Biomedical subjects

M Hallak

Publications and source records attributed to M Hallak.

At least 37 records · Page 2Linked to original sources

PubMed2001

Albumin-dependent digoxin transfer in isolated perfused human placenta.

OBJECTIVE: To determine the effects of albumin (BSA) concentration in perfusion medium on digoxin transfer in isolated perfused human placental cotyledon. STUDY DESIGN: Isolated placental cotyledons from 13 normal human placentas were dually perfused after cannulating artery and vein of the chorionic plate and piercing 4 catheters through the corresponding basal plate with M199 medium enriched with BSA and glucose. Flow rates were 12 and 6 ml/min in the maternal and fetal circuits, respectively. Digoxin was added to the maternal reservoir at a final concentration of 5.51 +/- 1.00 ng/ml. BSA in maternal and fetal perfusate was kept at 3 concentrations: 1, 3 and 5 mg/ml (Groups I, II, III). Transplacental passage of digoxin was calculated from repeated fetal and maternal perfusate samples collected over 3 hours in the 3 groups. Digoxin levels were measured by FPIA (TDx, Abbott). RESULTS: There was no transfer of digoxin from the maternal to fetal compartment when the concentration of BSA was 1 mg/ml. Increasing the concentration of BSA led to a substantial increase in the transfer of digoxin to the fetal compartment. Steady state levels of digoxin in the fetal compartment were 0.61 +/- 0.19 ng/ml at 3 mg/ml of BSA. CONCLUSION: Maternal and fetal serum concentration of BSA affect digoxin transfer in isolated perfused human placentas. Three mg/ml are considered to be the optimal albumin concentration.

Analysis of Variance↗

PubMed2001

Lack of prenatal care in a traditional society. Is it an obstetric hazard?

OBJECTIVE: To examine the association between lack of prenatal care (fewer than three visits at any prenatal care facility) and perinatal complications in the Bedouin parturient population where lack of prenatal care is not associated with absence of prenatal services, substance abuse or marital status. STUDY DESIGN: The study population consisted of all Bedouin women lacking prenatal care (n = 7,601) who gave birth between the years 1990-1997 in the Soroka University Medical Center. The analysis consisted of a comparison of labor and delivery outcomes in women without prenatal care to outcomes in women who had some prenatal care. RESULTS: During the years 1990-1997 there were 36,281 singleton deliveries to Bedouin women at our institution. Of those, 20.9% did not receive prenatal care. Mothers in the no-prenatal-care group tended to be in the extremes of their reproductive cycles (< 18 years, > 35 years) and were of higher parity (P < .001) than those receiving prenatal care. There were more deliveries prior to 32 weeks of gestation in the no-prenatal-care group (2.8%) in comparison to the prenatal care group (1.5%, P < .001) and fewer postterm deliveries (> 42 weeks, P < .01). The incidence of low birth weight (< 2,500 g) in the no-prenatal-care group was higher than in the prenatal-care group (11.2% vs. 8.4%, P < .001). Women who did not receive adequate prenatal care had statistically significantly higher rates of antepartum fetal death (OR = 1.8, 95% CI 1.4-2.3, P < .001), intrapartum fetal death (OR = 2.38, 95% CI 1.2-4.5, P < .03) and postpartum fetal death (OR = 1.60, 95% CI 1.2-2.1, P < .001). Multiple logistic regression models were used to analyze the independent contribution of lack of prenatal care to perinatal mortality and to very-low-birth-weight newborns. In both models lack of prenatal care was an independent contributing factor. CONCLUSION: Lack of prenatal care is an independent contributor to perinatal mortality and low birth weight in a traditional society. In light of the high percentage of lack of prenatal care in Bedouin society, special attempts should be made to encourage women to use the available prenatal services.

Adolescent↗

PubMed2001

Failed vacuum extraction. Maternal risk factors and pregnancy outcome.

