bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sedation breaks: are they good for the critically ill patient? A review
Authors: Pinder Sally , Christensen Martin 
Published: February 2008

AbstractBackground:  Tradition has led us to believe that a heavily sedated patient is a comfortable, settled, compliant patient for whom sedation will improve outcome. The current move witnessed in clinical practice today of limiting sedation has led health care in recent years to question the benefit and necessity of routine, continuous sedation for all patients requiring mechanical ventilation. However, as a result there has been a rise in the amount of agitation being reported as being experienced by patients with the daily withdrawal of sedation.Aims:  The purpose of this paper is to review current arguments for and against perserving with agitation versus re‐sedating, when it presents during the daily sedation breaks.Findings:  Of the literature reviewed, the question to re‐sedate the mechanically ventilated agitated patient during sedation breaks remains an issue of contention. Although there is evidence focusing on the psychological effects of long‐term sedation and sedation breaks specifically, the complex nature of critical illness in some cases means that individualized care is of paramount importance and in‐depth assessment is crucial when deciding to re‐sedate in the face of undetermined agitation. Agitation has been closely linked with several incidents that can be detrimental to patient safety, such as removal of lines and unplanned self‐extubation.Conclusion:  The recommendations of this review are that nurses should re‐commence sedation if the patient becomes agitated following a sedation break.
Medical emergency team: a review of the literature
Authors: Barbetti Julie , Lee Geraldine 
Published: February 2008

AbstractBackground:  A medical emergency team (MET) comprises of a team of doctors and nurses with advanced life support skills, which are hospital based, who respond to emergency calls following a deterioration in a patient’s clinical condition. The role and contribution of such approaches promoting the early recognition and intervention of these vulnerable patients demands critical appraisal.Aim:  To investigate the contribution of medical emergency teams and whether there are clinical antecedents evident prior to the triggering the MET system. The paper will also discuss factors influencing effective utilization and implementation strategies to encourage a culture change required to adopt the MET system.Methods:  A critical review the relevant literature of studies focussed on the MET system.Results:  The majority of published work relating to MET systems was conducted in single‐centres. The introduction of MET systems appears to be linked to a reported reduction in adverse outcomes and early recognition and intervention in clinically deteriorating patients. Additionally, a consistent observation in the studies reviewed was the reported presence of clinically abnormal physiological observations prior to the clinical events such as the cardiac arrest. The evidence in support of MET or equivalent systems, is not straightforward. Issues such as education, resources (human and financial) and communication are vital to success with implementation. Responding promptly to patients who unexpectedly become acutely ill demands skill and competence; however, more research evaluating the role of early ’response’ systems is warranted.
Clinical Trial of SE 505 … A New Oxytocic Mixture
Authors: Barbaro C. A. , Smith G. O. 
Published: February 2008

SummaryA clinical trial has been conducted using SE 505, a new oxytocin: ergometrine mixture. Administration was by intramuscular injection after delivery of the foetus. Comparing the results obtained in a similar group of patients given ergometrine by intravenous injection after delivery of the foetus and ergometrine by intramuscular injection after delivery of the placenta, the new Compound was found to be associated with a significantly greater postpartum haemorrhage rate and mean blood loss.
A Study of Congenital Malformations: PART I
Authors: Pitt David B. 
Published: February 2008

SummaryFour hundred infants with major and minor malformations recognizable at birth have been studied. The incidences were 1.51% and 0.28% respectively (total, 1.79%). The commonest malformations were talipes and congenital heart defects.No correlation with sex incidence was found, other than a male preponderance in genito‐urinary malformations. No correlations were found with the racial origin of the mothers, maternal blood groups, or antenatal obstetrical emergencies.The association with prematurity was confirmed, one‐third of the infants with major malformations being 2,500 g. or less in weight. A tendency was shown for the grosser malformations to result in more premature births.Congenital malformations were a little commoner in the infants of primigravidae; in the infants of mothers over 41 years of age the incidence was increased threefold.Central nervous system malformations, congenital heart defects and multiple malformations contribute most to the pool of perinatal mortality and infant morbidity.
Relation of Congenital Anomalies of the Central Nervous System to the Blood Group of the Mother
Authors: Collmann R. D. , Stoller A. 
Published: February 2008

