bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Ketoconazole and Miconazole Vaginal Pessary Treatment for Vaginal Candidosis
Authors: Sharma J. B. , Buckshee K. , Gulati N. 
Published: February 2008

EDITORIAL COMMENT: Ketoconazole (Nizoral) is available in Australia but is normally not indicated as first line therapy for candidiasis, largely because of the risk of hepatic damage (occasionally fatal) and because it is relatively expensive. The approved indications are for systemic or deep mycoses where other forms of therapy have failed, or recalcitrant cases of superficial mycoses which fail to respond to local therapy. The duration of the topical treatment in this study was longer than commonly used in Australia; miconazole pessaries (100 mg) were administered for 14 days whereas the usual regimen is to use 100 mg pessaries once daily for 7 days, or 200 mg pessaries once daily for 3 days.Since colonization of the bowel by Candida is a well known factor in recurrent candidiasis it is not surprising that use of a systemic and local agent concurrently was more effective than either therapy alone. We consider that the result obtained with local treatment (78% cure, 12% recurrence) would generally be regarded as quite acceptable in clinical practice. This study shows that topical or systemic antifungal agents are quite effective at eradicating Candida albicans with an enhanced effect if both modes of administration are used concurrently.Paul Drink water, Director of Pharmacy, Mercy Hospital for WomenSummary: This prospective study was carried out on 250 patients having clinical and mycological evidence of vaginal candidosis. One hundred patients received ketoconazole orally (400 mg/day for 5 days), another 100 patients received miconazole vaginal pessary treatment (one 100 mg tablet locally for 14 days), while the other 50 patients received combination therapy of oral ketoconazole and miconazole vaginal tablets. Although all 3 regimens were significantly effective in relieving patients symptoms and physical signs, the combination therapy gave the best results. There was 98% symptomatic relief with the combination therapy in contrast to 82% and 78% in the oral ketocanozole and vagina] miconazole groups respectively (p < 0.001). Mycological cure rates were also significantly higher in the combination therapy group (94% versus 80% and 76%). The relapse rate was least in the combination group 2% versus 8% and 12%. The combination therapy is recommended for the best results in vaginal candidosis.
Position and Mobility of the Urethrovesical Junction in Continent and in Stress Incontinent Women Before and After Successful Surgery
Authors: Carey Marcus P. , Dwyer Peter L. 
Published: February 2008

EDITORIAL COMMENT: This paper has a nice discussion regarding the anatomical supports of the upper urethra and how the position of the urethrovesical junction influences urinary continence during acute episodes of raised intraabdominal pressure. Because of the importance of urinary incontinence in the female the urethrovesical junction has been the site of a wider range of surgical manoeuvres than any other part of the genitourinary tract. This paper will not settle the debate but it reexamines the theories and will interest many readers. The principles of the Burch and Stamey operations are also discussed and explanation provided of why surgery may fail to cure stress incontinence of urine.Summary: The position of the urethrovesical junction and its movement with straining was assessed using lateral chain cystourethrography in 9 continent women and 27 women with genuine stress incontinence before and after continence surgery. The women with genuine stress incontinence had a significantly lower urethrovesical junction related to the symphysis pubis which descended more with straining than the continent women. Surgery was successful in 25 of the 27 women. Following both successful Burch colposuspension and Stamey operation the urethrovesical junction was significantly higher, closer to the symphysis and less mobile. The position of the urethrovesical junction was significantly higher following the Burch colposuspension than Stamey operation and was similar to the continent control group. Overelevation of the urethrovesical junction can be avoided at the time of Burch colposuspension by not tying the suspension sutures with excessive tension but leaving a free space of 2–4 cm between the vaginal wall below and the iliopectineal ligament above.The posterior urethrovesical angle was similar in continent and incontinent women but was significantly narrower following successful surgery.
Teenage Pregnancy in South Australia, 1986–1988
Authors: Zhang Baoping , Chan Annabelle 
Published: February 2008

