Felix Wong

Maternal and neonatal factors influencing premature birth and low birth weight in Australia.

This study identified the influences of neonatal and maternal factors on premature birth and low birth weight in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected neonatal and maternal characteristics with premature birth and low birth weight. The findings of this study showed that premature birth and low birth weight rate significantly varied by infant sex, maternal age, marital status, Aboriginality, parity, maternal smoking behaviour during pregnancy and maternal hypertension. First-born infants, and infants born to mothers aged less than 20 years, or who were single, separated/divorced, Aboriginal or who smoked during the pregnancy, were at increased risk of being premature or of low birth weight. This study also found that risk factors for premature births and low birth weight were similar in both singleton and multiple births. Gestational age was confirmed to be the single most important risk factor for low birth weight. The findings of this study suggest that in order to reduce the incidence of low birth weight and premature births, health improvement strategies should focus on anti-smoking campaigns during pregnancy and other healthcare programmes targeted at the socially disadvantaged populations identified in the study.

Serum Ultrafiltrable Copper, Total Copper and Caeruloplasmin Concentrations in Gynaecological Carcinomas

Serum copper and caeruloplasmin concentrations are elevated in various carcinomas, but it is not known whether the rise in serum copper is due to elevation of caeruloplasmin alone or whether it is also due to the elevation of ‘free’ copper. We therefore determined ultrafiltrable copper to answer this question. Serum ultrafiltrate was prepared using the Amicon micropartition system and ultrafiltrable (free) copper was determined by flameless atomic absorption spectrophotometry. Serum total copper was determined by flame atomic absorption spectrometry and caeruloplasmin by rate nephelometry. There was no significant difference in the ultrafiltrable copper concentration between patients with gynaecological tumours and control subjects. However, total copper and caeruloplasmin concentrations were significantly elevated in cancer patients compared with control subjects. In contrast to total copper and caeruloplasmin concentrations, ultrafiltrable copper concentrations showed no significant increase with increase in the stage of the cancer.

Comparing vaginal tape and transobturator tape for the treatment of mild and moderate stress incontinence.

Objective: To compare the efficacy and safety of the tension‐free vaginal tape (TVT) and transobturator suburethral tape (TVT‐O) procedures for the treatment of mild and moderate stress urinary incontinence (SUI). Methods: A total of 56 women were randomly selected to undergo the TVT‐O or the TVT procedure. In some patients, vaginal repair or vaginal hysterectomy was done simultaneously for associated indications. Results: Mean blood loss and hospital stay duration were the same for the 2 groups, but mean ± SD operative time was significantly shorter in the TVT‐O than in the TVT group (16 ± 4 min vs 27 ± 6 min; P < 0.001). On the second day following surgery a residual urine volume less than 100 mL was noted in 86% and 89% of the patients in the TVT‐O and TVT groups, respectively; cure was achieved in 92.9% and 92.6% of the patients. No serious complications occurred in either group. Outcome was subjectively assessed, with the patients followed‐up for a mean of 27.6 months. Conclusion: No significant differences in rates of cure, postoperative urine retention, or operative complications were found following the TVT‐O or the TVT procedure.

Uterine leiomyosarcoma diagnosed during treatment with agonist of luteinizing hormone-releasing hormone for presumed uterine fibroid

Medical treatment with an LH-RH agonist may be used in selected cases of uterine fibroids. Although rare, rapid increase in uterine or fibroid volume may suggest an underlying leiomyosarcoma that would require prompt surgical intervention. Close monitoring of the response to treatment with an LH-RH agonist is essential.

Profile of Maternal Smokers and Their Pregnancy Outcomes in South Western Sydney

Objective: The prevalence of maternal smoking remains high in New South Wales. In order to better understand the profile of maternal smokers, a study has been conducted to examine the social and demographic characteristics and pregnancy outcomes of women who smoked during their pregnancy in south western Sydney.

