bluuebunny/crossref_metadata_2025 huggingface dataset:
Endometrial responses to various hormone replacement regimens in ovarian failure patients preparing for embryo donation
Authors: Sauer M.V. , Stein A.L. , Paulson R.J. , Moyer D.L.
Published: April 2004

Various regimens are recommended for replacing sex steroids in ovarian failure patients attempting donor embryo transfer. We histologically assessed endometrial biopsies obtained on simulated cycle day 26 from functionally agonadal patients (n = 19) receiving hormone replacement according to three different regimens: Regimen 1, oral micronized estradiol (E2) 2 mg days 1–5, 4 mg days 6–9, 6 mg days 10–13, 4 mg days 14–28, with progesterone vaginal suppositories, 100 mg day 15 followed by 200 mg days 16–28; Regimen 2, oral micronized E2 1 mg days 1–5, 2 mg days 6–9, 6 mg days 10–13, 2 mg days 14–28, with progesterone vaginal suppositories, 100 mg day 15 followed by 200 mg days 16–28; Regimen 3: oral micronized E2 1 mg days 1–5, 2 mg days 6–9, 6 mg days 10–13, 2 mg days 14–28, progesterone 50 mg intramuscularly delivered day 15 followed by 100 mg intramuscularly days 16–28. Biopsies were interpreted according to Noyes criteria. While all regimens resulted in variable degrees of stromal pseudodecidualization, Regimen 1 biopsies uniformly demonstrated glandular abnormalities consistent with excessive estrogen stimulation. This included aberrant maturation, intraluminal papillary excrescences and variations in epithelium size and stratification. Regimen 2 biopsies were morphologically normal in most patients, yet many manifested minor variations in gland maturity. Only Regimen 3 biopsies were consistently normal on day 26 or slightly advanced in maturation. We conclude that endometrial morphology differs according to the hormone replacement preparation and route of administration. A combination of oral E2 and intramuscular progesterone, given according to Regimen 3 design, reliably produces in‐phase secretory endometrium morphologically indistinguishable from a natural spontaneous cycle.
Premenstrual tension: A placebo‐controlled efficacy study with spironolactone and medroxyprogesterone acetate
Authors: Hellberg D. , Claesson B. , Nilsson S.
Published: April 2004

Forty‐three healthy women with a characteristic history of premenstrual tension participated in a placebo controlled, crossover study. The effects of spironolactone (Aldactone) and medroxyprogesterone acetate (Gestapuran) on ten symptoms of premenstrual tension were evaluated. Placebo tablets as well as spironolactone and medroxyprogesterone acetate significantly improved a mood index score (which ia a generally accepted method to measure premenstrual symptoms). Spironolactone and medroxyprogesterone acetate were however both significantly (P < 0.05) better than placebo in relieving the symptoms.
Essential fatty acids in pregnancies complicated by intrauterine growth retardation
Authors: Vilbergsson G. , Samsioe G. , Wennergren M. , Karlsson K.
Published: April 2004

The relative fatty acid composition of lecithin was measured in maternal and cord blood serum in human pregnancies at risk for intrauterine growth retardation (IUGR) (n = 28) as compared to controls (n = 20). In the IUGR cases (n = 13) linoleic acid was lower in maternal samples but higher in cord blood, oleic acid was elevated in both whereas docosohexaenoic acid was lower. Essential fatty acid composition of lecithin was found to be different in IUGR.
The value of human menopausal gonadotropin treatment in patients with unexplained infertility
Authors: Gürgan T. , Kişnişçi H. , Yarali H. , Aksu T. , Zeyneloĝlu H. , Develioĝlu O.
Published: April 2004

The role of multiple ovulation with human menopausal gonadotropin (HMG) in the treatment of unexplained infertility is evaluated. Of a total 73 patients with unexplained infertility, 39 received four cycles of HMG, whereas, 34 were left untreated. Eight (20.5%) women conceived during HMG treatment, in comparison to only 1 (2.9%) in the control group (P < 0.05). This study gives further credit to the value of HMG treatment for unexplained infertility.
Rural maternity care in Sierra Leone
Authors: Kargbo T.K.
Published: April 2004

The training and duties of a new category of health worker, the Maternal and Child Health Aide, is described. She is a literate women recruited from the place where she will eventually work. She has become the immediate supervisor of the traditional birth attendants (TBAs), who continue to conduct most deliveries in Sierra Leone.
Scanning electron microscopy of endometriotic lesions in the pelvic peritoneum and the histogenesis of endometriosis
Authors: Hayata T. , Matsu T. , Kawano Y. , Matsui N. , Miyakawa I.
Published: April 2004

OBJECTIVE: To determine whether the epithelium of an endometriotic lesion has eutopic endometrial glandular epithelium morphology or not for the histogenesis of endometriosis. METHOD: Scanning electron microscopy (SEM) of the endometrium was done for 25 cases. Histologically proven endometriotic lesions of 10 of these 25 cases were processed for SEM. Peroneum samples of another 15 cases without histological endometriosis were also studied. RESULT: Three of 10 cases with histologically proven endometriotic lesions revealed endometrium‐like morphology by SEM, whereas normal appearing peritoneum without histological endometriosis in 15 cases showed no endometriumlike structures by SEM. CONCLUSION: Although abovementioned results did not support retrograde menstruation and implantation, they suggested a possibility of derivation from the endometrium.
Cervical priming and labor induction by multiple doses of intracervical prostaglandin E2 gel
Authors: Norchi S. , Zanini A. , Regalia A.L. , Pollini A. , Silva A.
Published: April 2004

