Biomedical subjects
J Savage
Publications and source records attributed to J Savage.
Randomized trial of amniotomy in labour versus the intention to leave membranes intact until the second stage.
OBJECTIVE: To compare by randomized prospective clinical trial the outcome of labours which are managed with the intention to leave the membranes intact, compared with the practice of elective artificial rupture of the membranes (ARM) in early established labour. DESIGN: Prospective randomized controlled trial of low risk women admitted in spontaneous labour, with intact membranes. SETTING: The labour ward of St. James's University Hospital, Leeds, UK. SUBJECTS: 362 women in spontaneous labour with intact membranes and no evidence of fetal distress, between 37 and 42 weeks gestation. During the course of the trial it was found that some randomization cards could not be accounted for and a system of daily checks was instituted. The results were analysed for all recorded women (n = 362) and after institution of the more rigorous system (n = 120). MAIN OUTCOMES MEASURED: The duration of each phase of labour, epidural rate, prevalence of an abnormal cardiotocograph (CTG) (assessed blind), method of delivery and neonatal outcome. RESULTS: 178 of the 183 women (97%) in the ARM group had their membranes ruptured in early labour, and 83 (46%) of the 179 women allocated to non-intervention had ARM performed at some stage. A significant decrease in the duration of labour (mean 8.3, SD 4.1 h vs mean 9.7, SD 4.8 h, n = 156; P = 0.05) was found amongst primigravidae allocated to ARM when compared with non intervention. The duration of the second stage of labour was unaffected. In the ARM group the epidural rate was higher and labour was more often complicated by CTG abnormalities. There were no differences in the method of delivery, fetal condition at birth (cord blood lactate, Apgar score) or postpartum pyrexia between the ARM and non-intervention groups. The same trends were observed when analysis was confined to women entered into the trial after the system of rigour was instituted. CONCLUSION: Routine ARM results in labour that is slightly shorter than if the membranes are allowed to rupture spontaneously but more epidurals are used suggesting that labour is more painful. There are fewer fetal heart rate abnormalities if the membranes are left intact but amniotomy has no effect on fetal condition at birth.
Intraplacental sonolucent spaces: incidences and relevance to chorionic villus sampling.
Detailed ultrasound examination of the placentae from 293 consecutive women requesting first-trimester chorionic villus sampling (CVS) showed evidence of intraplacental sonolucent spaces with varying density in 42.3 per cent of these placentae. Their presence, however, did not complicate the subsequent course of these women's pregnancies. Their prime significance relates to CVS, where inadvertent entry into these areas can lead to bleeding and contamination of the villus specimens with blood. A search for these spaces should be made before sampling, and when present, they should be avoided wherever possible.
The influence of structural modifications of dihydrophenazines on arachidonic acid mobilization and superoxide generation by human neutrophils.
In this study the effects of nine dihydrophenazine derivatives, relative to clofazimine (B663), on the N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP) stimulated release of superoxide anion and on the spontaneous generation of arachidonic acid by human neutrophils were investigated. Previous findings that the pro-oxidative activity of the agents depended largely on the substitution in position 2 of the phenazine molecule and on chlorination in the paraposition of the phenyl and anilino rings were confirmed. Only riminophenazines, but not aposafranone derivatives or the imidazophenazine B621, could enhance superoxide release from activated neutrophils. The lack of chlorination of the phenyl and anilino rings could be compensated for by chlorine substitution in position 7 of the phenazine core. The priming effect of the agents on FMLP stimulated superoxide generation was completely prevented by the phospholipase A2 inhibitor 4-p-bromophenacyl bromide. Furthermore pro-oxidative activities correlated closely with a stimulatory effect of the agents on arachidonic acid release. It was therefore concluded that dihydrophenazine derivatives with pro-oxidative properties can prime neutrophils for FMLP-stimulated superoxide release by modulation of phospholipase A2 activity.
Analysis of the heterogeneity of the binding site specificities of hyperimmune human anti-A and -A, B sera: the application of competition assays using murine monoclonal antibodies.
Monoclonal antibodies PL41 and AL62 have previously been shown to recognize two distinct blood group A epitopes on the red cell surface. Competitive inhibition of the binding of 125I-PL41 and 125I-AL62 to group A1 red cells, by hyperimmune polyclonal human antibodies, has been employed to investigate the binding site specificities of 15 anti-A and 8 anti-A,B sera. Differences in the degree of inhibition of the binding of the two MABs by individual anti-A or -A,B samples indicate that polyclonal reagents are composed of varying proportions of up to 3 (or more) different antibody specificities, each recognizing a distinct epitope: PL41-like, AL62-like and a third (as yet undefined) category of antibody. In general, those anti-A sera with PL41-like specificities are superior agglutinators of A2B cells with weakly expressed A antigens; similarly, the specificity of potent anti-A,B, sera capable of strongly agglutinating Ax cells was likewise directed towards PL41-binding blood group A trisaccharide haptens.
