Preinduction cervical ripening with the Foley catheter and the risk of subsequent preterm birth

OBJECTIVE: The Foley catheter is a safe and effective form of preinduction cervical ripening and is quickly growing in popularity. Its major effect appears to be through mechanical dilation, which has raised the concern that the use of the Foley catheter for cervical ripening may damage the cervix and result in a higher rate of subsequent preterm birth. STUDY DESIGN: We conducted a review of all induction of labor at our institution from July 1998 to July 2001 that required preinduction cervical ripening and had a subsequent birth. The primary outcome variable was preterm birth at <35 weeks of gestation. Demographic and potential confounding variables were analyzed. A probability value of <.05 was considered significant. RESULTS: The cases of 126 women (63 women in the Foley group and 63 women in the prostaglandin group) were studied. Women in the prostaglandin group had a prostaglandin agent used. There was no difference in maternal age, gravidity, parity, Bishop score, total time of induction, gestational age, oxytocin use, maximum oxytocin level, tobacco or drug use, or type of delivery in the index pregnancy between the groups. In the subsequent pregnancies, there were no differences in maternal age, gravidity, parity, spontaneous abortions, terminations, cone or Loop Electrosurgical Excision Procedure (LEEP) procedures, history of cervical manipulation, tobacco or drug use, stillbirth, need for induction, mode of delivery, episiotomy, gestational age at delivery, Apgar scores, labor duration, use of oxytocin, or birth weight. There were no differences in preterm birth at 37, 35, or 32 weeks of gestation between the groups. CONCLUSION: The use of the Foley catheter for preinduction cervical ripening does not appear to increase the risk of preterm birth in a subsequent pregnancy.     

Interferon α in the treatment of polycythemia vera

Interferon alpha (IFN) inhibits the growth of the abnormal clone in patients with myeloproliferative disorders, leading to a reduction of the clinical and laboratory signs of the pathologic myeloproliferation. The therapeutic efficacy of IFN in polycythemia vera (PV) is demonstrated by the summarized treatment results of 279 patients participating in 16 prospective nonrandomized studies and in three case reports. The initial IFN dose ranged from 3 to 35 million IU/week. In 82% of the patients the frequency of phlebotomies was reduced. In 50% a complete remission was achieved, defined as a stable hematocrit of 45% without concomitant phlebotomies. Reduction of splenomegaly was seen in 77% and control of pruritus in 81% of the patients. The median observation time of the studies was 13 months (ranging from 3 to 84 months). Individual cases were followed for up to 126 months. In 21% of the patients IFN was terminated, owing mostly to side effects. The selective suppression of the malignant clone by IFN was demonstrated by the induction of cytogenetic remissions in sporadic cases with a chromosomal marker and by the observation of unmaintained remissions that lasted up to 4.8 years. IFN has no known mutagenic or teratogenic effects. The data presently available demonstrate that IFN is an effective alternative to the present forms of treatment in PV. Controlled prospective studies are essential to clarify whether the favorable biologic properties are also reflected by a benefit in clinical course and survival, and whether IFN may reduce the rates of acute leukemia and myelofibrosis. A randomized study that compares IFN and hydroxyurea in patients with PV has recently been initiated by the Suddeutsche Hamoblastosegruppe (SHG) in Germany.     

The evidence-based use of induction chemotherapy in Breast Cancer

The use of induction chemotherapy, also known as pre-operative or neoadjuvant chemotherapy has been studied in a number of randomised trials. Response rates are generally high, ranging from 70-90%, which allows for the downstaging of primary tumours and breast conservation surgery. Conserving surgery as opposed to mastectomy in this setting appears to be safe, effective and improves quality of life, although there is a suggestion of a small increase in local recurrence rate. Data from the randomised trials presented in this review shows that the use of induction chemotherapy neither prolongs nor decreases overall or disease free survival when compared with the same chemotherapy given in an adjuvant setting. There is a direct correlation between response of a primary breast tumour to induction chemotherapy and patient outcome, probably because this approximates the effect of induction chemotherapy on micrometastases which are present at presentation in many patients with apparently localised primary breast cancers. A pathological complete response after surgery is an excellent predictor of long term outcome, and is more likely to be seen in smaller tumours. Induction chemotherapy can be used as an in vivo measure of tumour response to treatment. This allows a further option of switching cytotoxic drugs in apparently resistant tumours.     

