bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Update On Ovarian Cancer Screening
Authors: Carter Jonathan 
Published: February 2008

EDITORIAL COMMENT: The overall perspective for screening for cancer in women seems to be that the need for screening for cervical cancer is well‐established and is relatively efficient although increasing emphasis is required to enrol the over 50's less than 50% of whom are currently regularly examined in VictoriaA. The cytological screening examination for cervical cancer also detects approximately 40% of cases of endometrial cancer; the examiner also has the opportunity to inspect the vagina and vulva for clinical evidence of pathology. The screening for breast cancer by mammography is a major initiative in Australia supported by the various State governments and holds high prospects for improvement in the early detection of this most important of female cancers. There is no doubt that women with an identified family risk of ovarian cancer warrant regular screening, or in some cases prophylactic oophorectomy, but it seems to the Editorial Subcommittee that the case is not proven by the data so far available that sophisticated screening of the general population for ovarian cancer is cost‐effective. It would be interesting to compare whether colonoscopy every 3 to 5 years in the over 40 age group has higher priority than annual transvaginal ultrasound and colour Doppler examination combined with CA 125 screening for ovarian cancer as suggested in this paper. Governments will, when funds are available, respond to the case made for the detection of the most common identifiable curable cancers. Carcinoma of the ovary remains, in spite of its importance, the Cinderella in terms of prospects for early detection of invasive lesions.(A) 57% screened in the last 3 years for the 50–59 year age group and 33% for the 60–69 year age group (Heather Mitchell, Medical Director, Victorian Cervical Cytology Registry, statement to the Editor).
The Role of Transvaginal Sonography in the Diagnosis of Placenta Praevia
Authors: Tan Niap H. , Abu Marlik , Woo Jean L.S. , Tahir Hashim M. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it confirms that vaginal probe ultrasonography is safe if performed carefully in women who have had antepartum bleeding and who are likely to have a placenta praevia Our understanding of the data presented here is that vaginal probe ultrasonography is more accurate than transabdominal ultrasonography in diagnosis of lesser degrees of placenta praevia. This is important now that it has become accepted practice to manage women with placenta praevia at home especially if there has been no major episode of bleeding. Vaginal probe ultrasonography is also useful to avoid misdiagnosis of placenta praevia and unnecessary hospitalization of such patients: this seems very likely to occur if praevia is diagnosed when transabdominal ultrasound shows the placental edge to be within 5 cm of the internal os. Readers are referred to the article by Rosen DMB and Peek MJ “Do women with placenta praevia without antepartum haemorrhage require hospitalization?‘ Aust NZ J Obstet Gynaecol 1994; 34: 2: 130) and the Editorial Comment which accompanied this paper. There are 2 remaining important questions about the antenatal management of a patient with placenta praevia where conservative management is an option. The first is when is it safe to allow the woman home when she has had an episode of haemorrhage, and the second is when should hospitalization be recommended in the absence of haemorrhage when there is a major degree of placenta praevia? One of the main points in this paper is that many days hospitalization could be saved by using transvaginal ultrasound for the diagnosis of placenta praevia. However, this argument seems based on the assumption that women were hospitalized unnecessarily because of misdiagnosis of placenta praevia, which is quite a different argument. Summary: Transvaginal sonography was performed in 70 patients diagnosed to have placenta praevia by transabdominal sonography. The diagnosis was confirmed either by digital examination in theatre at term or operative finding at delivery. Forty‐nine cases (70%) were correctly diagnosed to have placenta praevia by both modes of sonography. Transvaginal sonography ruled out placenta praevia in 12 cases (17%) thought to be placenta praevia by transabdominal ultrasound. Both transabdominal and transvaginal sonography demonstrated ‘placental migration’ in 4 cases (6%) which were no longer praevia at delivery. Five patients (7%) were erroneously believed to have placenta praevia by both sonographic techniques. Overall, the diagnostic accuracy of transvaginal sonography was 92.8% compared with 75.7% for transabdominal sonography. None of the subjects experienced any exacerbation of bleeding or other complications. The results suggest that transvaginal sonographic localization of the placenta is safe and superior to the transabdominal route.