Energy expenditure and intake in infants born to lean and overweight mothers.
We investigated the contributions of low energy expenditure and high energy intake to excessive weight gain in infants born to overweight mothers. The subjects were infants of 6 lean and 12 overweight mothers, recruited soon after birth. Total energy expenditure and metabolizable energy intake were measured with a new doubly labeled water method over a period of seven days when the infants were 3 months of age, and the postprandial metabolic rate was measured by indirect calorimetry when the infants were 0.1 and 3 months of age. The results were related to weight gain in the first year of life. No significant difference was observed between infants who became overweight by the age of one year (50 percent of infants born to overweight mothers) and those who did not, with respect to weight, length, skinfold thicknesses, metabolic rate at 0.1 and 3 months of age, and metabolizable energy intake at 3 months. However, total energy expenditure at three months of age was 20.7 percent lower in the infants who became overweight than in the other infants (means +/- SE, 256 +/- 27 and 323 +/- 12 kJ per kilogram of body weight per day; P less than 0.05). This difference could account for the mean difference in weight gain. These data suggest that reduced energy expenditure, particularly on physical activity, was an important factor in the rapid weight gain during the first year of life in infants born to overweight mothers.
Is routine antenatal booking vaginal examination necessary for reasons other than cervical cytology if ultrasound examination is planned?
Sixteen ovarian cysts, including one borderline ovarian malignancy, and ten trichomonal vaginal discharges but no cases of cervical incompetence or ectopic pregnancy had been detected at booking vaginal examination in 11,622 consecutive antenatal case records abstracted retrospectively. In an attitude survey of pregnant women 77% believed that vaginal examination was reassuring, 55% found it unpleasant, and 18% thought it could cause miscarriage. This, and a review of the literature, suggests that routine vaginal examination if ultrasound is planned has few advantages beyond the taking of a cervical smear.
Effect of weaning on accuracy of doubly labeled water method in infants.
Variations in background 2H and 18O abundances in body water influence the accuracy and precision of the 2H218O method for determination of energy expenditure. To investigate the effect of weaning during infancy on background 2H and 18O abundances, urine samples from 44 breast- or formula-fed infants aged 5-16 wk were analyzed. 2H and 18O abundances were significantly higher (P less than 0.001) in breast- than in formula-fed infants. The relationship between 2H and 18O abundances was linear and independent of diet [slope, 4.16 +/- 0.43 (SE)]. By use of this information, the effect of weaning on the accuracy of the 2H218O method was evaluated, taking into account the effect of 2H-18O abundances in the isotope loading dose. In infants weaned completely from breast milk to formula during the measurement, energy expenditure can be overestimated by 18.0%, even if 2H-18O abundances in the isotope dose equal the ratio of naturally occurring background changes. However, this error can be reduced to less than 3.0% by manipulating the study duration and isotope dose. During gradual weaning, the overestimation of energy expenditure is only 0.3-2.0%.
Recommended standard theophylline doses are inadequate in chronic obstructive pulmonary disease.
Theophylline serum levels were measured in 34 adult patients suffering from chronic obstructive pulmonary disease. It was not possible to establish a simple relationship between the dose of theophylline and the serum levels measured. Only 53% of peak concentrations and 40% of trough concentrations were found to be within the recommended therapeutic range. In 82% of patients studied, two or more drugs in addition to theophylline, were required for adequate bronchodilation. For optimisation of theophylline therapy, the importance of measuring serum theophylline levels is stressed.
Adenocarcinoma of the endometrium with trophoblastic differentiation and metastases as choriocarcinoma: a case report.
Nongestational choriocarcinoma is seldom observed outside of gonads or teratomas. No case of choriocarcinoma arising in endometrium is reported in the literature. Here we present a 70-year-old female with endometrial adenocarcinoma focally differentiating to choriocarcinoma, and metastasizing to liver, kidney, brain, and lung as pure choriocarcinoma. Foci of trophoblastic differentiation in the primary endometrial lesion and metastatic lesions are positive for hCG by immunocytochemical stain. This case is similar to gastrointestinal and lung carcinomas that contain trophoblastic change. Possible histogenesis of this tumor is discussed.
Does lambswool promote growth in preterm infants?
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Metabolism of high density lipoproteins by the perfused rabbit liver.
