The combined effect of small volume hypertonic saline and normal saline solutions in uncontrolled hemorrhagic shock.

Recently, small volume hypertonic saline solution (HTS) has been suggested for treatment of trauma casualties. Previously, we reported that small volume HTS treatment of uncontrolled hemorrhagic shock (UCHS) leads to increased bleeding, hemodynamic deterioration and early mortality. In the present study, large volume normal saline solution (NS) combined with small volume HTS was used to treat UCHS in rats. The rats were randomly assorted into four groups. Group 1 (n = 9) included rats in which UCHS induced by 12 per cent resection of the tail was untreated; group 2 (n = 8) consisted of those in which UCHS was treated after 15 minutes with 41.5 milliliters per kilogram of sodium chloride, 0.9 per cent (NS); group 3 (n = 7) included rats in which UCHS was treated with 5 milliliters per kilogram sodium chloride, 7.5 per cent (HTS); and group 4 (n = 9) included rats in which UCHS was treated by a combination of HTS and NS. In group 1, resection of the tail was followed by bleeding of 4.9 +/- 0.3 milliliters in 15 minutes, a decrease in mean arterial pressure (MAP) from 105 +/- 5 to 51 +/- 3 torr (p less than 0.001) and pulse rate from 377 +/- 9 to 305 +/- 22 beats per minute (p less than 0.05). Further loss of blood after 30 minutes was 0.5 +/- 0.2 milliliters, MAP rose to 58 +/- 6 torr (p less than 0.05) with the death of two rats. Infusion of NS in group 2 was followed by further bleeding of 3.3 +/- 1.0 milliliters (p less than 0.01) and rise in MAP to 76 +/- 9 after 30 minutes. Infusion of HTS in group 3 was followed by bleeding of 1.9 +/- 0.3 milliliters (p less than 0.05) and fall in MAP to 57 +/- 14 torr (p less than 0.05). Continued loss of blood in this group resulted in further fall in MAP to 36 +/- 11 torr (p less than 0.01) with death of 71 per cent (p less than 0.01) of the rats in four hours. Combined HTS and NS infusion in group 4 was followed by bleeding of 2.0 +/- 0.4 milliliters (p less than 0.05) and an increase in MAP to 93.0 +/- 3.0 torr (p less than 0.005) after 30 minutes with the death of only one animal in four hours. Total loss of blood in the three treated groups was similar and significantly higher than in the untreated group.(ABSTRACT TRUNCATED AT 400 WORDS)     

Effect of portasystemic shunts on subsequent transplantation of the liver

Portasystemic (PS) shunts have been regarded as a relative contraindication to hepatic transplantation (HT) because of the potential for increased technical difficulties during the transplant operation. We compared operative blood loss, morbidity and mortality in 27 patients with PS shunts and 147 patients with no shunts (NS) who underwent HT. The PS shunt group included 12 portocaval (PC), eight mesocaval, four central splenorenal and four distal splenorenal shunts. The PS shunt and NS groups were similar with respect to age, preoperative medical status and ABO blood group matching between donors and recipients. There were no significant differences in the mean (plus or minus S.D.) intraoperative blood transfusion (9.1 +/- 7.6 versus 9.2 +/- 11.0 units), mean (plus or minus S.D.) duration of anesthesia (8.1 +/- 1.4 versus 7.8 +/- 1.5 hours) and operative mortality (7 versus 11 per cent) between the PS shunt and NS groups, respectively. Complications of the biliary tract were significantly higher in the PS shunt group (22.0 versus 5.4 per cent, p less than 0.01) but they did not increase the mortality rate. We conclude that a prior PS shunt should not influence the decision to accept patients for HT. PS shunts remain a reasonable surgical option for patients with cirrhosis and variceal hemorrhage (refractory to sclerotherapy) who, by virtue of good hepatic function, do not merit immediate HT.     

