Heterotrimetallic Mixed-Valent Molecular Precursors Containing Periodic Table Neighbors: Assignment of Metal Positions and Oxidation States.

A known trinuclear structure was used to design the heterobimetallic mixed-valent, mixed-ligand molecule [CoII (hfac)3 -Na-CoIII (acac)3 ] (1). This was used as a template structure to develop heterotrimetallic molecules [CoII (hfac)3 -Na-FeIII (acac)3 ] (2) and [NiII (hfac)3 -Na-CoIII (acac)3 ] (3) via isovalent site-specific substitution at either of the cobalt positions. Diffraction methods, synchrotron resonant diffraction, and multiple-wavelength anomalous diffraction were applied beyond simple structural investigation to provide an unambiguous assignment of the positions and oxidation states for the periodic table neighbors in the heterometallic assemblies. Molecules of 2 and 3 are true heterotrimetallic rather than a statistical mixture of two heterobimetallic counterparts. Trinuclear platform 1 exhibits flexibility in accommodating a variety of di- and trivalent metals, which can be further utilized in the design of molecular precursors for the NaMM'O4 functional oxide materials.

Perpetrators', Victims', and Witnesses' Folk Explanations of Aggressive Behaviors.

Unsurprisingly, victims and perpetrators often view aggressive behaviors differently. The current study examined whether victims, perpetrators, and witnesses also explained aggressive behaviors differently. The current study included 408 participants who recalled a time when they harmed another person (i.e., perpetrator memory), when another person harmed them (i.e., victim memory), and when they witnessed an aggressive behavior (i.e., witness memory). Replicating past research, participants rated their recalled aggressive behaviors from the victim perspective as being more harmful and less justified than they did for their recalled behaviors from the perpetrator perspective. When examining their explanations for the behaviors, participants most often explained their own aggressive behaviors by referring to their mental deliberations that led to their behavior (i.e., reason explanations). In comparison, they referred to background causal factors (i.e., causal history of reasons explanations)-such as personality traits, demographic factors, cultural norms, etc.-more when explaining others' aggressive behaviors, especially when the explanation was from the victim perspective. These findings show the subtleties in how people communicate about their aggressive interactions: When communicating about their own aggressive behaviors, people use modes of explanations that portray their behaviors as sensible, and when communicating about a time when another person behaved aggressively towards them, people use modes of explanations that omit the thought processes that led to those behaviors.

[Management of malignant gliomas diagnosed during pregnancy]. / Prise en charge des gliomes malins découverts au cours d'une grossesse.

INTRODUCTION: Glioma is seldom diagnosed during pregnancy. In this situation management presents difficult problems for both neuro-oncologists and obstetricians. We report four cases and discuss the management of this unusual situation. CASE REPORT: The first patient was admitted to hospital at 29 weeks' gestation because of a generalized seizure and a right hemiparesis. MRI showed a left fronto-insular lesion. A stereotactic biopsy was obtained and revealed an anaplastic oligodendroglioma. With corticosteroids the patient remained stable until cesarean delivery at 36 weeks. In post-partum additional treatment with chemotherapy was started. The second patient was hospitalized at 26 weeks' gestation because of cranial hypertension, right hemiparesis and aphasia. MRI showed an important left fronto-parietal lesion. Partial resection was performed at 28 weeks. Histology revealed a glioblastoma multiforme. With corticosteroids the patient remained stable until cesarean delivery at 33 weeks. In post-partum additional treatment with radiotherapy and chemotherapy was started. The third patient was admitted to the hospital at 12 weeks' gestation because of cranial hypertension. MRI showed a left frontal lesion. A subtotal resection was done at 13 weeks. Histology revealed a glioblastoma multiforme. Two weeks after surgery the patient's neurological condition worsened and in agreement with the patient a therapeutic abortion was decided. Afterwards additional treatment with radiotherapy and chemotherapy was started. The last patient received combined treatment with radiotherapy and chemotherapy for local recurrence of a mesencephalic high-grade glioma. A posteriori it was discovered that the patient was at 4 months' gestation during this treatment. Cesarean delivery was done at 36 weeks. The child was normal at birth and is still in good health 5 years later. CONCLUSION: The management of gliomas diagnosed during pregnancy should not be different from the standard management of gliomas in young non-pregnant adults. Pregnant women because of their young age can have a long survival. Their pregnancy should not prevent them from receiving the best treatment for their glioma. Treatment will depend upon clinico-radiological presentation, histology, gestational age and the patient's desires. Generally speaking, surgical resection of high-grade gliomas should not be delayed during pregnancy. Progress in anesthesia and neurosurgery have greatly reduced the risks for the foetus. After delivery, if the delay between surgery and delivery is too long it is possible to begin cerebral radiotherapy during pregnancy. After the first trimester of gestation this treatment can be given without any important risks for the child.

