bluuebunny/crossref_metadata_2025_split huggingface dataset:
High grade abnormalities following an‘inconclusive’ smear
Authors: Valmadre S , Atkinson K , Houghton R , Carter J , McKenzie P , Russell P , Dalrymple C 
Published: October 2004

ABSTRACTObjectiveThe National Health and Medical Research Council (NHMRC) recommends a report of ‘inconclusive ‐ possible high grade epithelial abnormality’, but many laboratories only report ‘inconclusive’ with reference to any possible high grade disease elsewhere in the report. This study was performed to determine possible reasons for cytological difficulties resulting in this category of report and to determine the rate of significant disease within this category.DesignRetrospective record review. Clinical details were extracted without patient‐identifying data.SettingGynaecological Oncology Department, King George V/Royal Prince Alfred Hospital.PopulationTwo hundred patients referred with the cytological abnormality.Materials and methodsAn adequate colposcopic diagram documenting size, distribution and grade of lesion was required. All patients had colposcopy with management according to colposcopic and histological results as appropriate to their disease.Outcome measuresColposcopic features, topography and size of any lesion, histological results, treatments performed and subsequent review of untreated patients.ResultsColposcopy found high‐grade lesions in 43% and carcinoma in 1%. Histopathology found 49% and 4% respectively. Treatment was performed in 124 patients. Inflammation was found in 27%, a small lesion in 43% and endocervical disease in 21%.ConclusionsThe high rate of endocervical disease, inflammation and small lesions may explain the cytological difficulties leading to an ‘inconclusive’ result. The authors believe that the term ‘inconclusive’ alone does not adequately convey the high level of risk faced by these patients.
Randomised trial of an integrated educational strategy to reduce investigation rates in young women with dysfunctional uterine bleeding
Authors: Searle Judith , Grover Sonia , Santin Anita , Weideman Prue 
Published: October 2004

ABSTRACTObjectivesTo assess the effectiveness of an integrated educational strategy to change clinician behaviour and reduce the number of hysteroscopies and/or dilatation and curettages for women 40 years or less with dysfunctional uterine bleeding (DUB).DesignRandomised controlled trial with six‐month followup.SettingPublic teaching hospital gynaecology units with 12,000‐13,000 relevant procedures per year.ParticipantsSix public gynaecology units made up of 62 gynaecologists or trainees allocated at random to intervention group ‐ three, or control group ‐ 3.InterventionAn educational strategy that included dissemination of evidence‐based guidelines via a problembased interactive workshop facilitated by an opinion leader and a laminated algorithm and guidelines.Main outcome measuresThe number of hysteroscopies and/or dilatation and curettages performed for DUB on women 40 years or less, clinician behaviour change and perceived booking rates of the procedure.ResultsAt six months, there was no significant effect on the number of hysteroscopies and/or dilatation and curettages performed but there was an increase in evidence‐based behaviour.
Medical and midwifery students: how do they view their respective roles on the labour ward?
Authors: Quinlivan Julie A , Thompson Christine M , Black Kirsten I , Kornman Louise H , McDonald Susan J 
Published: October 2004

ABSTRACTBackgroundIt has been suggested that much of the medical and midwifery student curricula on normal pregnancy and birth could be taught as a co‐operative effort between obstetric and midwifery staff. One important element of a successful combined teaching strategy would involve a determination of the extent to which the students themselves identify common learning objectives.AimThe aim of the present study was to survey medical and midwifery students about how they perceived their respective learning roles on the delivery suite.MethodsA descriptive cross‐sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral hospital in obstetrics and gynaecology. Survey participants were medical students who had just completed a 10 week clinical attachment in obstetrics and gynaecology during the 5th year of a six year undergraduate medical curriculum and midwifery students undertaking a one year full‐time (or two year part‐time) postgraduate diploma in midwifery.ResultsOf 130 and 52 questionnaires distributed to medical and midwifery students, response rates of 72% and 52% were achieved respectively. The key finding was that students reported a lesser role for their professional colleagues than they identified for themselves. Some medical students lacked an understanding of the role of midwives as 8%, 10%, and 23% did not feel that student midwives should observe or perform a normal birth or neonatal assessment respectively. Of equal concern, 7%, 22%, 26% and 85% of student midwives did not identify a role for medical students to observe or perform a normal birth, neonatal assessment or provide advice on breastfeeding respectively.SummaryMedical and midwifery students are placed in a competitive framework and some students may not understand the complementary role of their future colleagues. Interdisciplinary teaching may facilitate co‐operation between the professions and improve working relationships.
How Oestrogen or Progesterone might Change a woman's susceptibility to HIV‐1 infection
Authors: Mingjia Li , Short Roger 
Published: October 2004

