bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Laparoscopic Surgical Training and Accreditation Program Up and Running
Authors: Munday D. , Kerin J. 
Published: February 2008

EDITORIAL COMMENT: In the words of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, ‘Because there are special risks and hazards relating to laparoscopic surgery there is a need to provide guidelines for minimum standards relating to training, practice and equipment used for gynaecological laparoscopic surgery’.The Australian Gynaecological Endoscopy Society (AGES) has been recognised by RANZCOG as the appropriate body to share with the College and hospital authorities the responsibility for implementation of supervised tuition for gynaecologists.The implementation of the AGES guidelines has provoked much debate amongst gynaecologists. The majority of them feel that they are under threat from the guidelines and that such regulation is unnecessary as they have already been credentialled as specialist gynaecologists. The rising cost of medical indemnity could also result in medical insurance companies demanding evidence of credentialling before gynaecologists are covered for surgical mishaps which may occur during advanced laparoscopic surgery. Patient advocate groups similarly may demand evidence of extra training in this new surgical specially.This paper reports the first successful attempt at implementing the AGES recommended College guidelines for advanced laparoscopic surgery. It addresses the problems that have confronted all institutions which have accreditation committees for laparoscopic procedures in place. We can all take heart that the oft quoted ‘draconian guidelines' have been tried and accepted in this teaching institution.Peter Maher, Past President, Australian Gynaecological Endoscopy SocietySummary: Beginning in March 1997, a training and accreditation program in laparoscopic surgery was established at our hospital according to the training guidelines provided by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) (1, 2). Registrars were accredited upon satisfactory completion of supervised surgery at each training level. Consultants seeking clinical privileges in advanced laparoscopic surgery were asked to submit a formal application. By August 1998, 143 minor laparoscopic procedures had been formally assessed resulting in 8 of 9 registrars successfully completing training to level 2 laparoscopy. Thirty‐three of 83 (39.8%) advanced laparoscopic procedures were directly supervised and an experienced laparoscopic surgeon was available, if required, for a further 15 procedures. Two consultants undertook additional supervised training before being granted full accreditation for level 3 laparoscopic procedures. Another 2 consultants have been given provisional accreditation for level 3 procedures. Although challenging, implementation of the RANZCOG guidelines on training and accreditation in laparoscopic surgery is quite possible. Greater efforts should be undertaken to establish these guidelines as the ‘gold standard’ for hospital accreditation committees.
Threatened Abortion: Prediction of Viability Based on Signs and Symptoms
Authors: Chung T.K.H. , Sahota D.S. , Lau T.K. , Mongelli J.M. , Spencer J.A.D. , Haines C.J. 
Published: February 2008

