Ropivacaine and bupivacaine for analgesia in labour.
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Amides↗
Biomedical subjects
S Segal
Publications and source records attributed to S Segal.
Viagra for temporary erectile dysfunction during treatments with assisted reproductive technologies.
During treatments with assisted reproductive technologies (ART), some men may have difficulties in producing spermatozoa on demand at the time of insemination, either for intrauterine insemination (IUI) or for in-vitro fertilization (IVF). This situation imposes tremendous stress on the couple and may cause cancellation of the treatment. Here we describe, for the first time, the use of sildenafil citrate (ViagraTM) for temporary erectile dysfunction in couples undergoing ART. The first case was a man who could not produce spermatozoa for the first IVF treatment after an exhausting trial for 12 h, despite the fact that he never had problems in providing sperm samples during previous IUI cycles. Using Viagra enabled him to provide spermatozoa, but the delay in oocyte insemination resulted in no embryonic development. This prompted us to be more alert to this option and to suggest the use of Viagra to men who had a history of erectile dysfunction during previous ART cycles. In these cases, the use of Viagra was planned in advance and it successfully solved any unpredictable erectile dysfunction on the day of insemination. Such cases emphasize the need to think in advance of this potential use of Viagra during ART.
3',5'-Cyclic-GMP Phosphodiesterases↗
The influence of the obstetrician in the relationship between epidural analgesia and cesarean section for dystocia.
BACKGROUND: The association between epidural analgesia for labor and the risk of cesarean section for dystocia remains controversial The authors hypothesized that if epidural analgesia were an important factor in determining cesarean section rates, then obstetricians with higher rates of utilization of epidural analgesia for labor would have higher rates of cesarean section for dystocia. METHODS: The frequency of use of epidural analgesia and frequency of occurrence of various patient risk factors for cesarean section were calculated for 110 obstetricians caring for > or = 50 low-risk parturients. These frequencies were compared by linear regression to obstetricians' rates of cesarean section for dystocia. Stepwise regression was used to attempt to predict obstetricians' cesarean rates from the incidence of various patient and provider risk factors. RESULTS: There was no relationship between frequency of epidural analgesia and rate of cesarean section for dystocia across practitioners (R2 = 0.019; P = 0.156). Weighting each obstetrician's data for the number of patients cared for during the study period did not change this result. Stepwise linear regression only modestly predicted obstetricians' cesarean section rates for dystocia, yielding a model containing 12 variables not including epidural analgesia (gestational age, induction of labor, maternal age, provider volume, nulliparity, and seven interactions; adjusted R2 = 0.312; P < 0.0001). CONCLUSIONS: The frequency of use of epidural analgesia does not predict obstetricians' rates of cesarean section for dystocia. After accounting for a number of known patient risk factors, obstetrical practice style appears to be a major determinant of rates of cesarean section.
Adult↗
Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia?
BACKGROUND: The combined spinal-epidural technique provides rapid onset of labor analgesia and, anecdotally, is associated with labors of shorter duration. Epidural analgesia, by contrast, has been suggested to prolong labor modestly. It is unclear, however, whether more rapid cervical dilation in patients who receive combined spinal-epidural analgesia is a physiologic effect of the technique or an artifact of patient selection. The authors hypothesized that anesthetic technique may influence the rate of cervical dilation, and we compared the effects of combined spinalepidural with those of epidural analgesia on the rate of cervical dilation. METHODS: One hundred healthy nulliparous parturients in spontaneous labor with singleton, vertex, full-term fetuses were enrolled in a double-blinded manner when their cervical dilation was less than 5 cm. The patients were randomly assigned to receive analgesia via a standardized combined spinal-epidural (n = 50) or epidural (n = 50) technique. Data were collected on cervical dilation, pain, sensory level, and motor blockade. RESULTS: When regional analgesia was induced in comparable groups at a mean of 3 cm cervical dilation, the mean initial cervical dilation rates were significantly faster in the combined spinal-epidural group (mean values, 2.1 +/- 2.1 cm/h vs. 1 +/- 1 cm/h; P = 0.0008). Five parturients in the combined spinal-epidural group had a very rapid (> 5 cm/h) rate of mean initial cervical dilation, compared with none of the women in the epidural group. Overall mean cervical dilation rates in patients who achieved full cervical dilation were 2.3 +/- 2.6 cm/h and 1.3 +/- 0.71 cm/h (P = 0.0154) in the combined spinal-epidural and epidural groups, respectively. CONCLUSIONS: In healthy nulliparous parturients in early labor, combined spinal-epidural analgesia is associated with more rapid cervical dilation compared with epidural analgesia. Further study is needed to elicit the cause and overall effect of this difference.
Adult↗
Vasomotor rhinitis following trauma to the nose.
