A comparison of labetalol plus hospitalization versus hospitalization alone in the management of preeclampsia remote from term

Two hundred primigravid women with mild preeclampsia at 26-35 weeks' gestation were randomly allocated to treatment with hospitalization alone or combined with labetalol. There were no differences between the two groups in mean systolic or diastolic pressures, mean gestational age, or initial laboratory findings at time of entry. Patients in the labetalol group demonstrated a statistically significant (P less than .005) decrease in blood pressure during treatment. No such decrease occurred in the hospitalization-alone group. Both groups exhibited significant deterioration in proteinuria, creatinine, and uric acid. The average days of pregnancy prolongation (mean +/- SD) were 21.3 +/- 13 and 20.1 +/- 14 days in the hospitalization and labetalol groups, respectively. There were no differences between the groups regarding any of the following: gestational age at delivery, birth weight, number of infants admitted to the special care unit, or cord blood gas measurements. However, the incidence of small-for-gestational-age infants was significantly higher in the labetalol group (19 versus 9%, P less than .05). There were no stillbirths, but one neonatal death in the labetalol group. Treatment of maternal blood pressure in preeclamptic pregnancies with labetalol did not improve perinatal outcome, and was associated with a higher frequency of fetal growth retardation.

Heterogeneous distribution of the cAMP receptor protein RII in the nervous system: evidence for its intracellular accumulation on microtubules, microtubule-organizing centers, and in the area of the Golgi complex

The cellular and subcellular distribution of the regulatory subunit RII of cAMP-dependent protein kinase was studied by light and electron microscopy immunocytochemistry in tissue sections from rat brain and in primary cultures of brain cells. RII immunoreactivity was present in most neurons, although at variable concentration. In addition, RII was also detectable in other cell types including glia, neuroepithelial cells, and cells of mesenchymal origin. In the cell cytoplasm, RII immunoreactivity was concentrated at certain sites. An accumulation of RII immunoreactivity was found in all RII-positive cells at the Golgi area, precisely at a region directly adjacent to one of the two major faces of the Golgi complex. RII was also highly concentrated in some microtubule-rich cell processes such as cilia and neuronal dendrites, but was below detectability in most axons. In neurons, its concentration in dendrites is consistent with the previously demonstrated high affinity interaction between RII and the dendritic microtubule-associated protein 2. In addition, RII was accumulated at basal bodies of cilia and at centrosomes, i.e., sites known to act as microtubule organizers. RII-labeled centrosomes, however, were visible only in cells where the Golgi complex had a pericentrosomal organization, and not in cells where the Golgi complex was perinuclear such as in neurons and glia in situ. We hypothesize that centrosomal RII is bound to the pericentriolar microtubule-organizing material and that this material remains associated with the trans region of the Golgi complex when the latter is no longer associated with the centrosome. Our results suggest a key but not obligatory role of cAMP in the Golgi-centrosomal area, the headquarters of cell polarity, mobility and intracellular traffic, and in the function of a subpopulation of microtubules.

A possible role for polyamines in cartilage in the mechanism of calcification

The role of polyamines in cartilage is not known: they may be somehow related to the mechanism of calcification. In epiphyseal cartilage from calf scapulas, they are more concentrated in the ossifying area, where calcification takes place, than in the resting region. Spermidine is present in greater amounts than spermine and putrescine. Since ornithine decarboxylase (EC 4.1.1.17) is measurable only in the resting region of the tissue, it is in this area that polyamine biosynthesis occurs, while they accumulate in the ossifying area. Immunohistochemical evidence is obtained that only in the ossifying zone is spermidine extracellular. It is at this level that the matrix is rearranged to become calcified, and proteoglycans are dissociated and partially removed. The effect of polyamines on solutions of proteoglycan subunits has been studied in vitro by following variations of turbidity and viscosity. While in the presence of putrescine the specific viscosity decreases to asymptotic values, in the presence of either 30 mM spermidine or 2.5-10 mM spermine, the decrement is more marked. At the same concentrations, increase of the turbidity of proteoglycan subunit solutions was observed. Only spermidine showed the capacity of displacing proteoglycan subunits from a column of Sepharose 4B-type II collagen: at 15 mM concentration, about 90% of proteoglycans were removed from the column. Alkaline phosphatase activity, which plays an important role in calcification, is enhanced by spermidine and spermine. These results obtained in vitro support the hypothesis that polyamines may be related to calcification of preosseous cartilage.

