bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nipple Pain, Mastalgia and Candidiasis in the Lactating Breast
Authors: Amir Lisa H. , Pakula Shyrla 
Published: February 2008

EDITORIAL COMMENT:We accepted this paper for publication because we thought it would interest readers and probably help their patients. The authors did not obtain confirmatory evidence of infection with Candida in Case 2 which is a pity, especially as the condition did not respond rapidly to nystatin and gentian violet. The editorial committee does not endorse the comments regarding the usefulness of dietary measures in the control of candidiasis. We would be interested to publish a study of a larger series of lactating women with these symptoms, with bacteriological diagnosis, and treatment by a single antifungal agent if C. albicans is isolated. Since the patients took so long to respond to treatment, it could be that an orally active antifungal agent would achieve a superior therapeutic result.Author's response: Itmay well be that an orally active antifungal agent would achieve a superior therapeutic result, but the only such agent available in Australia at present is ketoconazole which is excreted in breast milk and is not recommended for use in lactating mothers. It is also contraindicated in pregnancy because it is teratogenic, and use in children is not recommended according to the manufacturers, as stated in MIMS 1991.Thus, we are limited to using nystatin as an oral agent in mothers or infants, or miconazole gel as a topical treatment for oral candidiasis in the infant; nystatin is not absorbed into the blood stream or excreted in breast milk, and the status of miconazole in relation to lactation is not understood, although it is considered safe even for newborn infants.There is also some difficulty in avoiding use of gentian violet as a topical nipple treatment in nipple thrush because we have experienced some degree of sensitivity to nystatin, miconazole and clotrimazole creams or ointments, probably due to the vehicle rather than the therapeutic agent. This is why we have decided to slay with gentian violet, fully aware of the animal studies which suggest it to be carcinogenic in mice; we have not found any allergic reactions in over 300 users. Thus, a study in which only one antifungal agent was used might be difficult to set up since application of some antifungal substance to the nipple seems necessary to clear symptoms.We think that we are dealing with a condition which usually develops over a period of several weeks, and which may need a similar time to resolve.Summary:During lactation, persistently sore nipples or shooting breast pain in the absence of local or systemic signs may be symptoms ofC. albicansinfection of the nipples and/or breast ducts. The nipple may be erythematous or fissured, but the appearance does not resemble oral or vaginal candidiasis. Case 1 is a woman with sore nipples following a course of antibiotics. Case 2 is a woman with severe shooting breast pain which was worsened by antibiotic treatment. Treatment included topical and oral antifungal treatment for the mother in conjunction with an ‘anti‐candida’ diet. The infant's mouth was also treated to prevent reinfection.
Antenatal Loss of One of Twins
Authors: Sonneveld S. W. , Correy J. F. 
Published: February 2008

EDITORIAL COMMENT: It would appear to the reviewer that the takeaway message of this paper is that intrauterine death of one twin, in the absence of maternal complication (placental abruption, preeclampsia) or fetal compromise (cardiotocography, ultrasonography, ultrasonographic assessment of fetal blood flow), should be managed conservatively if the pregnancy has not reached 37 weeks' gestation. Caesarean delivery is not specifically indicated by intrauterine death of one twin, except in the case of monoamniotic twin pregnancy, unless tests of fetoplacental function are abnormal. It is likely that the maternal risk of disseminated intravascular coagulopathy has been exaggerated in the literature, and is unlikely to occur unless one twin has been dead for more than 4 weeks. One of the problems is that the duration of fetal death is often not known in these cases. The risk of coagulation failure seems to be much less in the case of fetus papyraceous where the dead twin is very small although the time from death until delivery is usually many months rather than weeks.Readers are referred to other editorial comments on this subject; 1990; 30: 134 and 1990; 30: 137.Summary The antepartum loss of a twin with survival of the second twin to delivery was studied in the Tasmanian population from 1980 to 1989 inclusive. No previous study of an Australian population has been reported. This rare complication occurs in 3.5% of twin pregnancies. The outcome of these pregnancies and the outcome for the surviving twin are discussed.
Prognosis in Fetal Cystic Hygroma
Authors: Anderson Nigel G. , Kennedy John C. 
Published: February 2008