One hundred seventy‐two term pregnant women with medical or obstetric conditions requiring induction of labor were treated with intracervical administration of 0.5 mg prostag‐glandin E2 in tylose gel. Multiple administrations were necessary in 42 cases (24.4%), two administrations in 31 cases (18.0%) and three administrations in 11 cases (6.4%). Intracervical administration of PGE2 tylose gel (0.5 mg dose) is useful to prime the cervix, induce labor, and significantly modify Bishop score.
Ovarian masses in postmenopausal women
Authors: Ovadia J. , Goldman G.A.
Published: April 2004

In an attempt to evaluate the significance of malignant tumors in postmenopausal women, we reviewed the charts of 380 postmenopausal women over 50 years of age, operated on in our department for adnexal masses, from January 1st 1980 to December 31st, 1989. Two hundred and ninety‐seven benign (78.2%) and 83 malignant (21.8%) tumors were found. In our group of patients the rate of malignancies increases significantly with the size of the lesion. Of the malignant tumors 25.1% were in the age group 50–60 years, 16.3% in the age group 60–80 years and 58.6%, a fourfold increase in the rate of malignancies, in the over 80 age group. Although surgery might pose problems in older patients, we conclude, on the basis of our experience, that surgical treatment should be considered for all adnexal masses in postmenopausal women.
The use of intradepartmental audit to contain cesarean section rate
Authors: Tay S.‐K. , Tsakok F.H.M. , Ng C.S.A.
Published: April 2004

In one department practicing critical review of indications for cesarean delivery, the overall LSCS rate was maintained at 12.3%, 11.1%, 11.2% and 11.4% for 1987, 1988, 1989 and 1990, respectively. A highly significant (P = 0.0013) reduction of 26.8% was observed in the LSCS rate for cephalo‐pelvic disproportion between 1987 and 1990. Perinatal mortality rate per 1000 births remained low at 8.25, 7.05, 9.39 and 5.83 for infants weighing 500 g or more.
The use of fetal tissue for therapeutic applications
Authors: Rojansky N. , Schenker J.G.
Published: April 2004

In recent years, dramatic progress has been made through research using dead human fetal tissue. Cellular transplantation is an attractive alternative to organ grafting when only a discrete function of the organ is impaired. Early fetal donor cells have an advantage because they engraft readily and do not cause graft‐versus‐host disease. Similarly, the fetus is an ideal recipient of allogenic fetal cells as it is incapable of rejecting them early in gestation. Recent research advances have led to its use in endocrine, neurologic and immune system disorders as well as in hematologic and hepatic deficiencies. Concurrently, this research has led to controversy over the ethics of using human fetal tissue, particularly tissue from induced abortions. Although legalized abortion remains a hotly debated controversial issue in the USA and some other countries, a consensus has been forming, in the scientific community, on the ethical use of fetal tissue in research and clinical transplantation. This review presents the theoretical background and recent research and clinical advances in fetal tissue transplantation, in the light of the current debate on its ethical and moral implications.
Cervical cancer in young women: A poorer prognosis?
Authors: Póká R. , Juhász B. , Lampé L.
Published: April 2004

Objective: The existence of an aggressive form of cervical carcinoma affecting young women is studied by survival analysis of a large patient population. Method: Between 1969 and 1986, 1577 cases of cervical cancer were treated according to well‐defined policies at the University Department of Obstetrics and Gynaecology in Debrecen, Hungary. Patients' records were reviewed to obtain data for survival analysis. Kaplan‐Meier survival curves were generated for each stage and stratified for age. The log‐rank test was used to compare the survival of younger and older patients at each stage. Multivariate analysis was performed to control for stage and treatment type when 5‐year survival trends across four different age groups were examined. Results: Comparison of survival of patients under 35 and over 35 years of age, and also those under 40 and over 40 years of age revealed no significant differences. Five‐year survival across the < 30, 30–39, 40–49 and ≥ 50 years age groups showed no significant trend. No differences in survival were revealed when the comparison was controlled for stage of disease and treatment type. Conclusion: Results suggest that cervical carcinoma in young women is not more aggressive than in other age groups.
Effect of blood transfusion in patients with gynecologic malignancy
Authors: McGehee R.P. , Dodson M.K. , Moore J.L. , Morrison F.S. , Bass J.D. , Burrow P. , Morrison J.C.
Published: April 2004

