Does cord presentation on ultrasound predict cord prolapse?

OBJECTIVE: To study the association of umbilical cord presentation found on antenatal ultrasound and the incidence of cord prolapse in labor. STUDY DESIGN: We reviewed the antenatal records of all deliveries in the Mount Sinai Hospital in a 5-year period and conducted two separate retrospective studies. In the first study we reviewed the antenatal sonograms of all women with proven cord prolapse for cord presentation (study A). In the second study we reviewed the obstetrical outcome of pregnancies where sonographic cord presentation was identified in the third trimester of pregnancy (study B). RESULTS: In study A, 16,551 delivery records were reviewed and 42 patients were found to have had clinical cord prolapse (0.25%). Sonograms were available for 16 of these 42 patients. Only 2 of them (12.5%) had cord presentation on ultrasound scan. In study B, cord presentation was reported in 13 of 8,122 consecutive sonograms (0.16%). Six of these patients (6/13, 46%) had been scanned once. Three required cesarean delivery for malpresentation and cord presentation on ultrasound (3/13, 23%), while the other 3 had uncomplicated vaginal deliveries (23%). The remaining 7 patients had repeat scans which revealed persistent cord presentation in 3 (23%). All 3 underwent cesarean delivery, 1 following cord prolapse. The other 4 spontaneously converted to vertex with resolution of cord presentation as proven at delivery (31%). CONCLUSION: Cord presentation and cord prolapse are not synonymous. Documented cord presentation during the third trimester necessitates repeat scans and intrapartum sonographic assessment to determine the mode of delivery.     

Spondylometaphyseal dysplasia, corner fracture type: a heritable condition associated with coxa vara

The authors present the radiographic features of a previously incompletely delineated bone dysplasia, which they call spondylometaphyseal dysplasia, corner fracture type. This is a dominant heritable condition associated with short stature and developmental coxa vara. The progressive hip deformity usually causes significant disability requiring surgical correction. Developmental coxa vara, simulated corner fractures of long tubular bones, and vertebral body abnormalities result in a diagnostic constellation. Knowledge of these distinctive radiologic features allows accurate diagnosis, which in turn should lead to appropriate genetic counseling and possibly to earlier, more efficacious surgical treatment of the coxa vara.     

Is BCG an “Orphan” Drug Suffering from Chemotherapists' Overkill?

Modern interest in cancer immunotherapy emerged in 1969 following the pioneer reports of George Mathe on the effect of Bacillus Calmette-Guerin (BCG) in suppressing murine cancer and apparently increasing survival of children with acute lymphatic leukemia (1). Mathe employed intensive repeated weekly multisite scarifications with BCG during both the induction and maintenance phases of the steadily improving chemotherapy in vogue in the late 1960s. His favorable but uncontrolled studies stimulated a number of “historically controlled” trials of intensive heavy weekly BCG treatment. In the last eight years, at least 60 randomized controlled trials and many other nonrandomized studies have been completed. These employ diverse immunomodulators including various formulations of BCG (2) and BCG derivatives [BCG-MER, BCG cell wall skeletons (CWS)], as well as Corynebacterium parvumlevamisole, thymosin, poly A-poly U, and other agents. A vast array of confusing fragmentary observations and generally nonsignificant borderline findings have been summarized in several published international symposia.     

Indium-111 labeled platelet deposition following transfemoral angiography

The incidence of thromboembolitic events in patients undergoing transfemoral angiography was examined using indium-111 labeled platelets. Twenty-seven patients received approximately 300 muCi of autologous labeled platelets at least 3 hours before angiography and were scanned with a gamma camera immediately before and after angiography. All patients were free of clinically obvious complications in the 1-2 day period after angiography. Our results showed evidence of platelet deposition at 21 sites other than the puncture site in 12 (44%) patients. Most platelet deposition (54%) occurred along the region between the puncture site and the aortic bifurcation; 24% occurred at sites not traversed by the catheter. At the puncture site itself, there was substantial platelet uptake in 44% of patients. This study indicates the need for further work in determining the most suitable catheter material and in assessing the efficacy of other measures such as anticoagulant or antiplatelet therapy.     

