bluuebunny/crossref_metadata_2025_split huggingface dataset:
Invasive Squamous Cell Carcinoma of the Vulva: Behaviour and Results in the Light of Changing Management Regimens
Authors: Lingard D. , Free K. , Wright R. G. , Battistutta D. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10‐year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.Summary: Ninety‐nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five‐year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.
Neonatal Herpes Simplex: Royal Women's Hospital 10‐year Experience with Management Guidelines for Herpes in Pregnancy
Authors: Garland Suzanne M. 
Published: February 2008

Summary: In the 10‐year period 1982–1991 inclusive, 6 cases of neonatal herpes simplex were diagnosed at the Royal Women's Hospital, Melbourne (1 disseminated, 1 pneumonitis, 4 cutaneous [1 with central nervous system involvement]), resulting in an incidence of 1 in 11,000 livebirths for this population. Three cases were due to HSV 1 and 3 to HSV 2. In no case did the mother have a recent or past history of overt genital herpes infection. Two cases were acquired in utero, an uncommonly recognized form of infection. A favourable long‐term outcome occurred in 2 of 4 cases in which diagnosis was prompt and antiviral therapy was instituted rapidly.Routine antenatal screening in the last trimester of pregnant women with a history of genital herpes before pregnancy is not advised, because the results have been shown to be unreliable in predicting viral shedding and hence the infants' risk of exposure to virus at delivery. A protocol for management of herpes in pregnancy is included.
Measurement of Blood Pressure During Pregnancy: Evaluation of the ‘TriCUFF’
Authors: Brown Mark A. , Buddie Megan L. , Whitworth Judith A. 
Published: February 2008

Summary: Previous surveys have revealed that a major source of error in measuring blood pressure in pregnant women is failure to use a large cuff when necessary. We have tested the hypothesis that this problem could be overcome by using a single cuff containing automatically selected inflation bladders of appropriate size, the TriCUFFr̀.We compared readings obtained with the TriCUFFr̀ with those obtained using standard adult or large (obese) cuffs in 51 pregnant women. Thirty nine had normal upper arm circumferences (< 34 cm) and 12 increased arm circumferences (≥34 cm). The TriCUFFr̀ overestimated standard cuff systolic and diastolic (phase IV) readings by 2 (0–4) mmHg (mean, 95% confidence limits)(< 0.05). There was no difference between readings for women with large arms. Agreement between readings by both methods was acceptable for clinical practice in most cases.Use of the TriCUFFr̀ could significantly improve the accuracy of blood pressure recording in pregnant women.
Catamenial Epilepsy
Authors: Chia Kee Vui , Scarffe Robert John 
Published: February 2008

EDITORIAL COMMENTS: We accepted this case so readers can judge when menstruation‐related epilepsy may warrant such a radical remedy as bilateral oophorectomy. We have published the report of a case of severe menstrual migraine which also responded to bilateral oophorectomy and hysterectomy, and in which subsequent oestrogen replacement therapy likewise did not cause a relapse (A).A. Holdaway IM, Parr CE, France J. Treatment of a patient with severe menstrual migraine using the depot LHRH analogue Zoladex. Aust NZ J Obstet Gynaecol 1991; 31: 164–165.
Should Assessment of Amniotic Fluid Volume Form an Integral Part of Antenatal Fetal Surveillance of High Risk Pregnancy?
Authors: Anandakumar C. , Biswas A. , Arulkumaran S. , Wong Y. C. , Malarvishy G. , Ratnam S. S. 
Published: February 2008

Summary: This study was conducted to evaluate the role of the Amniotic Fluid Index (AFI), used along with nonstress cardiotocography (NST) and fetal acoustic stimulation test (FAST), when required, in prediction of adverse pregnancy outcome. Over a 3‐year period 565 pregnant women had antepartum fetal surveillance due to various high risk pregnancy factors and delivered within 7 days of the test. Antepartum fetal surveillance included nonstress cardiotocography together with estimation of AFI. Need for induction of labour, presence of meconium at rupture of membranes, Caesarean section for fetal distress, Apgar score at 5 minutes, need for neonatal endotracheal intubation, admission to neonatal special care unit and perinatal death were the main outcome measures.Nonreactive nonstress tests and Caesarean sections for fetal distress were more common and neonatal outcome was significantly poorer in patients with AFI < 5 cm than in those with higher AFI values. Of the 4 perinatal deaths in the group with AFI < 5 cm, 3 had a reactive NST within 7 days of fetal death.It is concluded that pregnancy outcome is often poor in the presence of very low AFI and in these cases a reactive NST loses its usual reassuring value. It is suggested that AFI estimation should be included as an integral part of antepartum fetal surveillance of high risk pregnancies.
Laparoscopic Hysterectomy ‐ a Technique
Authors: Jones Robert A. 
Published: February 2008

