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10,003,100 | The analysis of case-referent data can be based on a consideration of case and referent counts in various exposure categories as the realization of a set of binomial processes. After appropriate modeling of the binomial parameters, a joint likelihood function can be formed and maximized to obtain estimates of the parameters constituting the model elements. The procedure has been applied to the problem of additive and multiplicative models of disease incidence rates, as encountered in case-referent studies. Likelihood ratios can be used to compare models with equal numbers of parameters. These ratios do not lead to significance tests, but to estimate of the relative degree of corroboration of different hypotheses by the data at hand. | [
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10,003,101 | Environmental influences on ocular refraction. | [
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10,003,102 | A note about the inference based on the proportionate mortality ratio. | [
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10,003,103 | "Asbestos in drinking water and cancer incidence in the San Francisco Bay area". | [
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10,003,105 | In a seroepidemiologic survey of 624 health workers representing a spectrum of exposure to blood and patients, the authors detected serologic markers of hepatitis B virus infection in 16%, significantly greater than the 5% prevalence in 462 volunteer blood donors (p less than 0.001). Frequency of hepatitis B serologic markers increased as a function of contact with blood, previous hepatitis history, years in occupation, and age but not as a function on contact with patients, years of education, previous needlestick, transfusion or globulin injection. The inclusion of testing for antibody to hepatitis B core antigen (anti-HBc) enhanced the sensitivity of surveillance by identifying an additional 3% of hospital personnel with hepatitis B exposure and proved to be a better indicator of intense exposure to blood and hepatitis B than antibody to hepatitis B surface antigen (anti-HBs). In addition, anti-HBc testing discriminated between the 47 (62%) of the 76 anti-HBs-positive health workers, predominantly those most intensely exposed to blood, who had anti-HBc and the 29 (38%), predominantly those with low-intensity blood contact, who did not. The association of the anti-HBs-positive/anti-HBc-negative pattern with infrequent blood contact suggests that in the setting of continuous, low intensity exposure to hepatitis B, health workers may become naturally immunized with hepatitis B surface antigen rather than infected with hepatitis B. | [
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10,003,106 | The relationship between the geographic distribution of lung cancer incidence and cigarette smoking in Allegheny County, Pennsylvania. | [
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10,003,107 | The results of the Third National Cancer Survey have shown substantial variations in lung cancer incidence rates for white males within Allegheny County, Pennsylvania. To explain these differences, two areas showing over a twofold difference in the 1970 age-adjusted incidence rates (127.7 compared to 59.0 per 100,00) were studied in greater detail. Estimates of smoking experience by age were determined in the two areas by survey sampling methods of white males 35 years of age and older. The results show the high risk area had a significantly greater proportion of males currently smoking and who had ever smoked cigarettes compared to the low risk area. Males in the high risk area also began smoking over four years earlier, and proportionally fewer men smoked filter cigarettes. Calculations of Lung cancer risk based on these results and a model of risk from the prospective and retrospective studies showed that almost all of the observed difference in risk between areas was attributable to cigarettes. | [
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10,003,108 | Smoking as a risk factor in cancer of the cervix: additional evidence from a case-control study. | [
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10,003,109 | The results of a case-control study in Toronto, Canada, demonstrated a two-fold risk of invasive squamous cell carcinoma of the cervix among current smokers relative to women who had never smoked. This significant effect of smoking was not diminished by simultaneously adjusting for age, education, and indices of sexual behavior. This association was further supported by the observations that ex-smokers were at a lower risk than current smokers (1.7 versus 2.3), and that the risk increased with the amount of cigarettes smoked (2.2 for less than half a pack per day to 2.9 for more than one pack per day). | [
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10,003,110 | Case definition in case-control studies of the efficacy of screening. | [
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10,003,111 | Hydatidiform mole in the United States (1970-1977): a statistical and theoretical analysis. | [
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10,003,112 | The incidence of hydatidiform mole and some epidemiologic features of the disease in the United States were studied. Data for the present study were obtained from the Hospital Discharge Survey (1970-1977) of the National Center for Health Statistics. The estimated incidence of hydatidiform mole over the eight-year period was 108.4 per 100,000 pregnancies (SE = 10.3) or one case in every 923 pregnancies. There was an apparent increase in the incidence rate from 1970 to 1975, but the rate dropped slightly after 1975. The distribution of hydatidiform mole by maternal age showed the highest rate among women 35 years and older, and the second highest rate among women aged 15-19. The distribution by maternal age found for the entire sample was also apparent within each race category. Overall, black women appeared to have an incidence rate half that of white women. Regional differences in the United States were observed in spite of race and age adjustment. Existing studies are reviewed in light of morphologic and cytogenetic classification schemes and recent hypothesis for the androgenetic origin of hydatidiform mole. A fresh approach to the epidemiology of hydatidiform mole which combines epidemiologic and genetic studies is indicated. | [
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10,003,113 | Direct and indirect associations of five factors with infant mortality. | [
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] |
