Clinical and biophysical aspects of HELLP-syndrome

OBJECTIVE: The maternal-perinatal outcome and the significance of biophysical parameters in HELPP syndrome patients were evaluated. METHODS: Sixty cases of HELLP syndrome were determined by retrospective analysis. Medical history, correlation of clinical, laboratory findings, records of fetomaternal Doppler studies, Nonstress test and maternal-perinatal outcome data were evaluated. Chi-square test was used for statistical analysis, and p < 0.05 was accepted as the significance level. RESULTS: The incidence of HELLP syndrome in our institution was 1.03%. Mean gestational age at birth was 33.2 weeks, mean birth weight was 1861 +/- 710 g and mean umbilical pH was 7.25 +/- 0.13. Neonatal thrombocytopenia was demonstrable in 38% of neonates. Patients with low antepartal platelets (< 60,000/microliter) had a significantly higher incidence of intrauterine growth retarded fetuses than patients with higher platelet counts (p = 0.002). Doppler flow measurements were performed in 33 patients (55%). In 16 (48.4%) a pathological Doppler flow was documented. Doppler findings demonstrated very high sensitivity (83%) and specificity (80%) in predicting adverse outcome in growth retarded fetuses. In 17 patients (27%) fetal heart rate monitoring had an obvious pathologic pattern. Respiratory distress syndrome (74.4%) was the main indication for NICU admission. Perinatal mortality rate was 8.3% and neonatal mortality rate was 11.6%. Maternal morbidity rate was 30%. The most commonly observed maternal complications were abruptio placentae (n = 8), disseminated intravascular coagulation (n = 3) and severe postpartal bleeding (n = 3). CONCLUSIONS: In HELLP syndrome patients it is very important to closely follow maternal vital signs and fluid intake and output, and to perform fetal status assessment tests. Of the biophysical parameters, Doppler flow measurement is an especially helpful predictor of poor perinatal outcome in growth retarded fetuses in HELLP patients. Patients with very low platelets have a significantly higher risk of intrauterine growth retarded fetuses.     

Dimensional structure of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used instrument to assess obsessive-compulsive symptomatology. The present study provides evidence that the Y-BOCS is best represented by a three-dimensional model comprising severity of obsessions (factor 1), severity of compulsions (factor 2) and resistance to symptoms (factor 3). On the basis of exploratory factor analysis, this structure was found for both baseline (n = 109) and discharge ratings (n = 68) following a multimodal cognitive-behavioral intervention. The factor solution remained essentially unchanged when two optional items (items 1b and 6b) were dropped from analysis. The three-factor structure was replicated with confirmatory factor analysis and showed better fit than previously proposed single- and two-factor models. For future research, we propose a new Y-BOCS scoring algorithm that takes this factor structure into account. A further result was that resistance significantly declined in response to cognitive-behavioral intervention, whereas drug treatment alone did not seem to moderate this variable according to previous research conducted by Kim et al. [Psychiatry Research 51 (1994) 203-211].     

Remarks of a paediatrician on informed consent in children

In medical practice, patients are frequently in a passive role with respect to consenting to medical measures. The basic threshold element of informed consent is medical competence to be controlled by individual self-criticism. The elements of information, such as disclosure and understanding, have to be adapted to the individual situation in order to achieve voluntariness and active autonomous authorization. In the paediatric age group, disclosure of information has to be guided by the age-dependent ability of understanding, leading to voluntariness and consent. Since force cannot be totally avoided in the management of children, parental information and consent should be as precise and conclusive as possible. The interaction between the paediatrician on the one hand, and the children and their parents on the other, is discussed.     

Serotonin receptor blockade increases food intake and body weight after total gastrectomy in rats

