Factors relevant to mode of preterm delivery with syndrome of HELLP (hemolysis,elevated liver enzymes,and low platelets)

OBJECTIVE: Our purpose was to investigate factors relevant to mode of delivery for patients with preterm (<34 weeks) gestation complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). STUDY DESIGN: The pregnancies of 189 patients with HELLP syndrome and delivery <34 weeks' gestation between January 1980 and October 1991 were studied retrospectively. Only patients with class 1 (platelet nadir ≤50,000 per microliter, n = 83) and class 2 (platelet nadir >50,000 to ≤100,000 per microliter, n = 106) HELLP syndrome were included. Maternal and perinatal factors relevant to type of delivery were reviewed. RESULTS: The incidence of cesarean delivery for all patients was 76.2% (primary rate 72.4%). Abdominal delivery occurred equally between class 1 (78.3%) and class 2 (74.5%) patients. Cesarean section was the mode of delivery for 87% of pregnancies at <30 weeks' gestation in contrast to 68% of pregnancies at≥30 weeks but <34 weeks' gestation (odds ratio 3.2, 95% confidence interval 1.4 to 7.5, p < 0.005). Indications for cesarean section included deteriorating maternal condition alone (50%), deteriorating maternal and fetal condition (27%), nonvertex fetal presentation (11.5%), and failure to progress (11%). Induction of labor was significantly more successful during the≥30 but <34 weeks' pregnancy interval (47.5%) than in pregnancies at <30 weeks (15.2%) (odds ratio 0.2, 95% confidence interval 0.1 to 0.55, p < 0.001). A trial of labor was successful in 22% of patients with an initial modified Bishop score ≤2 versus 45% with an initial Bishop >2 (odds ratio 0.5, 95% confidence interval 0.2 to 1.3, p = 0.16). CONCLUSION: Parturients with class 1 and 2 HELLP syndrome at <34 weeks' gestation are at high risk for cesarean delivery. At a gestational age <30 weeks, the likelihood of successful labor induction with vaginal delivery is remote, especially in association with an unfavorable cervix or the absence of labor. (AM J Obstet Gynecol 1994;170:1828-34.)     

Effect of anterior Nasal Packing on middle ear pressure

Eighty Ears of 40 patients requiring anterior Nasal Packing for 48–72 hrs. were evaluated by tympanometry, to find out the effect of anterior Nasal Packing on middle ear pressure. The study shows that Nasal Packing results in eustachian tube dysfunction & negative middle ear pressure, which is reversible in nature.     

Cervical ripening before medical induction of labor: a comparison of prostaglandin E, estradiol, and oxytocin

Objective: Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin, E² intracervical gel, and estradiol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term.Study design: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score <4) requiring induction of labor. The patients received prostaglandin E² gel (0.5 mg) intravervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump.Results: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demongraphics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E² groups was similar (3.90 = 3.02 cm, 3.63 ± 2.79 cm, and 4.65 ± 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 minutes were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement on Bishop score over baseline (p = 0.023) with an improvement of 7.08 ± 2.42.Conclusion: No differences were detected among prostaglandin E₂ gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions.     

The value of high-pass resolution perimetry in glaucoma

High-pass resolution perimetry (HRP) is a perimetric technique that relies on low-contrast, high-spatial-frequency-filtered, ring-shaped test targets. It was devised as a quick and user-friendly technique that reflects the status of the retino-corneal pathway. Since its introduction in 1987, HRP has undergone substantial investigation, primarily in cross-sectional studies on patients with glaucoma, though it is also used in patients with neuro-ophthalmologic disorders. HRP has a shorter test time compared with conventional perimetry. Currently, evidence suggests that HRP is a viable test for the evaluation of the glaucomatous visual field.     

Optic disc movement with variations in intraocular and cerebrospinal fluid pressure

PURPOSE: To determine the effect of intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) on optic disc movement and lamina cribrosa displacement using confocal scanning laser tomography (CSLT). METHODS: The anterior chamber and lateral ventricles were cannulated in mixed-breed dogs (n = 8) to allow modulation and control of IOP and CSFP, respectively. Optic disc topography was determined after baseline (set at IOP 15 mm Hg and CSFP of 0 mm Hg) and with each step-wise increase in IOP (steps of 3-5 mm Hg up to an average of 32 mm Hg) with CSFP fixed at 0 mm Hg. After the pressure returned to baseline, images were obtained after each step-wise increase in CSFP (steps of 2 to 4 mm Hg up to an average of 12 mm Hg) with IOP fixed at 15 mm Hg. Data were analyzed by a new probabilistic method for CSLT and global parameters generated by the instrument software. The global parameter changes from baseline were analyzed as a function of the translaminar pressure difference (IOP minus CSFP). RESULTS: Elevation in IOP resulted in significant posterior displacement of the disc surface, whereas elevation in CSFP resulted in significant anterior displacement. For a given degree of pressure change, an increase in CSFP resulted in larger changes than a corresponding increase in IOP. The deepest 5% of locations within the disc surface were displaced nonlinearly (with an inverse exponential function, r = 0.92) as a function of the difference in translaminar pressure. Most displacement occurred at low translaminar pressure differences, with little extra movement at differences higher than 15 mm Hg. The change in the volume subtended by the anterior lamina cribrosa showed a nonlinear relationship similar to the translaminar pressure difference (r = 0.98), with negligible volume change at high difference in pressures. CONCLUSIONS: Most optic disc movement occurs with pressure changes in the low range of translaminar pressure differences. This is consistent with the mechanical properties of collagen.     

