bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Chronic Pelvic Pain in Women May Be Caused By Ligamentous Laxity in the Posterior Fornix of the Vagina
Authors: Petros Pe Papa 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because severe chronic pelvic pain, often with associated secondary dysmenorrhoea and dyspa‐reunia, is a difficult gynaecological problem to deal with, and is not uncommon. The women are usually premenopausal and bimanual palpation of the uterus reproduces the pain they complain of ‐ the uterus seems tender but the explanation could be that described in this paper. In these women the uterus is freely mobile and there is no palpable adnexal pathology, and as noted by the author, laparoscopic findings are normal. It is widely believed that it is the ovaries and not the uterus (or the contents of its supporting ligaments) that are the cause of this syndrome, and when hysterectomy is contemplated, the question of whether to perform bilateral oophorectomy arises. Hysterectomy alone is often curative of pain in these patients (A) but the lesser procedure described here warrants consideration in patients with chronic severe pelvic pain. To establish that the proposed operation is effective, it would be necessary to perform a properly designed blinded randomized controlled trial, with the control women having a ‘placebo’ operation (e.g. anaesthetic/sedation, local analgesia infiltration, incision of vagina without plicating the uterosacral ligaments). We believe that such a trial is feasible.Summary: The aim was to prospectively study the relationship between pelvic pain of otherwise unknown origin and laxity in the posterior vaginal fornix. Twenty‐eight patients with negative laparoscopy findings, lower abdominal pain and laxity in the posterior ligamentous supports of the uterus underwent surgical approximation of their uterosacral ligaments. At 3‐month review, 85% of patients were cured, and at 12 months, 70%. Nonorganic pelvic pain has frequently been attributed to psychological factors. However, the results suggest that this may be a T12‐L1 parasympathetic pain referred to the lower abdomen, perhaps due to the force of gravity stimulating pain nerves unable to be supported by the lax uterosacral ligaments in which they are contained. It was concluded that laxity in the posterior ligaments of the vagina should first be excluded before referring patients with pelvic floor discomfort or pain for psychiatric care.
Vaginal Delivery After Caesarean Section: Factors Influencing Success Rates
Authors: Lovell Rosemary 
Published: February 2008

SummaryIn a retrospective review of 333 pregnancies in women who had 1 previous Caesarean section, 244 (73.3%) underwent a trial of scar, and 89 (26.7%) had an elective Caesarean section. In the trial of scar group 197 (80.7%) had a vaginal delivery and 47 (19.3%) required an emergency Caesarean section. The success of the trial was favourably influenced by a nonrecurring indication for the original Caesarean section, a previous vaginal delivery, and a smaller baby. Maternal morbidity was greater in the groups requiring a Caesarean section, whether elective or emergency. Those patients delivered vaginally spent significantly less time in hospital. In 2 of the 244 patients (0.8%) who underwent a trial of scar the previous lower segment scar was found at Caesarean section to have dehisced or ruptured.
Termination of Early Human Pregnancy with Either 50 mg or 200 mg Single Oral Dose of Mifepristone (RU486) in Combination with Either 0.5 mg or 1.0 mg Vaginal Gemeprost*
Authors: Prasad R.N.V. , Choolani M. 
Published: February 2008

SummaryMifepristone (RU486) is licensed for use in France at a dose of 600 mg in combination with 1.0 mg of vaginal gemeprost (a prostaglandin E1 analogue) for medical termination of early pregnancy up to 7 weeks' amenorrhoea resulting in 96% complete abortion rates. This study examines if it is possible to use lower doses of mifepristone and gemeprost to achieve similar success for women with pregnancies up to 56 days' amenorrhoea. Four groups of 25 women were scheduled to be given single oral doses of either 50 mg or 200 mg of mifepristone followed 48 hours later by insertion of a single vaginal pessary of 0.5 mg or 1.0 mg gemeprost. The lowest dose combination (i.e. 50 mg mifepristone + 0.5 mg gemeprost) was found to have unacceptable efficacy with a complete abortion rate of only 82%; the highest dose combination (i.e. 200 mg mifepristone + 1.0 mg gemeprost) resulted in a satisfactory complete abortion rate of 96% which is comparable with the rates for the recommended high 600 mg mifepristone dose (+ 1.0 mg gemeprost) in routine clinical use in France. The current study shows that efficacy can be maintained using a third of the recommended dose of mifepristone.
Complications of 174 Laparoscopic Hysterectomies
Authors: Cooper M.J.W. , Cario G. , Lam A. , Carlton M. , Vaughan G. , Hammill P. 
Published: February 2008