Immediate preoperative phlebotomy with autologous blood donation for aortic replacement

The preferential use of autologous blood provided by phlebotomy can reduce the need for homologous blood transfusion in patients undergoing extensive elective operations. This blood is usually provided either by intraoperative isovolemic hemodilution or phlebotomy one to two weeks preoperatively. To minimize the intraoperative time delay or preoperative period between phlebotomy and operation required in these patients, we performed preoperative isovolemic hemodilution in 69 patients one to two days prior to elective aortic replacement for infrarenal aneurysmal disease. Patients underwent phlebotomy a mean of 0.57 +/- 0.01 liter of whole blood; volume was replaced with lactated Ringer's solution. Hematocrit levels decreased from a mean value of 42.9 +/- 0.4 per cent to 33.7 +/- 0.3 per cent. Mean intraoperative blood loss was 1.2 +/- 0.05 liters. Hemodynamic parameters (blood pressure, cardiac output, pulmonary capillary wedge pressure, central venous pressure, oxygen delivery and systemic vascular resistance) remained stable throughout the perioperative and intraoperative time periods. In addition, we evaluated the technical modification of exclusion aneurysmorrhaphy (n = 50) versus open aneurysmorraphy (n = 19) on reduction of intraoperative homologous blood transfusion in these patients. Seventy-two per cent (36 of 50) of patients whose aneurysms were excluded received no homologous blood intraoperatively. Blood loss was decreased in the excluded versus open aneurysmorraphy group, 920 +/- 90 milliliters versus 2,030 +/- 250 milliliters, as were homologous blood transfusion requirements, 175 +/- 35 milliliters versus 570 +/- 119 milliliters. Two patients died (2.9 per cent mortality rate), and there was no increase in morbidity. Surgical treatment of large aortic aneurysms is frequently performed on an urgent basis; thus, provision of autologous blood for this operation in a short period of time may be beneficial. Isovolemic hemodilution performed during the immediate preoperative period can reduce homologous blood requirements and be safely performed without adverse effects on mortality, morbidity and myocardial performance. Exclusion aneurysmorrhaphy may further reduce dependence on homologous blood.     

The systemic activation of platelets by Dacron grafts

Dacron (polyester fiber), a stimulus to platelet aggregation in vitro, accumulates platelets to a greater extent in vivo than autogenous artery, polytetrafluoroethylene (PTFE) or human umbilical vein (HUV). We conducted a series of experiments using the ex vivo shunt in the baboon to determine whether or not systemic activation of platelet function was produced by a Dacron graft. Two 5 centimeter segments of 4 millimeter internal diameter graft materials were placed in series in the ex vivo shunt perfused at 25 milliliters per minute flow rate for two and one-half hours. Deposition of autologous Indium 111 labeled platelets was monitored. The ex vivo shunt procedures were divided into two groups, both with PTFE as the proximal graft: one with a distal Dacron graft (n = 21), the second with PTFE or HUV distally (n = 17). In this study, an increase in platelet deposition on the proximal PTFE graft represents systemic platelet activation caused by the distal graft. Increased platelet deposition on PTFE was noted at all time points in the presence of a Dacron graft (p less than 0.05). This property of Dacron has important clinical implications, potentially accelerating the progression of vascular disease, increasing the failure rate of composite grafts and subsequent arterial reconstruction.     

