bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective, randomized trial of steroid withdrawal in kidney recipients treated with mycophenolate mofetil and cyclosporine
Authors: Pelletier Ronald P , Akin Baris , Ferguson Ronald M
Published: September 2005

Abstract: Our transplant centre began a prospective, randomized trial of steroid withdrawal in low risk renal transplant recipients on triple immunosuppression consisting of mycophenolate mofetil (MMF), microemulsion cyclosporine (CSA), and prednisone. One hundred and twenty patients were randomized either to discontinue or remain on steroids (60 patients per group). Study design consisted of analyses of 1‐yr outcomes after study entry. This report includes the 1‐yr results plus results at last follow‐up (mean follow‐up 3.7 yr). There were no significant differences in rates of patient and graft survival at 1 yr or at last follow‐up. Additionally, the incidences of acute and chronic rejection as well as graft function were the same at 1 yr and at last follow‐up. Significant improvement was noted in total serum cholesterol and bone density at 1 yr and last follow‐up. Initial improvement in patient weight at 1 yr was not sustained at last follow‐up. No significant impact of steroid withdrawal on serum triglycerides, blood pressure, or post‐transplant diabetes mellitus was observed. To date, we have observed no immunologic risk, and some significant benefit in regards to side effects, of steroid withdrawal between 6 and 36 months after transplantation in low risk renal transplant recipients maintained on prednisone, MMF, and microemulsion CSA.

Conclusion: Steroid withdrawal in low risk kidney transplant recipients is safe and ameliorates many of the unwanted sides effects of steroid use.
Long‐term renal function after liver transplantation is related to calcineurin inhibitors blood levels
Authors: Morard Isabelle , Mentha Gilles , Spahr Laurent , Majno Pietro , Hadengue Antoine , Huber Olivier , Morel Philippe , Giostra Emiliano
Published: September 2005

Abstract:  Background:  Renal dysfunction is common after liver transplantation (LT). The aim of our study was to assess the prevalence of renal dysfunction 5 yr after LT and to identify risk factors for the development of this complication.

Patients and methods:  A total of 134 adult patients underwent LT from 1987 to 1998 and 74.6% of them were alive 5 yr after. Pre‐LT, 1 and 5 yr post‐LT renal function were calculated by Cockroft and modification of diet in renal disease (MDRD) formula. Since 1987 glomerular filtration rate (GFR) has been measured by radiolabeled tracers clearance (RTC). Risk factors for GFR < 50 mL/min were analyzed using a multivariate logistic regression model.

Results:  Mean pre‐LT GFR was 79 and 85 mL/min with Cockroft and MDRD respectively; 11% of the patients had a GFR ≤ 50 mL/min. 5 yr after LT, mean GFR was 63, 61 and 70 mL/min with MDRD, Cockroft and RTC respectively, GFR decreased by 26%, and 25% of the patients had a GFR < 50 mL/min. Independent risk factors associated with impaired renal function were: trough levels of cyclosporin A (CyA) ≥ 150 μg/L or tacrolimus (FK) ≥ 10 μg/L at 1 yr and CyA ≥ 100 μg/L or FK ≥ 8 μg/L at 5 yr.

Conclusion:  5 yr after LT, patients have lost 26% of their initial GFR and 25% of them have a GFR < 50 mL/min. This complication is predicted by high levels of calcineurin inhibitors (CNI). Therefore CNI levels should be reduced as low as possible and use of alternative drugs should be considered.
Limited sampling strategy for cyclosporine (Neoral®) area under the curve monitoring in pediatric kidney transplant recipients
Authors: Strong Dawn K. , Lai Amanda , Primmett Dennis , White Colin T. , Lirenman David S. , Carter James E. , Morrison Hurley R. , Virji Mumtaz , Ensom Mary H.H.
Published: September 2005

Abstract:  Cyclosporine (CSA; Neoral®) is one of the most common immunosuppressants used in pediatric renal transplantation. Research in adult renal transplant recipients has shown that 2‐h post‐dose concentration (C2) monitoring and limited sampling strategies (LSSs) are better at predicting drug exposure and outcome than trough concentrations (C0). While C0 monitoring is the usual practice in pediatric renal transplant patients, area under the curve (AUC) monitoring has been shown to be superior in terms of predictive ability and outcomes. However, AUC monitoring is impractical and inconvenient in a clinic setting because it involves many blood samples. An LSS provides a reliable alternative. The purpose of this study was to prospectively define an LSS (AUC0−12) for CSA monitoring and to test its predictive performance. As well, an LSS (AUC0−4) for CSA was developed and its predictive performance tested. Blood samples for CSA concentrations were collected in 29 stable pediatric renal transplant patients prior to (t = 0) and at 0.5, 1, 2, 4, 6, and 8 h following a steady‐state morning CSA dose. AUC was calculated by the trapezoidal method; LSSs for AUC0−12 and AUC0−4 were determined using multiple regression analysis in 14 patients; and the LSSs’ predictive performance was tested in 15 additional patients. Both LSSs require two blood samples. For the LSS (AUC0−12), blood samples are required immediately before the dose and 2 h post‐dose: AUC0−12 = 12.45 C0 + 2.17 C2 + 723.16 (r2 = 0.909). For the LSS (AUC0−4), blood samples are required at one and 2 h post‐dose, AUC0−4 = 1.17 C1 + 1.85 C2 − 41.00 (r2 = 0.971). The LSSs demonstrated low bias and high precision for both AUC0−12 and AUC0−4. Our two‐concentration LSSs are accurate and precise predictors that are more clinically useful for our patient population than other LSSs that have been developed for pediatric renal transplant patients. Our study template provides a guide for other centers to develop accurate and precise LSSs specific to their own patient population.
In vitro test of virulence in the progeny of a Heterobasidion interspecific cross
Authors: Olson Å. , Lind M. , Stenlid J.
Published: September 2005

