bluuebunny/crossref_metadata_2025_split huggingface dataset:
Registrar Experience in Vaginal Breech Delivery. How Much is Occurring?
Authors: Robson Stephen , Ramsay Bruce , Chandler Karen 
Published: March 2008

SummaryThe debate surrounding the safety of vaginal breech delivery compared to Caesarean delivery may be close to resolution, with a large randomized trial underway. However, trends in the management of vaginal breech delivery over recent years have led to suggestions that training in the technique of such deliveries may be inadequate. We have attempted to quantify the level of training in vaginal breech delivery available to registrars. This was accomplished by surveying obstetric training schemes in comparable regions of England and South Australia. Our findings suggest that registrar exposure to this important obstetric skill may be insufficient to guarantee expertise.
Home Within 24 Hours of Laparoscopic Hysterectomy
Authors: Chou Danny C.Y. , Rosen David M.B. , Cario Gregory M. , Carlton Mark A. , Lam Alan M. , Chapman Michael , Johns Chris 
Published: March 2008

SummaryWe assessed the feasibility of safe discharge home within 24 hours following laparoscopic hysterectomy in 30 patients who met the inclusion criteria and consented to be enrolled in the study group. Patients were admitted on the day of their surgery with the expectation of discharge within 24 hours. Appropriate home nursing follow‐up and phone contact by the surgical team were organized preoperatively. Inclusion criteria were: age 30–65 years, absence of any major medical history that would require prolonged hospitalization, availability of home support for the first 48 hours after discharge and presence of a working telephone line and an address within the area of the Community Home Nursing service. All 30 operative procedures were completed without incident. Six patients underwent total laparoscopic hysterectomy (TLH) (all the procedures of hysterectomy being performed laparoscopically including the suturing of uterine arteries, colpotomy and closure of the vaginal vault. The uterus was removed vaginally) and 24 patients underwent laparoscopic hysterectomy (LH) (this techniques differs from TLH in that the colpotomy was performed laparoscopically but the uterosacral ligaments were divided vaginally and the vault also was closed vaginally after the uterus was removed vaginally). The average operating time was 115 minutes (range 85–150 minutes) and the average blood loss was 97 mL (20–250 mL). There were no intraoperative complications, no requirement for transfusion and no readmission to hospital for any of the patients in the study. Postoperative complications were minor (umbilical cellulitis (1), intestinal colic (1)) and both were treated with resolution of the symptoms. Ninety per cent of patients in the study were discharged within 24 hours of their surgery, the average duration of stay being 22.9 hours (20–24 hours). Three patients were not fit for discharge at 24 hours postoperatively due to general lethargy, migraine and nausea; their average discharge time was 53.5 hours. The study showed that laparoscopic hysterectomy can be associated with a reduction in length of in‐patient stay compared to traditional laparotomy. Furthermore this reduction could be safely reduced to 24 hours following laparoscopic hysterectomy. There was also an associated cost saving in terms of inpatient bed days. Patient satisfaction with this protocol was high in this selected and motivated group.
Splenic Infarction in Pregnancy
Authors: Siva Sashi , Smoleniec John 
Published: March 2008

SummaryWe present a case of splenic infarction in pregnancy, secondary to acute bacterial endocarditis. Left upper quadrant pain in pregnancy can be due to a variety of causes and in the septic or unwell patient, splenic infarct should be considered in the differential diagnosis. The diagnosis of splenic infarct should be considered especially in those at increased risk of bacterial endocarditis. Acute bacterial endocarditis can occur even in patients without any risk factors. Bacterial endocarditis is rare in pregnancy and splenic infarction is even rarer. However when it occurs, rapid diagnosis and management are necessary to minimize embolic phenomena. With the increasing use of intravenous drugs and with increasing numbers of Pacific Islanders in our pregnant population, it is important to be alert to the risk of bacterial endocarditis and to avoid serious sequelae. Patient education to the importance of medical follow‐up in order to prevent such a life‐threatening condition, and to avoid more complicated acute treatment, is imperative.
Anterior Sacral Meningocele as a Pelvic Complication of Marfan Syndrome
Authors: Voyvodic Frank , Scroop Rebecca , Sanders Robin R. 
Published: March 2008

