Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section.

Prophylactic antibiotics have been shown to be effective in decreasing the incidence of febrile morbidity associated with cesarean section after labor. However, the relative effectiveness of different single antibiotics has been studied infrequently, and these investigations have been limited by small patient samples. Several new, broad-spectrum antibiotics are now available, and any further benefit from more traditional antibiotics for surgical prophylaxis remains untested. A randomized prospective double-blind therapeutic trial was therefore undertaken to compare the value of a first-generation cephalosporin (cefazolin) with a new third-generation cephalosporin (moxalactam). Between July 1981 and June 1983, 254 qualifying women who underwent primary cesarean section after labor were randomly chosen for either of the two treatment groups. Although not statistically significant, the rates of febrile morbidity, wound infection, and endometritis were less for those treated with cefazolin (4.0, 3.2, and 0.8%, respectively) than for those treated with moxalactam (9.2, 7.7, and 1.6%, respectively). No serious adverse effects were apparent in the mother and newborn infant from short-term exposure to either drug. Although the newer, more expensive, and broader-spectrum cephalosporin, moxalactam, was associated with a low postoperative febrile morbidity rate and short postpartum hospitalization, it was no more beneficial than cefazolin.     

Neutrophil alkaline phosphatase: comparison of enzymes from normal subjects and patients with polycythemia vera and chronic myelogenous leukemia.

To determine whether decreased alkaline phosphatase activity in the granules from neutrophils of patients with chronic myelogenous leukemia (CML) was due to an absence of enzyme or the production of defective enzyme, we compared the immunologic properties of granule alkaline phosphatase derived from patients with CML with that of normal subjects and patients with polycythemia vera (PRV). Antisera prepared in rabbits against granule alkaline phosphatase purified from the neutrophils of a patient with PRV produced a single precipitin line of antigenic identity when reacted with extracts of normal, PRV, and CML neutrophil granules. A histochemical stain for alkaline phosphatase activity (alpha-naphthyl acid phosphate coupled with Fast Blue RR) specifically stained the precipitin line. A variety of quantitative precipitin techniques failed to produce satisfactory precipitation of alkaline phosphatase activity. Comparative analyses were therefore performed by affinity chromatography using goat antirabbit-gammaglobulin linked to Sepharose 4B to adsorb alkaline phosphatase complexed with rabbit gamma globulin. With this method, 100% of CML, normal, and PRV alkaline phosphatase could be adsorbed. Using limiting concentrations of antibody, a proportionally smaller fraction of enzyme activity was absorbed as the concentration of PRV alkaline phosphatase or normal alkaline phosphatase was increased. Extracts of CML granules containing comparable amounts of protein but 200-fold less alkaline phosphatase activity per milligram did not specifically reduce adsorption. Thus, in CML, we found no evidence that the granulocytes contained a large amount of antigenically normal but enzymatically defective alkaline phosphatase. Examination of electron micrographs revealed no significant differences in the number or distribution of granules in the granulocytes of normal subjects or patients with PRV or CML. This suggests that the low level of neutrophil alkaline phosphatase in CML granulocytes is the result of decreased enzyme content and not a consequence of synthesis of catalytically defective enzyme.     

Chronic liver diseases with negative laboratory findings]

Chronic liver diseases may be overlooked, when regular laboratory-chemical findings are overvalued. This is important especially for those which coincide with a particupation of the bile ducts. Even in insignificant clinical references laparoscopy and biopsy under direct vision are necessary. The blind biopsy of the liver is not always sufficient as it does not regularly deliver characteristic tissue.     

Rapid fluctuations in glycohemoglobin (hemoglobin Alc) related to acute changes in glucose

Since glycohemoglobin (Hb Alc) has been observed to change acutely, Hb Alc was studied in both human and monkey subjects to determine whether acute changes occurred with rapid changes in plasma glucose concentration. A marked increase in Hb Alc was observed over 2 days in a 3 1/2-year-old boy who developed steroid-induced diabetes mellitus. In addition, a significant fall in Hb Alc was observed over 7 days in a pregnant woman recovering from hyperglycemia and ketoacidosis. During marked acute hyperglycemia and its recovery, three normal rhesus monkeys were studied for changes in plasma glucose and Hb Alc over 1 day. Hb Alc more than doubled in each study by the time plasma glucose reached approximately 90 mmol/L and then declined by 12 hr. While maintained at their usual stable glucose concentrations, human and monkey subjects showed little differences in Hb Alc levels for dialyzed and nondialyzed hemolysates. With acute changes in blood glucose, however, the dialysis for 48 hr yielded lower Hb Alc values. Hb Alc increased when hemolysates were dialyzed against high glucose concentrations. Thus the effect of dialysis in sample preparation may be an important factor in correlating glycohemoglobin with acute and chronic changes in glucose status.     

Characteristics of the mother and child in teenage pregnancy

As shown in 11,464 black and white pregnant teenagers and 28,477 older pregnant women, teenage mothers tend to be of small stature and weight, consistent with age and early maturation. The small size of their infants is in proportion to their smaller size and not to their early age at conception. Although the progeny of teenage mothers show a higher incidence of prematurity and diminished birth size, in the extent of fetal loss, low Apgar and Bayley scores, and in the frequency of medical abnormalities, they are not at a disadvantage compared with infants of third-decade mothers of comparable size.