A rare occurrence of persistent hypoglossal artery and its clinical significance

Persistent hypoglossal artery (PHA) is an embryological vascular variation mostly originating from the internal carotid artery. The presence of PHA has been associated with the incidence of some diseases such as cerebral ischaemia, atherosclerosis, and aneurysm. Here, a very rare case of PHA that was discovered incidentally by digital subtraction angiography in Turkey is reported. Endovascular stenting was not performed for this patient. Also, its clinical importance is discussed.

Erratum: Field-Induced Magnonic Liquid in the 3D Spin-Dimerized Antiferromagnet Sr_{3}Cr_{2}O_{8} [Phys. Rev. Lett. 116, 147201 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.116.147201.

Pharmacokinetics of once-daily darunavir/ritonavir in HIV-1-infected pregnant women

OBJECTIVES

HIV antiretroviral therapy during pregnancy is recommended to reduce the risk of mother-to-child transmission and for maternal care. Physiological changes during pregnancy can affect pharmacokinetics. The impact of pregnancy was evaluated for once-daily (qd) darunavir/ritonavir.

METHODS

HIV-1-infected pregnant women on an antiretroviral regimen that includes darunavir were enrolled in the study and further treated with darunavir/ritonavir 800/100 mg qd. Plasma concentrations were assessed over 24 h during the second and third trimesters and postpartum using a validated high-performance liquid chromatography tandem mass spectrometry assay for total darunavir and ritonavir, and using (14) C-darunavir-fortified plasma for unbound darunavir. Pharmacokinetic parameters were derived using noncompartmental analysis. Safety and antiviral response were assessed at all visits.

RESULTS

Data were available for 16 women. The area under the plasma concentration-time curve from 0 to 24 h (AUC24h ) for total darunavir was 34-35% lower during pregnancy vs. postpartum. Unbound darunavir AUC24h was 20-24% lower during pregnancy vs. postpartum. The minimum plasma concentration of total and unbound darunavir was 32-50% and 13-38% lower, respectively, during pregnancy vs. postpartum. The antiviral response (< 50 HIV-1 RNA copies/mL) was 59% at baseline and increased to 87-100% during the trial; the CD4 count increased over time. One serious adverse event (gestational diabetes) was judged as possibly related to study medication. All 16 infants born to women remaining in the study at delivery were HIV-1 negative (two were premature).

CONCLUSIONS

Total darunavir exposure decreased during pregnancy, but the decrease was less for unbound (active) darunavir. These changes are not considered clinically relevant. Darunavir/ritonavir 800/100 mg qd may therefore be a treatment option for HIV-1-infected pregnant women.

Field-Induced Magnonic Liquid in the 3D Spin-Dimerized Antiferromagnet Sr_{3}Cr_{2}O_{8}

We report on ultrasound and magnetization studies in three-dimensional, spin-dimerized Sr_{3}Cr_{2}O_{8} as a function of temperature and external magnetic field up to 61 T. It is well established [A. A. Aczel et al., Phys. Rev. Lett. 103, 207203 (2009)] that this system exhibits a magnonic-superfluid phase between 30 and 60 T and below 8 K. By mapping ultrasound and magnetization anomalies as a function of magnetic field and temperature we establish that this superfluid phase is embedded in a domelike phase regime of a high-temperature magnonic liquid extending up to 18 K. Compared to thermodynamic results, our study indicates that the magnonic liquid could be characterized by an Ising-like order but has lost the coherence of the transverse components.

