bluuebunny/crossref_metadata_2025_split huggingface dataset:
An economic evaluation of transcervical endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia
Authors: Sculpher Mark J. , Bryan Stirling , Dwyer Nuala , Hutton John , Stirrat Gordon M. 
Published: August 2005

ABSTRACTObjective
To evaluate the relative health service cost of endometrial resection versus abdominal hysterectomy for the treatment of menorrhagia and the value women attach to their health state before and after surgery.Design
A prospective economic evaluation running alongside a randomised controlled trial.Setting
The gynaecology department of a teaching hospital.Subjects
200 women requiring surgical treatment of menorrhagia between January 1990 and May 1991; after withdrawals, 97 women underwent hysterectomy and 99 underwent endometrial resection.Main outcome measures
The total health service cost of managing women in the two arms of the trial until 4 months after their operation. The change in women's valuation of their health state a fortnight after and a minimum of 4 months after surgery relative to that 1 month prior to their operation.Results
Total health service costs are significantly higher amongst abdominal hysterectomy patients (mean £1059.73) than amongst endometrial resection patients with a mean difference of £499.68 (95% CI £432–£567). This significant difference exists under alternative assumptions about the difference in lengths of stay in hospital between the two treatment groups and the hotel cost per in‐patient day. On a scale of 0 to 100, relative to a month before surgery, there is a statistically significant difference in favour of endometrial resection between the two groups in the increase in value women attach to their health state at a fortnight after surgery (mean difference 11.2; 95% CI 0.6–21.7), but not at a minimum of 4 months after surgery (mean difference 7; 95% CI –17.4 to 3.4).Conclusions
On the basis of health service resource cost up to 4 months after surgery, endometrial resection has a cost advantage over abdominal hysterectomy. However, given the fact that a subgroup of women requires retreatment due to resection failure and that this study considers a relatively short period of follow up, the long term costs and benefits of endometrial resection need to be evaluated before widespread diffusion is justified.
Clinical birthweight standards for a total population in the 1980s
Authors: Campbell Doris , Hall Marion , Lemon John , Carr‐Hill Roy , Pritchard Colin , Samphier Michael 
Published: August 2005

ABSTRACTObjective
To derive clinical standards for singleton birthweight in a population based on area of residence.Design
Analysis of variables recorded in Aberdeen Maternity and Neonatal Databank, calculating for each birth a standardised birthweight score, taking account of determining factors.Subjects
All singleton live births of 32 to 42 weeks gestation to Aberdeen City District residents from 1979 to 1983.Results
Basic standards of birthweight are presented correcting for gestational age, sex of the baby and parity of the mother. Birthweight is not normally distributed and empirical data are presented rather than smoothed curves. Adjustment for maternal height is straightforward but adjustment for maternal weight must take account of the gestation at which the woman was weighed. A method of calculating the appropriate correction for height and weight is described in detail.Conclusion
Birthweight is not normally distributed at each week of gestation. Standardisation for parity, gestation and sex of the baby is essential, but adjustment for maternal size is complex.
Endometrial changes in postmenopausal women treated with tamoxifen for breast cancer
Authors: Cohen Ilan , Rosen Doron J. D. , Shapira Jeremiah , Cordoba Mario , Gilboa Shlomo , Altaras Marco M. , Yigael Dror , Beyth Yoram 
Published: August 2005

ABSTRACTObjective
To evaluate whether risk factors, other than tamoxifen, can be identified for the development of endometrial pathologies in postmenopausal breast cancer patients treated with tamoxifen.Design
A cross‐sectional study.Setting
Department of Obstetrics and Gynaecology and Oncology Clinic, Sapir Medical Center, Kfar Saba, Israel.Subjects
77 asymptomatic postmenopausal women, treated with tamoxifen for breast cancer. Of these, 55 had no endometrial tissue and 22 had endometrial tissue obtained by biopsy.Main outcome measures
Demographic characteristics, health habits, risk factors, vaginal ultrasonographic evaluations of endometrial thickness and texture, and histologic evaluations of endometrial biopsies.Results
Overall, there was a high rate (29%) of endometrial pathological change among the 77 asymptomatic postmenopausal women. There were no significant statistical differences in the features tested between the two groups.Conclusion
It is impossible to predict which postmenopausal women will develop pathological endometrial changes after treatment with tamoxifen and thus a routine periodic endometrial sampling‐follow up is suggested for all postmenopausal women being treated with this agent.
Haematological risk factors for pregnancy outcome in Jamaican women with homozygous sickle cell disease
Authors: Morris Joanne S. , Dunn David T. , Poddar Damayanti , Serjeant Graham R. 
Published: August 2005

