Measurements of surface diffusivity and coarsening during pulsed laser deposition.

Pulsed laser deposition (PLD) of homoepitaxial SrTiO(3) 001 was studied with in situ x-ray specular reflectivity and surface diffuse x-ray scattering. Unlike prior reflectivity-based studies, these measurements access both time and length scales of the evolution of the surface morphology during growth. In particular, we show that this technique allows direct measurements of the diffusivity for both inter- and intralayer transport. Our results explicitly limit the possible role of island breakup, demonstrate the key roles played by nucleation and coarsening in PLD, and place an upper bound on the Ehrlich-Schwoebel barrier for downhill interlayer diffusion.

Choroidal neovascularization following photodynamic therapy in a patient with chronic central serous chorioretinopathy.

PURPOSE: To present the clinical features and treatment of subfoveal choroidal neovascularization complicating photodynamic treatment (PDT) performed for chronic central serous chorioretinopathy (CSC). METHOD: A 48-year-old healthy woman who had chronic visual deterioration in her right eye due to chronic CSC was treated with standard PDT protocol. RESULTS: Three weeks after the initial PDT, she experienced recovery in her vision and neurosensory detachment subsided clinically. However, six weeks after the PDT she returned with decreased visual acuity and metamorphopsia in the right eye. Fluorescein angiogram and optic coherence tomography delineated a classic subfoveal subretinal neovascular membrane. PDT was reperformed two more times, three months apart and closure of neovascular membrane was obtained. CONCLUSION: Choroidal neovascularization might have occurred during the natural course of disease process or as a consequence of PDT. PDT seems to be effective for treating the choroidal neovascularization complicating PDT performed for CSC.

Sustained hypoglycemia affects glucose transporter expression of human blood leukocytes.

The scarce data available on leukocyte glucose transporter expression are contradictory and nothing is known about its regulation by glycemic state. Therefore, cytospin preparations of blood leukocytes were searched immunocytochemically for the high-affinity glucose transporters GLUT1, 3, and 4. Hypoglycemia-associated quantitative changes in transporter expression were assessed by flow cytometry. Granulocytes and monocytes stained for GLUT1, 3, and 4. Granulocyte GLUT4 levels were increased by 73% (P < 0.05) under hypoglycemic conditions, which was paralleled by a reduction in GLUT1 and a rise in GLUT3. In monocytes, GLUT3 was elevated by 134% (P < 0.05), whereas GLUT1 and GLUT4 remained unaffected upon hypoglycemia. Apart from a minor subpopulation, lymphocytes were negative for these carriers. In conclusion, GLUT1, 3, and 4 are abundantly expressed in granulocytes and monocytes. The differential response of individual isoforms to hypoglycemia may represent a mechanism to protect the cells from the stress of glucose deprivation.

Are endometrial carcinoma cells disseminated at hysteroscopy functionally viable?

OBJECTIVE: The aim of this study was to evaluate the rate of transtubal dissemination of endometrial carcinoma cells by hysteroscopy and the functional viability of disseminated tumor cells by assessing cell adhesion in an in vitro model. METHODS: We studied 24 uteri obtained at TAH+BSO in patients with endometrial carcinoma. Further inclusion criteria were negative peritoneal cytology, no involvement of the uterine serosa or extrauterine disease, and endometrial surface involvement >1 cm in diameter. In vitro fluid hysteroscopy was performed with a 5-mm single-flow rigid hysteroscope. A maximum of 150 ml saline was infused at a maximum pressure of 100 mm Hg for a maximum of 3 min. Fluid running off through the tubes was collected. The cell suspension was enriched by a density gradient centrifugation. The isolated cells had a mean viability of 90% as judged by trypan blue exclusion. Viable cells (5 x 10(4) per 2-cm(2) polyvinyl chloride well plate) were cultured with equal parts of Dulbecco's modified Eagle's minimal essential medium and Ham's F-12 for 24 h. The endpoint of the analysis was the adherence of tumor cells to the polyvinyl chloride well plate, which was taken as a proxy for functional cell viability. Cytological evaluation was performed separately by two cytologists blinded to the source and date of the smears. RESULTS: Transtubal fluid dissemination was seen in 20 of 24 (83%) uteri. Tumor cells were found in 17 specimens (71%). In 10 (42%) specimens the disseminated tumor cells were functionally viable. CONCLUSIONS: Our model suggests that hysteroscopy can cause dissemination of malignant cells into the abdominal cavity from uteri containing endometrial carcinoma and that these cells can be functionally viable and adhere to a matrix.

Reproductive outcome after laparoscopic instillation of hyperosmolar glucose into unruptured tubal pregnancies.

