bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three methods for hysterectomy: a randomised, prospective study of short term outcome
Authors: Consultant Christian Ottosen , Lingman Göran , Ottosen Lena 
Published: August 2005

Objective
To detect differences in clinical short term outcome between total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.Design
Randomised controlled trial.Setting
Department of Obstetrics and Gynaecology, Hospital of Helsingborg, Sweden.Sample
One hundred‐twenty women scheduled for hysterectomy for various indications.Methods
Randomisation into three treatment arms: total abdominal hysterectomy (n= 40); vaginal hysterectomy (n= 40) and laparoscopic assisted vaginal hysterectomy (n= 40). During traditional abdominal and vaginal surgery, laparoscopic assistance was kept to a minimum. Substantial number of cases needed volume‐reducing manoeuvres due to uterine size.Main outcome measures
Duration of surgery, anaesthesia, time in hospital and recovery time.Results
Mean duration (range) of surgery was significantly longer for laparoscopic assisted vaginal hysterectomy compared with vaginal hysterectomy and total abdominal hysterectomy, 102 min (50–175), 81 min (35–135) and 68 min (28–125), respectively. Mean stay in hospital and mean time to recovery was significantly longer for total abdominal hysterectomy compared with vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy. The difference between vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy was not significant. It was possible to remove uteri under 600 g with all three methods. Four laparoscopic assisted vaginal hysterectomies and one vaginal hysterectomy were converted to open surgery. Reoperation and blood transfusion were required after two vaginal hysterectomies and one laparoscopic assisted vaginal hysterectomy. One woman needed blood transfusion after total abdominal hysterectomy.Conclusions
Traditional vaginal hysterectomy proved to be feasible and the faster operative technique compared with vaginal hysterectomy with laparoscopic assistance. The abdominal technique was somewhat faster, but time spent in theatre was not significantly shorter. Abdominal hysterectomy required on average a longer hospital stay of one day and one additional week of convalescence compared with traditional vaginal hysterectomy. Vaginal hysterectomy should be a primary method for uterine removal.
RhD genotyping by quantitative fluorescent polymerase chain reaction: a new approach
Authors: Pertl Barbara , Pieber Doris , Panzitt Thomas , Haeusler Martin C. H. , Winter R. , Tului L. , Brambati B. , Adinolfi M. 
Published: August 2005

Objective
To develop a new method of RhD/d genotype determination using a quantitative fluorescent PCR (QF‐PCR) assay.Methods
Polymerase chain reaction amplification (PCR) of fragments of exon 7 of both the RHD and RHCE genes was performed from 32 amniotic fluid and 26 chorionic villus samples known to be heterozygous for the RHD gene, 74 peripheral blood samples of RhD‐positive blood donors (homozy‐gous or heterozygous) estimated by serologic typing and 24 RhD‐negative fetal samples. The number of copies of the RHD gene in RhD‐positive samples was determined by comparing the fluorescent intensities of the amplification products specific for the RHD and the RHCE genes.Results
A ratio of fluorescent intensities of 1:1 clearly indicated D/D homozygous individuals whereas a ratio of 1:2 was demonstrated in samples from D/d heterozygous individuals. The mean fluorescent intensity ratio of the peak areas of homozygous samples was 1.12 (SD 0.128), the mean ratio of the peak areas of heterozygous samples was 0.51 (SD 0.060). Complete agreement was obtained between RhD/d typing by QF‐PCR and RhD genotypes assessed by family studies and serological methods.Conclusions
The fluorescent PCR‐based DNA test allows easy, rapid and accurate determination of the zygosity for the RHD gene. This new technique provides useful information for the clinical management of pregnancies of sensitised RhD‐negative mothers.
Does a discrepancy between gestational age determined by biparietal diameter and last menstrual period sometimes signify early intrauterine growth retardation?
Authors: Larsen T. , Nguyen T. H. , Greisen G. , Engholm G. , Møller H. 
Published: August 2005

