bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of endovascular treatment in cases of abnormal placentation with post‐partum hemorrhage
Authors: La Folie Trévor , Vidal Vincent , Mehanna Mayssoun , Capelle Marianne , Jaquier Alexis , Moulin Guy , Bartoli Jean Michel 
Published: September 2007

AbstractAim:  The purpose of this study was to evaluate the clinical success of selective arterial embolization in cases of post‐partum hemorrhage due to abnormal placentation.Methods:  Six patients with persistent hemorrhage and abnormal placental implantation underwent uterine artery embolization over a period of three years.Results:  In four patients, the placenta was left in place after a gentle attempt at removal and post‐partum hemorrhage was controlled during or shortly after the procedure. In all cases, embolization was possible even when there was previous arterial ligation (two cases). In one case, a hysterectomy was required at 21 d later due to uterus and bladder necrosis. Arterial embolization in cases of abnormal placental implantation remains an uncommon treatment and is less efficient in these cases than in normal placental implantation.Conclusion:  Our results confirmed that even in cases of moderate bleeding, conservation treatment and embolization are possible, but that complications may be more common than in normal placentation.
Celecoxib versus magnesium sulfate to arrest preterm labor: Randomized trial
Authors: Borna Sedigheh , Saeidi Fatemeh Mir 
Published: September 2007

AbstractAim:  The effectiveness of the management of preterm birth remains an important health care issue, especially when considering that more than two thirds of singleton neonatal death occurs in preterm labor. The purpose of this study was to compare oral celecoxib with intravenous magnesium sulfate as tocolytic.Methods:  This was a randomized study of patients who were between 24 and 34 weeks of gestation with preterm labor. One hundred and four pregnant women with preterm labor were randomly assigned to receive celecoxib 100 mg b.i.d. for 48 h or intravenous magnesium sulfate (MgSO4) for maximum of 48 h. Outcome variables included delay of delivery for 48 h and the incidence of side‐effects. Data was analyzed using the Student t‐test and the χ2 test.Results:  There was no difference between the groups over the course of the study in demographic characteristics, cervical examination and amniotic fluid index. Labor was arrested for 48 h was in 42 (81%) and 45 (87%) of the patients in the celecoxib and magnesium sulfate groups, respectively (p‐0.298). There were no severe maternal or neonatal complications in either group.Conclusion:  Celecoxib is as effective as magnesium sulfate for primary tocolysis.
Plasma levels of α‐defensins 1–3 are an indicator of neutrophil activation in pregnant and post‐partum women
Authors: Okazaki Takayuki , Ota Yoriko , Yuki Nobuhiro , Hayashida Ayako , Shoda Akiko , Nishikawa Masayoshi , Oshima Kyoko , Fukasawa Ichio , Watanabe Hiroshi , Inaba Noriyuki 
Published: September 2007

AbstractAim:  In severe preeclampsia and septic shock, excessively activated neutrophils are thought to injure tissue irreversibly. On the other hand, mild neutrophil activation is known to occur during normal pregnancy. The objective of this study was to determine whether elevated plasma levels of α‐defensins 1–3 could be used as an indicator of neutrophil activation in pregnant and post‐partum women.Methods:  Defensin concentrations in 21 non‐pregnant women and men, 184 normal pregnant women, and 55 post‐partum women were quantified using an enzyme‐linked immunosorbent assay (ELISA). The expression of the surface markers, CD11b and Toll‐like receptor‐4 (TLR‐4), on the neutrophils were analyzed by flow cytometry in a cohort of subjects different from that used for the analysis of α‐defensin levels.Results:  The concentrations of α‐defensins were significantly higher in women that were in labor than in any of the other subjects. These levels diminished after delivery, but remained significantly elevated at one month post‐partum. The expression of both CD11b and TLR‐4 was significantly higher in women in labor compared to non‐pregnant donors (controls). CD11b expression remained high on the third post‐partum day, while TLR‐4 expression fell to non‐pregnant levels.Conclusion:  Our results suggest that there is a positive association between defensin levels and neutrophil activation in pregnant and post‐partum women.
Cervical intraepithelial neoplasia II‐III with endocervical cone margin involvement after cervical loop conization: Is there any predictor for residual disease?
Authors: Kietpeerakool Chumnan , Khunamornpong Surapan , Srisomboon Jatupol , Siriaunkgul Sumalee , Suprasert Prapaporn 
Published: September 2007