Annosum root rot, caused by Heterobasidion annosum s.l., is the economically most devastating disease of coniferous forests in the northern hemisphere. We have analysed virulence of the progeny isolates of a H. annosum interspecific cross between one S and one P homokaryotic isolate from North America. Virulence was measured as mortality rate among 29 pine (Pinus sylvestris) or 58 spruce (Picea abies) seedlings per homokaryotic progeny isolate. The assay showed a wide range of virulence among the 97 progeny isolates on pine and segregated as a continuous character. The heritability of virulence on pine was estimated to be 0.088 in this study. A strong correlation between virulence on pine and spruce was also found, although the range of virulence between isolates on spruce was smaller than that on pine. No correlation between high virulence and either fast radial growth rate on malt extract agar or high wood decay capacity was found.
Stump treatment against Heterobasidion with Phlebiopsis gigantea and some chemicals in Picea abies stands in the western Alps
Authors: Nicolotti G. , Gonthier P.
Published: September 2005

The effectiveness against Heterobasidion natural airborne infections on Norway spruce stumps was tested for six treatments: aqueous suspension of Phlebiopsis gigantea oidiospores, 10%, 20% and 30% aqueous urea solutions, 4% copper oxychloride aqueous solution, and borax powder. The experiment was carried out in four naturally regenerated forests in the western Alps, each characterized by a different airborne inoculum potential. Within each stand, all treatments, with the exception of urea 10%, were effective and resulted in colonized areas of stumps significantly lower than controls. The effect of ambient spore loads on the stump colonization is discussed.
Primary gastrointestinal lymphomas: A radiological–pathological review. Part 1: Stomach, oesophagus and colon
Authors: Mendelson RM , Fermoyle S
Published: September 2005

Primary gastrointestinal lymphomas are most common in the stomach, followed by small intestine and then colon. The most frequently used pathology classification of lymphomas is the Revised European and American Lymphoma /World Health Organization classification. The correlation of radiological morphology with histology is relatively poor, although characteristic subtypes will be discussed. In the stomach, the majority of primary lymphomas are of B‐cell origin of mucosa‐associated lymphoid tissue (MALT) type. Low‐grade MALT lymphomas are associated with Helicobacter pylori infection and often respond to eradication of this organism. Radiological features include thickened folds, nodularity, depressed lesions, ulcers, prominent areae gastricae. High‐grade (large B‐cell) tumour patterns include infiltrative, polypoid, nodular, ulcerated or a combination. Endoscopy, endoscopic ultrasound and CT are important in diagnosis and staging, although appearances on barium studies should be recognized. Primary colonic lymphomas are rare. Most are of B‐cell origin. Focal and diffuse forms are seen, the former producing polypoid or nodular or cavitating masses and the latter producing ulcerative or nodular (polyposis) patterns on imaging. Even when circumferential, lymphoma rarely causes obstruction. Small bowel lymphomas will be discussed in the forthcoming part 2 of this review.
Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation
Authors: Giuffre BM , Lisle DA
Published: September 2005

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.
SAPHO syndrome masquerading as metastatic bone disease
Authors: Theumann NH , So A , Mouhsine E , Spoletini P , Hoesli P , Boubaker E , Duvoisin B , Schnyder P , Pugnale M
Published: September 2005

A 46‐year‐old woman who had had a right mastectomy for breast carcinoma a month before underwent bone scintigraphy. The examination revealed multiple pelvic, vertebral and sternal hot spots suggestive of bone metastases. Standard X‐rays and CT confirmed the presence of bony lesions but they were not typical of bone metastases. As the radiographic appearance was reminiscent of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), bone biopsies were performed. Histology showed fibrosis and hyperostosis but no tumour cells. On further questioning, the patient revealed she had had palmar pustulosis and sacroiliitis some years earlier. The purpose of the case report is to show that accurate diagnosis of SAPHO syndrome requires careful clinical and radiological examinations.
Magnetic resonance imaging of acute myocardial infarction in dextrocardia with situs solitus (dextroversion)
Authors: Salanitri JC , Welker M , Pereles FS
Published: September 2005

