Prostaglandin F2alpha human blood during labor.

Plasma prostaglandin F2alpha (PGF2alpha) concentrations were determined by radioimmunoassay in serial samples during labor and the early postpartum period. PGF2alpha was also measured during and between contractions every 20 to 30 seconds. The highest levels of PGF2alpha were found during expulsion of the fetus and placenta with an additional rise half an hour after delivery and a decrease 2 hours after delivery to the levels of first stage of labor. PGF2alpha values from cord blood were higher than in maternal peripheral blood in labor. The maximum PGF2alpha concentration occurred between 100 to 120 seconds after the peak uterine contraction and between 40 and 60 seconds prior to peak of the next contraction. The possible explanation is that PGF2alpha initiates uterine contractions and plays a role in the maintenance of labor, in the expulsion of the fetus and the placenta, and in the involution after delivery.

External bladder--amniotic fluid shunt for fetal urinary tract obstruction.

Ultrasound diagnosis of bilateral hydronephrosis, hydroureters, and megacystis together with oligohydramnios secondary to urethral stenosis was made in a male fetus at 29 weeks' gestation. In utero decompression of the obstructed urinary tract and expansion of the amniotic fluid was achieved by placing an external bladder-amniotic fluid shunt using two catheters, one inserted into the fetal bladder and the other placed in the amniotic sac. The infant was delivered by cesarean section at 35 weeks' gestation and had a favorable outcome.

Principles and performance of an electron spin echo spectrometer using far infrared lasers as excitation sources.

We have built an electron spin echo spectrometer operating at 604 GHz, extending the frequency limit of existing spectrometers by more than a factor of 4. In order to handle this high frequency we have used optical techniques, i.e., molecular gas lasers for the excitation pulses and far infrared techniques for the heterodyne detection system. The different components of the spectrometer are described in detail and first experimental results are given.

Further developed device for human sperm freezing by the twenty-minute method.

A further developed, practical device for human sperm freezing is described by which the preparation of sperm and the freezing process are reduced to a simple procedure requiring about 20 minutes. The instrument is based on the principle of evaporation of liquid nitrogen, which acts as a refrigerant for the freezing plate under the control of a thermostat. Rapid-rate freezing can be performed for pellet production and slow-rat freezing for paillettes; a high degree of isolation of samples is maintained by easily interchangeable freezing plates. Typical stages of freezing are accomplished at temperatures of +5 degrees C and--80 degrees C, with storage at--196 degrees C. The recovery index is 50% to 70%. The treatment was applied to 56 patients, resulting in 19 normal deliveries, 3 abortions, and 9 current pregnancies.

A new, practical method of freezing and storing human sperm and a preliminary report on its use.

PIP: Various methods of freezing and storing human sperm are discussed, and a new sperm-freezing apparatus is described. The new apparatus is simple and economical to use, employs vapors of liquid nitrogen, and produces pellets from the sperm. The equipment may be used for both rapid and slow freezing. Its recovery index is between 60% and 70%. Of 16 women artificially inseminated with sperm frozen according to the new method, 7 became pregnant. The longest period of successful preservation of sperm was 8 months.^ieng

Effect of caffeine on increasing the motility of frozen human sperm.

A preliminary report on the effect of the addition of caffeine to 45 frozen sperm samples, in order to restore the effectiveness and motility of frozen stored human sperm, is presented. The addition of 7.2 mM caffeine proved optimal and resulted in 40% to 80% increased sperm motility after 30 days of frozen storage. The use of rapid-rate freezing to produce frozen sperm pellets and the addition of one frozen pellet of buffered caffeine (7.2 mM) to five sperm pellets before thawing are recommonded. For slow-rate freezing in paillettes, the addition of a caffeine solution (final concentration, 7.2 mM) to the sperm and protective medium is recommended. With these methods, frozen storage of hypomotile sperm, which previously could not be preserved by freezing, is now practical.

Correlation between estradiol and progesterone in cycles with luteal phase deficiency.

Many studies have been published on luteal phase deficiency, and the emphasis in most of them is on progesterone deficiency. In this study 144 patients (455 cycles) with infertility were studied. The patients were divided into four groups. Group 1 consisted of patients with high estradiol and high progesterone levels in the midluteal phase. Group 2 consisted of patients with high estradiol and low progesterone levels. Group 3 consisted of patients with low estradiol and low progesterone levels. Group 4 consisted of patients with low estradiol and high progesterone levels. As expected, patients in groups 2 and 3 showed a low conception rate with outphased endometrial biopsy. However, group 4, in spite of the normal progesterone levels, had a low conception rate with an outphased endometrium. We conclude that estradiol deficiency during the luteal phase is a major factor in infertility, and replacement therapy with progesterone alone in these patients may not improve fertility.

