bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intramyometrial vasopressin as a haemostatic agent during myomectomy
Authors: Frederick J. , Fletcher H. , Simeon D. , Mullings A. , Hardie M. 
Published: August 2005

ABSTRACTObjective
To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy.Design
A randomised placebo controlled trial.Setting
University Hospital of the West Indies, Kingston, Jamaica.Subjects
Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group.Intervention
Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline).Main outcome measures
The efficacy of vasopressin was measured by comparing pre‐ and post‐operative haemoglobin levels and haematocrit, changes in intra‐operative pulse and blood pressure, measured blood loss, need for blood transfusion and post‐operative febrile morbidity in the treatment and control groups.Results
The use of vasopressin resulted in median blood loss of 225 ml (range 150–400 ml) compared with 675 ml (range 500–800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5%vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P= 0.03). There were no significant differences between the groups in intra‐operative pulse and blood pressure or post‐operative white blood cell counts or temperature.Conclusion
The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.
Treatment with the gonadotrophin releasing hormone‐agonist goserelin before hysterectomy for uterine fibroids
Authors: Lumsden M. A. , West C. P. , Thomas E. , Coutts J. , Hillier H. , Thomas N. , Baird D. T. 
Published: August 2005

ABSTRACTObjective
To investigate the effect of the gonadotrophin releasing hormone (GnRH)‐agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre‐operative symptoms, difficulty of operation and operative blood loss.Design
Randomised placebo‐controlled study.Setting
Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle.Subjects
Seventy‐one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy.Interventions
After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH‐agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment.Main outcome measures
Haemoglobin concentrations at recruitment, at operation and post‐operatively, pre‐operative symptoms, operative difficulty and blood loss and post‐operative complications.Results
Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187 (60–600) ml vs 308 (118–1000) ml respectively; P < 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post‐operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision.Conclusions
This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.
Clustering of perinatal markers of birth asphyxia and outcome at age five years
Authors: Yudkin P. L. , Johnson A. , Clover L. M. , Murphy K. W. 
Published: August 2005

ABSTRACTObjectives
In a cohort of term infants with cerebral depression at delivery, to investigate the association of perinatal signs of birth asphyxia, particularly abnormal fetal heart rate patterns in labour, acidaemia, and serious neonatal encephalopathy, with neurodevelopmental outcome at age five years.Design
Five year follow up study of a birth cohort.Setting
Regional maternity hospital.Subjects
One hundred and eighty‐four singleton infants with a 1 min Apgar score ≤ 3, born at term between January 1984 and September 1985.Main outcome measures
Neonatal death, cerebral palsy, and scores on a battery of neurodevelopmental tests at age five.Results
Seven infants had a cluster of perinatal signs suggestive of birth asphyxia; all included serious neonatal encephalopathy. Three of these infants died neonatally, three had spastic quadriparesis with profound developmental delay, and one was unimpaired at the age of five. Among the remaining infants, no association was found between severely abnormal fetal heart rate patterns in labour and scores on neurodevelopmental tests, or between acid–base status at delivery and test scores.Conclusions
Birth asphyxia, identified by a cluster of abnormal perinatal signs, including serious neonatal encephalopathy, has a poor prognosis. If serious encephalopathy is not present, cerebral depression at birth preceded by abnormal fetal heart rate patterns in labour, or with acid–base derangement, is not predictive of later impairment.
Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence
Authors: Spence‐Jones Clive , Kamm Michael A. , Henry Michael M. , Hudson C. N. 
Published: August 2005

