bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum levels of macrophage colony‐stimulating factor after cesarean section, vaginal delivery, or laparotomy in normal pregnant women and gynecologic patients
Authors: Hayashi Masatoshi , Shibazaki Mitsuei , Sohma Ryoichi , Ohkura Takeyoshi , Inaba Noriyuki 
Published: June 2003

Background.  Macrophage colony‐stimulating factor (M‐CSF) is located in villous cells lining the vessels in the placenta in the third trimester and has been implicated in placental growth and development. Macrophage colony‐stimulating factor levels in peripheral blood increased significantly with progression of pregnancy in uncomplicated pregnancies. The serum levels of M‐CSF appear to be altered after laparotomy in normal pregnant women and nonpregnant gynecologic patients. Thus, the present study examined changes in serum levels of M‐CSF before and after laparotomy and compared these findings between the two groups. Macrophage colony‐stimulating factor levels before and after vaginal delivery were also examined.Methods.  Peripheral blood was collected before, 1 day, and 10 days after laparotomy or vaginal delivery from 38 subjects, of whom 14 were normal pregnant women who underwent cesarean section (group 1), 12 were gynecologic patients (group 2), and 12 were normal pregnant women who delivered vaginally (group 3). The M‐CSF level was determined by the sandwich ELISA method using three antibodies.Results.  In all groups, the serum levels of M‐CSF increased significantly 1 day after laparotomy or vaginal delivery, but then decreased significantly after 10 days. The net increase 1 day after laparotomy was significantly lower in group 1 than in group 2. Before and 1 day after laparotomy, the M‐CSF levels were significantly higher in group 1 than in group 2, but not 10 days after laparotomy. Changes in M‐CSF levels in group 3 were relatively similar to those in group 1.Conclusions.  Serum levels of M‐CSF were significantly higher in groups 1 and 3 than in group 2, before laparotomy or vaginal delivery. The M‐CSF level increased moderately 1 day after cesarean or vaginal delivery, and it increased remarkably after gynecologic laparotomy. The increases in M‐CSF levels postlaparotomy may occur via different mechanisms between groups 1 and 2. Placental removal and termination of pregnancy might contribute to the decrease in M‐CSF levels, leading to only a moderate increase in M‐CSF levels 1 day after laparotomy in group 1.
Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal–neonatal complications
Authors: Al‐Kadri Hanan , Sabr Yasser , Al‐Saif Saif , Abulaimoun Bdair , Ba’Aqeel Hassan , Saleh Ahmed 
Published: June 2003

Background.  To identify the risk factors for failed instrumental vaginal delivery, and to compare maternal and neonatal morbidity associated with failed individual and sequential instruments used.Design.  A retrospective case‐control study.Methods.  From January 1995 to June 2001, there were 39 508 live births at >37 weeks' gestation of which 2628 (6.7%) instrumental vaginal deliveries were performed, 1723 (4.4%) were vacuum extractions and 905 (2.3%) were forceps. A total of 155/2628 (5.9%) patients who had failed instrumental delivery were matched with 204 patients who had successful instrumental delivery. The patients were divided into five groups. Group I (n = 129) had failed vacuum extraction, group II (n = 13) failed forceps, group III (n = 13) failed both (i.e. failed attempt at both instruments sequentially), group IV (n = 138) had successful vacuum extraction and group V (n = 66) successful forceps.Results.  The failure rate for vacuum extractions 129/1723 (7.5%) was significantly higher than that for forceps 13/905 (1.4%) [odds ratio (OR) = 5.6, 95% CI 3–10.3]. There were no significant differences in all maternal complications (25.5% vs. 26.6%) between vacuum (groups I and IV) and forceps (groups II and V) assisted deliveries. There were more maternal complications in group III (46.2%) than in groups I (35.7%), II (23.1%) and V (27.3%) that did not reach statistical significance but were significantly higher than in group IV (15.9%, OR = 4.5, 95% CI 1.2–16.9). There was a significantly higher rate of all fetal complications in group III [11/13 (84.6%)] than in groups I [69/129 (53.5%)], II [7/13 (53.8%)], IV [35/138 (25.4%)] and V [22/66 (33.3%)] (OR = 4.8, 95% CI 0.9–19.9).Conclusions.  Applying the instrument at ≤0 fetal station, nulliparous women, history of previous cesarean section and fetal head other than occipitoanterior position were risk factors for failed instrumental delivery. Sequential use of instrumental delivery carries a significantly higher neonatal morbidity than when a single instrument is used.
Tension‐free vaginal tape and laparoscopic mesh colposuspension in the treatment of stress urinary incontinence: immediate outcome and complications − a randomized clinical trial
Authors: Valpas Antti , Kivelä Aarre , Penttinen Jorma , Kauko Minna , Kujansuu Erkki , Tomas Eija , Haarala Mervi , Meltomaa Seija , Nilsson Carl‐Kustav 
Published: June 2003