SummaryAnterior sacral meningocele (ASM) is well recognized in Marfan syndrome as a consequence of dural ectasia. Two cases presenting as non‐gynaecological pelvic masses are described highlighting the clinical difficulty in diagnosis and the classical radiological findings. The classification of ASM and associated anomalies of the sacrum are reviewed.
Prenatal Diagnosis and Management of Nonimmune Hydrops Fetalis
Authors: Swain S. , Cameron A.D. , McNay M.B. , Howatson A.G. 
Published: March 2008

Summary:We examined the incidence, aetiological factors and outcome in 40 cases of nonimmune hydrops fetalis (NIH) and suggest a rational approach to management. The incidence of NIH was 1 in 830 deliveries during the last 10‐year period. In spite of extensive antenatal and postnatal investigation no cause could be established in 14 (35%) cases. A probable aetiological factor was found in 65% of cases. These included viral infection (7), cardiovascular (6), twin‐to‐twin transfusion (3), chromosomal abnormality (3), other malformation syndromes (4), renal dysplasia (1), laryngeal atresia (1) and severe fetomaternal haemorrhage (1). Five of the 40 fetuses survived, 2 treated antenatally for tachyarrhythmia, 2 had spontaneous resolution and the fifth fetus had repeated intrauterine transfusions because of human parvovirus B19‐induced anaemia. After diagnosis of nonimmune hydrops fetalis, early referral to a tertiary centre is to be encouraged for investigation and provision of intensive perinatal care. Investigation allows parents to be counselled appropriately that the mortality is no longer 100% and a steadily growing number may be amenable to some form of fetal therapy.
Is the Vacuum Extractor Really the Instrument of First Choice?
Authors: Chan C.C.T. , Malath I. , Yeo G.S.H. 
Published: March 2008

Summary:This study was a retrospective analysis of the pattern of usage of both the forceps and vacuum extractor as well as the neonatal outcome on all the instrumental deliveries conducted in 1995 at the Kandang Kerbau Hospital, Singapore. There were a total of 927 forceps deliveries and 495 vacuum extractions but neonatal data was available for only 481 forceps and 255 vacuum extractor babies. (There were 2 neonatal units which accepted admissions on alternate days; all of the data were collected from 1 of the units only). Demographic data were comparable in most aspects except that vacuum deliveries were significantly associated with higher parity and shorter labours. There was a trend towards using the vacuum extractor in less difficult cases. Almost all the instrumental deliveries were conducted by specialists. Birth trauma was significantly more likely to occur with the vacuum extractor. Almost all the deliveries were conducted with similar expertise in both groups, yet the use of the vacuum extractor resulted in more birth trauma even in the presence of ‘easier’ cases. This may suggest an inherent risk in using the vacuum extractor.
Back to Basics Midwifery in Arawa, Bougainville, During 1998
Authors: Jones I.S.C. 
Published: March 2008

Summary:Working in a country, which is suffering the aftermath of war, is a very professionally rewarding and at the same time, humbling experience. It highlights so many things that we in Australia take for granted. The importance of a safe water supply and an efficient sewerage system is vital for the well‐being of a community. Illnesses that were important in Australia 30 or more years ago, were commonplace on Bougainville in 1998 and 1999. I was also reminded of how much reliance we place on modern technology as we practise obstetrics in Australia in 1999. In Bougainville clinical skills and common sense were all that the midwives had and they used them to great effect. Tribute should be paid to the men and women of the PMG (Peace Monitoring Group) for without their dedication and professionalism the improvement in the health of the people in Bougainville during the last 18 months would not have been possible.
Serum Insulin and Lipid Profile in Normal Pregnant and Pregnancy‐Induced Hypertensive Women from North India
Authors: Tripathy Chandana , Malik Sunita , Shah Pankaj , Lakshmy R. , Tripathy Devjit 
Published: March 2008

