bluuebunny/crossref_metadata_2025_split huggingface dataset:
Massive Ovarian Oedema: 3 Cases and Clinical Considerations
Authors: Fernando Sujatha S.E. , Guibani‐Bousfield Elizabeth , Wong Felix W.S. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication although a case of massive ovarian oedema was recently reported in this journal (A) because the condition must be less rare than previously considered. The editor and subcommittee have not experienced a case between them yet consider that we should all be aware of the condition since conservative therapy without oophorectomy seems advocated, although seldom practised ‐figure 1 indeed shows an ovary that few would conserve although the other ovary should be inspected for tumour or unusual mobility warranting surgical intervention.Summary: Three cases (2 of which presented with torsion) of massive ovarian oedema occurring in young women, clinically suspected to be a neoplasm, are presented. Microscopic examination of each showed diffuse interstitial oedema and multiple cysts, some surrounded by luteinized cells. As the patients are young, we advocate conservative management with sparing of reproductive capacity, although that is not what happened with any of our 3 patients.
Graft Versus Host Disease Following Intrauterine and Exchange Transfusions for Rhesus Haemolytic Disease
Authors: Harte Glenn , Payton Diane , Carmody Frank , O'Regan Peter , Thong Y. H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication because it seems to link graft versus host disease with intrauterine transfusions. Since the association of transfusion with graft versus host disease is exceedingly rare it would seem to the editorial subcommittee that it is reasonable to support the recommendation of the authors that irradiated blood should be used for intrauterine transfusions but as far as we can see the case for doing so for transfusions after birth is yet to be sustained. It seems important to study the fetal maturity at the time of intrauterine transfusions that are known to have been associated with graft versus host disease, the occurrence of which is presumably related to immune tolerance of the fetus to the transfused blood products. Our paediatrician reviewer informed us that at the Royal Women's Hospital, Melbourne, blood for fetal transfusions has always been irradiated since the early 1980s when intravascular transfusions were commenced. However, at this institution they do not irradiate blood for transfusions to infants after birth either for exchange transfusions, when the dose of lymphocytes transfused must be enormous, or for simple transfusions, with a reduced dose of lymphocytes. Reply to Editorial Comment: The comments by the paediatrician reviewer are noted.However the decision not to irradiate blood for transfusions to a neonate, be it for an exchange transfusion or a top up transfusion is contrary to current accepted practice.Indeed, the “dose of lymphocytes must be enormous”. Because of this, the British Blood Transfusion Task Force (A) and the American Association of Blood Banks (B) state that the indications for irradiation of blood are ABSOLUTE for the following:

Intrauterine and all subsequent transfusions and neonatal exchange transfusions.
Premature/very low birth‐weight infants (<1,500 g).

It would therefore seem prudent to follow the British and AABB Standards.A. Guidelines on Gamma irradiation of blood components for the prevention of transfusion‐associated graft versus host disease. B.C.S.H. Blood Transfusion Task Force, Transfusion Medicinef 1996; 6: 261–271.B. AABB Standards for Blood Bank and Transfusion Services 16th.
Transvaginal Sonography of the Endometrium in South Indian Postmenopausal Women
Authors: Kekre Aruna N. , Jose Ruby , Seshadri Lakshmi 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper because it has a simple important message, namely that postmenopausal women with an endometrial thickness ≤4 mm will not have an endometrial cancer; they are likely to have endometrial atrophy. A vaginal ultrasound examination to measure endometrial thickness is a noninvasive investigation. There are about 100 papers on this subject in the world literature at present, and it appears that this investigation will adequately exclude endometrial malignancy in postmenopausal women. This is especially useful in older, unfit or frail women. However, if bleeding is heavy or persists it would still be recommended that hysteroscopy and/or curettage be performed.Summary: Endometrial carcinoma is not commonly seen in India as in the West. Nevertheless, the diagnosis has to be entertained in women presenting with postmenopausal bleeding. The aim of the study was to compare die transvaginal sonographically‐measured endometrial thickness with the histopathological diagnosis in postmenopausal women. Eighty postmenopausal women were studied prospectively. All of them underwent transvaginal sonography followed by eidier an office dilatation and curettage and/or a hysterectomy. Eight women had endometrial carcinoma and their mean endometrial thickness was 12.6±5 mm (mean ± SD). Taking 4 mm endometrial thickness as cut off the sensitivity of transvaginal scan to detect endometrial pathology was 97%, specificity 98%, positive predictive value 97% and negative predictive value 94%. Hence, we conclude that measurement of endometrial thickness by transvaginal scan is a good screening test in postmenopausal women for differentiating endometrial pathology from those who do not have an endometrial lesion.
A Phase II Trial of Carboplatin and Etoposide for Relapsed or Metastatic Carcinoma of the Cervix
Authors: Tebbutt Niall , Rischin Danny , Quinn Michael , Rome Robert , Millward Michael J. , Toner Guy C. , Bishop James F. 
Published: February 2008

