Evaluation of a rapid latex test for direct detection of Streptococcus agalactiae in various obstetrical and gynaecological disorders

Cervical samples collected during speculum examination in 413 women were tested for the presence of Streptococcus agalactiae by Gram staining, a new latex agglutination test and standard cultures. The results of each method are reported in correlation with the clinical circumstances of isolation. Gram stain and the latex agglutination test had a sensitivity of 30% and 78%, and a specificity of 89% and 98% respectively compared with culture. The sensitivity of the latex agglutination test was higher in cases of premature rupture of membranes (90%), presumed chorioamnionitis (86%), presumed post-partum endometritis (86%) and presumed salpingitis (87%). This latex agglutination test appears to be useful for identifying patients who are heavily colonized with Streptococcus agalactiae and are at a high risk of infection.

Parental opinions about biomedical research in children in Tours, France

In order to evaluate parental awareness of the law governing clinical trials in France (Loi Huriet), a study was performed by questionnaire between February and April 1991 in a maternity unit during the days following delivery. The response rate was 59%. 59% of the parents (319/541) were informed of the existence of the law by the media (75%) or their general practitioners (12%). Twenty-one percent (116/541) of the parents would accept the participation of their children in a clinical trial and 74% would refuse. The principal reasons for acceptance were: for the benefit of other children, contribution to medical progress and confidence in physicians. The reasons for refusal were: risk of side effects and unproven efficacy. Parents who would accept had more often received higher education (44%) than parents who would refuse (30%), the latter being less influenced by the explanations of physicians and less willing to accept that a physician should decide for them. Physicians should consider transmitting information directly to parents and indirectly via the media.

[Endometriosis and sterility: whom to treat and how?]

The difficulty in evaluating the efficacy of treatments for endometriosis in terms of sterility results from the frequent confusion between the inhibition of the natural progression of endometriosis and a beneficial effect on fertility. The authors review the supposed benefits and the drawbacks of the various medical and surgical treatments available and medically assisted fertilization (IVF) in the context of the various types of endometriosis damage. They highlight the inadequacy of the AFS score, which gives very similar scores for effects with widely differing impacts on fertility. The authors attempt to identify the therapeutic associations which seem currently to be useful in treating endometriosis and also beneficial in obtaining a pregnancy.

For a systematic policy of i.v. oxytocin inducted placenta deliveries in a unit where a fairly active management of third stage of labour is yet applied: results of a controlled trial

The authors analysed the effect of the i.v. oxytocin induced third stage of labour in a controlled trial concerning 1000 patients. The appliance of such an policy in a unit that already had a fairly active management of delivery was very encouraging. The incidence of post-partum haemorrhage (greater than 500 ml) is significantly (P less than 0.001) less than in the control group; and the same for severe haemorrhage. The third stage is significantly (P less than 0.001) shorter in the oxytocin-injected group than in the control group. Moreover, there is no significant difference between the two groups for retained placenta. The economy of blood transfusion, which is a major concern nowadays, could be the real interest of this active management of the third stage of labour.

[What place is given to autopsy in cases of perinatal death?]

The authors studied two series of deaths (437 cases in all), one from a prospective study on the Centre region and the other from a retrospective study on the Tourangelle region; they compared the clinical and paraclinical data recorded during pregnancy, labour and the neonatal period to the autopsy results and those of the different tissue examinations, and strived to define the most judicious indications for autopsies in case of perinatal death. From their conclusions, based on the clinical context of the death, 5 different types of situations can be distinguished: for two of them, namely the medico-legal context and the malformation context, the post mortem examination seems indispensable for different reasons. In case of "obvious clinical diagnosis", the need for an autopsy has not been proven. However, when the clinical diagnosis seems "probable" or when the aetiology has not been found clinically, the post mortem examination of the foetal body is recommended, although certain particular situations, related to the age of the mother, the parity, the interest shown by the couple about the result, to ethnic or religious factors, may lead to the request of only a limited examination, which is much less expensive.

Frequent isolation of capnophilic bacteria in aspirate from Bartholin's gland abscesses and cysts

Aspirate samples were obtained from 73 patients undergoing surgery for a Bartholin's gland abscess or cyst. Capnophilic bacteria were isolated from 22% of cases, in contrast to previous reports of sporadic isolation. The three Streptococcus pneumoniae isolates were serotype 3 or 4. The eight Haemophilus influenzae isolates could not be serotyped; six of them were biotype II but the electrophoretic band patterns of their outer membrane proteins were heterogeneous, indicating that non-serotypable strains from the same anatomical site may not be related. Four Neisseria gonorrhoeae isolates and one strain of Neisseria subflava were recovered. The role of capnophilic bacteria in the pathogenesis of infections of the Bartholin's gland remains to be clarified.