七氟烷与丙泊酚用于小儿唇腭裂手术诱导比较

目的:比较小儿麻醉用七氟烷吸入诱导和丙泊酚静脉诱导的临床特点。方法:择期手术的患儿30例,美国麻醉医师协会(ASA)Ⅰ-Ⅱ级,随机分为两组:七氟烷(Sev)组和丙泊酚(Pro)组,分别记录诱导至意识消失的时间,和诱导前、诱导时、插管后即时和插管后1分钟的血压、心率、SpO_2,及诱导时躁动、屏气、喉、支气管痉挛、恶心、呕吐等不良反应。结果:两组患儿意识消失的时间没有显著差异,分别为丙泊酚组(35.5±11.7)s;七氟烷组(38.5±11.4)s。两组诱导和插管后血压与诱导前比较均无明显变化,但心率变化两组相差较大。丙泊酚组与诱导前相比心率显著增加(P<0.05);而七氟烷组心率较诱导前明显下降(P<0.05)。发生躁动七氟烷组显著多于丙泊酚组(P<0.05),分别是46%和20%。两组均未见屏气、喉及支气管痉挛和恶心、呕吐等不良反应。结论:两组在麻醉诱导的时间和有效性、安全性上没有差别。但是丙泊酚静脉诱导心率明显增快;七氟烷吸入诱导患儿躁动相对较多。     

Induction of puberty in boys with delayed adolescence by methandrostenolone

Methandrostenolone administration at a daily dose of 0.03 mg/kg for 3 months was successful in inducing puberty in 9 boys (aged 14 6/12±6/12 years, m±SD) with delayed puberty and studied in the prepubertal stage. One year after initiation of treatment they reached a mid-pubertal stage (testicular volume m±SD 6±2 ml and pubic hair development Tanner stage 3–4). At the same time growth velocity accelerated from 5.3±1.5 to 8.5±3.4 cm/yr and bone age advanced from 10 9/12±9/12 to 13±6/12 years (m±SD).During treatment there was suppression of basal plasma LH and FSH (m±SD) from 1.3±0.3 to 0.5±0.2 mIU/ml (P<0.001) and from 1.4±0.8 to 0.8±0.3 mIU/ml (P<0.05) respectively, and of the LH response to LRH (50 mcg/m², i.v.) from 5.2±1.0 to 1.9±0.6 mIU/ml (P<0.001). After discontinuation of methandrostenolone there was a significant and prolonged elevation of the basal plasma LH (2.0±0.4 mIU/ml) and testosterone levels (from 24±7.7 to 175.6±67.5 ng/dl, P<0.01) and an enhanced LH response to LRH (8.3±2.4 mIU/ml, P<0.05), compared to the pre-treatment levels.Eleven prepubertal boys with constitutional short stature (aged 9 3/12±9/12 years, m±SD) maintained their prepubertal state one year following the same therapeutic regime with methandrostenolone. No significant changes in the basal plasma testosterone and gonadotropin levels, or the responses to LRH, were noted in this group.During treatment a significant increase in growth velocity was noted (from 4.1±1.7 to 9.7±3.0 cm/year, P<0.02), with a subsequent decrease to 5.4±2.9 cm/year (m±SD) which was not significantly different to the pre-treatment value. Bone age advanced from 6 3/12±1 before treatment to 8±1 6/12 years 12 months following methandrostenolone administration.It is concluded that methandrostenolone can induce puberty in boys with delayed puberty if administered in the prepubertal stage, but not in younger prepubertal boys with short stature. The concomitant changes in the basal plasma testosterone and gonadotropin levels, and their response to LRH stimulation, which were found in the boys with delayed puberty indicate that a certain degree of maturation of the hypothalamic pituitary gonadal axis is probably needed to permit induction of puberty by methandrostenolone. The effect of this drug is due in part to its androgenic potency and probably also to its modulation of negative feedback in the hypothalamic-pituitary-gonadal axis, causing a rebound phenomenon following brief suppression.Supported in part by the Harry C. Bernard Fund     

两种新的维生素D3类似物对白血病细胞的体外作用

为了寻找更加有效的诱导分化剂，我们测试了两种新的维生素Ｄ３类似物（ＥＢ１０８９和ＭＣ９０３）对人早幼粒细胞白血病细胞系（ＨＬ－６０）和人巨核细胞白血病细胞系（ＨＩＭｅｇ－１）的体外抑制生长和诱导分化作用。集落形成试验结果显示ＥＢ１０８９，ＭＣ９０３和１，２５（ＯＨ）２Ｄ３抑制ＨＬ－６０细胞生长的ＥＤ５０分别为９×１０＾－９ｍｏｌ／Ｌ，１×１０＾－８ｍｏｌ／Ｌ和７×１０＾－８ｍｏｌ／Ｌ；它们抑制ＨＩ     

Analgesic effects of acetaminophen,diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study

Objectives: This prospective, randomized study aimed to compare the analgesic effects of acetaminophen, diclofenac and hyoscine-N-butylbromide (HnBB) in cases of second trimester pregnancy termination.

Methods: In 60 women with indications for second trimester pregnancy termination, three analgesic agents were randomized into three groups: group 1, acetaminophen; group 2, diclofenac; and group 3, HnBB. A visual analog scale (VAS) used for the evaluation of pain perception. The primary outcome of the study was mean VAS score during the procedure and last VAS score before the completion of termination. The secondary outcomes were the induction-to-abortion interval, the percentage of aborted cases within the first 24?h and finally the need for parenteral analgesia.

