bluuebunny/crossref_metadata_2025_split huggingface dataset:
CA125 Serum Levels and Secondary Laparotomy in Epithelial Ovarian Tumours
Authors: Rome Robert M. , Koh Hoon , Fortune Denys , Cauchi Maurice 
Published: February 2008

EDITORIAL COMMENT: Late presentation of ovarian cancer remains a major problem in gynaecology and stimulates the search for an accurate tumour marker; a simple blood test at the time of regular gynaecological examination (cervical cytology, bimanual pelvic palpation, examination of the breasts) is what is needed! Cytology of fluid aspirated from the pouch of Douglas was found to be impractical and ultrasonography, although still to be fully evaluated, is unlikely to be costeffective. The ideal tumour marker would serve as both a screening test in asymptomatic women to detect early stage disease and as an accurate monitor of therapeutic response obviating the need for second‐look laparotomy. As shown in this paper, CA125 lacks the sensitivity required to fulfil these 2 aims due to the inability to detect small volume tumour. Serial measurements of this tumour marker may serve to indicate therapeutic response in patients with advanced disease, supplementing clinical and radiographic assessment but second‐look laparotomy still remains the most satisfactory means of establishing response to therapy.Summary: CA125 serum levels were assayed prior to 57 secondary laparotomies for ovarian epithelial tumours. Tumour was present in all 16 patients with an elevated level > 35 U/ml but the absence of tumour was incorrectly predicted in 15 of the 33 (45.5%) patients with CA125 levels < 35 U/ml. For these patients the CA125 level was elevated in 14 of 20 (70%) with tumour greater than 1.5 cm, 1 of 7 (14.3%) with macroscopic tumour less than or equal to 1.5 cm and 1 of 4 (25%) with microscopic tumour. Tumour was resectable to less than or equal to 0.5 cm in 7 of 12 (58.3%) patients with CA125 < 35 U/ml, 2 of 4 (50%) with CA125 in the range 35–100 U/ml and only 1 of 11 (9.1%) with CA125 > 100 U/ ml (p < .05). The CA125 level was elevated in 1 of 13 (7.7%) patients with less than 15 cm3 of tumour compared with 16 of 18 (88.9%) patients with 15 cm3 of tumour or more (p < .0001). The correlation between the CA125 serum level and the tumour volume was almost statistically significant (r =+ 0.31, p = .053). The level of CA125 was normal in all 8 patients with mucinous tumours — 4 of whom were found to have tumour at secondary surgery. Those patients in whom the CA125 level is normal or slightly elevated (up to 100 U/ml) are most likely to benefit from the second‐look laparotomy as they are significantly more likely either to be free of tumour or to have tumour which is resectable to 0.5 cm or less. We conclude that CA125 assay is a useful test when secondary laparotomy is envisaged.
The Pap Smear Revisited
Authors: Shield P.W. , Daunter B. , Wright R.G. 
Published: February 2008

Summary: Papanicolaou smear screening for cervical cancer has become an established practice in most developed countries. This is because the cervix is relatively accessible to investigation and treatment, and early stages in the morphogenesis of cervical cancer are both recognizable and easily treated.The Pap smear is a valid test. It is simple, relatively inexpensive, reliable, and free of risk. Although the test has far from perfect sensitivity, it has high specificity, and false‐positive results are rare. In most reported series, the majority of false‐negative results have been found to be attributable to collection errors rather than laboratory errors. Despite the importance of Pap smear screening, controlled prospective trials have not been undertaken to determine its efficiency in reducing cervical cancer incidence and mortality. However, countries with well‐organized programmes, wide population coverage and correct follow‐up appear to have had some impact on mortality from cervical cancer. Nevertheless, coverage of high‐risk groups, particularly women over 40 years of age, remains the greatest problem.Recommendations on the frequency of testing vary considerably. Statistical models indicate triennial testing may deliver almost all of the effectiveness of annual testing at a substantially reduced cost, but the numerous reports of false‐negative results argue strongly in favour of annual screening. It is possible that these problems may be solved in the future by increasing the sensitivity of the test and/or by the use of additional tests.
Determinants of Birth‐weight in the New Territories of Hong Kong
Authors: Rogers M.S. , Wong F.W.S. , Chang A.M.Z. 
Published: February 2008