Background. The purpose of the study was to evaluate the immediate outcome and complications of the tension‐free vaginal tape (TVT) and laparoscopic mesh colposuspension (LC) procedures in the treatment of female stress urinary incontinence (SUI).Methods. One hundred and twenty‐eight patients suffering from urodynamically confirmed SUI were recruited to this multicenter, randomized clinical trial. After randomization there were seven drop‐outs – 121 patients were operated upon: 70 patients in the TVT group and 51 in the LC group. The patients were evaluated according to the study protocol before operation and 6 weeks after it. The independent sample t‐test and the Mann–Whitney U‐test were used to calculate statistical differences between the study groups.Results. Immediate cure rates, defined as negative stress test with 300 mL saline in the bladder, were similar (92.9% in the TVT group and 88.2% in the LC group; p = ns). Return to normal voiding was faster in the TVT group (9.2 h in the TVT group vs. 24.4 h in the LC group; p = 0.004). Fewer analgesics were used in the TVT group and hospital stay was shorter in this group. Complication rates associated with the procedures were similar and the number of complications was small.Conclusions. The immediate outcome of both procedures is the same. The rates of complications were similar. However, the TVT procedure seems to be less invasive and requires fever hospital resources than LC.
Serum nitric oxide metabolites and E‐selectin in preterm premature rupture of membranes
Authors: Loukovaara Mikko , Ylikorkala Olavi 
Published: June 2003

Background.  Diseases with low‐grade inflammation perturb endothelial function. We investigated whether preterm premature rupture of membranes (PPROM) is associated with endothelial dysfunction, as assessed by the levels of endothelium‐derived nitric oxide metabolites (NOx) and E‐selectin in maternal serum.Methods.  The concentrations of NOx and E‐selectin were measured in 32 pregnant women with PPROM and in 27 healthy gestational age‐matched control women. The grade of inflammation was estimated by measuring serum C‐reactive protein (CRP) and interleukin‐6 (IL‐6) concentrations.Results.  NOx and E‐selectin concentrations were not different in PPROM patients as compared to controls. In 17 patients with PPROM, CRP rose above 12 mg/L. In this group, IL‐6 concentration was significantly higher than among controls, but concentrations of NOx and E‐selectin remained unaltered. There was a negative correlation between the levels of NOx, CRP and IL‐6 and the interval from PPROM to delivery. The levels of NOx correlated positively with those of IL‐6.Conclusions.  PPROM, with or without CRP and IL‐6 surges, does not affect endothelial function markedly, as judged from the unaltered concentrations of NOx and E‐selectin in maternal serum.
Iron supplementation during pregnancy in Sweden: to what extent is the national recommendation followed?
Authors: Wulff Marianne , Ekström Eva‐Charlotte 
Published: June 2003