Minilaparotomy in the management of benign gynecologic disease

BACKGROUND: Considering the enormous advantages of minimally invasive surgery, attempts to explore less invasive trans-abdominal incisions could represent an alternative to laparoscopic gynecologic surgery. The aim of this study was to assess the feasibility and clinical outcome of minilaparotomy in a large series of patients. METHODS: In this retrospective study we describe our 6-year experience on 252 patients undergoing surgery by minilaparotomy for benign adnexal or uterine disease. Surgical treatments included total abdominal hysterectomy, myomectomy, mono or bilateral salpingo-oophorectomy and adnexal surgery. RESULTS: The mean population age and BMI were 39.2 years (+/-13.2 S.D.) and 23.6 (+/-3.31 S.D.), respectively. The mean operative time was 75.4 min (+/-31.8) and the estimated blood loss was never significant except in two cases (0.8%). The mean duration of ileus was 1.58 days (+/-0.6 S.D.) and the mean days until discharge were 3.06 (+/-1.14 S.D.), with a significantly lower duration of recovery in the group of simple adnexal surgery with respect to the others (p = 0.0001). No severe early post-operative morbidity was observed. CONCLUSIONS: The current report describes minilaparotomy as a feasible surgical approach in benign gynecological diseases. The operative time is quite similar or shorter than reported for laparoscopy, laparotomy and vaginal surgery. The estimated blood loss is not significant as well as the duration of the ileus and discharge. Moreover, a prospective randomised study, already ongoing in our department, will better answer the question of whether minilaparotomy could be an alternative to laparoscopic and vaginal surgery.     

Infusion of small volume of 7.5 per cent sodium chloride in 6.0 per cent dextran 70 for the treatment of uncontrolled hemorrhagic shock

The effect of a solution of 7.5 per cent sodium chloride in 6.0 percent dextran 70 was studied in a rat model of uncontrolled hemorrhagic shock induced by partial resection of the tail of the rat. Fifty rats were randomly assorted into five groups of ten rats each. In group 1, uncontrolled hemorrhagic shock was induced by sharp resection of 10 per cent of the terminal portion of the tail of the rat. In group 2, uncontrolled hemorrhagic shock was treated with 5 milliliters per kilogram of 0.9 per cent sodium chloride. In group 3, uncontrolled hemorrhagic shock was treated with 5 milliliters per kilogram of 6 per cent dextran 70. In group 4, rats were treated with 5 milliliters per kilogram of 7.5 per cent sodium chloride, and in group 5, 5 milliliters per kilogram of 7.5 per cent sodium chloride in 6.0 per cent dextran 70 were infused. During the first five minutes, bleeding in rats in group 1 was 3.0 +/- 0.4 milliliters and the mean arterial pressure fell from 105 +/- 5 to 73 +/- 7 torr (p less than 0.001). In group 4, bleeding at 15, 30 and 60 minutes was 1.9 +/- 0.3 milliliters (p less than 0.02), 2.0 +/- 0.7 milliliters (p less than 0.04) and 2.4 +/- 1.1 milliliters (p less than 0.02), and in group 5, 2.5 +/- 0.6 milliliters (p less than 0.02), 2.2 +/- 0.6 milliliters (p less than 0.04) and 3.1 +/- 0.8 milliliters (p less than 0.04), respectively, compared with bleeding in group 1. Increased bleeding was followed by a fall in mean arterial pressure in groups 4 and 5 with a 60 per cent mortality rate (p less than 0.01) in both groups and respective, mean survival times of 135 +/- 29 and 144 +/- 26 minutes, which were significantly increased compared with group 1 (p less than 0.01 for both). The intravenous infusion of 6 per cent dextran 70 alone in group 3 resulted in delayed bleeding of 1.23 +/- 0.6 milliliters (p less than 0.04) after 180 minutes. It is concluded that infusions of small volume of 7.5 per cent sodium chloride or 7.5 per cent sodium chloride in 6.0 per cent dextran 70 solutions in rats in a state of uncontrolled hemorrhagic shock led to increased bleeding, decrease in mean arterial pressure and increased mortality.     

Red cell deformability alterations in normal late pregnancy: possible role of plasma components.

Red cell deformability of 30 nonpregnant volunteers and 20 normal pregnant women in the 3rd trimester was assessed by determination of filterability of red cells suspended either in autologous plasma or in buffer by St. George's filtrometer method. Total red cell deformability was decreased in normal pregnancy [transit time (Tc) = 7.79 +/- 0.86 vs. 6.99 +/- 0.65, p less than 0.01] as compared to nonpregnant women when erythrocytes were studied in buffer suspensions, while the number of profoundly rigid red cells was lower in pregnant patients [clogging particles (CP) = 0.864 +/- 0.225 vs. 1.103 +/- 0.246, p less than 0.01]. Total red cell deformability was no longer reduced in pregnant women when erythrocytes were suspended in autologous plasma (Tc = 7.25 +/- 0.66 vs. 7.13 +/- 0.69, p = NS) while the number of rigid erythrocytes was still lower (CP = 0.802 +/- 0.157 vs. 1.055 +/- 0.210, p less than 0.01). Our data suggest that by the end of normal pregnancy, red cell deformability decreases with a consequent accelerated turnover and a fast elimination of very poorly deformable erythrocytes; plasma alterations in late pregnancy partly counteract the intrinsic loss of deformability of red blood cells.     