10,003,114 | The relationship between several factors including maternal age, race, education and prior obstetric experience to infant mortality was investigated using vital statistics data from four regionalized networks in 1974 and 1975 and applying the log-linear model. By making a causal assumption, these relationships can be decomposed into a direct component and an indirect component acting through the association of the variables with birth weight. Detailed examination of the interactions between these factors revealed that all of the factors except education could demonstrate a direct component at the 5% significance level in their relationship to neonatal death, while all but birth order had a direct component relating to postneonatal deaths. The strength of the direct components was expressed in the form of odds ratios, leading to a conclusion confirming some earlier reports from these data, but suggesting that births to mothers over 35 years of age have smaller increased neonatal risk relative to those aged 18-34 years than had been reported previously. In addition, the direct component associated with first births does not show a higher risk than those of birth order 2 and 3. Added risk in this group is traceable to the indirect component. The disadvantage associated with having a prior fetal death is only found among low birth orders, with a possible reversal of the pattern in the high parity group. Analysis of postneonatal risks shows an interaction between maternal age and race, in which births to mothers under age 18 had increased risks only for whites. | [
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] |
10,003,115 | A review of goodness of fit statistics for use in the development of logistic regression models. | [
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] |
10,003,116 | Several statistics have recently been proposed for the purpose of assessing the goodness of fit of an estimated logistic regression model. These statistics are reviewed and compared to other, less formal, procedures in the context of applications in epidemiologic research. One statistic is recommended for use and its computation is illustrated using data from a recent study of mortality of intensive care unit patients. | [
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10,003,117 | Telephone management of drug-related problems in a family practice clinic. | [
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10,003,118 | Physiochemical properties of aminophylline-dextrose injection admixtures. | [
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] |
10,003,119 | The compatibility and stability of aminophylline-dextrose injection admixtures were investigated. Aliquots of 5% dextrose injection, 0.9% sodium chloride injection, and 5% dextrose and 0.9% sodium chloride injection were studied for these physiochemical properties: pH, color, clarity, absorbance in a spectrophotometer at 400 nm, and hydroxymethylfurfural (HMF) content. Aminophylline injection was added to the solutions, and aliquots were withdrawn after 0, 6, 24, and 48 hours of storage at 5, 25, 35, and 55 degrees C for testing of the physiochemical properties and aminophylline content. An aminophylline admixture in 5% dextrose injection was passed through an in-line filter (IVEX-2), and eluents were collected for aminophylline assay and for testing the above physiochemical properties. HMF and theophylline were assayed to high-pressure liquid chromatography (HPLC). The aminophylline concentration remained constant in all admixtures studied. A yellow color developed in dextrose-containing aminophylline admixtures stored at 25, 35, and 55 degrees C for 48, 24, and 6 hours, respectively. HMF concentration, pH, and clarity remained within compendial limits. The in-line filter did not retain active ingredients or alter the physiochemical properties of the admixture. Solutions that were yellow showed additional peaks on HPLC. HMF seemed to be a precursor for this yellow color, inasmuch as HMF concentration increased with increasing color intensity. It is concluded that aminophylline-dextrose admixtures are visually and chemically stable for 48 hours when stored under refrigeration or at room temperature. | [
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10,003,120 | Computer hardware and software. | [
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] |
10,003,121 | Basic hardware and software components of computers are described and related concepts are defined using examples related to the hospital pharmacy department. Hardware components described include the central processing unit, storage devices, and input and output devices. System software, application software, computer language, and computer characteristics for hospital pharmacy systems are identified. Trends toward computer miniaturization, increased processing capacity at reduced costs, and new software technologies will enable an accelerated pace of new system development and implementation. Applications that are now difficult to justify because of high development cost or low benefit to the hospital will become more easily cost justified. | [
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10,003,122 | Alcohol spray versus wipes in disinfecting vial diaphragms. | [
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10,003,123 | Effect of freezing on particle formation in three antibiotic injections. | [
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10,003,124 | Physician perceptions of a clinical pharmacy program. | [
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10,003,126 | Medical information dialogues: continuing education for physicians. | [
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10,003,128 | The graying of America: implications for the pharmacist. | [
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] |
10,003,129 | Implications of the increased longevity of the U.S. population for the pharmacist are described. Recently, the growth of the population 65 years and older has been greater than that of the total population, and this trend is expected to continue at least until the end of the century. Because the elderly have more chronic illnesses than the younger population, the aging of the population means an increased use of prescription drugs. In addition, the sex ratio of men to women in the elderly population is decreasing; this trend is important for pharmacy practice because women at every age are prescribed and use more drugs than men. The need for prescription drugs imposes a financial burden on the elderly, many of whom live at or near the poverty level. Drugs constitute a major expense for the aged because drugs are a large percent of their out-of-pocket medical expenditures. Medication errors and noncompliance are chronic problems among the elderly because of their complex drug regimens, diminished physical activity, social isolation, physical and mental impairments, and lack of drug knowledge. In addition, the high cost of prescription drugs may contribute to medication under-use. Strategies for the pharmacist to prevent or treat noncompliance among the elderly are described. While most of the strategies have not been tested with the elderly population, practitioners working with geriatric patients have found them useful. | [
