Interlocking design, programmable laser manufacturing and testing for architectured ceramics.

Tough and impact-resistant ceramic systems offer a wide range of remarkable opportunities beyond those offered by the conventional brittle ceramics. However, despite their promise, the availability of traditional manufacturing technique for fabricating such advanced ceramic structures in a highly controllable and scalable manner poses a significant manufacturing bottleneck. In this study, a precise and programmable laser manufacturing system was used to manufacture topologically interlocking ceramics. This manufacturing strategy offers feasible mechanisms for a precise material architecture and quantitative process control, particularly when scalability is considered. An optimized material removal method that approaches near-net shaping was employed to fabricate topologically interlocking ceramic systems (load-carrying assemblies of building blocks interacting by contact and friction) with different architectures (i.e., interlocking angles and building block sizes) subjected to low-velocity impact conditions. These impacts were evaluated using 3D digital image correlation. The optimal interlocked ceramics exhibited a higher deformation (up to 310%) than the other interlocked ones advantageous for flexible protections. Their performance was tuned by controlling the interlocking angle and block size, adjusting the frictional sliding, and minimizing damage to the building blocks. In addition, the developed subtractive manufacturing technique leads to the fabrication of tough, impact-resistant, damage-tolerant ceramic systems with excellent versatility and scalability.

Endocervical-type epithelium in endometrial carcinoma: a report of 10 cases with emphasis on histochemical methods for differential diagnosis.

A review of the histologic material from 100 patients with endometrial carcinoma revealed 10 cases in which endocervical-type epithelium constituted an integral component of endometrial adenocarcinoma. In nine of these, the endocervical epithelium was focal while in one patient, reported in detail, the curetted endometrial carcinoma presented as an almost pure endocervical-type lesion. In most instances, the endocervical epithelium was papillary and mature, but areas of tufting, pseudostratification and atypism were also evident. Endocervical-type epithelium in endometrial cancers was more common in curettings than in hysterectomy specimens probably because of its superficial location within the tumor. The endocervical nature of these components, which are most likely of metaplastic origin, was evident on light and electron microscopy. Histochemical stains established the similarities of the cytoplasmic mucins of these cells to that of normal endocervix and well-differentiated endocervical adenocarcinoma and emphasized the dissimilarities to the mucin content of papillary, secretory and clear-cell endometrial carcinoma. Thus, awareness of this type of lesion, application of strict histologic criteria and use of histochemical stains make it possible to reach the correct diagnosis in most cases, even in those in which the endocervical-type epithelium composes the major portion of curettings from an endometrial adenocarcinoma.

The efficacy of intraamniotic steroids for induction of labor.

Labor induction in humans by the injection of 18 mg of betamethasone (Celestone) into the amniotic sac was investigated in a group of 19 pregnant women. Eight of the cases were high-risk pregnancies of 36-39 weeks' gestation, and 11 were normal pregnancies of 40-42 weeks' gestation. A group of 19 women at similar stages of pregnancy served as a control group. The criterion for the efficacy of the technique was the onset of labor or rupture of the membranes within 72 hours of the injection. Contrary to other reports, it was concluded that the technique is ineffective since no significant difference was found between the experimental and control groups.

The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness.

OBJECTIVE: To evaluate the accuracy of Pipelle endometrial sampling with and without sonographic measurement of endometrial thickness. METHODS: We studied prospectively 176 consecutive patients (23% after and 77% before menopause) scheduled for D&C. Sonographic measurement of the endometrium and endometrial biopsy with the Pipelle were performed before the curettage. RESULTS: In 159 cases (90%), the endometrial histologic results of curettage agreed with those of the Pipelle biopsy. All three cases of endometrial cancer were identified by Pipelle aspiration. In seven cases (4%), the Pipelle aspiration failed to detect hyperplasia. Sonographic endometrial thickness of more than 5 mm slightly increased the sensitivity and slightly decreased the specificity of Pipelle aspiration from 82 to 92% and from 99 to 96%, respectively. In postmenopausal patients admitted for bleeding, the sensitivity and specificity reached 100%. CONCLUSIONS: Our data suggest that normal Pipelle aspirates in premenopausal patients with abnormal uterine bleeding are highly accurate. In postmenopausal patients with sonographic endometrial thickness of 5 mm or less, the accuracy reached 100%.

Management of labor with umbilical cord prolapse: a 5-year study.

Fifty-one cases of cord prolapse, in which delivery was not imminent and the fetus was still alive, were managed by filling the bladder with 500-700 mL of saline and by intravenous ritodrine. Delivery was by cesarean section as soon as possible. Among the cases so managed, there were no perinatal deaths. The mean 5-minute Apgar score was 9.5, and in only three cases was it less than 7. In eight cases, fetal distress continued after treatment, as compared with 33 cases before this type of treatment started (P less than .001); no difference was found in the outcome between neonates weighing less than or greater than 2500 g.