SummaryThe case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8–68.5) years, mean weight 70.2 (50–121) kg and mean parity 2.3 (0–4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45–285) minutes and mean hospitalization 2.6 (1–11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (>16 weeks). The mean follow‐up period was 2.2 (1–18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.
A Review of Results in a Series of 113 Laparoscopic Colposuspensions
Authors: Cooper M.J.W. , Carlo G. , Lam A. , Carlton M. 
Published: February 2008

SummaryThe case records of 113 women having laparoscopic retropubic colposuspensions (Burch procedure) performed for the treatment of genuine urinary stress incontinence between December, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 49.4 (30–80) years, mean weight 72.1 (44.5–114) kg, and mean parity 2.7 (0–8). All patients had preoperative urodynamic study to confirm genuine stress incontinence (GSI). Sixteen patients (14%) had dual pathology (GSI and detrusor instability).A transperitoneal approach was used in 93 operations and extraperitoneal in 20. The mean operating time was 108 (30–320) minutes and mean hospitalization 3.3 (1–10) days. In 13 women the operation was converted to laparotomy; 10 due to adhesions and diminished bladder mobility, 1 for inferior epigastric vessel injury, 1 for an ovarian tumour discovered incidentally at the procedure and 1 for equipment problems. Operative complications included 10 cystotomies (5 repaired laparoscopically), 2 extraperitoneal cases converted to transperitoneal, 1 inferior epigastric vessel injury, 1 vaginal tear, 1 suture through the bladder and 1 case of possible enterotomy oversewn at laparoscopy.The mean follow‐up period was 8.4 (1–28) months. All patients were reviewed postoperatively and then contact was attempted either by telephone or in consultation. There was an overall 87% subjective success rate. Two patients felt sutures tear out at 4 and 6 months and were deemed failures; 4 felt their incontinence was improved but had ongoing stress incontinence of urine; 9 had symptoms of detrusor instability and one developed an enterocele 9 months after surgery.
Role of Endoscopy in Retrieval of Misplaced Intrauterine Device
Authors: Mittal Suneeta , Kumar Sunesh , Roy Kallol K. 
Published: February 2008

SummaryWe report a series of 45 patients with misplaced intrauterine devices (30 extrauterine and 15 intrauterine). Only those patients with intrauterine misplacements in whom conventional blind removal was not possible were included in the study. All of the 15 misplaced intrauterine devices could be removed hysteroscopically; 22 of the 30 extrauterine misplaced devices (73%) could be removed laparoscopically. One patient required both laparoscopy and hysteroscopy. Only 7 (15.5%) of 45 patients required laparotomy for safe removal of misplaced devices. Considerable comfort and minimal hospital stay associated with endoscopic procedures should offer these as the first line attempt to remove a misplaced intrauterine or extrauterine translocated device.
An Audit of the Women Who Died During 1994 from Cancer of the Cervix in Victoria, Australia
Authors: Mitchell Heather , Medley Gabriele , Higgins Vicky 
Published: February 2008

SummaryAn audit of 73 Victorian women who died from cervical cancer during 1994 is presented. Seventy per cent of the deaths occurred in women who were 50 years at the time of cancer diagnosis. Younger women had significantly better screening histories than older women, but overall only 10% of the deaths occurred among women who were adequately screened. There was no excess of deaths in rural women or in women of non‐English speaking background. Four of the 6 deaths in women who were diagnosed with cancer while <35 years of age occurred in adequately screened women. If this finding is confirmed in a larger series, it raises questions about the ability of Papanicolaou screening to control disease in this age group.
Rectosigmoid Complications of Radiotherapy in Stage 3B Carcinoma of the Cervix
Authors: Vyas Rakesh Kumar , Dixit Sanjay , Singhal Sandip , Baboo Harshad A. , Aurora Dayal C. , Venkatratnam S. 
Published: February 2008

