RESUMO
Major reshaping of electromagnetic MM-wave beams transmitted at resonant frequencies through high-quality multilayer structures is demonstrated. Beam reshaping emerges due to efficient excitation of intrinsic quasi-optical modes with complex spatial profiles by an incident beam. This leads to a significant increase of width and distortion of shape of transmitted beams, which grow with increasing likelihood of excitation of higher-order modes. The beam shape is extremely sensitive to imperfections of real structures and can become complex and asymmetric even at the normal-angle transmission of symmetric incident beams. The effect is of importance for the resonant MM-wave and THz spectroscopy of low-loss dielectric materials.
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Waitea circinata var. circinata was first reported as the causal agent of brown ring patch on annual bluegrass (Poa annua L.) in the United States in 2007 (2). In early April to mid-June of 2009, circular to irregularly shaped yellow rings resembling symptoms of this disease were observed on an annual bluegrass putting green at Rutgers University in North Brunswick, NJ. Severely infected foliage eventually turned brown as the disease progressed. During the same time period, similar disease symptoms were observed on creeping bentgrass (Agrostis stolonifera L.) from a golf course in Bedminster Township, NJ. The disease reappeared in both locations in April of 2010. Five additional samples with similar symptoms on creeping bentgrass and annual bluegrass were received at Rutgers Diagnostic Laboratory from Paramus, Madison, Allamuchy, and Farmingdale, NJ between late April and early May of 2010. Portions of diseased leaf and sheath tissue that displayed symptoms of the disease were disinfested for 1 min in 0.5% NaOCl, rinsed with sterile distilled water, and plated on potato dextrose agar (PDA) amended with 50 mg/liter of streptomycin sulfate. At the first sign of fungal growth, single hyphal tips were transferred to PDA. After 1 week at 25°C, white-to-orange mycelial colonies formed in culture and eventually turned brown with age. Minute sclerotia (≤3 mm), which followed the same color development pattern, formed within 10 days. These features are consistent with those described of W. circinata var. circinata (2,3). The internal transcribed spacer (ITS) region of the ribosomal RNA gene was amplified using primer pair ITS1/ITS4 and sequenced with ITS4 (GenBank Accession Nos. HQ166065 to HQ166071). BLASTn analysis of the ITS sequences showed a 99 to 100% similarity to W. circinata var. circinata sequences deposited in GenBank (1,2). Pathogenicity tests were conducted in 2010 using 6-week-old creeping bentgrass seedlings cv. Declaration inoculated with colonized oat grain that had been autoclaved and then infested with the Bedminster Township isolate. Eight colonized oat grains were uniformly spread around the crowns of seedlings grown in 10-cm-diameter pots. Control plants were treated with autoclaved grain. Plants were incubated at 25°C and high humidity maintained by misting the plants three times per day. Within 3 days postinoculation, foliage near infested grain turned chlorotic. All foliage in pots became completely blighted and spherical orange-brown sclerotia were observed on leaf sheaths by the eighth day. W. circinata var. circinata was consistently reisolated from inoculated plants (as confirmed by isolate morphology and ITS sequencing) but not from control plants. The ITS sequence data, morphological characters of the isolates, and pathogenicity tests demonstrate that W. circinata var. circinata is present in New Jersey. To our knowledge, this is the first report of W. circinata var. circinata infecting turfgrass in New Jersey. References: (1) C. M. Chen et al. Plant Dis. 93:906, 2009. (2) K. A. de la Cerda et al. Plant Dis. 91:791, 2007. (3) T. Toda et al. Plant Dis. 89:536, 2005.
