bluuebunny/crossref_metadata_2025 huggingface dataset:
Regulation of traJ transcription in the Salmonella virulence plasmid by strand‐specific DNA adenine hemimethylation
Authors: Camacho Eva M. , Casadesús Josep
Published: August 2005

The traJ gene of the virulence plasmid of Salmonella enterica serovar Typhimurium (pSLT) encodes a transcriptional activator of the transfer operon. The leucine‐responsive regulatory protein (Lrp) is an activator of traJ transcription. The upstream‐activating‐sequence  of  the  pSLT traJ  promoter  contains  two  Lrp binding sites (LRP‐1 and LRP‐2), both necessary for transcriptional activation. The promoter‐proximal site (LRP‐2) contains a GATC site (GATC‐II) whose methylation state affects Lrp binding: GATC‐II methylation in both DNA strands decreases the affinity of Lrp for the LRP‐2 site, while efficient Lrp binding occurs to a non‐methylated GATC‐II site. The effect of GATC‐II hemimethylation on Lrp binding is strand‐specific: methylation of the traJ non‐coding strand permits formation of the major Lrp–DNA retardation complex, but methylation of the coding strand does not. This asymmetry supports a model in which passage of the replication fork may permit Lrp‐mediated activation of conjugal transfer in one daughter plasmid molecule but not in the other. A remarkable trait of this regulatory design is that hemimethylation of a single GATC site can generate distinct epigenetic signals in otherwise identical plasmid DNA molecules.
Psychological trauma associated with the World Trade Center attacks and its effect on pregnancy outcome
Authors: Engel Stephanie Mulherin , Berkowitz Gertrud S. , Wolff Mary S. , Yehuda Rachel
Published: August 2005

The destruction of the World Trade Center (WTC) on 11 September 2001 was a source of enormous psychological trauma that may have consequences for the health of pregnant women and their fetuses. In this report, we describe the impact of extreme trauma on the birth outcomes of women highly exposed to the WTC. We enrolled 187 women who were pregnant and living or working within close proximity to the WTC on 11 September. Among women with singleton pregnancies, 52 completed at least one psychological assessment prior to delivery. In adjusted multivariable models, both post‐traumatic stress symptomatology (PTSS) and moderate depression were associated with longer gestational durations, although only PTSS was associated with decrements in infant head circumference at birth (β = −0.07, SE = 0.03, P = 0.01). The impact of stress resulting from extreme trauma may be different from that which results from ordinary life experiences, particularly with respect to cortisol production. As prenatal PTSS was associated with decrements in head circumference, this may influence subsequent neurocognitive development. Long‐term follow‐up of infants exposed to extreme trauma in utero is needed to evaluate the persistence of these effects.
Classical versus low‐segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies
Authors: HALPERIN MARY E. , MOORE DONALD C. , HANNAH WALTER J.
Published: August 2005

Summary. In a retrospective, controlled, follow‐up study of 326 women who had a primary preterm caesarean section, the risks of postoperative maternal morbidity and uterine rupture or dehiscence in subsequent pregnancies were investigated in relation to the mode of incision (classical compared with low‐segment transverse incision). The classical incision was associated with a higher frequency of postpartum fever in the immediate postoperative period (16% compared with 6%, P<0·01). Of the 326 patients reviewed 286 (88%) were contacted for information about subsequent pregnancies. Information was obtained for 70 pregnancies subsequent to a classical caesarean section, and 71 pregnancies subsequent to a low‐segment transverse caesarean section, which had continued for more than 20 weeks gestation. Of the pregnancies after the classical operation 13% had abnormal scars compared with none of those after the low‐segment transverse operation (P=0·0014). The frequency of scar dehiscence was 6% after a classical scar compared with none after a low‐segment transverse scar (P=0·0581).
Surgical wound drainage: a survey of practices among gynaecologists in the British Isles
Authors: HILTON PAUL
Published: August 2005

Summary. All 2836 members and fellows of the Royal College of Obstetricians and Gynaecologists were circulated with a questionnaire concerning their practices with regard to wound drainage. The overall response rate was 43%, although that from practitioners of consultant and senior registrar status was 67%. The use of wound drainage was consistent between surgeons of differing levels of experience and different subspecialty interests within gynaecology. At routine ‘clean’ operations the use of drains is limited; only 0·4% of gynaecologists drain the peritoneal cavity, 1% the pelvis, 4% the subcutaneous tissues, and 20% the rectus sheath routinely. At more specialist ‘clean’ procedures, however, greater use of drains is made; at suprapubic incontinence operations 51% of surgeons drain the retropubic space; at radical hysterectomy 55% drain the pelvis; and at radical vulvectomy 63% use drains in the groins, routinely. In all the above operations much greater use is made of active (83%) than passive drains (17%). With potentially contaminated wounds, however, 46% of gynaecologists use a passive drain.
The changes in fetal habituation patterns due to a decrease in inspired maternal oxygen
Authors: LEADER LEO R. , BAILLIE PETER
Published: August 2005

Summary. Habituation is widely regarded as a basic form of learning. A fully functioning central nervous system is probably required for a normal habituation pattern. Habituation of the behavioural response to vibroacoustic stimulation was studied in 23 normal human fetuses whose gestational age was 36 or more weeks. Eighteen were tested whilst their mothers breathed either air or a 12% oxygen in nitrogen mixture. The test was repeated the following day with the order of the gases reversed. In addition five fetuses were tested while their mothers breathed air on both occasions. Of the 18 fetuses 17 had a normal habituation pattern when tested in air but only two had a normal pattern when their mothers breathed 12% O2. Four of the five fetuses tested both days in air had normal patterns on the second day. Altering the amount of inspired maternal O2 alters the fetal habituation pattern.
Did Princess Charlotte die of pulmonary embolism?
Authors: FRIEDMAN ANDREW J. , KOHORN ERNEST I. , NULAND SHERWIN B.
Published: August 2005