EDITORIAL COMMENT: This paper was accepted for publication to inform readers of the current consensus regarding management when ultrasonography reveals fetal cystic hygroma. After counselling the parents, amniocentesis is performed to identify the high proportion of fetuses with an abnormal karyotype, assuming that the parents would opt for termination under this circumstance, and that the period of gestation renders this act an option. If the karyotype is normal, and there are no other malformations apparent, especially hydrops, then most would agree that treatment should be conservative. In many such cases the lesions will resolve spontaneously. Figure 1A illustrates a large cystic hygroma in a newborn male infant; the child was growth retarded (birth‐weight 2,970 g at 39.2 weeks' gestation) but otherwise normal. The tumour disappeared spontaneously when the infant was aged 6 months and due for operation! The child is now aged 18 years, lives in Queensland, and according to his father who is a psychiatrist, is ‘doing brilliantly’! There is also controversy regarding management when ultrasonography identifies fetal choroid plexus cysts. Although an abnormal karyotype was identified in 6.5% of fetuses (4 of 62) in one reported series (A) all 4 of these fetuses had other ultrasonographic abnormalities. This suggests that genetic counselling and cytogenetic studies are indicated only when the choroid plexus cyst, irrespective of size or bilaterality, is associated with additional abnormalities. In all other cases choriodplexus cysts can be expected to resolve, usually within 2–5 weeks.A. Piatt LD, Carlson DE, Medearis AL, Walla CA. Fetal choroid plexus cysts in the second trimester of pregnancy: A cause for concern. Am J Obstet Gynecol 1991; 164: 1652–1656.Summary Axillary and lateral cervical fetal cystic hygromas in a fetus with normal karyotype are described. Fetal death at 25 weeks' gestation occurred. A literature review revealed that for cystic hygroma 42% of infants are 45XO, 38% have a normal karyotype, and 18% have trisomies. Prognosis is grim if the karyotype is abnormal or if hydrops or bilateral pleural effusions are present. Survival rate progressively improves with normal karyotype (27%), unilateral pleural effusion (40%), atypical location (56%), and resolution of cystic hygroma (71%). No single feature signifies 100% survival. The overall survival rate for fetal cystic hygroma is 10%. Prognosis remains guarded regardless of all other factors until the fetus reaches 26 weeks' gestation, after which time a 67% chance of ultimate survival can be expected. Only 42% of documented survivors were completely normal at follow‐up.
The Diagnostic Value and Patient Acceptability of Outpatient Endometrial Sampling with Gynoscann
Authors: Sun‐Kuie Tay , Sian‐Ann Tan , Ka‐Mui Chua , Soo‐Kim Lim‐Tan 
Published: February 2008