ABSTRACTWorldwide, 18.5 million women are infected with the human immunodeficiency virus (HIV‐1). At least 80% of these HIV infections have occurred as a result of sexual intercourse with an infected male partner. This review focuses on how HIV‐1 enters the human female reproductive tract, and how oestrogen or progesterone, by altering the cervicovaginal epithelium, might change a woman's susceptibility to HIV infection.Experiments on hysterectomised Rhesus monkeys suggest that the vagina, rather than the cervix or uterus, is the main site of viral entry. If ovariectomised monkeys are given systemic oestrogen treatment, this makes them completely resistant to infection by intravaginally administered simian immunodeficiency virus (SIV), whereas progesteronetreated animals, like the untreated controls, are extremely susceptible.Some studies have also shown that women on systemic long‐acting gestagen‐only contraceptives have a thinner vaginal epithelium and hence might be more susceptible to HIV infection; this is certainly true of post‐menopausal women. The beneficial effects of oestrogen are thought to be due to increased thickness and cornification of the cervicovaginal epithelium, which prevents the virus from coming into contact with the target Langerhans cells (LCs).Topical vaginal oestrogen treatment is widely used as a safe and effective way of thickening and keratinising the vaginal epithelium in post‐menopausal women. Perhaps this could be an exciting new way of protecting women from HIV infection.
Outcome of pregnancy complicated by pre‐gestational diabetes – improvement in outcomes
Authors: Gunton Jenny E , Morris Jonathan , Boyce Stewart , Kelso Ian , McElduff A 
Published: October 2004

ABSTRACTPre‐gestational diabetes mellitus (DM) is associated with adverse fetal and maternal outcomes. We have previously reported outcomes for women with DM. To determine whether review, and discussion of the results, affected outcomes, pregnancies in women with DM from July 1998 to July 2001 were examined in a prospective cohort study. The results were then compared to the results from the previous review.MethodsThirty‐five pregnancies were included (24 in 20 women with Type 1 DM, 11 in 11 with Type 2 DM). Type 1 women were more likely to be Caucasian (100% versus 22.2%, p < 0.0001), and had a longer duration of diabetes (13 ± 6 versus 3 ± 2 years, p < 0.0001).ResultsPregnancy planning rates improved significantly for Type 1 DM (62.5% planned versus 18.9% in original inal study p = 0.01), and did not change for Type 2 DM. Caesarean section (LSCS) rate was high in the original study, particularly in Type 1 DM (77%), and was lower after review (47.6% in Type 1 DM p < 0.05 compared to original study, and 44.4% in Type2 DM, p = ns).Planning was associated with lower HbA1c before and during pregnancy (6.0 ± 1.4% versus 8.1 ± 1.8% (p = 0.0035), and 5.5 ± 1 versus 6.5 ± 1.5%(p < 0.001)), greater gestational age at delivery (38.2 versus 36.2 weeks p = 0.0318) and lower rate of LSCS (31.6% versus 72.7% (p = 0.0295)).ConclusionsIt is important to continue improving pre‐pregnancy planning. Extensive discussions involving a multi‐disciplinary team improved planning rates and decreased the LSCS rate while maintaining outcomes.
Prenatal diagnosis of mosaic trisomy 20 in New Zealand
Authors: James Paul A , Gibson Kate , McGaughran Julie 
Published: October 2004