Objectives: To determine the effect of blood transfusion on long‐term outcome (disease‐free interval, recurrence of disease after treatment, and survival) in women with invasive gynecologic malignancy. Methods: In this retrospective study, 125 patients with gynecologic malignancy were assessed over a 36‐month period. The variable of whether patients received blood transfusion during therapy was used to divide the sample into two groups. Results: There were no differences in the age, ethnicity, and site‐stage of tumor of the two groups. Treatments (surgery, radiotherapy, chemotherapy, or multimodal) were similar between the two groups, as were initial hematocrits. The disease‐free interval was significantly better in women who did not receive homologous blood (P < 0.001). Life table analysis illustrated that more patients were alive and free of disease if they did not receive blood (P < 0.001). Likewise, persistence‐recurrence of cancer was more common in the transfusion group (P < 0.001). Finally, overall survival time was adversely affected by transfusion (P = 0.045). Conclusions: The use of blood products in patients with invasive gynecologic cancer is associated with enhanced recurrence or persistence of malignancy, a decrease in the disease‐free interval, and reduction in the probability of survival without evidence of disease.
Score prognosis for the infertile couple based on historical factors and sperm analysis
Authors: Bahamondes L. , Alvarez Alma F. , Faúndes A. , Vera S.
Published: April 2004

Objective: To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. Methods: The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. Results: Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. Conclusions: The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.
The outcome of pregnancy following untreated impaired glucose tolerance
Authors: Nasrat A.A. , Augensen K. , Abushal M. , Shalhoub J.T.
Published: April 2004

Objective: To study the outcome of untreated impaired glucose tolerance (IGT) during pregnancy. Methods: Two hundred twelve pregnant women with IGT and 212 pregnant women with normal glucose tolerance. The main outcomes at delivery were mean gestation at delivery, incidence of preterm labor and induction of labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to NICU, mean values of neonatal capillary blood glucose and hematocrit at 2 h of age. Results: The mean age and parity of women with IGT during pregnancy were higher than those in control women. Their babies were heavier and had lower neonatal capillary blood glucose and higher hematocrit concentration than controls. However, the proportion of babies with birthweight ≥ 2 S.D. above the mean, neonatal capillary blood glucose < 1.5 mmol/1 (28 mg/dl) or hematocrit ≥ 65% were equal in both groups. Conclusion: IGT, as defined by the World Health Organization, did not result in any adverse outcomes.
Adolescent attitudes to authority
Authors: Coleman John , Coleman Eva Zajicek
Published: April 2004

This study is concerned with adolescent attitudes to authority. In particular the investigation focuses on notions of the ideal authority figure, attitudes to the sorts of conflicts experienced at home and in school, and on the types of resolutions to conflicts preferred by young people. Subjects were 43 adolescents from working class areas in outer London boroughs, all of whom were given a semistructured interview. Results indicated important differences in the amount of control required at home and in the school, and showed adolescents of 14 and 15 to have relatively little need for autonomy but a very considerable need for support from parents and teachers.
The relationship between criminal conviction and interrogative suggestibility among delinquent boys
Authors: Gudjonsson Gisli H. , Singh Krishna K.
Published: April 2004

This study investigates the relationship between interrogative suggestibility, as measured by the Gudjonsson Suggestibility Scale (GSS), and number of previous convictions among 35 delinquent boys. The GSS measures two independent aspects of suggestibility. First, the extent to which subjects give in to suggestive questions. Second, the extent to which subjects give in to interpersonal pressure given in the form of critical feedback about test performance. The number of convictions were found to correlated negatively with the latter aspect of interrogative suggestibility, but not significantly with the former.
Curricula interventions for identity change: substantive and ethical considerations
Authors: Waterman Alan S.
Published: April 2004

The rationale for school‐based curricula interventions to promote identity formation is based on the advantages of psychological functioning associated with use of the more sophisticated identity statuses and the opportunities available in school settings to create the conditions facilitating developmental movement in that direction. A variety of education strategies pertaining to identity development are described, along with their probable impacts upon various aspects of the processes involved in forming a sense of identity. Ethical considerations for both supporting and opposing identity‐related interventions are presented. Suggestions are offered as to how best to proceed when implementing identity‐related education curricula.
Strategies of self‐control in male young offenders who have reduced their alcohol consumption without formal intervention
Authors: McMurran Mary , Whitman Jessica
Published: April 2004

Fifty‐one imprisoned male young offenders who reported having stopped or reduced their alcohol consumption without formal intervention were studied to discover which self‐control strategies they used to help them change their drinking behaviour. Change was precipitated by adverse consequences of drinking, particularly crime and violence. The most commonly used strategies involve social change: finding alternative activities, avoiding heavy‐drinking friends, and avoiding situations where heavy drinking typically occurs. Next most frequently used strategies involve setting limits: restricting drinking time, expenditure on drink, and alcohol consumption. Finally, rate control, including beverage changes from stronger to weaker or non‐alcoholic drinks, is a commonly reported strategy. The implications for the design of intervention programmes are discussed.
Ethnic differences in self poisoning: a comparative study between an Asian and White adolescent group
Authors: Biswas Sheela
Published: April 2004

A preliminary retrospective case note study is presented comparing various characteristics of self poisoning between a White and an Asian group of adolescents. A group of 38 Asian and 34 White adolescents of ages 17 years and below, was studied. The results showed that the sex ratio of both samples was similar. Also, “Culture Conflict” was implicated in slightly more of the Asian female self poisonings as compared to the males. Asian females used “non ingestants” significantly more than their White counterparts, and significantly more described their overdose as “accidental”. Significantly more White females were in care at the time of the overdose.
Secure accommodation for very difficult adolescents: some recent research findings
Authors: Bullock Roger , Hosie Kenneth , Little Michael , Millham Spencer
Published: April 2004

