bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is HIV infection associated with an increase in the prevalence of cervical neoplasia?
Authors: Smith J. R. , Kitchen V. S. , Botcherby M. , Hepburn M. , Wells C. , Gor D. , Forster S. M. , Harris J. R. W. , Steer P. , Mason P. 
Published: August 2005

ABSTRACTObjective
To test the hypotheses:

that HIV infection predisposes to cervical intraepithelial neoplasia (CIN);
that this CIN is a result of HIV related immunosuppression; and
that this CIN is a result of immunosuppression causing increased expression of the potentially oncogenic viruses, human papilloma virus (HPV), Epstein Barr virus (EBV) and herpes simplex virus (HSV).

Design
A matched cross sectional study.Setting
The Department of Gynaecological Oncology, The Samaritan Hospital, London; the Department of Genitourinary Medicine, St Mary's Hospital, London; and the Family Planning Clinic, Claremont Terrace, Glasgow.Subjects
Fifty HIV seropositive women enrolled from the Genitourinary Medicine Department and the Drug Dependency Unit at St Mary's Hospital, London, and the Unit of Infectious Diseases at Ruchill Hospital, Glasgow. Forty‐three HIV seronegative controls enrolled from the Department of Genitourinary Medicine at St Mary's Hospital, matched against 43 of the seropositive women for age, age at first intercourse, lifetime number of sexual partners, and smoking habit.Main outcome measures
Associations between CIN, as detected by cytology and histology, and HIV infection. Association was also sought between CIN and immunosuppression, as measured clinically by T4 cell number, β‐2‐microglobulin and p24 antigen. Associations of these with: (1) HPV, as detected by Southern blot testing and the polymerase chain reaction; (2) EBV, as detected by Southern blot testing; and (3) HSV, as detected by tissue culture of endocervical swabs, was also studied.Results
There was no significant difference in the prevalence of CIN or oncogenic viruses between HIV seropositive and seronegative women in the absence of immunosuppression. If the HIV infected women showed signs of immunosuppression, the prevalence of CIN was increased. No association was shown between detection of HPV, EBV and HSV and immunosuppression or CIN.Conclusion
HIV infection may only be associated with an increased risk of CIN when immunosuppression is present.
Correlation between clinical staging (FIGO) and prognostic groups with gestational trophoblastic disease
Authors: Smith David B. , Holden Lydia , Newlands Edward S. , Bagshawe Kenneth D. 
Published: August 2005

ABSTRACTObjective
To compare the Charing Cross Hospital scoring system with FIGO staging for gestational trophoblastic disease.Design
A retrospective analysis of patients referred to Charing Cross during the period 1979–1989.Setting
National referral centre.Subjects
Two hundred and seven women with gestational trophoblastic disease presenting between 1979–1989.Main outcome measures
The women were classified according to the Charing Cross Hospital scoring system and FIGO clinical staging and the results of treatment compared.Results
Of the 207 women studied, there were 102 low risk, 39 medium risk and 66 high risk according to the Charing Cross system and 26 stage 0,83 stage 1,23 stage 2,51 stage 3 and 24 stage 4 according to the FIGO system. If the FIGO system had been used to determine therapy, 17 women would have been at risk of under‐treatment and nine of overtreatment. The main prognostic factors contributing to a higher Charing Cross score and thus more intensive chemotherapy from the outset were: HCG > 105, interval from antecedent pregnancy >12 months and term delivery.Conclusions
The Charing Cross scoring system incorporates factors predictive of the presence of drug resistant tumour and thus allows more appropriate use of chemotherapy from the start of treatment than is possible with the anatomically based FIGO staging. Moreover, the system is easy to apply relying only on history and clinical examination in addition to a reliable quantitative HCG assay.
Transdermally administered oestradiol combined with oral medroxyprogesterone acetate: the effects on lipoprotein metabolism in postmenopausal women
Authors: Mattsson Lars‐Åke , Samsioe Göran , von Schoultz Bo , Uvebrant Margareta , Wiklund Ingela 
Published: August 2005