Summary: Weights of babies born in the Prince of Wales Hospital, Hong Kong, in its first 2 years of operation were studied, and compared with previous reports.Birth‐weight in Hong Kong appears to have increased significantly in recent years. The method of data collection effects reference standards of birth‐weight. The effect of different methods of data collection and statistical treatment of data for providing reference standards of birth‐weight are discussed.In this series average birth‐weight increased by 6.8 g per year of maternal age, 13.3 g per cm of maternal height, 42.5 g per previous baby and 104.9 g per week of gestational age; males were 110 g heavier than females. The effects of parity became significant at 35 weeks, and that of maternal age and height at 36 weeks; the effect of fetal sex was significant from 38 weeks onwards.
Granular Cell Tumours of the Vulva
Authors: Raju G.C. , Naraynsingh V. 
Published: February 2008

Summary: Granular cell tumours occur in a variety of sites, including the vulva. Origins from myogenic, histiocytic, fibroblastic and neurogenic elements have been proposed. Female preponderance suggests that oestrogenic hormones are involved.Seven cases of granular cell tumours of the vulva have been studied. In none was the correct diagnosis made preoperatively. They were solitary lesions and local excision was curative. Paraffin sections of these cases were studied by peroxidase‐ antiperoxidase method for myoglobin, lysozyme, alpha‐1‐antitrypsin and S‐100 protein localization. Antimyoglobin, antilysozyme and anti‐alpha‐1‐antitrypsin antibodies were not localized in these tumours; however, S‐100 protein was localized in all of them. These results agree with previous data that suggest a neurogenic origin for granular cell tumours.
Acute Puerperal Inversion of the Uterus — An Obstetric Emergency
Authors: Rachagan S.P. , Sivanesaratnam V. , Kok K.P. , Raman S. 
Published: February 2008

EDITORIAL COMMENT: This paper carries the important messages about acute inversion of the uterus. Firstly do not pull on the umbilical cord unless the uterine fundus is contracted and palpable — it is the abdominal, not the cord‐pulling hand, that provides the ‘control’ in delivery of the placenta by controlled cord traction. Likewise the traction should not be excessive — if the placenta does not quickly deliver, pass a catheter, and the miracle occurs (and so it seems, so prompt is the response, even though it is an everyday experience), the placenta no longer being imprisoned either in uterine fundus, or lower segment by cervical oxytocin‐induced contraction. The second message is to replace the inverted uterus as soon as it is diagnosed and before removing the placenta if it is still attached — this gives a firmer ‘fundus' for the fist to push against after general anaesthesia relaxes the uterus for correction of the inversion. With incomplete inversion (11 of the 15 cases in this report) the placenta has usually been delivered by strong (? too strong) controlled cord traction and the dimple in the still palpable uterine fundus has not been noted — the inversion is felt in the upper vagina like a large broad‐based endocervical polyp when vaginal examination is performed because of postpartum haemorrhage. In the editor's experience of one such case the inversion was rapidly manually corrected once the uterus was relaxed by halothane, with immediate cessation of haemorrhage.Summary: Over a 17‐year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 delveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.
Maternal Mortality at the Women's and Children's Hospital, South Okkalapa (1978–1982)
Authors: FRCOG Ma Khin Kyi 
Published: February 2008