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10,003,131 | Potential toxicity of theophylline in combination with Quinamm. | [
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10,003,132 | Phenytoin pharmacokinetics: inappropriate data analysis. | [
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10,003,133 | Guidelines sought for reconstitution devices. | [
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] |
10,003,134 | Review of computer applications in institutional pharmacy--1975-1981. | [
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] |
10,003,135 | A literature review of computer applications in institutional pharmacy, covering papers published from 1975 to 1981, is presented. Articles are categorized as computer concepts, applications to administrative functions, controlled substances, drug distribution systems (including on-line and off-line services, intravenous admixture services, and ambulatory services), drug information, clinical services (including drug-use review, drug interactions and therapeutic incompatibility surveillance, and pharmacokinetics), and pharmacy-related applications developed by nonpharmacists. Before 1975, computer applications in institutional pharmacy reported in the literature were largely single-use applications. After 1975, many reports described the integration of individual applications into sophisticated systems that supported many functions. There is still a need for good cost justification studies of computerization in pharmacy. | [
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10,003,136 | Analysis of information provided by clinical pharmacists. | [
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10,003,137 | Data were collected to characterize the interactions between clinical pharmacists and other health professionals in a university hospital with decentralized pharmaceutical services. A self-report data collection form was developed. Six faculty pharmacists participated in the study. Each pharmacist collected data by recording all clinical interactions that occurred in his normal activities for a one-month period. the pharmacists' practice sites were inpatient internal medicine, inpatient pediatrics (two pharmacists), family practice clinic, pediatric clinic, and inpatient physical medicine and rehabilitation. A computer program was written to provide correlation data among the locations, contents, and participants of the interactions. Data were collected on the time required for a literature search and on the outcomes of the interactions. Four hundred ninety-nine interactions were documented. Work rounds were the most common location for these interactions, and the housestaff physicians were the most frequent participants. Patients' dosage schedule was the most common topic discussed (17%). Pharmacokinetics accounted for only 6% of the communications; drug interactions, only 3%. Ninety-six percent of the pharmacists' recommendations were adopted within 24 hours. More than half of the interactions (56%) required no literature search by the pharmacists and nearly half (249) required less than one minute of pharmacist time. | [
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10,003,138 | Hospital pharmacists as a source of drug information for physicians and nurses. | [
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10,003,139 | Integrating pharmaceutical services and education in an academic medical center. | [
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10,003,140 | System to measure the use of pharmacy personnel. | [
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10,003,141 | The development of a program to monitor the use of pharmacy personnel is described. The program is part of a hospital-wide Labor Information System developed to support requests for additional staff, to highlight opportunities for improved and allocation of manpower, and to serve as a conceptual model of the department from a manpower perspective when communicating with other members of the hospital organization. Nine major functions of the pharmacy department were identified. Detailed activities for each function were listed along with the type of personnel who performed each activity. Standards representing the amount of time spent on each activity were then developed. Variable, fixed, and open standards were used. Workload volumes are tabulated on a biweekly basis and entered into a computer. Payroll data covering the same period are simultaneously fed into the computer system. The resulting computer-generated report compares the service hours necessary to perform the actual workload (based on the predetermined time standards) to the available hours actually worked by each job category of pharmacy personnel. The ratio of service hours to available hours measures the use of personnel by functional activity. The system has been successfully applied to support requests for additional personnel, to forecast staffing needs for new programs, and to make operational improvements. In addition, the system has the capacity to accurately monitor personnel time for providing clinical services. | [
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10,003,142 | Comprehensive pharmaceutical services for a state correctional facility. | [
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10,003,143 | A contractual model for comprehensive pharmaceutical services involving a major medical center pharmacy, a university, and a state department of corrections is described. Project goals and methods for the provision of services are described. These include areas of formulary development, inventory management, drug distribution, on-site placement of pharmacy operations, and educational development. Impact of the program was assessed over a 30-month period. Development of policies and procedures for drug use in a correctional setting enabled implementation of a strict patient population-specific drug formulary. Procedural changes resulted in an 83% decrease in on-site drug inventories and a 62% decrease in quarterly drug expenditures. A one-time saving of more than $26,500 resulted from the decrease in on-site inventory, and an annual saving of $44,000 is projected for decreased drug expenditures. All but five controlled substances were removed from the formulary, and only 13 nonprescription items remained in the formulary. An educational course on health care in correctional settings provided exposure for pharmacy students to this new area of institutional practice. The contractual model proved both cost-effective and functional for the department of corrections. | [