EDITORIAL COMMENT": We accepted this paper for publication because it considers many of the minutiae of how to perform a laparoscopic hysterectomy. The editorial board considers it is appropriate to publish this information since there is an apparent revolution in consideration of this new method of rendering vaginal hysterectomy safe in the patient who otherwise would require an abdominal hysterectomy. Readers are also directed to the discussion in this paper which considers the philosophy of the operation and the possible changes it may inspire regarding gynaecological surgery in general.The laparoscope and hysteroscope seem engaged in a new competition for the best way to manage menorrhagia and abdominal pain in the patient who previously was treated by abdominal hysterectomy. This Journal has published a number of papers in the past 18 months that present an overview of both of these 2 new techniques.Summary: A technique for the performance of laparoscopic hysterectomy (laparoscopic‐assisted vaginal hysterectomy) is described. There are particular advantages to the patient in using this technique. There are also social and financial advantages. It is envisaged that this technique will become part of the routine surgical armamentarium of the gynaecological surgeon, whose personality disposes him towards this type of surgery. A prediction is made as to the future use of this surgical technique.
Laparoscopic Removal of Endometriosis in the Pouch of Douglas
Authors: Wood Carl , Maher Peter , Hill David 
Published: February 2008

EDITORIAL COMMENT": This paper provides important data on dealing, via the laparoscope, with endometriosis involving the uterosacral ligaments and peritoneum of the pouch of Douglas in patients with pelvic pain and/or infertility. None of the 26 women in this study had had a hysterectomy, although this procedure usually relieves pain associated with endometriosis involving the pouch of Douglas and uterosacral ligaments. Perhaps we require more data regarding symptoms from residual endometriosis in patients having hysterectomy and uterosacral endometriosis; relevant considerations include whether bilateral oophorectomy is also performed or whether the patient receives postoperative hormone replacement therapy in this circumstance. It seems to the editor that the uterosacral ligaments and pouch of Douglas are seldom removed when hysterectomy is performed in the type of cases reported in this paper; one achieves mobility of the uterus before its removal by cutting the uterosacral ligaments, not removing them; in these cases we are concerned about the keeping away from the ureters and rectum rather than excising scarring due to endometriosis ‐ yet the authors note that ‘biopsy of scarred lesions often shows active endometriosis!Summary: Twenty‐six patients with endometriosis in the pouch of Douglas were treated by laparoscopic excisional surgery; previous medical and surgical therapy had failed in 24 of them. Endometriosis in the pouch of Douglas occurred infrequently in association with bladder or ovarian endometriosis. Coital and rectal pain were markedly reduced or cured 6 months after surgery in all except 2 patients. Laparoscopic surgical excision of endometriosis is indicated when drug or other surgical treatments fail and may avoid the need for hysterectomy in some patients.
A Pregnancy After Planned Partial Endometrial Resection
Authors: Wood Carl , Rogers Peter 
Published: February 2008

Summary: A 28‐week pregnancy is reported after a planned partial endometrial resection in an infertile patient. The fetus died 32 hours after birth because of prematurity consequent to premature membrane rupture and premature labour. A partial placenta accreta was dealt with at Caesarean section.Complete endometrial resection may not be required to cure menorrhagia. It may be possible to control menorrhagia by targeting specific areas of endometrium associated with menorrhagia. Fertility may be retained by leaving the fundal and peritubal endometrium.The increased risks of pregnancy complications following endometrial resection suggest that more information is required to design endometrial resection so as to both cure menorrhagia and to sustain successful pregnancy.
Primary Liver Carcinoma Complicating Pregnancy
Authors: To W. K. , Ghosh A. 
Published: February 2008

