bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sulforaphane inhibits growth of a colon cancer cell line
Authors: Frydoonfar H. R. , McGrath D. R. , Spigelman A. D. 
Published: December 2003

AbstractObjective  The consumption of cruciferous vegetables has a protective effect on the development of colorectal cancer. The phytochemical Sulforaphane is an isothiocyanate found almost exclusively in cruciferous vegetables. We have studied the effect of Sulforaphane on cell proliferation of an HT‐29 colon cancer cell line.Materials and methods  HT‐29 colon cancer cells were cultured in 96‐well microtitre plates. Sulforaphane (in concentrations ranging from 0.01 to 0.1 mmol) were added to the wells. Cell proliferation was measured using the colourimetric assay technique.Results  The proliferation of colon cancer cells was significantly reduced by Sulforaphane at concentrations of ≥0.02 mmol.Conclusion  These findings may help explain the epidemiologically proven protective effect of vegetables against colon cancer.
Colo‐rectal anastomotic leakage often masquerades as a cardiac complication
Authors: Sutton C. D. , Marshall L. J. , Williams N. , Berry D. P. , Thomas W. M. , Kelly M. J. 
Published: December 2003

AbstractObjective  The aim of this study was to identify the mode of presentation of patients with clinical anastomotic leaks following restorative colorectal resection for carcinoma.Patients and methods  Prospective information was collected on all patients having restorative resection of colorectal cancer. These data were reviewed for a five‐year period (1994–1998) to identify all patients who had suffered a clinical anastomotic leak and their notes were retrieved and reviewed.Results  Three hundred and seventy‐nine patients underwent restorative resection for colorectal cancer during the study period (178 female, 201 male), mean age 70 years (range 36–94). There were 22 (6%) clinical anastomotic leaks. Seven (32%) patients presented with obvious abdominal peritonitis. The remaining 15 (68%) were initially misdiagnosed. Thirteen (59%) patients were treated for cardiac symptoms, 1 (5%) patient for obstruction and 1 (5%) for ascites. The delay in diagnosis ranged from 0 to 11 days (mean 4 days). For the whole series of 379 there were 30 patients who suffered cardiac symptoms (8%) 13(43%) of whom had an anastomotic leak.Conclusion  Patients who develop cardiac symptoms following restorative colorectal resection for carcinoma should have a water soluble enema as there is a 40% chance that they will have an anastomotic leak.
Open‐magnet MR defaecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception
Authors: Dvorkin L. S. , Hetzer F. , Scott S M. , Williams N. S. , Gedroyc W. , Lunniss P. J. 
Published: December 2003

AbstractObjective  The aim of this study was to determine whether open‐magnet magnetic resonance (MR) defaecography could provide more useful clinical information than evacuation proctography (EP) alone in the evaluation of a cohort of patients with full‐thickness rectal intussusception and could assist in decisions concerning management.Methods  Ten patients (4 male; median age 43, range 30–65) with symptomatic circumferential rectal intussusception diagnosed on EP, underwent open‐magnet MR defaecography. Pathologies visible with each technique were recorded and 12 parameters of anorectal configuration and morphology measured and compared.Results  There was discordance in the diagnosis of rectal intussusception in three cases. In another two patients, MR defaecography demonstrated mucosal descent only. Measurements of anorectal configuration and morphology were similar between techniques; only rectal size and lateral dimensions of the rectocoele were significantly different, being smaller on MR defaecography than EP. Two patients were shown on MR defaecography to have significant bladder descent and two female patients had significant vaginal descent.Conclusion  EP remains the first line investigation for the diagnosis of rectal intussusception, but may not distinguish mucosal from full‐thickness descent. MR defaecography further complements EP by giving information on movements of the whole pelvic floor, 30% of the patients studied having associated abnormal anterior and/or middle pelvic organ descent. If surgery is planned for patients with rectal intussusception, MR defaecography provides useful information regarding the presence and degree of anterior pelvic compartment descent that may need to be addressed if a good functional outcome is to be achieved.
Defining the Divine
Authors: Richardson Carol M. 
Published: December 2003

Books reviewed in this article:Rona Goffen, Renaissance Rivals: Michelangelo, Leonardo, Raphael, TitianFrancis Ames‐Lewis and Paul Joannides (eds), Reactions to the Master: Michelangelo's Effect on Art and Artists in the Sixteenth CenturyCristina Acidini et al. The Medici, Michelangelo, and the Art of Late Renaissance FlorenceJack Wasserman, Michelangelo's Florence Pietà
The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double‐blind, placebo‐controlled trial
Authors: Kozman Ezzat , Collins Peter , Howard Ann , Akanmu Tolu , Gibbs Alan , Frazer Malcolm 
Published: December 2003

