bluuebunny/crossref_metadata_2025 huggingface dataset:
A distinct AMP‐activated protein kinase phosphorylation site characterizes cardiac hypertrophy induced by l‐thyroxine and angiotensin II
Authors: Jiang Sheng‐Yang , Xu Ming , Ma Xiao‐Wei , Xiao Han , Zhang You‐Yi
Published: May 2010

1. The purpose of the present study was to evaluate differences in the AMP‐activated protein kinase (AMPK) phosphorylation sites in cardiac hypertrophy induced by l‐thyroxine and angiotensin (Ang) II.

2. Cardiac hypertrophy was induced in wild‐type and AMPKα2‐knockout mice by treatment with 1 mg/kg, i.p., thyroxine or 1.44 mg/kg per day AngII for 14 days. The phenotype of the hypertrophy was evaluated using echocardiographic measurments and histological analyses. The phosphorylation of AMPK at α‐Ser485/491 and α‐Thr172 was determined by western blot analysis.

3. In wild‐type mice, the phosphorylation of AMPKα‐Ser485/491 was significantly elevated in the AngII‐treated group, but not in the thyroxine‐reated group, compared with the vehicle control group. In contrast, the phosphorylation of AMPKα‐Thr172 was significantly increased by thyroxine, but not AngII, treatment compared with the vehicle control group. Furthermore, knockout of the AMPKα2 subunit abolished phosphorylation at the α‐Ser485/491 site and significantly suppressed phosphorylation at the α‐Thr172 site, resulting in alleviation of thyroxine‐ but not AngII‐induced hypertrophy.

4. In conclusion, l‐thyroxine and AngII induce the phosphorylation of distinct sites of AMPK in cardiac hypertrophy. Phosphorylation of AMPK α‐Thr172 may contribute to thyroxine‐induced cardiac hypertrophy.
Tertiapin‐Q removes a mechanosensitive component of muscarinic control of the sinoatrial pacemaker in the rat
Authors: Han SuYoung , Wilson Suzanne J , Bolter Chris P
Published: May 2010

1. In an isolated right atrial preparation, an increase in right atrial pressure (RAP) produces an increase in atrial rate. This rate response is larger and occurs faster when there is background vagal or muscarinic stimulation.

2. We hypothesized that in the latter situation, an increase in RAP antagonizes the effect of muscarinic stimulation through stretch inactivation of the mechanosensitive muscarinic potassium current IK,ACh.

3. In two groups of bath‐mounted right atria isolated from male Wistar rats (control n = 12; 300 nmol/L tertiapin‐Q treated (to block IK,ACh) n = 10), we examined the change in atrial rate when RAP was raised from 2 to 8 mmHg; oxotremorine‐M (oxo‐M; from 10 to 500 nmol/L) was added to incrementally activate muscarinic receptors.

4. In both control and tertiapin‐Q‐treated groups, oxo‐M reduced atrial rate, but its effect was less (∼40–50%) in the latter group (P < 0.001). In control preparations, responses to an increase in RAP became progressively larger and quicker as the concentration of oxo‐M was increased, whereas in tertiapin‐Q treated preparations oxo‐M did not affect either the amplitude or the speed of the response (P < 0.0001 for both).

5. The results support the hypothesis that atrial stretch antagonizes muscarinic slowing by its effect on IK,ACh. We suggest that through this mechanism, parasympathetic control of heart rate may be modulated continuously by RAP.
Embodied reflection in practice—‘Touching the core of caring’
Authors: Ranheim Albertine , Kärner Anita , Arman Maria , Rehnsfeldt Arne Wilhelm , Berterö Carina
Published: May 2010

Ranheim A, Kärner A, Arman M, Rehnsfeldt AW, Berterö C. International Journal of Nursing Practice 2010; 16: 241–247 Embodied reflection in practice—‘Touching the core of caring’

A study was performed with the aim of clarifying the integration of the caring act of touch with reflection on caring theory. Seven participant nurses in elderly care volunteered as ‘coresearchers’ and performed a caring act called Rhythmical Embrocation, together with reflective dialogues on caring theory. The project lasted for 6 months and at the end qualitative interviews with participants were used to evaluate the study. The findings showed an opening of awareness, embodied moments of presence and an extended ability to act creatively in caring. In this study, the movement between theory and practice was the integration of the caring act with reflection on basic caring concepts. Implications for praxis development are that implementation and reflection by teams over certain caring acts might open the door to an expanded view of one's own caring ability that in the long run will benefit the patient.
Manual handling risks associated with the care, treatment and transportation of bariatric patients and clients in Australia
Authors: Cowley Stephen P , Leggett Susan
Published: May 2010

Cowley SP, Leggett S. International Journal of Nursing Practice 2010; 16: 262–267 Manual handling risks associated with the care, treatment and transportation of bariatric patients and clients in Australia

To gain an understanding of the factors that affect the risks and the adoption of risk control measures during the care of bariatric patients, focus groups were conducted in rural and metropolitan locations in Australia. It was found that the manual handling injury risk to carers is influenced by the design of the environments within which patient movement is undertaken; the limited range of handling equipment available for use with bariatric patients; and the efficacy of organizational procedures and training. Adoption of risk controls is hampered by the absence of a standard definition of the term ‘bariatric’ and limitations in the use of weight and body mass index in definitions. There are gaps in information flow during the bariatric patient journey through the health‐care system and a lack of knowledge about how to safely manage the unique needs of bariatric patients.
Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective
Authors: McGrath Pam , Phillips Emma , Vaughan Grahame
Published: May 2010

McGrath P, Phillips E, Vaughan G. International Journal of Nursing Practice 2010; 16: 274–281 Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective

