bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in serum vascular endothelial growth factor following initiation of estrogen replacement after hysterectomy and oophorectomy
Authors: Akkad Andrea , Al‐Azzawi Farook 
Published: March 2003

Background. Vascular endothelial growth factor has been shown to play an important role in preservation and restoration of endothelial integrity. Similar effects on endothelial function have been described with estrogen replacement. This poses the question whether some of the mechanisms ascribed to estrogen are in fact vascular endothelial growth factor mediated. The objective of this study was to examine the effect of continuous transdermal estrogen replacement on serum levels of secreted vascular endothelial growth factor in women following hysterectomy and oophorectomy.Methods. In a nonrandomized, prospective study, 40 hysterectomized and oophorectomized women were treated with transdermal estrogen. Their serum vascular endothelial growth factor levels were measured before and six months following estrogen treatment, using a commercially available ELISA kit.Results. The mean serum vascular endothelial growth factor level fell from 328 ng/ml (s.d. 164) before treatment to 285 ng/ml (s.d. 124) following six months of estrogen replacement. This decrease was statistically significant (p<0.03).Conclusion. Transdermal estrogen replacement in hysterectomized and oophorectomized women appears to be associated with a significant reduction in secreted serum vascular endothelial growth factor. However, the effect of hysterectomy and oophorectomy per se needs to be explained in appropriately designed trials.
Preoperative CA‐125 level as a predictor of non optimal cytoreduction of advanced epithelial ovarian cancer
Authors: Gemer Ofer , Segal Shmuel , Kopmar Alexander 
Published: March 2003

Background. Suboptimal cytoreduction of advanced ovarian cancer is related to initial tumor bulk which correlates with CA125 level.Methods. Retrospective record study of 40 patients with stage III ovarian cancer. The ability of a CA125 threshold level of 500 U/mL to predict suboptimal cytoreduction was determined.Results. Twenty‐four (60%) of the patients were optimally cytoreduced. At the CA125 cut off level of 500 U/mL the sensitivity for predicting suboptimal debulking was 62% and specificity was 83%. Above a CA 125 level of 1500 U/mL none of the patients were optimally cytoreduced.Conclusions. More data are needed to determine the CA125 cut off level at which the standard approach of initial laparotomy and cytoreduction may be modified.
Analysis of outcome in hydrops fetalis in relation to gestational age at diagnosis, cause and treatment
Authors: Sohan Karen , Carroll Stephen G. , De La Fuente Sergio , Soothill Peter , Kyle Phillipa 
Published: March 2003

Objective. To examine fetal outcome in hydrops fetalis in relation to gestational age at diagnosis and following investigation and treatment.Methods. All cases of hydrops fetalis presenting to the Fetal Medicine Unit during the last seven years, between 1993 and 1999, were identified from the Fetal Medicine Database. During this time 87 of 13,980 patients who attended the Fetal Medicine Unit had hydrops fetalis. The cases were examined for gestational age at presentation according to etiology and fetal survival following investigation and treatment. The fetal survival rates for non‐immune cases of hydrops before and after 24 weeks were compared.Results. The cause of hydrops was determined antenatally in 71 of the 87 (82%) cases. Of the 51 cases presenting before 24 weeks’ gestation, 23 (45%) were due to chromosomal abnormality. After 24 weeks, fetal tachyarrhythmias and hydrothorax were the most common causes and accounted for 14 (38%) of the 36 cases. Thirty‐four cases (39%) of hydrops received intrauterine treatment. The survival rates excluding chromosomal abnormalities in the non‐immune cases before and after 24 weeks’ gestation were 31% and 48%, respectively, and were not significantly different.Conclusions. The survival rate in cases of hydrops fetalis may be improved with appropriate prenatal investigation and therapy. The etiology of hydrops is different before and after 24 weeks, and even when cases of chromosomal abnormality are excluded the survival rate is similar before and after 24 weeks.
Antibiotic treatment for threatened abortion during the early first trimester in women with previous spontaneous abortion
Authors: Ming‐Cheh Ou , Chung‐Chu Pang , Fu‐Min Chen , Chin‐Hsu Su , Dennis Ou 
Published: March 2003

