Analysis of malpractice claims: The Franco-Belgian "Cœlio Club" experience.

Malpractice claims are a regularly increasing concern in gastrointestinal surgery. The goal of this study was to compare the current status of claims in two different French-speaking communities by a retrospective descriptive study of surgeons' experiences, from the beginning of their practice up until December 31 2014. Data included the number, the reasons, and the results of medicolegal claims and their jurisdictions. Forty-three surgeons participated in this study. Two hundred medicolegal claims were analyzed. The mean number was 5.8 per surgeon. Bariatric surgery, colorectal surgery and parietal surgery were the most exposed. Forty-six (23%) faults were noted, while no fault was pronounced in 139 (69.5%) cases. The main reasons for lodging complaints were nosocomial infections, anastomotic leaks, poor postoperative care, hollow organ perforation, peripheral neurologic complication, and insufficient preoperative information. Forty-four percent of the complaints were analyzed by the conciliation and compensation commissions and 43.5% by the High Court. In the French-speaking group, there were 13 complaints, two of which gave rise to compensation. French surgeons are highly exposed to complaints: in French law, clumsiness or technical maladdress is considered as a fault. The patient should be informed preoperatively of all possible severe risks of a medical procedure. In Belgium, complications are exceptional and are considered random therapeutic events. Adhering to the recommendations emanating from the French High Authority of Health and Learned Societies as well as accreditation issued by the same High Authority should allow to decrease the number of undesirable events related to care and malpractice.

Presence of anesthesiologists and nurses in the operating room: Liability of surgeons and health care facilities.

The presence of an anesthesiologist and certified registered nurse anesthesiologist in the operating room remains a topic of discussion in many facilities. This article provides an overview on the legislation and recommendations on this topic and recounts some of the related jurisprudence. The opinions of various actors, surgeons, anesthesiologists, anesthesiology-intensive care physicians, certified registered nurse anesthesiologists, care-facility directors and insurance companies are included. Based on these elements, we attempt to answer the question of presence of competence in anesthesiology in the operating room.

Expert witness testimony step by step and how to prepare it.

The medical expert witness testimony is a key moment in the pathway of patient complaints as well as in the line of defense of the defendant-physician. For the defendant, it is a difficult time, often experienced as humiliating, because his or her competences are questioned, appraised and discussed in public. However, the defendant must perceive and use this encounter as an opportunity to express his/her viewpoint on the medical accident. This article provides the principal juridical rules that govern the medical expert witness testimony that must be known, as well as some practical advice on how the medical expert witness testimony evolves and how to protect oneself from the complaints, In order to enable the defendant to best prepare for this confrontation between the involved parties.

Medical expert witness testimony in France and in Europe.

Health care professionals are usually at a loss when it comes to medical "complaints", essentially because they lack knowledge with regard to existing litigation procedures. After a short reminder of the different rights of appeal in France, we describe how medical appeals function in other European countries. Next, we give the details of how the evaluation of claims of bodily damage works, a process in which every physician may be called upon to participate several times in a career, either as the defendant, or as a medical counselor, or as an expert. The goal of this update is to understand the different compensation appeal circuits available to patients and help the surgeon demystify and dedramatize the situation while preparing for the medical expert witness testimony. All such testimony reports, via whatever appeal circuit, follow a similar procedure, even if they are not exactly identical.

Malpractice claims and abdominal wall hernia repair.

PURPOSE: To present factual data on the medico-legal aspects of medicolegal claims after abdominal wall surgery in France. METHOD: Analysis of the complaints following parietal surgery that were addressed to a company that specializes in medical malpractice insurance between 2010 and 2016. RESULTS: Of 209 files, 180 were analyzable; these included 75 women and 105 men with a mean age of 51 years and a mean BMI of 29.8. Cases were mainly heard by the Conciliation and Compensation Commission (CCI) (82 patients) and the High Court (79 patients). The surgical procedures concerned were groin hernias (85 patients) or anterior abdominal wall hernias (95 patients). Conventional open surgery was performed in 123 patients and laparoscopic surgery in 57 patients. The incidents motivating patient complaints after groin hernia surgery were chronic pain (27 patients), infection (24 patients), testicular damage (10 patients). Seven patients died as a result of this surgery (including one fetus). Claims after ventral hernia repair were motivated by infections (46 patients) and post-operative peritonitis or bowel obstruction (12 patients). Nine patients died following these ventral hernia repairs. Surgical error was identified in 59 of the 168 cases analyzed (35.1%); 44% of recognized faults were surgical site infections, 27% linked to delay in re-operation, and 20% were related to the operating room environment. CONCLUSION: Hernia surgery, although an everyday event for many practitioners, requires the same rigor as all other visceral surgery.