Olive Fruit Fly (Bactrocera oleae) Population Dynamics in the Eastern Mediterranean: Influence of Exogenous Uncertainty on a Monophagous Frugivorous Insect

Despite of the economic importance of the olive fly (Bactrocera oleae) and the large amount of biological and ecological studies on the insect, the factors driving its population dynamics (i.e., population persistence and regulation) had not been analytically investigated until the present study. Specifically, our study investigated the autoregressive process of the olive fly populations, and the joint role of intrinsic and extrinsic factors molding the population dynamics of the insect. Accounting for endogenous dynamics and the influences of exogenous factors such as olive grove temperature, the North Atlantic Oscillation and the presence of potential host fruit, we modeled olive fly populations in five locations in the Eastern Mediterranean region. Our models indicate that the rate of population change is mainly shaped by first and higher order non-monotonic, endogenous dynamics (i.e., density-dependent population feedback). The olive grove temperature was the main exogenous driver, while the North Atlantic Oscillation and fruit availability acted as significant exogenous factors in one of the five populations. Seasonal influences were also relevant for three of the populations. In spite of exogenous effects, the rate of population change was fairly stable along time. We propose that a special reproductive mechanism, such as reproductive quiescence, allows populations of monophagous fruit flies such as the olive fly to remain stable. Further, we discuss how weather factors could impinge constraints on the population dynamics at the local level. Particularly, local temperature dynamics could provide forecasting cues for management guidelines. Jointly, our results advocate for establishing monitoring programs and for a major focus of research on the relationship between life history traits and populations dynamics.

Hydroxyapatite ocular implant and non-integrated implants in eviscerated patients

INTRODUCTION

This study compares the outcomes and complications of hydroxyapatite ocular implant and non-integrated ocular implants following evisceration.

MATERIALS AND METHODS

This is a retrospective study of 90 patients who underwent evisceration for different ocular affections, in the Ophthalmology Department of the University Emergency Hospital Bucharest, between January 2009 and December 2013. The outcomes measured were conjunctival dehiscence, socket infection, implant exposure and extrusion rate.

RESULTS

Forty-three patients had the hydroxyapatite implant (coralline-Integrated Ocular Implants, USA or synthetic-FCI, France) and forty-seven received non-integrated ocular implants (24 acrylic and 23 silicone). Five cases of socket infection, thirteen cases of extrusion and two cases of conjunctival dehiscence were encountered.

CONCLUSIONS

There was a higher rate of conjunctival dehiscence with hydroxyapatite ocular implant, but implant extrusion and socket infection were found in non-integrated ocular implants.

Ultrasound study of FeCr2S4 in high magnetic fields

We report on ultrasound studies of FeCr2S4 in static and pulsed magnetic fields exhibiting an orbital-order transition at 9 K. A longitudinal acoustic mode exhibits distinct features in the phase space of temperature and magnetic field due to magnetic and structural transformations. Pulsed-field measurements show significant differences in the sound velocity below and above the orbital-ordering transition as well as the spin-reorientation transition at 60 K. Our results indicate a reduction of the magnetocrystalline anisotropy on entering the orbitally ordered phase.

High-field magnetization and magnetoelasticity of single crystalline HoFe5Al7

Magnetization and ultrasound measurements have been performed in pulsed magnetic fields up to 60 T on a ferrimagnetic HoFe5Al7 single crystal (Curie temperature TC = 216 K, compensation point Tcomp = 65 K) with a tetragonal crystal structure of the ThMn12-type. The compound exhibits a high magnetic anisotropy of the easy-plane type. A large anisotropy is also observed within the basal plane having an easy-magnetization direction along the [110] axis with the spontaneous magnetic moment Ms = 2 µB/f.u. at T = 2 K. Along the easy axis, two first-order field-induced magnetic transitions are observed. At both transitions sharp anomalies in the acoustic properties are found. The critical fields of the transitions depend on temperature in a different manner. Within molecular-field theory and using the high-field magnetization data the Ho-Fe inter-sublattice exchange parameter has been determined to be nHoFe ≈ 4 T/µB. The magnetoelasticity has also been probed by magnetization measurements under hydrostatic pressure. TC decreases with a rate dTC/dp = -10 K/GPa, whereas Tcomp increases with dTcomp/dp = 3.5 K/GPa.

Topographic measurements of eyelids and orbit in enucleated eyes with hydroxyapatite integrated implant versus PMMA implant

INTRODUCTION

This study reports our results relating to palpebral eyelid fissure and orbital measurements following evisceration with orbital implantation of hydroxyapatite integrated implant and PMMA implant.