EDITORIAL COMMENT: Readers please note that this paper on teenage pregnancy has the unique quality of coming from the only Australian State in which it is a statutory requirement to notify all cases of termination of pregnancy. The authors have therefore been able to provide important information regarding the characteristics of pregnant teenagers and the changing incidence of abortion as well as the obstetric results in continuing pregnancies. These data allow deductions concerning teenage behaviour resulting in pregnancy. The results identify subgroups of our population who require special counselling and care. Hopefully the Council members of the Royal Australian College of Obstetricians and Gynaecologists will use their influence to encourage alt State Parliaments to introduce legislation requiring notification of all cases of termination of pregnancy. We need the facts to identify the high risk groups, so that available resources can be appropriately directed.Summary: Teenage pregnancies accounted for 6.0% of confinements and 24.8% of legal abortions in South Australia in 1986–1988. The teenage pregnancy rate has declined by 28.5% since the early 1970s, associated with a 52.6% decline in the confinement rate. The abortion rate rose in the 1970s but fell slightly in the 1980s; nearly half the teenage pregnancies now end in legal abortion: abortion was a more likely pregnancy outcome for younger teenagers and for teenagers resident in metropolitan areas. Compared with women confined in their twenties, confined teenagers were more likely to be single, primigravid and Aboriginal, to have few antenatal visits and to have a medical or obstetric complication during their pregnancy. They were less likely to have an induction of labour or an elective Caesarean section. They had higher frequencies of preterm deliveries (8.9%) and low birth‐weight babies (9.3%). The youngest teenagers had the most risk factors and the worst outcomes. In the small group of Aboriginal teenagers aged 16 years and under, about a third of the babies were low birth‐weight or premature and one in 12 babies was a perinatal death. Comparison of singleton pregnancies of teenagers with women in their twenties all of whom were single, Caucasian and primigravid, with 7 or more antenatal visits, showed similarity in outcomes. This suggests that being teenage is not in itself a risk factor. Continued support and extension of teenage counselling and antenatal care services is essential.
First Antenatal Visit Haematocrit and Pregnancy Induced Hypertension
Authors: Goh Judith TW 
Published: February 2008

EDITORIAL COMMENT: Women with severe preeclampsia often have a reduced circulatory blood volume and increased haematocrit. It was a nice idea to see if the booking haematocrit value was predictive of subsequent preeclampsia/severe preeclampsia. The answer in this study was negative but this should not be the end of the enquiry. It may be worth seeking such an associated/predictive test (with the possibility of prevention or amelioration of preeclampsia by rest, dietary measures and/or aspirin) at a later time in pregnancy since preeclampsia and its presumed provoking placental poison is not likely to be operative early in pregnancy. Alternatively further analysis of booking haematocrit values could be useful if the study group included a group of women who went on to develop early‐onset (before 3 7 weeks) severe preeclampsia ‐ such a study would require large numbers to recruit sufficient patients with severe preeclampsiaOur reviewer when commenting on current views on the aetiology of preeclampsia stated that the ‘uteroplacental bed, primed by genetic factors and disturbed by immunological reactions, produces a biochemical defect (an imbalance between the placental production of the prostaglandins (prostacyclin and thromboxane ‐ the production of which is affected by aspirin)) which lead to placental ischaemia. Placental ischaemia in turn leads to release of uterine renin and an increase in angiotensin activity. These effects trigger reduction in plasma volume, increased coagulability and a vicious cycle of deteriorating organ function’. This thesis provided by our reviewer assumes that the low blood volume inpatients with severe preeclampsia does not antedate pregnancy.Summary: First antenatal visit haematocrit values during the first and second trimesters were retrospectively collected from 546 nulliparas with singleton pregnancies. The results were analysed for correlation with development of pregnancy induced hypertension (PIH) later in pregnancy. It was found that women with higher haematocrit values, especially over 0.40, had an increased risk of developing PIH. However, there appeared to be no absolute level of haematocrit which had sufficient discriminative value to be useful in clinical practice.
Study of Lupus Anticoagulant in Pregnant Women with Recurrent Abortion
Authors: Das Indira , Vasishta Kala , Dash Sumitra 
Published: February 2008

EDITORIAL COMMENT: The management of patients with recurrent fetal loss is controversial but it is generally agreed that the presence of lupus anticoagulant (LA) should be tested for in these women. There are 2 reports of the treatment of groups of patients with LA and/or anticardiolipin antibodies (ACA) with high‐dose prednisone and/or low dose aspirin (1,2). However, although raised levels of LA or ACA have a predictive value for recurrent abortion, as well as thrombosis and thrombocytopenia, there is conflicting evidence about whether high‐dose immunosuppression (± plasmapheresis) is necessary in order to improve fetal survival (3). Our physician reviewer treats pregnant women who are LA or ACA positive with prednisolone 45–50 mg per day until the test is negative, and also antiplatelet therapy is given (aspirin 100 mg per day and dipyridamole 100 mg QID). Treatment with prednisolone and aspirin can lead to successful pregnancies in these women but with a high incidence of preeclampsia and fetal growth retardation (2). These patients require careful fetal surveillance, and preterm delivery is often necessary.Summary: The relation between lupus anticoagulant (LA) and repeated abortions was evaluated in a case‐controlled study of 50 women with 3 or more unexplained spontaneous abortions compared with 50 control subjects who had 2 or more normal pregnancies and no previous spontaneous abortion or fetal deaths. LA was detected in 5 of 50 cases (10%, 95% confidence limits 1.69% to 18.31%) but in none of the 50 controls. There was an indication that missed abortions may be more frequent in LA positive women. The women who had recurrent abortions but were LA negative had prolonged prothrombin time values (though within normal range) compared to the control group. LA being a treatable cause of idiopathic recurrent abortion should be sought for in women with unexplained fetal losses.
Failed Suction Termination of Pregnancy: Case Reports and Review
Authors: Barker G. K. , Wade K. J. 
Published: February 2008

