bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of frozen section for the operative management of endometrial cancer
Authors: Quinlivan Julie A. , Petersen Rodney W. , Nicklin James L. 
Published: December 2003

Objective
To assess the accuracy of intra‐operative frozen section reports at identifying the features of high risk uterine disease compared with final histopathology.Design
Retrospective study.Methods
The records of 460 patients with uterine cancer registered with the Queensland Centre for Gynaecological Cancer between January 1, 1996 and December 31, 1998 were reviewed. Intra‐operative frozen section was undertaken in 260 patients with endometrial adenocarcinoma. Frozen section pathology was compared with the final histopathology reports. Inter‐observer reliability was assessed using percentage agreement and kappa statistics. Clinical notes were also reviewed to determine if errors resulted in sub‐optimal patient care.Results
Respectively, tumour grade and depth of myometrial invasion were accurately reported in 88.6% of cases (expected 61.5%, Kappa 0.70) and 94.7% (expected 53.8%, Kappa 0.89). Errors were predominantly attributable to difficulties with respect to the interpretation of tumour grade. The error resulted in the patient receiving sub‐optimal surgical management in only 11 cases (5.3%)Conclusion
Frozen section is accurate at identifying the features of high risk uterine disease in the setting of endometrial cancer and can play an important role in directing primary operative management.
Influence of peritoneal factors on port‐site metastases in a xenograft ovarian cancer model
Authors: Agostini Aubert , Robin François , Aggerbeck Martine , Jaïs Jean‐Philippe , Blanc Bernard , Lécuru Fabrice 
Published: December 2003

Objective
We determine the main physical effects of pneumoperitoneum on tumour dissemination and port‐site metastases occurrence.Design
A prospective randomised study in rats.Methods
A human ovarian cancer cell line (IGR‐OV1) was xenografted in nude rats. Seven days after cancer inoculation, surgery was performed. Rats were randomised in two main groups and underwent either: gasless laparoscopy (n= 20) CO2 laparoscopy with pneumoperitoneum pressure at 4 mmHg (n= 20), or 8 mmHg (n= 20) with in each case, increasing operative duration: 30,60,90 or 120 minutes (five rats for each time). Animals were killed seven days after the intervention.Main outcome measures
Tumour dissemination and frequency of port‐site metastases.Results
Tumour dissemination was not influenced by gas pressures or duration of procedure. The rate of rats with at least one port‐site metastasis (one or two) was similar in all groups: gasless: n= 10/20; 4 mmHg CO2: 5/20; 8 mmHg CO2: 7/20,(P= 0.26). The number of port‐site metastases were significantly higher in the gasless group compared with the 4 mmHg CO2 group (15/40 (37.5%) vs 5/40 (12.5%), P= 0.01). Difference was not significant between the 8mmHg group and the gasless group (9/40(22.5%) vs 15/40(37.5%), P= 0.14) or the 4mmHg group (9/40(37.5%) vs 5/40 (12.5%), P= 0.24). Duration of procedures had no significant influence on port‐site metastases rate (P>0.05).Conclusions
Unlike previous animal studies, port‐site metastases were more frequent with gasless laparoscopy than with CO2 pneumoperitoneum. Local peritoneal factors could play an important role in port‐site metastases mechanism.
A randomised double‐blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thrombolic events after caesarean section: a pilot study
Authors: Burrows Robert F. , Gan Eng T. , Gallus Alexander S. , Wallace Euan M. , Burrows Elizabeth A. 
Published: December 2003

Objective
To pilot a protocol for a national multicentre randomised trial in which a low molecular weight heparin will be compared with placebo for prevention of venous thrombotic events occurring within six weeks after caesarean section.Design
Double‐blind randomised controlled trial.Setting
Tertiary care centre.Participants
Seventy‐six women having had a caesarean section, 37 in the control group and 39 in the Dalteparin group.Methods
Consenting patients having had an emergency or elective caesarean section were commenced on study medication 6–24 hours post‐operatively. The study medication, dalteparin 2500iu or saline, was given subcutaneously once daily for four or five days post‐operatively depending on the patient's length of stay. Patients were reviewed in hospital for operative outcomes and contacted at two and six weeks post‐operatively.Results
Of the 141 women given information about the trial, 76 (54%) consented to participate. Follow up to six weeks was achieved in all women who were recruited. More women in the placebo arm had general anaesthesia, but otherwise the two groups had similar characteristics at randomisation. There was only one occurrence of a deep vein thrombosis during the study. This patient was in the treatment arm and the thrombosis occurred between two and six weeks post‐operatively. All other outcomes were similar in the two groups.Conclusion
Our experience of a 26% recruitment rate, the thrombosis rate of 1.3% (95% CI 0.03‐7.1%) and the contactability of all participants two and six weeks post‐operatively, indicates that this study is feasible.
Magnetic resonance imaging in the assessment of complex Müllerian anomalies
Authors: Minto Catherine L. , Hollings Nicholas , Hall‐Craggs Margaret , Creighton Sarah 
Published: December 2003

