Foley balloon catheter to prevent or manage bleeding during treatment for cervical and Cesarean scar pregnancy.

OBJECTIVE: To demonstrate the efficacy of placement and inflation of Foley balloon catheters prophylactically to prevent, or as an adjuvant therapy to control, bleeding in women undergoing treatment for Cesarean scar pregnancy (CSP) or cervical pregnancy (CxP). METHODS: This was a retrospective study of 18 women with either CSP (n = 16) or CxP (n = 2), who underwent Foley balloon catheter placement under continuous transvaginal or transabdominal ultrasound guidance to prevent or manage bleeding following treatment, which in most cases comprised local (intragestational sac) and intramuscular (IM) methotrexate (MTX) injections. In eight cases, the balloon catheter was placed immediately following local and/or IM MTX treatment, either because of bleeding or prophylactically; in eight cases, the catheter was placed as part of a two-step protocol, with patients first treated with local and IM MTX injection, then suction aspiration on Day 4 or 5, followed by planned insertion of a balloon catheter; in one patient the balloon was placed on Day 21 after local and IM MTX treatment, due to sudden bleeding; and in one case of a heterotopic pregnancy, one intrauterine and one cervical, the balloon was placed due to severe bleeding. Human chorionic gonadotropin (hCG) levels were evaluated weekly following MTX injection. RESULTS: Gestational ages at balloon placement ranged between 5 and 12 + 2 weeks. All embryos/fetuses, with the exception of the cervical heterotopic one, had heart activity and catheter placement was well-tolerated by all women. The balloon tamponade effectively reduced or prevented maternal vaginal bleeding in all except one patient; this woman had a heterotopic CxP and required abdominal robotic cerclage to control the bleeding. Catheters were kept in place for a mean of 3.6 (range, 1-6) days. hCG levels returned to low or zero levels within 19-82 days following MTX injection. Fifteen women required antibiotic treatment following the procedure. One woman with CSP developed an arteriovenous malformation requiring uterine artery embolization. CONCLUSION: Ultrasound-guided placement and inflation of Foley balloon catheters was easy to perform and well-tolerated by patients undergoing treatment for CSP or CxP, and successfully prevented or helped in the management of bleeding complications. Based on our experience and previous publications we suggest having the option of balloon catheter insertion available when local treatment of CSP or CxP is undertaken.

A physiological ligand of positive selection is recognized as a weak agonist.

Positive selection is a process that ensures that peripheral T cells express TCR that are self-MHC restricted. This process occurs in the thymus and requires both self-MHC and self-peptides. We have recently established a TCR transgenic (TCR(trans)(+)) mouse model using the C10.4 TCR restricted to the MHC class Ib molecule, H2-M3. Having defined H2-M3 as the positively selecting MHC molecule, the severely limited number of H2-M3 binding peptides allowed us to characterize a mitochondrial NADH dehydrogenase subunit 1-derived 9-mer peptide as the physiological ligand of positive selection. Here, we demonstrate that the NADH dehydrogenase subunit 1 self-peptide is seen by mature C10.4 TCR(trans)(+) T cells as a weak agonist and induces positive selection at a defined concentration range. We also found that the full-length cognate peptide, a strong agonist for mature C10.4 TCR(trans)(+) T cells, initiated positive selection, albeit at significantly lower concentrations. At increased peptide concentrations, and thus increased epitope densities, either peptide only induced the development of partially functional T cells. We conclude that successful positive selection only proceeded at a defined, yet fairly narrow window of avidity.

A physiological ligand of positive selection is seen with high specificity.

Positive selection is a process that ensures that peripheral T cells express TCR that are restricted to self-MHC molecules. This process requires both self-MHC and self-peptides. We have recently established a TCR transgenic mouse model (C10.4 TCRtrans+) in which the transgenic TCR was selected on the nonclassical MHC class Ib molecule H2-M3 in conjunction with a physiologically occurring peptide derived from the mitochondrial NADH-dehydrogenase subunit 1 gene (9-mer peptide). Here, the specificity of positive selection of C10.4 TCRtrans+ T cells was examined using a fetal thymic organ culture system. We demonstrated that at low peptide concentrations, shortening the NADH-dehydrogenase subunit 1 gene 9-mer peptide or mutating its surface-exposed side chains severely impaired its ability to induce positive selection. We concluded that under physiological conditions positive selection of C10.4 TCRtrans+ T cells was highly specific and occurred at low epitope densities.

Rural Minnesota family physicians. Practice characteristics, gender, income, and job satisfaction.

This study investigated rural physicians' job satisfaction, income, and working conditions through a survey of a random sample of rural family physicians in Minnesota. Of the 300 surveys sent, 210 (70%) were returned and usable. Male physicians reported more years of experience, work hours, and call hours per week than female physicians (p < 0.0005). On a scale of 1 to 5, average overall job satisfaction among the physicians was 4.04, with men averaging 4.0 and women, 4.3. Overall job satisfaction was positively correlated with the presence of a hospital in town (p < 0.05) and negatively correlated with the number of work hours, including hours on call, per week (p < 0.05). Overall job satisfaction was lowest for those in practice 20-34 years. Average reported annual income was $127,213 (men, $131,400; women, $97,800; p < 0.0001). In a comparison of physicians working the same number of hours including call, men earned more than women. Rural Minnesota family physicians reported high job satisfaction. Income was positively correlated with size of practice, years of experience, and number of hours worked. In addition, men earned more than women, and physicians whose pay was based on production earned more than physicians on straight salary.

Positive selection of an H2-M3 restricted T cell receptor.

Thymocytes are positively selected for alphabeta T cell antigen receptors (TCR) that recognize antigen in conjunction with self-major histocompatibility complex (MHC) molecules. MHC bound peptides participate in positive selection; however, their role has remained controversial. A TCR transgenic mouse was established using a TCR restricted to the MHC class Ib molecule, H2-M3. Having defined H2-M3 as the positively selecting MHC molecule, the severely limited number of H2-M3 binding peptides allowed us to characterize an NADH dehydrogenase subunit 1 (ND1)-derived peptide as the physiological ligand of positive selection. This peptide bears no apparent sequence homology to the cognate peptide, is expressed ubiquitously, and yet does not interfere with peripheral T cells. Our studies also suggest that positive selection becomes promiscuous at high epitope densities.

[Health risks of vaccination of farmed fish]. / Helserisiko ved vaksinasjon av oppdrettsfisk.

In 1991, three cases of anaphylactoid reactions among vaccinators of farmed fish were registered in Norway. The reactions developed after repeated accidental self-injection of vaccine against salmon furunculosis. In 1991, some 60 million salmon were vaccinated against furunculosis at approximately 50 grams body weight. Following such self-injection of vaccine, inflammatory reactions are seen in the injected finger, also spreading occasionally to the hand. More seldom a "flu" like syndrome with fever, muscle aches, and general malaise is experienced probably caused by endotoxins in the vaccine. Devices to protect the fingers against accidental self-injection have been developed and, so far, the results are promising.

An algorithm for planning stereotactic brain implants.

A computer software package was developed for the planning and execution of brain biopsy and radioactive implant procedures with the BRW Stereotaxic System. With the application of computer graphics and a zero-one integer variable programming algorithm, an implant plan with accompanying isodose distributions and stereotactic coordinates can be easily accomplished at the time of the operation when the computer imaging terminal and a printer/plotter is placed in the operating room.