Is factor V Leiden a risk factor for fetal loss?

A successful pregnancy is dependent on the development of adequate placental circulation. The abnormalities of placental vasculature may result in a number of gestational pathologies, including fetal loss. The aim of our study was to determine whether women with f V Leiden are at an increased risk of pregnancy loss. For this purpose we assessed three groups of women. In a prospective group we examined 30 females with spontaneous abortions for f V Leiden. In a retrospective group we assessed the frequency of abortions in 80 women (172 pregnancies) with f V Leiden (72 heterozygous, 8 homozygous) from 57 unrelated families. In a control group we evaluated the frequency of abortions in 45 women without f V Leiden. Factor V Leiden was found in 3% of women in the 1st group. Fetal loss occurred in 10% of women in the 2nd group and in 9% in the 3rd group. Factor V Leiden was not found to be a risk factor for fetal loss in our study group.     

β-Radiation of the fetal fluid in man

Summary It was experimentally proved that the activity of -radiation of the fetal fluid is different depending upo the sex of the embryo.Thus, radiation activity of the fluid in which a fetus of the female sex (Table 1) was developing, was found to be significantly higher than that of the fluid in which a fetus of the male sex was developing (Table 2).Submitted by Active Member of the Academy of Medical Sciences USSR Professor L.V. Gromashevsky     

Chorioamnionitis-induced changes of fetal extramedullar hematopoiesis in the second trimester of gestation. Is diagnosis from fetal autopsy possible?

Chorioamnionitis, as the most frequent cause of second trimester abortions, is commonly diagnosed by histomorphological examination of placental tissue. We determined whether chorioamnionitis induces a fetal extramedullary hematopoietic response and estimated whether chorioamnionitis can be diagnosed from fetal liver alone. Clinical data and morphological and histological findings of 39 second trimester abortions, caused by chorioamnionitis, were compared with 32 age-matched control cases. Using hematoxylin and eosin staining, naphtol-ASD-chloracetate esterase and Berliner Blau reaction, total hematopoiesis, erythropoiesis, myelopoiesis and intracytoplasmatic iron of fetal liver were examined. In the study group, total hematopoiesis was increased compared with the controls (94.9% versus 84.4%). The same was seen in erythropoiesis (69.2% versus 56.2%, P>0.05). Chorioamnionitis resulted in a significant increase of fetal myelopoiesis with clustering of leukocytes in 56.4% (P=0.001). Neutrophiles were located predominantly intrasinusoidal and periportal (74.4%), while an isolated periportal location was often observed in controls (50.0%). Isolated perivenous iron storing was more often seen with chorioamnionitis (28.3% versus 3.1%) and correlated with the increasing severity of chorioamnionitis. It can be stated that infectious diseases, such as chorioamnionitis, increase fetal intrahepatic myelopoiesis as one defense mechanism. The morphology of fetal intrahepatic hematopoiesis and iron storing might also be helpful in the diagnosis of chorioamnionitis, especially when the placenta is not available for examination.     

“Memory bias” for recall of experiences during initial weight loss is affected by subsequent weight loss outcome

Research has suggested that memories of mood, emotions, and behaviors are not purely unbiased retrieval, but more similar to reconstructions based on current opinions, positive or negative experiences associated with the memory, and how a person believes they would have felt, thought, or acted. We investigated this memory bias in 66 adult participants with overweight/obesity who rated their mood, emotions, and behaviors during a 12-week, Internet-based behavioral weight loss program and later recalled these ratings at Month 3 (immediate post-test) and Month 12 (follow-up). At Month 3, participants recalled the intervention more positively than reported previously, p = .010, but reported remembering the intervention more negatively at the Month 12 follow-up, p = .004. Memory bias was associated with initial weight loss and regain, ps < .05, such that participants who lost more weight at Month 3 remembered their mood, emotions, and behaviors during intervention more positively, and those who regained more weight at Month 12, more negatively. Future research should investigate whether this bias is associated with willingness to re-engage with intervention.     

Is there a human fetal gallbladder contractility during pregnancy?