Summary. The cause of death of the Princess Charlotte of Wales in 1817 has been attributed to postpartum haemorrhage. Although an autopsy was performed, pulmonary embolism was not diagnosed because this condition was not recognized until 1846, but the clinical description of her last hours clearly points to pulmonary embolization as the most likely cause of death.
Studies on the effects of nitrendipine on oxytocin‐angiotensin II‐ and ergometrine‐induced contraction of pregnant human myometrium in vitro
Authors: ODUM C. UCHE , PIPKIN F. BROUGHTON
Published: August 2005

Summary. Calcium channel blockers inhibit myometrial contractility by preventing the increase in intracellular free calcium which follows stimulation. They could thus be useful in treating premature labour. The effect of nitrendipine, a dihydropyridine calcium channel antagonist, on the contractile response of strips of pregnant human myometrium to oxytocin, angiotensin II (All) and crgomctrinc has been examined. A total of 68 tissue strips were studied, with random allocation to treatment group. Initial concentration: response curves to one of the three agonists were determined; the concentration: response determinations were repeated in the presence or absence of nitrendipine at 10−9M. The initial EC50s for tissues exposed to oxytocin and All were 8·2xlO−10M and 3·4x10 8m respectively. The contractile response to both agonists was significantly blunted in the presence of nitrendipine (ANOVA; P<0·001 for both agents). This effect was greatest at high agonist concentrations. The initial EC50s for tissues exposed to ergometrine was 3·9xlO−8M. Exposure to nitrendipine blunted the response (ANOVA; P<0·001), an effect most marked at low concentrations of ergometrine. The effect of nitrendipine on myometrial responses to the naturally occurring hormones oxytocin and All supports suggestions of a role for it in inhibiting premature labour.
The ultrastructural changes of the mucosa of blocked fallopian tubes
Authors: TAM P. P. L. , MAO K. R. , MAC‐MOUNE LAI F.
Published: August 2005

Summary. The ultrastructure of the epithelium was studied in four blocked fallopian tubes which difffered in the site of blockage and the degree of luminal distension. In all four specimens, there were large areas of the luminal surface which became barren and devoid of both the secretory and ciliated cells. Necrotic secretory cells arid partially sloughed ciliated cells were observed in the remaining epithelium. Isolated patches of attenuated epithelium decorated with ciliated cells were sometimes found in the crypt of the mucosal folds. Results of this study suggest that pathological changes in the epithelium are common to tubes of both the terminal and cornual blockage.
Postpartum pleural effusion
Authors: UDESHI U. L. , McHUGO J. M. , CRAWFORD J. SELWYN
Published: August 2005

Summary. A prospective ultrasound study investigated the reportedly high frequency of asymptomatic pleural effusions in the early post‐partum period. The pleural space of 50 women within 1–45 h of delivery was scanned with a real‐time sector scanner. Only one woman had a pleural effusion. This patient had severe pre‐eclampsia with clinically apparent pulmonary oedema. Our findings do not substantiate the previously reported high frequency of pleural fluid in healthy women immediately after delivery.
Immunohistochemical study of cytoplasmic oestradiol receptor in normal, dysplastic and malignant cervical tissue
Authors: HENRY R. J. W. , GOODMAN J. D. S. , GODLEY M. , RAJU K. S. , COFFER A. I. , KING R. J. B.
Published: August 2005

Summary. Using a monoclonal antibody raised against an oestrogen receptor‐related protein, p29, and an indirect immunoperoxidase technique to stain human tissue, the presence of the antigen was investigated in normal, dysplastic and malignant tissue of the uterine cervix. In normal tissue p29 was present throughout the ectocervix during the menstrual cycle and virtually absent from the endocervix. In dysplastic cervical tissue there was a decreasing p29 content with increasing severity of the dysplasia, and very low levels were seen in the carcinomatous tissues.
Low second trimester maternal serum unconjugated oestriol in pregnancies with Down's syndrome
Authors: CANICK J. A. , KNIGHT G. J. , PALOMAK1 G. E. , HADDOW J. E. , CUCKLE H. S. , WALD N. J.
Published: August 2005

Summary. Second trimester maternal serum unconjugated oestriol levels were measured in the stored serum samples from 22 pregnancies associated with Down's syndrome and 110 unaffected control pregnancies, matched for maternal age, gestational age, duration of storage of the serum sample, smoking habits and maternal weight. The serum unconjugated oestriol level of each affected pregnancy was expressed as a multiple of the median (MoM) of its five matched controls. The unconjugated oestriol levels were significantly lower in the affected pregnancies than in the unaffected pregnancies; the median MoM was 0·79 (P<0·05). This association between low serum unconjugated oestriol and fetal Down's syndrome early in pregnancy raises the possibility that serum unconjugated oestriol measurement may be added to maternal age and alpha‐fetoprotein measurement in the antenatal screening for Down's syndrome.
Candidiasis in women fitted with an intrauterine contraceptive device
Authors: PAREWIJCK WALTER , CLAEYS GEERT , THIERY MICHEL , VAN KETS HENRY
Published: August 2005