Serum sialyl stage-specific embryonic antigen levels in adenocarcinoma of the lung.

The serum levels of sialyl stage-specific embryonic antigen (SSEA-1) in 67 patients with adenocarcinoma of the lung were studied to assess their values for diagnosis. A solid-phase immunoradiometric sandwich assay with an FH6 monoclonal antibody was used. Another 49 healthy adults, 52 patients with benign pulmonary diseases, and 142 lung cancer cases with cell types other than adenocarcinoma were evaluated for comparison. The mean (+/- S.D.) levels (U/mL) for adenocarcinoma of the lung, lung cancer other than adenocarcinoma, benign pulmonary diseases and normal subjects were 182.9 +/- 309.7, 53.5 +/- 22.6, 38.9 +/- 17.1 and 30.5 +/- 6.5, respectively. The mean serum sialyl SSEA-1 level was significantly higher in adenocarcinoma of the lung, compared with lung cancer other than adenocarcinoma (p < 0.001), benign pulmonary diseases (p < 0.001), or normal subjects (p < 0.001). For late stage (Stages III and IV, n = 58) adenocarcinoma of the lung, the mean (+/- S.D.) serum sialyl SSEA-1 level (204.3 +/- 327.6 U/mL) was significantly higher than that of earlier stage (Stages I and II, n = 9) adenocarcinoma of the lung (39.9 +/- 19.3), p < 0.001. There was no statistical difference among the mean serum levels of various histologic types of lung cancer other than adenocarcinoma (p > 0.05). In the lower range of values, considerable overlap existed between adenocarcinoma of the lung and lung cancer other than adenocarcinoma. However, very high sialyl SSEA-1 levels (> 140 U/mL) were only encountered in late stage adenocarcinoma of the lung (22/58).(ABSTRACT TRUNCATED AT 250 WORDS)     

The relation of the true conjugate to maternal height and obstetric performance in Ghanaians

The true conjugate was determined intraoperatively with a caliper in 114 Ghanaian women and was correlated with their height, obstetric performance and fetal dimensions. Those patients undergoing cesarean section for cephalopelvic disproportion (Group Ia) were found to have a significantly shorter mean true conjugate (9.54 cm +/- 0.63 S.D.) and mean body height (152.68 cm +/- 5.46 S.D.) and a smaller true conjugate - fetal biparietal diameter difference (10.93 mm) than those who had no cephalopelvic disproportion (Group Ib) and whose mean measurements were 10.61 cm +/- 0.81 S.D., 157.20 cm +/- 5.69 S.D. and 21.50 mm, respectively (P = 0.0001). Recommendations for appropriate referral of rural clinic patients and for selection of patients for repeat cesarean sections are based on the above findings.     

A one-year randomized double-blind, multicentre study to evaluate the effects of an oestrogen-reduced, continuous combined hormone replacement therapy preparation containing 1 mg oestradiol valerate and 2 mg dienogest on metabolism in postmenopausal women.