Estrogen receptor in pelvic floor tissues in patients with stress urinary incontinence

Abstract Our study is to investigate the presence of estrogen receptor (ER) and its possible etiological relationship with the development of stress urinary incontinence (SUI). Thirty-one biopsy specimens from pelvic floor tissues were obtained from 31 patients categorized into three groups: pelvic organ prolapse (POP), SUI and control groups. ER in the pelvic muscles tissues was evaluated quantitatively after immunohistochemical staining to visualize the ER in the tissue. The sampling rate of levator ani (striated) muscle was 6.7% in total sample from the pelvic floor tissues, with the remaining showing connective tissues, smooth muscles and nerve fibers. ER positive staining was found in the in the nuclei of connective tissue, smooth muscles and nerve fibers. The positive rates of ER staining in tissues were 1.4%, 4.7% and 5.7%, respectively in control group versus 1.1%, 2.8% and 2.7% in SUI group and 4.1%, 9.5% and 11.6% in POP group. The positive rates of ER staining in connective tissue, smooth muscle and nerve fibers in SUI group were significantly lower than that in control and POP group (P<0.01). Our study suggests that a decrease of ER in the pelvic floor tissues might be related to the occurrence of SUI and implies that hormone replacement therapy might not be effective in treatment for SUI.

Microlaparoscopic Left Upper Quadrant Entry in Patients at High Risk of Periumbilical Adhesions

Summary: We performed a prospective study of microlaparoscopic direct entry in the left upper quadrant (LUQ) to determine the efficacy of this technique and the incidence and site of anterior abdominal wall adhesions in high‐risk patients. Direct insertion of the MiniPort introducer was successful with 1 attempt in 16 patients and in 2 attempts with 1 patient. Overall, 12 patients (71%) had either bowel or omentum adherent to the anterior abdominal wall. Eight of the 12 patients (75%) with a previous midline abdominal wall incision were found to have subumbilical adhesions. Two patients were noted to have LUQ omental adhesions. Direct insertion of a 2 mm microlaparoscopic primary port in the LUQ appears to be simple, safe and quick to perform. It provides an excellent view of the peritoneal surface of the anterior abdominal wall and umbilical area. This procedure is likely to be the preferred method of peritoneal entry in high‐risk patients in the future.

Study of Oestrogen and Progesterone Receptors in Normal Human Endometrium during the Menstrual Cycle by Immunocytochemical Analysis

Monoclonal antibodies to human oestrogen and progesterone receptors were applied to frozen sections of normal endometrium in various phases of the menstrual cycle. Both oestrogen and progesterone receptors were localised within the nuclei of target cells. There are no oestrogen or progesterone receptors in endometrial vessels. Oestrogen receptor contents remained fairly constant during the proliferative and early secretory phases but decreased markedly in the late secretory phase. This decline was more obvious in the glandular cells than in the stromal cells, where receptor staining disappeared in most cases. The receptors were localised predominantly in the glandular cells at most stages of the menstrual cycle except in the late secretory phase, where the reverse was observed. In contrast, progesterone receptors rose gradually throughout the proliferative and early secretory phases followed by a decrease to various degrees depending on the cell types in the late secretory phase. This decrease was more marked in the glandular cells where again receptor staining disappeared in most cases, whereas the receptor contents in the stromal cells only decreased to the level of the late proliferative phase. The progesterone receptors were also localised predominantly in the glandular cells at most stages in the cycle apart from the late secretory phase.

Pregnancy outcome following radiotherapy for naso-pharyngeal carcinoma

Nasopharyngeal carcinoma complicating pregnancy is uncommon, and its treatment with irradiation is problematical, as the irradiation risks in pregnancy have not been well defined. In this paper, we described a pregnant patient with nasopharyngeal carcinoma who received irradiation treatment during the pregnancy. The management and the risk of irradiation are discussed.

Serum ceruloplasmin, plasma copper concentration and copper to ceruloplasmin ratio in cervical carcinoma.

Several studies have shown that plasma/serum copper and ceruloplasmin concentrations are increased in various carcinomas. We determined serum concentrations of ceruloplasmin and plasma copper concentration to evaluate the clinical usefulness of these tests in patients with cervical carcinomas. There was a significantly higher ceruloplasmin concentration in patients with cervical carcinoma compared to healthy controls. Plasma concentrations of copper were not significantly different in the two groups of subjects. The copper to ceruloplasmin ratio was lower in cancer patients than in control subjects. There was a significant increase in the serum concentrations of ceruloplasmin with increasing FIGO stage of cancer. Copper concentration in advanced tumours (FIGO stage 3) were significantly higher compared to control subjects or FIGO 1 and 2. Copper to ceruloplasmin ratio was lower in FIGO stage 2 and 3 patients compared to stage 1 or control subjects. Ceruloplasmin can also discriminate between large tumours which are inoperable and early cervical carcinomas better than copper or copper to ceruloplasmin ratio.