Summary Objective: To examine the relationship between signs and symptoms associated with threatened abortion and viability of the pregnancy. Design: A prospective observational study Setting: A university teaching hospital Participants: One thousand consecutive women presenting with a threatened abortion. Intervention: A structured history and an examination were performed as initial clinical assessment. These were followed by transvaginal sonography to determine the status of the pregnancy. Main outcomes: The relationship between individual signs and symptoms and the status of the pregnancy was determined. Logistic regression was performed to determine which signs or symptoms were independent predictors of spontaneous abortion. Results: A history of having passed a tissue mass, the presence of products of conception in the vagina and an open cervix were the only sign or symptom associated with a greater than 90% chance that the pregnancy was non‐viable.Logistic regression of signs and symptoms at presentation indicated that maternal age greater than 35 years, a history of passing clots vaginally, vaginal bleeding similar to normal menstruation, increasing vaginal bleeding and discrepancy of 4 or more weeks between the uterine size on examination and that which would have been expected by menstrual dates were significant predictors of nonviable pregnancy.A history of vomiting was predictive of a viable pregnancy. Conclusion: The clinical assessment of threatened abortion is unreliable in most cases and should be superseded by ready access to sonographic assessment.
Transvaginal Chorionic Villus Sampling—an Alternative Approach
Authors: George Korula , S. George Susan , James Christina , Fernandes Herman A. , Shaji R. V. , Srivastava Alok , Chandy Mammen 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it seems so sensible to use a transvaginal approach for a posteriorly situated placenta for chorionic villus sampling especially when the uterus is retroverted and the patient is obese. Consultation with the leading practitioners of chorionic villus sampling in Melbourne showed that all were aware of this approach, as mentioned in the literature, although they had not used it. The authors mention that a smaller needle may be appropriate such as the 20 gauge needle usually used for abdominal chorionic villus sampling. One reviewer stressed the importance of not performing this investigation before 10 weeks' gestation because of the recorded association with reduction defects of the limbs in the fetus, presumably due to interruption with vascular supply by trauma to the chorion. Future reports of a larger series of patients is required to reinforce the authors' message that this technique does not carry significant risk of infection. N.B.Summary: Conventional transabdominal approach for chorionic villus sampling (CVS) is difficult in obese women, retroverted uteri and when the placenta is posteriorly placed, while the transcervical method is technically demanding. We investigated the use of an alternative approach‐transvaginal‐in 38 consecutive women undergoing CVS for prenatal diagnosis of haematological conditions. This is an effective method with regard to access and visualization of the placenta, patient tolerance and tissue yield. No major complications were encountered. We recommend that the transvaginal approach be considered for CVS, especially in difficult cases.
Choriocarcinoma Developing After Prolonged Molar Surveillance
Authors: Nada Wagdy , Parke Jim , Carter Jonathan 
Published: February 2008

EDITORIAL COMMENT: This case, as the authors point out, illustrates yet again the unpredictability of the development of malignant trophoblastic disease especially after a hydatidiform mole. The editor is not an oncologist but has been interested in hydatidiform moles and their sequelae for more than 40 years. It would seem that the method of treatment of an evacuated or unevacuated hydatidiform mole in a multipara aged 44 years should consider ‘primary prophylactic hysterectomy’ as advocated by Professor Tow as a result of his analysis of a large series of patients in Singapore and analyzed in detail in his MD thesis. Had hysterectomy been performed in this patient following the diagnosis of a hydatidiform mole she would almost certainly have avoided the need for chemotherapy and the risks of metastatic choriocarcinoma. Readers are referred to the fourth paragraph of the summary of a study of 328 consecutive molar pregnancies in the State of Victoria during the 30 years 1940 to 1970, that ‘it is concluded that Tow's recommendation for primary prophylactic hysterectomy in patients over 40 is valid for this community’ (A). N.B.(A) Beischer NA, Bettinger HF, Fortune DW, Pepperell R. Hydatidiform mole and its complications in the State of Victoria. J Obstet Gynaecol Br Commonw 1970; 77: 263–276
Successful vaginal delivery in a woman with amyoplasia
Authors: Hackett Anna , Giles Warwick , James Sue 
Published: February 2008

Summary: We report on the pregnancy management of a 22‐year‐old woman with amyoplasia, the commonest type of arthrogryposis multiplex congenita (AMC). Extrapolating from childhood and adult studies, the majority of cases are likely to be ambulatory and live independent lives as adults. Many females, therefore, would be expected to achieve a pregnancy.There have been several case reports on anaesthetic management for Caesarean section delivery in women with arthrogryposis, but no medical literature exists regarding the likelihood or management of vaginal delivery. This is the first reported case of conservative management of a woman with amyoplasia. A multi‐disciplinary team was involved in her care. This involved careful assessment of her suitability for vaginal delivery, possible anaesthetic complications and potential difficulties in caring for an infant at home. Induction of labour at 37 weeks gestation resulted in the successful vaginal delivery of a liveborn healthy male.
Term breech birth in New South Wales, 1990–1997.
Authors: Roberts Christine L. , Peat Brian , Algert Charles S. , Henderson‐Smart David 
Published: February 2008

