bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of 114 non‐neoplastic vulvar biopsies
Authors: O'keefe Rodeney J. , Scurry James P. , Dennersten Graeme , Sfameni Salvatore , Brenan John 
Published: August 2005

ABSTRACTObjective
The purpose of this study was to show the benefits and limitations of vulvar biopsy in the setting of a multidisciplinary clinic specialising in non‐neoplastic diseases of the vagina and vulva.Design
One hundred and fourteen vulvar biopsies were reviewed and classified according to the classification of the International Society for the Study of Vulvar Diseases.Results
The histological diagnoses were lichen sclerosus 25 YO, nonlichen simplex chronicus 35%, erosive inflammatory dermatoses comprising psoriasis, spongiotic dermatitis, dermatophytosis and psoriasiform dermatitis 13%, erosive vulvitis and lichen planus 9%, nonspecific inflammation 6%, miscellaneous 9% and normal 4%.Conclusions
Biopsies in cases of lichen sclerosus were useful for confirmation of clinical diagnosis and to exclude early invasive malignancy. In lichen simplex chronicus, biopsies helped exclude an underlying dermatosis requiring specific treatment. Psoriasis, spongiotic dermatitis, dermatophytosis and excoriated lichen simplex chronicus posed a common clinical differential diagnosis of the reddened vulva. The eroded vulva often proved a diagnostic problem clinically and histologically. The clinical syndrome of vestibulitis did not have a specific histological picture, and biopsies showed nonspecific inflammation, mild hyperplasia or were normal. No case of squamous cell hyperplasia was diagnosed and the place of this diagnosis in the ISSVD classification needs review.
Management of female genital mutilation : the Northwick Park Hospital experience
Authors: McCafrey M. , Jankowska A. , Gordon H. 
Published: August 2005

ABSTRACTObjective
To outline the problems associated with female genital mutilation and to highlight the need for deinfibulation before delivery.Design
A review of women attending a newly established African Well Woman Clinic. Age at infibulation, gravidity of clinic attenders and adequacy of introitus for management of labour were assessed.Setting
Northwick Park Hospital, Harrow, Middlesex.Subjects Fifty women attending a newly established African Well Woman Clinic, of whom 13 were nulliparous, 14 were primigravid and 23 were multigravid.Results
The average age at which infibulation had occurred was 6–7 years. At the time of clinic attendance the mean age of pregnant and nonpregnant patients was 26 and 23.3 years, respectively. Of the 14 primigravid patients, only 50% had an adequate introitus to allow management of the first and second stages of labour. Five had deinfibulation performed antenatally or at delivery. Ninety‐three percent of the primigravid patients and 74% of the multigravid patients had a vaginal delivery.Conclusions
We believe that the Northwick Park Hospital management policy for intibulated women closely mirrors the cultural practices in Somalia. The policy also improves obstetric management of infibulated patients. Twenty‐six percent of referrals were of nonpregnant women, and this practice is to be encouraged.
Obstetric antecedents of surgically treated obstetric brachial plexus injuries
Authors: Ubachs J. M. H. , Slooff A.C. J. , Peeters L. L. H. 
Published: August 2005

ABSTRACTObjective
To determine whether the anatomy of an obstetric brachial plexus lesion (OBPL) is causally related to the preceding obstetric history.Design
Anatomical classification of the OBPL during reconstructive neurosurgical treatment in consecutive infants who had surgery for OBPL between 1986 and 1994 and relating these findings with the characteristics of the preceding birth.Setting
De Wever Hospital, Heerlen, The Netherlands.Subjects
All infants who had surgical treatment for OBPL between 1 April 1986 and 1 January 1994 (n= 130).Results
An Erb's C546 injury was preceded more frequently by a difficult breech birth (19/26 cases or 73 YO). In contrast, the more extensive forms of Erb's palsy classified as a C547 injury or a total palsy with a C5–Tl injury were observed more frequently after complicated cephalic birth (52/59 or 88%, and 43/45 or 96%, respectively). The extent of anatomical damage as expressed by the incidence of an avulsion of one or more spinal nerves was 18/26 (69 %) in Erb C5–C6, 13/59 (22%) in Erb C547 and 21/45 (47%) in total C5–T1 palsy.Conclusion
The Erb's CS‐C6 palsy, occasionally bilateral and/or complicated by phrenic nerve injury, was the most frequent form of OBPL after a breech birth. The more extensive form of Erb's palsy and the total palsy were observed more frequently after delivery in a cephalic presentation. The pure form of Erb's palsy and the total palsy were characterised by a higher incidence of nerve avulsions than the extensive form of Erb's palsy.
The European Collaborative Study: clinical and immunological characteristics of HIV 1‐infected pregnant women
Authors: Thorne Claire , Newell Marie‐Louise , Dunn David , Peckham Catherine ,   The names of all collaborators and others who assisted may be found on page 874
Published: August 2005