The case report of an 88‐year‐old woman with dextroversion and acute anterior wall myocardial infarction is presented. The patient, who had been diagnosed with dextrocardia 3 years prior to this admission, presented with right‐sided chest pain. Coronary angiography demonstrated an 80% proximal left anterior descending artery stenosis which was successfully stented. A cardiac MRI was performed to exclude a left atrial thrombus after an inconclusive echocardiogram. The MRI demonstrated findings consistent with dextroversion, with delayed contrast‐enhanced viability sequences confirming a near transmural anterior wall myocardial infarct. To our knowledge, this is the first report illustrating the cardiac MRI findings in such a case.
Desmoplastic infantile ganglioglioma: A questionably benign tumour
Authors: Taranath A , Lam A , Wong CKF
Published: September 2005

Desmoplastic infantile ganglioglioma is a rare intracranial tumour of childhood that involves the cerebral cortex and the leptomeninges. We report two patients with desmoplastic infantile gangliogliomas and multiple cerebrospinal metastases. To our knowledge, only two similar cases have been reported in the published literature. Pathologically, this rare intracranial tumour shows glial and ganglionic differentiation, accompanied by an extreme desmoplastic reaction. These are low‐grade neoplasms that are questionably benign.
Role of magnetic resonance imaging in the early diagnosis of Takayasu arteritis
Authors: Halefoglu AM , Yakut S
Published: September 2005

Takayasu arteritis is a non‐specific inflammatory process of unknown aetiology affecting the aorta and its major branches. It may lead to stenosis or occlusion. We have examined eight patients with clinically diagnosed Takayasu arteritis using contrast‐enhanced MRI and also 3‐D MR angiography. All patients were female and their ages varied between 22 and 48 years. We were able to show subtle arteritic changes and stenotic lesions in branch vessels in the early phase of the disease by using this imaging modality. Thus, we can state that contrast‐enhanced MRI with 3‐D MR angiography can be used for the initial diagnosis of Takayasu arteritis. It provides a means to evaluate the vascular tree non‐invasively and may replace conventinal angiography.
Breast magnetic resonance imaging: An essential role in malignant axillary lymphadenopathy of unknown origin
Authors: McMahon K , Medoro L , Kennedy D
Published: September 2005

The aim of this retrospective case series was to assess the role of breast MRI in the investigation of ‘occult’ malignancy, and the associated potential to influence patient management. Between January 2000 and March 2004, 18 patients, who presented with axillary lymphadenopathy, most likely due to ‘occult’ breast cancer, were examined with MRI of the breast. The results showed 12 true positives, four true negatives, and two false positives. This gave an overall sensitivity of 85.7% and an overall accuracy of 86.7%. In those in whom malignancy was identified on MRI and subsequently proven histologically, 78% of these cancers were identified, and localized by preoperative MRI‐guided sonography. In addition, 55% of these patients were eligible for conservative surgery. As such, MRI of the breast is highly sensitive for the detection of mammographically and clinically occult breast cancer. The use of MRI enables a preoperative diagnosis to be made in a high percentage of patients and may allow retrospective targeted ultrasound localization. Definitive surgical planning, including the option of breast conservation, is made possible with the result of the MRI examination.
Interpreting the improved outcome of patients with central nervous system metastases managed in clinical trials compared with standard hospital practice*
Authors: Tang JI , Back M , Shakespeare T , Lu JJ , Mukherjee R , Wynne C , Liang S
Published: September 2005

The aims were to determine the median survival and prognostic factors of patients with central nervous system (CNS) metastases managed with whole‐brain radiation therapy (WBRT), and to explore selection criteria in recently published clinical trials using aggressive interventions in CNS metastases. A retrospective audit was performed on patients managed with WBRT for CNS metastases. Potential prognostic factors were recorded and analysed for their association with survival duration. The proportion of patients with these factors was also compared with those of patients managed under three recently reported studies investigating aggressive interventions, such as radiosurgery and chemotherapy for CNS metastases. Seventy‐three patients were treated with WBRT for cerebral metastases over a 12‐month period. The median survival of the population was 3.4 months (95% confidence interval: 2.7–4.1), with 6‐ and 12‐month survival rates of 30 and 18%, respectively. Significant prognostic factors for prolonged median survival were Eastern Cooperative Oncology Group status 0–2 (P = 0.015), Medical Research Council neurological functional status 0–1 (P = 0.006), and Recursive Partitioning Analysis Class 2 versus Class 3 (P = 0.020). On multivariate analysis, younger patient age (P = 0.02) and better performance status (P < 0.01) were associated with improved outcome. When comparing these characteristics with selected published studies, our study cohort demonstrated a higher proportion of patients with poor performance status, a greater number of metastases per patient and a higher incidence of extracranial disease. This reflects the selected nature of patients in these published studies. Central nervous system metastases confer a poor prognosis and, for the majority of patients, aggressive interventions are unlikely to improve survival. The use of potentially toxic and expensive treatments should be reserved for those few in whom these studies have shown a potential benefit.
Radiologically placed temporary hepatic artery catheter for treatment of liver cancer
Authors: Gananadha S , Yan TDB , Zhao J , Clingan P , Glenn D , Morris DL
Published: September 2005

