Histomorphometric features of hydatidiform moles in early pregnancy: relationship to detectability by ultrasound examination.

OBJECTIVE: The majority of partial (PHM) and complete (CHM) hydatidiform moles are diagnosed in early pregnancy. About half are identified as molar on ultrasonographic examination prior to evacuation. It is uncertain whether unsuspected cases represent an intrinsically different molar phenotype or are simply dependant on sonographer expertise. We measured a microscopic parameter, average villus diameter, of evacuated PHMs and CHMs to ascertain the cause of non-detection on ultrasound. METHODS: Fifty-four molar pregnancies were examined from the files of the Trophoblastic Disease Unit, in which results of an ultrasound examination prior to evacuation were known. In each, the average cross-sectional diameter of the largest 10 villi was recorded. Maximum villus diameters were compared between gestational age groups (<14 weeks and >or=14 weeks), and ultrasound detection groups (detected (d) and not detected (nd)). RESULTS: The average maximum villus diameter of the largest hydropic villi was significantly less in the first trimester for both PHMs and CHMs that were undetected by ultrasound examination compared to those identified as molar sonographically (P<0.001 and P<0.001, respectively). There was no significant difference in the maximum villus diameter between PHMs and CHMs that were not detected sonographically in the first trimester (P=0.44). Beyond 14 weeks of gestation, there was no significant difference between PHMs detected and undetected sonographically (P=0.88). CONCLUSION: The average diameter of the largest, most hydropic villi, is significantly greater in cases of PHMs and CHMs detected by ultrasound examination in the first trimester compared to that of those not detected sonographically, but beyond 14 weeks such differences are minimal. These findings suggest that, although sonographer expertise could potentially increase ultrasound detection rates somewhat for PHMs and CHMs, a significant proportion of cases demonstrate minimal hydropic change in the first trimester and are therefore likely to remain unidentifiable by ultrasound examination prior to evacuation, even with improved sonographer expertise.     

How much of a primary care nurse's time is spent on those with respiratory disease? A pilot study.

A pilot study was undertaken to assess the respiratory component of primary care nurses' working time. 13 nurses were interviewed and 10 completed a diary during one working week. The nurses spent a mean 6.6% of their time caring for those with respiratory disease and were of the opinion that during this time they undertook 68% of the management of long term respiratory illness in the practices. More time was spent with those with asthma than with other respiratory conditions and the nurses felt that they were appropriately trained for the tasks undertaken. However, with more training they felt that they could undertake more basic care of those patients with COPD, and more advanced care of those patients with asthma.     

Corticosteroids for the Enhancement of Fetal Lung Maturity: Impact on the Gravida with Preeclampsia and the HELLP Syndrome

Summary: This study was undertaken to determine maternal impact of corticosteroids administered for the promotion of fetal lung maturity in mothers with the HELLP syndrome. Twenty-seven of 427 women with the HELLP syndrome treated between 1980–1991 received a full course of steroids prior to preterm delivery. This group was compared to 27 matched control patients with the HELLP syndrome who received no corticosteroids. Subjects were matched for maternal age, race, sex of the fetus, and severity of the HELLP syndrome. The antepartum platelet count stabilized or increased in 25 of 27 steroid-treated women in contrast to 0 of 15 control women (p <0.00001). In comparison to control patients, LDH serum concentrations in steroid-treated patients stabilized or decreased and the SGOT/AST and SGPT/ALT stabilized or decreased during therapy (p < 0.005). The interval from delivery to platelet nadir in patients with Class III HELLP syndrome was shorter in the steroid-treated group (p<0.008) than in untreated patients.     

Psychological and clinical effects of renal biopsy performed using sedation

.A sedation regimen using sequential oral trinepazine, intravenous Pethco (pethidine, chlorpromazine and promethazine) and diazemuls was evaluated in children having native kidney (n = 17) and transplant kidney (n = 17) biopsies. Biopsy was successful in all cases, with no serious side effects. A self-reported scale of memory recall and pain perception showed the optimal time for biopsy to be between 30 and 90 min after the intravenous Pethco. The child’s level of distress was measured by a self-reported scale, a parent-reported scale and an observational scale for doctors and nurses; 45% of children rated themselves highly distressed prior to the procedure, their parents being the best assessors of this distress. Younger children and those undergoing native kidney biopsy had less understanding of the procedure. Children’s worries could be clearly categorised into procedural and outcome issues: those undergoing transplant biopsy were more worried about outcome, whereas those undergoing native kidney biopsy were more worried about the procedure. Received April 3, 1995; received in revised form and accepted April 17, 1996     

Asbestos Exposure of Building Maintenance Personnel

The exposures of building maintenance personnel and occupants to airborne asbestos fibers, and the effects of operations and maintenance programs on those exposures, continue to be an important public health issue. The subject of this investigation was a large metropolitan county with numerous public buildings which routinely conducted air sampling for asbestos. A total of 302 personal air samples in nine task categories collected during maintenance worker activities in proximity to asbestos-containing materials were analyzed; 102 environmental air samples in four task categories were also analyzed. The arithmetic means of the 8-hr time weighted average exposures for personal sampling for each task category were all below the Occupational Safety and Health Administration permissible exposure level of 0.1 fibers (f)/cc > 5 μm. The highest mean 8-hr time weighted average exposure was 0.030 f/cc > 5 μm for ceiling tile replacement. The maximum asbestos concentration during sample collection for environmental samples was 0.027 f/cc > 5 μm. All asbestos-related maintenance work was done within the framework of an Operations and Maintenance Program (OMP) which utilized both personal protective equipment and controls against fiber release/dispersion. Results are presented in association with specific OMP procedures or controls. These results support the effectiveness of using Operations and Maintenance Programs to manage asbestos in buildings without incurring unacceptable risk to maintenance workers performing maintenance tasks.     

Limits of binocular fusion in the short wave sensitive ("blue") cones

Stereoscopic depth perception is possible when the short wave sensitive (SWS or "Blue") cones are isolated using a yellow adapting field. We have measured the maximum disparity that can be fused (the diplopia threshold) as a function of the separation between pairs of dots or lines. Under all conditions, these diplopia thresholds are the same for the isolated SWS cones as for the entire visual system. In addition, SWS diplopia thresholds vary as a linear function of dot or line separation, so that they exhibit disparity scaling. Further experiments show that disparity scaling is dependent upon the presence of low spatial frequencies in the stimulus and not upon the retinal eccentricity of stimulation. These data indicate that the SWS cones provide information to the disparity processing system through more than one low spatial frequency channel but not through high frequency ones.