Results: Demographic characteristics were similar among the groups. The mean VAS and last VAS scores before termination did not differ among the groups (p?=?0.3 and 0.2, respectively). The need for parenteral analgesia did not differ among the groups (p?=?0.3). Although a shorter induction-to-abortion interval and greater number of cases with successful termination before 24?h were found in the HnBB group, the differences were not statistically significant (p?=?0.6 and 0.5, respectively).

Conclusions: Our study did not demonstrate a difference in pain perception among second trimester pregnancy termination cases using acetaminophen, diclofenac and HnBB.     

Effects of long-term electrical stimulation on some contractile and metabolic characteristics of fast rabbit muscles

Summary Intermittant long-term stimulation of fast rabbit muscles up to 28 days with a frequency pattern resembling that of a slow muscle (10 Imp/sec) led to a slowing of the time course of contraction already during the first week. There was an increase of tetanic tension as well. The observed rearrangement of activities of key enzymes of energy supplying metabolism was found to occur sequentially. Decreases of extramitochondrial enzymes of glycogenolysis (phosphorylase), glycolysis (triosephosphate dehydrogenase, lactate dehydrogenase) and energy rich phosphate transfer were found initially together with a decrease of mitochondrial glycerolphosphate dehydrogenase. The isozyme pattern of lactate dehydrogenase was changed. Large initial increases were found in enzymes involved in glucose phosphorylation (hexokinase) and fatty acid activation (palmitoyl-CoA synthetase). Later an increase of key enzymes of the citric acid cycle (citrate synthase) and fatty acid oxidation (3-hydroxyacyl-CoA dehydrogenase) as well as ketone body utilization (3-ketoacid-CoA transferase) could be shown.Histochemical staining and comparative activity determination of succinate dehydrogenase in single fibres revealed that the mosaic like fibre composition of the fast muscle was transformed into a more uniform population resembling that of a predominantly slow muscle.This study was supported by grants from Medical Research Council, Deutsche Forschungsgemeinschaft and Deutscher Sportbund.     

参附注射液在肿瘤病人使用异丙酚麻醉诱导期间的循环稳定作用

目的 :观察参附注射液在肿瘤病人使用异丙酚麻醉诱导期间对血流动力学的影响。方法 :选择乳腺及头颈部肿瘤手术病人 30例 ,随机分为 2组 ,S组于麻醉诱导前静脉注射参附注射液 0 8ml kg(参附组 ,n =15 ) ,P组麻醉诱导前静脉注射乳酸林格氏液 0 8ml kg(异丙酚组 ,n =15 ) ,5分钟后麻醉诱导 ;两组均静脉注射维库溴铵0 12mg kg ,芬太尼 2 μg kg ,异丙酚 2mg kg麻醉诱导。于麻醉前静息状态下、诱导即刻、插管后即刻、插管后 1分钟、2分钟、3分钟、5分钟、10分钟分别测定收缩压 (SBP)、舒张压 (DBP)、心率 (HR)并记录。结果 :S组患者在麻醉诱导及插管时血流动力较为稳定 ,并且情况优于P组。结论 :参附注射液可有效维持肿瘤病人使用异丙酚麻醉诱导期间循环的稳定     

盐酸纳美芬预防全麻诱导期舒芬太尼诱发呛咳的临床观察

摘 要 目的：观察盐酸纳美芬对全麻诱导时使用的舒芬太尼引起的呛咳的预防作用,并观察其对插管过程中患者血流动力学的影响。方法: 全麻患者80例随机分为对照组和观察组。观察组患者在诱导前5min静脉注射盐酸纳美芬0.25 μg·kg^-1,对照组静脉注射等容量的0.9%氯化钠注射液,观察两组患者静脉注射舒芬太尼1 min内发生呛咳的次数和程度;监测并记录两组患者麻醉诱导前（T0）、静注舒芬太尼1min时（T1）和插管即刻（T2）的血压、心率和血氧饱和度等血流动力学指标变化。结果: 对照组呛咳发生率37.5%,观察组发生率为0,两组呛咳发生率及程度比较差异均有统计学意义（P<0.05）。对照组患者T1时血流动力学各指标较T0时点变化显著（P<0.05）,且与观察组有明显差异（P<0.05）,T2时各指标基本恢复到T0时点的水平。观察组患者在不同时点血流动力学各指标无明显波动（P＞0.05）。结论:预先注射盐酸纳美芬能有效减少全身麻醉诱导时舒芬太尼所致呛咳的发生及其程度,并减少因呛咳反应导致的血流动力学波动,但不影响舒芬太尼对插管反应的抑制作用。