The purpose of this study was to evaluate whether human fetal gallbladder contractility exists in the second half of pregnancy. Ultrasound examinations were performed on 54 normal pregnant women from 20 to 40 weeks of gestation. Fetal gallbladder volume was monitored every 30 min from 08:00 to 18:00 h in each patient. Maximum gallbladder volume was related linearly with gestational age between 20 and 32-35 weeks of gestation, after which a plateau was observed. Minimum gallbladder volume was unchanged throughout gestation. Functional capacity (maximum volume - minimum volume) of the fetal gallbladder increased linearly with advancing gestation until 32-35 weeks gestation, and thereafter was constant. Contractility rate [(maximum volume - minimum volume/maximum volume)x100] increased curvilinearly with advancing gestation (R(2) = 30.7%, P < 0.0001). The daily change in fetal gallbladder volume showed a typical sinusoidal pattern, and the contractility cycle of gallbladder volume was unchanged during pregnancy (3.1 +/- 0.6 h). These results suggest that there is an apparent gallbladder contractility in human fetuses in utero, and that maternal meals seem not to affect the volume of the fetal gallbladder. Further study is needed to clarify the physiological role of fetal gallbladder contractility during pregnancy.     

How much blood is really lost in total knee arthroplasty?. Correct blood loss management should take hidden loss into account

In total knee arthroplasty (TKA) the total blood loss is composed of 'visible' blood loss from the surgical field and wound drainage, and blood loss into the tissues which is hidden. Blood management should be aimed at addressing the total blood loss. The measured loss is generally an underestimation of the 'true' loss, which can be calculated. Sixty-three TKAs were prospectively studied at the Avon Orthopaedic Centre, Bristol, UK. All but two TKAs were performed under a tourniquet. Thus the intraoperative blood loss was usually zero. Reinfusion of drained blood was carried out when appropriate. The drainage and volume reinfused were recorded. None of the patients studied received a bank blood transfusion. All patients had FBC including haematocrit (Hct) pre- and post-operatively. Each patients height and weight were recorded pre-operatively. The true total blood loss was calculated using height, weight and pre- and post-op Hct. Subtracting the visible loss gives the hidden loss. As the object of the study was to determine the proportion of blood loss that is hidden, rather than document blood loss in general, seven patients with very large blood losses were excluded from the study to minimise the effect of haemodilution on our calculation. The threshold chosen was 1.5 l. In TKA, the mean total calculated blood loss was 1474 ml. The mean hidden loss was 735 ml. It can be seen that the hidden loss is 50% of the total loss, making the true loss following TKA twice the volume usually recorded. This is due to bleeding into the tissues and haemolysis when reinfusion is carried out. It is concluded that when planning blood management after TKA, account should be taken of the probable substantial hidden blood loss.     

Sudden sensorineural hearing loss: an autoimmune disease?

Objectives

To review our current knowledge of the pathogenesis of sudden sensorineural hearing loss, including viral infection, vascular occlusion and immune system-mediated mechanisms, and to discuss the pathogenesis as it relates to pharmacotherapy.

Systematic review methodology

Relevant publications on the pathogenesis of sudden sensorineural hearing loss from 1944 to 2010 were analysed.

Results and conclusions

Sudden sensorineural hearing loss is defined as hearing loss of 30 dB in three sequential frequencies over 3 days or less. It can be an isolated symptom or the presenting symptom of a systemic disease. The aetiology and pathogenesis remain unknown. Detailed investigation typically reveals a specific cause in about 10% of patients. Proposed theories of causation include viral infections, vascular occlusion and immune system-mediated mechanisms. A variety of therapies have been proposed based on the various proposed aetiologies.     

Early pregnancy loss: how do men feel?

One in five pregnancies (20%) end in miscarriage. A specialized early pregnancy loss clinic to provide dedicated medical advice and support was established at the Rotunda Hospital in July 2002. A qualitative pilot study was conducted in July 2002 to assess the emotional response of male partners and also to establish if sufficient support services are provided for them. Ten consecutive couples attending the clinic 6-8 weeks following early pregnancy loss were included in the study. The partners were asked to complete a questionnaire with open and closed questions and return in the envelope provided. Nine questionnaires were returned. The average age of men attended was 28.6 years (range 20-39). The feelings described by men were typical of the grief and bereavement process. All wanted more time for discussion with doctors. They felt marginalized and although they felt support services for their partner were adequate, they felt that more support services for male partners should be provided. Based on these research findings, the specialized early pregnancy loss clinic is being developed to partner's needs and expectations. The appointment letter sent to the women now specifically states that the partner is welcome to attend. Partners are now included in the consultation.     

Portal hypertension: return to fetal life to re-attempt differentiation?

We speculate on the final meaning of the alterations that characterize portal hypertensive enteropathy.The similarity of these alterations with certain morphofunctional characteristics of prenatal splanchnic development makes it possible to hypothesize that the dedifferentiation with return to early stages of development could constitute a portal hypertension induced pathogenic mechanism.