Maternal and neonatal elimination of amobarbital after treatment of the mother with barbiturates during late pregnancy.

Plasma half-lives of amobarbital were determined in newborn children of 10 mothers who had been treated with barbiturates for hypertension in pregnancy for 6 to 42 days prior to delivery. Five mothers had received amobarbital, 200 mg daily, and 5, phenobarbital, 60 to 180 mg daily. Half-lives in 7 of the babies ranged from 16.6 to 49.4 hr, comparable to those previously reported in babies of mothers who had received only a single dose of amobarbital. Thus there was no evidence of induction of amobarbital hydroxylation in these children. Two babies who had a greater than normal rise in serum bilirubin had longer half-lives (86.1 and 117.7 hr). In 1 baby whose mother had membranous glomerulonephritis, plasma amobarbital concentration did not significantly change over the period of the study.

Black-white differences in injury. Race or social class?

In the United States injuries are the leading cause of years of potential life lost and the leading cause of death for persons less than 45 years of age. Minority groups, particularly African-Americans, are disproportionately represented among those persons who die as a result of injury. Homicides account for much of this racial disparity; however, other forms of injury also contribute significantly to the differential. This paper examines death rates due to four types of injuries that contribute most to the black/white mortality gap. Our examination of death rates from 1984 to 1988 reveals no major reduction in the racial gap during the period, despite the initiation of some prevention efforts. We suggest that socioeconomic status rather than race is perhaps the major correlate of the social conditions and lifestyle choices which contribute to these injuries. We propose that injury prevention efforts must target both the causes and the consequences of socioeconomic inequality.

Inequality, culture, and interpersonal violence.

Policymakers often are at odds over what strategies will be most effective at reducing the incidence of violent behavior in high-risk populations. Beginning with the position that social theory and public policy are inextricably linked, the author examines the policy implications of the long-standing debate in the social sciences over the relative contributions of socioeconomic inequality versus cultural differences as causes of violence. While the weight of the scholarly evidence favors neither of these explanations, existing and proposed policies often reflect a preference for the importance of culture. This paper discusses the limitations of that choice and advocates alternative policies that consider the importance of both sets of etiological factors.

Some scanning electron microscopic features of human cervical epithelium in cell culture.

Human cervical epithelial cells, growing out in confluent monolayers from small explants, develop cytoplasmic extensions from the margins of the growth, extending out and terminating on the glass substrate. The marginal fibrils are particularly frequent on the edges of cellular lamellipodia, protruding in advance of the growing edges. Marginal cells with microvilli tend to have more marginal fibrils on their leading edges than smooth more differentiated cells, and occasionally there is continuity between microvilli and marginal fibrils. Where there is cellular overlap, marginal fibrils extending over the surface of another cell can be seen; where these is an intercellular cleft, cytoplasmic bridges have the same appearance as marginal fibrils. Colchicine (10-6 M) did not affect marginal fibril formation.

Assessment of teratogenicity.

Animal tests for teratogenicity of drugs have more medicolegal and political significance than relevance to human therapeutics. Test conditions differ widely from human therapeutic regimens and major species differences are common. Occasionally the tests will define a drug or group of drugs with an unpleasant potential, and sometimes a mode of action which needs careful exploration in humans will be found. Anecdotal case reports of purported associations between drug use and congenital malformations provide a vast source of misinformation, yet they were responsible for the indictment of thalidomide as a human teratogen. Retrospective studies on patients who have taken a drug in pregnancy are susceptible to recall bias, and at best provide a basis for planned prospective studies which are seldom instituted for fear of medicolegal consequences. Prospective surveillance of drugs already accepted for use in pregnancy and reporting of `adverse reactions' to drugs inadvertently used in pregnancy thus provide the only effective source of information on teratogenicity of psychotropic drugs in humans.

Antibacterial activity in human amniotic fluid: relationship to zinc and phosphate.

Antibacterial activity, tested with B. subtilis, was present in all 44 human amniotic fluids at between 36 and 42 weeks of pregnancy and was unrelated to gestational age within these limits, or to maternal age or parity. High-molecular-weight (beta-lysin) activity, present in all samples, was directly related to concentration of bound zinc, but not to that of free zinc. Low-molecular-weight antibacterial activity (less than 1000 Daltons) was only present in nine specimens, but sub-threshold concentrations were demonstrable by concentrating the ultrafiltrates in more than half of the remaining specimens. Low-molecular-weight activity in the ultrafiltrates was directly related to the concentration of bound zinc in the original amniotic fluid. Neither high- nor low-molecular-weight antibacterial activities were associated with amniotic fluid phosphate levels.

