Fetal pulse oximetry: a new method of monitoring the fetus

Experimental pulse oximetry devices, similar to the existing systems used in adult and neonatal monitoring, can be used on the fetus to provide safe, and rapid information about oxygenation. They have been calibrated using fetal lambs and validated in human cross-sectional studies. Experiments have shown that fetal oxygen saturation decreases during normal labour, and drops after a uterine contraction especially with oxytocin-induced tachysystole. When the mother is given oxygen the fetal oxygen saturation increases. Readings are effected by caput and movement, and trends seem to be more meaningful than absolute values. Pulse oximetry can predict fetal outcome and a normal oxygen saturation result is specific for a good outcome perhaps even if the CTG is abnormal. However the technique is still experimental and there is insufficient data to support its use as a replacement for fetal blood sampling or a discriminator for an abnormal fetal heart trace.

Female genital tuberculosis--a retrospective clinico-pathologic study of 501 cases

A retrospective clinico-pathological study of 501 cases of female genital tuberculosis (FGTB) observed from 1974 to 1991 was conducted. The frequency of FGTB was 1.8% in 1974 rising to 2.4% in 1982, thereafter showing a steady decline to 0.8% in 1989 and onwards. Two thirds of the patients were infertile and between 17 to 40 years of age, while 82.3% of all cases of FGTB were between 20-30 years of age. Involvement of the endometrium was noted in 99.5%, fallopian tubes in 94.7%, cervix in 81.5%, ovaries in 62.5% and vulva in 0.2% of cases. Extensive caseous lesions in the genital tract were a notable feature in elderly women 70 years of age. Staining for Acid Fast Bacilli was not found to be useful, however follow-up biopsies from endometrium and cervix in 45 cases on anti-tubercular therapy showed complete disappearance of the granulomas.

Maternal deaths--a ten-year study

In a 10-year retrospective study of maternal deaths at RG Kar Medical College, Calcutta there were 651 maternal deaths with 410 in first 5-year period and 241 in second 5-year period. The leading causes of deaths were due to abortion, toxaemia, haemorrhage (antepartum and postpartum) and jaundice in pregnancy. Direct causes were responsible for death in 77.6% cases, indirect causes in 17.5% cases and unrelated causes in 4.9% cases. Majority (557) were unbooked and mostly multigravida (434) cases. Most of them (251) were in the age group of 20-25 years. Haemorrhage was the single most common cause to claim 188 lives. It was also noted that 155 deaths occurred within 12 hours of hospital admission.

Should we use prostaglandins, tents or progesterone antagonists for cervical ripening before first trimester abortion?

Sixty-four women requesting first trimester termination of pregnancy were recruited into a comparative cohort study comparing the cervical ripening properties of a mechanical dilator (Lamicel; n = 17), prostaglandin, antiprogesterone and placebo control (n = 15), gemeprost; n = 17) and mifepristone; n = 15). Compared to the placebo group, all 3 active agents dilated the cervix (p < 0.02) and they significantly reduced the force required to dilate it to 8 mm Hegar (p < 0.001). Although Lamicel insertion resulted in the largest pre-operative cervical dilatation all agents are effective. Therefore the cervical priming agent of choice should be the most convenient to use and the one with least side-effects. The oral antiprogesterone, Mifepristone, is the easiest to administer and has less side effects.

The effect of squatting on pelvic dimensions

Lateral X-ray pelvimetry was performed on 63 women in the sitting and squatting positions on the 5th or 6th post-natal day to assess whether squatting has any effect on pelvic dimensions. Four assessors measured the inlet and outlet pelvic dimensions from 25 cases with good radiographic views in order to minimise observer bias. There was no statistically significant change in pelvic dimensions with squatting. Some possible explanations are discussed.

Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies

OBJECTIVE

To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy.

DESIGN

A pragmatic randomized trial.

SETTING

St James's University Hospital, Leeds.

SUBJECTS

500 pregnant women at high risk of intrauterine growth retardation or still birth.

INTERVENTIONS

Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians.

MAIN OUTCOME MEASURES

Gestational age at delivery, obstetric intervention rates and short-term neonatal morbidity.

RESULTS

Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group.

CONCLUSIONS

The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end-diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.