EDITORIAL COMMENT": We accepted this case report because the Australian population now has many women who are hepatitis B surface antigen positive. This case will remind readers that primary carcinoma of the liver can occur in such women and that effective management is now available by spectacular major surgery. Ideally all women (and men) who are hepatitis B surface antigen positive should have regular (every 1–2 years) serum alpha fetoprotein estimations to facilitate early diagnosis of primary hepatocellular carcinoma.Summary: Primary hepatic carcinoma complicating pregnancy has been sporadically reported in the literature. Its association with grossly raised serum alphafetoprotein values is of particular interest to obstetricians who perform routine maternal alphafetoprotein screening in the second trimester. A case with favourable maternal and fetal outcome is presented.
Clinical Estimate of Birth‐weight in Labour: Factors Influencing Its Accuracy
Authors: Chauhan Suneet P. , Meydrech Edward F. , Washburne Joseph F. , Hudson Jeffrey L. , Martin Rick W. , Morrison John C. 
Published: February 2008

Summary: Clinical assessments of birth‐weight were made among 88 parturients at term, to determine what maternal and neonatal factors influence the accuracy of predicting neonatal weight. An estimate within ±10% of actual weight was considered accurate, while a prediction off by more than 10% was classified as inaccurate.Seventy‐one per cent (63 of 88) of the estimates were considered accurate and 28% (25 of 88) inaccurate. Among these 2 groups of patients, univariate analysis did not identify maternal age, gravidity, parity, gestational age, maternal height, prepregnancy weight and maternal body mass index, maternal weight and maternal body mass index at the time of delivery, change in body mass index during pregnancy, intrapartum amniotic fluid index, newborn's weight, length, and ponderal index as being significant correlates of an accurate clinical estimate of the birth‐weight. Over 2 years, as the provider gained experience in predicting the neonatal weight, the accuracy of the clinical estimate of birth‐weight did not improve.
Clomiphene Citrate and Pregnancy Outcome
Authors: Venn Alison , Lumley Judith 
Published: February 2008

Summary: Data from Australia and elsewhere have shown consistently that adverse perinatal outcomes such as preterm birth and perinatal mortality are more common in pregnancies resulting from assisted conception with IVF and GIFT than normally conceived pregnancies. Factors that may contribute to the excess of poor outcomes include maternal factors, the assisted conception procedures themselves and possibly the influence of drugs used to induce superovulation. This review examines the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes.The review shows that whilst some studies have suggested higher rates of ectopic pregnancy, spontaneous abortion and congenital malformations in clomiphene citrate induced pregnancies, the findings are inconsistent and the data are flawed. There are only very poor data available on the incidence of preterm birth. Multiple pregnancy is a well‐recognized adverse outcome of clomiphene citrate induced pregnancies. Attempts to improve perinatal outcomes of pregnancies following assisted conception will be helped by a better understanding of the relative contributions of maternal and treatment factors and further studies of pregnancy outcome after ovulation induction are needed.
Beta HCG Levels after Conservative Treatment of Ectopic Pregnancy: is a Plateau Normal?
Authors: Thompson G.R. St.J. , O'Shea R.T. , Harding A. 
Published: February 2008

Summary: In 32 women with unruptured tubal ectopic pregnancies we undertook conservative laparoscopic treatment [local injection of 20 mg methotrexate (n = 18), laser salpingotomy (n = 14)]. The results of serial quantitative beta HCG measurement were followed until either a negative level was reached or until rising levels necessitated alternative/additional therapy. Plateaued values of beta HCG were observed in both the successful (n = 16) and the unsuccessful cases (n = 5).To test the hypothesis that daily variation in the assay could account for some or all of the observed plateaued results in successful cases, the sera were retested serially on the same ‘run’. In only one case did laboratory variation account for the observed plateau. The clinical implications of the findings are discussed. We conclude that serially monitored beta HCG results after conservative treatment of ectopic pregnancy may show plateaued values without indicating failure of treatment.
The Menopause: When It Is All Over or Is It?
Authors: Burger Henry G. 
Published: February 2008

Summary: The menopause is defined rigorously as the cessation of menstruation as a result of ovarian follicular depletion. Although in common clinical usage, the term is used to encompass the menopausal transition, a period which may average 4 years in duration, and during which alterations in menstrual regularity and/or flow may be accompanied by somatic or psychological symptoms. Measurement of serum follicle‐stimulating hormone (FSH) with or without oestradiol (E2) is frequently advocated as providing a useful indicator of menopausal status.Several studies have shown an increase in serum FSH, with or without decrease in E2, in women over the age of 40 years who continue to cycle regularly. Abrupt fluctuations in serum FSH and E2 may be observed, with typically post menopausal levels subsequently returning to the normal reproductive range. In a cross sectional study, of regularly cycling women randomly selected from the Melbourne community, and over the age of 45 years, 7% had FSH levels typical of the post menopause, and 39% had levels above those found during the follicular phase in women aged less than 35 years. It is concluded that serum FSH is of little diagnostic value in the assessment of menopausal status, which can currently be made only on clinical grounds. An elevated serum FSH level cannot tell us reliably ‘when it is all over’.
Prostaglandins and Biological Control of Cervical Function
Authors: Calder Andrew A. 
Published: February 2008

