Intrapartum Detection of a Maerosomie Fetus: Clinieal Versus 8 Sonographic Models

Summary: The purpose of this study was to determine whether clinical or sonographic models have 1) the highest accuracy in differentiating newborns with birth-weights ≥ 4,000 g (macrosomia) versus ≤ 3,999 g, and 2) among macrosomics which method of predicting birth-weight has the lowest percentage error. Prospectively, 602 consecutive parturients at term had a clinical estimate of birth-weight followed by sonographic measurement of fetal parts. The sonographic prediction of birth-weight was derived using 8 different models that utilize either 1 measurement or a combination of 2 to 4 parameters. The incidence of macrosomia was 11.1% (67 of 602). Analysis of ROC curves indicated that clinical predictions (w = 0.85) were significantly better than 4 of the 8 sonographic models. The mean standardized absolute error among maerosomie newborns is significantly lower when predictions are derived clinically (99 ± 70 g/kg) than using 1 or 2 fetal parts. Sonographic assessment of birth-weight is not significantly more accurate in the detection of a maerosomie fetus than clinical predictions.     

Short Communication: The Importance of Psychosocial Factors in Understanding Child Distress During Routine X-ray Procedures

Thirty-eight children, aged 1-4 years, with a query or definite diagnosis of congenital heart disease (CHD) were observed during an X-ray procedure and their behaviour rated on an amended version of the Observational Scale of Behavioural Distress. Families were followed up and assessed on a number of psychosocial variables. High rates of behavioural distress were found to be associated with children's low stranger sociability and parental style of discipline. Possible patterns of interaction between CHD children and their families are discussed.     

Ureteric Endometriosis: 3 Case Reports and a Review of the Literature

Endometriosis involving the ureter is a relatively rare phenomenon but at least 121 cases have been reported previously. The 3 cases presented in this report emphasize some important facets of this condition: the lack of symptoms leading to late diagnosis, the presence of severe renal damage with very localized pelvic disease, how an incomplete initial operation may lead to further major difficulties, and the failure of medical therapy to halt its progress. The potentially lethal nature of ureteric endometriosis is stressed, and the different treatment modalities for patients of different ages and parity discussed. Surgical management, either conservative or radical, is suggested as the modality of choice, and where conservative operation is undertaken very careful continuing observation of renal function is a necessity.     

Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy

Between 1983 and 1994, posterior cervical foraminotomy as described by Frykholm was performed on 89 patients with exclusively radicular symptoms caused by cervical osteophytes. The main presenting feature was arm pain. Objective neurological signs were present in 50% of the patients. At mean postoperative follow-up of 8.6 months, 95.5% of patients reported excellent or good results, while 4.5% were not improved. No patient was rendered worse following the procedure. There were no deaths and the complication rate was 2.2%. Further surgery for recurrent root symptoms was required by 6.7% of patients. Our findings are in keeping with the good results and low complication rate of this procedure as described in other studies. Informal inquiries suggest that this procedure is not widely used, at any rate in the United Kingdom, and we present this series in order to emphasize the efficacy and safety of this procedure.     

Does the Menstrual Cycle Play a Role in Sexual Arousal?

Menstrual cycle effects on erotic arousability were tested in 13 women aged 20–28. Vaginal blood volume and pulse amplitude were measured with a light emitting diode photoplethysmograph, labial temperature was measured by a small thermistor, and subject self-report of arousal was estimated on a 7-point Likert scale in response to audio erotic tapes and fantasy over five different phases of the menstrual cycle. Pre-session levels of blood volume and labial temperature showed no important changes across the cycle, but pooled blood volume, pulsatile blood volume and labial temperature reliably demonstrated sexual arousal during tape and fantasy sessions. Repeated measures analyses of variance and covariance of physiological change scores from baseline and subjective ratings failed to demonstrate that significant changes in self-reports, vaginal blood volume, vaginal pulse amplitude, or labial temperature occurred as a function of menstrual cycle phase. This study provides objective physiological evidence that there appears to be no one phase in the menstrual cycle during which women are more sexually arousable to erotic stimuli as detected by these physiological measures.     

