Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence

OBJECTIVE: The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance. DESIGN, SETTING AND METHODS: A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000. The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care. This program consists of weekly visits from 16 weeks' gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico-vaginal bacteriology and fetal fibronectin swabs. Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at 相似文献   

Morbidity and mortality associated with renal insufficiency and endovascular repair of abdominal aortic aneurysms: a 5-year experience

To evaluate the outcome of patients with renal insufficiency undergoing endovascular repair of abdominal aortic aneurysm (AAA), data were prospectively collected between 1998 and 2003 on patients undergoing elective repair of their AAA with a stent graft. The patients were divided into 2 groups: those with serum creatinine (Crs) concentrations <1.2 (Group A) and those with Crs > or =1.2 mg/dL not requiring hemodialysis (Group B). The outcomes of the procedure for these 2 groups were compared. Different variables that existed between the 2 groups and contributed to mortality included estimated blood loss (EBL), volume of contrast used in the operating room, incidence of diabetes (DM), tobacco use, and history of myocardial infarction (MI). In total, 213 patients underwent elective repair of their AAA with use of a stent graft: 61% who had a Crs <1.2 mg/dL (Group A) and 39% who had a Crs > or =1.2 mg/dL not requiring dialysis (Group B). Among 129 patients with normal renal function there was an 18.6% complication rate and 1.6% mortality rate. Of 83 patients with renal insufficiency not on hemodialysis 30.1% (Fisher's Exact Test = 0.076) had 1 or more complications and there was a 6% (Fisher's Exact Test = 0.166) mortality rate. One patient in Group A (0.8%) progressed to hemodialysis and 5 (6%) patients in Group B progressed to end-stage renal disease requiring hemodialysis (p=0.068). A statistically significant higher proportion of the patients in Group B had a history of MI (p<0.001). There was no difference in the amount of EBL between the 2 groups, but a significantly lower amount of contrast (p<0.05) was used in patients with renal insufficiency.     

Self-perceived health among Canadian opiate users: a comparison to the general population and to other chronic disease populations

BACKGROUND: There are an estimated 40,000 to 90,000 injection opiate users in Canada. The social, economic and health consequences of opiate addiction have been well documented. However, there are no data on the self-perceived health status of opiate users in Canada. Therefore, the goal of this research is to gain an understanding of the self-perceived health status of opiate users by comparing the health-related quality of life of opiate users to chronic disease populations and to the general population. METHODS: The SF-36 was administered to a nonrandom sample of 143 opiate users entering low-threshold methadone treatment. Two sample t-tests were performed to assess statistical differences, at a 5% level of significance, between population scores across SF-36 dimensions. RESULTS: Opiate users perceived both their mental and physical health as worse than the general population and individuals with minor and serious medical problems, but comparable to those with diagnosed psychiatric illnesses. CONCLUSIONS: Methadone treatment services should incorporate both primary care and psychiatric care into their programs, or at the very least secure appropriate referral mechanisms to ancillary services to ensure that the health concerns of opiate users are dealt with in the context of their treatment program.     

Antenatal and intrapartum antecedents of cerebral palsy: a case-control study

AIM: To identify antenatal and intrapartum factors contributing to the aetiology of cerebral palsy (CP). METHODS: A case-control study using moderate/severe cases of cerebral palsy identified from the Victorian Cerebral Palsy Register and two controls per case identified through the Victorian Perinatal Data Collection Unit. RESULTS: A number of previously identified risk factors for CP were confirmed in our data. New observations were (in specific sub-groups): protective effects of mother's negative Rhesus status, cigarette smoking at the first visit and episiotomy and an increased risk of CP associated with an abnormal antenatal cardiotocograph. CONCLUSIONS: Although the result of the deliberate investigation of specific aspects of the antenatal and intrapartum period identified from a pilot study, our new findings must be interpreted with caution as they were not all based on specific a priori hypotheses, although some had been examined by other investigators. We would encourage their evaluation in other data sets.     

Comprehensive I-125 multi-seed comparison for prostate brachytherapy: dosimetry and visibility analysis.