ABSTRACTObjective
To investigate the effects of two doses of transdermally applied oestradiol on lipid and lipoprotein metabolism in climacteric women.Design
A randomised double blind cross‐over comparison.Setting
Departments of Obstetrics and Gynaecology, Östra and Sahlgren's Hospital, Göteborg and Karolinska Hospital, Stockholm, Sweden.Subjects
Fifty‐two women with climacteric symptoms were treated with oestradiol transdermally applied (50 μg and 100 μg/24 h). A daily dose of 5 mg oral medroxyprogesterone acetate was added 14 days each treatment cycle of four weeks.Interventions
Blood samples were drawn after an overnight fast before and after four and eight months of treatment.Main outcome measures
Assays for serum triglycerides and cholesterol as well as low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol including the subfractions HDL2 and HDL3 were performed.Results
Significant decrements were found in triglycerides and serum and LDL cholesterol during treatment with both doses. A modest rise in HDL2 cholesterol was observed after treatment with the 100 μg/24 h dose.Conclusions
The serum lipid and lipoprotein profile encountered in these women was similar to that reported with oral formulations except for a decrease in triglycerides. The metabolic differences between the two doses of transdermal oestradiol is probably of minor clinical significance in normal postmenopausal women.
Concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle in normal, fertile women
Authors: Li T. C. , Ling E. , Dalton C. , Bolton A. E. , Cooke I. D. 
Published: August 2005

ABSTRACTObjective
To determine the variation in concentration of endometrial protein PP14 in uterine flushings throughout the menstrual cycle comparing this to concentrations in plasma samples.Design
Precise timing of all samples by the luteinising hormone surge.Setting
Jessop Hospital for Women, Sheffield.Subjects
Twenty‐three regularly cycling, previously fertile volunteer women.Interventions
Observational study; 10 ml of physiological saline was used to flush the uterine cavity once or serially in the cycle of the study.Main outcome measures
The measurement of PP14 levels by radioimmunoassay in uterine flushings and plasma samples.Results
In uterine flushing, PP14 levels were not detectable in significant amounts in the proliferative phase and the early luteal phase; after day LH+6, the concentration rises rapidly with a doubling time of only 6.6 to 14.6 h in the midluteal phase. In the late luteal phase, the concentrations in uterine flushing were over a hundred times higher than the corresponding plasma samples.Conclusions
The measurement of PP14 in uterine flushings is likely to be of greater value than the measurement in plasma samples; it may provide a valuable alternative to the evaluation of endometrial function.
Noninvasive test of microvascular endothelial function in normal and hypertensive pregnancies
Authors: Eneroth‐Grimfors E. , Lindblad L. E. , Westgren M. , Ihrman‐Sandahl C. , Bevegárd S. 
Published: August 2005

ABSTRACTObjective
To examine microvascular endothelial cell function in vivo in pre‐eclampsia.Design
Iontophoresis of acetylcholine (Ach), which gives rise to endothelial cell dependent vasodilatation, and of sodium nitroprusside (SNP), which elicits vasodilatation independently of functioning vascular endothelium.Setting
Södersjukhuset, Stockholm, Sweden.Subjects
Ten pre‐eclamptic patients, ten healthy pregnant women and ten healthy nonpregnant women were examined.Main outcome measures
The degree of vasodilatation following iontophoretic administration of Ach compared with SNP was recorded with a laser Doppler technique, the data being analysed on a personal computer.Results
Both Ach and SNP administration resulted in marked vasodilatation; the magnitude of the vasodilatation was similar in the three groups of women.Conclusion
Following iontophoretic administration of endothelial cell dependent or independent vasodilatators, laser Doppler measurement of blood flow demonstrated no microvascular endothelial cell dysfunction in pre‐eclamptic women.
Fetal angiotensin II levels and vascular (type I) angiotensin receptors in pregnancies complicated by intrauterine growth retardation
Authors: Kingdom John C. P. , McQueen James , Connell John M. C. , Whittle Martin J. 
Published: August 2005

