bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Treatment of Symptomatic Benign Breast Disease with Danazol
Authors: Ramsey‐Stewart George 
Published: February 2008

EDITORIAL COMMENT: Breast disease should concern all obstetricians and gynaecologists as well as general practitioners, since patients often report their breast symptoms at the time of attendance for a Papanicolaou smear. It is natural that the patient expects the one practitioner to advise her regarding prevention/ early diagnosis of cancer of the breast and cervix. Since 5–8% of women develop carcinoma of the breast and fewer than 1 in 10 breast lumps are found on biopsy to be malignant, breast pathology is too common and important to be ignored in this journal. The more common symptoms of breast pain and tenderness also warrant consideration. Many patients with breast symptoms require only reassurance, although the investigations available for screening for breast cancer will often require discussion (1).Summary: A prospective randomized double blind trial, using danazol in a dose of 200 mg twice a day, was carried out on 80 women presenting with severe cyclical symptomatic benign mammary dysplasia. Standardized scores for 4 parameters of disease severity (breast pain, breast tenderness, breast nodularity and breast cysts) were defined and measured monthly on all patients admitted to the trial. Using nonparametric statistical analysis, significant improvement in breast pain, tenderness and nodularity, was found in both the double blind and crossover arms of the trial. An insufficient number of patients presented with breast cysts to draw any conclusions regarding the efficacy of danazol on cysts. Six months of treatment may produce a more sustained response, than 3 months of treatment. Danazol appears to be efficacious in managing patients with severe breast symptoms due to benign disease.
Colposuspension for the Treatment of Female Urinary Incontinence
Authors: Korda Andrew , Ferry James , Hunter Peter 
Published: February 2008

EDITORIAL COMMENT: This paper reviews the results of a large series of patients with urinary incontinence treated by the Burch colposuspension with a few minor alterations. The operation is performed entirely from above, the vagina being suspended on either side of the bladder neck and attached to the iliopectineal ligament at the pelvic brim. It is noteworthy that only 36 of the 174 patients had pure stress incontinence as a symptom and 59 were obese. Selection of the patient who requires surgery when stress incontinence is associated with urgency and other urinary symptoms is very difficult. All of the 30 patients who remained incontinent after the operaton had urodynamic investigaton and 16 were found to have detrusor instability. It would seem that the author's results justify their willingness to operate on patients with mixed urinary symptoms. The success rate and incidence of complications in this series is consistent with other studies — however, there was a high incidence of voiding difficulties postoperatively as revealed by a mean postoperative catheter drainage time of 10 days, 5 patients requiring to go home using self‐catheterization with 2 needing this long‐term, and a postoperative incidence of detrusor instability of 10%. One reviewer believes this is due to overelevation of the bladder neck at the time of colposuspension which may be avoided by leaving the suspending sutures long at the time of surgery. The takeaway message is that patients with mixed urinary symptoms who have stress incontinence confirmed urodynamically have a good chance of being cured by surgery. It would be prudent that such patients should have a trial of medical management and pelvic floor exercises before resorting to surgery.Summary: Between June 1, 1983 and June 30, 1988, 174 patients with stress incontinence were treated with a colposuspension operation; 144 patients were cured, 30 remained wet. Sixteen patients who remained wet had detrusor instability; 9 of these were cured by anticholinergic medications. Of 25 patients who had dual pathology 19 were cured. Seventy nine patients had urinary tract infections. Two patients had ureteric obstruction due to kinking; it is postulated that this can be an in‐fequent and sometimes unavoidable complication.
Outcome of Treatment with Bromocriptine in Patients with Hyperprolactinaemia
Authors: Al‐Suleiman Dr S.A. , Najashi Dr S. , Rahman Dr J. , Rahman Dr M.S. 
Published: February 2008