The influence of in vitro caffeine treatment on human sperm morphology and fertilizing capacity.

After publication in the literature that in vitro caffeine treatment causes damage of the normal shape of the sperm head and thereby decreases fertilizing capacity, we carried out a clinical and electron microscopic study to determine the influence of caffeine on the fertilizing capacity and sperm cell morphology. Sixty women (with infertile husbands) underwent artificial insemination by donor with frozen/thawed semen over a period of 12 months, using randomized addition of caffeine in alternate months. Fourteen women became pregnant during the 6 months they received caffeine-treated semen, whereas only 7 pregnancies occurred during the 6 months the women received semen without caffeine. Scanning electron microscopic examinations of fresh proven donor semen showed no morphologic changes caused by the in vitro caffeine treatment. However, quantitative morphologic analysis of the frozen/thawed semen was unsatisfactory because of the freezing technique and the masking effect of the protective medium. It is concluded that in vitro caffeine treatment of fertile donor semen does not damage the spermatozoa; furthermore, it seems to improve the fertilizing capacity.

The prostaglandin inhibitor effect of antiinflammatory drugs in the therapy of male infertility.

The effects of various doses of indomethacin and ketoprofen as compared with placebo were examined in 100 oligospermic patients who participated in this study. It was found that the treatment increased sperm count, sperm motility, and fertilizing capacity. The radioimmunoassay examination showed an increase in plasma follicle-stimulating hormone and luteinizing hormone but a decrease in testosterone. The results show that the influence of indomethacin was better in the dose of 75 mg daily. The mechanism of those changes is not clear. Treatment should be at least 60 days.

Hospital management contracts: institutional and community perspectives.

Previous studies have shown that external management by contract can improve the performance of managed hospitals. This article presents a conceptual framework which develops specific hypotheses concerning improved hospital operating efficiency, increased ability to meet hospital objectives, and increased ability to meet community objectives. Next, changes in the process and structure of management under contractual arrangements, based on observations from two not-for-profit hospital systems, are described. Finally, the effects of these management changes over time on hospital and community objectives are presented. These effects suggest progressive stages in the development of management contracts. The first stage focuses on stabilizing hospital financial performance. Stage two involves recruitment and retention efforts to secure necessary personnel. In the third stage, attention shifts to strategic planning and marketing.

Interorganizational factors affecting the delivery of primary care to older Americans.

OBJECTIVE: To discuss different types and forms of interorganizational linkages involved in the provision of primary care to older Americans, along with their distinguishing characteristics. RESEARCH STRATEGY: To take advantage of these linkage characteristics. The strategy requires a partnership with health services organizations and providers actually involved in the provision of services along with a planned sequence of activities involving hypotheses and methods development, intervention trials, and finally, demonstration and implementation. CONCLUSION: Because older Americans are frequent users of health services, their need for continuity and access provides an opportunity to examine changes to the delivery system and to monitor the system's capability for meeting their healthcare needs.

Measuring community hospital service in Michigan.

Using discharge abstracts from Michigan hospitals, we divided the state into hospital use communities with measured populations. We constructed population-based rates measuring use, cost, and some aspects of quality. The results cover 54 communities comprising 90 percent of the Michigan population and ranging in size from Detroit (population 600,000) to very small (population less than 25,000) communities. Age-adjusted patient days per 1,000 population, length of stay, cost per person per year, hospitalization rates for surgery, trauma and vascular disease, and childbirth problems show large variations, generally ranging from 2 to 1. High values usually are positively associated with each other and with population size. Patient days per 1,000 (mean 1,114, range 600-1,700) and cost per person(mean +223, range +110-+290) are distributed such that almost 75 percent of communities are below the mean. We believe this information will be useful to community hospital trustees, physicians, and administrators.

The merger of rural primary care and home health services.

The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.

Compulsive water drinking in pregnancy.

A case report of a pregnant woman with primary polydipsia is presented. The workup, including an investigation of the disturbance and the implications for fetal outcome, is described. The terms primary and secondary polydipsia are defined, and the differential diagnosis is discussed. Compulsive water drinking was finally diagnosed following psychiatric evaluation. A brief review of the literature concerning compulsive water drinking is presented.

The effect of indomethacin in labour at term.

The effect of indomethacin as an antagonist to prostaglandin was evaluated on a series of 16 women during spontaneous labour in the ninth month of pregnancy. The evaluation of the effect of indomethacin on the progression of labour was determined by the deviation from the normal curve of Friedman. In 8 cases there was complete cessation of labour from 3 to 192 hours and in 8 additional cases there was protraction of the active phase from 3 to 17 hours. In 2 cases there was no effect. Seven births terminated spontaneously and in 9 cases it was necessary to administer pitocin intravenously to strengthen or renew contractions in order to terminate the pregnancy. There is no correlation between the obstetric state (the degree of cervical dilation, or effacement or rupture of membranes) at the time of indomethacin administration and the uterine response, or the speed of return to the normal curve of Friedman. The effect of indomethacin, as an antagonist to prostaglandin, at the time of labour was studied.