Hepatic artery infusion (HAI) chemotherapy is associated with higher response rates compared to systemic chemotherapy in those patients with unresectable liver malignancies. Operative hepatic artery catheter (HAC) insertion has significant morbidity and mortality, especially in patients with high‐volume disease, some of whom may not respond to HAI chemotherapy. We report our experience in 45 patients with high‐volume liver disease who were initially treated with HAI chemotherapy via a radiologically placed temporary HAC to try to select the responders who then went on to have an operative HAC. In these 45 patients who had 62 radiologically placed HAC, we found very few major complications, and certainly no complications such as cholecystitis, vascular or malperfusion problems.
ENDOSCOPIC RESECTION FOR EARLY GASTRIC CANCER AND FUTURE EXPECTATIONS
Authors: Hamanaka Hisanao , Gotoda Takuji
Published: September 2005

Considering the risks of surgery and the patient's poor quality of life after gastrectomy, it is sensible to offer endoscopic resection for the patients without risk of lymph node metastasis. Endoscopic resection (ER) of early gastric cancer (EGC) is now standard therapy in Japan and is increasingly becoming accepted and regularly used in other countries. The indications, techniques, and pathological assessment methods of ER in the treatment of EGC are demanding and require the endoscopist to follow them closely in order to ensure successful outcomes. New developments in ER techniques to dissect the submucosa directly, called ESD, allow resections of larger lesions in en‐bloc, although long‐term outcome data are currently still in progress. The purposes of the present review are to introduce ER methods for carrying out proper treatment and to describe future expectations.
Integrating environmental and spatial processes in ecological community dynamics
Authors: Cottenie Karl
Published: September 2005

The processes controlling the abundances of species across multiple sites form the cornerstone of modern ecology. In these metacommunities, the relative importance of local environmental and regional spatial processes is currently hotly debated, especially in terms of the validity of neutral model. I collected 158 published data sets with information on community structure, environmental and spatial variables. I showed that approximately 50% of the variation in community composition is explained by both environmental and spatial variables. The majority of the data sets were structured by species‐sorting dynamics (SS), followed by a combination of SS and mass‐effect dynamics. While neutral processes were the only structuring process in 8% of the collected natural communities, disregarding neutral dispersal processes would result in missing important patterns in 37% of the studied communities. Moreover, metacommunity characteristics such as dispersal type, habitat type and spatial scale predicted part of the detected variation in metacommunity structure.
Trouble on the reef: the imperative for managing vulnerable and valuable fisheries
Authors: Sadovy Yvonne
Published: September 2005

Reef fishes are significant socially, nutritionally and economically, yet biologically they are vulnerable to both over‐exploitation and degradation of their habitat. Their importance in the tropics for living conditions, human health, food security and economic development is enormous, with millions of people and hundreds of thousands of communities directly dependent, and many more indirectly so. Reef fish fisheries are also critical safety valves in times of economic or social hardship or disturbance, and are more efficient, less wasteful and support far more livelihoods per tonne produced than industrial scale fisheries. Yet, relative to other fisheries globally, those associated with coral reefs are under‐managed, under‐funded, under‐monitored, and as a consequence, poorly understood or little regarded by national governments. Even among non‐governmental organizations, which are increasingly active in tropical marine issues, there is typically little focus on reef‐associated resources, the interest being more on biodiversityper seor protection of coral reef habitat. This essay explores the background and history to this situation, examines fishery trends over the last 30 years, and charts a possible way forward given the current realities of funding, capacity, development patterns and scientific understanding of coral reef ecosystems. The luxury live reef food‐fish trade is used throughout as a case study because it exemplifies many of the problems and challenges of attaining sustainable use of coral reef‐associated resources. The thesis developed is that sustaining reef fish fisheries and conserving biodiversity can be complementary, rather than contradictory, in terms of yield from reef systems. I identify changes in perspectives needed to move forward, suggest that we must be cautious of ‘fashionable’ solutions or apparent ‘quick fixes’, and argue that fundamental decisions must be made concerning the short and long‐term values of coral reef‐associated resources, particularly fish, for food and cash and regarding alternative sources of protein. Not to address the problems will inevitably lead to growing poverty, hardship and social unrest in many areas.
The implications of increasing variability of fish landings
Authors: Halley John M. , Stergiou Konstantinos I.
Published: September 2005

Ghoti papers  Ghoti aims to serve as a forum for stimulating and pertinent ideas. Ghoti publishes succinct commentary and opinion that addresses important areas in fish and fisheries science. Ghoti contributions will be innovative and have a perspective that may lead to fresh and productive insight of concepts, issues and research agendas. All Ghoti contributions will be selected by the editors and peer reviewed.

Etymology of Ghoti  George Bernard Shaw (1856‐1950), polymath, playwright, Nobel prize winner, and the most prolific letter writer in history, was an advocate of English spelling reform. He was reportedly fond of pointing out its absurdities by proving that ‘fish’ could be spelt ‘ghoti’. That is: ‘gh’ as in ‘rough’, ‘o’ as in ‘women’ and ‘ti’ as in palatial.

