bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulatory blood pressure as predictor of preeclampsia in diabetic pregnancies with respect to urinary albumin excretion rate and glycemic regulation
Authors: Lauszus Finn F. , Rasmussen Ole W. , Lousen Thea , Klebe Thomas M. , Klebe Joachim G. 
Published: March 2003

Background. Twenty‐four‐hour ambulatory blood pressure was evaluated as a predictor of preeclampsia in women with insulin‐dependent diabetes mellitus with respect to urinary albumin excretion rate and glycemic regulation.Methods. One hundred and fifty‐one women with insulin‐dependent diabetes mellitus were consecutively recruited from the outpatient maternity ward for 24 hour ambulatory blood pressure measurement with a portable monitor (SpaceLab 90207). Blood pressure was measured three times during pregnancy and once after delivery. Evaluation was performed with receiver‐operator‐characteristics curves in primiparous women. Stratified analysis and multiple regression was applied with respect to urinary albumin excretion rate, HbA1c, age, duration of diabetes mellitus, uric acid, and BMI.Results. The incidence of preeclampsia was significantly associated with increasing urinary albumin excretion rate, primiparity, and ambulatory blood pressure. Ambulatory blood pressure was associated with HbA1c throughout pregnancy adjusted for urinary albumin excretion rate. The ambulatory blood pressure was higher from first trimester throughout pregnancy in women developing preeclampsia compared to women who did not have preeclampsia. The best sensitivity and specificity for predicting preeclampsia in primiparous women were at cut‐off values of systolic and diastolic day ambulatory blood pressure above 122 and 74 mmHg, respectively. The relative risk of preeclampsia was significantly higher when ambulatory blood pressure was above the cut‐off values and increased further with higher urinary albumin excretion rate.Conclusions. The relationship between ambulatory blood pressure and preeclampsia is not confined to women with macroalbuminuria but is also present in women with normo‐ and microalbuminuria. Poor glycemic control and increased urinary albumin excretion rate is associated with preeclampsia when ambulatory blood pressure is above cut‐off values of 122/74 mmHg (systole/diastole). Ambulatory blood pressure is a reliable measurement for prediction of preeclampsia in primiparous women with insulin‐dependent diabetes mellitus.
Suspected big baby: a difficult clinical problem in obstetrics
Authors: Haram Kjell , Pirhonen Jouko , Bergsjø Per 
Published: March 2003

Background. Large for gestational age fetuses, also called macrosomic fetuses, represent a continuing challenge in obstetrics.Methods. We review various problems with large for gestational age fetuses. We have performed a literature search, mainly through the database PubMed (includes the Medline database). The clinical problem is discussed from the primary care provider's, the patient's and the obstetrician's point of view.Results. Macrosomomia is arbitrarily defined as having a fetal weight of above the 90th percentile, a birth weight of above 4000 g or 4500 g, or a birth weight of over +2 standard deviation of the mean birth weight by gestational age. The diagnosis of macrosomia is difficult, both by palpation and symphysis fundus measurement; even with sophisticated sonographic measures. The combination of biparietal diameter, femur length and abdominal circumference appears to be no better than abdorminal circumference alone..Interpretation. Based on the literature, labor should not be induced in nondiabetic pregnancies. The best policy is to await spontaneous birth or to induce labor after 42 weeks completion. A great number of cesarean sections have to be performed to avoid a single case of plexus brachialis paresis resulting from a difficult shoulder delivery. Cesarean section should not be considered in nondiabetic pregnancies unless the estimated fetal weight is above 5000 g. In pregnancies complicated by diabetes mellitus there are reasons for selective induction of labor if macrosomia is suspected and for cesarean section if the calculated birth weight is above 4000 g. Each department should have a strategy to handle such a situation because the problem with the difficult shoulder delivery cannot be completely avoided. Different procedures of managing difficult shoulder delivery are described.
Termination of third‐trimester pregnancy before term with gemeprost vaginal pessaries
Authors: Frambach Torsten , Müller Thomas , Blissing Silke , Sütterlin Marc , Dietl Johannes 
Published: March 2003

