinine clearance alone.

Conclusion: These results suggest that in patients with gynecologic malignancies, a calculated creatinine clearance prior to chemotherapy is sufficient for evaluation of renal function and measured creatinine clearance would be determined only when calculated creatinine clearance is below the threshold for dose modification.
Short Protocol of Gonadotropin Releasing Hormone Agonist Administration Gave Better Results in Long Protocol Poor‐Responders in IVF‐ET
Authors: Tašdemir Murat , Tašdemir Išik , Kodama Hideya , Fukuda June , Tanaka Toshinobu
Published: August 2010

Objective: To determine the effectiveness of a short protocol (SP) of gonadotropin‐releasing hormone agonist (GnRH‐a) administration in patients who already had undergone at least one in vitro fertilization (IVF) and embryo transfer (ET) treatment cycle with the long protocol (LP) and had shown poor results.

Methods: One hundred and twelve patients were studied. The E2 levels, the number of preovulatory follicles, the number of oocytes retrieved and fertilized, the number of embryos cleaved, the fertilization rate and the number of embryos transferred were calculated.

Results: The values for the mentioned parameters were significantly higher in the SP than those in the LP. So were the pregnancy rates per cycle and per ET (23.2% and 24.1%, respectively) in the SP significantly (p < 0.0001) higher than those in the LP (12.5% and 13.5%, respectively).

Conclusion: In cases who showed poor results to the LP, instead of repeating the same protocol the SP may be substituted. This strategy may not only improve the results, but also decrease the total cost of the IVF‐ET treatment.
Spontaneous Rupture of the Uterus Due to Placenta Percreta at 25‐Weeks' Gestation: A Case Report
Authors: Kinoshita Toshihiko , Ogawa Keigo , Yasumizu Takehiko , Kato Junzo
Published: August 2010

Placenta percreta is a rare but serious complication of pregnancy, and is rarely diagnosed in the second trimester of pregnancy. We report a very rare case of placenta percreta accompanied by spontaneous uterine rupture at 25‐weeks of gestation.

A 30‐year‐old woman with severe abdominal pain was admitted to our hospital at 25 weeks of gestation. A laparotomy was immediately performed because of intraabdominal bleeding. The uterus revealed a perforation of the fundus. A supra‐vaginal hysterectomy was performed. A pathological investigation of the uterus revealed placenta percreta.

The patient had neither gravity nor any prior uterine operation. It is very rare for placenta percreta to be recognized in a primigravida woman or in the second trimester of pregnancy.
Mother‐to‐Infant Transmission of Hepatitis C Virus in Human Immunodeficiency Virus‐Coinfected Mother: A Case Report
Authors: Koseki Satoshi , Taga Michiyoshi , Aoyama Mika , Hirabuki Tomoo , Hirahara Fumiki , Takahasi Tsuneo , Minaguchi Hiroshi , Yokota Shumpei , Ito Akira
Published: August 2010

We report a case of vertical transmission of HCV in a mother infected with both HCV and HIV. Our case suggests that coinfection with HIV, by causing an immune dysfunction, might be one of the risk factors for the transmission of HCV.
Comparison of the 50 g Capillary Plasma Glucose Tolerance Test with the 75 g Venous Plasma Glucose Tolerance Test in Pregnancy
Authors: Henry Olivia A. , Shelley‐Jones David C. , Oats Jeremy N. , Wein Peter , Beischer Norman A.
Published: August 2010

Objective: To compare the 50 g oral glucose tolerance test with capillary sampling used in the Mercy Hospital for Women, Melbourne with the 75 g test with venous sampling advocated by the Australasian Diabetes in Pregnancy Society.

Methods: Both the 50 g and 75 g glucose tolerance tests were performed on 60 women. Criteria for diagnosing gestational diabetes were the combination of a 1‐hour capillary plasma glucose ≥ 9 mmol/l and a 2‐hour glucose ≥ 7 mmoll for the 50 g test and a fasting glucose ≥ 5.5 mmol/l and/or a 2‐hour venous plasma glucose ≥ 8.0 mmol/l for the 75 g test.

