How does the mode of delivery affect the cost of maternity care?

Summary. In this paper we present estimates of the difference in the cost of hospital care for women having different modes of singleton delivery. The estimates are based on observation of resources used in different procedures, and on data from the North West Thames Region Maternity Information System. For vaginal delivery the average cost is £363, but could fall between £189 and £773, and for caesarean section the average cost is £1123, with a likely range from £837 to £1560. The wide ranges in the costs of the two modes of delivery reflect variation in the length of stay and in the intensity of care required. The average cost for intrapartum care and postnatal stay is estimated to be £451 for all singleton births. Variation in operative delivery rates between hospitals implies differences in the overall cost of care at different maternity units. This partly reflects differences in the needs of the population served by the units, but also differences in clinical practice. It is important for decision makers to consider the balance between the costs and outcomes of different policies of care.     

Failure to Pace following High Dose Antiarrhythmic Therapy—Reversal with Isoproterenol

A patient with resistant ventricular tachycardia treated with a combination of antiarrhythmic agents is described. Sudden onset of a wide complex ventricular rhythm with periods of asystole and failure to achieve transvenous pacing were observed, presumably due to antiarrhythmic drug toxicity. Inability to pace was reversed by the infusion of isoproterenol.     

Conformational change that accompanies pepsinogen activation observed in real time by fluorescence energy transfer

Pig pepsinogen has been reacted with N-carboxymethylisatoic anhydride to form N-carboxymethyl-anthraniloyl-(CMA-) pepsinogen, derivatized at Lys_p18 Lys _p23, Lys_p27, Lys_p30, and Lys₃₂₀. Conformational change associated with activation was detected by following energy transfer from tryptophan residues of the pepsin moiety, excited at 295 nm, to CMA groups, monitored by emission above 415 nm. Efficiency of this energy transfer is a measure of conformational change. For this zymogen derivative the change in efficiency occurs with a first order rate constant of 0.041 s^-1 at pH 2.4, 22°, which equals the rate at which, following acidification, alkali-stable potential activity becomes alkali-labile. For the native zymogen the rate of this conversion had been shown to be identical to the rate of cleavage of the scissile bond of pepsinogen. Therefore, the correspondence in this derivative of the rates of conversion to alkali lability and change in energy transfer demonstrates that a conformational change accompanies the peptide bond cleavage of activation.     

Binding of Acrylonitrile to Parvalbumin

A previous study has shown that acrylonitrile (ACN) has a longhalf-life in rainbow trout muscle and that [¹⁴C]ACN appearsto be bound to a 10,000-Da protein in muscle. The labeled proteinwas purified from muscle of trout exposed to [¹⁴C]ACN, separatedon 20% SDS–PAGE, and digested for amino acid analysisand sequence analysis. These studies indicated that the labeledprotein was the Ca2⁺-binding protein parvalbumin. Parvalbuminis an important calcium-binding protein thought to be involvedin the regulation of calcium levels in various parts of thebody ranging from neurons to fast-twitch muscle contractions.To study the reaction between parvalbumin and [¹⁴C]ACN, frogparvalbumin was incubated with [¹⁴C]ACN in vitro under variousconditions. These studies indicated that the maximum labelingoccurred at 1 nmol/nmol parvalbumin and at pH 7. Amino acidanalysis of the labeled protein indicated that the labeled aminoacid was probably histidine, and endoproteinase Glu-C (V-8)digestion studies revealed that the ¹⁴C was in the 1–81amino acid segment of the protein, an area that contains twohistidines.     

Morphologic Correlates of Host Response in Endometrial Carcinoma*

ABSTRACT: Cases of endometrial carcinoma reviewed for this study were divided into two groups: 1) Premenopausal, perimenopausal and postmenopausal patients in whom a history of anovulation, obesity, ovarian hyperthecosis (including Stein-Leventhal syndrome) or feminizing tumors, and/or exogenous estrogen intake were found; and 2) postmenopausal, elderly patients, without known hormonal or metabolic disturbances and without any history of estrogen therapy. In the first group, frequent associated findings were precursor stages of endometrial carcinoma, such as adenomatous and atypical hyperplasia. In the majority of cases, the cancer was confined to the endometrium, rarely infiltrating the myometrium. In the second group, the cancer was associated most often with an inactive, atrophic endometrium and frequently diffusely infiltrated through the myometrium, with lymphatic and vascular involvement. The lymphatic and plasma-cell infiltrate was evaluated in both groups. It was found to be more abundant in the first group, both at the tumor-host interface and perivascularly, than in the second. As reported in other malignancies of the female reproductive system, the presence or absence of a lymphocytic infiltrate as a morphological expression of local cellular immune response of the host correlates well with the biological behavior of the tumor. A challenging question is the relationship, if any, between hormonal factors and immune mechanisms in tumors arising in tissues such as the endometrium that, even normally, are targets of hormonal stimulation.     

