bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcervical resection of endometrium and fibroids Initial complications
Authors: Istre Olav , Schiötz Hjalmar , Sadik Latif , Vormdal Jarle , Vangen Oddbjörn , Forman Axel
Published: November 2007

Transcervical resection of endometrium‐and of submucous fibroids when present‐seems to represent a new alternative to hysterectomy for patients with uncontrolled bleeding disorders. In the present study, we report our initial experience with the first 20 patients treated with a standard, rigid urological resectoscope. Resection of endometrium—and of fibroids when present—was carried out under general anesthesia. The uterine cavity was distended and irrigated with glycine 1.5%. Two perforations occurred, but damage to neighboring organs was not seen. In one patients, copious bleeding was encountered and hysterectomy became necessary the following day. Clinical signs of postoperative infection occured in 3 patients. Otherwise, no major morbidity was seen during or after the procedure. In 2 patients with persistent metrorrhagia, re‐resection was performed after 2–3 months and satisfactory bleeding control achieved. At the 3‐month follow‐up, 2 further patients complained of persistent bleeding and had an abdominal hysterectomy performed. In the remaining patients, satisfactory bleeding control was reported at the 6‐month follow‐up. Although large series are needed to assess the complications associated transcervical resection of the endometrium, the technique may be applied in departments with experience in routine hysteroscopy, and the approach seems to represent an attactive alternative to hysterectomy.
Severe ovarian hyperstimulation syndrome complicated by ectopic pregnancy
Authors: Aboulghar Mohamed A. , Mansour Ragaa T. , Serour Gamal I. , Ramsy A. M.
Published: November 2007

The difficulty in the diagnosis and mangement of ectopic pregnancy associated with OHSS is illustrated in a 29‐year‐old infertile woman.
Twin pregnancy with a fetus in each half of a uterus didelphys
Authors: Kekkonen Raimo , Nuutila Mika , Laatikainen Timo
Published: November 2007

A rare case of a twin pregnancy with a fetus in each half of a uterus didelphys (double uterus, double cervix and septate vagina) is reported. A longitudinal vaginal septum and two portios were detected during the first labor of this patient. During her second pregnancy ultrasonography was performed in the 16th week, and pregnancy was detected in each half of the double uterus. Both fetuses were of similar size and corresponded to the gestational age. A completely separated double uterus was confirmed by ultrasonography. In the 38th week a female and a male infant were delivered by cesarean section. The follow‐up of this pregnancy and the management of the labor are reported.
Small cell carcinoma of the ovary diagnosed in early pregnancy
Authors: Rasmussen Kjeld Leisgård , Jensen Marianne Lidang , Nielsen Kirsten Marie , Velander Geert
Published: November 2007

Small cell carcinoma of the ovary is a rare malignancy affecting young women. We report the first case of small cell carcinoma of the ovary and coincident pregnancy. The patient died of the disease 23 months after the initial diagnosis.
Open Randomized Comparison of Prostaglandin E2 Given by Intracervical Gel or Vagitory for Preinduction Cervical Ripening and Induction of Labor
Authors: Poulsen Henning Kvist , Moller Lars Krag , Westergaard Jes G. , Thomsen Sten Grove , Geirsson Reynir T. , Arngrímsson Reynir
Published: November 2007

Intracervical application of prostaglandin E2 (PGE2) in a viscous gel was compared with conventional wax‐based PGE2 vagitories (pessaries) for ripening of the cervix prior to induction of labor. A total of 226 healthy pregnant women at term were randomly allocated to receive intracervical gel with an effective dose of 0.5 mg (n = 116) or vagitories containing 2.5 mg PGE2 (n = 110). All women had a modified cervical score of ≤ 4. The numbers of cases contributed by each of the three centers were similar. There was no significant difference in parity, gestational length, maternal characteristics, indications for induction or preinduction cervical scores between the treatment groups. The rate of spontaneous birth was 71% in the gel group, compared with 69% in the vagitory group. Successful treatment was defined as active labor within 24 h or a change in cervical dilatation allowing artificial rupture of the membranes with subsequent progressive labor. The success rate was not significantly different in the gel group (82%) compared with the vagitory group (80%). There were no differences in the frequency of fetal distress, outcome of labor, assisted delivery rates or maternal side effects. The cervical scores were not different at 12 and 24 h after application. Intracervical gel and intravaginal application of PGE2 were similar in their efficacy and safety for ripening of the cervix and inducing labor at term.
Female Circumcision in Somalia and Women's Motives
Authors: Dirie Mahdi A. , Lindmark Gunilla
Published: November 2007

Two hundred and ninety Somalian women have participated in a study. They responded adequately to the questionnaire administered. One hundred percent of these women were circumcised, despite their relatively high socio‐economic status as shown by their educational level. Eighty‐eight percent of them had been circumcised with excision and infibulation, A. 5% were circumcised with clitoridectomy and the remaining 5.5% with Sunna. The majority of these women justified the practice of female circumcision with religious reasons and all were willing to circumcise their daughters. Fifty‐two percent of the respondents had been operated on by medically untrained persons, usually traditional birth attendants and the majority were operated on at home.
Screening for Chlamydia Trachomatis Infection in Women and Aspects of the Laboratory Diagnostics
Authors: Svensson Lars‐Olof , Mares Ivo , Olsson Sven‐Eric , Nordstrom Mari‐Louise
Published: November 2007