AbstractAim:  To determine the clinicopathological predictors for residual disease in women who have had cervical intraepithelial neoplasia (CIN) II‐III with endocervical cone margin involvement after loop electrosurgical excision procedure (LEEP).Methods:  All of the women who had CIN II‐III on LEEP specimens with endocervical margin involvement, and underwent subsequent surgical treatment including repeat LEEP or hysterectomy at Chiang Mai University Hospital between May 2003 and June 2006 were reviewed.Results:  During the study period, 85 women who matched the study inclusion were identified. The mean age was 48.6 years. Fifty‐two women (61.2%) were postmenopausal. The most common Pap smear before LEEP was high‐grade squamous intraepithelial lesion (HSIL) (65.9%), followed by squamous cell carcinoma (21.2%). Twenty‐five women (29.4%) had concurrent ectocervical and endocervical cone margin involvement. Residual disease was noted in 44 women (51.8%, 95%CI = 40.7–62.7) of whom six had unrecognized invasive squamous cell carcinoma, while the remaining 38 had CIN II‐III. Only extensive endocervical cone margin involvement (3–4 quadrants) was noted as the significantly independent predictor for residual disease (aOR = 14.2, 95% CI = 3.6–55.8; P < 0.001).Conclusion:  Extensive endocervical cone margin involvement after LEEP for CIN II‐III is a strong predictor for residual disease. Therefore, the number of involved quadrants should be evaluated to plan further management.
Laparoscopy should be strongly considered for women with unexplained infertility
Authors: Nakagawa Koji , Ohgi Shirei , Horikawa Takashi , Kojima Rieko , Ito Megumu , Saito Hidekazu 
Published: September 2007

AbstractAim:  Women with unexplained infertility frequently become pregnant after diagnostic laparoscopy. In this study the effect of laparoscopic surgery on such women was evaluated by the pregnancy rate after laparoscopic surgery.Methods:  A total of 47 unexplained infertile women underwent laparoscopic evaluation during the period August 2002 to January 2005 in our center. The percentage of positive laparoscopic findings and the pregnancy rate after laparoscopy were calculated. The patients were divided into 5 subgroups according to maternal age, pregnancy rates were calculated for each group, and compared with the outcome of assisted reproductive technology (ART) treatment for the same age groups.Results:  In 87.2% of the women, laparoscopy revealed abnormal findings; endometriosis lesions, peritubal adhesions and tubal obstructions were found in 21, 17 and 3 cases, respectively. After laparoscopy 23 achieved pregnancy (pregnancy rate: 48.9%). The pregnancy rates of the groups at the age of 25 years old or less, 26–30, 31–35, 36–40 and over 41 years old were 100%, 75.0%, 45.5%, 27.2% and 0%, respectively. In the case of the 26–30 years old group, the pregnancy rate after laparoscopy was significantly higher than that in the ART treatment group (33.3%, P < 0.05).Conclusions:  Laparoscopy should be strongly considered for examining women with unexplained infertility.
Morphometric study of GnRH analog/HMG/HCG effects on ultrastructure of human endometrial epithelium in early and mid‐luteal phase
Authors: Novin Marefat Ghaffari , Bazy Parviz , Rad Jafar Soleimani , Sarani Sir Ahmad , Farzadi Laya , Ghasemzadeh Aliyeh 
Published: September 2007

