bluuebunny/crossref_metadata_2025 huggingface dataset:
Interpretação das reações sorológicas para diagnóstico e seguimento pós-terapêutico da sífilis
Authors: Nadal Sidney Roberto , Framil Valéria Maria de Souza
Published: March 2008

A sífilis ainda é freqüente, e quando não diagnosticada e tratada corretamente, poderá causar seqüelas irreversíveis. Desta maneira, faz-se necessário saber quais os exames mais adequados para cada forma da infecção, bem como interpretar os seus resultados. Atualmente, a pesquisa da doença é realizada combinando testes específicos e não específicos, e a maioria dos autores utiliza o VDRL ou o RPR e o FTA-ABS ou o ELISA. Muitos laboratórios têm optado pelo VDRL e o ELISA por serem de fácil execução. Essas reações se tornam positivas a partir da segunda semana após o aparecimento do cancro sifilítico. O VDRL é considerado positivo quando seu título for igual ou superior a 1/16. Títulos inferiores são considerados falso-positivos quando os testes treponêmicos forem negativos. Entretanto, algumas condições estão associadas com VDRL reagente e ELISA não reagente, sem história prévia de sífilis. O VDRL é indispensável no seguimento pós-tratamento da sífilis. Recomenda-se o exame a cada seis meses, até o final do segundo ano. O teste pode permanecer positivo em 6,6% nos casos de doença primária e em 8,39% das formas secundárias 30 meses após o tratamento. Nesses casos, é necessário diferenciar entre a persistência do exame reagente e a re-infecção pelo T.pallidum. Nos doentes infectados pelo HIV, recomenda-se o exame a cada três meses. A reversão do VDRL é similar à dos doentes HIV-negativo e não está relacionada à contagem sérica dos linfócitos T CD4. O resultado falso-positivo foi descrito como 10 vezes mais freqüente nessa população. O exame torna-se negativo após 10 semanas, na maioria dos casos.
Explaining agro-industrial contract breaches: the case of Brazilian tomatoes processing industry
Authors: Zylbersztajn Decio , Nadalini Lygia B.
Published: March 2008

Three hundred small tomato growers located in Brazilian northeast states, supplied a processing industry. In view of the large number of contract hazards and weak enforcement of clauses, managers have decided to move to the Midwest, where a reduced number of larger farmers have been contracted. The industry blamed high transaction costs due to the weak mechanism of public enforcement of property rights. The industry blamed some farmers of selling the product at the market for fresh consumption. Also, farmers blamed the industry for taking advantage of asymmetric information related to quality. This study presents an analysis of contract architecture and an evaluation of effects of transaction costs related variables on the likelihood of contract breaches. A panel data study with 1,523 observations and limited dependent variable models has been formulated to test hypothesis based on transaction cost theory. Results show that opportunism and the absence of courts guarantees of property rights precluded the possibility of achieving a stable contract relationship in the region.
Participação e cultura política: os conselhos municipais de desenvolvimento rural sustentável no território Portal da Amazônia
Authors: Olival Alexandre de Azevedo , Spexoto Andrezza Alves , Rodrigues José Alesando
Published: March 2008

Apesar de se constituírem em uma das mais importantes inovações institucionais na política brasileira, a profusão dos conselhos de gestão municipal não garante em si um aprimoramento da democracia brasileira. O objetivo do presente estudo foi avaliar o perfil dos conselhos de desenvolvimento rural sustentável e de seus conselheiros, identificando possíveis diferenças entre os representantes da sociedade civil e do poder público. Para isso foram aplicados questionários contendo questões abertas e fechadas para 100 conselheiros de 12 dos 16 municípios que formam o território Portal da Amazônia. Os resultados indicam que os conselheiros são formados por uma elite local, principalmente em relação à cultura política, havendo fortes diferenças entre os representantes da sociedade civil e do poder público, podendo indicar uma correlação de forças desigual dentro destes espaços de deliberação. Os resultados indicam ainda que grande parte dos conselhos ainda possui perfil consultivo e não desempenha seu papel de auxílio na formulação de planos de desenvolvimento, havendo pouca participação da população nas deliberações dos conselhos. Como conclusão, a pesquisa aponta a necessidade de implementação de estratégias para maior envolvimento da população e para a importância da capacitação dos conselheiros para o processo participativo.
Eficácia e evolução dos indicadores socioeconômicos de famílias beneficiadas pelo programa de combate à pobreza rural: Projeto São José no Estado do Ceará
Authors: Khan Ahmad Saeed , Silva Lucia Maria Ramos
Published: March 2008

Objetivou-se verificar a evolução de indicadores socioeconômicos das famílias beneficiadas pelo programa de Combate à Pobreza Rural. Para tanto, foram feitas comparações intertemporais (ano de 1998 - ano base - e ano de 2001) de informações levantadas com beneficiários de subprojetos selecionados (abastecimento de água, eletrificação rural, mecanização agrícola e Ação Fundiária) em 27 comunidades no Estado do Ceará. Os resultados permitem concluir que houve melhorias, entre outras, no nível de educação, nas condições de moradia, nos hábitos alimentares, na aquisição de bens duráveis e na renda dos beneficiários entre os dois períodos e, ainda, observou-se que os beneficiados apresentaram "renda capita" superior à renda "renda capita" da população rural do Estado do Ceará.
Construção de um sistema educacional inclusivo: um desafio político-pedagógico
Authors: Oliveira Anna Augusta Sampaio de , Leite Lucia Pereira
Published: March 2008

