Endosseous implant placement in conjunction with inferior alveolar nerve transposition: a report of an unusual complication and surgical management

Inferior alveolar nerve transposition and placement of endosseous implants is one of the treatment options for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. The possible complications associated with this technique include prolonged neurosensory disturbances, infection, and pathologic fracture. This report presents the surgical management of a patient who sustained a mandibular fracture after inferior alveolar nerve transposition for the placement of 3 endosseous implants.     

Maternal near miss and maternal death in the World Health Organization��s 2005 global survey on maternal and perinatal health

Objective

To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes.

Methods

In a multicenter cross-sectional study, we collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter’s association with maternal characteristics and perinatal outcomes.

Findings

Of the 97 095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section.

Conclusion

Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.     

Antenatal diagnosis of a third trimester interstitial pregnancy: a case report

Interstitial pregnancy cases that advance to term, or near term, are occasionally reported. We present an unusual case of a third trimester interstitial pregnancy with antenatal diagnosis and expectant management. She presented at 20 weeks of pregnancy with an early preterm premature rupture of membranes, and expectant management was initiated. The ultrasound suggested an interstitial location and a posterior magnetic resonance image, obtained at 26 weeks, confirmed the diagnosis. Because of the risk of uterine rupture, an elective cesarean section was performed at 28 weeks. During the laparotomy, the uterine fundus appeared intact with an asymmetric bulge that provided evidence of placenta increta. The baby was delivered, and an obstetric hysterectomy was performed. The newborn was admitted to the neonatal intensive care unit with a severe respiratory distress syndrome. No response to mechanical ventilation was observed, and neonatal death was reported. A uterine pathological examination confirmed the diagnosis.     

The combination of mifepristone and misoprostol for the termination of pregnancy

The combination of 200 mg of mifepristone followed by 25 μg to 800 μg (depending on gestational age) of misoprostol has been shown to be effective for the termination of pregnancy throughout gestation. The dose of misoprostol should be reduced as gestational age increases. Mifepristone is not indicated for induction of labor with a live fetus because there are no data to confirm that it does not have a possible deleterious fetal effect. The course of treatment and prerequisites for medical abortion and recommended mifepristone and misoprostol regimens for different gestational ages are described, along with the side effects, management of complications, and postabortion care. The use of the mifepristone-misoprostol combination regimen for induction of labor in cases of fetal death is also described.     

Simplifying NFP: preliminary report of a pilot study of the 'collar' method in Brazil

Natural methods of fertility regulation are acceptable in most cultures. Many couples worldwide do not wish to use contraceptives or do not have access to them but wish to limit their family size or lengthen the time between births. Barriers to expanding use of natural family planning (NFP) methods include a lack of providers who can teach NFP and a lack of time to teach and follow couples during the initial months of NFP use. If simple yet effective methods of NFP are available, then NFP could be introduced to a wider audience. Recently, calendar rules have been revised that use a set interval to identify fertile days. These new rules provide better coverage of fertile days and require less abstinence than the rules traditionally used with the calendar method. One of these new rules is being field tested in a pilot study in Brazil. Couples are asked to abstain from day 9-19 (inclusive) of the menstrual cycle, using a beaded necklace (the 'collar') as a mnemonic device. Focus groups with the teacher-monitors and in-depth interviews with female and male users were carried out to evaluate the acceptability of the 'collar' method. A preliminary analysis of these focus groups and interviews from the first site is presented.     

Composition of the human zona pellucida and modifications following fertilization

The composition of individual human zonae pellucidae and modificationsto this extracellular coat both before and after fertilizationwere analysed using a rapid, sensitive, non-radioactive biotinylation-or lectin-based detection system; these assays use commerciallyavailable reagents and can be performed on fragments of individualzonae pellucidae. The zona pellucida from unfertilized eggsis composed of three glycoprotein species designated as huZP1,huZP2 and huZP3. Under non-reducing conditions, the molecularweights of these proteins are 150 kDa,100 kDa, and 55–65kDa respectively. Following fertilization, huZP1 was not detectedunder either non-reducing or reducing conditions. In contrast,after fertilization huZP2 was detected under non-reducing conditions,but not under reducing conditions. The ability to detect pre-and post-fertilization changes in a single human zona pellucidais discussed in relation to its value in assessing deficienciesin clinical and laboratory protocols used for in-vitro fertilization. fertilization/human/in-vitro fertilization/zona pellucida     

Timing of onset of contraceptive effectiveness in Norplant implant users. II. Effect on the ovarian function in the first cycle of use.