SUMMARYData on 636,708 women delivering a singleton infant of gestational age >37 weeks in NSW from 1 January 1990 to 31 December 1997 were used to examine trends in breech births at term and the mode of delivery. From 1990 to 1997, although the crude rate of breech births at term remained stable at 3,4%, the adjusted odds ratio for breech birth compared with cephalic birth decreased over time. Among live breech births, the crude rate of vaginal breech birth declined from 29.4% to 19.7%, with an attendant increase in elective Caesarean sections from 49.1 % to 58.4%. Most of this increase was at 38 and 39 weeks gestation. There was no change in the perinatal mortality rate among breech births during the study period. Despite increasing maternal age, the adjusted odds of a breech birth at term decreased over time. This could be due to offsetting factors, such as increased use of external cephalic version. If the decrease in vaginal breech birth continues, it may lead to the skills for this procedure being lost.
Risk factors related to premature rupture of membranes in term pregnant women: a case‐control study
Authors: Kovavisarach Ekachai , Sermsak Patipan 
Published: February 2008

SUMMARYA case‐control study of premature rupture of membranes (PROM) of full term pregnant women was undertaken between 1 November 1996 and 30 July 1997 at Rajavithi Hospital to determine the risk factors related to PROM.Two hundred and twenty pregnant women with PROM and 220 pregnant women without PROM were recruited by a simple random sampling. The diagnosis of rupture of membranes was made from history and from positive microscopic ferning and pH tests performed during a speculum examination. The demographic data was not significantly different between the two groups. The risk factors, such as a history of PROM in a previous pregnancy, a history of abortion in a previous pregnancy, and body mass index (BMI) <20 were significantly different between the PROM group and the control group. However, on using multiple logistic regression analysis, we found that the residual significant risk factors were a history of PROM in a previous pregnancy and BMI < 20.
Surgery and post‐operative radiotherapy for early stage cervical cancer
Authors: Vinod S K. , MacLeod C A. , Dalrymple C , Elliott P , Atkinson K , Carter J , Firth I 
Published: February 2008

SUMMARYThe use of post‐operative radiotherapy in the treatment of cervical cancer is controversial. The aim of this study was to document the results and toxicity of adjuvant irradiation in patients with Stage 1B and 2A cervical cancer.We performed a retrospective review of all patients treated with post‐operative radiotherapy at Royal Prince Alfred Hospital between 1986 and 1993. Patient, tumour and treatment factors and late toxicity were recorded. Relapse‐free and overall survival were calculated.Eighty‐one patients form the study population. The median follow‐up was 6.1 years. Fifty‐eight patients (72%) had stage 1B cervical cancer and 23 (28%) stage 2A. The 5 year relapse‐free and overall survival were 78% and 80% respectively. Six patients (7%) had late toxicity requiring inpatient medical treatment and 6 patients (7%) required surgery.The survival was comparable to other series reported in the literature. There was an incidence of 14% late toxicity requiring medical or surgical intervention which is greater than with hysterectomy or pelvic irradiation alone. Clinical prognostic factors should be used to select patients for either surgery or radiotherapy alone to minimise the increased toxicities associated with a combination of surgery and radiotherapy.
Sickle cell disease in pregnancy
Authors: Ladwig Petra , Murray Henry 
Published: February 2008

SUMMARYHomozygous sickle cell anaemia (Hb S) is the most common major haemoglobinopathy in the United States, occurring in approximately 1 in 626 African Americans. While haemoglobinopathies involving Hb S occur commonly in blacks of African descent, they are also found in people of Middle Eastern, East Indian and Mediterranean origin. It is an uncommon disease, especially in homozygous form, in Australia. We present the case of a woman in her third pregnancy, originally from Ghana, with HB F, and discuss the current issues in the management of sickle cell disease in pregnancy.
Operative vaginal delivery: clinical appraisal of a new vacuum extraction device
Authors: Vacca Aldo 
Published: February 2008

