bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer associated human papillomaviruses: perinata transmission and persistence
Authors: Pakarian Farzin , Kaye Jeremy , Cason John , Kell Barbara , Jewers Richard , Derias Nawal W. , Raju Kankipati S. , Best Jennifer M. 
Published: August 2005

ABSTRACTObjective
To demonstrate the perinatal transmission and persistence of the cancer associated human papillomavirus types 16, 18, 31 and 33.Design
Cervical swabs were taken from pregnant women between 20 and 38 weeks of gestation. Buccal and genital swabs were taken from infants at 24 h and at six weeks after delivery and examined for HPV‐16, ‐18,–31 and –33 DNA by the polymerase chain reaction.Setting
Maternity Unit at St Thomas' Hospital, London.Subjects
Thirty‐one pregnant women, 16 with a previous history of cervical intraepithelial neoplasia or genital warts, or both, and their 32 infants (one set of twins).Results
Twenty of the 31 (65 %) women were positive for HPV‐DNA prior to delivery. Twelve of 32 (38%) and eight of 31 (26%) infants were HPV‐DNA positive at 24 h and six weeks respectively. Swabs taken at 24 h demonstrated HPV type 16 in five mother‐infant pairs and HPV type 18 in two mother‐infant pairs. Dual infections with HPV types 16 and 18 were demonstrated in swabs from three mother‐infant pairs. At six weeks, HPV‐16 was demonstrated in swabs from six infants and HPV‐18 in swabs from two infants.Conclusions
Perinatal transmission of human papillomavirus types 16 and 18 occurred in 55% cases. Persistent human papillomavirus infection was demonstrated at six weeks of age. Whether acquisition of human papillomavirus during the perinatal period predisposes to an increased risk of cervical intraepithelial neoplasia among female infants in later life remains to be established. Information on the persistence of perinatally acquired human papillomavirus is required before rational vaccination programmes can be considered.
The use of ultrasonography and Doppler in the prediction of fetal haemolytic anaemia: a multivariate analysis
Authors: Oepkes D. , Brand R. , Vandenbussche F. P. , Meerman R. H. , Kanhai H. H. H. 
Published: August 2005

ABSTRACTObjective
To assess the value of ultrasonography and Doppler to predict the severity of fetal haemolytic anaemia.Design
Ultrasonographic measurements of the fetal liver, spleen, umbilical vein and placenta, and Doppler measurements of umbilical venous and fetal aorta flow velocities were performed before the first intrauterine blood transfusion. Multivariate regression models for the prediction of the fetal haemoglobin level were derived from the measurements.Setting
National referral centre for management of alloimmunised pregnancies.Subjects
Forty fetuses in 39 severe red cell alloimmunised pregnancies.Results
A logistic regression model, incorporating the two Doppler parameters only, predicted the presence or absence of severe anaemia in nonhydropic fetuses with an accuracy of 90 %. Positive predictive value was 89% and negative predictive value was 100%.Conclusion
In severe red cell alloimmunised pregnancies, Doppler blood flow velocity studies can be used to predict the severity of fetal anaemia. This may lead to a reduction of invasive diagnostic tests, to more accurate timing of intrauterine transfusions, and thus to a higher survival rate.
Pharmacology of the human ovarian vein: responses putative neurotransmitters and endothelin‐1
Authors: Stones R. W. , Beard R. W. , Burnstock G. 
Published: August 2005