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10,003,144 | Immunizations for international travel as a pharmaceutical service. | [
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10,003,145 | Impact of a drug bulletin on prescribing oral analgesics in a teaching hospital. | [
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10,003,146 | The impact of a drug bulletin on prescribing oral analgesics in a teaching hospital was studied. Using an abbreviated time-series design, prescriptions for oral analgesics for all inpatients were surveyed one, three, and five weeks before and one, three, five, and seven weeks after the distribution of one of the hospital's regular drug bulletins. This bulletin contained guidelines for the treatment of minor, moderate, and severe pain. The 493 patients included in the study were classified by drug category, pain severity, and timer period. The drug categories were: (1) propoxyphene, (2) aspirin or acetaminophen alone or with codeine 8 mg or less, and (3) codeine alone or in combination products with more than codeine 8 mg, or other oral narcotic drugs. Each patient's pain severity was determined by interviewing attendant nursing staff; the validity of this approach was confirmed by correlating nurse and physician perception of pain at one time point. Multivariate contingency table analysis revealed that the drug bulletin significantly (p less than or equal to 0.05) reduced the prescribing of propoxyphene hydrochloride across both the minor and moderate pain categories. An increased use of aspirin and acetaminophen was significant three weeks after the release of the drug bulletin. This effect, however, was not significant at other time points. Drug bulletins can be used to achieve a temporary change in physician prescribing patterns of oral analgesics. For a sustained effect, alternative strategies are needed. | [
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10,003,147 | Diagnostic dilation and curettage: a reappraisal. | [
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10,003,148 | Diagnostic dilation and curettage (D & C) is widely considered to be the method of choice for obtaining samples of endometrium for histologic examination, although the scientific basis for this assumption is elusive. Despite extensive use of D & C, the tissue yield and diagnostic accuracy of this technique have not been adequately evaluated. More is known about these features of a newer diagnostic procedure, Vabra aspiration (VA). VA also appears to be safer, less expensive, and more convenient than D & C. Until the alleged benefits of diagnostic D & C can be shown to outweigh its risks and costs (approaching one billion dollars per year in the United States alone), D & C probably should not be the primary procedure used for obtaining most samples of endometrium. | [
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10,003,149 | Ultrasonic placental grading and fetal pulmonary maturity. | [
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] |
10,003,150 | Pregnancy-induced hypertension associated with hypervolemia: case report. | [
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10,003,151 | Cardiovascular complications of terbutaline for preterm labor. | [
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] |
10,003,152 | Endocervical lavage in early pregnancy. | [
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] |
10,003,153 | CAMP versus cAMP. | [
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10,003,154 | Fatal methyldopa-associated granulomatous hepatitis and myocarditis. | [
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10,003,155 | A 78-year-old woman developed spiking fever of obscure etiology while receiving long term therapy with methyldopa and died suddenly seven days after admission to the hospital. Autopsy showed widespread granulomas in the liver, spleen, lymph nodes and bone marrow, interstitial myocarditis with granulomatous features and renovascular vasculitis. Eosinophils were prominent in the granulomas and in the myocardium consistent with a drug-induced cell mediated hypersensitivity reaction presumably triggered by methyldopa. The need for a careful drug history in fever of obscure etiology is emphasized. | [
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10,003,156 | Effect of Zanchol and chenic acid on bile acid pool size and gallstones in hamsters. | [
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10,003,157 | After receiving a lithogenic regime for 12 weeks (Phase I), 60 hamsters were allocated to groups of 10 animals. During Phase II, except for one group which remained on the lithogenic regime, all groups were switched to a standard diet and chenic acid 20 mg/kg/day or Zanchol 5, 15 or 25 mg/kg/day or no other therapy. Half the animals in each group were sacrificed at 3 weeks and the remainder at 10 weeks. Gallstones were found in all animals except those receiving chenic acid for 10 weeks. At 3 weeks in Phase II, with chenic acid, the bile acid pool size was not significantly decreased and bile remained saturated despite a 38% lower rate of hepatic synthesis of cholesterol (p less than 0.01), but became unsaturated at 10 weeks at which time the bile acid pool size was increased by 37% (p less than 0.01). The highest at which time the bile acid pool size was increased by 37% (p less than 0.01). The highest dose of Zanchol increased the bile acid pool size by 74% (p less than 0.01) while increasing the hepatic synthesis of file acid by 38% (p less than 0.01). None of the doses of Zanchol, however, significantly changed biliary cholesterol saturation. In conclusion, chenic acid decreased the hepatic synthesis of cholesterol prior to increasing the bile acid pool, unsaturating bile and dissolving gallstones. Zanchol did not affect the biliary cholesterol saturation of dissolve gallstones despite an increase in the synthesis and pool size of the bile acids. | [
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10,003,158 | Risk of cardiovascular disease after hysterectomy. | [