ABSTRACTObjective
To describe the changing clinical and immunological characteristics and timing of diagnosis of HIV‐infected pregnant women enrolled in the European Collaborative Study.Design
A prospective study of the mothers of children enrolled in the European Collaborative Study on children born to HIV‐infected women.Setting
Twenty‐one European centres in seven countries.Subjects
One thousand six hundred and ninety HIV‐infected women and their 1754 deliveries.Results
The proportion of women in whom HIV infection had been diagnosed before pregnancy increased significantly over time, from 7% in 1984–1985 to 65% in 1994 (P < 0.001). The prevalence of breastfeeding, which was related to the timing of diagnosis, significantly declined over the study period. The mean CD4 count was 510 cells/mm3, and there was a significant decline in average CD4 count over the study period. Black women had a significantly lower CD4 count than white women. From survival analysis it is estimated that five years after delivery 14% of women will have died and 24% will have developed CDC stage IV disease.Conclusions
Timing of diagnosis is of critical importance if mother‐to‐child transmission is to be reduced through avoidance of breastfeeding and zidovudine therapy and effective antenatal screening policies have become increasingly important. The rate of progression of maternal disease highlights the implications of HIV infection for their children, both infected and uninfected.
Lack of evidence for a circadian rhythm of IGFBP‐1 in the mother and fetus during labour
Authors: Harding S. , Kyei Mensah A. , Hills F. , Howell R. J. S. , Chard T. 
Published: August 2005

ABSTRACTObjective
To determine whether the circadian rhythm of circulating levels of insulin‐like growth factor binding protein‐1 (IGFBP‐1) is evident at the time of delivery.Design
Prospective observational study in six pregnant women and cross‐sectional study in 65 women at the time of delivery.Subjects
Six pregnant women sampled over a period of 24 hours, 23 women sampled at the time of elective caesarean section, and 42 women sampled at the time of vaginal delivery.Results
In the women sampled serially over a 24 hour period there was an obvious circadian rhythm of IGFBP‐1 with a peak between 01.00 and 09.00 hours. In the women sampled at the time of delivery there was no evidence for any relationship between the time of delivery and maternal or fetal levels of IGFBP‐1.Conclusions
The circadian rhythm of IGFBP‐1 is not observed in women in labour. Therefore, the time of day is not an important confounding variable in studies on IGFBP‐1 levels at the time of normal delivery.
Pre‐operative morphological and colour Doppler features of borderline ovarian tumours
Authors: Zanetta Gerardo , Lissoni Andrea , Cha Stephen , Bertalero Carlo , Scalambrino Salvatore , Bratina Giorgio 
Published: August 2005