Summary: This study reports the results of a phase II trial of carboplatin 100 mg/m2 combined with etoposide 120 mg/m2 each given for 3 consecutive days every 28 days in women with recurrent or metastatic carcinoma of the cervix.Seventeen eligible patients were treated between August, 1990 and May, 1993. In the 16 evaluable patients, there were 2 complete responses, and no partial responses with an overall objective response rate of 12.5% (95% confidence interval 1.6%‐38%). The main toxicities of this regimen related to myelosuppression and emesis. The combination of carboplatin and etoposide did not achieve either a better response rate or a substantially improved toxicity profile than is seen with single agent cisplatin.
Successful Pregnancy in a Patient with Previous Bladder Exstrophy
Authors: Sharma Damyanti , Singhal Savita Rani , Singhal S.K. 
Published: February 2008

EDITORIAL COMMENT: Usually we do not accept anecdotal case reports for publication. Chambers twentieth century dictionary defines an anecdote as ‘a short narrative of an incident of private life’. Readers can decide if this case is anecdotal. There appears to be a lot left unsaid about this woman's private life, if not her private pans. She was admitted to hospital as a nonbooked emergency case in labour. The symphyseal separation shown in figure 2 clinched our decision to accept the case for publication. The editor did not see such a case in 38 years of obstetrics practice.Summary: Bladder exstrophy is an unusual congenital anomaly. Patients becoming pregnant with such anomaly after surgical repair are even rarer. The present case reports a lower segment Caesarean section delivery of a living healthy baby in a woman who had been operated on for bladder exstrophy at the age of 18 years. This is the first case of this type seen in our institution in 35 years.
Uterovaginal Prolapse Associated with Rectal Prolapse
Authors: Kriplani Alka , Banerjee Neelam , Kriplani Ajay Kumar , Roy Kallol Kumar , Takkar Deep 
Published: February 2008

EDITORIAL COMMENT: There are hundreds of papers in the literature dealing with the surgical management of rectal prolapse, but that of combined Uterovaginal prolapse and rectal prolapse is another matter (A). This paper describes the management of combined Uterovaginal and rectal prolapse using vaginal and laparoscopic approaches at 1 ‘sitting’ (anaesthetic). We accepted this paper for publication because it has 2 messages for readers: (i) remember to exclude rectal prolapse in women with Uterovaginal prolapse especially when there is a history of severe pelvic pain, difficult or unsatisfied defaecation and/or rectal incontinence. Incidentally and importantly, rectal prolapse can be hidden by a Sims speculum and thus overlooked when the woman is asked to ‘bear down’ to display her Uterovaginal prolapse! The Editor had such an experience in 1963 in 1 of the numerous ‘short cases’ in the Clinical Gynaecology examination for the degree of Master of Gynaecology, University of Melbourne, held at the Royal Melbourne Hospital and arranged by Mr Leslie Gleadell and Mr Ian Mcdonald, the senior gynaecologists of the hospital. It was a unique experience to be involved in a clinical examination with 4 very senior examiners and a ward full of patients, some with extraordinary lesions, in order to test just 2 candidates, namely Norman Beischer and Ian Johnston! For readers with an interest in medical history this was the first clinical examination for the MGO degree in the University of Melbourne. The examiners were Professor Lance Townsend, Professor Lawrence Wright, Mr Walter Johnstone and Mr Leslie Gleadell. (ii) laparoscopic surgery is being used more frequently and is an alternative to the open approach in the management of rectal prolapse.(A) Barham K, Collopy BT. Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. Aust NZ J Obstet Gynaecol 1993; 33: 300–303.Summary: A case of combined genital prolapse and rectal prolapse in a 55‐year‐old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.
Uterus Didelphys, a Rare Cause for Tubal Sterilization Failure
Authors: Sharma Damyanti , Singhal Savita Rani , Singhal S.K. 
Published: February 2008