[Problems of development and care of children born with selected congenital malformations: Down's syndrome, cardiopathy, cleft lip and palate, clubfoot]

In connection with the surveillance programme of congenital malformations in Emilia Romagna led by I.M.E.R. Group since 1978 a crosswise survey has been performed on selected malformations: Down's syndrome, cardiac defects, unilateral or bilateral cleft lip and/or palate, unilateral or bilateral club foot. This survey has been useful as a pilot-study for another longitudinal survey which had a place in the programmes of the C.N.R. (National Research Council). By means of a multi-discipline approach we have collected information both of pediatric and of psycho-social character. A total of 187 children with the above named malformations were recorded at birth, 106 boys and 81 girls, aged from 9 months to 4 years. The neonatal diagnosis was confirmed in 84 out 86 cases under study. The rate of infant mortality was particularly high among children with heart defects (39.1%) and Down children (27.4%). The surgical centres where these children were operated upon, through with large variations in connection with the type of malformation, were in Emilia Romagna (49%), outside it (40%), and abroad (10.9%). As for the parental reaction to the birth of babies with congenital malformations, it was of initial rejection 5 cases of Down children, 3 cases of cardiopathy and 1 case of cleft lip and palate. Later the refusal was permanently confirmed only in 2 cases of Down children (who were subsequently adopted). The birth of a malformed baby has affected the relationship between husband and wife contributing to the separation in 3 cases of Down's syndrome and in 1 case of cardiopathy.

[Genito-urinary malformations in a regional survey in Emilia Romagna]

In a multicentric survey carried out in Emilia Romagna area on congenital malformations 1914 babies out of 103484 babies born from 1978-1984 were discovered to have malformations. Out of these malformations cases 17% were found to be affected by genitourinary tract anomalies (GU) divided as follows: 235 genital malformations and 91 urinary tract anomalies. All these GU patients were diagnosed within the first week of life. Genital malformations: Genital malformations are mainly constituted by hypospadias, found in 214 out of 235 babies. Among these babies, 72% have first degree hypospadias, 22.4% have second degree, and only ten babies were found with third degree hypospadias. In this study 4.1 out of 1000 male newborns have been found affected by hypospadias, in agreement with the results of other researches whose values were between 2% and 4.4%. Many different variables (such as parental age, exposure to smoke, alcohol, RX-ray before pregnancy, low birth weight, early age at menarche, exposure to progestins for threatened abortion, shorter gestation) have been considered in order to verify their correlation with the hypospadias, comparing with control group. Among these the most statistically significant are the exposure to progestins for threatened abortion (p less than 0.05), early age at menarche (p less than 0.001) and the intrauterine growth retardation (p less than 0.001). Also these results agree with the previous studies. Urinary tract anomalies: the 93 babies with kidney and-or urinary tract malformations out of 103484 newborns represent the 8.9%. The diagnoses were made or suspected (and later confirmed) during the first week of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical study on bronchodilation induced by a metered aerosol of fenoterol in combination with ipratropium bromide

The response to an aerosol preparation containing 100 micrograms fenoterol and 40 micrograms ipratropium bromide per puff (Duovent) was compared with a placebo in 18 asthmatic patients in a double-blind cross-over fashion. We measured changes in lung function tests and pulse rate. Duovent induced a significant improvement in lung tests with statistical relevance for VEMS and Raw in comparison with placebo. The combination of fenoterol and ipratropium bromide also provided a long-lasting bronchodilatation without side effects.

Genitourinary tract anomalies: neonatal medical problems

The results of a multicentric survey in the Emilia-Romagna area from 1978 to 1984 are given. During the first week of life, 103,484 babies were examined. Anomalies were detected in 1,914 babies, 326 of which had genitourinary malformations. There were 214 cases of hypospadias with a history of exposure to progestogens for threatened abortion, intrauterine growth retardation and early maternal menarche. Ninety-one cases of urinary tract malformations were found and in 66 babies this was the only anomaly. Until 1983 antenatal ultrasound examinations detected only 25% of urinary tract anomalies. In 1984 this figure climbed to 70%.