OBJECTIVES: To evaluate the impact of an oestrogen-reduced, continuous combined hormone replacement therapy preparation containing 1 mg oestradiol valerate (1EV) and 2 mg dienogest (2DNG) on metabolism. METHODS: In a randomized double-blind study, 1EV/2DNG was compared with a reference preparation containing 1 mg 17Beta-oestradiol and 0.5 mg norethisterone acetate (E2/NETA). For the primary variable, i.e. the ratio of HDL cholesterol (week 52 to baseline), at least 98 case evaluations were planned. Secondary variables were other lipid parameters, haemostasis factors and carbohydrate metabolism. RESULTS: After 1 year of treatment, the mean HDL cholesterol levels had decreased by 4.5 +/- 14.8% in the 1EV/2DNG group and by 6.1 +/- 13.9% in the E2/NETA group (treatment difference NS). The ratio of HDL cholesterol (week 52 to baseline) was 0.944 for 1EV/2DNG and 0.929 for E2/NETA (geometric means). The primary efficacy variable, the ratio of the geometric means of the two treatments (1EV/2DNG/E2/NETA) was 1.016, with a lower one-sided 95% confidence limit of 0.973, which was clearly above the prespecified non-inferiority bound of 0.85 (p-value < 0.001). HDL2 cholesterol increased by 0.3 +/- 34.4% (1EV/2DNG) and decreased by 6.2 +/- 34.3% (E2/NETA; treatment difference NS); HDL3 cholesterol decreased by 4.4 +/- 19.9% (1EV/2DNG) and 8.2 +/- 17.7% (E2/NETA; treatment difference NS). Changes in the haemostasis and carbohydrate variables were very similar in both treatment groups. CONCLUSION: This study provides evidence that a new oestrogen-reduced HRT preparation containing 1 mg oestradiol valerate and 2 mg dienogest has no major impact on lipid variables. Minimal changes were seen in haemostatic and carbohydrate variables.     

A randomised study of GnRH antagonist (cetrorelix) versus agonist (busereline) for controlled ovarian stimulation: effect on safety and efficacy

OBJECTIVE: To assess safety and efficacy of cetrorelix utilisation in controlled ovarian stimulation (COS). STUDY DESIGN: Phase III, randomized, single center study of 131 patients undergoing COS and IVF with or without ICSI, in a University affiliated Hospital. Sixty-six patients were allocated to the protocol with antagonist and 65 to the agonist protocol arm. The Student's t-test, the Mann-Whitney test and the chi-square test were applied as required, using SPSS for Windows with a two-sided 5% significance level. RESULTS: The mean (+/-S.D.) duration of stimulation was 9.5+/-1.7 days in the antagonist group and 10.6+/-2.1 days in the agonist group (P=0.02). The mean (+/-S.D.) duration of suppression was 4.6+/-1.3 days in the antagonist group and 27.3+/-5.2 days in the agonist group (P<0.0001). No significant differences were noted in other outcome measures: amount of rFSH required, estradiol level on hCG day, number of follicles>or=15 mm and endometrial thickness on oocyte retrieval day, number of oocytes retrieved, fertilization rate and number of OHS cases. Clinical pregnancy rates per-attempt and per-transfer were 15.1% and 17.0% in the antagonist group and 16.9% and 20.0% in the agonist group (P=0.79 and 0.71, respectively). CONCLUSIONS: GnRH antagonists are an effective, safe and well tolerated alternative to agonists for COS.     

Popliteal aneurysms

A 15 year experience with 50 popliteal aneurysms in 36 patients is reviewed. Forty-seven popliteal aneurysms were atherosclerotic while three were related to entrapment of the popliteal artery. Fourteen asymptomatic popliteal aneurysms were observed preoperatively during a mean period of 26 months. Ischemic complications developed in five of these. At admission, 16 limbs were asymptomatic (group 1) while the other 34 limbs presented with ischemic symptoms (group 2). No operation was performed upon three limbs, and another two were surgically explored and amputated. No operative deaths resulted from 45 vascular reconstructions. Results from follow-up study of one to 176 months (a mean of 57 months) revealed a late patency rate of 62 per cent. The late patency rate of autologous saphenous vein (ASV) was 100 per cent; polytetrafluoroethylene (PTFE) and Dacron (polyester fiber) grafts had a patency rate of 74 and 34 per cent, respectively (ASV versus PTFE, p = N.S.; ASV versus Dacron, p less than 0.002). The rate of late salvage of limbs was 88 per cent. The bypass grafts of group 1 and those performed upon limbs with good runoff fared significantly better than others (p less than 0.05 and p less than 0.001). The risk of natural complications of popliteal aneurysms and the good results from surgical treatment suggested that a revascularization procedure in the asymptomatic stage is always recommended. The use of PTFE grafts for repair of popliteal aneurysms is justified when the ASV is not available. The use of Dacron grafts is no longer indicated.     

