Evaluation of umbilical cord pH and its relationship with Apgar score in term newborn infants

The value of the Apgar score as an index of birth asphyxia has been recently questioned. The purpose of the present study is to evaluate the relationship between cord blood pH and Apgar score in term newborn infants.A cross-sectional study involving 76 term newborn infants was performed from March through September 1995 at the Obstetric Unit of Hospital de Clínicas de Porto Alegre. The blood samples were obtained from umbilical cord artery and vein at the moment of delivery. Infants were divided in three different groups according to the Apgar score: Group A (n=60): >or=7 at one and five minutes; Group B (n=13): < 7 at one minute and >or=7 at five minutes; Group C (n=3): < 7 at one and five minutes. The frequency of acidemia in Group A was 18.3% (11 newborn infants) considering arterial pH < 7.20 and 5% considering arterial pH or= 7.20 and nine (56.2%) had arterial pH > 7.10. None of the newborn infants in Group C had arterial pH > 7.10. The sensitivity and specificity values for Apgar score less than 7 at one minute for detection of fetal acidemia were, respectively, 54.1% and 94.1%. This study confirms a poor correlation between Apgar score and umbilical blood cord pH, even in a term newborn, and emphasizes the importance of obtaining umbilical cord pH to consider the diagnosis of perinatal asphyxia.     

Comparison of DMSA scintigraphy with intravenous urography for the detection of renal scarring and its correlation with vesicoureteric reflux.

A series of 208 patients was prospectively assessed for reflux nephropathy by intravenous urography (IVU) and 99mTc-dimercaptosuccinate (DMSA) scintigraphy. All patients were studied at least 3 months after their most recent urinary tract infection and micturating cystourethrography (MCU) was performed prior to the scintigraphic studies. DMSA scintigraphy detected significantly more cortical abnormalities than did IVU. There was also a correlation between cortical abnormalities in the DMSA studies and the degree of reflux on MCU. The validity of DMSA as a cortical imaging agent is evaluated and the histological evidence for its efficacy derived from the animal model is reviewed, lending weight to its establishment as the "gold standard" for renal cortical scarring.     

Comparison of enhancement of GGTase-positive foci and induction of ornithine decarboxylase in rat liver by barbiturates

The induction of ornithine decarboxylase (ODC) by barbituratesand the ability of barbiturates to enhance neoplastic progressionof chemically initiated cancer was examined in rat liver. Allseven barbiturates induced ODC with barbital (7.7 fold increase)and phenobarbital (5.7 fold increase) demonstrating the mostpotent activity. Maximum induction of ODC by phenobarbital wasobtained in 18 h. Barbital (500–5000 p.p.m.) and phenobarbital(500 p.p.m.) administered in the drinking water enhanced theappearance of diethylnitrosamine (DENA)-initiated -glutamyltranspeptidase(GGTase)-positive foci. Amobarbital, hexabarbital and pentabarbitaldid not enhance the appearance of GGTase-positive foci. In theabsence of previous initiation by DENA, the enhancing regimenof the barbiturates did not cause the appearance of GGTase-positivefoci. Barbiturates induced ODC activity in rat liver and enhancedthe incidence of DENA initiated GGTase-positive foci.     

The cancer patient with chronic pain due to herpes zoster

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, and as such has been an area of extensive medical research for the past three decades. The patients at highest risk for PHN include those older than 50 years, those with severe acute cases of zoster, and those with shingles in a trigeminal distribution. As persons with malignancy are at a high risk for developing zoster itself, PHN is a complication that will be faced by many of these patients and their caregivers. This article reviews the available treatments and preventative measures for this debilitating condition.