bluuebunny/crossref_metadata_2025_split huggingface dataset:
Waiting for elective general surgery: physical, psychological and social consequences
Authors: Oudhoff Jurriaan P. , Timmermans Danielle R. M. , Bijnen Arnold B. , Van Der Wal Gerrit 
Published: May 2004

Background:  Long surgical waiting lists are common and receive serious consideration. To evaluate the positive and negative effects of waiting lists, insight into the consequences of waiting is needed. The present study aims to assess what insight the current literature provides into the effects of delayed surgery for varicose veins, inguinal hernia in adults, gallstones, and breast cancer in terms of physical, psychological and social aspects.Methods:  Searches of Medline and Embase, for the period January 1985−September 2003, were performed to identify articles providing direct or indirect insight into the consequences of waiting for surgery for each disorder. Reference lists of retrieved reports were examined for relevant articles.Results:  Seven studies were identified with direct data on consequences of delay in elective surgery. Relevant indirect data were found in 32 reports. Results indicated that delayed varicose vein surgery or inguinal hernia repair involves marginal physical, psychological or social suffering, and that severe deterioration is unlikely. The impact of delayed cholecystectomy seems more profound by suffering on all three health aspects. Complications while waiting do occur, with a higher risk for patients with previous complications. Longer delays for breast cancer surgery seem to adversely affect prognosis, although it is unclear which interval is associated with such an effect. Moreover, having breast cancer undoubtedly affects psychological health.Conclusions:  There is a remarkable paucity of studies addressing the consequential impact of waiting for elective surgery on patients’ health for each of the four studied disorders. Current literature permits merely general estimation of this consequential impact. As specific assessment of these consequences is important for daily practice and for policy, further research is required.
Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia
Authors: Bilgin Tufan , Özuysal Sema , Ozan Hakan , Atakan Türkan 
Published: May 2004

AbstractAim: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH).Methods: Forty‐six consecutive women who underwent hysterectomy for AEH were analyzed.Results: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC.Conclusion:  A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.
Ultrasound‐guided local injection of methotrexate to treat an invasive hydatidiform mole
Authors: Tsukihara Satoru , Harada Tasuku , Terakawa Naoki 
Published: May 2004

AbstractA 28‐year‐old Japanese woman had an invasive hydatidiform mole which was diagnosed by means of transvaginal ultrasonography. After the two initial courses of systemic methotrexate (MTX) therapy given over a period of weeks, the tumor was 14 mm in diameter and the surrounding blood supply remained rich. In addition to the two initial courses of systemic MTX therapy, local ultrasound‐guided injection of MTX therapy was given three times, once per week. After the local MTX treatment, the βhCG level, which had been as high as 240 ng/mL, dropped to less than 0.1 ng/mL. We then gave two additional courses of systemic MTX therapy (once per week). More than 3 years have passed since the final systemic MTX therapy, and the patient's serum βhCG levels continue to be less than 0.1 ng/mL. An invasive mole can be treated with an ultrasound‐guided local injection of MTX in addition to the established systemic MTX treatment.
Stavudine effects on rat pregnancy outcome
Authors: Barreto Regina Lúcia Braga , De Jesus Simões Manuel , Amed Abes Mahmed , Soares Júnior José Maria , Oliveira‐Filho Ricardo Martins , Luiz Kulay  
Published: May 2004

AbstractObjective: Stavudine is an inhibitor of HIV reverse transcriptase and acts as a chain terminator during DNA synthesis. The aim of the study presented here was to evaluate the effects of stavudine during rat pregnancy.Methods: Female rats were randomly divided into four treatment groups: GI (treated with the drug vehicle); GII; GIII; and GIV (treated with 1, 3 or 9 mg/kg of stavudine, respectively) (n = 25 pregnant rats for every group). Rats were treated by gavage once daily. The treatment period extended from day 0 until the 20th day of pregnancy. Body weights were recorded weekly during this period. At term, the rats were sacrificed, and the implantation sites and number of fetuses and resorptions were recorded. The fetuses were evaluated for external abnormalities under a stereomicroscope.Results: No differences in body weight gain between the groups were observed. The mean number of implantations per dam in stavudine‐treated groups was higher than in the control group (P < 0.05); however, only GIII presented an increase in the mean number of resorptions compared to the other groups (P < 0.01). The resorption/implantation rate was higher in the GII group and lower in the GIV group as compared to the other groups. Neither the mean fetal weights nor the placental weights differed significantly among the groups. No external anomalies were observed at dissection in rat fetuses, placentae or uteri.Conclusion: Rat pregnancy outcome seems to be affected by stavudine, mainly with respect to the mechanisms of intrauterine concept survival.
Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan
Authors: Shimano Satoshi , Nishikawa Akira , Sonoda Tomoko , Kudo Ryuichi 
Published: May 2004