Objective.  Determination of the efficacy and side‐effects of the synthetic prostaglandin analog gemeprost for termination of pregnancy in the third trimester.Patients.  Retrospective record study of 40 women who had undergone third trimester termination of pregnancy before term by serial administration of gemeprost because of intrauterine fetal death or hopeless fetal prognosis. Patients with multiple pregnancy, a Bishop score > 5, contractions or contraindications to prostaglandins were excluded.Methods. Gemeprost vaginal pessaries (1‐mg) were given at 6‐hourly intervals until labor intervened. The main parameter studied was the induction‐delivery interval, the length of time between administration of the first dose and delivery. Statistical analysis was performed with the chi‐square and the Mann–Whitney U‐test.Results. The median induction‐delivery interval was 14.4 h (range 3–48 h). Delivery occurred within 12 h in 17 women (42.5%), within 24 h in 27 women (67.5%) and within 36 h in 37 women (92.5%). An average of 2.6 doses were given per patient. Multigravidae had a significantly shorter induction‐delivery interval than primigravidae (p < 0.01). A total of 87.5% women required analgesia. Side‐effects were infrequent.Conclusions. The administration of gemeprost vaginal pessaries represents an efficient method with few side‐effects for the induction of labor in the third trimester, provided patients are chosen carefully and monitored closely.
Ovarian tumor cell detection in peripheral blood progenitor cells harvests by RT‐PCR
Authors: Kurata Hitoshi , Takakuwa Koich , Tsuneki Ikunosuke , Aoki Yoichi , Tanaka Kenichi 
Published: March 2003

Background.  To evaluate the frequency of tumor cell contamination in autologous peripheral‐blood progenitor cells from patients with ovarian cancer, and to determine the impact of infusing such cells on relapses after high‐dose chemotherapy.Methods.  Seventy‐three samples of peripheral‐blood progenitor cells from 24 ovarian cancer patients were studied for contaminated tumor cells by cytokeratin 7 and cytokeratin 20 reverse transcriptase polymerase chain reaction.Results.  Tumor cell contamination in peripheral‐blood progenitor cells was detected in 11 of 24 patients (46%) and, among these, in four of 11 patients who received transplantations of peripheral‐blood progenitor cells. There was no trend towards longer relapse‐free survival in patients infused with cytokeratin‐negative peripheral‐blood progenitor cells as compared with positive ones. Interestingly, two of four patients who received transplantations of peripheral‐blood progenitor cells containing tumor cells were free from progression at 20 and 41 months after transplantation.Conclusion.  Tumor cell contamination of peripheral‐blood progenitor cells was frequently noted by transcriptase polymerase chain reaction in patients with ovarian cancer. The biological and clinical significance of this finding remains to be elucidated.
Induction to delivery time interval in patients with and without preeclampsia: a retrospective analysis
Authors: Griffiths Anthony N. , Hikary Nadia , Sizer Andrew R. 
Published: March 2003

Background.  Anecdotally, it is suggested that patients with preeclampsia have a shorter induction to delivery interval than patients without preeclampsia, despite there being no good objective evidence.Methods.  A retrospective analysis of 136 primiparous, singleton, cephalic, nonassisted vaginal deliveries between January 1997 and January 2000. Sixty‐eight women had induction of labor for preeclampsia and 68 women without preeclampsia had induction of labor for other reasons. The two groups were already case‐matched for maternal and gestational age. The following details were recorded from the case notes: maternal age, gestation at delivery, initial Bishop score, total dose of prostaglandin administered, induction to delivery interval, duration of second‐stage labor, birthweight, and the percentage of Apgar scores < 7 at 5 min. Statistical analysis was carried out with a Mann–Whitney U‐test, with the aid of SPSS version 9, Microsoft WindowsResults.  The women with preeclampsia had a statistically significant longer induction to delivery interval than those without preeclampsia. The mean induction to delivery interval of women with and without preeclampsia was 1049.5 min and 762.5 min, respectively (p < 0.001)Conclusion.  Women with preeclampsia had a longer induction to delivery interval than patients without preeclampsia. This fact must be considered when deciding upon the mode of delivery in preeclamptic patients.
Cytologic screening and human papilloma virus test in women undergoing artificial fertilization
Authors: Lundqvist Monalill , Westin Cecilia , Lundkvist ÖRjan , Simberg Niklas , Strand Anders , Andersson Sonja , Wilander Erik 
Published: March 2003