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BACKGROUND: Single-use negative-pressure wound therapy (sNPWT) has been reported to reduce the incidence of reconstruction failure in prepectoral breast reconstruction compared with standard surgical dressings. The aim of this economic evaluation was to investigate the cost-effectiveness of sNPWT compared with standard care for the prevention of reconstruction failure in prepectoral breast reconstruction in the UK. METHOD: A decision tree model was used to estimate the expected cost and effectiveness per patient. Effectiveness was measured both by the number of reconstruction failures avoided and the gain in quality-adjusted life-years (QALYs). The baseline incidence of reconstruction failure (8.6 per cent) was taken from a recently published study of 2655 mastectomies in the UK. The effectiveness of sNPWT used results from a clinical study comparing sNPWT with standard dressings. Previously published utility weights were applied. The cost of reconstruction failure was estimated from detailed resource data from patients with reconstruction failure, applying National Health Service reference costs. One-way, probabilistic, scenario and threshold analyses were conducted. RESULTS: The undiscounted cost per patient associated with reconstruction failure was estimated to be £23 628 (£22 431 discounted). The use of sNPWT was associated with an expected cost saving of £1706 per patient, an expected increase in QALYs of 0.0187 and an expected 0.0834 reconstruction failures avoided. Cost-effectiveness acceptability analysis demonstrated that, at a threshold of £20 000 per QALY, 99.94 per cent of the simulations showed sNPWT to be more cost-effective than standard care. CONCLUSION: Among patients undergoing immediate prepectoral breast reconstruction, the use of sNPWT is more cost-effective than standard dressings.
Assuntos
Mamoplastia/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Padrão de Cuidado/estatística & dados numéricos , Infecção da Ferida Cirúrgica/prevenção & controle , Bandagens , Análise Custo-Benefício , Feminino , Humanos , Mamoplastia/economia , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/economia , Anos de Vida Ajustados por Qualidade de Vida , Padrão de Cuidado/economia , Medicina Estatal , Infecção da Ferida Cirúrgica/epidemiologia , Reino UnidoRESUMO
Initial guidelines for cystic fibrosis (CF) carrier screening were issued in 2001 by the American College of Medical Genetics and the American College of Obstetricians and Gynecologists and updated in 2004. It is unknown how these guidelines have influenced laboratory practice. This study examined the uptake of two components of these guidelines for CF screening in genetic testing laboratories. A survey of directors of US genetic testing laboratories was conducted. Of 190 respondents, 178 answered questions about CF testing. Nearly half (49%) performed some type of DNA testing for CF; most of these (92%) performed CF carrier screening. Ten percent used a 23-mutation panel for CF screening. The results of 5T tests were reported as a reflex test by 79% of laboratories, while 8% always returned 5T results and 7% never returned them. Seven percent of laboratories adopted both guidelines, 80% adopted one of the two guidelines, and 13% had not adopted either recommendation, suggesting that factors other than clinical guidelines may influence laboratories' CF screening practices. Further studies are needed to determine whether the adoption of CF screening guidelines has significant clinical or economic effects on population-based CF screening programs.
Assuntos
Fibrose Cística/diagnóstico , Triagem de Portadores Genéticos , Testes Genéticos/normas , Técnicas de Laboratório Clínico , Fibrose Cística/genética , Fibrose Cística/prevenção & controle , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Testes Genéticos/organização & administração , Humanos , Guias de Prática Clínica como Assunto , Diagnóstico Pré-NatalRESUMO
There are limited published data about the surgical management of self-inflicted facial gunshot wounds. The aim of this retrospective study was to review our management of subjects who initially survive such a wound and were admitted to a tertiary care trauma centre between 2002 and 2012. Only subjects with definitive evidence of a self-inflicted facial gunshot wound and who were admitted alive were included. Data collected included personal and clinical details, characteristics of the gunshot wound, and medical and surgical management. Types of operations and their duration were recorded, and primary reconstruction was divided into early (within the first 48hours after presentation) or delayed (longer than 48hours). Determinants of infection were assessed with univariate analysis. Seventy-six subjects (65 male and 11 female, mean (range) age 44 (18-83) years) were included in the study. Twenty-five patients needed an early surgical airway and five needed emergency intervention to control haemorrhage. Forty-five patients had primary reconstructions (28 early and 17 delayed) and 12 who were treated by delayed repair had a submental entry site to the wound. There were no significant differences in infection rates between those who had early, compared with those who had late, reconstructions. Early primary reconstruction can be successful for patients with self-inflicted facial gunshot wounds, particularly when the entry point of the bullet is in the upper and midface area. Delayed primary reconstruction was more common when the bullet entered the lower face.