The purpose of this paper is to explore, from the mothers' perspective, the decision‐making experience with regard to subsequent birth choice for women who had previously delivered by Caesarean section. A qualitative methodological approach was taken to the exploration of mothers' knowledge of the risks of vaginal birth after Caesarean (VBAC) or elective Caesarean following a prior birth by Caesarean section. This paper presents the insights provided by the four women who chose VBAC. The health professionals' attitude to birth, and thus the support they offer to mothers, is predominantly pro‐Caesarean. In view of the declining numbers of VBACs and the fact that the clinical literature documents risks for both elective Caesarean and VBAC, it is important for health professionals to be very sensitive and balanced in the information and support offered for the VBAC birth option.
Information level of patients in discharge training given by nurses following open heart surgery
Authors: Ozcan Hacer , Yildiz Findik Ummu , Sut Necdet
Published: May 2010

Ozcan H, Findik UY, Sut N. International Journal of Nursing Practice 2010; 16: 289–294 Information level of patients in discharge training given by nurses following open heart surgery

Providing discharge information following a surgery is one of the most common nursing approaches. Patients should be given discharge training after open heart surgery in order to eliminate or reduce physical and emotional problems. The study aims to assess the information level of patients in discharge training provided by nurses following open heart surgery. The study is a prospective study including 50 patients who underwent open heart surgery. The information level of patients who received discharge training was assessed before training and 1 month after the training. Data were collected using the personal information form, and pretest and post‐test questionnaires. Data were assessed by using percentage, McNemar chi‐squared, Wilcoxon signed ranks and stepwise linear regression analysis tests. Results indicated that patients were well informed following discharge training (Z = −6.166, P < 0.05), and that age and marriage variables affected the information level (P = 0.032, P = 0.045, respectively). Discharge training following open heart surgery increases the knowledge of patients and should be given to patients in a planned manner.
Caring to death: The murder of patients by nurses
Authors: Field John , Pearson Alan
Published: May 2010

Field J, Pearson A. International Journal of Nursing Practice 2010; 16: 301–309 Caring to death: The murder of patients by nurses

Beyond the initial ‘shock‐horror’ reaction in the mass media, little attention is paid by nurses or the public to nurses who murder patients. This study used discursive inquiry to uncover social constructions of this phenomenon and their implications for the definition and treatment of such murders. The mass media and professional literature were searched for commentary on cases of nurses who had been convicted of murder between 1980 and 2006. The retrieved texts were subjected to discursive analysis. Discursive constructions included the profile of murderous nurses; types of murders; contexts in which murder occurs; factors that aid detection and apprehension; legal processes and punishment; and reactions of the public, profession, regulators and families. The findings imply that murder of a patient by a nurse might occur in any setting in which nurses care for vulnerable patients—the old, the young, the sick and the disabled. Trust in nurses assists a nurse to murder. Nurses have a responsibility to understand how their workplaces can form crucibles in which murder can take place. The profession needs to acknowledge the possibility of nurses who murder patients and to commence a discussion about what might be done to limit the harm they do.
Carbon dioxide‐based portography: An alternative to conventional imaging with the use of iodinated contrast medium
Authors: Maruyama Hitoshi , Okugawa Hidehiro , Ishibashi Hiroyuki , Takahashi Masanori , Kobayashi Satoshi , Yoshizumi Hiroaki , Yokosuka Osamu
Published: May 2010

Background and Aim:  To clarify the efficacy of carbon dioxide (CO2) as a contrast material to evaluate portal vein images by percutaneous transhepatic portography (PTP).

Methods:  Twenty patients (38–76 years; male 13, female 7) with chronic liver diseases were the subjects of this prospective study. Portal venous opacification by PTP was compared between CO2‐based images and iodinated contrast medium (ICM)‐based images by two independent reviewers, according to the three‐grade scoring; 0 for none, 1 for weak and 2 for sufficient.

Results:  Total scores of extrahepatic portal veins (137 for CO2, 93 for ICM), collateral vessels (64 for CO2, 60 for ICM) and intrahepatic portal veins (69 for CO2, 76 for ICM) were not statistically significant between CO2‐based and ICM‐based images (P = 0.0623). Sufficient opacification of superior mesenteric vein was more frequent on CO2‐based images (none 0, weak 4, sufficient 16) than ICM‐based images (none 19, weak 0, sufficient 1; P < 0.0001). The score was not statistically significant between CO2‐based and ICM‐based images in portal trunk, splenic vein, inferior mesenteric vein and other collateral vessels. Although opacification grade in the intrahepatic left portal vein was not statistically significant between CO2‐based and ICM‐based images (P = 0.1515), weak opacification was significantly frequent on CO2‐based images (weak 10, sufficient 10) compared to ICM‐based images (weak 0, sufficient 20; P = 0.0003) in the intrahepatic right portal vein. Inter‐reviewer agreement was excellent between the two reviewers for CO2‐based images (kappa = 0.913) and ICM‐based images (kappa = 0.924).

