bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies in Otitis Media: Children's Hospital Of Pittsburgh–University of Pittsburgh Progress Report—2004
Authors: Bluestone Charles D.
Published: October 2004

Objectives/Hypothesis: The present Progress Report has summarized the key otitis media clinical trials and laboratory studies conducted since 1969 by investigators at the Children's Hospital of Pittsburgh–University of Pittsburgh (Pittsburgh, PA).

Study Design: Review.

Methods: Included in the discussion are the following: 1) studies of the epidemiology and risk factors; 2) anatomy and pathology of the eustachian tube–middle ear from human temporal bone histopathological specimens; 3) physiology and pathophysiology of the eustachian tube–middle ear in humans and animal models; 4) pathogenesis; 5) otitis media in special populations (e.g., patients with cleft palate, Native Americans, patients with Down syndrome); 6) microbiology; 7) diagnosis; 8) outcomes of randomized clinical trials that evaluated efficacy of nonsurgical and surgical methods of treatment and prevention; 9) studies of certain complications and sequelae (e.g., effect of middle‐ear effusion on hearing, early child development, and the vestibular system; chronic suppurative otitis media). Also included are relevant summary tables and 256 references.
Eugenics or empowered choice? Community issues arising from prenatal testing
Authors: Parker Malcolm H , Forbes Kevin L , Findlay Ian
Published: October 2004

The prevention of inherited disabilities is viewed in two contrasting ways – either as enhancing reproductive choice and improving population health, or as discriminating against disabled community members. We argue that modern clinical genetics, including preimplantation genetic diagnosis (PGD), reflects a persistent and defensible desire by the community to prevent disability, rather than as increasing discrimination or threatening to produce a ‘new eugenic’ society. Screening should be presented as a distinct issue for decision‐making about the prevention or acceptance of disability, rather than as a routinely accepted component of antenatal care. The community must improve its understanding of the experiences of those who manage disability, and continue to debate the issues of discrimination, selective genetic prevention and enhancement, reproductive freedom, and eugenics.
Legal abortion in South Australia: a review of the first 30 years
Authors: Yusuf Farhat , Siedlecky Stefania
Published: October 2004

Objectives

To review the first 30 years' experience of legal abortion in South Australia and its demographic implications.

Data and methods

Information was obtained from official abortion statistics and demographic publications of the Australian Bureau of Statistics. Standard demographic and statistical techniques of analysis were used.

Results

After an initial rise during the 1970s, abortion rates remained fairly constant for the next decade but have increased since 1990. The Pregnancy Advisory Centre opened in 1992, to reduce waiting times and to cater for late abortions. This resulted in an increase in abortions earlier in pregnancy and also an increase in late abortions. With the adoption of vacuum aspiration techniques and improved services, abortion is now a day‐only procedure, performed by specially trained doctors. Morbidity and mortality have been greatly reduced. Concurrent sterilisation has also declined. The increase in abortion has affected all age groups, but particularly women under 30, consistent with the national trend towards the postponement of births. After an initial rapid decline, the total pregnancy rate has risen slightly since 1990, showing changes in patterns of contraceptive use. However, this is not reflected in an increase in the total confinement rate.

Conclusion

Overall, contraception has had a greater effect than abortion in reducing births in South Australia. The abortion rate is still lower than in the rest of Australia as calculated from Medicare data, even though this is an underestimate because it includes only fee‐paying patients. There remains a need for continuing emphasis on better contraceptive use, including emergency contraception.
Audit of maternal and fetal outcomes in women treated for glucose intolerance during pregnancy
Authors: McIntyre H David , Begg Lisa M , Parry Annette F , Oats Jeremy
Published: October 2004

Objective

To determine whether one should aim for glycaemia that is statistically ‘normal’ or for levels of glycaemia low enough to prevent macrosomia (if such a threshold exists) when glucose intolerance is detected during pregnancy

Design

An audit of pregnancy outcomes in women with impaired glucose tolerance in pregnancy as compared to a local age‐matched reference group with normal glucose tolerance.

Results

Our study suggests that for most patients, more intensive therapy would not have been justified. Maternal smoking appeared to convey some ‘advantages’ in terms of neonatal outcomes, with reduction in large‐for‐gestational‐age (LGA) infants and jaundice in babies of impaired glucose tolerance (IGT) mothers.

Conclusions

These observations demonstrate the importance of considering risk factors other than GTT results in analysing pregnancy outcomes, while emphasizing that ‘normalisation’ of fetal size should not be our only therapeutic endpoint. Our detailed outcome review allows us to reassure patients with GDM that with current treatment protocols, they should have every expectation of a positive pregnancy outcome.
Factors associated with success or failure in trials of vacuum extraction
Authors: Mola Glen DL , Amoa AB , Edilyong James
Published: October 2004

Failure rates for vacuum extraction of between one in 16 and one in 600 have been reported. Most studies report that unexpected failure carries a greater risk to both mother and fetus. The aim of this study was to determine factors that were likely to predict success or failure in trials of vacuum extraction.

At the Port Moresby General Hospital, 59 trials of vacuum extraction were performed between 1 December 1997 and 30 November 1999. These cases were analysed according to whether vacuum extraction was achieved with more than or less than three pulls, or an alternative method of delivery was required to effect delivery.