Assuntos
Traumatismos Faciais/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Tentativa de Suicídio , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto JovemRESUMO
The adult mammalian central nervous system (CNS) exhibits a limited regenerative response to injury. It is well established that polysialylated neural cell adhesion molecule (PSA-NCAM) contributes to nervous system plasticity. In the visual system, PSA-NCAM participates in retinal ganglion cell (RGC) axon growth during development and specifically influences RGC innervation of its principle target tissue, the superior colliculus (SC). The goals of this study were to determine whether PSA-NCAM is expressed in the normal adult mouse SC and to evaluate PSA-NCAM expression following RGC injury. In the normal rostral, but not caudal, SC we find that PSA-NCAM is present in the retinorecipient layers; however, PSA-NCAM and RGC axons do not co-localize. In the deeper collicular layers, PSA-NCAM is observed as several distinct patches that occur at the same depth along the medial-lateral axis throughout the colliculus. RGC axotomy denervates predominantly the contralateral colliculus, where increased PSA-NCAM levels are seen at 7 and 10 days after the injury. Further evaluation of the retinorecipient layers of the partially denervated SC reveals that some intact CTB-traced RGC axons (less than 5%) labeled from the ipsilateral eye do co-localize with PSA-NCAM. This study is the first characterization of PSA-NCAM expression in the normal and partially denervated adult SC and may indicate that PSA-NCAM is involved in attempted visual system remodeling after injury.
Assuntos
Axônios/metabolismo , Molécula L1 de Adesão de Célula Nervosa/metabolismo , Traumatismos do Nervo Óptico/metabolismo , Células Ganglionares da Retina/patologia , Ácidos Siálicos/metabolismo , Colículos Superiores/metabolismo , Animais , Toxina da Cólera , Feminino , Lateralidade Funcional , Regulação da Expressão Gênica/fisiologia , Proteína Glial Fibrilar Ácida/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Traumatismos do Nervo Óptico/patologia , Fosfopiruvato Hidratase/metabolismo , Fatores de TempoRESUMO
Self-inflicted head and neck gunshot wounds are a common modality of suicide in the USA. This study reviewed all self-inflicted head and neck gunshot wound patients with complete records (n=157) treated at a tertiary centre between 2002 and 2012 inclusive. The associations between mortality and patient/clinical variables were evaluated with the χ(2) test or Fisher's exact test for statistical difference testing. Outcomes recorded were death (n=92, 59%), discharge to long-term care/rehabilitation (n=58, 37%), and discharge home (n=7, 4%). The majority of patients were male (86.6%) and single/separated/divorced (55.5%). The mortality rate by site, in descending order, was temporal 82%, frontal scalp 69%, submental/intraoral 30%, and neck 25%. Involvement of the central nervous system (n=127) resulted in a 70% mortality, but a lower mortality was observed among patients with an avulsion injury (P=0.025). A tracheostomy within 24h of admission was statistically associated with improved survival (P<0.001), but confounding factors were found. Multivariate analysis revealed increasing age, temporal entry site, and the severity of central nervous system involvement to be positively associated with an increased mortality.
