Fetal electrocardiotocography in labor and neonatal outcome: an observational study in 1889 patients in the French center of Edouard Herriot, Lyon.

BACKGROUND: The STAN methodology has been shown to reduce both operative delivery for fetal distress and the cord artery metabolic acidosis rate. OBJECTIVE: The objective of this study was to monitor delivery modes and perinatal outcomes following the introduction of the STAN methodology and the evolution of its use at our institution. METHODS: Two periods were characterized: June 2000-June 2002 (period 1) and July 2002-April 2005 (period 2). Parity, mode of labor and delivery, ST events, and neonatal outcome (Apgar score and pH of the umbilical cord artery and vein), cases of metabolic acidosis and operative delivery for fetal distress were studied. RESULTS: One thousand eight hundred and eighty-nine women were included in the study. The rate of use of STAN increased from 13.5% to 16% over these two time periods. The rate of metabolic acidosis was low: 0.28% and 0.45%, respectively. No cases of neonatal encephalopathy or of perinatal death were diagnosed. There was a decrease in the rate of operative delivery for fetal distress (163/701 (22.9%) vs. 228/1111 (20.3%), p = 0.26). CONCLUSIONS: According to the literature, our use of the STAN appears to be very successful; the metabolic acidosis rate was 0.38% and the rate of operative delivery for fetal distress decreased. We improved the accuracy of the interpretation of the fetal heart rate.     

Directing exocrine secretory vesicles to the apical membrane by actin cables generated by the formin mDia1

The final stage in exocrine secretion involves translocation of vesicles from their storage areas to the apical membrane. We show that actin-coated secretory vesicles of the exocrine pancreas travel this distance over bundles of specialized actin cables emanating from the apical plasma membrane. These bundles are stable structures that require constant G-actin incorporation and are distinct from the actin web that surrounds the exocrine lumen. The murine mammalian Diaphanous-related formin 1 (mDia1) was identified as a generator of these cables. The active form of mDia1 localized to the apical membrane, and introduction of an active form of mDia1 led to a marked increase in bundle density along the lumen perimeter. Compromising formation of the cables does not prevent secretion, but results in disorganized trafficking and fusion between secretory vesicles. Similar apical secretory tracks were also found in the submandibular salivary glands. Together with previous results that identified a role for Diaphanous in apical secretion in tubular organs of Drosophila, the role of Diaphanous formins at the final stages of secretion appears to be highly conserved.     

Successful correction of type C complete atrioventricular canal associated with tetralogy of Fallot. A case report

This is the eighth reported case of successful repair of tetralogy of Fallot associated with complete atrioventricular canal, Type C. The high surgical mortality rate in this combination is in part due to failure to recognise the associated anomaly pre-operatively, and in part to not closing the ventricular septal defect completely. In our case the atrial and ventricular septal defects were closed with two separate patches. The undivided hemivalves were attached to the septal patches by interrupted mattress sutures. The right ventricular outflow tract obstruction was relieved by infundibulectomy, pulmonary valvotomy and the placement of a Dacron patch over the infundibulum. One year postoperatively, the condition of the patient is satisfactory without the need for diuretics or digitalis.     

Vertical forces in labial and lingual orthodontics applied on maxillary incisors--a theoretical approach

Theoretical and experimental biomechanical analyses explain most labial orthodontics (LaO); however, lingual orthodontic (LiO) biomechanical principles are rarely introduced. The objective of this study was to apply basic biomechanical considerations in understanding the influence of maxillary incisor inclination and to compare the effect of labial vs lingual intrusive/extrusive forces on tooth movement. Basic anatomic and geometric hypotheses were assumed, ie, tooth length (crown and root), location of the center of resistance, and crown thickness. Incisor inclination as related to a perpendicular line to the occlusal plane (OP) varied between -35 degrees (retroclination) and 45 degrees (proclination). A 0 degrees inclination was defined as a tooth position with its long axis perpendicular to the OP. The buccolingual moment for characterizing root movement was calculated for an applied force perpendicular to the OP. The results showed that when using LaO, an extrusion force resulted in labial root movement from a retroclination of 20 degrees up to a proclination of 45 degrees. In LiO, labial root movement occurred only when the tooth was proclined more than 20 degrees. In all other tooth inclinations, lingual root movement occurred. The opposite tooth movement occurred when an intrusive force was applied. Application of a vertical force has different clinical effects on tooth movement with labial and lingual appliances. Application of a lingual force is more complicated, and its effect on tooth movement depends on bracket position and initial tooth inclination.     

