Vaginal breech delivery at term and neonatal morbidity and mortality - a population-based cohort study in Sweden.

INTRODUCTION: The routine to deliver almost all term breech cases by elective cesarean section (CS) has continued to be debated due to the risk of maternal and neonatal complications. The aims of the study were (1) to investigate if mode of delivery impacts on the risk of morbidity and mortality among term infants in breech presentation and (2) to compare the rates of severe neonatal complications and mortality in relation to presentation and mode of delivery. METHODS: This population-based cohort study used data from the Swedish Medical Birth Register. All women (and their newborn infants) with singleton pregnancies who gave birth at term to an infant in breech (n = 27,357) or cephalic presentation (n = 837,494) between 2001 and 2012 were included. Births with vacuum extraction and induced labors were excluded, as well as antepartum stillbirths, births with infants diagnosed with congenital malformations and multiple births. RESULTS: On one hand, the rates of neonatal complications and mortality were higher among infants born in vaginal breech compared to the vaginal cephalic group. On the other hand, after CS, the rates of all neonatal complications under study and neonatal mortality were lower among infants in breech presentation than in those in cephalic presentation. After adjustment for confounders, infants delivered in vaginal breech had 23.8 times higher odds AOR (ratio) for brachial plexus injury, 13.3 times higher odds ratio for Apgar score <7 at 5 min, 6.7 times higher odds of intracranial hemorrhage (ICH), or convulsions and 7.6 higher odds ratio for perinatal mortality than those delivered by elective CS. CONCLUSIONS: Despite a probable selection of women who before-hand were considered at low risk and, therefore, could be recommended vaginal breech delivery, infants delivered in vaginal breech faced substantially increased risks of severe neonatal complications compared with infants in breech presentations delivered by elective CS. Key message Vaginal breech delivery is associated with increased risk for severe neonatal complications.

A clinical evaluation of the TK 210 ELISA in sera from breast cancer patients demonstrates high sensitivity and specificity in all stages of disease.

Thymidine kinase (TK1) is an enzyme involved in DNA synthesis that leaks into the blood as a result of high cell turnover, particularly in the case of cancer. Serum TK1 activity has been used for prognosis and monitoring of leukemia and lymphoma patients for many years. Here, we describe the first clinical results with the newly developed TK 210 ELISA from AroCell AB. Sera from 124 breast cancer patients with known TNM classification along with sera from 53 healthy females were analyzed by TK 210 ELISA for TK1 protein and TK1 activity levels by the 3[H]-deoxythymidine (dThd) phosphorylation assay. The limit of detection for the TK 210 ELISA was 0.17 ng/ml, and 60 % of the sera from female blood donors were below this value. The median TK1 levels found in sera from breast cancer patients with T1 to T4 stage disease were 0.31, 0.46, 0.47, and 0.55 ng/ml, and these levels significantly differed from healthy controls. The median values of the biomarker CA 15-3 were also increased in patient sera from T1 to T4 patients (16, 34, 36, 40 U/ml, respectively). TK 210 ELISA showed significantly higher sensitivity for the T1 and T2 breast cancer patients compared to the TK activity assay. The combination of the TK1 ELISA and CA 15-3 biomarkers demonstrated a significant increase in sensitivity up to 15 % compared to each marker alone. This evaluation of the TK 210 ELISA strongly suggests that it can provide independent and complementary information for patients with breast cancer.

Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial.