MATERIALS AND METHODS

This study is a prospective study of 43 patients that underwent evisceration for different ocular affections at University Emergency Hospital Bucharest, Ophthalmology department between January 2009 and September 2010 (Group A comprising of twenty patients had the coralline hydroxyapatite implant -Integrated Ocular Implants, USA and Group B comprising of twenty-three received non-integrated PMMA ocular implants) .The outcomes measured were the degree of exo /enophthalmos, horizontal eyelid fissure and palpebral fissure height at 4 years after surgical intervention related to measurement to the contralateral eye.

RESULTS

Horizontal eyelid fissure (HEF) was suffering a shortening of 7.4% in the group B versus the contralateral eye, and only 1.9% in the group A related to the contralateral eye. Eyelid fissure height was greater in the group B with 5.2% regarding the contralateral eye, and 1.2% in group A. The degree of enophthalmia was higher in the group B of 4 mm versus the contralateral eye and lower in group A 1.5 mm regarding the contralateral eye.

CONCLUSIONS

. Although a hydroxyapatite implant may be not as economic as a PMMA implant, a patient must be warned about the effect on its ocular structures in time and that cosmetic appearance over years will change more dramatically than in the fellow normal eye. Therefore preoperative counseling of the patient is crucial in long term patient satisfaction.

Total and unbound darunavir pharmacokinetics in pregnant women infected with HIV-1: results of a study of darunavir/ritonavir 600/100 mg administered twice daily

Objectives

Antiretroviral therapy during pregnancy is recommended to reduce the risk of mother-to-child transmission of HIV and for maternal care management. Physiological changes during pregnancy can affect pharmacokinetics, potentially altering pharmacological activity. We therefore evaluated the pharmacokinetics of twice-daily (bid) darunavir in HIV-1-infected pregnant women.

Methods

HIV-1-infected pregnant women receiving an antiretroviral regimen containing darunavir/ritonavir 600/100 mg bid were enrolled in this study. Total and unbound darunavir and total ritonavir plasma concentrations were obtained over 12 h during the second and third trimesters and postpartum. Total darunavir and ritonavir plasma concentrations were determined using a validated high-performance liquid chromatography tandem mass spectrometry assay and unbound darunavir was determined using ¹⁴C-darunavir-fortified plasma. Pharmacokinetic parameters were derived using noncompartmental analysis.

Results

Data were available for 14 women. The area under the plasma concentration–time curve from 0 to 12 h (AUC_12h) for total darunavir was 17–24% lower during pregnancy than postpartum. The AUC_12h for unbound darunavir was minimally reduced during pregnancy vs. postpartum. The minimum plasma concentration (C_min) of total and unbound darunavir was on average 43–86% and 10–14% higher, respectively, during pregnancy vs. postpartum. The antiviral response (< 50 HIV-1 RNA copies/mL) was 33% at baseline and increased to 73–90% during treatment; the percentage CD4 count increased over time. One serious adverse event was reported (increased transaminase). All 12 infants born to women remaining in the study at delivery were HIV-1-negative; four of these infants were premature.

Conclusions

Total darunavir exposure decreased during pregnancy. No clinically relevant change in unbound (active) darunavir occurred during pregnancy, suggesting that no dose adjustment is required for darunavir/ritonavir 600/100 mg bid in pregnant women.

Unconventional magnetostructural transition in CoCr2O4 at high magnetic fields

The magnetic-field and temperature dependencies of the ultrasound propagation and magnetization of single-crystalline CoCr(2)O(4) have been studied in static and pulsed magnetic fields up to 14 and 62 T, respectively. Distinct anomalies with significant changes in the sound velocity and attenuation are found in this spinel compound at the onset of long-range incommensurate-spiral-spin order at T(s)=27  K and at the transition from the incommensurate to the commensurate states at T(l)=14  K, evidencing strong spin-lattice coupling. While the magnetization evolves gradually with the field, steplike increments in the ultrasound clearly signal a transition into a new magnetostructural state between 6.2 and 16.5 K and at high magnetic fields. We argue that this is a high-symmetry phase with only the longitudinal component of the magnetization being ordered, while the transverse helical component remains disordered. This phase is metastable in an extended H-T phase space.

