bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple Polypoid Endometriosis‐A Rare Complication Following Withdrawal of Gonadotrophin Releasing Hormone (GnRH) Agonist for Severe Endometriosis: A Case Report
Authors: Othman Nor H. , Othman M.S. , Ismail A.N. , Mohammad N.Z.N. , Ismail Z. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because the condition of multiple pelvic polypoid lesions seems previously unreported, is an interesting clinical puzzle, and may be a rare complication of hormone therapy. Sections of these polyps have been reviewed by very senior pathologists one of whom confirmed that ‘they consist of an endometrial glandular component, a mesenchymal component and large numbers of blood vessels. One possibility is that simply these are very much altered foci of endometriosis‐though I find it difficult to believe that these lesions are due to hormonal therapy for if they were I am sure such lesions would have been recorded before now’. Can any reader provide further relevant information?Summary: A 30‐year‐old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.
Malignant Degeneration of Mature Cystic Teratomas*
Authors: Zorlu C. Gürkan , Kuscu Esra , Soysal Mehmet Emin , Caglar Turhan , Aydogdu Tugrul , Cobanoglu Omer , Alaybeyoglu Tuncay , Gökmen Oya 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper to remind readers that about 2% of cystic teratomas have undergone malignant transformation at the time of presentation. Frozen section study of the tumour may allow appropriate staging laparotomy and excisional surgery in these women. In the editor's experience frozen section of macroscopically benign ovarian tumours is being used increasingly. The false negative results of frozen section in 2 of 4 cases reported in this study is noteworthy but recent large series have shown that with the exception of tumours of borderline malignancy, the sensitivity and specificity of frozen‐section diagnosis of ovarian tumours are high (A).A. Rose PG, Rubin RB, Nelson BE, Hunter RE, Reale FR. Accuracy of frozen‐section (intraoperative consultation) diagnosis of ovarian tumors. Am J Obstet Gynecol 1994; 171: 823–826.Summary: Malignant transformation of benign cystic teratoma is rare and the most common malignancy is squamous cell carcinoma. The diagnosis is rarely made preoperatively and the prognosis is usually poor. We report 4 cases with dermoid cysts showing malignant transformation, 3 with squamous carcinoma and 1 with adenocarcinoma. The patients were within the reproductive age and underwent surgical intervention with intraoperative evaluation. Frozen section identified 2 cases with malignant transformation and staging laparotomy was performed at the initial laparotomy. One of the remaining underwent reoperation following a pregnancy termination and the other refused further surgery. None had metastases and/or capsule invasion. One had tumour rupture during excision and received combined chemotherapy following surgery. Three of the patients remain well and 1 is lost to follow‐up.
Association of Contraceptives and HTV‐1 Infection in Thai Female Commercial Sex Workers
Authors: Taneepanichskul Surasak , Phuapradit Winit , Chaturachinda Kamhaeng 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it shows that condom usage is significantly associated with a lower incidence of HIV‐1 infection in commercial sex workers. This important message can more readily be obtained from a community with a high prevalence of HTV‐1 infection. This paper also provides a sad glimpse into the lives of these sex workers whose condom usage is at best described as modest.Summary: We conducted a case‐control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV‐1 infected sex workers were eligible for inclusion and 258 HIV‐1 negative women were recruited as controls during the period of October 1, 1993 to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work and sexual practice during menstruation. The ratio of case per control was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pill, injection, other contraceptives and HIV‐1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high‐risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.
Ovarian Response to Purified FSH in Infertile Women with Long‐standing Hypogonadotrophic Hypogonadism
Authors: Fox Robert , Ekeroma Alec , Wardle Peter 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper to illustrate an important point, namely that purified FSH preparations may not be appropriate for ovulation induction in ‐women lacking adequate levels of endogenous luteinizing hormone. Furthermore, if these preparations are used then reliance on oestradiol determinations alone may lead to inappropriate conclusions about the number of preovulatory follicles. However, there is probably a place for preparations of purified FSH in women with high circulating levels of endogenous luteinizing hormone.Summary: It has previously been proposed that all anovulatory women requiring exogenous gonadotrophin therapy could be treated by purified FSH alone in the follicular phase. We have studied the ovarian response to purified FSH in 5 amenorrhoeic women with low endogenous LH production as a result of longstanding hypothalamic amenorrhoea. Follicles developed in all of the women but the rise in oestradiol was very slow. As a consequence of the HCG injection being delayed to allow the follicles to become functionally mature, too many follicles attained a preovulatory size. After the treatment was changed to more conventional preparations containing bom FSH and LH, the women had improved ovarian responses and 3 of them conceived. It is clear that FSH alone will promote follicular growth but that LH is needed to stimulate follicular function. We conclude that LH does play an important role in follicular maturation and that it is a critical component of exogenous gonadotrophin therapy for women with prolonged hypogonadotrophic hypogonadism.
