Altered sonographic umbilical cord morphometry in early-onset preeclampsia

OBJECTIVE: To determine whether the sonographic morphometry of the umbilical cord components is different in preeclamptic compared with healthy pregnant women. METHODS: Consecutive women admitted after 20 weeks' gestation with the diagnosis of preeclampsia and whose fetus was normally grown (cases) were included in the study. Each case was matched to a healthy pregnant woman (controls) who had ultrasonography at the same gestational age (+/- 3 days). The sonographic cross-sectional areas of the umbilical cord and umbilical vessels were obtained in all patients and plotted on reference ranges. The umbilical artery resistance index was measured in all patients with preeclampsia. RESULTS: Twenty-five preeclamptic women were enrolled. The proportion of cases with a lean (below the tenth centile) umbilical cord was higher in cases than in controls (12 of 25 versus 1 of 25, P <.001). The Wharton's jelly area was lower in cases than in controls (median 105.8 mm(2) [range 49.6-212.9 mm(2)] versus 138.7 mm(2) [79.7-226.6 mm(2)], P =.024). The umbilical vein area was less in cases than in controls (median 29.2 mm(2) [range 8.0-52.8 mm(2)] versus 37.4 mm(2) [13.8-70.8 mm(2)], P =.032). The proportion of patients with a lean umbilical cord was higher among those with early-onset preeclampsia than in those with late-onset preeclampsia (12 of 19 versus 0 of 6, P =.014). CONCLUSION: Early-onset preeclampsia frequently is associated with reduced Wharton's jelly area and umbilical vein area compared with normal pregnancy. Sonographic umbilical cord morphometry might have clinical value for prompt identification of women at risk for preeclampsia.     

Joel-Cohen or Pfannenstiel incision at cesarean delivery: does it make a difference?

OBJECTIVE: To evaluate whether the technique to open the abdomen might influence the operative time and the maternal and neonatal outcome. METHODS: All consecutive women who underwent a cesarean section at a gestational age greater than or equal to 32 weeks were randomly allocated to have either the Joel-Cohen or the Pfannenstiel incision. Exclusion criteria were two or more previous cesarean sections and previous longitudinal abdominal incision. During the study period 366 patients underwent a cesarean delivery. Of these patients, 56 did not meet the inclusion criteria. The remaining patients were allocated to the Joel-Cohen (n = 152) group and to the Pfannenstiel (n = 158) group. Extraction time was defined as the time interval from skin incision to the clamping of the umbilical cord. RESULTS: The total operative time was similar in both groups [Joel-Cohen 32 min (12-60) vs. Pfannenstiel 33 min (18-70)]. The extraction time was shorter in the Joel-Cohen group than in the Pfannenstiel group [190 s (60-600) vs. 240 s (50-600), p = 0.05]. This remained statistically significant after adjustment for confounding variables (Hazard = 1.26, p = 0.05). No difference was found between groups in terms of intraoperative and postoperative complications. No difference was found in the neonatal neurodevelopmental assessment at 6 months of age in relation to the abdominal incision performed. CONCLUSION: The Joel-Cohen method of opening the abdomen at cesarean delivery is faster then the Pfannenstiel technique at delivering the fetus. However, considering the absence of benefits to the mother and the fetus there is no clear indication for performing a Joel-Cohen incision.     

Oral contraceptives and the risk of focal nodular hyperplasia of the liver: a case-control study

OBJECTIVE: A role of female hormones, including oral contraceptives, has been suggested in the etiology of focal nodular hyperplasia of the liver. There is, however, no epidemiologic quantification of this relationship. STUDY DESIGN: A hospital-based case-control study was conducted in Italy of 23 women with histologically confirmed focal nodular hyperplasia of the liver and 94 controls in the hospital for acute diseases. Odds ratios (ORs) were computed by use of multiple logistic regression models. RESULTS: Focal nodular hyperplasia was not associated with menstrual and reproductive factors. Ever oral contraceptive use was reported by 83% of cases and 59% of controls. The multivariate OR was 2.8 (95% confidence interval [CI], 0.8-9.4) for ever use, and 4.5 (95% CI, 1.2-16.9) for use > or = 3 years. The trend in risk with duration was statistically significant. CONCLUSIONS: This study confirms previous clinical observations, and provides a quantitative estimate of the association between use of oral contraceptives and focal nodular hyperplasia of the liver.     

