[Severe precocious pre-eclampsia : how to manage the feto-maternal conflict of interest]

BACKGROUND

The HELLP syndrome is usually treated by rapid termination of pregnancy as the most effective way of limiting the risk of disease aggravation and maternal complications. The drawback is the risk of fetal complications due to prematurity when pregnancy is terminated before 32 weeks gestation. A controlled study has suggested that corticosteroid therapy could be effective in early HELLP syndrome.

PATIENTS AND METHODS

From January 1, 1996 to March 1, 1999, we treated patients presenting early HELLP syndrome defined as platelet counts below 150,000 and ALAT above 50 U/l prior to 32 weeks gestation with dexamethazone (Soludecadron((R))) via intravenous administration of 10 every 12 hours to the end of pregnancy or until platelet counts rose above 150,000.

RESULTS

Among 14 patients with early HELLP syndrome, 10 were treated (including 5 primiparous women). Six patients among the 10 had platelet counts between 50,000 and 100,000. Mean term at the first injection of dexamethazone was 29 weeks 3 days. Platelet counts rose and transaminase levels fell in all patients. Pregnancy was prolonged 7 2 days. The only maternal complication was one case of disseminated intravascular coagulation. There were no neonatal deaths.

DISCUSSION

Our results are similar to those reported in the literature but such a treatment scheme can only be instituted within a rigorously controlled monitoring system in a unit with neonatal and maternal intensive care facilities. This protocol remains safe for patients with HELLP syndrome whose platelet count remains at least above 50,000.

[Validation of laparoscopic surgery in gynecology]

Laparoscopic surgery is presently the gold standard for treatment of benign adnexal pathologies although the evaluation of other surgical techniques such as laparoscopic assisted hysterectomy or myomectomy remains to be made. Multicenter observational studies and data collection should be pursued to evaluate these new surgical techniques as they spread from a few promoting centers.

Prenatal diagnosis of Gaucher's disease type 2. Ultrasonographic, biochemical and histological aspects

We report on the early prenatal diagnosis of fetal Gaucher disease type 2 by ultrasound examination and beta-glucosidase activity assay on amniocytes from a fetus of 15 weeks' gestation whose first sibling fetus had previously been affected with hydrops fetalis. These cases emphasize the importance of the pathological examination of all fetuses presenting with hydrops fetalis and also stress that minimal and precocious echographic signs can be suggestive of such a lysosomal storage disease.

Screening for depression in mothers bringing their offspring for evaluation or treatment of depression

OBJECTIVE

Numerous studies have shown that the highest risk for first onset of depression occurs in women of childbearing years and that there is a strong association between lifetime rates of depressive disorders in mothers and their offspring. This association is found regardless of whether the mother or child is the targeted patient. However, little is known about rates of current depression in mothers who bring their offspring to outpatient clinics for evaluation and/or treatment of depression. This information might be useful in developing intervention strategies.

METHOD

One hundred seventeen mothers bringing their offspring for evaluation or treatment for depression were screened with the Patient Problem Questionnaire to determine current symptoms of depression, anxiety disorders, and substance abuse as well as current psychiatric treatment.

RESULTS

Thirty-six (31%) of the mothers screened positive on the Patient Problem Questionnaire for a current psychiatric disorder. Sixteen (14%) screened positive for current major depression, 20 (17%) for panic disorder, 20 (17%) for generalized anxiety disorder, two (2%) for alcohol abuse, and one (1%) for drug abuse. In addition, 50 (43%) of the mothers had psychiatric symptoms that did not meet the diagnostic threshold for any of the above disorders. Twenty-six (22%) of mothers expressed suicidal ideation or intent. Only five (31%) of the 16 mothers diagnosed with major depression were currently receiving any psychiatric treatment.

CONCLUSIONS

A substantial number of mothers bringing their offspring for evaluation or treatment of depression were themselves currently depressed and untreated. The treatment of depressed mothers may help both the mothers and their depressed offspring.