Na realidade brasileira a proposta da construção de um sistema educacional inclusivo encontra-se amparada legalmente e em princípios teóricos fundamentados em ideais democráticos de igualdade, eqüidade e diversidade. No entanto, muitas vezes, as práticas inclusivas se distanciam sobremaneira das proposições teóricas e legais. Assim, neste artigo, temos como objetivo discutir aspectos relacionados ao delineamento de políticas públicas de inclusão educacional, considerando as ações político-administrativas e as de caráter pedagógico. Colocamos em debate as dificuldades de apreensão do caráter inter-setorial do processo, do conceito de educação inclusiva, como também as dificuldades de materialização de práticas não excludentes, da transformação do contexto educacional, tanto no que se refere às concepções quanto às ações na busca de implantação e implementação de um sistema inclusivo.
Influência de doses de fósforo no fluxo difusivo em solos de Alagoas
Authors: Bastos Adelmo L. , Costa José P. V. da , Silva Ivandro de F. da , Raposo Roberto W. C. , Souto Jacob S.
Published: March 2008

Objetivando avaliar o efeito de diferentes doses de fósforo sobre o fluxo difusivo deste elemento em amostras de solos do Estado de Alagoas, conduziu-se um experimento em laboratório, no Centro de Ciências Agrárias da Universidade Federal de Alagoas, município de Rio Largo, AL. Os solos utilizados foram classificados como Latossolo Amarelo coeso (LAx), Argissolo Acinzentado (PAC), Neossolo Flúvico (RU), Neossolo Quartzarênico RQ), Luvissolo Crômico órtico (TCo) e Luvissolo Crômico pálico (TCp). Realizaram-se análises químicas, físicas e mineralógicas. O P remanescente foi determinado na solução de equilíbrio e a CMAP o foi em função do fósforo remanescente, utilizando-se, como unidades experimentais, anéis de PVC, que serviram como câmara de difusão. As doses de fósforo corresponderam a 0, 10, 20 e 30% da CMAP. Para avaliação do fluxo difusivo de fósforo dos solos, se utilizaram papel de troca aniônica e a metodologia de papel-filtro impregnado com óxido de ferro. O ensaio consistiu em um arranjo fatorial (6 x 4) correspondendo, respectivamente, a seis solos e quatro doses de fósforo. Os solos mais arenosos (RQ e RU) e a maior dose usada indicaram sempre os maiores fluxos difusivos de fósforo.
Blendas SAN/NBR: influência do teor de acrilonitrila e da viscosidade da borracha nitrílica nas propriedades mecânicas
Authors: Leitzke Tatiana Cunha , Pezzin Ana Paula Testa , Pezzin Sérgio Henrique
Published: March 2008

Com o objetivo de desenvolver materiais poliméricos com elevada tenacidade, borrachas de poli(butadieno-co-acrilonitrila) (NBR), com teores de acrilonitrila (NA) variando de 32,9 a 45,7%, foram incorporadas ao poli(estireno-co-acrilonitrila) (SAN), por extrusão seguida de injeção. A adição do NBR resultou em um aumento significativo na resistência ao impacto e na deformação na ruptura, que foram fortemente influenciadas pela composição da blenda, pelo teor de acrilonitrila e pela viscosidade dos NBRs, porém, houve a diminuição da resistência à tração. Os resultados mais expressivos para resistência ao impacto (157,1 ± 3.7 J/m) foram obtidos para a blenda 70/30 (%m/m) utilizando NBR com 33,1% de acrilonitrila e viscosidade Mooney de 51 ML 1+4 (100°C), um valor cerca de 700% maior que o verificado para o SAN puro (22,4 ± 1.1 J/m). A análise da superfície de fratura por microscopia eletrônica de varredura revelou homogeneidade dos domínios elastoméricos dispersos na matriz, bem como o aparecimento de microtrincas e/ou deformação plástica para todas as blendas. O tamanho dos domínios de NBR diminui com o aumento do teor de acrilonitrila presente no NBR, enquanto a quantidade de domínios diminui com o aumento da viscosidade.
Synthesis and characterization of nanostructured ceramics powders for biomedical applications
Authors: Camargo Nelson Heriberto de Almeida , Bellini O. J. , Gemelli Enori , Tomiyama M.
Published: March 2008

Nanostructured materials have been largely studied in the last few years because they have a great potential to applications in different fields like physics, chemistry, biology, mechanic and medicine. Synthesis and characterization of nanostructured materials is a subject of great interest involving science, market, politicians, government and society. The nanostructured materials are in demand in biomedical area, mainly the bioceramics composed of calcium phosphates (Ca/P), which have an excellent biocompatibility and mineralogical characteristics similar to those of bones. The aim of this work was to optimize the method of powder synthesis of nanostructured calcium phosphate and of nanocomposites composed of calcium phosphate//SiO2n, containing 5, 10 and 15% (in volume) of nanometric silica (SiO2n). The results are expressed according to the method of synthesis, mineralogical and morphological characterization, and thermal behavior for the different compositions of the nanostructured powder synthesized.
Maternal serum screening for Down's syndrome on population basis
Authors: Salonen Riitta , Turpeinen Ursula , Kurki Laina , Lappalainen Mari , Ämmälä Pirkko , Hiilesmaa Vilho , Teramo Kari , Von Koskull Harriet , Gahmberg Nina , Stenman Ulf‐HäKan
Published: March 2008

Background. The favorable attitude among the public towards prenatal diagnostics in Finland allowed us to start a trial on population basis when screening for Down's syndrome by maternal serum markers and age was introduced.