In this paper, we measured the variance of fisheries landings using 344 time series from the Food and Agriculture Organization (FAO) of the United Nations: the series chosen had neither blank records nor zeroes over the period 1950–1996. We compared the results with 431 terrestrial populations from the Global Population Dynamics Database. The logarithm of landings (for fish) and the logarithm of population abundance (for terrestrial organisms) were employed. For both original and detrended time series, the Hurst exponent (a time series autocorrelation index that detects non‐random changes) was used to measure the rate of increase of variance as a function of time span. For most FAO time series, variability increased with series length. A large proportion of fish landings series had very large Hurst exponents, suggesting a greater contribution to the total variance by longer‐period oscillations for marine data relative to terrestrial ones but this difference between the marine and terrestrial data virtually disappeared when the series were detrended. In fish landings and terrestrial series there was no indication of variance stabilizing at a finite value. This growth in variance may extend to longer time scales, as indicated by analysis of two of the longest time series for marine fish. Our findings have major ecological and management implications as continuously increasing variability implies that there can be no long‐term equilibrium yield. This is incompatible with many models currently used for fisheries management that assume bounded equilibrium yields. Models or management strategies looking to the long‐term must account for this phenomenon.
Indicators to support an ecosystem approach to fisheries
Authors: Jennings Simon
Published: September 2005

Indicators are needed to support the implementation of an ecosystem approach to fisheries (EAF), by providing information on the state of the ecosystem, the extent and intensity of effort or mortality and the progress of management in relation to objectives. Here, I review recent work on the development, selection and application of indicators and consider how indicators might support an EAF. Indicators should guide the management of fishing activities that have led to, or are most likely to lead to, unsustainable impacts on ecosystem components or attributes. The numbers and types of indicators used to support an EAF will vary among management regions, depending on resources available for monitoring and enforcement, and actual and potential fishing impacts. State indicators provide feedback on the state of ecosystem components or attributes and the extent to which management objectives, which usually relate to state, are met. State can only be managed if the relationships with fishing (pressure) and management (response) are known. Predicting such relationships is fundamental to developing a management system that supports the achievement of objectives. In a management framework supported by pressure, state and response indicators, the relationship between the value of an indicator and a target or limit reference point, reference trajectory or direction provides guidance on the management action to take. Values of pressure, state and response indicators may be affected by measurement, process, model and estimation error and thus different indicators, and the same indicators measured at different scales and in different ways, will detect true trends on different timescales. Managers can use several methods to estimate the effects of error on the probability of detecting true trends and/or to account for error when setting reference points, trajectories and directions. Given the high noise to signal ratio in many state indicators, pressure and response indicators would often guide short‐term management decision making more effectively, with state indicators providing longer‐term policy‐focused feedback on the effects of management action.
Status, trends and management of sturgeon and paddlefish fisheries
Authors: Pikitch Ellen K , Doukakis Phaedra , Lauck Liz , Chakrabarty Prosanta , Erickson Daniel L
Published: September 2005

The 27 extant species of sturgeons and paddlefishes (Order Acipenseriformes) represent a unique and relict lineage of fishes. Producers of coveted black caviar, sturgeons are one of the most valuable wildlife commodities on earth. The group is among the most endangered fishes with all species listed under Convention on International Trade in Endangered Species (CITES) Appendix I (two species) or II (25 species), only two species considered Lower Risk by IUCN, four of the nine US taxa and one Caspian species protected under the Endangered Species Act, and local extinctions recorded for 19 of 27 species. Despite their well‐publicized imperilled status, commercial pressure on 15 species persists. Here, after reviewing the biological characteristics of sturgeons and paddlefishes and their commercial use, an overview of global fisheries is presented. The synopsis demonstrates that, with few exceptions, sturgeon and paddlefish are imperilled across the globe and long‐term survival in the wild is in jeopardy. All major sturgeon fisheries have surpassed peak productivity levels, with 70% of major fisheries posting recent harvests <15% of historic peak catches and 35% of the fisheries examined crashing within 7–20 years of inception. Even in Caspian Sea fisheries, the most important globally, present catches are below 10% of historic peak landings. Improved domestic and international fisheries management and attention to habitat and species restoration is now needed. Although captive rearing offers promise for caviar alternatives and endangered species restoration, it must advance cautiously to avoid environmental harm. To ensure a continued supply of caviar and the survival of these unique fishes we offer recommendations for priority conservation action for the future.
Adaptations of amphibious fish for surviving life out of water
Authors: Sayer Martin D J
Published: September 2005

