bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early invasive cervical adenocarcinoma: its potential for nodal metastasis or recurrence
Authors: Hirai Yasuo , Takeshima Nobuhiro , Tate Shinichi , Akiyama Futoshi , Furuta Reiko , Hasumi Katsuhiko 
Published: December 2003

Objective
To investigate the potential for nodal spread or recurrence in patients with early invasive cervical adenocarcinoma. The possible application of the International Federation of Gynecology and Obstetrics (FIGO) classification (1994) to this variant was also examined.Design
Retrospective observational study.Setting
Gynaecological oncology division of Cancer Institute Hospital, Japan.Population
302 patients with FIGO Stage 0‐IIB cervical adenocarcinoma treated surgically at the Cancer Institute Hospital.Methods
Clinicopathological analysis was performed on 47 patients with early invasive cervical adenocarcinoma in whom the depth of stromal invasion was 5 mm or less. All patients underwent radical hysterectomy and pelvic lymphadenectomy.Results
In 30 patients with a depth of tumour invasion of 3 mm or less, no lymph node metastasis was found, while two patients developed recurrence; one had a depth of invasion of 3 mm and a horizontal tumour spread of 3 mm, and the other had horizontal spread of more than 7 mm. In 17 patients with a depth of invasion from 3 to 5 mm, there was also no lymph node metastasis, but two patients developed recurrence; one had horizontal tumour spread of 7 mm or less, and the other had horizontal spread of more than 7 mm.Conclusion
Early invasive cervical adenocarcinoma with a depth of invasion of 3 mm or less and a horizontal spread of 7 mm or less has little potential for nodal metastasis or recurrence. It seems possible that the FIGO definition (1994) of early cervical cancer may be applicable in its present form to early cervical adenocarcinoma.
Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia
Authors: Wright Barry , Gannon Michael J. , Greenberg Maurice , House Allan , Rutherford Tony 
Published: December 2003

Objective
To explore the relation between pre‐operative psychiatric morbidity, menstrual blood loss and psychiatric outcome in women receiving endometrial ablation for heavy periods.Design
A prospective cohort study.Setting
The menorrhagia clinic at Leeds General Infirmary.Population
One hundred and twenty consecutive women referred to the Clinic for endometrial ablation.Methods
Psychiatric interview and actual menstrual blood loss measurements at presentation pre‐operatively and one year post endometrial ablation.Main outcome measure
Psychiatric status using the semi‐structured interview, Present State Examination, with measurement of menstrual blood loss.Results
Endometrial ablation was performed on 92 women. Of the 87 women evaluated 51 (59%) had clinically significant psychiatric symptoms, mainly depression and anxiety. Psychiatric morbidity fell to 21.8% at one year after endometrial ablation. Women with the best psychiatric outcome (6% post‐operative psychiatric morbidity) were those with genuine menorrhagia (≥80 mL) and low psychiatric morbidity pre‐operatively. Those who fared worst (39% post‐operative psychiatric morbidity) were women with high pre‐operative psychiatric morbidity and low menstrual blood loss. Of seven women with very low losses [mean 19 mL (SD 17)] who did not proceed to surgery after counselling, six (86%) had significant psychiatric morbidity.Conclusions
Pre‐operative psychiatric status and menstrual blood loss are predictors of outcome of surgery for women with reported heavy periods.
The prevalence of domestic violence in pregnant women
Authors: Johnson J.K. , Haider F. , Ellis K. , Hay D.M. , Lindow S.W. 
Published: December 2003

Objective
To determine the prevalence of domestic violence in a population of pregnant women.Design
Questionnaire survey.Setting
Antenatal booking clinic in a north of England hospital.Population
Five hundred consecutive women were included.Methods
Anonymous confidential questionnaire to women who were not accompanied by their partners.Main outcome measures
Disclosure of a past history of physical, emotional or sexual abuse.Results
Four hundred and seventy‐five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26–30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity.Conclusion
The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.
The use of lidocaine for fetocide in late termination of pregnancy
Authors: Senat M.V. , Fischer C. , Bernard J.P. , Ville Y. 
Published: December 2003