Chromosome aberrations in peripheral blood lymphocytes of welders and characterization of their exposure by biological samples analysis

Chromosomal aberrations in cultured lymphocytes obtained from 55 welders and 55 matched controls were analyzed. Depending on the welding techniques and the nature of the consumables and metals welded, three separate groups of welders were examined. Chromium, nickel, and manganese levels in serum and urine were measured to assess the exposure to welding fumes. A statistically significant increase of chromosomal aberrations was found in one of the three analyzed groups of welders. This group used the semi-automatic metal active gas welding process with cored wire containing nickel for welding mild steel. These welders had significantly higher concentrations of serum and urine manganese and, unlike the other welders, significantly elevated concentrations of nickel, both in serum and urine. However, no significant correlations between nickel or manganese levels and the frequency of chromosomal aberrations were found. There was a significant correlation between the length of welding employment of these welders and the frequency of chromosomal breaks, although there was no significant correlation between age and the frequency of chromosomal aberrations. The other two groups of welders, for which the analyses of biologic fluids proved chromium and manganese exposure, had no statistically significant higher frequency of chromosomal aberrations. One of these groups used the manual metal arc welding process with coated electrodes for welding mainly mild steel and the other group used the tungsten inert gas welding process for welding stainless steel. A significant correlation between the daily amount of cigarettes smoked and the frequency of chromosomal breakages, in controls as in welders, was observed. The present data indicate that certain welding processes may generate fumes that seem to have a clastogenic activity.

Respiratory hazards in hard metal workers: a cross sectional study

A cross sectional study was conducted on 513 employees at three hard metal plants: 425 exposed workers (351 men, 74 women) and 88 controls (69 men, 19 women). Cough and sputum were more frequent in workers engaged in "soft powder" and presintering workshops compared with controls (12.5% and 16.5% v 3.5%). Spirometric abnormalities were more frequent among women in sintering and finishing workshops compared with control women (56.8% v 23.8%) and abnormalities of carbon monoxide test were more frequent in exposed groups than in controls; this difference was more pronounced in women (31.4% v 5.6%) than in men (18.5% v 13%). No significant correlation was observed between duration of exposure and age adjusted lung function tests. Slight abnormalities of chest radiographs (0/1, 1/1 according to ILO classification) were more frequent in exposed men than controls (12.8% v 1.9%) and mostly in soft powder workers. In subjects with abnormal chest radiographs FVC, FEV1 and carbon monoxide indices (fractional uptake of CO or CO transfer index or both) were lower compared with those with normal chest radiographs. Although relatively mild, the clinical, radiological, and functional abnormalities uncovered call for a regular supervision of workers exposed to hard metal dust.

[Perfusion of prostaglandins in the cervix uteri. A new method of cervical maturation after premature rupture of the membranes]

Many authors consider that using prostaglandins is the best way of obtaining adequate maturation of the cervix uteri before induction of labour; however, in case of premature rupture of the membranes the conventional methods can seldom be used. An original technique for this relatively rare situation is presented, consisting of an intracervical infusion of prostaglandin F2-alpha at the initial rate of 0.3 mg/hour. Details are given of the technique as well as of the results obtained in a preliminary study of 10 patients. With a mean 7.5 mg total dose of prostaglandin F2-alpha, the mean durations of maturation and delivery were 15 and 20 hours respectively. No infection developed and the procedure was well tolerated by the patients. Nevertheless, this technique should be reserved to those cases where conventional methods cannot be used.

[Maternal behavior toward her newborn infant. Potential modification by peridural analgesia or childbirth preparation]

The effects of sophrology and epidural analgesia on early relationship between the mother and her child were studied on a simple of 190 deliveries. The mothers were observed during and just after delivery. Mothers who had been separated from their child before the end of the observation were excluded from the study. The patients had the choice between epidural analgesia or prenatal care with sophrology. Participation to prenatal courses has statistically a positive effect on the relation between the mother and her child (p less than 0.01). Instead, epidural analgesia and posture have very limited effect on this factor. However, a trend to more interaction is found in multipari and patients who didn't choose epidural analgesia.

[Seasonal, weekly and lunar cycles of birth. Statistical study of 12,035,680 births]

The authors have studied the seasonal, weekly and lunar rhythms which could characterize deliveries, based on 12,035,680 french births, between January 1, 1968 and December 31, 1982. The seasonal rhythm is the most remarkable. It is characterized by a maximum of newborn in May and a minimum in November; there is an increased number of births during the month of September. The weekly rhythm is characterized by a drop in the number of births especially on Sundays, but also on Saturdays, with a maximum on Tuesday. The number of births also fluctuate according to the lunar cycle. Their amplitude is low. They are however significant. From that standpoint, these results confirm other studies already conducted in France and the USA, in a much smaller scale.

[Active management of labor in Dublin: what is it 15 years later?]