EDITORIAL COMMENT: In 1982–1984 the maternal mortality rate in Australia was 13.16 per 100,000 confinements; of the 94 deaths 42 were directly attributable to pregnancy and childbirth, 25 were indirect and 25 were from incidental causes. There was only 1 death associated with abortion, the numbers in the 6 previous triennia beginning 1964–1966 being 45, 25, 25, 2, 5 and 3. These figures are provided for the reader to contrast with those presented in this paper from Burma which considers, without equivocation, the clinical details of 44 maternal deaths in one major hospital, 1978–1982. Abortions accounted for 50% of the deaths. Excluding these the maternal mortality rate was 98 per 100,000 maternities. The author has firm views on proper definitions of parity, abortion and maternal mortality and these are stated. This paper has been published with minimal editorial interference — it was considered that readers would appreciate the unabridged case histories, especially that of the death resulting from falling astride a bamboo spike.Summary: The maternal deaths between the years 1978 and 1982 were studied. There were 22,468 maternities and 10,623 abortion patients treated at the hospital. There were 44 maternal deaths; 22 due to abortion and 22 due to other causes. The maternal mortality rate including abortions was 1.33 per 1,000 maternities and that excluding abortions 0.98 per 1,000. The abortion was 2.0 per 1,000 abortions treated at the hospital. To reduce maternal mortality, ways and means should be found to reduce the abortion deaths, most of which were avoidable.
Pregnancy Outcome in Maturity Onset Diabetes at Young Age (MODY)
Authors: Dicker Dov , Yeshaya Arie , Feldberg Dov , Samuel Nurith , Karp Moshe , Goldman Jack A. 
Published: February 2008

EDITORIAL COMMENT: The point of this paper is that the authors wish to classify separately those patients aged less than 25 years known to be diabetic before the onset of pregnancy, who when not pregnant can be managed without insulin — presumably these patients can maintain normal blood sugar levels by diet alone when not pregnant. The authors have not explained why age is a criterion for classification. In other words the MODY group of diabetics are a subgroup of noninsulin dependent diabetics (type 2) who previously have been divided into nonobese and obese groups. The 1978 update of White's classification of pregnant women with diabetes has 15 categories and ‘its increasing complexity may have impaired its usefulness’1. This warning is quoted so that we do not become distracted front the principles of obstetric management of diabetics: (1) prepreghancy counselling with stabilization of blood glucose levels before conception (2) good pregnancy control (3) monitoring of fetal condition in late pregnancy (oestriol assay, cardiotocography, ultrasonography) and (4) timing of delivery according to maternal and fetal condition. Unless obstetric complications dictate earlier intervention, pregnancy is allowed to go to full term (40 weeks). If insulin is required we favour induction of labour at 38 weeks' gestation after amniocentesis for estimation of the L/S ratio; before any elective induction the L/S ratio should be measured if there is doubt about fetal maturity.

Williams Obstetrics 17th Edition. Prichard JA, MacDonald PC, Gant NF, Norwalk, Conn; Appleton‐Century‐Crofts 1985; p 599.

Summary: Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature.Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin.This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin‐dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin‐dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Cae‐sarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.
Shoulder Dystocia: Risk Factors and Prevention
Authors: Hassan Adnan A. 
Published: February 2008

EDITORIAL COMMENT: Shoulder dystocia or impacted shoulders occurs in 2 4 per 1,000 deliveries in most reports. However, in this editor's opinion, some difficulty with delivery of the shoulders is encountered in 20 — 40 per 1,000 vaginal deliveries, and is often the result of occipitoposterior position with nonrotation of the shoulders. In this series of 41 cases there were 14 operative vaginal deliveries but, to my surprise, arrest of the occiput posterior to the transverse diameter did not rate a mention! 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) ceases. The problem is probably more common with epidural analgesia, and should be anticipated in all midforceps deliveries, especially when there are signs of cephalopelvic disproportion. The author states that ‘the majority of cases of shoulder dystocia can be anticipated;’ he infers that elective Caesarean section should be performed when clinical judgement plus ultrasonographic assessment indicates fetal birth‐weight of 4,500 g or more — in this series of 19,000 vaginal deliveries, shoulder dystocia occurred in approximately 1 in 5 such infants. The clinician must be alert to recognize the 1 in 100 fetus that will have a birth‐weight of 4,500 g or more. Another indication for elective Caesarean section to avoid shoulder dystocia is the multipara who suffered this complication in a previous delivery and again has a fetus of ample proportions.Summary: Failure of the shoulders to deliver after delivery of the head is known as shoulder dystocia.The risk factors associated with its occurrence were examined in women delivering vaginally at Jordan University Hospital. The profile of the patient most likely to present with shoulder dystocia was determined to be a multiparous, obese patient, over 42 weeks' gestation in a pregnancy complicated by preedampsia or diabetes with an infant weighing 4,500 g or more.Neonatal complications were noted to be high. There was no maternal death but 4 stillborn infants were delivered and 1 died in the immediate neonatal period.
Umbilical Cord Knots And Encirclements
Authors: McLennan Harold , Price Elva , Urbanska Maria , Craig Nellie , Fraser Monica 
Published: February 2008