Results: Twenty‐eight of 60 women had gestational diabetes diagnosed with the 50 g test; 24 of these, and an additional 5 had gestational diabetes diagnosed on the 75 g test. Twenty‐seven women had normal results on both tests. The kappa statistic was 0.70. The 1‐hour glucose value was similar for both tests, but the 2‐hour value was significantly higher for the 75 g test (mean difference 0.65 mmol/l, 95% confidence limits 0.24–1.01 mmol/l, p = 0.003). The area under the curve was similar for the 2 tests.

Conclusions: The 2 tests diagnose similar women as having gestational diabetes. The combination of a 75 g load and venous sampling gives similar 1‐hour but higher 2‐hour values than a 50 g load and capillary sampling.
Amoebiasis of the Female Genital Tract: A Case Report
Authors: Nopdonrattakoon Lek
Published: August 2010

In 1994, a 56‐year‐old Burmese woman presented with bloody discharge per vaginam had undergone pelvic examination disclosing multiple small ulcerated and friable lesions with contact bleeding at vulva, vagina and cervix. Wet smears from vaginal discharge showed typical Entamoeba histolytica trophozoites. The patient was treated with metronidazole 750 mg three times daily for 7 days, resulting in complete recovery of the lesions in 10 days.

The pathology, risk factors, diagnosis and management of the disease are discussed.
Factors Influencing the Prolonged Second Stage and the Effects on Perinatal and Maternal Outcomes
Authors: Kuo Yueh‐Chang , Chen Chie‐Pein , Wang Kuo‐Gon
Published: August 2010

Objective: To examine the factors influencing the prolonged second stage and the maternal‐perinatal outcomes after a prolonged second stage of labor.

Methods: Between Janualy 1993 and June 1993, 165 women who delivered with a prolonged second stage of labor were enrolled in this study. The control group was 1750 term pregnancies that delivered under 2 hours in the second stage. Maternal and neonatal outcomes included one and 5 minute Apgar scores, umbilical blood gas determination, thick meconium stain, fetal trauma, and length of hospital stay.

Results: Factors such as nulliparity (p < 0.005), maternal weight gained during pregnancy (p < 0.01), active phase length (p < 0.05), persistent occiput posterior position (p < 0.05), station at complete cervical dilation (p < 0.05) and a need of instrumental vaginal delivery (p < 0.05) were significantly associated with a prolonged second stage of labor. Maternal and neonatal outcomes were not different significantly between the study and control group.

Conclusion: The maternal and perinatal well‐beings from the normal second stage group did not appear to be more favorable than the prolonged second stage. Under monitored condition, if the fetal heart rate is considered normal, then the natural labor course could be continued.
Plasma Exchange in a Patient with Postpartum HELLP Syndrome
Authors: Hamada Shin‐ichi , Takishita Yoshihiro , Tamura Takao , Naka Osamu , Higuchi Kazuhiko , Takahashi Hiroko
Published: August 2010

The case of a patient with HELLP syndrome, who was unresponsive to supportive management but successfully treated with plasma exchange, is presented. The significance of plasma exchange in the treatment of HELLP syndrome is discussed.
A Case of Pregnancy with Adult T‐Cell Leukemia
Authors: Utsumi Tohru , Tsuda Akira , Hirano Hideto , Goto Kaoru , Tsubaki Hiromitsu , Tanaka Toshinobu
Published: August 2010

The incidence of adult T‐cell leukemia (ATL) arising in women of childbearing age is documented infrequently. This report is the second in the world's literature of a case of ATL that occurred during pregnancy. A 43‐year‐old woman developed ATL during pregnancy and died of widespread disease 4 weeks after cesarean delivery.
Screening and Epidemiological Trends in Cervical Cancer
Authors: Kim Seung Jo
Published: August 2010

The developed or less developed countries where basic conditions for the screening of cervical cancer are quite different in terms of essential factors such as accuracy of cytology, cost effectiveness and development of new methods of diagnosis. Considering these factors the screening program made by annual Pap smear with adjunctive cervicography and HPV DNA test in the women aged from 20 to 69 years may have universal validity.
Parental Attitudes toward Obstetric Ultrasound Examination
Authors: Zlotogorski Z. , Tadmor O. , Rabinovitz R. , Diamant Y.
Published: August 2010

Objective: The aim of the study was to assess the effect of ultrasound examination on parental attitudes and anxieties.