Objective
To evaluate the accuracy of magnetic resonance imaging in assessment of adolescent patients with complex Müllerian anomalies and its contribution towards operative management.Design
A retrospective review of magnetic resonance imaging and operative findings.Setting
A London teaching hospital that is a tertiary referral centre for complex reproductive tract disorders.Sample
All adolescents referred for assessment of complex Müllerian anomalies, from 1996 to 1999, and undergoing both magnetic resonance imaging and surgical assessment.Method
In the nine suitable patients magnetic resonance imaging and surgical findings were compared and the role of magnetic resonance imaging in determining the route and type of surgery was evaluated.Main
outcome measures Magnetic resonance imaging data on reproductive tract anatomy and surgical findings detailing reproductive tract anatomy.Results
There was good correlation of magnetic resonance imaging and operative findings in all cases. The best correlation was with uterine structure. In four cases the magnetic resonance imaging findings were essential for the appropriate choice of the surgical approach and type of procedure.Conclusions
Magnetic resonance imaging is a valuable tool in the management of this particular complex group of patients.
Choosing a strategy to prevent neonatal early‐onset group B streptococcal sepsis: economic evaluation
Authors: Stan Catalin M. , Boulvain Michel , Bovier Patrick A. , Auckenthaler Raymond , Berner Michel , Irion Olivier 
Published: December 2003

Objective
To determine the most appropriate strategy to prevent neonatal streptococcal sepsis in a setting with a low incidence of the disease.Design
Decision analysis and economic evaluation.Setting
Geneva University Hospitals, Switzerland.Population
Pregnant women at 35‐37 weeks of gestation and in labour.Methods
Local data and data from the literature were used in a decision analysis to compare the current policy of antibiotic administration at Geneva University Hospitals with the recommended preventive strategies.Main outcome measures
Number of episodes of sepsis averted; cost and number needed to treat to prevent one episode of sepsis; and proportion of women receiving antibiotics during labour.Results
Compared with the current policy, the risk factors strategy would prevent 69 streptococcal sepsis per million deliveries and the screening strategy would prevent 102 cases of sepsis per million deliveries. Cost per averted sepsis case would be £60, 700 and £473, 600, respectively. The number needed to treat to prevent one sepsis would be 1087 with a risk factors strategy and 1029 with a screening strategy. Preventive strategies would increase the proportion of women receiving antibiotics during labour from 6% with the current policy, to 13.5% and 16.5% respectively.Conclusions
Preventive strategies are more effective than the current policy, but imply increased hospital costs and a notable increase in the proportion of women receiving antibiotics during labour, which may be unjustified in a low incidence setting.
Activin βA‐subunit and activin receptors in human myometrium at term and during labour
Authors: Schneider‐Kolsky Michal , Manuelpillai Ursula , Gargett Caroline , Wallace Euan M. 
Published: December 2003

Objective
To measure activin A content and to localise and semi‐quantitate activin receptors in human myometrium at term and during labour.Design
Myometrium was collected from non‐pregnant women (n= 6), pregnant women at term not in labour (n= 6) and at term in labour (n= 6).Setting
Monash Medical Centre, Melbourne, Australia.Main
outcome measures Tissue lysates of myometrium were analysed for activin A content using an enzyme‐linked immunosorbent assay and activin receptor proteins IA, IIA and IIB using Western hybridisation. Activin βA‐subunit and activin receptors were localised in myometrium by immunohistochemistry.Results
Activin A was detected by ELISA in non‐pregnant, pregnant and labouring myometrium. Levels were significantly higher in labouring myometrium. The three activin receptors IA, IIA and IIB were detected in all myometrial samples by Western hybridisation. Receptor IA was expressed in significantly higher levels in pregnant myometrium. Receptor IIA was very weakly expressed throughout. The expression of receptor IIB was similar in all three groups. Activin βA‐subunit and all three receptors were localised to the endothelial cells of myometrial blood vessels. Neither activin βA‐subunit nor any of the three activin receptors were immunolocalised to myometrial smooth muscle cells in the three groups. This result was confirmed by Western blotting for expression of activin receptors in isolated myometrial smooth muscle and microvascular endothelial cells.Conclusion
The myometrium is not a target for activin A during late pregnancy or labour. However, activin A may have a role in the regulation of microvascular endothelial cell function in the myometrium.
Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units
Authors: Moster Dag , Lie Rolv Terje , Markestad Trond 
Published: December 2003

