Management and outcome of 21 triplet and quadruplet pregnancies

The course of gestation and the outcome of fifteen triplet and six quadruplet pregnancies are reviewed. Twenty pregnancies followed induction of ovulation and only one was spontaneous. Bed rest, the use of beta-mimetics and betamethasone, and prolonged hospitalisation were part of the management. Elective cervical suture was not used. The most frequent antenatal complications were preterm labor, preterm rupture of membranes and pregnancy-induced hypertension. The median gestational age was 33.5 weeks in the triplets and 32 weeks in the quadruplets. The overall perinatal and neonatal mortality was 4.9%. The neonatal complications resulted from prematurity and sepsis.     

Carbohydrate metabolism during hormonal substitution therapy

Oestrogens and progestogens are known to influence glucose tolerance. Impairment of glucose tolerance is seen in particular among users of progestogens with androgenic properties. Dydrogesterone is frequently used as the progestogen adjunct during oestrogen substitution therapy for the management of climacteric complaints in post-menopausal women. However, no detailed data have been published concerning its effects on carbohydrate metabolism. In this study, 20 healthy post-menopausal women received equine oestrogens at a dose of 0.625 mg/day for 2 mth, following which dydrogesterone was added cyclically (20 mg/day for 12 days/mth) over a period of 6 mth. Oral glucose tolerance tests were performed before and after each treatment regimen. In relation to the concentrations observed after oestrogen was given alone, dydrogesterone induced only a small increase in blood insulin values which was not statistically significant. The effect was similar to that produced by endogenous progesterone, which is known to be of no clinical significance.     

Equine estrogen-dydrogesterone therapy in the management of postmenopausal women

The clinical and metabolic effects of equine estrogen and dydrogesterone combined therapy were investigated in twenty healthy women aged 45 to 59 years with menopausal complaints. Equine estrogens (0.625 mg per day) were given for 2 months, then dydrogesterone (20 mg daily) was cyclically added for 12 days per month, during an additional period of 6 months. The combination was very efficacious in reducing complaints, with a limited number of side effects. Blood pressure, body weight and cervical smears were unaffected. No influence on glucose tolerance, liver or blood coagulation parameters was seen. A VLDL cholesterol decrease of 41% and an increase in apo AI concentrations of 41% was observed. Total, HDL and LDL cholesterol remained almost unaltered, as well as the total:HDL cholesterol ratio. We conclude that the use of the equine estrogen-dydrogesterone combination provides an efficacious, acceptable and probably safe therapy for menopausal complaints.     

Inhibition of natural killer cell activity by retroplacental sera as compared to peripheral sera. Lack of influence of immune complexes

A decrease of natural killer cell activity (NKCA) during human pregnancy might contribute to the acceptance of the allogeneic fetus by the maternal host. The inhibition of NKCA might be due to serum factors derived from the trophoblast. We focused especially on the role of immune complexes, as it has already been described that these complexes depress NKCA and as they are found frequently in retroplacental serum. We have compared the influence of 19 paired retroplacental and peripheral blood sera on NKCA of normal donors. One peripheral and eight retroplacental sera contained immune complexes. Normal donor mononuclear cells were incubated with carboxyfluorescein-labeled K562 cells in the presence of retroplacental serum or peripheral serum. NKCA was measured on a FACS Analyzer. Ten of 19 retroplacental sera inhibited NKCA significantly in comparison to the corresponding peripheral serum (P = 0.003). There was no correlation between NKCA and the immune complex level. We conclude that, as compared to peripheral serum taken at delivery, there is a retroplacental serum-induced inhibition of NKCA, which is not correlated with the presence of immune complexes.     

Frailty as a predictor of mortality in the elderly emergency general surgery patient

Background: The number of surgical procedures performed in elderly and frail patients has greatly increased in the last decades. However, there is little research in the elderly emergency general surgery patient. The aim of this study was to assess the prevalence of frailty in the emergency general surgery population in Belgium. Secondly, we examined the length of hospital stay, readmission rate and mortality at 30 and 90 days.