Nine hundred and thirty‐three women who attended consecutively a gynecological clinic for various symptoms, for abortion, or for contraceptives, were screened for genital Chlamydia trachomatis infection. A total of 95 (10.2%) women were found infected. Of women below 25 years of age, 13.4% were infected, as compared with 4.9% over 25. Women with symptoms of genital infection were not over‐represented in the infected population. Enzyme immunoassays (EIA) verified with a direct flourescence antigen test were evaluated and compared with culture controls. Reactive samples detected using EIA were regarded as true positive if they were also positive according to the verification test. The sensitivity of the verified EIA test was 91%, the specificity 100%, the positive predictive value 100% and the negative predictive value was 99%. The sensitivity of the culture was 90%. Low age is the most predictable risk factor for genital Chlamydia trachomatis infection. Compared with cultures, EIA verified with a direct flourescence antigen test is a rapid and effective method for clinical use.
Smoking and reproduction: Short and long term effects and benefits of smoking cessation
Authors: Fredricsson Bengt , Gilwam Hans
Published: November 2007

There have been many attempts during the last years to restrict smoking because of the significant health hazards. In particular the high prevalence of smoking among women in their reproductive years has been a matter of concern.

This review was prompted in order to make the medical profession, and gynecologists in particular. confident with the underlying data. This will hopefully result in enabling them to provide balanced information to their patients, not overemphasizing the dangers of smoking, but rather presenting ways to properly recognize and treat tobacco dependence. It is a widely held view that the various risks imposed by smoking are very modest. A doubling of the risk for a rare problem may not prevent many women from continuing to smoke. However, a doubling of the risk for early miscarriage or a significant reduction of success rate in the treatment of infertility may be much more discouraging. The purpose of this review is to list the various effects smoking may have on the different phases of reproduction and to present an overview of the explanation models which have been suggested. Late effects on the child and its development will also be discussed. Hopefully, this will lead to proper concern about the problems and thus increase the motivation to quit smoking even before attempting a pregnancy. In addition, we give some hints on smoking cessation programs.
Lupus anticoagulant and anticardiolipin antibodies in an obstetric population
Authors: Rix Per , Stentoft Jesper , Aunsholt Niels‐Aage , Dueholm Margit , Tilma Karen Andersen , Høier‐Madsen Mimi
Published: November 2007

Lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) have been reported to he associated with fetal loss.

Objective. Our aim was to estimate the incidence of LA and to examine the correlation hetween LA and ACA in pregnant women.

To investigate the clinical significance of LA and ACA in an obstetric population.

Study design. A prospective, cross sectional study of 2856 consecutive women admitted to a department of obstetrics and gynecology for delivery or due to pregnancy complications during an 11 month period.

Methods. Activated partial thromboplastine time (Am) was determined in all patients. LA and ACA were determined if APTT ≥ 35 sec. For reference ACA was determined in a group of randomly selected patients with APTT < 35 sec. The results were analyzed in relation to the obstetrical records.

Results. Overall incidence of APTT ≥ 35 sec.: 7.0%, significantly more frequent in patients with early spontaneous abortion (18.6%) and intrauterine growth retardation (17.5%).

Incidence of LA 0.07%. The patients had undetectable ACA and no clinical condition related to LA.

Incidence of ACA class IgM (IgM‐ACA) in patients with APTT ≥35: 20.4%. significantly higher than in the reference group (9.6%).

Uncomplicated pregnancy in 84% of patients with IgM‐ACA.

No cases of ACA class IgG(IgG‐ACA) in patients with APTT ≥ 35 but two cases in the reference group (one normal pregnancy, one spontaneous abortion).

Conclusion. LA is a rare manifestation with uncertain significance in otherwise healthy pregnant women. IgM‐ACA in low titer occurs relatively frequently during normal pregnancy.
Sonographic evaluation of the endometrium in in vitro fertilization IVF cycles: A way to predict pregnancy?
Authors: Bergh Christina , Hillensjø Torbjörn , Nilsson Lars
Published: November 2007

The endometrial thickness and echogenic pattern were prospectively evaluated in 100 patients undergoing IVF‐treatment. On the day before oocyte aspiration (day‐1) the endometrium was significantly thicker in the group of patients achieving an ongoing pregnancy than in the group that failed to conceive. The minimal endometrial thickness on day‐1 compatible with an ongoing pregnancy was 9 mm. Before oocyte aspiration two different endometrial patterns could be distinguished, a multilayered, ‘triple line’, hypoechogenic endometrium (A) and an isoechogenic pattern (B). Other studies have, in addition. described a hyperechogenic endometrium with a poor pregnancy rate but that pattern could in the present study only be demonstrated after follicle aspiration. 32 clinical pregnancies occurred. Among patients with endometrial pattern A, 36% conceived and among patients with pattern B 23% conceived which was not significantly different. It is concluded that the day before aspiration an endometrial thickness of at least 9 mm appears to be required for an ongoing pregnancy. In all cases a triple line (hypo‐or isoechogenic) pattern was evident before aspiration.
Multicystic mesothelioma with endometriosis
Authors: Groisman Gabriel M. , Kerner Hedwiga
Published: November 2007

