Family-centered postpartum care

The birth of a baby is a significant event for a family and may result in physical, emotional, or social changes for any family member. The medical community has traditionally focused its attention on the infant and the mother during this period. This paper discusses postpartum health changes that may be experienced by mothers, fathers, and siblings, and proposes a method for integrating the entire family into postpartum care routines. Expanding the traditional view of postpartum change and recovery to include the entire family promotes the well-being of each individual family member, as well as that of the family unit as a whole.

Local anesthesia for neonatal circumcisions: are family practice residents likely to use it?

Dorsal penile nerve block with lidocaine (DPNB) is a local anesthetic technique for neonatal circumcision which is both effective and consistent with ethical concerns for infant welfare. As such, it should be included in training programs that prepare residents to care for newborns. To assess the current level of DPNB use by residents in a family practice training program and to identify attitudes and other factors that relate to use, a survey was sent to 127 residents in the Department of Family Practice and Community Health, University of Minnesota. Of the 101 respondents, 55% had used DPNB, and 17% could be characterized as high users, employing the technique for over one half of the circumcisions they performed. Residents with comprehensive understanding of the newborn's capacity to feel pain were more likely to be using DPNB than their less well-informed counterparts. Four factors were identified as predicting use: cooperation of nursery staff for the procedure, accessibility of instruction in PNB technique, belief that PNB is effective in reducing infant pain, and likelihood of parents giving consent for PNB. These results suggest strategies which may be implemented by family practice educators who wish to promote the principles and techniques of DPNB.

Studies of immunologic tolerance to host minor histocompatibility antigens following allogeneic bone marrow transplantation in mice

We showed previously that transplantation of 10(7) unmanipulated C57BL/6 marrow cells to irradiated LP mice yields healthy (B6-LP) chimeras showing no signs of rejection or graft-versus-host disease (GVHD). The aim of this work was to gain more insight into the mechanism(s) responsible for tolerance to host minor histocompatibility antigens following allogeneic bone marrow transplantation (BMT). (B6-LP) chimeras showed very good immune reconstitution when studied in vitro for proliferative response to mitogens and alloantigens and generation of T cell cytotoxic activity. In co-culture experiments their spleen cells showed no natural suppressor activity. When used as cell donors, their capacity to initiate GVHD in four strains of mice presenting H-2 differences was normal when compared to C57BL/6 donors. However, they provoked no GVHD in the three strains of H-2 compatible mice studied. Re-irradiated (B6-LP) chimeras rapidly died of GVHD following injection of C57BL/6 marrow + spleen cells. (B6-LP.R111) chimera cells appeared tolerant to LP minor antigens presented in the context of H-2r or H-2b. No anamnestic anti-idiotypic suppressor response was noted when stable (B6-LP) chimeras were stimulated with naive C57BL/6 cells. These findings suggest that in BMT chimeras transplanted across minor histocompatibility barriers: (1) both host and donor-derived antigen-presenting cells can present host antigens to donor T cells whose numbers in the marrow inoculum will determine if GVHD or tolerance will ensue, (2) GVHD can be triggered by only a limited number of 'dominant' minor antigens, and (3) we found no evidence for the presence of natural suppressors, veto cells or anti-idiotypic suppressor T cells.

A causal model describing the relationship of women's postpartum health to social support, length of leave, and complications of childbirth

Recovery from childbirth is a complex process that may involve not only the gynecological organs, but also the cardiovascular, respiratory, musculo-skeletal, urologic, gastrointestinal, endocrine, and nervous systems. The process of postpartum recovery may span several months and is related to a variety of personal, family, and social variables. This paper presents a model that describes changes in women's health over the first postpartum year and the relationship between health changes and other variables. The model's dependent variables--mothers' mental and physical health--have a reciprocal effect on one another. The independent variables within the model include length of maternity leave, social support, complications of childbirth, baby's health, mother's use of cigarettes and alcohol, and demographic characteristics. This model is proposed as a research tool for future investigations in postpartum health, and as a conceptual framework to enhance our understanding of the relationship between postpartum health and other important variables.

[Insulin pharmacokinetics in insulin-dependent diabetics. Mathematical models]

The study of insulin pharmacokinetics must help for a better understanding of clinical phenomenons commonly observed among diabetic patients, when insulin therapy is administered either intra-venously (I.V.), or subcutaneously (S.C.). We realized this work in a population of insulin-dependent diabetics. None of the subjects had significant levels of anti-insulin-antibodies. We analysed the absorption profiles (SC(t] of radio-iodine labelled insulin after a subcutaneous injection, the plasmatic profiles (P(t] after an intra-venous bolus of cold insulin. We demonstrate that, using a convolution calculation, it is possible to predict the plasmatic in insulin kinetics after subcutaneous injection or during S.C. infusion, even if the infusion rates are varying. An estimation of the proportion of insulin which is degraded at the injection site can easily be done. This model may be useful for a better understanding of the kinetics of insulin among diabetics, but also to evaluate new modes of insulin administration.