AbstractAim: Our aims were to evaluate the prevalence of bacterial vaginosis (BV), Chlamydia trachomatis (C. trachomatis) infection and Mobiluncus spp. infection among pregnant women in Otaru, Hokkaido, Japan according to the month and year of the first prenatal visit, and to evaluate their risk factors.Methods: Six thousand and eighty‐three pregnant women who were seen consecutively at our hospital between 1993 and 2000, were enrolled in the study. Vaginal and endocervical swabs were subjected to Gram stain and detection of C. trachomatis. Univariate and multivariate methods were used to investigate the association between each infection and potential risk factors including age, gravidity, parity, history of dilatation and curettage (D & C), and history of natural abortion.Results: The annual rate of BV increased from 13.6% in 1993 to 21.4% in 2000. The annual rate of C. trachomatis infection was relatively constant. The prevalence of bacterial vaginosis, C. trachomatis infection and Mobiluncus spp. infection over the 8‐year period was 18.2%, 4.2%, and 4.1%, respectively. The prevalence of the three infections was significantly higher among teenagers and among women with a history of D & C. The prevalence of C. trachomatis and Mobiluncus spp. infections was significantly higher among women with no history of delivery. BV was not associated with parity on multivariate analysis. The monthly prevalence of BV was significantly higher in May than in December, and the monthly prevalence of C. trachomatis infection was high in August.Conclusion: The differences in the annual and monthly infection patterns between BV and C. trachomatis infection suggest that the etiologies of the two infections differ.
Evaluation of endometrial steroid receptors and cell mitotic activity in women using copper intrauterine device: Can Cu‐T prevent endometrial cancer?
Authors: Guleria Kiran , Agarwal Neera , Mishra Kiran , Gulati Rachna , Mehendiratta Anita 
Published: May 2004

AbstractAims: To study changes in endometrial proliferative indices (i.e. cell mitosis and Ki67), endometrial steroid (estrogen and progesterone) receptors, and serum estradiol and progesterone level in women using copper intrauterine device (IUD) after 6 months of use.Methods: Fifteen healthy women were recruited having no contra indication to IUD or endometrial biopsy. Endometrial biopsies and serum samples were taken on 10/11th day of menstrual cycle at recruitment and after six months. The endometrial samples were subjected to: (i) steroid receptor estimation by immunohistochemistry; (ii) cell mitosis and Ki67 estimation by morphology and proliferative indices.Results: The mean glandular mitotic index was 1.69 ± (0.39) at first visit and 0.35 ± (0.15) at second visit after 6 months. Similarly, Ki‐67 count in glands was 11.79 ± (1.59) at first visit and 2.40 ± (0.54) at second visit. In the stroma, Ki67 decreased from a mean of 0.85 to 0.01 in six months. This suggested statistically significant reduction in proliferation and mitotic activity in endometrial glands and the stroma of women who used Cu‐T continuously for a long period.There was a significant reduction of estrogen receptor concentration in glands (from a mean of 51.67 down to 11.67) and the stroma (from a mean of 33.00 to 8.00) over this 6‐month period. The observed fall in progesterone receptor counts was less compared to other parameters studied, being marginally significant in stroma (from a mean of 32.00 down to 14.33), but not significant enough in glands (from a mean of 45.00 down to 25.00). No changes were observed in serum hormone levels in these two visits.Conclusion: Continuous use of copper intrauterine device causes significant reduction in endometrial mitotic activity as well as estrogen receptor concentration without affecting serum estradiol or progesterone levels. This finding infers that Cu‐T may have a protective role against endometrial cancer.
Unsafe abortion: A neglected tragedy. Review from a tertiary care hospital in India
Authors: Jain Vanita , Saha Subhas C. , Bagga Rashmi , Gopalan Sarala 
Published: May 2004