The results of tubal surgery in the treatment of infertility in two non-specialist hospitals

The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow-up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non-iatrogenic tubal blockage.

A quantitative structure-activity relationship study on the inhibitory effects of local anesthetics on sodium flux, phosphoinositide breakdown, and binding to sodium channels

The inhibitory effects of a series of nonspecific local anesthetics on batrachotoxin-elicited sodium flux, batrachotoxin-elicited phosphoinositide breakdown, and on the binding of [3H]batrachotoxin-A 20 alpha-benzoate to sodium channels in guinea pig cerebral cortical synaptoneurosomes are shown to be well-correlated with the molecular size and the hydrophobic character of the molecules. These correlations lead us to suggest that the drug-receptor interaction involves a dispersion interaction, and that the overall effects of local anesthetics is dependent upon their ability to reach the receptor site.

Effect of mifepristone on dilatation of the pregnant and non-pregnant cervix

The effect of the progesterone antagonist mifepristone on the cervix was investigated in two randomised double-blind placebo-controlled trials, the first in 30 women undergoing first trimester surgical termination of pregnancy and the second in 30 non-pregnant premenopausal women. 600 mg mifepristone, given orally 48 h before surgery, increased the mean preoperative cervical dilatation in both pregnant and non-pregnant treatment groups and also reduced the force required to dilate the pregnant and non-pregnant cervix.

Phospholipase A production by isolates of Salmonella species

The incidence of intra- and extra-cellular phospholipase-A production by Salmonella isolates from human, poultry and environmental material was investigated. Nearly 17 per cent (15/90) of the strains tested produced phospholipase A. Phospholipase production was encountered in S. typhi, S. paratyphi A, S. typhimurium, S. seftenberg, S. bareilly, S. weltevredeen, S. newport, S. adelaide, S. alachua and S. gallinarum. Maximum (10/15) phospholipase producers were isolated from the human material. Phospholipase positive human isolates exhibited a high incidence of simultaneous multiple drug resistance, enterotoxigenicity and cell surface hydrophobicity.

A quantitative structure-activity relationship study for local anesthetic activity of mono-and diaryl-2-quinuclidinylcarbinols

The local anesthetic activity of a series of arylquinuclidinylcarbinols is shown to be significantly correlated with their lipophilic character, suggesting that lipophilicity is an important factor for the local anesthetic action of drugs.

Quantitative structure-activity relationship study on some 5-lipoxygenase inhibitors

A quantitative structure-activity relationship (QSAR) study has been made on some lipoxygenase inhibitors belonging to the series of omega-phenylalkyl hydroxamic acids, omega-naphthylalkyl hydroxamic acids, eicosatetraenoic acids, and 1H.benzimidazole-4-ols. It was found that the hydrophobic character of the molecules and the size of their substituents selectively govern their lipoxygenase inhibitory activity. The enzyme active site possesses a non-heme ferric ion, a hydrophobic domain, and a carboxylic acid binding site. It was found that while the functional group of inhibitors must interact with the ferric ion, the substituent on one side of it would be involved in hydrophobic interaction and that on the other side in van der Waals interaction with the enzyme so leading to an enhancement in the inhibitory activity of the inhibitors.

A QSAR study on renin inhibitors

Quantitative structure-activity relationships (QSAR) were studied in a series of chain-modified peptide analogues of the active site of angiotensinogen. The activity of these renin inhibitors was found to be significantly correlated with Kier's first-order valence molecular connectivity index (1 chi v) and with the molecular weight (MW) of the molecules. The activity was less well correlated with the van der Waals volume (Vw), and not at all with the hydrophobic character (log P) of the molecules. These findings suggest that there is a strong dispersion interaction between the inhibitor molecules and the enzyme, and that hydrophobicity plays little part in the interaction.

The action of squatting in the early postnatal period marginally increases pelvic dimensions

X-ray pelvimetry was performed on 43 women in the squatting and erect positions within 1 week of delivery. The act of squatting increased the transverse and antero-posterior pelvic dimensions by 1%. The theoretical mechanisms by which posture may affect dimensions are discussed.