Summary: The efficacy of a new vacuum extraction device, the Kiwi OmniCup, and its effects on mothers and infants were tested in a study of 18 non‐rotational and 32 rotational vacuum assisted deliveries. Forty‐nine (98%) of the extractions resulted in successful vaginal births. Autorotation of the fetal head when the occiput was transverse or posterior was achieved in 31 (97%) of the 32 vacuum procedures. The high success rates recorded for both vaginal delivery and autorotation of the fetal head were largely attributable to the fact that flexing cup applications were achieved in 90% of the vacuum attempts.There were no cases of serious maternal trauma or clinically significant neonatal injuries. Two infants had cephalohaematomas and one infant developed a small subgaleal haemorrhage following a difficult delivery, which resolved rapidly without complications.It was concluded that the Kiwi OmniCup is an efficient and safe vacuum device for assisted vaginal delivery, provided it is used correctly and appropriately.
The fetal inflammatory response syndrome and cerebral palsy: yet another challenge and dilemma for the obstetrician
Authors: Svigos John M 
Published: February 2008

Summary: There is increasing evidence demonstrating a relationship between intrauterine infection and the development of neonatal intraventricular haemorrhage and periventricular leukomalacia with the subsequent occurrence of cerebral palsy, which is thought to be mediated through the generation of pro‐inflammatory cytokines by the fetus.In the light of this relationship, a review of the current management of intrapartum infection and the associated complications of intrauterine infection such as preterm labour and preterm premature rupture of the membranes would seem timely, along with the development of potential strategies which might prevent or ameliorate the effects of the fetal inflammatory response syndrome.The suggested changes in the understanding and management of the fetal inflammatory response syndrome provide a challenge and pose a dilemma for the practising obstetrician.
Effects of ethnicity on glucose tolerance, insulin resistance and beta cell function in 223 women with an abnormal glucose challenge test during pregnancy
Authors: Gunton Jenny E , Hitchman Rosemary , McElduff Aldan 
Published: February 2008

Summary: This study was conducted to investigate body‐mass‐index (BMI), insulin resistance and beta cell function in a group of pregnant women. Two hundred and twenty‐three consecutive women with an abnormal 50 g glucose challenge test in the third trimester were studied. All underwent oral glucose tolerance testing; 97 had a 100 g test and 126 a 75 g test. Fasting insulin was measured. Insulin resistance and beta cell function were calculated using the homeostasis model.Among the 136 Caucasian, 60 Asian, 11 Indian and 16 Arabic women studied, there were no age differences. Arabic women had higher parity (p < 0.05). Asian women had lower BMI than Caucasian (p < 0.001), Indian (p < 0.01), and Arabic women (p < 0.01).Women with gestational diabetes had higher insulin resistance than women with normal glucose tolerance (2.9 ± 4.0 vs 2.3 ± 2.5 p = 0.025). Women with gestational diabetes tended to have lower beta cell function 199 ± 203 vs 247 ± 380 p = 0.08). Asian women had higher glucose levels than Caucasian women after 50 g challenge (8.9 + 2.1 mmol/1 vs 8.6 ± 1.6; p = 0.034). Asian women were more likely to have gestational diabetes than Caucasian women (31.7% vs 14%; p = 0.02). Fasting glucose and insulin were comparable in Asian and Caucasian women. Mean insulin resistance and beta cell function in Asian and Caucasian women were not significantly different.We concluded that Asian women had lower BMI than Caucasian women. Women with gestational diabetes were more insulin resistant. Insulin resistance and beta cell function in Asian and Caucasian women are similar. Gestational diabetes in Asian women is of similar aetiology to that seen in Caucasian women, but occurs at a lower BMI.
Follicular flushing at oocyte retrieval: a reappraisal
Authors: Knight David C , Tyler John PP , Driscoll Geoffrey L 
Published: February 2008