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10,003,159 | The value of the angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy. | [
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10,003,160 | Normal pregnant women are resistant to the pressor effect of intravenously administered angiotensin II (AII), but women who are destined to develop hypertensive complications in pregnancy show an increased sensitivity to AII several weeks before the onset of the first clinical symptoms. In 231 normotensive nulliparous women (age 25 +/- 5 years), an angiotensin sensitivity test (AST) was performed between weeks 28 and 32 of gestation. If an effective angiotensin pressor dose (APD) of less than 10 ng . kg-1 . min-1, is considered to be a positive test result, 58 subjects had a positive AST and 173 had a negative AST. Twenty-six of 34 women who ultimately developed pregnancy-induced hypertension (PIH) or preeclampsia had a positive test, and the diagnosis was made early. Each of the eight pregnant subjects with a false negative test developed only a mild form of the hypertensive disorder. In this series, 11 women had a premature onset of labor; eight of them also had an APD of less than 10 ng . kg-1 . min-1. The study confirms the high predictive value of negative test results. Therefore, the AST can be used as an appropriate method for identifying women who are destined to develop hypertensive complications in pregnancy. However, because of the low practicability of the test, it may not be recommended as a screening method in routine prenatal care. | [
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10,003,161 | Endocrine, structural, and functional changes in the uterus during premature labor. | [
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10,003,162 | Rats which were subjected to ovariectomy on day 18 of pregnancy and were treated with 17 beta-estradiol underwent delivery prematurely at 0900 +/- 1.9 hours on the morning of day 18. All animals had in plasma and uterine tissue a precipitate and highly significant progesterone withdrawal and a corresponding significant increase in prostaglandin F and prostaglandin F metabolite. Progesterone replacement therapy given to a second group of castrated animals prevented progesterone withdrawal and premature labor, because the hormonal profile in plasma and uterine tissue of these animals was identical with that of the intact pregnant vehicle controls. Electron microscopy of longitudinal and circular myometrial layers showed a precipitate and highly significant increase in the number, size, and area of gap junctions in the uteri of the group undergoing premature delivery. In the uteri of the progesterone-treated and vehicle control groups (both intact pregnant), gap junctions were conspicuously scarce. Thus the extensive regulatory imbalance, provoked by progesterone withdrawal, induced a significant increase in myometrial gap junctions. This structural change established contacts between individual myometrial cell which could transform the multibillion cell community of the uterus into a syncytium, to generate low-resistance pathways to the flow of current and thus promote the propagation of trains of electrical discharge in support of labor. | [
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10,003,163 | Complicated eclampsia: fifteen years' experience in a referral medical center. | [
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10,003,164 | The statistical study of a large number of eclamptic patients (n = 704), divided into five successive 3-year periods, was undertaken at the Hospital de Gineco-Obstetricia No. 2 del Centro Médico Nacional in Mexico City in orders to detect significant changes in therapeutic results and/or in the basic character of the disease, as it occurs in a large referral medical complex. The following variables were studied: maternal and perinatal deaths, obstetric profile, main clinical data of the eclamptic episode, frequency of cesarean operation, timing of delivery after admission, main therapeutic changes, frequency of complications in survivors of ante- and intrapartum eclampsia, and cause of death with associated complications. The study showed (1) a continuous increment in the number of cases from the first to the last period, (2) averages for maternal age (24.9 +/- 0.45 years) and for previous parity (1.7 +/- 0.19) unlike those commonly accepted, (3) a significant progression in the severity of the disease in recent years, (4) a frequency of 22.9% of important complications in survivors of ante- and intrapartum eclampsia, and (5) a very limited overall influence of some therapeutic changes on the final outcome of complicated eclampsia, and (6) the impossibility of improving morbidity figures significantly during the 15 years of the study. It was concluded that prevention, early diagnosis, and timely simple medical care offer the only perspective for true medical progress in this particular problem. | [
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10,003,165 | Functional and biochemical aspects of laminaria use in first-trimester pregnancy termination. | [
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10,003,166 | The effect of laminaria-induced cervical dilatation of plasma levels of the prostaglandin metabolite 13, 14-dihydro- 15-keto prostaglandin (PGFM) was evaluated in women undergoing elective first-trimester pregnancy termination. Seventy-one women were randomly assigned to either a treatment (n = 45) or control (n = 26) group. Cervical dilatation measured at the time of insertion of the laminaria was 3.0 +/- 0.1 mm compared to 10.2 +/- 0.2 mm at the time of removal of the laminaria 14 to 16 hours later (p less than 0.001). Peripheral levels of PGFM rose from 28.3 +/- 2.4 pg/ml (mean +/- SEM) to 43.0 +/0 2.6 pg/ml at the time of removal of the laminaria (p less than 0.001). Peripheral concentrations of PGFM in controls remained unchanged. Peripheral concentrations of PGFM did not correlate with the patient's symptoms. Although the hydrophilic property of laminaria is considered to be the principal mechanism promoting cervical dilatation, laminaria may alter the elaboration, release, or degradation of uterine prostaglandin F2 alpha. Thus, biochemical as well as mechanical factors may enhance cervical dilatation in laminaria-treated women. | [
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10,003,167 | The relationship of blood lead levels to obstetric outcome. | [
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] |