The appropriate use of secure accommodation for very difficult adolescents continues to cause concern. Research in the 1970s highlighted the variety of young people admitted to secure units and the difficulties of fashioning treatment programmes. As a result, gate‐keeping and admission criteria have been tightened. Recent research has further clarified the needs and problems of young people in secure units and has highlighted the relationship between provision offered in child‐care, penal and health services. New research findings, particularly those arising out of studies of young people in Youth Treatment Centres, are discussed in the light of these issues.
Relations between young adults and their parents
Authors: Miller Judi Beinstein , Lane Mary
Published: April 2004

Young adults' relationships with mothers and fathers are compared in a survey of undergraduates. Both men and women report spending more time with mothers than fathers. They indicate receiving more positive treatment from mothers and experiencing more positive emotion and closeness with them than fathers. Correlations between perceptions of treatment and experience of emotion are moderately strong, as are those between treatment/emotion and intentions to model parents. Young adults express greater certainty in using mothers than fathers as models in childrearing, which is associated with experiencing more positive treatment and emotion with them. Since they report no more negative treatment from fathers than from mothers, their closer connections with mothers are probably due to a more positive dynamic with mothers rather than a negative dynamic with fathers. These results are consistent with previous findings that individuation and well‐being in adolescence are facilitated by close, positive relationships with parents rather than distancing ones.
The best possible unification for any collection of physical theories
Authors: Herrmann Robert A.
Published: April 2004

We show that the set of all finitary consequence operators defined on any nonempty language is a join‐complete lattice. This result is applied to various collections of physical theories to obtain an unrestricted standard supremum unification. An unrestricted hyperfinite ultralogic unification for sets of physical theories is also obtained.
Prophylaxis against prostaglandin‐induced gastrointestinal side effects
Authors: Fahmy Kamal
Published: April 2004

Prostaglandin F2α was administered by intravenous drip in 130 patients with missed, incomplete inevitable and septic abortion, intrauterine death and vesicular mole and for therapeutic termination of midtrimester pregnancies. In 84 patients (control group), no prophylactic antiemetic or antidiarrheal drugs were administered, while in 46 patients (study group), an antiemetic (prochlorperazine) and an antidiarrheal (diphenoxylate hydrochloride with atropine sulfate) drug were administered prophylactically before and during prostaglandin infusion. The incidence in vomiting and diarrhea was statistically much less in the study group (P < 0.0005 for vomiting and P < 0.005 for diarrhea). There was no statistically significant difference in the success rate of prostaglandin induction in the two groups (P > 0.05).
Investigations into the metabolism of human spermatozoa in relation to penetration capacity
Authors: Bernoth E. , Schiller S. , Glier C. , Donat H.
Published: April 2004

Using a special chamber, the authors investigated the penetration capacity of spermatozoa of 120 sterile couples in both simple and crossed mucus penetration tests. Moreover, the glycolytic activity and the oxygen consumption of the ejaculates were biochemically determined in an artificial cervical mucus medium. A negative spermatozoan penetration was found to be associated with a markedly reduced aerobic glycolytic activity. It was for low‐motility spermatozoa that no penetration was observed in cervical mucus, if the aerobic glycolysis was diminished, but the respiratory activity enhanced. Comparative investigations into the penetration capacity of spermatozoa in an artificial cervical mucus medium permit the detection of causes of male sterility, which exhibit metabolic regulation disturbances of spermatozoa.
Real time ultrasonic evaluation of the fetal heart
Authors: Filkins Karen A. , Brown Thomas F. , Levine O. Robert
Published: April 2004

A series of measurements of cardiothoracic ratios (C/T) at various gestational ages are reported. Thirty fetuses ranging from 16 to 36 weeks gestational age were studied using real time ultrasonography. The cardiothoracic ratio remained constant regardless of gestational age. A case report is presented in which a congenital heart malformation was detected in utero using real time ultrasonography, illustrating the value of these measurements in selected cases.
Vaginal morphology following hysterectomy
Authors: Jaszczak Stanislaw E. , Evans Tommy N.
Published: April 2004

This study was designed to gain more information about morphology of the vagina after hysterectomy. The prospective clinical observations of patients subjected to abdominal or vaginal extrafascial or intrafascial hysterectomy with or without correction of anatomical urinary stress incontinence were included. The length, configuration and axis of the vagina were determined using a vaginal cast technic. Vaginal casts were prepared prior to and 6 months to 4 years after surgery.

The gross appearance of the vagina after hysterectomy is affected by understanding normal pelvic anatomy and physiology, careful preoperative evaluation of pelvic defects, proper planning and competent performance of surgery. Proper handling of the endopelvic fascia and its condensations, the cardinal and sacrouterine ligaments, corrects preexisting weakness, provides vaginal suspension and prevents future vaginal disfigurement. Inadequate surgical technics result in magnifying preexisting weakness of pelvic supports. Successful surgery involves correcting the levator complex by reducing and shifting the levator hiatus ventrally. Reconstruction of the perineal body is essential.

