bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?
Authors: Seracchioli R. , Colombo F.M. , Bagnoli A. , Govoni F. , Missiroli S. , Venturoli S. 
Published: December 2003

Objective
The purpose of the study was to evaluate the post‐operative course and follow up of women who had undergone laparoscopic removal of intramural fibroids penetrating the uterine cavity.Design
Retrospective study.Setting
Center for Reconstructive Pelvic Endosurgery, Italy.Population
Thirty‐four women with fibroids penetrating the uterine cavity.Methods
Laparoscopic myomectomy.Main outcome measures
Feasibility and safety of surgical technique, length of operation, blood loss, intra‐ or post‐operative complications, length of hospital stay, resolution of symptoms and future obstetric outcome.Results
The mean operative time was 79 (SD 30) minutes; the mean reduction in haemoglobin was 1.1 ± 0.9 g/dL. No intra‐ or post‐operative complications were observed. The average post‐operative stay in hospital was 54 (SD 22) hours. Nineteen (73%) out of 26 patients who had experienced symptoms prior to surgery reported resolution of these symptoms post‐operatively. All patients resumed work within a mean time of 20 (SD 8) days. Among 23 of the 32 patients attempting pregnancy during the follow up period, nine (39%) conceived within one year. Seven pregnancies went to term without complications.Conclusion
The clinical results of this study suggest that laparoscopic myomectomy for intramural fibroids penetrating the uterine cavity is a safe procedure, providing well known advantages of minimal access surgery.
The 24‐hour pad test in continent women and men: normal values and cyclical alterations
Authors: Karantanis E. , O'Sullivan R. , Moore K.H. 
Published: December 2003

Objective
To obtain control values for the 24‐hour pad test in a wide age range of continent women using accurate weighing scales and to compare the results obtained from pantyliners and pads in women and men.Design
Prospective anonymous study.Setting
A Sydney Tertiary Urogynaecology Unit.Population
One hundred and forty continent women and 14 continent men.Methods
A 24‐hour pad test was performed in 120 continent women of widely varying ages, in whom hormonal status and exercise habits were documented. These continent women wore a standardised pantyliner for 24 hours and a high precision beam balance (accuracy 0.1 g) was used to measure the loss on the pad. To assess any variation in pad weights with differing pads, 20 female volunteers undertook the 24‐hour test firstly with pantyliners then larger pads. To understand evaporative qualities of the two types of pads, one male wore each type of pad, instilled with 5 mL normal saline for eight hours overnight. Furthermore, to understand the contribution of vaginal secretions, a group of male volunteers performed a 24‐hour test with pantyliners followed by pads.Main outcome measures
Pad weight, with regard to hormonal status, exercise, pad type and gender.Results
The median age of subjects was 48 (interquartile range [IQR] 32–60), with a median pad weight gain of 0.3 g (IQR 0.2–0.6; 95th centile 1.3 g). Subgroup analysis showed no significant trends for pad loss in relation to menopause status, use of hormone replacement therapy or hormonal contraception and exercise status during the 24‐hour period. Control values for pantyliners were not significantly different from those for continence pads. In addition, normal values in 14 males showed similar results, regardless of pad type.Conclusions
The response rate of 39% might limit the applicability of the results. However, our finding that women lose only 0.3 g of vaginal secretions in 24 hours is much lower than previously reported. This might arise from the use of a highly accurate beam balance and the recruitment of a large sample of women with widely varying ages. This result might lower the threshold for objective diagnosis of urinary incontinence and alters the pad test definition of ‘cure’.
Hormone replacement therapy and hypercoagulability. Results from the Prospective Collaborative Danish Climacteric Study
Authors: Sidelmann J.J. , Jespersen J. , Andersen L.F. , Skouby S.O. 
Published: December 2003

