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PubMed2000

[Multiple pregnancy as a cause of premature delivery].

Authors analysed management, complications and outcome of 13 multifetal pregnancies (11 triplet and 2 quadruplet), their duration, the way of delivery, indications for cesarean section and perinatal mortality rate. A majority of the multifetal pregnancies were diagnosed before the end of 20 weeks gestation, and 69.2% of women had cervical cerclages. Tocolysis was used in 9 cases (69.2%). The mean gestational age at delivery was 32.8 weeks. Cesarean section was performed in nine cases (29 neonates). Of the 41 neonates there were 2 stillbirth (4.88%) and 3 neonatal death (7.31%). In 87.9% of cases, delivery occurred before the end of 37 weeks gestation. The most common maternal complications were toxemia (23.1%) and anemia (46.2%).

Adult↗
PubMed1976

Respiratory rhythmicity in the cat.

Brain stem respiratory neuron activity in the cat was studied in relation to efferent outflow (phrenic discharge) under the influence of several forcing inputs: 1) CO2 tension: hypocapnia produces disappearance of firing in some neurons, and conversion of respiratory-modulated to continuous (tonic) firing in others. 2) Lung inflation: during the Bruer-Hering reflex, some neurons have "classical" responses and others have "paradoxical" responses (i.e., opposite in direction to peripheral discharge). 3) Electrical stimulation: stimulus trains to the pneumotaxic center region (rostral lateral pons) produce phase-switching, whose threshold is: a) sharp (indicating action of positive-feedback mechanisms), and b) dependent on timing of stimulus delivery (indicating continuous excitability changes during each respiratory phase). Auto- and crosscorrelation analysis revealed the existence of short-term interactions between: a) medullary inspiratory (I) neurons and phrenic motoneurons; b) pairs of medullary I neurons; c) medullary I neurons and expiratory (E) neurons. A model of the respiratory oscillator is presented, in which the processes of conversion of tonic to phasic activity and switching of the respiratory phases are explained by recurrent excitatory and inhibitory loops.

Action Potentials↗
PubMed1992

[Delivery of neonates with a birth weight of less than 1500 grams. Perinatal results during a 6-year period and possibilities of affecting them].

The authors evaluated the perinatal mortality and condition on delivery of 167 neonates with a birth weight under 1500 g who were delivered and hospitalized at the 2nd Department of Gynecology and Obstetrics in Brno between Jan. 1, 1985 and Dec. 31, 1990. The perinatal mortality of neonates with a birth weight below 1000 g was 73.1%, of those with a birth weight 1000 g-1500 g it was 25.9%. Early neonatal mortality was not influenced by the patient's age exceeding 30 years, occupation, environment, status, number of interrupted pregnancies, spontaneous abortions and previous spontaneous and induced deliveries, administration of tocolysis, corticoids, the position of the foetus, transport in utero, way of delivery, indication for Caesarean section and sex. Early neonatal mortality was influenced by the mother's age less than 20 years, administration of antibiotics, multiple pregnancy, grade of asphyxia, presence of RDS, necessity of respiratory support, incidence of intracerebral haemorrhage and birth trauma. In the discussion the authors mention possible ways of reducing the perinatal morbidity and early neonatal morbidity in the mentioned range of birth weights.

Adult↗
PubMedDate not supplied

[Renal regulation of sodium excretion in experimental heart failure: study of hemodynamics and renal tubular function].

This study was designed to evaluate the role of the kidney on sodium retention in congestive heart failure by clearance and hemodynamic studies. Twenty seven dogs were studied during hydropenia and aqueous diuresis 96 hours after the construction of a bilateral femoral A-V fistula, in 3 periods: 1) with open fistulae; 2) with closed fistulae and 3) with reopened fistulae. The animals retained sodium and water and developed edema during the first period when the fistulae were opened. Closure of the AV fistulae produced an enhanced diuresis and natriuresis associated with an increase in phosphaturia and distal sodium delivery, suggesting a diminished proximal sodium reabsorption. However, when the fistulae were reopened, sodium retention was observed in the presence of an increase in free-water clearance corrected by distal sodium delivery, indicating an increase in sodium reabsorption by distal segments. These findings were not associated with alterations in cortical distribution of renal blood flow. In conclusion, the sodium and water retention in congestive heart failure produced by A-V fistula is due to an increase in sodium reabsorption by the distal nephron segments, and it is not associated to a redistribution of the cortical renal blood flow.

Animals↗
PubMed1991

Prediction of pregnancy-induced hypertension by a combination of rollover test and Doppler flow velocity measurement.