Objective
To assess the use of lidocaine (1%) to induce permanent fetal cardiac asystole for fetocide in late termination of pregnancy.Design
Prospective observational study.Setting
One tertiary referral fetal medicine unit in France.Sample
Fifty patients undergoing termination of pregnancy between 20 and 36 weeks of gestation for severe abnormalities or severe maternal conditions.Methods
Fetocide was performed by umbilical vein puncture under ultrasound guidance with injection of sufentanil (5 μg) followed by 7 to 30 mL of lidocaine (1%).Main outcome measures
Percentage of successful procedures to obtain permanent fetal cardiac asystole and maternal side effects.Results
The procedure was successful in 92% of cases (46/50) with complete cessation of heart activity. The mean amount of lidocaine was 15.3 (6.5) mL. In three cases, fetocide was performed by cardiocentesis and in one case lidocaine was unsuccessful and fetocide was performed with KCl. There were no maternal side effects.Conclusion
Lidocaine is an effective drug to perform fetocide with doses below the toxic dose for the mother.
A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding
Authors: Hawe Jed , Abbott Jason , Hunter David , Phillips Graham , Garry Ray 
Published: December 2003

Objective
To compare the effectiveness of the Cavaterm thermal balloon endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding.Design
Randomised controlled trial.Setting
Minimal access gynaecological surgery unit in a district general hospital.Population
Seventy‐two women with dysfunctional uterine bleeding requesting conservative surgical management of their condition.Methods
Women with a normal endometrial biopsy and normal uterine cavity were randomly allocated to endometrial ablation by Cavaterm or Nd:YAG laser. Patients completed pre‐operative and 6‐ and 12‐month post‐operative questionnaires assessing menstrual symptoms, quality of life, sexual activity and procedural satisfaction and acceptability. All patients received a single dose of gonadotropin‐releasing hormone analogue one month pre‐operatively and kept blinded to the procedure performed until after the 6‐month assessment.Main outcome measures
The primary outcome measure was amenorrhoea rate. Secondary outcomes were effect on blood loss, quality of life, sexual activity, patient satisfaction and procedure acceptability.Results
Seventy‐two women were randomised. Amenorrhoea rates at 12 months in the Cavaterm and endometrial laser ablation groups were 29% vs 39% (P= 0.286), with combined amenorrhoea and hypomenorrhoea rates of 73% vs 69%, respectively. At 12 months, repeat surgery rates were higher in the endometrial laser ablation group (15% vs 12%, P= 0.395). Cavaterm was an acceptable procedure and 93% of patients satisfied or very satisfied at 12 months (95% endometrial laser ablation). Both treatments were associated with an increase from baseline in the SF‐12 physical score (Cavaterm mean difference −3.9, 95% CI −7.9, 0.2, ns; endometrial laser ablation mean difference −5.1, 95% CI −9.5, −0.7, P= 0.003) and mental health score (Cavaterm mean difference −5.6, 95% CI −9.9, −1.3, P= 0.001; endometrial laser ablation mean difference −5.9, 95% CI −11.7, −0.2, P= 0.04). Patient's own assessment of health (EQ‐5D VAS) improved from baseline in both groups (Cavaterm mean difference −7.6, 95% CI −13.9, −1.3, P= 0.02; endometrial laser ablation mean difference −5.4, 95% CI −14.9, 4.2, ns). EQ‐5D index scores also improved (Cavaterm mean difference −0.06, 95% CI −0.2, 0.005, ns; endometrial laser ablation mean difference −0.17, 95% CI −0.3, −0.02, P= 0.02). There were no major complications in either group.Conclusions
The results with the Cavaterm thermal balloon endometrial ablation system are as good as those obtained with the Nd:YAG laser when used for the treatment of dysfunctional uterine bleeding in the short term. It results in a significant reduction in menstrual blood loss, patient satisfaction and improvement in patient quality of life. Larger studies with longer follow up are required to determine its place in the modern treatment of dysfunctional uterine bleeding.
Screening for chromosomal abnormalities in the first trimester using ultrasound and maternal serum biochemistry in a one‐stop clinic: a review of three years prospective experience
Authors: Spencer Kevin , Spencer Christine E. , Power Maureen , Dawson Carolynne , Nicolaides Kypros H. 
Published: December 2003