Background.  While there has been a worldwide trend to reduce the recommended amount of iron in prenatal supplements, this has still not been implemented in Sweden. It is likely that the current national recommendation of 100 mg of iron/day to all pregnant women provides a larger amount of iron than warranted and results in increased occurrence of side‐effects and reduced compliance. This may also reduce midwives' motivation to implement the recommendation. The aim of this study was to assess adherence to the current recommendation and to describe factors associated with prescription and use of iron supplements.Methods.  A questionnaire capturing determinants for and use of prenatal iron supplementation was distributed to newly delivered women and midwives in five regions of Sweden. In addition, an inquiry about implementation of the recommendation was sent to all senior obstetricians in charge of antenatal care.Results.  Most (79%) of the senior obstetricians indicated adherence to the national recommendation. A lower percentage of midwives (41%) and a further lower proportion of pregnant women (28%) did so. Despite limited compliance to the recommendation, the majority of pregnant women had used some type of iron‐containing supplement. Side‐effects of supplements, perceived need and advice from midwives influenced their use. Many midwives preferred and practiced a selective supplementation strategy.Conclusions.  The current recommendation is not practiced. Side‐effects and perceptions that the amount of iron is larger than necessary contribute to its limited use. A revision is needed to address the amount of iron required and strategies to ensure good adherence.
Expectant management of first‐trimester miscarriage in clinical practice
Authors: Blohm Febe , Fridén Barbro , Platz‐Christensen Jens‐Jörgen , Milsom Ian , Nielsen Sven 
Published: June 2003

Background.  The aim of this study was to evaluate treatment efficacy and patient compliance in women with an early miscarriage managed expectantly in routine clinical practice.Methods.  During 1995–98, 263 consecutive women who sought medical attention for an ongoing or incomplete miscarriage (gestational length <99 days), and who were circulatory stable and had a gestational residue measuring 15–50 mm (anterio–posterior, A–P diameter) on ultrasound examination were invited to participate in this study. Hemoglobin (Hb), C‐reactive protein (CRP), human chorionic gonadotrophin (hCG), progesterone and Rh‐factor were analyzed and a questionnaire regarding the pregnancy, duration of genital bleeding and number of days of absenteeism was completed on admission and after 1 and 4 weeks.Results.  Expectant management was considered to be complete (vaginal ultrasound, gestational residue <15 mm after 1 week) in 83%. The patients who were managed successfully by expectant management had a smaller gestational residue (p = 0.026) and a lower mean serum progesterone level (p = 0.025) on referral than in the group of women with failed expectant management. A gynecologic infection was diagnosed in seven cases (3%) and five of the infections were in the group of women who underwent dilatation and curettage. No patient required a blood transfusion. The mean number of days of absenteeism was 3.2 days. There were no differences in Hb levels before or after treatment, number of bleeding days or absenteeism between the groups.Conclusions.  Expectant management of clinically stable patients with symptoms of early miscarriage is safe, efficient and well tolerated.
Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low‐income countries: A cost‐benefit study in Mozambique
Authors: Kayihura Vicente , Osman Nafissa Bique , Bugalho Antonio , Bergström Staffan 
Published: June 2003

Background.  There is a need to assess the cost‐benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource‐scarce settings.Design.  Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis.Methods.  Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection.Main outcome measures.  Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used.Results.  Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one‐tenth of the cost of the standard postoperative scheme.Conclusion.  In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week‐long postoperative therap, but at approximately one‐tenth of the cost.
Clinical evaluation in treatment of oral lichen planus with topical fluocinolone acetonide: a 2‐year follow‐up
Authors: Thongprasom K. , Luengvisut P. , Wongwatanakij A. , Boonjatturus C. 
Published: June 2003