ABSTRACTObjective
To examine the association between fetal outcome and the steady state haematology of mothers with homozygous sickle cell disease.Design
A retrospective observational study. The data were taken from dockets kept at the Sickle Cell Clinic and verified by interview with 45% of the patients.Setting
The Sickle Cell Clinic at the University Hospital of the West Indies or two peripheral clinics operated by the staff of the MRC Laboratories.Subjects
All women aged 14 years or older with homozygous sickle cell disease who had experienced at least one pregnancy in the period 1977 to 1986.Main outcome measures
Three fetal outcomes including miscarriages, perinatal deaths, and birthweight.Results
There were 270 singleton pregnancies in 175 women with an overall fetal wastage of 32.2%. There was a significant increased risk of perinatal death with low maternal fetal haemoglobin level, but there were no haematological associations with miscarriages or birthweight.Conclusions
These data suggest that maternal steady‐state haematology has little influence on fetal outcome, with the exception that mothers with high HbF levels are less prone to perinatal deaths. Further study is required to investigate acute haematological changes associated with pregnancy.
The prevalence of lupus anticoagulant and anticardiolipin antibodies in women with a history of first trimester miscarriages
Authors: MacLean M. A. , Cumming G. P. , McCall Frances , Walker I. D. , Walker J. J. 
Published: August 2005

ABSTRACTObjective
To determine the prevalence of lupus anticoagulant and raised anticardiolipin antibodies in women with a history of two or more miscarriages in the first trimester of pregnancy.Design
A prospective study of lupus anticoagulant and anticardiolipin antibody levels in unselected women with a history of two or more first trimester miscarriages.Setting
The prepregnancy clinic and miscarriage antenatal clinic in a tertiary referral centre.Subject
Two hundred and forty‐three women, of whom 113 (47%) had a past history of two miscarriages, and 130 (53%) had three or more miscarriages.Main outcome measures
Quantitative detection of lupus anticoagulant and anticardiolipin antibodies; number of miscarriages in women in the normal and the abnormal groups.Results
Of the 243 women tested, 41 (16.8%) had an abnormality of lupus anticoagulant or anticardiolipin antibodies. This was significantly different from the normal population as previously reported. Sixteen women (6.6%) were positive for lupus anticoagulant, 20 (8.2%) had elevated anticardiolipin antibodies, and five (2%) had both abnormalities. The most frequently positive test for lupus anticoagulant was the dilute Russel viper venom time, and IgG was the most frequently elevated anticardiolipin antibody. Of the women with a history of only two miscarriages, 15 % had an abnormality of lupus anticoagulant or anticardiolipin antibodies, compared with 18.5% of those with a history of three or more miscarriages. This did not reach statistical significance. There were 117 (48%) primary miscarriers and 126 (52%) secondary miscarriers. Of the primary miscarriers, 17% had an abnormality, compared to 18 % of the secondary miscarriers.Conclusions
These findings provide further evidence of an association between lupus anticoagulant and anticardiolipin antibodies and early pregnancy loss. It is not known if these are the cause of miscarriage, markers for miscarriage, or if antiphospholipid antibodies develop as a result of a noncontinuing pregnancy. Further studies comparing various treatments are required before women with these antibodies can be optimally managed.
Intervention debulking surgery in advanced epithelial ovarian cancer
Authors: Redman C. W. E. , Warwick J. , Luesley D. M. , Varma R. , Lawton F. G. , Blackledge G. R. P. 
Published: August 2005