Objective
To compare neonatal mortality in geographical areas where most deliveries occur in large hospitals with areas where a larger proportion of deliveries occur in small maternity units.Design
Population‐based study using data from The Norwegian Medical Birth Registry.Setting
Records on all deliveries in Norway from 1967 to 1996, a total of 1.7 million births, were equipped with data on the size of the maternity units used by delivering women in that particular area.Main outcome measure
Risk of neonatal death.Results
Women living in areas where the most frequently used delivery unit had less than 2000 annual deliveries had 1.2 fold the risk of experiencing neonatal death of their newborn (95% CI 1.1‐1.3). The relative risk of neonatal death in geographical areas where more than 75% of deliveries occurred in units with more than 3000 annual births was 0.8 (95% CI 0.7‐0.9) compared with areas where none delivered in such large units. The relative risk of neonatal death in areas where the most frequently used delivery units had less than 100 annual births was 1.4 (95% CI 1.1‐1.7) compared with areas where units of more than 3000 annual births were the most frequently used. Differences in outcome could not be explained by differences in travelling distance to an urban centre where most referral delivery units are located, differences between rural and urban municipalities, or by differences in biological or socio‐economic risk factors between municipalities.Conclusions
We observed a small but significantly decreased neonatal mortality in areas where the great majority of births occurred in large hospitals.
Computerised analysis of fetal heart rate recordings in maternal type I diabetes mellitus
Authors: Tincello Douglas , White Sarah , Walkinshaw Stephen 
Published: December 2003

Objective
1. To study computerised cardiotocograph parameters from women with type I diabetes; 2. to examine the significance of observed differences from the expected normal values.Design
Prospective observational study in the third trimester of pregnancy.Setting
The medical antenatal clinic of a tertiary referral centre.Population
Twenty‐six women with type I diabetes mellitus with a singleton pregnancy.Methods
Computerised cardiotocograph recordings were made weekly from 28 to 39 weeks. Derived parameters were compared with the published figures for uncomplicated singleton pregnancies. Details of maternal blood sugar, labour and delivery and neonatal outcome were recorded. Data were compared between groups according to the computerised analysis of the antenatal CTGs.Results
One‐hundred and thirty‐one recordings were made with a median of five per patient (range 1–12). 11.3% showed absent episodes of high variation compared with the expected value of 0.8%, a difference of 9.5% (95% CI 4.5‐15.3). Differences in short term variation, basal heart rate, frequency of fetal movements and heart rate accelerations were also found which changed with gestation. Overall these changes represented a more immature form of fetal heart rate than that which would be expected. No relationship between the changes and adverse fetal outcome could be identified.Conclusions
Significant differences exist in cardiotocographs in maternal type I diabetes compared with normal fetuses. The changes may represent a delay in fetal maturation. The analysis mode of the computer will register these as abnormal features, but there is no evidence that they are pathological. We would recommend that computerised analysis is not used to assess pregnancies complicated by maternal type I diabetes mellitus.
Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years
Authors: Nieminen Kari , Heinonen Pentti K. 
Published: December 2003

Objective
To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse.Design
Retrospective observational study with long term follow up.Setting
Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland.Sample
and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80‐93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2‐113] months.Main
outcome measures Intra‐ and post‐operative morbidity, mortality and recurrence of prolapse.Results
Sixteen of the 25 women (64 %) had no major intra‐ or post‐operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy.Conclusion
Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.
Cellular proliferation in the female lower urinary tract with reference to oestrogen status
Authors: Blakeman Peter J. , Hilton Paul , Bulmer Judith N. 
Published: December 2003

Objective
To assess cell proliferation throughout the tissues of the female lower urinary tract and to compare cell proliferation rates in women of varying oestrogen status.Design
Prospective observational study.Setting
A large teaching hospital.Sample
Fifty‐nine women undergoing surgery for urogynaecological conditions of whom 23 were premenopausal, 20 were postmenopausal and taking no oestrogen supplementation and 16 were postmenopausal and receiving some form of hormone replacement therapy. Biopsies were taken during surgery from the bladder dome, trigone, the proximal and distal urethra, vagina and vesico‐vaginal fascia in the region of the bladder neck.Methods
Formalin‐fixed paraffin‐embedded biopsies were labelled by an avidin–biotin technique with a monoclonal antibody raised against part of the nuclear matrix known as Ki‐67 antigen.Main
outcome measures Ki‐67 expression was assessed in the epithelial, subepithelial and muscle or deep fascial regions of all tissues and related to oestrogen status.Results
Ki‐67 expression was only found in high levels in biopsies containing squamous epithelia. Significantly higher levels of Ki‐67 expression were observed in the tissues of oestrogen replete women in the premenopausal and hormone replacement groups, compared with postmenopausal women receiving no oestrogen supplementation.Conclusions
Squamous epithelia of the female lower urinary tract exhibit greater levels of cell proliferation in oestrogen replete as compared with oestrogen deficient women. As these same squamous epithelia also consistently express oestrogen receptors, the findings suggest a mechanism by which oestrogen exerts its effect on the lower urinary tract and also provide an explanation for the success of oestrogen in the treatment of some conditions causing lower urinary tract dysfunction in postmenopausal women.
Estimation of an expected caesarean section rate taking into account the case mix of a maternity hospital. Analysis from the AUDIPOG Sentinelle Network (France)
Authors: David Sandra , Mamelle Nicole , Rivière Olivier ,   Obstetricians of AUDIPOG
Published: December 2003

