The pharmacologic basis of diuretic therapy in the newborn

Effective use of diuretics in critically ill newborns requires an understanding of the ontogeny of renal function, a knowledge of the pathophysiology of the patient's disease, an expectation of the pharmacodynamics of the several classes of diuretics, and an appreciation of the kinetics and toxicities of the selected agents. Unfortunately, the number and scope of clinical pharmacologic studies of diuretics in critically ill newborns are inadequate for optimal therapy with most of these drugs.     

Legal aspects of urogynaecology

Lesions of the urinary tract are rare, but, typical complications of gynecologic surgery. Gradual loss of surgical experience results in a lack of knowledge of prevention and management of lesions. Pretherapeutical work-up, selection of adequate procedure and surgeon, recognition of atypical postoperative symptoms might cause mistakes in selection and organization of the physician responsible. The principle possibility of a laceration is a rare cause, more frequently disregarding of typical symptoms of complication and prolonged timing of additional investigations are reasons for legal implications. Recommendations of medical associations are of help, but, might be a burden.     

Graphic portrayal of relative pelvic size

A method of graphic portrayal of size and approximate shape of inlet, mid-, and outlet planes is presented. This is accomplished by diagramming each plane on a graphic outline of its normal counterpart. Six measurements, the anteroposterior and transverse of the inlet and midplane, and their point of intersection, and the posterior sagittal and transverse of the outlet are sufficient for graphic portrayal. Four of the six measurements can be obtained, or closely estimated, manually. Roentgenographic mensuration is necessary for the transverse diameter of the inlet, the anteroposterior of the midplane, and the determination of the point of intersection of the two basic diameters of each of these levels. It is desirable for determination of the transverse diameter of the midplane. When roentgenographic mensuration is performed, it is obviously better to make all measurements from the films than to depend in part upon manual mensuration.By means of graphic portrayal of relative pelvic size, accurate prognosis is possible. It is also possible to make precise prognosis of modifications of the course of labor occasioned by mild cephalopelvic disproportion.     

Induction of labour

Induction of labour describes the artificial stimulation of the onset of labour and occurs in up to 20% of pregnancies in the United Kingdom. Both mechanical and pharmacological methods of induction of labour exist. In the vast majority of women, the recommended method of induction of labour is by the use of vaginal prostaglandin E2. Induction of labour is associated with less maternal satisfaction and potentially increased rates of instrumental delivery and caesarean section compared with spontaneous vaginal delivery. Therefore, the decision for induction of labour should not be undertaken lightly and appropriate counselling of the mother and appropriate documentation of the provision of information in addition to the indications, risks, benefits and alternatives to induction of labour is advocated.     

Circulating immune complexes in the blood serum of patients with untreated cervical cancer--their occurrence and quantitative analysis

Circulating immunological complexes (KI) are one of the parameters of humoral immunity. The occurrence of KI was found in the course of neoplastic diseases both in animals and humans. They are formed as a result of interaction of neoplastic antigens with specific tumor antibodies. Immunological complexes may be favourable or unfavourable to the modulation of effector mechanisms directed against neoplastic cells. In spite of extensive research, the participation of KI in immunological neoplastic response has not been clearly defined. The quantitative analysis of KI in the serum of patients with neoplasms revealed that the levels of KI may correlate with the degree of the progression of the disease, which has been shown for example in malignant melanoma, embryonal neuroma and carcinoma of the breast. The investigation of KI in the serum of patients with cervical carcinoma is rarely reported. The present paper shows 71 patients with squamous epithelial cervical carcinoma in various stages of progression, patients not receiving therapy. The evaluation of KI was made by means of two methods: test of inhibition of forming rosettes EA and inhibition of forming rosettes EAC. The authors of the few reports on the subject agree (which was also confirmed in our research) that the serum of patients with cervical carcinoma reveals the presence of KI. The frequency of occurrence and levels of KI may correlate with the degree of progression of a neoplastic process.     

A national survey on preterm labor

A national survey was conducted to examine the American obstetricians' approach to management of preterm labor. Multiple-choice questionnaires were mailed to all current members of the Society of Perinatal Obstetricians and 750 randomly selected diplomates of the American College of Obstetricians and Gynecologists. Respondents included 249 members of the Society of Perinatal Obstetricians and 441 fellows of the American College of Obstetricians and Gynecologists. Analysis of the replies reflects wide variations among American obstetricians' criteria to diagnose preterm labor, choice of tocolytic agent, use of amniocentesis, and use of corticosteroids. Significant differences were found between the two groups in many aspects of diagnosis and management of preterm labor. However, the replies reflect a high degree of awareness of and many instances of first hand experience with severe beta-adrenergic therapy complications, including maternal death. These findings emphasize the need for caution in selection of patients for beta-adrenergic tocolytic therapy and judicious use of these agents.     