Effect of a traditional herbal medicine, tokishakuyakusan, on the fetal development of the spontaneously hypertensive rat

Forty-three pregnant spontaneously hypertensive rats were administered 1.5% saline and divided into 2 groups: The experimental group of 21 rats and the control group of 22 rats. The animals in the experimental group were administered daily 500 mg/kg of Tokishakuyakusan. No drug was administered to the animals in the control group. Systolic blood pressure measured from 4 to 18 days of pregnancy was similar in both the experimental and control groups. Mean (+/- S.E.) levels of blood viscosity in the experimental group measured on the 19th day of pregnancy were 13.6 +/- 1.6 centipoise (cp) at a shear rate of 0.5/sec and 3.5 +/- 0.1 cp at a shear rate of 230/sec and were significantly lower than those of the control group (19.1 +/- 1.6 cp at 0.5/sec, p less than 0.02; 4.4 +/- 0.2 cp at 230/sec, p less than 0.001). There were observed no significant differences in hematocrit, erythrocyte deformability and fibrinogen levels between two groups. There was observed no significant difference between the mean number in the litter in the 2 groups. The mean weight of the fetuses in the experimental group delivered on the 19th day of pregnancy was 2.4 +/- 0.1 g, being significantly heavier than that of the control group (2.0 +/- 0.0 g) (p less than 0.01). These results indicated that Tokishakuyakusan accelerated development of fetuses of hypertensive rats by utero-placental circulatory improvement which was caused by decreased maternal blood viscosity.     

Studies on serum CA125 levels in pregnant women

To confirm the change in serum CA 125 levels in cases of pregnancy, we measured serum CA 125 levels in 234 normal pregnant women, 40 postpartum women and 14 abnormal pregnant women (12 of IUFD and 2 of H. mole), using an RIA kit. The mean CA 125 level (+/- S.D.) and positive ratio (greater than 34U/ml) for pregnant women at 4-11 weeks of gestation were 65.0 +/- 77.3 U/ml and 64.6%, respectively, being the highest values in all the groups. On the contrary, those for pregnant women at 12-23 weeks of gestation were 22.3 +/- 10.6 U/ml and 12.7%, respectively, the lowest in all gestational groups. Changes in serum CA 125 levels in normal pregnant women showed a trend toward decrease, as gestation advanced. But the CA 125 levels for women at postpartum showed a slight trend toward increase. The mean CA 125 level (+/- S.D.) for 12 patients with IUFD was 392.5 +/- 275.8 U/ml and that for 2 patients with H. mole was 65.0 +/- 15.0 U/ml. Serum CA 125 levels for patients with IUFD were higher than that in cases of normal pregnancy. When utilizing CA 125 as a marker for ovarian cancer, the influence of pregnancy must be considered. And it indicates that CA 125 can be used as an aid to the diagnosis of IUFD in serous cases.     

Maternal serum levels of estradiol, progesterone and human chorionic gonadotropin in ectopic pregnancy and their correlation with endometrial histologic findings