OBJECTIVE: To evaluate obstetric risk factors associated with a failed trial of vacuum extraction and to assess its pregnancy outcome. STUDY DESIGN: All attempted vacuum extractions between the years 1990 and 1998 were identified, and a comparison of successful and failed trials of vacuum extraction in singleton, vertex deliveries was performed. RESULTS: Of 2,111 trials of vacuum extraction, 113 (5.4%) cases were complicated by failed extraction and underwent cesarean section. Those neonates were significantly more likely to be large for gestational age, specifically to weigh > 4,000 g as compared to the controls. Patients lacking prenatal care had significantly higher rates of failed vacuum extraction trials. While cervical and uterine tears were rather rare, parturients who had failed trials of vacuum extraction had significantly higher rates of cervical and uterine tears as compared to those with successful vacuum extractions. This association remained significant after controlling for a previous cesarean section using the Mantel-Hanszel technique. Women from the failed vacuum extraction group had significantly higher rates of postpartum anemia. Pregnancies complicated by failed vacuum extraction had significantly higher rates of intrapartum and postpartum fetal death. Those neonates had significantly higher rates of Apgar scores < 7 at one and five minutes. CONCLUSION: Failed trial of vacuum extraction is associated with adverse maternal and fetal outcomes. Risk factors associated with such failures are fetal weight and lack of prenatal care. Thus, careful estimation of fetal weight should be performed before the procedure, and estimated fetal weight > 4,000 g might be considered a relative contraindication to vacuum extraction, especially among patients who did not have prenatal care.

Adolescent↗

PubMed2001

Risk factors for antepartum fetal death.

OBJECTIVE: To determine the demographic, maternal, pregnancy-related and fetal risk factors for antepartum fetal death (APFD). STUDY DESIGN: From our perinatal database between the years 1990 and 1997, 68,870 singleton birth files were analyzed. Fetuses weighing < 1,000 g at birth and those with structural malformations and/or known chromosomal anomalies were excluded from the study. In order to determine independent factors contributing to APFD, a multiple logistic regression model was constructed. RESULTS: During the study period there were 246 cases of APFD (3.6 per 1,000 births). The following obstetric factors significantly correlated with APFD in a multiple logistic regression model: preterm deliveries: small size for gestational age (SGA), multiparity (> 5 deliveries), oligohydramnios, placental abruption, umbilical cord complications (cord around the neck and true knot of cord), pathologic presentations (nonvertex) and meconium-stained amniotic fluid. APFD was not significantly associated with advanced maternal age. CONCLUSION: APFD was significantly associated with several risk factors. Placental and umbilical cord pathologies might be the direct cause of death. Grand multiparity, oligohydramnios, meconium-stained amniotic fluid, pathologic presentations and suspected SGA should be carefully evaluated during pregnancy in order to decrease the incidence of APFD.

Adult↗

PubMed2001

Accidental vaginal incision during cesarean section. A report of four cases.

BACKGROUND: Transverse vaginal incision during cesarean section, also known as anterior vaginotomy, is a recognized entity, mostly made unintentionally. CASES: At our institution, four patients underwent a transverse vaginal incision during cesarean section over an eight-year period. In three of them, excessive bleeding required blood transfusion. In one case, only hypogastric artery ligation resulted in bleeding control. None of the patients had subsequent vaginal deliveries. CONCLUSION: The exact incidence of anterior vaginotomy is difficult to evaluate. Accidental vaginal incision occurs mostly following a prolonged second stage of labor but is possible during the first stage. Risk factors include prolonged second stage of labor and an emergency setup. Reported complications resulting from anterior vaginotomy include excessive hemorrhage, with a possible need for hysterectomy, difficult approximation, and bladder or ureter injury. Massive bleeding and multiple blood transfusions occurred in our series as well. Fetal outcome and future obstetric behavior do not seem to be compromised. A high index of suspicion is essential when trying to avoid accidental anterior vaginotomy. Meticulous hemostasis, a search for bladder injury and anatomic closure are mandatory when managing this complication.

Accidents↗

PubMed2000

Magnesium sulfate protection of fetal rat brain from severe maternal hypoxia.