Factors that were predictive of failure were: (i) Highlands origin of the mother; (ii) longer duration of the second stage of labour; (iii) severe moulding of the fetal head; (iv) cup detachments and deflexing cup applications; and (v) operator persisting with the procedure after three pulls.

The cervix being less than fully dilated when the trial was commenced was not associated with a higher risk of failure, nor was it associated with a significantly higher risk of cervical trauma.

Perinatal death and serious fetal scalp trauma were associated with deflexing cup applications, making more than three pulls and failed vacuum extractions.
High‐grade vulval intraepithelial neoplasia (VIN 3): a retrospective analysis of patient characteristics, management, outcome and relationship to squamous cell carcinoma of the vulva 1989–1999
Authors: Sykes Peter , Smith Natasha , McCormick Peter , Frizelle Frank A
Published: October 2004

Objectives

To determine patient and disease characteristics, treatment patterns and long‐term outcomes, in order to help direct management of patients with VIN 3, to examine the risk of development of cancer following a diagnosis of VIN 3 and the risk of recurrent disease requiring multiple treatment episodes, and to review patients with vulval cancer, in order to establish the relative prevalence of VIN 3 related vulval cancers.

Design

Retrospective chart review of 65 consecutive patients diagnosed with VIN 3 between 1989 and 1999.

Population or sample

All patients diagnosed with VIN 3 at Christchurch Womens' Hospital (1 January 1989 to 31 December 1999) and Dunedin Public Hospital (1 January 1990 to 31 December 1999)

Main outcome measures

Age at diagnosis, symptoms, medical history, disease characteristics, treatment, outcome and follow‐up.

Results

The median age at diagnosis was 38 years. Smokers were younger than non‐smokers. Two‐thirds had associated dysplasia of the lower genital tract, 43% had high‐grade lesions. Seventy‐nine per cent were symptomatic for a median of 9.5 months. All had macroscopically visible disease. Colposcopy and histology diagnoses correlated in 72% of cases. Treatment by local excision was undertaken in 84% of cases of which 65% had involved margins. Fifty‐one per cent required further treatment, risk factors were positive margins and multifocal disease. Three developed micro‐invasive cancer.

Conclusions

Treatment by local excision is both diagnostic and therapeutic. Excision may reveal micro‐invasive cancer, patients are usually symptomatic and VIN 3 has some potential to become invasive. Treated patients may develop microinvasive disease but frank invasion was not seen. The true rate of malignant progression in untreated patients remains unclear and radical surgery is rarely indicated. All patients require long‐term follow up.
Breastfeeding patterns and return to fertility in Australian women
Authors: Gross Barbara A , Burger Henry ,   the WHO Task Force on methods for the natural regulation of fertility
Published: October 2004

Objective

The purpose of this study was to understand the relationship between infant feeding patterns and the return of fertility during lactation.

Design

Mother‐infant pairs were followed up prospectively from the first week postpartum until the return of two normal menstrual bleeds (as judged by the woman) or pregnancy.

Setting

This study was conducted in the Sydney and Melbourne areas of Australia, and was part of a seven‐country research project.

Sample

Six hundred and twenty‐four Australian mother‐infant pairs participated in the study.

Methods

Follow‐up interviews occurred in the mothers' homes every two weeks. Mothers completed a daily diary record chart of vaginal bleeding and infant feeding, and completed a detailed diary card of the time and duration of breastfeeds and the frequency and nature of all other feedings once every two weeks.

Main outcome measures

The main outcomes of the study were measured as the median duration of lactational amenorrhoea and lifetable pregnancy rate during lactational amenorrhoea.

Results

The median duration of amenorrhoea in the Australian breastfeeding women who participated in the study was over 8.5 months. Breastfeeding was shown to be an effective method of fertility control in that no non‐contracepting, sexually active, amenorrhoeic, breastfeeding woman became pregnant in the first six months after delivery. Regular supplements commenced on average at five months and the Australian women rarely introduced non‐caloric (water), caloric (juices), or milk‐based supplements before this time.

Conclusions

This confirmed the Bellagio Consensus and the effectiveness of the Lactational Amenorrhoea Method.
Intravaginal 400 μg misoprostol for pregnancy termination in cases of blighted ovum: a randomised controlled trial
Authors: Kovavisarach Ekachai , Sathapanachai Udomsak
Published: October 2004

Objective

To investigate the effectiveness and side effects of intravaginal misoprostol 400 micrograms compared with a placebo for facilitating complete abortion in cases of blighted ovum.

Design

A prospective randomised placebo‐controlled trial.

Setting

Rajavithi Hospital, Thailand between 1 July 1998 and 31 January 1999.

Sample

Fifty‐four pregnant women with gestations of up to 12 weeks whose diagnosis of blighted ovum had been made by transvaginal ultrasound.

Methods

The patients were assigned randomly into two equal groups; the study group received two tablets of vaginal misoprostol (200 micrograms/tablet), and the control group received two tablets of a vaginal placebo.

Results

The complete abortion rate was significantly higher in the women receiving misoprostol (63%) compared with those receiving the placebo (18.5%) (p < 0.05). Lower abdominal pain (74.1%) and fever (14.8%) were significantly higher in the study group than in the placebo group (22.2%) and (0%) respectively, (p < 0.05).

