Acute renal failure of obstetric origin.

Acute renal failure of obstetric origin is common among North Indian patients and comprised 72 (22.1%) of 325 patients undergoing dialysis over an 11-year period. Of these, 46 gravidas had developed renal failure following abortion, and 29 cases were due to complications of late pregnancy. The most striking feature of this study was a high incidence of irreversible renal lesions of bilateral diffuse cortical necrosis in early (18.6%) as well as late pregnancy (37.8%). Overall incidence of diffuse cortical necrosis was 25%. In the remainder, acute tubular necrosis was seen in 52 (72.2%), patchy cortical necrosis in 1 (1.4%), and tubular necrosis along with glomerular involvement in 1 patient (1.4%). Pathogenetic factors which contributed to the development of renal failure, either singly or in combination, were loss of blood failure, either singly or in combination, were loss of blood (79.1%), septicemia (31.9%), hypotension due th hemorrhagic and septicemic shock (51.4%), eclamptic toxemia (11.1%), and disseminated intravascular coagulation in 12.5% patients. Infrequent occurrence of disseminated intravascular coagulation in the septic anc eclamptic patients who developed diffuse cortical necrosis was an interesting finding, as was the fact that coagulopathy was more frequently observed in acute tubular necrosis. Late referral, frequent sepsis, and high incidence of bilateral diffuse cortical necrosis contributed significantly to a high mortality (55.3%).

Short-term effects of norethisterone oenanthate and medroxyprogesterone acetate on glucose, insulin, growth hormone, and lipids.

The effects on carbohydrate and lipid metabolism in 24 healthy female subjects of the long-acting steroid contraceptives norethisterone oenanthate (200 mg) (11 subjects) and depo-medroxyprogesterone acetate (150 mg) (13 subjects) were studied. The subjects were between the ages of 18 and 25 years, with a history of normal menstrual periods. Pretreatment levels of plasma cholesterol, plasma triglycerides, phospholipids, blood glucose, insulin, and growth hormone were compared with those obtained 3 weeks and 12 weeks after the initial injections. There were no statistically significant differences from the pretreatment levels in any of the values obtained at 3 weeks and 12 weeks in either group.

Phase I and II clinical trials with Vicoa Indica (Banjauri), a herbal medicine, as an antifertility agent.

Safety and contraceptive efficacy of Vicoa Indica (Banjauri), a herbal contraceptive, has been evaluated in female subjects for the first time by using modern methods of a clinical trial. The drug, when administered in a dose of 15 gm once a day for 3 days for 3 cycles, was found to be free from side effects and possessed antifertility activity which is dose-related and can be improved upon by modifying the drug delivery system.

PIP: Vicoa Indica, a plant belonging to the family Compositae is used by Adivasies (tribal population) in Bihar state of India to produce sterility. The plant is locally known as Banjauri which literally means an agent which makes a woman sterile when administered for 3 consecutive days immediately after delivery. It is believed that this plant prevents conception for periods as long as 5-7 years. Sometimes it is also taken during menstrual cycles, the effect of which is variable. Banjauri had been subjected to antifertility studies in female albino rats and was found to be more effective when given postpartum than when administered during early pregnancy. The preclinical toxicity study carried out in 2 rodent species, albino rats and albino rabbits, did not show abnormal changes in the various biochemical, hematological and histopathological parameters, when the drug was administered at 7 times the human dose for 3-6 weeks duration. In this study, the safety and contraceptive efficacy of Vicoa Indica has been evaluated in female subjects for the 1st time by using modern methods of a clinical trial. The drug, when administered in a dose of 15 gm once a day for 3 days for 3 cycles, was found to be free from side effects and possessed antifertility activity which is dose-related and can be improved upon by modifying the drug delivery system.

Analysis of menstrual records of women immunized with anti-hCG vaccines inducing antibodies partially cross-reactive with hLH.

Menstrual data of 13 control subjects and 88 subjects immunized with three beta-hCG-based vaccine formulations were analysed. Immunization did not change the menstrual regularity; bleeding days were normal (3-7 days) and 89% of the menstrual cycles were within the normal range of 22-35 days. Irregular (short or long) cycles were observed in both immunized and control groups. These were, however, unrelated to prevailing anti-hCG antibody titres or to cross-reactivity of antibodies with hLH.

Phase I clinical trials with three formulations of anti-human chorionic gonadotropin vaccine.

Comparative phase I clinical trials were carried out in 5 centres with three formulations of beta-hCG-based vaccines inducing antibodies against human chorionic gonadotropin. The objectives of these trials were to determine their relative immunogenicity, duration, reversibility and safety. A total of 116 tubal ligated women volunteers were enrolled in the study and 101 subjects were followed-up for one year or more until the antibody titres declined to near zero levels. Every woman receiving the vaccine produced anti-hCG and anti-tetanus antibodies. Clinical examination carried out at intervals of 4-6 weeks revealed no abnormality. No serious side effects or adverse reactions were reported with any of the formulations during primary immunization with three monthly injections of the vaccine. Eleven women, however, demonstrated hypersensitivity to test dose at the time of the booster injection. The reaction was to tetanus toxoid; gonadotropin subunits conjugated to another carrier did not evoke any such reaction. Progesterone in bleeds taken at midluteal phase, as well as complete progesterone and estradiol done in two immunized women, indicated normal ovulatory cycles. Immunization with these formulations had no significant effect on haematological, clinical chemistry and other metabolic parameters. In summary, the results indicate that none of the three beta-hCG-based contraceptive vaccines had any adverse effects clinically, on endocrine status and metabolic parameters. Formulations A and B induced comparatively higher anti-hCG titres than M. Thus, further work can be undertaken to study the efficacy of these vaccines in humans for preventing pregnancy.