OBJECTIVE: To determine whether severe maternal hypoxia affects fetal rat physical characteristics and causes neuronal damage, and whether magnesium sulfate can decrease these effects. METHODS: At 17 days gestation, rats were randomly assigned to one of four groups that received saline injections and room air (n = 6), magnesium sulfate and room air (n = 5), saline and hypoxia (n = 5) or magnesium sulfate and hypoxia (n =5). Maternal magnesium sulfate or saline injections were given for 4 hours. In groups 3 and 4 this was followed by a hypoxia chamber protocol that included a gas mixture of 9% oxygen and 3% carbon dioxide for 2 hours. After 72 hours of recovery, fetuses were delivered abdominally, perfused transcardially, and brains removed intact. Fetal body and brain weight and size were measured. Brains were embedded in paraffin, sectioned, and stained. A neuropathologist masked to the protocol performed histologic grading of brain regions. RESULTS: Exposure to the hypoxia chamber resulted in decreased maternal oxygen tension and pH (from 82.8 +/- 20.0 to 49.2 +/- 14.4 mmHg, and from 7.37 +/- 0.05 to 7.20 +/- 0.04, respectively; P <.005). Magnesium sulfate administration resulted in higher magnesium levels in blood (from 1. 52 +/- 0.2 to 3.77 +/- 0.7 mg/dL; P <.001). The hypoxia protocol resulted in a significant decrease in fetal body and brain size, but not weight. Hypoxia also caused an increase in the proportion of fetal rats that had brain injury, including shrinkage of cells and karyorrhexis in the hippocampus and thalamus (from 0% to 38.1% and 38.9%, respectively; P <.05). Magnesium sulfate reduced these effects on fetal brain histopathology and size. CONCLUSION: Severe maternal rat hypoxia resulted in significant fetal neuronal damage and decreased fetal body and brain size. Maternal magnesium sulfate administration reduced the effect of hypoxia on fetal brain histopathology and size without affecting body size.

Animals↗

PubMed2000

The cytoskeletal components of the myelin fraction are affected by a single intracranial injection of apotransferrin in young rats.

We have previously shown that in rat pups intracranially injected with a single dose of apotransferrin (aTf), there is an early oligodendroglial cell OLGc differentiation. The expression of the mRNAs of myelin basic proteins and of 2',3' cyclic nucleotide 3'-phosphodiesterase and the amount of the corresponding proteins, as well as myelin glycolipids and phospholipids, were significantly increased in these animals at 10 and 17 days of age. Microtubules and myelin basic proteins appear to be closely associated in OLGc and it has been shown that the mRNAs of myelin basic proteins are concentrated in the OLGc processes. The aim of this work was to clarify if the accelerated myelination produced by aTf could be linked to changes in certain cytoskeletal elements present in the myelin fraction such as tubulin, actin, and different microtubule-associated proteins (MAPs). A significant increase in the expression of the mRNA of tubulin and actin was observed in the brain of the aTf-treated animals. Several MAPs, particularly MAP 1B and stable tubule only peptide as well as actin and tubulin, were markedly increased in the Triton X-100 insoluble pellet obtained from the myelin fraction of these animals. The changes that we have previously described in the myelin of aTf intracranially injected rats, could be the consequence of its action on the cytoskeletal network of the OLGc. An enlargement of this structure would result in a more efficient and faster movement of the different components that are normally transported to the myelin by the cytoskeleton of this cell.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed2000

Magnesium prevents seizure-induced reduction in excitatory amino acid receptor (kainate and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid) binding in pregnant rat brain.