Complaints of nasal obstruction following nasal trauma without any deformation have been noticed by rhinologists for many years. However, neither an epidemiologic nor a pathophysiologic connection has ever been established. The complaints and physical examination findings of these patients resemble those of vasomotor rhinitis. Only very few articles suggesting nasal trauma as a possible cause for vasomotor rhinitis have ever been published. We present a retrospective study that found 87 of 802 patients to suffer from vasomotor rhinitis following nasal trauma. No other factors known to cause vasomotor rhinitis were present in these patients. None had any previous nasal problems. We therefore suggest that nasal trauma was the causative factor in their vasomotor rhinitis.
Humans↗
The demographic transition then and now: processes, perspectives, and analyses.
Fifty years have passed since the post-World War II development of demography as an academic field. During this time, one of the central focuses of research has been the study of demographic and fertility transitions. The authors review a selection of research developments and analytic issues that have appeared in the literature. After presenting, in roughly chronological order, the general development of this research work, they raise questions concerning theory and methodology. In doing so, they argue that some research directions have been overemphasized to the neglect of others.
Demography↗
Platysma myocutaneous flap for intraoral reconstruction: an option in the compromised patient.
The platysma myocutaneous flap is an infrequently used flap in head and neck reconstruction. This flap should be considered for reconstruction of small and medium-sized defects of the oral cavity. We present two cases demonstrating the utility of this local flap in reconstruction. Advantages, contraindications and limitations of the platysma myocutaneous flap are discussed.
Aged↗
Labor abnormalities as a risk factor for shoulder dystocia.
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Adult↗
The potent lipid mitogen sphingosylphosphocholine activates the DNA binding activity of upstream stimulating factor (USF), a basic helix-loop-helix-zipper protein.
We previously demonstrated that the sphingolipid, sphingosylphosphocholine (SPC) increased DNA binding activity of AP-1 proteins accompanying cellular proliferation. Herein, the effects of SPC on DNA binding activity and transcription of the basic, helix-loop-helix, leucine zipper (bHLH-ZIP) proteins Myc, Max, and USF were investigated because they regulate genes involved in mitogenesis. E-box (CACGTG) DNA binding proteins were detected by electrophoretic mobility shift assays in nuclear extracts from Swiss 3T3 fibroblasts. The slowest migrating complex (complex I) increased within 1-3 min after treatment with SPC, remained elevated for 10 min, and increased again after 12 h. Complexes I and II contained USF-1 and USF-2 proteins, and complex I migrated similarly to recombinant USF-1 protein/DNA complex. Treatment of nuclear extracts with alkaline phosphatase decreased these complexes suggesting USF might be a phosphoprotein, post-translationally modified by SPC. max and usf-1 mRNA levels were unaffected by SPC treatment. In contrast, c-myc mRNA was rapidly elevated, reached maximum levels at 0.5-1 h, and showed an additional increase after 12 h, just preceding S phase. Thus, certain bHLH-ZIP transcription factors may be involved in cell growth regulation by SPC.
3T3 Cells↗
Scalp dysesthesia.
BACKGROUND: Cutaneous dysesthesia syndrome is a disorder characterized by chronic cutaneous symptoms without objective findings. Patients complain of burning, stinging, or itching, which is often triggered or exacerbated by psychological or physical stress. These symptoms may be manifestations of an underlying psychiatric disorder or may represent a type of chronic pain syndrome. OBSERVATIONS: Eleven women presented with chronic severe pain and/or pruritus of the scalp only without objective physical findings, a condition we term "scalp dysesthesia." Five women described pain, stinging, or burning only; 4 women complained of pain and pruritus; and 2 women reported pruritus only. The patients ranged in age from 36 to 70 years. The duration of symptoms ranged from 9 months to 7 years. Five women had physician-diagnosed psychiatric disorders, including dysthymic disorder, generalized anxiety, and somatization. Seven women reported that stress triggers or exacerbates their symptoms. Eight women experienced improvement or complete resolution of symptoms with treatment with low-dose doxepin hydrochloride or amitriptyline hydrochloride. One patient responded completely to treatment with sertraline and hydroxyzine hydrochloride but then experienced a relapse. CONCLUSIONS: We describe 11 patients with a new syndrome that we term scalp dysesthesia. Of 11 patients, 9 benefited from treatment with low doses of antidepressants.
Adult↗
Superior ophthalmic vein thrombosis: complication of ethmoidal rhinosinusitis.
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Adult↗
Endometrial cancer in patients undergoing diagnostic curettage.
We made a retrospective review of in 2769 patients in whom curettage was performed. Of 1468 women under 50 years of age, only one (0.08%) had endometrial cancer. Of 834 patients presenting with postmenopausal bleeding 31, (3.7%) had endometrial cancer.
Adult↗
Transnasal endoscopic drainage of a medial subperiosteal orbital abscess.
The exact incidence of orbital complications due to sinusitis in children is unknown. However, a medial subperiosteal orbital abscess is the most common serious complication to occur. Surgical intervention is mandatory whenever antibiotic treatment fails. Most authors prefer open surgical procedures such as external ethmoidectomy, while others recommend transnasal endoscopic drainage as the first attempt at sinus decompression. Five out of 12 children with proven subperiosteal orbital abscess and sinusitis on computed tomographic scans failed antibiotic treatment and required surgical drainage. Transnasal endoscopic drainage of the abscess was performed on four patients, while one child underwent external ethmoidectomy. Our experience with endoscopic surgery in these four cases is discussed, along with a brief review of the advantage of this procedure over external surgery.