Preoperative grip strength measurement and duration of hospital stay in patients undergoing total hip and knee arthroplasty

PURPOSE

This study explored whether a relationship exists between preoperative pinch and power grip strength, and length of hospital stay in patients undergoing hip and knee arthroplasty at a busy UK hospital. We investigated whether handgrip dynamometry could be used preoperatively to identify patients at greater risk of longer inpatient stays. This would allow focussed intervention preoperatively and facilitate predictors of length of stay postoperatively.

METHODS

One hundred and sixty-four patients (64 male, 100 female) undergoing lower limb arthroplasty (83 total knee replacement, 81 total hip replacement) were assessed in pre-admission clinic. Average measurements of pinch grip, power grip and grip endurance were taken from each patient using the Jamar hydraulic dynamometer (Jamar, USA). Duration of inpatient stay of each patient was recorded.

RESULTS

Average duration of hospital stay was 9.4 days. Both average pinch grip strength and average power grip strength had a significant negative correlation with duration of inpatient stay. Those patients with a pinch grip strength less than 6.3 kg remained an inpatient for an average of 2 days longer than those with a pinch grip greater than 6.3 kg.

CONCLUSIONS

This simple test may be highly beneficial preoperatively in identifying those patients likely to require longer inpatient stays and therefore those who would benefit from early nutritional intervention and focussed physiotherapy. It may also facilitate predictors of length of stay postoperatively. We believe this may effect significant cost reductions in the NHS.

Angle-dependent evolution of the Fulde-Ferrell-Larkin-Ovchinnikov state in an organic superconductor

We report magnetic-field and angular-dependent high-resolution specific-heat measurements of the organic superconductor β''-(BEDT-TTF)2SF5CH2CF2SO3. When the magnetic field is aligned precisely within the conducting BEDT-TTF layer, at low temperatures a clear upturn of the upper critical field beyond the Pauli limit of 9.73 T is observed, hinting at the emergence of a Fulde-Ferrell-Larkin-Ovchinnikov state. This upturn disappears when the field is oriented out of plane by more than ∼0.5  deg. For smaller out-of-plane angles, the specific-heat anomaly at T(c) sharpens and a second peaky phase transition appears within the superconducting state.

Magnetostructural transitions in a frustrated magnet at high fields

Ultrasound and magnetization studies of bond-frustrated ZnCr(2)S(4) spinel are performed in static magnetic fields up to 18 T and in pulsed fields up to 62 T. At temperatures below the antiferromagnetic transition at T(N1)≈14  K, the sound velocity as a function of the magnetic field reveals a sequence of steps followed by plateaus indicating a succession of crystallographic structures with constant stiffness. At the same time, the magnetization evolves continuously with a field up to full magnetic polarization without any plateaus in contrast to geometrically frustrated chromium oxide spinels. The observed high-field magnetostructural states are discussed within a H-T phase diagram taking into account the field and temperature evolution of three coexisting spin structures and subsequent lattice transformations induced by the magnetic field.

Magnetic phase diagram of multiferroic MnWO4 probed by ultrasound

The magnetic phase diagram of multiferroic MnWO(4) is studied in magnetic fields up to 60 T using sound velocity and sound attenuation measurements. Anomalies are observed at temperatures T(N1) = 7.6 K, T(N2) = 12.6 K and T(N3) = 13.6 K that separate commensurate antiferromagnetic (AF1) to helical AF2 and commensurate AF3 to paramagnetic phases, respectively. The anomalies are significantly different and shed light on the spin-phonon coupling and evolution of the various order parameters in this multiferroic material. For temperatures below T(N2) pronounced field hysteresis effects are also observed in the sound velocity, indicating field-induced transformations. In the temperature dependence of the attenuation we observe anomalies distinctively different from the usual maxima related to relaxation effects. They are attributed to the combination of dispersion effects due to domain walls and the discontinuously changing sound velocity. In total, six different magnetic phases, at various temperatures and fields including a novel high-field phase, are revealed and analyzed.

