Technology assessment: monitoring fetal growth.
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Female↗
Biomedical subjects
J Villar
Publications and source records attributed to J Villar.
Peritoneal cytology in stage I endometrial cancer.
Peritoneal lavage fluid for cytologic study was obtained in 73 patients undergoing primary surgery for stage I endometrial adenocarcinoma. Preoperative irradiation was not used. Malignant cells consistent with endometrial adenocarcinoma were present in eight (11 percent) cases. There was no significant difference in the proportion of patients with "positive peritoneal cytology" when patients with grade 1 and 2 tumors, five of 45 (11 percent), were compared with those with grade 3 and adenosquamous tumors, three of 28 (10.7 percent), between deeply invasive tumors, two of 20 (10 percent), and those with superficial or no invasion, six of 52 (11.5 percent), between stage IA, six of 42 (14.5 percent) and stage IB disease, two of 31 (6.5 percent). The prevalence of positive peritoneal cytology in this series of 73 patients who received no preoperative irradiation is similar to that reported in other series where preoperative irradiation was used. No correlation between positive peritoneal cytology and other reported poor prognostic indicators in stage I endometrial adenocarcinoma was found.
Adenocarcinoma↗
The changing pattern of low birth weight in the United States--1970 to 1980.
Analysis of US Natality Statistics using a bivariate (birth weight-gestational age) approach shows that trends among term-low-birth-weight infants (less than or equal to 2,500 g; greater than or equal to 37 weeks, term low birth weight) and preterm-low-birth-weight infants (less than or equal to 2,500 g; less than 37 weeks, preterm low birth weight) have different patterns over time and by race. Between 1970 and 1980 the incidence of preterm low birth weight for all races declined 7.1%, while the term-low-birth-weight incidence declined almost three times as much (20.9%). The incidence of preterm low birth weight among white infants, during the same period, declined 9.0% with the black preterm-low-birth-weight rate declining by 5.8%. The term-low-birth-weight incidence, however, was 24.6% lower among whites and 14.9% lower among black term-low-birth-weight infants for the same period. The reduction in the overall low-birth-weight incidence for both populations is principally caused by reduction in the incidence of term-low-birth-weight infants. Term- and preterm-low-birth-weight infants reflect different etiologic insults and require different intervention strategies for prevention.
Birth Rate↗
Plasma methotrexate levels in patients with gestational trophoblastic neoplasia treated by two methotrexate regimens.
Plasma methotrexate levels were measured in six patients with nonmetastatic and three patients with "low-risk" metastatic gestational trophoblastic neoplasia who were treated by two different methotrexate regimens. Five patients were treated with 16 cycles consisting of methotrexate, 1 mg/kg (days 1, 3, 5, and 7) followed in 24 hours by citrovorum factor, 0.1 mg/kg (days 2, 4, 6, and 8). Cycles alternated between intravenous and intramuscular administration. Statistical differences in plasma levels were found at 1 and 48 hours between the two routes of administration but probably were not of clinical importance. The plasma levels at the time of citrovorum factor administration were below that necessitating citrovorum factor rescue. Four patients were treated with alternating cycles of intravenous or intramuscular methotrexate, 0.5 mg/kg for 5 consecutive days without citrovorum factor. A total of 15 cycles demonstrated no difference in plasma levels at 1, 12, and 24 hours between intravenous and intramuscular administration. Statistical differences in plasma methotrexate levels were noted between the two methotrexate regimens only with intramuscular administration but were not of clinical importance. The reduced toxicity of the methotrexate-citrovorum factor may be due to the scheduling of the methotrexate and not to the citrovorum factor.
Antineoplastic Combined Chemotherapy Protocols↗
Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life.
Postnatal growth and development were studied in two groups of term infants with intrauterine growth retardation (IUGR) and one group of infants with normal birth weight up to 3 years of age (total sample, 205 infants). Infants with IUGR were classified as having low ponderal index (IUGR-LPI) or adequate ponderal index (IUGR-API). At birth, the two groups of infants with IUGR had similar birth weight, but length and head circumference measurements were significantly different. Overall, the IUGR-API infants remained lighter and shorter and had smaller head circumferences up to 30 months of age. The IUGR-LPI infants experienced catch-up growth in weight during the first months, because of greater fat deposition. At 24 months of age, the IUGR-API infants scored below the others on mental items. At 3 years of age the IUGR-API infants had the lowest values on seven of eight developmental measures and on the composite score; at these two time periods, the group with normal birth weight scored the highest, and the IUGR-LPI infants obtained intermediate values. It is concluded that infants with IUGR tend to follow postnatal growth and developmental patterns that are associated with their physical characteristics at birth.
Body Height↗
The mediating role of the parathyroid gland in the effect of low calcium intake on blood pressure in the rat.