SummaryA retrospective analysis of 165 patients with Stage 3 B carcinoma of the cervix treated with radiotherapy alone was done; 120 patients were treated with a combination of external radiotherapy and intracavitary treatment while 45 patients received external radiotherapy only. Early rectosigmoid reactions were seen in 65% of cases with Grade 1, 2 and 3 reactions in 40%, 20% and 5% of cases respectively. Late rectosigmoid sequelae were observed in 25 patients (16%) with moderate complications in 5%. Severe rectal complications were seen in 2 women only. Rectosigmoid complications are the most common sequelae of pelvic irradiation and seen more in advanced stages where a greater dose is given by external radiotherapy. The role of rectal dosimetry is equivocal if proper precautions are taken during intracavitary treatment.
Abnormal Cervical Cytology Leading to the Diagnosis of a Primary Serous Adenocarcinoma of the Peritoneum
Authors: Maher Chris E , Haran Mano V. , McLaughlin John 
Published: February 2008

SummaryA case is presented where abnormal cervical cytology in an asymptomatic female led to the diagnosis of a primary serous adenocarcinoma of the peritoneum. We would like to highlight the importance to the physician of a tumour diathesis on malignant cervical cytology.
Ovarian Epithelial Tumour in Gonadal Dysgenesis A Case Report and Literature Review
Authors: Lam S.K. , Yu M.Y. , To K.F. , Chan M.K.M. , Chung T.K.H. 
Published: February 2008

SummaryA patient with gonadal dysgenesis was found to have a mucinous epithelial ovarian tumour on the left side and a streak gonad on the right. The preponderance of mucinous tumours (5 of 8) over other epithelial tumours in these patients is noted but the significance is not fully understood. Two models of pathogenesis (incessant ovulation and hypergonadotrophic hypogonadism) were proposed but neither satisfactorily explains the development of the tumours. Further ultrastructural, chromosomal and molecular biological study of these tumours may help to elucidate the underlying cause and pathogenesis.
Accuracy of Estimated Fetal Weight below 1,000g
Authors: Scott Fergus , Beeby Philip , Abbott Jason 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it gives useful information on the interpretation of ultrasonographic estimates of fetal weight when considering whether fetal viability is such that Caesarean section is indicated on fetal grounds as the method of delivery in a complicated pregnancy.Summary: The Wars of formula is 1 of 3 currently recommended by the Australian Society for Ultrasound in Medicine for the routine estimation of fetal weight. However, this formula was derived using mostly large fetuses, and its accuracy in extremely low birth‐weight fetuses is not known. Using this formula, we studied 184 infants delivering within 14 days of an estimated fetal weight (EFW) <1,000 G, The mean percent error in EFW was 11.7% underestimation, with 80% of infants underestimated and 61% of estimates within 15% error. The percent error was consistent at 9.6% throughout the first 9 days, but increased to 32% after 10 days post scan (p<0.0001). There was a significant association between the accuracy of EFW and maternal height, but not with placental position, liquor volume or multiple pregnancy. EFW underestimated birth‐weight on average by 9.6% during the first week, and this error appeared to be mainly due to the formula. The error in EFW became unacceptable after 9 days and repeating the estimate before 10 days is recommended. A different formula may be more suitable for extremely low birth‐weight fetuses.
Intrauterine Adhesions: Hysteroscopic Lysis and Adjunctive Methods
Authors: Bellingham F. Richard 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because the author describes a sophisticated method of dealing with adhesions under ultrasound control in those patients where the adhesions are dense. It is always difficult to assess the effectiveness of therapies used in the treatment of infertility especially as most studies do not have a control series. This comment may particularly apply to patients with minor adhesions that are divided by the passage of a hysteroscope.Summary: A series of 17 patients with significant intrauterine synechiae is presented with a demonstration of various adjunctive therapeutic measures which may be helpful. The procedure is ideally performed under ultrasound control and this is essential if the adhesions are extensive. There may be a place for postoperative use of an intrauterine contraceptive device or of hormone therapy, but these modalities are not universally accepted. However, 11 of 13 patients regained normal menstruation and 8 of the 10 desiring pregnancy achieved livebirths with these methods. Four of the latter had had severe adhesions. One patient (Case 9) was not seen after the postoperative visit (“lost to series‘) and 1 (Case 7) later had a hysterectomy for pain but the operative specimen showed a normal uterine cavity.
Iatrogenic Cardiac Tamponade During Pregnancy
Authors: Yim So‐fan , Lam Siu‐keung , Haines Christopher J. 
Published: February 2008