Analysis of factors influencing the cord blood sample collection for clinical purposes

The survival rate of patients after cord blood transplantation depends on the number of nucleated cell transplants. The number of nucleated cells available for transplantation closely correlates with collected volume of cord blood. The influence of several obstetric factors on the volume of cord blood donation was investigated. Cord blood was obtained from 32 normal full-term deliveries. Length of gestation, age of mother, weight of placenta and length of umbilical cord were analysed for their impact on the volume of cord blood. Mean volume of collected cord blood was 103 ml. We did not establish the correlation between the volume of collection and the weight of placenta (measured after blood collection), the length of gestation and the age of mothers. A close and significant correlation (p < 0.05, r = 0.78) concerned the length of umbilical cord and the volume of cord blood donation. Length of umbilical cord is the parameter which may be useful for selection of the most promising cases in the collection of cord blood.     

Prolonged inhibition of human myometrial contractility by intermittent isoproterenol

Regular, spontaneous contractions of human myometrial strips obtained at the time of elective cesarean section were recorded in a tissue bath in five experiments. Administration of the beta-adrenergic agonist isoproterenol (1 mumol/L) resulted in the rapid onset of myometrial relaxation. In the continuous presence of the beta-agonist, myometrial contractions of amplitude equal to or greater than that of baseline resumed after 10 to 40 minutes (mean +/- SEM = 29.7 +/- 7.3), indicating the development of desensitization of the tissue to the tocolytic effects of isoproterenol. In contrast, intermittent exposure of the myometrial strips to isoproterenol prevented the onset of desensitization and resulted in prolonged inhibition of myometrial contractions. These findings suggest that modification of the present regimen of administration of beta-adrenergic agonists from continuous to intermittent infusion may improve the success of these agents in the prevention of preterm births.     

Ganglion affection in the invasive vulvar carcinoma

This is a study of 150 cases of epidermal carcinoma of the vulva, treated in the Service of Gynecology of the National Institute on Oncology, of which inguinal lymphoadenectomy was practised in 126 cases. The histopathological study of the ganglions removed shows an incidence of 42% of total metastasis. Ganglionic metastasis was analyzed side by side with the clinical state and that of the localization of the tumor. The results of the metastasis of the "Cloquet ganglions" are also presented plus the invasion of the regional pelvic-ganglions with the existence or non-existence in the above mentioned ganglions.     

Placental changes in diabetes mellitus with special reference to villi maturation disorders. (Morphological findings and severity of the disease)]

The placentas of 30 cases of diabetes mellitus were examined. The degree of severity of the disease was classified according to the schema of White. Related to the gestation period different degrees of severity of diabetes mellitus revealed nearly the same weight of the placentas. Similar relations were found referred to the height of the placenta-child-index. Implantation lesions occured in 56, 7% of all cases, most of these in cases with strong diabetes mellitus. The greater number of lesions were insertion anomalies of the cord. All placentas-showed disturbed circulation by dominance of disturbed blood supply. A relation to the degree of the severity of the disease wasn't provable. Very often we found villi necrosis and proliferations of the syncytiotrophoblast. Also we could see alterations of the villi vessels and a compensatory angiomatosis. 83,3% of diabetes cases showed disturbed maturation of the villi; the grade of these changes could not be referred to the degree of severity of this disease; it was merely a ramification block. The authors point out that in diabetes mellitus the degree of danger to the pregnancy does not depend on the severity of the maternal disease. It is always necessary to have a sufficient metabolic condition.     

Perinatal care in the Czech Republic in 1997 and prospects for the near future--II. Regional analysis

In interregional comparisons of different indicators of quality of perinatal care from the aspect of the importance of revealed differences, it is due to errors of small numbers (number of births per year) better to use instead of frequency analysis the developmental trend of these indicators in the course of several years. From a thus conducted analysis ensues that along with the continual decline of the general perinatal mortality in the majority of regions a marked interregional difference persists in the frequency of very low birth weight neonates as well as in the quality devoted to these neonates. The advantage of regional analyses, as compared with nationwide analyses, is the possibility to assess interrelations between some indicators, e.g. between general early mortality, the frequency of very low birthweight infants and their specific early neonatal mortality which reflects the quality of care of these neonates in the perinatological centre of the catchment area. In the region one of the important tasks of the centre are annual interinstitutional comparisons of quality of care, using selected indicators.     