The objective of this study was to time the onset of contraceptive effectiveness in Norplant implant users, when the capsules were inserted beyond the first 7 days of the cycle, based on the immediate effect on the ovarian activity. A total of 42 healthy women requesting Norplant implant contraception were enrolled at clinics in Santo Domingo, Dominican Republic, and in Baltimore, Maryland. Implants were inserted on days 8-13 of the menstrual cycle. Blood samples for estradiol (E2), progesterone (P), luteinizing hormone (LH) (in a subset of 12 women), and levonogestrel (LNG) assay, were taken at 0 h and at 6, 12, 24, 72, and 168 h postinsertion. Ovulation, as defined by P > 2.5 ng/mL, occurred in 40% of subjects. A short lasting, frequently blunted, LH peak occurred within 12 h postinsertion, in all these subjects. The remaining subjects had anovulatory cycles with two distinct E2 profiles: continuously increasing E2 levels to a high mean of 414.3 pg/mL (28%), or no sustained increase in E2 (32%). Most cycles (86%) in which Norplant was inserted with high E2 levels (> 175 pg/mL) were ovulatory, whereas none were ovulatory with low E2 (< 100 pg/mL) at insertion. Based on the endocrine effects of Norplant implant insertion in the midadvanced follicular phase, in which ovulation will either occur within 48 h of insertion or will be impaired, additional contraceptive protection is necessary only for 3 days.     

Premature chromatid separation and altered proliferation of human leukocytes treated with vanadium (III) oxide

Vanadium is a widely distributed metal in the Earth’s surface and is released into the environment by either natural or anthropogenic causes. Vanadium (III) oxide (V₂O₃) is present in the environment, and many organisms are exposed to this compound; however, its effects at the cellular and genetic levels are still unknown. Therefore, in this study, the ability of V₂O₃ to induce chromosomal damage and impair cell proliferation was tested on human leukocytes in vitro. The cultures cells were treated for 48?h with different concentrations 2, 4, 8 or 16?μg/mL of V₂O₃, and we use the sister chromatid exchange’s (SCE) test and the viability assay to evaluate the effects.

In the results, no change was observed in either the viability or the frequency of SCE; however, a significant increase was observed in the incidence of premature chromatid separation (PCS), and a decrease was observed in both the mitotic index (MI) and the replication index (RI). Therefore, it can be suggested that V₂O₃ induces a genotoxic effect at the centromere level, indicating that it is a cause of aneuploidy that is capable of altering cell cycle progression.     

A multicenter study of levonorgestrel—Estradiol contraceptive vaginal rings II — Subjective and objective measures of effects: An international comparative trial

Comparative clinical trials of 2 sizes of contraceptive vaginal rings and of an oral contraceptive were undertaken at 8 investigational sites (9 clinics). More than 500 women enrolled on each of the 3 study regimens. Side effects of the rings and of Nordette,¹ the oral contraceptive, were evaluated by noting spontaneous complaints, by recording medications taken and by physical examination. Inquiries about changes in the frequency of specific conditions were made at the end of the subjects' participation in the first year of the study. The incidence of spontaneous complaints was similar among users of the 2 different-sized rings and of the pill. Vaginal and menstrual complaints were significantly more frequent among ring users. Headaches, dizziness and nausea were reported significantly more frequently by users of Nordette. All the regimens were associated with weight gain and increased hemoglobin levels. Nordette was associated with small but significant increases in both diastolic and systolic blood pressure.     

Functional life-span of the dominant follicle in pharmacologically induced anovulatory cycles

With the purpose of measuring the duration of the functionallife-span (FLS) of the anovulatory follicle in women under continuouslow-dose progestogen treatment, the oestradiol curve of Norplantimplant users was retrospectively analysed. From all the datacollected during the previous 5 years at the Department of BiomedicalResearch at the Family Planning Clinic of Profamilia, SantoDomingo, Dominican Republic, data from all 29 Norplant implantusers showing follicular activity without luteal activity wereselected for this retrospective analysis. Serial blood samplingtwice or three times a week for 5 or 6 consecutive weeks hadbeen taken in all subjects. The duration of the FLS of the dominantfollicle in anovulatory cycles was defined as the period fromthe first day of ascending oestradiol curve until the day precedingonset of menses. The mean FLS of the dominant follicle in anovulatorycycles under continuous low-dose progestogen administrationwas 21.1 4.2 days, independently of the length of the menstrualcycle. The duration of the FLS of the anovulatory dominant follicleappears not to be different from the duration of a normal follicle/corpusluteum unit.