ABSTRACTObjective
To investigate the aetiological importance of bowel dysfunction in patients with uterovaginal prolapse and urinary stress incontinence.Design
Observational study using a questionnaire about obstetric history and bowel function, and anorectal physiological studies.Setting
Physiology unit and gynaecological outpatients departments of two teaching hospitals.Subjects
Twenty‐three women with uterovaginal prolapse (mean age 57 years), 23 women with urinary stress incontinence (mean age 52 years) and 27 control women (mean age 52 years).Results
There was no statistically significant difference between the three groups in their parity, age or birthweight of their children. However, straining at stool as a young adult prior to the development of urogynaecological symptoms was significantly more common in women with uterovaginal prolapse (61%vs 4%, P < 0.001) and women with urinary stress incontinence (30%vs 4%, P < 0.05), compared with controls. A bowel frequency of less than twice per week as a young adult was also more common in women with uterovaginal prolapse than in control women (48%vs 8%, P < 0.001). At the time of consultation, 95% of the women with uterovaginal prolapse were constipated, compared with only 11% of control women. Many of these women also needed to digitate to achieve rectal evacuation. Compared with controls, women with uterovaginal prolapse had a prolonged pudendal nerve terminal motor latency (1.9 ms vs 2.2 ms, respectively, P= 0.003). Women with stress incontinence of urine had a normal pudendal nerve latency (2.0 ms). Other tests of anorectal function were normal.Conclusions
Constipation, in addition to obstetric history, appears to be an important factor in the pathogenesis of uterovaginal prolapse.
Investigation of folate intake and metabolism in women who have had two pregnancies complicated by neural tube defects
Authors: Wild Jennifer , Seller Mary J. , Schorah Christopher J. , Smithells Richard W. 
Published: August 2005

ABSTRACTObject
To investigate folate intake and blood levels of folic acid and vitamin C in women with and without a history of two NTD‐affected pregnancies and to measure the increase in serum folate following ingestion of orange juice.Subject
Sixteen women with a history of two NTD‐affected infants and 16 controls with no such history, none of whom were either pregnant or taking vitamin supplements. The orange juice loading test was carried out on eight matched pairs.Main outcome measures
Dietary intake of folate was assessed by questionnaire and blood levels of folate and vitamin C were measured.Results
There was no evidence of decreased intake of folate in subjects who had had two NTD‐affected pregnancies. In controls, both serum and red cell folate showed significant correlation with dietary folate, while in subjects there was no such correlation. Subjects also had smaller increases in serum folate following an oral load than controls, although the differences were not significant.Conclusion
Women who have had two NTD‐affected pregnancies may have defective folate metabolism. Further investigations on short term utilisation of ingested food folates in these women are required.
Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes
Authors: Budeiri D. J. , Li Wan Po A. , Dornan J. C. 
Published: August 2005

ABSTRACTObjective
To demonstrate similarities and differences between the various instruments used by clinical trialists for measurement of premenstrual syndrome to encourage development of consensus of measurement to aid future research.Design
Computer and manual searches of all trials of drugs used for premenstrual syndrome supplemented by retrieval of all questionnaires and scales cited. Letters were sent to the main manufacturers to identify trials not in the public domain.Main outcome measures
Number of scales in current use for classifying premenstrual syndrome; the symptoms included within them; their organisation of symptoms into clusters; the numerical values used in the scaling; the most frequently used items; and the extent of overlap in the criteria used.Results
Three hundred and fifty clinical trials of 115 different drugs were identified. The most common symptoms or signs used in the scales were (frequency in square brackets) irritability [44], headache or migraine [40], depression [37], tearfulness [34], tension [31], anxiety [31], breast tenderness [31], mood swings or lability [30], back pain [30], weight gain [29], abdominal bloating [28], lack of concentration [28], food craving [28], and increased appetite [26]. Sixty‐five different questionnaires or scales were used to classify premenstrual syndrome and for assessing entry eligibility and treatment outcomes; of these 65, 47 included sufficient details for a formal analysis and 18 scales grouped the symptoms or items into clusters or subgroups.Conclusion
There is wide diversity in the scales used for assessing entry eligibility and treatment outcomes in premenstrual syndrome. This makes comparative evaluation of possible treatments extremely complex and difficult. It is recommended that authorities and organisations involved in conducting trials of treatments for premenstrual syndrome develop a consensus statement about the best instrument to be used. Regulatory authorities could perhaps provide guidance to which scales they would accept when clinical trials of drugs for premenstrual syndrome are submitted to them for assessment. This would ensure that industry‐sponsored trials provide objective data. Consensus is required given the poor performance of most current treatments of premenstrual syndrome.
Expression of integrin adhesion molecules in endometrium and endometriosis
Authors: Bridges J. E. , Prentice A. , Roche W. , Englefield P. , Thomas E. J. 
Published: August 2005