Protection against aerosolized Yersinia pestis challenge following homologous and heterologous prime-boost with recombinant plague antigens

A Yersinia pestis-derived fusion protein (F1-V) has shown great promise as a protective antigen against aerosol challenge with Y. pestis in murine studies. In the current study, we examined different prime-boost regimens with F1-V and demonstrate that (i) boosting by a route other than the route used for the priming dose (heterologous boosting) protects mice as well as homologous boosting against aerosol challenge with Y. pestis, (ii) parenteral immunization is not required to protect mice against aerosolized plague challenge, (iii) the route of immunization and choice of adjuvant influence the magnitude of the antibody response as well as the immunoglobulin G1 (IgG1)/IgG2a ratio, and (iv) inclusion of an appropriate adjuvant is critical for nonparenteral immunization.     

Identification and characterization of the N-acetylglucosamine glycosyltransferase gene of Haemophilus ducreyi

Haemophilus ducreyi is the causative agent of chancroid, a sexually transmitted ulcerative disease. In the present study, the Neisseria gonorrhoeae lgtA lipooligosaccharide glycosyltransferase gene was used to identify a homologue in the genome of H. ducreyi. The putative H. ducreyi glycosyltransferase gene (designated lgtA) was cloned and insertionally inactivated, and an isogenic mutant was constructed. Structural studies demonstrated that the lipooligosaccharide isolated from the mutant strain lacked N-acetylglucosamine and distal sugars found in the lipooligosaccharide produced by the parental strain. The isogenic mutant was transformed with a recombinant plasmid containing the putative glycosyltransferase gene. This strain produced the lipooligosaccharide glycoforms produced by the parental strain, confirming that the lgtA gene encodes the N-acetylglucosamine glycosyltransferase.     

Paired human chorionic gonadotrophin determinations for the prediction of pregnancy outcome in assisted reproduction

The aim of this study was to determine the prognostic value of single and paired measurements of serum concentrations of human chorionic gonadotrophin (HCG) for successful pregnancy following in-vitro fertilization (IVF) and tubal embryo transfer (TET). We analysed serum HCG concentrations 15 and 22 days after IVF or TET in 198 conception cycles. Cut-off values of serum HCG were determined by a receiver operating characteristic (ROC) curve. On the basis of single HCG samples on day 15 (HCG15) after transfer, using a cut-off value of HCG15 = 150 mIU/ml, the sensitivity was 71% and the specificity was 77%. The positive predictive value (HCG15 > or = 150 mIU/ml indicating a normal pregnancy) was 89%, while the negative predictive rate (HCG15 < 150 mIU/ml indicating an abnormal pregnancy) was 51%. Patients with HCG15 < 150 mIU/ml but HCG22/HCG15 ratio > or = 15, still had a 90% chance of normal pregnancy. However, in patients with HCG15 < 150 mIU/ml and an HCG22/HCG15 ratio < 15, there was an 84% chance of an abnormal pregnancy. We conclude that a single HCG15 determination combined with the ratio of HCG22 to HCG15 has a higher diagnostic accuracy for prediction of pregnancy outcome than either analysis alone.      

Development of biodegradable poly(propylene fumarate)/poly(lactic-co-glycolic acid) blend microspheres. I. Preparation and characterization

We developed poly(propylene fumarate)/poly(lactic-co-glycolic acid) (PPF/PLGA) blend microspheres and investigated the effects of various processing parameters on the characteristics of these microspheres. The advantage of these blend microspheres is that the carbon-carbon double bonds along the PPF backbone could be used for their immobilization in a PPF scaffold. Microspheres containing the model drug Texas red dextran were fabricated using a double emulsion-solvent extraction technique. The effects of the following six processing parameters on the microsphere characteristics were investigated: PPF/PLGA ratio, polymer viscosity, vortex speed during emulsification, amount of internal aqueous phase, use of poly(vinyl alcohol) (PVA) in the internal aqueous phase, and PVA concentration in the external aqueous phase. Our results showed that the microsphere surface morphology was affected most by the viscosity of the polymer solution. Microspheres fabricated with a kinematic viscosity of 39 centistokes had a smooth, nonporous surface. In most microsphere formulations, the model drug was dispersed uniformly in the polymer matrix. For all fabricated formulations, the average microsphere diameter ranged between 19.0 and 76.9 microm. The external PVA concentration and vortex speed had most effect on the size distribution. Entrapment efficiencies varied from 60 to 98% and were most affected by the amount of internal aqueous phase, vortex speed, and polymer viscosity. Overall, we demonstrated the ability to fabricate PPF/PLGA blend microspheres with similar surface morphology, entrapment efficiency, and size distribution as conventional PLGA microspheres.