10,003,168 | Lead represents a significant environmental hazard to pregnant women and their offspring. Exposure to high environmental levels of lead has been associated with spontaneous abortion, premature rupture of fetal membranes (PROM), and preterm delivery. The relationship between lower exposures and obstetric complications is unknown. The concentration of lead in the blood was measured in 635 specimens of umbilical cord blood collected at delivery. No relationship was found between concentrations of lead in cord blood and the incidence of PROM, preterm delivery, preeclampsia, or meconium staining. Maternal and infant capillary blood was collected 24 hours post partum from 154 of these deliveries. The concentrations of lead in the blood did not vary significantly among cord, infant, and maternal samples, and the three measurements were highly correlated. Levels of zinc protoporphyrin (ZnP) were increased in cord blood as compared with mothers' blood, but no concentration-response relationships between the ratio of cord ZnP to maternal ZnP and lead were found. | [
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10,003,169 | An evaluation of two equations for predicting fetal weight by ultrasound. | [
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10,003,170 | In an earlier study we presented a method of determining fetal weight from ultrasound measurements of abdominal circumference (AC) and biparietal diameter (BPD). From an equation with these two measurements as independent variables we generated tables of estimated fetal weights (E1). Although these tables have been very useful, we had the impression we were underestimating fetal weight. Therefore, we reconsidered an earlier unpublished table generated from a different equation (E2). While most estimates from E1 and E2 were likely to be within 10% of actual weight, there was significant underestimation with E1. E2 provides a better balance between the distribution of overestimations and underestimations. | [
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10,003,171 | Fetal lactic acidosis with epidural anesthesia. | [
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10,003,172 | Three hundred thirty-six consecutive cesarean deliveries performed under epidural anesthesia were reviewed. Twenty per cent of mothers suffered at least a 20% fall in blood pressure following administration of epidural anesthesia. An additional 24% required ephedrine, a vasopressor with predominantly beta activity, when other corrective measures failed. Thus, 44% of these patients suffered significant hypotension. Forty-one percent of all elective repeat cesarean sections were treated wih ephedrine because of maternal hypotension. Fifty-one patients delivered by scheduled repeat cesarean section were divided into ephedrine-treated and untreated groups. There were no differences in Apgar scores among infants of both groups. Fetal acidosis was proportional to the severity of hypotension and the ephedrine dose. The metabolic abnormalities were most pronounced when severe hypotension, requiring over 15 mg of ephedrine, was present. Following restoration of blood pressure with conventional measures and ephedrine therapy, lactic acidosis persisted until delivery, whereas PO2 and PCO2 reverted toward normal values. The hypoperfusion of the intervillous space was the most likely cause of the observed significant umbilical venous and arterial lactic acidosis. Maternal hypotension remains a significant problem complicating conduction anesthesia. | [
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10,003,173 | The mechanism of late deceleration of the heart rate and its relationship to oxygenation in normoxemic and chronically hypoxemic fetal lambs. | [
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10,003,174 | The responses of fetal heart rate and blood pressure to a transient reduction in uterine blood flow were studied in normoxemic and chronically hypoxemic lambs. In normoxemic fetuses, a reduction in uterine blood flow, if prolonged sufficiently, produced reflex bradycardia mediated through chemoreceptors and was associated with a decrease in carotid arterial PO2 to below 20 torr. The bradycardia was associated with a marked decrease in left ventricular output as measured by electromagnetic flowmeter; both were abolished by atropine. In chronically hypoxemic fetuses, a reduction in uterine blood flow produced a delayed deceleration of the heart rate which consisted of three components: reflex bradycardia due to chemoreceptor stimulation; baroreceptor-mediated reflex bradycardia which involved the slow and late recovery of the heart rate; and nonreflex bradycardia which was probably secondary to hypoxic myocardial depression. Quantitative analysis revealed a relationship between the components of delayed deceleration and the status of fetal oxygenation prior to the reduction in uterine blood flow. The lower the carotid arterial PO2, the shorter was the delay in the onset of bradycardia, the greater the decrease in heart rate, and the more prolonged the duration of bradycardia. The conclusion is that the response of fetal heart rate to a transient reduction in uterine blood flow is related to the duration of the reduction and to the status of fetal oxygenation prior to the decrease in uterine blood flow. | [
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10,003,175 | The neonatal significance of selected perinatal events among infants of low birth weight. II. The influence of ruptured membranes. | [
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10,003,176 | A retrospective study was made of 356 infants who weighed less than 2,001 grams. One hundred thirty-three babies were delivered after premature rupture of the membranes. Nonaggressive management was utilized in uncomplicated situations. Vaginal examination was prohibited. Delivery was accomplished only for infection, abnormal presentation, bleeding, labor, or maternal complications. Corticosteroids were not used. There was significantly better survival of babies who weighed 500 to 1,200 grams than of the control infants. Babies who weighed 1,201 to 2,000 grams showed no significant difference. The advantages with ruptured membranes was also noticed among babies less than 30 weeks' gestation by mothers' date and newborn assessment. The advantages were noticed primarily among infants with membranes ruptured more than 48 hours. Appropriate for gestational age (AGA) babies survived more often than small for gestational age (SGA) babies. The incidence of respiratory complications was not altered. The incidence of maternal fever was significantly higher among patients referred for care than among our own. Mortality among referred febrile patients was higher than among our own; no deaths occurred among the latter. Few cases of sepsis occurred, and there were no deaths caused purely by sepsis. The suggestion is that prolonged ruptured membranes in infants of very low birth weight confers some advantage. This advantage may be abolished if fever is prolonged, and infection may be promoted by vaginal examination. | [