AbstractBackground:  Oral lichen planus (OLP) is a chronic inflammatory disease which is recalcitrant to medical treatment. The purpose of this study was to compare the effectiveness of various forms of the topical steroid fluocinolone acetonide applications in patients with OLP.Methods:  Data of OLP patients were collected retrospectively from the chart record and the 97 OLP patients were divided into three groups. The first group (n = 28) was treated with a 0.1% solution of fluocinolone acetonide (FAS), the second group (n = 22) with 0.1% fluocinolone acetonide in orabase (FAO), and the third group (n = 47) with both FAS and FAO (FAS/FAO) throughout the study. Each group was clinically evaluated as complete remission (CR), partial remission (PR), or no response (NR), following the treatment. Also, the side‐effect of oral candidiasis was recorded in each group.Results:  Two years of treatment resulted in complete remission of 77.3, 21.4, and 17.0% of patients in the FAO, FAS, and FAS/FAO groups, respectively. There was a statistically significant difference in disease remission (P < 0.05), but not in oral candidiasis appearance (P > 0.05) among various forms of topical steroid application.Conclusion:  The study concluded that FAO or FAS can produce improved results in the management of OLP by long‐term follow‐up.
Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?
Authors: Mc Loughlin R. M. , Sebastian S. S. , O'Connor H. J. , Buckley M. , O'Morain C. A. 
Published: June 2003

SummaryA ‘test and treat’ strategy is advocated for patients with dyspepsia under the age of 45 years, with endoscopy reserved for those with alarm symptoms or aged over 45 years. One of the consequences of this strategy will be a reduction in population infection rates of Helicobacter pylori. It is now clear that H. pylori is one of the prime initiators of gastric cancer with up to 70% of gastric cancers attributable to H. pylori. What remains unclear is if H. pylori reduction will lead to a reduction in gastric cancer.
Hepatocellular carcinoma: indications for liver transplantation
Authors: Mela M. , Mancuso A. , Burroughs A. K. 
Published: June 2003

SummaryThe role of liver transplantation for hepatocellular carcinoma has evolved over the years and currently is one of the curative therapies for small tumours. The survival rates are similar with those for nonmalignant liver disease after transplantation. The treatment of small tumours eligible for both resection and transplantation depends on the experience of the transplant centre and the waiting time for a liver graft. With waiting times for liver transplant becoming gradually longer, prioritization of the tumour patients has been suggested. Adjuvant therapies may delay the tumour progression while patients wait for a transplant. The living donor and the domino liver transplantation are useful alternatives given the shortage of organs but the experience is still limited in the Western world and the selection for the domino livers is fairly restricted.
Crohn's disease: monitoring disease activity
Authors: Sostegni R. , Daperno M. , Scaglione N. , Lavagna A. , Rocca R. , Pera A. 
Published: June 2003

SummaryA global measurement of Crohn's disease activity, comprising clinical, endoscopic, biochemical and pathological features is not available yet and perhaps is unobtainable. In this review we analyse the most used and validated clinical indices (Crohn's Disease Activity Index [CDAI], Perianal Disease Activity Index [PDAI], fistula drainage assessment), quality of life scores (Inflammatory Bowel Disease Questionnaire [IBDQ]), sub‐clinical markers (C‐reactive protein, faecal calprotectin, intestinal permeability) and endoscopic indices (Crohn's Disease Endoscopic Index of Severity [CDEIS]/Simple Endoscopic Score for Crohn's Disease [SES‐CD], Rutgeeerts' score for postsurgical recurrence). We also review the main advantages and disadvantages of each of these scoring systems. All these indices are rather complex and time‐consuming, therefore their use is limited to clinical trials. In everyday clinical practice most gastroenterologists rely on their global clinical judgement, which is less reproducible, but simpler for decision‐making.
Medical treatment of severe ulcerative colitis
Authors: Rizzello F. , Gionchetti P. , Venturi A. , Campieri M. 
Published: June 2003

SummarySevere colitis is a life‐threatening complication of ulcerative colitis. Early recognition of the severity of the colitis and intensive treatment and monitoring have all contributed to improved outcome. Since their introduction in 1950s, corticosteroids are the first line therapy for severe active ulcerative colitis (UC). Several prognostic parameters (such as stools movement per day, C‐reactive protein, increased amount of intestinal gas or small bowel dilation, hypoalbuminemia, fever etc) help the physician to quickly introduce cyclosporin or to refer the patient to the surgeon. This decision requires a careful evaluation of the patient and a medical /surgical team. Infliximab seems to be a promising drug but more controlled trial are needed.
Medical treatment of mild to moderately active Crohn's disease
Authors: Löfberg R. 
Published: June 2003