AbstractAim:  The aim of the present study was to investigate the effects of long protocol ovulation induction on the ultrastructure of the human endometrial epithelium on days luteinizing hormone (LH) + 4 and LH+ 6 of the menstrual cycle.Methods:  Endometrial biopsies were obtained on days LH+ 4 (n = 9) and LH+ 6 (n = 10) from infertile women who were under standard long protocol with luteal phase supplementation with IM (intramuscular) progesterone, but where the embryo had not been formed or transferred, due to the male factor problem. Biopsies were also taken on days LH+ 4 (n = 5) and LH+ 6 (n = 5) from fertile women who had not received ovulation induction drugs as control groups. After preparation and taking light and electron micrographs from samples, qualitative and quantative evaluations (morphological and morphometric) were accomplished and the data was compared using the unpaired student t‐test.Results:  Qualitative results showed the presence of the nuclear channel system, vacuoles of glycogen and giant mitochondria in all of the samples. Qualitative analysis showed that the volume fraction (Vv) of the euchromatin to the nucleus, the rough endoplasmic reticulum and the mitochondria to the cell, were not statistically different (P > 0.05) in samples taken on LH+ 4 in both control and test groups. The Vv of these features, however, to the cell in the test group was significantly (P < 0.05) higher than those in the control taken on LH+ 6.Conclusions:  These results suggest that long protocol ovulation induction with luteal phase support with progesterone alter the normal development of the human endometrium in the mid luteal phase and could decrease the implantation success rate.
Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy
Authors: Shibahara Hiroaki , Shimada Kazuhiko , Kikuchi Kumiko , Hirano Yuki , Suzuki Tatsuya , Takamizawa Satoru , Fujiwara Hiroyuki , Suzuki Mitsuaki 
Published: September 2007

AbstractAim:  Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review.Methods:  The authors carried out diagnostic or operative THL in 177 infertile women, aged 22–43 years. Major complications during THL and a review of the literature were analyzed.Results:  Two cases of bowel injury were diagnosed during diagnostic THL. No complication occurred during operative THL. In total, the incidence of bowel injury was 1.1%. The injuries were diagnosed during THL and treated expectantly under strict conditions in both cases. Ten studies in the literature reported a total of 4232 procedures, including 26 bowel injuries (0.61%) and one perforation of a retroflexed uterus (0.02%).Conclusions:  The usefulness of THL for diagnostic and operative purposes is in no doubt. However, informed consent should be obtained and vigilance before and during THL should be maintained, although it can be done on an outpatient clinic basis.
Intrauterine therapy with cytomegalovirus hyperimmunoglobulin for a fetus congenitally infected with cytomegalovirus
Authors: Sato Akira , Hirano Hideto , Miura Hiroshi , Hosoya Naoko , Ogawa Masaki , Tanaka Toshinobu 
Published: September 2007

AbstractReported herein is a case of hydrops fetalis in which the cord blood expressed cytomegalovirus (CMV) antigen. Fetal ascites was removed from an infected fetus with hydrops in utero and 2.5 g CMV hyperimmunoglobulin was administered into the fetal abdominal cavity at 28 weeks gestation. After immunoglobulin administration, fetal ascites vanished, preload index of the inferior vena cava decreased and platelet count of the infant increased. However, despite intrauterine therapy and intensive neonatal care, the infant died soon after birth. The expression of CMV antigen in the nucleus of polymorphonuclear leukocytes in fetal cord blood indicated that the fetal hydrops was caused by CMV infection. When symptomatic CMV infection of a fetus is suspected from serological and ultrasound findings, further examinations should be performed for the diagnosis. Intrauterine immunoglobulin therapy could be one of the therapeutic options for the affected fetus.
Nitric oxide metabolite levels in preterm labor
Authors: Chadha Sandeep , Jain Vanita , Gupta Indu , Khullar Madhu 
Published: September 2007