Plasma levels of estradiol 17-beta (E2), progesterone (P) and beta-human chorionic gonadotropin (b-HCG) were measured in 59 patients with ectopic pregnancy and in control patients made up of ten women with normal intrauterine pregnancies and five patients with threatened abortion. The gestational ages of the three groups were not statistically different, the means being 6.6, 6.5 and 6.7 weeks, respectively. The endometria in the patients with an ectopic pregnancy were examined histologically and the correlation with the hormonal levels was studied. Mean levels of b-HCG, E2 and P in patients with ectopic pregnancies (4,893 +/- 5,435 S.E.M. milli-international units per milliliter, 311 +/- 191 S.E.M. picograms per milliliter and 8.3 +/- 5.5 S.E.M. nanograms per milliliters, respectively) were significantly lower than those measured in normal pregnant control patients (b-HCG = 22,173 +/- 2,696 S.E.M. microunits per milliliter, p less than 0.00001; E2 = 769 +/- 81 S.E.M. picograms per milliliter, p less than 0.0001 and p = 37.8 +/- 6.1 S.E.M. nanograms per milliliter, p less than 0.0001), and in patients with threatened abortion (b-HCG = 20,310 +/- 1,688 S.E.M. milli-international units per milliliter, p less than 0.0001; E2 = 803 +/- 91 S.E.M. picograms per milliliter, p less than 0.001 and P = 29.7 +/- 2.9 S.E.M. nanograms per milliliter, p less than 0.001). Mean levels of P in ectopic pregnancies with secretory type endometria (10.4 +/- 6.0 S.E.M. nanograms per milliliter), were significantly higher than those with proliferative endometria (5.0 +/- 3.2 S.E.M. nanograms per milliliter, p less than 0.001). Data is provided not previously known, on the levels of E2 and P in ectopic pregnancy and correlation with endometrial histologic factors.     

Fluoride concentration in amniotic fluid and fetal cord and maternal plasma

Fluoride concentrations were determined in plasma of 50 pregnant women, 44 samples of amniotic fluid and fetal cord blood of 29 fetuses at various stages of normal pregnancies, from an area with a relatively low water fluoride (less than 0.5 ppm) content. The mean concentrations of fluoride from maternal plasma, cord plasma and amniotic fluid (+/- S.D.) were 0.033 +/- 0.003, 0.028 +/- 0.005 and 0.017 +/- 0.003 ppm, respectively. Maternal and fetal plasma fluoride concentrations did not differ significantly. In the older age group fetal cord plasma fluoride concentration was significantly lower than maternal plasma levels (0.012 +/- 0.08 ppm vs. 0.023 +/- 0.001, respectively; p less than 0.05). Amniotic fluid fluoride levels were significantly higher at term than in midtrimester pregnancy, 0.017 +/- 0.0018 vs. 0.010 +/- 0.009 ppm (P less than 0.05), respectively. This higher concentration may imply higher fetal urinary excretion of fluoride at term due to the lower sequestration of fluoride as the process of bone calcification is more complete.     

Effect of gestational diabetes on erythrocyte aggregation

In order to elucidate the tendency to erythrocyte aggregation in gestational diabetes, blood viscosity at a standard hematocrit of 45% (corrected viscosity) was measured at low shear rates in the third trimester of normal pregnancy and pregnancy with gestational diabetes. The mean values (+/- S.D.) for corrected viscosity of 20 gestational diabetic patients were 69.2 +/- 16.6cp at shear rate of 0.11 sec-1, 34.9 +/- 5.3cp at 0.54sec-1 and 27.9 +/- 5.0cp at 0.99sec-1. They were significantly higher than those of 40 normal pregnant patients (55.2 +/- 11.4cp at 0.11sec-1, 29.0 +/- 2.6cp at 0.54sec-1 and 24.4 +/- 2.4cp at 0.99sec-1). The mean value of fibrinogen of gestational diabetic patients was 408.8 +/- 106.7 mg/dl and significantly higher than that of normal patients (313.3 +/- 65.1 mg/dl). The increased tendency to erythrocyte aggregation observed in the diabetic patients was due to increased fibrinogen and would induce microcirculatory disturbance and mild hypoxia in the placental tissue. The cytotrophoblastic cell proliferation which is a characteristic morphological finding of diabetic placenta would be induced as a result of the reaction of placental tissue to the hypoxia thus produced.     