Summary. Vaginal colonization by Candida spp. was compared in 117 women fitted with an intrauterine contraceptive device (IUCD users) and in 100 women not wearing an IUCD (control group). None of the subjects had factors currently assumed to predispose to yeast colonization or infection. Yeasts were present significantly more often in the IUCD users (20%) than in the control group (6%). In two of the 21 women with positive cultures the tail of the IUCD yielded substantially more colonies than the vaginal specimen and in seven, only the tail culture was positive. These findings strongly suggest that the IUCD is a predisposing factor in vaginal colonization by Candida strains. In half the women the presence of yeasts in the vagina was not associated with signs and symptoms of clinical infection. Of the 29 yeast strains isolated 17 were C. albicans, there was no difference in the prevalence of C. albicans between IUCD users and non‐users or between symptomatic and asymptomatic women.
Early pregnancy wastage after gamete manipulation
Authors: YOVICH JOHN L. , MATSON PHILLIP L. , YOVICH JOHN L.
Published: August 2005

Summary. The outcome of 1034 pregnancies in women who conceived after referral for infertility management in seven treatment groups is detailed. The mean early pregnancy wastage (before 20 weeks gestation) was 27% and ranged from 18% after AID (artificial insemination by donor semen) to 33% after IVF‐ET (in‐vitro fertilization and embryo transfer). These differences were not due to maternal age which was similar in all groups (means between 29.7 and 32.7 years). Excluding the AID group, there was a high rate of ectopic pregnancy which was significantly higher after GIFT (gamete intrafallopian transfer) and was only partly related to underlying tubal disease. Blighted ova was the main category of early pregnancy loss and was highest after AIH (artificial insemination by husband's semen). There was a higher rate of biochemical pregnancies after GIFT, PROST (pronuclear stage tubal transfer) and IVF‐ET. Our findings confirm a high pregnancy wastage rate in subfertile women and highlight deficiencies in the sperm separation, gamete handling and IVF/embryo culture techniques.
Cost‐benefit analysis of cephradine and mezlocillin prophylaxis for abdominal and vaginal hysterectomy
Authors: DAVEY PETER G. , DUNCAN IAN D. , EDWARD DOREEN , SCOTT ARCHIE C.
Published: August 2005

Summary. Four hundred patients (300 abdominal and 100 vaginal hysterectomies) were randomized to receive a single, pre‐operative intravenous injection of saline (placebo), 2 g cephradine or 5 g mezlocillin. The frequency of wound and pelvic infections was significantly reduced (P<0.05, χ2‐ or Fisher's exact test) in the abdominal hysterectomy patients who received cephradine (16% vs 23% mezlocillin, 29% placebo) and in the vaginal hysterectomy patients who received cephradine or mezlocillin (0% mezlocillin, 6% cephradine vs 27% placebo). These results are similar to those of previous studies and suggest that prophylaxis is more effective for vaginal than for abdominal hysterectomy. However, a cost‐benefit analysis supported the opposite conclusion. Cephradine prophylaxis for abdominal hysterectomy resulted in cost savings to the hospital and the community health services with measurable benefits to the patient. In contrast, cephradine or mezlocillin prophylaxis for vaginal hysterectomy resulted in increased costs to the hospital, no savings to community services and no significant benefit to the patient. We conclude that cost‐benefit analysis provided valuable additional information to the conventional, statistical analysis of wound or pelvic infection rates.
The distribution of CA 125 in the reproductive tract of pregnant and non‐pregnant women
Authors: JACOBS I. J. , FAY T. N. , STABILE I. , BRIDGES J. E. , ORAM D. H. , GRUDZINSKAS J. G.
Published: August 2005

Summary. Investigation of serum and tissue homogenates obtained from first, second and third trimester pregnancies, and from nonpregnant women, has provided further insight into the possible origin of the CA 125 antigen. Serum CA 125 levels were higher in the first trimester (median 53.6 U/ml, range 15.6.268.3 U/ml) than in nonpregnant women (median 19.3 U/ml, range 7.2.27.0 U/ml) and later in pregnancy (second trimester: median 18.5 U/ml, range 12.0.25.1 U/ml, third trimester: median 19.2 U/ml, range 16.8.43.8 U/ml) (P<0.05) but were two orders of magnitude less than in second trimester amniotic fluid (median 4825 U/ml, range 3200.9300 U/ml). Fetal serum CA 125 activity was consistently <20 U/ml. The highest tissue levels of CA 125 were detected in first trimester decidual homogenate (median 4547 U/ 100 mg, range 340.4–20 851 U/100 mg) and were greater than in nonpregnant endometrium (median 388 U/100 mg, range 100.9–3341 U/100 mg) (P<0.01) and term decidua (median 116 U/100 mg, range 32.7–449.9 U/100 mg) (P<0.01). These observations suggest that CA 125 is synthesized by normal endometrium and decidua and that increased CA 125 activity during pregnancy is of decidual origin.
Can ultrasound reliably diagnose ectopic pregnancy?
Authors: STABILE I. , CAMPBELL S. , GRUDZINSKAS J. G.
Published: August 2005

