bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcervical resection of the endometrium: a review of 400 consecutive patients
Authors: RANKIN L. , STEINBERG L. H. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of transcervical resection of the endometrium (TCRE) in women presenting with menstrual disorders.Design
A retrospective audit of 400 patients.Setting
The Department of Gynaecology, St John's Hospital, Chelmsford, Essex.Subjects
400 consecutive referrals with various bleeding disorders which were suitable for treatment with TCRE.Interventions
TCRE, either partially or completely.Main outcome measures
Patient satisfaction with procedure at 4 months. The procedure was initially recorded as a failure if any further therapy was required but satisfaction after a second procedure was assessed.Results
432 procedures were performed in 400 women. Major operative complications were rare with two (0.46%) uterine perforations, four (0.93%) primary haemorrhages requiring Tamponade to control bleeding and one (0.23%) secondary haemorrhage requiring hysterectomy to control it. Glycine toxicity was not clinically apparent. 85% were satisfied after the initial TCRE and 92% were satisfied if the procedure was repeated.Conclusion
TCRE is an advance in the management of menstrual disorders. Extensive training is required to minimise complications. The lack of long term follow‐up is its major deficiency but this will be rectified in the future.
Serum and intracellular magnesium during normal pregnancy and in patients with pre‐eclampsia
Authors: SEYDOUX JACQUES , GIRARDIN ERIC , PAUNIER LUC , BÉGUIN FRANÇOIS 
Published: August 2005

ABSTRACTObjective
To determine the serum and lymphocyte magnesium concentrations during normal pregnancy and to compare the magnesium status in the third trimester of pregnancy between women with normal pregnancy and those with gestational hypertension (GH) or pre‐eclampsia (PE).Design
A prospective cross‐sectional study followed by a prospective comparative study.Setting
Department of Obstetrics and Gynecology, Department of Pediatrics and Genetics, Hôpital Cantonal Universitaire Genève, Switzerland.Subjects
Seventy‐one healthy pregnant women, with normal pregnancies between 6 and 38 weeks gestation. The second part included 43 women in the third trimester of pregnancy, 11 had GH, 11 had PE and 21 formed the comparison group of healthy normotensive women.Main outcome measures
Total serum and intralymphocytic Mg concentrations and urinary Mg excretion.Results
There was a progressive reduction in total serum magnesium concentrations during normal pregnancy, thought to be partly due to haemodilution, because the decline in concentration of serum proteins paralleled that of Mg (P<0.001), In the three groups studied in the third trimester the serum Mg concentration was very similar in the GH and the comparison groups, but it was significantly higher in the PE group (P<0.01). The intralymphocytic Mg concentrations and the urinary Mg excretion were similar in all three groups. In five patients treated with MgSO4 there was a large increase in the serum Mg concentration and in the urinary Mg excretion. The intralyphocytic Mg concentration remained remarkably stable.Conclusions
Our data does not support the conclusion that Mg deficiency is the primary cause of pre‐eclampsia.
A tale of two prior probabilities—avoiding the false positive antenatal diagnosis of autosomal recessive polycystic kidney disease
Authors: LILFORD R. J. , IRVING H. C. , ALLIBONE E. B. 
Published: August 2005

ABSTRACTWe describe a case in which the typical ultrasound diagnosis of infantile polycystic kidney in a woman with no family history of renal disease was not confirmed by histology following termination of the pregnancy. This is contrasted with the situation in another couple who were known carriers of autosomal recessive polycystic kidney disease and where the prenatal ultrasound diagnosis was confirmed histologically. When prior genetic risk is low, the possibility of a normal or less severe outcome must be discussed with parents when fetal ultrasound shows large, echogenic kidneys but normal amniotic fluid volume.
The role of trophoblast dysfunction in the aetiology of miscarriage
Authors: Johnson M. R. , Riddle A. F. , Grudzinskas J. G. , Sharma V. , Collins W. P. , Nicolaides K. H. 
Published: August 2005