There are a small number of fish species, both marine and freshwater, that exhibit a truly amphibious habit that includes periods of aerial exposure. The duration of emersion is reflected in the level of physical and physiological adaptation to an amphibious lifestyle. Fish that are only briefly out of water retain predominantly aquatic attributes whereas there are semi‐terrestrial species that are highly adapted to prolonged periods in the aerial habitat. Desiccation is the main stressor for amphibious fish and it cannot be prevented by physiological means. Instead, amphibious fish resist excessive water loss by means of cutaneous modification and behavioural response. The more terrestrially adapted fish species can tolerate considerable water loss and may employ evaporation to aid thermoregulation. The amphibious habit is limited to fish species that can respire aerially. Aerial respiration is usually achieved through modification to existing aquatic pathways. Freshwater air‐breathers may respire via the skin or gills but some also have specialized branchial diverticula. Marine species utilize a range of adaptations that may include modified gills, specialized buccopharyngeal epithelia, the intestine and the skin. Areas of enhanced respiratory activity are typified by increased vascularization that permits enhanced perfusion during aerial exposure. As with other adaptations the mode of nitrogenous elimination is related to the typical durations of emersion experienced by the fish. Intertidal species exposed on a regular cycle, and which may retain some contact with water, tend to remain ammoniotelic while reducing excretion rates in order to prevent excessive water loss. Amphibious fish that inhabit environments where emersion is less predictable than the intertidal, can store nitrogen during the state of emersion with some conversion to ureotelism or have been shown to tolerate high ammonia levels in the blood. Finally, the more amphibious fish are more adapted to moving on land and seeing in air. Structural modifications to the pectoral, pelvic, dorsal and anal fins, combined with a well‐developed musculature permit effective support and movement on land. For vision in air, there is a general trend for fish to possess close‐set, moveable, protruberant eyes set high on the head with various physical adaptations to the structure of the eye to allow for accurate vision in both air and water.
Evidence-Based Medicine and Headache Patient Management by General Practitioners in Italy
Authors: Bianco A , Parente MM , De Caro E , Iannacchero R , Cannistrà U , Angelillo IF
Published: September 2005

The study explores the awareness of technical terms used in evidence-based medicine (EBM) and manner of treating patients with migraine among a random sample of 500 general practitioners (GPs). A mailed questionnaire included questions on GPs' demographics and practice characteristics; awareness of EBM; sources of information about migraine and EBM; and patient's treatment behaviour. Only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on EBM. For two-thirds of GPs, disability is equivalent to illness diagnosis, and this behaviour was more prevalent in those who agreed that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine and that the clinical approach to migraine required an evaluation of clinical effectiveness, in those who treated a lower number of headache patients, who were older, and in those who did not use guidelines. The majority (93.1%) of GPs indicated that it is important to integrate clinical practice and the best available evidence, and this behaviour was significantly more frequent in those who agreed that the clinical approach to migraine required a clinical effectiveness evaluation, that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine, and in those who attended courses on EBM. Training and continuing educational programmes on EBM and guidelines on treatments of headache for GPs are strongly needed.
Is it necessary to catheterise the bladder routinely before gynaecological laparoscopic surgery?
Authors: TANG Kwok Keung , WONG Chung Kit , LO Siu Fai Leslie , NG Tai Keung
Published: September 2005

Background:  Catheterisation of the bladder was routinely performed before gynaecological laparoscopy, but such an established practice is not evidence based and may lead to an increase in postoperative urinary symptoms and urinary tract infection.

Aims:  To compare routine urethral catheterisation and non‐catheterisation before laparoscopic surgery with respect to bladder injury, postoperative urinary symptoms and urinary tract infection (UTI).

Methods:  This was a prospective, double blind randomised study. All women undergoing gynaecological laparoscopy, both elective and emergency, were invited to participate in the study. Cases involving bladder dissection, second trimester pregnancy and those who could not void preoperatively were excluded. Patients were randomly allocated to catheterise group and non‐catheterise group. Requirement of catheterisation in the non‐catheterise group, bladder injury, postoperative catheterisation, urinary symptoms and UTI were studied.

Results:  Two hundrend and seventy‐nine women were recruited of whom 262 were suitable for final analysis. Each group contained 131 cases. Patient characteristics and operative parameters were comparable in both groups. There was no bladder injury. Four percent of the women in the non‐catheterise group needed catheterisation and catheterisation was significantly associated with surgery longer than 90 min (P < 0.001). Postoperative UTI was insignificantly reduced in the non‐catheterised group. When postoperative urinary symptoms and urinary tract infections were studied as a composite outcome, they were statistically significantly reduced in the non‐catheterise group (P = 0.017).

Conclusions:  The policy of non‐catheterisation before gynaecological laparoscopic surgery is safe and feasible. Although the reduction in UTI is insignificant, the overall postoperative urinary problems (urinary symptoms or UTI) are reduced significantly.
Postpartum curettage: An audit of 200 cases
Authors: PATHER Selvan , FORD Monica , REID Rosemary , SYKES Peter
Published: September 2005

Aim:  To assess whether delivery details, clinical features at presentation and laboratory investigations could accurately predict the presence of retained products of conception (RPOC) following a postpartum curettage (PPC) and to assess the morbidity associated with this procedure.

Methods:  A retrospective chart review of patients who underwent a PPC at a tertiary referral hospital over a 5‐year period.

Results:  Two hundred patients were included in the study and 50% of patients who had histological evaluation demonstrated retained product of conception. Mode of delivery, placental status at delivery and immediate postpartum haemorrhage was unrelated to final histology however, patients presenting with pelvic infection were significantly less likely to have RPOC, χ2 = 6.358 (P = 0.042). The sensitivity and specificity of ultrasound in detecting RPOC was 94% and 16%, respectively; the presence of an echogenic focus together with a thickened endometrium of more than 10 mm was the most accurate ultrasound feature of RPOC (positive predictive value 80%). Seventeen (8.5%) patients experienced major morbidity following curettage and 14 (7%) underwent a repeat procedure with further morbidity. Patients presenting with pelvic infection were more likely to experience postoperative morbidity.