Methods. Screening by maternal serum markers for Down's syndrome was offered to all 17 200 pregnant women in the Helsinki area during the study period of 2.5 years. Screening due to advanced maternal age, 37 years or more, was continued as previously, and 1133 pregnant mothers used this option. Alpha‐fetoprotein, human chorionic gonadotrophin, and during the first year also unconjugated estriol were used as markers.

Results. The uptake of serum screening was 84%. The proportion of false positive results i.e. risk for Down's syndrome, 1:350 or more at term, was initially 5.7%. After ultrasound scan 4.1% of the mothers remained ‘screen positive’. The amniocentesis or chorionic villus sampling uptake was 98.4%. Ten out of eighteen cases of Down' syndrome were detected by maternal serum screening, sensitivity 56%, 95% CI 31‐79%. Other chromosomal abnormalities were found in three cases, and there were four cases of mosaicisms confined to the placenta. These were trisomies 16, 7 and 2, and tetraploidy. Elevated serum alpha‐fetoprotein was found initially in 0.7% of the cases. One case of congenital nephrosis of the Finnish type and ten other, mainly structural, abnormalities were detected by high AFP.

Conclusions. The screening was well received by the mothers. The detection rate of 56% is in the same range as in previous studies. Ultrasound scan before the test would effectively lower the false positive rate caused by incorrect timing.
Analysis of obstetric complications reported to the National Patient Insurance Association in Finland from 1987 to 1995
Authors: Kurki Tapio
Published: March 2008

Background. The launch of the National Patient Insurance Association in 1987 off erred a good starting point to evaluate obstetric claims in Finland. In order to obtain full compensation after patient injury, proof of malpractice is no longer required. Thus, the register of the Association offers a solid data base to analyze these injuries.

Methods. A nationwide descriptive study of obstetric claims reported to the National Patient Insurance Association from 1.5.1987 to 31.12.1995. The recorded statistical datafiles of the Association were used in the analysis.

Results. A total of 801 obstetric claims were analyzed. This comprised 2% of all (n = 39189) claims during the same time period. Nearly all injuries leading to claims (683/801, 85%) occurred during delivery. In all, 156 (19.5%) claims resulted in compensation. The total sum of compensation paid was $ 1.3 million. Most often (30/80 37.5%) and highest compensation ($ 0.8 million) was paid due to delay in the diagnosis of fetal asphyxia. In all, 118 (0.3%) malpractice trials in court have arisen from all claims to the Association during the study period; only two (1.7%) resulted from obstetric causes.

Conclusions. The data indicate that most common and serious obstetric complications are associated with delay in the diagnosis of fetal asphyxia. Thus, from both the legal and the medical points of view, pertinent fetal monitoring during delivery and umbilical artery blood gas analysis after delivery in all risk deliveries should be obligatory in all delivery units. Finally, and perhaps most importantly, the patient insurance has effectively prevented obstetric malpractice trials in court.
Preterm birth and cerebral palsy
Authors: Topp Monica , Langhoff‐Roos Jens , Uldall Peter
Published: March 2008

Background. Preterm infants are at 8 times higher risk than term infants for pre‐ and perinatal brain damage, resulting in cerebral palsy. In this paper we have analysed the influence of prenatal and birth‐related risk factors on cerebral palsy in preterm infants.

Methods. In a register‐based study, 175 preterm singleton infants with cerebral palsy, born in 1982‐86, were compared with 687 controls matched by gestational age and year of birth.

Results. Statistically significant higher rates in cases were found in parity ≥3 (22% vs. 16%, p<0.05), Cesarean section (67% vs. 56%, p<0.01), and low Apgar scores at 1 minute (45% vs. 36%, p<0.05). By multivariate analyses, two variables remained statistically significant: parity ≥3 (adjusted OR=1.53 (95% CI 1.00‐2.34), p<0.05) and Cesarean section (adjusted OR=1.57 (95% CI 1.07‐2.32), p<0.05).

Conclusions. Pregnancy complications preceding preterm birth did not imply a higher risk of cerebral palsy. Delivery by Cesarean section was a prognostic factor for developing cerebral palsy, and the predictive value of Apgar scores was highly limited.
Effects of prostaglandin treatment and paracervical blockade on postoperative pain in patients undergoing first trimester abortion in general anesthesia
Authors: Hall Gerd , Ekblom Anders , Persson Elisabeth , Irestedt Lars
Published: March 2008

Background. The postoperative analgesic efficacy of a paracervical blockade (PCB) as an adjunct to general anesthesia (GA) during outpatient abortion (dilatation and curettage) is unclear, and the present study was initiated to evaluate if PCB is of significant importance per‐or postoperatively.