Material and Method: Ultrasound examinations were carried out on 1,089 pregnant women with uncomplicated pregnancies at a mean gestational age of 20.9 weeks (minimum 10 weeks). Before and after the ultrasound examination, patients completed a questionnaire comprising 26 five‐point numerical scales relating to anxiety levels, and difference scores for pre‐ and post‐scan levels of fears and anxieties were computed.

Results: We showed that the reduction of anxiety following ultrasound examination was inversely related to gestational age, but was unrelated to demographic or medical variables, such as the risk level at the time of the scan. Similarly, anxiety was not reduced because of the presence of the spouse, although the spouse's presence did significantly increase inter‐partner bonding.

Conclusion: This study showed that “routine” ultrasound scan may have significant psychological effects on parental attitudes toward each other and the fetus.
Possible Association of Body‐Fat Distribution with Preeclampsia
Authors: Ijuin Hirofumi , Douchi Tsutomu , Nakamura Sachiko , Oki Toshimichi , Yamamoto Schinichi , Nagata Yukihiro
Published: August 2010

Objective: To investigate whether preeclampsia is associated with body‐fat distribution.

Methods: Twenty‐two patients with preeclampsia (mean age: 31.9 ± 6.0 years) and 126 controls without preeclampsia (mean age: 30.9 ± 5.2 years) were enrolled in this study. We compared baseline characteristics and 4 body‐fat indices measured by DEXA on Day 5 postpartum. The possible correlation between the variables and the development of preeclampsia was evaluated by multivariate analysis.

Results: The body‐fat ratio, the upper‐half body‐fat amount, upper‐half‐body body‐fat amount ratio, and upper‐/lower‐half‐body body‐fat amounts ratio on Day 5 postpartum were significantly higher in the preeclampsia group. However, the upper‐/lower‐half‐body body‐fat amount ratio was best correlated with preeclampsia among variables in multivariate analysis.

Conclusion: Upper‐body‐fat distribution might be associated with the development of preeclampsia.
Adenomyosis in the Broad Ligament and Tamoxifen: Report of a Case
Authors: Chung Yi‐Pei , Lin Ho‐Hsiung , Sheu Bor‐Ching , Mao Tseuy‐Liang , Chang Daw‐Yuan , Huang Su‐Cheng
Published: August 2010

Adenomyosis confined to the broad ligament is extremely rare. Herein we present a case of adenomyosis in the broad ligament with unusual gross features. This 41‐year‐old woman had been on tamoxifen therapy for 3 years due to breast cancer. Ten months after discontinuing tamoxifen, she underwent exploratory laparotomy for a right adnexal mass suspected as ovarian malignancy. At laparotomy, the mass was located in the right broad ligament with a fibrous stalk connecting to the uterus. Total abdominal hysterectomy with bilateral salpingo‐oophorectomy was performed. Histopathologic examination revealed adenomyosis with cyst formation and an unusual thick capsule. The possible effects of tamoxifen upon the uterus are discussed in this article, in view of reports of tamoxifen associated with endometrial carcinoma and endometriosis.
Cellular and Subcellular Localization of Nicotinamide Adenine Dinucleotide Phosphate Diaphorase Activity in the Human Placenta
Authors: Matsubara Shigeki , Minakami Hisanori , Takayama Takeshi , Sato Ikuo
Published: August 2010

Objective: To determine the cellular and subcellular distribution of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH‐d) in the human placenta and thereby to shed light on the possible role of nitric oxide (NO) and NO synthase in this tissue.

Methods: NADPH‐d activity in 10 term placenta and in 10 first‐trimester placentas! was examined by enzyme histochemistry and by both light microscopy and electron microscopy.

Results: Light microscopy revealed that NADPH‐d activity was marked in the syncytiotrophoblasts, moderate in the endothelium of cord vessels, and weak in the amniotic epithelia and chorionic trophoblasts. At the electron‐microscopic level, NADPH‐d activity was apparent as small patches distributed throughout the cytoplasm of the syncytiotrophoblasts.