ABSTRACTObjective
To investigate the endocrine changes associated with spontaneous miscarriage after fetal heart activity has been demonstrated.Design
Prospective study during the first trimester of pregnancy comparing the circulating levels of human chorionic gonadotrophin (hCG), Schwangerschaft protein 1 (SP‐1), pregnancy‐associated plasma protein A (PAPP‐A), oestradiol (E2), and progesterone (P), and fetal growth (crown‐rump length [CRL] and gestational sac volume [GSV]) in women who miscarried after the identification of fetal heart activity with those of normal singleton and twin pregnancies achieved following in vitro fertilisation (IVF) and embryo transfer (ET).Setting
The Assisted Conception Unit of King's College Hospital, London.Subjects
Nine women who miscarried after demonstration of fetal heart activity, 52 normal singleton and 22 normal twin pregnancies.Interventions
Weekly blood tests and ultrasound assessments of CRL and GSV.Results
Four fetuses (all singleton) died between 9 and 12 weeks gestation (Group 1), and seven (three singleton and two twin) died between 16 and 20 weeks gestation (Group 2). In Group 1, both fetal growth and placental function, as assessed by serial measurements of CRL and GSV, and of serum levels of PAPP‐A, SP‐1 and hCG respectively, were reduced before fetal death. In Group 2, while fetal growth was maintained in all but one case, placental function was reduced in 4 of 5 women.Conclusion
These findings suggest that there may be a relationship between trophoblast dysfunction and some forms of miscarriage. Furthermore, the pattern of the reduction in the circulating levels of the placental proteins in later miscarriages suggests that the function of specific cell types may be impaired.
Alphafetoprotein levels in amniotic fluid from 8 to 18 weeks of pregnancy
Authors: Wathen N. C. , Campbell D. J. , Kitau M. J. , Chard T. 
Published: August 2005

ABSTRACTOabjective
The aim of this study was to ascertain the normal range of amniotic fluid alphafetoprotein (AFP) levels from 8 to 18 weeks of pregnancy.Design
Amniotic fluid samples obtained by amniocentesis were analysed by radioimmunoassay for AFP. From 8 to 12 weeks, fluid was obtained by transvaginal amniocentesis prior to termination of pregnancy. Samples from 13 to 18 weeks were obtained from amniotic fluid specimens submitted for cytogenetic analysis.Setting
A tertiary referral prenatal diagnostic service.Subjects
Two hundred thirty‐seven women between 8 and 18 weeks gestation.Results
High levels of AFP were present in amniotic fluid at 8 weeks (median 83.0 kU/ml), falling rapidly to 11 weeks (median 19.9 kU/ml) (P<0.01). Levels then rose to a peak at 13 weeks (median 30.7 kU/ml), thereafter falling to 18 weeks.Conclusions
A single coherent view of the levels of AFP from 8 to 18 weeks of pregnancy is presented for the first time. The rapid changes and complex pattern of AFP levels in early pregnancy suggest that interpretation of amniotic fluid AFP levels in the diagnosis of neural tube defects may be more difficult between 8 and 13 weeks of pregnancy than in the second trimester.
Phenytoin prophylaxis in severe pre‐eclampsia and eclampsia
Authors: Robson S. C. , Redfern N. , Seviour J. , Campbell M. , Walkinshaw S. , Rodeck C. , de Swiet M. 
Published: August 2005

ABSTRACTObjective
To determine plasma phenytoin levels and seizure outcome in women given phenytoin for seizure prophylaxis in severe pre‐eclampsia and eclampsia.Design
Prospective observational study comparing two phenytoin loading regimens.Setting
Two UK teaching hospitals.Subjects
Sixty‐seven consecutive women with severe pre‐eclampsia and five with eclampsia.Interventions
The first 29 women were given a 15 mg/kg intravenous loading dose of phenytoin. The next 43 received 17.5 mg/kg. All were given 500 mg phenytoin 12 h after completion of the loading dose and then 250 mg every 12 h for four doses.Main outcome measures
Total plasma phenytoin levels at 30 min, 6 h and 12 h after loading dose, 6 h after first maintenance dose and on days 2 and 3 of maintenance therapy; eclamptic seizures after starting phenytoin.Results
Mean plasma phenytoin levels were higher at 30 min and 6 h after the 17.5 mg/kg loading dose. Nine of 29 (31%) phenytoin levels 30 min after the loading dose were above the therapeutic range in the 15 mg/kg group compared with 26/38 (68%) in the 17.5 mg/kg group (P<0.01). Six of 27 (22%) phenytoin levels 12 h after the loading dose were subtherapeutic in the 15 mg/kg group compared with 2/38 (5%) in the 17.5 mg/kg group (P<0.05). Three women, two in the 17.5 mg/kg group, developed seizures after starting phenytoin. All three had plasma levels within the therapeutic range.Conclusions
Compared with a loading dose of 17.5 mg/kg, loading with 15 mg/kg phenytoin was associated with a lower incidence of high plasma levels at 30 min but a higher incidence of subtherapeutic levels at 12 h. Seizures occur in 2 to 3% of pre‐eclamptics despite apparently therapeutic phenytoin levels.
The coelomic cavity: an important site of materno‐fetal nutrient exchange in the first trimester of pregnancy
Authors: Campbell James , Wathen Neville , Perry Gillian , Soneji Suryakant , Sourial Nefertiti , Chard Tim 
Published: August 2005

