Contraction stress test by intermittent nipple stimulation.

Although the nonstress test has generally supplanted the contraction stress test as the primary test for assessment of fetal well-being, the contraction stress test continues to be useful. Objectionable factors of the contraction stress test have included the time required to complete the test and the frequent necessity for intravenous oxytocin. The authors developed a contraction stress test protocol using contractions produced by intermittent nipple stimulation and used the method for 345 tests on 193 high-risk pregnancies during a 15-month period. The women were instructed to stimulate one breast, through their clothes, for two minutes and then to rest for five minutes. This cycle was repeated as necessary, but was interrupted whenever contractions began. Using this protocol, the authors were successful in achieving an adequate contraction frequency with every attempt, and hyperstimulation was not more frequent than previously reported with the standard contraction stress test. The average time requirement was 45 minutes. No unexplained stillbirths occurred after a negative test.

The unfavorable cervix in prolonged pregnancy.

One hundred ninety-seven women who had completed 42 weeks of gestation underwent weekly evaluation of the cervix according to the Bishop score until the spontaneous onset of labor. Confirming the clinical impression that the cervix is seldom favorable in prolonged pregnancy, the initial Bishop score was only 3.6, and in only 8.2% was the score 7 or more. The degree of dilatation at the last predelivery examination was significantly related to an infant's Apgar score at one and five minutes; effacement was significantly related to the Apgar score at one minute. The Bishop score at 42 weeks and more was not related to the patient's parity or to the infant's birth weight. Finally, dilatation and effacement of the cervix and station of the head were more predictive of the interval from examination until delivery than were other elements of the Bishop score.

Altered mechanisms of sympathetic activation during rhythmic forearm exercise in heart failure.

In congestive heart failure (CHF), the mechanisms of exercise-induced sympathoexcitation are poorly defined. We compared the responses of sympathetic nerve activity directed to muscle (MSNA) and to skin (SSNA, peroneal microneurography) during rhythmic handgrip (RHG) at 25% of maximal voluntary contraction and during posthandgrip circulatory arrest (PHG-CA) in CHF patients with those of an age-matched control group. During RHG, the CHF patients fatigued prematurely. At end exercise, the increase in MSNA was similar in both groups (CHF patients, n = 12; controls, n = 10). However, during PHG-CA, in the controls MSNA returned to baseline, whereas it remained elevated in CHF patients (P < 0.05). Similarly, at end exercise, the increase in SSNA was comparable in both groups (CHF patients, n = 11; controls, n = 12), whereas SSNA remained elevated during PHG-CA in CHF patients but not in the controls (P < 0.05). In a separate control group (n = 6), even high-intensity static handgrip was not accompanied by sustained elevation of SSNA during PHG-CA. 31P-nuclear magnetic resonance spectroscopy during RHG demonstrated significant muscle acidosis and accumulation of inorganic phosphate in CHF patients (n = 7) but not in controls (n = 9). We conclude that in CHF patients rhythmic forearm exercise leads to premature fatigue and accumulation of muscle metabolites. The prominent PHG-CA response of MSNA and SSNA in CHF patients suggests activation of the muscle metaboreflex. Because, in contrast to controls, in CHF patients both MSNA and SSNA appear to be under muscle metaboreflex control, the mechanisms and distribution of sympathetic outflow during exercise appear to be different from normal.

Influences of gender on sympathetic nerve responses to static exercise.

We compared reflex responses to static handgrip at 30% maximal voluntary contraction (MVC) in 26 untrained men (mean age 35 +/- 3 yr) and 23 untrained women (mean age 39 +/- 4 yr). Women demonstrated attenuated increases in blood pressure and muscle sympathetic nerve activity (MSNA; by microneurography) compared with men. This difference was also observed during a period of posthandgrip circulatory arrest. 31P-nuclear magnetic resonance (NMR) spectroscopy studies demonstrated attenuations in the production of diprotonated phosphate and the development of cellular acidosis in women compared with men. Subjects also performed ischemic handgrip to fatigue. During this paradigm, MSNA responses were similar in the two groups, suggesting that freely perfused conditions are necessary for the full expression of the gender effect. Finally, we examined MSNA responses to adductor pollicus exercise in 7 men (26 +/- 1 yr) and 6 women (25 +/- 2 yr). MVC values and times to fatigue were similar in the two groups (MVC: men, 4.3 +/- 0.4 kg; women, 4.0 +/- 0.3 kg; not significant. Time to fatigue: men, 209 +/- 16 s; women, 287 +/- 50 s; not significant). At periods of end exercise and postexercise circulatory arrest, MSNA responses were attenuated in the women compared with the men. We conclude that, during nonischemic static exercise, sympathetic neural outflow is less in women compared with men. This response is due to an attenuated metaboreflex in women. Finally, on the basis of the adductor pollicus experiments, this effect appears independent of muscle mass, workload, and the level of training.

Relationships between human cataracts and environmental radiant energy. Cataract formation, light scattering and fluorescence.

This preliminary report has two parts. The first is based upon data obtained from a group of cataract patients in southern Florida (USA) with the object of relating the types of cataracts removed to their personal background and their protein biochemistry. Intra-capsular cataract surgery patients at the Venice Eye Clinic (Florida) were interviewed, and their extracted lenses were classified. The parameters were: age, place of residency, occupation, medical and family history and indoor/outdoor activity. Subcapsular cataracts were found mainly in the youngest patients and in those who were in Florida the least. Mixed cataracts predominated in the oldest patients, while non-nuclear cataracts were associated most with outdoor activity. Water-insoluble protein was elevated in nuclei of lenses with nuclear opacities. Soluble proteins in the nuclei of nuclear cataracts had increased levels of voided (heavy) protein, beta-crystallins, and less than 20 Kd peptides. The above changes were enhanced in brunescent cataracts. In lenses with cortical opacities, only increased size heterogeneity in the beta-crystallin region was observed. The second part of this report is based upon direct measurements of the optical properties of freshly extracted intra-capsular cataracts obtained in Rochester, New York (USA). The purpose was to attempt to learn the relative contributions that absorption, scattering, and fluorescence make toward obscuring vision. A general conclusion is that the shorter wavelengths of radiant energy in environmental lighting influence the above-stated optical properties the most, and thus appear to be the major contributors to obscured vision.

Oxytocin challenge test for antepartum fetal assessment. Report of a clinical experience.

OCT's were performed 1,209 times on 533 fetuses at risk for UPI. OCT interpretation was negative for 72% of tests, and there were were no fetal deaths within a week following a negative test. Our data thus support the concept that the use of the OCT for fetal surveillance most frequently justifies a course of nonintervention. Of 69 fetuses with positive test, 47 were subjected to the stresses of labor with maternal hyperoxygenation and lateral poisoning. Twenty of these 47 (43%) tolerated labor without biophysical evidence of distress. Reactivity of the FHR, when present during a positive test, significantly increased the likelihood that a fetus would tolerate labor. The fetal and perinatal mortality rates in the patients identified as a risk for UPI and studied with OCT's were no greater than in a comparable group of pregnancies without identifiable risk for UPI and not studied with OCT's.