ABSTRACTObjective
To study whether intervention debulking surgery improves survival in patients with advanced ovarian cancer who have bulky (> 2 cm) residual disease after primary surgery.Design
A prospective multicentre randomised study.Setting
Hospitals in the West Midlands.Subjects
Ovarian cancer patients with bulky residual disease after primary surgery who are considered well enough to receive cis‐platinum based chemotherapy and further surgery.Methods
Eligible patients were randomised to receive combination chemotherapy alone or combined with intervention debulking surgery.Main outcome measure
Survival was assessed using product limit method and log‐rank test.Results
Seventy‐nine patients were entered into the study. Thirty‐seven patients were randomised to intervention debulking surgery, 25 (67%) of whom underwent intervention debulking surgery, which was performed a median of 13 weeks after primary surgery. The median survival for the intervention debulking surgery group was 15 months (95% CI 10–20 mo) and that of those randomised to chemotherapy alone, which was 12 months (95% CI 8–16 mo), were not significantly different (hazard ratio = 0.71; 95% CI 0.44–1.13).Conclusion
Intervention debulking surgery may not improve survival in patients with advanced ovarian cancer.
Initial experience with supracervical laparoscopic hysterectomy and removal of the cervical transformation zone
Authors: Ewen Simon P. , Sutton Christopher J. G. 
Published: August 2005

ABSTRACTObjective
To assess the feasibility and outcome of laparoscopic supracervical hysterectomy with removal of the cervical transformation zone.Design
A prospective clinical study.Setting
The department of Gynaecology, Royal Surrey County Hospital, Guildford.Subject
Eleven consecutive women who were on the waiting list for abdominal hysterectomy and fulfilled the selection criteria.Intervention
Laparoscopic supracervical hysterectomy using a modification of the classical abdominal supracervical hysterectomy technique with removal of the cervical transformation zone.Main outcome measures
Operating time, blood loss, duration of hospital stay, time to full recovery and complications.Results
All 11 procedures were successfully completed laparoscopically. The mean operating time was 111 min, and mean blood loss was 185 ml. The mean duration of hospital stay was three days, and the mean time to full recovery was 20 days. There were no major complications.Conclusions
Laparoscopic supracervical hysterectomy appears to result in a shorter hospital stay and more rapid recovery than total abdominal hysterectomy. This shortened convalescence is of benefit to the patient. The operation appears to be safe when carried out by surgeons experienced in laparoscopic surgery. A randomised comparative study with total abdominal hysterectomy is currently being undertaken.
Prenatal determination of human platelet antigen type using DNA amplification following amniocentesis
Authors: Bennett Phillip R. , Warwick Ruth , Vaughan Janet , Chana Haj , Lubenko Anatole , Fisk Nicholas M. 
Published: August 2005

ABSTRACTObjectives
To demonstrate that fetal human platelet antigen (HPA1) type can be determined, without the need for fetal blood sampling, by amplification of fetal DNA from amniotic fluid cells using polymerase chain reaction and allele specific oligonucleotide hybridisation.Design
Oligonucleotide DNA primers were designed to amplify a portion of the platelet glycoprotein GpIIIa gene which spans the site of the single base change which differentiates HPAla from HPAlb. Specific oligonucleotides were designed to hybridise either to the amplified HPAla allele or to the HPAlb allele. Amniotic cells were used as the DNA template both directly and following formal isolation of DNA. Fetal HPA1 type, determined by this method in fifteen pregnancies not at risk of perinatal alloimmune thrombocytopaenia, was compared to typing of fetal blood obtained following cordocentesis. The methodology was then used to HPA type the fetus in two pregnancies at risk of the disease.Setting
Department of Molecular Biology and Centre for Fetal Care, Queen Charlotte's Hospital.Subject
Fifteen women undergoing amniocentesis and fetal blood sampling for other indications and two women at risk of perinatal allo‐immune thrombocytopaenia whose partners were heterozygotes.Results
In the 15 control cases and the two clinical cases, determination of fetal HPA1 type from amniotic fluid cells agreed with typing of fetal blood. There was no difference in the efficiency of amplification from amniotic fluid cells directly or from isolated DNA.Conclusions
Fetal HPA type may be reliably determined by amplification of DNA from amniotic fluid cells, eliminating the need for fetal blood sampling or immunoglobulin administration when the fetus is HPAla negative.
Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of a Scottish population, 1985–1990
Authors: Hughes R. G. , Craig J. I. O. , Murphy W. G. , Greek I. A. 
Published: August 2005