Methods. Two hundred women (aged 18‐49 years) were assigned to one of four groups; group 1 received vaginal prostaglandin (PG) (PGE1, gemeprost lmg) for softening of the cervix preoperatively and surgery was performed in GA, group 2 received preoperative PG and surgery was performed in GA + PCB; group 3 did not receive PG treatment and surgery was performed in GA and group 4 were subjected to GA + PCB without preoperative PG.

Results. Women receiving preoperative prostaglandin treatment (groups 1 and 2) reported significantly higher pain intensity already preoperatively, but also postoperatively as compared to patients not treated with PG. The patients subjected to prostaglandin treatment (groups 1 and 2) also had a significantly higher consumption of analgesics as compared to non‐PG treated groups (3 and 4). The addition of PCB did not influence pre‐ and postoperative pain intensity significantly or consumption of analgesics. Patients receiving PG also reported significantly more nausea than the others although nausea was of low intensity. Patients receiving PG were, however, discharged earlier than the others from the hospital.

Conclusions. Preoperative treatment of the cervix with prostaglandins was associated with significantly higher pain intensity both pre‐and postoperatively, and increased need for analgesics postoperatively and more intense nausea. PCB given just before surgery did not result in significant postoperative analgesia. More efficient techniques for pain control should be developed for women subjected to first trimester abortion with preoperative PG treatment.
Oral contraceptive use among female elite athletes and age‐matched controls and its relation to low back pain
Authors: Brynhildsen Jan , Lennartsson Helena , Klemetz Maria , Dahlquist Pia , Hedin Barbro , Hammar Mats
Published: March 2008

Background. Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain.

Objective. To evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non‐users and if it differs between women taking part in different sports.

Methods. A questionnaire was sent to female elite athletes in volleyball (n=205), basketball (n=150), and soccer (n=361) as well as to age‐matched controls (n=113). The questionnaire comprised questions about age, constitution, occupation, parity and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems.

Results. The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups with an average of 30%, whereas only 18% of the controls suffered from low back pain (p<0.01). The prevalence of low back pain within each group, athletes as well as controls, was similar in women who used, and did not use oral contraceptives.

Conclusions. This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity is probably more important.
Spirometric disorders in women with genital descensus
Authors: Strinić Tomislav , Eterović Davor , Dujić Željko , Marković Vinko , Tocilj Jadranka
Published: March 2008

Background. We hypothesized that abnormalities in connective tissue, found in women with genital descensus, could impact their pulmonary function.

Method. Therefore we compared lung flows and volumes between women with (n = 100) and without (n = 100) descensus.

Results. Patients exhibited highly significant decrements in all expiratory flows, especially in the peak expiratory flow (‐35%) and other flows at large lung volumes. The forced vital capacity and forced expired volume at 1 second, but not their ratio, were also decreased (−16% and −17%, respectively). These differences were exaggerated in postmenopausal subjects and in patients with third degree of descensus, but did not depend on the presence of stress incontinence. Lung flows and volumes did not change between follicular and luteal phase of the cycle, either in patients or in controls. The forced vital capacity decreased with increasing years past the menopausis in patients (65 ± 10 ml per year), but not in controls.

Conclusion. In women with genital descensus deteriorations in lung ventilatory function were observed in association with the presence and duration of postmenopausis.
Pyospermia and preterm, prelabor, rupture of membranes
Authors: Kjaergaard Niels , Hansen Dennis , Hansen Estrid Staehr , Schoenheyder Henrik Carl , Uldbjerg Niels , Madsen Hans
Published: March 2008

Objectives. To investigate the possible association between presence of clinically unrecognized, specific genito‐urinary tract microorganisms in men and preterm, prelabor rupture of membranes (PPROM) in their spouses.

Study design. Case control study. Eleven couples with PPROM were enrolled in the case group and 18 couples with normal pregnancies in the control group. For each man, samples of urine and semen were collected and a urethra swab was obtained. Microbiological assessment included, for each woman, cultures from vagina/cervix, urine and placenta. A smear from the vagina was obtained.

Results. In the case group, pyospermia was found in three men. Two of these men, as well as their spouses, were Chlamydia trachomatis positive, and in the third man no microorganisms could be detected. None of the controls had pyospermia (p=0.045). Among the eight cases without pyospermia one man and one woman with Chlamydia trachomatis was found, but their spouses were negative. In the control group, no Chlamydia trachomatis was detected (p=0.014). Among the women two cases and one control had positive culture of Group B streptococci (NS).

Conclusion. We suggest that the genital microflora of the man is associated with PPROM.
The relationship between umbilical artery Doppler findings, fetal biophysical score and placental inflammation in cases of premature rupture of membranes
Authors: Yücel Neşe , Yücel Og̈uz , Yekeler Hayrettin
Published: March 2008

Background. To assess the relationship between placental inflammation, umbilical artery Doppler waveforms and fetal biophysical profile score, umbilical artery Doppler studies and fetal biophysical evaluations were performed in 24 preterm pregnants with premature rupture of membranes (PROM).

Subjects. After delivery, the placentas were microscopically examined and two subgroups were formed including noninflamed or inflamed placentas.