Objective
To assess the association between gestational age estimated from the last menstrual period (GALMP) or from the biparietal diameter (GABPD), and the subsequent birthweight for gestational age.Design
Population‐based follow up study.Setting
Of 21,936 pregnancies contained in the ultrasound database, 16,387 singleton pregnancies with a reliable last menstrual period date and an ultrasound examination between 12 and 22 weeks of gestation were included.Main outcome measures
Correlation between: 1. birthweight deviation (birthweight‐expected weight for gestation); 2. birthweight; and 3. pregnancy length and (GALMP‐GABPD). Relative risk of birthweight < 2500 g and low birthweight for gestation (> 22% below normal weight) related to five levels of discrepancy between (GALMP‐GABPD).Results
(GALMP‐GABPD) was not associated with deviation of birthweight related to GABPD However the risk of low birthweight (< 2500 g) and low birthweight for gestational age was significantly increased when (GALMP‐GABPD) was > 7 days.Conclusion
A biparietal diameter smaller than expected from the last menstrual period date is mainly a problem of an error related to estimated time of ovulation. At the same time the relative risk of a low birthweight infant is slightly increased.
The surgical management of cervical carcinoma within the South West of England: progress through an audit loop
Authors: Murdoch J. B. , Weeks J. F. , Howe K. , Smith J. , Kirkpatrick A. , McCrum A. 
Published: August 2005

Objective
To define and use a minimum clinical dataset for prospective data collection in order to audit the surgical management of cervical cancer in the South West of England. To compare this data set with a retrospective audit allowing assessment of the quality of care offered to patients.Design
Prospective collection of a defined dataset on paper forms which were put into a computerised database for analysis. Registrations validated against histopathology databases and hospital coding.Setting
All 13 hospitals in the South West of England which participated in the retrospective audit.Participants
One hundred and sixty‐five women with cervical cancer diagnosed in 1997.Main outcome measures
Distribution of cases by hospital and surgeon; workload of individual surgeons; adequacy and accuracy of FIGO staging; adequacy of histological information; and adequacy of surgery.Results
There is a trend to centralisation of cancer care and radical surgery in the region. Prospective collection of data has dramatically improved FIGO staging with 92% of all cases staged. For cases greater than Stage la, 98% were staged suggesting that a target of 100% staging is feasible. The histological dimensions of tumours were not measured in a high proportion of cases (20% of tumour diameters and 28% of tumour thicknesses). Apparent inadequacies in surgical management are explored. In 10/165 cases (6%) inappropriate conservative surgery may have been unavoidable, suggesting that a quality standard of 95% for appropriate radical surgical management of cervical cancer can be achieved. An anatomically complete removal of pelvic node‐bearing tissue, yielding greater than 10 nodes in more than 95% cases, should be achievable with each surgeon/pathologist achieving a mean of more than 20 nodes.Conclusion
Regional audit of cervical cancer management is feasible. It can be used to improve the quality of information on management and guide improved service provision.
Piperazine oestrone sulphate and interrupted norethisterone in postmenopausal women: effects on bone mass, lipoprotein metabolism, climacteric symptoms, and adverse effects
Authors: Alexandersen Peter , Byrjalsen Inger , Christiansen Claus 
Published: August 2005

Objective
To compare the effects of two doses of piperazine oestrone sulphate combined with interrupted norethisterone, with that of oestradiol continuously combined with norethisterone acetate, and with placebo, in postmenopausal women.Design
A prospective randomised trial.Participants
Two hundred postmenopausal women.Setting
Monocentre study with expertise in osteoporosis.Methods
The participants were randomly assigned to two years of treatment with alternating three‐day cycles of 1.5 mg of piperazine oestrone sulphate plus 0.7 mg of norethisterone (highEP), or alternating three‐day cycles of 0.75 mg of piperaine oestrone sulphate plus 0.35 mg of norethisterone (lowEP), or 2 mg of 17β‐oestradiol continuously combined with 1 mg of norethisterone acetate (E2+NETA), or placebo.Main outcome measures
Change in bone mineral density, lipoprotein metabolism, climacteric symptoms, and adverse effects.Results
One hundred and twenty‐one women completed the study. Spinal bone mineral density was increased about 9% over two years by E2+NETA, about 6% by highEP, 4% by lowEP, but remained unchanged in the placebo group. The same pattern was seen in the hip and forearm. All hormone regimens decreased markers of bone turnover and alleviated climacteric symptoms. Serum lipoproteins decreased by about 10% in all hormone groups.Conclusions
All hormone regimens studied prevented bone loss completely and lowered serum lipids.
Reactive thrombocytosis after caesarean section and vaginal delivery: implications for maternal thromboembolism and its prevention
Authors: Atalla Rami K. , Thompson John R. , Oppenheimer Christina A. , Bell Stephen C. , Taylor David J. 
Published: August 2005