ABSTRACTObjective
To evaluate pre‐operatively the sonographic morphology and colour Doppler findings of borderline ovarian tumours and to compare these findings to those of benign and malignant tumours.Methods
Pre‐operative transvaginal and colour Doppler ultrasound examinations were performed on 150 women with adnexal tumours. Pulsatility index, resistance index, peak systolic velocity, site, number and confluence of vessels were recorded.Results
Fifty‐six women had malignant ovarian tumours, 74 had benign and 20 had borderline tumours. No biological, morphological or demographic parameters were specifically predictive of borderline tumours. Intratumoral vessels with a pulsatility index of below 1.0 were observed in 19 of the 20 borderline tumours; a morphological score suggested malignancy in 15 women whereas the CA125 exceeded 30 u/ml in 10 cases. Confluence of blood vessels was observed only in three cases. A model including intracystic complexity (either vegetations or septa), pulsatility index of less than 1.0, absence of confluence of vessels, CA125 of less than 150 u/L, in a woman under 60 years of age allowed borderline tumours to be detected with 85% sensitivity, 92 % specificity and 91 % accuracy.Conclusion
Borderline tumours have haemodynamics resembling those of malignant tumours but the distribution of vessels is often similar to that observed in benign tumours; this observation should be considered when proposing multiparameter scoring systems including colour Doppler ultrasound to identify malignancies of the ovary. Colour Doppler findings may be of assistance in the follow up of women after conservative surgery for ovarian malignancies.
Evaluation of flexible senior registrar training in obstetrics and gynaecology
Authors: Fiander Alison 
Published: August 2005

ABSTRACTObjective
To evaluate part‐time senior registrar training in obstetrics and gynaecology from the perspective of the trainees.Design
Postal questionnaire.Subjects
Past and present senior registrar trainees on the PM(79)3 scheme.Results
Thirty‐two questionnaires were returned (86% response rate) from 20 current trainees (100% response) and 12 (71% response) past trainees. Family commitments were the main reason for training part‐time. Of these, 84% were satisfied with their training and most (81%) thought the quality as good or better than full time training. Personalised timetables were seen to be of particular benefit. Negative attitudes towards part‐time training and discrimination in favour of full time trainees were seen as some of the biggest difficulties associated with part‐time training. Other problems included administrative delays in organising part‐time posts, time restriction, and the length of training.Conclusions
Part‐time senior registrar training is effective in retaining trainees with domestic commitments within the speciality. It is regarded as being of high quality but with attendant problems, particularly those related to the negative attitudes of others. Recommendations for improvements have been made.
The 1993 British Society for Colposcopy and Cervical Pathology/National Coordinating Network United Kingdom Colposcopy Survey
Authors: Kitchener H. C. , Cruickshank M. E. , Farmery E. 
Published: August 2005

ABSTRACTObjective
To evaluate colposcopic practice over a 12‐month period in the UK, April 1993 to March 1994, to compare this with 1988, and to test penetration and acceptance of previously introduced national guidelines.Design
A nationwide survey of colposcopy practice by postal questionnaire, including referral criteria, diagnosis and treatment, follow up, waiting times and information and counselling.Setting
All gynaecology clinics in the United Kingdom.Results
Returns were obtained from 215 clinics (78%), that saw an average of 434 new women per year. Seventy percent of clinics follow the current national guideline for cytological referral criteria for colposcopy. Diathermy loop excision is now by far the most popular treatment method for CIN. The majority of clinics employ both colposcopy and cytology for follow up. A total of 103 invasive cancers following treatment for CIN were reported during the 12‐month period of the survey. Most clinics provide new patients with both information and counselling.Conclusions
Colposcopy practice has undergone considerable changes in the last five years. There has been a good response to the introduction of a national guideline for referral for colposcopy. While local audits are necessary to identify improvements that need to be made to individual clinical services, this national audit has shown some trends over the past five years, has highlighted the problem of invasive cancer following treatment for CIN and has assessed the impact of a national guideline.
Blues and depression during early puerperium: home versus hospital deliveries
Authors: Pop V. J. , Wjnen H. A. , van Montfort M. , Essed G. G. , de Geus C. A. , van Son M. M. , Komproe I. H. 
Published: August 2005

ABSTRACTObjective
To investigate whether women who give birth at home are less prone to mood disturbances during the early puerperium than those who give birth in hospital.Design
A prospective study of 303 pregnant women who registered for antenatal care.Setting
The antenatal clinic at St Joseph's Hospital, Veldhoven, The Netherlands, and five antenatal consultation programmes of local midwives working in the surrounding region.Subjects
Three hundred and eighty‐two consecutive Caucasian women registering for antenatal care were approached. Of these, 303 consented to participate and 293 completed the study.Main outcome measure
The predictor variable was the way in which the women gave birth: spontaneous vaginal parturition at home or in hospital as follows: spontaneously; vaginal parturition after stimulation with medication; vaginal parturition with forceps/vacuum extraction; or caesarean section. The outcome variables were blues and depression. The occurrence of blues was assessed at 4 weeks postpartum, using Pitt's criteria. The occurrence of depression was assessed at 4 weeks postpartum using the Research Diagnostic Criteria. The possible confounding effects of a set of obstetrical and psycho‐social variables relating to the early puerperium were investigated using logistic regression analysis.Results
Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium.Conclusions
Women who give birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.
Ovarian cancers related to minimal access surgery
Authors: Crawford Robin A. F. , Gore Martin E. , Shepherd John H. 
Published: August 2005