SummaryWhen percentage distributions by ABO groups or Rh factor were compared, no significant differences were found between the mothers of children with central nervous system malformations, either taken separately or combined, and those of a control group. This result is in accord with the Rhode Island findings. The Dublin result for mothers of anencephalics, however, showed that a statistically significant excess belonged to group O. It might be noted that the incidence of anencephaly in Dublin was very much higher than that for Rhode Island or Melbourne, the rates being 5.9 per 1,000 total hospital births (in one Dublin hospital it was 8.6), 1.93 and 0.66 respectively. It might be said here that the relevant hospital records used in the Melbourne survey were complete and adequate.Whatever genetic or environmental factors may be involved in the aetiology of these malformations, there does not appear to be any appreciable association between the Rh factor or ABO blood grouping and these malformations of the central nervous system, although Penrose (1957), commenting on the Dublin and Rhode Island percentages of group O mothers of anencephalics, suggests that ABO incompatibility remains a possibility in its causation.
Carcinoma In Situ of the Uterine Cervix:Conservative Management in 84 of 190 Cases
Authors: Green G. H. 
Published: February 2008

SummaryA series of 190 patients with cervical carcinoma in situ has been presented. All have been followed for at least 1 year, and more than half for at least 2 years.The definitive treatment was total hysterectomy in 106 patients and local excision in 84. Four of the latter patients ultimately had a hysterectomy.The method of cone biopsy used, and some of its complications, are described.Of the patients who underwent hysterectomy one had positive vaginal smears after operation.Eleven of the conservatively‐treated patients showed evidence of persistent disease and one with incomplete follow‐up is assumed to have it also. The investigation and outcome of these patients are considered in detail; all except one are cytologically free of disease at present.The relative efficiency of the various types of biopsy, in completely excising a carcinoma in situ, is discussed.
Antidiuretic Effects of Oxytocin, Morphine and Pethidine in Pregnancy and Labour
Authors: Liggins G. C. 
Published: February 2008

Summary:Diuresis was induced by a constant intravenous water load in women in late pregnancy and early labour. The effects on urine flow and clearance values of synthetic oxytocin (Syntocinon), morphine and pethidine were studied after their intravenous administration.Oxytocin caused a consistent antidiuretic response when given in doses above 20 mU/min. Morphine and pethidine also caused a marked antidiuresis which persisted for about 7 hours and 2 hours respectively.The onset of painful uterine contractions was not associated with inhibition of diuresis.
Physiological Metaplasia on the Human Cervix Uteri
Authors: Reid B. L. , Blackwell P. M. 
Published: February 2008

Summary:Tissue from the columnar‐covered area of the cervix of women, removed at the first postnatal visit (about 6–7 weeks after delivery) was subjected to the following histo‐chemical procedures: the PAS technique for demonstration of the basement membrane and of mucin, the acid phosphatase technique (studied by both light and electron microscopy) and the DDD technique for the demonstration of SH groups.The variability in structure extending to complete absence of the basement membrane at certain stages of the process of metaplasia is described. The significance of the intimacy of the epithelial and subepithelial tissues at these stages is discussed from the viewpoint of a possible inductive effect analogous to embryonic induction. Columnar cell mucin was noted to be absent in cells of more prominent or superficial situation and toward the vaginal end of the cervical canal.Acid phosphatase labelling of this tissue is shown to occur in columnar epithelial cells and in plasma cells of the subepithelial tissue. Such epithelial staining is, as with mucin, markedly reduced on prominences, e.g., the tips of villous processes. An hypothesis is developed that lysosomes of columnar cells which are responsible for some of the acid phosphatase stain are ruptured by conditions associated with the alteration of the prevailing pH at the cervico‐vaginal junction. Such rupture may in turn damage the columnar cells, depleting their mucin content, and stimulate the production of new (squamous) cells.A gradation of staining with the DDD reagent for SH groups in plasma cells, which are plentiful in sites of active metaplasia, suggests that there is a maturation process at these sites where plasma cells are stimulated to produce antibody. Some part of the plasma cell function appears to be production of antibody and the possible reasons for its production are discussed.
The Place of Foetal Transfusion in Haemolytic Disease: A Report of 22 Transfusions in 16 Patients
Authors: Green G. H. , Liley A. W. , Liggins G. C. 
Published: February 2008