T cell status influences colon tumor occurrence in min mice fed short chain fructo-oligosaccharides as a diet supplement

We have previously shown that addition of short chain fructo-oligosaccharides (indigestible carbohydrates) to food prevented colon tumors in C57BL/6-Apc(Min/+) mice, a model for human colon cancer. As gut-associated lymphoid tissue was concomitantly developed, we suggested that the immune response generated by this food may interfere with carcinogenesis due to involvement of mucosal cells in the regulation of tissue homeostasis. In the present experiment, we tested whether T cell status may influence colon tumor formation in Min mice fed a food supplement of short chain fructo-oligosaccharides. Min mice depleted of CD4(+) and CD8(+) lymphocytes developed twice as many tumors as immunocompetent mice (0.8 as compared with 0.4, the mean number in 7-week-old Min mice when food supplementation began; P = 0.02). It is concluded that food supplementation with a substrate (a known prebiotic) fermented in the colon may stimulate a mechanism of immunosurveillance that would otherwise remain inefficient.

Gastrointestinal injuries during gynaecological laparoscopy

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.

Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases

A multicentre study was carried out in seven top French centres for laparoscopic gynaecological surgery. This series covers a period of 9 years, in which 29,966 diagnostic and operative laparoscopic operations were performed. The risk of complications has been assessed according to the complexity of the laparoscopic procedure in question. The means of diagnosis and treatment of the complications have been analysed, together with the importance of the surgeon's degree of experience. The mortality rate was 3.33 per 100,000 laparoscopies. The overall complication rate was 4.64 per 1000 laparoscopies (n = 139). The rate of complications requiring laparotomy was 3.20 per 1000 (n = 96). The complication rate was significantly correlated with the complexity of the laparoscopic procedure (P = 0.0001). One in three complications (34.1%; n = 43) occurred while setting up for laparoscopy, and one in four (28.6%) were not diagnosed during the operation. As new indications for laparoscopic surgery in gynaecology have appeared, there has been a parallel and statistically significant increase in the rate of urological complications (P = 0.001). Increased experience by the surgeons has had three consequences: a statistically significant drop in the number of bowel injuries (P = 0.0003), a drop in the rate of complications requiring laparotomy for those laparoscopic surgical procedures that are well defined (P = 0.01), and a change in the way complications are treated, with a significant increase in the proportion of incidents treated by laparoscopy (P = 0.0001).

[Nutritional fetal rickets. A case report]

We report the case of a newborn who showed typical signs of rickets at birth craniotabes and severe hypocalcemia. The diagnosis of fetal rickets was confirmed by radiography. Maternal deficiency was revealed by an excessively low vitamin D level. The multiparous Moroccan mother had suffered low back pain and paraesthesia for several years. She wore the veil and rarely left her home. Nutritional and vitamin D deficiency was demonstrated. We report this exceptional case to recall the importance of vitamin D in the development of fetal calcium supply, the prevention of gravid osteomalacia and the prevention of neonatal hypocalcemia. Vitamin D supplementation (ideally 1000 IU per day during the third trimester or at least one 100,000 IU dose at the sixth and eighth months or a single dose of 2 to 3,000,000 IU at the sixth month) should be the rule in pregnancy.

Screening for psychologically traumatized rape victims

OBJECTIVE

This study aimed to determine whether the General Health Questionnaire, a simple psychological screening instrument, could be useful to non-specialists in screening for psychologically traumatized rape victims.

STUDY DESIGN

285 rape victims (mean age 22.5, men 8%) attending consecutively a Consultation for Victims of Psychological Trauma at the University Hospital in Tours, France, were assessed through the Structured Interview for Post-Traumatic Stress Disorder (SI-PTSD), and the French 28-item version of the self-rated General Health Questionnaire (GHQ-28).

RESULTS

70% had Post-Traumatic Stress Disorder (PTSD) and 72% a GHQ-28 overthreshold score. The principal component analysis of the GHQ-28 ratings yielded a 4-factor solution: social dysfunction, feeling of foreshortened future type of depression, somatoform complaints and hyperalertness anxiety. GHQ-28 reliability and validity in screening for PTSD were studied through computation of Cronbach's alpha coefficient (0.95), sensitivity (88%) and positive predictive value (86%). CONCCLUSION: Using the GHQ-28 is valid and appropriate for practical use.

Major vascular injuries during gynecologic laparoscopy

BACKGROUND

This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention.

STUDY DESIGN

Retrospective case review study.

RESULTS

Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 +/- 11.6 years, and the mean body index mass was 21.6 +/- 3.08 kg/m2. Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation).