This study suggests a relationship between successful surgical treatment of urinary stress incontinence and reconstruction of pelvic supportive structures, with restoration of the physiological vaginal axis.
Serial monitoring of serum estradiol and progesterone levels during the HMG‐HCG therapy in six anovulatory women
Authors: Sakuragi Noriaki , Tanaka Toshinobu , Fujimoto Seiichiro , Ichinoe Kihyoe
Published: April 2004

Serum estradiol (E2) and progesterone (P) levels were radioimmunoassayed every or every other day for monitoring the HMG‐HCG therapy in six anovulatory patients, and the clinical significance of measuring steroid hormones as precautionary counter‐plot against the ovarian hyperstimulation syndrome and multiple pregnancies was evaluated.

Administration of HCG is recommended to trigger ovulation when serum E2 levels reach 400–600 pg/ml.

Mean peak P level in 7–8 days after ovulation induced by HMG‐HCG was 22.9 ng/ml, which is significantly higher than P levels of the same period in spontaneous and clomiphene‐induced ovulations. This result suggests that there may occur multiple ovulations which result in multiple pregnancies in HMG‐HCG therapy.
The adolescent and contraception: Issues and controversies
Authors: Rosenfield Allan
Published: April 2004

Issues relating to adolescent sexuality and high fertility in the U.S. are reviewed briefly. Similar issues in the developing world are discussed, with emphasis placed on the limited data on the subject currently available in most developing countries. The contraceptive options available for the sexually active teenager are presented, together with a discussion of the very difficult decisions and controversies that result from the lack of an ideal or even preferable method of contraception at present.
Blood group specific substances in saliva of patients with cervical carcinoma
Authors: Gupta Y.N. , Gupta Saroj , Sanyal B.
Published: April 2004

Secretion of blood group specific substances in saliva of 380 patients with carcinoma of the cervix was studied, along with age‐matched controls. The study shows that carcinoma of the uterine cervix is much more common in non‐secretors (55.0%) than in secretors (45.0%). Statistically, this difference was found to be highly significant (P < 0.001).
Clinical causes and classification of perinatal mortality in Lagos
Authors: Abudu O. , Akinkugbe A.
Published: April 2004

Perinatal deaths in singleton births at the Lagos University Teaching Hospital during a 5‐year period were reviewed. Causes of deaths were classified into eight groups using a modified form of the Aberdeen classification. Perinatal mortality was high (42.5/1000 total births). The stillbirth rate was 32.5/1000 total births. The major causes of perinatal mortality were trauma (30.5%), low birth weight (23.9%), hemorrhage (13.7%), toxemia of pregnancy (10.3%) and mature, cause unknown (10%). Congenital malformation (4.3%) was not a major cause of perinatal deaths in this study.
High risk antenatal hospitalization
Authors: Phillippe Mark , Frigoletto Frederic D. , von Oeyen Paul , Acker David , Kitzmiller John L.
Published: April 2004

High risk, antenatal units have been established to provide highly sophisticated obstetric care for women with complications of pregnancy. In an effort to more precisely define the patients requiring this care, and to begin to document the benefits of antenatal hospitalization, a 2‐year prospective evaluation of the Antenatal Unit (AU) at the Brigham and Women's Hospital was performed. Between July 1, 1978 and June 30, 1980, 1488 consecutive patients were admitted to the AU. Demographic data, antenatal hospitalization time, hospitalization outcome, and delivery data were determined for these patients. Diabetes mellitus, premature labor, hypertensive disorders, premature rupture of the membranes, and late pregnancy bleeding disorders resulted in over 60% of the admissions. Follow‐up data demonstrated that among these 1488 patients admitted to the AU, there occurred 32 stillbirths (21.5/1000), 50 neonatal deaths (33.6/1000), and no maternal deaths. This study demonstrated that a broad spectrum of medical, surgical, and obstetric complications necessitate antenatal hospitalization, resulting in an overall perinatal survival rate of 95%.
Sterilization in Bangladesh: Mortality, morbidity, and risk factors
Authors: Rosenberg Michael J. , Rochat Roger W. , Akbar Jalaluddin , Gould Patrick , Khan Atiqur R. , Measham Anthony , Jabeen Suriya
Published: April 2004

Although surgical sterilization in Bangladesh is common and has been designated as the primary means of helping the country slow its population growth, no reliable information exists regarding the procedure's safety. To define the types and rates of medical complications associated with sterilization, we followed 5042 women and 264 men undergoing sterilization. The problems that increased most markedly after the procedure compared with before included painful urination, shaking chills, fever for at least 2 days, and frequent urination. Most of the postoperative problems could be predicted by the presence of the same problem before the operation. Factor analysis of complaints in those persons who did not have a specific preoperative complaint showed that complaints clustered into three groups: urinary tract symptoms (urinary urgency and frequency), skin problems (bleeding from the incision, sore with pus, and stitches or skin breaking open), and general complaints (weakness and dizziness). The patient's sex, the sponsor and patient load of the sterilization center, and the dose of sedatives administered to women were significantly associated with specific postoperative complaints. Five women died during the study, resulting in a death‐to‐case rate of 9.9/10,000 procedures tubectomies; four deaths were due to respiratory arrest caused by oversedation.
Forearm blood flow in the normal menstrual cycle
Authors: Lehtovirta Pentti
Published: April 2004