Conclusion

Intravaginal 400 μg misoprostol is significantly more effective for termination of blighted ovum than placebo, but lower abdominal pain and fever are signifcantly higher in the misoprostol group.
The absence of factor V Leiden mutation in Malays with recurrent spontaneous abortions
Authors: Yusoff Narazah Mohd , Abdullah Wan Zaidah , Ghazali Selamah , Othman Mohd Shukri , Baba Abdul Aziz , Abdullah Norazmi , Isa Mohd Nizam , Chong Chan Li
Published: October 2004

Objectives

The objectives of this study were to investigate the prevalence of factor V Leiden mutation in Malay women with recurrent spontaneous abortion and to clarify the contribution of the factor V Leiden mutation to recurrent miscarriages in these women.

Design

A prospective case control study between June 1999 and April 2000.

Setting

Hospital University Science of Malaysia, Kubang Kerian, Kelantan, and Maternal and Child Health Clinic, Pasir Mas, Kelantan, Malaysia.

Samples

A total of 46 Malay women with a history of three or more first or second trimester miscarriages were studied. The control group consisted of 46 parous women without obstetric complications.

Methods

Diagnosis of factor V Leiden mutation was made by examination of factor V Leiden allele product following Mnl I digestion of factor V Leiden alleles amplified by polymerase chain reaction.

Results

None of the 46 women with recurrent spontaneous abortion carried the mutation. Also, we found no subject carrying the factor V Leiden alleles in the control group.

Conclusion

These results suggest that that there is no association between the factor V Leiden mutation and recurrent spontaneous abortion in the Malay population.
The anatomy of the perineal membrane: its relationship to injury in childbirth and episiotomy
Authors: Hudson Christopher N , Sohaib Syed A , Shulver Helen M , Reznek Rodney H
Published: October 2004

Background

Episiotomy during childbirth, intended to protect the anal sphincter, may fail to do so. Furthermore damage to the anal sphincter complex may occur without complete perineal tear.We hypothesise that these particular injuries may occur due to posterior displacement of the anus leading to distraction of the anal sphincter complex from an anterior attachment to the perineal membrane. However, the anatomical basis for this has not been well defined.

Objective

To investigate the relationship between the anal sphincter and the perineal membrane. Materials and methods High‐resolution MRI scans of a female cadaver perineum were performed. The imaging findings were correlated with the anatomical structure identified on dissection and histological examination.

Results

The perineal membrane was easily identified on MR imaging. Fibres from the perineal membrane could be seen to attach to the anal sphincter complex at the apex of the perineal body. This was confirmed on histological examination and was a deeper layer than that of the decussation of the superficial transverse perineal muscle with the superficial part of the external anal sphincter.

Conclusion

The upper ano‐rectal canal and apex of the perineal body have demonstrable attachment to the free margin of the perineal membrane postero‐lateral to the lower vagina. This attachment would resist posterior displacement of the anal canal.
A retrospective cohort study comparing microwave endometrial ablation with levonorgestrel‐releasing intrauterine device in the management of heavy menstrual bleeding
Authors: Henshaw Richard , Coyle Christy , Low Stephanie , Barry Christopher
Published: October 2004

Objective

To compare microwave endometrial ablation (MEATM) with a levonorgestrel‐releasing intrauterine device (Mirena®) in the management of heavy menstrual bleeding.

Design

A retrospective cohort study.

Sample

Thirty‐nine women were treated with MEATM and 23 women with Mirena®, in the South East Regional Health Service of South Australia during 1998 to 2001; the mean duration of follow‐up was 14.6 months.

Main outcome measures

Primary measures include acceptability of the treatment process, effectiveness of the treatment, and satisfaction with outcomes. Secondary measures included side effects, complications and quality of life (using the SF‐36).

Results

Acceptability of the treatment process and satisfaction with outcomes was very high for both procedures. Each treatment led to a statistically significant reduction in menstrual bleeding (p < 0.0001) and dysmenorrhoea scores (p < 0.002).

Conclusions

There were no statistical differences between the two treatments for any of the primary or secondary outcome measures assessed. The treatments seem equally effective in the management of heavy menstrual loss.
Laparoscopic diagnosis of endometriosis
Authors: Wood Carl , Kuhn Raphael , Tsaltas Jim
Published: October 2004

Objective

To consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy.

Design

Retrospective patient record review.

Setting

The Endometriosis Care Centre of Australia and the private practices of authors.

Sample

Two hundred and fifteen patients with clinical evidence of endometriosis examined laparoscopically between March 1999 and May 2001.

Main outcome measures

Confirmation of endometriosis by histological biopsy.

Results

Endometriosis was confirmed in 168 of the 215 women. Of these women 38 had a previous negative laparoscopy within 12 months of the current laparoscopy.

Conclusions

It is possible that in some of the patients, who previously had a negative laparoscopy, endometriosis was not recognised. Possible reasons for difficulty in diagnosis have been identified and techniques to improve diagnosis suggested.

This retrospective study was performed to consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy.
Total laparoscopic hysterectomy: a new option for removal of the large myomatous uterus
Authors: O'Shea Robert T , Cook Jennifer R , Seman Elvis I
Published: October 2004

This is the first report of a series of women who underwent total laparoscopic hysterectomy (TLH) to remove a large myomatous uterus weighing more than 390 g. The case history notes of 21 women undergoing TLH in both the private and public sectors of Flinders Endogynaecology were studied.

The mean uterine weight was 534.7 g (390‐1022 g). The mean operating time was 155.0 ± 56.1 minutes and mean blood loss was 297.6 mL (50‐1000 mL). The mean hospital stay was 3.2 ± 1.0 days. The two complications were a post‐operative deep venous thrombosis (DVT) and an estimated blood loss of 1000 mL in separate cases.

