Neonatal effect of prolonged anesthetic induction for cesarean section

The relationship of induction-to-delivery and uterine incision-to-delivery intervals to neonatal outcome was studied in 105 parturient women undergoing cesarean section. Sixty patients received general anesthesia and 55 were given spinal anesthesia. During general anesthesia, induction-to-delivery intervals of more than 8 minutes and uterine incision-to-delivery intervals of more than 3 minutes were associated with significantly more instances of neonatal acidosis (umbilical artery pH 7.31 versus 7.22) and a greater incidence of low 1-min Apgar scores (4% versus 73%). In the groups receiving spinal anesthesia, prolongation of uterine incision-to-delivery interval by more than 3 minutes was found to be the only important factor influencing fetal outcome, as determined by an increased acidosis (umbilical artery pH 7.30 versus 7.18) and by depressed Apgar scores (0% versus 62%).

Epidural anesthesia for cesarean section in diabetic parturients: maternal and neonatal acid-base status and bupivacaine concentration

Acid-base status and blood levels of bupivacaine were determined in 16 diabetic parturients and their infants after epidural anesthesia for cesarean section. The newborn infants were divided into two groups based on umbilical artery pH at birth. Group A consisted of 10 infants who had a pH of less than 7.2 and group B consisted of six infants with a pH of greater than 7.2. Neonatal acidosis was related to both the severity of maternal diabetes and the presence of maternal hypotension after epidural anesthesia. In addition, the half-life to bupivacaine was prolonged in acidotic infants. The placental transfer of bupivacaine, as judged by umbilical vein/maternal vein ratios, was significantly greater in acidotic infants.

beta 2-Microglobulin levels in serum and urine of rheumatoid arthritis patients on gold therapy

The levels of beta 2-microglobulin (beta 2-m) in serum and urine of 24 seropositive patients with rheumatoid arthritis (RA) treated with regular gold (sodium aurothiomalate) injections have been investigated. The values obtained were compared with levels from 20 seropositive patients with RA treated only with nonsteroidal anti-inflammatory drugs and 20 age and sex matched normal controls who had received no medication. A significant increase of urinary beta 2-m levels was found in the gold-treated RA group. No correlation between dose of gold received and the levels of beta 2-m in the urine could be established. There was also no correlation between the erythrocyte sedimentation rate (ESR) or total lymphocyte count and beta 2-m levels in serum or urine. We conclude that serum and urinary beta 2-m levels appear to be poor indices of joint inflammation, but sequential urinary beta 2-m levels may prove valuable in monitoring the development of renal tubular lesions due to gold therapy.

Stimulation by a low-molecular-weight angiogenic factor of capillary endothelial cells in culture

A low-mol.-wt compound isolated from rat Walker 256 carcinoma and found to induce neovascularization in vivo was tested on cultures of cow brain-derived endothelial cells (CBEC) growing on plastic and collagen substrates. This factor had a mitogenic effect on CBEC cultured on native collagen gels and for this reason has been called "endothelial-cell-stimulating angiogenesis factor" (ESAF). CBEC growing on plastic culture dishes or denatured collagen films were not stimulated by ESAF. The mitogenic effect of ESAF was equally apparent when added to cells already attached to the native collagen substrate or when the collagen substrate was pre-incubated with ESAF before plating the cells. A floating collagen gel pre-incubated with ESAF in cultures of CBEC growing on plastic dishes did not stimulate cell growth. Our data indicate that the substrate influences cell behaviour and that CBEC only respond to ESAF when growing on a native collagen substrate.

Angiogenic factor from synovial fluid resembling that from tumours

Synovial fluids from 2 of 2 patients with osteoarthritis, 2 of 8 with rheumatoid arthritis, and 2 of 2 with ankylosing spondylitis contained a low-molecular-weight angiogenesis factor apparently identical with that derived from tumours. The amount of factor present was highest in patients with osteoarthritis, 2 patients with psoriatic arthropathy gave negative results. It is suggested that angiogenesis factor is involved, directly or indirectly, in the production of synovial exudate.

Epidural anesthesia for cesarean section: a comparison of bupivacaine, chloroprocaine, and etidocaine

The authors studied three groups of patients undergoing elective cesarean section during lumbar epidural anesthesia with bupivacaine, 0.75 per cent (15 patients), chloroprocaine, 3 per cent (15 patients) or etidocaine, 1 per cent (ten patients). Excellent sensory and motor block were obtained with chloroprocaine and bupivacaine; sensory anesthesia was inadequate with etidocaine in most patients. Onset of anesthesia, induction--delivery interval, and stay in the recovery room were all longer with bupivacaine when compared with chloroprocaine. Fetal outcomes, as determined by Apgar scores, acid--base status and neurobehavioral testing, were equally good in all groups. At delivery, fetal/maternal concentration ratio of bupivacaine was 0.31 and that of etidocaine, 0.25. The umbilical artery--umbilical vein blood concentration difference for etidocaine was significantly higher than that for bupivacaine. Excellent clinical results were obtained using either bupivacaine, 0.75 per cent, alone, or chloroprocaine, 3 per cent- for induction and maintenance of anesthesia, supplemented with bupivacaine, 0.25 per cent, before removal of the catheter.