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10,003,177 | In vivo sex differentiation of congeneic germinal cell aplastic gonads. | [
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10,003,178 | Gonads of mice carrying a genetic mutation (Sl/Sld), which results in failure of germinal ridges to become populated by the primordial germ cell line, continue to differentiate according to the genetic sex of the animal. The gonads from fetuses of 11, 12, 13, and 14 days' gestation were examined histochemically and histologically for the presence of germ cells and sex cord formation. In both normal and mutant fetuses, sex differentiation was found to progress according to the genetic sex. Testes from mutant adult male mice display well-developed seminiferous tubules populated by Sertoli cells only. Germinal cell aplastic ovaries have the appearance of streak gonads in that stromal tissue alone is present. These results affirm the concept that gonadal sex differentiation is an inherent function of the somatic gonadal elements, is not dependent upon the presence of the germ cell line, and may further help in explaining the etiology of some cases of germinal cell aplastic gonads. | [
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10,003,179 | Efficacy of treatment regimens for lower urogenital Chlamydia trachomatis infection in women. | [
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10,003,180 | One hundred thirteen women had Chlamydia trachomatis isolated from the cervix, or urethra, or both, were treated, and followed until failure occurred or for at least 40 days after initiation of treatment. On regimens given four times daily for 7 days, failure occurred in three (8%) of 38 on tetracycline, 500 mg, in none of five on erythromycin, 500 mg, and in three (8%) of 37 on erythromycin, 250 mg. On regimens of 500 mg given four times daily for 10 days, failure occurred in none of nine on tetracycline and in one (4%) of 24 on sulfisoxazole. Erythromycin, 500 mg, was stopped because of severe side effects. Another 10 women were given a loading dose of ampicillin plus additional ampicillin for 3 to 21 days and were followed for 4 to 76 days after treatment was stopped. Only two women remained culture positive after therapy. This study demonstrates that antimicrobial regimens that are frequently given to women in North America have significant activity against C. trachomatis. | [
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10,003,181 | Vaginal colonization with resistant aerobic bacteria after antibiotic therapy for endometritis. | [
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10,003,182 | To assess the effect of broad-spectrum antibiotic therapy upon vaginal colonization, we collected vaginal specimens for culturing at the end of therapy from 50 patients treated for postcesarean section endometritis. Infected patients had participated in a double-blind therapy protocol and had received either clindamycin plus gentamicin or cefamandole plus placebo. Repeat vaginal culturing was performed 6 weeks later. Similar vaginal specimens for culturing were collected from 25 control patients who also had undergone cesarean section but had not received antibiotics. Of 26 patients treated with cefamandole, 16 (62%) developed vaginal colonization with isolates resistant to that drug; of 24 patients treated with clindamycin-gentamicin, two (8%) developed isolates resistant to these agents (p less than 0.001). Among 25 control patients, there was only one isolate resistant to cefamandole and none resistant to clindamycin-gentamicin. Compared to controls, more antibiotic-treated patients developed isolates resistant to cefamandole (p = 0.001) and to clindamycin-gentamicin (p = 0.06). Colonization did not persist, and there were no late infections in this population. | [
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10,003,183 | Electrical activity in the human oviduct during the menstrual cycle. | [
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] |
10,003,184 | Electrical activity in 25 isolated human oviducts on different days of the menstrual cycle was recorded with six simultaneous suction electrodes in at least 18 locations. During the follicular phase, electrical activity consisted of a smooth, single slow spike that lasted 3 to 6 seconds, and on which was superimposed a fast spike(s) in the ampulla immediately after menstruation. The shape of this activity changed at midcycle, first in the ampulla and later in the isthmus, to a burst of potentials; in the ampulla it sometimes changed to a slow wave on which was superimposed a series of fast spikes. The pacemakers were stable and their number few. The electrical activity spread with a velocity of 1 to 3 mm/sec. The probability of spread toward the uterus varied with the location in the oviduct and with the day of the cycle. After menstruation, electrical activity spread in the uterine direction. On cycle day 12, activity spread toward the ampullary-isthmic junction (AIJ) from both ends of the oviduct. On days 14 and 15, it spread a short distance from the ampulla to the isthmus, through the AIJ. On cycle day 18, spread toward the uterus covered the uterine half of the ampulla. AIJ, and the isthmus. Two to 5 days later, no constant features could be detected in the spread. These findings suggest that the human oviduct functions like the oviducts of other mammalian species, with the spread of electrical activity and the transport of ova being related. | [
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10,003,185 | A simple way to determine nonspecific effects of plasma and serum components in radioreceptor assays and radioimmunoassays for human chorionic gonadotropin. | [
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10,003,186 | A simple approach is validated for the determination of nonspecific effects of human plasma and serum in the radioreceptor assays and radioimmunoassays for human chorionic gonadotropin (hCG). The approach is based on the findings that, despite differences in the degree of inhibition of 125I-hCG binding to its receptors and antibodies by nonhormonal components in different dilutions of pool plasma and serum, the standard curves (plotted as the percentage of control for each serum or plasma dilution) are superimposable. The approach consists of (1) running a single standard curve with no pool plasma or serum, (2) including a set of "correction" tubes which contain pool plasma or serum diluted correspondingly to the dilution of the unknown samples in the assay, (3) dividing the counts per minute found in the correction tubes into the counts per minute of the unknown samples and multiplying by 100, and (4) using this value to obtain the amount of hCG in the unknown samples by comparison with the no pool plasma or serum standard curve. | [