Summary:High serum insulin and lipoproteins have been reported in pregnancy‐induced hypertension. Little is known about the insulin and lipoprotein profile in Indian women. To address this question we compared serum insulin and lipoproteins of women with pregnancy induced hypertension (PIH) and normotensive pregnant women. The serum insulin, triglycerides, total cholesterol and HDL cholesterol of 104 women with PIH were compared with 99 control women. Hypertensive women had significantly higher insulin (53.94 ± 29.58 versus 37.69 ± 17.39 pmol/L, p=0.0004) and triglyceride (3.27 ± 1.2 versus 2.66 ± 0.6, p=0.0001). There was no significant difference in total cholesterol and HDL cholesterol levels. Insulin levels had a positive correlation with systolic blood pressure (r=0.64) and diastolic blood pressure (r=0.55) in women with PIH. These differences persisted even after adjusting for possible confounding variables such as age, body mass index and the period of gestation. We conclude that elevated serum insulin values or insulin resistance may contribute to the pathogenesis of PIH in Indian women.
The Comparison of Uterine Artery Doppler Velocimetry with the Histopathology of the Placental Bed
Authors: Sagol S. , Özkinay E. , Öztekin K. , Özdemir N. 
Published: March 2008

Summary:We determined the relationship between the histopathological findings of the placental bed and Doppler flow measurements of the uterine artery in women with preeclampsia and fetal growth retardation. Doppler velocimetry in the uterine artery was evaluated in 17 pregnant women with preeclampsia, 15 of whom had fetal growth retardation, and 20 normal pregnant women, within 14 days of Caesarean delivery and placental bed biopsy. The placental bed biopsies were evaluated in terms of trophoblast migration into the myometrium and physiological changes of the spiral arteries. The results were compared with Doppler velocimetry values. Trophoblast migration and physiological changes were not detected in 10 (59%) cases with preeclampsia and in 4 (20%) with normal pregnancies (p<0.05). In the preeclamptic group, 9 of 15 cases that were complicated with intrauterine growth retardation had no trophoblastic migration into the myometrium. The mean systolic/diastolic ratio, resistance index and pulsatility index of the uterine artery in women with preeclampsia and fetal growth retardation was significantly higher than women with normal pregnancies (p<0.01). The mean resistance index of the uterine artery in the impaired migration group was significantly higher than the migration group (p=0.02). The incidence of impaired trophoblast migration was significantly higher in the group with a high systolic/diastolic ratio (above 2.5) and resistance index (above 0.58) than cases with low systolic/diastolic ratio and resistance index (72%, 23% respectively, p<0.05). The incidence of early diastolic notch in the impaired trophoblast migration group was significantly higher than the migration group (57% versus 13%, p<0.01). Our study supports the hypothesis that high uterine artery flow resistance is related to the reduced trophoblast migration into the myometrium and inadequate physiological changes in the spiral arteries in women with intrauterine growth retardation and preeclampsia.
Medium‐term Follow‐up of the Intravaginal Slingplasty Operation Indicates Minimal Deterioration of Urinary Continence With Time
Authors: Petros Pe Papa 
Published: March 2008

Summary:An assessment of the medium term efficacy of stress incontinence cure in a group of patients who had undergone the intravaginal slingplasty (IVS) operation is presented. Eighty‐five unselected patients, aged 27 to 83 years at the time of surgery, 12 with pure stress symptoms, and 73 with mixed incontinence symptoms underwent the IVS procedure between 31 and 57 months previously (mean 3.9 years). The patients were assessed with the same self‐administered semiquantitative questionnaire used in the initial assessment. The results were compared with the original cure rate which was 88% at 1.75 years with another 2.5% more than 70% improved (total 90.5%). The cure rate in the 75 patients assessed at 3.9 years was 81%, with another 8% reporting more than 70% improvement (total 89%). Included in the latter were 2 patients who, though originally designated as failures, gradually achieved almost 100% continence within 2 years of surgery. Deterioration of continence following the IVS operation appears more like the Burch colposuspension than needle suspensions. It is possible to explain deterioration of continence with time in terms of age‐related connective tissue laxity of the vaginal hammock. Improvement in 2 women with time can be explained by tightening of the hammock via paraurethral scar contraction with time. Whether the IVS operation improves or deteriorates in the longer term may depend on which process predominates.
Evaluation of Serum Creatine Kinase as a Diagnostic Marker for Tubal Pregnancy
Authors: Saha P.K. , Gupta I. , Ganguly N.K. 
Published: March 2008