Conclusion: NO might be generated in the syncytiotrophoblast of the human placenta and might play a role in the regulation of placental hemodynamics or in the signaling between the syncytium and the villous mesenchyme.
Intrinsic Ureteric Involvement by Endometriosis: A Case Report
Authors: Takeuchi Shigeto , Minoura Hiroyuki , Toyoda Nagayasu , Ichio Takao , Hirano Hiroshi , Sugiyama Yoichi
Published: August 2010

Endometriosis occasionally involves the urinary tract, and a ureteral obstruction from this order constitues a rare variant with serious consequences. Intrinsic ureteric involvement by endometriosis is an exceedingly rare event. This case report describes intrinsic ureteric involvement by endometriosis. The case involved 47‐year‐old woman, gravida 4, para 2, who had a 4‐year history of dysmenorrhea and hypermenorrhea. An intravenous pyelogram showed a right hydronephrosis. She underwent a total abdominal hysterectomy and a right ureteroureterostomy. A pathologic examination revealed complete obstruction of the right ureter by intrinsic intramural endometriosis. We conclude that because ureteral endometriosis, especially intrinsic endometriosis, is usually silent and results in a high rate of renal loss before recognition, physicians should have a hightened awareness of this uncommon but serious manifestation of endometriosis.
Comparative Study of Different Anticonvulsants in Eclampsia
Authors: Chatterjee Alokendu , Mukheree Joydev
Published: August 2010

One hundred eclampsia patients were admitted in this hospital from January 1993 to November 1993 and they were subjected to different anticonvulsant regimes. There were 28 patients in lytic cocktail group, 16 in diazepam group, 16 in magnesium sulphate group and 40 patients in phenytoin sodium group. The results are compared in every aspect. Feto maternal outcome is best with magnesium sulphate regime followed by phenytoin sodium regime. They produce significantly better results than lytic cocktail and diazepam.
Ectopic Pregnancy in Uterosacral Ligament
Authors: Lo Keith Wing‐Kit , Lau Tze‐Kin
Published: August 2010

Two cases of ectopic pregnancy in the uterosacral ligament are presented. The cases are reported not only because of its rarity but also to arouse the thought of primary aetiology. With the increasing incidence of ectopic pregnancy due to assisted reproduction, gynaecologists are posed with the diagnostic challenge. The golden rule of management in extra‐tubal pregnancy is to maintain high index of suspicion.
Spontaneous Resolution of a Postcesarean Arteriovenous Fistula of the Uterine Cervix: The Usefulness of Transvaginal Color Doppler Scanning
Authors: Itoh Hiroaki , Keitoku Miho , Fukuoka Masatsune , Sagawa Norimasa , Mori Takahide , Togashi Kaori
Published: August 2010

We encountered in a woman at the 28th day after cesarean delivery the transient appearance of a uterine cervical mass with a prominent blood flow, that was revealed to be an acquired arteriovenous fistula. The size and blood flow of the mass were monitored using transvaginal color Doppler scanning and magnetic resonance imaging (MRI). Based on these findings, the arteriovenous fistula was managed conservatively Without any adverse complications.
Tropical forests are not flat: how mountains affect herbivore diversity
Authors: Rodríguez‐Castañeda Genoveva , Dyer Lee A. , Brehm Gunnar , Connahs Heidi , Forkner Rebecca E. , Walla Thomas R.
Published: August 2010

Ecology Letters (2010) 13: 1348–1357

Ecologists debate whether tropical insect diversity is better explained by higher plant diversity or by host plant species specialization. However, plant–herbivore studies are primarily based in lowland rainforests (RF) thus excluding topographical effects on biodiversity. We examined turnover in Eois (Geometridae) communities across elevation by studying elevational transects in Costa Rica and Ecuador. We found four distinct Eois communities existing across the elevational gradients. Herbivore diversity was highest in montane forests (MF), whereas host plant diversity was highest in lowland RF. This was correlated with higher specialization and species richness of Eois/host plant species we found in MF. Based on these relationships, Neotropical Eois richness was estimated to range from 313 (only lowland RF considered) to 2034 (considering variation with elevation). We conclude that tropical herbivore diversity and diet breadth covary significantly with elevation and urge the inclusion of montane ecosystems in host specialization and arthropod diversity estimates.
Laparoendoscopic single‐site pyeloplasty: a comparison with the standard laparoscopic technique
Authors: Stein Robert J. , Berger Andre K. , Brandina Ricardo , Patel Neil S. , Canes David , Irwin Brian H. , Aron Monish , Autorino Riccardo , Shah Gaurang , Desai Mihir M.
Published: August 2010

Study Type – Therapy (case series)

Level of Evidence 4

What’s known on the subject? and What does the study add?