[Marfan's syndrome and pregnancy]. / Syndrome de Marfan et grossesse.

The Marfan's syndrome is an autosomal dominant genetic disorder resulting in a diminished strength of connective tissue. The ocular, skeletal and cardiovascular systems are mostly at risk. Principal complications of the disease are aortic dilatation and the risk of acute dissection. Pregnancy increases this risk. Based on the experience of our obstetrics department and after reviewing medical literature, we have tried to establish guidelines for obstetric care adapted to pregnant patients affected by Marfan's syndrome. Women with aortic root > 40 mm should avoid pregnancy. In all cases B-adrenergic receptor blockers must be used as soon as possible. Because there is a 50% risk that offspring will inherit the syndrome, prenatal diagnosis should be suggested. In addition to usual pregnancy monitoring, echocardiography should be performed every 3 months as well as 2 months after delivery. No increase of obstetrical complications has been shown in these patients. Route of delivery also depends on the diameter of the aortic root: vaginal delivery is warranted if the aortic root is<40; cesarean section should be performed in the other cases. Thus, with appropriate supervision, women with Marfan's syndrome will tolerate pregnancy without any adverse effect.

[Cystic fibrosis and pregnancy: report of a twin pregnancy and review of the literature]. / Mucoviscidose et grossesse: á propos d'un cas de grossesse gémellaire et revue de la littérature.

We report here the first published case of twin pregnancy in a woman with cystic fibrosis. This situation will become more and more common because the increased life expectancy of patients with cystic fibrosis and the development of medically assisted procreation. Conception of this twin pregnancy was medically assisted in a cystic fibrosis woman with moderate pulmonary disease. This observation is in accordance with several recent reports dealing with single pregnancies: morbidity, mortality and degradation of lung function have not been found to increase. The only effect of cystic fibrosis on pregnancy is an increased risk of preterm delivery. There is thus no systematic contraindication to pregnancy among women with cystic fibrosis provided that they are given attentive care by a multidisciplinary team. Genetic counselling and prenatal diagnosis also have an important role to play.

[Compliance with a protocol of prevention of neonatal group B streptococcal sepsis in the Aurore perinatal network]. / Application d'un protocole de prévention de l'infection materno-foetale à streptocoque B hémolytique au sein du réseau périnatal Aurore.

OBJECTIVE: Our purpose was to measure the compliance with the network hospitals protocol for preventing neonatal group B streptococcal sepsis. MATERIALS AND METHOD: All vaginal deliveries during a one-week period in 37 maternities of the perinatal network were reviewed retrospectively. RESULTS: A total of 752 records were reviewed. Compliance with the protocol regarding the time of culture was 91.1%. Overall, prevalence of group B streptococcal carriage was 14.2%. Among patients eligible for intrapartum antibiotics, 46.4% received adequate prophylaxis. Considering the length of labor, one out of two patients could have received intrapartum adequate antibiotics. Regarding newborns, 86.1% received adequate medical surveillance. There was no confirmed case of group B streptococcal sepsis during the week of study. CONCLUSION: All the maternities of network Aurore accepted and adopted evaluation principle. Some elements of protocol could be better applied, in particular delivering adequate intrapartum antibiotic prophylaxis.

Dynamic histomorphometric evaluation of human fetal bone formation.

We have evaluated dynamic and static parameters of bone formation in femoral metaphyses collected from two human fetuses at 19 weeks of gestation. Tetracycline was administered to the mother at set intervals (2-5-2 day schedule) before interruption of pregnancy. Labels were distinct and sharply linear, suggesting a well organized calcification front at this early stage of mineralization. Mineral apposition rate (MAR) was fastest (4.1 +/- 0.3 microns/d) in the periosteal (Ps) envelope, and about half that value in the endosteal envelopes (endocortical: 2.5 +/- 0.1, cancellous 2.1 +/- 0.1 microns/d). Because cellular activities may vary throughout the metaphyseal area, sections were arbitrarily separated in 0.75 mm layers starting from the growth plate. Three measured parameters decreased rapidly with increasing distance from the physis: Ps MAR: 4.9 to 2.3 microns/d, trabecular osteoid thickness: 5.9 to 1.2 microns, and cartilage volume (CgV/TV): 5.4% to 1.2%. Others did not vary significantly along the metaphysis. Comparison of several static parameters with those measured in five autopsy specimens from full-term infants showed that bone and cartilage volume, and trabecular thickness increased while osteoid thickness and parameters of resorption decreased in the second half of the gestation period. The study indicates that fetal bone matrix mineralization is already highly organized at mid-gestation, and validates the use of histomorphometry to assess bone maturation during early skeletal development.

[Treatment of cancer of the uterine cervix by surgery alone]. / Le traitement du cancer du col utérin par la seule chirurgie.