Summary. A total of 252 women with amenorrhoea and with abdominal pain or vaginal bleeding, or both, had an emergency high‐resolution ultrasound sector scan. In 100 women the symptoms were unrelated to any identifiable abnormal ultrasound rinding, none of them was pregnant and their symptoms settled spontaneously; 33 other women had follicular or luteal cysts and 30 had pelvic inflammatory disease, Histological examination confirmed an ectopic pregnancy in 60 women (24%); in seven a live fetus was observed outside the uterus allowing a confident diagnosis of ectopic pregnancy; in 27 the thickness of the endometrium was >10mm (sensitivity 50%, specificity 84%, positive predictive value 28%, negative predictive value 87%); in 15 the uterine area measurement was <20 cm2 (sensitivity 72%, specificity 41 %, positive predictive value 20%, negative predictive value 79%); and 43 had an adnexal mass volume >10ml separate from the ovary (sensitivity 85%, specificity 37%, positive predictive value 23%, negative predictive value 90%). Only three had negative ultrasound findings. The negative predictive value of an ultrasound examination could be increased to 96% by using a combination of these ultrasound features. The addition of hCG (>25 i.u./l) improved the specificity to 98% and the negative predictive value to 100%. These criteria may improve the ultrasound diagnosis of ectopic pregnancy.
The effect of sublingual nifedipine on uteroplacental blood flow in hypertensive pregnancy
Authors: LINDOW S. W. , DAVEY D. A. , DAVIES N. , SMITH J. A.
Published: August 2005

Summary. The effect of nifedipine on uteroplacental blood flow was investigated in nine hypertensive women in the third trimester of pregnancy and compared with the effects of a placebo in nine similar hypertensive women. An index of uteroplacental blood flow was obtained, twice before treatment and once after treatment, by measuring the increase in radioactivity in the region of the placenta with a gamma camera following an intravenous injection of indium‐113m. There was no significant change in the blood flow index in either the nifedipine‐ or the placebo‐treated groups despite a significant fall in blood pressure with nifedipine. Nifedipine lowers the blood pressure without any apparent reduction in uteroplacental blood flow.
Genital virus infection and cervical neoplasia
Authors: KITCHENER HENRY C.
Published: August 2005

Summary. The reported association between genital infection by herpes simplex virus (HSV) type 2 and cervical neoplasia has been investigated at a molecular level. Tissue culture of over 50 cervical cancers resulted in the development of several cell lines but none of these expressed HSV information. The permanent cell line, Cxl06, which was generated was found to contain multiple genome copies of human papillomavirus (HPV) type 16. Southern blot analysis of nine cervical cancers showed an authentic 2.8 Kb fragment of HSV‐2 DNA in one of the tumours. This piece of viral DNA maps in a morphological transforming region of the HSV genome. Superinfection of cervical cancers with temperature‐sensitive (ts) mutants of HSV 1 and 2 did not generate recombinant virus, suggesting that HSV DNA was not present in the tumours studied. An attempt to identify latent HSV close to the cervix in organ cultures of uterosacral ligament tissues resulted in reactivation of virus in several instances. These results are discussed against a background of decline in acceptance by many, for the HSV link with cervical cancer, and the dramatic impact of the discovery of a close relation between HPV type 16 and lower genital tract neoplasia.
The prevalence of pleural effusions in pre‐eclampsia: an ultrasound study
Authors: WALLIS M. G. , McHUGO J. M. , CARRUTHERS D. A. , CRAWFORD J. SELWYN
Published: August 2005

A prospective ultrasound study was undertaken to investigate the prevalence of pleural effusion in patients with moderate or severe pre‐eclampsia. The costophrenic angles of 34 consecutive patients were scanned postpartum with a real‐time sector scanner. Six patients had pleural effusions. These patients did not have a greater degree of hypertension or proteinuria than the group without pleural effusion but had early severe disease requiring early delivery. The prematurity of these infants resulted in tenfold increase in perinatal death.
Ultrasound and pulsed electromagnetic energy treatment for perineal trauma. A randomized placebo‐controlled trial
Authors: GRANT ADRIAN , ASHURST HAZEL , SLEEP JENNIFER , McINTOSH JEANNE
Published: August 2005

Ultrasound and pulsed electromagnetic energy therapies arc increasingly used for perineal trauma sustained during childbirth. The study included 414 women with moderate or severe perineal trauma randomly allocated to receive active ultrasound, or active pulsed electromagnetic energy, or corresponding placebo therapies; the allocation was double‐blind for each machine. Overall, more than 90% thought that treatment made their problem better. There were no clear differences between the groups in outcome either immediately after treatment, or 10 days or 3 months postpartum, other than more pain associated with pulsed electromagnetic energy treatment at 10 days. Bruising looked more extensive after ultrasound therapy but then seemed to resolve more quickly. Neither therapy had an effect on perineal oedema or haemorrhoids. The place of these new therapies in postnatal care should be clarified by further controlled trials before they become part of routine care.
Medroxyprogesterone acetate in the treatment of pelvic pain due to venous congestion
Authors: BEARD R. W. , FRANKS S. , REGINALD P. W. , WORTH J. WADS , ADAMS J.
Published: August 2005

Ovarian function was suppressed with 30 mg of medroxy‐progesterone acetate, daily for 6 months, in 22 women with lower abdominal pain due to pelvic congestion. There was reduction in pelvic congestion demonstrated by venography in 17 of the 22 women, and in 16 this was associated with induction of amenorrhoea which suggests that effective ovarian suppression is an important component of successful treatment. In the 17 women who showed a reduction in veno‐gram score, the median change in pain score was 75% compared with only 29% in the five women with no change in venogram score (P<0·01). This significant association between reduction in pelvic congestion and pain indicates that pelvic congestion is likely to be the cause of pain in these women and that treatment with medroxyprogesterone acetate could be of value.
Epidemiology and trends in hospital discharges for pelvic inflammatory disease in England, 1975 to 1985
Authors: BUCHAN HEATHER , VESSEY MARTIN
Published: August 2005