Correlation between composition, microstructure, and emission properties in Nd-doped Si-rich Si oxynitride films: investigation into the nature of the sensitizer.

Rare earth (RE) ions doped in Si-based materials, compatible with Si technology, are promising compounds with regards to optical communication and energy conversion. In this article, we show the emission properties of Nd-doped Si-rich Si oxynitride (Nd-SRSON) films, and their dependence on the dangling bond density and the nature of the sensitizer. These films were prepared by reactive magnetron sputtering and post-annealing. The film composition, microstructure, and emission properties were investigated as a function of deposition parameters and annealing temperatures. Both Fourier transform infrared (FTIR) and ellipsometry spectroscopy measurements have confirmed that the sample composition (Si/N ratio) can be carefully tuned by varying the ratio of reactive nitrogen to argon in the sputtering plasma. Moreover, FTIR and x-ray photoelectron spectroscopy measurements demonstrate the existence of both nitrogen and oxygen dangling bonds (N· and O·) in as-deposited samples. These dangling bonds were passivated during annealing. Under non-resonant excitation at 488 nm, the films exhibit a significant photoluminescence (PL) signal from Nd3+ ions demonstrating the occurrence of an effective sensitization of Nd3+ ions in the host matrix. Both PL excitation and ellipsometry results (the energy band gap from new amorphous model) exclude the sensitization by an exciton with energy over the band gap, whereas the presence of Si agglomerates, at the atomic scale, have been identified as effective sensitizers towards Nd3+ ions. This work not only provides knowledge to optimize Si-based materials for favorable emission properties, but also, presents a universal methodology to investigate the nature of sensitizers for RE emitters. This allows one to find correlations between composition, microstructure, and emission properties.

The nitrogen concentration effect on Ce doped SiOxNy emission: towards optimized Ce3+ for LED applications.

Ce-Doped SiOxNy films are deposited by magnetron reactive sputtering from a CeO2 target under a nitrogen reactive gas atmosphere. Visible photoluminescence measurements regarding the nitrogen gas flow reveal a large emission band centered at 450 nm for a sample deposited under a 2 sccm flow. Special attention is paid to the origin of such an emission at high nitrogen concentration. Different emitting centers are suggested in Ce doped SiOxNy films (e.g. band tails, CeO2, Ce clusters, Ce3+ ions), with different activation scenarios to explain the luminescence. X-ray photoelectron spectroscopy (XPS) reveals the exclusive presence of Ce3+ ions whatever the nitrogen or Ce concentrations, while transmission electron microscopy (TEM) shows no clusters or silicates upon high temperature annealing. With the help of photoluminescence excitation spectroscopy (PLE), a wide excitation range from 250 nm up to 400 nm is revealed and various excitations of Ce3+ ions are proposed involving direct or indirect mechanisms. Nitrogen concentration plays an important role in Ce3+ emission by modifying Ce surroundings, reducing the Si phase volume in SiOxNy and causing a nephelauxetic effect. Taking into account the optimized nitrogen growth parameters, the Ce concentration is analyzed as a new parameter. Under UV excitation, a strong emission is visible to the naked eye with high Ce3+ concentration (6 at%). No saturation of the photoluminescence intensity is observed, confirming again the lack of Ce cluster or silicate phase formation due to the nitrogen presence.

Structural and emission properties of Tb3+-doped nitrogen-rich silicon oxynitride films.