BACKGROUND: The copper intrauterine device (IUD) is a highly effective and safe contraceptive method, also in nulliparous women. However, insertion of an IUD through a narrow cervix may be technically difficult. Misoprostol has been shown to be effective for cervical priming in non-pregnant women prior to hysteroscopy. METHODS: Eighty nulliparous women requesting an IUD were randomly allocated to receive sublingually 400 microg misoprostol and 100 mg diclofenac (misoprostol group) or 100 mg diclofenac alone (control group) 1 h prior to IUD insertion. Cervical dilatation was measured prior to insertion using Hegar pins. Ease of insertion was judged by the investigator. Pain, bleeding and side effects were recorded at insertion and until follow-up performed one month later. RESULTS: Following treatment with misoprostol, insertion was significantly easier than in the control group [P = 0.039, difference 19.36%, confidence interval (CI) -0.013, 39.99]. Pain estimated on a visual analogue scale (1-10) showed no evidence of a difference between the groups. The overall distribution of side effects did not differ. However, shivering was more common in the misoprostol group (P = 0.0084, difference 23.27%, CI 6.64, 39.90). CONCLUSIONS: Misoprostol facilitates insertion of an IUD, and reduces the number of difficult and failed attempts of insertions in women with a narrow cervical canal. The optimal regimen of misoprostol remains to be defined.

Pharmacokinetic profiles up to 12 h after administration of vaginal, sublingual and slow-release oral misoprostol.

BACKGROUND: It has been shown that the route of administration of misoprostol has a strong impact on the pharmacokinetic profile and result in different clinical efficacy. No study has so far evaluated the pharmacokinetics beyond 6 hours. Furthermore a new slow-release misoprostol formulation was included in the study. METHODS: Pharmacokinetics of a novel slow-release (SR) oral misoprostol was compared during 12 h after administration to conventional misoprostol administered vaginally or sublingually. Thirty-three women requesting surgical abortion up to 12 weeks were randomly allocated to groups receiving a single dose of 400 microg conventional misoprostol administered vaginally or sublingually or 800 microg SR oral misoprostol. Blood samples were taken before (0 h) and 0.5, 1, 2, 3, 4, 6, 8, 10 and 12 h after misoprostol administration. Misoprostol acid (MPA) was determined in serum samples using liquid chromatography/tandem mass spectrometry. RESULTS: Three women did not complete the study. Serum concentrations reached their highest level following sublingual misoprostol (P<0.0001) and the time to peak concentration was shortest for this group (P=0.0094). The area under the curve (AUC) up to 12 h was greater following sublingual treatment than for the other alternatives (P<0.0001) and lowest for SR misoprostol. Cumulative serum levels of MPA did not increase beyond 6 h following sublingual and vaginal administration, while they continued to increase up to 12 h following SR misoprostol. CONCLUSIONS: The new SR form of misoprostol demonstrated lower peak levels and a lower AUC but longer lasting elevation in serum levels when compared to conventional misoprostol administered sublingually or vaginally. SR misoprostol may offer an alternative to repeated administration of conventional misoprostol.

Pharmacokinetics of a novel oral slow-release form of misoprostol.

BACKGROUND: The pharmacokinetics of a novel slow-release (SR) misoprostol was studied and compared to conventional misoprostol. METHODS: Thirty-one women, pregnant between 8 and 12 weeks, requesting surgical abortion were randomly allocated to receive orally 400 microg conventional misoprostol, 400 microg SR misoprostol or 800 microg SR misoprostol. Venous blood samples were taken at 0, 30, 60, 120, 240 and 360 min after the administration of misoprostol. Misoprostol acid (MPA) was determined in serum samples using liquid chromatography/tandem mass spectrometry. RESULTS: Serum peak concentration (Cmax) was highest for conventional oral misoprostol. The time to peak concentration (Tmax) was similar for all groups. The area under the curve up to 360 min was similar for conventional and for 800 microg SR misoprostol and significantly greater for these groups compared to 400 microg SR misoprostol (P = 0.013). CONCLUSION: The new SR form of misoprostol demonstrated lower peak levels but longer-lasting elevation in plasma levels compared to conventional oral misoprostol. The AUC for 800 microg SR misoprostol was similar to that of 400 microg of conventional oral misoprostol. SR misoprostol may offer an alternative to repeated administration of oral misoprostol or to vaginal administration.

Effects of slow release misoprostol on uterine contractility in early pregnancy.