Laparoscopic Surgical Treatment of Ectopic Pregnancy: Salpingectomy or Salpingostomy?
Authors: Parker Jim , Bisits Andrew 
Published: February 2008

EDITORIAL COMMENT: We accepted this review for publication because it examines the important point of whether the classical operation of salpingectomy for tubal ectopic pregnancy provides superior results to salpingostomy in terms of subsequent fertility, and the possibility of short‐term complications due to incomplete removal of the ectopic pregnancy, or subsequent complications in terms of recurrence of a further ectopic pregnancy in the same tube. Of course there is seldom an indication for salpingectomy when the ectopic pregnancy is situated in the patient's only remaining Fallopian tube although it can be necessary if the tube is destroyed by rupture or salpingectomy is required to achieve haemostasis. In any case the woman can still become a mother with in vitro fertilization‐embryo transfer technology. This paper contains considerable information about the value of laparoscopy versus laparotomy in the surgical management of ectopic pregnancy but it seems to the Editorial Subcommittee that the important point being examined is whether or not salpingostomy should be attempted rather than salpingectomy in the majority of patients with ectopic tubal pregnancySummary: There is a widespread belief that salpingostomy is the treatment of choice for ectopic pregnancy. The ability to treat most ectopic pregnancies via a laparoscopic approach has been a major advance in gynaecological surgery. Despite die well publicized benefits of laparoscopy over laparotomy only 50% of patients with ectopic pregnancies in Australia presently benefit from this surgical advance. Although it is clear that laparoscopic treatments are preferable to laparotomy there is no consensus on whether salpingectomy or salpingostomy should be performed, despite over 40 years of research since the introduction of conservative tubal treatment. A systematic review of laparoscopic surgical treatments is needed and could be incorporated into die Cochrane Collaboration. A prospective clinical study, with long‐term follow‐up, needs to be performed to evaluate fertility prognosis and complications after laparoscopic salpingectomy versus salpingostomy.
Vulval Varicosities and Labial Reduction
Authors: Fliegner John R.H. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since we agree with the author that it is rare for patients to request surgery for enlargement of the labia minora. Presumably patients would take such a problem to a gynaecologist, although as reference 3 shows, the editor would refer the unusual problem of vulval varicosities requiring surgery to a vascular surgeon, although the case concerned was complicated in other ways. Variation in size of the labia minora is quite remarkable as is the rarity of women seeking surgical correction of the condition. The editor has managed only one such patient, a woman with asymmetrical enlargement of the labia minora. Against his better judgement a simple reduction was performed on the left labium minus. Postoperatively the patient complained of intolerable pain although the wound appeared uncomplicated and healed uneventfully. The woman when last seen at follow‐up 3 months later remained unhappy with the operation and was concerned by the apparent enlargement of the right labium minus. Perhaps we should ask our plastic surgeon colleagues if they often perform plastic surgery for enlargement or asymmetry of the labia minora. Our senior gynaecologist reviewer stated that he has performed ligation of vulval varicosities in nonpregnant women in the way described by the author. He also stressed the need to mark the varicosities with the patient in the standing position prior to surgery. We reviewed the gynaecological surgical audit of one Melbourne hospital for 6 years to determine the prevalence of labial reduction. There were 3,896 cases of major abdominal or vaginal surgery, 2,126 laparoscopics and 14,054 of minor surgery, including 6 of labia minora reduction by excision of the excessive tissue; the operation was unilateral in 5 women and bilateral in 1.Summary: Vulval varicosities and hypertrophic labia minora are 2 conditions that receive relatively little attention in the literature. However, they may cause especially bothersome discomfort in some women. Appropriate surgical treatment is eminently successful if certain guidelines and attention to detail are followed. The treatment of both conditions is described based on illustrative case reports, and a review made of the surgical anatomy.
A Case of Complete Iatrogenic Amnioreduction at 20 Weeks' Gestation
Authors: Griffin Christopher , Peek Michael John 
Published: February 2008

EDITORIAL COMMENT": The editorial committee found this case report irresistible as an example of triumph over misfortune and disability. Iatrogenic, accidental, prolonged and complete amnioreduction is unique in the editor's clinical experience and knowledge of the literature. Importantly the case also illustrates that conservative management of ‘premature rupture of the membranes'can be successful. The favourable outcome may have been related to the abdominal rather than the usual cervical route of amnioreduction, and the restoration of normal liquor volume after the amnioreduction was discontinued. Moreover, in spontaneous rupture of the membranes the cause of the problem is likely to be persistent.Summary: A successful outcome for an infant following complete iatrogenic amnioreduction at 20 weeks gestation is possible without any invasive medical treatment.