EDITORIAL COMMENT: The results obtained in Ms series of hyperprolac‐tinaemic women indicates the efficacy and safety of bromocriptine therapy. Not everyone would agree with the need for routine surgical excision of pituitary macroadenomas nor with the cessation of the medication at 12 to 16 days after the first missed menstruation, since microadenomas may also enlarge in pregnancy.Summary: Results in 136 hyperprolactinaemic women who presented with infertility, amenorrhoea, menstrual irregularities and/or galactorrhoea are reported. There was radiographic evidence of pituitary microadenoma in 21 (15.4%) patients and 5 (3.7%) had macrodenoma. Four patients were taking antidepressants, 2 an‐tihypertensive drugs and 7 had taken oral contraceptives for a period of 6 months to 5 years. The remaining patients had no obvious cause for elevated prolactin levels. Patients with pituitary adenoma had a significantly higher (p<0.001) baseline serum prolactin level (182 ± 4.6 ng/ml) than those with no adenoma (59.2 ± 4.2 ng/ml). All patients in the study were treated with bromocriptine (2.5 — 10 mg) to normalize serum prolactin or to achieve a pregnancy. The patients without an adenoma required a significantly smaller dose of bromocriptine (2.5 ‐ 5.0 mg) (p<0.005) than those with an adenoma. Galactorrhoea disappeared in all 64 patients within 2–4 months of treatment, sixty‐six (71%) of the 93 patients who desired pregnancy achieved it within 3 to 8 months of bromocriptine therapy; 32 of these patients received additional treatment with clomiphene and human chorionic gonadotrophins for induction of ovulation. In the remaining 70 patients menstruation became regular and ovulation was evident in 40% of them. There was no significant difference in the pregnancy rate between the patients with or without pituitary adenoma. Similarly, presence of galactorrhoea or a high level of prolactin did not influence the pregnancy rate. No complications were observed during pregnancy related to pituitary adenomas; 8 (12%) pregnancies ended in first trimester abortion. No lethal congenital fetal abnormalities were observed in the patients treated with bromocriptine. It is concluded that hyperprolactinaemia in infertile patients with or without pituitary adenoma can be safely treated with bromocriptine with a high pregnancy rate and resumption of a normal menstrual pattern. All 5 patients with macroadenomas had excision of the tumour performed before bromocriptine therapy.
Combined Treatment With Gonadotrophin Releasing Hormone Agonist and Gonadotrophins In Poor Responders To Hyperstimulation For In Vitro Fertilization (IVF): Clinical and Endocrine Results
Authors: McKenna K. Mark , Foster P. , McBain J. , Martin M. , Johnston W.I.H. 
Published: February 2008

EDITORIAL COMMENT: We believe that this study on gonadotrophin releasing hormone agonist requires comment for our general readers. The emphasis of this journal is on clinical papers but it would be a pity if our general readers passed by reading some of the special aspects of modern endocrinology such as discussed in this paper. The detailed regimens for administration of drugs will mainly interest en‐docrinologists, but the general reader should be aware of the application of these recently available hormones and the rationale of their use for stimulation of the ovaries so that oocytes can be collected for in vitro fertilization or intra‐Fallopian tube deposition. The authors of this paper were asked, and have provided, the necessary introduction to explain the present indications for the use of gonadotrophin releasing hormone agonist. This paper explains how difficult it has become to improve results in the treatment of infertility in those patients who do not respond to the conventional regimens — it is becoming more expensive in time and money to prise new secrets from Nature on the control of the process of ovulation and conception.Summary: Seventy three cycles of combined gonadotrophin releasing hormone (GnRH) agonist/gonadotrophin treatment for IVF controlled ovarian hyperstimulation in previous poor responders to standard ovarian hyperstimulation therapy are reported. Oocyte numbers obtained were better than the previous average results, but were similar to the previous best response. In general more oocytes than the previous mean could be expected but low order responders were not transformed into high order responders. Pregnancies did occur in this difficult group of patients but the rate was modest. Because of a reduction in cancelled cycles, patients might reduce their total costs in time and gonadotrophin used, however this treatment is not a panacea for the true low order responder.
Ovarian Remnant Syndrome
Authors: Webb Maurice J. 
Published: February 2008

Summary: Twenty‐seven patients with ovarian remnant syndrome were operated on by the author in a 7‐year period. All patients presented with pelvic pain as their major symptom. A mass was palpable in 20 patients. In 3 patients, no mass was palpable but a lesion was visible on computed tomographic scanning. In 4 patients, there was no palpable mass and scans were negative, yet an ovarian remnant was found at laparotomy. Segmental bowel resection was necessary to obtain clearance in 8 patients, and partial bladder resection was performed in 2. Previous pelvic operations (mean, 4.3) in this group of patients probably contributed to the development of this syndrome.The ovarian remnant syndrome occurs in a patient who has previously had a bilateral salpingo‐oophorectomy. A piece of ovarian tissue remains, and this remnant often produces symptoms, usually pelvic pain and associated dyspareunia. Usually the patient has had a hysterectomy as well as bilateral salpingooophorectomy, so that the pain is often dismissed as ‘not gynaecological’ in origin (1–5).This syndrome is not synonymous with residual ovary syndrome, in which an ovary that has previously been intentionally conserved either develops an abnormal pathological process or causes symptoms necessitating its surgical removal (6). Unfortunately, awareness of the problems caused by an ovarian remnant is not widespread, and often these patients have been to many gynaecologists, general surgeons, or even psychiatrists in an attempt to get relief from their symptoms.It is not possible to estimate the incidence of symptomatic ovarian remnants, but certainly when an awareness of the syndrome develops, referral of patients with the problem is common (7).
Evidence Against Diathermy as a Beneficial Treatment for Human Papillomavirus Infection of the Cervix
Authors: Mitchell Heather , Medley Gabriele 
Published: February 2008