BACKGROUND: The effect of a novel slow release form of misoprostol (SR misoprostol) on uterine activity during early pregnancy was investigated in a pilot study. METHODS: Thirty women with a pregnancy between 8 and 12 weeks requesting surgical abortion were allocated to treatment according to computerized randomization. SR misoprostol (400 and 800 microg) was compared to 400 microg of conventional misoprostol, all given orally. Intrauterine pressure was recorded using a pressure transducer inserted extra-amniotically and connected to a computer 30 min before treatment until 4 h thereafter when suction curettage was performed. Uterine tonus (mmHg) and contractility in Montevideo Units (MU) were calculated. RESULTS: An increase in uterine tonus occurred after a significantly shorter time interval and was significantly more pronounced following conventional misoprostol compared to SR misoprostol. Regular uterine contractions developed in only a few patients treated with 400 microg conventional misoprostol or 400 microg SR misoprostol. In contrast the increase in uterine contractility (MU) was significantly more pronounced following 800 microg SR misoprostol treatment and was still continuing at 4 h of recording. CONCLUSIONS: SR misoprostol acts less on uterine tonus than orally administered conventional misoprostol but leads to development of regular uterine contractions.

Sublingual compared with oral misoprostol for cervical dilatation prior to vacuum aspiration: a randomized comparison.

The aim of the study was to compare the effect of oral and sublingual administration of misoprostol for cervical priming prior to vacuum aspiration. Thirty-two first-time-pregnant women with 8-12 weeks amenorrhea were randomly assigned to receive 400 microg misoprostol either orally or sublingually 3 h prior to surgery. The degree of baseline dilatation and the cumulative force needed for dilatation of the cervical canal did not differ between the two treatment groups. However, the number of patients in whom a strong force was needed was significantly higher following oral than following sublingual treatment. It was shown that sublingual administration is more effective than oral administration of misoprostol for cervical priming and is associated with less blood loss but a higher frequency of side effects.

Effects of misoprostol on uterine contractility following different routes of administration.

BACKGROUND: The effect of misoprostol administered by different routes on pregnant uterine contractility was investigated. METHODS: Thirty-two women with a pregnancy between 8 and 11 weeks of gestation requesting termination of pregnancy were recruited. Misoprostol was administered either orally (0.4 mg), vaginally (0.4 mg) or sublingually (0.2 or 0.4 mg) according to consecutive allocation. Intrauterine pressure was recorded using a Grass polygraph connected to a pressure transducer 30 min before misoprostol was given and for 4 h thereafter. At the end of the recording, suction curettage was performed. RESULTS: The first effect observed was an increase in uterine tonus, which occurred after a significantly shorter time following oral (7.8 min) and sublingual (10.7-11.5 min) than after vaginal (19.4 min) treatment. The time to maximum tonus elevation was also significantly shorter (39.5, 47.1-51.7 and 62.2 min for the three groups respectively). Regular uterine contractions developed in all subjects following sublingual and vaginal administration but not after oral administration. The increase in uterine activity measured in Montevideo Units was significantly higher after 2 h and thereafter for sublingual and vaginal treatment than for oral misoprostol. CONCLUSIONS: Based on recording of uterine activity, sublingual misoprostol acts as rapidly as oral treatment, while development of contractions was similar to that seen following vaginal administration.

Effects of alpha-MSH on kainic acid induced changes in core temperature in rats.

The effects of intraperitoneal (i.p.) administration of kainic acid (KA) and alpha-melanocyte-stimulating hormone (alpha-MSH) alone or in combination, on core temperature of freely moving rats were examined. KA or saline was administered once (10 mg/kg) and alpha-MSH or saline was given repeatedly i.e. 10 min before and 10, 30 and 60 min after the administration of saline or KA. Two doses of alpha-MSH were used: 0.5 and 2.5 mg/kg. KA alone produced a biphasic effect on core temperature, i.e. an initial short-lasting hypothermia followed by hyperthermia that lasted about 6 h. The higher dose of alpha-MSH had a potentiating effect on KA-induced hypothermia, while the lower dose of alpha-MSH increased the hyperthermia produced by KA. alpha-MSH administered alone produced a late (3 h), dose-dependent increase in core temperature. It is conceivable that repeated administration of alpha-MSH in the doses used in our study may cause a cumulative effect in raising body temperature for a limited period of time. The previously described interactions between KA and alpha-MSH, respectively, with dopaminergic and serotoninergic systems may account for the effects on core temperature in rats observed in our study.