OBJECTIVE: To determine intrauterine and ectopic pregnancy rates after local instillation of 50% glucose into unruptured tubal pregnancies. DESIGN: Retrospective cohort of 183 patients, who were observed for 16 to 108 months (median, 64 months). SETTING: University hospital. PATIENT(S): One hundred eighty-three women who underwent laparoscopic instillation of hyperosmolar glucose for unruptured tubal pregnancies. INTERVENTION(S): Completion of questionnaires. MAIN OUTCOME MEASURE(S): Pregnancy rate, tubal recurrence rate. RESULT(S): A total of 124 women returned the questionnaire and had a desire for spontaneous conception. The conception rate and the intrauterine pregnancy rate were 79% and 73%, respectively. Seventy percent of all women with desire for spontaneous conception had live births. The rate of subsequent ectopic pregnancies was 12%. Tubal patency of the treated tube was demonstrated in 69% of 39 women at hysterosalpingography. CONCLUSION(S): The long-term prognosis for conception after laparoscopic instillation of hyperosmolar glucose for unruptured tubal pregnancy is favorable and comparable to that of other conservative treatments.

Hyperglycaemia in vitro alters the proliferation and mitochondrial activity of the choriocarcinoma cell lines BeWo, JAR and JEG-3 as models for human first-trimester trophoblast.

AIMS/HYPOTHESIS: Early intrauterine growth delay in diabetes could be caused by a reduced growth of the placenta. Our study investigates whether hyperglycaemia in vitro reduces trophoblast proliferation. METHODS: First-trimester trophoblast cell models (BeWo, JAR and JEG-3 choriocarcinoma cells) were cultured for 24 and 48 h with 5.5 mmol/l D-glucose, 25 mmol/1 D-glucose (hyperglycaemia) and with an osmotic control. Cell number, total protein and nucleic acid content and mitochondrial activity (tetrazolium salt assay) were measured, the cell cycle analysed (FACS, cyclin B1 levels) and apoptosis (Annexin-V) measured. RESULTS: In BeWo cells hyperglycaemia reduced cell number, protein, nucleic acid and cyclin B1 levels. The reduced G2/M and increased G0/G1 population after 24 h reflects growth arrest at G0/G1. In JAR cells after 24 h the population was arrested in G0/G1, whereas after 48 h the G0/G1 block was abrogated and the cells were arrested at G2/M. The net effect was an unchanged cell number. In JEG-3 cells hyperglycaemia resulted in fewer cells after 24 h but not after 48 h indicating some adaptation. Mitochondrial activity was either stimulated (BeWo) or reduced (JAR, JEG-3) under hyperglycaemia. Some of these effects were also induced by hyperosmolarity alone. CONCLUSION/INTERPRETATION: Hyperglycaemia has the potential to inhibit the proliferation of first-trimester trophoblast cell models. The mechanisms leading to growth arrest and to changes in mitochondrial activity are complex and depend on differentiation. We hypothesise a hyperglycaemia-induced impairment of placental growth in the first trimester of a poorly controlled diabetic pregnancy.

Cord blood oxygen saturation in vigorous infants at birth: what is normal?

OBJECTIVE: To define the normal ranges of umbilical cord blood oxygen saturation (SaO2) and acid-base status at birth and to evaluate the effect of gestational age on cord blood values in vigorous newborn infants following spontaneous vaginal birth from a vertex position. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, University of Graz, Austria. SAMPLE: Cord blood samples from 1281 vigorous newborn infants. METHODS: Cord blood sampling was performed following on newborn infants following spontaneous vaginal birth in a vertex position. SaO2 was measured directly by a spectrophotometer and pH, base excess, pCO2 and pO2 by a pH/blood-gas analyser. Infants with a 5-minute Apgar score > or = 7 were considered vigorous. Subgroups were classified according to the gestational age: preterm, term and post-term (< 37, 37-42 and > 42 weeks, respectively). RESULTS: The median umbilical artery SaO2 was 24.3% and the 2.5th centile was as low as 2.7%. The median umbilical artery values were pH = 7.25, base excess = -4.3 mmol/L and pO2 = 16 mmHg. The 2.5th centiles were 7.08, -11.1 mmol/L and 5 mmHg, respectively. The median umbilical artery pCO2 was 50 mmHg and the 97.5th centile was 75 mmHg. The mean umbilical artery and vein SaO2 values were not significantly influenced by gestational age. The umbilical artery SaO2 and base excess values were strongly skewed. The mean umbilical artery pH values in preterm infants were higher than in other subgroups. The mean umbilical artery and vein base excess values were lower in post-term newborn infants than in other subgroups. CONCLUSIONS: The physiological range of oxygen saturation in umbilical cord of vigorous newborn infants at birth is wide and skewed. In contrast to pH and base excess, umbilical cord blood oxygen saturation is not influenced significantly by gestational age at birth.