AbstractAim: With 16% of the world's population, India accounts for over 20% of the world's maternal deaths. The maternal mortality ratio, defined as the number of maternal deaths per 100 000 live births is incredibly high at 408 per 100 000 live births for the country. Abortion has been legalized in India for the past three decades. However, the share of unsafe abortion as a cause of maternal mortality continues to be alarming. The objective of the present study is to identify the magnitude of problem of unsafe abortion in India.Methods: Emergency gynecologic admissions to a tertiary care center in North India over a 15‐year period (1988–2002) were reviewed to evaluate the demographic and clinical profile of patients admitted as a result of unsafe abortion. The records were analyzed with regard to the age group, parity and marital status of the abortion seekers, the indication of abortion, the methods used, qualification of abortion providers, complications and fatality rate.Results: The majority of women who were admitted with diagnosis of unsafe abortion were in the third decade of their lives. They were married, multiparous women living with their spouses. Sixty percent of the women had approached unqualified abortion providers who used primitive methods of pregnancy termination. All the women were admitted with serious complications of unsafe abortions and one‐fourth of them succumbed to the complications.Conclusion: Unsafe abortion constitutes a major threat to the health and lives of women. This study highlights the need to focus more directly on the needs and preferences of women who seek abortion as well as on the accessibility of contraceptives and skills of the providers of abortion services, in order to improve the quality of abortion care.
Therapeutic termination of second trimester pregnancies with intrauterine fetal death with 400 micrograms of oral misoprostol
Authors: Pongsatha Saipin , Tongsong Theera 
Published: May 2004

AbstractObjective: To assess the efficacy and maternal side‐effects of oral misoprostol for second trimester termination of pregnancies with intrauterine fetal death.Methods: A prospective descriptive study was conducted on 63 pregnant women who had intrauterine fetal death with unfavorable cervix (Bishop scores ≤4). All received 400 µg of misoprostol orally every 4 h until favorable cervix was achieved. Main outcome measures included success rate of termination within 12, 24, 36 and 48 h, mean induction to delivery time and maternal side‐effects.Results: The success rates of termination within 12, 24, 36, 48 h were 50.8%, 84.1%, 88.9% and 92.1%, respectively. Mean induction to delivery time in cases of delivery within 48 h was 13.2 ± 8.4 h, range 2.25–22.9 h. The most common maternal side‐effect was chill (33.3%). No serious maternal complication was detected.Conclusion: 400 µg oral misoprostol every 4 h is effective for pregnancy termination in cases of intrauterine fetal death and may be an alternative regimen because of its ease and convenience.
Auto antibodies against oxidized low density lipoprotein in severe preeclampsia
Authors: Jain Meenakshi , Sawhney Harjeet , Aggarwal Neelam , Vashistha Kala , Majumdhar Siddarth 
Published: May 2004

AbstractBackground: To study autoantibody titres against oxidized low density lipoprotein in preeclamsia.Methods: Ten millimeters of heparinized blood samples were collected from 20 primigravidae with severe preeclamsia (study group) and 20 gestation‐matched normotensive primigravidae (control group). Concentration of malondialdehyde, metabolite of lipid peroxidation were measured in sera by HPLC and autoantibodies against oxidized low density lipoproteins (obtained after oxidation with 2 mm CuSO4) were determined by ELISA. Statistical analysis was performed by Student's t‐test and χ2 test.Results: Mean triglyceride levels were significantly (P < 0.001) higher in the study group (193.20 ± 31.16 mg/dL) compared to the control group (170.60 ± 23.2 mg/dL). Mean plasma lipid per oxide levels were not significantly different between the study (4.45 ± 1.28 mmol/mL) and control (3.88 ± 0.99 mmol/mL) groups. The majority of women in both groups had low antibody titres (<1.32) against low density lipoprotein. Six women (30%) of the study group and four (20%) of the control group had high autoantibody titres (≥1.32). In preeclamptic women, diastolic blood pressure, the amount of urinary protein excretion and the plasma level of urea were significantly higher (P < 0.05) in patients with higher auto antibody titre.Conclusion: Titres of autoantibodies to oxidized low density lipoprotein were similar in normotensive and preeclamptic women. In preeclamptic women, titres correlated positively with the severity of preeclampsia.
Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance
Authors: Modanlou Houchang D. , Murata Yuji 
Published: May 2004

AbstractObjectives: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology.Background: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh‐sensitized and dying fetuses. This FHR pattern was called ‘sinusoidal’ because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death.Undulating FHR pattern: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre‐mortem FHR pattern; (4) pseudo‐SHR pattern; and (5) equivocal FHR patterns.Fetal conditions associated with SHR pattern: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth.Definition of true SHR pattern: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120–160 bpm; (b) amplitude of 5–15 bpm, rarely greater; (c) frequency of 2–5 cycles per minute; (d) fixed or flat short‐term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity.Physiopathology: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology.Conclusion: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics.
Evaluation of the Pyruvate Kinase isoenzyme tumor (Tu M2‐PK) as a tumor marker for cervical carcinoma
Authors: Kaura Babita , Bagga Rashmi , Patel Feruza D. 
Published: May 2004