EDITORIAL COMMENT: In recent years there have been numerous reports regarding human papillomavirus infection of the female genital tract and its possible association with preinvasive and invasive carcinoma of these sites (cervix, vagina, vulva). The most alarming information comes from studies of DNA hybridization techniques which indicate that a very high proportion of patients with apparently normal cervices on colposcopy and cytology harbour this virus. Many studies indicate that only a small proportion of patients who show clinical evidence of the papillomavirus have evidence of continuing infection or go on to develop intraepithelial or invasive carcinoma. The proportion of patients who spontaneously eradicate signs of the disease is not established, neither do we know why some patients cure themselves of the disease and why others do not. There is also confusion in the literature as to whether local treatment can eradicate this disease. This paper gives a very good account of the current state of knowledge about papillomavirus infection. It seems difficult to understand how diathermy to the cervix can eradicate this viral infection when many studies have shown that papillomavirus infection is usually present in the vagina and vulva when it involves the cervix, unless the cellular damage induced by the cautery enhances the patient's immune response. There is evidence in numerous reports that biopsy of papillomavirus lesions and early dysplasias of the cervix modifies the natural history of these lesions, possibly by alteration of local immune function. The present study also indicates that treatment of the cervix for papillomavirus infection alone does not affect the incidence of subsequent development of intraepithelial neoplasia. These authors have stressed the fact that further long‐term follow‐up is required of patients with evidence of papillomavirus infection.Summary: An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77–2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.
Trial of Labour after Previous Caesarean Section: Obstetric Outcome
Authors: Chua S. , Arulkumaran S. , B.Sc(Hons) Piara Singh. , MD S. S. Ratnam. FRCOG FRCS(Ed) 
Published: February 2008

EDITORIAL COMMENT: Recently we have accepted a number of papers on trial of scar because of the importance of avoiding unnecessary repeat Caesarean sections. This paper reports impeccable results from Singapore but readers should heed the authors' warnings regarding the need for careful assessment before and during labour, especially when augmentation with oxytocin is employed.In this series trial of labour was permitted when the previous Caesarean was indicated for by cephalopelvic disproportion. It is not enough to monitor labour electronically in such patients — when uterine rupture occurs it can do so suddenly without warning deterioration in fetal condition — an experienced clinician should review these patients regularly during labour, especially when oxytocin augmentation is planned because of uterine dysfunction. Cephalopelvic disproportion may be unrecognized particularly if the patient is obese.In this series the incidence of scar dehiscence was 1.4% (3 of 207) in patients who had a trial of labour; all 3 cases were associated with oxytocin augmentation of labour, and 2 of the 3 laboured for longer than 12 hours (table 6). It is also worth noting that vaginal delivery was achieved in only 2 of 14 mothers who had a trial of labour when birth‐weight was more than 4,000 g (table 5).Note the authors takeaway message that the trial of scar finesse in their institution achieved a reduction of 2% in the overall Caesarean section rate. Note also that in this series, which has acceptable results, 90% of patients allowed a trial of scar had spontaneous onset of labour.Summary: Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28‐month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth‐weights revealed a trend towards more repeat Caesareans with increasing birth‐weight beyond 2,500g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour.A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.
An Alternative Regimen of Hormone Replacement Therapy to Improve Patient Compliance
Authors: Kemp John F. , Fryer Judith A. , Baber Rodney J. 
Published: February 2008