The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement

To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min. Thereafter, a constant IV infusion of 10 mg . kg(-1) . h(-1) was administered until 12 h after final deflation of the limb tourniquet. In group TA-short, a similar regimen was followed; however, the constant IV infusion was discontinued 2 h after final deflation of the limb tourniquet (time of discharge from the postanesthesia care unit). Thereafter, oral TA 1 g was administered after 6 and 12 h. In group TA-oral, 60 min before surgery an oral dose of TA 1 g was administered. After surgery, a similar dose of TA was administered every 6 h for the next 18 h. In the control group, TA was not administered. At patient discharge, postoperative allogeneic blood administration was significantly more in group Control when compared with each of the three TA treatment groups. Because oral drug administration is simple and does not require specific infusion equipment, the authors suggest that oral TA is a superior blood-sparing strategy compared with IV drug administration.     

Predictors of bereaved parents' satisfaction with group support: an Israeli perspective

This study evaluates various aspects of groupwork with bereaved parents who lost a child during military service. More specifically, it assesses the unique and cumulative contributions of various features of groupwork to the participants' satisfaction with the group support. One hundred and thirty-eight bereaved parents, who participated in 16 support groups, answered a battery of questionnaires tapping 3 aspects of the groupwork: their motives for joining the group, the interpersonal relations among the group members, and the group leadership style. In addition, the participants were asked to evaluate the contribution of the intervention to their adjustment. The findings indicate that the supportive elements of the intervention were associated with the groups' perceived contribution. The clinical implications of these results are discussed.     

Intraoperative mitomycin C 0.02% for pterygium: effect of duration of application on recurrence rate

PURPOSE: To compare the effect of a 3- and 5-minute intraoperative application of topical mitomycin C 0.02% on the recurrence of pterygium. METHODS: A comparative, prospective clinical design was used. The study population consisted of 134 consecutive patients with unilateral primary advanced pterygium (growth of 3 mm or more horizontally from the limbus). All underwent excision of the lesion, leaving the sclera bare. At completion of surgery, topical mitomycin C 0.02% was applied for 3 minutes in the first 60 patients (group A) and for 5 minutes in the remaining 74 patients (group B). The patients were followed for 26 months by slit-lamp biomicroscopic examination of the anterior segment. Recurrent pterygium was defined as the postoperative appearance of a fibrovascular tissue crossing the limbus. RESULTS: After 12 months of follow-up, pterygium recurred in 20 patients (33.3%) in group A and in two patients (2.7%) in group B. After 15 months, the recurrence rates were 36.6% and 5.4%, respectively, and remained unchanged at 26 months. There were no cases of drug toxicity in either group. CONCLUSIONS: Five-minute intraoperative application of a single dose of 0.02% mitomycin C is safe and more effective than a 3-minute application in recurrence of pterygium.     

Bouveret's Syndrome as a Rare Complication of Cholecystolithiasis: Report of a Case

Bouveret's syndrome, which is gastric outlet obstruction caused by a gallstone in the duodenum or pylorus, is a very rare complication of gallstone disease. It occurs most commonly in women (65%), with a median age of 68.6 years. This disorder is usually treated by surgery, but it has also been successfully treated by endoscopy, with or without extracorporeal shock wave lithotripsy. The mortality rate has improved to 12% in recent years. Herein we report the case of a 76-year-old woman with Bouveret's syndrome, and review the literature on this unusual entity. Received: January 7, 2002 / Accepted: May 7, 2002 Reprint requests to: E. Shiloni