Abscess↗
Use of intranasal endoscopic surgery to relieve ostiomeatal complex obstruction in fibrous dysplasia of the paranasal sinuses.
The use of endoscopic nasal surgery for debulking ethmoidal fibrous dysplasia, blocking the right ostiomeatal complex is presented. Removal of the obstructing bony mass was done by ear curette and drills. The procedure was limited to the ostiomeatal complex in order not to violate the orbital contents. The advantages of this method over the external approach are outlined in this paper.
Adolescent↗
Elevation of erythrocyte redox potential linked to galactonate biosynthesis: elimination by Tolrestat.
Alternate pathways of galactose metabolism were explored in erythrocytes from normal subjects and patients with galactose-1-phosphate uridylyltransferase (GALT) deficiency incubated with galactose. Micromolar quantities of galactonate accumulated in both normal and mutant cells linearly with time up to 5 hours and with concentrations of galactose up to 25 mmol/L. Galactitol also was found at levels less than one third of the galactonate level, while galactose-1-phosphate concentrations comparable to those of galactonate were found in galactosemic cells. Concomitant with the formation of these galactose metabolites, the erythrocyte redox potential based on measurement of lactate and pyruvate increased fourfold in both cell types. This was due to a 60% to 72% decrease in pyruvate and a 24% to 26% increase in lactate. The oxidation of galactose to galactonate, which is known to generate NADH, is the most likely explanation for the increase in the redox state. The aldose reductase inhibitor (ARI), Tolrestat (Wyeth Ayerst Research, Princeton, NJ), at 70 micromol/L inhibited the formation of both galactonate and galactitol in both cell types without affecting galactose-1-phosphate, and eliminated the increase in the redox potential as indicated by restoration of pyruvate and lactate levels to the levels obtained before exposure of the cells to galactose. A functioning galactonate pathway is a route of galactose disposal in patients with GALT deficiency, but by altering the cellular redox potential, it may also contribute to galactose toxicity.
Adult↗
AIDS and reproductive health.
Over 24 million adults worldwide have been infected with HIV. Primarily a sexually transmitted disease, AIDS is inexorably linked to reproductive health and care. Because HIV tends to infect those who are in their reproductive years, the impact of this disease on population growth and life expectancy is projected to be immense in some parts of the world, especially in sub-Saharan Africa. Not least is the challenge to individual families and infant care programs to care for AIDS babies. Estimates of the rate of vertical transmission of HIV range from < 10 to 46%. Transmission through sexual contact accounts for 75-85% of HIV infection worldwide, and today, nearly 20 years into the epidemic, the main tool to stall the spread is advocating change in sexual conduct. Numerous studies leave no doubt that the attributable risk of co-infection with other STDs--both ulcerative and non-ulcerative--in heterosexual transmission is substantial. The only known contraceptive method proven to reduce both infectiousness and susceptibility to HIV is barrier contraception. Spermicidal agents currently available have not been shown to reduce HIV concentrations in genital secretions, or to reduce transmission of the virus. The challenges that lie ahead are tremendous: we must continue to focus on development of affordable preventive measures; urge policy-makers to back further research in prevention to complement condom use; and advocate for continued support of basic research to learn more about fundamental mechanisms of HIV transmission.
AIDS-Related Opportunistic Infections↗
Massive pleomorphic adenoma of the maxillary sinus. A case report.
A case of pleomorphic adenoma of the maxillary sinus in a 78-year-old man with associated mucocele is reported. The diagnosis and treatment of this rare lesion is discussed.
Adenoma, Pleomorphic↗
Incidence of epidural catheter replacement in parturients: a retrospective chart review.
We noted in our practice of obstetric anesthesia at a large teaching hospital that the epidural catheter failure rate was higher than previously reported. We undertook this study to determine the incidence of epidural catheter failure in parturients and to determine the primary causes of failure. After institutional approval, we evaluated the charts of parturients who received epidural analgesia for labor or anesthesia for cesarean section for 6 randomly selected months spanning one year. We examined 4240 anesthesia records for patient-related data, operator-related data (years of training) and technical information. The participants were unaware there was a study in progress, and data were collected in a systematic fashion so as to minimize data collection related biases. Chi2, Mantel-Haenszel chi2, analysis of variance and univariate logistic regression were used to analyze data. P<0.05 was considered statistically significant. Overall epidural catheter failure rate was 13.1% with a dural puncture rate of 1.03%. The major causes of catheter failure were no analgesia and unilateral block. The experience of the anesthesiologist, the mode of delivery, patient age, patient weight, type of epidural catheter, occurrence of paresthesia and the use of CSE were all associated with significantly different epidural catheter replacement rates. Despite the initially high failure rate, the overall patient satisfaction rate was greater than 98%.
Journal Article↗