Analysis of the major surfactant-associated proteins in human lung.

The protein component of human pulmonary surfactant was analysed. A purified surfactant preparation, after delipidation, was subjected to gel filtration on Sephadex G-200. The proteins present in the surfactant were categorised by means of SDS-polyacrylamide gel electrophoresis into serum and non-serum components. Molecular masses determination showed the presence of three sub-groups with molecular masses of 60-68 kDa, 28-36 kDa and 10-18 kDa, respectively. Antiserum generated against 28-36 kDa protein strongly reacted with the purified surfactant and amniotic fluid, while it did not show any cross reactivity with other groups of proteins and serum in a double diffusion immunoprecipitation assay. We propose that this protein is the major non-serum surfactant-associated protein present in human lung surfactant.

Perinatal outcome in relation to maternal glycaemic control in diabetic mothers.

The relationship between glycaemic control and perinatal outcome was assessed in 60 pregnant diabetic women, divided into three groups on the basis of the mean plasma glucose level. Group I, had mean plasma glucose less than 120 mg/dl (32 patients); group II, mean plasma glucose 121-140 mg/dl (13 patients); and group III, mean plasma glucose exceeding 140 mg/dl (15 patients). The degree of maternal glycaemic control appeared to affect the perinatal outcome. Neonatal morbidity was minimum in group I (31.25%) followed by group II infants (46.15%) and maximum in group III infants (66.6%). Maintenance of maternal plasma glucose level at or below 120 mg/dl was thus associated with minimum neonatal morbidity.

Body water distribution in newborn infants appropriate for gestational age.

Total body water (TBW), extracellular water (ECW) and intracellular water (ICW) were measured within 6 h of birth in 99 appropriate for gestational age (AGA) infants. The two groups of infants included were term (mean +/- SD gestation 272 +/- 7 days) and preterm (mean +/- SD gestation 238 +/- 11 days) infants. The mean TBW +/- SD was 777 +/- 26 ml/kg in preterm infants and 737 +/- 26 ml/kg in term infants. The corresponding ECW was 349 +/- 26 ml/kg and 331 +/- 30 ml/kg respectively. Weight was the best correlate of TBW (r = 0.98) and ECW (r = 0.92) volumes. TBW per unit of body weight showed significant decline with increasing gestation (r = -0.54) and birth weight (r = -0.51). ICW per kg showed a moderate correlation with TBW (r = 0.63), whereas ECW per kg had a low correlation (r = 0.35) with it. TBW/kg in our infants was comparable to infants from other ethnic groups. ICW/kg, however, was consistently higher and ECW/kg lower at all stages of maturation in Indian infants as compared to Caucacian and Negroid infants.

Isolation and chemical composition of surface-active material from human lung lavage.

Surface-active material (SF) was isolated from human lung lavage fluid collected at autopsy employing differential and sucrose density gradient centrifugation. The isolated material showed well-defined electron microscopic structure, consisting of clearly preserved, closely packed vesicles with limiting membranes and inclusion bodies. It showed a very high degree of alkaline phosphatase specific activity and was devoid of other subcellular contaminants. The isolated material also showed a high phospholipid/protein ratio and increasing surface activity when monitored at different stages of purification. It contained 68.5% phosphatidylcholine, 11.5% phosphatidylglycerol and relatively smaller amounts of phosphatidylethanolamine and other individual phospholipid (PL) classes. In addition, cholesterol, unesterified fatty acids, triacylglycerols and other neutral lipids were found. Saturated fatty acids, particularly palmitic acid (16:0), predominated in the major PL fractions. However, various fatty acids of which oleic acid (18:1) constituted a large proportion also are present. Chemical analysis of the material showed that besides lipids and proteins, nucleic acids, sialic acid, hexose, amino sugars, nitrogen and phosphorus were present. The delipidated material showed the presence of three to four proteins as characterized by sodium dodecylsulfate (SDS)-polyacrylamide gel electrophoresis, and gel permeation chromatography on Sephadex G-200 resolved two well-separated peaks. The first fraction contained serum-associated 68 kDa protein, while the second fraction had two apoproteins with molecular weights of 34 kDa and 10 kDa. These two proteins were associated with the SF and they, as well as the whole surface-active material, strongly reacted with the antibody directed against the whole SF in a double-diffusion immunoprecipitation assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant mixed mesodermal tumor of ovary.

