PET imaging of the normal human auditory system: responses to speech in quiet and in background noise

The neural mechanisms involved in listening to sentences, and then detecting and verbalizing a specific word are poorly understood, but most likely involve complex neural networks. We used positron emission tomography to identify the areas of the human brain that are activated when young, normal hearing males and females were asked to listen to a sentence and repeat the last word from the Speech in Noise (SPIN) test. Listening conditions were (1) Quiet, (2) Speech, (3) Noise, and (4) SPIN with stimuli presented monaurally to either the left ear or the right ear. The least difficult listening task, Speech, resulted in bilateral activation of superior and middle temporal gyrus and pre-central gyrus. The Noise and SPIN conditions activated many of the same regions as Speech alone plus additional sites within the cerebellum, thalamus and superior/middle frontal gyri. Comparison of the SPIN condition versus Speech revealed additional activation in the right anterior lobe of the cerebellum and right medial frontal gyrus, near the cingulate. None of the left ear–right ear stimulus comparison revealed any significant differences except for the SPIN condition that showed greater activation in the left superior temporal gyrus for stimuli presented to the right ear. No gender differences were observed. These results demonstrate that repeating the last word in a sentence activates mainly auditory and motor areas of the brain when Speech is presented, whereas more difficult tasks, such as SPIN or multi-talker Noise, activate linguistic, attentional, cognitive, working memory, and motor planning areas.     

Induced and spontaneous abortion and breast cancer risk: results from the E3N cohort study

Recent reviews reach conflicting conclusions on breast cancer risk after spontaneous or induced abortion. E3N is a large-scale cohort study collecting detailed information on environmental and reproductive factors. We investigated the relation between breast cancer and a history of induced and/or spontaneous abortion, using the data from the 100,000 women aged 40-65 at entrance in 1990. Among them, over 2,600 new invasive breast cancers had been diagnosed by June 2000. Multivariate analysis, adjusted for known potential confounders, showed no association between a history of induced abortion and breast cancer risk either in the whole population (relative risk [RR] = 0.91, 95% confidence interval [CI] 0.82-0.99) or in subgroups defined by parity or by menopausal status. Overall, the association between spontaneous abortion and breast cancer was not significant (RR = 1.05, 95% CI 0.95-1.15). However, there is a suggestion of increased risk with increased number of miscarriages (RR = 1.20, 95% CI 0.92-1.56 after 3 or more). Moreover, an interaction with menopausal status was observed. In premenopause, the risk decreased with increasing number of spontaneous abortions, whereas it increased in postmenopause. Among nulliparous and parous women, the relative risk estimates were respectively equal to 1.16 (95% CI 1.04-1.30, p trend < 0.0008) and 1.14 (95% CI 1.01-1.28, p trend = 0.005). Premenopausal breast cancer, on the other hand, appeared to be less frequent in women who had had repeated miscarriages. We conclude that there is no relationship between breast cancer and induced abortion but that an association with spontaneous abortion is possible and may depend on menopausal status.     

The pharmacokinetics of mifepristone in humans reveal insights into differential mechanisms of antiprogestin action

The pharmacokinetics of mifepristone is characterized by rapid absorption, a long half-life of 25–30 h, and high micromolar serum concentrations following ingestion of doses of ≥100 mg of the drug. The serum transport protein— 1-acid glycoprotein (AAG)—regulates the serum kinetics of mifepristone in man. Binding to AAG limits the tissue availability of mifepristone, explaining its low volume of distribution and low metabolic clearance rate of 0.55 L/kg per day. In addition, the similar serum levels of mifepristone following ingestion of single doses exceeding 100 mg can be explained by saturation of the binding capacity of serum AAG. Mifepristone is extensively metabolized by demethylation and hydroxylation, the initial metabolic steps being catalyzed by the cytochrome P-450 enzyme CYP3A4. The three most proximal metabolites, namely, monodemethylated, didemethylated and hydroxylated metabolites of mifepristone, all retain considerable affinity toward human progesterone and glucocorticoid receptors. Also, the serum levels of these three metabolites are in ranges similar to those of the parent mifepristone. Thus, the combined pool of mifepristone—plus its metabolites—seems to be responsible for the biological actions of mifepristone. Recent clinical studies on pregnancy termination and emergency contraception have focused on optimization of the dose of mifepristone. In these studies it has become apparent that the doses efficient for pregnancy termination differ from those needed in emergency contraception—mifepristone is effective in emergency contraception at a dose of 10 mg, which results in linear pharmacokinetics. However, the ≥200 mg doses of mifepristone needed for optimal abortifacient effects of mifepristone result in saturation of serum AAG and thus nonlinear pharmacokinetics. In view of the pharmacokinetic data, it may be speculated that dosing of mifepristone for pregnancy termination and for emergency contraception could be reduced to approximately 100 mg and 2–5 mg, respectively. It remains to be seen whether the newly synthesized, more selective antiprogestins will prove more efficacious in the clinical arena.     

