Acute versus chronic conditions for studies of fetal nutrient requirements: applicability to the human.

In order to validate results obtained in 'acute' versus 'chronic' experimental conditions, two fetal sheep nutrients, lactate and glucose, have been determined in 'acute' conditions and compared with the 'chronic' data in the literature. Maternal and fetal blood glucose in 'acute' conditions was in the range of published 'chronic' data. Fetal blood lactate was similar in 'acute' and during 'chronic' conditions. Maternal and fetal veno-arterial (VA) differences were in the same direction in 'acute' and in 'chronic' conditions for both lactate and glucose and of the same magnitude for lactate. For glucose, a good relationship was observed between umbilical VA differences and maternal arterial concentrations for all 'acute' and 'chronic' values. Thus no fundamental differences appear in the results obtained in 'acute' or during 'chronic' conditions. The applicability of such animal results to the human and the use of acute conditions to study fetal nutrition in the human are discussed.

Does fetal acidosis develop with maternal glucose infusion during normal labor?

The actual effects of glucose infusion on fetal acid-base status were studied during 125 normal deliveries in which plasma glucose and acid-base parameters were determined after maternal infusion of either 10% glucose or Ringer's solution. After 80 minutes, mean (+/- SD) plasma glucose levels were significantly higher in the glucose group (N = 59) than in the Ringer's group (N = 66), both for the mother (183.6 +/- 46.8 versus 95.3 +/- 18.0 mg/dL) and the fetus (108.4 +/- 41.4 versus 64.8 +/- 16.2 mg/dL). Fetal plasma lactate concentrations did not differ between the glucose and the Ringer's groups, but were significantly lower in the fetuses delivered by elective cesarean section in both groups. With glucose administration, fetal pCO2 was higher and pH values were lower than in the Ringer's group. However, the magnitude of acid-base status changes, indicated by both pH and pCO2 shifts (ie, the difference between umbilical artery and scalp values), failed to differ between the two groups. In fetuses with progressing hypoxia, no differences in any of the acid-base parameters were observed between glucose and Ringer's administration. These data indicate that at a glucose infusion rate of 30 g/hour, fetal acidosis, when it occurs, results from hypoxia rather than from maternal glucose administration.

The validity of fetal heart rate monitoring during the second stage of labor.

Fetal blood pH, pCO2, and lactic acid were measured before and after the final period of the second stage of labor in an attempt to better understand th validity fetal heart rate (FHR) monitoring at this time. Following a classification derived from Melchior, six FHR patterns were recognized: 0, 1, 2a, 2b, 3, and 4. In the second stage of labor, until bearing-down efforts began, the fetal acid-base status did not change regardless of the type of tracing. At the time of delivery, as compared with values measured before the beginning of the final stage, the highest shift of lactic acid, coupled with the lowest pH shift, was associated with the type 3 pattern. The most rapid increases of lactic acid and pCO2 and decreases in pH were associated with type 2b patterns. Both type 3 and 2b patterns were ominous, but low Apgar scores were more frequent in type 3 because the duration of the final stage of labor was longer. Working from the mean slopes of the shifts of biologic parameters as a function of time, theoretical limits were derived and discussed for safe duration of the final stage of labor.

[The use of Fogarty's catheter for salpingoplasties in laparoscopic surgery]. / Intérêt de la sonde de Fogarty pour les salpingoplasties en coeliochirurgie.

Nowadays new techniques of laparoscopic surgery make it possible to carry out fimbrioplasties and salpingostomies with results as good as those obtained by microsurgery. We describe a new use for the Fogarty catheter as a means of traction and for demonstrating the ampulla and the fimbrial end of the tube. The pneumatic balloon of the end of the catheter is blown up in the tubal ampulla. This makes it possible to bring the tube close to the laparoscope which makes it possible to carry out precise precise maneuvers with such degrees of enlargement as make it like a form of microsurgery. This kind of procedure helps in these delicate and difficult operations.

[Acute fatty liver of pregnancy. Diagnostic value of hyperuricemia in the pre-jaundice stage]. / Un cas de stéatose hépatique aiguë gravidique. Intérêt diagnostique de l'hyperuricémie au stade pré-ictérique.

Acute fatty liver of pregnancy, with a case history where an early diagnosis could have been made, and a review of the French literature. Acute fatty liver of pregnancy, or Sheehan's syndrome is a rare but very serious complication of pregnancy. The disease is demonstrated by vomiting, abdominal pain and a high level of uric acid in the blood before jaundice is noted. Within a few days the triad of jaundice, pruritus and encephalopathy occur. These are often associated with toxaemia of pregnancy and with polyuria and polydipsia. A raised white blood count and a high level of bilirubinemia are almost always present. The outlook is very serious when haemorrhage appears. This malignant form of the disease is characterised by liver and kidney failure. Liver biopsy confirms the diagnosis. The prognosis is related to an early diagnosis and is good when labour is induced or caesarean section performed. Acute fatty liver of pregnancy is an emergency from the diagnostic as well as the therapeutic angles.

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide both clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

The role of context in the inhibitory conditioning of honeybees.

Conditioned inhibition or CI training (A+/AB-) was compared with S- training (A+/B-) in three experiments on proboscis-extension conditioning in harnessed honeybees. The purpose was to test the Rescorla-Wagner assumption, widely credited in the vertebrate literature, that a nonreinforced stimulus acquires inhibitory properties in proportion to the excitatory value of the context in which it is presented. In prior work with free-flying honeybees pretrained with sucrose to come of their own accord to the experimental situation, no differences were found in the consequences of CI and S- training, perhaps because A added little to the excitatory value of the context (already very high) in which B occurred. In the new experiments, with harnessed subjects brought involuntarily into the training situation, negative results again were obtained. The possibility is considered that inhibitory conditioning in honeybees is independent of the excitatory value of the context.

Suggested principles of professional ethics for the online provision of mental health services.

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.

[The Infraguide system in laparoscopic surgery]. / Le système infraguide en coeliochirurgie.

Infraguide is a system to transmit laser beams into the abdominal cavity through multiple reflexions in a hollow tube of ceramic mirror. The latter is protected by a metal tube of 3 mm outside diameter. After an experience of 45 cases, the authors analyse the advantages and the disadvantages of this system. The advantages are: the manageability, the small diameter, the excellent visibility of the pilot beam and the easy evacuation of the smoke. The disadvantage is minor: the focused spot cannot be smaller than 0.78 mm.

Are there two biological parts in the second stage of labor?

In 228 patients, fetal blood pH, pCO2 and lactic acid were measured in two distinguishable parts of the second stage of labor. The 'first' part begins at full cervical dilatation and ends when the mother starts her first voluntary bearing down efforts. In our study, the fetal acid-base status did not change in this part, regardless of a late developing hypoxia. In contrast, higher levels of lactic acid and pCO2 and lower pH values were observed in the 'final' part of the second stage, indicating increasing acidosis. In this 'final' part, the fetuses with clinical signs of distress, as defined by an ominous Apgar score at birth, showed quicker and larger acid-base shifts than did the normal fetuses. Thus the two parts of the second stage of labor actually differ in their potential to stimulate fetal acidosis. Since such fetal acidosis may develop especially during the 'final' part of labor, we have concluded that special particular attention should be devoted to this part.