Results. In the first group, which includes 14 cases with no histological signs of placental inflammation, we found increased systolic/diastolic ratio only in one patient, whereas in the second group including ten cases with microscopically proven inflammation, nine were found to have increased systolic/diastolic ratios (p< 0.05). Mean systolic/diastolic ratio in the first and the second groups were 2.74 ± 0.18 and 4.64 ± 0.93 respectively (p<0.001). Mean biophysical profile score was 9 ± 1.04 in the first group and 7 ± 1.05 in the second group (p<0.001). Conclusion. Abnormal biophysical profile scores along with increased arterial systolic/diastolic ratios have been shown to be the markers of impending clinical infection.
Superovulation combined with insemination or timed intercourse in the treatment of couples with unexplained infertility and minimal endometriosis
Authors: Isaksson Rita , Tiitinen Aila
Published: March 2008

Background. To compare intrauterine insemination (IUI), direct intraperitoneal insemination (DIPI), and timed intercourse (TI), each combined with superovulation, in the treatment of couples with unexplained infertility, including couples with minimal endometriosis.

Methods. A retrospective analysis of 233 superovulation cycles in 70 couples with unexplained infertility or minimal endometriosis. Stimulation protocol, pregnancy rate, pregnancy outcome, and complications of treatment were analyzed.

Results. The pregnancy rare was 8.6% per cycle and 28.5% per couple. A majority of all treatment pregnancies (85%) occurred during the first four cycles of treatment. The duration of infertility did not influence the pregnancy rate. The pregnancy rate in patients with unexplained infertility was higher, but not significantly, than in patients with minimal endometriosis (27.7% versus 18.4%). No predictive marker for successful stimulation was found, except for the higher luteal progesterone level in cycles resulting in pregnancy. The multiple pregnancy rate was high: 30% of all pregnancies and 40% of all deliveries were multiple.

Conclusions. Superovulation in combination with insemination or intercourse is effective and is still recommended in the treatment of couples with unexplained infertility.
Ovarian cysts and cyclic hormone replacement therapy: is there an association?
Authors: Bar‐Hava Itai , Orvieto Raoul , Vardimon David , Manor Yoram , Weissman Ariel , Nelinger Roni , Ben‐Rafael Zion
Published: March 2008

Objectives. To evaluate whether there may be an association between postmenopausal ovarian cysts and hormone replacement therapy.

Methods. The study comprised 564 consecutive, asymptomatic, postmenopausal women who were referred for routine, transvaginal ultrasound examinations between January 1 and December 31, 1995. Various demographic and ultrasonographic parameters were recorded on a prospectively‐created, computerized data base.

Results. There was no difference in the prevalence of ovarian cysts with or without hormone replacement therapy (10.5% vs. 12.5%, respectively). However, in the subgroup of early postmenopausal women (40‐55 years), the use of hormone replacement therapy was associated with a significantly reduced prevalence of ovarian cysts (10.4% vs. 28.6%; p<0.05). Conclusions. Hormone replacement therapy is associated with a reduced prevalence of ovarian cysts in early postmenopause.
Prospective comparison of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence
Authors: Su Tsung‐Hsien , Wang Kuo‐Gon , Hsu Chin‐Yuan , Wei Hsiao‐Jui , Hong Bin‐Kuan
Published: March 2008

Objective. To compare prospectively the results of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence and to evaluate the efficacy, technique, and functional and anatomical changes after these two procedures.

Materials and methods. Ninety‐two patients with urodynamically proven genuine stress incontinence participated in this study, with 46 patients randomly allocated to laparoscopic colposuspension, and the other 46 patients to the traditional procedures. All patients had repeat studies at least 3 months after operation.

Results. The bladder neck position was significantly elevated after operation either at rest or during straining in both groups (all p<0.001), but it was higher in the traditional group than the laparoscopy group during straining (p<0.05). Comparison of urodynamics before and after operation in both groups showed significantly increased minimal urethral resistance and improved pressure transmission ratios at the proximal urethra (Q2). The blood loss was less in the laparoscopy group. The duration of bladder drainage after laparoscopic colposuspension was shorter, and was not affected by subsequent laparotomy. The operative time was almost the same. The success rate of the laparoscopy group was lower than that of the traditional group (80.4% vs. 95.6%, p=0.044). The complication rates were 10.8% and 17.4% respectively.

Conclusion. Laparoscopic colposuspension is an effective method for the treatment of GSI, as documented by anatomical and functional assessments. However, the success rate is still lower than for the traditional procedure.
An economic evaluation of laparoscopy and open surgery in the treatment of tubal pregnancy
Authors: Mol Ben W.J , Hajenius Petra J. , Engelsbel Simone , Ankum Willem M. , Van der Veen Fulco , Hemrika Douwe J. , Bossuyt Patrick M.M.
Published: March 2008

Background. Laparoscopy has generally replaced open surgery in the treatment of ectopic pregnancy. This study assesses the impact of the introduction of laparoscopy in the surgical treatment of tubal pregnancy on costs.

Methods. Consecutive patients undergoing primary surgery for tubal pregnancy between January 1992 and December 1995 were included in the study. Surgery was performed laparo‐scopically or by open surgery. Cost for each treatment was calculated by multiplying resources used with calculated resource unit prices. The analysis was stratified for radical and conservative surgery.