EDITORIAL COMMENT: : We accepted this case report for publication because uterus didelphys and its often‐associated longitudinal vaginal septum can cause a variety of complications in the practice of obstetrics and gynaecology. When performing tubal ligation the surgeon would search for the second Fallopian tube and presumably could, as suggested in this paper, misdiagnose one half of the didelphys as a unicomuate uterus. The fold of peritoneum between bladder and sigmoid colon could obscure the other uterine horn. When the editor was a resident with Lance Townsend at The Royal Women's Hospital, Melbourne, in the 1950's, when abortion by the medical profession was not readily available, we had to cope with a patient with an unwanted pregnancy in one horn of her uterus didelphys, a condition unknown to her doctors when they had inserted a Grafenberg ring into the other horn for contraception. The vaginal septum can lead to diagnosis by causing dyspareunia and obstructed labour. The editor has also diagnosed the condition when performing a Manchester repair in a postmenopausal woman. In this case it was not until the cervix was amputated that the laterally‐displaced vaginal septum and the second cervix it had hidden from view, was first recognized. This woman had used one half of her vaginal and uterine complement for coitus, conception and delivery of her children without symptoms due to extreme lateral displacement of the vaginal septum. See also Editorial Comment. Uterus didelphys with unilateral imperforate vagina and ipsilateral renal agensis. Aust NZ J Obstet Gynaecol 1991; 31: 288.Summary: Uterus didelphys is a rare congenital anomaly. It can result in a variety of misadventures even in the hands of an expert. The present case reports uterus didelphys as the cause for tubal sterilization failure. This is the first case of this type seen in our institution in 35 years.
Outcome of Pregnancy in Women with Idiopathic Thrombocytopenic Purpura
Authors: Al‐Jama Fathia E. , Rahman Jessica , Al‐Suleiman Suleiman A. , Rahman Mohammad Sayedur 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it provides useful information concerning idiopathic thrombocytopenic purpura (ITP) in a centre in which cordocentesis and fetal scalp‐blood sampling for antepartum assessment of fetal blood platelet counts is not performed. The results in this series of 28 pregnancies were excellent in that the only fetal loss was an intrauterine death at 32 weeks' gestation; it is difficult to see how antepartum testing could have prevented this death even if it was due to ITP. The series includes a mother who may have lost 3 previous infants from intracranial haemorrhage due to ITP. This woman was thereafter delivered in 2 pregnancies by Caesarean section, with both infants surviving, their cord blood platelet counts being shown in the footnote to table 2 provided by the authors after reading the original editorial comment. The authors do not favour Caesarean section as the preferred method of delivery in women with ITP, because of the fetal risk of intracranial haemorrhage, unless the maternal blood platelet count is <50 ± 109/L. However in this series the mothers of 3 of the 4 infants born with cord blood platelet counts <50 ± 109/ had platelet counts at delivery <50 x ± 109/L and 2 had platelet counts <151 ± 109/L. The authors also remind us that women with ITP require special management for safe Caesarean section.Summary: The obstetric management and haematological problems in 28 pregnancies of 23 mothers with idiopathic thrombocytopenic purpura (ITP) are analyzed. There was no maternal death and only 1 stillbirth occurred in the series. Ten infants were born by Caesarean section and 18 were delivered vaginally. Neonatal cord blood platelet counts showed thrombocytopenia in 12 infants, but in only 4 (14.3%) was the cord blood platelet count <50 ± 109/L. None of the 27 liveborn infants died, although 4 required supportive treatment with corticosteroids and IgG. No maternal characteristics could be used to predict the neonatal platelet count. These results are comparable with other studies reported in the literature. The rarity of poor neonatal outcome in mothers with ITP does not justify obstetric intervention solely on the basis of their platelet counts. The management of patients should be individualized and carefully planned.
Antenatal transfer of rural women to perinatal centres
Authors: Roberts Christine L , Henderson‐Smart David , Ellwood David A , Group****** High Risk Obstetric and Perinatal Advisory Working 
Published: February 2008