Methods: We conducted a prospective observational study at Ghent University Hospital. All patients older than 65 admitted to a general surgery ward from the emergency department were eligible for inclusion. Primary endpoint was mortality at 30 days. Secondary outcomes were mortality at 90 days, readmissions and length of stay. Cross-sectional observations were performed using the Fisher exact test, Mann–Whitney U-test, or one-way ANOVA. We performed a COX multivariable analysis to identify independent variables associated with mortality at 30 and 90 days as well as the readmission risk.

Results: Data were collected from 98 patients in a four-month period. 23.5% of patients were deemed frail. 79% of all patients underwent abdominal surgery. Univariate analyses showed that polypharmacy, multimorbidity, a history of falls, hearing impairment and urinary incontinence were statistically significantly different between the non-frail and the group. Frail patients showed a higher incidence for mortality within 30 days (9% versus 1.3% (p?=?.053)). There were no differences between the two groups for mortality at 90 days, readmission, length of stay and operation. Frailty was a predictor for mortality at 90 days (p=?.025) (hazard ratio (HR) 10.83 (95%CI 1.34–87.4)). Operation (p=?.084) (HR 0.16 (95%CI 0.16–1.29)) and the presence of chronic cardiac failure (p=?.049) (HR 0.38 (95%CI 0.14–0.99)) were protective for mortality at 90 days.

Conclusion: Frailty is a significant predictor for mortality for elderly patients undergoing emergency abdominal/general surgery.

Level of evidence: Level II therapeutic study.     

Size Analysis of Small Particles in Wet Dispersions by Laser Diffractometry: A Guidance to Quality Data

In the present work, the question how to obtain high-quality laser diffraction (LD) results is discussed by investigating various hurdles that can be encountered during particle size measurements in wet dispersions and the associated data interpretation. Following this an effective troubleshooting is discussed based on theoretical insight into the LD measurement. As an important element in the Mie theory, the refractive indices of the model compounds, bedaquiline and cinnarizine, were quantified using the LD software, the Becke line technique, and the single solvent technique, as described by Saveyn et al. [Saveyn H, et al. Part Part Syst Char. 2001;19:426-432]. The influence of parameters such as obscuration level, background quality, and fitting of data were investigated and a summative flow chart has been provided. Through this analysis the present work emphasizes the need for a systematic approach when conducting LD measurements, including standard performance of an obscuration titration and an extended method optimization, to reach high-quality LD results.     

Renal failure in pregnancy, treated by hemodialysis

A patient with renal failure in pregnancy is presented. Prior to pregnancy she was known to have impaired renal function due to chronic pyelonephritis. Renal insufficiency was successfully treated by hemodialysis. The literature concerning etiology and proper management of renal failure in pregnancy and the results and complications of its treatment with hemodialysis are reviewed. A multidisciplinary approach is important for the successful outcome of these pregnancies.     

Paranasal Sinus Pathology in Allergic and Non-Allergic Respiratory Tract Diseases

Two hundred and seventy patients with asthma and/or rhinitis (162 or 60% allergic, 108 or 40% non-allergic) were studied for sinus pathology by means of standard X-rays and tomograms. Sinus pathology was defined as abnormal sinus X-rays, either on standard or tomography. Fifty-four percent of the X-rays were classified as abnormal based on mucosal thickening, loss of translucency of the cavities of polyps. Asthma was significantly more often associated with sinus X-ray abnormalities (65.1%) than rhinitis and/or chronic cough (44.4%). Loss of translucency of the cavities is more frequent in children, whereas mucosa thickening becomes more frequent with progressing age. Since in this prospective study the taking of X-rays of the sinuses was not dependent on or related to temporarily occurring symptoms which could be attributed to acute sinusitis, the presence of sinus abnormalities on X-rays can be considered as an indicator of the chronicity of airways diseases and might provide an indication for prophylactic therapy of the associated airway disease in a continuous way. The importance of sinus tomograms is stressed, since only 32.5% of the patients with mucosa thickening could be detected on standard X-rays.