Efficacy of danazol treatment for minimal endometriosis in infertile women. A prospective, randomized study

We compared pregnancy rates between a danazol-treated and an untreated group of infertile women with minimal endometriosis. After completion of a basic infertility workup and laparoscopy, women with minimal endometriosis were entered into the study and randomly selected to receive either a six-month course of danazol or no treatment at all. Those patients with other infertility factors were included in the study only if the factors were correctable and ultimately determined to be noncontributory. Life-table analysis was used to compare pregnancy rates between the two groups over a 12-month period that started immediately after laparoscopy in the untreated group and after completion of danazol therapy in the treated group. The cumulative pregnancy rate (+/- SEM) was 37.2 +/- 8.4% in the danazol group (n = 37) and 57.4 +/- 10.4% in the untreated group (n = 36) (NS, P greater than .10). This prospective, randomized study showed danazol to be ineffective in improving pregnancy rates over doing nothing at all in patients with minimal endometriosis.     

Intramyometrial injection of vasopressin in laparoscopic supracervical hysterectomy

STUDY OBJECTIVE: To investigate the effectiveness of vasopressin in reducing blood loss in laparoscopic supracervical hysterectomy (LSH). DESIGN: Retrospective chart analysis (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: In all, 143 women who had LSH for benign gynecologic disease. INTERVENTIONS: Laparoscopic supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: From January 2001 through December 2006, 143 patients were identified who had consecutive, successful LSH performed by different gynecologic laparoscopists. There were no exclusion criteria. The patients were divided into 2 groups based on whether intramyometrial vasopressin injection was used intraoperatively to reduce blood loss; 77 (54%) patients received intramyometrial vasopressin injection and 66 (46%) did not. The 2 groups were compared with regard to blood loss, operating time, uterine weight, hospital stay, concomitant salpingo-oophorectomy, perioperative complications, and patient characteristics including age, gravity, parity, body mass index, surgical history, and number of cesarean deliveries. No difference existed in the first postoperative day decrease in hemoglobin between the vasopressin and control group (2.3 +/- 0.9 vs 2.1 +/- 1.2 g/dL, respectively, p = .56). No significant difference existed between the groups with respect to operating time (146.9 +/- 52.6 vs 131.9 +/- 42.8 min, p = .07) or uterine weight (145.4 +/- 121.8 vs 119.5 +/- 66.9 g, p = .14). All other parameters and patient characteristics were similar between the 2 groups except for the duration of hospital stay. Patients who received intramyometrial vasopressin injection experienced a slightly longer duration of hospital stay (1.4 +/- 0.7 vs 1.1 +/- 0.4 days, p = .02). CONCLUSION: Our study does not support the routine use of intramyometrial vasopressin injection during LSH to reduce blood loss.     

Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial

OBJECTIVE: To ascertain whether adjuvant gonadotropin-releasing hormone (GnRH) agonist therapy decreases blood loss during abdominal myomectomy. DESIGN: Randomized controlled trial. SETTING: Academic reproductive surgery center. PATIENT(S): One hundred premenopausal women requiring first-line conservative surgery for symptomatic intramural or subserous fibroids. INTERVENTION(S): Eight weeks of treatment with depot triptorelin before myomectomy or immediate surgery. MAIN OUTCOME MEASURES: Intraoperative blood loss, operating time, degree of difficulty of the procedure, and short-term rate of fibroid recurrence. RESULT(S): Mean (+/-SD) intraoperative blood loss was 265 +/- 181 mL in triptorelin recipients and 296 +/- 204 in patients who had immediate surgery (mean difference, -31 mL [95% CI, -108 to 46 mL]). No significant differences were observed in blood loss according to uterine volume, number of fibroids removed, or total length of myometrial incisions. Most procedures in either group were of routine difficulty. On ultrasonography 6 months after myomectomy, four women in the GnRH agonist group and one in the immediate surgery group had tumor recurrence. CONCLUSION(S): Treatment with a GnRH agonist before abdominal myomectomy has no significant effect on intraoperative blood loss. Thus, systematic use of medical therapy before abdominal myomectomy does not seem to be justified.