Hospital Inpatient Enquiry data were analysed to determine trends in hospital discharges for pelvic inflammatory disease in England from 1975 to 1985. Cases where the disease was thought to be related to another condition, e.g. appendicitis, were excluded from the analysis. Discharge rates for both acute and chronic disease increased over the review period and there was a 28% increase in the discharge rate for total disease. Women in their 20s were most likely to be involved and this group showed the greatest increase in the discharge rate, both for acute and chronic disease. In the 20–24‐year age group the rate of discharge for acute disease rose by 50%, from 125.6/100 000 in 1975 to 189·0/100 000 in 1985. Patients with a diagnosis of chronic pelvic inflammatory disease tended to be older than those with acute disease. Women who were divorced were more at risk of both acute and chronic forms of the disease than single or married women. Increase in the use of surgery to confirm the diagnosis occurred only for those with chronic disease. About a quarter of patients with acute disease had the diagnosis confirmed surgically, and this proportion did not change in the period studied, although laparoscopy increased as laparotomy decreased.
Neonatal thyrotrophin and mode of delivery
Authors: LAO T. T. , PANESAR N. S.
Published: August 2005

This study was performed to assess the association between labour and the mode of delivery with the umbilical cord plasma thyroxine (T4) and thyroid‐stimulating hormone (TSH) concentrations in full‐term uncomplicated pregnancies delivered in our hospital. Babies born vaginally had statistically significantly higher umbilical cord plasma TSH but similar T4 concentrations than babies born by caesarean section. Labour was not associated with either higher TSH or T4 concentrations. All the babies with an elevated TSH concentration (>20 miu/1) were born vaginally. Our findings indicate that the mode of delivery should be taken into consideration in the interpretation of umbilical cord plasma TSH results.
The development and implementation of a computerized on‐line obstetric record
Authors: GONZALEZ F. A. , FOX H. E.
Published: August 2005

We developed and implemented a completely paperless and on‐line obstetric record in the high‐risk obstetric clinics at Columbia Presbyterian Medical Center. Patient care and interactions are input directly into the computer by the health care providers. Laboratory information is transferred automatically from the Laboratory Information Service into the computerized prenatal record. The system has been in continuous operation for 2 years and is highly regarded. Problems such as illegible handwriting, missing records, and missing laboratory data have disappeared. Research and data query capabilities have been facilitated. The feasibility and applicability of a computerized record replacing the paper record has been demonstrated.
North Staffordshire/Wigan assisted delivery trial
Authors: JOHANSON RICHARD , PUSEY JOHANNA , LIVERA NICOLA , JONES PETER
Published: August 2005

Summary. In a trial conducted at the North Staffordshire and Billinge Maternity Hospitals (NSMH and BMH) a total of 264 women who required an assisted delivery in the second stage of labour were randomly assigned to be delivered either by Kobayashi silicone cup ventouse or by forceps. A larger proportion (90%) of those assigned to the forceps group were actually delivered by the allocated instrument compared to those in the silicone cup group (73%). However, there was a significantly higher rate of maternal morbidity in terms of perineal trauma and discomfort in the forceps group. No differences in neonatal morbidity were detected.
Factors influencing neonatal morbidity in gestational diabetic pregnancy
Authors: NORDLANDER E. , HANSON U. , PERSSON B.
Published: August 2005

Summary. The influence of obstetric factors and indices of maternal blood glucose control on neonatal morbidity was examined in 261 women with gestational diabetes. A reference group of 218 women, matched for age and day of delivery, within 1 week, was used for comparison. Perinatal morbidity was significantly more frequent in the gestational diabetic pregnancies (23%) than in the reference group (13%), whereas the occurrence of large‐for‐gestational‐age infants was not different between the groups. Infants born to women with gestational diabetes were categorized to a no‐morbidity group (n=200) and a morbidity group (n=61). The group with morbidity had significantly shorter gestational age at delivery, higher frequency of caesarean section, higher maternal pre‐pregnancy weight and higher area under the glucose tolerance curve. There was no significant difference in third‐trimester blood glucose between the groups. Discriminant analysis revealed that the most significant influence on neonatal morbidity was gestational age at delivery. After correction for this factor the only factor with added significance for neonatal morbidity was maternal pre‐pregnancy weight. The present study clearly illustrates that other factors beside blood glucose control are of importance for neonatal outcome in gestational diabetic pregnancy.
Evidence of redistribution of cardiac output in asymmetrical growth retardation
Authors: AL‐GHAZALI WIDAD , CHITA SUNDER K. , CHAPMAN MICHAEL G. , ALLAN LINDSEY D.
Published: August 2005

Summary. Thirty‐one fetuses with growth retardation were studied by Doppler estimation of the cardiac output from each side of the fetal heart. Asymmetrical growth retardation was diagnosed in 16 fetuses by a head to abdominal circumference ratio above the 95th centile. In the 15 fetuses with symmetrical growth retardation, the distribution of cardiac output was normal. The mean and maximum velocity of blood flow in the pulmonary artery and aorta were similar to values in normal fetuses, and there was a greater calculated output from the right heart than from the left. The right heart flow expressed as a percentage of the combined cardiac output was not statistically significantly different from that in normal fetuses. In contrast, all 16 fetuses with asymmetrical growth retardation had a higher mean and maximum velocity in the aorta than in the pulmonary artery. The calculated volume flow from each side of the heart showed a greater output from the left than the right heart in 15. The right heart flow expressed as a percentage of the combined cardiac output was statistically different from the value in normal fetuses. These findings are consistent with theories of the redistribution of fetal blood flow, where cerebral blood flow is preferentially ‘spared’.
Histological features of uteroplacental vessels in normal and hypertensive patients in relation to birthweight
Authors: FRUSCA T. , MORASSI L. , PECORELLI S. , GRIGOLATO P. , GASTALDI A.
Published: August 2005