Affective disorders in children and adolescents: the dysthymic disorder dilemma

From 60 patients referred for assessment of their depressive symptomatology, 13 were found to suffer from major affective disorder and 14 from dysthymic disorder. The results from self-rating scales (the Children's Depression Inventory and the Children's Depression Scale) were compared with the findings from diagnostic interviews (using DSM-III criteria). The large proportion of dysthymic disorders in this sample is compared to the low reported figure in most other samples and some comments about the possible usefulness of this diagnosis are made.

Effects of methylprednisolone on sputum biochemical components in asthmatic bronchitis

Nineteen patients with chronic mucus hypersecretion and reversible airway obstruction were studied during an acute exacerbation. One group of patients was treated with antibiotics and aminophylline, the other, additionally, with gradually decreasing doses of methylprednisolone, starting with 80 mg/day. The sputum specimens were collected on the day of admission and 2 weeks later. In whole sputum, we examined macromolecular components both transudated from serum and locally secreted: albumin, fucose, N-acetylneuraminic acid, total protein, IgA, IgM, IgG. At the end of the second week albumin (marker of serum transudate), and fucose (marker of mucus glycoproteins), were significantly lower in the group treated with corticosteroids. IgG and albumin behaved in the same way suggesting a marked IgG serum exudation. IgM was partially reduced by corticosteroids while IgA remained unchanged.

Effects of rise-fall time, frequency, and intensity on the early/middle evoked response

Auditory evoked responses to tone pips were recorded on 10 normally hearing adults. Tone pips centered at 500 and 2000 Hz with 1, 2, and 4 ms rise-fall times were presented at intensities of 40, 30, 20, and 10 dB nHL. The band-pass of the recording-amplifier system was set to 55 and 3000 Hz. Responses were measured during the first 25 ms following the onset of the stimulus and the first three prominent waves were labeled P10, N15, and P20. The results indicated that varying rise-fall times from 1 to 4 ms had little effect on the detectability of these waves. Consequently, the 4-ms rise-fall time was recommended because of its greater frequency specificity. The number of identifiable responses was similar for both 500 and 2000 Hz for waves P10, N15, and P20. The similarity in the number of detectable responses suggests that any of these waves may be used as a threshold indicator. The acoustic/physiologic mechanisms underlying the latency changes are discussed.

[Hematological variables in marathon and ultramarathon runners]

The haemoglobin concentration of runners has been reported to be often below normal (1). In the present investigation the haemoglobin and iron concentrations and the haematocrit have been determined in 45 marathon runners examined before and after the 1982 Italian Marathon Championship and in 79 runners examined before and after the 1982 Firenze-Faenza race (107 km). The results obtained suggest that the training programs followed by the marathon runners (up to 260 km per week in the months preceding the race) are accompanied by a significant decrease of the haemoglobin and iron levels and of the haematocrit. Similar results have been observed in the participants to the Firenze-Faenza race. Nevertheless in these ultramarathoners the decrease of the haemoglobin and iron concentration and of the haematocrit are less marked, possibly because their training programs are less intense than those of the marathon runners. The findings obtained are in favour of the hypothesis that the degree of "sport anaemia" might be related to the amount of training of the athletes.

[Fetal defects caused by the passive consumption of drugs]

The neuroactive drugs taken by pregnant women have two principals side effects: a teratogenic effects and a postnatal withdrawal effect. Three are the characteristic syndromes: the hydantoin-barbiturate syndrome, the trimethadione-paramethadione syndrome, the fetal alcohol syndrome. The prenatal exposure to heroine and to morphine interfere mainly with the cerebral development. Drug addiction, like postnatale withdrawal syndrome, are mainly due to passive exposure to drug narcotic (heroine, methadone), to sedative-hypnotic agents (barbiturates Diazepam Chlordiazepoxide) and to alcohol. The cigarette smoke is responsible for third group of side effects, namely for the reduced fetal growth and for the premature labor. No side effects on the human fetus were observed due to abuse of coffee or to use of marihuana during pregnancy.

[Partial onychectomy and plastic surgery as treatment of ingrown nails]

The Authors report on a technique for a preserving treatment of the ingrowing nail, by means of partial onycectomy associated with plastic repair of soft tissues of the surrounding nail bed.