Following a rollover test performed in 306 nulliparous women in the 28th gestational week, Doppler flow velocity studies were conducted in all 34 women with positive rollover findings and in 67 women selected at random from those with negative findings. The mean systolic diastolic ratios in both the uterine and the umbilical arteries were significantly higher in women with positive rollover findings than in the control group. A review of the patients' medical records after delivery, indicated that this combined two-stage screening approach--a rollover test followed by a Doppler flow study--improved the predictive value and the sensitivity of the screening procedure from 35% and 39% respectively for the rollover test alone, to 56% and 50% with no decline in specificity. The sensitivity of the Doppler flow test as a single one among the 101 flow-studied women was higher--61%. However, broader studies are needed in order to establish its superiority as a single test for early prediction of pregnancy-induced hypertension.

Adult↗
PubMedDate not supplied

Venous dysfunction of late pregnancy persists after delivery.

Pregnancy is associated with DVT, pelvic thrombophlebitis, and lower extremity varicosities. Pelvic venous compression by the gravid uterus is blamed. A prospective controlled study using plethysmography was performed. Venous capacitance and outflow were measured at term, and at 1 week, 6 weeks and 3 months following delivery. Results show decreased venous capacitance and venous outflow at term pregnancy, no improvement 1 week after delivery, modest improvement at 6 weeks, and dramatic statistically significant improvement in both parameters by 3 months. The persistence of venous dysfunction for several weeks after delivery indicates that changes in venous function at term pregnancy are largely the result of factors other than pelvic venous compression by the gravid uterus.

Female↗
PubMed1986

[Prognostic significance of heart rate accelerations of the fetus in the first stage of labor].

The clinical data and the cardiotocograms of 232 low-risk-deliveries and that of 344 cases of high risk deliveries (98 premature deliveries, 102 cases with meconium stained amniotic fluid, 86 cases with EPH gestosis and 58 cases of fetal distress necessitating emergency cesarean section) have been studied. It is concluded that the fetal heart rate accelerations even in cases of high risk pregnancies and deliveries indicate a good fetal state and a good neonatal outcome. In the presence of both of decelerations and accelerations the fetal state is still good. In the presence of accelerations the low- and high risk deliveries (except the premature deliveries) have a similarly good prognosis. In the lack of accelerations the neonatal mortality, the frequency of resuscitations is higher, and the low Apgar-scores are commoner.

Asphyxia Neonatorum↗
PubMed1985

Defective IFN-gamma production in the human neonate. I. Dysregulation rather than intrinsic abnormality.

Cord blood leukocytes (CBL) stimulated with PHA, Con A, or with the monoclonal antibody OKT3 proliferate normally but produce very low titers of IFN-gamma. This defect was not observed with maternal leukocytes collected at the time of delivery, indicating that the defective production of IFN-gamma in CBL is not a mere consequence of a hormonal change associated with labor. CBL produced large amounts of IFN-gamma (comparable to those observed in adult control and in mothers) after stimulation with staphylococcal enterotoxin A (SEA). Furthermore, gamma-irradiation with as little as 500 or 1000 rad, or incubation at 37 degrees C for 24 hr, reversed the defect in PHA-induced IFN-gamma secretion. This finding indicates that the defective secretion of IFN-gamma of CBL is not intrinsic, but rather is the consequence of a subtle dysregulation. We could not find evidence for a defective accessory function with cord blood monocytes, because the addition of adherent cells from adult donors did not reverse the defect. In co-cultures of adult leukocytes and CBL, PHA-induced IFN-gamma secretion was comparable to that of adult cultures tested alone. Nonirradiated CBL were not able to suppress IFN-gamma secretion by irradiated autologous leukocytes. Together, our results suggest that the defective PHA-induced IFN-gamma secretion of CBL is the result of an original type of dysregulation and is associated with an excessive sensitivity to suppressive signals rather than excessive suppressor function.

Adult↗
PubMed1984

Renal water handling in minimal change nephrotic syndrome.

Renal water handling was studied in proteinuric and non-proteinuric phase in 25 children with minimal change nephrotic syndrome. Clearance of inulin was determined during water diuresis and in hypodropenia followed by intravenous saline infusion. The diluting capacity, evaluated both as minimal urinary osmolality and as free water clearance did not differ from that in controls. An inverse correlation was found between distal tubular sodium delivery and serum albumin concentration during proteinuric phase. The concentrating capacity, evaluated as maximal urinary osmolality did not differ in proteinuric and non-proteinuric phase. Free water reabsorption, however, was significantly lower in proteinuric phase than in remission. The correlation of severe hypoalbuminemia with high distal tubular sodium delivery indicates a decrease in proximal sodium reabsorption in proteinuric phase, and the normal diluting capacity supports an intact, probably increased, distal tubular sodium reabsorption. The normal ability to excrete a water load suggests that the water retention in the nephrotic syndrome is secondary to sodium retention.