ABSTRACTObjective
To compare the expression of cell adhesion molecules by endometrium and endometriosis.Design
A comparative study of integrin expression, determined immunohistochemically, in eutopic and ectopic endometrium biopsied synchronously from patients with endometriosis diagnosed at laparoscopy or laparotomy.Setting
University Departments of Obstetrics and Gynaecology, and Pathology, Southampton; Department of Obstetrics and Gynaecology, Newcastle upon Tyne.Samples
Eighteen paired samples of endometria and endometriosis.Results
A wide distribution of collagen‐laminin receptor proteins was demonstrated. α1 integrin expression was limited to secretory endometrium. β3 expression was only demonstrated on proliferative endometrium.Conclusions
Expressions of the integrin proteins differed between the various elements of the endometrium. Cyclical changes in integrin expression also were demonstrated. No difference in cell adhesion molecule expression was seen when comparing endometrial and endometriosis samples.
Antenatal fetal magnetocardiography: a new method for fetal surveillance?
Authors: Quinn Andrew , Weir Andrew , Shahani Uma , Bain Rhoderick , Maas Peter , Donaldson Gordon 
Published: August 2005

ABSTRACTObjective
To establish the reliability of fetal magnetocardiography as a method of measuring the time intervals of the fetal heart during the antenatal period.Design
A prospective study.Setting
Wellcome Biomagnetism Unit, Southern General Hospital.Subject
One hundred and six low risk pregnant women at 20 to 42 weeks gestation.Main outcome
measures Success in obtaining QRS complexes, P waves and T waves. Correlation of time intervals with fetal outcome.Results
The technique was acceptable to pregnant women. A QRS complex was successfully demonstrated in 68 (67%) of the unaveraged traces. Using off‐line averaging techniques on these 68 cases, P waves were obtained in 75% and T waves in 72%. Although good quality traces were obtained throughout the range of gestational ages, in general it was more difficult below 28 weeks. QRS duration (R2= 7%, P= 0.02) demonstrated a positive linear correlation with increasing gestation. Of the 35 (51%) cases with umbilical vein pH analysis available, only one result was less than 7.2. No significant relation was found between measurements of the fetal waveforms and the pH results.Conclusion
The technique of fetal magnetocardiography provides a significant advance in the technological field for the demonstration of QRS complexes and the full PQRST waveforms in gestations from 20 weeks onwards. With further technical improvements the clinical impact of this technique can be assessed more fully.
Intravenous immunoglobulin in the prevention of recurrent miscarriage
Authors:   The German RSA/IVIG Group
Published: August 2005

ABSTRACTObjective
This study was undertaken to verify a specific effect of intravenous immunoglobulin on the outcome of pregnancy in patients with a history of recurrent miscarriage as an alternative to immunotherapy with allogeneic leucocytes.Study design
In a randomised double‐blind multicentre study 64 patients with a history of unexplained primary recurrent miscarriage were treated with intravenous immunoglobulin (verum) or 5% human albumin (placebo) infusions during their following pregnancy.Results
Success rates for both verum and placebo, were compared excluding seven patients with explained miscarriage (20/27 (74%) versus 21/30 (70%)) and without any such exclusion (20/33 (61%) versus 21/31 (68%)). The difference between the two groups was not statistically significant.Conclusions
A specific effect of intravenous immunoglobulin in primary recurrent miscarriage could not be demonstrated. These results imply the possibility of psychological influence, i.e. a placebo effect of intravenous immunoglobulin, on the outcome of pregnancy. Since success rates for both verum and placebo were in the same range as for treatment with allogeneic leucocytes, psychological effects might be responsible also for other kinds of immunotherapy for prevention of recurrent miscarriage. However, it cannot be excluded that success rates only reflect background values as reported for recurrent miscarriage patients without any treatment.
Persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy
Authors: Chen Ruey‐Jien , Huang Su‐Cheng , Chow Song‐Nan , Hsieh Chang‐Yao , Hsu Hey‐Chi 
Published: August 2005

