Marital status and cohabitation during pregnancy: relationship with social conditions, antenatal care and pregnancy outcome in France

Summary. A survey of a representative sample of 5508 births in France in 1981 permitted the study of social characteristics of pregnant women, the medical care they received during their pregnancy and their pregnancy outcome, as a function of their marital status and whether or not they lived with the father of the child. Unmarried women living with the father (n = 412) like unmarried women living alone (n = 171), were more often younger, having their first baby and had a lower educational level than did married women living with the father (n = 4590). However, among the unmarried women, those living alone were in a more unfavourable position than those living with the father; in particular, they were more often less than 20 years old, had the minimum educational level required and were unemployed. Both groups of unmarried women had a higher preterm delivery rate than did married women, even after taking other risk factors into account in a logistic regression. The odds ratios (95% confidence interval) for pre-term delivery among unmarried mothers living without the father was 1.9 (1.0–3.4) and that for the unmarried cohabiting with the father was 1.6 (1.0–2.4). Thus, to fully appreciate the perinatal risks and medical needs during pregnancy, both the marital and cohabitational status of the women should be considered.     

Determination of left ventricular volume by two-dimensional echocardiography: comparison with magnetic resonance imaging

Left ventricular volume was determined in 12 healthy volunteersusing a newly developed two-dimensional echocardio-graphic delineationmethod. The results were compared with those of magnetic resonanceimaging, which served as the method of reference. Left ventricularend-diastolic volume was 123 ± 12 ml, echocardiographicallydefined, and 121 ± 12 ml calculated with magnetic resonanceimaging. End-systolic volume was 41 ± 7 ml on echocardiographyand 37±6 ml on magnetic resonance imaging. Left ventricularejection fraction was 67 ± 4%, echocardiographicallydefined, and 70 ± 5%, calculated with magnetic resonanceimaging. There was no statistical difference for any of themeasured parameters. Interstudy and inter-observer variabilitywas minimal. In conclusion, in healthy volunteers left ventricularvolume was accurately defined, using this newly developed two-dimensionalechocardiographic delineation method. During endocardial delineationa dynamic display is continuously available on a second window,allowing precise visual edge-detection. Moreover, correctionscan be made easily and quickly. These two advantages enhancethe accuracy of the method, even in cases of poor echogenicity.     

Synthesis and biological activities of some cholecystokinin analogues substituted in position 29 by a β-alanine

Syntheses of analogues of the C-terminal heptapeptide of cholecystokinin are described. These analogues were obtained by replacing glycine 29 by a β-alanine. The C-terminal phenylalanine amide was in some cases substituted by 2-phenylethyl alcohol and/or residues of the C-terminal tetrapeptide by their d -enantiomers. These compounds were tested for their action on stimulation of amylase release from rat pancreatic acini and for their ability to inhibit binding of labeled CCK to rat pancreatic acini and guinea pig brain membranes. Some of these derivatives behaved as CCK receptor antagonists.     

Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis

Intentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B(n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl-linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500–1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST-segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST-segment changes, or with arrhythmias or haemodynamic instability.     

Values for Mitral Valve Annulus Dimensions in Normals and Patients with Mitral Regurgitation

Objectives. The present study was designed to investigate the dimensions of mitral valve annulus in the presence of mitral regurgitation. Method. Fifty-four patients were examined. On transthoracic echocardiographic images, we performed linear measurements in the parasternal plane in order to define the size of the left ventricle, left atrium, and mitral valve annulus. We compared these findings with those obtained in 16 control subjects. Results. Twenty-one patients with mild or moderate mitral regurgitation demonstrated no significant change of the mitral valve annulus compared with the control group (P > 0.05). Seventeen patients with severe mitral regurgitation (grade of 4) had a significant increase of the dimensions of the mitral valve annulus, left ventricle, and left atrium (P < 0.05). The etiology of mitral regurgitation was degenerative in 32 patients, rheumatic in 2 patients, and mitral valve prolapse in 4 patients. All patients had normal left ventricular systolic function. Thirty-one patients were in normal sinus rhythm, and seven were in atrial fibrillation. Conclusions. The measurement of the diameter of the mitral valve annulus is feasible with transthoracic echo-cardiography. In addition to the evaluation of mitral valve leaflets and subvalvular apparatus, the measurement of the mitral valve annulus is important in the evaluation of mitral regurgitation, as its enlargement is indicative for severe mitral regurgitation .     