Conclusions:  Carbon dioxide may be a first‐line contrast material for evaluating portal vein images by PTP.
Systemic treatment in advanced/metastatic hepatocellular carcinoma in the era of targeted therapy
Authors: Han Kwang‐Hyub , Park Jun Yong
Published: May 2010

See article in J. Gastroenterol. Hepatol. 2010; 25: 1117–1122
Two cases of idiopathic infantile arterial calcification
Authors: Ryerson Lindsay M , Chiletti Roberto , Zacharin Margaret , Tibballs James
Published: May 2010

We present the clinical course and management of two infants with idiopathic infantile arterial calcification. Both had coronary artery involvement and presented with ischaemic cardiac failure. Neither responded well to conventional therapy with inotropic agents, glyceryl trinitrate, diuretic and mechanical ventilation, nor to short‐term biphosphonates. One was treated with levosimendan and extracorporeal membrane oxygenation to no avail.
Sturge–Weber syndrome without facial nevus: An unusual cause of neonatal seizures
Authors: Wong Sau Wei , Kyaw Linn , Ong Lai Choo , Zulfiqar Annuar M
Published: May 2010

Sturge‐Weber syndrome is a neurocutaneous syndrome characterised by facial port wine stain, ipsilateral leptomeningeal angioma and vascular eye abnormalities. We report a rare case of Sturge‐Weber syndrome without facial nevus presenting with neonatal seizures.
Malaysian Antenatal Risk Coding and the Outcome of Pregnancy
Authors: Geefhuysen Coeli J. , Isa Abdul Rahman , Hashim Mohammed , Barnes Anthony
Published: May 2010

Objective: Measure the effectiveness of the colour coding system in Malaysia for the prediction of risk in pregnancy.

Method: Cohort study of records and interviews of 253/279 women examined at first antenatal visit.

Results: Nurses' final coding showed poor concordance with guidelines; recod‐ing produced a predictive value of high risk of 48%; 25% of those with low risk had 50% of complications. Complication rates were moderate and intervention rates low. The mothers had little appreciation of risk and preferred home delivery. Home deliveries gave excellent results except for the 17% requiring transfer to hospital during labour or delivery.

Conclusion: The coding system is ineffective with Malaysia's relatively low reproductive risk. Women require more personalised counselling about risk to make appropriate choices.

Better results depend on simpler but consistent selection for hospital delivery using reproductive history, combined with better communication and transport systems for home deliveries and a reorientation within hospitals to rapid emergency care.
Magnetic Resonance Imaging of Fetal Autosomal Recessive Polycystic Kidney Disease
Authors: Nasu Kaei , Yoshimatsu Jun , Anai Takanobu , Miyakawa Isao , Komatsu Eiji , Maeda Tomoki
Published: May 2010

We present a case of fetal autosomal recessive polycystic kidney disease (ARPKD) at 34 weeks of gestation, diagnosed by magnetic resonance imaging (MRI). MRI demonstrated enlarged fetal kidneys that were low signal intensity on T1‐weighted images and high signal intensity on T2‐weighted images. These MRI findings suggested a high water content in the renal parenchyma, consistent with the innumerable, tiny renal cysts present in ARPKD.
Silent Premature Rupture of Membranes, Detected and Monitored Serially by an AFP Kit
Authors: Yamada Hideto , Kishida Tatsuro , Negishi Hiroaki , Sagawa Tadashi , Fujimoto Seiichiro
Published: May 2010

A 24‐year‐old woman underwent conization and cervical cerclage during pregnancy. After she later complained of fluid leakage, a premature rupture of the membranes (PROM) was suspected, because of positive results on a test for nitrazine, the intra‐amniotic dye injection method (PSP test), and an AFP‐kit test at 22 weeks of gestation. The nitrazine and PSP tests later turned negative. However, during the period from the 22nd through 26th weeks of gestation, the results of AFP‐kit tests fluctuated, with repeated positive indications for bacterial cultures and elevated granulocyte elastase activity in the cervical mucus. The pregnancy was well maintained with administration of antibiotics and ritodrine hydrochloride until 34 weeks of gestation. The presence of chorioamnionitis, local inflammation of the fetal membranes, was found by pathological examination after the delivery. We propose a new clinical entity‐to be referred to as silent PROM‐the premature chemical rupture of the membranes.
Fetal Growth Retardation, Particularly within Lymphoid Organs, following Repeated Maternal Injections of Betamethasone in Sheep*
Authors: Quinlivan Julie A. , Archer Michael A. , Dunlop Sarah A. , Evans Sharon F. , Beazley Lyn D. , Newnham John P.
Published: May 2010

Objective: To examine the effect of single or repeated injections of maternally administered corticosteroids on fetal growth in sheep.

Methods: Forty‐six date‐mated singleton gestation ewes were allocated at random to one of 3 groups: a single, or repeated injections of betamethasone, or a control group which received saline. On days 125 (preterm) or 145 (term) caesarean section delivery was performed. After lambs were killed, measures of size and weight were recorded. Data were analysed using Fishers Exact test and the Student's t‐test.

Results: Significant betamethasone dose dependent reductions in body and organ weights and biometry were found at preterm and term gestational ages (p < 0.05). There was little catch up growth in those in whom delivery was delayed until term. Thymus, spleen and liver were particularly targeted.

Conclusion: Repeated injections of betamethasone to the pregnant ewe cause significant reductions in fetal growth with little evidence of catch up by term. The effect of repeated maternal injections of corticosteroids in human pregnancy will await the results of randomized controlled trials.
The Accuracy of Intraoperative Frozen Section in the Diagnosis of Ovarian Tumors
Authors: Yeo Evelyn L. K. , Yu K. M. , Poddar N. C. , Hui P. K. , Tang Lawrence C. H.
Published: May 2010

A retrospective study of 316 ovarian neoplasms which had frozen section evalutation between January 1, 1990 to December 31, 1995 was conducted to determine the accuracy of frozen section diagnosis of ovarian neoplasms. The frozen section results were compared with final diagnoses from paraffin sections. The frozen section diagnosis was accurate in 95.2% of all cases and inaccurate in 4.8%. The positive predictive value of a positive (or malignant) frozen section was 100%, the negative predictive value of a negative (or benign) frozen section was 98.2%. The sensitivity for malignant tumors was 87%. For tumors of borderline malignancy, the sensitivity and specificity were 60% and 98.6% respectively. Of the false negative frozen section diagnoses, 73% (8 cases) occurred in tumors of borderline malignancy. We concluded that with the exception of the sensitivity for the diagnosis of tumors of borderline malignancy, the sensitivity and specificity of frozen section diagnosis for benign and overtly malignant ovarian neoplasms are high.
Preeclampsia: Haemostatic Status and the Short‐Term Effects of Methyldopa and Isradipine Therapy
Authors: Yin Kyi Htay , Koh Stephen C. L. , Malcus Peter , Sven Montan S , Biswas Arjit , Arulkumaran S. , Ratnam Shan S
Published: May 2010

Objective: To determine the haemostatic status in preeclampsia and to investigate the effects of short‐term use of anti‐hypertensive drugs, methyldopa and isradipine.