Objective
To assess the influence of a variety of HRT regimens on the haemostatic balance using markers of fibrin turnover and inhibitors of coagulation.Design
An open randomised study allocating women to either a control group or five different HRT treatment groups.Setting
Gentofte Hospital, Hellerup, and Rigshospitalet, Copenhagen, Denmark.Population
One hundred and forty‐nine postmenopausal women without previous venous thromboembolic disease.Methods
Prothrombin fragment 1+2 (F1+2), fibrin degradation products, antithrombin, protein C, total protein S and activated protein C‐normalised ratio were measured at baseline and after 6 and 12 months of HRT in six groups of healthy postmenopausal women: (A) no HRT (reference group), (B) continuous oestradiol valerate (E2V) plus cyproterone acetate, (C) cyclic E2V plus cyproterone acetate, (D) continuous combined oestrogen (E2) plus norethindrone acetate, (E) E2 combined with local delivery of levonorgestrel and (F) E2V plus medroxyprogesterone.Main outcome measures
HRT‐induced changes in the concentration of inhibitors of coagulation and markers of fibrin turnover during 12 months of treatment.Results
Significant decreases of antithrombin and protein S were found in all treatment groups, of protein C in Groups C, D, E and F and of activated protein C‐normalised ratio in Groups E and F. Fibrin degradation products increased after three months of treatment, whereas F1+2 was persistently increased after three months in Group F. The cumulative response of antithrombin was significantly lower in Groups D, E and F than in the reference group. The cumulative response of protein S and activated protein C‐normalised ratio was lower, whereas that of F1+2 was significantly higher in Group F than in the reference group.Conclusion
HRT reduces the inhibitory potential of coagulation significantly. The effect is related to the type of E2/progestin combination administered, but seems to be oestrogen‐derived as the most pronounced effect is found with only quarterly progestin intake. Such procoagulant activity of HRT may well translate into clinical manifestations in thrombosis‐prone individuals.
Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery
Authors: Fitzpatrick Myra , Behan Michael , O'Connell P. Ronan , O'Herlihy Colm 
Published: December 2003

Objective
To compare, in a prospective, randomised controlled trial, differences in anal sphincter function following forceps or vacuum assisted vaginal delivery in an institution practising standardised management of labour.Design
Prospective, randomised controlled trial.Setting
Tertiary‐referral maternity teaching hospital.Population
One hundred and thirty women.Methods
Primiparous women were recruited antenatally and if an instrumental delivery was indicated, were randomised to either a vacuum or low‐cavity, non‐rotational forceps assisted delivery. Follow up consisted of a symptom questionnaire, anal manometry and endoanal ultrasound at three months postpartum.Main outcome measures
Faecal continence scores, anal manometry, endoanal ultrasound.Results
Sixty‐one women delivered with forceps assistance (40 for failure to progress in the second stage) and 69 with vacuum assistance (33 for failure to progress); 16/69 vacuum deliveries proceeded to a forceps assisted delivery (23%). There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 10 (16%) forceps and 5 (7%) vacuum deliveries. Based on intention‐to‐treat analysis, 36 (59%) women complained of altered faecal continence after forceps delivery compared with 23 (33%) following vacuum delivery three months postpartum (RR 2.88, 95% CI 1.41–5.88). Endoanal ultrasound was reported as abnormal following 34 (56%) forceps deliveries and 34 (49%) vacuum deliveries (RR 1.3, 95% CI 0.65–258). After exclusion of ‘failed vacuum’, median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone (P= 0.004). There were no significant differences in degree of ultrasound abnormality between the two groups.Conclusions
Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery.
A cost–utility analysis of tension‐free vaginal tape versus colposuspension for primary urodynamic stress incontinence
Authors: Manca Andrea , Sculpher Mark J. , Ward Karen , Hilton Paul 
Published: December 2003