EDITORIAL COMMENT: Reports in the literature during the past 15 years seem to have established that asymptomatic pericardial effusion is common in women with apparently normal pregnancies, especially in the third trimester. There seems to be no association with cardiac disease or preeclampsia. We accepted this case report to inform readers about the occurrence of pericardial effusion and to deliver the authors' warning that conservative management should be favoured. It is common, indeed usual, to see an accumulation of fluid in the peritoneal cavity at Caesarean section, especially when performed in labour when there is cephalopelvic disproportion. The editor has always assumed this to be a sign of obstructed labour due to transudation of fluid from peritoneum of the pelvis and bladder, perhaps due to obstructed lymphatics or increased venous pressure in compressed tissues. The members of the editorial committee remain puzzled concerning the aetiology of pericardial effusions in pregnancy. We hope to be offered a review of the problem to dispel our ignorance. The physiology of peritoneal fluid production in complicated and normal pregnancy also remains unexplained.(A) Calvin S, Silva M, Weinslein L, Finley P, Witse M. Characterization of ascites present at cesarean section. Am J Perinatal 1991: 8: 99–102.Summary: A 26‐year‐old primigravida who presented to us with threatened preterm labour which was suppressed successfully with sulindac, was found to have a pericardial effusion. Pericardiocentesis was performed because of evidence of right ventricular compression. However, it was complicated by inadvertant puncture of the left ventricle causing cardiac tamponade, and hypovolaemic shock shortly afterwards. An emergency pericardiotomy was performed to rescue the patient.
A Validation Study of Home Uterine Activity Monitoring Technology in Western Australia
Authors: Dickinson Jan E. , Godfrey Maryellen , Legge Mathew , Evans Sharon F. 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it shows that there is technology available to reliably record uterine contractions and that the information can be transferred by a telecommunications system. As the authors indicate there is no consensus in the literature concerning the usefulness of home monitoring in the prevention of prematurity and whether the newer methods of biochemical monitoring will prove superior. Final judgement must be deferred until data are presented regarding testing this methodology on high and low‐risk patients in their homes including those in areas remote from hospital.Summary: Home uterine activity monitoring has been developed as an ‘early warning’ device to detect premature uterine activity, thereby encouraging earlier referral and tocolysis of women at risk of preterm delivery. This ambulatory monitoring system, utilizing a ring‐guard tocodynamometer, was piloted in Western Australia to determine if it can reliably record and transmit antenatal uterine activity data in an Australian environment. Pregnant women were readily able to correctly apply and use the ambulatory monitoring device. The information collected was able to be transmitted using standard Australian telecommunications systems within our hospital environment. Validation studies with the ambulatory monitor and current external tocodynamometry hardware were performed. The ring‐guard tocodynamometer detected more uterine activity at gestations less than 32 weeks compared with conventional external tocodynamometers. As term approached, however, the sensitivity of the ring‐guard tocodynamometer decreased. A cross‐sectional profile of antenatal uterine activity was developed for women at low risk of delivering preterm. A gradual increase in the number, duration and amplitude of uterine contractions as pregnancy advanced was observed.
Candida G lab rata Chorioamnionitis Following In Vitro Fertilization and Embryo Transfer
Authors: Sfameni Salvatore F. , Talbot James M. , Chow Steven L.S. , Brenton Lisa A. , Scurry James P. 
Published: February 2008