Vaginal and Speculum Examination in Medical Curricula
Authors: Abraham Suzanne 
Published: February 2008

EDITORIAL COMMENT: We hope that this paper will receive close attention from all our readers especially those who as professional teachers or full‐time clinicians instruct medical students or midwives in performing vaginal examination, either bimanual or with a speculum, either at an outpatient clinic or in the labour ward. It seems to the reviewers of this paper that there is an urgent need to improve our teaching experience concerning vaginal and speculum examination, and the first step is to realize how inadequate our teaching is at present. The suitability of the outpatient clinic for instruction of students would be enhanced if time was put aside specifically for the purpose of instructing the students rather than expecting the consultant to cope with a busy workload and also the problem of student teaching. It would also seem that the more detailed and prolonged the teaching vaginal examination is, the more necessary it becomes for the supervisor to gain formal consent from the patient, which is an increasingly sensitive issue in teaching hospitals in Australia. It is the Editor's opinion that teaching bimanual vaginal examination when the patient is anaesthetised is a very suitable procedure, but should only be practised when the woman realizes that the student is a member of the medical team looking after her, and that there is only 1 student in the team, and that she can choose not to consent to the teaching examination. Summary: Medical students' perception of their own psychomotor skills and attitudes to different methods of teaching the gynaecological examination were studied. Students rated their physical skills poorly, only 7% feeling confident they could detect an abnormality and only 14% considering their ability to perform a Pap smear was good or very good. They rated their doctor/patient skills better, 55% considering they are good at conducting an examination with sensitivity and 67% at explaining to their patient what they were doing and why. Students' first preference for instruction was to examine patients in the Outpatient Clinic under the supervision of a doctor, a method experienced by most students on one occasion. The next preferred method was for students to work with 2 trained gynaecological assistants, acting as patient and instructor, with discussion of feelings and feedback (see Subjects and Methods). The option of student volunteers was a least favoured method but was cited as first preference by 5 % of students. Over 25 % of the female students considered volunteering for vaginal examination a ‘possibility’ if they were examined by a student of the same sex. Over 25% of males would ‘possibly’ volunteer for rectal examination only if the same sex was present. The comments by the students offer help in the future planning of teaching vaginal examination.
OCCASIONAL REVIEW: Vulvar Cancer: The Cinderella of Gynaecological Oncology
Authors: Giles Graham G. , Kneale Barry L.G. 
Published: February 2008

EDITORIAL COMMENT; We have accepted this paper for publication because it gives a good overview of the current situation in Victoria regarding the epidemiology and management of vulvar cancer. There are some problems that still need to be resolved especially the need to divide the cases into those that are associated with intraepithelial carcinoma of the vulva and those that present in the traditional manner of the older woman with a macroscopically apparent lesion, at least if you look carefully, which is not always as easy as it sounds! It may be that it is confusing to consider the 2 groups together. Summary: Cancer of the vulva is a rare malignancy that increases progressively with age. The age‐standardized incidence averages between 1 and 2 per 100,000 women in Western countries. The majority (80–90%) are squamous cell carcinomas, melanoma and adenocarcinoma each accounting for about 5% of cases. Internationally, the incidence of vulvar cancer varies more than 30‐fold, the highest rates being seen in populations of Portuguese South America. In many populations the incidence appears to be stable but there is some evidence that the incidence of in situ carcinoma is increasing in the United States of America. Epidemiological studies have identified sexual factors, particularly human papilloma virus (HPV) infection, as increasing risk. Smoking also increases risk by interacting synergistically with HPV infection and genital warts. The aetiologies of vulvar intraepithelial neoplasia (VIN)3/in situ disease and invasive cancer appear to differ. VIN does not automatically progress to invasive cancer and is strongly associated with HPV infection. Many older women with invasive vulvar cancer do not have evidence of HPV and do not smoke. More research is needed on the cause of vulvar carcinoma in this group. Treatment has become more conservative over the years and this has reduced morbidity and probably mortality. Although FIGO data do not show much by way of improvement in survival, data from population‐based cancer registries have shown definite increases in survival (5‐year survival proportions in excess of 80%, when age and Stage have been taken into account). Improvement is particularly related to the preponderance of early stage disease.