Terbium doped silicon oxynitride host matrix is suitable for various applications such as light emitters compatible with CMOS technology or frequency converter systems for photovoltaic cells. In this study, amorphous Tb3+ ion doped nitrogen-rich silicon oxynitride (NRSON) thin films were fabricated using a reactive magnetron co-sputtering method, with various N2 flows and annealing conditions, in order to study their structural and emission properties. Rutherford backscattering (RBS) measurements and refractive index values confirmed the silicon oxynitride nature of the films. An electron microscopy analysis conducted for different annealing temperatures (T A) was also performed up to 1200 °C. Transmission electron microscopy (TEM) images revealed two different sublayers. The top layer showed porosities coming from a degassing of oxygen during deposition and annealing, while in the region close to the substrate, a multilayer-like structure of SiO2 and Si3N4 phases appeared, involving a spinodal decomposition. Upon a 1200 °C annealing treatment, a significant density of Tb clusters was detected, indicating a higher thermal threshold of rare earth (RE) clusterization in comparison to the silicon oxide matrix. With an opposite variation of the N2 flow during the deposition, the nitrogen excess parameter (Nex) estimated by RBS measurements was introduced to investigate the Fourier transform infrared (FTIR) spectrum behavior and emission properties. Different vibration modes of the Si-N and Si-O bonds have been carefully identified from the FTIR spectra characterizing such host matrices, especially the 'out-of-phase' stretching vibration mode of the Si-O bond. The highest Tb3+ photoluminescence (PL) intensity was obtained by optimizing the N incorporation and the annealing conditions. In addition, according to these conditions, the integrated PL intensity variation confirmed that the silicon nitride-based host matrix had a higher thermal threshold of rare earth clusterization than its silicon oxide counterpart. Analysis of time-resolved PL intensity versus T A showed the impact of Tb clustering on decay times, in agreement with the TEM observations. Finally, PL and PL excitation (PLE) experiments and comparison of the related spectra between undoped and Tb-doped samples were carried out to investigate the impact of the band tails on the excitation mechanism of Tb3+ ions.

Prevention of parastomal hernia by intraperitoneal onlay mesh reinforcement at the time of stoma formation.

PURPOSE: Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of this study is to assess the safety and prophylactic effect of intraperitoneal onlay mesh (IPOM) reinforcement of the abdominal wall at the time of primary stoma formation to prevent PSH occurrence. MATERIALS AND METHODS: This multicentre prospective study concerned 20 patients operated for low rectal carcinoma between 2008 and 2010. Those patients had an elective and potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round composite mesh centred on the stoma site and covering the lateralised colon. There were 8 men and 12 women with a median age of 69 years (range: 44-88) and a body mass index of 27 (range: 21-35). The major outcomes analysed in the study were operative time, complications related to mesh and PSH occurrence. Patients were evaluated 1 month after surgery and then every 6 months with physical examination and computed tomography scan (CT-scan). For PSH, we used the classification of Moreno-Matias. RESULTS: Surgery was performed by laparoscopy in 17 patients and by laparotomy in 3; 12 had an extraperitoneal colostomy, and 8 had a transperitoneal colostomy. The median size of the mesh was 15 cm (range: 12-15). The median operative time was 225 min (range: 175-300), and specific time for mesh placement was 15 min (range: 12-30). One month after surgery, one patient presented with a mild stoma stenosis that was treated successfully by dilatation. With a median follow-up of 24 months (range: 6-42), no other complication potentially related to the use of the mesh was recorded and no mesh had to be removed. On clinical examination, one patient (1/20 = 5 %) had a stoma bulge that appeared a few months after surgery, but was not associated with symptoms. CT-scan evaluation confirmed that all the patients with a normal clinical examination had no PSH and revealed that the patient with the stoma bulge had a stoma loop hernia (type 1a hernia). This patient was followed up for 36 months, no clinical or radiological aggravation of the stoma loop hernia was observed, and he remained totally asymptomatic. CONCLUSIONS: With 95 % of excellent results, IPOM reinforcement at the time of end colostomy formation in selected patients is a very promising procedure. A drawback of this technique is the possibility of developing a stoma loop hernia due to sliding of the exiting colon between the covering mesh and the abdominal wall. However, this risk is low, and no adverse clinical consequence for the patient was noted in our series.

A critical role for NMDA receptors in parvalbumin interneurons for gamma rhythm induction and behavior.

Synchronous recruitment of fast-spiking (FS) parvalbumin (PV) interneurons generates gamma oscillations, rhythms that emerge during performance of cognitive tasks. Administration of N-methyl-D-aspartate (NMDA) receptor antagonists alters gamma rhythms, and can induce cognitive as well as psychosis-like symptoms in humans. The disruption of NMDA receptor (NMDAR) signaling specifically in FS PV interneurons is therefore hypothesized to give rise to neural network dysfunction that could underlie these symptoms. To address the connection between NMDAR activity, FS PV interneurons, gamma oscillations and behavior, we generated mice lacking NMDAR neurotransmission only in PV cells (PV-Cre/NR1f/f mice). Here, we show that mutant mice exhibit enhanced baseline cortical gamma rhythms, impaired gamma rhythm induction after optogenetic drive of PV interneurons and reduced sensitivity to the effects of NMDAR antagonists on gamma oscillations and stereotypies. Mutant mice show largely normal behaviors except for selective cognitive impairments, including deficits in habituation, working memory and associative learning. Our results provide evidence for the critical role of NMDAR in PV interneurons for expression of normal gamma rhythms and specific cognitive behaviors.