A quantitative structure-activity relationship study on some pyrazolo[4,5-c]quinolines acting as inhibitors of benzodiazepine-receptor binding

By a quantitative structure-activity relationship (QSAR) study, the ability of a series of 1-arylpyrazolo[4,5-c]quinolin-4-ones to displace specific [3H]-flunitrazepam from bovine brain membranes is shown to be significantly correlated with steric and hydrophobic constants of aryl subtituents, suggesting that substituents of 2- and 6-positions produce dominant steric effects and that those of 3- and 5-positions are involved in strong hydrophobic interaction with the receptor.

Factors affecting intra- and extracellular phospholipase A1 production by Salmonella newport

The effect of various physico-chemical factors on production of intra- and extracellular phospholipase A1 by Salmonella newport was investigated. Maximum intracellular enzyme levels were observed when cells were grown in brain heart infusion broth, after 12 h of incubation at 37 degrees C. Highest level of extracellular phospholipase A1, however, was seen in synthetic medium (pH 7.0) after 24 h of incubation at 37 degrees C. Agitation during incubation had no effect on the intracellular enzyme synthesis but enhanced extracellular enzyme levels. Addition of surfactants to the growth media significantly decreased both intra- and extracellular phospholipase A1 production.

An experiment of squatting birth

Women throughout the ages have preferred to be delivered with their trunks vertical and most delivery positions illustrated in historical texts show birth in an upright posture with abducted thighs. A consumer attitude study in our hospital showed that patients have considerable interest in alternative birth positions. Squatting has been advocated to prevent caval compression, increase the diameter of the pelvic outlet and, perhaps with least justification, to enlist the force of gravity and thereby facilitate maternal expulsive effort. Despite the extensive literature advocating squatting birth, the suggested advantages of this method have not been examined in any formal, let alone unbiased study. We therefore conducted a randomised trial to examine the effect of squatting on the duration of second stage of labour, the duration of pushing, and several other variables.

Quantitative structure-activity relationship study on some dihydropteridine reductase inhibitors

The dihydropteridine reductase (DHPR) inhibitory potencies of some 4-phenyltetrahydropyridines, 4-phenylpiperidines, and 4-phenylpyridines, are analyzed in relation to their physico-chemical and molecular properties. They are found to have significant correlation with Hammett constant sigma and the van der Waals volume Vw. The correlation is linear with sigma and parabolic with Vw. Hence, it is argued that DHPR inhibition involves dispersion interaction and is enhanced by electron donation from the substituents but hindered by steric effects produced by large substituents. It is also found that these electronic and steric effects are significant only when they are produced by substituents being at specific position in the molecules.

A quantitative structure-activity relationship study of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors

A quantitative structure-activity relationship study has been made of some 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. The HMG-CoA reductase inhibition activities of mevinolin analogs and 6-substituted 4-hydroxypyran-2 ones have been mostly found to be significantly correlated with the molecular size of substituents. In one case, however, the inhibition potency was found to be related to the hydrophobicity of molecules. These findings led us to suggest that the enzyme HMG-CoA reductase possesses an active site which is involved in dispersion interaction and another site which is involved in hydrophobic interaction with inhibitor molecules, depending upon the proper orientation of the latter towards these sites. Furthermore, the results indicate that both active sites possess limited steric bulk tolerance.

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.

Anti-inflammatory derivatives of indan-1-acetic acids with low gastric irritancy

In an attempt to minimize the gastric ulcerogenicity of 6-methoxyindan-1-acetic acid and 5,6-dimethoxyindan-1-acetic acid exhibiting high anti-inflammatory activity, we synthesized their esters, amides and nitrile derivatives. It was found that the anti-inflammatory activity of ethyl esters were almost equal to those of parent acids and phenylbutazone while other derivatives were less potent. Those ethyl esters were also found to be much less ulcerogenic than phenylbutazone.

Further studies on anti-inflammatory activity of two potent indan-1-acetic acids

The anti-inflammatory activity of 6-methoxyindan-1-acetic acid (1a) and 5,6-dimethoxyindan-1-acetic acid (1b) was evaluated in various acute, subacute and chronic models of inflammation. The results of these studies suggest that they have equal or slightly more anti-inflammatory activity than phenylbutazone, a standard anti-inflammatory drug. Of the two compounds, 5,6-dimethoxyindan-l-acetic acid appeared to be slightly more active than 6-methoxyindan-l-acetic acid.