Objective
To provide maternity unit with an expected caesarean section rate, according to its case mix (i.e. women's characteristics associated with caesarean section risk).Design
Cohort study.Setting
149 maternity units in France.Sample
40,512 single births collected by the French Sentinelle Network, in January every year, from 1994 until 1998.Methods
Univariate analysis was used to identify caesarean section risk factors, and multivariate analysis to adjust for the role of the maternity units’ characteristics, after taking into account the women's characteristics. A two‐level logistic model was used to show that the caesarean section rate varied according to maternity units’ characteristics and to estimate therefore expected caesarean section rates (before and during labour), for each maternity unit, according to its case mix.Main outcome
caesarean section rates (before and during labour).Results
Within the Sentinelle Network the caesarean section rate was 15.0% (7.6% were before labour). The joint effect of the size and juridical status on caesarean section risk was studied. The reference hospital was university maternity units with more than 2000 deliveries/year. Community or private maternity units with more than 2000 deliveries/year carried out fewer prophylactic caesarean sections than the reference hospital (ORadj=0.7 and 0.6, respectively). Conversely, private maternity units with fewer than 2000 deliveries/year performed more prophylactic caesarean sections than the reference hospital (ORadj= 1.7). The two‐level logistic model showed that a maternity unit effect still existed after taking into consideration both women's characteristics and those of the maternity unit, and estimated expected caesarean section rates.Conclusion
Knowledge of the expected caesarean section rate constitutes a personal reference to which the maternity hospital can compare its observed caesarean section rate, and is thus likely to have a significant effect on delivery practices.
Fetal bone metabolism in normal and rhesus isoimmunised pregnancies
Authors: Ogueh Onome , Wright Eileen M. , Jones Julia , Alaghband‐Zadeh Jamshid , Nicolaides Kypros H. , Johnson Mark Richard 
Published: December 2003

Objective
To construct gestation‐specific reference intervals for fetal concentrations of biochemical markers of bone metabolism and assess the effect of rhesus isoimmunisation on these.Methods
Fetal blood samples were obtained by cordocentesis from 175 pregnancies (43 complicated by rhesus isoimmunisation) and assayed for carboxy terminal pro‐peptide of type I pro‐collagen (PICP) and cross‐linked carboxyterminal telopeptide of type I collagen (ICTP) which directly monitor the rate of bone formation and resorption respectively.Results
Both plasma PICP and ICTP were negatively correlated with gestational age (r =−0.351 and−0.472 for PICP and ICTP, respectively, and P<0.001 for both). In fetuses affected by rhesus isoimmunisation PICP levels were lower (P=0.030) and more variable (P <0.001) than expected, compared with normal unaffected fetuses. However, no such differences were found in the ICTP levels. In the fetuses affected by rhesus isoimmunisation there was a significant correlation between haemoglobin concentration and both PICP (r = 0.504, P= 0.001) and ICTP (r = 0.343, P= 0.030).Conclusions
Fetal bone turnover declines from early second trimester to term, and may be deranged in fetuses affected by rhesus isoimmunisation.
Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions
Authors: Bouvier‐Colle Marie‐Hélène , Ould El Joud Dahada , Varnoux Noelle , Goffinet François , Alexander Sophie , Bayoumeu Françoise , Beaumont Etienne , Fernandez Hervé , Lansac Jacques , Lévy Gérard , Palot Maryse 
Published: December 2003

Objective
To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage.Design
Retrospective questionnaire survey.Setting
Three administrative regions of France.Population
All women who were pregnant or had recently given birth during the year before the survey.Methods
A European survey (MOMS‐B) defined severe haemorrhages as blood loss ≧1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne‐Ardenne, the Centre and Lorraine. An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty‐five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and ‘mixed’ care were both considered substandard. The 165 cases were coded and then studied with uni‐ and multivariate analysis (logistic regression with SAS and SPSS software).Results
Of the 165 cases identified, 51 % (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24‐hour on‐site anaesthetist at the hospital and a low volume of deliveries (<500 births per year) were the factors associated with substandard care.Conclusion
Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.