Objective To determine whether two percent lignocaine gel can reduce the perception of pain during Vabra endometrial aspiration.Design Randomised, double‐blind placebo‐controlled trial.Setting Women's Health Directorate, Warrington Hospital NHS Trust.Population Women were referred to the endometrial sampling clinic for the investigation of pre and postmenopausal vaginal bleeding.Methods Randomisation to either pre‐sampling intrauterine two percent lignocaine gel or an inert gel. Patients, recruiters and assessors were blinded to the gel used.Main outcome measures The difference between the study groups in the proportion of women who, after Vabra sampling, recorded a pain score of ≥6 out of 10 on a visual analogue scale.Results Three hundred and eight women were randomised, 284 (92%) completed a pain scale before and immediately after the procedure. After the procedure, 84 women (30%) recorded a pain score of ≥6, 38 (26%) received anaesthetic and 46 (33%) an inert gel. The difference in the proportion of women recording a pain score of 6 or above between the two study groups was not significant (relative risk (RR) for the anaesthetic gel=0.79 95% CI, 0.55, 1.14).Conclusions Intrauterine application of 2% lignocaine gel did not significantly reduce the frequency with which women experienced unacceptable levels of pain or anxiety during endometrial aspiration compared with placebo.
Evaluating ambulatory urodynamics: a prospective study in asymptomatic women
Authors: Salvatore Stefano , Khullar Vik , Cardozo Linda , Anders Kate , Zocchi Gaia , Soligo Marco 
Published: December 2003

Objective
To identify abnormal detrusor contractions in asymptomatic women undergoing ambulatory urodynamics, to standardise the investigation technique for women with urinary symptoms for clinical practice.Design
Prospective observational study.Setting
Two tertiary referral urogynaecology units: one in London, UK and one in Varese, Italy.Methods
Women without urinary symptoms were recruited into the study. Ambulatory urodynamics was performed according to the King's College Hospital protocol. All the traces were analysed in four different ways: 1. without the second bladder transducer measurements displayed on the screen and without the diary; 2. as in 1. but with the diary; 3. with the second bladder sensor displayed on the screen but without the diary; 4. as in 3. but with the diary. The diary was always interpreted at the end of the test with the woman present. For each method we reported the total number of detrusor contractions and whether the woman would have been diagnosed as having abnormal detrusor contraction. Cochran's Q test was used for statistical analysis.Results
Twenty‐six women (mean age 31.7 years) were recruited. Ambulatory urodynamic testing lasted an average of 3.57 hour. The diagnosis of abnormal detrusor contraction varied by 65.4% depending on the method of analysis used. The diary and the women's symptoms during the test were the most discriminating factors. A significant difference between the diagnoses was obtained when comparing the four different ways of analysis. According to our protocol only three women (11.5%) had abnormal detrusor contractions.Conclusions
Using our protocol almost 90% of asymptomatic women have a stable bladder on ambulatory urodynamics. This is similar to the results of labouratory urodynamic testing of asymptomatic women but is in contrast to previous reports of ambulatory urodynamics of asymptomatic women. The technique used during ambulatory urodynamics determines the tests ability to detect detrusor instability with an accurate symptom diary being the most important.
The effectiveness of the levonorgestrel‐releasing intrauterine system in menorrhagia: a systematic review
Authors: Stewart Antony , Cummins Carole , Gold Lisa , Jordan Rachel , Phillips Wendy 
Published: December 2003

Objective To determine whether the levonorgestrel‐releasing intrauterine device (LNG‐IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings.Methods A systematic review addressing the effectiveness and cost effectiveness of the LNG‐IUS for menorrhagia was undertaken.Results Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG‐IUS (range 74%–97%). Another showed reduction in menstrual disturbance score. The LNG‐IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found.Discussion Small studies of moderate quality indicate the LNG‐IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up.Conclusion Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient‐centred outcomes in women with menorrhagia.
A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy
Authors: Sowter Martin C. , Farquhar Cindy M. , Petrie Keith J. , Gudex Guy 
Published: December 2003