Endoscopic Minilaparotomy
Authors: Maher Peter J. , Wood E. Carl , HilP David J. 
Published: February 2008

EDITORIAL COMMENT: This and the following paper described further modifications of laparoscopic techniques for gynaecological surgery. It has always been standard teaching at laparotomy to mobilize endometriotic ovaries adherent to the broad ligament and other peritoneal structures by blunt dissection with the finger pressed against the back of the uterus and broad ligament. Experience has shown that this is much safer than dissection in situ and less likely to cause haemorrhage or damage to other structures such as rectum and ureter. To the nonlaparoscopist writer of this comment it appears that this minilaparotomy technique retains this classical method of mobilization of the ovaries and possibly it is not only quicker but safer than dissection via the laparoscope! Summary: In a preliminary study the principles of standard gynaecological surgery, new operative laparoscopic techniques and mechanical elevation of the abdominal wall are combined. These early results indicate an advantage to both patient and hospitals from this approach. Further studies are required to verify our impressions that minilaparotomy combined with no insufflation laparoendoscopy will open up the concept of operative laparoscopic surgery to most gynaecologists.
OCCASIONAL REVIEW: Spontaneous Uterine Perforation as a Serious Complication of Pyometra in Elderly Females
Authors: Sawabe Motoji , Takubo Kaiyo , Esaki Yukiyoshi , Hatano Nobuhiko , Noro Toshio , Nokubi Mitsuhiro 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication to inform readers that pyometra is an entity in itself with a significance apart from that of underlying pathology such as carcinoma of the cervix or endometrium. The authors' takeaway message seems to be that a pyometra needs treatment by cervical dilatation in addition to that of associated complications including peritonitis and septicaemia as a result of perforation of the uterus. Summary: Spontaneous uterine perforation of pyometra is closely related to physiological uterine involution and requires a correct diagnosis, rapid surgical intervention and administration of antibiotics.
Insertion of a Permanent Electrode for Intractable Detrusor Instability
Authors: Brieger Geoffrey , Ditton John , Korda Andrew 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of the miseries or urinary incontinence in elderly women, and because this problem is so common. Any method of cure or control merits consideration. Also urinary incontinence is often the reason why women with their intellectual facilities apparently intact become institutionalized. The woman portrayed in this report was made of stern stuff So too were her medical attendants, since urinary incontinence resulting from a motor vehicle accident (details of injuries not provided) would be treated by conservative means alone by many practitioners, including the writer of this comment, who would have prescribed the vaginal application of dienoestrol cream, which improves symptoms in many women with urinary incontinence and renders other therapies unnecessary in some (A). In less than 2 years this woman was investigated and treated with urodynamic study x 4, drug regimens x 5 and surgical procedures x 4. The takeaway message is that her urinary incontinence was controlled. (A) Beischer N A, Grant FT. Management of gynaecological disorders in older women. Update in Geriatric Medicine. Part 2. Merck Sharp and Dohme University Program for General Practitioners pl‐12.
Goserelin Reduction of Uterine Fibroids Prior to Vaginal Hysterectomy
Authors: Eizenberg David H. 