Background. We retrospectively examined the usefulness of antibiotic therapy for management of first‐trimester threatened abortion in women with previous spontaneous abortion.Methods. From 1993 through 1999, women with first‐trimester threatened abortion received antibiotic therapy. Only those with gestational age less than 9 weeks and previous spontaneous abortion were included in this analysis. Women with mild abdominal cramping received amoxicillin plus erythromycin for 1 week; those with severe abdominal pain received amoxicillin plus clindamycin for 1 week. Recurrence was documented on the basis of either lower abdominal pain or vaginal bleeding.Results. Of the 23 women included, 15 (65%) had abnormal vaginal flora (a score above 4, Nugent’s criteria). Seven of 16 women who received amoxicillin plus clindamycin and three of seven who received amoxicillin plus erythromycin had complete resolution of lower abdominal pain and vaginal bleeding without recurrence (p=1). The recurrence rate was higher, though not significantly, in women with abnormal bacterial vaginal flora (8/15 vs. 2/8, p=0.379). Twenty‐two (96%) of the 23 pregnancies were carried to term, with no identifiable neonatal anomalies.Conclusions. These results suggest the usefulness of early antibiotic therapy in preventing pregnancy loss in women with threatened abortion early in the first trimester, and warrant further clinical trials.
Increased tissue concentrations of arachidonic acid in umbilical artery and placenta in fetal growth retardation
Authors: Matorras Roberto , López De Larrucea Arantza , Sanjurjo Pablo , Ignacio Ruiz Jose , Echevarría Yolanda , Nieto Aníbal , Perteagudo Lourdes , Aldamiz‐Echevarria Jose Luis 
Published: March 2003

Objective. To compare the fatty acid phospholipid composition of the umbilical artery and the placenta in cases of fetal growth retardation (FGR) and of normal growth, as well as in symmetric and asymmetric FGR.Design.. Case‐control study.Setting. University hospital.Population. Thirty‐nine FGR cases (12 asymmetric, 27 symmetric) and 78 cases with normal growth.Main outcome measures. Thin layer gas‐liquid capillary chromatography of phospholipid fatty acids in umbilical artery and placental cotyledons. Newborns were classified as FGR if their weight was under the l0th percentile for our center. FGR was defined as symmetric if the ponderal index was >2.32, and as asymmetric if it was <2.32.Results. In FGR, arachidonic acid was significantly increased both in placenta (24.05%±2.78 vs 22.46%±2.93) and in umbilical artery (16.76%±2.40 vs 15.58%±3.67). Indeed this increase was significantly higher in asymmetric than in symmetric FGR (25.70±2.32 vs 23.32±2.68 in placenta and 18.06±1.46 vs 16.14 ±2.53 in umbilical artery). On the other hand, in the placenta there were a number of differences in the metabolic ratios analyzed when comparing symmetric and asymmetric FGR, indicating a lower DHA availability and a higher n‐6 fatty acid elongation and desaturation in asymmetric FGR.Conclusion. FGR is characterized by an increase in arachidonic acid both in the placenta and umbilical artery phospolipids, probably reflecting a different mobilization from tissue stores. It is speculated that the different arterial composition could be partially responsible for the increased cardiovascular risk of FGR in adulthood. On the other hand the metabolic status of the placenta concerning polyunsaturated fatty acids was very different in symmetric and asymmetric FGR, suggesting a different pathogenesis.
Comparison of Endorette® and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding
Authors: Epstein Elisabeth , Skoog Lennart , Valentin Lil 
Published: March 2003

Main question. To compare the diagnostic properties of Endorette® and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women’s experiences of the two methods.Methods. In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette® sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling.Results. Endorette® sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette® sampling, and the doctor underestimated the pain in 62% of the women. Endorette® failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette® device had not reached the uterine fundus. In women with endometrium <7 mm, Endorette® and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium ≥7 mm, Endorette® yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C.Conclusion. Endorette® and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium <7 mm. D&C is superior to Endorette® in women with endometrium ≥7 mm.
A low dose (‘Dhaka’) magnesium sulphate regime for eclampsia
Authors: Begum Rashida , Begum Anowara , Johanson Richard , Ali Mohammad Nawsher , Akhter Syeba 
Published: March 2003