Recent reports suggest an inverse relationship between calcium intake and blood pressure. This effect could be mediated by parathormone (PTH), since a low calcium intake leads to an increase in PTH and this hormone produces an increase in intracellular calcium, raising the excitability of the muscle arteriolar cells. Wistar female rats, 56 days old, were submitted to a parathyroidectomy or to a sham operation. After that, they were placed on a normal or on a calcium-free diet during 10 weeks. Four groups of nine rats were studied: parathyroidectomized animals on a normal calcium diet, parathyroidectomized ones on a calcium-free diet, controls (sham operation) on a normal calcium diet, and controls (sham operation) on a calcium-free diet. The control calcium-free diet showed a significant increase in blood pressure values over the treatment period. The parathyroidectomized calcium-free diet group did not show any increase. The difference between these two groups regarding change in blood pressure was statistically significant. The parathyroidectomized-calcium-free group showed no weight increase during the study, while rats in the other three groups significantly increased their weight. PTH could be the mediator of the blood pressure rise observed in the calcium-deprived rats in spite of the possible confounding effect of the poor weight increase detected in the parathyroidectomized-calcium deprived animals. These results warrant future studies since the role of PTH in the regulation of blood pressure needs to be confirmed. This possibility, therefore, opens a new area of research in the study of the pathophysiology of hypertension.
Animals↗
Preliminary evidence of the effect of calcium supplementation on blood pressure in normal pregnant women.
In this study the hypothesis that calcium supplementation during pregnancy can modify blood pressure patterns in a population of normal pregnant women was tested. Thirty-six women with normal single pregnancies, between 20 and 35 years of age, in the second trimester of gestation (15 weeks), were randomly assigned to receive 1 gm of calcium per day (n = 11), 2 gm per day (n = 11), or a placebo (n = 14). No differences were observed at the times of admission into the study (baseline) in demographic and clinical variables or in the calcium intake of each group. Baseline blood pressure measures in several positions also were not different. After the initial blood pressure measures (fifteenth week), five follow-up blood pressure measures were obtained. The supplemented groups had significantly lower diastolic blood pressure than the control subjects between the twentieth and twenty-fourth weeks of gestation. Thereafter, an increase in the control group and the group receiving 1 gm of calcium was observed, but levels were similar at term. On the contrary, patients receiving 2 gm of calcium had blood pressure values that remained significantly lower throughout the third trimester. No differences or clear patterns were observed in the blood levels of calcium, magnesium, phosphorus, and proteins between and within groups during gestation. A possible explanation involving parathyroid hormone is attempted.
Adult↗
Reduction of blood pressure with calcium supplementation in young adults.
Epidemiologic and animal studies have suggested an inverse relationship between calcium intake and BP. Furthermore, calcium intake seems to be inversely correlated with the incidence of eclampsia in pregnancy. In a randomized clinical trial, young adults were allocated to a calcium-supplemented group receiving 1 g/day of elemental calcium (15 men and 15 women) or a placebo group (14 women and 13 men) for a period of 22 weeks. The calcium-supplemented group showed a significant decrease in diastolic BP; this effect was stabilized after nine weeks in women and six weeks in men. The reduction in diastolic BP was 5.6% and 9% from the initial values for women and men, respectively. This study supports epidemiologic and animal evidence of the effect of calcium intake on BP and suggests the need for more research exploring the mechanisms involved in the observed effect.
Adolescent↗
Alternating multiagent chemotherapy for advanced ovarian cancer.
A chemotherapy regimen consisting of hexamethylmelamine (H) 150 mg/m2 orally days 1-14, cyclophosphamide (C) 500 mg/m2 IV day 1 of a 28-day cycle with Adriamycin (A) 40 mg/m2 IV day 1 alternating with cis-diamminechloroplatinum (C-P) 50 mg/m2 IV day 1 every other cycle was administered to 29 patients with advanced epithelial ovarian cancer. Toxicity to this regimen included alopecia, nausea, and vomiting in all patients. Mild paresthesias occurred in four patients. Hematologic toxicity required only minimal dose modification. There was no cardiac, renal, or auditory toxicity. The clinical response rate of 55% and median survival of 14 months compare favorably with that of other reported series. This chemotherapy regimen seems to be well tolerated without jeopardizing the patients' response.
Adenocarcinoma↗
Epidemiologic observations on the relationship between calcium intake and eclampsia.
In Guatemala, the obstetric population has a very low incidence of eclampsia despite the presence of factors that would be expected to favor appearance of the disease. In this study, the eclampsia incidence and calcium intake for three countries, Guatemala (low eclampsia incidence, high calcium intake); Cali, Colombia (high eclampsia incidence, low calcium intake); and the USA (low eclampsia incidence, high calcium intake) have been compared. Crude rates for eclampsia incidence were adjusted to control the effects of well-documented predisposing factors: age, parity, and prenatal care. Results of the study support an association between calcium intake and development of eclampsia.
Adolescent↗
A prospective randomized study of doxycycline as a prophylactic antibiotic in patients undergoing radical hysterectomy.
