The Yolo County Midwifery Service. A descriptive study of 496 singleton birth outcomes, 1990

The Yolo County Midwifery Service was begun in January 1989 to serve pregnant low-income women who were denied care by local obstetricians. In 1990, 58% of women served were Latina and 33% were Anglo-white. Their mean age was 24.5 +/- 5.5 years, and their mean level of education was 9.9 +/- 3.5 years. Thirty-seven percent were nulliparous. All deliveries were at the only hospital in the county with a maternity service. To evaluate the effectiveness of nurse-midwifery care in this sample, a prospective study of the service's 496 singleton birth outcomes during 1990 was undertaken. Although the cesarean rate in 1990 for the obstetricians not associated with the midwifery service at this hospital was 20.6%, the midwifery clients experienced a primary cesarean birth rate of 3.7% and a total rate of 6.7%. Instrument-assisted deliveries took place for 1.0% of births. The success rate for women attempting vaginal birth after cesarean was 87.2%. Delivery over an intact perineum occurred for 51.8%. Preterm birth was experienced by only 1.0% of the women. A newborn birth weight of < 2,500 g occurred in 2.4% of births. Occult cord prolapse preceded a single neonatal death, resulting in a perinatal and neonatal death rate of two per 1,000. These data add to the growing body of information about nurse-midwifery in which that care is found to be a safe, well-accepted, and cost-effective adjunct to existing obstetric care services.

Interdisciplinary management of hemicorporectomy after spinal cord injury

Hemicorporectomy (HCP) is infrequently used, but its effects can devastate the patient's body image, autonomic function, and physical abilities even more than a spinal cord injury of comparable level. Interdisciplinary management is of the utmost importance. This report describes the 2 year course, including four separate rehabilitation admissions, of a patient who was initially paraplegic, and then underwent a HCP for complications secondary to a cauda equina ependymoma. The patient's expectations for functional independence were established by his successful initial spinal cord rehabilitation. The HCP was performed 6 months after initial discharge secondary to infected Harrington rods and rapid spread of the tumor. Extensive use of the interdisciplinary team approach allowed comprehensive analysis and treatment of the patient's comfort, mobility, skin tolerance, and upper extremity functional abilities. Four successive prostheses were developed and modified, until all concerns were successfully addressed. The patient ultimately became completely independent at the wheelchair level. The evaluations, treatment plan, and emphasis of each discipline, including physical therapy, occupational therapy, rehabilitation nursing, therapeutic recreation, social work, vocational rehabilitation, and physiatry are summarized. Differences between the patient's course and standard spinal cord rehabilitation are detailed.

Pemphigus vulgaris following a cutaneous thermal burn

Pemphigus vulgaris developed in a 59-year-old man following a cutaneous thermal burn. This is an example of induced pemphigus and should be included with the small number of cases where this sequence has been reported.

Survival from pentamidine induced pancreatitis and diabetes mellitus

Serious and occasionally fatal reactions to pentamidine have been reported and with the increased use of the drug in immunocompromised patients they are likely to become more frequent. We report the development of acute pancreatitis and permanent diabetes mellitus in an AIDS patient treated with intravenous pentamidine for Pneumocystis pneumonia. The literature on pentamidine induced pancreatic damage is reviewed.

Novel cell lines display properties of nociceptive sensory neurons

Hybrid cell lines derived from neonatal rat dorsal root ganglia neurons fused with the mouse neuroblastoma N18Tg2 exhibit sensory neuron-like properties not displayed by the parental neuroblastoma. These properties include an inward (depolarizing) current with a conductance increase in response to activation of a bradykinin receptor, an inward (depolarizing) current with a conductance increase in response to the sensory excitotoxin capsaicin, the expression of sensory neuropeptides (substance P, CGRP and somatostatin), the expression of phosphatidylinositol-anchored molecules including adhesion molecules of the immunoglobulin superfamily that can be regulated in serum-free culture by nerve growth factor (N-CAM, F-3 and Thy-1), and low permissivity to herpes simplex virus infection. These lines thus provide appropriate models for the study of mechanisms involved in nociceptor activation and the regulation of expression of sensory-neuron specific markers including neuropeptides.