Summary. Placental bed biopsies were obtained during caesarean section from normal, pre‐eclamptic and hypertensive pregnancies. Of the 14 biopsies from normal pregnancies 13 showed normal vascular physiological changes in the decidua and in the myometrium. Biopsies from 24 pregnancies complicated by pre‐eclampsia showed acute atherosis in 18 and physiological changes limited to the decidua in six; none had normal physiological changes. Biopsies from five hypertensive patients showed all three types of histological changes. The mean birthweight centile was lower in the group with atherosis than in the group with limited and the group with normal physiological changes.
Circadian variations of plasma atrial natriuretic peptide in four types of hypertensive disorder during pregnancy
Authors: SUMIOKI HISAO , SHIMOKAWA HIROSHI , MIYAMOTO SHINGO , UEZONO KEIKO , UTSUNOMIYA TAKAFUMI , NAKANO HITOO
Published: August 2005

Summary. Circadian variations in plasma atrial natriuretic peptide were studied, to clarify the characteristic pathophysiology of pregnancy‐induced hypertension (PIH). The mean 24‐h values (range) of atrial natriuretic peptide in mild and severe PIH, pregnancy‐aggravated hypertension, chronic hypertension and normal pregnancy were 130·1 (97·3−207·0), 225·4 (202·8−281·8), 213·1 (183·2−249·5), 81·3 (61·8−116·1) and 77·1 (56·0−123·5) pg/ml, respectively. The values in PIH and pregnancy‐aggravated hypertension were significantly higher, although those in chronic hypertension were no different from normal pregnancy. Plasma atrial natriuretic peptide showed a clear circadian rhythm with acrophase in the middle of the night, in mild and severe PIH. In the other hypertensive disorders, a circadian rhythm could not be confirmed. The results indicate that the elevated values of plasma atrial natriuretic peptide in hypertensive disorders during pregnancy relate to generalized vasoconstriction, and that the diurnal rhythm is a specific characteristic of PIH.
Neutrophil activation in pregnancy‐induced hypertension
Authors: GREER I. A. , HADDAD N. G. , DAWES J. , JOHNSTONE F. D. , CALDER A. A.
Published: August 2005

Summary. Human neutrophil elastase may be a major mediator of vascular damage and could contribute to the vascular damage seen in women with pregnancy‐induced hypertension (PTH). Elevated plasma levels of this substance will reflect neutrophil activation in vivo. To determine neutrophil activation in PIH, we studied 30 normal nonpregnant women, 32 women with normal pregnancies, 19 with mild/moderate PIH and 16 with severe PIH between 28 and 39 weeks gestation. Plasma neutrophil elastase was measured by radioimmuno‐assay. There was a significantly higher concentration of plasma neutrophil elastase in both mild/moderate and severe PIH than in normotensive pregnancies and this may contribute to the vascular lesion associated with PIH. Concentrations were also significantly higher in normal pregnancy than in non‐pregnant women which suggests that neutrophil activation and degranulation are increased in normal pregnancy.
The efficacy of paracervical injections of lignocaine before laser ablation of the cervical transformation zone. A randomized placebo‐controlled double‐blind clinical trial
Authors: JOHNSON N. , CROMPTON A. C. , RAMSDEN S.V.E.
Published: August 2005

In a prospective double‐blind randomized placebo‐controlled clinical trial the efficacy of paracervical lignocaine was compared with saline in reducing pain in 70 women undergoing laser ablation of the cervical transformation zone. Paracervical lignocaine had no significant measurable effect on reducing the pain experience during the laser procedure. The mean subjective visual linear analogue pain score in the lignocaine and saline groups was 27% (95% CI 17 to 38) and 30% (95% CI 24 to 41) respectively (t= 1·0; P = 0·35). The median (quartiles) objective pain scores for the same groups were 0 (0‐2) and 0 (0‐1) respectively (P= 0·58).
Maternal thyroid hormones and outcome of pre‐eclamptic pregnancies
Authors: LAO T. T. , CHIN R. K. H. , SWAMINATHAN R. , LAM Y. M.
Published: August 2005

Summary. Plasma concentrations of total and free thyroxine (TT4 and FT4), total and free triiodothyronine (TT3 and FT3), thyroid‐stimulating hormone (TSH), plasma albumin and urate were measured in 39 proteinuric pre‐eclamptic patients presenting before labour. Preeclamptic patients had significantly lower FT4 and higher TSH concentrations compared with values in third trimester normotensive pregnancies. There was a significantly higher frequency of lower TT4, TT3 and high TSH levels in the subgroup of pre‐eclamptic patients who had low‐birthweight babies. Thyroid hormone concentrations were not correlated with gestation at delivery or birthweight but, with the exception of FT4, were correlated with plasma albumin and urate concentrations. Plasma TSH correlated with birthweight and with plasma urate. The results suggest that mild biochemical hypothyroidism may be found in proteinuric pre‐eclampsia, and the concentrations of TT4, TT3, FT3 and TSH may reflect the severity of pre‐eclampsia.
A randomized comparison of early with conservative use of antihypertensive drugs in the management of pregnancy‐induced hypertension
Authors: PLOUIN P.‐F. , BREART G. , LLADO J. , DALLE M. , KELLER M.‐E. , GOUJON H. , BERCHEL C.
Published: August 2005