Large tunneling anisotropic magnetoresistance in (Ga,Mn)As nanoconstrictions

We report a large tunneling anisotropic magnetoresistance (TAMR) in (Ga,Mn)As lateral nanoconstrictions. Unlike previously reported tunneling magnetoresistance effects in nanocontacts, the TAMR does not require noncollinear magnetization on either side of the constriction. The nature of the effect is established by a direct comparison of its phenomenology with that of normal anisotropic magnetoresistance (AMR) measured in the same lateral geometry. The direct link we establish between the TAMR and AMR indicates that TAMR may be observable in other materials showing room temperature AMR and demonstrates that the physics of nanoconstriction magnetoresistive devices can be much richer than previously thought.

Influence of human immunodeficiency virus infection on pelvic inflammatory disease

OBJECTIVE

To examine the influence of human immunodeficiency virus (HIV) infection on clinical and microbiologic characteristics of pelvic inflammatory disease (PID).

METHODS

Forty-four HIV-infected women and 163 HIV noninfected women diagnosed with PID by standard case definition were evaluated by using clinical severity scores, transabdominal sonograms, and endometrial biopsies. After testing for bacterial infections, patients were prescribed antibiotics as recommended by the Centers for Disease Control and Prevention (CDC).

RESULTS

Symptoms of PID and analgesic use before enrollment did not differ by HIV serostatus. More HIV-infected women had received antibiotics before enrollment (40.9% versus 27.2%, P =.08), a factor associated with milder signs regardless of serostatus. More HIV-infected women had sonographically diagnosed adnexal masses at enrollment (45.8% versus 27.1%, P =.08), a difference that yielded higher median severity scores (17.5 of 42 points versus 15 of 42 points, P =.07). However, those differences were not significant at the P <.05 level. Mycoplasma (50% versus 22%, P <.05) and streptococcus species (34% versus 17%, P <.05) were isolated more commonly from biopsies of HIV-infected women. Within 30 days after enrollment, HIV-infected women generally responded as well to therapy as HIV-noninfected women did, regardless of initial CD4 T-lymphocyte percentage.

CONCLUSION

Among women with acute PID, HIV infection was associated with more sonographically diagnosed adnexal masses. Clinical response to CDC-recommended antibiotics did not differ appreciably by serostatus. Mycoplasmas and streptococci were isolated more commonly from HIV-infected women, but those organisms also might be associated with PID in immunocompetent women.

Detecting and improving compliance. Is concordance the solution?

BACKGROUND

Despite the proven benefits of hypertension control, fewer than 50% of those treated for hypertension have their blood pressure adequately controlled. The major reason for this is poor compliance with treatment.

OBJECTIVE

This article examines the extent of the problem, methods of detection and effective strategies in managing the problem of poor compliance with medical care with particular reference to hypertension. New ideas in the field are also discussed.

DISCUSSION

Self-report is probably the best method of detection of poor compliance. Strategies of managing the problem are discussed.

