Clinical formulas, mother's opinion and ultrasound in predicting birth weight

CONTEXT AND OBJECTIVE: Accurate fetal weight estimation is important for labor and delivery management. So far, there has not been any conclusive evidence to indicate that any technique for fetal weight estimation is superior to any other. Clinical formulas for fetal weight estimation are easy to use but have not been extensively studied in the literature. This study aimed to evaluate the accuracy of clinical formulas for fetal weight estimation compared to maternal and ultrasound estimates. DESIGN AND SETTING: Prospective study involving 100 full-term, cephalic, singleton pregnancies delivered within three days of fetal weight estimation. The setting was a tertiary public teaching hospital in S?o Paulo, Brazil. METHODS: Upon admission, the mother's opinion about fetal weight was recorded. Symphyseal-fundal height and abdominal girth were measured and two formulas were used to calculate fetal weight. An ultrasound scan was then performed by a specialist to estimate fetal weight. The four estimates were compared with the birth weight. The accuracy of the estimates was assessed by calculating the percentage that was within 10% of actual birth weight for each method. The chi-squared test was used for comparisons and p < 0.05 was considered significant. RESULTS: The birth weight was correctly estimated (+/- 10%) in 59%, 57%, 61%, and 65% of the cases using the mother's estimate, two clinical formulas, and ultrasound estimate, respectively. The accuracy of the four methods did not differ significantly. CONCLUSION: Clinical formulas for fetal weight prediction are as accurate as maternal and ultrasound estimates.     

Multicenter phase II study of brequinar sodium in patients with advanced lung cancer

Summary A total of 53 patients with advanced lung cancer [non-small-cell (NSC), 21; small-cell (SC), 32] were treated with brequinar sodium. All of the NSC patients were chemotherapy-naive, but 31/32 (97%) SC patients had failed a multiagent chemotherapy program prior to study entry. Brequinar was given intravenously at a median weekly dose of 1200 mg/m². The toxicity was moderate, with 19 patients (36%) experiencing grade 3 or 4 toxicity. Objective responses were observed in one NSC and two SC patients. We conclude that at this dose and on this schedule, brequinar does not have sufficient activity in patients with NSC or in patients with previously treated SC to warrant further evaluation. However, since responses were observed in previously treated SC lung-cancer patients, further evaluation in chemotherapy-naive patients may be warranted.This study was supported by The DuPont Pharmaceutical Co., Wilmington, Delaware     

Extensive intraduct component in invasive duct carcinoma of the breast: prevalence and significance in a south Asian setting

Extensive intraduct component (EIC) in invasive duct carcinoma is one of the main factors affecting local cancer recurrence and thereby a major consideration in breast conserving therapy. A retrospective study was undertaken to assess the prevalence of extensive intraductal component in a South Asian setting. 105 cases of invasive duct carcinoma reported at a University Pathology Department during a 75 month period from January 1992, were reviewed. 48.6 percent of all cases assessed had an intraductal component. 13.3 percent had an EIC. Of the seventy-two T1 and T2 tumours reviewed 5.6 percent showed EIC. The results of this study indicate that by virtue of its low prevalence. EIC in infiltrating ductal cancer is unlikely to be a major obstacle in the decision of breast conserving therapy in the South Asian region.     

Syndromic hereditary deafness. Usher's syndrome. Oto-neurologic and genetic factors

Usher syndrome (USH) is an autosomal recessive hereditary disorder characterized by congenital bilateral sensorineural hearing loss and progressive loss of vision due to retinitis pigmentosa (RP). The prevalence of Usher syndrome is estimated to be 3-4.4 cases per 100.000 people. Several clinical types have been distinguished by age at onset, rate of progression, and severity of symptoms. Type I (USH1) is characterized by a congenital, severe-to-profound deafness and absent vestibular function. Type II (USH2) shows a congenital and moderate-to-severe hearing loss and normal vestibular response. It is also suggested a third type (USH3), clinically similar to USH2, but with progressive hearing loss. Genetic heterogeneity of USH is quite extensive. Up to now, seven different loci responsible for the defect are known: 14q, 11q, 11p, 10q and 21q for USH1; 1q for USH2 and 3q for USH3. Moreover, there are USH1 and USH2 families that fail to show linkage to these candidate regions demonstrating that should exist other loci causing USH, although their ubications are unknown. To date, only two genes involved in the USH pathology are known, although together they are responsibles of about the 80% of total USH cases: myosin VIIA, an unconventional myosin, involved in the USH1b phenotype and a protein similar to the laminina, responsible for the USH2a phenotype.     