CONCLUSIONS

Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeon's experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

Case report and review of the literature: primary twin ovarian pregnancy

A case report of primary twin ovarian pregnancy is presented. A 36 year old woman, gravida 4 para 3, was admitted to the hospital for suspected ectopic pregnancy, with vaginal bleeding at 11 weeks after her last menstrual period, associated with pelvic pain. An endovaginal ultrasonography led to the diagnosis of twin ovarian right ectopic pregnancy with two dead fetuses associated with a compartmentalized haemoperitoneum. Unilateral oophorectomy was carried out by laparotomy. Histological studies confirmed an uni-ovular di-amniotic ovarian pregnancy. Seven cases of ovarian twin pregnancies are reviewed in the literature. This case is the first one where diagnosis has been made by endovaginal sonography.

Endocervical infection in a pregnant woman caused by Neisseria meningitidis: evidence of associated oropharyngeal colonization of the male partner

A case of premature birth associated with an endocervical infection caused by Neisseria meningitidis is reported. Treatment of the mother with amoxycillin eradicated the bacteria from the endocervix and avoided newborn colonization or infection. Epidemiological investigation identified meningococcal oropharyngeal colonization of the male partner. The two strains were of the same antigenic formula B:4:P1.14 and exhibited identical rDNA restriction fragment patterns and outer membrane protein profiles. This phenotypic and genomic identity of strains is the first clear evidence for cross-colonization between sexual partners.

Intrahepatic cholestasis of pregnancy: a French prospective study

The aim of this prospective study was to analyze the characteristics of intrahepatic cholestasis of pregnancy (ICP) in a French population. From 1989 to 1995 we studied 50 consecutive pregnant women with ICP (41 single, 7 twin, and 2 triplet pregnancies) referred for hepatologic consultation. All patients suffered from pruritus and/or jaundice associated with elevated fasting serum levels of total bile acids (mean 49 micromol/L, range 7-290). No patients had concomitant liver disease and all recovered normal liver function after delivery. Overall prematurity rate was 60%: 100% in multiple pregnancies and 41% in single pregnancies. Three of 61 babies died. Systematic clinical interviews revealed that 34 patients had been treated with oral micronized natural progesterone (200-1,000 mg/d) during the current pregnancy for risk of premature delivery, including at least 32 (64%) before the onset of pruritus. Onset of pruritus was statistically earlier in patients previously receiving progesterone than in patients not receiving progesterone (217 +/- 21 vs. 240 +/- 26 days, P < .01). This was also found in the single pregnancy subgroup of patients (222 +/- 19 vs. 240 +/- 26 days, P < .05). Pruritus disappeared before delivery in 10 of 50 patients, i.e., after withdrawal of progesterone in 7 patients (only one concurrently treated with cholestyramine), after decrease in dose of progesterone in 1 patient, and spontaneously in 2 patients. During the same period, the percentage of pregnant women without ICP who had been treated with progesterone during pregnancy was statistically lower than the percentage of patients treated with progesterone before the onset of pruritus in our group of patients with ICP (36% vs. 64%, P < .01, odds ratio 3.16, 95% CI:1.29-7.80). These results suggest that orally administered progesterone might be an exogenous factor which triggers ICP in predisposed women.

A small heat shock protein from Leuconostoc oenos induced by multiple stresses and during stationary growth phase

In Leuconostoc oenos, a malolactic bacterium, the synthesis of a stress protein called LO18 with an apparent molecular mass of 18 kDa was greatly induced after heat (42 degrees C), acid (pH 3) or ethanolic (12% (v/v)) shocks. Moreover, the LO18 protein synthesis was induced in stationary growth phase and was detected for a long time (30 h) during this growth phase. Significant identity was found between the N-terminal parts of the LO18 protein and the Hsp18 from Clostridium acetobutylicum suggesting that LO18 protein belongs to the family of small heat shock proteins conserved in prokaryotic and eukaryotic cells.

Short-chain fructo-oligosaccharides reduce the occurrence of colon tumors and develop gut-associated lymphoid tissue in Min mice

C57BL/6J-Min/+ mice, which are heterozygous for a non-sense mutation in the Apc gene, provide a model for both familial adenomatous polyposis and sporadic colon cancers. In our study, gut tumors and small intestine lymphoid nodules were counted in Min mice fed fiber-enriched diets for 6 weeks. Neither starch-free wheat bran nor resistant starch modified the number of tumors. However, short-chain fructo-oligosaccharides dramatically reduced the incidence of colon tumors and concomitantly developed gut-associated lymphoid tissue. Our experiment shows that short-chain fructo-oligosaccharides counteract advanced stages of colon carcinogenesis, possibly via stimulation of antitumoral immunity by modulation of the colonic ecosystem.