Methods: Thirty preeclamptic (PE) women admitted to the hospital for observation and treatment were randomized to receive either methyldopa or isradipine for 2 weeks. Their blood pressure were monitored for 24 h before treatment and again at 7 days and 14 days after treatment using the programmable automated ambulatory blood pressure (ABP) monitoring system. Blood sampling was performed before commencement of anti‐hypertensive treatment, 7 days and 14 days after treatment and the haemostatic parameters studied was compared before treatment with normal pregnancy and the effects of anti‐hypertensive treatment. Nineteen normal pregnant subjects with a total of 30 blood sampling at various gestation and good pregnancy outcome served as controls. The following haemostatic parameters were determined; thrombelastography, fibrinogen, antithrombin III (ATIII), thrombin‐antithrombin (TAT)‐complex, β‐thromboglobulin (β‐TG), plasminogen activators (t‐PA, u‐PA), plasminogen activator inhibitors (PAI‐1.PAI‐2), and plasminogen.

Results: Significant lowering of blood pressure was evident at Days 7 and 14 of therapy with either methyldopa or isradipine. Increased mean plasma fibrinogen and decreased ATIII levels were seen in preeclampsia together with decreased u‐PA and t‐PA activity levels in contrast to increased t‐PA antigen and β‐TG. No significant differences were seen for TAT‐complex, PAI‐1, plasminogen and D‐dimer levels although their mean levels were higher than observed in non‐pregnant subjects except for PAI‐2, the level was significantly reduced when compared with normal pregnancy. Two‐way analysis of variance showed no significant alteration on all haemostatic parameters studied in preeclamptic women receiving either methyldopa or isradipine after 7 and 14 days of therapy.

Conclusion: Enhance activation of coagulation was observed together with raised fibrinolysis in normal pregnancy and PE. However, in PE a further reduction in ATIII, u‐PA and FAI‐2 with increased fibrinogen and platelet activation could lead to an imbalance in the coagulation/fibrinolysis equilibrium which favours fibrin deposition. All these changes seen in PE including the coagulation kinetics were not altered by the short‐term effects of methyldopa and isradipine even though significantly lowered blood pressure were observed during therapy.
Adenomyosis: Diagnosis by Hysteroscopic Endomyometrial Biopsy, Correlation of Incidence and Severity with Menorrhagia
Authors: Goswami Anu , Khemani Manju , Logani K. B. , Anand Rama
Published: May 2010

Objective: To assess the possibility of diagnosing adenomyosis by hysteroscopic endomyometrial biopsy in patients with menorrhagia and to compare the incidence and depth of penetration in patients who did not have menorrhagia.

Study Design: The study group included 53 patients who had menorrhagia and the control group included patients who were to have hysterectomy for conditions like prolapse uterus. Hysteroscopic endomyometrial biopsy was done in the menorrhagia group. The incidence and depth of penetration of adenomyosis were compared in both the groups using Kruskal Wallis H test. For correlation of severity of menorrhagia with depth of adenomyosis: Student's i‐test and ANOVA were used.

Result: The incidence of adenomyosis was 60% (18 patients) by endomyometrial biopsy in the menorrhagia group as compared to 33.3% in the control group. The mean depth of invasion of myometrium was 4.103 mm in the menorrhagia group and 2.03 mm in the control group.

Conclusion: There is a definite correlation between menorrhagia and adenomyosis both in incidence and depth of penetration.
Fetal Vascular Responses to Maternal Glucose Administration in Streptozocin‐Induced Ovine Diabetes Mellitus
Authors: Dickinson Jan E. , Meyer Bruce A. , Palmer Sue M.
Published: May 2010

Objective:To assess the impact of administration of a glucose load to the pregnant diabetic ewe on fetal biochemistry and umbilical‐placental perfusion.

Methods: Six pregnant ewes were rendered glucose intolerant by the administration of streptozocin at 85–90 days gestation. An intravenous glucose load was administered to the 6 diabetic ewes and 4 control animals at 125—130 days gestation. Assessment of the fetal responses to this glucose load was made by cardiovascular monitoring, biochemical evaluation and measurement of fetal blood flows by the radioactive microsphere technique.

Results:In the fetus of the diabetic ewe the arterial pH progressively decreased from 7.36±0.04 to 7.10±0.09 (p<0.05) 180 minutes after the maternal glucose load. These fetuses displayed a consistent and significant reduction in arterial oxygen tension compared to controls, with a decrease in pO2 from 14.9± 3.3 mmHg at baseline to 11.3 + 3.7 mmHg after 180 minutes. Umbilical‐placental blood flow did not alter significantly in the fetus of the diabetic ewe following glucose administration, although in the control fetuses there was a significant reduction from baseline after 60 minutes. Blood flow to the fetal brain and kidney were significantly elevated in the fetus of the diabetic ewe compared to control at all times, suggesting a metabolic adaptation to preserve oxygen delivery may be present.