Bio-alcamid: a novelty for reconstructive and cosmetic surgery

Research for new biocompatible and easily implantable materials continously proposes new molecules and new substances with biological, chemical and physical characteristics more and more adapted to aesthetic and reconstructive surgery. Bio-Alcamid (Polymekon, Italy) is a non reabsorbable polymeric material composed of alkylimide-amide groups. This cosmetic agent has been used for the treatment of 2000 patients by a multicentric trial led by different Hospitals and University in Italy and abroad. Very serious aesthetic defects such as pectus excavatum, Poland Syndrome, postoperative traumas, in addition to common aesthetic defects such as lips, cheek-bone and chin hypovolumetry and relaxing of nasolabial sulcus, have been treated by surgical implant of Bio-Alcamid. Aesthetic results were excellent; tissues felt soft and the implants were uniformly distributed. No migration or dislocation of the implants, no granulomas, no allergic response and no kind of intolerance were observed. Only 12/2000 patients had post-operative complications (Staphylococcus infections) and only 3/12 cases could be directly ascribed to the implanted material. For its characteristics Bio-Alcamid can be considered a novelty in the aesthetic and reconstructive surgery; it is absolutely biocompatible, non toxic, non allergenic, easily injectable and quickly removable. Bio-Alcamid can be defined a sort of "endoprosthetis", perfectly suitable for soft tissue augmentation and for the correction of different tissue deficiences, with a long-term safety and efficiency.     

Influence of acute exercise on human platelet responsiveness: possible involvement of exercise-induced oxidative stress

The aim of this study was to evaluate in sedentary male subjects the effects of an acute bout of strenuous and moderate exercise on ex vivo platelet responsiveness and its possible relationship with exercise-associated modifications of oxidant-antioxidant status. An increased ADP- and collagen-evoked platelet aggregation associated with modified membrane fluidity and ion homeostasis was observed after exhaustive exercise. After moderate exercise, we found a decrease of platelet aggregation evoked by low concentrations of agonists. Strenuous exercise, but not moderate exertion, resulted in the enhanced accumulation of secondary products of lipid peroxidation, decreased total antioxidant capacity, including a diminished superoxide dismutase activity, and increased susceptibility of low-density lipoprotein (LDL) to in vitro oxidation. Acute elevation of plasma nitrite/nitrate (NO_X) content was observed following each single session of physical test, whilst the platelet NO_X content was decreased after strenuous exercise and increased after moderate exercise. Findings of the present study suggest that oxidative stress induced by acute strenuous exercise may interfere with platelet responsiveness most likely by promoting oxidized LDL-mediated platelet activation and by decreasing plasma and platelet-derived nitric oxide (NO) bioactivity. Moreover, our results further suggest that platelet responsiveness following an acute moderate physical stressor may depend on the efficiency of plasma and intraplatelet NO to desensitize platelets to agonist stimulation. Electronic Publication     

Physical activity, heart and ageing: a morpho-functional study by Echo-Color-Doppler in sedentary and non sedentary healthy subjects

Several papers have shown that in young people sports activity is associated with a higher prevalence of cardiac valves incompetence, that can be detected, though to a lesser extent, even in healthy subjects randomly selected from the population. Aim of the present study was to analyse the effects of physical activity not only in young subjects but even in the elderly, with particular reference to valve competence, by using the Echo-Color-Doppler. The study cohort was represented by 80 healthy young subjects, 40 men and 40 women, aged between 20 and 25 years, each group subdivided into two subgroups, sedentary and non sedentary, and 80 healthy elderly subjects, 40 men and 40 women, aged between 65 and 91 years, again divided into sedentary and non sedentary. Valve incompetence was more frequent in the elderly if compared to young subjects (P<0.001) and in non sedentary if compared to sedentary subjects (P<0.01), while no significant difference was found between males and females. Worth of interest the fact that in young subjects valve incompetence was more frequent in non sedentary if compared to sedentary subjects (P<0.001), while in the elderly no significant difference was found between sedentary and non sedentary subjects. This original datum may be explained both by the natural higher prevalence of valve incompetence in the elderly, and by the kind of physical activity usually performed by the elderly, i.e. endurance activity.     

Oxidative stress and neuronal adaptation in Alzheimer disease: the role of SAPK pathways

Recent evidence indicates that oxidative stress occurs early in the progression of Alzheimer disease, significantly before the development of the hallmark pathologies, namely neurofibrillary tangles and senile plaques. The interaction of abnormal mitochondria, redox transition metals, and oxidative stress response elements contributes to the generation of reactive oxygen species in diseased neurons. Oxidative damage to major cellular molecules is seen in a number of disease states that are either acute or chronic and it is apparent that without eliciting compensations that restore redox balance, cells will rapidly succumb to death. Indeed, although oxidative stress is a prominent feature in Alzheimer disease, few vulnerable neurons show clear signs of apoptosis, suggesting that the level of oxidative stress does not significantly exceed neuronal oxidative defenses. In light of this observation, we propose that neurons in Alzheimer disease are exposed to low, but chronic, levels of oxidative stress that lead neurons to elicit adaptive responses such as the activation of stress-activated protein kinase pathways.