EDITORIAL COMMENT: This paper confirms that a long umbilical cord is more likely to become knotted or encircle the fetal neck. Because these cord complications seldom harm the fetus, clinicians should look for other causes of birth asphyxia or ‘unexplained’ stillbirth. Greater awareness of spontaneous fetomaternal haemorrhage may eventually lead to diagnosis sufficiently early to permit effective treatment (Fliegner JRH, Fortune DW, Barrie JV. Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity. Aust NZJ Obstet Gynaecol 1987; 27: 158–161). Other circumstances where cord entanglements may distant the clinician away from the real cause of corrective fetal compromise include intrauterine infection, maternal drug therapy, haemorrhage from vasa praevia and diaphragmatic hernia.Summary: Although cord knots and/or encirclements account for 1 in 10 stillbirths of infants weighing 2,500 g or more, no problem due to this cause was encountered in a prospective study of 1,115 vaginal deliveries. In this study there were 6 cases of cord knot (0.5%) and 158 of cord encirclement (14.2%). The range of cord length was 27 — 122 cm, the 10th, 50th and 90th percentiles being 40, 52 and 69 cm respectively. In this study there was no clinical warning (fetal distress) of cord encirclement or knot during pregnancy, labour or delivery.
Further Evaluation of First Morning Urinary Oestrogen in Monitoring Gonadotrophin Therapy
Authors: Tang Grace W. K. , Chan Steven Y. W. 
Published: February 2008

EDITORIAL COMMENT: These authors previously reported that a first morning urinary oestrogen to creatinine ratio correlates well with 24‐hour urinary oestrogen excretion (13). This paper reports the successful application of this assay in monitoring the ovarian response to gonadotrophin therapy.Summary: Efficient gonadotrophin therapy requires both biochemical and ultrasonic measurements of ovarian response. Biochemical monitoring can take the form of measurement of plasma oestradiol levels or urinary oestrogen excretion. Levels of first morning urinary oestrogen to creatinine ratio have been shown to correlate well with 24‐hour total urinary oestrogen excretion. Such urine collection is not cumbersome and is less invasive than daily venepuncture. Eighty gonadotrophin treatment cycles were evaluated by first morning urinary oestrogen to creatinine ratio and ultrasound scanning of follicles. Analysis confirmed that the ratio correlated significantly both with plasma oestradiol and 24‐hour urinary oestrogen levels. The administration of the ovulating dose of human chorionic gonadotrophin depended primarily on ultrasonic demonstration of the presence of mature follicles in the ovaries. There was no increased incidence of multiple gestation or hypersti‐mulation syndrome in 135 treatment cycles. It is concluded that first morning urinary oestrogen to creatinine ratio is a convenient and cheap method of efficient biochemical monitoring of ovarian response to gonadotrophin therapy.
Microbiological Profile of the Cervix in 1,000 Sexually Active Women
Authors: Kovacs G.T. , Westcott M. , Rusden J. , Asche V. , King H. , Haynes S.E. , Moore E.K. , Hall B.E. 
Published: February 2008