ABSTRACTObjective
To measure levels of folate and vitamin B12 in matched samples of amniotic fluid and extraembryonic coelomic fluid from 9 to 12 weeks' gestation.Design
Prospective observational study.Setting
Homerton Hospital, London.Subjects
Twenty‐two women with ultrasonographically normal pregnancies before surgical termination.Methods
Transvaginal ultrasound‐guided needle aspiration of amniotic fluid and extra‐embryonic coelomic fluid was performed. Pure samples of amniotic fluid and extra‐embyronic coelomic fluid were obtained from each pregnancy, and folate and vitamin B12 were measured using microbiological assays.Results
Levels of folate and vitamin B12 were higher in extra‐embyronic coelomic fluid than in amniotic fluid and maternal serum. Amniotic fluid folate levels were lower than in maternal serum whereas vitamin B12 levels in amniotic fluid were higher than in maternal serum. All differences in concentration were significant (P<0.0005; paired t‐Test). Positive correlations were found between the concentrations of folate and vitamin B12 in each fluid. There was a linear correlation between gestational age and amniotic fluid folate levels (r= 0.648; P= 0.001).Conclusions
High concentrations of folate and vitamin B12 in coelomic fluid suggest that the coelomic cavity plays an important role in the materno‐fetal exchange of these nutrients.
Infertility treatment: from cookery to science. The epidemiology of randomised controlled trials
Authors: Vandekerckhove P. , O'Donovan P. A. , Lilford R. J. , Harada T. W. 
Published: August 2005

ABSTRACTObjectives
To review the epidemiology of published randomised controlled trials in infertility treatment over the last 25 years, with special emphasis on the number and quality of trials.Design
Computer literature review by MEDLINE backed up by a manual search of 41 journals. Each trial was classified according to the methodology described and quality criteria. The results were recorded in a computer database. Odds ratios (OR) and confidence intervals (CI) were calculated where the data were sufficient.Subjects
Couples suffering from primary or secondary infertility. The trials studied 33 761 patients overall.Setting
Institute of Epidemiology and Health Services Research, Leeds.Results
Five hundred and one randomised trials in male and female infertility treatment were identified between 1966 and 1990. Pregnancy was an outcome in 291 (58%) and these were the subject of detailed analysis. Two hundred and twenty‐four (77%) and 67 (23%) ‘pregnancy trials’ were concerned, respectively, with female and male infertility. Four per cent of the trials were preceded by a sample size calculation, and the average sample size was 96 patients (range 5–933); 700 patients per group would be required to demonstrate plausible success rates for most treatments. The method of randomisation was unstated or pseudo‐randomised in 206 (71%) of trials where pregnancy was an outcome. Only 29 (5.8%) of studies were multicentre. The method of confirmation of pregnancy was omitted for 70% of papers. Cross‐over design was used in 103 (21%) of cases. Meta‐analysis is possible for selected topics such as the use of anti‐oestrogens in idiopathic oligospermia and unexplained female infertility. Eight cases of double reporting were identified.Conclusions
Trials using randomised methodology were relatively few in comparison with other branches of medicine, although their use is important in the evaluation of treatment for infertility as treatment‐independent pregnancy is common. It was encouraging to note that an exponential increase in the use of this methodology occurred during the last three years, especially in association with assisted conception techniques, and meta‐analysis has become possible for selected topics. However, many trials suffer from an unrealistically small sample size, inappropriate use of cross‐over design or pseudo‐randomisation. The trend towards properly controlled studies should be encouraged but these studies should be of improved quality and organised on a multicentre or even international basis.
Distribution of mast cells and the effect of their mediators on contractility in human myometrium
Authors: Rudolph M. Isolde , Reinicke Karin , Cruz M. Antonieta , Gallardo Victoria , Gonzalez Clemente , Bardisa Luis 
Published: August 2005