EDITORIAL COMMENT: We accepted this case for publication not only because it provides, for the first time, convincing evidence that Candida glabrata can cause chorioamnionitis and premature rupture of the membranes, but for the suggestion that infection in the upper vagina and/or cervix should be considered in women having in vitro fertilization and embryo transfers (IVF‐ET). The authors suggest swab and culture to exclude infection before IVF‐ET. Since this technique could cause ascending infection an alternative would be to set up a culture from the cannula used to introduce the embryo(s) into the uterus, and commence appropriate antibiotic therapy if the culture was positive. Although previously not reported these cases illustrate that systemic treatment of Candida glabrata is indicated in women with a positive culture who have had IVF‐ET or have developed premature rupture of the membranes. In retrospect, the management in Case 1 was indeed conservative. As the authors indicate Candida glabrata is extremely resistant to all antifungal agents so the value of treatment of patients such as those reported here remains to be established.Summary: Candida glabrata is a yeast which is considered to be a commensal of the vagina with limited pathogenicity in die immunocompetent host. We report 2 cases of severe chorioamnionitis occurring in pregnancies achieved by in vitro fertilization techniques which resulted in preterm delivery and pregnancy loss. Candida glabrata as the causative agent was probably introduced into the uterus by the cannula at the time of embryo transfer. It is recommended mat appropriate investigation of the microbial flora of the cervix be undertaken and treatment instituted prior to embryo transfer in order to prevent this complication.
Peripartum Cardiomyopathy
Authors: Ladwig Petra , Fischer Eddy 
Published: February 2008

EDITORIAL COMMENT": Cardiomyopathy is an important primary cause of indirect maternal deaths and in the last 3 published triennial reports on maternal deaths in Australia accounted for 2 of 11 deaths due to cardiovascular disease in the 1988‐90 triennium (total deaths 96), 3 of 14 in 1985‐87 (total deaths 86), and 2 of 14 deaths due to cardiovascular disease in the 1982‐84 triennium in which the total number of maternal deaths was 94. This paper reports 3 cases of peripartum cardiomyopathy and provides valuable information concerning diagnosis, differential diagnosis and treatment. Case 1 has the anecdotal advantage of presenting the first successful pregnancy after cardiac transplantation in Australia.Summary: Peripartum cardiomyopathy is an uncommon condition of unknown aetiology. Diagnosis requires exclusion of other causes of congestive cardiac failure and the demonstration of global ventricular dysfunction on echocardiography. Treatment consists of diuretics, vasodilators, digoxin and anticoagulants. Prognosis is related to recovery of ventricular function. The availability of cardiac transplantation has improved the outlook for those with persistent dysfunction.
Prophylactic Amnioinfusion During Labour Complicated by Meconium
Authors: MD Anju Huria Khosla , MD Krishna Sangwan , MBBS Shanti Devi Ahuja 
Published: February 2008

EDITORIAL COMMENT: This study of amnioinfusion during labour complicated by the known passage of meconium shows that the technique seems clinically worthwhile, even in a centre without facilities for electronic fetal heart monitoring or scalp blood pH and blood gas analysis. The series is small and more data from larger studies is required to test the conclusions reported by the authors.Summary: A prospective study to see the safety and efficacy of transcervical amnioinfusion in labour complicated by meconium‐stained amniotic fluid (MSAF) was carried out in a teaching hospital with limited resources. Fifty patients in labour with meconium‐stained amniotic fluid and fulfilling the inclusion criteria (vertex presentation, gestational age of 36 weeks or more, no medical or obstetrical complications and normal fetal heart rate at time of inclusion) were taken for the study; 25 patients received amnioinfusion. The control group received only supportive therapy. Labour outcome was compared in the 2 groups. The incidence of Caesarean section was seen to be decreased but neonatal parameters showed no significant difference in the amnioinfusion group.