Childbirth Practices: From Darkness Into Light

Some now seemingly bizarre childbirth practices of the Middle Ages, such as "child-breaking," baptism in utero, excessive modesty, and use of the obstetric chair and tools, are described. Also outlined are the slow, painful steps in the climb out of these dark times: education for midwives, permitting the male in the lying-in room, aseptic technique, und the use of anesthesia.     

Height and weight in cystic fibrosis: a cross sectional study. UK Cystic Fibrosis Survey Management Committee

Cross sectional data reporting the height, weight, and body mass index of UK patients with cystic fibrosis are presented. During the first decade of life height and weight in patients with cystic fibrosis are maintained at about 0.5 SD below those of the general population, which reflects an improvement over earlier published observations. Postpubertal stature and weight maintenance in the cystic fibrosis population still show substantial deficits which may be related to treatment.     

Murine monoclonal antibody with anti-e-like specificity: suitability for screening for e-negative cells

A directly agglutinating murine monoclonal antibody of the IgG3 isotype has been produced after mice were immunized with papain-treated Bombay phenotype, e-positive red cells (RBCs). The antibody strongly agglutinated all e-positive RBCs and gave negative reactions with RBCs from Rhnull persons and those homozygous for Rh deletion genes. Variable reactivity was found with e-negative RBCs, ranging from weak to negative with R2R2, slightly stronger with r"r", and stronger still with RzRz. These reactions, together with results from tests with a large panel of Rh-variant RBCs, suggested a specificity for an epitope that is part of the e mosaic but is also expressed at least partially on e-negative RBCs and is influenced by the presence of C. This antibody has been standardized for use as a screening reagent for R2R2 cells by a microplate technique, and over 6000 donations have been screened in this way. No discrepancies have been found in confirmatory tests for e-negative status using human anti-e.     

Alkaline Phosphatase,Sucrase, and Insulin-like Growth Factor Receptors are Present in Atrophied Small Bowel 14 Years after Jejunoileal Bypass

The authors obtained atrophied and hypertrophied small intestinal tissue from a patient undergoing jejunoileal (JI) bypass reversal. Tissue from both segments was examined for insulin, insulin-like growth factor-I (IGF-I) and IGF-II receptors, and alkaline phosphatase and sucrase. We were interested in the potential of the atrophied segment to respond to luminal stimulation once the food train was re-established. Within the atrophic segment, flow cytometric evaluation of the receptors revealed (expressed as percent positive staining cells): Insulin, 17.1%; IGF-I, 33.6%; and IGF-II, 60.8%, while the immunoreactive sucrase was 87.7% and alkaline phosphatase was 88.6%. Actual sucrase activity (expressed as glucose generated) in this segment was 17.9ng/min/μg protein and alkaline phosphatase was 28.0 U/L/μg protein as assessed by conventional methods. Receptor evaluation in the hypertrophic segment demonstrated 9.7% positive staining cells for insulin, 26.6% for IGF-I and 70.2% for IGF-II. Immunoreactive sucrase was 91.2% and alkaline phosphatase was 91.4%. Enzyme activity for sucrase was 10.4ng/min/μg protein and for alkaline phosphatase was 59.4U/L/μg protein. This data suggests that even in atrophied bowel insulin and IGF receptors as well as sucrase and alkaline phosphatase enzymes are present and may assist in the rapid recovery of the atrophied portion following reversal of the JI bypass.     

Spontaneous Rupture of the Liver during Pregnancy: A Case Report

Hepatic congestion resulting in hepatic rupture during pregnancy is a rare yet catastrophic event carrying a 60 to 70% maternal mortality rate. With preeclampsia and associated epigastric pain continuing to be a major problem confronting pregnant women, hepatic congestion may be more prevalent than believed. Current etiology, treatment, and characteristics of women who experience hepatic rupture are examined. A case report and nursing protocol are presented.     

A technique to visualize wound bed microcirculation and the acute effect of negative pressure

Although previous studies have proved that subatmospheric pressure in vacuum assisted closure therapy increased blood flow at the wound edge, no reports have presented data on blood flow in the wound bed. This study examined a technique that visualized microcirculation of the wound bed and estimated the acute effect of negative pressure. The superficial stratum of the mouse gluteal skin was microsurgically excised preserving the subdermal vascular plexus. The preserved vessels were visualized as the wound bed microcirculation using an intravital microscope–video–computer system. Three levels of negative pressure (?125 mmHg [n=12], ?500 mmHg [n=12], 0 mmHg [n=8]) were applied to the wound. Our experimental model successfully and quantitatively visualized wound bed microcirculation under negative pressure application. A negative pressure of ?125 mmHg significantly increased wound bed blood flow immediately after pressure application, maintained for 1 minute after pressure release, whereas in the ?500 mmHg group blood flow decreased with time and reached a statistically significant level 5 minutes after pressure application. These findings reinforce the hypothesis that enhanced blood flow in the wound bed as well as at the wound edge may contribute to the beneficial effects of certain levels of negative pressure therapy for wound perfusion.     

Blue naevus with satellitosis mimicking malignant melanoma

Blue naevus is an acquired benign melanocytic naevus. It is a firm, sharply defined dark blue to grey-black papule or nodule, which is likely to arise from the arrested dermal melanocytes in the dermis. In the last few years, blue naevus has attracted much attention due to the recognition of new entities and to its confusion with malignant melanoma. We report a 69-year-old man who developed a blue-black nodular lesion with satellitosis on his scalp. Although clinically it was thought to be a malignant melanoma, histopathological investigation and conservative methods such as dermatoscopy and power Doppler ultrasonography did not confirm this diagnosis. Histopathological examination excluded malignant melanoma, as there were no cellular atypia and mitotic activity in either the nodular lesion or the satellitosis. Doppler ultrasonography confirmed the benign nature of the lesion. Dermatoscopic examination showed homogeneous steel-blue pigmentation with individual blue globules, dots and some brown veils, and confirmed the histopathological diagnosis. To the best of our knowledge, our case is the third reported case of a blue naevus with satellitosis mimicking malignant melanoma.     

Stevens–Johnson syndrome in two patients treated with cranial irradiation and phenytoin

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to medication. In this report, we present two patients diagnosed with SJS, which developed in patients with brain tumour, after receiving cranial irradiation and phenytoin. Concomitant application of these two therapies may play an important role in the occurrence of the disease.