Published: February 2008

EDITORIAL COMMENT: This paper is provocative and we accepted it for publication so that interested readers, as well as the editorial subcommittee, could be provoked! Our reviewer reminded us that ‘one swallow does not a summer make’ and also that the GNRH agonist did not seem to reduce the size of the fibroids greatly. Not every gynaecologist would tackle such a uterus vaginally (for what it is worth the editor certainly would not). Stovall and colleagues have reported again on the problem of having treated 90 women with uterine size of 14–18 weeks and 60 with uterine size greater than 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotrophin‐releasing hormone agonist. The results were favourable and more or less support the views expressed in this case report. The reference is given for interested readers, but please note that vaginal hysterectomy was attempted only ‘iftheuterus wasmobileand s 14 weeks'gestational size on bimanual examination’. (Stovall TG, Sumit RL, Washburn SA, Ling FW. Gonadotrophin‐releasing hormone agonist use before hysterectomy. Am J Obstet Gynecol 1994; 170: 6: 1744–1751. Response from author to editorial comment: I am happy with your editorial comment except that the GNRH agonist did reduce the size of the fibroids by 50% (volume). If you look at the ultrasound size and convert this to volume and compare the pathology specimen, you will note that the volume has reduced from approximately 280 ml to 125 ml. This agrees with references 7 to 9 where a volume reduction of approximately 50% was obtained. Summary: A case utilising GNRH agonist to reduce the bulk of uterine fibroids to allow vaginal hysterectomy is presented.
The Beneficial Use of Risk Scoring in a Remote and High‐Risk Pregnant Population
Authors: Humphrey Michael D 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because obstetric practice in this region of Australia is important and readers will be interested to see the results of an audit performed by the author and assessed with the scoring system that is described. It is well known that scrutiny improves performance though how this is achieved is often not clear. Readers will not be surprised that there was a higher perinatal mortality rate in the unscoredpatients which, according to our interpretation of the data presented, included all of the nonbooked patients. However the reduction in perinatal mortality, both in the Cairns Base Hospital and in the patients born outside Cairns over the time reviewed, is impressive. It is of interest to note that the perinatal mortality rate in the babies born outside the Cairns Base Hospital, where the scoring system was not practised, fell from 10.5 per 1,000 singleton births in 1991 to 5J per 1,000 in 1993, although this reduction does not quite reach statistical significance.Summary: The Peninsula and Torres Strait Health Region in Far North Queensland is a large and remote region with a high incidence of at‐risk pregnancies and few experienced caregivers to provide antenatal care. Pregnancy Risk Scoring was trialled as a means of best allocating meagre resources. All 3,679 women with singleton pregnancies who gave birth at Cairns Base Hospital were studied over a 30‐month period, during which time the Hospital and Regional perinatal mortality rates fell by more than 50%. Risk scoring was applied to 2,875 of these pregnancies. Preterm birth, the birth of low birth‐weight babies, and birth intervention were less likely to occur in those women with a low‐risk score, with the lower likelihood of preterm birth reaching clear statistical signficance. Where pregnancy care resources are scarce and large numbers of high‐risk pregnant women are scattered throughout a remote area it would appear that risk scoring assists positively with decisions about the best use of resources.
High Long‐Term Cure Rate Justifies Routine Treatment of Cervical Intraepithelial Neoplasia Grade I
Authors: Tay Sun‐Kuie , Yong Tze‐Tein 
Published: February 2008

Summary: The long‐term clearance of cervical intraepithelial neoplasia (CIN) Grade 1 after one treatment was studied retrospectively in 105 patients. Treatment was by CO2 laser vaporization (74 patients), cone biopsy (8), loop electroexcision (LEEP) (7), electrodiathermy (1) and hysterectomy (2); 79 of the 92 treated patients (85.9%) had normal cervical cytology and colposcopy on a mean follow‐up period of 36.7 months (95% confidence interval between 33.1‐40.4 months). Life table analysis showed that the probability of the cervix remaining disease free was 81% at 72 months of follow‐up.Of the 13 patients with a cervical abnormality after the initial treatment, 4 had persistent CIN 1,3 persistent human papillomavirus (HPV) infection, 2 recurrent CIN 1 and 4 had recurrent HPV infection. In contrast, of the 13 untreated patients with CIN 1,7 (53.8%) continued to demonstrate an abnormality on the cervix after a mean follow‐up period of 27.5 months (95% confidence interval between 18.8 and 36.3 months). No significant perioperative morbidity was recorded in the treated patients.The results of this study suggest that CIN 1 can be effectively eradicated in more than 80% of women with 1 treatment alone. The treatment should be considered for all these patients to spare them the psychological and emotional trauma of having to face repeated abnormal cervical cytology on follow up.