Assuntos
Traumatismos Craniocerebrais/cirurgia , Lesões do Pescoço/cirurgia , Tentativa de Suicídio , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Acute pancreatitis has many causes, all leading to a common pathway of changes within the pancreatic acinar cell. Key amongst these changes is premature intracellular activation of digestive enzymes but this is also accompanied by the appearance of cytosolic vacuoles, co-localization of digestive and lysosomal enzymes, activation of NF-kappaB, and release of pro-inflammatory cytokines. The exact mechanism responsible for enzyme activation remains the subject of much research effort and not a little debate, however it is clear that all of these changes are triggered by an abnormal, sustained rise in cytosolic calcium concentration, which is itself dependent both on release of calcium from endoplasmic reticulum stores and uptake from the extracellular milieu. Activated enzymes are directly damaging to the acinar cell themselves, but recruitment of circulating neutrophils leads to further cellular damage. Cytokines and neutrophil activation are also responsible for the systemic inflammatory response typically seen in severe acute pancreatitis.
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Pâncreas/citologia , Pancreatite/patologia , Pancreatite/fisiopatologia , Doença Aguda , Apoptose , Cálcio/metabolismo , Colecistocinina/fisiologia , Citosol/química , Humanos , Necrose , Infiltração de Neutrófilos , Pâncreas/enzimologia , Fosfatidilinositol 3-Quinases/fisiologiaRESUMO
Standard reflectance meters were modified by the addition of memory chips capable of storing 440 glucose determinations with corresponding time and date. These modified reflectance meters (MR) were given to 20 individuals with type I diabetes in an effort to determine the level of reliability and accuracy they could achieve on a self-monitoring regimen. During a 6-wk period these subjects measured their capillary blood glucose and recorded the results in a logbook (LB). At 2-wk intervals they visited the clinic. Data from the MR was offloaded onto an Apple IIe microcomputer (Apple Computer, Inc., Cupertino, California) and presented to the subjects in a graphic format, depicting the level of metabolic control over the previous 2 wk. The performance of subjects for the 6-wk period showed that they averaged 7 omissions from the LB for every 100 MR recordings; 1 added value in the LB for every 200 MR recordings; and 1 error in accurately copying the test value for every 100 determinations. In comparison with subjects who participated in an earlier study in which they were unaware of the memory function of the reflectance meter, performance during the current study improved in all categories. It was also observed that consistency in reliable and accurate record keeping did not diminish throughout the study period. Despite these positive changes in performance, no alteration in glycemic control was found.
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Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Autocuidado , Adolescente , Adulto , Capilares , Feminino , Humanos , Masculino , Microcomputadores , Monitorização Fisiológica , Cooperação do PacienteRESUMO
The importance of radical-induced damage to DNA is apparent from the ever-increasing number of publications in this area. This review focuses on the damage caused to DNA by reactive oxygen-centred radicals, however formed. These may be hydroxyl radicals, which arise either from the radiolysis of water by ionizing radiation (gamma-rays or X-rays), or from a purely chemical source. Alternatively, metal-bound oxyl radicals (M-O.) are also active intermediates in DNA-cleaving reactions and may be formed from synthetic compounds or from natural products such as bleomycin (BLM). Chemical mechanisms leading to the observed degradation products are covered in detail. The biological effects of some of the DNA base lesions formed are touched upon, concentrating on the molecular mechanisms behind the initial events that lead to mutagenesis.
