Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

OBJECTIVE: To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. METHODS: We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. RESULTS: The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. CONCLUSIONS: Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.     

The incidence of childhood inflammatory bowel disease in Wales

A prospective study was undertaken throughout Wales over the period from 1 January 1995 to 30 March 1997, to determine the incidence of childhood inflammatory bowel disease (IBD). Thirty-eight (24 male) new cases of IBD were reported. Twenty (16 male) of the reported cases had Crohn's disease, 11 (5 male) had ulcerative colitis (UC) and 7 (3 male) indeterminate colitis. Crohn's disease occurred four times more often in boys than girls, whereas there was no sex difference in the incidence for UC and indeterminate colitis. The median age at presentation was 12 (range 1.5–16) years and there was no difference in the age of presentation or the duration of symptoms prior to diagnosis in any of the types of IBD. Conclusion The overall incidence (95% confidence intervals) for IBD in Wales was 2.6 (1.87–3.48) cases per 100,000 per year. The incidence for Crohn's disease was 1.36 (0.86–2.04) cases per 100,000 per year, for UC 0.75 (0.39–1.28) cases per 100,000 per year and for indeterminate colitis 0.48 (0.2–0.92) cases per 100,000 per year. Received: 14 June 1999 / Accepted in revised form: 23 September 1999     

Angiomyoma of the uterus: case report and review of literature

Angiomyomas of the uterus are uncommon tumors that apparently arise from the smooth muscles of blood vessels. We describe here an unusually large angiomyoma of the uterus in a 45-year-old woman who presented with an abdominal lump. An exploratory laparotomy was followed by a pan-hysterectomy. The dissected section of the uterus showed a huge fleshy mass measuring 20 cm with areas of hemorrhage. Histopathological examination showed many dilated vascular spaces amidst smooth muscle bundles, which is characteristic of cavernous angiomyoma of the uterus.     

A comparison of subjective and mathematical estimations of fetal heart rate variability.

OBJECTIVES: To develop a computerized algorithm to quantify fetal heart rate (FHR) variability and compare it to perinatologists' interpretation of FHR variability. METHODS: FHR variability was calculated using data from 30 women who had a fetal scalp electrode placed for a clinical indication, and compared to the assessment of FHR variability from four perinatologists who interpreted paper tracings of the same data. Inter-rater reliability was calculated and receiver-operator curve analysis was done. RESULTS: Correlation between the computer algorithm's assessment of variability and the perinatologists' assessment (0.27-0.68) was similar to the inter-rater reliability between perinatologists (0.33-0.72). CONCLUSIONS: A computer-based algorithm can assess FHR variability as well as expert clinicians.     

Management of allergic fungal sinusitis with intracranial spread

Allergic fungal sinusitis (AFS) is a form of paranasal nasal disease if not managed early often involves bone destruction and extension into the orbit and anterior skull base. We present our study of patients with AFS with intracranial, exdradural extension. This study includes our experience of 26 patients with the histological and immunological diagnosis of AFS based on findings of branching septate fungi interspersed with eosinophilic mucin and Charcot-Leyden crystals without fungal invasion of soft tissue, with intracranial extension. All had erosion of bone, which was observed on computerized tomography (CT) scans, extending intracranially and eight had disease that additionally involved the lamina papyracea. The average age of patients in this study was 25 years (range 9–46). There were 20 male and 6 female patients. All patients were immunocompetent. Skin test against aspergillin showed all patients had Type 1 hypersensitivity. All patients underwent transnasal and/or transmaxillary endoscopic approaches for debridement and eight underwent orbital decompression. No patient underwent craniotomy for removal of intracranial extradural disease. No patient had a cerebrospinal fluid leak. Postoperatively, all 26 were treated with a course of corticosteroids. The follow-up period ranged from 2 to 5 years. We conclude AFS is a unique form of fungal disease that might mimic anterior skull base and paranasal sinus tumors. Most cases can be successfully managed with transnasal and/or transmaxillary endoscopic techniques.     

The effect of Qat chewing on blood pressure and heart rate in healthy volunteers

The leaves of the Qat plant (Catha edulis Forsk., Celastraceae) which contain amphetamine like compounds are widely chewed in Yemen and East Africa for their pleasurable stimulant properties. There are also a number of unwanted side-effects and this paper studies the effect on heart rate and blood pressure in 80 healthy volunteers. During a 3-h period of chewing fresh Qat leaves there was a significant and progressive rise in systolic and diastolic blood pressure and heart rate, and levels had not returned to baseline 1 h after chewing had ceased. Further studies are needed on possible cardiovascular morbidity associated with regular Qat chewing.     

Ras protein p21 processing enzyme farnesyltransferase in chemical carcinogen—induced murine skin tumors

Farnesylation of ras protein p21 is crucial for the protein's membrane localization, which is essential for its cell-transforming activity, which in turn is thought to be critical for the ultimate induction of cancer. The cytosolic enzyme farnesyltransferase plays a major role in posttranslational modification of p21, but the level of farnesyltransferase activity in mammalian tumors and its relationship to the processing of cytosolic p21 that leads to tumorigenesis are unknown. We report here that farnesyltransferase activity was significantly higher in chemical carcinogen—induced benign skin papillomas in SENCAR mice than in the epidermises of control animals. The enzyme is primarily epidermal in origin, and kinetic studies with cytosol from epidermis and papillomas showed that the reaction was linear with respect to time, substrate concentration, and protein content. Skin papillomas showed significantly elevated levels of both cytosolic and membrane-bound Ha-ras p21, whereas far lesser cytosolic and almost negligible amounts of membrane-bound p21 were present in the epidermis of control mice. There was a positive correlation between increased enzyme activity in papilloma cytosol and the processing of overexpressed cytosolic Ha-ras p21 for its localization to membrane.