Background.  Infertile women in Sweden are offered in vitro fertilization (IVF) within the frame of the social security system. The present investigation was undertaken to evaluate the prevalence of genital human papilloma virus (HPV) infection in relation to the results of cytologic screening and to the infertility in these women.Material and methods.  Two hundred and fourteen women, mean age 32 years (range 20–40), admitted to the Center for Reproduction at Uppsala University Hospital for investigation of infertility and IVF were studied. Human papilloma virus tests were performed by a sensitive polymerase chain reaction‐based technique in cervical smears obtained at a medical examination or during oocyte retrieval. Cytologic screening results were obtained from medical records or at the time of investigation. The infertile women were compared with 197 healthy female controls.Results.  Infertility resulted from female factors in 47% and male factors in 29% of the cases, and remained unexplained in 24%. Seven percent of the infertile women were HPV‐positive compared with 9.1% of the controls. Only genital and oncogenic HPV types were identified. Human papilloma virus type 16 was most prevalent, and examination of the HPV 16 E6 gene showed that this prototype predominated over variants. No correlation was found between HPV infection and cause of infertility. Abnormal cytology was observed in 2.3% of the infertile women and 4.1% of the controls.Conclusions.  Human papilloma virus infections might appear somewhat less frequently in infertile women admitted for IVF than in a control population. In both groups HPV infection was more common than cytologic abnormalities, possibly indicating that present HPV tests are more sensitive in detecting HPV infections than cytologic screening.
Cost‐analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension‐free vaginal tape procedure
Authors: Persson Jan , Teleman Pia , Etén‐Bergquist Christina , Wølner‐Hanssen Pål 
Published: March 2003