Effects of dermabrasion on acne scarring. A review and a study of 25 cases.

Acne scarring is often treated with dermabrasion and results are evaluated using photographs. We have studied 25 patients before treatment and up to 1 year after dermabrasion for acne scars. Comparisons of results evaluated in different ways show that dermabrasion works best for superficial scars, results for more severe forms of scarring being less predictable.

In vivo effects of 13-cis retinoic acid treatment on the concentration of proteins and lipids in serum.

A number of serum components, whose concentrations or gene expression have been shown to be modulated by all-trans retinoic acid in vitro, were monitored in patients before and during treatment with Roaccutane (13-cis retinoic acid, 40-60 mg/day) for severe acne. The 13-cis retinoic acid concentration in serum rose from 5.25 +/- 1.09 to 593 +/- 65 nmol/l (mean +/- SD) 24 h after the latest dose. The concentration of all-trans retinoic acid in serum under Roaccutane treatment was measured in model experiments and shown to be 10-20 nmol/l i.e., 2-4 times the basal levels (4.65 +/- 0.85 nmol/l) when the 13-cis retinoic acid concentration was 370-980 nmol/l. The concentrations of creatine kinase-MB, apolipoprotein B, total cholesterol and LDL cholesterol increased significantly while the other measured serum components, including lipoprotein lipase activity, were unaffected by Roaccutane treatment.

Dental amalgam and mercury.

Mercury concentration in intraoral air and urine of seven females with dental amalgam was measured before and after intake of one hard-boiled egg. A considerable decrease in mercury concentration in intraoral air was found. Twenty women with about equal dental amalgam status, with or without subjective symptoms related to dental amalgam, were also studied. Mercury concentrations in intraoral air and urine were measured. For all the 27 women the basal intraoral air concentration of mercury ranged over 0.6-10.4 micrograms/m3 (median value 4.3 micrograms/m3). This corresponds to a release of 0.02-0.38 ng/s (median value 0.16 ng/s). In urine, the mercury concentration varied from less than 0.8-6.9 micrograms/g creatinine (median value 1.9 microgram/g creatinine). Data from both parameters were significantly correlated to the total number of teeth areas with dental amalgam. Protein values in urine indicated no renal damage. Maximum concentrations of mercury vapour in intraoral air for the 27 women who had chewed chewing gum for 5 min varied between 2-60 micrograms Hg/m3 (median value 19 micrograms Hg/m3). This corresponds to 0.07-2.20 ng Hg/s and a median value of 0.70 ng Hg/s.

Predictive sites of inflammatory manifestation in the prostatic gland: an experimental study on nonbacterial prostatitis in the rat.

In rats that had been subjected to standardized experimental stress stimuli for 3 and 10 days, respectively, prostatic inflammatory changes of type nonbacterial prostatitis were found in a lobe-differentiated histological examination. The inflammatory manifestations were marked in the ventral lobes, whereas they were sparse in the dorsolateral lobes. The lobe difference in this respect corresponds to a concomitant difference in morphology and tissue chemical content.

Oral retinoids in mycosis fungoides and Sézary syndrome: a comparison of isotretinoin and etretinate. A study from the Scandinavian Mycosis Fungoides Group.