EDITORIAL COMMENT: A specialist abortionist once remarked to the editor that it was unwise to terminate a pregnancy before 7 weeks'gestation, especially in a nullipara since cervical softening may be minimal and cervical dilatation difficult. Some operators believe that injection of 2 ml of 1% lignocaine into the cervix at each of the 4, 8 and 12 o'clock positions facilitates dilatation and lessens the risk of damage to the cervix. Copious bleeding does not guarantee that a pregnancy has been dislodged; histology of tissue obtained should be a routine practice although the presence of chorionic villi is not a guarantee against an ongoing pregnancy. We agree with the authors' conclusion that ultrasonography at the postabortal check‐up visit is essential if the uterine size is larger than expected, or if pregnancy symptoms persist.Summary: This paper presents two case reports of failed suction termination of first trimester pregnancies which occurred at Geelong Hospital over a short period of time and thus drew our attention to this very difficult problem. The international experience with such failed terminations is then reviewed, with discussion of the recognized associations, prevention and management of such cases.
A Rare Case of Endodermal Sinus Tumour of the Vagina in an Infant
Authors: SenGupta S. K. , Murthy D. P. , Martin W. M. C. , Klufio C. 
Published: February 2008

EDITORIAL COMMENT: We accepted this sad case report for publication to remind readers that persistent vaginal bleeding in an infant requires investigation to exclude the rare primary malignancies of cervix and/or vagina.Summary: A rare case of endodermal sinus tumour (EST) of the vagina in a 1 year 5 months old Papua New Guinean female is described and the literature on vaginal ESTs in childhood is briefly reviewed.
The Effects of Chronic Maternal Hypotension During Pregnancy
Authors: Ng Peng H. , Walters William A. W. 
Published: February 2008

Summary The relationship between chronic maternal hypotension and obstetric outcome was examined retrospectively in a group of 134 pregnant women and compared with a normotensive control group. The hypotensive women had significantly increased risks of delivery before the 38th week of gestation, lower birth‐weight of babies for gestational age, and postpartum complications. In addition, the rates of preterm delivery before 37 weeks' gestation, birth‐weight less than 2,500 g and significant meconium‐staining of the amniotic fluid were higher in the hypotensive group, although these results did not reach statistical significance.These data support the need for a prospective study of the effects of chronic hypotension during pregnancy.
Fetal Arrhythmias: A 3‐Year Experience*
Authors: Rajadurai V. Samuel , Menahem Samuel 
Published: February 2008

Summary Eight cases of fetal arrhythmia were seen over a 3‐year period. Two had atrial and/or ventricular extrasystoles, 1 had complete atrioventricular block and 5 had tachyarrhythmias ‐ 3 supraventricular tachycardia, 1 atrial flutter and 1 ectopic atrial tachycardia. All had structurally normal hearts. Nonimmune hydrops fetalis was the initial presentation in 3 of the 5 cases with tachyarrhythmias. There were 2 deaths ‐a stillbirth and a neonatal death, while 2 others required neonatal intensive care. The 6 survivors have remained well and are now off treatment.The diagnosis, careful assessment and management of a fetal arrhythmia may lead to a successful outcome. The complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.
Inflammatory Bowel Disease Presenting in Pregnancy
Authors: Morton Mark R. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it reports an unusual case of ulcerative colitis occurring for the first time during pregnancy. In the discussion the author reviews the literature on ulcerative colitis and Crohn disease in pregnancy, these being the 2 important examples of inflammatory bowel disease encountered in pregnant women.Summary A case of inflammatory bowel disease (IBD) presenting in pregnancy is described. Despite previous reports of severe fulminating disease in this type of patient, this woman did well with an uncomplicated course; she responded to standard medical therapy and there were no fetal complications.IBD should not be a contraindication to pregnancy unless the disease is poorly controlled. Pregnancy does not increase the risk of relapse of IBD, but should this occur it is more likely in the first trimester or in the postpartum period.Treatment of IBD in pregnancy should be much the same as in the nonpregnant woman. Corticosteroids and sulphasalazine are safe in pregnancy and are the mainstays of medical treatment. Surgery should proceed for the usual indications of toxic megacolon and perforation. In the group requiring surgery fetal mortality is considerable but the maternal outcome is improving. Patients presenting with IBD in pregnancy may have more severe disease but recent reports suggest that the outcome for mother and infant in this group is improving.
Human Menopausal Gonadotropins in the Treatment of Unexplained Infertility
Authors: Hughes Graeme J. , Garrett Donald K. , Lowy Margo 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it describes treatment of patients with unexplained infertility by a drug regimen that appeared to have satisfactory results; 25 of 91 women treated became pregnant and 20 livebirths resulted. It should be noted that, as in most papers reporting results of infertility treatment, there was no control series. Women with unexplained infertility often ask what comes next, when pregnancy does not occur after all investigations are found to be normal. Many are aware of the availability of ovulation induction, GIFT and IVFprogrammes. It seems to us that there is no consensus on how long a couple with normal tests should persevere before being accepted as candidates for sophisticated management. We beg our readers to offer us reports of results of controlled trials of conservative management versus the new technologies in management of these couples. We need such data so we can advise our patients wisely.Summary : Ninety one patients with unexplained infertility were treated with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG). The overall pregnancy rates were 29% per patient and 11% per cycle. In patients under the age of 37, the rates were 40% per patient and 15% per cycle.Many cycles (15%) were cancelled because of poor response to stimulation and by definition these women had normal cycles prior to stimulation.Within 1 year of ceasing HMG treatment, 9 patients had conceived spontaneously and another 4 conceived by GIFT.
Urinary Bladder Carcinoma as Apparent Cause of Antepartum Haemorrhage in Pregnancy
Authors: KriplaniJ Alka , Buckshee Kamal , Karak A. K. , Gupta N.P. 
Published: February 2008