Summary: The aim of this study was to describe antenatal transfers of rural women to perinatal centres, and among transferred women, to assess the use of selected evidence‐based therapies and determine the predictors of preterm and imminent births. The clinical records of rural women antenatally transferred to perinatal centres in NSW and the ACT during 1997–1998 were reviewed. Of 453 rural antenatal transfers, 408 (90%) were emergency transfers. Increasing remoteness was associated with increased rates of antenatal transfer but not with a lower probability of giving birth. Of all transferred women, 64% delivered; 58% of preterm transfers delivered preterm and of those delivering preterm, 76% delivered within 7 days.Although the main reason for antenatal transfer was the possibility of preterm birth, women presenting with preterm contractions only were less likely to deliver preterm (OR = 0.2,95% CI 0.1‐0.4) or ≤. 7 days (OR = 0.3,95% CI 0.2‐0.5) than women with any other presenting symptoms. The overall usage of effective interventions (antenatal steroids, antibiotics for PPROM and β‐mimetie tocolysis to delay birth) among antenatally transferred rural women was high, but there is room for increased; uptake prior to transfer.
Fetal growth charts for Aboriginal fetuses
Authors: Humphrey Michael , Holzheimer Deborah 
Published: February 2008

Summary: The study aimed to determine whether fetal growth parameters in Aboriginal pregnancies are such that separate fetal growth charts are necessary for their appropriate care. We designed a prospective study of a cohort of Aboriginal women presenting for antenatal care before 20 weeks gestation (ultrasound proven) and a reference cohort of Caucasian women.Four remote North Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital took part in the survey.One hundred and four Aboriginal and 101 Caucasian women with no known medical factors affecting fetal growth or gestation were recruited, and 96 Aboriginal and 96 Caucasian women completed the study. Measurements took the form of longitudinal percentile charts of fetal biparietal diameter, abdominal circumference and femur length.Ultrasound measurements of fetal biparietal diameter, abdominal circumference and femur length were obtained 3 to 5 times during Aboriginal and Caucasian pregnancies, where the gestation was established by ultrasound before 20 weeks gestation, and no known medical conditions which affect fetal growth were present in the mother. There were no statistical or clinically important differences in biparietal diameter, femur length and abdominal circumference of Aboriginal and Caucasian fetuses.We concluded that there is no reason to use separate fetal growth charts when examining Aboriginal fetal growth.
Parental decision‐making differences between patients in two healthcare systems for choroid plexus cysts
Authors: Apodaca Christina C , Jr Roderick F Hume , Evans Wendy J , Martin Laura S , Evans Mark I , Calhoun Byron C 
Published: February 2008

Summary: We evaluated the medical‐sociological implications of parental perception of risk and decision‐making choices for prenatally ascertained choroid plexus cysts (CPC) between two obstetric populations.The Wayne State University (WSU) Reproductive Genetics database and the Madigan Army Medical Center (MAMC) experience were reviewed to compare the rates of aneuploidy and invasive testing for cases with CPC. Aneuploidy rates were compared between those with isolated CPC, CPC with advanced maternal age (AMA), and CPC associated with multiple anomalies.In the WSU cohort 186 cases were identified, of whom 27 (15%) declined invasive fetal testing. In the remaining 159 cases, aneuploidy was present in 2/132 (1.5%) isolated CPC, 3/11 (27%) CPC with AMA, and 15/16 (93%) CPC with multiple anomalies.In the MAMC cohort 107 cases were identified, of whom 99 (92%) declined invasive fetal testing. No aneuploidy cases were found in the 3/12 AMA cases or 5/95 non‐AMA cases that underwent amniocentesis.The two cases of aneuploidy with isolated CPC cannot be ignored, and provide an estimated attributable risk of at least 0.8%, a higher risk than 38 years of age. However, the parental sociologic context may be as important for decision‐making as the genetic‐prognostic risk.
An experience with transvaginal sonography in gynaeeologic tumour surveillance
Authors: Carter Jonathan 
Published: February 2008