The peripheral hemodynamics of the normal menstrual cycle were investigated in twenty‐two healthy young women. The total blood flow in a segment of the forearm, as measured by plethysmography and local vascular resistance, were estimated both at rest and during postischemic reactive hyperemia in eight subjects. Resting cutaneous blood flow was measured in 14 subjects using 133Xe clearance method. No significant differences were observed between the results obtained in the pre‐ and postovulatory phases of the cycle.
Mycoplasma colonization in primate animal laboratories
Authors: Khatamee Masood A.
Published: April 2004

The role of bacterial and protozoal infections in reproductive failure and fetal loss has been difficult to establish in humans. This study was done in 78 female primates to determine if ureaplasma urealyticum was present. The highest overall incidence of positive cultures (36.4%) occurred among the chimpanzees, who also had the highest number of breeders (i.e., sexually active females.) This suggests that the organisms may be transmitted sexually. An opportunity is now available to study the role of ureaplasma urealyticum in reproductive problems, to determine the exact nature of its pathogenicity.
Endocrine and clinical effects of estradiol and testosterone pellets used in long‐term replacement therapy
Authors: Kapetanakis E. , Dmowski W.P. , Auletta F. , Scommegna A.
Published: April 2004

Ten women with estrogen deficiency symptoms because of premature menopause [3], gonadal dysgenesis [3], or surgical menopause [4] received subcutaneous implants consisting of 25–75 mg estradiol (E2) with or without 75 mg testosterone (T). All had elevated plasma FSH, and LH, and low E2 prior to treatment. Plasma levels of FSH, LH, E2, T and estrone (E1) were measured by specific radioimmunoassay techniques prior to treatment, three times a week for the first week and once a week for up to 76 weeks after implantation.

Mean plasma E2 levels rose abruptly and reached a maximum of 190 ± 35 pg/ml within 2 weeks. They fluctuated around 150 pg/ml for 46 weeks, then gradually declined, but remained above pretreatment values for more than 68 weeks. Plasma E1 increased to a lesser extent resulting in E2 : E1 ratio between 1 and 5. Elevated FSH and LH titers became suppressed within 4–6 weeks.

The lowest average E2 increase occurred after 25 mg implant and was associated with incomplete FSH and LH suppression. There were no differences in maximal E2 levels reached after 50 mg or 75 mg implant, however, after 75 mg implant, E2 levels appeared less variable and were sustained for a longer period of time, averaging 125 pg/ml for 70 weeks.

Plasma FSH and LH concentrations were suppressed below pretreatment levels in all patients. The degree of suppression was related to the dose of E2 implanted and, therefore, to plasma E2 levels. The FSH and LH suppression appeared more complete in women with gonadal dysgenesis than in those with premature or natural menopause.

Plasma T rose abruptly to a peak mean level of 2.5 ± 1.6 ng/ml within 2 weeks of implantation. A precipitous and steady decline with return to preimplantation titers between 17th and 18th week were then observed. The E2 : E1 ratio during the first 18 weeks after implantation was significantly higher in women who received E2 implant alone than in those who received E2 + T implant. Clinically, all patients had symptomatic improvement within 24–48 hours. Regular withdrawal bleeding followed administration of oral progestogen for up to 76 weeks after implantation in six patients with intact uterus.
CIN and preclinical cervical carcinoma. A study of morbidity trends over a 10‐year period
Authors: Dietl Johannes , Semm Kurt , Hedderich Jürgen , Buchholz Fritz
Published: April 2004

Between 1971 and 1980 1312 cone biopsies were performed at the Department of Gynecology and Obstetrics, Kiel. Comparing the two intervals from 1971 to 1975 and 1976 to 1980 the number of cases with dysplasia and Carcinoma in situ significantly rose in the last 5 years in patients 16–30 years of age. Amongst other reasons for this increase, on the basis of our investigation, the regular gynecological examination in combination with the prescription of the ovulation inhibitors seems to be responsible. The average age of patients (36–44 years) undergoing cone biopsy for the first time decreased in the period between 1971 and 1980 (approx. 8 years).

The excision of carcinoma in situ in women under 30 years of age mostly showed margins free of pathological epithelium. With increasing age the cases of not free margins increased to 70%. For the hemostasis of the conization crater up to 1977, the conventional suture technique was applied, since 1977 cone coagulation probe according to Semm was used. In this group (1977–1980) treated with coagulation after cone biopsy, 45% of the cases with carcinoma in situ not free margins had histologically normal epithelium of the extirpated uterus. In patients with the desire for a child or in pregnant women a secondary coagulation of the wound crater is achieved to preserve the uterus.
Clinical implications of the unicornuate uterus with rudimentary horn
Authors: Heinonen Pentti K.
Published: April 2004