Laparoendoscopic single site surgery (LESS) is a novel technique for performing a variety of procedures including Urological upper tract reconstructive surgery. As of now few studies have compared perioperative factors and outcomes between LESS and standard laparoscopic or robotic approaches. In this comparison between LESS and standard laparoscopic pyeloplasty we identified no significant differences in terms of narcotic requirements, quality of life indicators, and outcomes although prospective evaluation is needed.

OBJECTIVE

• To compare laparoendoscopic single‐site (LESS) and standard laparoscopic pyeloplasty procedures with the aim of defining whether perioperative, recovery or health‐related quality of life (HRQL) benefits exist for the LESS procedure.

PATIENTS AND METHODS

• From November 2007 to August 2008, sixteen patients underwent LESS pyeloplasty at a tertiary care referral centre. These patients were compared with a matched cohort of patients undergoing standard laparoscopic pyeloplasty.

• Matching criteria included gender and age (within 10 years), as well as preoperative degree of obstruction (T½ within 15 min) and differential renal function (within 10% ipsilaterally) based on diuretic radionuclide scanning. Mean follow‐up was 13 ± 4 months for the LESS group and 17 ± 3 months for the standard laparoscopic group.

• LESS pyeloplasty procedures were all performed using a single‐port device in the umbilicus and suturing was assisted with a 2‐mm grasping instrument. Perioperative variables, successful relief of obstruction and HRQL measurements were compared between the two groups.

RESULTS

• Except for a lower body mass index in the LESS group (23 ± 6 kg/m2 vs 30 ± 7 kg/m2, P= 0.002), no difference was noted for perioperative variables between the two cohorts, including hospital stay and analgesic requirement.

• No significant HRQL advantage was noted for either group based on a six‐item non‐validated questionnaire.

• All patients in both groups experienced clinical resolution of their symptoms. A patient in the standard laparoscopy group and two patients in the LESS group had T½ > 20 min (0.063% vs 0.125%, P= 1.00) on diuretic radionuclide scanning.

• Limitations include the retrospective nature of the present study, as well as the relatively small study population and short follow‐up.

CONCLUSIONS

• No benefit was noted for LESS pyeloplasty over the standard laparoscopic procedure beyond aesthetic advantages.

• Further comparisons are needed to determine whether these results are generalizable to other LESS procedures.
The consequences of using different measures of mean abundance to characterize the abundance–occupancy relationship
Authors: Wilson Peter D.
Published: August 2010

Aim  To investigate the influence of choice of the measure of mean abundance on the abundance–occupancy relationship, and to examine the implications for identifying causal mechanisms.

Innovation  Simulations were performed to generate stochastic abundance–occupancy data sets covering a wide range of scenarios representative of empirical abundance–occupancy data. Two common measures of mean abundance were used: local mean abundance (mean abundance calculated using only data from occupied sites) and global mean abundance (mean abundance calculated using all sites or samples). I found that the choice of mean abundance measure had a strong effect on the correlation between abundance and occupancy. Local mean abundance was associated with a high proportion of negative correlations (mean percentage of negative correlations across 24 simulations = 44.39), while global mean abundance was strongly associated with positive correlations (mean percentage of negative correlations across 24 simulations = 0.02).

Main conclusions  The choice of abundance measure influences the correlation between abundance and occupancy. Negative correlations between local mean abundance and occupancy are an inherent and unavoidable consequence of using this measure of abundance. Efforts to identify causal mechanisms that give rise to the abundance–occupancy relationship have attempted to explain occasional negative correlations when the expectation was for positive correlations. This study shows that negative correlations arise from the choice of mean abundance measure and that this artefact confounds efforts to identify ecological causal mechanisms.