Summary:

A series of 22 foetal transfusions performed in 16 patients over a period of 12 months is presented.
In infants hydropic at the first transfusion the procedure was of no benefit, all such infants dying in utero. Demonstrable hydrops is at present a contraindication to foetal transfusion.
Of 8 infants not hydropic at the first transfusion, 6 survived and were well at periods of 2 months of age and more. One developed hydrops prior to a second transfusion and one died in the neonatal period at 32 weeks after 3 foetal transfusions.
Amniotic fluid analysis is considered to be of the utmost importance in the selection of cases.
Some points in the technique are briefly discussed. No notable risks to foetuses so treated have yet been demonstrated.
The place of foetal transfusion in the management of pregnancy complicated by rhesus sensitization is discussed. Theoretically it should not be necessary in more than 1 in 2,000 pregnancies. Benefits accruing from the procedure are the saving of some babies poised between the risks of intrauterine death and neonatal death from prematurity, the drawing of attention to the prognostic value of amniotic fluid analysis by spectrophotometry, and an indication of the principle that it is possible to treat an infant in utero.
Any patient with rhesus sensitization whose amniotic fluid shows an optical density for the 450 mμ peak of above 0.20 between 28 and 32 weeks of pregnancy should be considered for foetal transfusion.
Mitotic Activity and Radiation Response in Uterine Malignancy*
Authors: Cox L. W. , Wakonig R. , Harvey N. D. 
Published: February 2008

Summary:1. Eighteen patients having intracavitary Cobalt 60 treatment in 3 divided doses for cervical carcinoma were assessed for mitotic activity.2. Two patients who showed active mitosis after 2 cobalt applications had residual carcinoma after a full course of radiation.3. Five patients who showed active mitosis after 1 cobalt application have no recurrence yet.4. All patients in whom mitotic activity had ceased after the first cobalt application have remained free from disease (except one where early metastases occurred outside the field of irradiation). The longest period of follow‐up is 2½ years.
Reservations on the Safety of Oxytocin Nasal Spray in Obstetrics*
Authors: Bradfield Alan 
Published: February 2008

Summary:1. Claims for the safety of oxytocin nasal spray in induction and enhancement of labour were tested in 102 patients. In 44 the pregnancies had been normal; in 58 the pregnancies were complicated by toxaemia, hypertension, post maturity, diabetes and elderly primigravidity.Foetal heart rate and amniotic fluid pressure were recorded continuously.2. The efficacy of the spray was confirmed, but in contrast to previous reports significant uterine hyperactivity and hypoxic foetal heart rate changes were observed.3. In 7 of the 102 patients the spray induced marked uterine hypertonus. Serious foetal bradycardia resulted and was followed by sustained tachycardia as uterine hyperactivity waned.Hypoxic foetal heart rate changes were more common when pregnancies were complicated. They were seen less frequently when the spray was employed in the induction of labour than in the enchancement of labour.4. Oxytocin nasal spray lacks precision. The preparation used in this study delivered a higher dose than that reported in similar studies from U.S.A. A metered aerosol pack is undergoing trial.5. Meanwhile, in complicated pregnancies uterine stimulation is more safely achieved by controlled intravenous infusion.
Advanced Tubal Pregnancy: A Case of Survival of Mother and Baby
Authors: Schokman Christopher M. 
Published: February 2008

Summary:A case has been reported of advanced tubal pregnancy. It was attended by the survival of the mother and, probably by the very nature of its mode of presentation, by survival of the child.Some diagnostic features of this unusual condition have been discussed in the light of previous reports of similar cases.Comment has been made on some clinical and radiographic features of the case.
Vehicular Accidents and Pregnancy
Authors: Elliott Murray 
Published: February 2008