Objective
To assess the cost effectiveness of tension‐free vaginal tape compared with open Burch colposuspension as a primary treatment for urodynamic stress incontinence.Design
Cost–utility analysis alongside a multicentre randomised comparative trial.Setting
Gynaecology or Urology departments in 14 centres in the UK and Ireland, including University‐associated teaching hospitals and district general hospitals.Population
Women with urodynamic stress incontinence. Exclusion criteria were: (1) detrusor overactivity; (2) major voiding problems; (3) prolapse; (4) previous surgery for incontinence or prolapse.Methods
Resource use data were collected on all 344 patients in the trial, including length of hospital stay, time in theatre and management of complications; resource use was costed using UK unit costs at 1999–2000 prices.Main outcome measures
Health outcomes were expressed in terms of quality‐adjusted life years (QALYs) between baseline and six months follow up, based on women's responses to the EQ‐5D health questionnaire.Results
Tension‐free vaginal tape resulted in a mean cost saving of £243 (95% CI £341 to £201) compared with colposuspension. Differential mean QALYs per patient (tension‐free vaginal tape − colposuspension) was 0.01 (95% CI −0.01 to 0.03). The probability of tension‐free vaginal tape being, on average, less costly than colposuspension, was 100%, and the probability of tension‐free vaginal tape being more cost effective than colposuspension was 94.6% if the decision‐maker was willing to pay £30,000 per additional QALY.Conclusion
The results from this trial suggest that, over a post‐operative period of six months, tension‐free vaginal tape is a cost effective alternative to colposuspension. The results will need to be reassessed on the basis of longer follow up.
A viable alternative to surgical vacuum aspiration: repeated doses of intravaginal misoprostol over 9 hours for medical termination of pregnancies up to eight weeks
Authors: Singh Kuldip , Fong Y.F. , Dong F. 
Published: December 2003

Objective
To study the efficacy of repeated doses of vaginal misoprostol over 9 hours in a day care setting for terminating pregnancies up to eight weeks of gestation.Design
An open, single arm prospective study conducted between January 2000 and December 2001.Setting
Fertility Control Clinic, National University Hospital, Singapore.Population
One hundred and fifty pregnant women with an unwanted pregnancy up to eight weeks of gestation requesting medical abortion.Methods
The women were given an initial dose of 800 μg of vaginal misoprostol. A further dose of 400 μg was repeated every 3 hours for a maximum of three doses.Main outcome measures
The complete abortion rate defined as successful cases that did not require vacuum aspiration.Results
The complete abortion rate was 84.7% and 96.0% at 15 days and 43 days after initial administration of vaginal misoprostol. The mean interval between first dose of misoprostol and the onset of expulsion of products of conception (SD) was 8.1 hours (6.3). The mean and the median percentage changes in the serum β‐hCG levels at day 15 as compared with pre‐abortion levels were statistically significant (P < 0.001) and were a good predictor of the likely outcome of the medical abortion. The mean duration of bleeding (SD) was 11.7 days (4.7) and the mean duration between the onset of procedure and the return of normal menstruation (SD) was 35.5 days (5.7). There was no significant change in haemoglobin concentration. Lower abdominal pain, fever (>38.0°C) and diarrhoea were the most common side effects.Conclusions
This regimen of repeated doses of vaginal misoprostol every 3 hours over a period of 9 hours, in keeping with the plasma level and pharmacokinetic of misoprostol administered vaginally, is an effective method of medical abortion that approaches the efficacy of surgical vacuum aspiration. The regimen would offer a suitable option for women requesting termination of pregnancy up to eight weeks of gestation in countries where mifespristone is and will never be made available.
Case–control study of teratogenic potential of thiethylperazine, an anti‐emetic drug
Authors: Czeizel A.E. , Vargha P. 
Published: December 2003

Objective
Thiethylperazine is a commonly used anti‐emetic drug during pregnancy in Hungary. One experimental study in mice and rats found an increased occurrence of cleft palate after the use of thiethylperazine during pregnancy but the human data of thiethylperazine have not been reported. Thus, the aim of the study was to investigate the possible human teratogenic effect of thiethylperazine.Design
Case–control approach.Setting
The teratogenic potential of thiethylperazine was evaluated in the population‐based large data set of the Hungarian Case–Control Surveillance of Congenital Abnormalities between 1980 and 1996.Sample
Of 38,151 newborn infants without any congenital abnormalities (control group), 746 (2.0%) had mothers who were treated with thiethylperazine, while of 22,843 cases with congenital abnormalities, 411 (1.8%) had mothers who were treated with thiethylperazine during pregnancy.Methods
Case–control pair analysis.Main outcome measure
Different congenital abnormalities.Results
The pairs of cases with congenital abnormalities and their matched controls without congenital abnormalities were compared and this approach showed a somewhat higher rate of cleft lip ± palate (OR: 2.0 with 95% CI: 1.0–4.0) in infants born to mothers with thiethylperazine treatment during the first trimester of pregnancy.Conclusion
Our data do not indicate clear teratogenic effect of thiethylperazine, however, a weak association was found between thiethylperazine use and cleft lip ± palate.
The Haven: a pilot referral centre in London for cases of serious sexual assault
Authors: Kerr Evelyn , Cottee Charlotte , Chowdhury Rima , Jawad Ruhi , Welch Jan 
Published: December 2003