[Is the term "blockage" just? (author's transl)]

The word "blockage" appeared the last ten years. It designs altogether a syndrom, a symptom and a pathogenic theory of squint. This term is analysed and discussed. The definitions, more or less precise, vary with the authors. The clinical signs attributed to the blockage are, in fact, due to the importance of the deviation. The electro-oculographic semeiology derives also partially of the magnitude of the angle of strabismus. The notion of a hypothetical nystagmus does not help for the understanding of the pathogenis of squint. The "faden operation", difficult and therefore dangerous in some hands, is perhaps an acquisition for the treatment of peculiar cases of nystagmus or paralysis. It would have been possible to expose the facts clearly by using only the terms of spasm and contracture. The confusion brought by the term of "blockage" is perhaps counterbalanced by the development of researches on the surgery of the arc of contact and on electro-oculography.

Differential fixation of poly(L-arginine) and poly(L-lysine) by tannic acid and its application to the fixation of collagen in electron microscopy

A differential fixation of poly(L-arginine) and poly(L-lysine) has been demonstrated by means of cellulose acetate electrophoresis and colorimetric titration. Electrophoresis showed that at pH 3.0 and concentrations between 0.025% and 2% the reagent interacts with poly(L-arginine) but not with poly(L-lysine). At pH 7.5, however, poly(L-lysine) also reacts, although at a higher concentration of tannic acid than was required to fix poly(L-arginine) at this pH. Colorimetric titration revealed that for poly(L-arginine) the reaction with tannic acid commences at pH 3.0 and is complete at pH 4.1 whereas for poly(L-lysine) the reaction commences at pH 3.5 and is complete at pH 4.9. It is suggested that the reaction is predominantly electrostatic. The results are discussed in relation to the use of tannic acid as a protein fixative in electron microscopy.

An angiogenic factor isolated from tumours: a potent low-molecular-weight compound

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Solid-phase radioimmunoassay for the detection of antibodies to collagen

A solid-phase radioimmunoassay has been developed using polystyrene tubes for the detection of class-specific antibodies to collagen. The optimal conditions for the adsorption of collagen onto the tubes, followed by incubation with the antisera and finally the radiolabelled antibody to the class-specific antibody are described. Studies carried out on antisera raised in rats and rabbits using this assay confirm its sensitivity and applicability.

Effects of maternal position on epidural anesthesia for cesarean section, acid-base status, and bupivacaine concentrations at delivery

In 25 patients excellent clinical anesthesia for elective cesarean section was obtained with lumbar epidural block using an average dose of bupivacaine of 130 mg (18 ml of 0.75 per cent solution). Supplemental drugs were not needed. All infants had normal Apgar scores at delivery. Ten patients were kept in a 35--40 degree semi-sitting supine position during induction, while 15 patients were similarly semi-sitting but turned into the left lateral position. Maternal position did not affect the adequacy of the anesthesia or the clinical condition of the infants, but did alter acid-base state and bupivacaine concentrations in the infants. At delivery, the infants whose mothers had been supine had significantly lower pH values in umbilical cord blood than those whose mothers had been in the lateral position. Also, high concentrations of bupivacaine were found in the umbilical vein blood of infants whose mothers were supine.

Effect of sugar and monoglyceride on fatty acid esterification

The effect of hexose and monoolein on fatty acid esterification was studied in everted rings of rat jejunum. By use of [3H]oleic acid and [U-14C]glucose, esterification via both phosphatidic acid and monoglyceride pathways was quantified. Our results showed that 1) metabolizable sugars stimulate fatty acids esterification regardless of their mode of transport; 2) in the presence of glucose alone, in vitro fatty acid esterification is mediated entirely by the phosphatidic acid pathway; 3) glucose stimulates both esterification pathways in the presence of monoolein; 4) monoolein stimulates only the monoglyceride pathway and has no effect on the phosphatidic acid pathway; and 5) the rate-limiting factor in the presence of monoolein alone is the formation of acyl-CoA, whereas in the presence of glucose alone, the rate-limiting factor is the formation of alpha-glycerophosphate.