Conclusions: Maternal hyperglycemia produces profound metabolic alterations in the ovine fetus which are unaccompanied by significant alterations in umbilical‐placental blood flow. In the chronically hyperglycemic pregnant ewe, a glucose load produces a major disturbance of fetal homeostasis.
Factors Affecting Pregnancy Outcome Resulting from Assisted Reproductive Technology (ART)
Authors: Zhou Canquan , Knight David C. , Tyler John P. P. , Driscoll Geoffrey L.
Published: May 2010

Objective:A retrospective, observational study of pregnancy outcome was performed on variables maintained in an ART database to determine factors that might affect miscarriage rate in pregnancies resulting from assisted reproduction technologies (ART).

Methods: Previously infertile couples, where conception was achieved after ART, were included. Seven handred and ninety‐four consecutive clinical pregnancies, diagnosed by ultrasound documentation of the gestation sac in the first trimester were divided into 2 groups; ‘miscarriage’ and ‘term birth’. Differences between the groups were analysed using crosstable regression analyses or t‐test in second yearly cohorts.

Results:A statistically significant positive relationship was seen between age and spontaneous abortion rate (p = 0.008) with a major increase after the age of 38 years. There was no significant difference in the mean number of oocytes retrieved between groups (p = 0.17). While there was a significant negative correlation between maternal age and the total number of oocytes collected (p < 0.001), there was no statistical difference between those women who miscarried or delivered a live infant. No relationships were found with any other variables analysed.

Conclusion:Maternal age is probably the most important factor in pregnancy outcome in ART. This survey could not determine any other variables as being major prognostic determinants for miscarriage once pregnancy was attained.
Fertility Outcome after Reversal of Sterilization
Authors: Yadav Reena , Reddi Rani , Bupathy A.
Published: May 2010

Objective:The study was designed to evaluate the fertility outcome in sterilization reversals and a variety of factors that have been suggested to influence the successful outcome of sterilization reversal procedures.

Method:It is a retrospective study involving all sterilization reversals performed between January 1991 and December 1995 in our hospital. A total of 58 cases were treated. Tubal anastomosis was performed according to rules of microsurgery. The loupe microsurgical technique with 4 × magnification comprising two main phases, preparation of healthy tubal segments and anastomosis carried out in two layers.

Results:It was possible to study subsequent fertility of 50 patients in all, as 8 patients were lost to follow‐up (13.76%). The overall conception rate was 68% (34 cases), out of which intrauterine pregnancy rate was 62% (31 cases), ectopic pregnancy rate was 6% and the abortion rate was 6%. Fifty percent of patients conceived within first 12 months of reversal of sterilization. The isthmic‐isthmic type of anastomosis has maximum incidence of pregnancies (88.88%).

Conclusion:Laparoscopic (Falope ring) sterilization should be preferred in women who are willing for interval sterilization and it should be done at isthmic segment of the tube, whereas the Pomeroy's method is to be reserved for occasional postpartum procedure. Reversal of sterilization should be done with strict adherence to principles of microsurgery.
Intrauterine Fetal Death during Pregnancy: Limitations of Fetal Surveillance
Authors: Künzel Wolfgang
Published: May 2010

Objective:Perinatal statistics in Germany have shown that fetal death during pregnancy remained unchanged during the past 12 years. The question arises whether the quality of prenatal care can be improved and contributing factors to ante partum mortality (APM) reduced.

Methods:The perinatal data base from Hesse was evaluated for 1990–1995. It comprises 347,463 deliveries in a population based survey from the state of Hesse/ Germany. Antepartum death occurred in 1,133 cases (0.33%). Pregnancy care was evaluated in a longitudinal investigation analysed from 1982 to 1995.

Results:Fetal surveillance showed during the past years a steady improvement demonstrated by the number antenatal visits of more than 10: it rose from 54 to 75%, by the CTG recordings ante partum: it increased from 55 to 90% and ultrasound examinations more than 5: it rose from 12 to 26%.

Despite the increase of ante partum care fetal death during pregnancy remained constant since 1985 at 0.5 to 0.6%.

Malformations contribute to APM in 8.3%. In 44.4% various risk factors could be identified, whereas in 47.4% no causes could be shown. Special risk factors are hydramnios, diabetes, placenta praevia, multiple pregnancy, IUGR and others. Fetal death occures preferentially during the last weeks of pregnancy with a maximum at 40 weeks of gestation. Social burden and insufficient prenatal care are contributing factors to APM.

Conclusion:APM can still be improved by using simple clinical estimates and by defined application of surveillance tools at present available.
Immunohistochemical and Ultrastructural Study of Langerhans's Cells in Squamous Cell Carcinoma of the Cervix
Authors: Abdou Laila A. , El‐Gazayerly Ibrahim M. , El‐Shazley Laila Y. , Zoheir Malak A. , Kholeif Aly E. , El‐Sedfy Amal S.
Published: May 2010

Objective: To study Langerhans's cells (LCs) in cervical squamous cell carcinoma.

Study design: The study was carried out in the Shatby University Hospital, Alexandria, Egypt. Thirty cases with squamous cell carcinoma, 10 cases with cervical intra‐epithelial neoplasia (CIN) and 10 cases with normal exocervix were recruited. Sections from the exocervix were stained with gold chloride, immunostaining with S‐100 protein antiserum, adenosine triphosphatase ATPase and electron microscopy. Statistical evaluation was done using the t‐test.