Total laparoscopic hysterectomy is a low morbidity procedure offering a new option for the removal of the large myomatous uterus and avoidance of abdominal hysterectomy.
A simple trainer for the loop electrosurgical excision procedure
Authors: Vella Paul V
Published: October 2004

This article describes the construction and use of a simple trainer for the loop electrosurgical excision procedure (LEEP), also known as large loop excision of the cervical transformation zone (LLETZ).
Human parvovirus B19 infection in pregnancy: should screening be offered to the low‐risk population?
Authors: Fean Wong Shell , Yee Chan Fung , Cincotta Robert B , Tilse Martin
Published: October 2004

Human parvovirus B19 infection during pregnancy can result in fetal hydrops and death. Intra‐uterine transfusion in hydropic fetuses affected by the virus can reduce perinatal deaths. Up to 33% of women with this infection are asymptomatic. In view of the significant adverse outcomes, the role of routine screening among low‐risk pregnant women is discussed.
Hypertension in pregnancy: do consensus statements make a difference?
Authors: Davis Gregory K , Homer Caroline SE , Brown Mark A
Published: October 2004

Objectives

(i) To document variation in management of hypertension in pregnancy; (ii) to determine whether this variation falls within current management guidelines; and (iii) to make recommendations for developing future guidelines.

Design

Questionnaire‐based survey.

Setting

Australia and New Zealand.

Population

All specialist obstetricians.

Methods

Questionnaires were sent to 1198 obstetricians in Australia and New Zealand. Those returned by respondents currently in obstetric practice were analysed. Information was obtained on their current clinical practices relating to the diagnosis and management of hypertension in pregnancy.

Results

Of 1198 obstetricians surveyed, 973 (81%) replied. Of these, 686 (71%) were responsible for obstetric care. Considerable variation in practice was found, particularly in relation to the measurement of blood pressure, the determination of hypertension and significant proteinuria, and the decision to institute antihypertensive drug treatment. The recommendations of the Australasian 1993 Consensus Statement appeared to have had little influence. There has been a striking increase in the use of magnesium sulphate for the prevention of convulsions in preeclampsia.

Conclusions

There is significant variation in management of hypertensive pregnancies that differs from current guidelines although it is not known whether this diversity adversely affects clinical outcomes. Until further outcome evidence is available, consensus statements may be better confined to basic aspects of management for which there is high level evidence.
Evaluation of restaging in clinical stage 1A low malignant potential ovarian tumours
Authors: Land Russell , Perrin Lew , Nicklin James
Published: October 2004

Objective

This study was undertaken to evaluate whether restaging clinical stage 1A low malignant potential (LMP) tumours previously incompletely staged in a non‐gynaecology oncology centre yields useful information for management and prognosis.

Methods

A retrospective chart review was undertaken of all patients with LMP tumours treated at the Queensland Centre for Gynaecological Cancer (QCGC) from 1982–2000.

Results

Fifty‐six (69%) of the 81 patients referred with a provisional stage 1A diagnosis underwent a second operation for staging purposes. Four (7%) out of the 56 patients who underwent restaging had their tumours upstaged. A single patient out of the 25 patients who did not undergo restaging had disease recurrence and died as a result. The mean follow‐up for all patients in the study was 60 months.

Conclusion

It is hard to justify routine surgical restaging for patients with a LMP ovarian tumour apparently confined to a single ovary. At the very least, hundreds of patients with clinical stage 1A tumours will need to be restaged before a single patient will have data that will change management. Consequently the morbidity of routine restaging is difficult to justify for such a small clinical gain.
The effect of hospitalisation on ambulatory blood pressure in pregnancy
Authors: Walker Susan , Permezel Michael , Brennecke Shaun , Tuttle Lynette , Ugoni Antony , Higgins John
Published: October 2004

Methods

Twenty‐four‐hour ambulatory blood pressure monitoring was performed on 40 women (20 hypertensive, 20 normotensive) on a hospitalised and nonhospitalised day. Mean blood pressure differences were calculated for the awake, sleeping and 24‐hour periods on both days.

Results

Mean heart rate was higher at home (1.79, p = 0.04) than in hospital, but there were no significant differences in mean systolic (1.30 mmHg, p = 0.06), diastolic (0.78 mmHg, p = 0.21) or mean arterial blood pressure (0.81 mmHg, p = 0.19) between the hospitalised and non hospitalised day for the group overall. Nevertheless, the range of individual responses was wide (‐8.5 mmHg to 15.4 mmHg mean arterial blood pressure). Hypertensive women receiving antihypertensive therapy had significantly greater differences in mean arterial blood pressure between the hospital and non‐hospital day when compared to the rest of the group (5.8 mmHg, compared to 3.3 mm Hg, p = 0.02).

Conclusions

Although hospitalisation does not significantly lower blood pressure in pregnant women as a group, women receiving antihypertensive therapy demonstrate significant differences in blood pressure between hospital and home. Based on conventional blood pressure measurements alone, these women may be at risk of either under treatment, or over treatment, of blood pressure.
Ten‐year results of Marshall Marchetti Krantz and anterior colporraphy procedures
Authors: Demirci Fuat , Yildirim Uzay , Demirci Elif , Ayas Selcuk , Arioglu Petek , Kuyumcuoglu Umur
Published: October 2004

Objective

To evaluate subjective results of Marshall Marchetti Krantz (MMK) and anterior colporraphy (AC) procedures.