EDITORIAL COMMENT: There is no doubt that the introduction of progestogen to regimens of oestrogen replacement therapy for menopausal women, because of the risk of endometrial carcinoma from unopposed oestrogenic stimulation of the endometrium, has had one very unfortunate result — many patients resent the return of menstruation and discontinue hormone therapy. Indeed having been warned about the risk of carcinoma, patients often fear that the return of bleeding heralds such a complication. This paper reports good patient compliance with a regimen aiming at 6‐monthly cycles. Annual endometrial sampling revealed no cases of carcinoma. Although this regimen warrants further study before endorsement, the authors have highlighted the need to judge regimens of hormone replacement therapy in terms of patient compliance as well as risks of endometrial hyperplasia and carcinoma.Summary: In order to achieve the long‐term benefits from hormone replacement therapy of a markedly reduced incidence of heart disease and osteoporosis, a high degree of compliance is essential.In an effort to obtain high compliance, it was decided to introduce a cyclic therapy of 6 months duration using conjugated oestrogens supported by a 10‐day course of progestogens.A total of 85 patients were treated prospectively. Compliance was assessed by the number of patients continuing treatment, and endometrial response was assessed by office biopsy and cytological or histological examination.Five patients withdrew, giving an overall compliance rate of 94%. Two have subsequently resumed therapy, thus 98% of those enrolled are currently receiving hormone replacement therapy.No cases of endometrial carcinoma were detected during the trial period of 4 years. Two cases of mild atypical endometrial hyperplasia were detected but both were mild and reverted to secretory or inactive endometrium following progestogen therapy.This regimen provides a viable alternative for those women who are troubled by progestogenic side‐effects and monthly withdrawal bleeding.
Cost Effectiveness of Antenatal Hepatitis B Screening and Vaccination of Infants
Authors: Thomas I. L. 
Published: February 2008

EDITORIAL COMMENT: We thought readers may appreciate definition of the terms vertical and horizontal transmission before reading this paper. To the epidemiologist vertical transmission means transmission of infection from mother to baby, at or before birth but not necessarily by the transplacental route. It is believed that babies usually become infected with hepatitis B from their carrier mother by ingestion of blood at delivery (vaginal or Caesarean). Horizontal transmission refers to all other types of cross‐infection via body fluids (saliva, blood, vaginal secretions, seminal fluid). Ingestion of infected breast milk would be an example of horizontal transmission from mother to baby. Immunization of infants born to carrier mothers reduces the risk of chronic infection (carrier status) from more than 90% to less than 10%. At birth the baby receives passive immunity by injection of hepatitis B immune globulin (HBIG) and active immunity is achieved by a course of 3 injections of hepatitis B vaccine, the first of which is given before the child leaves hospital; the second is given 6 weeks later and the third 6 months later. Prevention of carrier status in babies is thus achieved by a combination of passive and active immunity.Summary: Over a 2‐year study period 5,858 public antenatal patients were screened with the Welcome hepatitis B surface antigen HA screening kit; 52 (0.89%) were positive (carriers) and 45 (87%) of these were identifiable as high risk patients and would have been diagnosed by selective screening; the remaining 7 (13%) would have been missed.Using a subsample of 1,000 women, it was found that high risk factors were present in 237 (23.7%).Restriction of screening to the high risk group cost an estimated $97 per carrier identified; universal screening cost $354 to identify each carrier. Screening only the high risk group would have missed the 7 carriers in the low risk group, which was estimated to number 4,470 patients (76.3% of the total). Estimated cost of screening the low risk group was $14,036, or $2,005 per carrier identified.The advent of highly effective vaccines enables the almost complete prevention of vertical transmission of hepatitis B. In mid‐1988, vaccine costs in terms of hepatitis B prevention per baby were estimated to be $2,432 for vaccination of babies born to mothers in the high risk group, irrespective of maternal serology; and $9,729 for universal vaccination.Carrier rates vary between populations. For our clinic patients, universal screening and vaccination of all babies of high risk group mothers are considered appropriate. Selective screening may be more appropriate in a low risk private practice.
Down Syndrome and Low Maternal Serum Alpha Fetoprotein
Authors: Jacobs Sue , Giles Warwick 
Published: February 2008

EDITORIAL COMMENT: This paper presents the case for routine mid‐trimester (16 weeks) screening of maternal serum alpha‐fetoprotein level for the diagnosis of increased risk of Down syndrome since low values can result in identification (by amniocentesis and karotyping of fetal cells) of approximately 30% of all Down syndrome infants; women aged 37 years at the calculated date of delivery are currently offered amniocentesis because of maternal age alone (New South Wales and Victoria). It is noteworthy that the authors do not believe that present data justify introduction of routine alpha‐fetoprotein testing alone for the diagnosis of increased risk of Down syndrome.Maternal serum alpha‐fetoprotein estimation has been performed routinely in many centres as a screening test for fetal neural tube defects especially in communities with a high prevalence of this disorder (I in 700 births in Australia; in Western Sydney the incidence is 3–5 in 1,000 births) ‐ high values allow selection of about 95% of cases of anencephaly and 75% ofspina bifida. Advocates for the introduction of a new test for universal application can usually present convincing cost‐effectiveness calculations in