Thirty-nine patients with mycosis fungoides in various stages or Sézary syndrome were treated with isotretinoin and 29 with etretinate as single drug therapy. Complete remission within 2 months was obtained with isotretinoin in 8 cases (21%) and partial remission in another 15 cases (38%). Etretinate induced complete remission in 5 cases (21%) and partial remission in 11 (46%). Only 1 case with Sézary syndrome went into partial remission. The first sign of remission occurred in 2 to 4 weeks. During continued treatment remissions could not always be maintained. Isotretinoin and etretinate were considered to be of equal potency in the treatment of mycosis fungoides.

Stress stimuli-induced histopathological changes in the prostate: an experimental study in the rat.

To elucidate a suggested relationship between stress stimuli and prostatis, a histological study on the genital organs of seven rats was performed. The specimens were histopathologically examined after a 10-day period, during which the rats had been submitted to standardized stress stimuli, and compared with corresponding organs from a control group of seven male rats. Inflammatory histopathological changes and large numbers of inflammatory cells were seen in the prostatic glands of all rats submitted to the long-term stress stimuli. The findings agreed with those from the prostatic glands of human males with prostatis. No corresponding changes were observed in the control group. There was no evidence indicating a bacterial origin. The results indicate a connection between stress stimuli and prostatitis.

[AIDS in Africa]. / AIDS i Afrika.

PIP: The main aspects of the acquired immunodeficiency syndrome (AIDS) epidemic in Africa as of mid-1986 are discussed. In certain parts of Africa the disease appears to be widespread and fairly evenly divided between the sexes. Most of the AIDS patients have traveled a great deal and been very active sexually, even while traveling. Prostitutes in such large cities as Nairobi are heavily infected with HIV. Recognized routes of infection are: sexual transmission, blood transfusion, contaminated injection equipment, and mother to child. The pathology of AIDS involves the death of the helper cell type of T-lymphocytes, which increases the patient's susceptibility to infections and tumors. There is some evidence that the HIV epidemic originated in central Africa, possibly as a mutant of the green monkey fever virus, and gradually spread to Europe and the USA. Clinically, AIDS should be suspected with such symptoms as persistent unexplained fever, chronic diarrhea, lymphadenopathy, severe wasting, and itching skin lesions, primarily on the extremities. Definitive symptoms include such opportunistic infections as candida esophagii, cryptococcus, severe varieties of herpes simplex, pneumocystis carinii pneumonii, disseminated strongyloids, cerebral toxoplasmosis and a typical mycobacteria. Serological diagnostic tests include enzyme linked immunosorbent assay (ELISA) and Western blot, both of which require advanced equipment. No treatment for AIDS is known; management should concentrate on preventing opportunistic infection.^ieng

Pustular psoriasis of v. Zumbusch type associated with recurring cholestatic jaundice.

A 46-year-old man with pustular psoriasis and recurring episodes of severe cholestatic liver disease is described. Six icteric periods have occurred parallelling high activity of the skin disease.

Urinary excretion of 6-hydroxy-5-methoxyindole-2-carboxylic acid and 5-S-cysteinyldopa during PUVA treatment.

The urinary excretion of the eumelanin metabolite 6-hydroxy-5-methoxyindole-2-carboxylic acid and the pheomelanin metabolite 5-S-cysteinyldopa was followed during PUVA treatment for 6 weeks. They showed similar excretion patterns, with the highest values within 1-2 wk.

Immunological comparison of glyoxalase I from yeast and mammals and quantitative determination of the enzyme in human tissues by radioimmunoassay.

Antibodies to glyoxalase I from yeast, rat liver, porcine erythrocytes and human erythrocytes were raised in rabbits. Gel precipitation and immunotitration experiments demonstrated that the mammalian enzymes were immunologically related, but distinct from the yeast enzyme. Fab fragments of the antibodies to human glyoxalase I did not inhibit the catalytic activity, indicating that the antigen binding sites were not directed towards the active site of the enzyme. A radioimmunoassay for glyoxalase I was developed. Quantitative analysis of human adult as well as fetal organs demonstrated that glyoxalase I was present in a concentration of approximately 0.2 micrograms/mg protein in most human tissues.