Summary: The uterine cervix is a vital structure for the success of pregnancy. It must remain firmly closed to contain the developing conceptus within the uterus until the fetus has grown to a stage of maturity appropriate for extra‐uterine survival. During the birth process itself, the cervix must undergo the rapid opening known as dilatation to allow the fetus to travel through the birth canal with a minimum of stress and trauma.The process of cervical dilatation must be preceded by the phenomenon of effacement whereby the substance of the cervix shortens and thins out. Both effacement and dilatation would be impossible unless the dense fibrous connective tissue of the cervix had undergone a radical modification. Cervical ripening requires a change of the collagen within the cervical stroma from a highly organised network of tightly bound collagen fibrils to a much looser arrangement whereby the tissue becomes more compliant. This is associated with profound changes in the composition of the ground substance of the cervical stroma with an alteration in the concentration and type of glycosaminoglycans (GAGs) which constitute the proteoglycan complexes.It was formerly assumed that these changes were under the control of those cellular elements within the cervical stroma (fibroblasts and smooth muscle cells) but it seems quite possible that the ripening process is associated with an infiltration of inflammatory cells especially neutrophils. Currently much interest is centering on the possible role of cytokines such as interleukin‐8 and there may also be a role in cervical ripening for leukotrienes. What is beyond dispute however is that prostaglandins, especially prostaglandin E2, are intimately concerned in the biological control of cervical ripening. This can be exploited clinically by using PGE2 to ripen the cervix and it also has implications for the prevention of pre‐term delivery by resort to inhibitors of prostaglandin synthesis.The role of prostaglandins in these processes and the additional factors which control their activities have been the subject of much investigation in recent years but further progress in understanding these phenomena will be essential before the clinician can control the processes of pregnancy and parturition more effectively.
Maintenance of High Risk Pregnancies: Role of Prostaglandins and Other Mediators
Authors: Gillin A. G. 
Published: February 2008

Summary: The initiation of a complex cascade of events resulting in the delivery of a healthy newborn appears to involve the integrated actions of the fetus, mother and the placenta. Many putative factors have already been extensively reviewed. Instead of concentrating on the action of estrogen and progesterone, the role of regulators of myometrial activity such as prostaglandins as well as the fetal pituitary‐adrenal system, oxytocin, corticosteroids, leukotrienes, platelet activating factor, endotoxin and cytokines to name a few, will be discussed. Nevertheless, there is an increasing weight of evidence suggesting that many of the above agonists converge upon a final pathway of prostaglandin production which subsequently increases myometrial responsiveness. Prostaglandins are involved at levels of myometrial regulation such as myometrial gap junction formation, intracellular calcium flux modulation, synchronisation of myometrial contraction via interaction with oxytocin thus having stimulatory effects on uterine contractility, as well as cervical maturation (via PGE2).Importantly, there has been clinical benefit of a more thorough understanding of the physiology of rnyometrial regulation at the time of partuition. The approach to the treatment of preterm delivery has improved, eventhough the exact mechanism(s) and cause(s) of this phenomenon remain an enigma. Current tocolytic therapy is not generally prophylactic but commences after labour, contractions and cervical dilatation are underway. Key regulatory pathways have been pin‐pointed that present opportunity for tocolysis including:‐ c‐AMP inhibition of contraction by (3‐mimetic agents, inhibition of calmodulin‐calcium function, inhibition of calcium influx by calcium channel blockers, inhibition of prostaglandin production, modulation of rnyometrial function by peptide hormones or antagonists (e.g. relaxin, VIP and oxytocin antagonists). New pathways and regulators may lead to further specific therapy. For example, Platelet Activating Factor may be one area of increased consideration; Changes in intracellular calcium concentrations in uterine muscle are clearly important in muscle contraction and Platelet Activating Factor increases cytosolic calcium concentration.