Every obstetrician, in his readings, must have come across a report of article by K. O'Driscoll, and could not remain indifferent (surprise, incredulity, even anger...) in front of astonishing results: 5% of caesarean sections, 5 to 6% of forceps deliveries, combined with a recruiting worthy of any large university center and creditable neonatal results which are accurately analysed. In view of the difficulty and understanding of the basis of "active management of labor", advocated by this team and described as the main reason of its success, the author tried to understand, while staying in this department, the highlights of its daily obstetrical practice. In this detailed report of the activities of this irish obstetrical team, the author wanted to put the results back in their context and broadly outline the organization of this department and the management of labor, in order to evaluate the significance of the figures reported in numerous international publications and too often not easy to analyse for uninformed readers.

Respiratory symptoms and pulmonary function in 871 miners according to Pi phenotype: a longitudinal study

Pi phenotype was determined and alpha 1 protease inhibitor (alpha 1 Pi) was measured in 871 iron-ore miners examined twice at five years interval. A questionnaire on respiratory symptoms was administered and lung function tests: spirometry (VC, FEV1.0), measurements of the residual volume (RV/TLC) and of the CO diffusion (FuCO), were carried out by the same medical and technical team, using the same apparatus. There were no differences in age, length of employment or smoking habits among the three Pi Phenotype groups: M (90.03%), MS (7.1%), MZ (2.8%). The prevalence of clinical symptoms at the initial survey and the incidence of symptoms between the 2 surveys were not related to Pi Phenotype groups. However a significantly steeper decline of FEV1.0/VC was observed in the alpha 1 Pi partially deficient groups MS and MZ (-3.9%) compared with the non-deficient group (-1.8%). No significant difference was observed for VC, RV/TLC and FuCO. This finding suggests that an intermediate deficiency of alpha 1 Pi may be related to a slight but statistically significant impairment of a lung function in occupational conditions.

Determination of manganese in biological materials by electrothermal atomic absorption spectrometry: a review

The great diversity of methods for measuring manganese in biological materials (serum, plasma, whole blood, urine, spinal fluid, and hair) reflects the difficulty in measuring extremely small quantities of this element. Detailed examination of these methods demonstrates that the one most used is flameless atomic absorption spectrometry. In this review we report the different instrument settings for wavelength, slit width, protection gases, graphite furnaces, type of background correction, amounts measured, and thermal programs. We give detailed recommendations by various authors for collecting samples. A thorough description of the preliminary steps and the handling of the specimen samples is also included: direct determination with or without dilution, addition of a matrix modifier or determination after ashing, with or without chelation-extraction steps. The preparation of the standards, procedures used, analytical criteria (accuracy, precision, specificity, detection limit, linearity), problems (interferences, matrix effects), and reference values and their physiological variations are also described. We give a consensus of recommendations concerning the choice of a method.

Decreased serum ceruloplasmin concentration in aluminum welders exposed to ozone

During an epidemiological survey on arc welders, serum copper and ceruloplasmin were determined in two groups of workers. One group consisted of aluminum welders who were divided into two groups: 13 welders working inside aluminum tanks (confined atmosphere) and 8 welders engaged in the production of vans for dump trucks (nonconfined atmosphere). The reference group consisted of 26 workers of the same plant who were not exposed to welding fumes. Ozone, the major pollutant in aluminum arc welding, was thought to be the principal factor in the significant decrease (P less than 0.01) of mean ceruloplasmin in confined welders. This decrease in the level of ceruloplasmin was still within the reference values and was not linked to age or to tobacco consumption. We found a linear relationship between ceruloplasmin concentration and the cumulated worktime along the week. This effect could be a sign in the serum of a lung reaction against oxidant activity in this type occupational exposure.

Determination of manganese in biological materials by electrothermal atomic absorption spectrometry: a review

The great diversity of methods for measuring manganese in biological materials (serum, plasma, whole blood, urine, spinal fluid, and hair) reflects the difficulty in measuring extremely small quantities of this element. Detailed examination of these methods demonstrates that the one most used is flameless atomic absorption spectrometry. In this review we report the different instrument settings for wavelength, slit width, protection gases, graphite furnaces, type of background correction, amounts measured, and thermal programs. We give detailed recommendations by various authors for collecting samples. A thorough description of the preliminary steps and the handling of the specimen samples is also included: direct determination with or without dilution, addition of a matrix modifier or determination after ashing, with or without chelation-extraction steps. The preparation of the standards, procedures used, analytical criteria (accuracy, precision, specificity, detection limit, linearity), problems (interferences, matrix effects), and reference values and their physiological variations are also described. We give a consensus of recommendations concerning the choice of a method.

Lung function and clinical findings in a cross-sectional study of arc welders. An epidemiological study

An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N2 washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.