ABSTRACTObjectiveMosaic trisomy 20 is not an uncommon finding on amniocentesis or CVS. Unlike other mosaic aneuploidies it is a relatively benign abnormality which, along with a lack of long‐term follow‐up of cases, has led to uncertainty when counselling parents. We aimed to identify known mosaic trisomy 20 pregnancies in New Zealand in the last 10 years and document their outcome.DesignRetrospective database review with prospective clinical follow‐up.MethodsCases were identified from the databases of the two clinical genetic services, as well as the four regional cytogenetics laboratories. Medical records were reviewed and where patients were available they were offered follow‐up.Results: Fourteen cases were identified (13 on amniocentesis, one on CVS), all with low levels of mosaicism (8–50%). In 12 cases, the children were physically and developmentally normal, with the longest follow‐up being 10 years. Minor anomalies were noted in two cases. There were no major malformations noted in any of the cases and where repeat karyotypes were performed on blood or urine cytology these were normal.ConclusionsThis series confirms a much lower incidence of phenotypic abnormalities associated with mosaic trisomy 20 compared to other forms of mosaic aneuploidy. Attempts to predict which of these pregnancies will have poor outcomes have not proven to be reliable. We recommend that, if a detailed anatomy scan is normal, parents be counselled that the risk of abnormality is less than 10%. Further tests should be performed only on the basis of a clinical indication.
Patterns of vitamin, mineral and herbal supplement use prior to and during pregnancy
Authors: Maats FH , Crowther CA 
Published: October 2004

ABSTRACTAt the antenatal clinic, 211 women were interviewed to assess vitamin, mineral and herbal use pre‐conceptually and in the three trimesters of pregnancy.The majority of women (62%) used both a vitamin or mineral supplement and a herbal preparation during the course of pregnancy. Folate (70%), iron (38%) and multivitamins (27%) were the vitamin and mineral supplements most frequently taken by pregnant women. Ginger (20%) and raspberry leaf (9%) were the most frequently used herbal preparations. Women relied on advice from friends and relatives in deciding to use herbal preparations.
Women's preferences for reporting of Down syndrome screening results
Authors: Mulvey Sheila , Pham Trang , Tyzack Katrina , Wallace Euan M 
Published: October 2004

ABSTRACTObjectiveThe aim of this study was to determine whether women prefer the results of screening for Down syndrome tests to be reported as the risk of Down syndrome in early pregnancy at the time of the screening test or the risk at delivery (which takes into account the number of Down syndrome pregnancies that will be spontaneously lost before birth).DesignA structured questionnaire.SettingA tertiary hospital antenatal clinic.SampleOne hundred and fifteen English‐speaking women who expressed an interest in having screening tests for Down syndrome performed.MethodsA structured questionnaire exploring women's preferences for risk reporting was self administered by women attending for their first antenatal visit.Main outcome measuresWomen's preference for reporting of screening test results as risk at time of test, risk at birth or both, and the reasons for this preference.ResultsThe majority (n = 82) of women preferred to have both the risk of Down syndrome at the time of screening and at the time of birth reported. The most common reason (n = 60) given for this preference was a desire to have as much information available as possible so that an informed decision regarding further investigations could be made.ConclusionsThe majority of women prefer to receive Down syndrome screening results as both the risk at the time of the test and the risk at birth.
Risk factors for strong regret and subsequent IVF request after having tubal ligation
Authors: Kariminia Azar , Saunders Douglas M , Chamberlain Marie 
Published: October 2004

ABSTRACTObjectivesTo identify and describe pre‐sterilisation characteristics most consistently associated with intensive poststerilisation regret and subsequent request for IVF.DesignCase control study.SettingFertility clinic in a tertiary referral urban hospital, Sydney, Australia.Sample casesNinety‐seven sterilised women who underwent evaluation for IVF during the period 1986–1996; Controls: 101 sterilised women who remained satisfied with their tubal ligation.Main outcome measuresVariables known at the time of sterilisation including age, number of living children, history of abortion, underlying medical diseases, marital status, race, education, and timing of sterilisation.ResultsIn the multivariate analysis of data, age at the time of sterilisation had the most pronounced effect on strong regret. Women younger than 30 years old at the time of sterilisation were more likely to request IVF treatment than women 30 to 34 years old. A concurrent caesarean section was associated with a threefold risk (95% CI, 1.05–10.03) relative to an interval procedure. A strong protective effect (OR = 0.07; 95% CI, 0.01–0.65) was found for women with more than two children compared to childless women. The overwhelming reason stated by women requesting IVF was change in marital status, and the desire to have a child with the new partner.ConclusionsWomen with such characteristics who are considering tubal ligation need further caution and counselling.
A six‐year audit of the management of ectopic pregnancy
Authors: Cooray Hashira , Harilall Mahesh , Farquhar CM 
Published: October 2004