Results: Gold chloride staining revealed significantly increased number of LCs in all cases of CIN compared to normal controls and with increasing grade of CIN (p < ll 0.001). No relationship between LCs number and the grade of carcinoma. Least branched LCs were predominant in the normal tissue while in neoplasia, these cells were of the most branched type, indicating a hyperactivity. S‐100 protein positive LCs were almost absent in normal controls while their number were almost lower than the corresponding cases of CIN and invasive carcinoma after gold chloride or ATPase stainings. Signs of hyperactivity were evident in LCs of neoplastic cases after electron microscopy.

Conclusions: Proliferation and increased number of LCs in CIN is an immune response, while such reaction is suppressed by invasive carcinoma.
The Association between Maternal Smoking and Fetal Hydranencephaly
Authors: To William W. K. , Tang Mary H. Y.
Published: May 2010

Objective: To evaluate the relationship between maternal smoking and fetal congenital central nervous system malformations.

Methods: Retrospective review of all cases of fetal congenital malformations of the central nervous system (CNS) identified at or shortly after birth over a 10‐year period (1986–1995) in a university teaching obstetric department.

Results: The total number of CNS abnormalities identified was 79, constituting 0.13% of all deliveries over the period (n = 59,392) and 4.7% of all congenital malformations (n = 1,678). The incidence of smoking mothers was 1.64% over the study period. Pour babies had hydranencephaly, 3 of these mothers being smoking teenagers. The odds ratio of having a hydranencephalic fetus in smoking mothers compared to non‐smokers was 56 (95% CI 7.41–427) in the group with CNS abnormalities, 136 (95% CI 14.5–1280) in the group including all congenital malformations, and 179 (95% CI 18.6–1719) in the group including all deliveries.

Conclusion: Maternal smoking did not appear to increase the incidence of fetal congenital CNS abnormalities overall, but might be associated with particular vascular patterns of damage to the developing brain that could predispose to a hydranencephalic malformation.
Prenatal Diagnosis of Intrapericardial Teratoma: A Case Report
Authors: Fujimori Keiya , Honda Shinya , Akutsu Hidenori , Ariga Hiromichi , Ujiie Niro , Yanagida Kaoru , Sato Akira
Published: May 2010

A hydropic fetus that exhibited intrapericardial teratoma with marked pericardial effusion was prenatally diagnosed. Intrauterine pericardiocentesis was performed to diagnose and to treat hydrops. Pericardiocentesis for tamponade secondary to a fetal intrapericardial teratoma might prevent fetal death and premature delivery.
Study on Genital Tract Chlamydia trachomatis and Gonococcal Infection in Han and Minority (Naxi and Dai) Women in China's Two Provinces
Authors: Lin Luo , Shi‐Zhoung Wu , Juesheng Chen , Yeying  , Tianxiu Li , Banzhong Gao , Namu Wang , Guilin Xiong , Mei Huang , Jinzhi Luo
Published: May 2010

Objectives: To estimate the prevalence of lower female genital tract chlamydial (GTC) and gonococcal infection in 3 different ethnic groups in China, and to analyze the risk factors influencing these infections.

Methods: A cross‐sectional survey + physical and laboratory examinations. 1,800 married women aged 18–35 Han (600, from Dujiangyan city, Sichuan), Naxi (600, from Yanyuan county, Sichuan), and Dai (600, from Jinghong Prefecture, Yunnan) were investigated between March 1996 to March 1997. Information was obtained about their personal history, socioeconomic status, medical history, STDs, sexual history, contraceptive history, results of both examinations. Tabulation, t‐test, Chi‐square test, multiple‐logistic models were used to analyze the data.

Results: 3.2% of Han, 12.8% of Naxi and 4.5% of Dai women tested positive for gonococci; and 9.1% of Han, 16.7% of Naxi and 27.5% of Dai women tested positive for GTC infection. The differences of GTC and gonococcal infections between Han and Naxi, and Han and Dai women were significant.

Conclusions: STDs are common in China today; both GTC and gonoccocal infections are related to non‐use of condom, having sexual partners other than husband, number of abortions, and low education; and condom has a function in prevention of STDs.
A Case Report: Pregnancy Complicated by Blue Rubber‐Bleb Nevus Syndrome
Authors: Wada Osamu , Unno Nobuya , Matsuoka Ryo , Taketani Yuji
Published: May 2010

Blue rubber‐bleb nevus (BRBN) syndrome, first reported in 1958 by Bean, manifests with multiple hemangiomas located in the skin and gastrointestinal tract. Characteristic laboratory data include chronic anemia with iron deficiency and consumption coagulopathy. We describe herein a pregnancy complicated by BRBN syndrome resulting in the delivery of a male infant by cesarean section.
An Analysis of Breastfeeding Patterns and Menses Returning in Chengdu, China
Authors: Cui Nian , Tang Guanghua , Li Minxiang , Xie Li , Yang Xiaofeng
Published: May 2010

Objective: To study the relationship between infant feeding practices and the duration of lactational amenorrhea, WHO conducted a multi‐centered prospective study in 7 countries from 1989. This paper reports the preliminary results based on the data collected in Chengdu center in China.

Methods: A detailed follow‐up survey was conducted among 541 pairs of mothers and infants from delivery to the returning of menses of mothers at the interval of every 2 weeks.

Results: The results showed that the mean number of breastfeeding episodes and mean duration of breastfeeds had little correlation with the time since delivery. Within 6 months since delivery, the percentage of infants' feeds consisting of breastmilk was over 90%, and this percentage dropped to 70% at 1 year's age of infants. The time to the start of regular supplementation was 153 days postpartum. The proportion of women in exclusive breastfeeding at 2 weeks postpartum was 73.4%, and these figures at 3 and 6 months postpartum were about 60% and 40%, respectively. Until 18 months postpartum, nearly 80% mothers were partial breastfeeding their infants. The cumulative probabilities of menses returning were 0.0150, 0.0395, 0.2345 and 0.6820 at 61, 89, 187 and 369 days postpartum respectively. The median duration of lactational amenorrhea was 282 days.