Mechanical ileus in pregnancy]

Mechanical intestinal obstruction during pregnancy is an extremely rare and dangerous complication. It refers mostly to small intestine. The cause of occurring this complication are previous operations and inflammations and one of their results: adhesions. The classical triad of symptoms stomachaches, vomiting, stop of fases and stool--are to seen very rarely in there pure form during pregnancy. These symptoms while occurring individually often accompany pregnancy. The diagnosis of the mechanical obstruction, independently on the size of pregnancy and the cause of affection, authorize to operational treatment. Opening of the abdominal cavity should be done by inferior medial section. The purpose of this operation is removing the cause of obstruction, decompression of the intestine, restitution of passage and preventing renewal of obstruction. The decision of simultaneous cesarean section must make allowances for the state of fetus, neonatal treatment facilities, sizes of the obstruction and general state of the pregnant. The cause of closing down the lumen of the intestine are adhesions in 60%, and more than a half of obstruction cases refers to the 3rd trimester of pregnancy. The death rate of mothers is 10-20% and of fetus 24-31%. A favourable prognosis for the mother of the child can be assured only by early diagnosis and early operational treatment.     

Incidence of aplasia of the umbilical artery in fetuses with intrauterine retardation]

The author analysed the occurrence of the aplasia of the umbilical artery in 320 umbilical cords of fetuses with intrauterine retardation and in 225 umbilical cords of normal fetuses and a normal course of pregnancy used as controls. Aplasia of the umbilical artery in umbilical cords of fetuses with intrauterine retardation was found in 5.93% and in the control group in 0.44% of cases (P less than 0.05). Fetuses with intrauterine retardation and aplasia of the umbilical artery showed a velamentous insertion of the umbilical cord in 31.57% of cases, an approximate duration of pregnancy of 36 weeks and 5 days, and the mean birth weight of 2250 +/- 2 S.D. 420 g. Out of 19 fetuses with intrauterine retardation and aplasia of the umbilical artery, 6 had congenital anomalies which in 50% of cases could not be detected by external examination. Perinatal mortality of fetuses with intrauterine retardation and aplasia of the umbilical artery proved to amount to 368.43% and of fetuses in the control group to 8.88% (P less than 0.05).     

An Evaluation of Two Methods of Antenatal Ultrasonic Fetal Weight Estimation

Summary: The accuracy of 2 methods of antenatal ultrasonic fetal weight estimation has been compared. The method of Warsof et al. (1977) computes the estimated fetal weight from measurements of the abdominal circumference and the biparietal diameter, whilst the method of Higginbottom et al. (1975) utilises the circumference of the abdomen alone. The estimated weights obtained by the 2 methods were compared with the actual weights at birth occurring within 48 hours of the estimation.
Using the tables of Warsof et al., 77% of the actual birth weights were within 10% of the estimated weight, with a coefficient of correlation of 0.95. Eighty-two per cent, of babies less than 2,500 g fell within 10% of the estimated weight (Warsof et al.), with a coefficient of correlation of 0.96. Using the formula of Higginbottom et al., 56% of the total birth weights fell within 10% of the estimated weight and the coefficient of correlation was 0.89. Forty-five per cent, of the babies weighing less than 2,500 g were within the 10% range, the coefficient of correlation of this subgroup being 0.91. It is concluded that antenatal fetal weight estimation using the computed tables of Warsof et al. is superior in our population to the method described by Higginbottom et al., and such antenatal fetal weight estimation is of potential value in many high risk pregnancies.     

Dynamics of morphologic changes in the ovaries of guinea pigs modified by implanted endometrium

The implantation of section of cornual endometrium into ovaries of guinea pigs was carried out. The purpose of the work is to evaluate the dynamics of morphologic changes occurring in ovaries following implantation of endometrium. During a 40-weeks period of followup, it was stated that after the initial massive degeneration of the normal endometrium, implanted into the ovaries, the regenerative processes of basic elements in endometrium take place, involving the excessive proliferation of its elements, and resulting afterwards in lesion of gonads. The morphologic manifestations in ovary consist principally in proliferation of glandular tubes, formation of endometrial cysts of various size, in growth of connective tissue, and progressive loss of vesicles in ovary. Presented morphologic dynamics may be a suitable experimental model for further studies on endometriosis in ovary.     