AbstractAim:  To investigate the role of nitric oxide metabolites as markers of infection in subjects with preterm labor or preterm premature rupture of membranes (PTPROM). PTPROM means that there was spontaneous rupture of fetal membrane before the onset of labor and gestational age was <37 weeks. This occurs because of imbalance between matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase. The cause of this imbalance that leads to degradation of collagen causing PTPROM is infection. The bactericidal, fungicidal, viricidal and tumoricidal activities of macrophages are determined in part by elaboration of nitric oxide, hence nitric oxide levels have been found to be increased in infectionsMethods:  During an 18‐month period 50 women with preterm labor or PTPROM and 50 controls were enrolled prospectively. Blood and urine samples were obtained for analysis of nitric oxide metabolites. Patients with known causes of preterm labor were excluded.Result:  The nitric oxide metabolites, which included both nitrite levels and citrulline levels were significantly higher both in blood as well as urine in patients with preterm labor and PTPROM compared to controls. Serum nitrite levels in subjects with preterm labor were 376.5 ± 345 nmol/L while in subjects with PTPROM they were 295.7 ± 161.1 nmol/L and in controls the levels were 62.7 ± 33.9 nmol/L. Serum citrulline levels in subjects with preterm labor were 5293.8 ± 2916.7 nmol/L; in PTPROM they were 6536.6 ± 609.91 nmol/L and in controls they were 949.8 ± 67.1 nmol/L. On comparing patients with preterm labor, those in whom preterm labor could not be inhibited had statistically significant higher levels of nitrite in both serum and urine (482.9 ± 387.7 nmol/L and 754.5 ± 336.5 nmol/L, respectively) compared to patients in whom labor could be inhibited (172.2 ± 61.9 nmol/L and 401.8 ± 236.9 nmol/L, respectively). The citrulline levels were also higher among the group who delivered preterm for both serum and urine (5355.4 ± 3229.7 nmol/L and 11 482.8 ± 2541.4 nmol/L, respectively) compared to patients in whom labor could be inhibited (5260.2 ±  2897.08 nmol/L and 10 651.4 ± 1502.7 nmol/L, respectively) but this did not reach statistical significance.Conclusion:  Higher nitric oxide metabolites in women with preterm labor are marker of subclinical infection.
Perforated colon volvulus coiling around the uterus in a pregnant woman with a history of severe constipation
Authors: Iwamoto Ichiro , Miwa Katsuhiro , Fujino Toshinori , Douchi Tsutomu 
Published: September 2007

AbstractA case of intestinal volvulus in both the sigmoid colon and cecum in a pregnant woman suffering from severe constipation is reported herein. The fetus was dead and the mother developed acute shock. The twisted sigmoid colon coiled twice around the uterus and was perforated. The mother died 10 h after the onset of severe abdominal pain. Volvulus should be considered when examining severe abdominal pain in a pregnant woman with a history of severe constipation. Early suspicion together with prompt intervention will minimize maternal and fetal morbidity and mortality of this rare complication of pregnancy.
Impact of maternal body mass index on obstetric outcome
Authors: Sahu Meenakshi T. , Agarwal Anjoo , Das Vinita , Pandey Amita 
Published: September 2007

AbstractAim:  The purpose of the present study was to correlate effect of maternal body mass index (BMI) on obstetric outcome. The studies conducted so far are from Western developed countries and there is a paucity of data from developing countries.Methods:  A prospective evaluation was carried out of 380 women in one unit of a tertiary care teaching hospital in North India from May 2005 to June 2006 on the effect of maternal BMI on pregnancy outcome. BMI was calculated as weight (kg) divided by height (m2). BMI was used to characterize women as lean (BMI < 19.8 kg/m2), normal (BMI 19.9–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2) or obese (≥30 kg/m2).Results:  Forty‐six women (12.1%) out of 380 were underweight, 99 (26.1%) were overweight, 30 (7.9%) were obese and the remaining 205 (53.9%) had normal BMI. Anemia (P = 0.02) and low birthweight (P = 0.008) was significantly present among lean women. Obese women had a significant risk for gestational diabetes (P = 0.0004), pre‐eclampsia (P = 0.004), cesarean delivery (P = 0.01) and macrosomia (P = 0.02).Conclusion:  Both lean and obese women carry a risk for adverse pregnancy outcome, therefore pregnant women should maintain a normal BMI to achieve a healthy pregnancy outcome.
High‐frequency stimulation of the subthalamic nucleus prolongs the increase in striatal dopamine induced by acute l‐3,4‐dihydroxyphenylalanine in dopaminergic denervated rats
Authors: Lacombe Emilie , Carcenac Carole , Boulet Sabrina , Feuerstein Claude , Bertrand Anne , Poupard Annie , Savasta Marc 
Published: September 2007