Objective
Several schemes have been reported to improve treatment of rape and to encourage reporting. The development of a comprehensive forensic and follow up service for complainants of sexual assault is described, and activities of the first year are reviewed.Design
Retrospective review of case records of complainants examined in The Haven.Setting
Department of Sexual Health in a London teaching hospital.Sample
All case records, 676 complainants, from the first year of cases seen in The Haven.Methods
Description of setting up a service in partnership between the National Health Service and the Metropolitan Police, called The Haven. Analysis of a standardised proforma used for case records.Results
Mean age of complainants is 26 years (range 11–66); 6% were male. Assailant was categorised as a stranger in 52% of cases; attack involved physical violence in 50% of cases; 24% of victims had genital injuries; 39% had other physical injuries. Immediate care given at time of forensic examination included 30% of women receiving emergency contraception and 5% of clients receiving post‐exposure prophylaxis against HIV. Fifty‐five percent of clients returned for a sexual health screen and/or counselling. Thirty‐one percent received screening for sexually transmitted infections and 12% were diagnosed with one or more infections.Conclusions
Requirements following sexual assault include forensic examination, first aid, postcoital contraception, prevention and management of sexually transmitted infections and psychosocial support. Provision of these services within a sexual health setting is feasible.
Myometrial microvascular endothelial cells express oxytocin receptor
Authors: Weston G.C. , Cann L. , Rogers P.A.W. 
Published: December 2003

Objective
1. To establish whether microvascular endothelial cells from the human myometrium (MMECs) express oxytocin receptor, and to compare its expression levels relative to HUVECs. 2. To verify an up‐regulation of oxytocin receptor expression in MMECs as a result of vascular endothelial growth factor (VEGF), which had been found in a previous study.Design
Laboratory scientific study.Setting
University department.Population or Sample
Myometrial biopsies from 12 hysterectomy specimens.Methods
MMECs and HUVECs were established in vitro. Immunohistochemistry of in vitro cultures was performed to investigate protein expression of the oxytocin receptor. Semi‐quantitative RT‐PCR and Northern blots were performed to examine the presence and relative abundance of oxytocin receptor mRNA in MMECs and HUVECs, and in both cell types with and without VEGF. Total RNA from oxytocin acetate (100 nmol/L) and vehicle stimulated endothelial cell cultures was used to examine gene expression differences on a 10.5K cDNA microarray.Main outcome measures
Oxytocin receptor mRNA and protein; gene expression anlysis.Results
Oxytocin receptor mRNA and protein was present in MMECs. The level of expression was the same as for the HUVECs, but much less than the pregnant myometrium. No effect on gene expression could be demonstrated by gene expression microarray following 10 hours of oxytocin stimulation. Twenty‐four hours of VEGF stimulation did not significantly alter oxytocin receptor mRNA expression in MMECs or HUVECs.Conclusion
The myometrial microvasculature expresses oxytocin receptor. This finding means that oxytocin may exert some of its effects on the myometrial microvasculature. No evidence could be found for a transcriptional effect of oxytocin stimulation in this study, but further work on the role of the myometrial vessel oxytocin receptor is needed.
Antenatal screening for human platelet antigen‐1a: results of a prospective study at a large maternity hospital in Ireland
Authors: Davoren Anne , McParland Peter , Crowley John , Barnes Anthony , Kelly Gabrielle , Murphy William G. 
Published: December 2003