A multicystic mesothelioma of the omentum in a 36 year old woman consisted of a multicystic mass with foci of typical endometriosis and ‘necrotic pseudoxanthomatous nodules’. The presence of endometriosis within multicystic mesothelioma has never been reported. Our findings support the hypothesis that endometriosis plays a role in the pathogencsis of multicystic mesothelioma and that this is a reactive rather than a neoplastic lesion.
Megacystis‐microcolon‐intestinal hypoperistalsis syndrome: Antenatal appearance in two cases
Authors: Carlsson Sven ÅRke , HoUkegård Klas‐Henry , Mattsson Lars‐Åke
Published: November 2007

Two cases with severe congenital megacystis‐microcolon‐intestinal hypoperistalsis syndrome (MMIHS) are presented. This is a rarely encountered syndrome in neonates and 45 cases have earlier been reported. The disease is usually lethal and it now seems clear that MMIHS is an autosomal recessive disorder. The enlarged bladder, typical of this syndrome. is however easy to define by ultrasound, sometimes even in early pregnancy. The concomitant finding of a dilatation of the urinary tract and the absence of oligo‐hydramnion may lead the physician to suspect the diagnosis. Because of the information available from sonography, appropriate investigations can be undertaken immediately after delivery. Prenatal ultrasound examination in subsequent pregnancies is recommended.
Neonatal septicemia caused by pneumococci
Authors: Johnsson Hans , Bergström Staffan , Ewald Uwe , Schwan Anna
Published: November 2007

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted.

On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed.

The presenting clinical picture in early‐onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS). The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances. The mortality is 50%, twice the figure given in recent GBS reports.
DNA ploidy and proliferative characteristics of human trophoblasts
Authors: Wakuda Koji , Yoshida Yoshinobu
Published: November 2007

By using DNA cytofluorometry, DNA ploidy and the distribution pattern of human trophoblasts at different sites were studied throughout pregnancy, and the proliferative activity during cell differentiation of trophoblasts was discussed. In the first and second trimesters, cytofluorometric nuclear DNA analysis demonstrated that cytotrophoblasts in the tip of the anchoring villi (proximal portion of the cell column) consisted of proliferating diploid and tetraploid populations. Cytotrophoblasts in the distal portion of the cell columns consisted of non‐proliferating diploid and tetraploid trophoblasts, as also did intermediate trophoblasts invading the maternal tissue. Villous trophoblasts consisted of proliferating diploid populations. In term placenta, villous trophoblasts were proliferating, diploid, whereas X‐cells in the decidual tissue consisted of non‐proliferating diploid and tetraploid populations. It was concluded that (1) trophoblasts in the generative zone consist of proliferating diploid and tetraploid populations, (2) intermediate trophoblasts having 4c DNA content were not proliferative, and (3) cytrotrophoblasts in the chorionic villi still had proliferative activity even in the term placenta.
Angiographic embolization for control of pelvic genital tract hemorrhage Report of 14 cases
Authors: Bakri Younes N. , Linjawi Tariq
Published: November 2007

Fourteen patients with intractable bleeding of obstetric or gynecological origin underwent transcatheter angiographic arterial embolization. Three patients had postpartum hemorrhage associated with dilutional coagulopathy, anticoagulant therapy and placental leukemic metastases, or placenta percreta. One patient had locally advanced gestational trophoblastic tumor, one had uterine sarcoma and 8 had advanced cervical malignancy. Bleeding was completely controlled in all patients regardless of the initiating event. The embolizing material was gelatin sponge particles in 12 patients, and spring coil in 2. In experienced hands, angiographic arterial embolization is a safe, effective and less invasive alternative to surgical ligation in some clinical states of pelvic female genital tract hemorrhage.
Hospital‐associated infections in obstetrics and gynecology
Authors: Evaldson George R. , Frederici Harriet , Jullig Claes , Mannerquist Kerstin , Nyström Bertil
Published: November 2007

Study objective: To determine whether continuous surveillance of hospital‐associated infections with regular feed‐back to the staff reduces the infection rate in obstetrics and gynecology.

Design: Two infection control nurses surveyed all patients over a 2‐year period for infections and potential risk factors. After an initial 9‐month period (period A), quarterly information to all doctors and nurses was introduced for the rest of the study (period B).

Setting: A department of obstetrics and gynecology at a Swedish university hospital.

Patients: All patients undergoing surgery, excluding vacuum aspiration abortions and dilatation and curettage.

Main results: 2,334 patients were surveyed. In period A, 14.2% of all operations were followed by an infection, compared with 9.5% in period B (p < 0.001). For purulent wound infections and for endometritis, a significantly reduced rate was noted from period A to B. Several risk factors for infection were significantly more common in period B than in period A. Cesarean sections and hysterectomies were the most common operations also having among the highest infection rates. For both of these operations, infection rates were significantly reduced from period A to period B (from 15.1% to 9.0% and from 15.7% to 10.7%, respectively). The average length of hospitalization was 6 days longer for an infected than for an uninfected patient.