Summary:A survey of 8 fatal and 31 non‐fatal traffic injuries in pregnant women is presented.The ability of women to withstand trauma is not greatly influenced by pregnancy, but the hypertrophied and distended pelvic blood vessels are more vulnerable to injury because of the commonness of fractured pelvis and violent movement of the pregnant uterus.Despite the protuberance of the pregnant uterus, it resists most blunt external trauma and purely obstetric complications are rare.The foetus seems remarkably safe in its intact amniotic sac. Maternal hypotension and not direct trauma is the commonest cause of foetal death.Uncontrolled haemorrhage was the usual cause of death in this series. Some of these tragedies may well have been prevented by earlier laparotomy.
Obstetric Acute Yellow Atrophy
Authors: Giles P. F. H. 
Published: February 2008

Acute liver failure in pregnancy is rare. Mother and foetus usually die whether liver failure is due to acute viral hepatitis, hepa‐totoxic agents, eclampsia, or whether it is due to “obstetric acute yellow atrophy” in which there is no necrosis but a gross fatty change in the liver. Moore (1956) suggested the term “acute fatty liver of pregnancy” for this unusual appearance. It was, however, Sheehan in 1940 who first recognized “obstetric acute yellow atrophy” as a distinct clinical entity and since then just over 40 cases have been reported.SUMMARYThe case history of a patient who died from obstetric acute yellow atrophy is presented and discussed.
An Unusual Case of Primary Abdominal Pregnancy
Authors: Beischer N. A. 
Published: February 2008

Advanced abdominal pregnancy, although infrequently encountered, is a well documented entity because it is one of the most hazardous complications of child‐bearing (Mackay, 1959). The diagnosis may not be made until the time of operation when the surgeon faces the major problem of the management of the placenta (Hibbard, 1957). It is evident that abdominal pregnancies will not be recognized unless they are considered in the differential diagnosis of obstetrical conditions having abnormal signs and symptoms (Cross et al, 1951).SUMMARYA case of primary abdominal pregnancy is reported.The placenta was attached to the posterior peritoneum of the pouch of Douglas which was expanded inferiorly and contained most of the gestation sac.Retroplacental bleeding had resulted in a large haematoma which occluded the vagina in its middle third and displaced the rectum to the right lateral pelvic wall.
Shock and Ureteric Obstruction following Vaginal Repair
Authors: Gudgeon C. W. 
Published: February 2008

Partial ureteric obstruction may occur in the course of a vaginal repair. Combined with urinary infection post‐operatively, a characteristic illness with nausea, pyrexia, shock, and oliguria may occur within the first week.SUMMARYThree patients with ureteric obstruction following vaginal repair are reported.This complication should be suspected if the post‐operative course is characterised by unexplained and prolonged nausea or pyrexia.The onset of rigors, oliguria and shock usually indicates the presence of gram‐negative endotoxic shock; the treatment of this condition is briefly discussed.
Brachial Arterial Blood Pressure in the Lateral Recumbent Position during Pregancy
Authors: Trower R. , Walters W.A.W. 
Published: February 2008

SummaryBrachial arterial blood pressures measured by sphygmomanometry fall significantly in most non‐pregnant and normal pregnant women when they turn from the supine to right or left lateral recumbent positions. These changes are most marked in the second trimester of pregnancy. This finding is in contrast with the rise in brachial arterial blood pressure and relief of adverse symptoms that occur when pregnant women who develop the supine hypotensive syndrome are turned into a lateral position.Possible mechanisms to account for these blood pressure changes are discussed.
Subarachnoid Haemorrhage Associated with Pregnancy
Authors: Baker J. W. 
Published: February 2008

SummaryFour cases of subarachnoid haemorrhage associated with pregnancy occurring at the Royal Women's Hospital in the period 1961–1965 have been presented. The only maternal death which occurred in Queensland during this period is also presented. A general review of the literature with regard to incidence, clinical features, angio‐graphy, aetiology, obstetrical management and prognosis is presented.
Antenatal Anaemia and Postpartum Haemorrhage
Authors: Dewar Marion J. 
Published: February 2008