EDITORIAL COMMENT: We were all taught as undergraduates to ask the woman with postmenopausal bleeding was she sure from which orifice the blood had issued. We have all seen a patient with endometrial carcinoma whose diagnosis was delayed while the urologist investigated her for ‘haematuria’. It is also true that urologists tell of the patient with carcinoma of the bladder whose diagnosis was delayed while the gynaecologist investigated her for postmenopausal bleeding presumed to arise from within the uterus. We know of no data that settles the question of whether urologist or gynaecologist is the greater sinner ‐ the message is to check the second system when the first tests negative.This paper was accepted for publication not only for its rare interest but to remind readers that urinary and genital tract bleeding can be confused in obstetric as well as in gynaecological practice. This case reminded the editor of a 41‐year‐old para 8, referred at 38 weeks' gestation as a nonbookedpatient to the Royal Women's Hospital, Melbourne, with a history of recurrent bleeding considered to be due to placenta praevia, for which she had been hospitalized for many weeks. This patient was cachectic and dying from a Stage 4 carcinoma of the cervix; review of the records revealed that on April 26, 1963 she was delivered of a surviving infant by classical Caesarean section performed because the growth massively involved the lower uterine segment and bladder. She was then treated unsuccessfully with pelvic irradiation and died from uraemia and sepsis 4 months after delivery.Summary A 34‐year‐old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of haemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. Cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing wtih a patient with antepartum haemorrhage.
A Case of Intrauterine Fetal Death Associated with Maternal Campylobacter coli Bacteraemia
Authors: Farrell D. J. , Harris M. T. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to remind readers that intrauterine infection can cause fetal death even though the membranes are intact; of course in patients with vaginal discharge in the second trimester it is often uncertain whether or not the membranes are ruptured. We support the authors' statement that the placenta should always be sent for histological and microbiological analyses when the infant is stillborn or born in poor condition; it is also suggested that a Kleihauer test be performed on the mother's blood in such cases since fetomaternal haemorrhage is more common than previously believed. Although permission for autopsy may occasionally not be granted, the placenta should always be available for examination. Indeed the editor has never heard of parents refusing to have a placenta examined and it is doubtful if their permission for such examination is required. Indeed in many centres it is recommended that after all deliveries the placenta should be kept refrigerated within a plastic bag for 1 week in case a clinical complication arises in the baby or mother which indicates its further examination. Our legal consultant informs us that placentas, like surgical specimens, are the property of the hospital. Testing for Aids antibodies is a special situation since it is a community expectation that this will not be performed without consent following adequate counselling. The occasional couple may have a birth plan which includes taking the placenta home for special disposal; this wish should be respected but does not preclude examination of the organ.Summary: Campylobacter species are known to cause infectious abortion in domestic animals. In humans, Campylobacter are an important cause of enteritis, an occasional cause of systemic infection and have had a rare association with abortion and perinatal infection. A case history of spontaneous abortion, at 26 weeks' duration, associated with maternal bacteraemia, due to Campylobacter coli is presented. Transmission, pathogenesis, treatment, and the need for further investigation are discussed.