Mild idiopathic lateral cerebral ventricular dilatation in utero: sonographic evaluation

The authors prospectively studied 20 fetuses with mild dilatation of the lateral cerebral ventricles but no other detectable central nervous system abnormality. One case (5%) occurred in a diabetic pregnancy, and three (15%) involved twin pregnancies. Fifteen (75%) fetuses were male, and one (5%) had trisomy 21. Postnatal follow-up at 15-31 months showed a normal outcome in eight cases (40%), an uncertain prognosis in four cases (20%), and death in eight cases (40%). Serial antenatal sonograms were obtained in 17 cases. Among the eight cases with a normal outcome, seven demonstrated no additional sonographic abnormalities and six showed resolution of the ventricular dilatation antenatally. Conversely, all 12 fetuses with demise or an uncertain prognosis demonstrated additional sonographic abnormalities, and six showed stable or progressive ventricular dilatation on follow-up sonograms. Since mild idiopathic lateral ventricular dilatation has a widely variable prognosis, antenatal detection of this finding warrants search for additional findings and follow-up sonography.     

Twin births in the university of Portharcourt teaching hospital Portharcourt: a 6 year review

Objective:To provide information on twin births and associated factors in Port barcourt South South Nigeria.Methods:Data on twin deliveries from 1st January 2003 to 31st December 2008 were collected and analysed.This included the maternal age and parity,gestation age,Apqar scores,sex and birth weight of twins.Results:A total of 11042 deliveries occurred over the study period with 333 being twins giving a twin rate of 1∶33.Male twins constituted 48% of twin births with male to female ratio of 1∶1.08.The mean age and parity of mothers were 29.6 years and 2.5 respectively.Presentation of the cephalic/cephalic for the first and second twins was the most common(63.4%).Severe birth asphyxia(first minute Apgar score 1-3)occurred in 3.9% of twins.Male-male twin pair occurred in 28.5% of twins,male-female in 39% while female-female occurred in 32.5%.The Caesarian section rate was 48%.Conclusion:The twining rate in this study is high.In this locality,there is a need for early ultrasound scanning of pregnant women particularly those of parities 1 to 3 and those aged 25-34 years in whom highest rates of twinning occurred to detect twinning when present and refer them to sufficiently equipped centres for adequate antenatal and perinatal care.     

Effects of S-carboxymethyl-l-cysteine on pulmonary sialyl transferase activity in vitro, in healthy and in sulphur-dioxide-induced bronchitic rats

S-carboxymethyl-L-cysteine (carbocysteine) improves the visco-elastic properties of bronchial mucus in vivo, possibly as a result of an increase in the relative proportions of sialomucins in bronchial mucus. Carbocysteine was therefore studied in vitro and ex vivo in both normal and bronchitic rats on pulmonary sialyl transferase, responsible for the addition of sialic acid to mucus glycoproteins. Bronchitis was induced in male Sprague-Dawley rats by repeated exposure to sulphur dioxide for two weeks. During this time they received either 500 mg kg-1 day-1 carbocysteine or its vehicle by the oral route. Rats not being exposed to SO2 received the same treatment. The animals were then killed, and subcellular fractions prepared by differential centrifugation of lung homogenates. Sialyl transferase was assayed using CMP-14C sialic acid as substrate and desialysed fetuin as exogenous acceptor. Enzyme activity was located in both the (Golgi-containing) 10,000 g and 100,000 g pellets with minor activity in the cytosolic supernatants. When tested in vitro between 10(-6) and 10(-3) M, carbocysteine had no effect on sialyl transferase activity in microsomes taken from healthy or bronchitis rats. Repeated administration of carbocysteine was without effect on the sialyl transferase activity in 10,000 g pellets taken from healthy rats. However, in bronchitic rats there was a small but statistically significant (P less than 0.05) increase in enzymic activity in the treated group compared to the animals receiving the vehicle. There was no difference in the activity of the microsomal enzyme compared to vehicle-treated controls in either healthy or bronchitic rats. We conclude that it is possible that an increase in sialyl transferase activity in a Golgi-containing fraction of bronchitic lungs could explain the relative increase in sialomucins in bronchitic subjects.     