Objective To compare single dose systemic methotrexate (50 mg/m2) with laparoscopic surgery for the treatment of unruptured tubal pregnancy.Design An open, pragmatic, prospective randomised trial.Setting Departments of obstetrics and gynaecology at three hospitals in Auckland, New Zealand.Participants Clinically stable women with an unruptured tubal pregnancy diagnosed by transvaginal ultrasound and quantitative serum β‐hCG measurement. Inclusion criteria included a serum β‐hCG concentration < 5000 IU/L, and a tubal pregnancy of < 3.5 cm diameter.Main outcome measures Treatment success, physical and psychological functioning, side effects, and subsequent ipsilateral tubal patency.Results Two hundred and eighteen women with ectopic pregnancies were seen at the three hospitals. 79 women (36% eligibility rate) were eligible for trial entry and 62 women (78% recruitment rate) were recruited. Twenty‐six of the 28 women (93%) randomised to laparoscopic surgery required no further treatment, compared with 22 of the 34 women (65%) randomised to methotrexate (95% CI of difference in success rate 10 ‐ 47%; P<0.01). Two women (7%) in the laparoscopic surgery group had persistent trophoblast. Nine women (26%) in the methotrexate group required more than one dose of methotrexate and five women (15%) underwent laparoscopy during follow up. In the laparoscopy group three women (11%) had negative laparoscopies and two women (7%) had were found to have a ruptured fallopian tube at the time of surgery. Women treated with methotrexate had significantly better objective physical functioning scores but there were no differences in any other psychological outcomes. Women treated with methotrexate experienced greater and more prolonged vaginal bleeding. The likelihood of methotrexate treatment failure was greater at higher serum β‐hCG concentrations. Ipsilateral tubal patency rates were similar in each group.Conclusion This trial shows that in the treatment of tubal pregnancy single dose systemic methotrexate is a less effective treatment than laparoscopic salpingotomy. It is well tolerated, but should only be offered as an alternative to surgery to women who have mild symptoms and present at low serum β‐hCG concentrations. In our population this likely to be no more than a quarter of women presenting with a tubal pregnancy.
In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour
Authors: Lyrenäs Sven , Clason Ingegerd , Ulmsten Ulf 
Published: December 2003

Objective To measure the release rate of prostaglandin E2 (PGE2) in vivo from a controlled‐release vaginal insert used for cervical ripening and induction of labour at term in women with intact membranes or pre‐labour rupture of membranes (PROM).Design Open‐label, single centre study.Population Women at term (≥ 37 gestational weeks) with unripe cervices (Bishop score ≤ 6) scheduled for labour induction for mainly medical reasons.Methods sixty‐eight women (47 with intact membranes and 21 with PROM) had the PGE2 vaginal insert placed in the posterior fornix of the vagina. Each insert was removed from the women at a predetermined time interval between 0.5 h and 24 h, or earlier if labour was induced, fetal distress was detected or maternal complications occurred. After removal, the vaginal insert was frozen and stored for subsequent assay of residual PGE2. Blood samples were collected immediately before insertion and at 4‐hour intervals until removal of the vaginal insert to determine plasma concentrations of PGE2 and the major PGE metabolite, 15‐Keto‐13, 14‐dihydro‐PGF2α (PGEm). Vaginal pH was measured immediately before insertion and directly after removal of the vaginal insert. Bishop score was assessed before induction, after 8 h, 12 h and immediately after removal of the vaginal insert.Results There was a positive linear relationship between the amount of PGE2 released from the insert and the duration of treatment in women with intact membranes (rp= 0.95, P= 0.0001), with a calculated PGE2 release rate of 0.52 ± 0.33 mg/h over 24 h. The PGE2 release rate in women with PROM was not linear. The PGE2 release rate was dependent on vaginal pH, with a faster release rate at higher vaginal pH. Forty‐seven women (69.1%) had the insert removed due to the successful induction of labour and consequently discontinued study treatment before their allocated time period. At vaginal delivery, the released amount of PGE2 at onset of labour was 4.0±3.0 mg and 2.4±2.1 mg for nulliparous women with PROM and intact membranes, respectively (P= 0.1). In multiparous women, the equivalent mean released amount was 3.2±2.6 mg and 1.9±1.4 mg, respectively (P= 0.14). In women with intact membranes, the mean plasma concentrations of PGE2 and PGEm after treatment were not statistically different to those women with PROM (P= 0.27 and 0.64, respectively). In women who were delivered vaginally, the median induction to delivery time interval was 17.0 h (range 4–42) in nulliparous women and 8.7 h (range 5–19) in multiparous women (P= 0.003). Ten (14.7%) women, who were all nulliparous, were delivered by caesarean section.Conclusions In women with intact membranes, the PGE2 release rate was linear over 24 hours. There was a positive linear relationship between vaginal pH and PGE2 release rate. The metabolite analysis revealed no evidence of dose dumping neither in women with intact membranes or in women with PROM.
Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception
Authors: Doll Helen , Vessey Martin , Painter Rosemary 
Published: December 2003