ABSTRACTObjective
A 16 year review of persistent gestational trophoblastic tumour when the antecedent pregnancy was a partial hydatidiform mole.Design
Cases of persistent gestational trophoblastic tumour with partial hydatidiform mole as the antecedent pregnancy were reviewed for the period 1976 to 1992. DNA ploidy was analysed by flow cytometry.Setting
A University Hospital which is a reference centre for gestational trophoblastic tumour.Subjects
The case notes of 207 women with persistent gestational trophoblastic tumour were reviewed.Main outcome measures
A rise (or failure to fall) of βhCG titre, or sign of metastasis.Results
Six (2.9 %) women had partial hydatidiform mole as the antecedent pregnancy and all were initially judged to be low risk. However, two developed pulmonary metastasis; one woman developed persistent gestational trophoblastic tumour shortly after a hysterotomy, and none developed choriocarcinoma. The geometric mean of serum βhCG concentrations at the initiation of chemotherapy was 868mIU/ml (95% CI 114–1524). Of the six women, one achieved remission after total abdominal hysterectomy, and five after chemotherapy. The mean interval from starting treatment to remission was 68 days (95% CI 27.9–108.0). The initial PhCG titre and interval were not statistically different from those found in cases of persistent gestational trophoblastic tumour when the antecedent pregnancy was not partial hydatidiform mole. Of the six, the DNA content was triploid in three and diploid in two. One of the two diploid cases required multiple courses of chemotherapy to achieve remission.Conclusion
Partial hydatidiform mole can have malignant sequelae and can develop very soon after treatment. Its DNA content can be either diploid or triploid, the lungs being the most common site of metastasis. After evacuation of partial hydatidiform mole, immediate chest X‐ray and regular follow up of the serum βhCG level is necessary.
The value of an absorbable adhesion barrier, Interceed®, in the prevention of adhesion reformation following microsurgical adhesiolysis
Authors: Li T. C. , Cooke I. D. 
Published: August 2005

ABSTRACTObjective
To determine whether Interceed®, an absorbable adhesion barrier, confers any additional benefit over conventional microsurgery, including the use of an adjuvant (hydrocortisone), in the prevention of adhesion reformation after pelvic microsurgery.Design
A prospective, randomised, controlled study.Setting
Jessop Hospital for Women, Sheffield, UK.Subjects
Twenty‐eight women who underwent pelvic microsurgery for infertility or for chronic pelvic pain and who had bilateral pelvic adhesions and deperitonealised areas following adhesiolysis.Interventions
Following microsurgical adhesiolysis, one side of the pelvis was randomised to have its deperitonealised areas covered with Interceed, whereas the contralateral side served as the control. A second look laparoscopy was carried out 3 to 14 weeks after microsurgery to evaluate adhesion reformation.Main outcome measure
The amount of adhesion reformation at second look laparoscopy compared with the amount of deperitonealised area exposed following microsurgical adhesiolysis.Results
The use of Interceed resulted in a significant reduction of adhesion reformation over and above that achieved by conventional microsurgical techniques with hydrocortisone as an adjuvant.Conclusion
Interceed, an absorbable adhesion barrier, is of value in the prevention of adhesion reformation and may be used in conjunction with hydrocortisone instilled intraperitoneally at the conclusion of microsurgery.
A comparative study of the fetal electrocardiogram recorded by the STAN and Nottingham systems
Authors: Skillern Laurence , Cockburn Jayne , Benjamin Mark , Malcolm Pearce J. , Sahota Daljit , Reed Nick , Mohajer Mich , James David , Symonds Malcolm 
Published: August 2005