[Complications of laparoscopy caused by trocars. Preliminary study from the national registry of the French Society of Gynecologic Endoscopy]

OBJECTIVE

To describe laparoscopic complications due to trocar insertions and to define their prevention as well as their risk factors.

STUDY DESIGN

The SFEG registry of laparoscopic complications was used for our study; 26 complications due to trocar insertions were recorded to this day by the register including 12 vascular injuries, 9 bowel injuries, 3 bladder perforations and 2 incisional herinas. In order to avoid accidents of this technique, patient profile, laparoscopy indications, trocar type, diagnosis and treatment of the complications as well as the outcome must be defined.

RESULTS

Whatever the operator's experience, the indication of laparoscopy and the trocar type some patients seem to have complications at laparoscopy: 70% of studied group had prior surgical treatment and 50% were over weight. However, it appeared that safety rules were not been taken into account for one-third of the trocar injuries. Consequently, laparotomy was used by the same surgeons for these complications in 89% of cases, laparotomy was delayed in 27% of the cases.

CONCLUSION

In order to prevent laparoscopic complications, the surgeon must (i) inform the patients about risks which may occur, (ii) be careful, and (iii) declare each complication to a national registry such as the SFEG registry.

[Ethical problems with the decision of refusal to a request for intra-conjugal in vitro fertilization]

What is our knowledge of the couples who suffer refusal of access to IVF when information is available for only 52% of the pregnancies obtained by IVF? With a retrospective study on IVF refusal datas in a centre where they are available, and an investigation by questionnaire in twelve other centers, the authors tried to evaluate the incidence of these refusal. IVF refusal concern 6 to 30% of the couples addressed, varying on a plurifactorial preselection; but a register including refusal is available in only four of the twelve centers. The main reason for refusal is maternal age. Only three of the twelve centers inquired have a real multidisciplinary staff for access decision. Moreover, if the twelve centers knows the future for the obtained pregnancies, it's true sometimes for only seven centers when IVF is unsuccessful, and never for ten centers when refusal of IVF. Assessment of IVF is incomplete, and improvement is needed based on: a better diffusion of the actual knowledge and its applications; a vast application of "ethical committee procedure" when decision for access is taken; and a global approach of IVF, considering refusal as well as success.

Prenatal diagnosis of trisomy 8 mosaicism in CVS after abnormal ultrasound findings at 12 weeks

We describe a case of trisomy 8 mosaicism in which fetal chromosome analysis was prompted by ultrasound abnormalities, i.e., hygroma colli and dilatation of the renal pelves. Chorionic villus sampling (CVS) was performed, with a false-negative result on direct karyotype analysis, although cultured trophoblasts revealed trisomy 8 mosaicism. Fetal autopsy confirmed the abnormalities found on ultrasound examinations and fetal tissue examination showed different levels of trisomy 8 mosaicism. To our knowledge, this is the first prenatal diagnosis of trisomy 8 made on ultrasound findings.

Effect of different exposure compounds on urinary kinetics of aluminium and fluoride in industrially exposed workers

OBJECTIVE

To conduct a field study to obtain information on the urinary concentrations of aluminium (Al) and fluoride (F-) depending on the different compounds exposed to in the aluminum industry.

METHODS

16 workers from one plant that produced aluminium fluoride (AlF3), and from two plants that produced aluminium electrolytically by two different processes participated in the study for one working week. Pollutants were monitored by eight hour personal sampling every day, and urine samples were collected during the week. Al and F- were analysed in both atmospheric and urine samples by atomic absorption spectrometry and an ion selective electrode.

RESULTS

The principal results show different characteristics of kinetic curves of Al and F- excretion in workers with different exposures. Some characteristics of excretory peaks were linked to specific exposures--for instance, after exposure to AlF3 there was one delayed Al peak associated with one delayed F- peak about eight hours after the end of the daily shift, and after mixed exposure to HF and AlF3, two F- peaks were noted, one fast peak at the end of the shift and another delayed peak at 10 hours synchronised with an Al peak. In one of the electrolysis plants, the exposure to Al and F- compounds led to the simultaneous excretion of Al and F- peaks, either as a single peak or two individual ones depending on the type of technology used on site (open or enclosed potlines). The average estimated half life of Al was 7.5 hours, and of F- about nine hours. Quantitative relations between excretion and exposure showed an association between the F- atmospheric limit value of 2.5 mg/m3 with a urinary F- concentration of 6.4 mg/g creatinine at the end of the shift, a peak of 7.4 mg/g creatinine, and 7.4 mg excreted a day. For Al, the exposure to 1.36 mg/m3 during the shift corresponded to a urinary concentration at the end of the shift of 200 microgram/g creatinine. Daily excretion of 200 micrograms corresponded to an exposure to 0.28 mg/m3.