OBJECTIVE: Our purpose was to evaluate the effect of seizures on kainate and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor binding in maternal rat brain and whether maternal peripheral administration of magnesium sulfate can decrease this effect. STUDY DESIGN: Rats were implanted with a bipolar electrode into the hippocampus. One week of recovery was allowed before breeding. Pregnant rats were randomly assigned to 1 of 4 groups, as follows: group 1, sodium chloride and no seizures (n = 5); group 2, magnesium sulfate and no seizures (n = 4); group 3, sodium chloride and seizures (n = 8); and group 4, magnesium sulfate and seizures (n = 9). Doses of sodium chloride or magnesium sulfate were administered every 20 minutes for 4 hours to all rats on gestational days 9, 11, 13, 15, 17, and 19, followed by seizure induction (groups 3 and 4). On gestational day 20, rats were perfused, brains were dissected, and cryostat sections were taken, labeled in vitro, and placed on Hyperfilm for 4 weeks. The ligands used included kainate receptor agonist and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor agonist and antagonist. Optical density measurements of binding in 15 brain regions on each section were evaluated by 1- and 2-way analysis of variance. RESULTS: Seizure activity was associated with decreased alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor binding of its agonist in pregnant rat brains (seizure effect, 25.9 +/- 3.2 and 92.6 +/- 3.4 fmol/mg tissue in hindbrain and forebrain, respectively; no seizure effect, 44.5 +/- 4.7 and 110. 7 +/- 5.0 fmol/mg tissue in hindbrain and forebrain, respectively; P <.01). Magnesium administration was associated with increased binding of tritiated alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (magnesium effect, 44.9 +/- 4.2 and 110.4 +/- 4.5 fmol/mg tissue in hindbrain and forebrain, respectively; sodium chloride effect, 25.5 +/- 3.7 and 92.9 +/- 4.0 fmol/mg tissue in hindbrain and forebrain, respectively; P <.01). The same trend was seen with the kainate receptor in the hippocampus and hypothalamus, with a significant interaction effect between seizure and magnesium (P <.05). CONCLUSIONS: The mechanism for maternal rat brain injury resulting from seizure activity may be, at least in part, associated with alteration in the function of excitatory amino acid receptors. Administration of magnesium sulfate can counteract this effect and may reduce resultant maternal brain damage.

Animals↗

PubMed2000

Determining risk factors for intrapartum fetal death.

OBJECTIVE: To determine the antenatal and intrapartum risk factors for intrapartum fetal death (IPFD). STUDY DESIGN: We analyzed 72,875 singleton deliveries > 500 g between the years 1990 and 1997. In order to find independent factors contributing to IPFD, a multiple logistic regression model was constructed. RESULTS: During the study period there were 64 cases of IPFD. Birth weight was inversely associated with IPFD in the multivariate analysis. Other significant factors in the multivariate analysis were mothers older than 35 years, polyhydramnios, congenital malformations, pathologic presentation, abruptio placentae and cord prolapse. No association was found with maternal diabetes or hypertension. CONCLUSION: IPFD was significantly associated with low birth weight, older maternal age, polyhydramnios, congenital malformations and pathologic presentation. Direct causes were abruptio placentae and cord prolapse. Pregnancies in older women and those complicated by polyhydramnios and pathologic presentation should be carefully evaluated during pregnancy and delivery in order to decrease the incidence of IPFD.

Adult↗

PubMed2000

Dual distant uterine placental insertion connected by a placental band. A case report.

BACKGROUND: There are several types of intrauterine membranes; most are not associated with any deleterious effect on fetal outcome. CASE: An unusual placental insertion was diagnosed sonographically at 23 weeks of gestation. It consisted of two distant placental insertions into the uterine wall, with a large placental mass between them floating freely in the uterine cavity. Normal fetal growth pattern and blood flow indices were found. A normal female neonate was delivered via low transverse cesarean section. There were no macroscopic or microscopic placental anomalies. CONCLUSION: This case raises several questions: the right mode of delivery, frequency of ultrasound follow-up and possibility of placental band rupture and hemorrhage during vaginal delivery.

Adult↗

PubMed1999

The effect of magnesium sulfate on fetal heart rate parameters: A randomized, placebo-controlled trial.