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Dano ao DNA , DNA/química , Espécies Reativas de Oxigênio/química , Animais , Sequência de Bases , DNA/efeitos dos fármacos , Radicais Livres , Humanos , Metais , Dados de Sequência Molecular , Mutagênese , Purinas/química , Pirimidinas/químicaRESUMO
The relationship between repetitive hemoglobin A1 values and daily blood glucose tests performed by 20 insulin-dependent diabetic outpatients was assessed over a six-week period using a modified reflectance meter capable of storing blood glucose determinations automatically. An average of four and a half determinations per subject per day was recorded with a range of average blood glucose values between 82 +/- 2 mg/dl and 316 +/- 5 mg/dl (mean +/- SE). The relationship between average blood glucose and hemoglobin A1 values was significant when hemoglobin A1 values at the end of the six-week period were correlated with the mean blood glucose level over that period (r = 0.55, p less than 0.02), but improved when a more remote hemoglobin A1 value obtained at 10 weeks was used (r = 0.64, p less than 0.005). Hemoglobin A1 values covering two-week intervals were extremely poor in reflecting average glycemia. The average fasting blood glucose level in these subjects was highly correlated with the overall daily blood glucose values (r = 0.89, p less than 0.0001), although the coefficients of variation of these parameters averaged 43 +/- 3 percent and 47 +/- 2 percent, respectively, and were greater than that of the hemoglobin A1 values over six weeks (10 +/- 2 percent). It is concluded that labile blood glucose control in patients with insulin-dependent diabetes is accurately reflected by the average fasting blood glucose level, although multiple determinations must be employed. Satisfactory assessment may be made by use of hemoglobin A1 value provided that the hemoglobin A1 determination follows a sufficiently long period of time, presumably related to the turnover of glycosylated hemoglobin.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Hemoglobinas Glicadas/análise , Computadores , Humanos , Fisiologia/instrumentação , Fatores de TempoRESUMO
Recent results from human clinical trials have established the critical role of HIV protease inhibitors in the treatment of acquired immune-deficiency syndrome (AIDS). However, the emergence of viral resistance, demanding treatment protocols, and adverse side effects have exposed the urgent need for a second generation of HIV protease inhibitors. The continued exploration of our hydroxylaminepentanamide (HAPA) transition-state isostere series of HIV protease inhibitors, which initially resulted in the identification of Crixivan (indinavir sulfate, MK-639, L-735,524), has now yielded MK-944a (L-756,423). This compound is potent, is selective, and competitively inhibits HIV-1 PR with a K(i) value of 0.049 nM. It stops the spread of the HIV(IIIb)-infected MT4 lymphoid cells at 25.0-50.0 nM, even in the presence of alpha(1) acid glycoprotein, human serum albumin, normal human serum, or fetal bovine serum. MK-944a has a longer half-life in several animal models (rats, dogs, and monkeys) than indinavir sulfate and is currently in advanced human clinical trials.
Assuntos
Antivirais/síntese química , Inibidores da Protease de HIV/síntese química , HIV-1/efeitos dos fármacos , Indanos/síntese química , Piperazinas/síntese química , Animais , Antivirais/química , Antivirais/farmacocinética , Antivirais/farmacologia , Bovinos , Técnicas de Cultura de Células , Cães , Avaliação Pré-Clínica de Medicamentos , Resistência Microbiana a Medicamentos , Inibidores da Protease de HIV/química , Inibidores da Protease de HIV/farmacocinética , Inibidores da Protease de HIV/farmacologia , Haplorrinos , Humanos , Indanos/química , Indanos/farmacocinética , Indanos/farmacologia , Masculino , Piperazinas/química , Piperazinas/farmacocinética , Piperazinas/farmacologia , Ligação Proteica , Ratos , Ratos Sprague-Dawley , Relação Estrutura-Atividade , Cálculos Urinários/induzido quimicamente , Cálculos Urinários/urinaRESUMO
Although caffeine is a commonly used CNS stimulant, neuronal mechanisms underlying its stimulatory effect are not fully understood. Orexin (hypocretin)-containing neurons play a critical role in arousal and might be activated by acute administration of caffeine. We examined this possibility by using dual-immunostaining for orexin B and c-Fos protein as a marker for neuronal activation. Rats were administered intraperitoneally with 10, 30 or 75 mg/kg caffeine, or saline. As previously reported, caffeine increased locomotion at 10 and 30 mg/kg, but not at 75 mg/kg. The numbers of orexin-immunoreactive and non-orexin-immunoreactive neurons expressing c-Fos were analysed using three counting boxes within the orexin field in the posterior hypothalamus. Compared with saline, all doses of caffeine increased the number of cells immunoreactive for both orexin and c-Fos. The average magnitude of this increase across doses in orexin neurons differed amongst regions; c-Fos expression increased by 343% in the perifornical area and by 158% in the more medial, dorsomedial nucleus. In the lateral hypothalamic area, c-Fos expression increased by 226% at 10 and 30 mg/kg but no change was seen at 75 mg/kg. In contrast, caffeine significantly increased the number of non-orexin-immunoreactive neurons expressing c-Fos only in the dorsomedial nucleus. These results indicate that systemically administered caffeine preferentially activates orexin neurons over non-orexin neurons in the same field, and that this activation is most pronounced in the perifornical region where orexin neurons are most concentrated. The activation of orexin neurons might play a role in the behavioural activation by caffeine.