Conclusion:  A PPC has a low diagnostic yield and is associated with a significant complication rate. While the therapeutic benefit of this procedure is unclear, expectant management is appropriate especially in the presence of pelvic sepsis.
Midurethral Tissue Fixation System sling – a ‘micromethod’ for cure of stress incontinence – preliminary report
Authors: PETROS Peter E. P. , RICHARDSON Peter A.
Published: September 2005

Aims:  To assess the effectiveness of the Tissue Fixation System (TFS) in patients with stress incontinence. The TFS uses two small plastic anchors to fix an (adjustable) midurethral polypropylene mesh sling into the soft tissues below the pubic bone.

Patients and methods:  Thirty‐six patients with stress incontinence, mean age 55 (35–87), mean weight 76 kg (33–117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation. The patients were preoperatively assessed with a structured questionnaire, 24‐h urinary diary, cough stress test, transperineal ultrasound, and urodynamics. Using the TFS delivery system, a midurethral mesh tape was attached to the fibromuscular tissues behind the perineal membrane. The suburethral vaginal fascia was also tightened. Post‐operatively. the patients were reviewed at 6 weeks, and at 3‐monthly intervals with ultrasound, and cough stress tests.

Results:  Primary symptomatic cure rate at mean 9 months (3–15 months) was 83.4% (n = 36). Pad test loss decreased from a mean 12.7 g to a mean of 0.2 g; mean operating time was 5 min, and mean hospital stay was 24 h (12–48 h). There were no cases of obstructed micturition, and minimal analgesia only was required postoperatively.

Conclusion:  The TFS is a promising new method. The results at this stage are similar to those achieved previously with the ‘tension‐free’ tape operations, but with greater safety and shorter operating time. Testing by other surgeons will be required to evaluate this method further.
Is there increased monozygotic twinning after assisted reproductive technology?
Authors: TOLEDO Manuela G.
Published: September 2005

Over the past two decades there has been an association between assisted reproductive technologies and increased monozygotic twinning. The association is not clear nor are the causes of assisted reproductive technology‐related monozygotic twinning understood, although there are several theories as to the possible mechanisms involved. This review looks at some of the assisted reproductive technologies which may be associated with an increased risk of monozygotic twinning such as intracytoplasmic sperm injection, assisted hatching and blastocyst transfers. Determining the true incidence of monozygotic twinning after assisted reproductive technologies is important as there is a well‐documented increase in perinatal morbidity and mortality of monozygotic twins compared to singleton and dizygotic pregnancies.
Chlamydia trachomatis infection in Sydney women
Authors: CHEN Marcus Y. , ROHRSHEIM Richard , DONOVAN Basil
Published: September 2005

Background:  In Australia, reported rates of Chlamydia trachomatis infection have been rising progressively since the mid‐1990s. Opportunistic testing of sexually active young women attending clinical services for other reasons has already been implemented in a number of other countries.

Aims:  To help guide chlamydia testing of women, this study aimed to establish factors predictive of chlamydial infection in an Australian clinical setting.

Methods:  Women attending a sexual health service in Sydney who tested positive for C. trachomatis by polymerase chain reaction and who did not have any concurrent urogenital infections (n = 170) were compared with chlamydia‐negative controls (n = 170). Factors independently associated with chlamydia were determined using logistic regression.

Results:  Although they were present in only a minority of infected women, symptoms of dysuria [adjusted odds ratio (AOR) = 3.2 (95% CI: 1.2–9.1), P = 0.03] and postcoital bleeding [AOR = 2.7 (95% CI: 1.0–7.1), P < 0.05] were each independently associated with chlamydia. Symptoms of vaginal discharge (P = 0.3), abdominal pain (P = 0.2), or intermenstrual bleeding (P = 0.1) did not help to discriminate between infected and uninfected women. The following factors were independently associated with chlamydia: younger age (P = 0.003); being overseas‐born [AOR = 2.3 (95% CI: 1.3–4.0), P = 0.005]; sex with a partner from overseas [AOR = 2.0 (95% CI: 1.3–12.3), P = 0.01]; and sex with a partner known or suspected to be chlamydia‐infected [AOR = 7.4 (95% CI: 3.6–15.0), P < 0.001].

Conclusions:  Chlamydia testing is clinically indicated in sexually active young women with dysuria, postcoital bleeding or contact with a suspected chlamydia‐infected partner. Consideration should be given to enhanced screening programs for travelling and migrant men and women in Australian cities.
Wrigley forceps to deliver a bulky uterus following a total laparoscopic hysterectomy for endometrial cancer
Authors: NEPPE Cliff , LAND Russell , OBERMAIR Andreas
Published: September 2005

Morcellation of the uterus is contraindicated in endometrial cancer and a uterine size of 11 weeks or larger has been considered a contraindication for total laparoscopic hysterectomy (TLH) in endometrial cancer. We describe a new technique of removing a bulky uterus in a patient with endometrial cancer with the use of Wrigley forceps following a total laparoscopic hysterectomy.
Factors associated with low immunity to rubella infection on antenatal screening
Authors: SATHANANDAN Deshanie , GUPTA Leena , LIU Bette , RUTHERFORD Alison , LANE Jennifer
Published: September 2005

Background:  Rubella infection during the first trimester results in congenital rubella syndrome. There has been little recent published evidence identifying those at‐risk of infection in the first trimester of pregnancy. This study examined the level of rubella immunity in pregnant women in a part of Sydney and risk factors for non‐immunity.