ABSTRACTObjective
To examine the distribution of mast cells in human uterine tissue and to study the interactions between mast cell mediators (histamine and serotonin) and PGF2α in human myometrium contractile activity.Design
Distribution of mast cells were analysed in cryostat sections of myometrium samples stained with Toluidine blue. Contractile activity was evaluated in an isolated organ bath preparation on myometrial strips obtained from women whose pregnancies ended in elective caesarean section.Setting
Biological Science Laboratories at the University of Concepción.Subjects
Twenty women undergoing elective caesarean and 10 women undergoing hysterectomy at the G. Grant Hospital.Main outcome measurements
Cumulative concentration‐response curves for histamine and serotonin before and after the addition of subumbral concentrations of the PGF2α or serotonin were performed.Results
Serotonin was more active than histamine to evoke contractions (EC50:0.20 (SE 0.02) μmol/l vs 1.5 (SE 0.2) μmol/l, respectively). Furthermore, threshold concentrations of serotonin (0.05 μmol/l) potentiated the contractile effect of histamine (EC50:0.3 (SE 0.06) μmol/l and 50% increase in Emax). PGF2α had a poor contractile effect, but threshold concentrations (0.05 and 0.10 μmol/l) enhanced the contractile effect of both serotonin and histamine. A population of mast cells was found in close apposition to smooth muscle fibres.Conclusions
It is postulated that the simultaneous release of mast cell mediators (histamine and serotonin) in myometrium could be an important stimulus for evoking strong contractions in the human uterus. PGF2α may have indirect effects in myometrium by amplifying the effects of histamine and serotonin.
Intra‐observer and inter‐observer reliability of the pulsatility index calculated from pulsed Doppler flow velocity waveforms in three fetal vessels
Authors: Scherjon Sicco A. , Kok Joke H. , Oosting Hans , Zondervan Hans A. 
Published: August 2005

ABSTRACTObjective
Study of the intra observer and inter observer reliability of the pulsatility index, calculated from pulsed Doppler recordings of three fetal vessels.Design
Flow velocity waveforms (FVW) were recorded from the umbilical artery, the fetal descending aorta and the fetal internal carotid artery. Intra‐observer reliability was assessed in six fetuses; ten repeated measurements were performed by one observer. Inter‐observer reliability was studied in 14 fetuses; two observers performed two repeated measurements in each fetus.Setting
A tertiary referral hospital.Subjects
High risk pregnancies with a gestational age ranging from 29 to 42 weeks.Main outcome measures
Analysis of variance with repeated measurements and a graphical method were used for data analysis. Intra‐observer repeatability was expressed as Intraclass Correlation Coefficient (IntraCC). Inter‐observer agreement was expressed as Interclass Correlation Coefficient (InterCC).Results
IntraCC for umbilical artery, descending aorta and internal carotid artery were 0.91, 0.78, and 0.54, respectively. InterCC values for these vessels were 0.39, 0.45 and 0.34, respectively. No systematic differences between the two observers except for the fetal descending aorta, were apparent. IntraCC decreased remarkable when fetuses with absent end diastolic velocities were excluded from the analysis.Conclusion
The pulsatility index (PI) used for fetal measurements has a poor reliability. This is of serious concern when clinical use of FVW measurements is considered as a diagnostic tool.
Type III collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants
Authors: Savvas M. , Bishop J. , Laurent G. , Watson N. , Studd J. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of subcutaneous oestradiol and testosterone on the proportion of type III collagen in the skin of postmenopausal women.Design
A cross sectional comparison.Setting
Dulwich Hospital menopause clinic.Subjects
Fourteen untreated women and 11 women who had received subcutaneous oestradiol and testosterone for a median 8.0 years (range 3–14). Ten of the untreated women received subcutaneous hormone implants and the effect on skin collagen was studied prospectively.Measurements
The proportion of type III collagen in skin biopsies taken from the lateral aspect of the thigh.Results
The median type III collagen content in the skin of the women who had received hormone replacement therapy (25.4%, range 21.4–30.2) was significantly higher (P<0.01) than in the untreated women (19.6%, range 18.2–28.8). The proportion of type III collagen in the skin of 10 untreated women increased significantly (P<0.01) from a median of 19.9% (range 18.2–23.9) to 22.4% (range 20.5–31.5) following 6 months of treatment with hormone implants.Conclusion
This study indicates an increase in the proportion of type III collagen in women receiving hormone replacement therapy.
Laparoscopic ovarian diathermy: an effective treatment for anti‐oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome
Authors: Armar N. A. , Lachelin Gillian C. L. 
Published: August 2005