Distinctive features of procoagulant response of monocytes from diabetic patients

The procoagulant activity (PCA) of disrupted monocytes was examined in 32 diabetic patients (26 with insulin-dependent and 6 with non-insulin-dependent diabetes) versus 30 control subjects. Diabetes monocytes exhibited a weak PCA before any incubation, associated in 10 cases with a significant amount of factor VII activity. Incubation led to a significant rise in PCA in diabetes cells, when stimulated with lipopolysaccharide or not, and in control cells only after stimulation. In incubated diabetes cells, PCA was prothrombinase-like when factor VII was associated with the freshly isolated cells, and tissue factor-like (as in the controls) when no factor VII was associated with the cells. The characteristics of PCA were not correlated with clinical features or with the type of diabetes. Our study suggests that diabetes monocytes exhibit a higher level of PCA than control ones, possibly corresponding to an in vivo stimulation, or at least a higher responsiveness to stimuli occurring in vitro.

[A rare cause of heart failure: hypocalcemic cardiopathy]

In this paper, the authors present the case of hypocalcemic cardiopathy observed in a female patient who underwent thyroidectomy which was complicated post-operatively by the development of hypoparathyroidism. Two attacks of heart failure experienced by this patient were improved by the administration of calcium in combination with digitalis treatment. A study of cases published in the medical literature reveals that this condition is a rare cause of heart failure which develops only in the course of chronic hypocalcemia, with few neuromuscular clinical manifestations. The dual negative inotropic and hypovolemic effects caused by hypocalcemia explain the efficacy observed with the administration of calcium therapy, while the usual symptomatic treatment of this condition is inadequate.

[Blood amylase and lipase in diabetic ketoacidosis]

The relation between increase of amylasaemia and increase of lipasaemia was studied during ketoacidosis in 31 insulin-dependent diabetics. The effects of metabolic disturbances on amylase production during the acute phase of ketoacidosis were also evaluated. The greatest increase of amylasaemia was observed after 24 hours in 17 cases (55%), with return to normal values after 3 to 7 days. Amylasuria was closely correlated with amylasaemia (r = 0.7; P less than 0.01). No correlation was found between hyperamylasaemia and the degree of ketoacidosis, but there was a correlation between plasma osmolality and hyperamylasaemia (r = 0.44; P less than 0.02). The increase of lipasaemia, considered more specific of pancreatic damage, was closely correlated with that of amylasaemia (r = 0.63: P less than 0.01). The electrolyte disturbances associated with ketoacidosis are responsible for cellular damage with release of enzymes in many tissues. The hyperamylasaemia consecutive to pancreatic damage might be of similar origin and aggravated by splanchnic hypoperfusion.

[Retroperitoneal liposarcoma. Clinical, prognosis and therapeutic aspects apropos of 4 cases]

Four further cases of retroperitoneal liposarcoma are reported. Principal modes of revelation and diagnostic features are discussed, values of different complementary examinations evaluated, and prognostic factors and therapeutic elements of this serious affection outlined.

[Mechanisms of diabetic impotence. 25 cases]

Twenty-five impotent diatetics were investigated by means of nocturnal penile tumescence monitoring, hormone determinations, penile blood pressure measurement, artificial erection test and dynamic cavernosography, bulbocavernous reflex latency time measurement and cortical evoked responses from pudendal nerves. Sexological treatment was then attempted for a better evaluation of the psychogenic element. Penile blood pressure was also measured in 15 non-impotent diabetics and was found to be abnormal as often as in impotent diabetics. The results as a whole demonstrated that impotence was predominantly psychogenic in 9 cases, predominantly organic in 12 cases and mixed psychogenic and organic in 4 cases. Diabetic impotence is often due to several causative factors, as was the case in 12 of our patients. The factors most frequently responsible were psychological (present in 13 cases), neurological (present in 12 cases) and vascular factors (arterial abnormalities in 7 cases, "venous leakage" in 4 cases). Endocrine abnormalities were observed in only 2 cases.