ObjectiveTo assess the duration and severity of reactive thrombocytosis after caesarean section and vaginal delivery.DesignA prospective cohort study.SettingA large teaching hospital.MethodsWomen admitted for delivery at the Leicester Royal Infirmary were recruited into the study. The platelet count was measured before delivery and postnatally on days 3, 8, 12, 16, 20 and 24. Women who had antepartum haemorrhage, postpartum haemorrhage and those delivered by instrumental delivery were excluded from the study. Sixty‐five were recruited, and 45 completed the study, 20 of whom were delivered by a normal vaginal delivery and 25 by caesarean section. A random effects model was used to compare platelet counts within and between the two groups to assess the severity and the timing of reactive thrombocytosis.ResultsThere were no statistically significant differences in booking and pre‐delivery platelet counts between the two groups (mean values 248.4 × 109/L and 245 × 109/L in the normal vaginal group and 269.4 × 109/L and 251.6 × 109/L in the caesarean section group, respectively). Postnatally, a rise in the platelet count was noted in the normal vaginal delivery group, reaching statistically significant peak values, compared with booking and pre‐delivery at days 8 and 12 of the postnatal period (mean value 365.8 × 109/L;P< 0.001and 369.4 × 109/L;P< 0.001respectively). In the caesarean section group, the platelet count was raised to a statistically significant high value, compared with booking and pre‐delivery at day 8 of the postnatal period. The platelet count peaked at days 12 and 16 of the postnatal period (mean value 522.5 × 109/L;P< 0.0001and 526.5 × 109/L;P< 0.0001, respectively) and remained significantly higher than booking and predelivery values for 24 days after the caesarean section. There was a greater rise in the platelet count in the caesarean section group compared with the vaginal delivery group. The platelet counts in the caesarean section group were significantly higher than these in the normal vaginal delivery group from day 12 to day 24 of the postnatal period.ConclusionA significant rise in platelet count occurred eight to twelve days after normal vaginal delivery and caesarean section. The increase in platelet count continued to rise for 16 days after caesarean section, and it stayed significantly higher for more than 24 days after the delivery.
Fetal distress increases interleukin‐6 and interleukin‐8 and decreases tumour necrosis factor‐α cord blood levels in noninfected full‐term neonates
Authors: Jokic Mickael , Guillois Bernard , Cauquelin Brigitte , Giroux Jean Dominique , Bessis Jean Louis , Morello Rémy , Levy Gérard , Ballet Jean Jacques 
Published: August 2005

Objective
To assess the influence of fetal distress on interleukin‐1β, interleukin‐6, interleukin‐8 and on tumour necrosis factor‐α blood levels in noninfected full‐term neonates.Study design
In a multicentre prospective study, cord blood samples were obtained at time of delivery from 234 noninfected full‐term neonates for the purposes of measuring serum levels of interleukin‐1β, interleukin‐6, interleukin‐8 and tumour necrosis factor‐α using immunoassays. Women were classified into four groups according to the mode of delivery (vaginal delivery or caesarean section) and the presence or absence of fetal distress. The role of labour was also investigated.Results
No significant relationship was found between cytokine cord blood levels and the mode of delivery. Fetal distress was associated with an increase in interleukin‐6 (P= 0.01) and interleukin‐8 (P < 0.001) levels, and a decrease in tumour necrosis factor‐α (P < 0.001). Labour was also associated with a significant increase in interleukin‐6 and interleukin‐8 cord blood levels (P= 0.01 and P < 0.001, respectively).Conclusion
Fetal distress and labour were each associated with elevated interleukin‐6 and interleukin‐8 cord blood levels in noninfected full term neonates while only fetal distress was associated with decreased tumour necrosis factor‐α levels.
Organisation and cost‐effectiveness of antenatal haemoglobinopathy screening and follow up in a community‐based programme
Authors: Cronin Eugenia K. , Normand Charles , Henthorn Joan S. , Graham Vesna , Davies Sally C. 
Published: August 2005