ABSTRACTObjective
To determine the long term efficacy of laparoscopic ovarian diathermy in the management of refractory anovulatory infertility in women with the polycystic ovary syndrome.Design
Open study of 50 women treated over a period of 3 years and 3 months, with follow up until 18 months after the last woman was treated.Setting
Teaching Hospital.Subjects
Fifty consecutive women with refractory anovulatory infertility (mean duration 5.3 (SD 3.5) years). All had been treated unsuccessfully with anti‐oestrogens and more than half with gonadotrophins.Interventions
Laparoscopic ovarian diathermy.Main outcome measures
Ovulatory cycles and pregnancies.Results
Forty‐three women (86%) ovulated following ovarian diathermy; the mean time to ovulation was 23 (SD 6.2) days. Three nonresponders ovulated following anti‐oestrogen treatment to which they were previously resistant. Thirty‐three women have conceived 58 pregnancies; 22 had no treatment other than ovarian diathermy prior to their first post‐operative conception; in seven an anti‐oestrogen was given because of lengthening cycles; two were treated elsewhere with gonadotrophins without prior postdiathermy anti‐oestrogen therapy and conceived; four had the operation repeated and two of these conceived. Twenty‐six women conceived within the first 8 post‐operative months. Forty‐two pregnancies ended in the birth of normal live healthy babies, eight are ongoing and eight miscarried. Of the 22 women who had no pelvic abnormality other than polycystic ovaries, 19 (86%) have had one or more successful pregnancies.Conclusion
Laparoscopic ovarian diathermy is a very effective treatment for anti‐oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome and should be considered as the next step in those who fail to respond to anti‐oestrogen treatment.
Prediction of fetal acidaemia in pregnancies complicated by maternal diabetes mellitus by biophysical profile scoring and fetal heart rate monitoring
Authors: Salvesen Douglas R. , Freeman Jill , Brudenell J. Michael , Nicolaides Kypros H. 
Published: August 2005

ABSTRACTObjective
To determine whether computer assisted fetal heart rate analysis or the biophysical profile score can provide noninvasive prediction of fetal acidaemia.Design
Cross sectional study.Setting
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital School of Medicine, London.Subjects
Forty‐one women with pregnancies complicated by diabetes mellitus.Interventions
Fetal heart rate (FHR) monitoring with computer assisted analysis, biophysical profile score (BPS) and cordocentesis for measurement of umbilical venous blood glucose concentration and blood gases, up to 24 h before delivery at 27 to 39 weeks gestation.Results
The mean umbilical venous blood pH was significantly lower than the normal mean for gestation, and was below the 5th centile in 18 pregnancies, including all six cases where the mother had nephropathy and hypertension. The mean pO2 was not significantly different from the normal mean for gestation. There were significant associations between fetal acidaemia and both the BPS (r= 0.46, P<0.01) and FHR variation (r= 0.42, P<0.01). However, of the 12 acidaemic fetuses of non‐nephropathic mothers, nine had normal BPS and six had normal FHR variation.Conclusions
In pregnancies complicated by maternal diabetes mellitus, BPS and FHR variation are of limited value in the prediction of fetal blood pH.