Conclusions: Surveillance of hospital‐associated infections including regular feed‐back to the staff was accompanied by a significant reduction in infection rates. A quality surveillance program for departments of obstetrics and gynecology therefore seems to benefit from including such surveillance. Surveillance could possibly be limited to only a few common operations with high infection rates.
Testicular feminization syndrome and associated gonadal tumors in Denmark
Authors: Bangsbøll Susanne , Qvist Ingelise , Lebech Paul Erik , Lewinsky Marianne
Published: November 2007

We studied the incidence of testicular feminization syndrome in Denmark over a 7‐year period and found it to be about 1:20,400. Twenty‐one patients are described in greater detail. Four patients had gonadal tumors, none of these being malignant. Ten patients (47.6%) had inguinal hernias in early childhood. All patients but one were gonadectomized. Eleven patients (52.4%) disclosed signs of partial androgen function. Only 5 of them had their gonads removed immediately.
A case of panic disorder induced by oral contraceptive
Authors: Ushiroyama Takahisa , Okamoto Yoshiaki , Toyoda Katsuhiro , Sugimoto Osamu
Published: November 2007

A 27‐year‐old woman experienced feelings of unreality and fear after taking an oral contraceptive in the form of birth control pills. She subsequently experienced a panic attack just after she had stopped taking the pills. This was characterized by palpitation, general fatigue, trembling of the whole body, and dyspnea. The panic disorder experienced by the patient could have been due to the drug's potentiating of the sympathoadrenal response to simple physiological stimuli, or possibly to a disorder in psychological functioning caused by an anxiotropic effect of rapid endocrinological change.
Endometrioid carcinoma of the ovary presenting as primary carcinoma of the breast
Authors: Ron Ilan‐Gil , Inbar Moshe , Halpern Marisa , Chaitchik Samario
Published: November 2007

A case is presented of endometrioid carcinoma of the ovary, metastasizing to the breast in a 63‐year old woman. Differentiation of metastatic cancer to the breast for primary breast carcinoma and discovering the primary tumor site are rather important for treatment and prognosis. Lumpectomy, followed by panhysterectomy, was performed and six courses of cisplatinum and cyclophosphamide were given. No signs of recurrence or metastasis are apparent 16 months after the discovery of the breast lesion.
Comparative evaluation of clindamycin/gentamicin and cefoxitin/doxycycline for treatment of pelvic inflammatory disease: A multi‐center trial
Authors:   The European Study Group, Noah Melvin L.
Published: November 2007

The clinical efficacy and safety of clindamycin‐gentamicin versus doxycycline‐cefoxitin in the treatment of acute pelvic inflammatory disease was evaluated in a comparative, randomized, prospective, multicenter study. Ten investigators enrolled 170 patients. Those judged to be eligible for efficacy were 60/88 (68%) who received the clindamycin‐gentamicin regimen and 55/82 (67%) of those treated with cefoxitin‐doxycycline. A successful clinical outcome was attained for 52/60 (87%) and 46/55 (84%) for patients treated with clindamycin‐gentamicin and cefoxitin‐doxycycline, respectively, a difference that was not statistically significant. In the clindamycin‐gentamicin series, 8/8 (100%) of patients with positive C. trachomatis culture at baseline were culture negative at the late follow‐up 21–35 days after treatment. For those given cefoxitin‐doxycycline, 9/11 (82%) who had C. trachomatis at pretreatment showed eradication at follow‐up. Neisseria gonorrhoeae was present at baseline in 8/60 (13%) of the clindamycin‐gentamicin patients and in 9/55 (16%) of those treated with cefoxitin‐doxycycline. Of those who had appropriate follow‐up cultures performed, 6 in the clindamycin‐gentamicin group and 8 in the cefoxitin‐doxycycline series, all showed eradication of the organism. It is concluded that clindamycin‐gentamicin and cefoxitin‐doxycycline have similar clinical cure rates for acute pelvic inflammatory disease, and based on this limited experience, it is suggested that the clindamycin‐gentamicin combination will satisfactorily eradicate Chlamydia trachomatis and Neisseria gonorrhoeae when either or both of these pathogens are present.
Analysis of uterine contractility after administration of the non‐steroidal antiinflammatory drug nimesulide
Authors: Pulkkinen Martti , Monti Tiziana , Macciocchi Alberto
Published: November 2007

To study the effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) on uterine contractility in different parts of the uterus and on the direction and velocity of propagation of the activity. intra‐uterine pressure (IUP) was measured simultaneously in 10 dysmenorrheic and 5 eumenorrheic patients with two microtransducer catheters at two locations (30 mm apart) before and after taking nimesulide, a newly developed NSAID. The uterus developed higher pressure cycles in the fundus than in the isthmus, in both eumenorrheic and dysinenorrhcic conditions. Nimesulide did not affect either the active pressure (AP) or the direction and velocity of propagation of the activity, though it alleviated pain significantly. In dysmenorrheic patients, resting pressure (RP) is at a high level only in the fundus. The velocity of propagation ranged from 12 to 19 mni/s. The mathematical probability of procervical activity (1.0 if all procervical; 0.0 if all profun‐dal). and thus the transport, was 0.59 in eumenorrheic and 0.68 in dysmenorrheic patients, the average for the whole series being 0.65. The luminal content (menstrual blood) moves in the cervical direction much more slowly than would be expected on the basis of simple calculations of velocity (velocity vector) of propagation.
An open study comparing two regimens of gemeprost for the termination of pregnancy in the second trimester
Authors: Thong Kok Joo , Baird David T.
Published: November 2007