Objective
To consider the organisation cost and effectiveness, of universal, community‐based antenatal screening for the haemoglobinopathies, and to estimate the cost‐effectiveness of programmes at different levels of prevalence and mix of haemoglobinopathy traits.Design
Retrospective review of laboratory and Sickle Cell and Thalassaemia Centre worksheets with costing of capital equipment, consumables, salaries and overheads, and estimation of costs in a range of circumstances.Setting
A haematology department, including a Sickle Cell and Thalassaemia Centre, providing antenatal and neonatal screening programmes in Inner London.Participants
Two thousand one hundred and one women booking at the antenatal clinic whose samples were referred for screening during 1994.Main outcome measures and Results
In addition to assessing the cost‐effectiveness of antenatal haemoglobinopathy screening in a number of settings, the following specific financial information was assembled for the service in Brent: 1. cost of identifying abnormal haemoglobin in mother (£209); 2. cost of identifying at‐risk fetus before confirmation by prenatal diagnosis (£2455); 3. cost of providing genetic information and counselling to mother with abnormal haemoglobin (£109); 4. programme savings from cases averted (£61,000).Conclusions
Antenatal screening with follow up counselling can be self‐financing at most prevalences of haemoglobinopathy traits, with greater savings where a high proportion of the traits are β thalas saemia. There is a net financial cost (£1350) only at prevalences below 2.5% of traits if these are mainly for sickle cell disease. Since there are other benefits is it likely that antenatal screening will be considered cost‐effective even at quite low levels of trait prevalence.
Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms
Authors: Chitrit Yvon , Caubel Patrick , Herrero Rafael , Schwinte Anne Lyse , Guillaumin Denis , Boulanger Marie‐Christine 
Published: August 2005

Objective
To investigate the effects of maternal dexamethasone administration on umbilical and fetal cerebral artery flow velocity waveforms.Design
Cross‐sectional study.Setting
Department of Obstetrics and Gynaecology, Robert Ballanger Hospital, Aulnay‐sous‐Bois, France.Sample
Twenty‐six pregnant women with singleton pregnancies considered at risk for preterm delivery. At baseline, all pregnancies had normal fetoplacental vascular resistance.Methods
These women were given weekly six intravenous doses of 4 mg of dexamethasone eight hours apart.Main outcome measures
Doppler studies were performed from both umbilical artery (UA) and fetal middle cerebral artery (MCA) before (day 0), during (day 2), immediately after (day 4) and shortly after (day 7) every steroid course.Results
No significant variation was noted in both umbilical artery pulsatility index (PI) and fetal heart rate through dexamethasone therapy. Compared with mean initial values, we found on day 4 a significant decrease in MCA PI of 0.28 (F = 7.17, P < 0.001) and a significant increase in UA:MCA PI ratio of 0.08 (F = 3.85, P= 0.013); in contrast no significant change was documented on days 2 and 7 in both MCA pulsatility index and UA:MCA PI ratio. After multiple regression analysis, only the decrease in fetal middle cerebral artery pulsatility index on day 4 remained significant (F=5.84, P= 0.001).Conclusions
The current study finds in healthy fetuses a transient, significant and unexplained decrease in fetal middle cerebral artery impedance on the fourth day following maternal dexamethasone administration. Further basic research and clinical studies including larger sample sizes or pregnancies with fetoplacental dysfunction are needed.
Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomised trial
Authors:   World Health Organisation Task Force on Post‐ovulatory Methods of Fertility Regulation Special Programme of Research, Development and Research Training, World Health Organisation, Geneva
Published: August 2005