Dopamine-secreting pheochromocytoma: an unrecognized entity? Classification of pheochromocytomas according to their type of secretion

A pheochromocytoma that exclusively secretes dopamine (DA) rather than predominantly DA among a blend of catecholamines is as yet unreported. Of the 50 patients with pheochromocytoma who have undergone surgery, 32 underwent treatment within the last 5 years (when DA assay has been available). One half of these patients (15/32) exhibited DA secretion either in mixed catecholamines (12 patients) or exclusively (three patients). All three patients with exclusive DA-secreting tumors were normotensive. Without hypertension, the clinical investigation was a diagnostic challenge (unexplained cough or flank mass with inflammatory features). All three tumors were malignant and two were ectopic. Five of the 12 patients with mixed catecholamine-secreting tumors whose secretions included DA were hypertensive. Five other patients had flank mass and one had an unexplained cough. Tumors were rather large, and three of the tumors with mixed secretion were ectopic. Of the 12 patients, seven had tumors that were judged to be malignant. Three patients exhibited a dramatic decrease in blood pressure under alpha-blockade, which was not used in subsequent cases. Predominant or exclusive secretion of DA would explain the lack of hypertension due to its antiadrenergic action that inhibits the vasoconstrictive effects of other amines. Hypertension in patients with pheochromocytoma might depend on the ratio of DA/noradrenaline + adrenaline.

[Nutrition survey assisted by computer]

Data processing has made data banks available to the nutritionist, enabled rapid conversion of food data, and supplied detailed even commented listings of eating behaviour. Until now, however, use of the computer has remained the privilege of the dietician. A conversational data programme employing a microcomputer has been developed, enabling patients to establish a dialogue with the calculator, with storage of data concerning their food habits. A double food survey was conducted in 93 adult subjects, one of which involved the dieticians from ISTA, and the other the computer. Good correlation was found between the two estimates of calorific rations (r = 0.84, p less than 0.001) and nutriments. Deviations between the two estimates were less than 20 p. cent in the majority (80 p. cent) of cases. Psychological questioning confirmed the good reception reserved for this type of computerized survey, whatever the initial reservations held against data processing. Performances were not altered by the sociocultural level of the persons surveyed. This type of interactive programme should lead to simplification of the food anamesis, thus favorizing the communication and the counselling role of the nutritionist. It can also be of value in the framework of epidemiological surveys or education of nutrition.

The utilization of hypnotics in chronic schizophrenics: some critical remarks

Of 23 hospitalized chronic schizophrenic patients, all under neuroleptic medication, hypnotics taken previously for a long time could be totally withdrawn in 16 cases, and in 7 cases, the dosage was diminished by 30%, without any sleep impairment. The gradual reduction of hypnotics was accompanied by a shift of neuroleptic dosage to the evening and bedtime, with reduction of the morning and midday dose, without change of the total daily dose. A significant improvement in the psychic state was observed in 16 patients after withdrawal of the hypnotic; 7 patients showed a slight improvement after reduction of the hypnotic. Monthly or bimonthly reassessment of insomnia in the hospitalized population of chronic schizophrenics is indispensable to avoid the deleterious effects and abuse of hypnotic drugs.

Long term treatment of tardive dyskinesia

A 4 year trial to treat tardive dyskinesia by a very slow progressive stepwise diminution of the neuroleptic dose and of antiparkinsonian agents as well as by administration of small, slowly increasing and then decreasing doses of reserpine or haloperidol was conducted on 62 chronic schizophrenic patients. This treatment program caused disappearance of tardive dyskinesia in 23, improvement in 26 patients and had no effect in 13 patients. The group of patients with disappearance of tardive dyskinesia had a mean age significantly lower than other groups. The rationale of this treatment was based on the concept of "desensitization" by a slow, progressive unblocking of dopaminergic receptor sites. Another tardive neuroleptic side effect, the "rabbit syndrome" was successfully treated in 7 other patients by antiparkinsonian drugs.

Anxiety and depression associated with caffeinism among psychiatric inpatients

Among 83 hospitalized adult psychiatric patients, 22% reported being high caffeine consumers (750 mg or more per day); these patients scored significantly greater on the State-Trait Anxiety Index and the Beck Depression Scale than moderate and low consumers. High consumers described significantly more clinical symptoms, felt that their physical health was not as good, and reported greater use of sedative-hypnotics and minor tranquilizers. Since caffeine modifies catecholamine levels, inhibits phosphodiesterase breakdown of cyclic AMP, and sensitizes receptor sites, association of caffeinism with both anxiety and depressive symptoms is possible.

Cholinesterase in serum and low density lipoprotein of hyperlipidemic patients

Cholinesterase activity in the low density lipoprotein fraction of serum is increased in types IIa, IIb and IV hyperlipoproteinemic patients, whereas only types IIb and IV show increases in serum cholinesterase activity. In obese patients, cholinesterase activity is increased both in the serum and low density lipoprotein fraction only when hyperlipidemia is present. Cholinesterase activity is also found to increase in proportion with increases in low density lipoprotein, cholesterol, and triglycerides both in the serum and low density lipoprotein fraction. We suggest on the basis of these findings that cholinesterase has a function in lipid and lipoprotein metabolism.