Coital Tear: A Rare Cause of Secondary Peritonitis
Authors: Khosla Anju Huria , Singhal Savita 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication to warn readers that coitus‐induced tears to the posterior fornix of the vagina can involve peritoneum and bowel. The authors claim this injury is common in India and at our request provided the information that in 1995 they treated a total number of 7 patients with coitus‐induced vaginal tears in their hospital which has some 4,000 deliveries per year. The authors noted that the incidence of this injury is much higher than these figures would indicate because ‘people do not like young girls being asked questions by male medical graduates and for this reason prefer to go to private hospitals for the problem of coital tears’. They stated that for Indians coital tears are relatively common and any obstetrician would see 4–5 cases every 1–2 years’. We have previously published information from Papua New Guinea describing 13 cases of laceration to the posterior fornix of the vagina from voluntary intercourse seen over a period of 3 years at the Port Moresby General Hospital (A), and 13 cases of women with coital injury admitted with haemorrhagic shock requiring resuscitation with blood transfusion seen over a period of 4 years from the Nehru Hospital (B). Anate (C) has reported the details of 36 cases of vaginal trauma due to intercourse seen over a 6‐year period in Nigeria. All of these papers stress the frequent involvement of the posterior fornix of the vagina in these coitus‐induced injuries.Summary: A rare cause of secondary peritonitis due to coital tear is presented. The correct diagnosis can be made by a detailed history and gynaecological examination. Prompt surgical management is mandatory to prevent grave prognosis.
Fertility Awareness in Women Attending a Fertility Clinic
Authors: Blake D. , Smith D. , Bargiacchi A. , France M. , Gudex G. 
Published: February 2008

EDITORIAL COMMENT: In this paper the authors have made an important point. Counselling concerning simple treatment options should be the first step in the management of infertility as for most other medical problems. Conversely it could be said, as stated by an Anglican priest to the editor about 10 years ago, that counselling the infertile couple, who were candidates for only the most complicated regimens of reproductive technology, should include acceptance of their infertility. Many years ago the editor, when doing a locum, met a couple whose longstanding infertility was the result of misunderstanding of the physiology of conception, with avoidance of coitus at the fertile time of the cycle ‐ conception occurred 2 months after a simple explanation of the physiology of the menstrual cycle as advocated in this paper.Summary: Eighty women attending for consultation at a tertiary referral fertility unit over a 3‐month period were surveyed for their knowledge of fertility awareness and how they used this information to enhance their chances of conception. It was hypothesized that less than 50% of the subjects had an adequate understanding of when the fertile time occurred in their menstrual cycle. A questionnaire was completed anonymously by each subject and these were scored in 3 categories for fertility awareness by 2 independent Natural Family Planning teachers. Scores ranged from 0 for women who had no concept of fertility awareness, to 6 for women who were highly aware. The results showed that 26% (n=21) of subjects had a score of 4 or greater which was considered as having an adequate understanding. The hypothesis was accepted, giving reason for concern about the effectiveness of consumer education at all levels of fertility investigation.
Spontaneous Rupture of the Urinary Bladder in the Puerperium
Authors: Kekre Aruna N. , Kekre Nitin , Nath Vishwambhar , Seshadri Lakshmi 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it is important for obstetricians to know that spontaneous rupture of the bladder can occur in the puerperium even when there is no predisposing cause such as obstructed labour or previous injury.Summary: Spontaneous rapture of the urinary bladder in the puerperium is extremely rare. The patient usually presents with acute abdominal pain. Awareness on the part of the treating surgeon that bladder rupture is a possibility will lead to an early diagnosis. Immediate exploration, removing urine from the peritoneal cavity or retropubic space, closing the rupture and securing good vesical drainage, results in resumption of vesical function, and thereby decreases the mortality and morbidity.
A Case of Transvaginal Evisceration
Authors: Cerqui Anthony J. , Haran Mano , Collier Sheree M. 