EDITORIAL COMMENT: Several recent reports have suggested that procedures short of curettage under anaesthesia are sufficient to exclude the possibility of intrauterine cancer. Nasri and colleagues (1) found that endometrial thickness, as assessed by vaginal scan, was greater than 5 mm in all of 29 patients with abnormal endometrial histology. Our pathologist reviewer reminded us of a recent patient with a tiny invasive lesion less than 3 mm in depth in a hysterectomy specimen, but he cannot be sure that endometrial thickness did not exceed 5 mm before the curettage that obtained the tissue that indicated the hysterectomy. How expert does the practitioner and his/her equipment need to be for endometrial thickness of 5 mm to be ‘an appropriate cut‐off level for conservative management of women with postmenopausal bleeding’ (1)? The Editorial Committee is reluctant to endorse a policy of not performing curettage for postmenopausal bleeding, and wishes to remind readers that in patients with this symptom, carcinoma of the endocervix or endometrium is found in at least 8–12% of cases in most series. It should be noted that in this report evaluating endometrial sampling, there were very few patients past the menopause. The cervix is more difficult to cannulate in older women which is another factor when considering whether outpatient instrumentation by any means, including hysteroscopy, is sufficient for sampling or assessment of the endometrium.1. Nasri MN, Shepherd JH, Setchell ME, Lowe DG, Chard T. The role of vaginal scan in measurement of endometrial thickness in postmenopausal women. Br J Obstet Gynaecol 1991; 98: 470–475.Summary Endometrial sampling with Gynoscann was performed in the outpatient department in 70 women with abnormal vaginal bleeding prior to dilatation and curettage (D&C). Successful endometrial sampling was achieved in 62 (89%) patients; Of the samples obtained 44 (71.0%) were adequate for cytological assessment and 46 (74.2%) for histological assessment, compared to 80% of D&C samples being adequate for histological examination. In those patients in whom outpatient endometrial sampling was adequate, both the cytological and histological diagnosis agreed with the D&C. The outpatient endometrial sampling was well tolerated by the patients since the majority (89%) experienced either no or little pain. Vaginal bleeding following the procedure was minimal in all except 1 patient. Endometrial sampling with Gynoscann may be useful for endometrial assessment prior to commencement of hormonal therapy and hysterectomy. It is a potentially useful screening test for early detection of endometrial cancer in patients at risk.
Diagnosis and Surgical Management of Endometriomas
Authors: Wood Carl , Maher Peter , Hill David 
Published: February 2008

Summary: Fifty two patients with endometriomas ≥ 1 cm were treated by surgical excision either with or without ovarian closure.Diagnosis is reliable when clinical features of the pain, vaginal ultrasound, and laparoscopy, including ovarian mobilization and needling, are considered.Fifty of 52 patients were free of pain after 1 year and 26 (50%) became pregnant within 1 year.A second laparoscopy is justified if pain persists or pregnancy does not occur. Adhesive disease was the most common complication (40%), and persistent or recurrent endometriosis occurred in 15%.Surgery by laparoscopy with drainage and excision of the endometrioma without ovarian sutures may be more effective than excision of the endometrioma and ovarian suture.
Laparoscopic Adnexectomy ‐ Indications, Technique and Results
Authors: Wood Carl , Hill David , Maher Peter , Lolatgis Nick 
Published: February 2008

Summary: Laparoscopic adnexectomy was performed successfully in 38 patients in whom the procedure was attempted. Failure may result from inexperience of the surgeon or when preliminary dissection near bowel suggests trauma is likely. The duration of the operation was between 15 and 105 minutes, blood loss was minimal and all but 2 patients were discharged within 24 hours of surgery. Pain was relieved in 33 of 35 patients in whom this was the dominant symptom. In 1 patient a small ovarian remnant implanted on the bladder was removed at subsequent laparoscopy.Preliminary experience of this procedure suggest it may be preferable to laparotomy because of the reduced risk of wound complications, pain, time in hospital and duration of convalescence.
Ultrasound Diagnosis and Laparoscopic Excision of an Interstitial Ectopic Pregnancy
Authors: Wood Carl , Hurley Victor 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report as readers may well marvel at the elegant details of careful removal of an interstitial pregnancy at laparoscopy. The procedure seems brave since the editor can recall being called by the junior author of this paper to lend a hand in a case of ruptured interstitial pregnancy with frightening haemorrhage at laparotomy ‐ in this case ergometrine lessened the bleeding that was then controlled by a mattress suture in the uterine wall. Dr Eric Bieber from Chicago delivered an interesting account of laparoscopic management of ectopic pregnancy in Melbourne in May, 1992, and strongly emphasized a point about the pathology of tubal ectopic pregnancy which seems important and was new to his audience ‐ namely that the pregnancy usually lies outside the tubal lumen having distended not the tube but the outer layer of the tubal wall beneath the peritoneum. This apparently explains how an ectopic pregnancy can be incised and evacuated without affecting tubal patency in a high proportion of cases. Our editorial committee would welcome a contribution giving details of this concept and its relevance to the success of conservative treatment of unruptured ectopic pregnancy.Summary: Interstitial tubal pregnancy occurs in about 5% of ectopic tubal pregnancies and is associated with an increased risk of severe haemorrhage (1). Diagnosis prior to rupture of the pregnancy into the peritoneal cavity is very important to avoid haemorrhage. Its presence has been considered to be a contraindication to laparoscopic surgery (2), although most ectopic pregnancies can be managed laparoscopically by an experienced endoscopist. We report the diagnosis of an interstitial pregnancy by ultrasound before rupture and treatment by laparoscopic excision of the pregnancy.
Delayed Fetal Death Following Electrical Injury in the First Trimester
Authors: Steer Roger G. 
Published: February 2008