Objective
To evaluate the performance of a one‐stop multidisciplinary clinic of screening for fetal chromosomal anomalies in the first trimester of pregnancy by a combination of maternal serum biochemistry and ultrasonography.Design
Retrospective review of screening performance.Setting
District General Hospital maternity unit.Population
All women booked for routine antenatal care at Harold Wood Hospital between 1 June 1998 and 31 May 2001. The population included 12,339 women with singleton pregnancies presenting at 10–14 weeks of gestation.Methods
Women were offered screening using a combination of maternal serum free β‐hCG and pregnancy associated plasma protein‐A (PAPP‐A) and fetal nuchal translucency thickness. Those with an estimated risk of ≥1 in 300 of carrying a fetus with trisomy 21 or trisomy 18 or trisomy 13 were offered the option of an invasive diagnostic test. Follow up of the outcome of all pregnancies was carried out.Main outcome measures
Uptake of screening and invasive testing, detection rate for fetal chromosomal abnormalities and false positive rate.Results
The uptake of first trimester screening was 97.5% and the uptake of invasive testing in the increased risk group was 77%. The rate of detection of trisomy 21 was 92% (23 of 25), of trisomy 13 or 18 was 100% (all 15) and of all aneuploidies was 96% (49 of 51). The false positive rate was 5.2%.Conclusion
First trimester screening for trisomy 21 and other aneuploidies can be delivered in an efficient manner in a one‐stop multidisciplinary clinic. The detection rates are far better than can be achieved by second trimester serum screening.
Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up
Authors: Moore K.H. , O'Sullivan R.J. , Simons A. , Prashar S. , Anderson P. , Louey M. 
Published: December 2003

Objective
To compare the efficacy and labour costs of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence.Design
Single centre randomised controlled trial of patients with mild or moderate leakage.Setting
Tertiary urogynaecology unit.Sample
One hundred and forty‐five consecutive patients with stress and/or urge incontinence.Methods
Standardised conservative therapy regimens, provided by nurse continence advisors and urogynaecologists.Main outcome measures
One‐hour pad test, frequency volume charts, a 20‐point incontinence score and two quality of life tests, staff treatment times and costs.Results
Of 110 women who completed 12‐week treatments, 64% of the women in the nurse continence advisor group (n= 58) and 52% of women treated by urogynaecologists (n= 52) were asymptomatic (dry pad test; OR 1.63, 95% CI 0.71–3.75). There was no significant difference between clinician groups for change in pad test result (P= 0.71), voids/day (0.43), incontinence score (P= 0.57) or quality of life scores (urogenital distress inventory, P= 0.27; Incontinence Impact Questionnaire, P= 0.41). Despite the expected longer consultation times for the advisor group (median 160 min, interquartile range [IQR] 130–210) versus the urogynaecologist group (median 90 min, IQR 60–120), the per capita labour cost for advisor treatment (median AU$59.20, IQR 48.10–77.70) was lower than for treatment given by urogynaecologists (median cost AU$ 189.70, IQR 120.60–250.70, Mann–Whitney U test, P < 0.0001). At 2.5 years, 23/58 patients (40%) treated by advisor and 27/52 patients (52%) treated by urogynaecologist group, who had been cured and discharged, were available for contact. Of these, 29% of women in the nurse continence advisor group and 41% of those treated by urogynaecologists remained continent (on 20‐point score). Quality of life improvement persisted equally in both groups. These data should be interpreted cautiously due to a 24% dropout rate.Conclusions
The reduction in urine leakage and improvement in quality of life observed in patients treated by nurse continence advisors and urogynaecologists were similar at 12 weeks and 2 years, but lower costs arose from treatment provided by nurse advisors. We suggest that conservative treatment by the nurse continence advisor could be used more widely in mild to moderate incontinence.
The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia
Authors: Bretelle Florence , Agostini Aubert , Rojat‐Habib Marie‐Christine , Cravello Ludovic , Roger Valérie , Blanc Bernard 
Published: December 2003