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10,003,187 | Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. | [
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10,003,188 | Data are presented to define a unique group of preeclamptic/eclamptic patients with the finding of hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). This entity has been termed the HELLP syndrome and may occur when the usual clinical findings to diagnose severe preeclampsia are absent. Often the patient is given a nonobstetric diagnosis and treatment is withheld or modified. The possible pathophysiology of this syndrome, the management of the patient, and the maternal and neonatal outcomes are presented. Recognition of the clinical and laboratory findings of the HELLP syndrome is important if early, aggressive therapy is to be initiated to prevent maternal and neonatal death. The practicing obstetrician must be knowledgeable about this severe consequence of hypertension in pregnancy. | [
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10,003,189 | Erythrocyte catechol-O-methyltransferase activity in pregnant women with pregnancy-induced hypertension. | [
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10,003,190 | Conclusive evidence for the presence of elastin in human and monkey cervix. | [
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10,003,191 | A comparison of terbutaline and ethanol in the treatment of preterm labor. | [
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10,003,192 | Ninety-two women in preterm labor were randomly assigned to either terbutaline or ethanol. In women with intact membranes, terbutaline was significantly more effective than ethanol in preventing progressive cervical dilation during the first 36 hours of treatment while betamethasone was given to the mother. Additionally, pregnancy was maintained significantly longer in women with intact membranes who were treated with terbutaline (15 +/- 4 days) rather than with ethanol (10 +/- 3 days). However, only 18% of women in each treatment group maintained their pregnancy beyond 36 weeks' gestation. In women with ruptured membranes and cervical dilation less than 4 cm, terbutaline was significantly better than ethanol in maintaining pregnancy for a minimum of 36 hours. Serious maternal side effects were not observed with terbutaline or ethanol, although a majority of women also received betamethasone. Neither drug caused serious adverse neonatal effects. | [
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10,003,193 | Oral contraception as a risk factor for preeclampsia. | [
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10,003,194 | Since the role of oral contraceptives as a risk factor for hypertension is now quite well established, we investigated the possible relationship between recent use or oral contraception around conception and the development of hypertension and preeclampsia later in the pregnancy. Subjects were randomly selected women being delivered during a 24 month period at a major medical center who had used oral contraceptives in the 12 months before conception. The overall incidence of preeclampsia was 4.69%. Women who discontinued oral contraceptives as recently as 2 months before conception or who inadvertently used them in early pregnancy (n = 99) did not differ significantly on incidence of preeclampsia (odds ratio (o) = 0.55, 95% CL = 0.15, 2.00) or hypertension at delivery (o = 1.01, 95% CL = 0.46, 2.20) than women last exposed 3 to 12 months before conception (n = 242). Potentially confounding maternal factors were examined and controlled. | [
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10,003,195 | Improved prediction of fetal lung maturity in diabetic pregnancies: a comparison of chromatographic methods. | [
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10,003,196 | Following planned termination of pregnancy, infants of diabetic mothers have shown a continued vulnerability to the respiratory distress syndrome (RDS), suggesting false positive results on fetal lung maturity testing. We studied the adequacy of the standard one-dimensional chromatographic lecithin/sphingomyelin (L/S) ratio for predicting RDS in 56 diabetic and 50 nondiabetic pregnancies. An exceptionally low incidence of RDS was noted for the study (0.95%) as well as for diabetic pregnancies alone (1.85%). The clinical results were further compared to a new method for determining L/S ratios and identifying other pulmonary phospholipids by two-dimensional chromatography. Values for two-dimensional L/S ratios were significantly lower from 36 through 38 weeks' gestation (P less than 0.01), suggesting improved accuracy and a lessened risk for false positive results in preterm deliveries. Positive identification of amniotic fluid phosphatidylglycerol (PG) was related to increasing L/S ratios (P = 0.001), but only 50% of nondiabetic and 16.7% of diabetic amniotic fluid samples contained PG when the L/S was 2:1 or greater (P = 0.02). The identification of PG serves to confirm fetal lung maturity, but the L/S ratio remains the best available indicator of fetal lung maturity for all high-risk pregnancies. | [
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] |
10,003,197 | The influence of asphyxia on fetal lidocaine toxicity. | [
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10,003,198 | Local anesthetics have played an important role in modern obstetrics. Although reasonably safe, these agents have been shown to have detrimental effects in some fetuses. In the present study we examined the influence of acute asphyxia in the fetal lamb on the distribution and cerebral uptake of maternally infused lidocaine. Results demonstrate that asphyxia is associated with higher lidocaine concentrations in the fetal plasma, increased presentation of the drug to the fetal brain, and increased cerebral lidocaine uptake. These findings underscore the importance of evaluation of fetal status when considering the risks and benefits of maternal drug use. | [
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10,003,199 | Bendectin and fetal development. A study of Boston City Hospital. | [
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] |
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