Viscoexpression of anterior chamber cysticercus cellulosae

We report a case of anterior chamber Cysticercus cellulosae that was removed by viscoexpression.     

Chemotherapeutic potential of curcumin for colorectal cancer

Colorectal cancer is one of the leading causes of cancer deaths in the Western world. More than 56,000 newly diagnosed colorectal cancer patients die each year in the United States. Available therapies are either not effective or have unwanted side effects. Epidemiological data suggest that dietary manipulations play an important role in the prevention of many human cancers. Curcumin the yellow pigment in turmeric has been widely used for centuries in the Asian countries without any toxic effects. Epidemiological data also suggest that curcumin may be responsible for the lower rate of colorectal cancer in these countries. Curcumin is a naturally occurring powerful anti-inflammatory medicine. The anticancer properties of curcumin have been shown in cultured cells and animal studies. Curcumin inhibits lipooxygenase activity and is a specific inhibitor of cyclooxygenase-2 expression. Curcumin inhibits the initiation of carcinogenesis by inhibiting the cytochrome P-450 enzyme activity and increasing the levels of glutathione-S-transferase. Curcumin inhibits the promotion/progression stages of carcinogenesis. The anti-tumor effect of curcumin has been attributed in part to the arrest of cancer cells in S, G2/M cell cycle phase and induction of apoptosis. Curcumin inhibits the growth of DNA mismatch repair defective colon cancer cells. Therefore, curcumin may have value as a safe chemotherapeutic agent for the treatment of tumors exhibiting DNA mismatch repair deficient and microsatellite instable phenotype. Curcumin should be considered as a safe, non-toxic and easy to use chemotherapeutic agent for colorectal cancers arise in the setting of chromosomal instability as well as microsatellite instability.     

SDF-1alpha is expressed in astrocytes and neurons in the AIDS dementia complex: an in vivo and in vitro study

Recent in vitro studies suggest that the alpha chemokine stromal-derived factor-1alpha (SDF-1alpha) and its receptor CXCR-4 may contribute to neuronal apoptosis in HIV infection of the brain. The cellular and regional expression of this chemokine and its relationship to the AIDS dementia complex (ADC), however, have remained undetermined. Using immunohistochemistry and semiquantitative RT-PCR, we examined the expression of SDF-1alpha in the frontal cortex (FC), the adjacent deep white matter (DWM). and the basal ganglia (BG) of 17 patients with ADC and 5 normal controls, and the FC and temporal cortex of 6 patients with Alzheimer disease (AD). Additionally, SDF-1alpha expression was studied in 3 different neuronal cultures: differentiated SK-N-MC cells, primary human fetal neuronal, and mouse hippocampal cultures. SDF-1alpha staining was predominantly localized to astrocytes in all 3 groups in the gray matter of the FC and the BG, often in the vicinity of cortical and basal ganglia neurons, but was generally absent in the DWM. Further, the number of positive neurons was significantly greater in the BG of AIDS subjects with advanced brain disease compared to subjects with lesser disease (p = 0.029). All cultures showed prominent SDF-1alpha staining of neurons within the cytoplasm and in neurites, whereas preferential expression in GABA-ergic neurons was found in hippocampal cultures. This is the first study to show that SDF-1alpha is constitutively expressed in astrocytes of the deep and cortical gray matter as well as in neurons of the human brain. Its increased expression in basal ganglia neurons of patients with advanced HIV CNS disease suggests it may also contribute to pathogenesis.     

A review of sonographic estimate of fetal weight: vagaries of accuracy.

PURPOSE: To determine the factors that might influence the accuracy of sonographic estimated fetal weight. STUDY DESIGN: A PubMed search (Jan 1975 to Jan 2003) of articles published in the English language was carried out and the inclusion criterion was that estimates were within 10% of birth weight. A Chi-square test for trend was used and odds ratio (OR) with 95% confidence intervals (CI) was calculated. RESULTS: Over 28 years, 175 articles were identified but only 54 (31%) met the inclusion criterion. Overall 62% (8895/14 384) of the predictions were within 10% of the actual weight. The accuracy was significantly different in articles where <7 vs. >7 days were allowed to lapse between examination and delivery (OR 2.17, 95% CI 1.93, 2.45); where examinations were done by registered diagnostic medical sonographers (RDMS; 65%) versus physicians (59%) or residents (57%; p < 0.0001); in term vs. preterm patients (OR 1.97, 95% CI 1.67, 2.13); and in studies with >1000 vs. <1000 cohorts (OR 1.62; 95% CI 1.51, 1.74). CONCLUSIONS: If feasible the sonographic examination should be done by RDMS and within a week of delivery.