PURPOSE: To compare the visibility of different manufacturers I-125, seeds, and to investigate the effect of differences in dosimetry on treatment planning. MATERIALS AND METHODS: Oncura Oncoseed, Oncura Echoseed, IBT Intersource, Bebig Isoseed and Nucletron Selectseed were investigated. The point dose at increasing distances from each seed type was calculated for three different angles; theta=0 degrees, 45 degrees and 90 degrees (where theta=0 degrees lies parallel to seed length). 10 patient plans were used to assess the effect of a change in dosimetry on treatment planning and quality of prostate and rectum implant indices such as Vp100, Vp200, Dp90, Vr100 and Vr69. All implant indices and dosimetry data were compared to Oncoseed. Visibility under X-ray, fluoroscopy, CT and MRI was investigated using prostate phantoms created in-house. Statistical significance was calculated using paired two-tailed t-tests. RESULTS: Dosimetric analysis was carried out for seeds of the same source strength. Differences in dose increase closer to the centre of each source, with the largest changes occurring for the angle theta=0 degrees. Selectseed and Isoseed seed types provide a consistently lower dose in all three directions. Changes to Vp100 are small and statistically insignificant for all seeds except Selectseed which shows a statistically significant decrease of 0.04% (p=0.02). Changes to Vp150 and Vp200 are statistically significant (p<0.01), with Intersource showing the greatest increase in both values. Selectseed shows a decrease in both Vp150 and Vp200. Echoseed shows an increase in both Vp150 and Vp200. Changes to D90 are statistically significant (p<0.01), with Intersource showing the greatest increase, followed by Isoseed then Echoseed. Selectseed shows a decrease in D90. For Vr100 there is no statistically significant change for any seed type. However, all seeds except Selectseed show a statistically significant increase in the value of Vr69, with Intersource showing the greatest increase. On fluoroscopy and X-ray images, Intersource seeds appear least visible, Echoseed and Oncoseed are similar, and Isoseed and Selectseed are most visible. Ultrasound greyscale beam profiles show that all seed images have a FWHM larger than the Oncoseed image. The CT greyscale beam profiles are similar for all seed images. The MRI signal voids are similar for all seed images except Intersource which shows a larger signal void. CONCLUSIONS: The greatest changes to point dose occur at very close distances to the seeds. Changing seed type may require a treatment replan to maintain satisfactory DVH criteria. Visibility on US and CT is similar, though it may vary on MRI, X-ray and fluoroscopy.     

Diffuse lamellar keratitis complicating laser in situ keratomileusis: post-marketing surveillance of an emerging disease in British Columbia, Canada, 2000-2002

PURPOSE: To describe a surveillance system and summarize data between January 2000 and December 2002 regarding diffuse lamellar keratitis (DLK), a complication of laser in situ keratomileusis (LASIK) surgery. SETTING: Community-based clinics in British Columbia, Canada, in which LASIK surgery is performed. METHODS: Monthly, all clinics in which LASIK is performed reported the number of LASIK procedures and nonnominal cases of DLK (by grade and onset date) to the British Columbia Centre for Disease Control. Diffuse lamellar keratitis outbreaks were investigated, and prevention and control measures were recommended. RESULTS: From 2000 to 2002, approximately 72,000 LASIK procedures were performed, with a mean DLK incidence rate of 0.67% (95% confidence interval, 0.61-0.73). The overall proportion of DLK cases attributed to outbreaks was 64%, decreasing from 72% in 2000 to 40% in 2003. CONCLUSIONS: An effective DLK surveillance program was implemented at all laser refractive clinics in British Columbia. Reported DLK incidence was 0.67 cases per 100 procedures, with 64% occurring in outbreaks.     

Calbistrin E and two other new metabolites from an Australian isolate of Penicillium striatisporum

An Australian isolate of Penicillium striatisporum collected near Shalvey, New South Wales, exhibited selective antifungal activity against Candida albicans versus Saccharomyces cerevisiae. Bioassay-directed fractionation yielded members of the rare class of fungal metabolites known as the calbistrins. These included a new example of this structure class, calbistrin E (1), as well as the known polyenes calbistrin C (2) and deformylcalbistrin A (3). Also recovered from P. striatisporum were new triene and butenolide acids, striatisporin A (4) and striatisporolide A (5), together with the known fungal metabolites versiol (6) and (+)-hexylitaconic acid (7). Structures for all metabolites were determined by detailed spectroscopic analysis.