Results. Data of 255 patients were analysed. Tubal pregnancy was successfully treated in all patients. Costs per patient were US$ 3,490 for radical open surgery, US$ 1,872 for radical laparoscopic surgery, US$ 3,420 for conservative open surgery and US$ 2,125 for conservative laparoscopic surgery. Differences in costs were caused by a decreased duration of hospital stay after laparoscopy, and, in case of conservative surgery, by an increased persistent tropho‐blast rate after laparoscopy.

Conclusions. Laparoscopy is equally effective as open surgery in the treatment of tubal pregnancy, and considerably reduces costs
Ultrasonic and magnetic resonance imaging of fetal sacrococcygeal teratoma
Authors: Kirkinen Pertti , Partanen Kaarina , Merikanto Juhani , Ryynänen Markku , Haring Pertti , Heinonen Kirsti
Published: March 2008

Objective. To evaluate ultrasonic and magnetic resonance imaging (MRI) and Doppler examination in fetal sacrococcygeal teratoma (SCT), in respect to the postnatal findings and histological type of the tumor.

Study design. Nine pregnancies complicated by histologically mature fetal sacrococcygeal teratoma in four cases and by immature/malignant teratoma in five cases. Transabdominal ultrasonic imaging and Doppler velocity waveforms were recorded during the second or last trimester in all cases, first trimester ultrasound examination was carried out in six cases and last trimester MRI in five cases. These findings were compared with postnatal and operative findings of the children.

Results. Ultrasound examination did not reveal intrapelvic parts of SCT, but this was possible by MRI. Velocity waveforms of the tumor arteries were similar in all histological types and the resistance index varied from 60 to 70. The mean gestational age at antepartal diagnosis was 25.2 weeks. Large tumor size with relatively large proportion of solid components was often recognized in cases with malignant/immature histology.

Conclusions. Antepartal MRI is useful for examination of fetal SCT, but reliable differentiation of mature and immature SCT is not possible antepartally.
Jugular venous blood flow velocity waveforms in human fetuses between 20 and 42 weeks of pregnancy
Authors: Gross Beth , Petrikovsky Boris M. , Forman Frimmit , Pellerito John , Mandel Francine S. , Goldman Mitchell
Published: March 2008

Background. The goal of the study was to measure the blood flow parameters of the fetal internal jugular vein during the second half of normal pregnancy using Doppler ultrasound.

Methods. Jugular blood flow was analyzed in 95 normal singleton fetuses between 20 and 42 weeks gestation. Color and pulsed Doppler ultrasound was used to obtain jugular venous waveforms at the level of the mid‐neck. Peak velocities, ratios of velocities, and time‐averaged maximum velocities were measured.

Results. Jugular venous waveforms in healthy fetuses consist of three phases ‐ the first forward peak occurs during ventricle systole; the second forward peak occurs during early diastole and the third peak occurs during atrial contraction. Forty‐eight percent of the fetuses demonstrated absent flow during atrial contraction; 32% of fetuses demonstrated forward flow during atrial contraction and finally 20% of fetuses demonstrated flow reversal during atrial contraction.

Conclusions. The reported jugular venous profile may serve as a foundation for future studies of jugular blood flow in high risk fetuses.
Hemoconcentration in smoking mothers is associated with impaired fetal growth
Authors: Zarén Birgitta , Lindmark Gunilla , Bergsjø Per
Published: March 2008

Objective. To examine the effect of maternal smoking on the relationship between maternal hemoglobin levels and pregnancy outcome.

Design. A prospective study of healthy parous women from early pregnancy and of their infants.

Setting. Three Scandinavian university hospitals covering all deliveries from well defined geographical areas.

Subjects. Smoking (669) and non‐smoking (368) mothers, para 1 and 2 and with >37 weeks of gestational length.

Main outcome measures. Birth weight and placental weight. Ponderal Index and Placental Index as measures of possible discordant fetal and placental growth.

Results. In non‐smoking mothers the hemoglobin levels in the three trimesters had no relation to birth weight. In smoking mothers a significantly lower birth weight was seen with a high hemoglobin level in the third trimester, but hemoglobin levels in early or mid‐pregnancy had no association to birth weight. Smoking mothers also had a significantly greater fall in hemoglobin concentration from first to second and third trimester as compared to non‐smokers although ferritin levels were similar in smokers and non‐smokers, implying similar iron stores. The ratio of placental weight to the weight of the newborn was significantly higher in smokers, but no association was found to different hemoglobin levels.

Conclusions. Fetal growth impairment associated with maternal smoking is even more pronounced in smoking mothers with high hemoglobin levels in late pregnancy. Smoking mothers were also found to have disproportional fetal/placental growth with relatively high placental weights. In non‐smoking mothers hemoglobin levels had no relation to birthweight.
Continued pregnancy among abortion applicants
Authors: Söderberg Hanna , Andersson Christina , Janzon Lars , Sjöberg Niels‐Otto
Published: March 2008

Objective. A certain proportion of women applying for legal abortion later change their minds. The present study was designed to ascertain whether such women differ from those who choose to terminate their pregnancy, with regard to age, civil status, other demographic characteristics, or reproductive history.