Conclusion: These results indicated that the duration of lactational amenorrhea would be prolonged if the time of exclusive/predominant breastfeed was extended and the supplementary food was introduced later. The paper concluded that the first menses returning was the signal for initiating contraceptive methods for women.
Placenta Previa Increta Penetrating the Entire Thickness of the Uterine Myometrium: Ultrasonographic and Magnetic Resonance Imaging Findings
Authors: Ito Takashi , Katagiri Chieko , Ikeno Sinji , Takahashi Hiroyuki , Nagata Naoki , Terakawa Naoki
Published: May 2010

This is the first report of placenta previa increta in which the placenta villi penetrated the entire thickness of the uterine myometrium, but did not invade the pubocervical fascia. Ultrasonographic and magnetic resonance imaging findings are described.
The Use of Rectal Misoprostol as Active Pharmacological Management of the Third Stage of Labor
Authors: Diab Khaled M. , Ramy Ahmed R. , Yehia Mohamed A.
Published: May 2010

Objective: To compare the effectiveness of rectal Misoprostolr̀ versus combined intramuscular oxytocin and ergometrine (O‐E) in the management of the third stage of labor.

Methods: Low‐risk women in 3rd stage of labor were allocated to receive either rectal Misoprostolr̀ [200 ug (n = 25), 400 ug (n = 45)] or 5‐units oxytocin and 0.2 mg ergometrine intramuscularly (n = 75). Clinical and hematological parameters were compared using t and chi‐square tests.

Results: Both groups were well matched and had similar duration of the 3rd‐stage of labor. Misoprostolr̀ users had lower 3rd‐stage estimated blood loss and needed less further ecbolics compared to O‐E group. Postpartum Hb and Hct levels were significantly lower in O‐E group than Misoprostolr̀ group. Postpartum hypertension occurred more in O‐E group. Subjects in Misoprostolr̀ group had more shivering. Subjects receiving 200 ug and 400 ug Misoprostolr̀ had similar outcome variables.

Conclusion: Rectal Misoprostol may be used safely in the management of the third stage of labor.
Efficacy of Magnesium Sulphate and Phenytoin in the Management of Eclampsia
Authors: Sawhney H. , Sawhney I. M. S. , Mandal R. , Subramanyam  , Vasishta K.
Published: May 2010

Fifty pregnant women admitted with diagnosis of eclampsia were randomly allocated to magnesium sulphate (Group A) or phenytoin sodium (Group B) treatment group. Incidence of recurrence of seizures maternal as well as perinatal morbidity and mortality were compared in both the groups. Mean maternal age, parity and gestational age was similar in both the groups. Mean birth weight was significantly lower in Group B compared to Group A. Seizure frequency prior to hospitalization was 5.4 + 4.7 in Group A and 4.8–3.6 in Group B. Mean time interval between occurrence of first seizure and hospitalization was 9.6 + 3.5 hours in Group A and 11.8 + 9.3 hours in Group B, the difference was not statistically significant. Women treated with phenytoin had a higher incidence of recurrent seizures (10/25–40%) than those treated with magnesium sulphate (2/25–8%). Majority of the women treated with phenytoin (6/10–60%) had single convulsion after initiation of anticonvulsant therapy and 1 woman of each group had recurrent convulsions (75). There was no significant difference in perinatal outcome in both the groups. Maternal morbidity was comparable in both the groups and there was no maternal death in either of the groups.
Clinicopathological Study of Recurrent Uterine Cervical Squamous‐Cell Carcinoma
Authors: Shiromizu Kenji , Kasamatsu Takahiro , Honma Tomokazu , Matsumoto Koji , Shirai Takako , Takahashi Michiko
Published: May 2010

Objective: To improve prognoses of patients with recurrent uterine cervical squamous‐cell carcinoma.

Patients and Methods: We clinicopathologically analyzed 464 patients with uterine cervical squamous‐cell carcinoma (126 positive, 338 negative pelvic lymph‐node metastasis) who were treated at the Saitama Cancer Center from January 1, 1976 to December 31, 1991.

Results: The recurrence rates of negative pelvic lymph‐node metastasis patients were 14. 2% (39/274) in pT1b and 32.8% (21/64) in pT2b. But for positive lymph‐node metastasis patients the rates were 39.0% (23/59) in pT1b and 58.2% (39/67) in pT2b. The interval to recurrence was shorter in positve pelvic lymph‐node patients than in negative patients. The 5‐year survival rates after relapse of negative lymph‐node patients with intrapelvic, extrapelvic, and both‐sites recurrence were 53, 12, and 40%, respectively. But among distant recurrent sites, lung metastasis in negative lymph‐node patients and lymphatic tract metastasis brought relatively fair prognoses.

Conclusions: Regular long‐term checks are necessary and active retreatments are recommended for patients with local recurrences, lung metastasis, or lymphatic vessel metastatic lesions.
B‐Cell‐Type Malignant Lymphoma with Placental Involvement
Authors: Nishi Yayoi , Suzuki Shunji , Otsubo Yasuo , Ishikawa Gen , Ichikawa Masao , Takei Rintaro , Sawa Rintaro , Yoneyama Koichi , Yoneyama Yoshio , Araki Tsutomu
Published: May 2010

We present here a case of B‐cell‐type mediastinal malignant lymphoma during pregnancy complicated by placental involvement. In this case, some nodular high‐echo patterns were recognized in the placenta by ultrasonography. A cesarean section and resection of the mediastinal tumor were performed at 33 weeks and 6 days of gestation due to the deterioration of the dyspnea. A female infant weighing 1,868 g was delivered and she is now a healthy 2‐year‐old. The mother, however, died of the disease 1 month after surgery, due to progression of the tumor. The placenta showed numerous white firm nodules varying from 3 mm to 3 cm in diameter. The pathologic findings of both the mediastinal tumor and the placenta indicated primary mediastinal (thymic) B‐cell lymphoma.
Antepartum Evaluation of Monochorionic Diamniotic (MD) Twins; MD‐Twin Score: A New Scoring Method for Perinatal Outcome
Authors: Kaneko Masatoki , Sameshima Hiroshi , Ikeda Tomoaki , Kodama Yuki , Ikenoue Tsuyomu
Published: May 2010

Objective: Our purpose was to establish a new scoring method to survey monochorionic diamniotic (MD) twins during antepartum periods.

