Early versus delayed oxytocin augmentation in nulliparous women with prolonged labour--a randomised controlled trial.

OBJECTIVE: To study the effects of early versus delayed oxytocin augmentation on the obstetrical and neonatal outcome in nulliparous women with spontaneous but prolonged labour. DESIGN: Randomised controlled study. SETTING: Two delivery units in Sweden. POPULATION: Healthy nulliparous women with normal pregnancies, spontaneous onset of active labour, a cervical dilatation of 4-9 cm and no progress in cervical dilatation for 2 hours and for an additional hour if amniotomy was performed due to slow progress. METHODS: Women (n = 630) were randomly allocated either to labour augmentation by oxytocin infusion (early oxytocin group) or to postponement of oxytocin augmentation for another 3 hours (expectant group). MAIN OUTCOME MEASURE: Mode of delivery (spontaneous vaginal or instrumental vaginal delivery or caesarean section) and time from randomisation to delivery. RESULTS: The caesarean section rate was 29 of 314 (9%) in the early oxytocin group and 34 of 316 (11%) in the expectant group (OR 0.8, 95% CI 0.5-1.4), and instrumental vaginal delivery 54 of 314 (17%) in the early oxytocin versus 38 of 316 (12%) in the expectant group (OR 1.5, 95% CI 0.97-2.4). Early initiation of oxytocin resulted in a mean decrease of 85 minutes in the randomisation to delivery interval. CONCLUSION: Early administration of oxytocin did not change the rate of caesarean section or instrumental vaginal delivery but shortened labour duration significantly in women with a 2-hour arrest in cervical dilatation. No other clear benefits or harms were seen between early and delayed administration of oxytocin.

The "critical colloid dose" in studies of reticuloendothelial function.

The [99mTc]sulfur colloid distribution in rat organs was investigated after the administration of different amounts of colloid particles. Saturation of the liver and spleen was not observed. Blood clearance was significantly reduced 15 min after injection above approximately 3 X 10(9) particles per kg body weight. With an increasing number of injected particles, lung uptake increased and bone marrow uptake decreased. Microfiltration studies showed that the colloid is unaffected by dilution with saline but may be affected after incubation in normal rat plasma. We conclude that the distribution of [99Tc]sulfur colloid in organs varies with the number of injected particles and therefore, is not dependent upon the blood flow to the reticuloendothelial organs alone. The "critical colloid dose" may differ among the reticuloendothelial organs and cannot, therefore, be evaluated by blood clearance measurements alone. The considerable influence of the number of injected colloid particles on bone marrow uptake should also be recognized when carrying out dosimetric calculations.

Dosimetry in lymphoscintigraphy of Tc-99m antimony sulfide colloid.

A quantitative kinetic technique using a scintillation camera has been developed for investigating lymph drainage and the uptake in the lymph nodes of 99mTcSb2S3 colloid injected subcutaneously. Twenty-two patients with primary malignant melanoma were examined. Lymph-node dissection was performed and 185 lymph nodes were individually measured for radioactivity. The kinetics of colloid uptake in individual nodes can be expressed by a simple two-compartment model. The outflow of colloid from the injection site was found to be monoexponential, and the tissue volume containing the injected colloid at the injection site increased asymptotically with time. A model has been developed for calculating absorbed doses at the injection site and in organs with colloid uptake. The following absorbed doses were estimated (muGy/MBq): whole body 0.7-4.5, gonads 0-22, liver 1.0-3.9, lymph nodes up to 1000 and injection site about 10,000. Possible biological effects in the skin and effective dose equivalents have been estimated when using other lymphoscintigraphic agents.

Radiolabeled colloids and macromolecules in the lymphatic system.