ABSTRACTObjective
To identify the reasons behind failures to prevent the development of Rhesus (D) haemolytic disease of the newborn.Design
Retrospective analysis of the case records of all pregnancies that resulted in the birth of an infant with a positive direct antiglobulin test on the cord red cells born to Rh(D) negative women between 1 April 1985 and 31 March 1990.Setting
Obstetric units in the South East Scotland region and the South East Scotland Regional Blood Transfusion Service Antenatal Laboratory.Main outcome measures
The causes and clinical consequences of maternal immunisation to the Rhesus (D) antigen.Results
Between 1985 and 1990, 80 pregnancies resulted in the birth of an infant sensitised with anti‐D on the cord red cells. There were no deaths due to haemolytic disease, but considerable resources were deployed in obstetric and neonatal care for these pregnancies. Sufficient data were available to categorise the cause of maternal immunisation in 70 pregnancies. Seven cases were due to immunisation by pregnancy before 1970. Sixty‐three cases could be attributed to failure of the Rhesus programme: 10 cases (16%) were due to failure to implement the programme adequately, the other 53 cases (84%) were due to failure of the current guidelines to provide adequate protection. Late immunisation in an uncomplicated pregnancy was the single commonest identifiable cause.Conclusions
It is likely that substantial further reductions in Rhesus (D) immunisation and haemolytic disease of the newborn will require changes in the Rhesus prevention programme. In particular the role of antenatal prophylaxis requires detailed consideration.
Effects of maternal age, parity, and smoking on the risk of stillbirth
Authors: Raymond Elizabeth G. , Cnattingius Sven , Kiely John L. 
Published: August 2005

ABSTRACTObjective
To examine the effects of advanced maternal age, nulliparity, and smoking on risk of stillbirth as gestation advances, and to explore possible clinical mediators of these effects.Design
A population based cohort study.Setting
Sweden, 1983 to 1989.Subjects
All singleton pregnancies of 28 weeks gestation or greater in Nordic citizens at least 20 years old (n= 638242).Main outcome measures
Crude and adjusted risks of stillbirth; gestational age specific risks of stillbirth.Results
Older women (35 years or older), smokers, and nulliparas had elevated risks of stillbirth. The elevated stillbirth risk in smokers was eliminated when women with intrauterine growth retardation, placental abruption, and placenta previa were excluded from the analysis. However, the higher risks in older women and nulliparas persisted even when the analysis excluded women with hypertension, diabetes, placental complications, or growth retardation. Over the course of the third trimester, the age related risk of stillbirth increased, the smoking related risk decreased, and the higher risk in nulliparas showed no clear trend with gestational age.Conclusions
The association between smoking and stillbirth is explained entirely by the higher incidence of growth retardation and placental complications in smokers. The clinical mediators of the associations of maternal age and parity with stillbirth remain unexplained. Gestational age is an important modifier of the effects of advanced maternal age and smoking on stillbirth risk.
Late fetal heart decelerations and changes in cerebral oxygenation during the first stage of labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R. 
Published: August 2005

ABSTRACTObjective To test the hypothesis that late fetal heart rate decelerations are associated with a decrease in cerebral oxygenation.Design Changes in fetal cerebral concentrations of oxyhaemoglobin and deoxyhaemoglobin were measured by near infrared spectroscopy, before, during and after contractions with late fetal heart rate decelerations and compared with changes during contractions with no alteration of heart rate.Setting Teaching hospital obstetric unit.Subjects Ten women in labour at term.Results The changes in fetal cerebral oxyhaemoglobin and deoxyhaemoglobin concentrations that occurred during contractions were quantitatively similar, irrespective of the fetal heart rate changes. However, late fetal heart rate decelerations were associated with a significantly greater fall, after the uterine contraction, in the mean concentration of fetal cerebral oxyhaemoglobin of 0.52μmol/100g (SD 0.25) (P < 0.001) and a significantly greater rise in the mean concentration of deoxyhaemoglobin of 0.36 pmol/100 g (SD 0.35) (P < 0.01).Conclusion Late fetal heart rate decelerations are associated with a significant decrease in cerebral oxygenation.
Screening for cervical neoplasia in Dundee and Angus 10 years on
Authors: van Wijngaarden W. J. , Duncan I. D. , Hussain K. A. 
Published: August 2005