ABSTRACTObjective
An investigation of excitatory vascular responses in the human ovarian vein, a blood vessel normally exposed to high concentrations of ovarian steroid hormones and capable of adaptation to circulatory changes associated with reproductive life.Design
Pharmacological responses of surgical specimens of human ovarian vein to electrical field stimulation of sympathetic nerves, noradrenaline, α,β‐methylene adenosine 5′‐triphosphate (α,β‐MeATP), endothelin‐1 (ET‐1), and 5‐hydroxytryptamine (5‐HT) were studied. Comparisons were made between in vitro pharmacological responses and the diagnostic category, age, smoking status, reproductive history and hormonal status of patients.Setting
Research laboratory.Results
Maximal contractile responses in longitudinal preparations, expressed as a percentage of the response to potassium chloride 125mmol 1−1, were 28% (SE 7.2) to electrical field stimulation and 107% (SE 15.1) to noradrenaline. In ring preparations, maximal responses to various agents were: noradrenaline 93% (SE 10.2); 5‐HT 79% (SE 8.0); α,β‐MeATP 48% (SE 8.4); and ET‐1 87% (SE 10.1). pD2(–log EC50) values for noradrenaline were 5.82 (SE 0.21) in longitudinal preparations and 5.65 (SE 0.10) in ring preparations; for ET‐1 in ring preparations these values were 7.88 (SE 0.74). Responses to sympathetic nerve stimulation were attenuated by the adrenoceptor antagonist phentolamine; any residual responses were blocked by desensitisation of P2‐purinoceptors with α,β‐MeATP or the addition of suramin, indicating that noradrenaline and adenosine 5′‐triphosphate may be co‐transmitters in these nerves. pD2 values for 5‐HT were 5.97 (SE 0.12) in specimens from unsterilised patients (n= 19) compared with 5.20 (SE 0.24) in specimens from those who had previously undergone sterilisation (n= 6) (P < 0.05). No other relation between clinical characteristics and pharmacological responses were detected and, in particular, there were no apparent changes associated with ageing or hormonal status.Conclusions
Three main conclusions may be drawn from this study: (1) adenosine 5′‐triphosphate is a co‐transmitter in sympathetic nerves in the human ovarian vein; (2) tubal sterilisation affects vascular responsiveness to 5‐HT; and (3) ovarian steroid hormones are likely to influence sympathetic vascular control via effects on catecholamine and adenosine 5′‐triphosphate synthesis, storage, release, degradation or re‐uptake, rather than via effects on vascular smooth muscle receptors.
Fetal lymphocyte subpopulations in red blood cell iso‐immunised pregnancies
Authors: Thilaganathan Baskaran , Makrydimas George , Plachouras Nicolaos , Nicolaides Kypros H. 
Published: August 2005

ABSTRACTObjective
To study the association between fetal anaemia and alterations in lymphocyte subpopulations.Design
Cross‐sectional study.Setting
The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London.Subjects
Forty‐three red blood cell iso‐immunised pregnancies undergoing cordocentesis at 19 to 38 weeks gestation.Main outcome measures
Fetal blood haemoglobin concentration, erythroblast count and lymphocyte subpopulations.Results
The mean T (CD3+), B (CD19+), T‐helper (CD4+), T‐suppressor/cytotoxic (CD8+) and natural killer (NK: CD16 +/CD56 +) cell counts in the anaemic fetuses were significantly lower than the appropriate normal mean for gestation (CD3 + : t=–3.25, P < 0.01; CD19 + : t=–2‐14, P < 0.05; CD4+: t–4.03, P < 0.001; CD8+ : t=–3.39, P < 0.01 and CD16 +/CD56+ : t=–3.49, P < 0.01). Furthermore, there was a significant association between the decrease in T lymphocyte number and the degree of fetal anaemia (r= 0.342, P < 0.05).Conclusions
Fetuses from red blood cell iso‐immunised pregnancies exhibit nonselective lymphopenia that is proportional to the degree of anaemia.
Magnitude and pattern of skeletal response to long term continuous and cyclic sequential oestrogen/progestin treatment
Authors: Nielsen S. Pors , Bärenholdt O. , Hermansen F. , Munk‐Jensen N. 
Published: August 2005