Comparison of once daily endralazine with placebo in the treatment of hypertension uncontrolled by a beta-blocker and diuretic

Summary We report the first placebo controlled parallel group study of once daily endralazine (5–20 mg) in hypertension uncontrolled by a beta-blocker plus a diuretic.Following a 4-week run-in period 22 patients with a sitting mean arterial pressure (MAP) greater than 110 mm Hg were entered into the study and received either endralazine 5 mg or placebo. Blood pressure was measured 2 h and 24 h after dosing and the drug dose doubled at 2 and 4 weeks if the 24-h MAP remained >110 mg Hg. The final blood pressure assessment was made after 6 weeks treatment in the 19 patients who completed the study. Three patients withdrew from the study because of side effects. The hypotensive effect (sitting) was in excess of placebo at 2 h by 15.8 mm Hg systolic (NS), 15.4 mm Hg diastolic (p<0.01), 15.5 mm Hg MAP (p<0.02) and at 24 hours by 7.7 mm Hg systolic (NS), 8.9 mm Hg diastolic (p<0.02) and 11.1 mm Hg MAP (p<0.02). This study suggests that endralazine should be prescribed twice daily.     

The introduction of nurse-initiated thrombolysis in coronary care

Nurse-initiated thrombolysis has emerged as an organizational strategy to improve the delivery of thrombolytic agents to patients suspected of having an acute myocardial infarction. This article will outline the evolution of nurse-initiated thrombolysis on the coronary care unit in the authors' trust and present data on the critical decision-making skills of those nurses who have expanded their practice. Patients who were assessed, and whose thrombolysis was initiated by a nurse designated to deliver this treatment, had "door-to-needle" times consistent with the current targets of the National Service Framework for Coronary Heart Disease (Department of Health (DoH), 2000). A cardiologist acting as a "gold standard" reviewed the assessments of the first 50 patients seen by nurses able to deliver thrombolysis, finding each treatment decision appropriate. This gives support to the notion that appropriately trained and experienced nurses can assess and make treatment decisions in this acute care situation.     

Autostimulation of growth by human myelogenous leukemia cells (HL-60)

We have studied the effects of medium conditioned by the human progranulocytic leukemia cell line, HL-60, on the subsequent growth of new inocula of HL-60 cells. When HL-60 cells were cultured at high cell density, optimal growth rate occurred in liquid suspension and confluent colony growth was observed in viscous medium without the addition of conditioned medium. However, when cells were cultured at lower cell density, growth rate was reduced and colony growth was nil unless conditioned medium from HL-60 culture was added. All HL-60 populations studied, including the earliest available passage, 9, both elaborated and responded to HL-60 CM. HL-60 CM did not stimulate normal human or mouse granulocyte-monocyte colony-forming cell (CFU-GM) growth. Conditioned media from other human cell lines varied in the ability to stimulate HL-60 cell and CFU-GM proliferation. Some, such as GCT CM, stimulated both HL-60 cells and normal CFU-GM, whereas others, like HL-60 CM, stimulated only HL-60 growth. The majority of cell line CMs tested did not stimulate either HL-60 or CFU-GM. Chromatography of HL-60 CM on Ultrogel AcA54 showed a single peak of HL-60 stimulating activity of apparent molecular weight 13,000. The ability of HL-60 cells to elaborate this activity provides a possible explanation for their proliferation at higher cell densities. Autostimulation may prove to be important in the high growth potential of other cell populations that undergo unrepressed proliferation.     

Nurses' Perceptions of Pediatric Nursing Functions

The purpose of this study was to describe nurses' perceptions of the importance of pediatric nursing functions and to determine if there were differences in perceptions of nurses in managerial clinical and teaching positions Subjects were 125 pediatric nurses in managerial clinical and teaching positions Respondents were asked to rate the importance of 43 nursing functions on a 9-point scale ranging from highly important to not at all important Mean ratings of pediatric nursing functions were determined and one-way analyses of variance performed. The five nursing functions perceived to be most important were, in order of ranking (a) providing emotional support of children (b) recognizing significant physical deviations, (c) implementing nursing interventions (d) preparing children psychologically for procedures and surgery and (e) identifying nursing problems Significant differences were found between groups in perceptions of the importance of 23 nursing functions mainly in the areas of psychosocial care teaching and nursing process Most differences were between the teaching and managerial groups or between teaching and the managerial and clinical groups combined Differences in perceptions of the importance of a number of nursing functions though not great suggest a need for more dialogue between managers teachers and clinicians.