Study design

Patients who had operations for genuine stress incontinence 10 years ago were surveyed regarding their current incontinence status. Results of both procedures were evaluated and compared.

Results

Fourteen of 28 patients in the MMK group and 21 of 67 patients in the AC group were evaluated at 10 years, the cure rates were found to be 64% and 38%, respectively.

Conclusion

We conclude that the success rate of both procedures declines over time. The anterior colporraphy procedure appears to have a lower success rate than MMK, although this was not found to be statistically significant.
Analgesic efficacy of continuous delivery of bupivacaine by an elastomeric balloon infusor after abdominal hysterectomy: a prospective randomised controlled trial
Authors: Leong WM , Lo WK , Chiu JW
Published: October 2004

Objective

To investigate the analgesic efficacy and morphinesparing effect of continuous bupivacaine wound infiltration after abdominal hysterectomy.

Design

Prospective, randomised controlled trial.

Sample

Fifty‐two female ASA I or II patients were enrolled with 26 patients in each of the study and control groups.

Methods

The study group received 0.5% bupivacaine infusion into the incisional (Pfannenstiel) wound via an elastomeric infusor at 2 mL/hr for 48 hours postoperatively plus morphine via a patient controlled analgesia (PCA) pump. The control group had only PCA morphine.

Results

There were no significant differences in the visual analogue scores (VAS) for pain nor PCA morphine usage for 48 hours postoperatively.

Conclusion

That continuous infusion of the incisional wound with 0.5% bupivacaine did not confer additional analgesia over PCA morphine after abdominal hysterectomy.
Transvaginal sonography and saline infusion sonohysterography in the evaluation of abnormal uterine bleeding
Authors: Nanda Smiti , Chadha Nivedita , Sen Jyotsna , Sangwan Krishna
Published: October 2004

Objective

To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) in diagnosing submucous fibroids and endometrial polyps in the patients of abnormal uterine bleeding (AUB).

Design

Prospective, comparative study.

Setting

Postgraduate Institute of Medical Sciences, Rohtak

Population

Fifty patients with AUB underwent TVS and SIS prior to hysterectomy.

Main outcome measures

Comparison of diagnosis of submucous fibroids and endometrial polyps at TVS and SIS with the final diagnosis at hysterectomy ie ‘gold standard’.

Results

Both procedures were helpful in detecting submucous fibroids and endometrial polyps. However, SIS was found to be more useful (sensitivity 89.5%, specificity 100%, likelihood ratios of the presence and absence of submucous fibroids of infinity and 0.1 respectively) than TVS (sensitivity 70% and specificity 96.6% and likelihood ratios of 21.2 and 0.3 respectively) for submucous polyps. Saline infusion sonohysterography was also more accurate for endometrial polyps (sensitivity 100%, specificity 97.8%) than TVS (sensitivity 66.6%, specificity 100%). With SIS and TVS, the post‐test probability with negative test was 0% and 4%, respectively, thus suggesting that no endometrial polyp would be missed on SIS.

Conclusion

Saline infusion sonohysterography is more accurate in diagnosing submucous fibroids and endometrial polyps in the patients of abnormal uterine bleeding than is TVS. TVS should be included in the standard protocol for the management of AUB. Saline infusion sonohysterography should be reserved for those patients who have centrally located fibroids as they may be submucous.
The place of bowel resection in initial debulking surgery for advanced ovarian cancer
Authors: Miller John , Proietto Anthony
Published: October 2004

Objective

To evaluate the efficacy and morbidity associated with bowel resection at the initial debulking procedure for patients with advanced ovarian cancer.

Design

Retrospective medical record and computerised database review.

Setting

John Hunter Hospital, Newcastle, New South Wales.

Sample

All women with FIGO stage III or IV epithelial ovarian cancer and with adequate case note documentation who underwent bowel resection as part of their primary debulking surgery at the John Hunter Hospital from 1991 to July 2000.

Main outcome measures

Cumulative overall and disease free survival, optimal (residual disease < 1 cm) versus suboptimal cytoreduction and short (< 6 weeks) and long‐term postoperative morbidity.

Results

For the optimally debulked patients the two and five‐year overall and disease free survival rates were 49%, 30%, 19% and 8.9% respectively. The two‐year overall survival rate for the suboptimally debulked patients was 20%. The major short‐term morbidity rate was 17.6%. Long‐term morbidity occurred in 10 of 51 patients; however, not all morbidity was surgery related.

Conclusions

Cytoreductive surgery, including bowel resection, appears indicated in the treatment of patients with advanced ovarian cancer. The surgical morbidity rate from these procedures appears acceptable.
Respiratory symptoms as an indicator of undiagnosed bowel perforation following laparoscopic surgery – an observation
Authors: Cooper MJ , Reid GD , Kaloo P
Published: October 2004

Undiagnosed bowel perforation following diagnostic or operative laparoscopies is associated with significant morbidity and is indeed the primary cause of laparoscopy related mortality. The diagnosis of bowel perforation remains difficult, predominantly because of the highly varied clinical presentation.