Objective
To determine whether frozen section in conisation improves the management of cervical intraepithelial neoplasia.Design
Randomised trial.Setting
Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France.Population
Patients referred for treatment or diagnosis of cervical intraepithelial neoplasia.Methods
Two hundred and three patients requiring conisation for diagnosis or treatment of cervical pathology were randomly assigned to have (n= 102) or not (n= 101) a frozen section of the endocervical margin of the cone specimen.Main outcome measures
The principal criterion was the 12 month residual or recurrent high grade disease rate.Results
At 12 months, the residual or recurrent disease rate of high grade lesions was 12.6% in the group that did not have frozen sections and 1% in the group that did (relative risk, RR, 11.9, 95% CI 1.6–89.5, P= 0.0025). The corresponding rates of margin involvement were 18.9% and 1%, respectively (RR 15.13, 95% CI 2.06–111.27, P= 0.0002). The groups did not differ as to the height of the cone (13.6 [5.6] mm vs 13.7 [4.7] mm, P= 0.75) or post‐operative morbidity (6% vs 7%, RR 1.01, 95% CI 0.94–1.09, P= 0.8). The rate of patients lost to follow up was similar in both groups 17% vs 12% (RR 1.42, 95% CI 0.71–2.81, P= 0.31).Conclusion
Frozen section is effective in conisation and significantly reduces residual or recurrent high grade disease. This finding improves the management of cervical pathology achieving immediate clear margins in most of conisations. This is of great interest because high rates of patients are lost to follow up as we and others authors have found.
Dexamethasone and ursodeoxycholic acid protect against the arrhythmogenic effect of taurocholate in an in vitro study of rat cardiomyocytes
Authors: Gorelik J. , Shevchuk A.I. , Diakonov I. , de Swiet M. , Lab M. , Korchev Y. , Williamson C. 
Published: December 2003

Objective
To establish whether the therapeutic agents ursodeoxycholic acid and dexamethasone protect cardiomyocytes from taurocholate‐induced arrhythmias in an in vitro model.Design
Laboratory study.Setting
Imperial College London, Hammersmith Campus.Sample
Neonatal rat cardiomyocytes.Methods
Using scanning ion conductance microscopy, we measured the rate, rhythm, amplitude of contraction and calcium dynamics of ventricular myocytes from one to two day old rats. Cells were pre‐incubated for 16 hours in dexamethasone (80 or 800 nM) or 0.1 mM ursodeoxycholic acid before adding taurocholate at different concentrations (0.3–4.5 mM).Main outcome measures
Changes in rate and amplitude of contraction, calcium dynamics and rhythm.Results
Taurocholate at concentrations of up to 3 mM induces abnormal changes including reductions in rate, amplitude of contraction, abnormal calcium dynamics and dysrhythmias. Although dexamethasone had no immediate protective effect on these changes, pre‐incubation with dexamethasone was protective. Ursodeoxycholic acid pre‐incubation was protective at taurocholate concentrations up to 1 mM.Conclusion
The therapeutic agents dexamethasone and ursodeoxycholic acid appear protective against the arrhythmogenic effect of taurocholate on cardiomyocytes.
Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours
Authors: Querleu D. , Papageorgiou Th. , Lambaudie E. , Sonoda Y. , Narducci F. , LeBlanc E. 
Published: December 2003