Low fetal oxygen saturation at birth and acidosis.

OBJECTIVE: To measure umbilical cord blood oxygen saturation, to calculate preductal oxygen saturation at birth, and to assess its predictive value for acidosis. METHODS: Umbilical cord blood samples of 1537 live-born singleton neonates were analyzed. Oxygen saturation was measured by spectrophotometry; pH and base excess were measured by a pH and blood gas analyzer. Preductal oxygen saturation was calculated with an empirical equation. Acidosis was defined as 2 standard deviations (SDs) below the mean of umbilical artery (UA) pH or base excess (7.09 and -10.50 mmol/L, respectively). The predictive value for acidosis of UA and umbilical vein (UV) oxygen saturation and calculated preductal oxygen saturation was determined with receiver operating characteristic curves. RESULTS: The mean values (+/-SD) of UV, UA, and calculated preductal oxygen saturation were 52 +/- 18%, 26 +/- 17%, and 31 +/- 16%, respectively. Forty-seven neonates had UA pH less than 7.09 and 60 had UA base excess less than -10.50 mmol/L. The UV, UA, and calculated preductal oxygen saturation showed considerably weaker relations to UA base excess (multiple r(2) =.056,.003, and.017, respectively; P <.001) than to UA pH (multiple r(2) =.112,.126, and.148, respectively; P <. 001). Receiver operating characteristic areas under the curve were higher when predicting low pH compared with low base excess (for UV, UA, and calculated preductal oxygen saturation: 0.716 versus 0.699, 0.747 versus 0.586, and 0.765 versus 0.628, respectively). The difference was significant for UA oxygen saturation (P <.05). All tests showed high sensitivity and negative predictive values, but low specificity and positive predictive values. CONCLUSION: Low fetal oxygen saturation measured at birth seemed to be associated with low fetal pH and base excess values, but its predictive value for acidosis in an unselected population was limited, particularly if acidosis was metabolic.

Course of maternal serum magnesium levels in low-risk gestations and in preterm labor and delivery.

OBJECTIVES: To describe the course of total and ionized magnesium and total calcium levels in maternal serum during low-risk pregnancies and to compare women who developed preterm labor and delivery with those who delivered at term. METHODS: 209 women with low-risk pregnancies were enrolled in a prospective trial before the 18th week of gestation. No woman received oral magnesium supplementation. The ionized and total magnesium and total calcium levels in maternal serum were measured every 4-6 weeks. The data were grouped into 3 gestational periods (/=28 weeks of gestation) for overall comparison and analyzed with the general linear model for repeated measurements and ANOVA. p values of < 0.05 were considered statistically significant. RESULTS: 145 gestations were available for analysis. 27 women were hospitalized for preterm labor and in 16 of these preterm delivery occurred. Ionized and total magnesium and calcium levels were significantly lower after the 18th week of gestation than before. The cation levels in women with preterm labor and delivery did not differ from those with term delivery. CONCLUSION: Ionized and total magnesium and calcium levels decrease with increasing gestational age. Preterm labor and delivery do not seem to be related to changes in serum cation levels.

Maternal perceptions of labor with fetal monitoring by pulse oximetry in a research setting.

OBJECTIVE: Little research has evaluated maternal experience with fetal pulse oximetry for fetal surveillance. The purpose of this study was to compare maternal perceptions of labor with intrapartal cardiotocography with or without fetal pulse oximetry in a research setting. METHODS: One hundred women with vaginal, vertex deliveries and uncomplicated fetal outcomes were enrolled. The study group was a subset of 50 mothers who had participated in a pulse oximetry trial. The control group of 50 mothers was monitored by cardiotocography only. Both groups were matched for age, parity, weeks of gestation, epidural anesthesia use, and duration of labor. A global measure of maternal perception of labor was established by experience with labor, general attitude toward monitoring devices, satisfaction with monitoring, nursing and medical care, and anxiety, each of which was evaluated separately. The mothers in the study group were also interviewed about aspects related to the fetal pulse oximetry research setting, such as information, movement restriction, discomfort, care, privacy, and safety. The questionnaires were based on a standardized rating scale model, and the interviews were conducted two to four days after delivery. The results were analyzed by chi-squared, paired t test, and ANOVA. RESULTS: No significant differences were observed between the study and control participants in any parameter concerning the maternal perception of labor. Mothers' experiences with pulse oximetry as assessed by interview was overwhelmingly positive. CONCLUSIONS: Fetal monitoring by pulse oximetry in a research setting did not affect maternal perceptions of labor. Mothers' experiences with pulse oximetry were highly positive, suggesting that research in fetal pulse oximetry need not compromise maternal perceptions of labor.