Two regimens of the prostaglandin E, analogue, gemeprost, were compared in an open trial for termination of pregnancy between 12 and 18 weeks. Fifty women received 5×1 mg of gemeprost every 3 h and in another 50 cases, 4×1 mg of gemeprost was administered every 6 h. Although the median abortion interval was slightly shorter in the 3‐hourly group (15.9 h vs. 16.9 h; p = 0.5), the cumulative abortion rates at 24 h were similar (88% vs. 82%;p < 0.5). In women who aborted within the first 24 h, significantly fewer pessaries (p < 0.01) were required to induce abortion in the 6‐h treatment group (median 3, range 1–4) than the 3‐h group (median 5, 2–5). Parous women in both treatment groups required fewer pessaries to induce abortion than did nulliparous women (not significant; p = 0.5). Significantly (p, < 0.01) fewer pessaries were required to induce abortion in the 6‐h gemeprost group. The were no significant differences between the groups regarding incidences of diarrhea, vomiting, or the request for analgesia. These results suggest that in many women the number of pessaries used to induce mid‐trimester abortion could bc reduced by lengthening the interval between insertion of pessaries within the first 24 h, without loss of clinical efficacy.
Chemotherapy as initial treatment for cervical carcinoma: clinical and tumor marker response
Authors: Leminen Arto , Alftan Henrik , Stenman Ulf‐Hakan , Lehtovirta Pentti
Published: November 2007

Chemotherapy was given as initial therapy to 23 patients with previously untreated early and advanced cervical carcinoma. A combination of cisplatin and VP‐16 was given in squamous cell carcinoma, and cisplatin, cpirubicin and cyclophoshamide in adcnocarcinoma in one to three courses at 4‐week intervals. The overall clinical response rate to initial chemotherapy was 78% (80′% in early and 78% in advanced disease). A complete response was achieved in 3 (13%) and a partial response in 15 (65%) patients. To obtain independent information on treatment response serial tumor marker determinations were used in patients with elevated pretreatment levels. Squamous cell carcinoma antigen (SCC) responded to chemotherapy by decreasing levels in 91% of the cases. carcinoembryonic antigen (CEA) in 33%, CA 125 in 83%, and tumor‐associated trypsin inhibitor (TATI) in 50%, respectively. These results show that cervical carcinoma is a drug‐responsive tumor and that SCC and CA 125 can be used as an aid in the cvaluation of response to chemotherapy. Initial chemotherapy appears be of value by reducing tumor volume thus providing better conditions for surgery and radiotherapy.
External skeletal fixation as treatment for total puerperal rupture of the pubic symphysis
Authors: Petersen Astrid Christine , Rasmussen Kjeld Leisgaard
Published: November 2007

A caw of total puerperal rupture of the pubic symphysis during non‐operative delivery is rcportcd and the literature reviewed. The patient in our case was successfully treated by external skeletal fixation. In agreement with the literature the authors recommend external skeletal fixation when lesions are unstable, when inadequate reduction is achieved. or when the diastasis is more than 40 mm.
Tumor debulking followed by immediate combination chemotherapy in advanced ovarian carcinoma: Phase II
Authors: Vardi Joseph R. , Tadros Gamal H. , Zamurovic Dragoslava , Rafla Sameer D.
Published: November 2007

Fifty‐one consecutive, previously untreated patients with FIGO stage III or IV epithelial ovarian carcinoma were enrolled in a prospective study over a period of 7 years (1981–1988). Significant improvement has been noted in patients with advanced ovarian cancer following the administration of modified PAC 1 (adriamycin, cytoxan and cyclophospha‐mide) immediately following primary debulking surgery (within 24 hours) and repeated for 11 monthly cycles. A second look operation was found as an important prognostic indicator. Thirty‐one patients (all Stage III) completed the chemotherapy course and were eligible for second look operation. Of these, 21 patients (68%) showed negative second look. Of the patients with negative second look, 17 of 21 (81%) are alive with a mean survival of 61 months (range 19–103 months) after diagnosis. Among those with positive second look only 3 of 10 are alive with a mean of 41 months after diagnosis. The remaining 20 patients (13 stage III and 7 stage IV) did not undergo second look laparotomy. Only 2 of these 20 patients are alive with a mean of 35 months after diagnosis. Other factors of significant importance were: age and completion of chemotherapy course. Patients appeared to benefit from the combined regimen of optimal debulking surgery, completion of 12 courses of chemotherapy with the first course administered immediately after surgery and second look operation. Tumor type or histologic gradc did not seem to influence results. The early use of chemotherapy was well tolerated and toxicity was minimal and acceptable.
Oral contraceptives and cancer of the cervix uteri: A meta‐analysis
Authors: Delgado‐Rodriguez M. , Sillero‐Arenas M. , Martin‐Moreno J. M. , Galvez‐Vargas R.
Published: November 2007

Aim and objective: Because the findings of epidemiologic studies of the relationship between oral contraceptive use and cervical cancer have not been consistent, we reanalyzed the relationship.

Design: Meta‐analysis of studies published to date.

Setting and subjects: Papers were located by searching the MEDLINE data base, supplemented by a hand search of all the references in the articles recovered.

Measurements: Studies were graded as to quality. Two meta‐analyses were performed: one including all the studies gathered and one including methodologically acceptable studies only. The method of Woolf was used to combine relative risks. Heterogeneity of the effect was assessed.

Main results: Fifty‐one published studies were collected: 21 case‐control, 18 cross‐sectional, and 12 cohort designs. Twenty‐one of these were considered as methodologically acceptable, but only 18 could be pooled. The main results observed were: relative risks was 1.52 (1.3–1.8) for dysplasia, 1.S2 (1.3–1.8) for carcinoma in situ, and 1.21 (1.1–1.4) for invasive cancer. A significant linear dose‐response effect was observed in dysplasia, carcinoma in situ, and invasive cervical cancer. Heterogeneity of the effect was present in some of the former estimates.