ABSTRACTObjectiveTo audit the management of ectopic pregnancy at National Women's Hospital over a six‐year period to monitor changes in practice and assess adherence to hospital protocols.Study designA retrospective audit of the management of women with a discharge diagnosis of ectopic pregnancy from 1996–2001 at National Women's Hospital, Auckland, New Zealand. Information was collected regarding the demographics, risk factors for ectopic pregnancy, delay in diagnosis, management undertaken and failure and complications of initial treatment.ResultsOver a six‐year period a total of 673 women had a discharge diagnosis of ectopic pregnancy. Surgery was the most frequent method of management but there was increasing utilisation of systemic methotrexate. The proportion of women who met the criteria for methotrexate varied from 27–54% over the six year period although the highest proportion who received methotrexate in any given year was only 24% (2001). The proportion of women who met the criteria for receiving methotrexate and had the option of methotrexate discussed with them increased from 12% in 1996 to 91% in 2001. Over the six year period 74 women received methotrexate and 14 (18.9%) failed and required surgical management. Surgical management was performed in 537 women and 30 (5.6%) required either further surgery or methotrexate or a combination of both. A laparoscopic procedure was performed in 86.5% (465/533) and 10.9% (51/465) converted to laparotomy.ConclusionsAlthough there is evidence that methotrexate is an effective and safe option for a proportion of women with ectopic pregnancy, the majority of women still undergo surgical management.
Is penicillin and/or erythromycin resistance present in clinical isolates of group B streptococcus in our community?
Authors: Stylianopoulos Anastasia , Kelly Nigel , Garland Suzanne 
Published: October 2004

ABSTRACTTraditionally group B streptococcus (GBS) has not exhibited resistance to the antibiotics penicillin and erythromycin. Recently there are reports from North America whereby some GBS isolates have exhibited resistance to erythromycin. There have been no studies reported to date to determine whether this resistance trend is also occurring in the Australian population.Over a period of six months from January to June 1999, 250 GBS isolates were collected at the Royal Women's Hospital, Melbourne. Sensitivity to penicillin, erythromycin and vancomycin was determined by disk diffusion. Any isolates that had reduced zones to penicillin, vancomycin or erythromycin had minimum inhibitory concentrations (MIC) determined. No isolates had reduced susceptibility to penicillin or vancomycin. Of the 250 isolates, seven (2.8%, 95% CI = 1.1–5.6%) had resistant MICs to erythromycin of > 1.0 μg/mL. These preliminary data suggest that penicillin therapy is still an effective first‐line antibiotic for intrapartum chemoprophylaxis and that erythromycin resistance is low in our population.
Laparoscopic‐assisted Vecchietti procedure for creation of a neovagina: an analysis of five cases
Authors: Kaloo Philip , Cooper Michael 
Published: October 2004

ABSTRACTThe aim of this study was to review the functional and psychological outcomes of subjects with vaginal aplasia undergoing a laparoscopic creation of a neovagina (Vecchietti procedure). A semi‐structured telephone interview was undertaken of five consecutive subjects who underwent the procedure in the preceding three years. Information was obtained with regard to the operation, immediate post‐operative period, complications experienced, sexual function and improvements in general and psychological well‐being.A functioning neovagina was formed in all subjects. All sexually active women noted satisfactory intercourse with significant improvements in self‐confidence, self‐esteem and general well‐being up to three years post‐operatively.
Using naltrexone implants in the management of the pregnant heroin user
Authors: Hulse G , O'Neil G 
Published: October 2004

