In Laparoscopic Myomectomy, Does a Caseload of 100 Patients During the Learning Curve Produce a Significant Improvement in Performance Measures?

Purpose: Laparoscopic myomectomy (LM) offers considerable advantages over open myomectomy; however, LM is technically complex and associated with a steep learning curve. Few studies have evaluated the effect of the learning curve, and the limitations of most of these studies were the number of women included and the multiplicity of surgeons undertaking the procedure. The aim of this study is to evaluate the effect of a caseload of 100 patients during the learning curve of a single experienced surgeon performing LM.

Comparing disciplines: outcomes of non melanoma cutaneous malignant lesions in oral and maxillofacial surgery and dermatology.

300 cases of non-melanoma cutaneous lesion procedures carried out by the Oral and Maxillofacial Surgery and Dermatology departments in a North West London hospital over a 6 month period between September 2011 and February 2012 were included in a retrospective case control study. The results from each speciality were compared. The mean age of the OMFS group was 75.

Vitamin D deficiency in pregnancy - still a public health issue.

The objectives of this study were to quantify the prevalence of vitamin D insufficiency and deficiency in pregnancy, explore associated risk factors and discuss the public health implications. The study used retrospective analysis of randomly selected data. This is the first report on serum vitamin D levels in an unselected multi-ethnic population of pregnant women collected between April 2008 and March 2009.

Catheterization of posterior tibial artery leading to limb amputation.

A cannula inserted into the posterior tibial artery of a preterm infant resulted in irreversible ischaemia of the foot with proximal extension to involve the lower leg. No predisposition to thrombosis was found and a below-knee amputation was ultimately required.

Permeability of the fetal villous microvasculature in the isolated perfused term human placenta.

1. Capillary permeability-surface area (PS) products for the low molecular weight radioactive tracers, 22Na, 51Cr-EDTA (relative molecular mass 357) and 57Co-cyanocobalamin (relative molecular mass 1353) were measured in the fetal circulation of isolated dually perfused lobules of normal term human placentae using the single circulation, multiple-tracer dilution technique. 2.

Transfer of heparin across the human perfused placental lobule.

A system of dual perfusion of an isolated lobule of term human placenta was used as a model to study the transfer of heparin from maternal to foetal circulation. The metabolic viability of the system was assessed by measuring beta-HCG and alkaline phosphatase levels in both maternal and foetal perfusates. Creatinine and antipyrine were used as markers to determine juxtaposition of the maternal and foetal circulations.

Is obstetric and neonatal outcome worse in fetuses who fail to reach their own growth potential?

Objectives: To determine the perinatal outcome of fetuses who had birthweights less than that expected from early third trimester ultrasound scanning.

Design: Retrospective estimation of centile fetal weight at early third trimester ultrasound scanning compared with actual centile birthweight corrected for gestational age, parity and sex.

Setting: Teaching Hospital Obstetric Unit, London.

Teenage pregnancy: doubts, uncertainties and psychiatric disturbance.

Fifty-two pregnant teenagers were assessed at 'booking' using the General Health Questionnaire (GHQ 28), a locus of control scale, and five visual analogue 'attitude scales'. Thirty-eight were in the antenatal and 14 in the termination clinic. One quarter had probable psychiatric disorder on the GHQ.

Measuring fetal and maternal temperature differentials: a probe for clinical use during labour.

The healthy fetus maintains a higher temperature than that of its mother during gestation and labour. This results from the thermal balance between the heat generated by the fetus and the heat loss to its maternal surroundings. The heat loss can be by heat exchange via blood flowing in the umbilical cord and placenta, and via conduction through the fetal skin and amniotic fluid to the maternal wall.

How obstetricians manage the problem of preterm delivery with special reference to the preterm breech.

A questionnaire regarding the route of birth for the preterm fetus with particular reference to the management of the preterm breech was sent to 180 consultants in England and Wales. Only 23% of respondents use electronic fetal monitoring below 26 weeks gestation and only 12% use caesarean section routinely for fetal indications at less than 26 weeks. Only 12% will use caesarean section for the preterm fetus presenting by the vertex in uncomplicated labour.

Vectorial transcytosis of immunoglobulin G by human term trophoblast cells in culture.

Trophoblast cells were grown on filters that allow access to apical and basal surfaces of cells. Using this experimental system, IgG transport was shown to be specific and to occur primarily in the apical to basal direction. This transport was time- and temperature-dependent, with approximately 10% of added IgG appearing on the basal side within a 60-min incubation at 37 degrees C.