Assuntos
Cafeína/farmacologia , Proteínas de Transporte/metabolismo , Estimulantes do Sistema Nervoso Central/farmacologia , Peptídeos e Proteínas de Sinalização Intracelular , Neurônios/efeitos dos fármacos , Neuropeptídeos/metabolismo , Proteínas Proto-Oncogênicas c-fos/metabolismo , Animais , Encéfalo/citologia , Contagem de Células , Relação Dose-Resposta a Droga , Expressão Gênica/efeitos dos fármacos , Imuno-Histoquímica , Masculino , Atividade Motora/efeitos dos fármacos , Neurônios/metabolismo , Orexinas , Ratos , Ratos WistarRESUMO
Methanol solutions of dipotassium tetramethyl osmate (DTMO) have been found to be useful as general stains in electron microscopic studies of plant and fungal ultrastructure. The stain solutions are easy to prepare, stable when anhydrous and convenient to use. Although generally similar in staining to lead citrate stains, some elements of cell ultrastructure appear different with dipotassium tetramethyl osmate staining, particularly the outer cell walls of fungi. Indications of specific precipitate-producing reactions in cell storage areas are observed.
Assuntos
Microscopia Eletrônica/métodos , Mixomicetos/ultraestrutura , Parede Celular/ultraestrutura , Citratos , Estudos de Avaliação como Assunto , Histocitoquímica , Osmio , Plantas/ultraestruturaRESUMO
Patients who require a bone marrow transplant (BMT) for leukaemia, lymphoma or other haematological disorders receive large quantities of blood products, including red cell concentrates, during the transplant period. Many receive red cell transfusions as part of treatment prior to BMT, adding to the potential iron load. However, organ dysfunction as a consequence of the transfused iron load would be surprising given the amounts of iron transfused. We studied 76 survivors of allogeneic and autologous BMT who were at least 1 year post-transplant and found that the majority (88%) had raised ferritins. Impaired liver function was common in these patients and in half was unexplained by viral hepatitis, veno-occlusive disease or graft-versus-host disease (GVHD), suggesting that iron overload may be an important contributing factor to liver disease in the stable post-transplant setting. This view is supported by the observation of improving liver function tests in 10 patients after a trial of venesection therapy.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Hemossiderose/etiologia , Hepatopatias/etiologia , Adolescente , Adulto , Hemossiderose/complicações , Hepatite C/etiologia , Humanos , Pessoa de Meia-Idade , Reação Transfusional , Transplante Autólogo , Transplante HomólogoRESUMO
The activity of calcium-independent, calcium-dependent and calcium + phospholipid-dependent (protein kinase C) kinases in cytosol fractions from rat brain glial cells in primary culture and from subcultured astrocytes and in oligodendrocyte-type 2 astrocyte lineage glia has been measured with histone Type IIIS as substrate. Accurate measurement of protein kinase C activity was achieved only after chromatography of glial cytosols on DE-52 anion exchange columns to remove an endogenous inhibitor, identified tentatively as a phosphatase possibly of the protein phosphatase 2A class. The specific activity of protein kinase C in glial cell cytosol increased from 7.5 +/- 0.8 to 37.9 +/- 0.9 nmol32P incorporated/mg protein/10 min with increasing culture age. Protein kinase C activity in glial cytosol was significantly higher when primary cultures were grown in a defined medium lacking serum. Astrocyte-conditioned medium and phorbol esters caused a rapid translocation of glial cell protein kinase C activity from cytosol to membrane compartments. Myelin basic protein and protamine have been compared with histone as substrates for measurement of calcium-independent, calcium-dependent and calcium + phospholipid-dependent kinase activities in glial cytosol.