Background. Eclampsia remains a common cause of maternal death in Bangladesh. Early experience of magnesium sulphate use for eclampsia in Bangladesh was based on a lower dose regime, tailored for use in the smaller woman.Objectives. a) To determine the recurrent convulsion rate with the low dose ‘Dhaka’ magnesium sulphate regime (recognizing the limitations of sample size). b) To identify whether toxicity occurs with this regime. c) To measure serum level of magnesium with this regime.Methods. This prospective study included 65 eclamptic patients receiving lower dose magnesium sulphate therapy at Dhaka Medical College Hospital from 25 March 1998–15 June 1998. The loading dose of magnesium sulphate was 10 gm. Following this 2.5 gm was given intramuscularly 4 hourly, for 24 hours after administration of the first dose. Four blood samples were collected for serum magnesium levels. Patients were monitored hourly by observing their respiratory rate, knee jerks and urinary output. Findings were matched with serum magnesium levels.Results. The range of serum magnesium levels was 1.74 to 6 mg/dl with mean (s.d.) values of 3.87 (0.78). Only five (9%) patients had diminished knee jerks 6, 10, 12, 12 and 15 hours after administration of the loading dose. But at those times the serum magnesium levels were 3.2 mg/dl, 3.8/dl, 3.4 mg/dl and 3.3 mg/dl respectively. Of the 65 patients, only one developed recurrent convulsions. This was 3 hours after the loading dose and was controlled by diazepam treatment and maintenance magnesium sulphate.Conclusion. Half of the standard dose of magnesium sulphate appeared to be sufficient to control convulsions effectively and serum levels of magnesium remained lower than levels which produce toxicity.
Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints
Authors: Damen Léonie , Buyruk H. Muzaffer , Güler‐Uysal Füsun , Lotgering Frederik K. , Snijders Chris J. , Stam Hendrik J. 
Published: March 2003

Objective. The aim of this study was to investigate the association between pregnancy‐related pelvic pain (PRPP) and sacroiliac joint (SIJ) laxity.Methods. A cross‐sectional analysis was performed in a group of 163 women, 73 with moderate or severe (PRPP+) and 90 with no or mild (PRPP−) PRPP at 36 weeks of pregnancy. SIJ laxity was measured by means of Doppler imaging of vibrations in threshold units (TU). Pain, clinical signs and disability were assessed with visual analog scale (VAS), posterior pelvic pain provocation (PPPP) test, active straight leg raise (ASLR) test, and Quebec back pain disability scale (QBPDS), respectively.Results. Mean SIJ laxity in the PRPP+ group was not significantly different from the PRPP− group (3.0 versus 3.4 TU). The mean left‐right difference, however, was significantly higher in the PRPP+ group (2.2 TU) than in the PRPP− group (0.9 TU). In the PRPP− group, only 4% had asymmetric laxity of the SIJs in contrast to 37% of the PRPP+ group. Between the PRPP+ subjects with asymmetric and symmetric laxity of the SIJs significant differences were found with respect to mean VAS for pain (7.9 versus 7.0), positive PPPP test (59% versus 35%), positive ASLR test (85 versus 41%) and mean QBPDS score (61 versus 50).Conclusions. Increased SIJ laxity is not associated with PRPP. In fact, pregnant women with moderate or severe pelvic pain have the same laxity in the SIJs as pregnant women with no or mild pain. However, a clear relation between asymmetric laxity of the SIJs and PRPP is found.
Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits
Authors: Sydsjö Gunilla , Sydsjö Adam 
Published: March 2003

Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant women's own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis.Methods. All of the 384 women who were delivered at the University Hospital during a 2‐month period were asked to answer a questionnaire anonymously. Information was sought concerning sickness absence and the use of parental benefits. In addition, questions were asked about working conditions and about each mother's own estimate of her level of ‘well being’. The women's attitudes towards work absence due to illness and towards social benefit programs were registered.Results. Forty‐three per cent of the women stated that they had been on sick leave during pregnancy. The main reason for sick leave was reported back pain. Seventy‐four per cent of the women who were on sick leave stated, nevertheless, that they had been in ‘good’ or ‘excellent’ health during pregnancy. Of the 149 women who did not take sick leave, 10 reported being in ‘bad’ or ‘very bad’ health during pregnancy. 4.3% of the women stated that they had considered themselves to be ill due to an obstetric condition.Conclusion. In addition to actual disease and severe discomfort, certain social conditions and attitudes as well, are likely to explain the increase of pregnant women on sick leave.
Prognostic value of screening for irregular antibodies late in pregnancy in rhesus positive women
Authors: Andersen Anita S. , Prætorius Lisbeth , Jørgensen Henrik L. , Lylloff Kirsten , Larsen Kim T. 
Published: March 2003