EDITORIAL COMMENT: The editor was recently ‘zapped’ on the back when repairing a fence with his neighbour's electrical contribution not turned off (a foolish venture) ‐ the single wire had a jolt far greater than that usually received from a farmer's fence, which reinforces the point made by the author ‐ keep away from electric fences and especially avoid contact with your head, and of course the pregnant abdomen or pelvis.Summary: A case of possible delayed fetal death following electrical shock in the first trimester is reported.Evidence from the literature of delayed effects of electrical injury later in pregnancy is presented, suggesting that delayed as well as immediate detrimental effects in the first trimester should not be discounted.Perhaps the spectrum of effects of electrical shock on the fetus could be investigated in animal experiments to elucidate the pathogenesis of such injury to the fetus.Electric fences are a possible hazard to pregnant women in rural areas.
Topical Application of Honey in Treatment of Abdominal Wound Disruption
Authors: Phuapradit Winit , Saropala Nopadol 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it should interest all readers, some of whom may decide they have the occasional patient suitable for this method of honey wound care. The healed wound shown in figure (d) would be cosmetically unacceptable to most women but perhaps resuture would have had a similar result. In the editor's experience, sew sanguineous discharge from a wound postoperatively invariably means dehiscence best treated by resuture once any precipitating ileus has resolved; when the skin sutures are removed the wound falls apart in these women and usually loops of bowel are adherent to the edges of the wound (figures A and B). In the case illustrated in this paper the peritoneum appears to be intact as if the problem was an infected haematoma which is an unusual cause of wound disruption in the editor's experience; yet the authors encountered 15 cases in 19 months, and quoted no case of the complete wound dehiscence referred to above!Summary: The usefulness of honey application as an alternative method of managing abdominal wound disruption was assessed. Fifteen patients whose wound disrupted after Caesarean section were treated with honey application and wound approximation by micropore tape instead of the traditional method of wound dressing with subsequent resuturing. We achieved excellent results in all the cases with complete healing within 2 weeks. Honey application is inexpensive, effective and avoids the need to resuture which also requires general anaesthesia.
Biopsy Diagnosis and Conservative Surgical Treatment of Adenomyosis
Authors: Wood Carl , Maher Peter , Hill David 
Published: February 2008

Summary: Fifteen patients with dysmenorrhoea and menorrhagia refractory to medical treatment were referred for surgical treatment.Pre‐operative diagnosis of adenomyosis was suggested by vaginal ultrasound in 13 patients and was confirmed pre‐operatively by myometrial biopsy in 5 and by transcervical myometrial biopsy at the time of endometrial resection in 7.Conservative surgery included endometrial resection (7), myometrial reduction by electrocautery (4), and myometrial excision (3).Marked improvement occurred in 4 of 7 patients after endometrial resection, 3 of 4 after myometrial reduction, and all of 3 having myometrial excision.Diagnosis of adenomyosis is improved by use of vaginal ultrasound and percutaneous or transcervical myometrial biopsy. Conservative surgical procedures including endometrial resection and myometrial reduction or excision may reduce the need for hysterectomy in the presence of adenomyosis.
Idiopathic Hirsutism or Polycystic Ovary Syndrome?
Authors: Jahanfar Shayesteh , Eden John A. 
Published: February 2008