ABSTRACTObjective
To investigate the magnitude and pattern of the changes in bone mass during five years of continuous and cyclic sequential oestrogen/progestin treatment.Design
Prospective study of normal, early postmenopausal women, initially a double‐blind, placebo controlled trial, subsequently an open, controlled investigation.Setting
Clinical physiology unit of a general hospital.Subjects
Sixty‐eight normal, early postmenopausal women.Results
1. Continuous treatment resulted in significantly higher lumbar spine bone density than did sequential treatment (P < 0.001). Lumbar spine bone density was 19% and 15%, respectively, above that of untreated women after three years and onwards, and 10% and 6%, respectively, above the initial value; 2. Both regimens induced a more pronounced rise in lumbar spine bone density than in forearm bone mineral content (P < 0.001); 3. The spontaneous decline (without treatment) in lumbar spine bone density and forearm bone mineral content averaged 1.86% and 1.90% per year, respectively. 4. There was a significant bone loss from the lumbar spine during the last year of active treatment (P < 0.001). This would suggest that lumbar spine bone density rises to a certain level and subsequently declines. However, neither data pooled before computation nor data processed individually for each patient over five years allowed for any definite conclusions regarding the pattern of the long term skeletal response to combined oestrogen/progestin treatment.Conclusion
Five years treatment with oestradiol/norethisterone resulted in a substantial gain in bone mass. The highest values were found in the axial skeleton with daily administration of 2 mg oestradiol and 1 mg norethisterone. It is likely that bone mass after an absolute rise begins to decline after about four years of treatment.
A randomised controlled trial of prophylaxis of post‐abortal infection: ceftriaxone versus placebo
Authors: Henriques Carsten Ulrik , Wilken‐Jensen Charlotte , Thorsen Poul , Møller Birger R. 
Published: August 2005

ABSTRACTObjective
To investigate the incidence of post‐operative infection after first trimester abortion in women treated with a long‐acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole.Design
A prospective, randomised controlled trial.Setting
Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark.Subjects
Nine hundred and ninety‐six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group.Interventions
All women were kept under observation, and, between six and 14 days post‐operatively, underwent pelvic examination. Clinical endpoints were noted.Main outcome measures
Post‐operative pelvic inflammatory disease in women applying for legal first trimester abortion.Results
Seven hundred and eighty‐six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group.Conclusions
This study demonstrated a significant reduction in post‐operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.
Menorrhagia—a pragmatic approach to the understanding of causes and the need for investigations
Authors: Fraser Ian S. 
Published: August 2005

ABSTRACTMenorrhagia is a symptom denoting excessively heavy menstrual bleeding. It is a complaint that is difficult to verify objectively in many cases, even with a detailed case history. Issues of perception and tolerance of symptoms are important in whether a patient presents to a doctor, and this varies considerably from one society to another. Research studies indicate that the upper limit of normal blood loss is between 60 and 80 ml/month. Above this level women tend to become progressively iron deficient. Hence, any development which may help the precision of this assessment is valuable, and several of these will be discussed. Causes of menorrhagia can be divided into three groups: (1) pelvic diseases, such as myomata and adenomyosis; (2) systemic disorders, such as coagulopathies and hypothyroidism; and (3) dysfunctional uterine bleeding—a diagnosis of exclusion. Investigations are mainly aimed at improving the precision of the underlying diagnosis, defining the severity of the condition and excluding anaemia. Hence, the most important investigations are a full blood count, a diagnostic hysteroscopy and endometrial sampling. In clinical practice, other specific investigations need only be carried out if there are unusual features in the history or examination, or if previous treatments have failed. In a research situation there have been numerous studies aimed at elucidation of the mechanisms of heavy bleeding and some of these will be reviewed.
Evaluation of surgical options in menorrhagia
Authors: Lalonde A. 
Published: August 2005

ABSTRACTTotal abdominal and vaginal hysterectomy has been the standard treatment for intractable and unmanageable menorrhagia for many years. However, in the last few years, hysteroscopic treatment of menorrhagia through surgical resection and/or ablation of the endometrial cavity has gained success. Over 625000 hysterectomies are performed each year in the USA alone. More than 30 % are done for menorrhagia as a primary diagnosis. Three times more hysterectomies are performed using the abdominal route than the vaginal approach. Morbidity is higher using the abdominal route alone. Complications of abdominal and vaginal hysterectomies will be briefly discussed. Menorrhagia caused by submucous fibroids can be treated hysteroscopically. A review of methods, complications, advantages and long‐term follow up will be presented. Laparoscopically‐assisted vaginal hysterectomy (LAVH) is the latest surgical option offered for menorrhagia. The advent of a hysteroscopic approach to the treatment of menorrhagia and careful analysis of the advantages and disadvantages of LAVH will be discussed.
Interleukin‐6, turnour necrosis factor and soluble turnour necrosis factor receptors in women with pre‐eclampsia
Authors: Vince Gill S. , Starkey Phyllis M. , Austgulen Rigmor , Kwiatkowski Dominic , Redman Christopher W. G. 
Published: August 2005