The role of the liver in the catabolism of high density lipoproteins (HDL) was examined in isolated perfused rabbit livers. Using 125I-labeled rabbit HDL the disappearance of labeled apolipoproteins from the perfusate was biphasic with 7% of the label removed after 20 min and a further 6% between 20 and 90 min. In contrast, with HDL labeled with [3H]cholesteryl esters 35% of label had been removed after 90 min. The effect of liver perfusion on HDL size and composition was further studied by recirculating rabbit HDL for 120 min. In control experiments HDL was incubated at 37 degrees C for 120 min with nonperfused media and with media that had been liver perfused. The added HDL was predominantly particles of 4.8-4.9-mm radius, and incubation with nonperfused and preperfused media produced no significant change in size. However, liver perfusion resulted in particles predominantly 4.2-4.3-mm radius. Hepatic perfusion also significantly reduced HDL cholesteryl ester composition as a percentage of lipoproteins mass from 13.3 +/- 2.2% in control incubations to 10.7 +/- 3.1% (p less than 0.001), and cholesteryl ester:protein mass ratio was reduced from 0.31 +/- 0.06 in control to 0.24 +/- 0.10 (p less than 0.001) after 120 min of liver perfusion. Thus interaction of rabbit HDL with rabbit liver results in smaller HDL particles significantly depleted of core cholesteryl esters.
Secretion of cholesteryl ester-enriched very low density lipoproteins by the liver of cholesterol-fed rabbits.
The output of lipids and lipoproteins by isolated perfused livers of normal-fed and cholesterol-fed rabbits has been examined. There was a comparable output of triglyceride by the livers of both groups, resulting in an accumulation of 40-50 mg triglyceride/liver/2 h in the perfusate in each case. The output of cholesteryl esters, however, was very much greater from the livers of cholesterol-fed (45 mg/liver/2 h) than from normal-fed (3.3 mg/liver/2 h) rabbits. The major lipoproteins in liver perfusates from both groups of animals were very low density lipoproteins (VLDL). In the perfusate of normal livers the VLDL were enriched with triglyceride and depleted of cholesteryl esters when compared with plasma VLDL from normal animals. VLDL in the perfusate of livers from cholesterol-fed rabbits, on the other hand, were markedly enriched with cholesteryl esters; cholesteryl esters accounted for 33% by mass of VLDL from cholesterol-fed livers and only 3.1% of VLDL from normal livers. The cholesteryl esters in the plasma lipoproteins of cholesterol-fed rabbits were relatively enriched with cholesteryl oleate when compared to those in normal plasma. Similarly, cholesteryl oleate predominated in the VLDL in the liver perfusate of the cholesterol-fed animals, consistent with an hepatic acyl CoA/cholesterol acyltransferase origin. Thus, cholesterol-feeding in the rabbit results in a marked increase in the hepatic secretion of cholesteryl esters as a component of VLDL.
Community nursing: a third hand for the arthritic.
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The student nurse of today--the qualified nurse of tomorrow.
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Norethisterone oenanthate as an injectable contraceptive: use of a modified dose schedule.
Norethisterone oenanthate (NET-OEN) was given as an injectable contraceptive to 295 healthy women over 1606 woman-months. A modified injection schedule was used. There were no pregnancies, and the 12-month, life-table, use-related discontinuation rate was 39.1/100 users. Menstrual disturbance (10.8/100 women), minor side effects (13.5/100 women), and personal reasons (12.0/100 women) were the main causes of use-related discontinuation. There was no difference in use-related discontinuation rates between women receiving their first injection during a normal menstrual period and those receiving it immediately after a pregnancy. There were no serious side effects. The use of NET-OEN in certain groups of women is recommended, particularly in those in need of highly effective contraception, who cannot or do not wish to take oral contraceptives, who are lactating, or who are awaiting hospital admission for sterilisation.
Norethisterone oenanthate as an injectable contraceptive: a study of patients discontinuing treatment.
Two hundred and ninety-five women were enrolled in a study of norethisterone oenanthate (NET-OEN) as an injectable contraceptive. One hundred and twenty-four patients who discontinued this contraceptive have been studied in detail. The main reasons for use-related closures of method were menstrual abnormality (22 patients), minor side-effects (23 patients), personal reasons (22 patients) with 18-month life-table net discontinuation rates of 14.7/100 women, 13.5/100 women, 14.2/100 women. There were no accidental pregnancies. The probability of discontinuing treatment was not affected by age, parity, time of starting treatment or previous contraception. Sixty-nine per cent of all discontinuations occurred in the first four months of treatment. There were no serious complications.
Localized crusting as an artefact.
Four patients are reported, two with gross crusting of the nose and two with gross crusting of the lips considered to be artefacts. The crusting was easily removed using soft paraffin or Viscopaste.