Micrognathia-prenatal ultrasonographic diagnosis.

The first case of prenatal real-time ultrasonographic diagnosis of micrognathia is presented. Diagnosis was made at 17 weeks' gestation in the fetus of a patient with previous infant affected with the syndrome of thrombocytopenia with absent radii (TAR). Recognition of micrognathia as a part of TAR syndrome and the easy visualization of fetal facial bones in the second trimester made diagnosis possible.

Intracervical administration of prostaglandin E2-gel prior to therapeutic abortion: a prospective randomized double-blind study.

Forty primigravid women due to undergo first trimester termination of pregnancy were randomly selected for intracervical application of 1 mg prostaglandin E2 in gel or gel only as placebo. In the PGE2-gel group, a marked dilatation of the cervical canal was obtained, with post-gel treatment mean Hegar dilatation of 11.18 mm in that group, compared to 4.4 mm in the control group (P 0.001). Moreover, 16 (80%) patients in the PGE2-gel group had a complete abortion, one (5%) patient had an incomplete abortion and in the remaining three (15%) patients, fetal demise was observed. The mean induction-abortion interval in this group was 7.5 h. In the placebo group, none of the above effects were observed. The only side effect noted was vomiting, which occurred in five (25%) of the patients in the PGE2-gel group. Termination of pregnancy was found to be easier in the PGE2-gel group, compared to the placebo group.

PIP: In Israel, 40 primigravid women due to undergo 1st trimester termination of pregnancy were randomly selected for intracervical application of 1 mg prostaglandin E2 in gel or gel only as placebo. In the PGE2-gel group, a marked dilatation of the cervical canal was obtained, with post-gel treatment mean Hegar dilatation of 11.18 mm in that group, compared to 4.4 mm in the control group (P 0.001). Moreover, 16 (80%) patients in the PGE2-gel group had a complete abortion, 1 (5%) patient had an incomplete abortion, and in the remaining 3 (15%) patients, fetal demise was observed. The mean induction-abortion interval in this group was 7.5 h. In the placebo group, none of the above effects were observed. The only side effect noted was vomiting, which occurred in 5 (25%) of the patients in the PGE2-gel group. Termination of pregnancy was found to be easier in the PGE2-gel group, compared to the placebo group. Major complications such as tear of the cervix or perforation of the uterus were not recorded in the 2 groups. On examination of the patients 4 weeks later, none of them showed any signs of pelvic inflammatory disease, but 1 patient in the placebo group complained of irregular bleeding and needed recuretage. In the present study patients were hospitalized, but the proceedure can be adapted to an out-patient setting with application of the drug in the early morning and termination by afternoon.

Prenatal diagnosis of placental hemangioma--clinical implication: a case report.

Placental hemangioma is considered to be associated with a high rate of maternal and fetal complications. We report a case where ultrasonography revealed the placental tumor at 28 weeks gestation. The patient was kept under strict surveillance which permitted diagnosis of pre-eclampsia at 34 weeks gestation with successful termination of pregnancy at 37 weeks. The ultrasonic features of the tumor are described and the clinical implication discussed.

Serum ovarian steroids, prolactin and prostaglandin metabolites in women using the inert intrauterine device.

Serum levels of 17 beta estradiol, progesterone, prolactin and metabolites of prostaglandins E2 and F2a were investigated in 18 healthy women before and after the insertion of a Saf-T-Coil intrauterine device. The results suggest that the presence of an intrauterine device may cause hormonal changes affecting the luteal phase of the menstrual cycle.

PIP: Despite a long clinical history of use of the inert IUD as a contraceptive, the hormonal changes whch may accompany its use are not yet entirely clear. Serum levels of 17 beta estradiol, progesterone, prolactin and metabolites of prostaglandins E2 and F2a were investigated in 18 healthly women before and after the insertion of a Saf-T-Coil intrauterine device. The present data shows a 3-days shift to the right of estrogen dip and rise with clinical shortening of the luteal phase. Serum level of both steroids was found to be significantly lower in the luteal phase and at the time of menstruation. In the present study significant increase in the level of prolactin was found at the luteal phase. Besides ovarian steroids and prolactin, prostaglandins were also implicated in the contraceptive effect of the IUD. The results suggest that the presence of an IUD may cause hormonal changes affecting the luteal phase of the menstrual cycle.

A life-cycle model of organizational federations: the case of hospitals.

Hospital federations are a form of multiorganizational collaboration in which a management group coordinates and directs the activities of three or more organizations. This paper introduces a life-cycle model of federations that focuses on factors that influence the transition from one stage to another.