OBJECTIVE: We sought to determine the effect of magnesium sulfate on fetal heart rate baseline value, variability, and acceleration-deceleration pattern. STUDY DESIGN: Normal, nonlaboring pregnant patients at >30 weeks' gestation were recruited. Baseline fetal heart rate monitoring for 1 hour was performed. After an 800-kcal meal, patients were randomized to receive either an intravenous loading dose of 6 g of magnesium sulfate in 100 mL of isotonic sodium chloride solution or 100 mL of isotonic sodium chloride solution alone. Subsequently, patients in the magnesium sulfate group received a 2-g/h intravenous infusion for 3 hours at a rate of 125 mL/h. Patients randomized to the sodium chloride solution group received a sodium chloride solution infusion at a similar rate (unlabeled intravenous bags). Maternal blood was drawn at 0, 1, and 3 hours for determination of total and ionized magnesium and calcium, electrolyte, and glucose levels. One hour of fetal heart rate monitoring was repeated at 1 and 3 hours of infusion. Tracings were interpreted without identifiers (of time or group) by using the National Institute of Child Health and Human Development fetal heart rate monitoring guidelines. RESULTS: Magnesium sulfate administration resulted in decreased fetal heart rate baseline values and variability in the third hour. The fetal heart rate baseline value was 134.4 +/- 6.3 versus 136.6 +/- 6.4 beats/min before infusion (P >.05), 134.4 +/- 7.1 versus 135.1 +/- 6. 6 beats/min in the first hour (P >.05), and 134.6 +/- 7.1 versus 132. 3 +/- 7.6 beats/min in the third hour (P <.05) in the sodium chloride solution group versus the magnesium sulfate group, respectively. Fetal heart rate variability (grades 1-5) was 2.75 +/- 0.33 versus 2.82 +/- 0.29 before infusion (P >.05), 2.81 +/- 0.30 versus 2.84 +/- 0.28 in the first hour (P >.05), and 2.71 +/- 0.52 versus 2.67 +/- 0.36 in the third hour in the sodium chloride solution group versus the magnesium sulfate group, respectively (P <. 05). Magnesium sulfate blocked the positive correlation between gestational age and number of accelerations found in control subjects. No significant decelerations were identified. CONCLUSIONS: Prolonged administration of magnesium sulfate was associated with decreased fetal heart rate baseline values and variability. Given the small magnitude of these changes, the clinical significance of these findings is questionable. Magnesium sulfate inhibition of the increasing number of accelerations with gestational age needs to be considered when fetal well-being is assessed.

Calcium↗

PubMed1999

Fetal rat brain damage caused by maternal seizure activity: prevention by magnesium sulfate.

OBJECTIVE: Our purpose was to determine whether maternal rat seizure activity was associated with fetal histopathologic brain changes and whether magnesium sulfate reduced these changes. STUDY DESIGN: Electrodes were stereotaxically implanted into the hippocampus of nonpregnant rats 1 week before breeding. Pregnant rats were randomly assigned to 1 of 4 groups: (1) sodium chloride solution and no seizure (n = 2), (2) magnesium sulfate and no seizure (n = 2), (3) sodium chloride solution and seizure (n = 5), and (4) magnesium sulfate and seizure (n = 5). On gestational days 9, 11, 13, 15, 17, and 19, subcutaneous doses of sodium chloride solution or magnesium sulfate were administered to all rats every 20 minutes for 4 hours (loading-maintenance-loading), followed by seizure induction. On gestational day 20, the rats were perfused with formalin and fetuses were delivered via cesarean. Fetuses were perfused with formalin, brains were obtained and embedded in paraffin, and the forebrain and hindbrain were sectioned in the coronal plane and stained with hematoxylin and eosin. A neuropathologist masked to the protocol performed histopathologic grading of each section, including extent and nature of cellular damage. Eleven brain regions were examined in each section. Scores were expressed as mean +/- SD. Kruskal-Wallis analysis of variance was used, and P <.05 was considered significant. RESULTS: We evaluated 26 fetal brains in group 1, 9 in group 2, 72 in group 3, and 45 in group 4. Fetuses in the sodium chloride solution-and-seizure group (group 3) presented significantly higher grades of neuronal damage in the hippocampus (group 1, 0.50 +/- 0. 88; group 2, 0.22 +/- 0.66; group 3, 1.01 +/- 1.17; and group 4, 0. 48 +/- 0.72) and in the tegmentum region (group 1, 1.0 +/- 1.0; group 2, 0.8 +/- 1.0; group 3, 1.7 +/- 0.7; and group 4, 1.5 +/- 0. 8) (P <.05, group 3 compared with others). Isolated and patchy neuronal injury with shrinkage of cells, nuclear pyknosis, and karyorrhexis were the main histologic findings. CONCLUSIONS: Maternal rat seizure activity was associated with histologic brain injury in the fetus. Maternal administration of magnesium sulfate before seizure prevented or significantly decreased this effect.

Animals↗

PubMed1999

Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome.