ABSTRACTObjective
To investigate the status of the fetal renin‐angiotensin system (RAS) in pregnancies complicated by severe intrauterine growth retardation (IUGR), and its possible relationship to elevated fetoplacental vascular resistance as indicated by abnormal umbilical artery Doppler flow velocity waveforms (FVW).Design
Prospective survey of pregnancies falling into predefined categories and presenting at the Queen Mothers Hospital, Glasgow, over the study period.Subjects
Effects of mode of delivery and gestational age were investigated using uncomplicated term pregnancies delivered vaginally (SVD group, n= 15) or by elective caesarean section (ECS group, n= 9), and normal pregnancies with spontaneous preterm onset of labour (PREM group, n= 6; normal birthweight for gestational age (31 weeks)). These groups were used as controls for the 13 IUGR cases delivered preterm (31 weeks) by caesarean section in the fetal interest.Main outcomes measures
Umbilical artery FVW, birthweight, cord venous angiotensin II concentration ([cv ANG II]), fetoplacental vascular ANG II receptor concentration.Results
Cord venous angiotensin II concentration was similar to maternal values in the ECS group (31–101 pmol/1, 95% CI), but was elevated (81–288 pmol/l, P= 0.03) after vaginal delivery. The concentration of ANG II receptors (type AT1, dissociation equilibrium constant, 1.27 nmol/l) in placental primary/secondary stem vascular tissue was lower in the SVD group (18–44 fmol/mg membrane protein, 95% CI), compared with the ECS group (29–122 fmol/mg, P= 0.03) consistent with acute receptor down‐regulation by the elevated ANG II levels. No effect of gestational age on receptor number was demonstrable (P= 0.13, PREM (premature delivery) vs ECS group). In the IUGR group, [cv ANG II] (94–378 pmol/l) was markedly elevated compared with the ECS controls (P= 0.001) but receptor concentration (28–84 fmol/mg) was not significantly altered (P= 0.13). No relationships between [cv ANG II] or receptor number and umbilical artery FVW could be identified. No changes in receptor affinity were observed.Conclusion
These results indicate activation of the fetal RAS in IUGR and suggest that responsiveness of the fetoplacental vasculature to the peptide is not diminished as would be expected from the elevated plasma ANG II levels. ANG II may contribute to the increased fetoplacental vascular resistance observed in this disorder, but does not apparently account for the abnormal umbilical artery FVW that is observed in a proportion of IUGR cases.
Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists Multicentre Randomised Trial of Cervical Cerclage
Authors:   MRC/RCOG Working Party on Cervical Cerclage, Macnaughton M. C. , Chalmers I. G. , Dubowitz V. , Dunn P. M. , Grant A. M. , McPherson K. , Pearson J. F. , Peto R. , Turnbull A. C. 
Published: August 2005

ABSTRACTObjective
To assess whether cervical cerclage in women deemed to be at increased risk of cervical incompetence prolongs pregnancy and thereby improves fetal and neonatal outcome.Design
Multicentre randomised controlled trial.Setting
Hospitals in the United Kingdom, France, Hungary, Norway, Italy, Belgium, Zimbabwe, South Africa, Iceland, Ireland, the Netherlands and Canada.Subjects
One thousand two hundred and ninety‐two pregnant women whose obstetricians were uncertain whether to recommend cervical cerclage, most of whom had a history of early delivery or cervical surgery.Interventions
Cervical cerclage was compared with a policy of withholding the operation unless it was considered to be clearly indicated.Main outcome measures
Delivery before 33 completed weeks, preterm delivery (<37 weeks), and vital status of the baby after completion of the pregnancy.Results
The overall preterm delivery rate was 28%. There were fewer deliveries before 33 weeks in the cerclage group (83 (13%) compared with 110 (17%), P=0.03) and this difference reflected deliveries characterised by features of cervical incompetence (painless cervical dilatation and prelabour rupture of the membranes). There was a corresponding difference in very low birthweight deliveries (63 (10%) compared with 86 (13%), P=0.05). The difference in the overall rate of miscarriage, stillbirth or neonatal death (55 (9%) compared with 68 (11%)) was less marked and was not statistically significant. The use of cervical cerclage was associated with increased medical intervention and a doubling of the risk of puerperal pyrexia.Conclusions
These results suggest that the operation had an important beneficial effect in 1 in 25 cases in the trial (95% confidence interval (CI) 1 in 12 to 1 in 300 sutures). Its use is associated with increased medical intervention and puerperal pyrexia. Nevertheless, this trial suggests that, on balance, cervical cerclage should be offered to women at high risk, such as those with a history of three or more pregnancies ending before 37 weeks gestation.
Previous pregnancy outcomes and subsequent risk of preterm rupture of amniotic sac membranes
Authors: Ekwo Edem E. , Gosselink Carol A. , Moawad Atef 
Published: August 2005