Respiratory symptoms have rarely been reported. We outline eight cases of undiagnosed bowel perforation in which the respiratory symptoms of dyspnoea and tachypnoea manifested themselves as an integral part of the clinical presentation. We believe these ‘atypical’ symptoms potentially further delayed the diagnosis and instigation of definitive management.

Dyspnoea and other respiratory symptoms should be considered as additional warning signs of possible undiagnosed bowel perforation following laparoscopic surgery.
Imaging cells on polymer spherulites
Authors: SIMON C. G.
Published: October 2004

Polymers are commonly used to construct tissue‐engineered medical products and the conditions used to process these polymeric materials can affect their biological performance. For semi‐crystalline polymers, thermal processing conditions can induce crystallization of the polymer chains into spherulites, which cause the polymer surface to become roughened. This change in surface topology can influence cell behaviours such as adhesion, morphology and proliferation. Herein, a simple microscope technique is presented, which combines fluorescence microscopy with transmitted white light microscopy using crossed polarizers. This technique allows simultaneous imaging of cells and polymer spherulites, which enables the biomaterials researcher to observe the effects of spherulites on cell alignment and morphology.
Automatic real‐time three‐dimensional cell tracking by fluorescence microscopy
Authors: RABUT G. , ELLENBERG J.
Published: October 2004

Live cell imaging has become an indispensable technique for cell biologists. However, when grown on coverslip glass used for live cell imaging many cultured cells move even during relatively short observation times and focus can drift as a result of mechanical instabilities and/or temperature fluctuations. Time‐lapse imaging therefore requires constant adjustment of the imaging field and focus position to keep the cell of interest centred in the imaged volume. We show here that this limitation can be overcome by tracking cells in a fully automated way using the mass centre of cellular fluorescence. Combined with automated multiple location revisiting, this method dramatically increases the throughput of high‐resolution live cell imaging experiments.
Maximum pixel spectrum: a new tool for detecting and recovering rare, unanticipated features from spectrum image data cubes
Authors: BRIGHT D. S. , NEWBURY D. E.
Published: October 2004

A new software tool, the maximum pixel spectrum, detects rare events within a spectrum image data cube, such as that generated with electron‐excited energy‐dispersive X‐ray spectrometry in a scanning electron microscope. The maximum pixel spectrum is a member of a class of ‘derived spectra’ that are constructed from the spectrum image data cube. Similar to a conventional spectrum, a derived spectrum is a linear array of intensity vs. channel index that corresponds to photon energy. A derived spectrum has the principal characteristics of a real spectrum so that X‐ray peaks can be recognized. A common example of a derived spectrum is the summation spectrum, which is a linear array in which the summation of all pixels within each energy plane gives the intensity value for that channel. The summation spectrum is sensitive to the dominant features of the data cube. The maximum pixel spectrum is constructed by selecting the maximum pixel value within each X‐ray energy plane, ignoring the remaining pixels. Peaks corresponding to highly localized trace constituents or foreign contaminants, even those that are confined to one pixel of the image, can be seen at a glance when the maximum pixel spectrum is compared with the summation spectrum.
THE EFFECT OF IRON NUTRITION ON PHOTOSYNTHESIS AND NITROGEN FIXATION IN CULTURES OF TRICHODESMIUM (CYANOPHYCEAE)1
Authors: Rueter John G. , Ohki Kaori , Fujita Yoshihiko
Published: October 2004

Cultures of Trichodesmium NIBB 1067 were grown in the synthetic medium AQUIL with a range of iron added from none to 5 × 10−7 M Fe for 15 days. Chlorophyll‐a, cell counts, and total cell volume were two or three times higher in medium with 10−7 M Fe than with no added Fe. Oxygen production rate per chlorophyll‐a was over 60% higher with higher iron. Increased iron stimulated photosynthesis at all irradiances from about 12–250 μE · m−2· s−1. Nitrogen fixation rate, estimated from acetylene reduction, for 10−7 and 10−8 M Fe cultures was approximately twice that of the cultures with no added Fe. The range of rates of O2 production and N2 fixation in cultures at the iron concentrations we used were similar to the rates from natural samples of Trichodesmium from both the Atlantic, and the Pacific oceans. This similarity may allow this clone to be used, with some caution, for future physiological ecology studies. This study demonstrates the importance of iron to photosynthesis and nitrogen fixation and suggests that Trichodesmium plays a central role in the biogeochemical cycles of iron, carbon and nitrogen.
PHOTOSYNTHESIS/PHOTON FLUX DENSITY RELATIONSHIPS AMONG COMPONENTS OF CORAL REEF ALGAL TURFS1
Authors: Williams Susan L. , Carpenter Robert C.
Published: October 2004

Photosynthesis/photon flux density (PFD) relationships were compared among some of the major components of sparse algal turfs (green endoliths, red crusts, red filaments, Crouania, Sphacelaria)/ from Tague Bay forereef St. Croix, U.S. Virgin Islands. Algal turfs grazed by the sea urchin Diadema antillarum were 2–10 times more productive per unit chl a than when not grazed by sea urchins. The maximum rate of net photosynthesis (Pnetmax) and saturation PFDs, but not the slope of the light‐limited portion of the curve (α), differed significantly among the algal turf components examined. The hypothesis that increased biomass‐specific primary productivity results from shifts in algal community structure was not supported because the maximum difference in photosynthesis between algal components was only a factor of two, and the less productive components were relatively more abundant under grazing. In the understory, green endoliths exhibited higher α and lower Pnetmax, suggesting shade adaptation. Photon flux density measurements taken with a fiber optic microprobe within the algal turfs indicated that photosynthesis of basal portions of algal filaments and red crusts are light‐limited in ungrazed algal turfs. As self‐shading changes with grazer‐mediated canopy removal, algal sublayers will contribute differentially to whole turf primary productivity.
DEVELOPMENT OF PHOTOSYNTHETIC ACTIVITY IN PORPHYRIDIUM PURPUREUM (RHODOPHYTA) FOLLOWING NITROGEN STARVATION1,2
Authors: Levy Israel , Gantt Elisabeth
Published: October 2004