The authors report a series of 434 patients with invasive cancer of the uterine cervix treated with primary surgery. The results are equivalent to those reported by others who treated cervix cancer with radiotherapy. Post-operative radiotherapy did not improve the results except in the most advanced forms (pT2b, pN1 or 2) when it increases the disease-free interval without altering the survival probability at 5 years. For the clinical stages I, IIA and IIB proximal (infiltration of the parametrium limited to the proximal part) surgery is the elective treatment. In stage IIB distal and for "operable" Stages III and IV, a combination of chemotherapy-surgery and radiotherapy is suggested.

The use of micronized progesterone in the treatment of menace of preterm delivery.

The results of a study concerning the treatment of acute menace of preterm labor are given: beta-mimetics were administered intravenously in all cases (44) and micronized progesterone or placebo was administered orally after classical double-blind randomization (22 cases in each group). The mean index of pregnancy prolongation was the same in both groups. However the mean duration of the intravenous perfusion and the mean quantity of beta-mimetics administered intravenously were significantly reduced in the progesterone group (P less than 0.01). The mean duration of hospital stay was also significantly reduced (P less than 0.05). Cost and risks are finally significantly lessened.

Hypertrophic cardiomyopathy and pregnancy.

The case of a young primiparous woman with defibrillator-assisted familial hypertrophic cardiomyopathy (HCM) has led us to review the literature on this pathology, which is exceptional because of its scarcity and the originality of the problems encountered. To our knowledge, this is the first observation ever reported of defibrillator-assisted activation during pregnancy in a woman with HCM. Several questions raised from this particular case, e.g. what are the risks caused by pregnancy in these patients, what is the impact of therapeutics, does the activation of an internal defibrillator involve particular risks, what is the best disposition for delivery and what are the risks for fetuses? We have tried to ask all of these questions, using as exhaustive a literature review as possible.

Planned vaginal delivery versus elective caesarean section in singleton term breech presentation: a study of 1116 cases.

OBJECTIVE: To compare neonatal and maternal morbidity and mortality between planned vaginal delivery and elective cesarean section for singleton term breech presentation. STUDY DESIGN: We studied retrospectively all deliveries of singleton breech presentations at term in the public Hospitals of Lyon between 1 January 1991 and 31 December 1995. To take only the effect of delivery on the fetus into account, we eliminated high risk pregnancies and fetal malformations. Fetal parameters were corrected perinatal mortality, Apgar score<7 at 1 and 5 min, umbilical cord arterial pH<7.15, neurological disorders, trauma and need for neonatal intensive care. Maternal parameters were mild, moderate and severe complications. RESULTS: Of the 1116 breech presentations, 702 (62.9%) underwent an elective caesarean section and 414 (37.1%) a planned vaginal delivery. In the latter group, 342 (30.6%) had a vaginal delivery and 72 (6.5%) a non-elective caesarean section. Infants for whom the vaginal route was planned were at higher risk of mortality and morbidity. There were 2 deaths in this group and none in the elective caesarean section group and all fetal parameters were poorer: more Apgar<7 at 5 min (RR: relative risk=3.05; 1.03-9.05), arterial pH<7.15 (RR=1.64; 1.11-2.43), intubations (RR=7.35; 2.10-25.6), neurological disorders, trauma (RR=4.24; 1.66-10.8), transfer to intensive care units (RR=3.23; 1.57-6.64). The overall maternal morbidity was lower in the planned vaginal delivery group (RR=0.65; 0.44-0.94) but this was only because of less mild complications. The moderate and severe complications were the same in the two groups (RR=0.97; 0.59-1.57). CONCLUSIONS: Planned vaginal delivery in singleton term breech presentation increases the risk of death and of neonatal complications. Elective caesarean section increases the risk of only mild maternal complications. For these reasons, elective caesarean section should be preferred for singleton term breech presentations.

Renal outcome of children exposed to cyclosporine in utero.

The number of pregnancies in immunosuppressed women has increased during the recent years and this has become a major part of the rehabilitation and quality of life of treated patients. Most of them are organ transplant recipients and large series from the literature have shown that children born to such women may present with intrauterine growth retardation, a condition which may be associated with significant reduction in nephron number and oligomeganephronia. On the other hand, experimental data in animals have demonstrated that in utero exposure to CsA may alter nephrogenesis and further alter renal function. Therefore offspring of organ transplant women treated with CsA exhibit a theoretical risk of renal impairment, due to both IUGR and fetal nephrotoxicity. However, despite the limited experience of long term studies in children, there is no evidence of any significant deleterious adverse effect of in utero exposure to CsA. However further studies based on large series are required in order to demonstrate that renal fetal effects have limited clinical consequences.

New insights into the postnatal growth of infants born 'idiopathic' small for gestational age.