Setting. Department of Obstetrics and Gynecology, University Hospital Malmo, Lund University, Sweden.

Subjects. All 1,446 abortion applicants attending the abortion clinic at University Hospital Malmö, in 1989.

Study design. A comparison of the women who continued the pregnancy and those who underwent abortion, with regard to the above mentioned factors.

Methods. Semistructured interviews and statistical analysis.

Results. Of this series of urban abortion applicants, almost one in ten underwent a change of mind. Women who chose to continue their pregnancy differed from those who held fast to their initial decision above all with regard to age and family situation. Less important was education, reproductive history, and stated reasons for abortion.

Conclusions. To answer the question why some women continue an unwanted pregnancy after a closer consideration is not easy. The complexity of a woman's feeling in the matter seems to be moderated by the kind of support and stability she has in her life situation and also of the stability in relation to her partner. An equally important question is whether this change of mind is associated with a changed attitude to the expected baby (i.e., does an unwanted child become a wanted one?).
Sexuality in women with traumatic spinal cord injury
Authors: Westgren Ninni , Hultling Claes , Levi Richard , Seiger Åke , Westgren Magnus
Published: March 2008

Background. Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

Methods. Survey of near‐total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self‐rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre‐ and post‐injury and information on sexual matters provided after injury were evaluated in detail. Out of a total of 65 women, 62 participated in the study.

Result. Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower‐level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner‐related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

Conclusion. The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.
Scientific basis for the content of routine antenatal care
Authors: Bergsjø Per , Villar José
Published: March 2008

Background. There is uncertainty concerning antenatal care as a tool to eliminate or alleviate adverse outcomes in the newborn. We identified congenital conditions, intrauterine infections, intrauterine growth retardation, preterm birth and some specific infectious diseases in the mother with a view to prophylactic and other interventions. The value of some special diagnostic tools is also under discussion.

Methods.Review of recent literature, especially randomized controlled trials and systematic reviews.

Results and conclusions.Genetic abnormalities cannot be prevented after conception, but many of them, and a number of acquired conditions, can be discovered by ultrasonographic and biochemical diagnostics. The advisability of screening must be determined locally for each condition, based on prevalence, treatment options and the legal requirements for abortion. Smoking. excessive alcohol intake, and severe undernutrition cause fetal growth retardation. Interventions to reduce maternal smoking have had limited success. Protein‐energy supplementation only modestly affects birthweight. Routine measurement of uterine height is a good predictor of severe growth retardation and in rural settings of perinatal death. Preterm birth has been linked to ascending infection and subsequent rupture of the membranes. Attempts to eradicate local infections have shown some benefit but results are not convincing yet. Cervical cerclage and betamimetic drugs have little, if any, effect. Claims for reduction of physical strain (standing >5 hours) at work should be supported. Tuberculosis in the mother should be discovered and treated. Malaria prophylaxis during pregnancy will protect the mother and possibly benefit the fetus. Adequate tetanus immunization of all mothers is a high priority intervention in developing countries. In HIV‐positive mothers, Zidovudine ante‐ and perinatally will lower perinatal HIV‐transmission significantly. Risk scoring may help identify some women for referral to higher level of care. Routine ultrasonography does not improve the outcome of pregnancy in terms of live births and morbidity, but may influence mortality through discovery and abortion of fetuses with major malformations. One vaginal examination during pregnancy is recommended but no repeat procedure unless medically indicated.
Effective obstetric paracervical block with reduced dose of bupivacaine: A prospective randomized double‐blind study comparing 25 mg (0.25 %) and 12.5 mg (0.125%) of bupivacaine
Authors: Nieminen Kari , Puolakka Jukka
Published: March 2008

Background. To study whether paracervical block (PCB) with 12.5 mg (0.125 %) of bupivacaine is as effective as with 25 mg (0.25 %) and if there are differences in fetal heart rate (FMR) patterns between the doses.

Methods. A prospective, randomized double‐blind study. Fifty‐two patients received PCB with 25 mg and 45 patients with 12.5 mg of bupivacaine. Pain intensity was assessed by the patients on a horizontal visual analog scale (VAS). Fetal heart rates of the fetuses were analyzed visually concerning basal rate, variability, accelerations, bradycardia, silent pattern and decelerations.

Results. The pain relief was statistically significant in both groups up to 120 min after PCB. The VAS‐values were similar in both groups both before and after PCB. Fetal heart rate changes appeared in both groups more frequently after than prior to PCB. In patients receiving 25 mg of bupivacaine there appeared to be more FHR changes than in those receiving 12.5 mg.

Conclusions. Paracervical block with 12.5 mg of bupivacaine is an effective method to relieve pain during labor. Fetal heart rate changes seemed to appear less frequently with this reduced dose. It seems that by lowering the dose of bupivacaine it is possible to reduce fetal side‐effects without losing analgesic effect.
Maternal serum levels of interleukin‐6 and clinical characteristics of normal delivery at term
Authors: Arntzen Knut Jørgen , Lien Egil , Austgulen Rigmor
Published: March 2008

Background. The objective of the present study was to study participation of cytokines and cytokine inhibitors during the process of normal parturition, as assessed by maternal serum levels of interleukin‐1 (IL‐1), interleukin‐6 (IL‐6), tumor necrosis factor (TNF) and soluble tumor necrosis factor receptors (sTNFRs, p55 and p75).