Adolescent↗
PubMed1978

[Effect of pathological liver values in late pregnancy on the course of pregnancy and on the status of the child].

In the years 1970 to 1975 90 out of 75213 women had the delivery in the infections delivery-room of the Municipal Clinics Berlin-Buch on account of suspected hepatitis infectiosa, i.e. 1,2 0/00. There was an increased prematurity in 15,6%, dysmaturity in 7,8% as well as necessity for operative delivery indicated by the child itself in 10%. That means a reduced function of placenta. In no case a specific damage to the child was to be found.

Berlin↗
PubMed1984

[Studies on the early diagnosis of endometrial carcinoma. Analysis of risk factors and cytological approach].

Clinical, cytological and hormonal studies were performed on 86 cases of endometrial carcinoma and 34 cases of endometrial hyperplasia for their early diagnosis. 68.6% of the endometrial carcinomas were in patients aged 50 to 64 and 3.5% in patients under 45 ages. The figures 17.4% infertility, 20.9% no delivery and 19.8% only one delivery indicate that endometrial carcinoma is associated with no birth or the birth of few child. Almost all cases of endometrial carcinoma had existed for more than ten years since the last pregnancy, when the lesions were detected. 20.9% of endometrial carcinomas belonged to premenopause and 24.4% to within the first 5 years following menopause. In total, 45.3% of them range around menopause and hormonal imbalance in climacteric periods. Clinical stages of endometrial carcinoma revealed no relation to enlargement of the uterus. 61.4% of endometrial carcinoma were found in obese patients. 63.1% of them showed abnormal glucose tolerance titers and preclinical lesions. Hypertension was found in 28.0% of them, but we did not consider it very significant, considering their advanced age. The serum steroid level indicated no hyperestrogenism in endometrial carcinoma. Diagnostic data showing positive and suspecious smears in endometrial carcinoma were 36.5% in vaginal, 67.5% in cervical and 84.3% in endometrial cytology. This means that direct sampling of cells from the uterine cavity is essential in the detection of endometrial carcinoma. The cytological features of endometrial carcinoma were nuclear enlargement, anisokaryosis, irregular distribution of chromatin and prominent nucleoli. Undifferentiated types of endometrial carcinoma were more characterized by these factors than differentiated types.

Adult↗
PubMed1981

Cesarean section indication and the risk of respiratory distress syndrome.

The frequency of respiratory distress syndrome (RDS) was assessed according to indications for delivery and the presence of antecedent labor among 236 newborns delivered by cesarean section. The presence of labor preceding cesarean section did not reduce the risk of RDS significantly, although a trend, not statistically significant, was noted in this direction. Of the delivery indications evaluated, only abruptio placentae appeared to be associated with an increased risk of RDS. However, prematurity was shown to be a possible confounding variable in this regard. These data suggest that the risk of RDS associated with cesarean section is related to the mode of delivery per se and not necessarily to any of the associated factors evaluated in this study.

Birth Weight↗
PubMed1980

Guaifenesin: cardiopulmonary effects and plasma concentrations in horses.

We determined the cardiopulmonary changes in horses given guaifenesin alone and in the same horses given xylazine (IV) immediately before administration of guaifenesin. In addition, plasma guaifenesin concentrations were determined in horses and 2 pregnant mares and compared with previously published values in ponies. The dose of guaifenesin necessary to produce lateral recumbency in adult horses was 134 +/- 34 mg/kg (mean +/- SD). The administration of guaifenesin caused insignificant (P less than 0.05) changes in heart rate, respiratory rate, right atrial pressure, pulmonary arterial pressure, and cardiac output. Systolic, diastolic, and mean arterial blood pressures were significantly (P less than 0.05) decreased. Arterial partial pressure of oxygen (PaO2) was transiently, but significantly (P less than 0.05), reduced. The administration of xylazine (IV) to the horses before they were given guaifenesin reduced the dose of guaifenesin necessary to produce lateral recumbency to 88 +/- 10 mg/kg. In these horses, there were significant transient decreases in heart rate, respiratory rate, cardiac output, and PaO2. Central venous pressure remained significantly (P less than 0.05) increased, whereas systolic, diastolic, and mean arterial blood pressures were significantly (P less than 0.05) decreased at all times. In horses given guaifenesin alone, plasma concentrations at the time of lateral recumbency were 313 +/- 108 microgram/ml, and in those given xylazine-guaifenesin, the concentrations of the drug were 277 +/- 83 microgram/ml. Neonatal concentrations of guaifenesin were approximately 30% of that of the mare immediately after delivery, indicating that significant amounts of guaifenesin cross the placental barrier in the mare.