A prospective randomized study was undertaken to evaluate doxycycline as a prophylactic antibiotic in patients undergoing radical abdominal hysterectomy and pelvic lymphadenectomy. Although 69 patients were initially randomized, 64 patients (34 study, 30 control) are the basis of this report: 5 patients were omitted because large pelvic lymph nodes positive for tumor were found at laparotomy and radical hysterectomy was abandoned. The two study groups were similar in both preoperative and operative risk factors. There was a statistically significant reduction in the 7- and 14- day febrile index in the doxycycline group. The rate of cuff and/or pelvic cellulitis was 2.3 times higher in the control group. Thus, single-dose doxycycline as a prophylactic antibiotic reduced both febrile morbidity and the rate of serious infections in the radical hysterectomy patient.
Adult↗
The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies.
The relative proportions of prematurity (less than or equal to 2,500 gm less than 37 weeks' gestation) and intrauterine growth retardation-low birth weight (IUGR-LBW) (less than or equal to 2,500 gm, greater than or equal 37 weeks' gestation) among total LBW infants were studied in 11 regions in the developed world and 25 developing areas where known gestational ages and birth weights were reported. In developing countries a straight correlation was observed between total LBW incidence and IUGR-LBW incidence rates (r = 0.95; b = 0.98; p less than 0.001); in contrast, prematurity was not significantly associated with total LBW incidence. Data from the developed population showed results exactly opposite to those described for developing areas. Therefore, when the incidence of LBW is higher than 10%, it is almost exclusively due to the increase in IUGR-LBW infants, while prematurity remains almost unchanged (5% to 7%). When LBW incidence is less than 10% (mean=6%), preterm infants represent the major component of LBW. Environmental factors susceptible to changing socioeconomic conditions may be responsible for the observed differences.
Birth Weight↗
Postnatal growth of intrauterine growth retarded infants.
205 single, term newborns were followed up to their first birthdays. Each was classified as intrauterine growth retarded (IUGR) (59), or adequate birth weight (ABW) (146), and further subdivided by their individual ponderal index at birth (PI). By the end of their first year the IUGR infants had not reached the weight and length of their normal counterparts. Those with low PI obtained adequate PI values by the third month; IUGR infants with adequate PI at birth remained shorter and lighter but with adequate PI throughout the first year of life. The catch-up process in the IUGR infants with low PI can be explained by a higher growth velocity in weight, triceps and subscapular skinfolds apparent during the first trimester of postnatal life. The limitations of using PI as a tool to monitor the growth patterns of a heterogenous group of IUGR infants are discussed.
Birth Weight↗
The timing factor in the pathophysiology of the intrauterine growth retardation syndrome.
Three different types of intrauterine growth retardation can be identified depending on the moment at which supplies to the fetus are diminished. When a reduction in sustenance occurs early in the first trimester of pregnancy, a well-proportioned but growth-retarded baby may be expected. When the negative factors develop around the 30th week of pregnancy, the result is a disproportionately growth-retarded infant. Both types of retardation can be illustrated using longitudinal uterine height and biparietal diameter values and by neonatal anthropometry. Epidemiological examples exist defining factors which produce these two kinds of retardation. The third type occurs when a reduction in food supplies takes place in the last month of pregnancy and causes a depletion of the fetal fat stored. Weight retardation is observed with little or no height impairment. In planning public health activities such as nutrition interventions for developing countries, the type of intrauterine growth retardation present in the target population should be considered in order to determine which type of intervention would be most appropriate, and establish its correct timing.
Cephalometry↗
[Effect of calcium ingestion on hypertension].
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Animals↗
Ip immunotherapy and chemotherapy in advanced epithelial ovarian cancer.
Nine patients with advanced epithelial ovarian cancer, classified as either stage III with macrometastatic residual disease or stage IV, received combination chemotherapy in conjunction with ip rabbit-derived human ovarian antitumor serum (HOATS). The HOATS regimen consisted of the ip instillation of 100 ml of ovarian antitumor serum on Days 1 and 3 of the first chemotherapy cycle. Side effects attributable to HOATS were low-grade fever in three patients and diffuse skin rash in two. The 1-year cumulative survival was 87%, with a clinical response rate of 80%. No significant toxic reactions to HOATS have been observed. Continuation of the present study seems justified.
Adenocarcinoma↗
Breastfeeding in developing countries.
The calculated protein and calorie requirements and nutritional status of intrauterine-growth-retarded infants of poor mothers in underdeveloped countries were compared with the estimated amounts of protein and calories supplied in the mother's milk and their nutritional status both before and during lactation. These mothers were only able to provide 69% of the infants' protein requirements at birth, falling to 51% at three months of age 123% of calorie requirements were supplied at birth, falling to 55% at three months. Conversely, in terms of g protein per 100 kcal, 56% of requirements were met at birth, rising to 95% at three months-figures which reflect the decreasing protein requirement with age. Socioeconomic factors determine nutritional status in developing countries and it is the responsibility of governments to ensure the health and adequate nutrition of mothers and infants.
Breast Feeding↗