Nifedipine in the treatment of severe preeclampsia.

We conducted a randomized clinical trial in which patients with severe preeclampsia between 26-36 weeks of gestation received either nifedipine (10-30 mg sublingually, then 40-120 mg/day orally; N = 24) or hydralazine (6.25-12.5 mg intravenously, then 80-120 mg/day orally; N = 25). Effective control of blood pressure was achieved with nifedipine in 95.8% of subjects and with hydralazine in 68%, a statistically significant difference (P less than .05). Maternal side effects were minor in both groups. Acute fetal distress developed in one nifedipine subject and in 11 treated with hydralazine. Mean prolongation of gestation was 15.5 +/- 10 days with nifedipine and 9.5 +/- 11 days with hydralazine, a difference that did not reach statistical significance (P less than .07). Infants born to women treated with nifedipine were delivered at more advanced gestational ages (34.6 +/- 2.3 versus 33.6 +/- 2.4 weeks; statistically not significant), weighed more (1826 +/- 456 versus 1580 +/- 499 g; statistically not significant), and tended to have fewer, mainly minor, complications. The average number of days spent in the neonatal intensive care unit was significantly lower in the nifedipine group (15.1 versus 32.7 days; P less than .005), leading to an average 31% reduction in total (maternal and neonatal) hospitalization-related charges for each nifedipine-treated pregnancy. We conclude that nifedipine is an effective, convenient, and low-cost treatment for patients with severe preeclampsia, and is not associated with undesirable side effects.

Teratogenicity of progestogens given during the first trimester of pregnancy.

Possible teratogenic effects of exogenous progestational agents given during early pregnancy were investigated by a controlled historic prospective study of 2754 infants born to mothers who had bled during the first trimester of pregnancy. The study group consisted of 1608 newborns whose mothers had been treated with progestogens (mostly medroxyprogesterone acetate) beginning in the first trimester. The control group comprised 1146 infants of untreated mothers. All newborns were subjected to thorough examination during the first days of life, with special attention to detection of various malformations classified according to the different anatomic systems. No significant difference was found between the treated and the control groups with respect to malformations in any of the systems examined. The overall rate of malformations was 120 per 1000 in the study group and 123.9 per 1000 in the control group. Major malformations occurred at rates of 63.4 and 71.5 per 1000, respectively. The study thus fails to demonstrate an increase in teratogenicity after administration of gestagens during the first trimester of pregnancy.

Determination of striatal extracellular gamma-aminobutyric acid in non-hibernating and hibernating arctic ground squirrels using quantitative microdialysis.

This study determined extracellular concentrations of gamma-aminobutyric acid ([GABA](ecf)) in striatum of non-hibernating and hibernating arctic ground squirrels to test the hypothesis that an increase in [GABA](ecf) was associated with profound CNS depression during hibernation. Quantitative microdialysis procedures were employed to circumvent the effects of low temperature on the relative recovery of the analyte across the dialysis membrane and yielded for the first time quantitative in vivo estimates of [GABA](ecf) in any brain region or any species. Laboratory housed, wild caught Arctic ground squirrels (Spermophilus parryii) were implanted intraperitoneally with radio transmitters that enabled the telemetric monitoring of activity and core body temperature (T(b)) and bilaterally implanted with cranial guide tubes that enabled the implantation of microdialysis probes into the striatum. Striatal [GABA](ecf) was determined in unrestrained, non-hibernating ground squirrels (T(b) range 34.7-38.9 degrees C) and hibernating ground squirrels (T(b) range 2.9-3.9 degrees C) using extrapolation to zero flow and very slow flow microdialysis techniques. The results show that [GABA](ecf) in non-hibernating squirrels was 73 nM and this level was decreased by approximately 50% during hibernation thereby suggesting that an increase in [GABA](ecf) does not play a major role in CNS depression during hibernation. The reduction of [GABA](ecf) parallels a decrease in plasma and CSF [glucose] and may be related to a decrease in GABA synthesis or reduced voltage dependent release. This paper demonstrates that measurement of extracellular concentrations of neurotransmitters in animals with vastly different body temperatures is possible using microdialysis techniques of extrapolation to zero flow or very slow flow rates that enable 100% recovery. Such quantitative techniques may prove valuable in the study of the neurochemistry of the cerebral mechanisms of hibernation and tolerance to cerebral ischemia exhibited by hibernating animals.

Constant ovulation on the side of an occluded tube treated with human menopausal gonadotropin.

