Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January, 1989 to April, 2001 were included. Data were retrieved from medical files and telephone interviews. RESULTS: A total of 68 patients required hypogastric artery ligation during the study period. Seventeen patients had 21 pregnancies with 13 term deliveries, two ectopic pregnancies, three miscarriages, and three abortions. Twenty-eight patients did not want a new pregnancy and one patient refused the interview. Twenty-three (34%) patients were lost to follow up. None of the patients suffered subsequent infertility and pregnancy was achieved in <12 months once planned. Pregnancy outcomes were normal. Fifty-four percent had vaginal deliveries. Three patients suffered a threatened post-partum haemorrhage that was easily treated medically. CONCLUSIONS: This is the largest reported series of pregnancies following hypogastric artery ligation. Hypogastric artery ligation for post-partum bleeding >1 l appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes.     

Uterine thermal balloon therapy under local anaesthesia for the treatment of menorrhagia: a pilot study

This study evaluates the use of local anaesthesia in a subset of patients undergoing uterine thermal balloon endometrial ablation for the treatment of menorrhagia. Out of 51 patients with dysfunctional uterine bleeding, 18 were included for uterine balloon therapy under local anaesthesia. Inclusion criteria were dysfunctional bleeding with absence of organic lesions in the uterine cavity, adequate relaxation and pain control during physical examination and diagnostic hysteroscopy, and patient desire to avoid a general anaesthetic. Paracervical block was performed with 20 ml of dilute 1% lignocaine HCl with epinephrine 1:200,000. Success of the procedure was defined as amenorrhoea, hypomenorrhoea, or eumenorrhoea. The median follow-up period was 13.9 +/- 5 months and 11 patients (61%) had follow-up of >1 year. Treatment led to a significant decrease in menstrual flow, duration, and pad count in all patients (P < 0.0001). No intra- operative complications occurred. A pain scale (level 1-10) was used to evaluate the patients' tolerance of the procedure (mean 3.8 +/- 1.3). In light of these successful and well tolerated procedures, thermal balloon endometrial ablation, utilizing local anaesthesia, appears practical as an office-based therapy.      

CD14 and tolerance to lipopolysaccharide: biochemical and functional analysis.

To evaluate the role of the high-affinity monocyte receptor for lipopolysaccharide (LPS), CD14, in the process of tolerance to LPS, the human monocytic cell line Mono-Mac-6 was cultured in the absence or presence of different amounts of LPS. The kinetics of CD14 modulation in these cells showed an initial 4-day period characterized by increased cell-surface expression, rate of biosynthesis (peaking at 48 hr) and release of its soluble forms (sCD14) which correlated with the amount of LPS in the culture. At this time, tolerance to LPS was already established, as measured by tumour necrosis factor-alpha (TNF-alpha) induction, it was LPS dose dependent and persisted up to 15 days. LPS also reduced the cell proliferation rate in a dose-dependent manner. After 8 days and up to 15 days, the CD14 biosynthesis, cell-surface expression and release of sCD14 inversely correlated with the level of LPS in the culture. The 48-hr LPS-pretreated cells showed a slightly decreased CD14 affinity for LPS, a relative high number of CD14 molecules per cells, and desensitization also to a phorbol 12-myristate 13-acetate (PMA) challenge. An anti-CD14 monoclonal antibody (mAb) protected the cells from tolerization when added at the beginning of culture, as revealed by challenge with LPS and PMA. The data indicate that in this model tolerization to LPS (1) precedes CD14 down-modulation, (2) operates by alteration of the receptor affinity for LPS and by a mechanism which affects a protein kinase C (PKC)-dependent signalling pathway, and (3) that CD14 plays a critical role in the establishment of tolerance to LPS. In addition, analysis of the data suggests the existence of a PKC-independent signalling pathway for LPS tolerization and a CD14-independent mechanism for establishing tolerance.     