Conclusions: Oral contraceptive use may be a risk factor for all stages of the natural history of cervical cancer, which may imply an initiator effect. Limitations to this research are discussed.
Pastewella multocida chorioamnionitis from vaginal transmission
Authors: Wong Geoffrey P. , Cimolai Nevio , Dimmick James E. , Martin Thomas R.
Published: November 2007

A 21 year old primigravida with a twin pregnancy developed Posteurellu multocidu chorioamnionitis. Infection occurred at 27 weeks gestational age after prolonged rupture of membranes. The twin in the separate sac presenting proximal to the cervix suffered infection and died shortly after birth whereas the other twin was not infected. The bacterium is believed to have caused ascending infection from asymptomatic colonization of the vaginal tract.
Expression of receptors for tumor necrosis factor in human placenta at term
Authors: Austgulen Rigmor , Espevik Terje , Mecsei Reidun , Scott Helge
Published: November 2007

The biological effects of tumor necrosis factor (TNF) are mediated through its interaction with high affinity receptors on target cells. Secretion of soluble cytokine receptors has been suggested as a mechanism of regulating cytokine activity in vivo. In a previous study we detected soluble TNF receptors (TNFRs) in amniotic fluid and urine samples from pregnant women, suggesting that secretion of soluble TNFRs may provide a mechanism for protection of the fetus against TNF action during pregnancy.

In the present study, TNFR containing cells in cryostat sections from normal placentas at term were evaluated by monoclonal antibodies against the 55kD ‐ and the 75kD TNFR in an indirect immunofluorescence technique. The 55kD TNFR was expressed by the villous syncytiotrophoblasts, by vascular endothelial cells, by some decidual cells and by occasional cells in the placental stroma. Staining for the 75kD TNFR was confined to the vascular endothelial cells, a relatively small number of stromal cells and decidual cells, whereas the villous syncytiotrophoblasts were negative.

The abundant expression of TNFRs in placental tissue suggests 1.) That a considerable number of the placental cells are receptive to the regulatory activities of TNF; 2.) That placental cells may be the cellular origin of soluble TNFRs secreted during pregnancy.
Clinical evaluation of contact Nd‐YAG laser conization for cervical intraepithelial neoplasia of the uterus
Authors: Ueki Minoru , Kitsuki Kosuke , Misaki Osamu , Seiki Yasuo , Ueda Masatsugu
Published: November 2007

Contact Nd.YAG laser conization (laser cone) was performed in 500 patients with preoperatively diagnosed cervical intraepithelial neoplasia (CIN) since September 1983. The patients treated were followed for 12 to 96 months (39.2 months on average). Average operation time was 11.4 minutes. A cure with laser cone (single treatment) was achieved in 98.6%, including cases with microinvasive and invasive carcinoma, post‐operatively. There were only 7 (1.4%) true residual cases of 47 cases (9.4% of total cases) with incomplete excision. High spontaneous cure rates (85.1%) in cases with incomplete excision are considered to be a characteristic of laser cone treatment. The contact laser cone method also got good specimens for histologic examinations. They gave a large amount of information for our follow‐up. The results indicate that contact Nd.YAG laser conization for CIN is an excellent conservative therapy from the point of cure rate, safety, indication, operation time and cone specimen, even compared with CO2 laser conization.
Fetal abdominal cavernous hemangioma diagnosed by duplex Doppler velocimetry
Authors: Battaglia C. , Artini P. G. , D'ambrogio G. , Droghini F. , Genazzani A. R.
Published: November 2007

A fetal abdominal wall mass was detected by ultrasound and analyzed by duplex Doppler showing a low resistence to blood flow through its vessels. The antenatal diagnosis of cavernous hemangioma was confirmed after birth.
First sexual intercourse: An epidemiological analysis of the beginning of the reproductive career
Authors: Wielandt Hanne Benedicte
Published: November 2007

The thesis views the data about first sexual intercourse from the investigation ‘Sexual experiences, contraceptive usage and unwanted pregnancy among 16–20 years old in Denmark’ (Studies I‐X).
Need for fetal assessment prior to and during external cephalic version: Occurrence of transient cardiac asystole
Authors: Kurup Asha , Arulkumaran S. , Montan S. , Ratnam S. S.
Published: November 2007

We encountered two cases of cardiac asystole for one and three minutes respectively following external cephalic version. We describe the two cases and discuss the necessity for one to be aware of such an event and the possible advantage of performing a fetal heart rate (FHR) recording prior to the procedure and observation of the FHR during the version.
Maternal smoking and age
Authors: Backe Bjørn
Published: November 2007

Study objective. To analyse the information on maternal smoking routinely recorded during antenatal care by general practitioners, with emphasis on the impact of smoking on birth weight and risk for small‐for‐gestational age (SGA) births. Design. Geographically based cohort study.

Setting. Evaluation of information recorded by general practitioners in antenatal records, in routine clinical practice without intervention.

Material. Women residing in one Norwegian county delivering during a 12 month period 1988/1989.