Antibacterial activity in human amniotic fluid: dependence on divalent cations.

Antibacterial activity, tested against Bacillus subtilis, was present in all 34 samples of human amniotic fluid collected between 37 and 41 weeks gestation. High-molecular-weight (beta-lysin) antibacterial activity was reduced after treatment with ethylene diamine tetra-acetic acid (EDTA), but not after treatment with 1, 10-phenanthroline or diphenylthiocarbazone. The activity was restored following incubation with magnesium, calcium, or zinc. Low-molecular-weight antibacterial activity (less than 1000 daltons) in acid-alcohol extracts was reduced after treatment with dithizone, but not after treatment with EDTA or 1, 10 phenanthroline. Activity was restored after treatment with manganese, cobalt or zinc. High-molecular-weight (beta-lysin) activity was therefore biochemically similar to serum beta-lysin but biochemically different from the low-molecular-weight antibacterial component of amniotic fluid.

A comparative study of three low dose progestogens, chlormadinone acetate, megestrol acetate and norethisterone, as oral contraceptives.

Three low dose progestogens, chlormadinone acetate (0-5 mg), megestrol acetate (0-5 mg) in oil, and norethisterone (0-35 mg), taken daily, were employed as oral contraceptives in postnatal women who desired to postpone their next pregnancy for up to a year. In a lower and middle social class population net pregnancy rates (life table) were five to six per 100 woman-years, of which about half were due to failure to take the tablets. Side effects other than menstrual disturbance were few. Norethisterone was the least likely of the three preparations to lead to discontinuation because of disturbance of menstruation. There were three ectopic gestations amongst 35 pregnancies in 4500 women-months of use. Ninety-five patients with varicose veins, 15 with a history of thrombophlebitis and 23 with a history of liver disease took progestogens without relevant untoward effects.

Intra-uterine granulation tissue with an intra-uterine contraceptive device in situ for 16 years.

PIP: This case report tells of intrauterine granulation tissue with an IUD in situ for 16 years. The 43-year-old patient had had 6 pregnancies, the last 16 years ago. After the last delivery she was fitted with a Lippes Loop IUD. She presented with a 2-week history of heavy intermenstrual bleeding, which had failed to respond to norethisterone. She had no other significant past medical history. General examination was normal. On pelvic examination the uterus was found to be bulky and anterverted, and the threads of the IUD were visible. She was admitted for dilatation and curettage, and the findings were confirmed. The IUD was removed, a uterine sound passed to 9 cm, and the cervix dilated to 9 mm. Normal looking curettings were obtained and sent for histological examination. The patient was fitted with a copper containing IUD. Histological examination of the curettings revealed an inflammatory infiltrate of plasma cells and lymphocytes superimposed on a proliferative endometrium. In addition to this, there were separate strips of simple granulation tissue composed of proliferative capillaries and venules in an edematous, necrotic background, containing lymphocytes, polymorphocellular cells and macrophages. There was no evidence of tuberculosis or actinomycosis on appropriate staining. Abnormal bleeding developing some time after insertion should always be investigated. In this patient no cause was found for the prolonged bleeding other than the granulation tissue. An intrauterine contraceptive devices are believed to work by causing inflammation and are associated with an increased incidence of pelvic inflammatory disease, it comes as a surprise that associated granulation tissue has not been reported previously.^ieng

Plasma factor IX levels in patients given hexoestrol or stilboestrol to suppress lactation.

A single injection of hexoestrol, 45 mg., is effective in suppressing lactation. Given in this way hexoestrol causes a small rise in plasma factor IX levels, of shorter duration than that produced by a customary and equally effective oral course of stilboestrol. With hexoestrol the plasma factor IX levels reverted to normal by the sixth day of the puerperium.

Scanning electron microscope study of Candida albicans invasion of cultured human cervical epithelial cells.

The invasion of monolayer cultures of epithelial cells from the human uterine cervix by clinical isolates of Candida albicans was observed. Blastospores settle on the epithelial cells and produce germ tubes within 2 h. Hyphae penetrate the epithelial cell walls and destroy the cells, weaving in and out of the cytoplasm. No phagocytosis of yeast cells by epithelial cells was seen.