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Cálcio/metabolismo , Neuroglia/metabolismo , Fosfotransferases/metabolismo , Proteína Quinase C/metabolismo , Animais , Células Cultivadas , Citosol/metabolismo , Proteína Quinase C/antagonistas & inibidores , RatosRESUMO
An iodoazide radical cascade cyclization strategy has been used as the key step in a formal synthesis of aspidospermidine. Specifically, this step generated the alkaloid's B- and E-rings in the ethylidene-functionalized tetracycle 5. In turn, this was converted into pentacycle 25, a known advanced synthetic precursor of aspidospermidine.
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Alcaloides/síntese química , Indóis , Quinolinas , Azidas , Ciclização , Indicadores e Reagentes , Alcaloides Indólicos , EstereoisomerismoRESUMO
[reaction: see text]. 1,4-pentadienyl-3-sulfonamides afford products including those resulting from disfavored 5-endo-trig reactions when subjected to radical cyclization conditions. Products resulting from pathways featuring 4-exo-trig cyclizations are also detected, even when the 4-exo-trig reaction leads to a highly strained bicyclo[3.2.0] ring system.
Assuntos
Sulfonamidas/síntese química , Alcadienos/química , Ciclização , Radicais LivresRESUMO
BACKGROUND: Certain situations dictate conservative management of grade 4 uterine or vaginal vault prolapse in women. The reduction of a prolapse may not be possible if the vagina cannot retain a single pessary. We have used double pessaries in the management of this condition. TECHNIQUE: With the patient in the dorsal lithotomy position, either a Donut or Inflatoball (Milex Products Inc., Chicago, IL) pessary is inserted and pushed into the vagina as far as is comfortable. A second pessary, either a flexible Gellhorn or Shaatz (Milex Products Inc.), then is placed caudad to the first. EXPERIENCE: We have used this approach in five women who have been followed for 7-15 months. There have been no erosions or vaginitis and all the women experienced symptomatic relief. CONCLUSION: In women who want or require conservative management of grade 4 prolapse and are unable to retain a single pessary, the placement of two pessaries often will be successful.
Assuntos
Pessários , Prolapso Uterino/prevenção & controle , Idoso , Feminino , Seguimentos , Humanos , Fatores de TempoRESUMO
OBJECTIVE: To determine if epidural analgesia improves the success rate of external cephalic version. METHODS: Women with singleton fetuses in breech or transverse presentation of at least 37 weeks' gestation were offered enrollment in a randomized trial. Inclusion criteria included maternal age of 18 years or older, nonvertex presentation confirmed by ultrasound, intact membranes, reactive fetal nonstress test, and estimated fetal weight (EFW) between 2000 and 4000 g. Women in the epidural group had lumbar epidural catheters inserted, through which 2% lidocaine and 100 microg of fentanyl were infused. External cephalic version attempts were done with ultrasound guidance in a standard fashion for both groups. The primary outcome variable was the successful version of the fetus to a cephalic presentation. RESULTS: There were no statistically significant differences between groups in gestation at time of procedure, placental location, fetal lie, gravity, parity, EFW, or amniotic fluid index. External cephalic version was successful in 32 of 54 women (59%) with epidural anesthesia compared with 18 of 54 (33%) with no anesthesia (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2, 2.8, P <.05). Vaginal delivery occurred in 29 of 54 women (54%) in the epidural group and 16 of 54 women (30%) in the control group (RR 1.9, 95% CI 1.2, 2.9, P <.05). CONCLUSION: Epidural analgesia increased the success rate of external cephalic version and the likelihood of subsequent vaginal delivery.