ABSTRACTObjective
To test the hypothesis that previous unfavourable pregnancy outcomes increase the risk for premature birth, with (PP) or without (PTB) premature rupture of the amniotic sac (PROM) at the index pregnancy and that multiple undesirable outcomes increase risk.Design
Case control study.Setting
Two university hospitals.Subjects
Four hundred sixty‐three women aged 15 to 45 years who were delivered preterm PROM, full term PROM and preterm without PROM matched with 463 women who delivered full term. All women included in the study had at least one previous pregnancy.Outcome measures
Odds ratio of previous adverse pregnancy outcome among index cases.Results
Compared with controls, PP cases had odds ratios of 95 for previous preterm birth, 186 for abortion and prematurity and 158 for fetal loss, abortion/prematurity after controlling for confounding variables. Compared with controls, PTB cases had an odds ratio of 96.5 for previous preterm delivery, 84 for abortion and prematurity, and 320 for fetal loss/abortion and prematurity after controlling for confounding variables.Conclusions
Previous preterm delivery, abortion and prematurity and fetal loss/abortion and prematurity all increase risk for subsequent preterm birth with or without PROM.
Changes in platelet reactivity following aspirin treatment for pre‐eclampsia
Authors: Sullivan M. H. F. , Elder M. G. 
Published: August 2005

ABSTRACTObjective
To determine whether aspirin therapy in women at risk of pre‐eclampsia alters in vitro platelet aggregation.Design
Longitudinal observational study.Setting
RPMS Institute of Obstetrics and Gynaecology, Hammersmith Hospital, London.Subjects
Six pregnant women at‐risk or with pre‐eclampsia.Methods Women considered to be at risk of pre‐eclampsia or with the disorder were treated with aspirin. In vitro platelet aggregation in response to platelet‐activating factor (PAF) and adenosine diphosphate (ADP) before and after aspirin therapy were analysed.Results
Prior to aspirin therapy platelet aggregation was decreased compared with normal pregnant women. After aspirin therapy platelet aggregation in response to PAF and ADP was greater, but did not return to levels associated with normal pregnancy.Conclusions
In women with pre‐existing decreased platelet aggregation suggestive of platelet exhaustion, aspirin increased aggregation. This suggests that aspirin decreases in vivo platelet activation and thereby decreases the platelet exhaustion revealed by the in vitro studies.
The intravascular mass of albumin during human pregnancy: a serial study in normal and diabetic women
Authors: Whittaker Paul G. , Lind Tom 
Published: August 2005

ABSTRACTObjective
To quantify the changes in serum albumin during human pregnancy.Design
Longitudinal prospective study.Setting
Before conception and antenatal clinic.Subjects
Sixty‐nine normal women and 23 women with Type 1 diabetes.Interventions
Administration of Evans' blue dye and collection of serum samples.Main outcome measures
Albumin concentration, plasma volume and intravascular mass of albuminResults
In normal subjects serum albumin concentration showed a significant decrease of 1.9 (95% CI 1.0 to 2.9) g/l by 7 weeks gestation with a further 8.2 (95% CI 7.5 to 8.9) g/l decrease by 36 weeks gestation, an overall change of 22%. Plasma volume first increased significantly by 190 (95% CI 105 to 275) ml between 7 and 12 weeks, with a further increase of 1003 (95% CI 871 to 1135) ml between 12 and 36 weeks of pregnancy, a change of 53%. The intravascular mass of albumin showed no change between non‐pregnant, 7 and 12 week values but there was a significant rise of 19.5 (95% CI 15.1 to 23.9) g between 12 and 28 weeks of gestation, an overall increase of 19%. Diabetic subjects showed similar changes.Conclusions
Rather than simply reflecting plasma volume dilution, the changes in serum albumin imply alterations in albumin metabolism during pregnancy.
Hydralazine boluses for the treatment of severe hypertension in pre‐eclampsia
Authors: Paterson‐Brown S. , Robson S. C. , Redfern N. , Walkinshaw S. A. , de Swiet M. 
Published: August 2005