Study Design: A retrospective study was performed regarding MD twins delivered between January 1992 and July 1996. Maternal and neonatal records were assessed for the following 5 perinatal variables; birth‐weight discordance, amniotic‐fluid discordance, hydrops fetalis, umbilical‐cord insertion, and fetal‐heart‐rate monitoring. Each variable was coded as normal or abnormal and then assigned an arbitrary weight of 0 if normal and 1 if abnormal, yielding a range of scores from 0 (all normal) to 5 (all abnormal). The relationships between individual variables and their combinations and the outcome of pregnancy was determined. A poor pregnancy outcome consisted of intrauterine death, neonatal death, or neurological sequelae of at least one twin. The 5‐variable combination was termed as the MD‐twin score. A chi‐square test and logistic regression analysis were used to determine statistical significance.

Results: There were 59 MD pregnancies, of which 13 pregnancies resulted in a poor outcome. The single variable that most likely contributed to a poor outcome was amniotic‐fluid discordance. All 35 pregnancies with an MD‐twin score of ≤ 2 had a good outcome. There were 14 pregnancies with a score of 3, and 21% of them had a poor outcome. All of the pregnancies with a score of ≥ 4 had a poor outcome. When we chose the MD‐twin score of 3 as the critical point for a poor outcome, the likelihood ratio statistics became the highest of any single variable or any combination of variables.

Conclusion: The MD‐twin score predicted poor outcomes better than did any single variable or combination of variables.
Profile of Maternal Smokers and Their Pregnancy Outcomes in South Western Sydney
Authors: Bai Jun , Wong Felix W. S. , Gyaneshwar Rajanishwar , Stewart Helen C.
Published: May 2010

Objective: The prevalence of maternal smoking remains high in New South Wales. In order to better understand the profile of maternal smokers, a study has been conducted to examine the social and demographic characteristics and pregnancy outcomes of women who smoked during their pregnancy in south western Sydney.

Methods: Women and babies of a retrospective cohort of 7,191 singleton births between March 1996 and December 1998, at Liverpool Hospital were analyzed.

Results: The prevalence of maternal smoking for the study population was 18.8%. The study found that the sociodemographic factors, such as marital status, ethnic origin, English speaking background, working status during pregnancy, and private health insurance status were independent risk factors for maternal smoking, but maternal age was not. Women who smoked during their pregnancy had higher rates of abruptio placenta, threatened premature labour, and premature labour. The adverse neonatal outcomes due to maternal smoking were low birth weight and increased neonatal morbidity. Smoking appears to have a protective effect on pregnancy induced hypertension.

Conclusion: The findings of this study suggests that future smoking cessation programs should pay more attention to addressing sociodemographic and cultural factors that influence the behaviour of maternal smokers.
A Case of Stage‐IVb Cervical Adenocarcinoma Successfully Treated by Combination Chemotherapy: Case Report
Authors: Takehara Masaki , Nishioka Yoshihiro , Saito Tsuyoshi , Baba Tsuyoshi , Suzuki Takahiro , Ito Eiki , Kudo Ryuichi
Published: May 2010

A 54‐year‐old patient with a Stage IVb adenocarcinoma of the cervix was treated with combination chemotherapy. This regimen consisted of intravenous cisplatin (70 mg/m2) and aclacinomycin A (30 mg/m2) on Day 1, followed by mitomycin C (5 mg/m2) on Day 2 and 3. A pathologically complete response was achieved by this regimen. The patient is well and has been free of symptoms for 66 months.
Gynaecology in the New Millennium
Authors: Fong Yoke‐Fai , Singh Kuldip , Ratnam S. S.
Published: May 2010

Great challenges await the gynaecologist in the 21st century. While advances in medical technology necessitate that gynaecology move more towards a medical discipline than a surgical one, gynaecologists will be expected to play an increasingly important role in the modern woman's life. This fundamental change is influenced by four main factors, namely, the world's aging population, spread of information technology, advances in molecular based medical therapy, and the changing lifestyle of the woman in the next century. Our role cannot get any lesser as we continue to advise, educate and facilitate the lives of women, and we must aspire a new generation of responsible gynaecologists to continue this ambition.
Laparoscopic Management of Heterotopic Pregnancy: A Review
Authors: Pschera Helmut , Gatterer Achim
Published: May 2010

Laparoscopic management of ectopic pregnancies is becoming more common. Having recently successfully treated one case of heterotopic pregnancy by laparoscopy in our department, the object of the present paper is to review the literature regarding laparoscopically treated cases of heterotopic pregnancy in order to assess benefits, complications and safety of this procedure. A Medline search yielded 10 additional cases with ampullary, interstitional or cornual tubal pregnancy, respectively. All surgical procedures were uncomplicated and all in utero pregnancies progressed normally. Despite a small number of cases, lack of complications in these reports is encouraging feasibility of laparoscopic management of heterotopic pregnancy.