Cushing Syndrome in Pregnancy Secondary to an Adrenal Cortical Adenoma
Authors: MacGibbon A. L. , Brieger G. M. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case report for publication because of the lesson that diagnosis of severe gestational diabetes indicates the need for consideration of an underlying cause other than hormones from the fetoplacental unit. In the other case of Cushing syndrome published in our journal (Kriplani and colleagues. Aust NZ J Obstet Gynaecol 1993; 33:428‐430) the woman had had diabetes requiring insulin for 3 years and investigations at 10 weeks' gestation were suggestive of pituitary‐dependent Cushing syndrome.Summary: Cushing syndrome in pregnancy is rare. This is explained by the syndrome's association with amenorrhoea, oligomenorrhoea, infertility and abortions. Cushing syndrome commonly presents with hypertension, weight gain, diabetes, striae or truncal obesity, all of which can be consistent with pregnancy in women without Cushing syndrome. We describe a case of Cushing syndrome in pregnancy secondary to an adrenal cortical tumour which was discovered after an abnormal glucose tolerance test. The woman developed classical features of Cushing syndrome including gestational diabetes and hypertension and was managed successfully to term after a unilateral adrenalectomy at 23 weeks. The case is reported not only because of its rarity but also because the diagnosis was made after a routine screening test for gestational diabetes. Early diagnosis and treatment of adrenal adenoma causing Cushing syndrome in pregnancy reduces maternal and fetal morbidity and mortality.
Shoulder Dystocia Report of 2 cases and review of the literature
Authors: Nand S.L. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication since everyone who practises obstetrics can profit from a revision of this information. Although shoulder dystocia is often not predictable, the editorial subcommittee, after a discussion of this article, agreed to advise readers that in their opinion there are 3 clinical warnings to be heeded. Firstly, there is the mother who has a past history of shoulder dystocia on 1 or more occasions and who appears to have an unusually large fetus; if Caesarean section is decided against, the delivery should be conducted in a suitable position (lithotomy) by suitable personnel (experienced medical practitioner plus assistant), with suitable conditions (episiotomy and analgesia/anaesthesia). Secondly, consider the possibility of shoulder dystocia when mid‐forceps delivery is performed when the fetal head arrests in the occipitoposterior or occipitolateral position, especially in an obese multipara where fetal size cannot be assessed. Thirdly, shoulder dystocia should be anticipated when a fetal head which is on view in the occipitoanterior position at the height of a contraction, recedes to the midpelvis and rotates to the occipitolateral position after the contraction and the mother's voluntary expulsive efforts cease‐ the ‘suitable conditions’ enumerated above should now be implemented. Many of these cases are associated with failure of anterior rotation of the shoulder when labour commenced with an occipitoposterior position. There are also those where the anterior shoulder has arrested above the pubic symphysis and these are the most difficult ones to deal with. Occipitoposterior positions continue to provide most of the problems encountered during labour (see previous comments on Shoulder Dystocia: Risk factors, prevention, association with macrosomia etc. Aust NZ J Obstet Gynaecol 1988; 28:107, 1989; 29:129 and 1990; 30:319).Summary: Shoulder dystocia, or impacted shoulders is an infrequently encountered obstetric emergency. Despite various risk factors identified by investigators, the occurrence of shoulder dystocia is difficult to predict. Two cases of severe shoulder dystocia managed personally by the author are presented. These cases illustrate some of the important issues regarding prediction of shoulder dystocia and the need to begin a series of well‐tested manoeuvres immediately, to successfully deliver the baby.