Studies on anti-inflammatory, analgesic and antipyretic activities of some indan acids

A series of indan-1 acids were synthesized and screened for anti-inflammatory activity. All the reported compounds showed varying degrees of anti-inflammatory activity in carrageenin-induced paw oedema test. They also exhibited appreciable antipyretic and analgesic activity in various animal test models. Among these compounds 6-methoxy-indan-1-acetic acid (compound 11) and 5,6-dimethoxy-indan-1-acetic acid (compound 12) showed activity profile close to that of phenylbutazone having prolonged action and lower toxicity than the latter.

Sterilization of solanaceous hadda, Epilachna vigintioctopunctata F. by irradiating pupae using gamma radiation

Sterility in males and females was observed in the resulting adults when 3--4-day-old pupae of solanaceous hadda, Epilachna vigintioctopunctata F. were exposed to gamma radiation doses of 2000 rad and 2500 rad. However, at 2500 rad longevity of treated insects was adversely affected.

Properties of cellulase from Trichoderma viride

Cellulase produced by Trichoderma viride acted on carboxymethyl cellulose with a Km of 4.9 g substrate per litre, showing a pH optimum at 4.5 and a temperature optimum at 55 degrees C. Ag+, Hg2+, Zn2+, Cu2+ and N3- were inhibitory..

Multiple sclerosis and malabsorption

Malabsorption tests were studied in 52 patients with multiple sclerosis. The stools were examined microscopically for fat and undigested meat fibers and were found to be abnormal in 41.6 and 40.9% respectively. Abnormally low five hour excretion of d-xylose was demonstrated in 26.6% cases. Malabsorption of Vitamin B12 was found in 11.9% cases. The jejunal mucosa was examined histologically and by tissue immune technic including viral studies. Histology showed normal mucosa in all except seven patients in whom an increased inflammatory infiltrate was present. Fluorescent antibody studies revealed the presence of measles virus antigen in all patients and immunofluorescent studies showed a variable degree of immune reaction in the majority of cases. The significance of these findings in the pathogenesis of multiple sclerosis is discussed.

Jejunal immunopathology in amyotrophic lateral sclerosis and multiple sclerosis. Identification of viral antigens by immunofluorescence

Jejunal mucosa from 7 patients with amyotrophic lateral sclerosis (A.L.S.), 20 newly reported patients with multiple sclerosis (M.S.), and 35 control patients without either disease was studied by immunofluorescence. An immune reaction was present in all A.L.S. specimens and consisted of altered ratios of immunoglobulin-labelled cells in the lamina propria, complement-labelled cells in the same location, and, in some, immunoglobulin and complement deposits in the epithelial basement membrane. Poliovirus antigen was detected in 4 cases, and in 1 of the these cases measles antigen was also present. A fifth specimen showed large amounts of herpesvirus antigen. In 2 cases studied at necropsy, both viral infection and immunological change was confined to the proximal jejunum. Measles antigen was identified in every case of M.S., and in biopsy specimens from 16 of the 20 M.S. patients immunological reactions similar to those seen in A.L.S. were present. With 2 exceptions, the controls did not show these changes in the jejunal mucosa. The exceptions were a patient with Friedreich's ataxia, who had an increase of IgG-labelled cells and some complement-bearing cells in the lamina propria, and a patient diagnosed as having non-tropical sprue, in whom large quantities of herpes antigen were seen.

N-Substituted indanamines as potential hypoglycemic agents

A number of indanamines substituted at the terminal amino nitrogen with various aliphatic, alicyclic, heterocyclic, and aromatic ring systems were synthesized and screened for hypoglycemic activity. None was found to possess significant activity compared to tolbutamide.

Polarography of molybdenum in aspartic acid solution

The polarographic behaviour of Mo(VI) in solutions of aspartic acid is reported. In 0.01M acid, two waves are obtained, but at pH 4 only one, and they are diffusion controlled. The determination is possible in the presence of Ni, Cr(VI), W(VI), Mn(II), Co(II), Cu(II) or Th, with an accuracy of 2% in the range 10(-5)-10(-3)M.