Thoracic outlet syndrome: evaluation with CT

Diagnosis of the thoracic outlet syndrome is often difficult, particularly in patients without osseous abnormalities on plain radiographs. The radiographic and computed tomographic (CT) findings were reviewed from 27 patients with thoracic outlet syndrome and 21 normal subjects. The plain radiographs and CT scans were assessed by two independent observers without awareness of the clinical history. Fifteen patients with thoracic outlet syndrome had osseous abnormalities (anomalous cervical ribs; abnormally long, drooping C-7 transverse processes) identifiable on plain radiographs. CT did not provide further diagnostic information in the patients with abnormal radiographs. Eight of 12 patients (66%) with normal plain radiographs had abnormal findings on CT scans, consisting of impingement of the C-7 transverse process on the scalene triangle or anteromedial aspect of the middle scalene muscle. Only two of 21 control patients (9.5%) displayed this CT abnormality (P less than .01). CT may be useful in patients with symptoms suggestive of thoracic outlet syndrome and no osseous abnormalities on plain radiographs.     

Tongue and oropharynx: findings on MR imaging

Ten healthy subjects and 44 patients with diseases of the tongue or oropharynx were studied with magnetic resonance (MR) imaging. Axial, coronal, and sagittal images with a thickness of 4 mm were obtained with a pixel size of 0.75 X 0.75 mm on a 256 matrix. Nineteen of the patients underwent computed tomography (CT). Nine of those patients later had surgery, and the specimens were obtained for organ sectioning. These three studies as well as clinical history and physical examination findings were correlated. MR imaging was equal to or better than CT in those patients having both examinations. However, neither CT nor MR allowed recognition of histologic features or detection of microscopic spread of disease. Direct coronal and sagittal imaging planes on MR imaging allowed visualization of intrinsic tongue musculature, not possible with CT; this was important in recognizing subtle tumor extension. For these reasons, MR is the imaging method of choice for studying diseases of the tongue and oropharynx.     

Liquid-chromatographic assay of cimetidine in plasma and gastric fluid

In this micro-scale method for liquid-chromatographic measurement of cimetidine in 250-microL volumes of plasma or gastric fluid, a combination of organic- and aqueous-phase extractions, and protonation of the internal standard and cimetidine, enabled us to detect 2.0 ng of cimetidine on the column. We also used a radial compression module, which reduced the retention times for cimetidine and the internal standard to only 2.78 and 2.00 min. The speed and sensitivity of this method facilitates analysis of large numbers of samples.     

Interindividual variability in sensitivity to warfarin--Nature or nurture?

BACKGROUND: Interindividual variability in responses to warfarin is attributed to dietary vitamin K, drug interactions, age, or genetic polymorphism in the cytochrome P4502C9 enzyme (CYP2C9) (allelic variants 2C9*2 and 2C9*3 ) linked with impaired metabolism of the potent enantiomere S-warfarin. PATIENTS AND METHODS: We quantified the relative effects of age and of simultaneously determined CYP2C9 genotype, plasma warfarin and vitamin K concentrations, and concurrent medications on warfarin maintenance doses in 156 patients at optimized stable anticoagulation. RESULTS: Allele frequencies for CYP2C9*1, CYP2C9*2, and CYP2C9*3 were 0.84, 0.10, and 0.06. Warfarin doses were 6.5 +/- 3.2, 5.2 +/- 2.4, and 3.3 +/- 2.0 mg/d in the 3 genotype groups (P < .0001). Warfarin doses decreased with age as follows: 7.7 +/- 3.7 versus 4.9 +/- 2.9 mg/d at < 50 years and >66 years (P < .001), mainly as a result of decreased plasma warfarin clearance (2.8 +/- 1.4 mL/min versus 1.9 +/- 0.8 mL/min; P < .001). Vitamin K (1.6 +/- 1.1 ng/mL) did not differ among the age or genotype groups. Patients >or=66 years old with the CYP2C9*3 allele required only 2.2 +/- 1.2 mg/d compared with 7.9 +/- 3.7 mg/d in those 相似文献