BACKGROUND: Total gastrectomy often results in early satiety and loss of body weight. Serotonin inhibits food intake, and postprandial serotonin release is increased after total gastrectomy. Serotonin might contribute to early satiety and loss of body weight after total gastrectomy. METHODS AND MATERIALS: Food intake and body weight were investigated with an automated recording system in gastrectomized rats 1-12 months postoperatively. Rats were treated with metergoline, a 5-hydroxytryptamine (5-HT)(1/2) receptor antagonist, two different 5-HT(3) receptor antagonists, a combination of metergoline and devazepide, a cholecystokinin (CCK) a receptor antagonist, or vehicle. In addition, metergoline or vehicle was applied continuously by an intraperitoneal osmotic minipump for 7, 28, or 84 days after total gastrectomy. RESULTS: Metergoline treatment resulted in a dose-dependent increase in food intake in gastrectomized rats. 5-HT(3) receptor antagonist treatment had no effect, and devazepide in addition to metergoline did not further stimulate food intake. Metergoline increased food intake at 1, 3, and 6 months postoperatively by up to 45% (24-h cumulative food intake [FI], 6 months: vehicle 3.83 +/- 0.10, metergoline 5.52 +/- 0.15 g/100 g body weight (BW), P < 0.0001). Chronic metergoline treatment for 7, 28, or 84 days significantly increased food intake after total gastrectomy compared to vehicle treatment (FI 7 days: vehicle 30.83 +/- 0.71, metergoline 36.27 +/- 0.85 g/100 g BW; P < 0.0002; average weekly FI during 28 days; vehicle 31.23 +/- 0.22, metergoline 36.83 +/- 0.33 g/100 g BW, P < 0.0001; average weekly FI during 84 days: vehicle 33.02 +/- 0.59, metergoline 35.07 +/- 0.48 g/100g BW, P < 0.008), and there was a significant body weight increase compared to vehicle treatment (7 days: DeltaBW vehicle -0.7 +/- 1.2 g vs DeltaBW metergoline 9.0 +/- 2.1 g, P < 0.001; 28 days: DeltaBW vehicle 0.3 +/- 2.2 vs DeltaBW metergoline 13.0 +/- 2.3, P < 0.001; 84 days: DeltaBW vehicle 25.7 +/- 10.2 vs DeltaBW metergoline 49.5 +/- 7.2, P < 0.04). Treatment for 84 days resulted in a significant body weight gain, while vehicle treatment had no effect (vehicle: 438 +/- 11 g vs 464 +/- 12 g, P < 0.2, n.s.; metergoline: 448 +/- 9 g vs 498 +/- 10 g, P < 0.007). CONCLUSIONS: Inhibition of food intake by serotonin might contribute to early satiety and loss of body weight after total gastrectomy.     

The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers

Artificial liver support aims to prolong survival time of patients with liver failure by detoxification. Albumin as a molecular adsorbent in dialysis solution is capable of attracting even tightly albumin-bound toxins from blood into the dialysate if a specific dialysis membrane is used and if the albumin's binding sites are on-line-purified by a sorbent/dialysis-based recycling system (i.e., molecular adsorbents recycling system, or MARS). The MARS technology has been shown to remove water-soluble and albumin-bound toxins and to provide renal support in case of renal failure. Fourteen centers have reported that MARS treatment improved mental status of patients with liver failure and hepatic encephalopathy. In treating liver failure and cholestasis, MARS was associated with hemodynamic stabilization, improvement of hepatic and kidney function, and disappearance of pruritus. In hepatic failure and hepatorenal syndrome, a prospective, randomized, controlled trial of MARS treatment was able to prolong survival time significantly. MARS has been used in 26 patients with acute liver failure or primary graft dysfunction. Nineteen centers reporting on 103 patients have shown that MARS treatment is safe, easy to handle, feasible, and effective.     

Exercise and eating disorders in college-aged women: profiling excessive exercisers

This study examined associations among excessive exercise, eating disorders, and selected psychological characteristics in college women ( N = 586). Participants were recruited from university classes and administered the Obligatory Exercise Questionnaire, Eating Disorders Inventory--2, Bulimia Test-Revised, and other psychosocial measures. Results indicated that obligatory exercise is best viewed as multidimensional. These dimensions were used, through cluster analysis, to generate a typology of exercisers. One identified group clearly manifested eating disorder traits and behaviors, as well as signs of psychological disturbance. Another group who exercised with equal intensity but less emotional fixation showed the fewest signs of eating disorders and psychological distress.     

Inter-individual variation,seasonal variation and close correlation of OGG1 and ERCC1 mRNA levels in full blood from healthy volunteers

The mRNA levels of the nucleotide excision DNA repair gene ERCC1 and the base excision DNA repair gene OGG1 were quantified in 43 healthy volunteers in a dietary intervention trial as markers for the DNA repair capacity. Nine samples were collected from each subject over a period of 52 days. Sampling took place from January to May. The mRNA levels of OGG1 and ERCC1 correlated closely (r = 0.86, P < 0.0001) after normalization to either 18S ribosomal RNA or to beta-actin mRNA. The levels of OGG1 and ERCC1 mRNA were relatively constant within an individual with intra-individual correlation (R(2) = 0.45-0.46) in a General Linear Model. The amounts of ERCC1 and OGG1 relative to 18S RNA were doubled in May compared with January. This coincided with an increase in the monthly influx of sunlight from 18 MJ/m(2) in January to 242 MJ/m(2) in May. The mRNA levels of both ERCC1 and OGG1 were positively correlated to the average daily influx of sunlight in the previous 30 and 5 days (r = 0.49; r = 0.37, respectively, P < 0.001). There were no significant effects of the dietary interventions. The inter-individual variation was 5-10-fold, which is more than the observed 2-3-fold seasonal variation. Thus, despite seasonal variation of the individual mRNA levels, the inter-person variation is still far larger than the intra-person variation, supporting the use as biomarkers.