ABSTRACTObjective
To audit the use of bolus hydralazine for control of severe hypertension within a protocol for the management of severe pre‐eclampsia.Design
A retrospective review.Setting
Three UK teaching hospitals.Subjects
Seventy consecutive women who received hydralazine for the treatment of sustained severe hypertension. Twenty‐five women had more than one episode of hypertension amounting to a total of 109 treatment episodes.Intervention
Intravenous bolus hydralazine 5 mg, repeated every 15min to reduce the mean arterial pressure to < 125 mmHg.Main outcome measures
Change in mean arterial pressure in response to bolus hydralazine, fetal condition, as assessed by heart rate changes and umbilical arterial pH at delivery, and protocol violations were analysed.Results
Mean arterial pressure fell by 12 mmHg (95% CI 10–14) after the first bolus, 9 mmHg (95% CI 6.5–12) after the second bolus and 5 mmHg (95% CI 1–10) after the third bolus. Eighty‐two (75 %) episodes were managed strictly according to the protocol; of these, blood pressure was controlled by bolus therapy alone in 89%. Of the 27 instances in which the protocol was not adhered to, blood pressure was not controlled in four. There were no significant differences in the incidence of cardiotocographic abnormalities or umbilical acidaemia in the women treated before delivery (n= 36) compared with those in whom treatment was first initiated afterwards (n= 34).Conclusions
Hydralazine given in 5 mg boluses is a safe and effective method of treating severe hypertension in pre‐eclampsia. Despite clear management guidelines, protocol violations were common, and in 4% of treatment episodes these were potentially serious resulting in failure to control blood pressure.
Fetal nuchal translucency: ultrasound screening for fetal trisomy in the first trimester of pregnancy
Authors: Nicolaides K. H. , Brizot M. L. , Snijders R. J. M. 
Published: August 2005

ABSTRACTObjective
To investigate a new method of screening for fetal trisomies on the basis of maternal age and fetal nuchal translucency thickness at 10 to 13 weeks of gestation.Design
A prospective screening study.Setting
Tertiary referral centre.Subjects
One thousand two hundred and seventy‐three women with singleton pregnancies undergoing first trimester fetal karyotyping because of advanced maternal age, parental anxiety, or family history of a chromosomal abnormality in the absence of balanced parental translocation.Methods
Estimates of maternal age‐related risks for fetal trisomies 21, 18 and 13 at this gestation were used to derive the expected incidence of these trisomies in fetuses with nuchal translucency < 3 mm, 3 mm and > 3 mm, respectively, and the ratio of observed to expected number of cases was calculated.Results
The nuchal translucency was ≥ 3 mm in 86% of the trisomic and in 4.5% of the chromosomally normal fetuses. The observed number of trisomies in the 1185 cases with nuchal translucency < 3 mm was approximately five times less than the number expected on the basis of maternal age. In the groups with translucency of 3 mm (n= 52) and > 3 mm (n= 36), the observed numbers of trisomies were approximately five times and 24 times higher than the respective numbers expected on the basis of maternal age.Conclusion
The risk of fetal trisomy can be derived by combining maternal age and fetal nuchal translucency thickness at 10 to 13 weeks of gestation. It is predicted that for a false positive rate of 5%, the sensitivity of the new method of screening would be at least 85%, which compares favourably with the respective 20 to 30% and 50 to 60% of screening based on maternal age alone or the combination of maternal age with maternal serum biochemistry.
Cervical carcinoma in the Grampian region (1980–1991): a population‐based study of survival and cervical cytology history
Authors: Macleod A. , Kitchener H. C. , Parkin D. E. , Sarkar T. , Miller I. D. , Mann E. , Gordon N. , Campbell M. 
Published: August 2005

ABSTRACTObjectives
To study survival in women treated for cervical carcinoma in Grampian region, to identify clinical and pathological prognostic factors, and to correlate survival with cytology history.Design
A retrospective study of all cases of cervical carcinoma using a prospectively gathered database. Data validated by 1 in 10 randomised retrospective case note sampling.Setting
Aberdeen Royal Infirmary.Subjects
Three hundred and sixty‐three women resident within Grampian diagnosed as having cervical carcinoma between 1980 and 1991, with five‐year survival data on the 206 diagnosed by the end of 1986.Main outcome measure
Five‐year survival rates.Results
The mean annual incidence of cervical carcinoma in our population was 11.2 per 100 000 women, with an overall five‐year survival of 67% in those under 40 years of age and 60% in those aged 40 years and over. On univariate analysis, survival was significantly adversely affected by tumour stage, grade and absence of previous smears. On multivariate analysis, the effect of previous smear history was lost, but stage and grade remained strong independent risk factors for survival. There was no significant difference in five‐year survival by age or tumour type.Conclusions
The prognosis of cervical carcinoma in Grampian region was independently affected only by stage of disease and tumour grading and cervical smear history.