The effects of nitrogen limitation on laboratory cultures of Porphyridium purpureum Bory, Drew and Ross were studied under continuous white light illumination (35 μE · m−2· s−1). Growth ceased, respiration exceeded photosynthesis, chlorophyll content was reduced by 80%, and phycoerythrin content was reduced by 99% over a period of 14 days under nitrogen limitation. Recovery upon addition of nitrogen resulted in increased phycobiliprotein content, appearance of phycobilisomes attached to the thylakoids, increased oxygen evolution, and increased fluorescence emission from photosystem 1 (720 nm) and photosystem 2 (685 nm) upon excitation by green light. Growth resumed after 72 h and was concomitant with an increase of chlorophyll, phycoerythrin and phycobilisomes per thylakoid area. The results suggest that photosystem 1 was less affected by nitrogen starvation than photosystem 2 and that the recovery was largely dependent on the restoration of phycobilisomes and other photosystem components.
SECRETION AND DEPLOYMENT OF BRISTLES IN MALLOMONAS SPLENDENS (SYNUROPHYCEAE)1
Authors: Beech Peter L. , Wetherbee Richard , Pickett‐Heaps Jeremy D.
Published: October 2004

Mallomonas splendens (G. S. West) Playfair has a cell covering of siliceous scales and bristles. Interphase cells bear four anterior and four posterior bristles that each articulate, at their flexed basal ends via a complex of labile fibers (the fibrillar complex), on a specialized body scale (a base‐plate scale). Body scales, base‐plate scales and bristles are formed independently of each other and at different times in silica deposition vesicles (SDVs) that are associated with one of the two chloroplasts. The fine structure of scale and bristle morphogenesis in M. splendens agrees with that previously described for Synura and Mallomonas.

Four new posterior bristles are formed at late interphase with their basal ends towards the cell posterior. The fibrillar complex is formed in situ on the bristle in the SDV. Mature bristles are secreted one by one onto the surface of the protoplast, beneath the layer of body scales, where the basal ends of the bristles adhere to the plasma membrane via the fibrillar complex. The extrusion of posterior bristles and their deployment onto the cell surface was monitored with video. A fine cellular protuberance accompanies the bristles as they are extruded from beneath the scale layer with their basal ends leading. When distant from the cell, the basal ends of the bristles appear attached to the protuberance, possibly by way of their fibrillar complexes. Once bristles are fully extruded, and their tips free in the surrounding environment, the bristle bases are drawn back to the posterior apex of the cell, apparently by the now shortening protuberance. Thus a 180° reorientation of the posterior bristles has been effected outside the cell. Thin‐sections of cells that are extruding bristles show a threadlike, cytoplasmic extension of the cell posterior which may be analogous to the protuberance seen in live cells. Four new posterior base‐plate scales are secreted after the bristles have reoriented. Scanning electron microscopy indicates that the fibrillar complex is involved in positioning the bristles onto their respective base‐plate scales. Anterior bristles are formed in new daughter cells in the same orientation as the posterior bristles; thus they are extruded tip first and no reorientation is required.
ROLE OF ALUMINUM AND GROWTH RATE ON CHANGES IN CELL SIZE AND SILICA CONTENT OF SILICA‐LIMITED POPULATIONS OF ASTERIONELLA RALFSII VAR. AMERICANA(BACILLARIOPHYCEAE)1
Authors: Gensemer Robert W.
Published: October 2004

Changes in cell size and silica content were examined in response to aluminum additions in cultures of the acidophilic diatom Asterionella ralfsii var. americana Körn at pH 6.0. The effects of Al were examined over a range of steady‐state growth rates using silica‐limited semicontinuous cultures (Si:P = 8.0). Additions of ≥ 2.8 μmol · L−1 total Al decreased mean cell length, total surface area, and biovolume up to 40–50%. The effects of Al were dependent on growth rate with the magnitude of size reduction increasing at higher growth rates. The proportion of small (approximately 15–20 μm) cell length classes increased relative to large (approximately 50 μm length) cell length classes when total Al exceeded 2.8 μmol · L−1, particularly at higher growth rates. The relationship between cell quota and steady‐state growth rate fit a Droop relationship at 0 and 2.8 μmol·L−1 total Al, but this fit was highly variable in the presence of Al. Cell quotas in the 6.22 μmol·L−1 total Al treatment were highest at low growth rates; therefore, a Droop relationship was an inappropriate descriptor of growth rate. Cells also became 30–40% more heavily silicified per unit surface area in the presence of Al and at growth rates ≥0.22 day−1. Although the mechanisms responsible for size reductions in response to Al additions are unclear, the relationship between metal concentration and frustule morphology may be useful as an indicator of Al loading to acidified lakes.
VISCOUS POLYSACCHARIDE AND STARCH SYNTHESIS IN RHODELLA RETICULATA (PORPHYRIDIALES, RHODOPHYTA)1
Authors: Kroen William K. , Ramus J.
Published: October 2004