Objective
To clarify the effect of the using the intrauterine device on fertility in nulliparous women.Design
Prospective cohort study of two groups of nulliparous women, one recruited while using an intrauterine device and the other while using an oral contraceptive.Setting
Seventeen family planning clinics in England and Scotland.Sample
1071 nulliparous, married women, aged 18–40 years, 558 of whom contributed information to the main objective of the study.Methods
The women were recruited between 1982 and 1985 and followed up annually to 1994. Dates and reasons for any contraceptive method changes (which were most frequently to barrier methods) were recorded, together with the outcome of any pregnancies, at each follow up.Main
outcome measures The number of nulliparous women giving birth at term after stopping contraception (oral contraceptive, intrauterine device or barrier method) in order to conceive.Results
Women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% were delivered after one year vs 39% of intrauterine device and 32% of oral contraceptive users (log rank P=0.002). There was no association between fertility and duration of oral contraceptive use: However, short term intrauterine device users (< 42 months) showed a fertility pattern more favourable than seen in those discontinuing oral contraceptives, with increasing duration of intrauterine device use being associated with decreasing fertility (linear trend P=0.005); the fertility of women who had used the intrauterine device for 78+ months was the most impaired (28% were delivered by 12 months vs 46% of short term users; at 36 months the corresponding figures were 79%vs 91%). This association remained after adjusting for potential confounding factors, including maternal age, husband's social class, and history of gynaecological illnesses, factors which themselves had independent associations with fertility.Conclusions
Long term intrauterine device use in nulliparous women appears to be associated with an increased risk of fertility impairment.
Familial Mediterranean fever and menstruation
Authors: Ben‐Chetrit Eldad , Ben‐Chetrit Avraham 
Published: December 2003

Objective
To study the prevalence, the nature and the genotype correlation of menstruation associated familial Mediterranean fever attacks.Methods
One hundred and forty‐one female patients with familial Mediterranean fever were studied. A questionnaire regarding the presence and nature of menstruation associated with familial Mediterranean fever was designed and filled in by the authors during the patients’ visits to the familial Mediterranean fever clinic. The patients who had a positive history for this manifestation were analysed for their familial Mediterranean fever mutations.Results
Ten out of 141 familial Mediterranean fever female patients (7%) had menstruation‐associated familial Mediterranean fever attacks. These patients varied in their disease age of onset and disease duration. Increase of colchicine dose, daily or during the perimenstrual period or oral contraceptives were beneficial in preventing these familial Mediterranean fever attacks. No correlation was found with specific mutations causing familial Mediterranean fever.Conclusions
Menstruation‐associated familial Mediterranean fever attacks are relatively uncommon. They are not related to the age of the women, the chronicity of their disease or to the mutations they bear. Various therapeutic approaches have to be tried in order to abolish these attacks. A decrease in oestrogen level during menstruation may have a role in this unique manifestation of familial Mediterranean fever.
Risk factors for third degree perineal ruptures during delivery
Authors: de Leeuw J.W. , Struijk P.C. , Vierhout M.E. , Wallenburg H.C.S. 
Published: December 2003

Objective
To determine risk factors for the occurrence of third degree perineal tears during vaginal delivery.Design
A population‐based observational study.Population
All 284,783 vaginal deliveries in 1994 and 1995 recorded in the Dutch National Obstetric Database were included in the study.Methods
Third degree perineal rupture was defined as any rupture involving the anal sphincter muscles. Logistic regression analysis was used to assess risk factors.Main outcome measures
An overall rate of third degree perineal ruptures of 1.94% was found. High fetal birthweight, long duration of the second stage of delivery and primiparity were associated with an elevated risk of anal sphincter damage. Mediolateral episiotomy appeared to protect strongly against damage to the anal sphincter complex during delivery (OR: 0.21, 95% CI: 0.20–0.23). All types of assisted vaginal delivery were associated with third degree perineal ruptures, with forceps delivery (OR: 3.33, 95%‐CI: 2.97–3.74) carrying the largest risk of all assisted vaginal deliveries. Use of forceps combined with other types of assisted vaginal delivery appeared to increase the risk even further.Conclusions
Mediolateral episiotomy protects strongly against the occurrence of third degree perineal ruptures and may thus serve as a primary method of prevention of faecal incontinence. Forceps delivery is a stronger risk factor for third degree perineal tears than vacuum extraction. If the obstetric situation permits use of either instrument, the vacuum extractor should be the instrument of choice with respect to the prevention of faecal incontinence.