The scintigraphic technique to investigate the lymphatic system is based on a good knowledge of basic criteria in order to correctly interpret the findings. This article penetrates these criteria, updates the present knowledge, and covers basic science work and clinical applications. The anatomy, physiology, and pathology of the lymphatic system are covered. Basic criteria for the radiopharmaceuticals to be used are described as well as their quality control. The principles for lymphoscintigraphy are described. The dosimetry in lymphoscintigraphy as well as radiation risk is estimated for different procedures. Experimental animal studies are summarized. Clinical applications cover staging procedures for breast cancer, malignant melanoma, pelvic neoplasms, and lymphoma. Lymphadenoectomy follow-up studies are also included. The use of lymphoscintigraphy in radiotherapy dose planning is described as well as lymphatic function studies in, e.g., edema and lymph transplantations.

Particle sizing and biokinetics of interstitial lymphoscintigraphic agents.

The biokinetics of inert lymphoscintigraphic agents strongly depends on their particle size. Different techniques for characterization of colloids are discussed. Experiments have been performed on eight different colloids. The particle size has been investigated with scanning electron microscopy. Activity distributions have been obtained with ultrafiltration and gel-column scanning technique. The colloids suggested for lymphoscintigraphy were found to have a median size of about 40-50 nm except one minimicro-aggregated human serum albumin colloid which has a median particle size around 10 nm. The biokinetics were studied with a scintillation camera in rabbits after a subcutaneous injection. Time-activity curves were generated. After 5 hr the rabbits were dissected and the activity content in different tissues measured. A compartment model for the biokinetics was designed and rate constants evaluated. The total and specific activity uptake in parasternal lymph nodes was highest for the small-particle colloids. The compartment model showed a good fitting to the experimental data.

A comparative analysis of the structure of the dentinoenamel junction in mammals.

Studies of the gross morphology and microstructure of teeth have provided a great deal of information about the function and evolution of mammals. Among the structural features studied, the dentinoenamel junction has received relatively little attention. In the present work, we used ground sections to perform a comparative analysis of the structure of the dentinoenamel junction (DEJ) among diverse mammalian species. Among the species studied, only two (human and Miguelsoria parayirunhor) presented a scalloped DEJ. In the other 14 species analyzed, the DEJ surface was formed by tiny spikes and depressions, corresponding to the impression of enamel prisms. Our results show that the topography of the DEJ in the analyzed taxa apparently does not relate to dietary, functional or structural features.

Mode of delivery modulates physiological and behavioral responses to neonatal pain.

OBJECTIVE: To study whether the mode of delivery alters pain expression. STUDY DESIGN: Full-term infants born by vaginal delivery or elective caesarean section were observed following high- and low-intensity pain stimuli, with recording of electrocardiogram, facial expression and vocalization. RESULT: Graded physiological and behavioral responses occurred, with greater responses to higher than lower intensity pain stimuli. Elevation in heart rate following both stimuli increased with time after vaginal delivery. Infants delivered by elective caesarean section showed stronger facial expressions and briefer time in vocalizations response to both interventions. CONCLUSION: Diminished responses following vaginal delivery suggest that physiological events associated with a normal delivery reduce the physiologic and sympathoadrenal activation by nociceptive mechanisms. Pain and stress reactivity appear to be inhibited during fetal life and sensory inputs during vaginal delivery may reverse this inhibition. To minimize neonatal pain, we recommend that postnatal invasive procedures to be performed shortly after vaginal birth.

Kondo decoherence: finding the right spin model for iron impurities in gold and silver.

We exploit the decoherence of electrons due to magnetic impurities, studied via weak localization, to resolve a long-standing question concerning the classic Kondo systems of Fe impurities in the noble metals gold and silver: which Kondo-type model yields a realistic description of the relevant multiple bands, spin, and orbital degrees of freedom? Previous studies suggest a fully screened spin S Kondo model, but the value of S remained ambiguous. We perform density functional theory calculations that suggest S=3/2. We also compare previous and new measurements of both the resistivity and decoherence rate in quasi-one-dimensional wires to numerical renormalization group predictions for S=1/2, 1, and 3/2, finding excellent agreement for S=3/2.

Controlling the magnetization direction in molecules via their oxidation state.