Summary. Two treatment strategies were compared in 155 women with pregnancy‐induced hypertension who were also given comprehensive non‐pharmacological care. The mean gestation at entry was 28 weeks. As long as the diastolic blood pressure (DBP) remained below 106 mmHg, oxprenolol, or oxprenolol plus dihydralazine, were given to the early treatment group, and matching placebos to the control group. Open antihypertensive treatment was provided for patients whose DBP rose above 105 mmHg. Proteinuria occurred in seven women in each group. In the early treatment group, 13 of the 78 women were delivered by caesarean section; the corresponding numbers in the control group were 27 of 76 (17 vs 36%, 95% confidence interval (CI) of difference: 5‐33%); the sections included seven and 16 in the early treatment and control groups, respectively, for severe hypertension and/or fetal distress. There were five perinatal deaths, two in the early treatment group and three in the control group. Early treatment did not influence gestational age at birth or birthweight. Respiratory distress syndrome occurred in four infants in the early treated group and in 10 in the control group; 14 infants in the former group and 26 in the latter were in hospital for more than 10 days (18 vs 35%; 95% CI of difference 4.32%). These results indicate that early antihypertensive treatment with oxprenolol is safe for the fetus and newborn in pregnancy‐induced hypertension, but has no advantage over non‐pharmacological care in terms of fetal growth. However, it may prevent acute hypertension in late pregnancy and associated fetal distress, and thus reduce the number of caesarean sections.
Osteopenia in pregnancy during long‐term heparin treatment: A radiological study post partum
Authors: DAHLMAN T. , LINDVALL N. , HELLGREN M.
Published: August 2005

Summary. Osteopenia, sometimes with compression fractures of the spine, is a side‐effect of long‐term heparin treatment. The frequency is unknown. In this study, 70 women were given subcutaneous heparin as therapy for, or prophylaxis against, thromboembolism during pregnancy. All, except two, were examined by X‐ray of the spine and hip first week post partum. The duration of treatment and the dosage of heparin varied. There were 12 (17%) with obvious Osteopenia, including two women with multiple fractures of the spine (3%). Re‐examination 6–12 months post partum showed that the changes were reversible in most cases. Another 18 women were examined about three years after heparin treatment during pregnancy. No obvious osteopenia was found among them or in a control group of 30 women examined in the first week post partum. The degree of osteopenia was not correlated with either the heparin dose or the duration of treatment. Women treated with heparin in consecutive pregnancies do not seem to have an increased risk of osteopenia.
Clinical and prognostic significance of concanavalin‐Ainduced suppressor cell activity in malignant cervical neoplasia
Authors: PILLAI M. RADHAKRISHNA , BALARAM PRABHA , HAREENDRAN N. K. , BINDU S. , PADMANABHAN T. K. , NAIR M. KRISHNAN
Published: August 2005

Summary. Peripheral blood lymphocytes from patients with different stages of cancer of the uterine cervix were analysed for concanavalin‐A induced suppressor cell activity. All cancer patients had high levels of suppressor activity, the increase corresponding to tumour load. Radiotherapy resulted in further increase of suppressor activity. About six months after radiotherapy, patients who remained disease free returned to pretreatment levels of suppressor cell activity and later showed even lewer levels of suppression. On the other hand, patients who developed recurrent disease maintained sustained high levels of suppression and for all stages they always had higher suppressor activity than the patients who remained disease free in the corresponding stage. These results stress the importance of a possible deranged immune system in these patients and also shows the clinical and prognostic significance of the assay.
Preventing IUCD‐related pelvic infection: the efficacy of prophylactic doxycycline at insertion
Authors: SINEI S. K. A. , SCHULZ K. F. , LAMPTEY P. R. , GRIMES D. A. , MATI J. K. G. , ROSENTHAL S. M. , ROSENBERG M. J. , RIARA G. , NJAGE P. N. , BHULLAR V. B. , OGEMBO H. V.
Published: August 2005

Summary. Most of the small increased risk in pelvic inflammatory disease (PID) associated with the intrauterine contraceptive device (IUCD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. This randomized clinical trial of 1813 women in Nairobi, Kenya, assessed the effectiveness of 200 mg of doxycycline given orally at the time of insertion in reducing the occurrence of PID. The rate of this infection in the doxycycline‐treated group was 31% lower than that in the placebo‐treated group (1.3 and 1.9%, respectively; RR 0.69; 95% CI 0.32 to 1–5). The rate of an unplanned IUCD‐related visit to the clinic was also 31% lower in the doxycycline‐treated group (RR 0.69; 95% CI 0.52 to 0.91). Although the significance level (P = 0.17) for the reduction is PID does not meet the conventional standard of 0.05, the results may be suggestive of an effect. Moreover, the reduction in IUCD‐related visits (P = 0.004) not only represents an important decrease in morbidity but also substantiates the reduction found for PID. Further studies are needed to corroborate these results. Consideration should be given to the prophylactic use of doxycycline at the time of IUCD insertion as an approach to preventing PID and other lUCD‐related morbidity.
Blood flow velocity waveforms from the fetal external iliac artery as a measure of lower extremity vascular resistance
Authors: STEWART P. A. , WLADIMIROFF J. W. , STIJNEN T.
Published: August 2005

