Dynamic cervical change: is real-time sonographic cervical shortening predictive of preterm delivery in patients with symptoms of preterm labor?

OBJECTIVES: To determine prospectively if dynamic cervical change (spontaneous real-time cervical shortening) is predictive of preterm delivery at < 37 weeks' gestation in patients with symptoms of preterm labor. METHODS: This was a prospective study of patients at 23-34 weeks' gestation who were symptomatic for preterm labor. Patients underwent a 10-min real-time sonographic cervical length assessment with measurements taken at 1-min intervals. The presence or absence of dynamic cervical change, defined as real-time changes in cervical length observable to the naked eye of the sonologist during the examination, was recorded. Gestational age at delivery was obtained from medical records. Preterm delivery was defined as delivery at < 37 weeks' gestation. Dynamic cervical change and initial and minimum cervical lengths were assessed for prediction of preterm delivery. RESULTS: Seventy-six patients were enrolled, and 66 were available for outcome analysis. Thirty-one patients (47%) exhibited dynamic cervical change. Patients with dynamic change had shorter initial cervical lengths (27 mm vs. 36 mm, P = 0.001), shorter minimum cervical lengths (20 vs. 33 mm, P < 0.001) and larger changes in cervical length during the examination period (10 vs. 4 mm, P < 0.001). In the subgroup of patients with an initial cervical length > 30 mm, those with dynamic change delivered earlier than did those without dynamic change (36.8 vs. 38.6 weeks, P = 0.02), and a higher percentage delivered preterm (27% vs. 11%, odds ratio (OR), 3.0 (0.5-17.0)). Multivariate analysis showed that minimum cervical length was a better predictor of preterm delivery than was initial cervical length. CONCLUSIONS: Dynamic cervical change occurs frequently in association with shortened cervical length. In patients with longer initial cervical lengths, dynamic change may increase the risk for preterm delivery. When dynamic change is noted in a patient with preterm labor symptoms, use of the minimum cervical length observed may be better compared with initial cervical length for determining preterm delivery risk.     

Identification and correction of common impression concerns: protocol and considerations.

Precise impression-making techniques are critical to indirect restorative success. By ensuring that a concise protocol is implemented during the impression capture phase, clinicians can predictably deliver optimal results. Common complications that may arise during impression making include inaccurate marginal detail, bubbles, tears, pits, and voids. Proceeding with impression making when such damage is evident will reduce the accuracy of restorative fit and integrity. This article discusses potential concerns during impression capture and addresses approaches to improve the overall quality of impressions taken.     

CSF inositol does not predict antidepressant response to inositol

Summary CSF inositol was reported to be reduced in depression and inositol has been reported to be effective in treatment of depression. We studied CSF inositol in 18 drug-free depressed patients and 36 normal controls; the depressed patients then participated in an open trial of 18 gm daily inositol treatment for 4 weeks. There was no difference in pre-treatment CSF inositol between depressed patients and controls. CSF inositol levels did not predict response on the Hamilton Depression Scale to 4 weeks of inositol treatment.     

Thiazides stimulate calcium absorption in the turtle bladder

The mechanism of action of the thiazide diuretics on calcium transport is not completely understood. The present study was designed to examine the effect of hydrochlorothiazide (HTZ) on Na transport, proton secretion, and Ca45 flux in the turtle bladder, a high resistance membrane. When added to the mucosal solution, 1 mM HTZ had no effect on Na transport or proton secretion, but significantly increased mucosa-to-serosa Ca45 flux at 60 minutes (control 118.9 +/- 39.7 pmol/mg/60 min versus thiazide 286.0 +/- 64.9 pmol/mg/60 min, N = 16, P less than 0.02). In the presence of 5 X 10(-4) M ouabain, a maneuver which inhibits active Na transport, HTZ again significantly enhanced mucosa-to-serosa Ca45 flux. The increment of calcium transport under these conditions was 83.4 +/- 35.2 pmol/mg/60 min (N = 8, P less than 0.05). Mucosal HTZ had no effect on serosa-to-mucosa (that is, bath-to-lumen) Ca45 flux after a 60 minute incubation. Serosal addition of HTZ had no effect on either of the unidirectional Ca45 fluxes or on Na transport. Mucosal tissue Ca45 content was enhanced by HTZ (mucosal) in the presence or absence of ouabain. These results provide support for the view that thiazides have a direct stimulatory effect on calcium absorption at the luminal membrane, perhaps secondary to increased mucosal calcium permeability.     

Upper extremity burn contractures

Upper extremity burn contractures are a major challenge to the reconstructive surgeon. Despite increasing sophistication in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in the hand. Reconstructive options for axillary, antecubital, wrist, metacarpophalangeal joint, and interdigital web contractures are discussed, with special emphasis on the techniques and advantages of local flap reconstruction.