Simultaneous inclusion body hepatitis and pox lesions in two pigeons

A natural dual infection of inclusion body hepatitis and pox was confirmed in pigeons by histopathological and electron-microscopical examination. Poxvirus particles were observed in epithelial cells and intranuclear adeno-like virus particles were found in the liver of two pigeons. However, no single cell was found with both viruses.     

Evaluation of Urea-motility-indole medium for recognition and differentiation of Salmonella and Shigella species in stool cultures.

A semisolid urea-motility-indole medium designed for detection in Enterobacteriaceae of urease activity, motility, and indole production in one tube was prepared and evaluated. The formulation of the medium was similar to that of Christensen urea agar, but the agar concentration was 0.2%, and 1% tryptone was added. Results with 687 strains of Enterobacteriaceae were the same as those obtained with standard test media (98% overall agreement). The urea-motility-indole medium was also used in combination with Kligler iron agar for the recognition and differentiation of Salmonella and Shigella species from colonies picked from plating media in fecal cultures. This combination was compared with the combination of Kligler iron agar and lysine iron agar with 507 strains of non-lactose-fermenting Enterobacteriaceae. Although both combinations enabled the presumptive recognition and differentiation of Salmonella and Shigella species, an analysis of data indicated that the combination of Kligler iron agar and urea-motility-indole medium performed better than the combination of Kligler iron agar and lysine iron agar in detecting Salmonella and Shigella species.     

Investigation of Gamma-aminobutyric acid (GABA) A receptors genes and migraine susceptibility

Background  

Migraine is a neurological disorder characterized by recurrent attacks of severe headache, affecting around 12% of Caucasian populations. It is well known that migraine has a strong genetic component, although the number and type of genes involved is still unclear. Prior linkage studies have reported mapping of a migraine gene to chromosome Xq 24–28, a region containing a cluster of genes for GABA A receptors (GABRE, GABRA3, GABRQ), which are potential candidate genes for migraine. The GABA neurotransmitter has been implicated in migraine pathophysiology previously; however its exact role has not yet been established, although GABA receptors agonists have been the target of therapeutic developments. The aim of the present research is to investigate the role of the potential candidate genes reported on chromosome Xq 24–28 region in migraine susceptibility. In this study, we have focused on the subunit GABA A receptors type ε (GABRE) and type θ (GABRQ) genes and their involvement in migraine.     

Mortality in psittacine birds resembling Pacheco's disease in Spain

The sudden death of five sulphur-crested cockatoos (Cacatua galerita) with no apparent clinical signs was investigated. The birds had hepatitis with intranuclear inclusion bodies (IIBs), as well as IIBs in mononuclear spleen cells, epithelial cells of the kidney tubules and endothelial cells of the glomerular capillaries. Ultrastructurally, icosahedral herpesvirus-like particles, 110 to 115 nm in diameter were found consistent with Pacheco's disease. This is the first time the disease has been reported in cockatoos in Spain.     

Intracellular acetylcholinesterase of adult rat myofibers is more concentrated in endplate than non-endplate regions

The intracellular distribution of acetylcholinesterase (AChE) was determined in adult rat anterior gracilis muscles. Echothiophate iodide (ECHO), a water-soluble cholinesterase inhibitor, was applied to muscles in situ to eliminate extracellular and/or extracellularly oriented enzyme. Control and ECHO-treated muscles were either cut into 1-mm segments and assayed for AChE activity or cytochemically stained for AChE. Subsequent analysis by light and electron microscopy showed that the AChE stain inside myofibers was highly localized and clearly visible only in the zone immediately underlying the point of nerve-muscle contact. Biochemical assay of muscle segments showed intracellular AChE to be most highly concentrated in regions containing large numbers of endplates (approximately twice the activity of endplate-free areas). Since such "endplate-rich" segments are in fact mostly extra-synaptic tissue, we conclude that intracellular AChE of adult rat gracilis myofibers, although present along the length of the cell, is more than two times as concentrated in sub-synaptic areas as compared to extra-synaptic areas. This result must be carefully considered when attempting to identify "endplate-specific" AChE activity of mammalian muscle, and further points to the importance of neural influences on AChE metabolism/regulation.