Comparing grades of urgency for classification of cesarean delivery

Objective

To evaluate the agreement between the traditional binary system and a new system for classifying urgency of cesarean delivery among obstetricians in The Netherlands and Belgium.

Methods

A total of 212 obstetricians were requested to grade a list of 18 obstetric scenarios using 3 classification systems: traditional binary classification; a new classification using 4 grades of urgency without additional interpretation; and the new classification with additional interpretation. Agreement was assessed by weighted kappa.

Results

Seventy-nine obstetricians responded (The Netherlands 62.2%, Belgium 9.9%). There was substantial agreement among them for all 3 classification systems (κ = 0.71, traditional classification; κ = 0.70, new classification; κ = 0.67, new classification with additional interpretation).

Conclusion

The traditional binary system and the new classification of cesarean delivery based on 4 grades of urgency, with and without additional interpretation, have similar but relatively low interobserver agreement. We suggest that the new classification should be used, but future studies are necessary to evaluate the effect of this implementation.     

Parenteral administration of amino acids to septic patients

The study investigates the status of plasma amino acids and their pathological changes under the specific conditions of sepsis in 20 intensive care patients, who were randomized into two groups with and without amino acid support. The study was designed to determine whether the concentration of the free amino acids in plasma or their relative proportions to each other determine the cellular uptake under septic conditions in such a way that would have relevance for the exogenous supply. Sepsis was defined as an increase in body temperature above 38 degrees C, a positive blood culture and changes in the white blood cell picture. Carefully standardized and quality-controlled low-pressure liquid chromatography was used along with a new procedure for data processing, based on personal physiological range with known ranges for individual amino acids. The concentrations of individual amino acids vary widely and did not allow a decision to be made about disturbance of homeostasis. The mean total concentrations varied between 1.27 mmol/l and 4.40 mmol/l. The range was similar whether amino acids were administered or not. This variation was also found in the branched chain amino acids, which were considered to have a specific importance in septic states. Valine varied between 114 mumol/l. The relative proportion of the individual amino acids to the whole amount of amino acids showed less variation and demonstrates that the oxidative action of the liver is able to correct any deviation from the normal and maintains the uptake of amino acids by the cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intracranial Hemorrhage as the First Manifestation of Severe Congenital Factor X Deficiency in a 20‐Month‐Old Male: Case Report and Review of the Literature

Factor X deficiency (FXD) is a rare bleeding disorder, which can result in severe bleeding symptoms such as intracranial hemorrhage (ICH). The most common bleeding symptoms are epistaxis and gum bleeding. ICH is reported in 9–26% of all patients with FXD, mostly during the first month of life. Here, we present a rare case of a male presenting with ICH at the age of 20 months as the first manifestation of FXD. Secondary prophylaxis with factor X substitution once weekly prevented further bleeding.     

The effect of atenolol on contractility and hemodynamics of the infarcted heart in comparison to propranolol and practolol (author's transl)]

In animals without myocardial infarction the new beta-sympathicolytic agent atenolol (4-[2'-hydroxy-3'-iso-propylaminopropoxy]-phenyl acetamide, ICI 66 082) dose-dependently decreased heart rate, systolic aortic pressure and cardiac output. Coronary mean flow, coronary resistance, stroke volume, left ventricular enddiastolic pressure and total peripheral vascular resistance did not change significantly. Atenolol significantly reduced myocardial contractility, expressed by (dp/dtmax), Vpm, t-(dp/dtmax) and pre-ejection period. Furthermore, the comparative studies in animals with myocardial infarction and concomitant reduced cardial efficiency revealed, that atenolol has neither a positive intrinsic activity as has practolol nor a negative intrinsic activity as has propranolol. The dose-contractility relation of atenolol resembles that of practolol: in low dosages a strong decrease is achieved, in higher dosages no further reduction of the contractility parameters is observed. Because of the strong negative inotropic and blood pressure lowering effect it is suggested to use atenolol only with great caution in patients with reduced cardiac efficiency.     

Magnetic mismatch fields elicited by vowels and consonants

 Auditory-evoked mismatch fields (MMFs) elicited by vowel contrasts and plosive stop consonant place-of-articulation contrasts were recorded over the left hemisphere of neurologically and audiologically normal subjects. Two experiments were conducted: vowels were presented in isolation in experiment 1 and embedded in consonant-vowel syllables in experiment 2. Best-fit equivalent MMF sources were obtained using the model of a single, spatiotemporal current dipole in a sphere. In both experiments, MMF sources activated by place-of-articulation contrasts were later in latency and smaller in dipole moment amplitude than MMF sources excited by vowel contrasts. There was evidence, albeit not unambiguous, for the vowel-contrast MMF sources being located more posteriorly than the consonant-contrast MMF sources in experiment 1 and more laterally in experiment 2. In both experiments, the MMF source excited by the contrast between /da/ and /ga/ was more anterior than the MMF source excited by the contrast between /da/ and /ba/. The effects on latency and dipole moment may be interpreted to mirror differences in perceptual discriminability and auditory memory decay between consonantal place-of-articulation contrasts and vowel contrasts. Similarly, the effects on location may be interpreted to reflect featural specificity of the mismatch response. Interestingly, the dipole source analysis results show a correspondence to the pattern of preservation and loss of the mismatch response to vowel and consonant place-of-articulation contrasts recently observed in Wernicke’s aphasia. Received: 14 June 1996 / Accepted: 6 February 1997