Rhodella reticulata Deason, Butler and Rhyne produces copious amounts of a viscous polysaccharide (VP) during growth in batch cultures. The VPs accumulated on the cell surface and in the culture medium once cells ceased growth; starch concurrently accumulated within the cells. Light‐saturated 14C‐uptake declined steadily as the cells aged. Net synthesis rates for starch and mucilage were two‐ and four‐fold lower, respectively, in non‐growing cells than in growing cells, while the relative partitioning of newly‐fixed carbon into these materials was not different. These data suggest that total photosynthetic loading, rather than partitioning into one specific pool, controls cellular synthesis rates. No preferential synthesis of VPs occurred during the stationary phase. The findings have important implications for the commercial production of VPs.
INFLUENCE OF IRRADIANCE ON THE FATTY ACID COMPOSITION OF PHYTOPLANKTON1
Authors: Thompson Peter A. , Harrison Paul J. , Whyte John N. C.
Published: October 2004

Eight species of marine phytoplankton commonly used in aquaculture were grown under a range of photon flux densities (PEDs) and analyzed for their fatty acid (FA) composition. Fatty and composition changed considerably at different PFDs although no consistent correlation between the relative proportion of a single FA and μ or chl a · cell−1 was apparent. Within an individual species the percentage of certain fatty acids covaried with PFDs, growth rate and/or chl a · cell−1. The light conditions which produced the greatest proportion of the essential fatty acids was species specific. Eicosapentaenoic acid. 20:5ω3 increased from 6.1% to 15.5% of the total fatty acids of Chaetoceros simplex Ostenfield grown at PFDs which decreased from 225 μE · m−2· s−1 to 6 μE · m−2· s−1, respectively. Most species had their greatest proportion of 20: 5ω3 at low levels of irradiance. Conversely, docosahexaenoic acid, 22:6ω3, decreased from 9.7% to 3.6% of the total fatty acids in Pavlova lutheri Droop as PFD decreased. The percentage of 22:6ω3 generally decreased with decreasing irradiances. In all diatoms the percentage of 16:0 was significantly correlated with PFD, and in three of five diatoms, with growth rate (μ). Results suggest that fatty acid composition is a highly dynamic component of cellular physiology, which responds significantly to variation in PFD.
DNA‐DNA REASSOCIATION STUDIES WITH DNA FROM PROCHLORON (PROCHLOROPHYTA) SAMPLES OF INDO‐WEST PACIFIC ORIGIN1
Authors: Halton Raymond W. , Stam Wytze T. , Boele‐Bos Stella A.
Published: October 2004

Seven Indo‐West Pacific Prochloron Lewin samples and one Caribbean cyanobacterial sample were compared by DNA‐DNA reassociation experiments. The quality and quantity of extracted DNA were affected by several cell preservation methods and DNA extraction and purification procedures. We conclude that Prochloron samples from six different hosts and three different geographical locations spanning ca. 9000 km belong to a single species but are not closely related to the strain of cyanohacteria used. The intraspecific genotypic variation within Prochloron is discussed with respect to host specificity and geographical distribution.
LOSS OF HYBRID LETHALITY DURING BACKCROSS PROGRAMS INVOLVING CHLAMYDOMONAS EUGAMETOS AND CHLAMYDOMONAS MOEWUSII (CHLOROPHYCEAE)1
Authors: Lee Robert W. , Lemieux Claude
Published: October 2004

Wild‐type strains of the interfertile species Chlamydomonas eugametos (UTEX 9 and 10) and Chlamydomonas moewusii (UTEX 96 and 97) male readily and reciprocally; however, considerable lethality occurs among F1 hybrid meiotic products. We prepared two hybrid backcross lineages using C. eugametos and C. moewusii. One lineage began with the cross C. eugametos mating‐type‐plus (mt+) × C. moewusii mating‐type‐minus (mt−). An F1 mt+ hybrid from this cross was back‐crossed to C. moewusii mt−, and a B1 mt+ hybrid was recovered. The B1 hybrid was again backcrossed to C. moewusii mt−, and this process was repeated through the fifth backcross. The other backcross lineage began with the reciprocal cross C. moewusii mt+× C. eugametos mt− and employed C. eugametos as the recurring mt− parent. This lineage also was continued through the fifth backcross. Meiotic product survival in the reciprocal interspecific crosses was less than 10%. In successive back‐cross generations associated with both lineages, this value increased progressively to a maximum of 85–90%, the level observed for the intraspecific crosses. These results are consistent with the hypothesis that multiple genetic differences exist between C. eugametos and C. moewusii and that these are the major source of meiotic product lethality associated with the interspecific crosses. The inheritance of chloroplast genetic markers for resistance to streptomycin (sr‐2) and for resistance to erythromycin (er‐nM1) was also scored w the interspecific crosses and in the backcrosses. Most hybrid zygospores transmitted the resistance markers of the mt+ parent only, or of both parents, with the former zygospore type being more common. Although the intraspecific C. eugametos and C. moewusii crosses differ conspicuously with respect to the fraction of zygospores which transmit chloroplast genetic markers of both parents, the inheritance of chloroplast genetic markers in the interspecific crosses and backcrosses at' scribed here failed to clarify the genetic basis for this difference.