Background.  The aim of this study was to compare laparoscopic colposuspension with tension‐free vaginal tape (TVT) in terms of costs to the county.Methods.  In a prospective, randomized study, we approached 270 consecutive women presenting for evaluation of stress urinary incontinence symptoms at one university hospital. Preoperatively, and at 1‐year follow‐up, the women underwent urodynamic evaluation, an ultra‐short pad‐test and completed a lower urinary tract symptoms questionnaire. We randomized 79 consenting, eligible women to either procedure; a 1‐year follow‐up examination was performed on 68/71 (96%) women that were available. The procedures were performed as described previously. Main outcome measures were all relevant costs for goods and services associated with the procedures.Results.  The baseline characteristics of the two groups were similar. The TVT procedure was performed significantly faster than the laparoscopic colposuspension, i.e. 44.9 ± 14.2 min compared with 60.5 ± 13.4 min (p < 0.0001). Even so, procedural costs were significantly lower for laparoscopic colposuspension than for TVT (€ 1273.4 compared with € 1342.8 p < 0.001). At the 1‐year follow‐up visit, three women operated on with TVT and one operated on with laparoscopic colposuspension required re‐operation for continuous stress urinary incontinence. One women operated on with TVT had her sling cut for bladder‐emptying problems. Total costs, including re‐operations were € 1462.6 for a TVT procedure and€ 1314.5 for a laparoscopic colposuspension.Conclusion.  In our hands, the laparoscopic colposuspension was less expensive to the county than the TVT procedure.
An update on the controversies of tocolytic therapy for the prevention of preterm birth
Authors: Ingemarsson Ingemar , Lamont Ronald F. 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 1–9. © Acta Obstet Gynecol Scand 2003Preterm birth is the major cause of perinatal mortality and morbidity in the developed world. Where there are no contraindications to their use, tocolytics can improve neonatal survival rates by approximately 3% per day between 23 and 27 weeks gestation with a concomitant reduction in morbidity. The ultimate aim of tocolytic therapy is to prolong pregnancy until growth and maturation is complete, but even short‐term delay may enable the administration of antepartum glucocorticoids to reduce hyaline membrane disease or to arrange transfer to a center with neonatal intensive care facilities. Both of these have been shown to reduce neonatal mortality and morbidity. Until recently, none of the currently used tocolytics, whether licensed or unlicensed, were developed specifically for the inhibition of preterm labor and consequently, they exhibit various potentially serious side‐effects. As a result of the recent licensing of the oxytocin antagonist, atosiban, developed for the treatment of preterm labor and due to its high utero‐specificity, obstetricians have experienced an advance in their options for the management of spontaneous preterm labor.
Elevated maternal mid‐trimester chorionic gonadotropin ≥4 MoM is associated with fetal cerebral blood flow redistribution
Authors: Hershkovitz Reli , Erez Offer , Sheiner Eyal , Landau Daniella , Mankuta David , Mazor Moshe 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 22–27. © Acta Obstet Gynecol Scand 2003Background. Elevated mid‐trimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG, fetal pathological arterial waveforms and maternal and perinatal complications.Methods. Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 121 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded.Results. Of 121 women with hCG > 2.5 MoM, 36/121(29.6%) had hCG between 2.5 and 3.0 MoM, 35/121(28.9%) had hCG between 3.0 and 3.5 MoM, 21/121(17.3%) had hCG of 3.5–4.0 MoM, 17/121(14.1%) had hCG levels between 4.0 and 4.5 MoM, and 12/121(9.9%) had hCG > 4.5 MoM. Middle cerebral artery PI was significantly lower in women with hCG > 4.0 MoM between 28 and 36 weeks' gestation, but not between 18 and 27 weeks' gestation. No differences of MCA PI were found when the cut‐off point of hCG was 3.5. Women with hCG levels > 4.0 MoM had a significantly higher rate of preterm deliveries, cesarean sections, higher rate of Apgar scores < 7 and a significantly lower mean birth weight in comparison with women with hCG < 4.0 MoM. The prevalence of PIH and preeclampsia and perinatal death were found to be higher among patients with hCG levels > 4.0 MoM, although not significantly. No differences were found at hCG levels less than 4.0 MoM.Conclusions. In pregnancies with mid‐trimester hCG > 4.0 MoM, redistribution of cerebral blood flow is expressed after 28 weeks' gestation. These pregnancies have higher rates of maternal and neonatal complications as compared to pregnancies with lower hCG levels.
Leiomyosarcoma of the uterus: a clinicopathologic study of 21 cases
Authors: Hsieh Chin‐Hsiung , Lin Hao , Huang Chao‐Cheng , Huang Eng‐Yen , Chang Shiuh‐Young , ChangChien Chan‐Chao 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 74–81. © Acta Obstet Gynecol Scand 2003Background. The purpose of the present study was to identify the prognostic factors of and to determine the most appropriate mode of treatment for uterine leiomyosarcoma.Methods. We reviewed the hospital records, including surgical notes and pathologic reports, of 21 patients with uterine leiomyosarcoma treated at Chang Gung Memorial Hospital, Kaohsiung, Taiwan, between 1987 and 1997. Univariate analysis was performed using the log‐rank test. Cox regression was used to identify independent prognostic factors.Results. The mean follow‐up time was 30 months, and the 5‐year disease‐free survival rate was 55%. Evaluating the correlation between clinicopathologic parameters and survival, early stage (p = 0.0002), tumor cells without necrosis (p = 0.0026), low‐grade tumor (p = 0.015), absence of vascular space involvement (p = 0.006), and tumor without atypia (p = 0.016) were associated with good prognosis. However, in a multivariate analysis using the Cox model, only advanced stage (p = 0.032) and tumor necrosis (p = 0.032) were found to be independent poor prognostic factors. The 5‐year disease‐free survival was only 21% in patients with the presence of any one or both of these two factors. Five of 11 patients in this group had received aggressive adjuvant therapy after surgery, and none of them survived more than 19 months.Conclusions. We found that patients with advanced stage or presence of tumor necrosis had an extremely poor prognosis. Adjuvant therapy seemed to play a limited role, and provided no survival benefit. Treatment for these patients should be palliative until effective therapeutic modalities prove otherwise.
Choroidal Langerhans' cell histiocytosis
Authors: Kim In Taek , Lee Sang Min 
Published: March 2003

