Foetal heart rate in early pregnancy by detection of optimally estimated displacements with pulsed Doppler signals.

Foetal heart rate (FHR) in the early stage of pregnancy can be optimally estimated by a simple system combining a conventional pulsed Doppler device with a microcomputer (CPU). The input signals for FHR have been obtained as low frequency components of foetal Doppler signals. These components are less than 50 Hz and are directly transferred from the conventional pulsed Doppler device to a microcomputer as radio-frequency signals by a specially designed I/O unit. The low frequency components have been converted into displacement signals by the continuous calculation of an arc-tangent function combined with five channel recordings from the foetal cardiac area, each separated by 2 mm on the same echo line. After selecting the optimal displacement data line, the FHR is measured by the proposed algorithm of non-parametric frequency estimation and/or the conventional autocorrelation method. The algorithm draws attention to the improved frequency selectivity by multiplication with reference signals, whose frequency is automatically optimized by the standard FHR rate determined by the length of pregnancy. The FHR determined from the displacement signals by this algorithm has provided a more optimally controlled selectivity than with the presently used autocorrelation method, especially in those pregnancies of less than 8 weeks gestation. Clinical application of this system allowed a complete determination of foetal heart rate from 6 weeks of gestation by a transvaginal approach and from 7 weeks by transabdominal procedures. In some specific cases, with prominent foetal components, it was possible from 5 weeks 2 days by a vaginal, and 6 weeks by an abdominal procedure.

An adaptive correlation ratemeter: a new method for Doppler fetal heart rate measurements.

For use in a cardiotocograph, ultrasound Doppler fetal singles have been thought to provide merely a limited reliability of the fetal heart rate record because of the difficulty of signal processing to obtain a consistent trigger, although the signal itself is easy to obtain with an excellent signal-to-noise ratio. However, the authors have developed a unique signal processing system using a correlation technique with an automatic adaptation algorithm, which solved almost all of the difficulties associated with the old Doppler cardiotocograph and showed that the ultrasound Doppler fetal signal can also provide heart rate records compatible to that obtained by a fetal ECG system. The authors are sure that their method is a most promising one in the coming age of microprocessor-oriented instrumentation.

[Clinical application of 6059-S in the field of obstetrics and gynecology. Effects on gynecological infection and infection of trimester of pregnancy (author's transl)].

6059-S, a new oxacephem antibiotic was applied in the clinical use of gynecological and obstetrical infection. 1. In obstetrical field, attention should be paid on choice of antibiotics in the case of maternal infection. Especially in the trimester of pregnancy, such drugs as ampicillin (ABPC) has been reported apparent unfavourable effects by decreasing the estriol (E3) level. 2. The comparative study between 6059-S, SBPC and ABPC was performed by various hormone level, including E3 (blood and urine), blood progesterone, alpha-fetoprotein, human chorionic gonadotropin (HCG), cortisol and human placental lactogen (HPL). 9 cases of intrauterine fetal growth retardation (IUGR) (ranging from 28 approximately 36 weeks of pregnancy) was selected, including toxemia of pregnancy or complicated pregnancy of myoma of uterus and diabetes mellitus. The determination of hormone level, one drug (2g) out of three test drug was chosen at random and administered by intravenous infusion on 3 approximately 4 days after admission. After 5 days of interval, another test dose was given, and the evaluation between the drug effects was performed on the hormonal level. 3. Following the single administration of ABPC (2 g) by intravenous infusion, the decrease of urinary E3 reached 26% on the 2 days after injection. As for SBPC the decrease was 21%, while in cases 6059-S, no apparent change was determined. Statistical difference between 6059-S and ABPC 5% by chi 2 determination was found. On the other hormonal level, there was relatively great individual difference, and the apparent day by day change was undeterminable. 4. Clinical estimation of 6095-S on the gynecological infection was also performed on the 7 cases of patients. The overall efficacy rate was 85.7%. No adverse reaction was observed except one case elevation of S-GPT.

[Basic and clinical studies of aztreonam in the field of obstetrics and gynecology].

Aztreonam (AZT), a new monobactam antibiotic, was basically and clinically applied to the field of obstetrics and gynecology, obtaining the following results. The pelvic dead space exudate level of AZT after 30 minutes-intravenous drip infusion of 1 g attained the peak of 22.66 micrograms/ml at 1 hour from initiation of infusion and thereafter declined gradually, contrasting the peak of 34.38 micrograms/ml of the cubital vein at 30 minutes. Total of 13 cases comprising 4 with intrauterine infection, 5 with adnexitis and 4 with pelveoperitonitis were intravenously treated with AZT at a dose of 1 g twice daily. The overall clinical results were excellent in 3 cases and good in 10 cases. No side effects were observed in any of the cases treated with AZT.