ABSTRACTObjectives Generalised maternal endothelial cell dysfunction appears to be an underlying problem in pre‐eclampsia presumed to be caused, directly or indirectly, by one or more circulating factors derived from the placenta. Recently it has been suggested that tumour necrosis factor (TNF) may play an important role in pre‐eclampsia and contribute to endothelial activation. This study was designed to investigate this proposal.Design Plasma TNF‐α, IL‐6 and both forms of soluble TNF receptors (p55 and p75 TNF‐R) have been measured by ELISA in 31 pre‐eclamptic patients and 31 pregnant controls matched for age, parity and gestational age.Results Levels of IL‐6, TNF‐α and soluble TNF‐R (p55 and p75) were significantly higher in pre‐eclamptic patients, compared with age and gestation matched controls with a wide variation in levels between pre‐eclamptic individuals. There was a correlation between levels of IL‐6 and TNF or TNF‐R and between TNF and TNF‐R levels. However, when the pre‐eclamptic patients were subdivided on the basis of the severity of their disease, the median values of plasma concentrations of IL‐6, TNF‐α and TNF‐R were all higher in the group with lower platelet counts.Conclusions These new findings are consistent with the concept that the maternal syndrome of pre‐eclampsia is associated with endothelial dysfunction and provide evidence that at least part of this dysfunction could arise from excessive release of TNF‐α into the circulation.
Circadian variation of urinary albumin excretion in pregnancy
Authors: Douma C. E. , van der Post J. A. M. , van Acker B. A. C. , Boer K. , Koopman M. G. 
Published: August 2005

ABSTRACTObjective The hypothesis was tested that circadian variations in urinary albumin excretion of pregnant women in the third trimester of normal pregnancy are different from nonpregnant individuals.Design Circadian variability in urinary albumin excretion was studied both in pregnant women and in nonpregnant controls either during normal daily activities or in contrast during continuous bedrest with standardised fluid and food intake to study endogenously generated rhythm.Setting Outpatient department and metabolic ward of a university hospital.Main outcome measures Urinary albumin excretion during fixed time periods over the day and the night.Results Both ambulant pregnant and nonpregnant women have circadian rhythm in urinary albumin excretion but pregnant women have, firstly, a hgher 24 h urinary albumin excretion, secondly, smaller relative day‐night differences than nonpregnant controls and thirdly, in the metabolic ward some pregnant women demonstrate absence of rhythm.Conclusions The higher albumin excretion during pregnancy in 24 h urine collections can largely be explained by a higher excretion during the night, compared with that of nonpregnant women. The day‐night difference in urinary albumin excretion of ambulant pregnant women is exogenously determined.
A follow up of silastic sling for genuine stress incontinence
Authors: Chin Yue Kim , Stanton Stuart L. 
Published: August 2005

ABSTRACTObjective To assess the use of silastic sling for genuine stress incontinence.Design Retrospective descriptive analysis.Setting Tertiary referral centre for urogynaecology.Subjects Eighty‐eight women with urodynamically proven genuine stress incontinence, 10 had coexistent detrusor instability. In 74 women, the sling operation was for recurrent incontinence.Intervention A low Pfannenstiel incision was used and a suburethral tunnel dissected to insert the sling, which was attached under minimal tension with non‐absorbable sutures to each ileopectineal ligament.Main outcome measures Clinical and urodynamic data were assessed between two and three months post‐surgery; thereafter clinical assessment and pad testing were performed at yearly intervals for five years.Results The subjective cure at three months was 81% and the objective cure was 69 %. There was a fall in success rate with increasing number of continence operations, and this was statistically significant for women with three or more previous continence operations (P < 0.05). Neither age, parity nor menopausal status made a statistical difference to the cure rate. Twenty‐three women had reached their fifth year follow up and the success rate using life table analysis was 71%. Post‐operatively, 29 women had detrusor instability: 22 women developed detrusor instability de novo and seven had detrusor instability presurgery. Urodynamic findings post‐surgery showed an increase (P < 0.001) in outflow resistance. Four women required removal of sling for voiding difficulties. Ten women developed sling erosions: five vaginal, four bladder erosions and one urethral erosion. After removal of the sling, seven women still remained continent.Conclusions A silastic sling operation for the treatment of genuine stress incontinence provides a good long term cure, considering that 45% of women had two or more previous failed continence operations. The high prevalence of detrusor instability and voiding difficulties post‐surgery should be noted.
The influence of maternal haemoglobin and ferritin on mid‐pregnancy placental volume
Authors: Howe D. T. , Wheeler T. , Osmond C. 
Published: August 2005