Twenty patients with unicornuate uteri were unexpectedly found during operative procedures. Of these, 18 women had unicornuate uteri with concomitant rudimentary horn and only two were without. Suspicion of ectopic pregnancy, chronic pelvic pain, or pelvic tumor, was most frequently the primary reason for admittance to hospital. Endometriosis (20%) was the most common finding in surgical procedures. Only one hematometra of the rudimentary horn was found. Two tubal pregnancies and two pregnancies in the rudimentary horn, one with rupture of the horn and one with placenta accreta in the horn, were observed. Treatment was the simple excision of the rudimentary horn in 12 cases. Fetal survival rate was 71%, prematurity 15%, and perinatal mortality 7.4% in 35 pregnancies and 27 deliveries. High incidence of breech presentation (33%) and cesarean section rate (30%) was observed. Two out of three pregnancies with cervical cerclage ended successfully. Of 15 pyelograms performed, nine (60%) showed abnormalities, the most frequently being the absence of a kidney.
Hypovolemic pregnant women and their risk determinants
Authors: Goodlin R.C. , Quaife M.A. , Smith J.J.
Published: April 2004

Among hypovolemic pregnant women there is a high risk of premature labor, fetal growth retardation, and/or hypertension. Arterial wave velocity was determined and Evan's blue disappearance rates measured in hypovolemic gravidas with complications. It appeared that those hypovolemic gravidas without increased cardiac performance are more likely to give birth prematurely, while those with increased cardiac performance and delayed in vivo mixing of Evan's blue dye develop hypertension.
Remission of Cushing's syndrome during pregnancy
Authors: Margulies Paul L. , Imperato‐McGinley Julianne , Arthur Ann , Peterson Ralph E.
Published: April 2004

We present the first report of pregnancy with Cushing's syndrome due to an adrenal cortical adenoma, in which the hypercortisolemia disappeared during the third trimester of pregnancy, but recurred following the delivery of a normal male infant at 38 weeks by Cesarean section. The case is also unique because plasma ACTH levels were elevated during gestation and postpartum. Also, urinary estriol excretion was very low during the third trimester of pregnancy. The relationship of Cushing's syndrome and pregnancy are reviewed. This study points up some of the limitations of the routinely used dynamic tests of pituitary‐adrenal function in Cushing's syndrome, and emphasizes the importance of various radiologic procedures in evaluation of patients with Cushing's syndrome.
Trends in perinatal mortality at a Hong Kong hospital
Authors: Woo Joseph S.K. , Chan Pak‐Hang , Wong Vivian C.W. , Ma Ho‐Kei
Published: April 2004

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the “P” list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970–1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre‐eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.
Effect of ethyl alcohol infusions on glucose and hormone status in ovine pregnancy
Authors: Cook P.S. , Head H.H. , Notelovitz M. , Abrams R.M.
Published: April 2004

Term pregnant ewes were given ethanol in dextrose water i.v. according to the usual 2‐h loading dose recommended for premature labor. Glucose, insulin, cortisol, progestins, estrone and estradiol in maternal and fetal plasma were measured for 5 h. In both treated animals and controls (dextrose water only) there was a reduction in maternal cortisol and a reduction followed by a rise in progesterone concentration. Mean concentration of insulin in maternal plasma across all sampling times was higher in ethanol treated animals.
Langerhans cells in human papillomavirus (HPV) lesions of the uterine cervix identified by the monoclonal antibody OKT‐6
Authors: Väyrynen M. , Syrjänen K. , Mäntyjärvi R. , Castrén O. , Saarikoski S.
Published: April 2004

The local inflammatory cell infiltrates in 263 cervical punch biopsies of the women followed‐up since 1981 (16 ± 14 months, mean ± S.D.) for an established human papillomavirus (HPV) lesion with or without concomitant cervical intraepithelial neoplasia (CIN) were analysed for occurrence of Langerhans cells, defined by the monoclonal antibody OKT‐6 using the avidin‐biotin peroxidase complex (ABC) technique, OKT‐6+ cells remained at the constant low level (1.5–1.9% of the inflammatory cells) in the different types of HPV lesions (flat, inverted or papillomatous condylomas), their percentages (range 0.8–2.1% of the cells) being slightly affected by the grade of HPV‐associated CIN, however (P < 0.05 between HPV‐CIN I and HPV‐CIS). Although cervical HPV lesions characteristically are a disease of young females, the relative levels of in situ Langerhans cells did not show any age‐dependence. Furthermore, the intensity of the inflammatory cell infiltrate did not correlate with the relative levels of OKT‐6+ cells in the biopsies. Practically identical (1.6%) levels of OKT‐6+ cells were found in the first biopsies of the HPV lesions shown to regress during the follow‐up period (28.8% of cases), when compared with those (1.7%) in the lesions persisted (52.1% of cases) or progressed (19.1% of lesions). The results are discussed in terms of the proposed immune surveillance function against viral infections, attributed to Langerhans cells in the SALT/MALT concept. The results confirm the presence of Langerhans cells as integral constituents of the local immunocompetent cell infiltrates in uterine cervix, and as such they may well contribute to the regulation of the clinical course of HPV lesions by the in situ immune reactions.
Postcoital recovery of sperm in Douglas pouch aspirates of infertile patients
Authors: Aref I. , Reda M. , Kandil O. , El Tagi A.
Published: April 2004