ABSTRACTObjective
To review the clinical features of women with ovarian cancer on whom minimal access surgery has been performed and to determine guidelines for the safe use of minimal access surgery for adnexal masses.Design
Postal survey of members of the British Gynaecological Cancer Society (BGCS) and retrospective case review.Results
BGCS consultants used ultrasound scanning (70%) and serum CA‐125 estimations (53%) prior to adnexal mass surgery. The membership felt that adnexal masses with solid elements, diameter greater than 8 cm, multi‐ocular or bilateral cysts or increased blood flow on Doppler scanning should not be operated on by minimal access surgery. A positive family history was also considered to be a contraindication. A total of 29 cases of ovarian cancer were identified on whom MAS had been performed. The incidence of cases was 4.1% of referrals to a tertiary referral centre (the Royal Marsden Hospital). The median age of patients was 37 years (range 20 to 68 years) and 13 had Stage I cancers. The mean delay between diagnosis and staging was 6.5 weeks.Conclusion
Guidelines on the use of minimal access surgery in the management of adnexal masses need to be agreed. Women who have an ovarian cancer diagnosed whilst having minimal access surgery should have an accepted staging procedure. We do not recommend the routine use of minimal access surgery for the treatment of ovarian cancer outside a trial.
Cyclic guanosine 3′3′ monophosphate concentrations in pre‐eclampsia: effects of hydralazine
Authors: López‐Jaramillo Patricio , Narváez Marcelo , Calle Andrés , Rivera José , Jácome Patricio , Ruano César , Nava Eduardo 
Published: August 2005

Objective
To elucidate the role of the L‐arginine: nitric oxide pathway in pregnancy and pre‐eclampsia.Participants
Pregnant women (nulliparous, age < 25 years). Normotensive pregnancy (n= 22) was defined when blood pressure remained at levels of < 120/80 mmHg and there was no proteinuria. Women with pre‐eclampsia (n= 22) had blood pressure measurements of > 140/90 mmHg and proteinuria of > 300 mg/l. Nonpregnant normotensive women (n= 22) were studied as controls.Study Design
Blood samples were taken for measurements of ionised calcium, atrial natriuretic factor, cyclic guanosine 3′5′monophophate (GMP), arginine and asymmetric dimethylarginine. Urine samples were collected for determination of cyclic GMP excretion. Cyclic GMP concentrations were also determined in 12 women with severe pre‐eclampsia before and after treatment with hydralazine.Results
L‐arginine, asymmetric dimethylarginine and atrial natriuretic factor were not different in any group. Cyclic GMP concentrations in plasma [0.94 (SD 0.23) nM] as well as in urine [50.1 (SD15.7)μM] were increased significantly (P < 0.05) in normal pregnancy compared to nonpregnant controls [plasma mean 0.46 (SD 0.12) nM and urine mean 18.4 (SD 10.3) μM], but not in the pre‐eclampsia group [plasma mean 0.48 (SD 0.10) nM and urine mean 24.1 (SD 14.5) μM]. Concentrations of cyclic GMP in plasma and urine increased significantly (P < 0.05) in women treated with hydralazine.Conclusions
The differences in cyclic GMP concentrations may reflect differences in nitric oxide production. Hydralazine increases cyclic GMP concentrations in severely pre‐eclamptic women. This action could explain the antihypertensive effect of hydralazine.
ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women
Authors:   ECPPA (Estudo Colaborativo para PrevenGdo da PrP‐eclampsia com Aspirina) Collaborative Group
Published: August 2005