A retrospective comparison between lamicel and gemeprost for cervical ripening before surgical interruption of first-trimester pregnancy

To study the effect and complication rate of lamicel versus gemeprost as pretreatment to vacuum aspiration for the interruption of early pregnancy, the files of 622 medical records of women having a first-trimester abortion at S?der Hospital were studied retrospectively. Group A consisted of 317 women treated with lamicel in 1995 and Group B of 305 women treated with gemeprost in 1996. Complications were more common in Group A than in Group B (55 vs. 22; p < 0.05). Re-admission took place more often in Group A (25) than in Group B (6) (p < 0.05). The complications were more severe in Group A than in Group B. Using multivariate logistic regression analysis, the only impact factor for having a complication was the use of product for cervical priming. Gemeprost for preoperative treatment was found to render a fairly low rate of complications in this study, while complication rate was higher after treatment with lamicel.     

A study of the efficacy of cervical ripening with nitric oxide donor versus placebo for cervical priming before second-trimester termination of pregnancy

This was a double-blind randomized control study to evaluate the efficacy of cervical priming by nitric oxide donor before second-trimester induced abortion. One-hundred healthy women with a singleton pregnancy between 14 and 20 weeks of gestation were randomized into either 40 mg isosorbide mononitrate or placebo, given intravaginally 12 h before induction. This was followed by intravaginal misoprostol induction. The induction-abortion interval, abortion rate, side effects and the woman's acceptability of the priming agent were recorded. All women completed the study and there was no severe complication recorded. There was no significant difference in the induction-abortion interval and abortion rate between the two groups. Isosorbide mononitrate group reported significantly more side effects of headache. More than 90% of the women in both groups found the priming agent acceptable. The application of intravaginal nitric oxide donors prior to the prostaglandins induction did not significantly improve the second-trimester induced-abortion process.     

Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration

When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.     

负压吸宫术前口服和阴道放置米索前列醇对宫颈扩张作用的随机比较研究

目的:比较在终止早期妊娠负压吸宫手术前口服和阴道放置米索前列醇对宫颈的扩张作用以及副反应。方法:将停经6～10周要求手术终止妊娠的100名妇女随机分为两组,分别口服或阴道放置400μg米索前列醇,用药后3～3.5小时行负压吸宫术。记录观察对象的宫颈扩张程度和用药后副反应以及术中出血量、手术所用时间。结果:两组对象宫颈扩张程度无明显差异(平均直径分别为6.96mm和7.02mm,P>0.05),口眼用药组恶心、呕吐发生率明显高于阴道用药组(P<0.05),阴道用药组腹痛的发生率大于口服用药组(分别为56％和44％),但差异无显著性(P>0.05)。其他副作用及术中出血量、手术所用时间等均无显著差异。结论:在终止早期妊娠的负压吸引术前口服或阴道放置米索前列醇400μg,均能有效扩张宫颈。口服用药方法简单、方便,可接受性好,但对于妊娠反应较明显的妇女,阴道用药更为可取。     

不全流产的声像图研究

目的探讨不全流产宫内残留物声像图表现,分析其形成原因。方法对369例不全流产宫内残留物声像图进行分析。结果不全流产宫内残留物声像图表现为：高回声型、低回声型、混合回声型、无回声型或无异常回声型。结论超声显像在不全流产宫内残留物有较高的应用价值。     

氟比洛芬酯联合丙泊酚与芬太尼联合丙泊酚用于无痛人工流产术的比较

目的：探讨氟比洛芬酯对无痛人工流产术麻醉及其术后镇痛的效果及安全性。方法：100例要求行人工流产者随机均分为2组，观察组先静脉注射氟比洛芬酯50mg，10min后静脉注射丙泊酚2mg／kg；对照组先缓慢静脉注射芬太尼1μg／kg，10min后静脉注射丙泊酚2mg／kg。两组丙泊酚静注速率均为100mg／min。观察并纪录两组用药前、睫毛反射消失时、术中、术毕时的收缩压、心率、呼吸频率及血氧饱和度，手术时间，苏醒时间，丙泊酚总用药量。不良反应，术中麻醉效果，以及术毕清醒后1、5、15、30min视觉模拟评分（VAS）值。结果：受术者睫毛反射消失时，观察组收缩压显著高于对照组（P〈0．05）；睫毛反射消失时及术中呼吸频率及血氧饱和度观察组显著高于对照组（P〈0．05），术中麻醉效果评定为优、良、差的例数及术毕清醒后1、5、15、30min时下腹部疼痛的VAS值，两组比较差异无统计学意义。结论：在人工流产术中应用氟比洛芬酯联合丙泊酚具有良好的术中麻醉及术后镇痛效果，对呼吸及循环抑制较轻，是一种较为安全有效的配伍方法。