Tubal dysfunction is certainly involved in some cases of infertility. Clinical diagnostic procedures for tubal patency are occasionally misleading and contradictory. Moreover, they provide no information on tubal function. The recovery of viable sperm in Douglas pouch aspirates (DPA) was used to evaluate tubal function in 94 infertile patients with different tubal findings at hysterosalpingography (HS) and laparoscopy. Sperm recovery in DPA of ten infertile patients with poor or negative postcoital Sims‐Huhner test results demonstrated the limitation of this test for evaluation of sperm transport in the female genital tract. Laparoscopic aspiration of DP may be performed in infertile patients under‐going chromosalpingoscopy as a part of their infertility investigation. The procedure should be supplementary to other available diagnostic parameters.
Vaginal versus cesarean section oriented approaches in the management of breech delivery
Authors: Confino Edmond , Ismajovich Bernardo , Sherzer Anat , Peyser Reuben M. , David Menachem P.
Published: April 2004

In a 5‐year retrospective study, 543 singleton breech presented infants weighing more than 1000 g were reviewed in two obstetric departments. Department “A” actively conducted the labor with lower cesarean section rate (26%). Department “B” attempted a trial of labor with less invasive procedures and performed more cesarean sections (38% P < 0.05 S). The management of labor, fetal and maternal outcome were compared between the two departments. Both vaginal and abdominal routes of delivery in fetuses weighing more than 1500 g resulted in the same fetal and maternal outcome. For fetuses weighing 1000–1500 g cesarean section is probably the recommended delivery route.
Plasma arginine vasopressin response to water load during labor
Authors: Singhi Sunit , Parshad Omkar
Published: April 2004

To find out whether plasma vasopressin (PAVP) response to a water load during pregnancy is inappropriately high, as had been speculated, we measured PAVP by radioimmunoassay in 30 women at the time of delivery. Ten women had received infusion of aqueous glucose solution during labor for hydration (GW group); another ten received infusion of glucose solution as a vehicle for oxytocin (OT group), and ten women did not receive any intrapartum intravenous fluid therapy (controls). Serum sodium and osmolality were also determined in all the subjects. PAVP levels were significantly lower in GW (0.70 ± 0.4 pg/ml) and OT groups (0.7 ± 0.6 pg/ml) (P < 0.05). Significant negative correlation was seen between the amount of glucose solution infused and levels of PAVP (r = −0.66; P < 0.01), while a significant positive correlation was seen between PAVP and serum sodium (r = 0.61; P < 0.01). These findings suggest that during labor, the physiological relationship between serum osmolality and PAVP is intact, and that infusion of a water load in the form of aqueous glucose solution is attended by an expected lowering of PAVP. We infer that inappropriate ADH response is not the cause of water retention and hyponatremia often seen in women receiving aqueous glucose solution during labor.
Pregnancy associated with advanced adenocarcinoma of the lung
Authors: Reiter Alexander A. , Carpenter Robert J. , Dudrick Stanley J. , Hinkley Clark M.
Published: April 2004

A case of a poorly differentiated adenocarcinoma of the lung associated with pregnancy is presented with emphasis on the intense interdisciplinary team work required in order to achieve the optimal outcome of pregnancy.
Ectopic pregnancy in a distal tubal remnant
Authors: Molloy B.G. , Beck I. , Glass M.R.
Published: April 2004

Ectopic pregnancy is a well‐recognized complication of tubal reanastomosis (Young PE, Egan JE, Barlow JJ: Reconstructive surgery for infertility at the Boston Hospital for Women. Am J Obstet Gynecol 108: 1092. 1970 and Hodari AA, Vibhasiri A, Isaac AY: Reconstructive tubal surgery for midtubal obstruction. Fertil Steril 28: 620, 1977). We describe here, however, a case of tubal pregnancy occurring in a tubal remnant on the opposite side to a successful tubocornual reanastomosis.
Congenital adrenal hyperlasia and luteal dysfunction
Authors: Villanueva A.L. , Rebar R.W.
Published: April 2004

A case of 21‐hydroxylase deficiency diagnosed and first treated at the age of 3 years is presented. Although pubertal development was delayed, full reproductive function was attained, with menses occurring at 14–33‐day intervals. Infertility evaluation at age 20 revealed elevated 17‐hydroxyprogesterone (17Po) and androgen concentrations and reduced luteal phase progesterone levels consistent with inadequate luteal function. This was corrected with additional cortico‐steroid replacement. Normal pregnancy and delivery followed.
The accuracy of hysterosalpingography versus laparoscopy in evaluation of infertile women
Authors: Ismajovich Bernardo , Wexler Shraga , Golan Abraham , Langer Lea , David Menachem P.
Published: April 2004

Two hundred fifteen infertile women underwent hysterosalpingography (HSG) and laparoscopy. One hundred twenty‐eight patients had bilaterally patent tubes on hysterosalpingography. Thirty‐one percent of these women had pelvic adhesions diagnosed by laparoscopy. Eighty‐seven women had either occluded tubes or suspected pelvic adhesions on hysterosalpingography. Thirty‐nine percent of these women had patent tubes without any pelvic pathology on laparoscopy. Inaccurate diagnoses limit the value of hysterosalpingography in evaluation of tubal and peritubal pathology.