HCH and DDT residues in human placentas in Murcia (Spain)

Organochlorinated insecticides are ubiquitous toxicants that are transplacentally transferred from mother to fetus and are reported to produce adverse health effects in pregnant woman and neonates. To investigate hexachlorocyclohexane (HCH) and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT) exposure in pregnant woman, a total of 102 placentas were analyzed by a gas chromatograph equipped with electron capture detector. Organochlorine residues were found in 69.6% of the samples. Lindane was detected in 24.5%, alpha-HCH in 2.9%, beta-HCH in 6.9%, p,p'-DDE in 44.1%, p,p'-DDT in 14.7% and p,p'-DDD in 10.8% of the samples. The pattern of dispersal by these substances in Murcia is similar to that described by different authors in other countries. Therefore, the past use of DDT and the present employment of lindane seem to be reflected in body tissues of the residents of this area.     

Reliability,feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases

OBJECTIVE: To assess the reliability, feasibility, and safety of lens-based minihysteroscopy. DESIGN: Retrospective comparative study. SETTING: Academic research environment. PATIENT(S): Women with different indications for hysteroscopy. INTERVENTION(S): Six thousand seventeen outpatient diagnostic hysteroscopies with a minihysteroscope (2.7-mm outer diameter [OD] telescope with 3.5-mm OD single-flow diagnostic sheath) and 4,204 with traditional hysteroscope (4-mm OD telescope with 5-mm OD single-flow diagnostic sheath). All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. MAIN OUTCOME MEASURE(S): Rate of successful introduction of the hysteroscope, rate of satisfactory examinations, pain intensity experienced using an arbitrary pain scale (0 = no pain; 1 = low pain; 2 = moderate pain; 3 = severe pain), and number of side effects and complications. RESULT(S): In the minihysteroscopy, group rates of successful introduction and satisfactory examinations were significantly higher than in the traditional hysteroscope group (99.52% vs.72.53% and 98.53% vs. 92.33%, respectively), while pain and vagal reactions were significantly lower (0.10 +/- 0.34 vs.1.09 +/- 0.53 and 2.25% vs.17.12%, respectively). CONCLUSION(S): Hysteroscopy with lens-based minihysteroscopes was easier, less painful, more reliable, and safer than with 5-mm hysteroscopes. Minihysteroscopy with a vaginoscopic approach is a very well tolerated, effective, and safe outpatient procedure.     

Pharmacokinetics of ciprofloxacin in impaired liver function

The pharmacokinetics of ciprofloxacin after a single 500 mg oral dose was studied in one group of healthy volunteers and in patients affected by liver cirrhosis and classified into three groups according to Child-Turcotte criteria. The serum concentrations were determined by an agar well diffusion assay 0.5, 1, 3, 6, 12 and 24 h after the administration of the drug. No significant differences were noticed in Cmax, Tmax, T1/2 and AUCtot in the group A and B of patients and in the control group. Class C patients showed on the other hand a Cmax 15-25% higher than in other groups (2.74 mcg/ml), a T1/2 1.12-1.42 hours longer than in other groups and a consequent much higher AUCtot (17.70 mcg/h/ml). The concomitant administration of diuretics of anti-H2 drugs was also evaluated as possible factors affecting the ciprofloxacin pharmacokinetics, but no significant differences were noticed. A mild or moderate impairment of the liver function did not affect the pharmacokinetics of ciprofloxacin, but the severe impairment of the liver function could affect its Cmax and serum half-life, so that further studies with multiple doses will be needed to evaluate if any dosage adjustment would be required in these patients.     

Sudden death caused by 2-directional tachycardia in an adolescent

The history of a 12 year old male, who developed a bidirectional tachycardia and sudden death without evidence of neurological or cardiac disease is described. The role of bidirectional tachycardia related to sudden death is discussed, as well as its possible origin and mechanisms, based on the case described.     