Uptake and intracellular routing of peroxidase-conjugated immunoglobulin-G by the perfused human placenta.

Selected lobules of term human placenta were extracorporeally perfused and human immunoglobulin-G complexed to horseradish peroxidase (IgG-HRP) was added to the maternal perfusate. After different durations of perfusion IgG-HRP was visualised by use of diamino-benzidine cytochemistry. Within the first 10 min of perfusion IgG-HRP was found bound to microvilli and coated pits of the syncytiotrophoblast; internalisation into coated vesicles and tubulo-vesicular bodies was also observed.

Reasons for declining participation in a prospective randomized trial to determine the optimum mode of delivery of the preterm breech.

Increasing numbers of preterm breech infants are being delivered by cesarean section, which confers no proven advantage to the infant and subjects the mother to increased risk. In order to assess the feasibility of performing a randomized controlled trial to compare elective with selective cesarean delivery for the preterm breech infant, consultants in 36 hospitals were asked if they would be willing to participate. In 25 hospitals all consultants agreed to participate, whereas in 11 universal support was not obtained.

Binding and internalization of immunoglobulin G by cultured human trophoblast.

A preparation consisting of a high percentage of trophoblasts can be obtained by centrifuging a mixture of cell types from trypsinized term placental villi on a discontinuous gradient of Percoll. When cultured these cells maintain trophoblast characteristics as judged by immunocytochemical markers and beta-human chorionic gonadotrophin production. Incubation of cells with labelled human immunoglobulin G demonstrated their ability to bind and internalize this macromolecule in a time- and temperature-dependent manner.

Immunogold localisation of endogenous immunoglobulin-G in ultrathin frozen sections of the human placenta.

Endogenous immunoglobulin-G was localised in ultrathin frozen sections of human term placenta by use of an indirect immuno electron-histochemical methodology. Immunoreactivity of endogenous IgG to rabbit anti-human immunoglobulin-G antibody was visualised by use of protein-A--colloidal gold complex. Gold marked the syncytiotrophoblast in both coated and uncoated regions of the apical plasmalemma, in vesicles and multivesicular bodies, and in vesicles near the basal plasmalemma.

Trends in sexual behaviour and risk factors for HIV infection among homosexual men, 1984-7.

To assess whether the spread of infection with HIV can be reduced by changes in behaviour among groups most at risk because of their sexual practices sexual behaviour was monitored among 1050 homosexual men tested for HIV infection at a genitourinary medicine clinic in west London from November 1984 to September 1987. Four cohorts, defined by date of presentation, were studied by questionnaire at their presentation, and blood samples were analysed. Between the first and last cohorts there was a considerable fall in the proportion reporting casual relationships (291/329 (88%) v 107/213 (50%] and high risk activities, such as anoreceptive intercourse with casual partners (262/291 (90%) v 74/106 (70%], with the greatest changes occurring before the government information campaign began in 1986.

Uptake of alpha 2-macroglobulin-trypsin complex by human placenta is mediated by a microvillous membrane receptor.

The fate of native alpha 2-macroglobulin (alpha 2M) or its trypsin complex (alpha 2M-T) was studied in the isolated dually-perfused lobule of term human placenta. [125I]-alpha 2M added to the maternal circuit was unchanged during the course of the perfusion with minimal activity becoming associated with the placental tissue. Transfer of radioactivity into the fetal circulation accounted for only 0.

Human immunodeficiency virus infection, hepatitis B virus infection, and sexual behaviour of women attending a genitourinary medicine clinic.

During the six months immediately after a public information campaign about the acquired immune deficiency syndrome 1115 women who attended a genitourinary medicine clinic in west London were tested for antibodies to the human immunodeficiency virus (HIV). Three women (0.27%) were positive, and all three were regular sexual partners of men with high risk lifestyles--two intravenous drug users and one bisexual.

Sexual behaviour in women attending a genitourinary medicine clinic.

In 1025 women attending a genitourinary medicine (GUM) clinic, sexual experience had started at an increasingly early age during the past 30 years, from a mode of 19 in the early 1950s to 16 in the early 1980s. Up to the age of 40, sexually active older women had as many recent sexual partners as younger women. Oral intercourse (fellatio) was practised by 714 (70%) women, and 378 (37%) experienced ejaculation in the mouth.

Students' assessment of a course in obstetrics and gynaecology.

A complete annual entry of 181 students were administered a questionnaire in which they were invited to make value judgements about all aspects of their 3-month course in obstetrics and gynaecology. The resulting performance indicators were used to compare individual staff and clinical firms.