Intraoperative events and their outcome: data from 4007 laparoscopic interventions by the French "Club Cœlio".

AIM: To assess the operative and postoperative course of intraoperative events occurring in laparoscopic surgery according to the classification of Clavien. This evaluation aims at ascertaining morbidity and mortality of abdominal laparoscopic operations, thus serving as a reference for future comparative studies. METHOD: Twenty-nine senior surgeons, all of them members of the Cœlio Club prospectively and consecutively summarized all their laparoscopic activity over a period of 6 months. RESULTS: Of 4007 patients, 373 (9.31%) developed complications, 69 (1.72%) requiring surgery. Establishing the pneumoperitoneum and trocar placement caused 15 vascular (0.37%) and six visceral (0.15%) injuries; seven vascular (0.17%) and 22 visceral (0.55%) injuries occurred intraoperatively. Surgery of the colon and especially the rectum were associated with the highest morbidity with Clavien grades III, IV and V reported in 8, 10 and 15.97% of patients, respectively; 1.2% occurred in biliary surgery and 0.67% in inguinal/femoral hernia repair. CONCLUSION: The prevalence of surgical intraoperative events and postoperative complications is higher than reported in the literature. Clavien's classification is applicable to abdominal laparoscopic surgery; further information is necessary to assess intraoperative surgical events as well as conversions.

On the nature of the stretched exponential photoluminescence decay for silicon nanocrystals.

The influence of hydrogen rate on optical properties of silicon nanocrystals deposited by sputtering method was studied by means of time-resolved photoluminescence spectroscopy as well as transmission and reflection measurements. It was found that photoluminescence decay is strongly non-single exponential and can be described by the stretched exponential function. It was also shown that effective decay rate probability density function may be recovered by means of Stehfest algorithm. Moreover, it was proposed that the observed broadening of obtained decay rate distributions reflects the disorder in the samples.

Thermal stability of high-k Si-rich HfO(2) layers grown by RF magnetron sputtering.

The microstructure and optical properties of HfSiO films fabricated by RF magnetron sputtering were studied by means of x-ray diffraction, transmission electron microscopy, spectroscopic ellipsometry and attenuated total reflection infrared spectroscopy versus annealing treatment. It was shown that silicon incorporation in the HfO(2) matrix plays an important role in the structure stability of the layers. Thus, the increase of the annealing temperature up to 1000 degrees C did not lead to the crystallization of the films. The evolution of the chemical composition as well as a decrease of the density of the films was attributed to the phase separation of HfSiO on HfO(2) and SiO(2) phases in the film. An annealing at 1000-1100 degrees C results in the formation of the multilayer Si-rich/Hf-rich structure and was explained by a surface-directed spinodal decomposition. The formation of the stable tetragonal structure of HfO(2) phase was shown upon annealing treatment at 1100 degrees C.

Dynamics of connexin 43 levels and distribution in the mink (Mustela vison) anterior pituitary are associated with seasonal changes in anterior pituitary prolactin content.