Summary: A survey of Australian assisted reproduction technique (ART) units revealed many (> 50%) use flushing of the follicle in addition to direct aspiration of the fluid during oocyte retrieval. The rationale is that flushing offers an advantage to the patient, with a larger number of oocytes being collected and thus a higher potential for pregnancy.Following a complication in a patient, the medical staff determined that flushing might have been implicated. While this was later shown to be unfounded, the unit changed the method of oocyte collection, thus providing an opportunity historically to evaluate the differences between aspiration of follicular fluid alone or with additional flushing of each follicle.Thus the aim of this analysis was to test the hypothesis that aspiration alone does not effect the outcomes of ART with respect to oocyte numbers collected, their quality and subsequent fertilisation, or ultimate pregnancy rate in a large patient group (n = 2378).During the review period (1991–1993) the manufacturer of the aspiration needles; the pump and pressure used for aspiration; the staff involved in all procedures; and the premises, equipment and media used for oocyte collection and culture remained constant. Similarly the two patient groups did not differ in their demographics and physical characteristics.There was no difference (p > 0.5) in the number of oocytes collected, the number of embryos created or the pregnancy rate for that treatment cycle. There was also no significant difference between the two groups in fertilisation rates, irrespective of the type of treatment being used in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT) or intracytoplasmic sperm injection (ICSI)).The data presented in this paper are not prospective. They use historical comparison and are confounded by minor changes in ovarian stimulation protocols, but the conclusions are still valid. These data suggest there is no difference in the outcome of ART (from oocyte collection through to pregnancy rate) whether or not aspiration of follicles is accompanied by flushing. First principles of surgery advocate the shortest possible operating time, the simplest procedure and minimum amount of tissue handling as maxims for reducing complication. Therefore, as a routine, flushing would seem superfluous in ART.
Antenatal counselling, resuscitation practices and attitudes among Australian neonatologists towards life support in extreme prematurity
Authors: Munro Michael , Yu Victor YH , Partridge J Colin , Martinez Alma M 
Published: February 2008

Summary: A questionnaire survey of Australian neonatologists was conducted to ascertain their antenatal counselling and resuscitation practices, and attitudes towards life support in the extremely preterm infant. This study showed that in antenatal parental counselling, whether a paediatrician was given the opportunity to participate depends on the gestation at the time of the threatened preterm delivery. The counselling employed almost invariably covered mortality and morbidity. The obstetrician's opinion was considered to be of utmost importance. Both financial and moral obligations were found to be of little importance in counselling and resuscitation. Only one‐third of institutions had guidelines for limiting resuscitation. The onus remained on the neonatologists concerning which infant to resuscitate, and the level of the resuscitation to be conducted.In Australia, resuscitation at birth was restricted to infants of 23 weeks' gestation or above, and neonatologists did not believe the legal system has a role to play in limiting or mandating resuscitation of extremely preterm infants. Neither were they concerned with the threat of litigation when they decide to limit resuscitation. The majority of neonatologists agreed with their institution's approach to life support in extremely preterm infants. One grey area was the question of withholding assisted feeding in an infant for which the decision to withdraw life support has been made. Australia lacked a current consensus policy on selective non‐treatment. The establishment of national guidelines would be helpful to aid Australian obstetricians and neonatologists in their clinical practice.
Oestrogen, glycogen and vaginal candidiasis
Authors: Dennerstein Graeme J , Ellis David H 
Published: February 2008

Summary: Our aim was to relate vaginal candidiasis to vaginal oestrogenisation. First, the incidence was determined (subjected to chi‐square analysis) of vaginal Candida albicans infection in 339 consecutive dermogynaecology clinic patients aged 55 years and over, of whom 142 were using and 197 were not using oestrogen. Second, the ability of Candida species to utilise glycogen as a sole nutrient source was studied by performing assimilation tests using yeast nitrogen broth as a basal medium.Of the women using oestrogen, 26% had C. albicans infection on initial presentation compared with 4oo in the cohort not using oestrogen (p < 0.001). All 34 isolates of C. albicans assimilated glycogen. Twenty‐six non‐albicans species of Candida tested did not assimilate glycogen.In this study of postmenopausal women, there was a highly significant relationship between the usage of oestrogen and the occurrence of C. albicans infection. The production of glycogen by oestrogen stimulated epithelial maturation provides an attractive substrate for C. albicans.