Main results. 1908 women gave birth. 30 % were recorded as smokers at first antenatal visit, 4% lacked information on smoking. The recording of smoking habits in week 36 was deficient as data were missing in 75% of the women who smoked at first antenatal visit. Smokers experienced a mean birthweight impairment of 182 grams (adjusted for parity and age). A dose‐response effect on birth weight of the number of cigarettes smoked per day at first visit was found. Also, a synergistic effect of increasing maternal age and smoking with regard to risk for SGA was demonstrated. The relative risk for SGA for smokers below 25 years was not significant, whereas women of 35 years and more had a relative risk of 3.8 for SGA. 18% of the SGA‐cases among the study subjects were attributable to smoking. Conclusions. Using the routinely collected information on smoking at first antenatal visit, the well known effects of smoking on birthweight are reproduced. The routine recording of smoking habits in week 36 is insufficient. Information on smoking registered in the antenatal records should be recorded in the Medical Birth Registry. Smoking in pregnancy appears not to be equally harmful for all women. The highest risk for SGA is found in the age group where smoking is most infrequent. The question of a more differentiated approach to the problem of smoking cessation in pregnancy, is raised.
Risk factors for multiple births
Authors: Parazzini Fabio , Tozzi Luca , Ferraroni Monica , Bocciolone Luca , Molteni Elena , Moreschi Cristina , Fedele Luigi
Published: November 2007

Study objective: To analyze risk factors for multiple births.

Design: A case‐control study. Cases were 103 women (median age 31 years, range 20‐44) who delivered multiple births not related with treatment for infertility at the ‘Clinica Luigi Mangiagalli’ of Milan. A total of 27 women delivered monozygotic twins and 76 dizygotic ones. Controls were 308 women (median age 30, range 17‐45) admitted for normal delivery on selected days to the same clinic where cases had been identified.

Results: Cases tended to be less educated than controls and the relative risk of multiple pregnancy, compared with women reporting seven years of schooling or less, was 0.4 in those reporting 7‐11 and 12 or more years of education. When the analysis was done separately for dizygotic and monozygotic multiple pregnancies, this relationship was restricted to dizygotic multiple pregnancies (χ21 trend for dizygotic pregnancies=3.82, p = 0.05). A family history of multiple pregnancies was reported in 36 women (48%) with dizygotic multiple pregnancy and 13 (52%) monozygotic ones and 88 (30%) controls. The corresponding relative risks (RR) were 2.2 and 2.5 respectively for dizygotic and monozygotic pregnancies. Compared with nulliparae, the estimated RR of dizygotic multiple pregnancies was 0.5 in women reporting two or more births, but the trend in risk with number of births was not statistically significant. No relationship emerged with spontaneous or induced abortions, body mass index, oral contraceptive or IUD use, age at menarche and risk of multiple pregnancies. Conclusions: This study confirms the role of familiarity in the risk of multiple pregnancies and suggests some different epidemiological characteristics in dizygotic and monozygotic multiple pregnancies.
Treatment of unexplained infertility: Fallopian tube sperm perfusion (FSP)
Authors: Kahn Jarl A. , Sunde Arne , von Düring Vidar , Sørdal Terje , Molne Kåre
Published: November 2007

Patients and methods. Fifty‐one couples with unexplained infertility were enrolled in the fallopian tube sperm perfusion (FSP) program. FSP is in short a combination of ovarian hyperstimulation, ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 4 ml volume.

Results. One hundred cycles were started; 93 of these were completed, resulting in 27 pregnancies (29.0% per cycle). The pregnancy rate in the first treatment cycle (41.2%) was significantly higher than in the subsequent treatment cycles (14.3%, p<0.01). Total pregnancy loss was 22.2% (2 ectopic pregnancies and 4 spontaneous abortions). The multiple birth rate was 14.2% (two sets of twins and one set of triplets).

Twenty‐two couples not conceiving following a maximum of three FSP treatments, were offered IVF treatment. Forty‐three IVF cycles were started resulting in 27 embryo replacements in 15 patients. Seven pregnancies occurred in six couples. In 11 of the couples treated, IVF treatment revealed a possible explanation for the infertility; development of multiple small follicles following ovarian hyperstimulation, empty follicle syndrome and partial or total fertilization failure. Only in five of the couples who did not conceive, no cause for the infertility could be found.

Conclusion. In the treatment of couples with unexplained infertility, the FSP procedure seems to give a birth rate of about 40% in less than two treatment cycles. FSP is less invasive and less expensive than alternative procedures such as GIFT, ZIFT and IVF and does not require the expertise and facilities for culturing of human oocytes and embryos.
Primary cutaneous endometriosis of thoracic skin with ovarian granulosa cell tumor
Authors: Ferrara Gerardo , Giordano Giovanna , Longo Maurizio , Magri Marilù
Published: November 2007

A case of non‐cicatricial endometriosis of the thoracic skin is described in a patient affected by an ovarian granulosa cell tumor, adult type. To the best of our knowledge, this is the first case of this type of association reported in the literature although some cases in which endometriosis was related to high estrogen levels are well documented. We suggest that in presence of an estrogen secerning neoplasm, foci of endometriosis might not be such a rare condition if clinicians and pathologists carefully looked for it.
Establishment of a tissue bank for fetal stem cell transplantation
Authors: Westgren Magnus , Ek Sverker , Bui The‐Hung , Hagenfeldt Lars , Markling Lola , Pschera Helmut , Seiger Åke , Sundström Erik , Ringden Olle
Published: November 2007

Study Objective. To analyse the yield of fetal liver tissue in first trimester abortions and to evaluate the number of nucleated cells obtained from each fetal liver during the sixth to twelfth week of gestation.

Design. Prospective descriptive study

Location University Hospital.

Material Women seeking abortion during a 12 month period 1992/1993.