Summary:Forty women comprising of 20 each in study and control groups had their serum creatine kinase (CK) estimated. The study subjects were proven cases of ectopic pregnancy and the controls were either medical termination of pregnancy seekers or antenatal cases matched for gestational age and with a confirmed intrauterine pregnancy. Total serum creatine kinase levels were found to be significantly higher in the study group i.e. 34.15 ± 1.17 IU/L compared to the controls 18.72 ± 1.25 (p < 0.001). Creatine kinase is estimated routinely in cardiac patients even on an emergency basis. Our findings indicate that when in doubt the test could be used as a marker for the diagnosis of ectopic pregnancy.
Massive Bilateral Phaeochromocytomas in Association with Von Hippel Lindau Syndrome in Pregnancy
Authors: Kothari Alka , Bethune Michael , Manwaring Janine , Astley Nicole , Wallace Euan 
Published: March 2008

Summary:We report a rare case of large bilateral phaeochromocytomas in pregnancy, found coincidentally by ultrasonography at 26 weeks' gestation, in a woman with a family history of Von Hippel Lindau syndrome. Further, we report maternal and fetal serum and amniotic fluid phenoxybenzamine levels from this case.
Is Surgical Salvage of Arteriovenous Grafts Feasible after Unsuccessful Percutaneous Mechanical Thrombectomy?
Authors: Maya Ivan D. , Smith Tamorie , Young Carlton J. , Allon Michael 
Published: March 2008

AbstractTreatment of thrombosed dialysis ateriovenous (AV) grafts in the radiology interventional suite requires percutaneous mechanical thrombectomy, along with angioplasty of the underlying stenotic lesion. We analyzed the anatomic reasons for unsuccessful percutaneous thrombectomy of AV grafts, and assessed the feasibility of surgical salvage. The radiologic reports of all thrombosed AV grafts undergoing unsuccessful percutaneous mechanical thrombectomy during a 5‐year period were analyzed for the specific problem precluding restoration of graft patency. We also compared the features of patients with unsuccessful graft thrombectomy to those with successful thrombectomy. Of 77 AV grafts undergoing unsuccessful percutaneous thrombectomy, only six (or 8%) could be revised surgically. Inability to salvage the graft surgically was because of: severe draining vein occlusion or stenosis (30 patients); severe central vein lesion (12); multiple intragraft stenoses (11); large pseudo‐aneurysms (six); venous anastomotic occlusion (six); and arterial anastomotic occlusion (four). When compared with 211 patients with successful graft thrombectomy, those with unsuccessful thrombectomy were more likely to have a forearm graft (53% vs. 27%, p < 0.001), and more likely to have a lesion in the draining vein (42% vs. 10%, p < 0.001), the central vein (17% vs. 3%, p < 0.001), or within the graft itself (23% vs. 1%, p < 0.001). An unsuccessful percutaneous graft thrombectomy is more likely in forearm than in upper arm grafts, and more likely if there is a lesion in the draining vein, central vein, or within the graft itself. Surgical salvage of a thrombosed AV graft after an unsuccessful percutaneous intervention is rarely feasible. Most patients have a severe anatomic lesion that cannot be repaired, and require creation of a new vascular access.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: A Sufficient Reason to Avoid Gadolinium‐Based Contrast in All Patients with Renal Impairment?
Authors: Willicombe Michelle , Cunningham John 
Published: March 2008

AbstractNephrogenic systemic fibrosis (NSF) was recently linked to gadolinium‐based contrast (GBC) exposure in patients with renal failure. As result, the U.S. Food and Drug Administration (FDA), the UK Commission on Human Medicines (CHM) and the European Pharmacovigilance Working Party Committee for Medicinal Products for Human Use (CHMP) recommended that GBC should be avoided in patients with advanced renal failure (GFR < 30 ml/minute/1.73 m2). Ones initial reaction is to advise avoidance of GBC exposure in patients with any level of kidney disease to prevent this awful complication. However, this approach is not based on data nor is it practical for patients who would benefit from this diagnostic modality. Thus, while complete avoidance cannot currently be advocated, GBC‐enhanced MRI in renal impairment should be reserved for neurological and vascular cases where the quality of information gained is sufficient to justify the risk of potential devastating adverse effects of NSF.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Non‐Gadolinium Options for the Imaging of CKD/ESRD Patients
Authors: Dawson Peter , Punwani Shonit 
Published: March 2008