Objectives
To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours.Design
Retrospective study.Setting
Cancer centre.Population
Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgeryMethods
From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri‐operative complications and follow up.Main outcome measures
Seroperative and postoperative data, pathology and clinical follow up.Results
Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed.Conclusions
Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure. It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.
Aggressive or expectant management of labour: a randomised clinical trial
Authors: Pattinson R.C. , Howarth G.R. , Mdluli W. , MacDonald A.P. , Makin J.D. , Funk M. 
Published: December 2003

Objective
To compare labour outcomes using aggressive or expectant management protocols.Design
Randomised trial.Setting
Pretoria Academic Complex, South Africa. It serves an indigent urban population.Population
Healthy nulliparous women in active labour, at term, with a health singleton pregnancy and cephalic presentation.Methods
The women were randomised to either aggressive (n= 344) or expectant (n= 350) management protocols. Aggressive management entailed using a single line partogram, a vaginal examination every two hours and use of an oxytocin infusion if the line was crossed. Expectant management entailed using a two line partogram, with the alert line and a parallel action line four hours to the right, with a vaginal examination every four hours. If the action line was reached, oxytocin was started. The women were reassessed every two hours thereafter. Analgesia was prescribed on request.Main outcome measures
Mode of birth, use of oxytocin and analgesia and neonatal outcome.Results
The groups were similar with respect to maternal age, cervical dilation at trial entry, number crossing the alert line and birthweight of the infants. Significantly fewer women managed aggressively had caesarean sections (16.0%) than those managed expectantly (23.4%) (relative risk [RR] 0.68, 95% confidence intervals [CI] 0.50, 0.93). Significantly more oxytocin was used in the aggressive management group, but there was no difference with respect to the use of analgesia or episiotomy or in neonatal outcome with respect to the Apgar score at 1 or 10 minutes. There were three perinatal deaths. One woman was found to have an intrauterine death before trial entry and the other two were in the aggressive management group but did not receive oxytocin. Compliance by staff was poor in the aggressive management group.Conclusions
Aggressive management of labour reduces the caesarean section rate in nulliparous women but requires more intensive nursing.
Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study
Authors: Hannestad Yngvild S. , Rortveit Guri , Daltveit Anne Kjersti , Hunskaar Steinar 
Published: December 2003

Objective
To examine whether modifiable lifestyle factors such as smoking, obesity, physical activity and intake of alcohol or caffeinated drinks were associated with urinary incontinence in women.Design
Cross sectional population‐based study.Setting
The Norwegian Epidemiology of Incontinence in the County of Nord‐Trøndelag (EPINCONT) Study is part of a large survey performed in a county in Norway during 1995–1997.Population
Women ≥20 years (n= 34,755, 75% of the invited) attended the first part of the survey and received the questionnaire. There were 27,936 (80% of source population) women who completed the incontinence part of the questionnaire.Methods
Questionnaire covering several health topics including urinary incontinence was received at a screening station. Logistic regression analysis was used to adjust for confounding and to establish associations with the different outcomes under investigation: any incontinence, severe incontinence and stress, urge and mixed subtypes.Main outcome measures
Effect measure were odds ratios with corresponding 95% confidence intervals.Results
Former and current smoking was associated with incontinence, but only for those who smoked more than 20 cigarettes per day. Severe incontinence was weakly associated with smoking regardless of number of cigarettes. The association between increasing body mass index and incontinence was strong and present for all subtypes. Increasing levels of low intensity physical activity had a weak and negative association with incontinence. Tea drinkers were at slightly higher risk for all types of incontinence. We found no important effects of high intensity physical activity, intake of alcohol or coffee.Conclusions
Several potentially modifiable lifestyle factors are associated with urinary incontinence. Highest odds ratios were found for body mass index, heavy smoking and tea drinking.