AbstractHigh‐frequency stimulation of the subthalamic nucleus (STN‐HFS) is a powerful approach for treating the motor symptoms of Parkinson's disease (PD). It results in clinical improvement in patients with PD, further reducing the l‐3,4‐dihydroxyphenylalanine (L‐DOPA) requirement and thus L‐DOPA‐induced dyskinesia. However, it remains unclear how STN‐HFS modifies the response to L‐DOPA. We investigated the effect of STN‐HFS on striatal extracellular concentrations of dopamine and its metabolites following acute L‐DOPA administration in intact or partially dopaminergic denervated (DA‐PL) rats. L‐DOPA treatment significantly increased striatal dopamine levels in intact and DA‐PL animals, with the maximal effect observed 1 h after L‐DOPA injection. This increase was more pronounced in DA‐PL rats (ipsilateral to the lesion) than in intact animals. It remained fairly stable 1 h after the maximal effect of L‐DOPA and then decreased towards basal values. STN‐HFS in intact rats had no effect on the maximal L‐DOPA‐induced increase in striatal extracellular dopamine concentration or the return to basal values, the profiles observed being similar to those for non‐stimulated intact animals. Conversely, STN‐HFS amplified the L‐DOPA‐induced increase in striatal dopamine levels during the stimulation period (1 h) in DA‐PL rats and this increase was sustained throughout the post‐stimulation period (2.5 h), without the return to basal levels observed in stimulated intact and non‐stimulated rats. These new neurochemical data suggest that STN‐HFS interferes with L‐DOPA effects, probably synergically, by stabilizing dopamine levels in the striatum and shed light on the mechanisms of STN‐HFS in PD.
Clinical validation of the Multidimensional Assessment of Pain Scale
Authors: RAMELET ANNE‐SYLVIE , REES NANCY WILLIE , MCDONALD SUE , BULSARA MAX K. , HUIJER ABU‐SAAD HUDA 
Published: September 2007

SummaryBackground:  The Multidimensional Assessment Pain Scale (MAPS), was developed to measure postoperative pain in critically ill preverbal children. Following preliminary psychometric testing, additional validation of this 5‐category 10‐point scale was required. This article reports the results of a follow‐up validation study that aimed to evaluate the clinical validity and utility of the MAPS.Methods:  The MAPS includes five categories and was tested in response to analgesics in a convenience sample of 19 postoperative critically ill children (94% intubated) aged between 0 and 31 months at a tertiary referral hospital in Western Australia. Convergent and concurrent validity was tested using the MAPS, Faces Legs Activity Cry Consolability (FLACC), and Visual Analog Scale observer (VASobs). Clinical utility of the MAPS was also evaluated.Results:  The Multidimensional Assessment Pain Scale scores decreased significantly by four points (40% of total score) after the administration of a potent dose of morphine (P < 0.001). Agreement measurements between MAPS and FLACC and MAPS and VASobs showed that the risk of measurement error was small. Internal consistency of the MAPS would improve if the physiologic item was deleted (Cronbach’s α 0.79–0.64). However, the actual values of heart rate, systolic, mean, and diastolic arterial pressure were shown to decrease significantly (7–14% decrease) at 15, 30, and 60 min after a potent bolus of morphine (P < 0.001). The MAPS also demonstrated clinical feasibility.Conclusions:  This study showed that ‘MAPS like FLACC and VASobs decreases similarly following rescue morphine. MAPS‐revised can be recommended for clinical application.
The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions
Authors: INGELMO PABLO , LOCATELLI BRUNO GUIDO , FRAWLEY GEOFF , KNOTTENBELT GRAHAM , FAVARATO MORENO , SPOTTI ANGELICA , FUMAGALLI ROBERTO 
Published: September 2007

SummaryBackground:  There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double‐blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery.Methods:  One hundred and forty‐one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4–0.6 ml·kg−1 epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded.Results:  There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P = 0.73)] when a median volume of 0.55 ml·kg−1 was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups.Conclusions:  While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
Long‐term use of an intravenous ketamine infusion in a child with significant burns
Authors: WHITE MICHELLE C , KARSLI CENGIS 
Published: September 2007

SummaryWe report the use of an intravenous ketamine infusion for 37 days in a 9‐year‐old child with 42% body surface area burns. Ketamine was administered both in the intensive care unit and the surgical ward and provided high quality analgesia as an opioid adjunct. Throughout the long duration of administration, the child did not develop tolerance or experience psychomimetic side effects and weaning of the ketamine infusion was achieved rapidly, without evidence of withdrawal. This case demonstrates the safe and effective use of long‐term intravenous ketamine in a child with significant burns on a surgical ward. We have focused the discussion on the issues of tolerance and weaning of long‐term ketamine infusions in children.