Synthesis and biological activity of 2-phenylethyl ester analogues of C-terminal heptapeptide of cholecystokinin modified in Trp 30 region

We have tried to evaluate the significance of the tryptophan side chain residue and of the surrounding peptide bonds in the antagonist activity of cholecystokinin analogues lacking the C-terminal amide function and having a d -tryptophan. In order to perform this study, analogues of the C-terminal heptapeptide of cholecystokinin were synthesized by replacing the C-terminal phenylalanine residue with 2-phenylethyl alcohol and by either replacing the tryptophan residue with an alanine, a norleucine and a phenylalanine residue, or introducing a “reduced peptide bond” in the tryptophan 30 region. Most of these compounds were able to reproduce only part of the response of cholecystokinin in stimulating amylase release from rat pancreatic acini, as was already observed for 2-phenylethyl ester analogues of CCK. These results point out the key role of tryptophan 30 in the biological response of cholecystokinin.     

HB8: a monoclonal antibody recognizing elastic fibre microfibrils

We report an ultrastructural study of the reactivity of an IgG monoclonal antibody, which reacts with human dermal elastic fibres. On electron microscopy, immunogold labelling demonstrated the reactivity of HB8 with the microfibrillar component of the fibres. In contrast, the electron-dense granular component which contains elastin was unlabelled with HB8. A fine network of microfibrils from the level of the oxytalan fibres to the large elastic fibres of the deep dermis was labelled with gold particles. No reactivity was detected on collagen fibres. These results demonstrate that HB8 reacts with the microfibrillar glycoproteins of the elastic fibres in normal skin. The precise biochemical nature of the antigens identified by HB8 is still unknown.     

ANAESTHETIC MANAGEMENT OF SYSTEMIC MASTOCYTOSIS

Systemic mastocytosis is an uncommon disorder of mast cell proliferationin connective tissues. Mast cell degranulation may occur onexposure to various stimuli and drugs. The release of histamine,heparin and vasoactive substances such as prostaglandin D₂ maycause severe hypotension and other anaphylactoid manifestations.Anaesthetic management should include perioperative stabilizationof mast cells and avoidance of the use of histamine-releasingdrugs. Intradermal skin testing is useful in predicting thesensitivity to drugs that may be used during anaesthesia. Wepresent a patient with systemic mastocytosis who underwent uneventfulcholecystectomy.     

Autotumour reactive T-cell clones among tumour-infiltrating T lymphocytes in B-cell non-Hodgkin's lymphomas

Summary. Seventy-three T-cell clones (TCC) were established from tumour-infiltrating lymphocytes-T (TIL-T) derived from lymph nodes involved by B-cell non-Hodgkin's lymphomas (B-NHL) in nine patients with different histological subtypes and clinical stages. 40 TCC (55%) expressed the CD25 Ag and were also able to proliferate in the presence of irradiated autologous B-NHL cells. Among them, 23 autotumour (AuTu) proliferative TCC were found not to proliferate to autologous EBV-transformed B-cell lines, indicating that the proliferative reactivity of these TCC was preferentially directed at autologous B-NHL cells. Tested against autologous B-NHL cells, only three AuTu prolifera- tive TCC (CD8 ⁺) showed a significant level of cytotoxicity (specific lysis > 15%). In blocking experiments, the AuTu proliferative reactivity of three TCC from one patient was strongly inhibited by anti-DR and anti-DQ mAbs, whereas that of three TCC from another patient was not affected by either anti-MHC class I or class II (DR., DP, DQ) mAbs. These findings suggest that the recognition of autologous B-NHL cells by AuTu proliferative TCC may occur through MHC-restricted as well as MHC-unrestricted mechanisms.     

Incidence and Predictive Factors of Atrial Fibrillation in Paced Patients

We have designed a prospective observational study to analyze the incidence and predictive factors of atrial fibrillation (AF) during a long follow-up, in a large population. Atrial fibrillation episodes were documented by the fallback mode switch (FMS) provided by implanted pacemakers. We have included 377 patients (61% men). The pacing indications were atrioventricular (AV) block (49%), sinus node disease (SND, 16%), bradycardia-tachycardia syndrome (BTS, 5%), AV block + SND (19%), AV block + BTS (6%), and BTS + SND (5%). The mean age at implant was 75 ± 12 (range 28–95). Atrial fibrillation before inclusion was documented in 10% of patients. Drug therapy at first follow-up included beta-adrenergic blockers (17% of the patients), amiodarone (13%), and others (16%). The mean follow-up was 30 ± 24 weeks. At least one AF episode was stored during follow-up in the memory of 169 pacemakers (45%). Among patients without history of AF at implant, 46% had documented FMS during follow-up. Patients with AF received more antiplatelet medications than patients without AF (P = 0.03). In patients with AF, New York Heart Association functional class was slightly higher, amiodarone and sotalol were more often prescribed, and the proportion of hypertension was higher than in patients without AF. However, these trends were not statistically significant. A significant higher incidence of premature atrial beats was observed in patients with AF than patients without AF (P < 0.0002). Patients with AF had a lower atrial percentage of paced events (55%) than patients without AF (63%, P < 0.02). These preliminary results confirm the high incidence of AF in paced patients and suggest a preventive effect of atrial pacing. The effects of other clinical variables may be confirmed with a longer follow-up in a larger population.