OBJECTIVE: We evaluated the value of all 3 common biochemical serum markers, maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, and unconjugated estriol, and combinations thereof as predictors of pregnancy outcome. STUDY DESIGN: A total of 60,040 patients underwent maternal serum screening. All patients had maternal serum alpha-fetoprotein measurements; beta-human chorionic gonadotropin was measured in 45,565 patients, and 24,504 patients had determination of all 3 markers, including unconjugated estriol. The incidences of various pregnancy outcomes were evaluated according to the serum marker levels by using clinically applied cutoff points. RESULTS: In confirmation of previous observations, increased maternal serum alpha-fetoprotein levels (>2.5 multiples of the median) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae. Increased beta-human chorionic gonadotropin levels (>2.5 multiples of the median [MoM]) were significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, and intrauterine fetal death. Finally, decreased unconjugated estriol levels (<0.5 MoM) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, intrauterine growth restriction, and intrauterine fetal death. As with increased second-trimester maternal serum alpha-fetoprotein levels, increased serum beta-human chorionic gonadotropin and low unconjugated estriol levels are significantly associated with adverse pregnancy outcomes. These are most likely attributed to placental dysfunction. CONCLUSION: Multiple-marker screening can be used not only for the detection of fetal anomalies and aneu-ploidy but also for detection of high-risk pregnancies.

Abruptio Placentae↗

PubMed1999

Uterine curettage following second trimester abortion by extraovular instillation of prostaglandin E2. A prospective-randomized trial.

OBJECTIVE: To evaluate the benefits associated with routine uterine curettage following complete second trimester termination of pregnancy by extraovular prostaglandin E2. STUDY DESIGN: Fifty-five patients between 15 and 24 weeks' gestation who had undergone complete termination of pregnancy by continuous extraovular instillation of prostaglandin E2 (PGE2), were randomly assigned into either no further intervention (n=25), or uterine curettage under general anesthesia (n=30). The need for late uterine curettage, clinical and ultrasonographic parameters at 1 and 42 days follow-up, as well as the incidence of the minor and major complications, were compared between groups. RESULTS: Baseline and post-abortion clinical and ultrasonographic characteristics were similar in both groups. Mean (+/- Standard error of the mean) number of post-abortion bleeding days in the curettage group was 8.9+/-1.8 versus 10.1+/-2.6 days in the non-curettage group (P=NS). No patient in the former group, compared to three patients in the latter group, needed late uterine curettage, (P=NS). Major and minor complications rates in the curettage and in the no-curettage groups were not significantly different. Considerably more patients in the curettage group needed analgesic agents following the abortion compared to the no-curettage group (60% vs. 3.3%, respectively; P<0.001). CONCLUSIONS: Routine uterine curettage in patients undergoing complete second trimester termination of pregnancy by extraovular instillation of PGE2, exerts no benefit.

Abortion, Induced↗

PubMed1999

Pelvic actinomycosis. Is long-term antibiotic therapy necessary?

OBJECTIVE: To describe 11 cases of actinomycosis and analyze whether long-term antibiotic use in necessary. STUDY DESIGN: Analysis of 11 cases of pelvic actinomycosis diagnosed and treated during the last nine years. Four patients had an intrauterine device (IUD) for 6-20 years, three patients had an IUD for 3-5 years, and four patients had no known etiology. In most patients the symptoms lasted from several days to one month. The actinomycotic lesions involved one or both ovaries in all 11 cases. In five patients the lesion extended to other areas, such as the uterus, omentum, parametrium, pelvic walls, colon, bladder, cul-de-sac and gallbladder. RESULTS: All patients underwent surgery that included removal of the lesions with the ipsilateral or both adnexa and, in specific cases, with extension of the lesions, hysterectomy, omentectomy, hemicolectomy and cholecystectomy. Confirmation of the diagnosis of actinomycosis was done by histology in all cases, and antibiotic treatment usually began 1-14 days after surgery. The drug of choice was penicillin. The duration of treatment was 12 months in 6 patients, 6 months in 3 and < or = 3 months in two. All patients were alive and well after two to nine years of follow-up. CONCLUSION: In contrast to actinomycosis at other sites, where the literature recommends antibiotic therapy for 6-12 months, pelvic actinomycosis could be a limited disease. We propose that in cases of pelvic actinomycosis where the abscess can be completely removed surgically, a shorter period of antibiotic therapy can be effective.

Actinomycosis↗

PubMed1998

Effect of parenteral magnesium sulfate administration on excitatory amino acid receptors in the rat brain.