Variations in the number of births by day of the week,and morbidity and mortality in very-low-birth-weight infants

Objective

To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients.

Sentinel Node Biopsy in Melanoma of the Trunk and the Extremities in Tumescent Local Anesthesia

Background.  The sentinel node biopsy (SNB) of axilla and groin is a common staging procedure and can be done in both general anesthesia and local anesthesia.
Objective.  To investigate the efficacy of tumescent local anesthesia (TLA) as a widely used type of local anesthesia in dermatologic surgery for the SNB of axilla and groin.
Method.  From 1999 to 2002, 195 patients underwent a SNB of axilla or groin. A 0.1% tumescent solution with prilocaine was used. In cases in which local anesthesia did not produce complete analgesia, there was additional medication using Midazolam and Tramadol.
Results.  In 74.9% of the patients, TLA was sufficient as the sole method. In 25.1%, sedation became necessary. Additional medication was required for 31.9% of the patients with SNB in the axilla and for 17.3% with SNB in the groin; 26.6% of the patients with SNB of both axillas and 25% with SNB of the axilla and the groin received additional medication using Midazolam. Two patients with a SNB of the axilla received a combination of Midazolam and Tramadol.
Conclusion.  SNB of the axilla and the groin in TLA is a good alternative to other anesthetic techniques, for example, general anesthesia or infiltration anesthesia.     

Risk factors for dental caries in children with cerebral palsy

This study was conducted to examine the oral condition and the salivary and microbiological parameters associated with dental caries in 62 children with cerebral palsy, who came from households of low socioeconomic status (Study Group). This group had mixed (6 to 11 years old) and permanent (11 to 16 years old) dentition. Dental examinations were performed to measure dental caries, plaque index, salivary levels of mutans streptococci and lactobacilli, salivary flow rate, pH of stimulated saliva, and buffer capacity of saliva. A group of 67 non-handicapped children from similar socioeconomic backgrounds also were examined using these parameters (Control Group). Data were analyzed statistically by non-parametric tests and by correlation. The results showed that children with cerebral palsy who had permanent dentitions had a higher mean decayed, missing and filled surfaces index, as well as a higher plaque index for both sexes. Microbiological examination revealed higher levels of mutans streptococci among Study Group subjects with mixed dentition than in the Control Group. Also, lactobacillus counts were higher in the Study Group, regardless of sex or dentition. With respect to salivary flow rate, pH and buffering capacity, lower mean values were obtained for the Study Group.     

Effect of ageing on the number of neuronal noradrenaline uptake sites in the rat vas deferens

Summary Previous work has shown an age-related reduction in neuronal uptake of noradrenaline in the prostatic, but not in the epididymal portion of the rat vas deferens. In the present paper, the influence of ageing on the number of [³H]desipramine binding sites and on the effect of lithium on neuronal [³H]noradrenaline uptake were studied in the prostatic and epididymal portions of vasa deferentia from 4- and 20-month-old rats. The affinity for [³H]desipramine (K _d values) in the epididymal and prostatic portions did not change with age. However, ageing reduced the maximal number of [³H]desipramine binding sites (B_max values) in the prostatic, but not in the epididymal portion. Lithium potentiated neuronal [³H]noradrenaline uptake only in the prostatic portion and this potentiation was not changed by ageing. The results showed differences in neuronal noradrenaline uptake between the two portions of the vas deferens. Furthermore, the data suggest that the age-related reduction in neuronal uptake in the prostatic portion is due to a reduction in the number of neuronal uptake sites for noradrenaline. Correspondence to R. Pekelmann Markus at the above address