Color Doppler flow imaging of the normal and abnormal orbit

Twenty-six normal orbits (16 subjects) and seven patients with suspected orbital disease were studied with color Doppler flow imaging CDFI). Arterial structures consistently identified included the ophthalmic artery, central retinal artery, and posterior ciliary branches. The terminal lacrimal branch was seen in the majority of orbits (n = 19). Venous structures consistently seen included the central retinal vein and venae vorticosae; the superior ophthalmic vein was identified in the majority of normal orbits (n = 22). Response of the superior ophthalmic vein to the Valsalva maneuver was assessed in six of the normal subjects (12 orbits). Retrograde flow was typically seen during the maneuver and accentuated antegrade flow after cessation of the maneuver. Pathologic entities correctly diagnosed with CDFI included a dural arteriovenous malformation (AVM) with spontaneous carotid-cavernous fistula, an orbital AVM, and superior ophthalmic vein thrombosis. Vascular lesions were excluded in two patients with orbital masses. Bilaterally enlarged superior ophthalmic veins were identified in a patient with unilateral symptoms suggestive of a varix; CDFI results were confirmed with computed tomography, but orbital venograms were interpreted as normal. These findings suggest that CDFI may be helpful in the evaluation of suspected vascular orbital disease.     

Effects of in-vitro capacitation of human spermatozoa on the action of the sperm-immobilizing and sperm-agglutinating antibodies. Possible therapeutic applications on female antisperm isoimmunization

In 51 serum samples (31 originating from infertile women, 20 from infertile men) with significant sperm immobilizing activity (S.I.T. with S.I.V. greater than 2) we carried out the following tests using semen from three proven fertile donors with excellent semenological characteristics: repetition of S.I.T.; carrying out of S.I.T. with sperm previously subjected to in vitro capacitation (S.I.T.-cap.); carrying out of T.A.T.; carrying out T.A.T. with sperm previously subjected to in-vitro capacitation (T.A.T.-cap.). Nor was there statistically significant difference evident in the results of the tests in relation to the use of the semen of the three different donors. In all 51 samples the repetition of S.I.T. involved the confirmation of sperm-immobilizing activity, while the result of such activity was constantly negative when it was carried out with S.I.T.-cap. In female subjects the comparison of the results of S.I.T. and S.I.T.-cap. showed a statistically significant difference (p less than 0.001). 38 out of the 51 serum samples examined showed positive T.A.T. with variant titers from 1:32 to 1:512 and with different types of agglutination (H, T, tip, M). In all the serum examined, T.A.T.-cap. resulted positive with a titer of 1:512 and agglutination of type H. The results of S.I.T.-cap. seem to underline the advantages linked to the use of capacitated semen in A.I.H. and in G.I.F.T. The evaluation of the results of T.A.T.-cap. make us suspect that they are not linked with the presence of antibodies in tested sera.     

Percutaneous placement of soft, indwelling ureteral stent

Ureteral stents, placed cystoscopically or percutaneously, have proved useful in a variety of indications. We present our technique for the placement of soft, biocompatible stents. With this material and technique, successful placement has been achieved in 77% of cases, with no significant complications, excellent patient tolerance, and a high degree of utility in achieving the desired outcome.     

Aluminum toxicity in patients undergoing dialysis: radiographic findings and prediction of bone biopsy results

Aluminum toxicity in patients undergoing dialysis currently requires bone biopsy for definitive diagnosis. The authors retrospectively reviewed clinical, histologic, and radiographic findings in 63 patients undergoing dialysis. In 30 patients, biopsy specimens were negative for aluminum toxicity, and in 33 patients, specimens were positive. In 21 of the 30 patients who had a negative biopsy specimen, absence of aluminum toxicity could be predicted by a high immunoreactive parathyroid hormone level (greater than 2,000 microliter Eq/ml [2,210 pM]) and fewer than three fractures, by the presence of osteosclerosis on radiographs, or if serum aluminum levels were less than 30 ng/ml. None of the patients who had a positive biopsy specimen met these criteria. In 18 of 33 patients who had a positive biopsy specimen, aluminum toxicity could be predicted by a low immunoreactive parathyroid hormone level (less than 500 microliter Eq/ml [553 pM]) and more than three fractures, or if serum aluminum levels were greater than 300 ng/ml. None of the patients who had a negative biopsy specimen met these criteria. Thus, based on the criteria identified, the aluminum status of 62% of these patients would have been correctly diagnosed.