CONCLUSION

Particular differences in the behaviour of Al and F- in urine depended upon the original molecular form in the pollutant. These results reinforce the principle that, in biological monitoring, the sampling strategy and the choice of limit value should be dependent on kinetic data that take the exposure compound of the element in question into account.

[Ethical problems with the current French practice in therapeutic abortions. Part 3: resolving moral dilemmas in fetal medicine]

OBJECTIVE

Based on the information acquired in the first two parts of this study and the data in the literature, to propose ethic codifications for solving moral dilemmas concerning fetal medicine.

METHODS

Identification of situations where the object of the conflict is ethics: general methodology propositions for making individual decisions.

RESULTS

In all cases a rigorous method is required, based on three main elements: a complete and well documented medical file; the opinion of the couple after appropriate participative communication; case by case collegial discussion.

CONCLUSION

The methodology proposed underscores the roles played by health carers: obtain a medical file as complete as possible with prime emphasis on the infant; establish active communication with the parents giving greater value to their free examination of the situation; collegial discussion in order to be pertinent social partners.

Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women

BACKGROUND AND DESIGN

For a period of 1 year, all pregnant women presenting with itching were investigated by clinical, histologic, immunopathologic, and laboratory studies. Fifty-one of 3192 pregnant women were studied.

RESULTS

We identified (1) two typical cases of herpes gestationis, with an approximate incidence of one in 1700 pregnancies; (2) 22 cases of pruritus gravidarum, including five cases with a polymorphous skin eruption, with an incidence of one in 145 pregnancies; (3) 25 cases of polymorphic eruption of pregnancy, including diseases without maternal or fetal side effects and without criteria defining herpes gestationis or pruritus gravidarum, with an incidence of one in 130 pregnancies; and (4) two cases of intercurrent disease (one scabies and one exfoliative dermatitis).

CONCLUSION

Our study is a prospective homogeneous account of pruritic dermatosis of pregnancy. Our results show that the incidence of herpes gestationis is higher than is usually reported in the literature and that pruritus gravidarum must be considered in the presence of itching occurring during pregnancy, with or without skin eruption.

Cobalt determination in serum and urine by electrothermal atomic absorption spectrometry

Cobalt determinations in biological fluids are of great interest in biological or toxicological research programs. Cobalturia is often chosen as an indicator for a biological monitoring program in occupational exposure to cobalt dusts. The method described here derives from the IUPAC reference method for nickel determination. It enables cobaltemia and cobalturia to be measured in small samples (1 mL). The mean usual values for cobalt in biological fluids are very low (2.7 nmol L-1 for serum and 6.7 nmol L-1 for urine), and therefore, thus require an analytical procedure with preconcentration and extraction. The sample is mineralized by wet acid digestion. After digestion, inorganic cobalt is extracted in form of ammonium pyrrolidine dithiocarbamate complex into isobutyl methyl ketone and measured in the organic layer by electrothermal atomic absorption spectrometry. The analytical parameters are described in detail. The extraction output is about 99%. The detection limits are 1.93 and 1.89 nmol L-1 for serum and urine, respectively. Sensitivity (expressed as the concentration that gives a 0.044 absorbance) is 3.4 nmol L-1 for serum and 3.3 nmol L-1 for urine. Within-run precision ranged between 3.9 and 2.5% (coefficients of variation) for serum and 4.2 and 1.1% for urine, at 87 and 136 nmol L-1 levels, respectively. Between-run precision ranged between 4.3 and 3.3% (coefficients of variation) for serum and 4.2 and 2.3% for urine, at 87 and 136 nmol L-1 levels, respectively. At very low concentration, 5.7 nmol L-1 for serum and 2.5 nmol L-1 for urine, the between-run precision is, respectively, 19.5 and 28%. Linearity is effective between 0 and 272 nmol L-1. Interferences and matrix effects are negligible for urine, serum, or plasma samples without hemoglobin. The method is easily applicable for routine determinations.