ABSTRACTObjective
To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors.Design
Prospective observational study.Setting
London teaching hospital delivery suite and research unit.Methods and subjects
The T:QRS ratios generated by the STAN and Nottingham FECG monitors were simultaneously recorded and compared using signals generated from a computer‐produced ECG signal and signals from 11 term fetuses recorded during labour.Results
There was an acceptable level of agreement between the two systems with the computer‐generated signals, but it was not clinically acceptable with the signals from the fetuses recorded during labour. Disagreements in the T:QRS values were probably due to differences in the reference points for the measurement of the S‐T segment and T‐wave height.Conclusion
The different points of reference for measurement of S‐T segment and T‐wave height can explain poor agreement between the two methods of FECG waveform analysis. The suggested adopted points of reference are those corresponding to adult electrocardiographic methodology.
The treatment of stage I carcinoma of the cervix in the west of Scotland 1980–1987
Authors: Bissett D. , Lamont D. W. , Nwabineli N. J. , Brodie M. M. , Symonds R. P. 
Published: August 2005

ABSTRACTObjective
To examine the results of different treatments for Stage IA and IB carcinoma of the cervix in patients treated in the West of Scotland between 1980 and 1987.Design
A retrospective review of case records.Setting
The Beatson Oncology Centre, Western Infirmary and Bclvidere Hospital, Glasgow, and the departments of gynaecology of hospitals in the west of Scotland.Subjects
One hundred and five patients with Stage IA and 420 patients with Stage IB carcinoma of the cervix.Results
A variety of treatments were used for women with Stage IA disease, with an overall actuarial five year survival of 100%. The overall actuarial five year survival for women with Stage IB disease was 79.5%. Patients with Stage IB disease treated by radical hysterectomy (n= 123) or radical radiotherapy (n= 229) had similar five year survival rates (86.3% and 79.5%, respectively), whereas patients treated initially by nonradical surgery (n= 68) had a significantly worse five year survival (68.1%; P= 0.008).Conclusions
These results emphasise the need for adequate and appropriate surgery and the centralisation of treatment for early cervical cancer.
The effect of maternal posture on fetal cerebral oxygenation during labour
Authors: Aldrich C. J. , D'Antona D. , Spencer J. A. D. , Wyatt J. S. , Peebles D. M. , Delpy D. T. , Reynolds E. O. R. 
Published: August 2005

ABSTRACTObjective To measure the effect of changes in maternal posture on fetal cerebral oxygenation during normal labour.Design A prospective study comparing changes in the fetal cerebral concentrations of oxy‐haemoglobin, deoxyhaemoglobin and cerebral blood volume, measured by near infrared spectroscopy, in women with effective epidural analgesia when moved from the left lateral to the supine position during labour.Setting A London teaching hospital obstetric unit.Subjects Fourteen women during uncomplicated labour at term.Results When compared with the left lateral position, the supine position was associated with a significant decrease in the mean concentration of fetal cerebral oxyhaemoglobin of 1.12 (SD 1.0, 95% CI 0.49 to 1.75) μmol. 100 g−1(P < 0.01) without any significant change in the mean concentration of deoxyhaemoglobin and cerebral blood volume. These changes were associated with a significant decrease in the mean cerebral oxygen saturation of 8.3 (SD 8.8, 95% CI 1.5 to 15.1)% (P < 0.05, n= 9).Conclusion Changes in maternal posture during labour, in women with effective epidural analgesia, are associated with a significant decrease in fetal cerebral oxygenation.