Published: February 2008

EDITORIAL COMMENT: These spectacular cases are often entitled ‘vaginal evisceration’ (seeReferences). Chambers twentieth century dictionary defines eviscerate as ‘to tear out the viscera or bowels of: to gut’ which seems to imply protrusion of a great deal more than what is seen in these frightening (to both patient and physician) rare cases. With respect, the editor strongly disagrees from lack of such cases seen by him, and his reading of the literature, that ‘most cases are probably unreported, occurring in premenopausal women as a result of coital trauma, rape or obstetric trauma’.Summary: We present a case of spontaneous evisceration of the small bowel through the vaginal vault in a 61‐year‐old woman. The predisposing factors and management are discussed.
A Novel Approach to the Management of Pregnancies Complicated by Uteroplacental Insufficiency and Previous Stillbirth
Authors: Oyelese K. O. , Black R. S. , Lees C. C. , Campbell S. 
Published: February 2008

EDITORIAL COMMENT: These interesting case reports present apparently favourable results of an uncontrolled experiment in the treatment of suspected fetal compromise. Women with a history of severe fetal growth retardation leading to fetal death in utero in whom no underlying cause (diabetes, renal disease, antiphospholipid syndrome) is found present a difficult management problem in future pregnancies. There is a clear risk of recurrence but there is no clearly proven effective method of prevention or treatment. In the past 40 years there have been many other methods of treating fetal growth retardation andplacental insufficiency, ranging from the introduction of intraamniotic amino acids and maternal intravenous dextrose infusions, to abdominal decompression, beta‐sympathomimetics, supplemental oxygen, dipyridamole, heparin and aspirin. Some of these methods carry risks and in the absence of a specific aetiology for the problem none of them has been shown effective in appropriately conducted trials. The use of trans dermal glyceryl trinitrate (GTN) for suspected fetal compromise has the advantages of ease of use and apparent safety, given the long experience with this drug. As the authors point out there is also theoretical and experimental justification of its use to improve Uteroplacental perfusion. However, these 2 cases cannot be considered reliable evidence of the use of GTN in clinical practice but may point the way for further research.Summary: To our knowledge, this is the first time that a combination of aspirin and glyceryl trinitrate (GTN) has been used in the prophylaxis of preeclampsia and fetal growth retardation, and their use associated with not only Doppler screening of the uterine arteries but also regular Doppler follow‐up of the fetal arterial and venous circulation. Whilst future trials are needed to prove whether screening, prophylaxis and Doppler management are individually beneficial, we propose that this combination of management strategies contributed to a good outcome in the cases described. Furthermore, randomized trials are required to determine the safety and efficacy of prophylactic low‐dose aspirin combined with GTN treatment in pregnancies affected by an impaired Uteroplacental circulation.
Symptoms During Normal Pregnancy: A Prospective Controlled Study
Authors: Martina Zib BMed Sc(Hons)  , Lynette Lim BSc (Hons)MSc, PhD and  , William A. W. Walters PhD FRCOG, FRANZCOG, FACSHP  
Published: February 2008

EDITORIAL COMMENT: This is an important study which attempts to evaluate the effect of pregnancy on numerous symptoms. The point of this comment is to direct readers to table 3 because it contains much information of interest and importance that has not been dealt with in the text because of space considerations. For example, there is confirmation of the wide‐held belief that epistaxis is much more common in pregnancy and the same can be said for fainting, flushing and shortness of breath. The increased incidence of nausea, heartburn and bleeding gums also fits with traditional teaching and beliefs, at least of the editor, but the finding that headache is less common in pregnant women was a surprise. There is confirmation that leg cramps and abdominal pain are common in pregnancy. The increased frequency of nail changes was news to the editor, although the urogenital symptoms preponderance in the pregnant group was expected. The huge increase in dyspnoea during at rest and exertion in the pregnancy group also warrants emphasis. N.B.Summary: Symptoms of normal pregnancy have received scant attention in the literature and what is reported is largely unsubstantiated. Yet this is an important aspect of antenatal counselling and care which deserves further investigation if symptoms are to be interpreted correctly. Accordingly, we conducted a prospective controlled study of symptoms during normal pregnancy in both primigravidas and multigravidas. A total of 38 symptoms occurred with a significantly different frequency (mainly increased) in the pregnant subjects in the third trimester compared with the controls. Of these a mean of 24.2 symptoms was experienced by each pregnant woman, double that (mean, 11.2) experienced by healthy nonpregnant controls. The 5 symptoms reported most frequently by the pregnant subjects were frequency of micturition, fatigue, pelvic pressure, insomnia and lower backache. However, a wide range of symptoms involving most body systems were reported. This study has established that symptoms of pregnancy are more numerous than mentioned in current obstetric texts and that they can be attributed to the effects of pregnancy. The third trimester is associated with the greatest number of symptoms and there is a marked decline in their number after delivery.