Alfuzosin, a selective alpha 1-adrenoceptor antagonist in the lower urinary tract

1. Phenylephrine-induced contractions of rabbit isolated trigone and urethra were antagonized in a competitive manner by alfuzosin (pA2 7.44 and 7.30, respectively) and prazosin. 2. The characteristics of [3H]-prazosin binding to human prostatic adenoma tissue were evaluated. [3H]-prazosin was potently displaced by alpha 1-adrenoceptor specific agents including alfuzosin, its (+)- and (-)-enantiomers and prazosin (IC50 0.035, 0.023, 0.019 and 0.004 microM, respectively), but only weakly by alpha 2-adrenoceptor selective agents, for example, yohimbine (IC50 = 6.0 microM). 3. In the pithed rat, alfuzosin (0.03-0.3 mg kg-1, i.v.) markedly inhibited pressor responses produced by the alpha 1-selective agonist, cirazoline but inhibited only slightly responses to the alpha 2-selective agonist, UK 14,304. Alfuzosin (1 mg kg-1, i.v.) had minimal effects against responses mediated by stimulation of prejunctional alpha 2-receptors (UK 14,304-induced inhibition of sympathetic tachycardia). 4. In the anaesthetized cat, alfuzosin (0.001-1 mg kg-1, i.v.) and prazosin (0.001-0.3 mg kg-1, i.v.) produced dose-related inhibition of the increases in urethral pressure caused by stimulation of sympathetic hypogastric nerves. Prazosin was approximately 5 fold more potent than alfuzosin. When phenylephrine was employed to induce urethral and vascular alpha 1-mediated tone simultaneously, prazosin inhibited both stimuli with similar potency whereas alfusozin was 3-5 fold more potent against elevated urethral pressure. This functional uroselectivity of alfuzosin was more evident by the intraduodenal route, since doses of 0.03 and 0.1 mg kg-1 alfuzosin inhibited urethral pressure with minimal effects on arterial blood pressure. 5. Alfuzosin is a potent selective alpha1-adrenoceptor antagonist in tissues of the lower urinary tract including the human prostate. This provides a pharmacological basis for its use in the treatment of benign prostatic hypertrophy.

Use of nonradioactive DNA probes to identify a Campylobacter jejuni strain causing abortion

A case of human abortion due to a Campylobacter infection is reported. Cultures revealed two morphologically different isolates with large and small colonies respectively. Using conventional methods of identification, the large colonies were identified as Campylobacter jejuni and the small colonies as Campylobacter coli. Dot blot hybridization and determination of rDNA restriction fragment patterns revealed that both colony types were the same strain of Campylobacter jejuni. This observation illustrates the need to use methods other than phenotypic methods when identifying strains of Campylobacter.

[Children's participation in biomedical research. A planned survey of 541 parents]

BACKGROUND

We have interviewed the parents of children born at two maternity hospitals to evaluate the knowledge of parents concerning the French Huriet law and their consent to the participation of their child in a randomized therapeutic trial.

METHODS

The inquiry was conducted between 15 February and 30 April 1991. Each couple of parents of whom the mother had given birth in one of the hospitals was sent an explanatory letter and a questionnaire on the second day after delivery. Parents who were unable to read adequately and those whose baby was ill were excluded from the study. The main questions were: age of parents, country of origin, education, profession, social insurance, frequency of medical consulting, their knowledge of the Huriet law, the source of that knowledge, their attitude to giving parental consent for their child to participate in a trial, the reasons for their consent or refusal.

RESULTS

Five hundred and eighty two questionnaires were distributed but only 541 were used. 73% of the parents said they knew that drugs were tested on volunteers. 59% claimed to know of the Huriet law, through the media (75%), their practitionist (12%), their environment (8%). 21% of the parents would consent to one of their children participating in such trial; 74% would refuse. Both parents were in agreement in 79% of cases, 12% of them for consent. The main reasons for refusal were the risk for side-effects of the drug (75%), lack of proof for efficacy (49%), disagreement in principle (19%). The mothers who consented were older than those who refused. The members of the "consent" group were more highly educated.

CONCLUSIONS

Law Huriet is still inadequately understood in France. Pediatricians should consider how best to provide parents and the media with better information before trying to obtain parental consent.