Summary: Surveillance of gynaeeologic cancer patients treated with a curative intent involves frequent presentations by the patient for a targeted history, detailed general and pelvic examination, including Pap smear. One of the aims of such surveillance is to detect potentially curable recurrences early to allow the initiation of further therapy, hopefully to attain eradication of the recurrent tumour.Six cases are presented where the prudent use of transvaginal sonography (TVS) was found to be useful in the exclusion of recurrent tumour in patients with symptoms; early diagnosis in patients who were asymptomatic; confirmation of disease in those with symptoms; to evaluate patients with obliterated upper vaginas due to therapy, and follow‐up of those with confirmed recurrence as a form of disease marker.
Oophorectomy at the time of surgery for moderate endometriosis: a survey of Australian gynaecologists
Authors: Dover Richard W , Chen Jack , Torode Hugh 
Published: February 2008

Summary: The decision to perform bilateral oophorectomy at the time of surgery for endometriosis is dependent upon many factors, one of which is the opinion of the surgeon concerned. At present there is no consensus on this subject, and in an attempt to document current opinion, we performed a postal survey of all Fellows of RANZCOG living within Australia.The questionnaire presented the Fellow with a clinical scenario describing moderate endometriosis, and then asked him/her to select their preferred option for each of a number of anatomical areas.Out of 1050 questionnaires, 688 (65.5%) were returned. Analysis of these replies suggests that current opinion supports a conservative approach to surgery, with only 27.5% of Fellows electing to perform a hysterectomy in conjunction with bilateral oophorectomy.
Outcome of pregnancies complicated by pre‐gestational diabetes mellitus
Authors: Gunton J E. , McElduff A , Sulway M , Stiel J , Kelso I , Boyce S , Fulcher G , Robinson B , Clifton‐Bligh P , Wilmshurst E 
Published: February 2008

SUMMARYPregestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. Studies suggest that optimal control of diabetes before and during pregnancy minimises these risks. There are few recent reviews of outcomes of pregnancies complicated by DM in Australia.Ninety‐three pregnancies in women with DM at our hospital since 1989 were identified. We collected data for maternal age, type of diabetes, duration of therapy, complications of diabetes, maternal complications of pregnancy and fetal outcomes including malformations. The rate of pregnancy planning with optimal glycaemic control at conception was low in our population, particularly in patients with Type 1 diabetes.Women who smoked had worse glycaemic control, and a higher rate of miscarriage. There was a high rate of Caesarean section, particularly in those women with Type 1 diabetes (77.4%). The rate of Caesarean section was lower in planned pregnancies. There were no perinatal deaths. The number of neonates with major congenital anomalies was high (13%) in the Type 1 population.It is important to increase the rates of prepregnancy planning and to optimise glycaemic control before pregnancy. In many cases there has been a long interval between diagnosis and pregnancy, so all women with diabetes should receive counselling at frequent intervals about pregnancy and the importance of planning. Women who planned their pregnancies had improved outcomes, with decreased rate of Caesarean section, better glycaemic control and better neonatal Apgar scores. Women with diabetes should not smoke during pregnancy because of the increased risk of miscarriage and poorer glycaemic control.
Incisional hernia in a 5 mm laparoscopic port site incision
Authors: Kwok Adrian , Lam Alan , Ford Robert 
Published: February 2008

SUMMARYHerniation of omentum or bowel through laparoscopic incision sites is uncommon. Herniations through 5 mm ports sites are very rare, with less than a handful described in the literature. Undoubtedly however, with the increasing interest