AbstractVarious isoforms of the glycolytic enzyme pyruvate kinase are expressed in different cell types. One of these isoforms, Tu M2‐PK, is over‐expressed in tumor cells and released into body fluids. Plasma determination of Tu M2‐PK has been shown to discriminate between benign and malignant lesions. Tu M2‐PK was quantitated in the plasma of 50 patients with cervical carcinoma, 10 patients with chronic cervicitis and 10 healthy controls. The concentration of Tu M2‐PK was determined by commercial kits using a sandwich enzyme linked immunosorbent assay based on two monoclonal antibodies (clone I and II) specific for Tu M2‐PK. The sensitivity of the test for discrimination of malignant from non‐malignant condition was 82% with a specificity of 60%. Highly significant statistical difference was found in the means of three groups (P = 0.0002). The present results indicate that Tu M2‐PK can be used as a tumor marker in follow‐up of patients with cervical carcinoma.
Primary omental ectopic pregnancy
Authors: Wong Wai Chung , Wong Bonnie Pui Yee , Kun Ka Yan , Ng Tai Keung , Kwok Shek Yuen , Lee Chun Kit 
Published: May 2004

AbstractOmental ectopic pregnancy is a rare form of ectopic pregnancy. Presented here is a case primary omental ectopic pregnancy according to Studdiford's criteria. This patient presented with epigastric pain and anemia without vaginal bleeding, lower abdominal or pelvic pain. Pregnancy status was confirmed after admission. Transvaginal ultrasound examination revealed intrauterine contraceptive device in situ and a large amount of free peritoneal fluid, but no intrauterine sac or adnexal mass. Laparoscopy was performed but pelvic pathology did not account for the 2500 mL of haemoperitoneum. Laparotomy was carried out and partial omentectomy was performed.
Prediction of successful menorrhagia treatment after thermal balloon endometrial ablation
Authors: Shaamash Ayman H. , Sayed Ezzat H. 
Published: May 2004

AbstractBackground: Thermal balloon endometrial ablation (TBEA) is a non‐hysteroscopic technique, which relies on a combination of heat and pressure within the uterine cavity to destroy endometrium and superficial myometrium. It is a simple, easy and minimally invasive procedure with an equivalent effectiveness to hysteroscopic endometrial ablation.Objectives: To evaluate the effectiveness of TBEA in the treatment of menorrhagia and to identify the possible predictive factors for a successful outcome after 2‐year follow‐up.Methods: A prospective study was conducted, including 45 patients suffering from serious menorrhagia. Under local anesthesia with i.v. sedation, the Therma‐Choice™ (Gynecare, Somerville, NJ, USA) balloon was inserted transcervically and after inflation in the endometrial cavity with 5% dextrose, it was heated to 87°C for an 8‐minute treatment cycle.Results: There were no intraoperative complications and postoperative morbidity was minimal. At 2‐year follow‐up the overall improvement of menstrual pattern was 85%; with reported 29% amenorrhea, 23.5% hypomenorrhea and 32.5% euomenorrhea. Menorrhagia persisted in 15% of patients. Multiple logistic regression analysis of the factors that could affect the outcome showed that the chance for a successful treatment increased significantly with increased age (P = 0.044), shorter uterine depth (P = 0.049) and adequate balloon pressure (P = 0.027). These were the predictive factors for successful outcome. However, parity, uterine volume and endometrial thickness were not predictive factors.Conclusion: At 2‐year follow‐up, thermal balloon endometrial ablation is effective in menorrhagia treatment. Increased age, shorter uterine depth and adequate balloon pressure can be predictive factors for successful treatment.
Vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women: A randomized controlled trial
Authors: Bunnasathiansri Soysuwan , Herabutya Yongyoth , O‐Prasertsawat Pratak 
Published: May 2004

AbstractAim: To investigate the efficacy of vaginal misoprostol for cervical priming before dilatation and curettage in postmenopausal women.Methods: Forty‐four postmenopausal women with indication for dilatation and curettage were randomly assigned to receive either 400 µg of misoprostol or placebo vaginally 6 h before dilatation and curettage. The main outcome measures were the number of women who required cervical dilatation, cervical width, time taken to dilate to Hegar 6 and other complications.Results: The mean cervical diameter (4.59 millimeters in the misoprostol group vs 4.41 millimeters in the placebo group) was comparable between the two groups. A similar number of women in the misoprostol group and in the placebo group required cervical dilatation (12 vs 16, P = 0.35). The operative times for both groups were similar. The incidence of side‐effects was comparable in both groups. There were two uterine perforations in the misoprostol group (2 vs 0).Conclusion: There was no significant benefit from applying 400 µg vaginal misoprostol 6 h prior to dilatation and curettage in postmenopausal women.