By means of ab initio calculations we predict that it is possible to manipulate the magnetization direction in organic magnetic molecules by changing their oxidation state. We demonstrate this novel effect on the Eu2(C8H8)3 molecule, in which the hybridization of the outer pi ring states with the Eu 4f states causes a redistribution of the orbitals around the Fermi level leading to a strong ferromagnetism due to a hole-mediated exchange mechanism. As a key result, we predict an oscillatory behavior of the easy axis of the magnetization as a function of the oxidation state of the molecule-a new effect, which could lead to new technological applications.

Morphine analgesia and gastrointestinal morbidity in preterm infants: secondary results from the NEOPAIN trial.

OBJECTIVE: To investigate the influence of morphine therapy and other factors on the attainment of full enteral feeds and on acquired gastrointestinal pathology in preterm infants. DESIGN: Secondary data analysis from a randomised, placebo controlled trial. SETTING: 16 neonatal intensive care units in USA, Sweden, France and UK. PATIENTS: 898 infants (treatment group 449, control 449). Gestation (median (range)): 27 (23-32) weeks; birth weight (median (range)): 985 (420-2440) g. INTERVENTIONS: Morphine (M) or placebo (Pl) given pre-emptively by intravenous loading dose (100 microg/kg of morphine) and infusion (10-30 microg/kg/h depending on gestation) while infants were ventilated, for up to 14 days. "Open-label" morphine (A) could be given if clinically indicated. MAIN OUTCOME MEASURES: Age at full enteral feeds and major acquired gastrointestinal pathology. RESULTS: The group randomised to morphine was later in attaining full feeds (median days (quartiles): M 20 (13-29), Pl 17 (12-26); p = 0.003), and in starting feeds (median days (quartiles): M 5 (3-8), Pl 4 (2-7)). In a linear regression model, age at full feeds was independently associated with birth weight, a score of neonatal morbidities, neonatal dexamethasone use and cumulative morphine dose. There was no relationship between morphine use and acquired gastrointestinal pathology (M 9/449, Pl 8/449; chi2 p = 0.81). CONCLUSIONS: Morphine delays the attainment of full enteral feeds, partly by delaying the start of feeding, but does not discernibly increase gastrointestinal complications. The attainment of full feeds is influenced by morphine dose, but other factors seem to be important, including birth weight and neonatal morbidity.

Vanishing magnetic interactions in ferromagnetic thin films.

We have used element-specific hysteresis measurements, based on the x-ray magnetic circular dichroism technique, to investigate magnetic trilayer structures composed of Fe and Ni layers. Within a critical regime we have discovered a class of structures in which the exchange interaction, the mechanism responsible for the macroscopic magnetism, can become vanishingly small. The experimental observations are supported by first principles theory and are explained as arising from a cancellation of several competing magnetic interactions. Hence, we have discovered a system with a novel exchange interaction between magnetic layers in direct contact that replaces the conventional exchange interaction in ferromagnets.

[Children's health. 40. Unacceptable that 14 million children die every year]. / Børns sundhed. 40. Uacceptabelt at 14 millioner børn dør hvert år.

PIP: The 40th annual report of the UN Children's Emergency Fund (UNICEF) states that about 7 million of the 14 million children who die throughout the world each year could be saved by modern methods of health care and food supply. UNICEF's executive director James Grant points out that 40 years ago little international attention was given to mass death from starvation, but today any such crisis attracts the mass media, and people and governments act to avoid mass death. Undernourishment and epidemics continue to threaten the world's children and more than 280,000 children die from these causes each week. Even with the crises of the past two years in Africa there have been more deaths among children in India and Pakistan than in all of Africa's 46 countries together. Existing knowledge on cheap methods of improving the health of children in underdeveloped countries is sufficient to save at least 7 million children's lives each year. Many millions more could have a normal growth with better information on replacements on mother's milk, vaccinations and access to supplies of water, sugar, and salt for oral rehydration therapy. Just as important are the new technologies of the communications revolution which is taking place in underdeveloped countries. Most homes have a radio, and televisions are available in most villages and in many small communities there are schools and health workers.^ieng

[The fight about people's genes]. / Kampen om menneskets gener.