The literature regarding magnesium sulfate central nervous system inhibitory effect will be reviewed. We suggest that its mechanism of action be through the excitatory amino acid receptors. We have demonstrated that magnesium sulfate enters the cerebrospinal fluid and brain after systemic administration. The significant rise in brain magnesium concentration is associated with an elevation of the seizure threshold and a marked resistance of the animal to electrically as well as NMDA stimulated hippocampal seizures. Using autoradiography we have studied the effect of magnesium sulfate on the NMDA receptor-channel complex, as well as on the AMPA and Kainate receptors. The results provide further information on the mechanism by which magnesium' central anticonvulsant activity is mediated in the rat model.

2-Amino-5-phosphonovalerate↗

PubMed1997

Activated protein C resistance (factor V Leiden) associated with thrombosis in pregnancy.

OBJECTIVE: Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium. STUDY DESIGN: This observational study was conducted prospectively during a 2-year period (July 1993 to June 1995) in a preselected population. All patients admitted to our high-risk pregnancy unit with a diagnosis of deep vein thrombosis, pulmonary emboli, transient ischemic attack, and cerebrovascular accident during pregnancy and the puerperium were included. Prothrombin time, partial thromboplastin time, fibrinogen levels, protein C, protein S, antithrombin III, functional test for activated protein C resistance, and factor V Leiden mutation by polymerase chain reaction were performed on each patient. RESULTS: Fifteen patients were included. Seven (46.6%) patients were positive for activated protein C resistance (factor V Leiden). All other coagulation studies were negative for all patients. All patients with activated protein C resistance had a venous thrombotic event, deep vein thrombosis, or pulmonary emboli, and only one had a cerebrovascular accident on the basis of sagittal sinus thrombosis. Only two of the activated protein C resistance-negative patients had venous thrombosis (pulmonary emboli). The remaining six patients had transient ischemic attacks or cerebrovascular accidents. For the subgroup with venous thrombosis during pregnancy and the puerperium, the incidence of activated protein C resistance (factor V Leiden) was 78%. CONCLUSION: This study demonstrates the incidence of factor V Leiden in a selected population in whom thrombotic events developed during pregnancy and the puerperium. This small-scale study provides justification for a large cohort study that will identify women with factor V Leiden and determine their risk for thrombosis during pregnancy and the puerperium. We believe that factor V Leiden should be evaluated in conjunction with thrombotic events in the pregnant woman.

Adult↗

PubMed1997

Ripening and dilatation of the unfavourable cervix for induction of labour by a double balloon device: experience with 250 cases.

OBJECTIVE: To determine the efficacy of the double balloon device (the Atad Ripener Device) in ripening and dilatation of the unfavourable cervix for induction of labour. METHODS: Two hundred and fifty women with unfavourable cervices (Bishop score < or = 4) underwent induction of labour with the Atad Ripener Device. Indications were pregnancy induced hypertension (n = 118), post-dates (n = 69), elective inductions (n = 23), other reasons including nonreassuring nonstress test, intrauterine growth retardation, previous caesarean section and diabetes mellitus (n = 40). The Atad Ripener Device was inserted into the cervix, the uterine balloon inflated in the internal os, and the cervico-vaginal balloon in the external os of the cervix (100 mL of normal saline to each balloon). Pressure produced by the inflated balloons caused gradual dilatation and effacement of the cervix. The Atad Ripener Device was removed 12 h after insertion, the cervix assessed again, and labour managed according to obstetrical criteria. RESULTS: The Atad Ripener Device caused an increase in the Bishop score in all subgroups with a mean change of 4.6 (from 2.0 prior to induction to 6.6 upon removal of the Atad Ripener Device; P < 0.05). The mean time interval from insertion of the Atad Ripener Device to delivery was 18.9 h, and from removal to delivery was 6.9 h. Caesarean section was performed in 39/250 patients (16%), and the others had a normal vaginal delivery. CONCLUSIONS: 1. The double balloon device induces significant ripening and dilatation of the unfavourable cervix. 2. Induction of labour was successfully achieved following removal of the Atad Ripener Device. 3. Our caesarean section rate was low compared with rates reported for women with an unfavourable cervix induced by other methods.

Adult↗