Spontaneous abortion following mid-trimester amniocentesis. Clinical significance of placental perforation and blood-stained amniotic fluid

Summary. The clinical significance of placental perforation and bloodstained amniotic fluid was studied in a group of 7238 Danish women undergoing mid-trimester amniocentesis for prenatal diagnosis under ultrasound guidance. The risk of spontaneous abortion was significantly increased both in pregnancies where the placenta was perforated and in those with blood-stained amniotic fluid. The risk estimate nearly doubled after placental perforation and more than doubled with a bloody tap. It is concluded that for women at relatively low risk of a fetal genetic abnormality, the indication of the amniocentesis should be reconsidered if a placental perforation is unavoidable.     

Craniofacial growth in bone marrow transplant recipients treated with growth hormone after total body irradiation

Abstract— The effect of growth hormone (GH) treatment on craniofacial development was studied in five children exhibiting growth retardation following bone marrow transplantation. Linear and angular measurements were made on lateral radiographic cephalograms taken prior to the start of GH treatment and after an average treatment time of 1.2 yr. The results showed that the mean growth increments of mandibular length in the GH treated children, exceeded the corresponding values of the control group by 150% during the period of investigation. It is suggested that this dimensional increase in the patients was due to GH stimulation on the chondral growth process in the mandibular condyles.     

Catecholamine Release after Physical Exercise

ABSTRACT A simple and practical provocative test is needed for early asymptomatic pheochromocytoma, which is a major risk for patients with multiple endocrine neoplasia type 2 (MEN-2). We measured plasma catecholamines before and after submaximal exercise in 26 MEN-2 gene carriers, eight of whom with asymptomatic pheochromocytoma, nine with medullary thyroid carcinoma and 10 after uni- or bilateral adrenalectomy. Seventeen clinically healthy individuals and 11 patients with neurovegetative lability and symptoms mimicking pheochromocytoma served as controls. Plasma adrenaline, noradrenaline and dopamine increased after excercise except for adrenaline after bilateral adrenalectomy. The post-exercise levels of adrenaline and the adrenalineldopamine ratio were significantly higher in the pheochromocytoma patients compared to the healthy controls and the patients with neurovegetative lability, while the patients with medullary thyroid carcinoma represented an intermediate group with a high probability of developing adrenal tumors. The present method is a physiological test with a high sensitivity and specificity. It is practical and well suited for repeated examinations and seems to be of value for the detection of early pheochromocytoma in MEN-2 patients. Furthermore, the test could be used in the differential diagnosis between pheochromocytoma and neurovegetative lability.     

Pacing Threshold Interval with Decreasing and Increasing Output

The study was made in 44 patients, of which 23 received a new endocardial electrode and 21 were investigated during pulse-generator replacement. Indication for pacemaker therapy was sino-atrial bradycardia in 12 patients and atrio-ventricular block in 32 patients. When the pacing threshold was determined with decreasing output it was found to be 0.6V/0.7 mA for new implantations and 2.0 V/2.0 mA with pulse generator replacement. When determined with increasing output the threshold was found to be an average 0.20 V/0.20 mA higher than when determined with decreasing output (threshold interval). The maximal difference observed was 0.70 V/0.55 mA. This threshold interval was of the same size irrespective of pacemaker indication and spontaneous activity and whether the electrode was newly implanted or not. Pacemaker ventricular block of Mobitz type I with Wenckebach periodicity was never observed.     

Well-being and future sick-leave: Multivariate analyses with regard to preceding sick-leave

Consistent associations between self-rated well-being and futuresick-leave have previously been noted in a selected group ofrepeated short-term sick-leavers. The object was to retest thoseassociations after ruling out expected influences of precedingsick-leave. Hypothetically the well-being-sick-leave linkagesinitially observed would thereby overlap with the behaviouralconformity over time. Accordingly, they would possibly be erasedin a hierarchical stepwise regression analysis. The study groupcomprised 61 females and 62 males with diffuse reasons for theirhigh repeated sick-leave. Instead of having to present a doctor'scertificate on every new sick-leave occasion, they chose totake part In a support programme. Altogether 8 hierarchicalmultiple regression analyses were run with sick-leave occasionsand days the first and second years after the contact as separatedependent variables. In the first step, long-term behaviouralproneness to sickness absence was evaluated, i.e. the correlationsbetween the sick-leave parameters the year before and each ofthe 2 years after the programme were computed. In the secondstep, the possible additional impact of well-being ascertainedat entrance Into as well as exit from the clinical contact wasestablished. Sick-leave correlated strongly over the study periodsas expected. Yet, fairly consistent associations between well-beingand future sick-leave remained. The well-being parameters accountedfor another 4–8% of the entire variance in 5 of the 8regression analyses performed. That increment corresponded tobetween 25 and 100% of the proportion initially explained bypreceding sick-leave. Thus the independent role of perceivedself-image for the long-term inclination to sickness absencein the current ‘risk’ group was underscored. Thiswas particularly so since the influence of several other backgroundand job-related factors have previously proven to be empiricallynegligible. Moreover, similar prospective correlations havebeen seen in other study groups.     

CARBOHYDRATE-DEFICIENT TRANSFERRIN: MARKER OF ACTUAL ALCOHOL CONSUMPTION OR CHRONIC ALCOHOL MISUSE?

Carbohydrate-deficient transferrin (CDT) is a useful indicatorof excessive alcohol consumption with higher sensitivity andspecificity than other markers that are used. In the presentstudy, CDT was analysed in 161 patients hospitalized in a surgicalward to evaluate whether history of drinking and chronic alcoholmisuse are important determinants of CDT elevations. Fifty-oneof the patients were diagnosed as alcohol-dependent and theyall reported a long history of alcohol abuse Several of these,as well as many of the non-dependent patients, reported a high,recent alcohol consumption (