EDITORIAL COMMENT: The take‐away message from this careful study is that of 1,000 women attending a family planning clinic, microbiological study isolated Mycoplasmas in more than 50%, Chlamydia in 5% and gonorrhoea in about 0.5%— although only 16% of the women presented because of pain, discharge or suspicion of sexually transmitted disease. In those patients with 2 or more sexual partners in the past year the incidence of mycoplasma infection was somewhat higher but the risk of chlamydial infection was doubled. In the 25% of women with symptoms, Gardnerella was cultured in 40% and Candida in only 20%. How does one apply this information to ordinary gynaecological or general practice? If a patient presents with vaginal itch and discharge, unless she has obvious clinical signs of Candida, she should be prescribed a course of a tetracycline (Chlamydia, Mycoplasmas, gonorrhoea) and metronidazole (Gardnerella, trichomonas). This is shotgun therapy but the only alternative is more sophisticated bacteriological investigation of outpatients — 2 cervical swabs for Chlamydia and a third in Amies transport medium for culture of Neisseria gonorrhoeae and the genital mycoplasmas, and for Gardnerella and other anaerobes. The final comment is that it is uncertain if any treatment is indicated when culture reveals Mycoplasmas or Gardnerella, especially if the patient is asymptomatic — it would be mindboggling if doctors should accept that almost 50% of asymptomatic women who attend for contraceptive advice harbour vaginal organisms that require treatment.Summary: One thousand consecutive women who attended the Richmond Family Planning Association Clinic and who were to undergo a vaginal examination were asked to participate in a large prospective microbiological study. Participants were questioned about their sexual activity during the previous 12 months and any apparent signs of sexually transmitted disease. On examination the cervix was inspected for evidence of inflammation, ectopy or discharge and cervical swabs were taken for microbiological assessment. Chlamydia trachomatis was isolated in 5.1 % of women tested while Ureaplasma urealyticum and Mycoplasma hominis were found in 48.8% and 16.4% of women respectively. Significant associations were found between the number of sexual partners during the previous 12 months and the incidence of all 3 organisms. The carriage rate of the genital mycoplasmas was significantly affected by the type of contraception. In addition the association between the presence of the genital mycoplasmas and pelvic and cervical abnormalities was determined.
Uterine Activity in Spontaneous Labour with Breech Presentation
Authors: Arulkumaran S. , Ingemarsson I. , Gibb D. M. F. , Ratnam S. S. 
Published: February 2008

EDITORIAL COMMENT: In this unusual and interesting study the authors found that uterine activity in patients with breech presentation is similar to that in patients with vertex presentations, when controlled for parity (nulliparas versus multiparas). The study did not consider the type of breech presentation, although one might expect labour to be more coordinate and effective with a breech with extended legs than with a complete breech. It is interesting to note that the authors practise amniotomy in the active phase of labour when the breech presents ‘provided that cord presentation or a high presenting part is excluded’. In this group of patients the authors did not employ either epidural analgesia or oxytocin enhancement of labour. The authors make the point that normal uterine activity in patients with breech presentation does not guarantee safe breech delivery. Readers should note that in this series criteria for inclusion included normal pelvic and fetal dimensions, and spontaneous onset of labour.Summary: Uterine activity was quantified for patients who had a breech presentation, spontaneous labour and a vaginal delivery. Results were studied according to parity and in relation to cervical dilatation. The multiparas with breech presentation overall had lower uterine activity compared to nulliparas when the whole labour was considered. These values were compared with control patients with vertex presentation who had spontaneous normal labour and vaginal delivery. The median uterine activity values in breech presentation were not significantly different from control nulliparous or multiparous patients. Among the breech deliveries, irrespective of parity, mean Apgar scores at 1 and 5 minutes were over 6 and cord arterial blood pH values were above 7.15, but these results were significantly lower than the contol cases with vertex presentation. The uterus performs similar uterine activity in spontaneous normal labour whether the fetus presents as a vertex or breech, when controlled for parity.