Infants born small for gestational age (SGA) are defined as those with a birth weight and/or birth length below two standard deviations for gestational age. Postnatal catch-up growth is absent in 8-12% of children born SGA and these children achieve adult heights far below their target height. The objectives of our retrospective study were to confirm the prevalence of catch-up growth and to refine the kinetics of the catch-up process. The 'Lyon series' of patients consisted of 179 children with 'idiopathic' SGA, of whom 8% did not achieve catch-up growth (i.e. their height remained below -2 SD throughout the study). The number of days that the mother was hospitalized before delivery was found to be significantly correlated with lack of catch-up growth. Maternal hypertension, term delivery and postnatal parenteral nutrition were also associated with lack of catch-up growth, but the relationship was not significant. In addition, an oscillatory growth velocity pattern was observed in boys and girls born SGA, with alternating periods of growth acceleration and deceleration. This suggests that catch-up growth is regulated in a sophisticated way by the hypothetical 'Somatostat', although further confirmation of this process is needed.

Amniotic fluid embolism during caesarean section.

Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.

Infective-hemorrhagic complications of cesarean section. A case review of 2220 subjects.

The authors consider the hemorrhagic-infective complications associated with cesarean section. The review comprised 2200 subjects undergoing cesarean section from 1983 to 1987 in the Obstetrics and Gynecology Unit (Director: D. Dargent) of the University of Lyon (France). The incidence of cesarean sections was 14.9%, and endometritis was diagnosed in 17% of cases. The incidence of infective complications was 25% of cases and that of major hemorrhage 1%. The authors conclude that the potential complications must be carefully considered whenever contemplating delivery by cesarean section.

[The pregnancy occuring during oral contraception or intra uterine device (i.u.d.) (author's transl)]. / La grossesse sous contraception orale ou stérilet.

It seems possible to answer most of the questions asked by our patients after failure of the contraception. The pill stopped within the first five weeks of gestation has never been responsible of congenital malformations. When this treatment is prolonged during the pregnancy, a risk of masculinisation of female fetus exists. No severe malformations has been reported. The I.U.D. does not play a role in the frequency of tubal pregnancy. The I.U.D. must be removed when a pregnancy occurs to prevent the risk of sepsis.

[Pregnancy in women undergoing dialysis in chronic renal insufficiency. Apropos of 3 cases]. / Grossesse chez les femmes insuffisantes rénales chroniques dialysées. A propos de 3 observations.

There are few cases of chronic renal deficiency associated with pregnancy for the following reasons: lowered fertility, a high level of spontaneous early abortions and unwillingness of doctors to allow such pregnancies to continue. The authors report their personal experience of three cases with different outcomes: one, delivery nearly at term, one premature delivery without complications and one premature delivery with neonatal death. The authors, having studied the literature, point out that there are different problems, on the one hand because od kidney conditions requiring more frequent dialysis and on the other hand the obstetrical conditions and in particular high blood pressure with its risk of premature delivery, and finally of intrauterine growth retardation. Finally, the authors point out how important it is to have effective contraception and, if pregnancy does occur, how important it is for the nephrologist, the obstetrician and the paediatrician to cooperate in the care of the patients.

[Cesarean section before the end of 32 weeks of amenorrhea]. / Les césariennes avant 32 semaines révolues d'aménorrhée.

The authors report the results of 59 caesarean operations in which 74 children were born before the end of the 32nd week of amenorrhoea. The gross mortality was 21.9% and the corrected mortality 18.5%. 7.9% of the infants had major neurological sequellae and 8.6% mild sequellae. 65.2% are alive and well with normal psychomotor development. The follow-up has been between 1 and 5 years. The factors that influence survival and the indications for caesarean section at this time are reviewed and discussed.

[Hospital infection in the maternity department. 3 years of surveillance in 9,204 deliveries of which 1,333 were cesarean sections]. / Infection hospitalière en maternité. Trois années de surveillance portant sur 9 204 accouchements dont 1 333 césariennes.

Hospital or nosocomial infection, or infection acquired in hospitals, is a health problem in all hospital departments and particularly in the maternity department. We report on a prospective survey of surveillance of hospital-acquired infections both from the mother and the baby's point of view after delivery vaginally or with caesarean carried out at the obstetrical clinic of the Edouard Herriot Hospital in Lyon (France) over three successive years with a series of 9,204 deliveries. The incidence of infection in women who were delivered without caesarean section was 1.37% when urinary tract infections had been excluded but 13% in women who had caesarean sections. Endometritis, skin infections and urinary tract infections were the leading causes. As far as the newborn were concerned, hospital infection ran at about 2.60% and this in the main was due to staphylococcal pustules in the skin. These figures are still too high and prevention should be based on more information given and more care taken by the whole staff of such a hospital.