Advanced mucinous adenocarcinoma in pregnancy

The incidence of masses in pregnancy is estimated to occur in 1/81 to 1/2,500 pregnancies. The development of colorectal carcinoma during pregnancy is a more rare event, with less than 30 cases above the peritoneal reflection reported in the last 70 years. The differential diagnosis of mucinous adenocarcinoma of ovarian vs. gastrointestinal origin is often difficult. We report a pregnant patient affected by advanced colorectal cancer, who presented with an asymptomatic unilateral adnexal mass on ultrasound. A 28-year old woman was referred to our hospital after a routine ultrasound examination at 26 weeks gestation showing a right adnexal mass. At elective exploratory laparotomy, the patient was found to have metastatic mucinous adenocarcinoma. Diagnostic and treatment choices of such a cancer in a pregnant patient were explored. The final diagnosis of colorectal cancer was made only at the time of a subsequent emergency laparotomy. The goal of an obstetrician/gynecologist and other care givers of pregnant patients, is to achieve a healthy mother and child. Unfortunately, physicians may unwillingly sacrifice the health of the mother by denying or delaying her procedures or treatments simply because she is pregnant. It is especially important in the case of adnexal masses and their related pathology, due to the difficulty in detection and management of such cases during pregnancy, that doctors actively assume the responsibility of assuring that pregnant patients receive the proper care they need.

Endothelin-1 stimulates the in vitro release of neurohypophyseal hormones, but not corticotropin-releasing hormone, via ETA receptors

The endothelins consist of a family of vasoconstrictor peptides originally isolated from endothelial tissue which are now known to be involved in neuroendocrine regulation. However, while there are data indicating the involvement of endothelins in the modulation of the hypothalamo-pituitary-adrenal (HPA) axis, the precise mechanisms involved have been unclear. We have therefore used a previously validated rat hypothalamic explant system in order to investigate the possible modulation of the neurohypophyseal hormones vasopressin and oxytocin, and corticotropin-releasing hormone (CRH), by endothelin-1 (ET-1) and endothelin-3 (ET-3). Following a period of stabilisation, the release of vasopressin, oxytocin and CRH remained approximately constant in successive 20-min incubations. Addition of ET-1 stimulated the release of vasopressin at a dose of 0.1 nmol/l (p < 0.05), and both vasopressin and oxytocin at 10 nmol/l (p < 0.01 and 0.05, respectively). The release of vasopressin and oxytocin induced by 10 nmol/l ET-1 were both totally blocked by co-incubation with either 1 or 10 mumol/l of the specific ETA receptor subtype antagonist cyclo (D-Trp-D-Asp-Pro-D-Val-Leu) (BQ-123). ET-1 had no effect on CRH release in the dose range of 0.1-1,000 nmol/l. In case any possible stimulation of CRH might be masked by simultaneous generation of nitric oxide (NO), an inhibitor of CRH secretion, addition of ET-1 was also carried out in the presence of the NO synthase inhibitor, L-NO-Arg: ET-1 was again without effect in this dose range.(ABSTRACT TRUNCATED AT 250 WORDS)

Caudal regression syndrome: etiopathogenesis, prenatal diagnosis, and perinatal management

Caudal regression syndrome represents a continuum of congenital malformations ranging from agenesis of the lumbosacral spine to the most severe cases of sirenomelia with lower extremities fusion and major visceral anomalies. The etiology of this syndrome is not well known. Maternal diabetes, genetic predisposition, and vascular hypoperfusion have been suggested as possible causative factors. The degree of associated anomalies usually parallels the severity of the primary defect. Ultrasonography is the diagnostic tool of choice revealing the absent distal vertebrae of the fetal spine. Amnioinfusion and magnetic resonance imaging (MRI) are of help in better evaluation of the fetal anatomy in cases with oligohydramnios. Perinatal management depends mainly on gestational age at diagnosis and severity of the lesion. It should include genetic counseling and serial sonography to assess interval growth and amniotic fluid volume. Surviving infants have usually a normal mental function and they require extensive urologic and orthopedic assistance. Their long-term morbidity consists mostly of neurogenic bladder dysfunction resulting in progressive renal damage and disabling neuromuscular deficits of the lower extremities. Neurosurgical and orthopedic intervention with physical rehabilitation is indicated to improve the quality of their lives.

Intraligamentary pregnancy

Intraligamentary pregnancy, although rare, tests the physician's acumen in diagnostic and therapeutic skills. Two cases illustrating this entity are presented, the first involves an 18-week fetus, the second a partial hydatidiform mole. Although their presentation and pathogenesis may be indistinguishable, their clinical course and management is different. To the best of our knowledge, this is the first reported case of an intraligamentary pregnancy involving a partial hydatidiform mole.