Because in mammals the anterior pituitary lacks innervation, we investigated whether gap junctions established between selected cells within the gland are part of an intrapituitary mechanism to ensure physiological synchronization of cells involved in the control of hormone secretion. We report here the dynamics of anterior pituitary connexin 43 (Cx43)-gap junctions throughout the mink (Mustela vison) annual reproductive cycle and its relationship with the anterior pituitary prolactin (PRL) content that parallels variations in serum PRL levels documented in the literature. We found that PRL anterior pituitary levels were maximal in spring and during lactation and that they were minimal in autumn and winter. Anterior pituitary Cx43 levels were maximal during periods of high PRL secretion. During these periods, Cx43-positive gap junctions localized to stellate-shaped cells occupying the center of anterior pituitary follicles and to the rounded cells occupying the remaining follicles. Connexin 43-positive gap junctions were also observed between adjacent follicles. During periods of low PRL pituitary content, Cx43-positive gap junctions localized to the stellate cells but not to the cells of the remaining follicles. Moreover, Cx43 labeling was undetected between adjacent follicles. To assess between which cells within the mink anterior pituitary the Cx43 gap junctions were established, the different anterior pituitary cell populations were separated by a discontinuous Percoll gradient, and Western blot analyses of each cell population using Cx43 antibodies were performed. The immunoblots showed a Cx43 immunoreactive band associated with the cell layer enriched in S-100-positive, stellate-shaped cells. The result was confirmed by fluorescence microscopy studies that showed that Cx43-mediated gap junctions were established preferentially between the cultured S-100-positive, elongated cells. The results show that in mink stellate cells, the junctional machinery associated with the Cx43 protein varies in synchrony with the anterior pituitary PRL content throughout the mink annual reproductive cycle. It is suggested that the Cx43 gap junctions on the stellate cells play an important role in the synchronization of cellular activity within selected follicles of the anterior pituitary, thus contributing to the control of PRL secretion during the annual reproductive cycle.

Biochemical and morphological diversity among folliculo-stellate cells of the mink (Mustela vison) anterior pituitary.

The folliculo-stellate (FS) cells are agranular cells of the anterior pituitary whose origin and function are still a matter of debate. This study examined the presence, topography, and morphological characteristics of FS cells in the mink anterior pituitary throughout the annual reproductive cycle. The S-100 protein was used as a FS cell marker. Immunoperoxidase labeling on tissue sections demonstrated the presence of two types of S-100 positive cells. Type 1 cells were stellate-shaped cells whose nuclei were localized near the center of pituitary follicles. In this type, S-100 labeling was strong in anterior pituitary sections obtained during spring, a period characterized by high prolactin pituitary content and low gonadotropin pituitary content. Type 2 cells were rounded cells occupying the periphery of the follicles. During periods of low prolactin pituitary content and high gonadotropin anterior content the type 2 S-100 positive cells formed aggregates of several cells. The total number of S-100 positive cells was constant during these two periods of the annual reproductive cycle, suggesting that type 1 and type 2 may reflect different morphological and physiological states of the same cell. Of the two subunits, alpha and beta, that, combined, form three different dimeric S-100 proteins, mink FS cells expressed mostly the beta subunit. FS cells also expressed the glial fibrillary acidic protein (GFAP). In culture, 8 +/- 3% of anterior pituitary cells were S-100 positive. Cultured S-100 cells were elongated, polygonal, or rounded. The S-100 labeling accumulated in the cytoplasm around and within the nucleus, whereas it was weak in pseudopods and large cytoplasmic vacuoles. The presence of pseudopods suggests that cultured FS cells could migrate. The vacuoles may be related to the phagocytic activity ascribed to these cells. Some FS cells presented membrane blebbing and peripheral vesicles that were immunopositive for S-100 and that may indicate a secretory activity. Cultured FS cells possessed actin filaments organized as a peripheral network; a few actin cables were also observed running across the cytoplasm. Pseudopods depicted a highly organized actin network. The microtubules of FS cells expanded throughout the cytoplasm. The intermediate filaments expressed by cultured FS cells were GFAP and vimentin. GFAP labeling was punctate and vimentin was organized as filaments. All cultured S-100 cells were positive for vimentin, suggesting a mesenchymal origin for the cells, and all cultured S-100 positive cells were positive for GFAP, suggesting a neuroectodermal origin. In conclusion, S-100 positive cells are heterogeneous with respect to cell shape and expression of S-100 subunits in the mink anterior pituitary. The presence of morphologically different S-100 positive cells is modified in accordance with the endocrine status of the animal, suggesting that FS cells may be involved in the modulation of the anterior pituitary endocrine activity in the mink.

¿Que es el método de costes basado en las actividades (ABC)?Aplicación al sector sanitario / What is the cost method based on (ABC)?

No disponible

Memory suppressor genes: enhancing the relationship between synaptic plasticity and memory storage.