Summary. Blood flow velocities were recorded in the external iliac artery (EIA) and umbilical artery (UA) in 94 normal pregnancies and in 14 with intrauterine growth retardation (IUGR) between 25 and 36 weeks gestation. In normal pregnancy the pulsatility index (PI) in both vessels decreased significantly with advancing gestational age, reflecting a reduction in lower extremity and placental vascular resistance. The EIA PI/UA PI ratio also decreased significantly with gestational age suggesting that vascular resistance is more pronounced in the lower extremities. In the pregnancies with IUGR, PI values from both vessels were nearly always above the upper limit (+2 SD) of the normal curve reflecting increased vascular resistance at lower extremity and placental level. In two pregnancies, absent end‐diastolic flow velocities in the umbilical artery were associated with reversed end‐diastolic flow velocities in the external iliac artery.
Gonadotrophin releasing hormone agonist (buserelin) in the treatment of endometriosis: changes in the extent of the disease and in CA 125 serum levels after 6‐month therapy
Authors: MARANA R. , MUZH L. , MUSCATELLO P. , LANZONE A. , CARUSO A. , DELL'ACQUA S. , MANCUSO S.
Published: August 2005

Summary. Twenty‐two women with endometriosis were treated with the luteinizing hormone‐releasing hormone (LHRH) agonist buserelin for 6 months. At second‐look laparoscopy the mean score of endometriosis had decreased from 23.1 (SD 17.0) to 17.2 (SD 20.2) (P<0.05). CA 125 serum levels decreased from 38.4 (SD 32.2) U/ml at diagnosis to 15.5 (SD 7.0) at second look (P<0.005). CA 125 levels correlated at diagnosis with total score of endometriosis (P<0.05) and with active score of endometriosts (P<0.05), but not with the adhesion score. CA 125 levels were not correlated with endometriosis scores at second look laparoscopy, thus suggesting that mechanisms other than the change in the extent of the disease may be involved in the CA 125 decrease during therapy. CA 125 levels may therefore not be a reliable indicator for monitoring the efficacy of LHRH agonist treatment of endometriosis.
Changes in circulating alphafetoprotein following administration of mifepristone in first trimester pregnancy
Authors: CHARD T. , OLAJIDE F. , KITAU M.
Published: August 2005

Summary. The occurrence of fetomaternal haemorrhage was investigated in 30 women by measuring maternal serum alphafetoprotein (AFP) levels before and after the administration of mifepristone (RU 486) for termination of first trimester pregnancy. A significant rise in AFP levels was seen in 21 women (70%), the increase ranging from 6 to 660% of baseline levels. The apparent frequency of fetomaternal haemorrhage was similar to that reported previously for surgical termination of first trimester pregnancies.
No effect of intralesional injection of interferon on moderate cervical intraepithelial neoplasia
Authors: FROST LARS , SKAJAA KRISTJAR , HVTDMAN LONE E. , FAY STEPHEN J. , LARSEN PETER MOSE
Published: August 2005

Summary. Women with histologically confirmed cervical intraepithelial neoplasia grade 2 (CIN 2) were treated in a double blind investigation of treatment with intralesioneal interferon alpha‐2b (Tntron a). Before treatment commenced, the existence and the types of human papilloma‐virus (HPV) were assessed in [35S] methionine‐labelled cervical biopsies by the determination of specific protein markers. Pronounced side effects occurred in all the women treated with interferon and the trial was stopped when it became apparent that there were no obvious beneficial effects. No positive benefits of interferon treatment were detected on either the CIN 2 or on the persistence of HPV types. It is concluded that intralesioneal injection of interferon has no place in the treatment of CIN.
Experience with a ‘physiological’ steroid replacement regimen for the establishment of a receptive endometrium in women with premature ovarian failure
Authors: CRITCHLEY HILARY O. D. , BUCKLEY C. HILARY , ANDERSON DAVID C.
Published: August 2005

Summary. Eighteen women with a premature menopause underwent assessment of serial serum oestradiol (E2) and progesterone levels and endometrial histology and function. Patients received continuous transdermal E2, and progesterone either orally or vaginally for 14 days. Physiological levels of E2 were attained. Significantly higher levels of progesterone were achieved with vaginal progesterone (P<0.01). Endometrial biopsies obtained during E2 replacement demonstrated normal proliferative features. Expression of an oestrogen related antigen (ER‐Ag) was localized in the cytoplasm of the epithelium. After 3 days of progesterone replacement the endometrium showed normal secretory features and expression of ER‐Ag in the stroma as well as in the glands. After 7 days of progesterone supplementation, vaginal administration produced a more consistent physiological appearance than oral administration. Thus transdermal E2 combined with vaginal progesterone is a highly satisfactory combination for establishing a physiological endometrium in women with premature ovarian failure.
Smoking during pregnancy: a significant cause of neonatal thyroid enlargement
Authors: CHANOINE J. P. , TOPPET V. , BOURDOUX P. , SPEHL M. , DELANGE F.
Published: August 2005

Summary.The influence of maternal smoking during pregnancy on the function and the echographic volume of the neonatal thyroid gland was examined in an area of borderline iodine intake (median maternal urinary iodine: 315 range 79–1558 nmol/l). There was a positive correlation (P<0.001) between cord serum thiocyanate (SCN) concentrations used as an index of maternal smoking and the maternal smoking habits. The thyroid volume/birthweight ratio increased significantly as a function of SCN values (P<0.005): this increase was secondary to a decrease in birthweight as well as to an increase in thyroid volume. There was also a positive correlation between cord serum thyroglobulin (Tg) and SCN levels (P = 0.001). Serum thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) values remained within the normal range for age in all newborn infants and were not significantly correlated with SCN values. These results show that smoking during pregnancy in areas with borderline iodine intake may be a significant cause of thyroid enlargement in the newborn.