Summary: Polycystic ovaries (PCO) were detected using ultrasound imaging in a series of 173 women who presented with significant hirsutism and in some cases with irregular menstruation. Patients were divided into 3 groups. Those with hirsutism and regular menstruation (cycles >8 per year, Group 1, n = 96); those with hirsutism and oligomenorrhoea (cycles < 8 per year, Group 2, n = 44) and those with hirsutism and amenorrhoea (cycles <2 per year, group 3, n = 33). These 3 groups were compared with subjects with normal ovaries and regular cycles of 26–34 days and without hirsutism (n = 29) and also with a group of women with PCO and regular cycles who had no sign of hirsutism (n = 90). PCO were found in 86% of Group 1, 97% of Group 2 and 94% of women within Group 3. The results suggest that the term ‘idiopathic hirsutism’ may not be appropriate.An abnormal biochemical test consisting of a luteinizing hormone level >9 U/L, testosterone level >2.2 nmol/L, sex hormone binding globulin <32 nmol/L or free androgen index >4.5 was 100%, 91% and 76% sensitive for detecting PCO amongst women with amenorrhoea, oligomenorrhoea and idiopathic hirsutism respectively.
Intrauterine Insemination with Husband's Sperm: Comparison of Pregnancy Rates in Couples with Cervical Factor, Male Factor, Immunological Factor and Idiopathic Infertility
Authors: Kossakowski Jacek , Stephenson Mark , Smith Howard 
Published: February 2008

Summary: Intrauterine insemination with husband's sperm (IUI) is offered to couples with infertility due to various causes although there is no general agreement on which of these causes should be so treated. In this report 77 couples were diagnosed as having either cervical factor, male factor, immunological factor or unexplained infertility, insemination was performed 24–32 hours after a rapid rise in the serum LH level. Two of 16 pregnancies which resulted miscarried, 1 was ectopic and the remainder were full term. Eleven occurred in the cervical factor group, 3 in the immunological factor and only 1 in each of the male factor and unexplained infertility groups. The differences in the number of pregnancies between the cervical factor and male and unexplained infertility groups are significant but not between the groups with cervical and immunological factors. The majority of pregnancies (81%) were achieved in the first 4 cycles.Patients with the cervical factor as the cause of their subfertility are likely to benefit from the IUI with their husband's sperm. The small number of patients with the immunological factor in this study does not allow for a conclusion. In our experience the male factor and unexplained infertility patients are unlikely to benefit from intrauterine insemination with husband's sperm.
A Review of 19 Sets of Triplets: The Positive Results of Vaginal Delivery
Authors: Clarke J.P. , Roman J.D. 
Published: February 2008

Summary: The outcome of 19 triplet pregnancies delivered at Waikato Women's Hospital is analyzed, with particular regard to the mode of delivery. During the period 1981–1992 the incidence of triplets was 1:1,945. Twelve sets of triplets were delivered by Caesarean section (63%) with 6 perinatal deaths occurring in this group, compared to none in 7 sets of triplets delivered vaginally (37%).All triplet pregnancies were correctly diagnosed antenatally by ultrasound examination at a mean gestational age of 19 weeks (range 11–28 weeks). The most common antenatal complications were preterm labour in 18 pregnancies (95%) and preeclampsia in 4 (21%). The mean gestation at delivery was 33 weeks (range 25–39 weeks).The outcome of triplet pregnancies was better in the group that delivered vaginally than those delivered by Caesarean section. Greater maturity of the infants delivered vaginally appeared to be the major factor for the lower neonatal morbidity and mortality.