Does the hemoglobin concentration in fetal blood interfere with the accuracy of fetal reflection pulse oximetry?

OBJECTIVE: Our goal was to investigate the influence of the fetal hemoglobin (Hb) concentration on the accuracy of reflection pulse oximetry. METHODS: 179 fetuses were monitored by a reflection pulse oximetry system (RPOX MK2). Pulse oximetry measurements (SO2POX) were compared with the oxygen saturation and pH of umbilical artery and vein (UA-, UV-SaO2) immediately after delivery. Correlation and linear regression analyses were performed. Because it is unknown whether low or high Hb concentrations might interfere with the SO2POX measurements, the influence of the Hb level on the correlations was evaluated by weighting the linear regression in both ways; by Hb concentrations as weighting factor and as an inverse weighting factor (1/Hb). RESULTS: There was a significant correlation between SO2POX and UV-SaO2 (for the last 10 min of delivery, r = 0.45, p < 0.0005) but not with pH or UA-SaO2. Linear regression analysis between SO2POX and UV-SaO2 showed a multiple R of 0.45. Hb concentration in fetal blood ranged from 9.2 to 20.5 mg/dl. The weighted regression indicated a multiple RHb of 0.49, which did not differ by the inverse weighting (multiple Rinverse Hb: 0.49). CONCLUSIONS: Pulse oximetry measurements seem to reflect oxygen saturation in fetal blood, however further improvement is necessary. The Hb concentration in fetal blood does not interfere with the accuracy of fetal pulse oximetry and need not be taken into consideration in calibration curves.

Thrombocytosis as a prognostic factor in endometrial carcinoma.

We reviewed the prevalence of thrombocytosis (platelet count >/=400, 000/microL) and its association with outcome in 135 consecutive endometrial carcinoma patients and compared the platelet count with other prognostic factors. Nineteen of 135 patients (14%) had thrombocytosis. Thrombocytosis was significantly more frequent in advanced disease (stage II-IV), unfavorable grade (G2 and G3), deep myometrial invasion, and lymph-vascular space invasion. The overall 5-year survival rate was 92%. The 5-year survival rate of the 19 patients with thrombocytosis was significantly worse than that of the patients without thrombocytosis (61 vs 96%, P < 0.0001). The recurrence rate was significantly higher in patients with thrombocytosis than in those with a platelet count <400,000/microL (7 vs 32%, P < 0.005). In a multivariate analysis, thrombocytosis continued to be a predictor of worse prognosis. In conclusion, we found thrombocytosis to be a prognostic factor for survival in patients with endometrial carcinoma.

Rare manifestations of the ovarian hyperstimulation syndrome: a report of two cases.

The increasing practice of ovulation induction has made ovarian hyperstimulation syndrome (OHSS) a frequent clinical problem which can also become life-threatening. Two unusual cases of OHSS are described. The first patient presented with a unilateral pleural effusion. The second patient developed severe OHSS after a low-dose protocol with highly purified follicle stimulating hormone (FSH HP) and in the absence of risk factors.

Fetal pulse oximetry and visual on-line signal identification in the second stage of labor.

OBJECTIVE: To determine the accuracy of reflection pulse oximetry and visual on-line signal identification during the second stage of labor. STUDY DESIGN: The reflection pulse oximetry system used allows visual on-line identification of valid signals by showing the original red and infrared signals. With this system oxygen saturation measurements are averaged over nine heartbeats only. An atraumatic suction probe was used. The measurements of the last 10 minutes before delivery were compared with umbilical venous cord blood samples taken soon after delivery. RESULTS: The correlation between reflection pulse oximetry readings during the last 10 minutes before delivery and umbilical vein oxygen saturation was significant (r = 0.45; p < 0.0005). Standard regression analysis showed R2 of 0.45. This did not change if weighted by the rate of valid signals (R2 = 0.42). If the predelivery loss of valid signals was less than 5 minutes, the correlation improved (r = 0.47, p < 0.001). Umbilical vein pH did not correlate with pulse oximetry readings. CONCLUSION: The reflection pulse oximetry system used allows visual on-line identification of even short periods of valid signals and reflects actual oxygen saturation in fetal arterial blood.

Rolling belt injuries in children.

The rolling belts on agricultural machinery attract children who unconsciously grab them. The injuries produced include friction burns, injuries to flexor tendons, digital nerves and arteries, skin in zone 2 and fractures. Subtotal or total amputation may occur. We present the results of such injuries to 44 fingers in 16 children aged 1 to 9. The functional results are not satisfactory. In order to grade the results we have devised a classification to this injury. The survival rate for all fingers was 71%, but in the fingers with circulatory problems the survival rate was 50%. On functional assessment seven patients had a good result, seven moderate, and two fair.