Emergency peripartum hysterectomy.

A total of 54 166 mothers delivered at the Riyadh Armed Forces Hospital between 1990 and 1997, including 6119 (11.3%) caesarean sections. Emergency peripartum hysterectomy for obstetric haemorrhage was carried out in 16 cases (0.3/1000 deliveries). The operation followed major degrees of placenta praevia in 12 (75%) cases and atonic postpartum haemorrhage in four (25%). All patients required blood transfusion. There was one neonatal death and no maternal deaths. Although the operation was straightforward, bladder injury occurred in five (31%) cases which was repaired with no residual damage. Placenta accreta was confirmed histologically in 12 (75%) patients. In conclusion, all obstetricians should be aware of the strong association between a scarred uterus, placenta praevia and placenta accreta which can be very adherent and difficult to remove causing bleeding and necessitating hysterectomy. The operation should be performed by an experienced obstetrician before the patient's condition is extreme.     

Interleukin-1beta increases urine flow rate and inhibits protein expression of Na(+)/K(+)-ATPase in the rat jejunum and kidney.

The effect of interleukin-1beta (IL-1beta) on urine flow rates and Na(+)/K(+)-ATPase activity and expression was studied in rat intestinal and renal epithelia. The cytokine produced a significant diuretic effect and increased urine flow rate by around 10-fold compared with the control. This effect was considered to be secondary to the well-documented natriuretic effect of the cytokine described in the literature. On the other hand, we have shown previously that IL-1beta inhibits glucose absorption from the jejunum. As sodium excretion and glucose absorption are both dependent on Na(+)/K(+)-ATPase activity, the effect of the cytokine on the renal and intestinal pump was investigated. IL-1beta inhibited, in a dose-dependent manner, the activity of Na(+)/K(+)-ATPase in villus and crypt jejunal cells and in medullary and cortical kidney cells. Western blot analysis revealed a decrease in the protein expression of the enzyme, which was confirmed by the radiolabeled ouabain binding assay. The results suggest that the diuretic and natriuretic effect of IL-1beta and its inhibitory effect on glucose absorption are all due to downregulation of the Na(+)/K(+) pump in the kidney and jejunum.     

Fetal heart rate and umbilico-placental Doppler flow velocity waveforms in early pregnancies with a chromosomal abnormality and/or an increased nuchal translucency thickness

Fetal heart rate, umbilical artery pulsatility index, end-diastolicflow,nuchal translucency thickness and placental thickness were recordedin 250 women with a viable singleton pregnancy undergoing chorionicvillous sampling for fetal karyotyping at 11–14 weeksof gestation. The fetal karyotype was normal in 210 cases andabnormal in 40, including 21 with trisomy 21, 13 with trisomy18, three with triploidy, two with monosomy X and one with trisomy13. A total of 52 fetuses with a normal karyotype had a nuchaltranslucency 3 mm and were considered separately. There wasa stable and significant increase in the mean fetal heart ratein trisomy 21 pregnancies compared to controls. No significantdifference was found for the other variables between the groups.In chromosomally normal fetuses with an increased nuchal thickness,the development of fetal heart rate and compliance of the umbilico-placentalcirculation were within the normal ranges. Some fetuses withtrisomy 18 or triploidy had an increased resistance to bloodflow in the umbilical artery, which was probably due to abnormalplacental development.     

Potato Disc Bioassay for Some Jordanian Medicinal Plants

Fifteen different plants representing different species, genera and families were used to test the effect of their aqueous extracts on tumor inhibition with a rapid, inexpensive, safe, animal sparing technique, and statistically reliable prescreen for in vivo murine leukemia antitumor activity, which is known as potato disc technique. The inoculum used contains the extract with the bacterium (Agrobacterium tumefaciens) that was known to cause crown gall tumor to different plant species especially dicotyledons and some gymnosperms. After 12 to 21 days of incubation the tumors appeared and were counted, and the maximum inhibition was then calculated. Thirteen species out of fifteen showed a good antitumor effect, and three of them showed a maximum inhibition of 80%. More experiments are necessary to determine the exact mechanism of action.     

Frequency of Mammary Artery Coiling in Single-Ventricle Patients and Future Coronary Artery Grafting

Pre-Fontan coil closure of aorto-pulmonary collaterals decreases single-ventricle volume load and improves outcome. Coiling of right and left internal mammary arteries may present a challenge to cardiothoracic surgery teams caring for these patients when future coronary artery bypass grafting is needed for SV patients. The goal of this study was to determine the frequency of internal mammary artery coil closure in SV patients in a single tertiary care center. A retrospective review of all pediatric single-ventricle patients who underwent cardiac catheterization between March 2009 and October 2015 at Rush Center for Congenital Heart Disease was performed. Fifty-one patients’ charts were reviewed. Twenty-five patients received coil closure of one or more internal mammary artery (coil group) and 26 received no coil closure (no-coil group). In the coil group, 21 (84 %) had their collateral vessels coiled in the pre-Fontan period and 4 (16 %) had their vessels coiled in the post-Fontan period. In the coil group, 18 (72 %) had their right internal mammary artery coiled and 7 (28 %) had both right and left internal mammary arteries coiled. None of the coil group had isolated coil closure of the left internal mammary artery. This study is the first to verify the frequency of right and/or left internal mammary artery coil closure in SV patients and the potential impact on future coronary artery bypass grafting. Extensive peri-Fontan coiling of the internal mammary arteries presents a significant potential challenge for subsequent management of SV patients as older adults.     

Accessibility to biologics and its impact on disease activity and quality of life in patients with rheumatoid arthritis in Kuwait

Clinical Rheumatology - Biologics are indicated in rheumatoid arthritis (RA) in case of persistent high disease activity despite conventional disease-modifying anti-rheumatic drugs (cDMARDs) or...