Summary and ConclusionA study was made of the postpartum haemorrhage rates in 170 patients with iron‐deficiency anaemia diagnosed in the last 3 weeks of pregnancy and in 1,743 non‐anaemic patients, both groups being delivered at National Women's Hospital during the period January to August, 1966. No significant difference between the 2 groups was found. It was concluded that urgent methods (blood transfusion and intravenous iron therapy) of overcoming iron‐deficiency anaemia in the last 3 weeks of pregnancy are not justifiable quite apart from their risks.
Induction of Labour by Amniotomy and Micro‐infusion of Oxytocin (Syntocinon)
Authors: Townsend Lance , Pepperell Roger J. 
Published: February 2008

SummaryA method of induction of labour by amniotomy and micro‐infusion of oxytocin (Syntocinon) is described. The micro‐in‐ fusion reduces the amount of intravenous fluid required to effect delivery to less than 500 ml. in most cases.There were no maternal complications and 96% of patients were delivered on the day of the infusion.The Caesarean section rate was 3%. There was no perinatal mortality attributed to the method of induction.The potential risks of the method are emphasized.
Spontaneous Respiratory Rate in First Stage Labour‐Comparison with the Breathing Exercises of Natural‐Childbirth Methods
Authors: Blankfield Adele 
Published: February 2008

SummaryThe spontaneous respiratory rates which occurred in normal labour have been timed during and between contractions, in calm patients. Respiratory rate in early first stage labour is not significantly influenced by contractions. With the progression of normal labour, the rate during contractions increases, particularly in late first stage when it is doubled. The rates of the psychoprophylaxis (Lamaze) method breathing exercises for late labour are very much higher than those which occur in normal, untrained patients at this stage.
Experiences with Artificial Insemination
Authors: Hill Arthur M. 
Published: February 2008

SummaryExperiences with 21 patients treated by artificial insemination are presented. The clinical features of the patients– 16 treated by A.I.D. and 5 by A.I.H. are discussed. As a result of insemination, 13 of 16 dedicated patients were delivered of 18 living, healthy children, while those who were casual in approach had no success.
The Relationship of Oral Contraception to Depression
Authors: Leeton John , Leinkram C. , Stiglitz J. 
Published: February 2008

SummaryA single double‐blind trial on a combined contraceptive drug was carried out on a lower socio‐economic group of women between Day 21 and 42 of the puerperium. Their levels of depression were measured before and after taking these drugs by means of a questionnaire. No statistical difference was found between the mean depressive score of the group on the active pill compared with that on the placebo.
The Investigation and Treatment of Patients with Ovulation Failure: with Special Reference to the Problems Arising with the use of Clomiphene
Authors: Schokman F. C. M. , Correy J. F. , Cusick E. T. 
Published: February 2008

SummaryAn analysis has been made of the results of investigation and treatment of patients with anovulation and oligo‐ovulation who attended a gynaecological endocrine clinic.This has revealed the need for a careful evaluation of the parameters for detecting ovulation and demonstrates the fallacy of using a single parameter as an indicator of ovulation. A scheme of management is proposed which takes into account the value of treatment with placebo and cyclic hormone therapy and which may help to elucidate the problem of failure to achieve pregnancy when the use of clomiphene followed by HCG has presumably resulted in ovulation.
Vasa Praevia
Authors: Quek S. P. , Tan K. L. 
Published: February 2008

SummarySeven cases of vasa praevia were encountered in 35,000 deliveries. The diagnosis was made antepartum in 5 cases. One death was directly attributable to this condition, and another may have been related to it.Although fetal mortality generally has been forbidding, it is stressed that a greater awareness of the condition, coupled with a high index of suspicion, can result in more frequent antepartum diagnosis and an improved fetal prognosis.
Oral Contraceptives and Thrombo‐embolism
Authors: McQueen E. G. 
Published: February 2008

SUMMARYOestrogencontaining oral contraceptives increase many of the factors involved in thrombosis, presumably as a result of hepatic enzyme‐induction, Clinical and pathological data suggest a special liability to thrombotic complications and retrospective statistical surveys appear to have confirmed an increased mortality and morbidity. It is possible that the diminished oestrogen content of oral contraceptives now in use may be diminishing the risk.