Methods:  We looked at data on all confinements at two maternity hospitals in Sydney in the 2‐year period between July 1999 and June 2001. Variables included in our data set included mother's country of birth, mother's date of birth, hospital status (public or private patient), parity, rubella status and postpartum rubella vaccination.

Results:  Of the 8096 confinements, the mother was documented as being non‐immune to rubella in 567 cases (7%) of cases. Of the 567 confinements where rubella status was documented as non‐immune, Asian‐born women comprised of 65% (366) of non‐immune women while 13% (73) were Australian‐born. Country of birth remained a strong predictor of immunity, even after controlling for age, parity and hospital status. Maternal age > 35 years and nulliparity were also significant risk factors for non‐immunity.

Conclusion:  Programs targeting underimmunised populations for rubella vaccination should focus on overseas‐born women, particularly those born in Asia, nulliparous women and also women > 35 years of age.
Transvaginal cervical length measurement; Its current application in a regional Australian level II maternity hospital
Authors: VAN RIJSWIJK Suzanne , NAGTEGAAL Mariëtte J. C. , MCGAVIN Steward , DEKKER Gus
Published: September 2005

Objective:  To evaluate the impact of cervical length (CL) measurements in pregnant women at risk for preterm delivery on intervention and pregnancy outcome.

Design:  Retrospective study.

Setting:  Regional high‐level II maternity unit.

Methods:  Hospital databases were reviewed for all women delivering between March 2001 and March 2003. Women at an increased risk for preterm birth with transvaginal (TV) cervical length measurements during pregnancy were included in this audit. Patients (n = 204) were analysed together and in subgroups with different risk profiles.

Results:  For women with a significant obstetrical history, most of the cervical lengths ≤ 2.5 cm were found between 24 and 28 weeks gestational age. None of the patients with twin pregnancy as single indication for cervical length measurements developed a cervical length ≤ 2.5 cm. In women with twin pregnancy plus additional risk factor as indication for cervical length measurement, 60.87% showed shortening of cervical length to ≤ 2.5 cm. Patients with previous gynaecological operations as the only risk factor had optimal perinatal outcomes. Notwithstanding the potential beneficial effects of therapeutic measures, patients with singleton pregnancies and a significant obstetrical history, and a short cervical length had a relative risk of 3 for preterm delivery. In the group of women presenting with signs and symptoms suggestive of threatening preterm delivery and a short cervical length, significantly more patients were treated with nifedipine compared to similar patients with ‘normal’ cervical length.

Conclusions:  For patients with a high‐risk obstetrical history, a first cervical length measurement at the time of foetal morphology scan followed by one measurement at about 24 weeks would result in a timely diagnosis of almost all cases of clinically relevant cervical shortening. Just having a twin pregnancy, in the absence of other risk factors for preterm birth, does not require cervical length monitoring. Having a twin pregnancy plus additional risk factors clearly identifies a group requiring cervical length measurement and intervention. Previous LLETZ procedures or ≥ 3 preceding curettages were not found to be a major risk factor for preterm birth.
Use of uterine Doppler in an Australian level II maternity hospital
Authors: NAGTEGAAL Mariëtte J. C. , VAN RIJSWIJK Suzanne , MCGAVIN Steward , DEKKER Gus
Published: September 2005

Objective:  To evaluate the clinical usefulness of uterine Doppler.

Design:  Retrospective study between March 2001 and March 2003.

Setting:  A high‐risk population of pregnant women in a busy level II Maternity unit.

Methods:  Resistance index (RI) measurements of the right and left uterine artery were obtained by using pulsed wave Colour Doppler. The presence of a unilateral or bilateral early diastolic notch was noted. An abnormal result was defined as a mean RI ≥ 0.58 with no, one or two notches or a mean RI < 0.58 in the presence of bilateral notches.

Results:  Pre‐eclampsia was found in 45 (24.7%) women, gestational hypertension (GH) in 22 (12.1%) and intrauterine growth restriction (IUGR) in 42 (23.1%) of women included (total 59.9%). In the overall group, 127 (69.8%) women were found to have abnormal uterine artery Doppler results and 55 (30.2%) of patients had a normal Doppler study. No significant differences were found between the group of women with abnormal uterine artery Doppler and the women with a normal velocity waveform in the prediction of pre‐eclampsia, IUGR and GH, this was also true in the various high‐risk‐subgroups.

Conclusions:  Uterine Doppler is not particularly useful to the obstetrician in the management of patients with an a priori very high risk to develop uteroplacental insufficiency.