PIP: This paper reports presentations at a Nov. 1989 congress on human genetics held in Copenhagen under the auspices of the Technology Committee of the lower house of the Danish Parliament. Although the conference submitted a report to Parliament supporting the establishment of screening and advisory services for families stricken with genetic diseases, the conference did not recommend broad scale screening of the population for genetic defects. Conference members expressed a concern that less and less serious genetic defects would be the subject of testing and that the new genetic screening technology would increase the level of anxiety among prospective parents. The group also recommended legislative action to prevent genetic screening from a basis for evaluating persons for employment, pensions or insurance. The conference pointed out that Danish hospitals were planning to test 10,000 Danish women a year for cystic fibrosis genes although 90 cases of cystic fibrosis had occurred in Denmark in the past 40 years. The conference also heard reports on genetic screening in early pregnancy in the Netherlands and on plans for coordinating genetic research in the European Community. Other reports presented to the conference dealt with the interaction of genetic and environmental effects and with the possibilities of developing genetic weapons which could threaten members of a particular race or ethnic group.^ieng

Double-balloon catheter for isolated liver perfusion: an experimental study.

PURPOSE: Further development of a previously described interventional method for isolated liver perfusion (ILP) with a new double-lumen balloon catheter, and evaluation of the side-effects of such isolation. METHODS: In six pigs a double-balloon occlusion catheter was placed via the transjugular approach with its tip in the portal vein. One of the balloons was positioned in the inferior vena cava (IVC), cranial to the origin of the hepatic veins and the other balloon in the portal vein. By the transfemoral approach, a single-balloon occlusion catheter was placed in the IVC caudal to the origin of the hepatic veins. A third catheter was placed by the transfemoral route with the occlusion balloon in the proper hepatic artery. After inflation of all balloons 99Tc(m)-labelled human serum albumin was recirculated through the liver. The isolation was evaluated by repeated measurement of radioactivity levels in peripheral blood. Laboratory tests of liver and pancreas function, and hemoglobin, were taken before, at the end of, and 3 days after the procedure. Blood gases were tested at the beginning and end of the procedure. RESULTS: One pig died during the procedure due to technical failure and was excluded from the study. In the other pigs leakage from the isolated liver to the systemic circulation increased slowly, up to 9.7% (mean) during 30 min of recirculation of the perfusate through the liver. Laboratory tests were normal in all pigs except insignificant acidosis directly after the procedure and the slight elevation of s-ALAT after 3 days. CONCLUSIONS: Only minor leakage from the liver to the systemic circulation was noted during ILP performed with a new, double-balloon catheter. There were no serious side effects.

Autocorrelation spectroscopy for particle sizing and stability tests of radiolabelled colloids.

In many nuclear medicine applications a well defined particle size and stability of administered colloids is of great importance. A fast and reliable sizing technique for routine quality control is therefore essential. This paper evaluates autocorrelation spectroscopy with an instrument capable of analysing several peaks simultaneously. A total of nine 99mTc-labelled colloids and one 99Y-labelled colloid were studied. The autocorrelation spectroscopy measurements were compared with the standard sizing technique of microfiltration. A good agreement between the sizing techniques was found for most of the colloids. The reproducibility of successive measurements was within +/- 12% and +/- 40% when using unimodal analysis and SDP analysis, respectively. Autocorrelation spectroscopy was found to be well suited for particle sizing and stability tests of radiolabelled colloids.

Hepatic reticuloendothelial function in rats with various portasystemic shunts and total liver arterialization.

Hepatic reticuloendothelial function was measured in 6 experimental groups of rats with various portasystemic shunts or total liver arterialization by computer calculation of the hepatic uptake rate of intravenously injected 99mTc-sulphur colloid. Marked reduction of the hepatic reticuloendothelial system (RES) function was found both 1 and 3 weeks after the construction of a mesentericocaval or conventional end-to-side portacaval shunt. Hepatic RES function was also lowered both 1 and 3 weeks after a modified portacaval shunt, but the reduction was much less pronounced. Total liver arterialization produced a similar mild reduction of hepatic RES function after 1 week; however, there was no longer any significant reduction after 3 weeks. This study concludes that total liver arterialization ameliorates the negative effect that portasystemic shunting has on hepatic RES function.