AbstractNephrogenic systemic fibrosis (NSF) is a severe systemic disorder developing apparently exclusively in patients in advanced renal failure who receive a gadolinium chelate contrast‐enhancing agent for magnetic resonance imaging. Some other apparent risk factors have been identified but their status remains uncertain. Physicians are frequently confronted with patients at risk of NSF who need imaging. An approach to planning imaging in patients at risk to develop NSF is outlined.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Dialytic Therapies to Prevent NSF Following Gadolinium Exposure in High‐Risk Patients
Authors: Rodby Roger A. 
Published: March 2008

AbstractProlonged exposure to gadolinium‐based contrast (GBC) appears to be the core pathophysiologic factor in the development of nephrogenic systemic fibrosis (NSF). As the GBC is renally excreted, this condition is predominantly seen only following exposure in patients with severe reductions in renal function. Fortunately, GBC is easily hemodialyzed with 95% of an administered dose removed after two hemodialysis sessions. Peritoneal dialysis, on the other hand, is not an efficient means of GBC removal. This has led to recommendations to hemodialyze a high‐risk patient immediately following GBC administration and to repeat the treatment the following day. Although this approach seems logical and is more aggressive than the usual thrice‐weekly hemodialysis schedule that most patients were receiving when they developed this devastating condition, there are no data to support the supposition that this approach will reduce the risk of NSF. Therefore, although an aggressive hemodialysis strategy postexposure is not unreasonable, it is probably best at this point to try to avoid GBC administration altogether in these high‐risk patients.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Patient Characteristics and Risk Factors for Nephrogenic Systemic Fibrosis Following Gadolinium Exposure
Authors: Grobner Thomas , Prischl Friedrich C. 
Published: March 2008

AbstractNephrogenic systemic fibrosis (NSF) is a systemic illness, which only affects patients with kidney failure. NSF risk increases with progressively lower levels of kidney function. It is characterized by red skin areas or plaques that develop over several weeks to painful thickened skin with a “woody” texture, resembling “peau d’orange.” It may ultimately cause flexion contractures of joints. Skin biopsy reveals thickened collagen bundles, mucin deposition, proliferation of fibroblasts and elastic fibers, without inflammation. Originally described as nephrogenic fibrosing dermopathy (NFD), because of its primarily cutaneous manifestation, it was renamed NSF because of the involvement of various organs like the lungs, myocardium, or striated muscles. The pathogenesis of the disease is not known yet, but recently we suggested a strong association between development of NSF and exposure to gadolinium‐based contrast (GBC) agents, thereafter confirmed by other authors. As a consequence of our recent observations, medical authorities imposed restrictions that exclude patients with advanced levels of renal insufficiency from potentially important magnetic resonance imaging studies with gadolinium. Unfortunately, the only alternatives in many situations (examination of brain, lungs, vasculature) are imaging modalities using iodinated radiocontrast agents. Thus, clinicians are faced with weighing the potential risk of NSF from GBC exposure against the risk of acute kidney injury‐associated with radiocontrast media. In this dilemma, clinicians must identify patients at high‐risk to develop NSF. Known risk factors critical for the development of NSF after exposure to GBC agents (certain chelates and higher doses) are end‐stage renal disease requiring dialysis, especially those with little or no residual renal function, and advanced kidney disease not on dialysis. Other potential risk factors include metabolic acidosis, iron overload/intravenous iron, divalent ion disturbances, endothelial/vascular injury, and high erythropoietin doses. Further studies are required.
Peripheral Neurostimulation in Supraorbital Neuralgia Refractory to Conventional Therapy
Authors: Asensio‐Samper Juan M. , Villanueva Vicente L. , Pérez Alfonso V. , López María D. , Monsalve Vicente , Moliner Susana , De Andrés Jose 
Published: March 2008

▪ Abstract:  Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation.Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery. ▪