[Fundamental and clinical studies on imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies on imipenem/cilastatin sodium (MK-0787/MK-0791) in the field of obstetrics and gynecology were carried out. The concentration of MK-0787 in uterine tissue was 5.9-12.2 micrograms/g at 30 minutes after an administration of 500 mg/500 mg of MK-0787/MK-0791 by a 30-minute intravenous drip infusion and 0.9-1.1 micrograms/g at 185 minutes. The clinical application of the drug to 9 patients with gynecological infections produced "good" results with all the patients clearly showing clinical or bacteriological improvement. Neither side effects nor abnormal laboratory findings were observed. Based on these findings, MK-0787/MK-0791 appeared to be a useful antibiotic for the treatment obstetrical and gynecological infections.

[Clinical studies on sulbactam/cefoperazone in the field of obstetrics and gynecology].

Sulbactam/cefoperazone (SBT/CPZ) was administered to 8 cases with gynecologic infections including pelvic peritonitis (2 cases), pyometra (2 cases), acute adnexitis, Bartholin abscess, endometritis and infected lymphocyst. The clinical efficacy was assessed as effective in 7 cases and poor in 1 case. The effective rate was 87.5%. No adverse reactions including clinical signs were observed. But slight elevation of GOT was observed in 1 case.

[Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology].

Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology were carried out. Transfer of T-1982 to various location in uterus tissue was more than 10 micrograms/g over 2 hours after T-1982 1 g intravenous injection. T-1982 was distributed in cervix uteri at the highest concentration followed by ovarium, oviduct, portio vaginalis, endometrium and myometrium. Mean transfer ratio of cervix uteri to uterus arterial blood was 67.6%. Ten cases of gynecological infections receiving T-1982 demonstrated "good" results in 9 cases, except 1 case excluded from the evaluation of efficacy. Neither side effect nor clinical test abnormality was observed. Based on the results of basic and clinical studies, T-1982 is considered to have efficacy in the treatment of gynecological infections.

[Clinical studies on cefuzonam in obstetric and gynecological infections].

Seventeen patients with gynecological infections (5 cases each of Bartholin's abscess and adnexitis, 4 cases of endometritis and 1 case each of bartholinitis, pyosalpinx and vulvar abscess) were treated with cefuzonam (CZON, L-105) administered by intravenous drip infusion, 1-2 g twice daily, for 4 to 12 days (6 g to 23 g in total). The clinical effectiveness reached 94.1%, including 1 excellent case, 15 cases good, and a poor case. Bacteria were detected in 9 cases, and with CZON treatment, bacterial eradications were obtained in 6 case, but, in 3 cases, bacterial replacements were observed. No abnormal laboratory findings were noted. From the above results, CZON seemed to be a highly effective and useful agent for gynecological infections.

[Laboratory and clinical studies on latamoxef in the field of obstetrics and gynecology].

Latamoxef (LMOX) is a new antibiotic synthesized by Shionogi Research Laboratory. Chemically LMOX is especially unique with a sulfur atom replacing the oxygen atom in the 1 position of the conventional cephalosporin nucleus, and in addition, this antibiotic has a cephamycin-like structure. The antibacterial activity of LMOX shows high potency against Gram-negative bacteria, but tends to be weak against Gram-positive bacteria. The tissue levels of LMOX in humans after intravenous injection of 1 g were examined. The levels in uterine and adnexa uteri tissue at 1 hour after administration were 25.4 and 27.4 micrograms/g respectively. LMOX was administered to 147 cases in infections of obstetric and gynecological field. The clinical effect according to disease was 94.6% for intrauterine infections, 95.0% for adnexitis, 87.0% intrapelvic infections, and 100% for external genital organ infections, making a total of 92.5%. The rate of occurrence of side effects or abnormal laboratory findings was similar to or slightly less than that seen with other beta-lactam antibiotics.

[Experimental and clinical studies of cefmenoxime in the field of obstetrics and gynecology].

The study group was organized to evaluate the usefulness of cefmenoxime (CMX) injection, a new synthetic cephalosporin, for the treatment of infections in the field of obstetrics and gynecology. Fundamental and clinical studies were made by the society and the following results were obtained. 1. The peak distribution of CMX's MIC for E. coli, Klebsiella sp., Enterobacter sp., Bacteroides sp. and Peptococcus sp. isolated from obstetrical and gynecological infections with relatively high frequencies area 0.1, less than or equal to 0.05, 0.2, 3.13, 1.56 micrograms/ml, respectively, with an inoculation of 10(6) cells/ml. 2. When 1 g of CMX is administered by intravenous drip infusion for 1 hour, the maximum concentrations in various tissues of female genital organs were as follows: 14.2 and 13.2 micrograms/g in ovary and oviduct, respectively, at 1.20 hours after the start of administration, and 16.9 and 26.3 micrograms/g in corpus uteri and cervix uteri, respectively, after 1 hour. As for the transfer to the exudate in the pelvic dead cavity, the peak concentration was 15.6 micrograms/ml after 2.13 hours. 3. In the clinical studies, CMX was given to 258 cases with female genital organ infections and others. As for the clinical effects, with exclusion of 3 cases in which other antibiotics are concomitantly used, responses were excellent in 76 cases, good in 162 cases and poor in 17 cases, among 255 cases in total. The efficacy rate was 93.3%. The efficacy rates by diseases were 97.1% (68/70) for intrauterine infections, 88.8% (79/89) for intrapelvic infections, 98.4% (62/63) for adnexitis, and 100% (23/23) for infections of external genital organs. As for the clinical effects on causative bacteria, the efficacy rates were 100% (19/19) for single infections due to Gram-positive bacteria, 94.8% (55/58) for single infections due to Gram-negative bacteria, and 88.2% (15/17) for single infections due to anaerobic bacteria. And its efficacy rates were 89.6% (69/77) for mixed infection cases. Side effects were observed in 2 cases (0.8%); 1 case with eruption, and 1 case with diarrhea and vomiting. As for abnormal laboratory findings, lower white blood cell count was observed in 2 cases and elevation of the values regarding hepatic functions in 9 cases. All cases were returned to the normal after the completion of the administration. Cefmenoxime showed a satisfactory clinical efficacy and a potent bacteriological effect in treatment of the infections in the field of obstetrics and gynecology, and it has been concluded that cefmenoxime will be useful addition to the antibiotics for the therapy of these infections.