SummaryCrohn's disease is a chronic, debilitating subset of inflammatory bowel diseases, which may affect any part of the gastrointestinal tract. The most common sites of inflammation are the terminal ileum and/or the colon. Fistulous disease is present in up to 20% of patients, particularly in those having rectal involvement.The aetiology of Crohn's disease still remains obscure, therefore medical therapy is directed towards symptomatic relief in active disease and relapse prevention in the long‐term setting. Contemporary Crohn's disease management comprises individual treatment depending mainly on Crohn's disease localization in the gastrointestinal tract and the disease severity.The mainstay of current medical treatment for mild to moderately active stages of Crohn's disease includes aminosalicylates, antibiotics, glucococorticosteroids and immunomodulators. Biologics such as anti TNF‐compounds and anti‐integrins are being introduced.
Medical treatment of moderate to severe Crohn's disease
Authors: Scribano M. , Prantera C. 
Published: June 2003

SummaryThe treatment for patients with Crohn's disease of moderate to severe activity includes traditional drugs, such as corticosteroids, the primary therapy for these forms of disease, able to induce the remission of symptoms in a high percentage of patients. Because of the side‐effects produced by systemic steroids, a new glucocorticoid derivative, budesonide, which acts locally in the mucosa, has recently been introduced with positive results. On the assumption that intestinal bacteria play a role in the causing Crohn's disease symptoms, antibiotics are often used in the treatment of active phases, as an alternative to or in association with steroids. The most widely employed antibiotics are metronidazole and ciprofloxacin. Immunosuppressors, such as azathioprine and 6‐mercaptopurine, are useful for the treatment of chronic active disease and for maintaining remission, but they have only a marginal role in the therapy of an acute flare‐up of Crohn's disease. Methotrexate acts more rapidly and its use in patients with active disease resistant to standard therapy is of interest. The discovery of biological agents represents a new era in the management of patients. To date, infliximab is the more extensively studied biological therapy in the treatment of Crohn's disease and clinical studies have demonstrated its efficacy in inducing remission of refractory disease.
Diagnosis and treatment of Helicobacter: a 2002 updated review
Authors: Basset C. , Holton J. , Ricci C. , Gatta L. , Tampieri A. , Perna F. , Miglioli M. , Vaira D. 
Published: June 2003

SummaryThe year 2002 saw advances on many fronts in the study of Helicobacter and gastroduodenal disease. Several studies have confirmed endoscopy as a valuable management procedure with confirmation of the diagnostic utility of the rapid urease test and the description of a new formulation of the test, which is more rapid in giving a result. Serology has been re‐confirmed as a useful investigation in selected populations. Some commercial kits for near patient testing have also been assessed and although generally regarded as less accurate than laboratory based tests some have shown acceptable accuracy. The recent exciting development in diagnostic serology is the availability of the faecal antigen test; further studies have confirmed its usefulness as recommended screening tests.There have been several studies demonstrating that a test and treat policy has a significant patient benefit, both economic and medical, although there is some doubt if eradication of Helicobacter leads to regression of atrophy and metaplasia. However, in low Helicobacter‐prevalence areas the test and treat policy is being challenged as an effective management strategy. Further studies have shown that compliance with treatment regimens is an important determinant of successful eradication. Finally several new eradication regimens have been reported particularly for use in patients who have had previous unsuccessful eradication attempts.
Startin's pneumatic inhaler
Authors: Walmsley D. A. , Zuck D. 
Published: June 2003

SummaryThis apparatus was seen by one of us (DAW) in a private collection. Although it was one of the first ether inhalers to be manufactured commercially, and was described in the medical literature of the time, it is not mentioned in any of the histories of anaesthesia. Its genesis was unusual, and it presents a number of interesting features, not least being the purpose for which it was originally designed.