Background.  To evaluate the prognostic value of screening for irregular antibodies late in pregnancy (third trimester) in rhesus positive women. Only those cases where irregular antibodies have not previously been demonstrated during routine screening in the first trimester with regard to clinically relevant complications in the newborn, were studied.Materials and methods.  All women living in Frederiksborg county and giving birth in 1996 (n = 4216) were assessed for inclusion in the study. This was done by gathering the files at the Hillerød and Hørsholm Hospitals' blood banks for antibody test results. Six hundred women were excluded because of the lack of either the rhesus type or the late antibody test.Results.  Of the 3616 women, 3046 were rhesus positive, and 3012 of these had a negative first trimester screen test. Fifteen of the 3012 women later developed irregular antibodies in the third trimester, and were included in the study. This corresponds to only 0.5%, and none of these cases entailed perinatal complications for the mother or the child.Conclusion.  Routine screening of rhesus positive pregnant women in the third trimester is not rational from a cost‐benefit perspective, if the only purpose is to prevent hemolytic disease of the newborn.
Patient‐rating of distressful symptoms after treatment for early cervical cancer
Authors: Bergmark Karin , ÅVall‐Lundqvist Elisabeth , Dickman Paul W. , Henningsohn Lars , Steineck Gunnar 
Published: March 2003

Background. More refined information on sources of symptom‐induced distress in a patient population can improve the quality of pretreatment information, make follow‐up visits more efficient and guide research priorities in the efforts to modify treatments.Methods. In a population‐based epidemiological study covering all of Sweden, data were collected 1996–97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB‐IIA cervical cancer registered in 1991–92 at the seven departments of gynecological oncology in Sweden.Results. A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom‐induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each).Conclusions. The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.
Symptom‐free women at increased risk of ectopic pregnancy: should we screen?
Authors: Mol Ben W. J. , Van der Veen Fulco , Bossuyt Patrick M. M. 
Published: March 2003

Background.  Transvaginal sonography, serum human chorionic gonadotrophin (hCG) measurement, and serum progesterone measurement provide the possibility to screen symptom‐free women at increased risk of ectopic pregnancy. The objective of the present study was to evaluate the cost‐effectiveness of screening for ectopic pregnancy, by addressing the expected benefits and costs of screening for ectopic pregnancy.Methods.  Screening programs incorporating transvaginal sonography, serum hCG measurement, and serum progesterone measurement were compared with a ‘watchful waiting’ strategy. Data were extracted from the literature. The strategies were compared on the expected number of prevented tubal ruptures, the expected number of false‐positive diagnoses, and expected costs.Results.  The cost‐effectiveness of screening appeared to be strongly dependent on the prevalence of ectopic pregnancy. At a prevalence of ectopic pregnancy of 6%, a screening program with transvaginal sonography and serum hCG measurement would reduce the number of patients with ruptured ectopic pregnancy from 2.1 to 0.61 per 100 screened women. Screening was expected to cost approximately Euro 933 per prevented tubal rupture, whereas the number of expected false‐positive diagnoses was 0.64 per prevented tubal rupture.Conclusion.  We conclude that screening for ectopic pregnancy reduces the number of patients with tubal rupture, but only at the expense of a large false‐positive rate. Although sonography in symptom‐free women at risk of ectopic pregnancy might be justified for psychological reasons, the medical and economic benefits of such a policy seem to be limited.
Amniotic fluid index in low‐risk pregnancy as an admission test to the labor ward
Authors: Ghosh Gisela , Marsál Karel , Gudmundsson Saemundur 
Published: March 2003

Background.  Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low‐risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress.Methods.  Ultrasonically estimated four‐quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective ‘blind’ study comprising 600 low‐risk pregnancies. Oligohydramnios was defined as an amniotic fluid index ≤ 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit.Results.  Two‐hundred and sixty‐seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25–11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied.Conclusion.  The results indicate that measurement of the amniotic fluid index in low‐risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.
Transvaginal hydrolaparoscopy: a new diagnostic tool in infertility investigation
Authors: Jónsdóttir Kristín , Lundorff Per 
Published: March 2003

Background.  To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo‐ovarian structures in the management of patients with unexplained infertility.Methods.  A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy. The remaining 106 patients had transvaginal laparoscopy performed under local anesthesia, with standard laparoscopy performed only on those with pathology, which required operative intervention. Information on pathology, complications, and successful access to the pouch of Douglas were recorded.Results.  The successful rate of access was 93%. Pathology was found in 29 patients, of whom 15 required operative laparoscopy. Also, out of 19 patients with adhesions, 11 (58%) had normal dye test bilateral, and only two (11%) had bilateral occlusion of the tubes. No complications were observed.Conclusion.  Transvaginal hydrolaparoscopy is a safe and well‐tolerated method for investigating the tubo‐ovarian structures in unexplained infertility. It is superior to hysterosalpingography for diagnosis of adhesions.