Objectives
To compare the efficacy of two different regimens of mifepristone followed by misoprostol for medical abortion in women with menstrual delay of ≤ 35 days.Design
Double‐blind, randomised controlled trial.Setting
Seventeen centres internationally.Participants
We enrolled 1589 healthy pregnant women with menstrual delay of ≤ 35 days who were requesting nonsurgical abortion.Interventions
Within gestational age strata, we randomly assigned women to receive a single oral dose of mifepristone, either 200 mg or 600 mg, followed in 48 h by misoprostol 400 μg by mouth. We concealed the allocation assignments from investigators and participants and maintained double‐blinding throughout the study.Main outcome measures
Complete abortion was the principal outcome measure. We also compared rates of side effects such as abdominal pain.Results
The complete abortion rate with the lower dose of mifepristone was similar to that with the higher dose (89.3%vs 88.1%) The crude relative risk of failure to achieve complete abortion with the 200 mg dose compared with the 600 mg dose was 0.9 (95% CI 0.7 to 1.2). The likelihood of complete abortion was inversely related to gestational age, although this finding is exploratory in nature. Among failures the percentage of women with continuing pregnancies increased from 1.4% at menstrual delay of two weeks or less to 9.0% when the delay was 4–5 weeks. Low efficacy led to stopping enrolment at 29 to 35 days' menstrual delay. Stopping criteria were also met at completion of the study in the group with 22–28 days' menstrual delay. No significant differences emerged in the frequency of side effects between the two mifepristone groups.Conclusions
Both regimens had similar efficacy. Women with a menstrual delay of four to five weeks had twice the risk of failure to abort compared with those who received treatment within two weeks of the expected menses. The efficacy of the mifepristone‐prostaglandin regimen was not reduced by decreasing the dose of mifepristone from 600 mg to 200 mg. The regimens of 600 mg or 200 mg of mifepristone, followed by a single oral dose of misoprostol 400 μg 48 hours later, were not sufficiently efficient in inducing abortion when the menstrual delay was > 21 days.
A clinical review of borderline glandular cells on cervical cytology
Authors: Mohammed D. Kusnah A. , Lavie Ofer , Lopes Alberto de B. , Cross Paul , Monaghan John M. 
Published: August 2005

Objective
To review the diagnoses and diagnostic pathway of women presenting with borderline glandular cells on cervical cytology. To outline the basis of clinical approach of these women.Design
Retrospective review.Population
Forty‐three women referred to the hospital department over a 32‐month period.Methods
Review of the casenotes for the demographic data, previous cervical cytology and/or histology report, indication for the smear resulting in borderline glandular cells, colposcopic findings, diagnostic and/or treatment procedures, final diagnosis and current status.Results
The average age was 36.7 years. Twenty‐four women (56%) had clinically significant lesions: seven women (16%) presented with cancers, of which one was endometrial in origin, and 17 (40%) with intraepithelial neoplasia (CIN and cervical glandular intraepithelial neoplasia (CGIN)). Sixty‐seven percent of all clinically significant lesions were of squamous origin. Thirty‐seven had histological diagnosis, while six went on to cytological surveillance. Colposcopy was the most significant predictor for clinically significant lesions (P < 0.05). Punch biopsies and loop excisions were diagnostic when based on abnormal colposcopic findings. Brush cytology was appropriate follow up for asymptomatic, premenopausal women with no colposcopic abnormality. In addition, endometrial sampling was recommended in the peri‐ and postmenopausal women.Conclusion
Borderline glandular cells have a high incidence of clinically significant lesions. Immediate referral for colposcopy and assessment is strongly recommended in women with two borderline glandular smears to avoid delays in potential cancer diagnosis.
Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids
Authors: Ferrari Maria Maddalena , Berlanda Nicola , Mezzopane Raffaella , Ragusa Guglielmo , Cavallo Michela , Pardi Giorgio 
Published: August 2005

Objective
To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids.Design
A prospective randomised study.Setting
The San Paolo Hospital, Milan.Population
Sixty‐two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids.Methods
Randomisation between LAVH and TAH. Comparison of outcomes on the whole series, patients with uteri ≤ 500 g (Group 1) and patients with uteri > 500 g (Group 2).Main outcome measures
To establish operating time, blood loss, complications, febrile morbidity, analgesics administration and hospital stay for both treatment approaches.Results
Median uterine weight was 400 g in both LAVH and TAH group. Median operating time was longer for LAVH (135 min compared with 120 min for TAH; P= 0.001), but patients undergoing LAVH had less analgesics administration (23% compared with 77%, P < 0.001) and a shorter median hospital stay (3.8 compared with 5.8 days; P < 0.001). LAVH, when compared with TAH in the two weight subgroups, required a significantly longer operating time only in Group 2, significantly reduced analgesics administration only in Group 1, and significantly reduced hospital stay in both groups. Conversions of LAVH to laparotomy were significantly more frequent in Group 2 (3/11) than in Group 1 (0/20) (P= 0.04).Conclusions
Compared with TAH, LAVH has advantages in removing uteri weighing ≤ 500 g, with comparable operating time, less post‐operative pain and shorter recovery. Among uteri weighing > 500 g LAVH showed a shorter recovery, but longer operating time than TAH and a 27% rate of conversion to laparotomy.