A case of primary malignant mixed mesodermal tumor (MMMT) of the ovary arising de novo in a post-menopausal multiparous female is reported. The tumor contained heterologous elements in the form of cartilage and fat in addition to carcinosarcomatous areas. Post-operatively, single-agent chemotherapy was administered and up to the time of reporting the patient has been alive and well. Because of the rarity of these tumors the proper treatment remains a dilemma. The differential diagnosis of MMMT of ovary and teratocarcinoma is considered, as the two are confused frequently.

Significance of serum iron levels as a biochemical marker in pregnancy-induced hypertension.

OBJECTIVE: To determine the changes in serum iron levels, if any, as a biochemical marker of pregnancy-induced hypertension (PIH). METHOD: Fifty-four primigravidas with PIH formed the study group and 20 normotensive primigravidas comprised the control group in a prospective study. Serum iron levels were estimated at diagnosis of PIH, at termination of pregnancy and in the postpartum period. Data was analyzed using Student's t-test, the chi 2-test and regression analysis. RESULTS: Subjects with PIH were found to have higher serum iron levels at diagnosis of PIH (recruitment value) and at termination of pregnancy than the controls (P < 0.001). Serum iron levels in the PIH subjects decreased markedly in the postpartum period simultaneously with the clinical recovery from PIH. Serum iron values of > or = 110 micrograms/dl was found to differentiate PIH from normotensive pregnancies with a sensitivity and specificity of 89% and 90%, respectively. CONCLUSIONS: Changes in serum iron levels correlated with the clinical course of PIH and appeared to be a uniform and specific biochemical marker of PIH although its correlation with the severity of PIH was found to be poor.

Childbirth following primary cesarean section--evaluation of a scoring system.

Of 1184 cases with previous cesarean section, 590 were selected for trial of vaginal delivery and 594 for repeat cesarean section. Of the former group, 76.6% had successful vaginal delivery. Incidence of uterine wound dehiscence and of perinatal mortality was highest in cases with primary classical cesarean section. Factors like indications for previous cesarean section, history of intercurrent vaginal delivery, weight of baby and period of gestation had positive correlation with delivery outcome.

Maternal determinants of birth weight of north Indian babies.

Birth weight charts of uncomplicated singleton pregnancies (n = 3293) were prepared from subjects who delivered between 30 and 42 weeks of gestation. Multiple regression analysis of the data revealed significant effect of maternal age, parity, height, weight and religion upon birth weight. Maternal blood pressure systolic > or = 160 mm of Hg and diastolic > or = 110 mm of Hg (severe PIH) were associated with significant lowering of birth weight. Male babies weighed more than female babies.

Interaction of pulmonary surfactant-associated protein (SP-A) with surfactant lipids.

A pulmonary surfactant-associated protein complex with components of 36, 32 and 28 kDa was isolated from human lung homogenates and reassembled with surfactant lipids prepared as small unilamellar liposomes. The role of divalent cations in the assembly of this recombinant lipoprotein complex was studied by monitoring the changes in turbidity, intrinsic tryptophanyl fluorescence and surface activity. The protein-facilitated lipid aggregation was promoted on addition of 5 to 20 mM Ca2+. Intrinsic fluorescence measurements on SP-A (28-36 kDa) indicated that the tryptophan side chains were in a relatively hydrophobic environment, that the wavelength of maximum fluorescence emission and also the relative fluorescence, were changed upon the binding of lipid. Tryptophanyl fluorescence of the lipoprotein assembly was quenched as indicated by a reduction in the effective Stern-Volmer constant. These results suggest that Ca2+ lipid-protein interactions are involved in the structure and function of extracellular lung surfactant assembly.

Placental transfer of fluoride in pregnant women consuming optimum fluoride in drinking water.

The study was conducted on 25 healthy women residing in optimum fluoride areas, who were to deliver normally through vaginal route, to correlate the maternal and cord plasma fluoride levels and evaluate the placental transfer of fluoride. A wide variation was found in the maternal and cord plasma fluoride levels. In only 8 percent of the cases the fluoride levels in cord plasma were higher than maternal plasma. It was deduced that the placenta allows passive diffusion of fluoride from mother to foetus and does not act as a barrier.

Combined vesical and abdominal endometriosis following abdominal hysterotomy and tubal ligation.

PIP: The article reports on the case of a 29 year old patient who developed abdominal endometriosis 4 years after having had hysterotomy and tubal ligation. About a month after the excision of the endometrial tissue she was examined for suprapubic pains, strangury, and frequency of micturition. A nodule was found in the deepest part of the abdominal wall and the patient was treated for 6 months, without success, with medroxyprogesterone acetate. A subsequent laparotomy showed bladder endometriosis, obviously still an endometrial implant at the time of hysterotomy, which was missed at the time of the first excision. Total hysterectomy was carried out and the patient recovered successfully. Bladder endometriosis is the most common site of involvement among urinary tract endometriosis. The peculiarity of the case presented here is in the total absence of hematuria, and in the fact that pains had no relation with the menstrual cycle. Hormonal therapy is often ineffective, and surgery often the only advisable form of treatment.^ieng