The induction of labor with prostaglandin F2.

PIP: This is a summary of the authors' experience in using PG (prostaglandin) F2alpha for the induction of labor at or near term. 30 women made up the study group. Vaginal delivery occurred in all 30 patients. No fetal complications attributable to the PGF2alpha were observed. There were no adverse maternal cardiovascular or pulmonary effects. A concentration of .05-.15 mug/kg/min of PGF2alpha was sufficient to stimulate uterine activity in all cases. It generally took less than 20 minutes between introduction of the PGF2alpha and the onset of uterine activity, regardless of parity. It is recommended that PG infusion be slow initially, then increased steadily until an effective infusion rate is obtained. The pattern of uterine activity induced by the PGF2alpha was different from that induced by oxytocin. Whereas the PGF2alpha produced the characteristic irregular uncoordinated contractions at the beginning, developing later into regular coordinated contractions, the oxytocin produces uniformly regular contractions. This would suggest that the mechanisms of action of the 2 substances differ.^ieng

The induction of abortion by prostaglandin F 2 .

PIP: PGF2alpha was administered intravenously to 15 women for induction of therapeutic abortion, missed abortion, or prematurely ruptured membranes. 7 women in the 6th to the 14th weeks of pregnancy were infused with 41 to 55 mcg/minute of PGF2alpha. Uterine response appeared after 10-20 minutes, and contractions became regular after 120-200 minutes. Infusion time ranged from 6 hours 16 minutes-10 hours 36 minutes. In 3 cases there was complete expulsion of fetus and placenta. Diarrhea was seen in all patients; nausea and vomiting appeared in some cases. 8 patients in the 18-29th weeks of gestation were treated with intravenous infusion of 11-33 mcg/min. This small dose cause remarkable contractions, and abortion was successful in all 4 cases of missed abortion, 3 cases of premature rupture of membranes, and 1 case of therapeutic abortion. Blood loss was minimal and there were few side effects. This study shows that intravenous infusion of PGF2alpha for the induction of midtrimester abortion is a safe and more reliable method than hypertonic saline or glucose solution. Vacuum aspiration remains the preferred method for induced abortion in the 1st trimester of pregnancy.^ieng

Attributes of microorganisms that contribute to recurrence and intractability of vaginal mycosis.

Recurrence or intractability of vaginal mycosis may be ascribable to various factors. Attributes of microorganisms that contribute to recurrence and intractability of vaginal mycosis have not fully been elucidated. We studied this problem by means of a modern fungal identification method, strict measurement of the minimum inhibitory concentration and close clinical analysis. As for the detection rate for Candida albicans (C. alb.) and Torulopsis glabrata (T. glab.) as pathogens of vaginal mycosis, we found a relative increase was observed in T. glab. that so far has shown strong adaptability, even under unfavorable environments, to general fungi. The MIC values for clotrimazole (CTZ) against T. glab. were about 4 times as high as those against C. alb. No acquired resistance to CTZ was observed in these 2 groups. Conventional identification methods have been unable to provide conclusive evidence of the self-infection of vaginal mycosis from the anus to the vagina via the vulva. In some of the cases examined in this study, the modern fungal identification method succeeded in demonstrating that the fungal species detected in these three regions were of the same origin. Some of the C. alb. and T. glab. strains which reappeared after treatment were found to be different from those detected before treatment, a finding indicating that reinfection, apart from recurrence, occurred. Besides, treatment occasionally resulted in replacement of C. alb. with T. glab.

The anterior and the posterior longitudinal ligaments of the lower cervical spine.

The anterior and the posterior longitudinal ligaments (ALL and PLL) of the cervical spine were examined. The ALL and the deep layer of the PLL are continuous, and surround the vertebral body. The superficisl layer of the PLL surrounds the dura mater, nerve roots and the vertebral artery, suggesting that this membrane may serve as a protective membrane for the soft tissues inside the vertebral canal rather than as a conventional ligament.