ABSTRACTObjectivesTo describe the case history and associated obstetric and neonatal outcomes of eight women who had their heroin dependency managed over pregnancy by naltrexone implant (two × 1.8 g of naltrexone embedded in poly‐DL‐lactide acid) treatment.MethodCase data on maternal management associated with naltrexone implant were collected at the Australian Medical Procedures Research Foundation, Perth, Australia and three Perth hospitals.ResultsDespite earlier instability on oral naltrexone and repeated relapses back to dependent heroin use these women, following treatment with naltrexone implant, remained heroin free throughout their pregnancies. Neonatal and obstetric outcomes were unremarkable.ConclusionsThis case series provides preliminary evidence that the pregnant heroin user can be managed by naltrexone implant without obvious risk to the mother or developing foetus.Importantly, the current case series suggests that the pregnant woman who finds it difficult to stabilise on oral naltrexone maintenance and returns to dependent heroin use may be managed using implantable naltrexone, thereby removing from her the onus for daily naltrexone medication compliance.The authors conclude that naltrexone implant may represent an important procedure for managing the pregnant heroin dependent patient who finds it difficult to shift away from her heroin use patterns.These preliminary findings require confirmation using a much larger controlled study.
Crystal orientation mapping of NiO grown on cube textured Ni tapes
Authors: WOODCOCK T. G. , ABELL J. S. , EICKEMEYER J. , HOLZAPFEL B. 
Published: October 2004

SummarySamples of cube textured Ni tapes were oxidized in flowing oxygen at different temperatures. Crystal orientation maps (COMs) of the resulting oxide layers were produced by electron backscatter diffraction. The oxide layers were also analysed by X‐ray diffraction (XRD), scanning electron microscopy and atomic force microscopy (AFM). The oxide grain size of a sample oxidized at 600 °C was similar to that of the substrate and the oxide was highly textured, both indicating epitaxial growth. The orientation relationship between the substrate and the oxide was directly observed from XRD to be (111)NiO//(001)Ni, [01]NiO//[110]Ni with four, equivalent, in‐plane variants. In each variant, the oxide has both <110>‐ and <211>‐type directions parallel to the Ni <110> directions. Differences in oxide thickness and surface roughness on neighbouring grains were revealed by AFM and these were attributed to the existence of a range of oxide growth conditions resulting from small differences in the orientation of each substrate grain. Similar macrotexture and microstructure were observed on a sample oxidized at 1300 °C, but additional, facetted oxide crystals had formed at the oxide grain boundaries. COMs showed that these crystals were either cube or 45° rotated cube orientated, a texture different to that of the large oxide grains. The grain boundary crystals were thought to form by inward diffusion of oxygen at defects in the growing oxide scale.
Index for spatial heterogeneity in breast cancer
Authors: SHARIFI‐SALAMATIAN V. , PESQUET‐POPESCU B. , SIMONY‐LAFONTAINE J. , RIGAUT J. P. 
Published: October 2004

SummaryHistopathological heterogeneity in cancer is a general concern. Breast carcinoma heterogeneity is now widely admitted as a source of histological grading imprecision and reproducibility problems. Classically, homogeneity is defined as equivalent to stationarity. A measure of heterogeneity based on asymptotic properties of spatial statistics is developed. Long‐range dependences in heterogeneous spatial processes make estimation of the proposed heterogeneity measure unreliable. A robust estimator based on the wavelet transform is presented; this bypasses long‐range dependences. The estimator extends previous works on one‐dimensional stochastic processes to two dimensions as appropriate for histopathological analysis. As a side result, the estimator gives confidence intervals for the heterogeneity measure that enables the formulation and validation of testable hypothesis on the observed histopathological samples. This approach is applied to the characterization of breast cancer tumours. We show that the heterogeneity measure for various blocks of a single tumour is invariable, even when various blocks differ in size and in number of marked nuclei.
Second‐order stereology of spatial fibre systems
Authors: KRASNOPEROV R. A. , STOYAN D. 
Published: October 2004

SummaryThis paper describes methods for second‐order stereology of spatial fibre systems. For stationary and isotropic fibre processes it gives practicable estimators of the K‐function and the pair correlation function, which are based on planar sections. The second‐order methods are applied in transmission electron microscopy analysis of blood capillaries in the rat thyroid. They lead to the result that the capillaries show an inhibitory pattern of their spatial arrangement, with a hard‐core distance of about 2.6 µm. There is a close relationship to three‐dimensional size characteristics estimated recently for these elliptical capillaries.