Memory suppressor genes encode proteins that act as inhibitory constraints to impede memory storage. The study of memory suppressor genes is important not only for understanding the link between synaptic plasticity and learning but also for identifying potential targets for future pharmaceuticals to treat memory disorders. This article first reviews the evidence for proteins that impede memory storage from work in invertebrates and then explores recent evidence for the existence of memory suppressor genes in vertebrates in the context of hippocampus-dependent forms of memory. In Aplysia, memory suppressor gene products act at each step in long-term facilitation: in the cytoplasm to regulate kinase activity, in the nucleus to alter the activity of transcriptional regulatory proteins, and on the cell surface to modulate cell-cell interactions. Studies of genetically modified Drosophila have provided behavioral evidence for the existence of memory suppressor genes. One of the best candidates for a neuronal mechanism underlying learning is long-term potentiation (LTP), which has been extensively studied in the mammalian hippocampus. Recent work has identified a number of putative memory suppressor gene products that act in the hippocampus at the levels of LTP induction, regulation of intracellular signaling cascades, and transcriptional control. Using these gene products as tools to study enhancements rather than deficits in LTP and learning may generate more precise information about the relationship between synaptic plasticity and behavioral learning. The study of mammalian memory suppressor genes may provide insights into alleviating the learning and memory deficits that accompany both normal aging and a variety of human disorders.

Lucifer Yellow filling of area X-projecting neurons in the high vocal center of female canaries.

The avian high vocal center (HVC) is a complex forebrain nucleus that coordinates the sensorimotor integration necessary for song learning and production. It receives auditory and potentially somatosensory input, and sends major projections to vocal motor and anterior forebrain nuclei. The HVC has at least four morphological classes of neurons for which the connectivity remains uncertain. Previous studies have alluded to the functional identity of the cell classes, but none have provided the definitive evidence necessary for subsequent identification of behaviorally relevant changes within known neuronal populations. The cell filling technique we have adapted for use in the song system provides a method by which hodologically identified classes can be described with precision, and song related changes in their morphology can be readily identified. Neurons in female canaries (Serinus canarius) that project to Area X of the anterior forebrain pathway were retrogradely labeled, selectively filled with Lucifer Yellow in a fixed slice preparation, and converted to a Golgi-like stain through an immunocytochemical reaction. We have identified Area X-projecting neurons as belonging to the thick dendrite class of Nixdorf et al. [B.E. Nixdorf, S.S. Davis, T.J. DeVoogd, Morphology of golgi-impregnated neurons in hyperstriatum ventralis, pars caudalis in adult male and female canaries, J. Comp. Neurol. 284 (1989) 337-349] and have shown definitively that they are among the HVC neurons that can receive direct auditory input, as this cell class has short dendrites that extend into the shelf region ventral to HVC that is known to receive auditory inputs. Well-filled axons had collaterals that ramified and terminated within the nucleus, demonstrating a network through which Area X-projecting cells can contribute to intrinsic HVC communication.

Fetal and maternal plasma atrial natriuretic factor responses to angiotensin II infusion.

Plasma atrial natriuretic factor and angiotensin II have opposing actions in the regulation of body fluid homeostasis and systemic blood pressure. Angiotensin II infusions stimulate atrial natriuretic factor release in some, but not all, studies in adult mammals. To examine the response during the perinatal period, graded intravenous angiotensin II infusions were administered to four chronically instrumented pregnant ewes and fetuses (132 +/- 1 days of gestation). Fetuses received successive 20-minute intravenous angiotensin II infusions at 25, 50, and 100 ng/kg/min. After a 90-minute recovery, maternal ewes received successive 20-minute angiotensin II infusions (5, 10, and 25 ng/kg/min). During the fetal infusions, mean (+/- SEM) fetal arterial blood pressure (47 +/- 2 to 61 +/- 2 mm Hg, p less than 0.05) and heart rate (155 +/- 16 to 196 +/- 36 beats/min, p less than 0.05) increased, although there was no change in maternal measured parameters. In response to the maternal infusion, maternal mean arterial blood pressure increased (92 +/- 7 to 110 +/- 8 mm Hg, p less than 0.05) and maternal heart rate decreased (136 +/- 4 to 125 +/- 2 beats/min, p less than 0.05) without change in fetal parameters. Fetal plasma atrial natriuretic factor levels (210 +/- 27 to 664 +/- 250 pg/ml, p less than 0.05) significantly increased during the fetal angiotensin II infusions in spite of no change in maternal plasma atrial natriuretic factor (85 +/- 21 to 124 +/- 22 pg/ml) during the maternal angiotensin II infusions. These findings indicate that similar increases in systemic blood pressure in response to angiotensin II infusions stimulate increased fetal, but not maternal, plasma atrial natriuretic factor.