Lack of correlation between fecal blood loss and drug-induced gastric mucosal lesions.

Increased fecal blood loss was produced in healthy volunteers by the administration of two nonsteroidal anti-inflammatory drugs (NSAID), naproxen or fenflumizole. Basal as well as drug-induced gastrointestinal blood loss was measured using 51Cr erythrocyte labeling. Median rise in daily fecal blood loss was 432%. All subjects were endoscoped at the initiation and at the completion of the study. Endoscopic findings were assessed quantitatively by two observers in two different ways. All subjects but three had gastric mucosal lesions at follow-up endoscopy. There was a good correlation between the endoscopic assessments but no statistical correlation between the endoscopic assessment and the increase in fecal blood loss. The data suggest that factors other than gastric mucosal lesions have to be taken into account when investigating NSAID-induced gastrointestinal bleeding.

Reticuloendothelial function in normal and tumor-bearing rats. Measurements with a scintillation camera technique.

The function of the reticuloendothelial system (RES) was evaluated after the inoculation of an experimental tumor in rats. Four groups were studied according to tumor size and site. Reticuloendothelial function was evaluated by measuring the biokinetics of a standardized [99Tcm]-sulfur colloid. Estimation of the uptake rate of the labeled colloid into the liver and other parts of the RES was performed through the use of a two-compartment model. Animals with small liver or subcutaneous tumors showed an increased activity of both the hepatic and the extrahepatic RES. Animals with large retroperitoneal tumors showed a significant decrease in the RE function of the liver. In these animals the function of the extrahepatic RES was not changed compared to controls but was, however, significantly decreased compared to animals with smaller tumors. The findings may reflect a difference in the impact of tumor size on RE function extra- and intrahepatically.

Homeopathic Resistant Malaria.

Multiresistant Plasmodium falciparum malaria is a major threat to travelers to subSaharan Africa. However, even if chemoprophylaxis does not prevent clinical malaria in some individuals, it does lead to a reduction in the severity of the disease.1 In Sweden, we have recently seen five patients with malaria (three due to P. ovale and two due to P. falciparum) who have used homeopathic drugs for prophylaxis during visits to West Africa. We are concerned about this incidence and afraid that reduced confidence in modern medical malaria prophylaxis will encourage some individuals to try totally ineffective alternatives. Three women (57, 40, and 39 years old) visited Guinea Conacry in January 1995 as members of a group of 24 persons learning about African dances. The 57-year-old woman took mefloquine irregularly but vomited each time after intake. She also used Spenglersan M, which is a homeopathic drug that is administered (one drop daily in the bend of the arm) as malaria prophylaxis. The two other women used Spenglersan M only. They all fell ill with P. ovale malaria despite ongoing intake. Spenglersan M is said to contain both antigen from P. falciparum and antibodies against the parasite diluted to 1:1,000,000,000 concentration. The fourth case was a 26-year-old man who visited Ghana and Burkina Faso in October and November 1994. He used China D-6 for prophylaxis. This is a homeopathic preparation of the bark from the cinchona tree. Not even trace amounts of quinine were found in the tablets with a very sensitive high-performance liquid chromatographic method.2 Four days after returning from Africa he fell ill with P. falciparum malaria and received sulphadoxine-pyrimethamine treatment. After clinical relapse (RI), mefloquine was given and the patient was eventually cured. The fifth case was a 34-year-old woman admitted to hospital because of P. falciparum malaria after a visit to Guinea Conacry in January 1995. She had taken a homeopathic drug, Charaka comp 118, as prophylaxis. The drug is said to contain different extracts from herbs diluted 30 times. At first she refused to stay in hospital, but 2 days later she was readmitted and treated in the intensive care unit because of severe malaria with hypotonia and anemia. She had hyperparasitemia with 23% infected erythrocytes. Exchange transfusion was done, quinine was given, and the patient recovered without sequelae. The mortality is about 1% in people with P. falciparum infection.3 We therefore urge the readers to stand up against the dangerous use of homeopathic drugs and instead motivate travelers to use protective malaria prophylaxis.