Identity of the calmodulin-binding proteins in bovine lens plasma membranes

Two bovine lens plasma membrane proteins have been identified that bind calmodulin in a Ca2(+)-dependent fashion. Electrophoretic analysis of lens membrane proteins photoaffinity-labeled with benzophenone[125I]calmodulin confirmed our previous observation [Louis, Johnson and Turnquist (1985) Eur. J. Biochem. 150, 271-8] that two major products are formed with Mr = 46 kDa and 36 kDa. Limited proteolysis of lens membrane proteins with chymotrypsin resulted in the formation of a 21-kDa-fragment that was derived from the hydrolysis of the major lens membrane protein MP26; this correlated with the loss of the 46-kDa complex, and the formation of a 41-kDa photoaffinity-labeled complex. Use of the [125I]calmodulin gel overlay procedure confirmed that the 46-kDa and 41-kDa photoaffinity-labeled complexes reflect the interaction of calmodulin with both MP26 and its 21-kDa chymotryptic fragment, respectively. Proteolysis of lens membranes with higher concentrations of chymotrypsin resulted in the hydrolysis of the 18-kDa protein which correlated with the generation of a 12-kDa fragment; this paralleled the loss of the 36-kDa photoaffinity labeled complex and the formation of a 28-kDa-complex. The [125I]calmodulin gel overlay procedure demonstrated that the 36-kDa and 28-kDa photoaffinity-labeled complexes reflect the interaction of calmodulin with the 18-kDa lens membrane protein and its likely 12-kDa chymotryptic fragment, respectively. Identification of these calmodulin-binding proteins suggests that MP26 and the 18-kDa membrane protein are likely candidates for the proposed calcium sensitive, calmodulin-dependent gating of lens fiber cell junctions.

Sphingomyelin lipidosis variant with cirrhosis in the pediatric age group

Two children with a variant of sphingomyelin lipidosis had otherwise unexplained cirrhosis that was histologically inactive and appeared to run an indolent course. The primary clinical problems involved the central nervous system, with vertical supranuclear ophthalmoplegia being the most distinctive feature. Biochemical analysis of cultured skin fibroblasts obtained from one of the children revealed that sphingomyelinase activity was 42% of control values. The typical inconspicuous hepatic storage and cirrhosis, coupled with the important morphologic finding of sea-blue histiocytes in the marrow, suggested that in cases of unexplained infantile or childhood cirrhosis the marrow should be closely examined for such histiocytes. Likewise, in cases of sea-blue histiocytes without evident etiology, with or without cirrhosis, this disease should be considered.

Abdominal pain as a presenting symptom of male germ cell tumour

Twenty-three patients who presented with abdominal pain and were found to have germ cell tumours have been reviewed. The overall survival of these patients was no different from the survival of those presenting with testicular swellings. Intra-abdominal germ cell tumour remains an important differential diagnosis of abdominal pain in men.

Monolithic tetracycline-containing fibers for controlled delivery to periodontal pockets

For the purpose of developing controlled delivery devices for periodontal therapy which would release over several days, six fiber types made of tetracycline-loaded biocompatible polymers were manufactured and tested. Polyethylene, polypropylene, polycaprolactone, polyurethane and cellulose acetate propionate all released their drug load within 1 day. Ethylene vinyl acetate fibers, however, provided in vitro sustained release for periods up to 9 days. A bioassay was designed to measure levels of tetracycline achieved by local delivery which used growth inhibition of Bacillus cereus as a measure of the amount of tetracycline in measured volumes of gingival sulcus fluid on filter paper strips. By this assay, fibers made from 25% loaded ethylene vinyl acetate established initial concentrations of approximately 500 micrograms/ml. The measurement of tetracycline concentration resulting from the placement of these fibers into deep periodontal pockets as a packing material provided indication that concentrations of greater than 50 micrograms/ml could be maintained for months by weekly to monthly replacement. These studies indicate that monolithic fibers made of tetracycline-loaded ethylene vinyl acetate have characteristics which could prove useful as the basis of a tetracycline delivery system for the treatment of periodontal disease.

Incidence of bacterial enteropathogens in foods from Mexico

We examined food consumption patterns of U.S. students temporarily living in Guadalajara, Mexico. Consumption of foods prepared in Mexican homes was associated with an increased risk of acquisition of diarrhea. Foods from commercial sources and private Mexican homes in Guadalajara were subsequently examined for contamination with coliforms, fecal coliforms, and bacterial enteropathogens. For comparison, selected restaurant foods were obtained in Houston, Tex. Food obtained from Mexican homes showed generally higher counts of coliforms and fecal coliforms than those obtained from commercial sources in Mexico and Houston. The foods in Mexico, both from homes and commercial sources, commonly contained Escherichia coli and occasionally enterotoxigenic E. coli. Foods in Houston were not contaminated with E. coli or enterotoxigenic E. coli. Salmonella (17 isolates), Shigella (4 isolates), and Aeromonas hydrophila (1 isolate) were found only in the foods obtained from Mexican homes. Enterotoxigenic non-E. coli Enterobacteriaceae was recovered with approximately equal frequency from all food sources.