We have presented the case of a woman with unilateral occlusion of a tube ovulated permanently on the same side. The other ovary and tube were intact. To overcome this problem, we gave full menotropic treatment to induce super-ovulation, and the patient became pregnant in the second treatment cycle. We think medical treatment should be attempted before paradoxical oophorectomy is contemplated in women with unilateral occlusion who cannot become pregnant.

Adult respiratory distress syndrome complicating ovarian hyperstimulation syndrome.

A rare case of OHSS complicated by an ARDS from which the patient recovered after appropriate treatment is presented. Pulmonary capillary leakage induced by prostaglandin release, hypoalbuminemia, and shift of dextran 40 macromolecules to the intraalveolar space is considered the most probable reason for this complication.

Midtrimester induction of abortion: comparison of extraovular prostaglandin E2 and intra-amniotic prostaglandin F2 alpha.

The efficacy of extraovular prostaglandin E2 and intra-amniotic prostaglandin F2 alpha for pregnancy termination in midtrimester was compared. A retrospective review of pregnancy termination in midtrimester using intra-amniotic instillation of 40 mg of prostaglandin F2 alpha (n = 133) or extraovular instillation of prostaglandin E2 at a rate of 500 micrograms/hour (n = 81) was performed. Both groups had a similar mean induction-to-abortion interval (19.5 +/- 19.9 and 20.9 +/- 18.2 hours for extraovular PGE2 and intra-amniotic PGF2 alpha, respectively) and a similar success rate of abortion within the first 24 hours of initial treatment (84.0% for extraovular PGE2 and 76.7% for intra-amniotic PGF2 alpha). The two groups had a similar and low (9.8%) incidence of complications. It is concluded that either of the methods used in the study (i.e. extraovular PGE2 or intra-amniotic PGF2 alpha) can be used safely and effectively for pregnancy termination in midtrimester.

PIP: A comparison was made of midtrimester induction of abortion by extraocular prostaglandin E2 (PGE2) and intraamniotic prostaglandin F2alpha (Pgf2alpha) in a recent series of patients at Kaplan Hospital, Rehovot, Israel. Pgf2alpha 40 mg was instilled intraamniotically in 133 women from July 1988-December 1990. PGE2 was instilled at 500 mcg/hour in 81 women treated from January 1991-June 1992. The abortion interval was 20.9 hours for Pgf2alpha and 19.5 hours for PGE2. 76.7% of women given Pgf2alpha and 84% of those given PGE2 aborted within 24 hours. If abortion did not occur within 24 hours, oxytocin or a repeat dose of Pgf2alpha was administered. Complication rates were 3.7 and 2.5% for hemorrhage requiring transfusion, 3.0 and 3.7% fever for 2 days, 0.7 and 1.2% for PG side effects, and 2.2 and 1.2% for curettage, with - Pgf2alpha and PGE2, respectively. One woman given PGE2 extraamniotically fibroids. In contrast with comparative studies of these 2 methods published in the 1970s, where extraamniotic PGE2 often produced more infection and intraamniotic Pgf2alpha often caused gastrointestinal side effects, this study found comparable complication rates for the 2 methods.

The influence of midtrimester termination of pregnancy on subsequent fertility: four to five years follow-up.

A four to five years follow-up upon subsequent fertility was performed on 46 women who underwent a midtrimester termination of pregnancy. Thirty out of 31 (96.8%) women who wanted to conceive became pregnant. Of those, term delivery rate was 73.3%. Only one woman who desired to conceive could not become pregnant. Her infertility workup revealed bilateral occlusion of tubes. We conclude that termination of pregnancy in midtrimester possibly has little, if any, impact upon subsequent fertility.

PIP: In Israel, obstetrician-gynecologists examined the charts of 64 women who underwent midtrimester abortion at Kaplan Hospital in Rehovot between July 1988 and November 1989 to determine whether or not the abortion affected subsequent fertility 4-5 years after the operation. 14 of the women (21.9%) did not want to conceive. 96.8% of the women who wanted to conceive did so. 73.3% of these women delivered a full-term infant. One woman who wished to conceive could not because of bilateral occlusion of tubes. After her uterus had expelled the conceptus 4-5 years earlier, physicians performed curettage. She claimed to have had no history of pelvic inflammatory disease after the abortion. None of the women had subsequent cervical incompetence. These findings suggest that termination of midtrimester pregnancy had little or no effect on subsequent fertility. Further research is needed, however, with larger cohorts of women to confirm the association between midtrimester termination of pregnancy and subsequent fertility.

Transverse uterine incision for cesarean delivery of the transverse-lying fetus.