Acceptability of prenatal HIV screening at the primary care level in Nigeria.

A survey of 333 pregnant women receiving antenatal care at the primary healthcare centres in Sagamu Local Government Area of Ogun State, southwest Nigeria was conducted between January and March 2005 to assess the acceptability of prenatal HIV screening among them. A total of 325 (97.8%) of the respondents were aware of HIV/AIDS but only 181 (54.3%) of them believed it is a problem in Nigeria. A total of 257 (77.2%) respondents agreed to undergo voluntary counselling and HIV testing (VCT). Multivariate logistic regression analysis of associated factors indicated that being married, self-perception of no risk of HIV infection, awareness of benefits of prenatal HIV testing and Christianity are independent predictors of acceptance of prenatal HIV testing in this population. Most of the respondents (78.9%) who were unwilling to take the test cited fear of being infected with its consequences of stigma and discrimination as the reason for their attitude. The survey suggests that a successful integration of VCT programme into the existing primary healthcare services for prevention of vertical HIV transmission is feasible in this part of Nigeria.     

Independent determinants of inaccuracy of colposcopically directed punch biopsy of the cervix

OBJECTIVE: The goal of this study was to determine the clinical factors independently associated with inaccuracy of colposcopically directed punch biopsy in defining extent and severity of epithelial lesions of the cervix. METHODS: The study was conducted in a colposcopy clinic devoted to the management of patients with abnormal Pap smear and/or histology diagnosis of cervical intraepithelial neoplasia (CIN) on punch biopsy or endocervical curettage. Seven hundred and thirty-nine patients (median age, 33 years; range, 18-83 years) referred with a punch biopsy diagnosis of CIN2-3 and treated with electrosurgical conization were evaluated. Cone histology diagnosis was assumed to supply the correct diagnosis. Two types of deviation of biopsy diagnosis were considered: (1). unconfirmed high-grade CIN diagnosis, defined as a cone diagnosis of CIN1 and reactive/reparative changes, and (2). nondiagnosis of carcinoma, defined as a cone diagnosis of microinvasive and invasive squamous carcinoma. Multinomial logistic regression analysis was used to assess the determinants of the probability of each type of deviation. RESULTS: The probability of unconfirmed high-grade CIN diagnosis (n = 190, 25.7%) was inversely related to number of quadrants involved, severity of referral Pap smear, and grade of biopsy. The probability of nondiagnosis of carcinoma (n = 43, 5.8%) was positively related to patient age, invisibility of the squamocolumnar junction, number of quadrants involved, and cone width. Endo-ectocervical location, cone depth, and time period had no effect whatsoever. CONCLUSIONS: The study confirmed previous observations regarding the positive association of patient age and invisibility of squamocolumnar junction with the probability of nondiagnosis of carcinoma. The concomitant positive effects of number of quadrants involved and cone width were suggested to mirror the effect of circumferential development and, respectively, surface area of CIN. Severity of referral Pap smear and grade of biopsy were shown to be inversely related to the probability of a cone diagnosis of CIN1 and benign changes.     

Cytogenetic studies on women during and following the use of hormonal contraceptives

The object of our investigations was the assessment of chromosomal changes in lymphocyte cultures of 33 women after long-term application of Ovosiston and Non-Ovlon (Group I), of 10 women with discontinued use of hormonal contraceptives at intervals of at least two month (Group II), cytogenetic investigations of 20 untreated healthy persons (Group III). We did not find an increase of numerical or structural aberrations in all cases. Our study of anomalies in the position of acrocentric chromosomes in the metaphase indicates a significantly increasing rate of associations after long-term use of hormonal contraceptives in lymphocyte culture. Origin connexion and importance of associations were discussed.     

Isolation of vital human sperm from seminal plasma following cryopreservation

In the present paper the conditions of separation of cryopreserved spermatozoa from seminal plasma were varied. The optimum seems to be at 300 g and 5 to 7 min of centrifugation. The effect of separation was approximately estimated by means of determination of concentration, motility, morphology, and supravital staining of spermatozoa. The concentration of seminal plasma was reduced to less than one per cent (use of a radioactive marker). After the separation the activity of free acrosin reached 64 p.c. of the total acrosin. The process of cryopreservation and separation reduced the ouabain-sensitive netto-uptake of K+ of spermatozoa by nearly 50 p.c.