ABSTRACT.Purpose: To report a patient with choroidal Langerhans' cell histiocytosis.Methods: A solitary tumor was found in the left eye of a 49‐year‐old male who had no definite history of systemic disorders, but had observed visual disturbances for a period of 1 month. Ultrasonography, fluorescein angiography, and indocyanine green angiography were performed and the eyeball was enucleated. We prepared the specimen for microscopic examinations.Results: Fluorescein angiographic findings of the lesion were mottled hyperfluorescence in the arteriovenous phase and strong hyperfluorescence in the late phase. Hypofluorescence in both early and late phases showed on indocyanine green angiogram. The lesion of choroid was widely infiltrated by histiocytes, though no extraocular invasion was found. Immunohistochemical studies including S‐100 and CD 68 staining revealed characteristic features of Langerhans' cell histiocytosis. Electron microscopic examination of the histiocytes showed histiocytosis X body (Birbeck granule) in the cytoplasm and indented nucleus.Conclusion: We consider that this is a case of choroidal Langerhans' cell histiocytosis with no evidence of systemic lesions.
Cyclosporine treatment of RPE allografts in the rabbit subretinal space
Authors: Crafoord Sven , Algvere Peep V. , Kopp Eva Dafgård , Seregard Stefan 
Published: March 2003

ABSTRACT.Purpose: To determine the effects of systemic cyclosporine A (CsA) on the survival of retinal pigment epithelial (RPE) allografts in the subretinal space in an animal model using atraumatic transplantation surgery.Methods: Following pars plana vitrectomy, an RPE cell suspension from brown rabbits was injected with a glass micropipette into the subretinal space of 39 albino rabbits. For immunosuppression, 22 rabbits were given an injection of CsA, 20 mg daily intramuscularly, 17 rabbits with RPE grafts were controls. The grafts were monitored by biomicroscopy, color fundus photography, and fluorescein angiography. Rabbits were sacrificed at 1, 3 and 6 months, respectively, and the eyes processed for light and electron microscopy including immunohistochemistry.Results: After three months, the transplanted RPE cells, in both the CsA group and the controls, formed a monolayer in the subretinal space. Although a few macrophages were encountered, there was no massive cellular infiltration and the photoreceptor layer was well preserved. After six months, however, there was a disruption of grafted RPE cells in both groups, characterized by dispersion of melanin pigment in the subretinal space, and invasion of macrophages with focal photoreceptor damage but no infiltration of lymphocytes in the retina or choroid. No significant differences between the CsA treated and the control eyes were discernible.Conclusion: Although the subretinal space has been considered an immunologically privileged site, we found that the survival of RPE allografts was limited. CsA did not prevent RPE allograft destruction in the subretinal space. The transplant seems to be disrupted either by immunological mechanisms that are not inhibited by CsA, or by nonimmunologic events.
Simultaneous, bilateral rhegmatogenous retinal detachment
Authors: Krohn Jørgen , Seland Johan H. 
Published: March 2003

ABSTRACT.Purpose: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment.Methods: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998.Results: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100 000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from −3 to −9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period.Conclusion: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.