ObjectiveFetomaternal mismatch for human platelet antigen (HPA)‐1a accounts for approximately 85% of cases of neonatal alloimmune thrombocytopenia. The purpose of the study was to determine the prevalence of the HPA‐1a negative platelet phenotype in a cohort of pregnant women in Ireland, the rate of alloimmunisation to HPA‐1a in HPA‐1 mismatched pregnancies and the associated incidence of neonatal alloimmune thrombocytopenia.DesignA prospective case–control study.SettingThe antenatal clinics of a large maternity teaching hospital.Population or samplePregnant women, regardless of parity, presenting at the antenatal clinics.MethodsAn enzyme‐linked immunosorbent assay (ELISA) designed for simultaneous HPA‐1a typing and antibody detection was used. Further analysis for HPA‐1a alloantibodies was performed using commercial ELISA's (GTI PakPlus and Pak1) and the monoclonal antibody immobilisation of platelet antigens assay. Confirmation of serological typing was by the polymerase chain reaction technique using sequence‐specific primers (PCR‐SSP).Main outcome measuresThe presence of the HPA‐1a negative phenotype and its association with the development of maternal anti‐HPA‐1a and infant thrombocytopenia.ResultsEighty‐four of 4090 consecutive women enrolled in the study tested positive for HPA‐1a in the screening ELISA. Confirmatory genotyping was performed on 67 women (representing 80% of the cohort), and 54 women (representing 3272 non‐selected pregnancies), were homozygous for the HPA‐1b allele (1.7%). Three of 34 (9%) women who delivered HPA‐1a positive babies had detectable anti‐HPA‐1a and all three babies had neonatal alloimmune thrombocytopenia, for an overall incidence of 1:1100 non‐selected pregnancies.ConclusionsThe observed prevalence of 1.7% for the HPA‐1a negative platelet phenotype is as expected from studies in other countries. While we have demonstrated the practicability of antenatal HPA‐1a screening, further research is warranted to investigate maternal parameters predictive of severe fetal thrombocytopenia in HPA‐1a alloimmunised pregnancies.
The influence of smoking on the pregnancy‐associated plasma protein A, free β human chorionic gonadotrophin and nuchal translucency
Authors: Niemimaa Marko , Heinonen Seppo , Seppälä Maija , Ryynänen Markku 
Published: December 2003

Objective
To analyse the effects of smoking on first trimester parameters used in prenatal screening for Down's Syndrome.Design
A chart study.Setting
Primary care centres and maternity clinics of the participating universities' and central hospitals.Population
Three thousand and one hundred fifteen women screened by nuchal translucency measurement and 4436 women screened by maternal serum samples. Only normal singleton pregnancies were included.Methods
The mean multiples of median of pregnancy associated plasma protein A (PAPP‐A), free beta human chorionic gonadotrophin (β‐hCG) and nuchal translucency were compared by independent samples t test after logarithmic transformation of the data between smokers and non‐smokers.Main outcome measures
PAPP‐A and free β‐hCG concentrations and nuchal translucency measurements.Results
PAPP‐A was significantly reduced and nuchal translucency increased if the mother smoked. The smokers were more frequently considered as being at high risk for Down's Syndrome.Conclusions
Correcting PAPP‐A median for smokers down by 20% might improve the accuracy of the risk evaluations given to individual women. If the association between increased nuchal translucency and smoking can be confirmed, it poses interesting questions as to the reasons for increased nuchal translucency among normal pregnancies.
Pathways to evidence‐based reproductive healthcare in developing countries
Authors: Geyoushi Bohaira E. , Matthews Zoë , Stones R. William 
Published: December 2003

Objective
Developing country clinicians are aware of the discourse of evidence‐based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health‐related medical knowledge in developing countries.Design
Qualitative study using semi‐structured interviews.Setting
India and Yemen.Sample
Forty‐one doctors working in obstetrics, gynaecology, general practice and family planning services.Methods
Interviews were tape recorded and transcribed verbatim. A theory‐driven approach was conducted to carry out thematic analysis. Main outcome measures Results
Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice.Conclusions
Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.