Objective
To determine the effectiveness of low dose aspirin in women at high risk of adverse outcomes associated with pre‐eclampsia.Design
A collaborative randomised trial comparing the effects of low dose aspirin (60 mg) with placebo on pre‐eclampsia and other materno‐fetal complications associated with hypertension.Setting
Twelve teaching maternity hospitals and 182 obstetricians' offices in Brazil.Subjects
One thousand and nine women considered to be at high risk for the development of pre‐eclampsia, or its complications, entered the study between 12 and 32 weeks of gestation. They were randomly allocated to receive aspirin (498 women) or placebo (511 women) until delivery, and follow up was obtained for 96%.Results
There were no significant differences between the treatment groups in the incidence of proteinuric pre‐eclampsia (6.7% aspirin‐allocated compared with 6–0% placebo‐allocated women), of preterm delivery (22.3% compared with 26.1%), of intrauterine growth retardation (8.5% compared with 10.1%), or of stillbirth and neonatal death (7.3% compared with 6.0%), nor were there significant differences in the incidence of proteinuric pre‐eclampsia in any subgroup of women studied, including those who had systolic blood pressures of 120 mmHg or above at entry (8.5% compared with 7.3%) or those who were chronically hypertensive (10.0% compared with 7.1%). Aspirin was not associated with a significant excess of maternal or fetal bleeding.Conclusion
The results of this study do not support the routine prophylactic administration of low dose aspirin in pregnancy to any category of high risk women (even those who have chronic hypertension or who are considered to be especially liable to early onset pre‐eclampsia).
Lower genital tract swabs in the prediction of intrauterine infection in preterm prelabour rupture of the membranes
Authors: Carroll S. G. , Papaioannou S. , Ntumazah I. L. , Philpott‐Howard J. , Nicolaides K. H. 
Published: August 2005

Objective
To examine the genital tract flora in women with preterm prelabour rupture of the membranes and to determine the relationship of these microorganisms to those found in fetal blood and amniotic fluid.Design
Prospective study of 97 patients with preterm prelabour rupture of the membranes.Setting
Maternal‐fetal medicine centre.Methods
High vaginal and endocervical swabs were taken for routine culture of aerobic and anaerobic bacteria and Ureaplasma urealyticum and Mycoplasma hominis. Cordocentesis and amniocentesis were performed and fetal blood and amniotic fluid were cultured for aerobic and anaerobic bacteria. Amniotic fluid was also cultured for Mycoplasma spp. The sensitivities and specificities of genital tract colonisation in the prediction of fetal blood and amniotic fluid infection were calculated.Results
Positive genital tract cultures for aerobic and anaerobic organisms predicted 40% of positive fetal blood and 53% of positive amniotic fluid cultures with false positive rates of 24% and 25%, respectively. The sensitivity and false positive rates for genital tract colonisation with Mycoplasma spp in the prediction of amniotic fluid infection with these organisms were 85% and 35%, respectively.Conclusions
In preterm prelabour rupture of the membranes lower genital tract cultures provide poor prediction of intrauterine infection.
Estimation of fetal lung volume using enhanced 3‐dimensional ultrasound: a new method and first result
Authors: D'Arcy Thomas J. , Hughes Stephen W. , Chiu Wilson S. C. , Clark Terry , Milner Anthony D. , Saunders John , Maxwell Darryl 
Published: August 2005

Objective To measure fetal lung volume using a computer based, enhanced, 3‐dimensional ultrasound imaging system.Design An observational study.Setting The Fetal Medicine Unit at Guys Hospital, London.Participants
Twenty healthy women with a singleton pregnancy between 24 and 36 weeks of gestation were scanned on one occasion during pregnancy using an ultrasound based 3‐dimensional imaging system. All delivered at term with weights above the 10th centile for gestation.Results Total lung volume increased exponentially with gestational age. Right lung volume measured consistently greater than left lung volume.Conclusions The use of this new enhanced 3‐dimensional imaging system allows for estimations of fetal lung volume. Preliminary data confirm that fetal lung volume, measured by a computerised 3‐dimensional ultrasound imaging system increased exponentially with gestational age. The use of this system has obvious application in the further study of lung growth in utero and possible clinical application in disease states where fetal lung growth may be impaired.