Estrogen-induced refractoriness to the pressor effects of infused angiotensin II

Estrogen may be important in the hemodynamic changes that develop during pregnancy; its role in the development of vascular refractoriness to the pressor effects of infused angiotensin II is unknown. We, therefore, examined the pressor responses to six doses of angiotensin II (0.115 to 5.73 micrograms/min) in unanesthetized, nonpregnant sheep both before and after treatment with either high-dose or low-dose 17 beta-estradiol (E2) and constructed dose-response curves. Although mean arterial pressure was unchanged after the infusion of E2, cardiac output rose 28% and systemic vascular resistance fell 19% (p less than 0.001). Infused angiotensin II resulted in dose-dependent rises in mean arterial pressure before and after E2; however, the pressor response after E2 was decreased 30% to 50%. Plasma renin activity rose from 1.15 +/- 0.09 ng/ml X hr to 2.57 +/- 0.39 and 3.21 +/- 0.61 ng/ml X hr with low-dose and high-dose E2, respectively (p less than 0.05). Acutely estrogenized nonpregnant sheep develop significant alterations in both the cardiovascular and the renin-angiotensin systems in addition to decreased pressor responsiveness to infused angiotensin II. Although our findings suggest that estrogen may be important in the development of the vascular refractoriness to angiotensin II seen in pregnancy, additional studies are needed to clarify the role of each E2-induced change.     

Koilocytotic metaplasia and koilocytotic dysplasia

Four hundred seventy-one patients undergoing diagnostic ultrasonography were identified as having moderately decreased amniotic fluid or oligohydramnios, and 339 of these cases were reviewed. Ninety-two of the patients were excluded from further statistical analysis because their decreased fluid was attributed to rupture of the membranes only. Of the remaining patients there was a 7% neonatal malformation rate. Decreased amniotic fluid before 27 weeks of gestation was associated with a significantly poor outcome. Of all the live births, infants of patients with oligohydramnios had lower Apgar scores at 1 minute and 5 minutes than did infants of patients with moderately decreased amniotic fluid. Of cases of patients with decreased fluid, 10% involved fetal distress during labor and in 17% meconium was present. Decreased levels of fluid were associated with an increased rate of abdominal deliveries. Preeclampsia was present in 24.7% of patients with decreased fluid. There was no correlation between the quantitative fluid amounts and the severity of the disease. In view of normative data and clinical experience, these observations suggest that the diagnosis of decreased amniotic fluid on routine ultrasonography requires a fetal scan to rule out anomalies, close antepartum observation to detect complications that may arise in the pregnancy, and delivery under conditions that allow appropriate support and intervention on behalf of the fetus.     

Neurological factors in chronic pelvic pain: Trigger points and the abdominal pelvic pain syndrome

A collection of neurological signs and symptoms, entitled abdominal pelvic pain syndrome, is identified as the most common cause of chronic pelvic pain. Techniques to identify abdominal wall, vaginal, and sacral components are described, with painful tissues commonly limited to a single dermatomic area. Superficial local areas of hyperpathia (trigger points) appeared not only to cause the pelvic pain but also to be responsive to local anesthetics for a duration in excess of the presence of the medication. Successful responses were noted in 89.3% of 131 patients, with 92.6% requiring five or fewer treatments and 68.2% followed up for longer than 6 months. The diagnosis of the abdominal pelvic pain syndrome is an important component in avoiding unnecessary operation in patients with pelvic pain.     

Susceptibility profiles of potential aerobic and anaerobic pathogens isolated from hysterectomy patients

A total of 1140 aerobic and anaerobic isolates were recovered from cultures of specimens from the reproductive tracts of 435 uninfected patients who underwent elective hysterectomy. Standard minimum inhibitory concentration susceptibility studies were performed on these isolates to 13 newer penicillins, cephalosporins, and some traditional antimicrobial agents. These data were generated to evaluate the in vitro efficacy of these antibiotics for potential use in prophylaxis or as a single agent for treatment of polymicrobial infections of the female pelvis. The minimum inhibitory concentration data for each antibiotic against 16 genera of aerobic and nine genera of anaerobic bacteria were determined and were used to compare the in vitro antimicrobial activity of newer antibiotics to that of the more traditional antibiotics. Of the antimicrobial agents tested, piperacillin had the highest in vitro activity against these isolates of any antibiotic tested.     

Congenital pernicious anemia: report of seven patients, with studies of the extended family

Unstimulated whole saliva was collected from 203 uninfected individuals at various ages from birth until adulthood. Levels of specific antibodies against Escherichia coli O antigens of secretory IgA, secretory IgM and IgG, as well as total amounts of SIgA, were determined using ELISA. Levels of SIgA antibodies found in adults were approached by the age of 12 months, but high levels could be attained earlier, presumably in response to antigenic exposure at the mucosal level. During the first few months of life, secretory IgM antibodies appeared in the saliva, possibly compensating for the relative lack of IgA.     

Epstein-Barr virus infections in pregnancy: a prospective study

We studied 4063 pregnant women during 4108 gestations for evidence of infection with Epstein-Barr virus. Forty-six (1.1%) were susceptible early in gestation, and only three showed seroconversion. Two of the infants born to these three women were normal, one had tricuspid atresia. None of the infants had IgM antibodies to EBV at birth, and their cord blood lymphocytes did not give rise spontaneously to EBV-carrying lymphoblastoid cell lines. Thus we were unable to document intrauterine infection with EBV.     

Triglycerides, free fatty acids, free fatty acids/albumin molar ratio, and cholesterol levels in serum of neonates receiving long-term lipid infusions: controlled trial of continuous and intermittent regimens

We compared intermittent (8 hours/day) versus continuous (24 hours/day) isocaloric lipid infusion regimens in 28 neonates. The lipid dose was increased incrementally by 0.5 gm/kg/day to either 3 gm/kg/day or until fat contributed 40% of daily calories. Serum total triglycerides, free fatty acids, free fatty acids/albumin molar ratio, and total cholesterol levels were measured prior to the daily lipid infusion, at the end of the intermittent infusion, and at 8 hours during the continuous infusion. Neonates less than 32 weeks postconception had significant fluctuation of triglycerides, free fatty acids, and free fatty acids/albumin molar ratio during the intermittent regimen at all lipid doses, but not during the continuous regimen. Neonates greater than or equal to 32 weeks postconception had significant fluctuation of serum triglycerides, free fatty acids, and free fatty acids/albumin molar ratio during the intermittent regimen with a lipid dose greater than or equal to 2 gm/kg/day, but not during the continuous regimen at all lipid doses. Serum free fatty acids correlated closely with serum triglycerides during both regimens (r = 0.89, P less than 0.001). Serum total cholesterol rose with increasing lipid doses during both regimens (f = 8.16, P less than 0.05). We conclude that neonates less than 32 weeks postconception tolerate the continuous regimen better than the intermittent regimen at all lipid doses; neonates greater than or equal to 32 weeks postconception tolerate both regimens well at lipid dose less than 2 gm/kg/day, but tolerate a continuous regimen better with lipid dose greater than or equal to 2 gm/kg/day.