Results. Out of 1271 women seeking abortion, 152 were asked whether they were willing to donate fetal tissue for fetal transplantation. Of these women, 105 (69%) accepted the proposal and undcrwent a modified low suction vacuum curettage. Fetal liver tissue was obtained in 61 (58%) of these procedures. The frequency at which tissue was retrieved was strongly related to gestational age and rose from 29% in week 6 to 79% in the tenth to twelfth week of gestation. The mean number of nucleated cells obtained from each fetal liver demonstrated a conconiitant increase with gestational age, rising from 16 to 43 × 106 per liver during these weeks of gestation. Of the 61 cases in which fetal liver was obtained. four subjects were shown to be abnormal by laboratory analyses and 11 did not alter the mandatory follow‐up appointment. This left 46 cases for use in the program of fetal to fetal transplantations.

Conclusions. Most women seeking abortion seem to be in favor of the idea of fetal tissue donation lor the treatment of other fetuses. The possibility of obtaining fetal liver tissue and the number of fetal stem cells retrieved are closely correlated to gestational age. A tissue bank appears to facilitate the operation of a fetal to fetal stem cell transplantation program.
Multifetal pregnancy reduction in Sweden: Utilization rate and pregnancy outcome (1986‐1992)
Authors: Radestad Arne , Bui The‐Hung , Nygren Karl‐Gösta
Published: November 2007

All departments of Obstetrics and Gynecology, as well as all private clinics in Sweden offering assisted cwnception, were surveyed by means of a questionnaire to determine the utilization rate and outcome of multifetal pregnancy reduction (MFR) for the period I January 1986 to 30 June 1992. The response rate was 100%. Multifetal reduction was performed in 26 women, giving an average utilization rate of 1/7 multiple births of three or more for the entire period. Of the various techniques used, intracardiac or intrathoracic injection of a potassiuni chloride solution was predominant. The experience of each center with multifetal reductioiis varied between one and six procedures. In this series, the overall complete pregnancy loss was 27% (n = 7). In 73% (n= 19) of women the pregnancy continued to delivery. One fetus died in utero in the second trimester, one child died from a subtentorial hemorrhage perinatall). and one child had a malformation of the right foot and hand. It seems necessary to limit MFR to a few centers in Sweden in order to maintain and increase the experience of the operators involved, and to decrease the fetal loss rate associated with the procedure. However. the ultimate goal is to make these procedures unnecessary when methods of avoiding excessive ovulation are refined and by limiting the number of replaced embryos in IVF‐treatment.
Osteoporotic fractures in young amenorrheic women
Authors: Fahy Una M. , Cahill David J. , Wardle Peter G. , Hull Michael GR
Published: November 2007

Two cases of osteoporotic fractures in young women are presented, which highlight the risks and need for prophylactic therapy.
Intramuscular interferon‐β treatment of cervical intraepithelial neoplasia II associated with human papillomavirus infection
Authors: de Aloysio Domenico , Miliffi Loredana , Iannicelli Teresa , Penacchlonl Paola , Bottiglioni Francesco
Published: November 2007

A placebo‐controlled trial to evaluate the efficacy and the safety of intramuscular injection of interferon‐p has been performed on 37 patients suffering from cervical intraepithelial neoplasia II (CIN II) associated with human papillomavirus (HPV) infection of the cervix: twenty‐two patients were treated with interferon‐β (2 × 106 I.U. daily) for ten days; fifteen received placebo (2 ml of saline solution daily) for ten days. Prior to therapy, and at day 70, 190. 370. 550, 730 after the beginning of treatment, patients were examined by colposcopy and punch biopsies of the cervix. Results showed a progressive amelioration in the interferon‐β treated patients. which was statistically significant at any control station (70, 190, 370, 550, 730 days) as compared to placebo treatment. Percentages of lesions that regressed, persisted or progressed were 36.4%, 54.5%, 9.1% respectively in the Interferon‐β group, and 0%, 67.7% and 33.3% respectively in the placebo group. Interferon‐β administered intramuscularly has shown to be an ellicacious treatment of CIN II (cervical intraepithelial neoplasia II) associated with HPV infection, without evident side effects; it can be used in patients requiring medical treatment with at least one‐year monitoring by cervical biopsies or as an adjuvant surgical treatment (which remains the principal treatment) in the management of patients suffering from CIN II associated with HPV infection.
Factors related to drug consumption during pregnancy
Authors: Bonassi Stefano , Magnani Maurizio , Calvi Angela , Repetto Elena , Puglisi Paolo , Pantarotto Fiorella , Lazzaroni Ferdinanda
Published: November 2007

A survey on drug intake during pregnancy was carried out in a sample of 3268 women who delivered live‐born infants in 11 hospitals located throughout Italy. A large questionnaire on drug use and other aspects of maternal life‐style was administered within five days of delivery to 3112 women who consented to the interview. An overall mean consumption of 2.17 drugs per woman was reported. Apart from dietary supplements, the most used drugs were tocolytics. analgesics, and antibiotics. The proportion of women who did not use any drug was 17.3%. The role of some non‐medical determinants of drug intake was evaluated as well. Geographic and socio‐economic factors were seen to increase drug intake up to 44%, while the presence of anxiety provoked a 60%) higher consumption of drugs other than dietary supplements. Other factors influencing drug use during pregnancy were rural vs. urban residence and smoking habits. The need for the recording of these socio‐economic factors in surveys on drug use during pregnancy is emphasized.