Nitric oxide modulates the release of vasopressin from rat hypothalamic explants

The enzyme nitric oxide (NO) synthase is present in the paraventricular nucleus, while nitric oxide has recently been shown to inhibit the stimulated release of corticotrophin-releasing hormone (CRH) in vitro. Thus the possible role of NO in regulating, vasopressin (AVP), which also plays an important role in pituitary-adrenal activity, has been investigated. The effects were studied of the NO donors, L-arginine, syndnonimine-1 (SIN-1) and sodium nitroprusside, on both the basal and stimulated release of AVP, employing a previously validated system. Rat hypothalami were incubated in either medium alone or medium containing the test substances and hormone release was measured by RIA. The effect of L-arginine in the presence of the NO synthase inhibitor, L-NMMA, was also investigated. L-arginine reduced KCl-evoked AVP release; this effect was reversed by L-NMMA and reduced by the addition of ferrous human Hb. Similarly, SIN-1 and sodium nitroprusside attenuated KCl-evoked AVP release. L-arginine also reduced IL-1 beta-stimulated AVP release. NO appears to directly and specifically inhibit the stimulated release of AVP from rat hypothalamic explants in vitro, similar to its effects on CRH. These findings provide further evidence that NO may be involved in neuroendocrine regulation.

Perinatal implications of cocaine exposure

Obstetric outcome was reviewed for 139 women who volunteered information on cocaine abuse during pregnancy past 20 weeks. Information on the duration of use during pregnancy was not accurate enough for documentation. In previous pregnancies, only 44.6% of the infants were live born, with spontaneous or therapeutic abortions in 41.1% and stillbirths accounting for 3.6%. In the current pregnancies, 91 patients (66.1%) were nonwhite, and multiple-drug usage was found in 92%, with intravenous cocaine use in 44.6% and freebasing in 31.7% as the main routes of administration. Syphilis or another infection, no prenatal care and poor weight gain (less than or equal to 19 lb) in pregnancy was present in one-third of the patients, while 38% did not know their gestational age. Precipitate labor was found in 63.9% and meconium-stained amniotic fluid in 20.5%. The mean birth weight of the infants was significantly lower than that of the general hospital population; low birth weight (less than 2,500 g) occurred in 36.2%, small size for gestational age in 32.4%, neurologic problems in 30.9% and syphilis in 15.4% of the infants. Congenital abnormalities, in 17.4%, seemed to be multifactorial. The consistent pattern of poor outcome in both the previous and present pregnancies reflects the life-style peculiar to cocaine abusers. Prospective studies are in progress to identify the true incidence of cocaine usage and to outline the counseling of childbearing women against cocaine use during pregnancy, emphasizing prevention since cures are not available.

Evaluation of surgical staples in cesarean section

Experience with Lactomer absorbable surgical staples (Auto Suture Poly CS 57 disposable surgical stapler) in 62 cesarean sections was compared with an equal number of operations performed with standard techniques. The technique of application of the stapler evolved with experience. Countertraction to staplers with Allis' clamps prevented uterine V incisions. Operative time was longer for the stapled suture group for primary cesarean sections, but was unchanged for repeat procedures. Excellent hemostasis of the uterine incision was achieved even when varicose sinusoidal veins were present. Significant reductions of hemoglobin deficits from 2.16 to 1.31 gm/dl, postoperative anemia from 29% to 6.4%, and endometritis from 22.5% to 6.4% occurred respectively in nonstapled and stapled groups. A reduced hospital stay, shortened by 2.1 days, saved each patient +F42950. Blood loss estimates by surgeons or anesthetists were often at variance. Surgeons' acceptance of the procedure grew with experience. On the basis of these results, use of absorbable staples offers certain advantages in reducing blood loss, infection, and hospital stay in cesarean deliveries.