ABSTRACTObjective To evaluate the effect of changed cervical screening policies on a steady population with low migratory tendencies.Design A retrospective analysis study.Setting Dundee and Angus, Scotland.Subjects All women who developed cervical carcinoma between 1957 and 1992.Main outcome measures The incidence of and mortality from cervical cancer after the introduction of organised cervical screening in 1962, according to age, stage, histology and screening history.Results The initial fall in incidence of cervical cancer seen in women between 35 and 54 years after the introduction of cervical screening was not sustained during the last 10 years of our study and appears to have been transferred to women aged 55 years and older instead. After 1976 an increase in the incidence of cervical cancer was seen in women under 35 years. The reduction in mortality from cervical cancer appears to have reached a plateau since 1976. No effect of cervical screening was seen on the incidence of adenocarcinoma of the cervix.Conclusions The effect of changed cervical screening policies has been shown for a small population for a period of 35 years. The incidence of the higher stages of squamous cervical cancer continues to fall. The increase in incidence of cervical cancer in women under 35 years confirms similar trends seen in other countries. A background mortality rate refractory to further intensification of screening appears to have been reached. Adenocarcinoma of the cervix appears to gain in importance as cervical screening policies are shown to have their effect on its squamous counterpart.
Oral contraceptives, pregnancy and the risk of cerebra1 thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease
Authors: Lidegaard ØJvind 
Published: August 2005

ABSTRACTObjective To assess the risk of developing cerebral thromboembolism among pregnant women and among fertile women with hypertension, migraine, diabetes, and previous thrombotic disease, and to investigate the interaction of these risk factors with the use of oral contraceptives.Design A retrospective case‐control study.Setting All gynaecological, medical, neurological, and neurosurgical departments in Danish hospitals.Subjects Seven hundred and ninety‐four women in Denmark aged 15 to 44 who suffered a cerebral thromboembolic attack during the period 1985 to 1989 and 1588 age‐matched, randomly selected controls.Response Of the 692 case and 1584 control questionnaires sent out, 590 (85.1%) and 1396 (88.1 %), respectively, were returned. Of the 590 cases, nine had had cerebral thrombosis before 1980, 15 refused to participate, 44 had a revised diagnosis (primarily multiple sclerosis) and 25 had an unreliable diagnosis, leaving 497 with a reliable cerebral thromboembolic diagnosis. Among the 1396 controls, 26 either refused to participate, were mentally handicapped, lived abroad or returned an uncompleted questionnaire, leaving 1370 controls included in the study.Results After multivariate analysis, pregnancy implied an odds ratio (OR) for a cerebral thromboembolic attack of 1.3 (nonsignificant), diabetes an OR of 5.4 (P < 0.001), hypertension an OR of 3.1 (P < 0.001) and migraine an OR of 2.8 (P < 0.01). Women with previous non‐cerebral thrombotic disease had an OR for cerebral thrombo‐embolism of 5.3 (P < 0.001). Women with other predisposing medical diseases had an OR of 8.3 (P < 0.001). These ORs were identical among users and non‐users of combined oral contraceptives.Conclusion In this study pregnancy implied a non‐significant elevated odds ratio of 1.3 for cerebral thromboembolism whereas diabetes, hypertension, migraine and past thromboembolic events increased the risk of cerebral thromboembolism significantly. Women with these increased thrombotic risks should use oestrogen‐containing oral contraceptives only after careful considerations of the risks, if at all.
Delayed gastric emptying as a factor in delayed postprandial glycaemic response in pregnancy
Authors: Stanley Katharine , Magides Andrea , Arnot Michelle , Bruce Chris , Reilly Charles , Mcfee Alasdair , Fraser Robert 
Published: August 2005

ABSTRACTObjective To determine whether an alteration in gastric emptying contributes to an altered postprandial glycaemic response in normal pregnancy.Design A longitudinal study in normal pregnancy and postpartum.Setting Teaching hospital in Sheffield.Subjects Primigravid women with uncomplicated pregnancies.Interventions Simultaneous meal tolerance and paracetamol absorption tests.Main outcome measures 1. Gastric emptying: maximum concentration (Cmax) and time to maximum concentration (Tmax) of paracetamol; 2. glycaemic response: Cmax, Tmax, and area under the curve of plasma glucose; 3. insulinaemic response: Cmax, Tmax, area under the curve of plasma insulin.Results An increased, but not delayed, insulin response, and an increased initial glucose response to a test meal in the third trimester were not accompanied by any simultaneous delay in gastric emptying.Conclusion Gastric emptying does not seem to be a factor in the glycaemic response of pregnancy.