ABSTRACTObjective To investigate whether low maternal haemoglobin and ferritin levels are associated with increased placental volume by mid‐pregnancy.Design Prospective study of women attending hospital for shared antenatal care.Setting A teaching hospital in the south of England.Subjects Five hundred and sixty‐eight women booking for delivery in the hospital.Main outcome measures Placental volume measured by ultrasound at 18 weeks gestation.Results At 14 weeks gestation 9% of women had haemoglobin levels ≤ 11 g/dl and 26% had ferritin levels < 13 μg/1. Placental volume at 18 weeks was inversely related to the maternal haemoglobin and ferritin levels. The influence of haemoglobin and ferritin concentrations was independent of maternal social class, parity, smoking, and weight. Larger placentae were found in taller women, those who had previously been pregnant, and in those who were smoking more than 15 cigarettes daily at the time of their last menstrual period.Conclusion These data suggest that placental development is influenced from early in pregnancy by the intrauterine environment provided by the mother. In conjunction with other studies they support the proposal that, as a result of these changes, programming of adult blood pressure may be initiated in early pregnancy.
Uptake of meta‐analytical overviews of effective care in English obstetric units
Authors: Paterson‐Brown Sara , Fisk Nicholas M. , Wyatt Jeremy C. 
Published: August 2005

ABSTRACTObjective To establish the current availability of meta‐analytical overviews of effective care in perinatal medicine, in the form of Effective Care in Pregnancy and Childbirth and the Oxford Database of Perinatal Trials, in English obstetric units and to find out how obstetricians without either one keep up to date.Design Standardised telephone questionnaire.Subjects The consultant obstetrician deemed to be the Royal College of Obstetricians and Gynaecologists' administrative contact in each of the 24 teaching hospitals, and in 74 of 173 (43%) district general hospitals in England.Main outcome measures Knowledge and use of Effective Care and the Oxford Database in the obstetric unit.Results Thirty‐seven percent of units did not have access to either Effective Care or the Oxford Database, with significant differences between district general hospitals and teaching hospitals in lack of availability (33/74 (45%) versus 3/24 (12%) respectively, P= 0.02). Effective Care was available in 51% of district general hospitals and 79% of teaching hospitals, compared with the availability of the Oxford Database which was only available in 16% and 62%, respectively. Reasons given for not obtaining either included non‐awareness, expense, and perceived lack of need. The consultants with neither Effective Care nor the Oxford Database claimed to keep up to date by various methods, usually as information from colleagues.Conclusions These results reflect both inefficient dissemination of medical knowledge in obstetrics and the reluctance of obstetricians to consider adapting their practice as a result of evidence from meta‐analyses of randomised controlled trials. Although Effective Care is more widely available than the Oxford Database, its datedness renders it inferior to the database as a means of facilitating effective care in obstetrics.
Pain and infertility – a rationale for different treatment approaches
Authors: Martin D. C. 
Published: August 2005

ABSTRACTEndometriosis may result in pain and/or infertility in some patients, while others may remain asymptomatic. The disease appears to progress and regress somewhat unpredictably, making it difficult to determine the appropriate treatment. Progression of the disease can be altered by medical and surgical treatments used according to general guidelines but selected for the individual. Coagulation, medical suppression and observation are frequently the first approaches to infertility or pain resulting from endometriosis. Deep dissection and excision may be indicated with deep disease, persistent pain or persistent tenderness.