Materials and methods. Twenty‐six healthy women in normal term labor were observed during parturition and until 2 h post partum. Serum was sampled every 2 h, and an evaluation of strength and frequency of contractions was performed at the time of sampling. Concentrations of IL‐1, IL‐6, TNF, p55 and p75 were analyzed, and non‐parametric tests were used to study whether any relationship existed between the serum analyzes and the clinical characteristics of parturition.

Results. There was a significant association between the strength of contractions and the levels of IL‐6 and p55. In addition, IL‐6 concentrations and frequency of contractions were correlated. Maternal serum levels of IL‐6 and p55 were highest 2 h post partum. TNF activity was detected in samples from nine women, whereas IL‐1 was not found in any sample. Conclusions. The present study suggests a role of IL‐6 and p55 in normal labor. However, as women being studied already were in labor, the study does not allow any conclusions whether observed changes in IL‐6 and p55 levels have a causal relation to the process of labor or if changes are secondary effects of the process itself.
Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?
Authors: Emanuel Mark H. , Wamsteker Kees , Lammes Frits B.
Published: March 2008

Background. To determine the predictive value of dilatation and curettage (D& C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding.

Methods. An observational descriptive study was performed in a large university‐affiliated teaching hospital. The suspicion of intrauterine disorders described in theater‐reports involving D & C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D & C. Pre‐test probability (prevalence), post‐test probabilities (predictive values) and likelihood‐ratio's were calculated.

Results. The pre‐test probability for all intrauterine disorders was 0.49. The post‐test probabilities for a 'suspect’ and a ‘not suspect’ D & C were 0.61 and 0.46 respectively with an overlap of confidence‐intervals. The corresponding likelihood‐ratio's were 1.69 and 0.87 respectively.

Conclusions. D & C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaints.
The clinical significance of an absent end‐diastolic velocity in the umbilical artery detected before the 34th week of pregnancy
Authors: Kurkinen‐Raty Merja , Kivela Aarre , Jouppila Pentti
Published: March 2008

Background. The aim of this study was to evaluate the clinical significance of absent or reversed (ARED) flow detected in the late second or early third trimester in the umbilical artery in high‐risk pregnancies.

Methods. Eighty‐three women with hypertensive disorders of pregnancy, gestational diabetes or a suspected disorder of the fetus (e.g. small‐for‐gestational age) were included in this retrospeethe study. A constant finding of ARED flow in the umbilical artery was registered with the pulsed Doppler method between the 23 + 0 and 33 + 6 gestational weeks. Perinatal mortality (PNM) rates. Apgar scores and arterial umbilical pH values, birth weights, the frequency of SGA, gestational ages at birth, NICU (=neonatal intensive care unit) days, anomalie fetuses and the mode of delivery were registered. Mann‐Whitney U‐test and χ‐squared test were used for statistical analysis.

Results. The PNM in the entire group under study was 19.3% (16 infants/fetuses). The rate of structurally or chromosomally abnormal fetuses was 15.7% (13 infants/fetuses). When anomalie fetuses were excluded the PNM was 18.6%. No non‐anomalic fetuses/newborns were lost in cases in which ARED was detected after the 30th week. No statistically significant difference was observed in PNM and SGA frequencies when comparing AEDV (absent end‐diastolic velocity) fetuses with those who had REDV (reversed end‐diastolic velocity). When anomalie fetuses were excluded the PNM rate in the AEDV group was 8.9% compared with the PNM rate of 35.7% in the REDV group; (p = 0.03).

Conclusions An early ARED finding (before the 34th week) in the umbilical artery signifies a marked warning signal of fetal distress. In these cases the rates of perinatal morbidity and mortality arc very high, which is a reflection of the severity of the condition. The majority of fetuses can. however, be saved.
Prenatal diagnosis of urinary tract abnormalities
Authors: Nishi T.
Published: March 2008

Background. To compare magnetic resonance imaging with ultrasonography for the diagnosis of urinary tract abnormalities.

Methods. Two cases of multicystic dysplastic kidney, six cases of ureteropelvic junction obstruction, and one case of autosomal recessive polycystic kidney disease were diagnosed on antenatal ultrasonography and/or magnetic resonance imaging.

Results. In case of multicystic dysplastic kidney and ureteropelvic junction obstruction, ultrasonography showed characteristic features of their diseases. Magnetic resonance imaging was insufficient to diagnose these diseases. In a case of autosomal recessive polycystic kidney disease, ultrasonography and magnetic resonance imaging were both useful to show characteristic features of this disease, and thus made it possible to make a correct diagnosis of the disease.

Conclusions. For a prenatal fetal diagnosis, it is necessary to observe both fetal anatomy and an evolution of the fetal abnormality. The above mentioned three types of urinary tract abnormalities changed their anatomic configurations and/or texture of urinary tracts as the pregnancies progressed. To observe these changes, the usefulness of ultrasonography is superior to that of magnetic resonance imaging for the present. Although ultrasonography and magnetic resonance imaging show fetal urinary tract abnormalities, these instruments should be used properly during the period of the pregnancy on case‐by‐case bases.