First in Human Validation of Impedance‐Based Catheter Tip‐to‐Tissue Contact Assessment in the Left Atrium

Background: In this study, a new method of contact assessment based on the measurement of the local electrical properties at the catheter tip‐to‐tissue interface was validated in a blinded fashion in vivo in the human left atrium. Methods: Using a 3‐terminal circuit model, local resistance and reactance between catheter tip and tissue surface were measured and combined in an electrical coupling index (ECI). Twelve patients undergoing atrial fibrillation (AF) catheter ablation were included in this study. The catheter was placed in the left atrium at various levels of contact. Blinded to the physician, measurements of electrogram amplitudes, pacing thresholds, and impedances at the catheter tip‐to‐tissue interface were performed. Results: As the catheter went from noncontact to contact, ECI increased from 118 ± 15 to 145 ± 24 (P < 0.0001), electrogram amplitudes increased from 0.14 ± 0.16 to 2.0 ± 1.9 mV (P < 0.0001), and pacing thresholds decreased from 13.9 ± 3.1 to 3.1 ± 2.0 mA (P < 0.0001). ECI was significantly higher in vascular tissue as compared with trabeculated and smooth myocardium. Patch orientation, operator, body mass index, or clinical type of AF had no influence on ECI values. On a patient‐by‐patient analysis, true contact/noncontact locations showed a mean ECI difference of 32.7 ± 11.6 units (95% CI 25.8–39.6). A cut‐off value of 5 ECI units was able to separate contact from noncontact with 97% sensitivity and 95% specificity. Conclusion: Measurement of local impedances between catheter tip and tissue is feasible to reproducibly describe electrical catheter contact within the left atrium in a clinical setting of AF catheter ablation.     

Effects of middle ear effusion on the vestibular system in children

Vertigo and dizziness are not common in childhood, but are probably present more often than was formerly thought. These symptoms caused mainly by otitis media and middle ear effusion, two of the most common diseases in children, have been neglected for a long time, both in the literature and in practice, until recently. The purpose of this study was to determine objectively the incidence of balance-related symptoms in children with long-lasting middle ear effusion and to discover whether these symptoms resolve after the insertion of ventilation tubes. One hundred thirty-six children, ages 4 to 9 years, were given electronystagmographic tests and the Bruininks-Oseretsky tests for motor proficiency before and after tube ventilation of the middle ear. The results were compared with those in 74 healthy children with no history of middle ear diseases. Pathologic findings were found in 58% of the children with chronic middle ear effusion, as compared with only 4% of the control group. The symptoms and signs of balance disturbances resolved in 96% of the children after ventilation tube insertion. The results of this study indicate that balance-related symptoms often encountered in young children may result from chronic middle ear effusion and that these symptoms will resolve after evacuation of the effusion and ventilation of the middle ear. (Otolaryngol Head Neck Surg 1998;119:695-9.)     

Predictive validity of attentional functions in differentiating children with and without ADHD: a componential analysis

Aim The objective of this study was to investigate which attentional components are of predictive utility in differentiating children with attention‐deficit–hyperactivity disorder, combined type (ADHD‐C) from their peers without ADHD. Methods Thirty‐four children participated in the study: 17 males with ADHD‐C (mean age 10y 4mo, SD 1y 9mo) and 17 comparison children (12 males, 5 females; mean age 10y 8mo, SD 1.7y). Attentional functions were assessed using a computer‐administered, child‐friendly test series in German (i.e. Testbatterie zur Aufmerksamkeitsprüfung für Kinder; KITAP). The KITAP measures several attentional components, including alertness and executive attention (inhibition, divided attention, flexibility). Results The variable best able to discriminate between children with and without ADHD‐C was found to be response time variability in a go/no go task, followed by, in order, number of errors in a divided attention task and response time variability in an alertness task. However, group discrimination was not facilitated by differences in either response latency or accuracy of response in visuospatial attention and attentional flexibility tasks. Interpretation The assessment of attentional functions proved to be a powerful instrument for discriminating between children with and without ADHD‐C. Notably, the discriminative power of executive attention was found to be task dependent and dependent on processing demands.     

Primary structure of osteocalcin from ovine bone

Osteocalcin was isolated from ovine (sheep) bone and purified by chromatography. The primary structure was determined using a manual micro-DABITC/PITC double coupling method. Ovine osteocalcin contains two modified amino acids, 4-hydroxyproline and γ-carboxyglutamate. These residues were readily identified in the sequencing process and the data presented here extend the micro manual sequencing method to include identification of 4-hydroxyproline and γ-carboxyglutamate residues. Ovine osteocalcin consists of 49 amino acid residues and the sequence confirms the high degree of conservation previously observed between bovine and human osteocalcins.