Low-isthmic transverse uterine incision was performed in 66 patients during Cesarean section indicated for transverse fetal lie. No significant differences were noted in the 1 and 5 min Apgar scores among fetuses delivered before or after rupture of the membranes. In only 5 (7.6%) of these cases was the incision converted into an inverted-T. The 1 min Apgar score was significantly lower in this group (6.0 +/- 1.3) compared to the rest of the group (7.5 +/- 1.7, P less than 0.01), however, the 5 min score showed no significant difference. No significant complications were noted in the post-operative course of mother and fetuses. We concluded that the transverse uterine incision is safe for the Cesarean delivery of the transverse-lying fetus.

Declining beta-human chorionic gonadotropin level may provide false security that tubal pregnancy will not rupture.

Two patients with declining serum concentrations of beta-human chorionic gonadotropin (beta-hCG) and a ruptured tubal pregnancy with hemoperitoneum are described. Declining beta-hCG does not rule out the possibility that the ectopic pregnancy will rupture.

Non-aggressive management of post-date pregnancies.

A non-aggressive approach to the management of post-date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less. Dates had been established with certainty in each case. In half of the patients (the study group) no time limit was imposed on the pregnancy, but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following: fetal movement count recorded daily by the mother, an oxytocin challenge test, and amnioscopy. The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score. In the 78 control patients labor was induced surgically on day 294, even if the pelvic score was low. In the study group, labor started spontaneously in 52 patients; labor was induced in 17 women after they showed an elevated pelvic score, in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed. There were 7 cesarean sections in the study group compared with 16 in the control group (P less than 0.05). The average duration of labor was 6.7 h in the study group, compared with 9.4 h in the control (P less than 0.01). There was no significant difference between the two groups with regard to meconium staining during labor, pathologic fetal heart rate, or the 5 min Apgar score. In the study group there was one neonatal death as a result of severe congenital heart disease, and in the control group one infant died due to asphyxia. It is concluded that conservative management of prolonged pregnancies, with close supervision, gives better results than routine induction of labor at 42 wk. The importance of the pelvic score as an indication for induction is stressed. A protocol has been developed which can be used in cases of uncertain dates as well.

Clinical aspects of ovarian tumors of low malignant potential.

A review of 21 cases of ovarian tumors of low-malignant potential diagnosed in our department over a period of 13 years was undertaken. Ninety percent of the patients presented with stage I disease. The average age at diagnosis (45 years) was younger than commonly found in patients with invasive epithelial cancer. Three patients received postoperative chemotherapy, and all of those were evaluated by second-look laparotomy. One of our patients with stage Ic serous tumor recurred with lung metastases. In two other patients with mucinous tumors, mucocele of the appendix was found. The five year survival in this series was 100%. Our study emphasizes the need for a prospective study to evaluate the value of adjuvant therapy in the various stages of these ovarian neoplasms.

Combined bladder augmentation and bladder neck suspension for neuropathic incontinence in girls.

We treated five girls with congenital neuropathic bladder, who had genuine stress incontinence combined with reduced detrusor compliance and/or detrusor hyperreflexia, by simultaneous Marshall-Marchetti-Krantz bladder-neck suspension and bladder augmentation using a sigmoid or ileocecal pouch. All are dry on 3 to 4 hourly intermittent self-catheterization and we suggest that this method represents a useful and much cheaper alternative to the artificial urinary sphincter.

Management of puerperal separation of the symphysis pubis.

Thirteen post-partum patients with symphysiolysis were treated by intra-symphysial injection of a combination of hydrocortisone, chymotrypsin and lidocain. The injection was given once a day and the full treatment consisted of between three to seven injections according to the severity of the symptoms. No other medication was given. Immediate relief was obtained in all cases after the first injection and all symptoms disappeared after the completion of treatment. The average time of hospitalization was 9.8 days. No complications were seen as a result of the treatment and the patients resumed their normal activities after being discharged from hospital. In comparison with other modes of treatment, the intra-symphysial injection of the above drug combination shortened the time of morbidity and effected complete recovery.

Tubal pregnancy with patent tube diagnosed by hysterosalpingography.

A demonstration of patent tube usually excludes the presence of tubal pregnancy. In the reported case tubal patency was demonstrated by hysterosalpingography in the presence of 6 weeks tubal pregnancy.

Bromocriptine treatment of hyperprolactinemic infertility with ovulatory disturbances.

We studied 77 women with hyperprolactinemic infertility and possible ovulatory disturbances. Galactorrhea was present in 27. Ovulation was normal in 15, 21 were anovulatory and 41 had luteal phase deficiency. All patients received bromocriptine for three months, resulting in normal serum prolactin levels. After that time, if no pregnancy occurred, clomiphene (with or without human chorionic gonadotropin) or human menopausal gonadotropin and human chorionic gonadotropin were added to the treatment. The overall pregnancy rate was 65%. The incidence of hyperprolactinemia in infertile patients is higher than expected, and patients with luteal phase deficiency can benefit from treatment with bromocriptine and ovulatory agents.