Animals↗
PubMed1981

Surgical separation of conjoined (Siamese) xiphopagus twins.

Conjoined twins of the xiphopagus type have been separated 24 hours after spontaneous delivery. Indication for early intervention was impending rupture of a large omphalocele as well as deterioration of one severely malformed twin who did not survive surgery, whereas the other one showed normal development up to 15 months after separation.

Abnormalities, Multiple↗
PubMed1981

Development and testing of an automated food dispenser for small rodents.

An automated feeder system capable of delivering variable quantities of ground stock diet at predetermined time intervals was developed. The system consisted of feeder units activated by a solenoid connected to a sliding food chamber, a wiring harness, and a control unit. Testing for reproducibility of food delivery indicated reliable and consistent results with a coefficient of variation not exceeding 3% for multiple consecutive deliveries. Field testing in an actual feeding experiment with 35 rats in seven groups showed remarkable adherence to preset conditions. No untoward effects were observed when one group of free-eating, ad libitum fed rats was compared to another group fed unrestricted amounts of feed by the automated feeder. The feeder system was versatile, reliable, and easily adjustable to animal room environments.

Animal Feed↗
PubMed1993

A randomized trial of extra-amniotic saline infusion plus intracervical Foley catheter balloon versus prostaglandin E2 vaginal gel for ripening the cervix and inducing labor in patients with unfavorable cervices.

OBJECTIVE: To compare the efficacy of extra-amniotic saline solution infusion plus an intracervical Foley catheter balloon versus 2.85 mg prostaglandin (PG) E2 vaginal gel in ripening the cervix, inducing labor, and achieving vaginal delivery in patients at term with an unfavorable cervix. METHODS: A randomized study of the two methods was performed in 112 patients with a Bishop score of 5 or less. RESULTS: Extra-amniotic saline infusion plus intracervical Foley catheter balloon was more effective than PGE2 vaginal gel in causing cervical ripening (relative risk [RR] 2.5965, 95% confidence interval [CI] 1.7277-3.9022, exact two-tailed P = .000001) and in inducing labor (RR 4.3333, 95% CI 1.7223-10.9026, exact two-tailed P = .0000181). However, the final delivery outcome was an equally high number of cesarean deliveries (26 of 56, or 46.4%) for both methods. Maternal and neonatal complications were minimal and not significantly different. CONCLUSIONS: Extra-amniotic saline infusion with a Foley catheter was more effective than 2.85 mg PGE2 vaginal gel in ripening the cervix and inducing labor. These advantages did not translate into a large number of vaginal deliveries, indicating that factors other than cervical ripening may be responsible for the high incidence of cesarean in patients with an unfavorable cervix.

Administration, Intravaginal↗
PubMed1997

Thrombophlebitis and varicosis syndrome in pregnancy.

Venous stasis of the lower limbs is common in pregnancy; the thromboembolic complications are 1 in 1000 and become reduplicated in puerperium. The management of 13 patients with deep venous thrombophlebitis of the lower limbs during pregnancy, the fetal outcome and delivery were evaluated retrospectively. The delivery indications were the classic ones. Therapy was administration of calcium heparin and an angio-protector like diosmina. Good results, whether fetal outcome or mother morbidity in puerperium, were obtained.

Adolescent↗
PubMedDate not supplied

Using a program logic model that focuses on performance measurement to develop a program.

A program logic model is used to make a program ready for an evaluation. It diagrammatically shows the relationships between the objectives of the program, program activities, indicators, and resources. This article describes an expanded logic model that has a greater focus on measurement of program performance. The expanded logic model specifies both outcome and process indicators, whereas other logic models only show service delivery indicators. Also, this article describes how the expanded logic model was used to develop a bicycle safety program. A workgroup established program boundaries and reviewed documents early in the process of developing the logic model. The workgroup developed the logic model which was subsequently reviewed by other stakeholders. The workgroup continually assessed the plausibility of the logic model. Challenges and advantages in using the logic model are discussed.

Accidents, Traffic↗