[COMPARATIVE STUDY OF THE TACTICS OF SURGICAL FIXATION WITH THE CLOSED INJURY OF THE CHEST: THE VIEW OF THE RESUSCITATOR, ECONOMIC ASPECTS].

The closed injury of chest with the breaks of edges is the vital problem of traumatology, anesthesiology and resuscitation For the change to conservative treatment with the aid of mechanical ventilation of lungs today come the methods of surgical fixation with the closed injury of chest. The conducted investigation showed the clinical and economic expediency of introducing the method of active surgical tactics.

[Fat embolism syndrome in skeletal trauma: particularities of the diagnosis, economic aspects and the role of non-invasive ventilation in intensive care].

The article deals with a multicenter study that demonstrates the possibility and feasibility of noninvasive ventilation in patients with skeletal trauma complicated wiith fat embolism syndrome. The authors found additional criteria for the severity of the condition of patients with trauma. Important criteria for the choose a type of ventilation (non-invasive and invasive) is the lack of consciousness, desynchronization of a patient with ventilator and the need for a specialized regimes or miorelaxation to synchronize with the respirator.

Diabetes induced by streptozocin results in a decrease in immunoreactive beta-endorphin levels in the pituitary and hypothalamus of female rats.

Immunoreactive beta-endorphin (IR-BE) was measured by radioimmunoassay in the anterior pituitary (AP), neurointermediate lobe of the pituitary (NIL), and hypothalamus of female rats 4 wk after being made diabetic by a single injection of streptozocin (STZ). STZ-induced diabetes resulted in a significant reduction in the content and concentration of IR-BE in the AP and the content of IR-BE in the hypothalamus. Total hypothalamic protein was also significantly diminished. IR-BE levels in the NIL were unchanged. Column chromatography indicated that the reduction in IR-BE in the AP of the diabetic female rats represented a decrease in peptides that co-eluted with beta-endorphin and beta-lipotropin. In the hypothalamus, the reduction in IR-BE was represented solely by a decrease in a peptide co-eluting with beta-endorphin. Beta-lipotropin was not detectable in the hypothalami of control or diabetic female rats. These results suggest that, in the rat, diabetes may produce alterations in the mechanism(s) that regulate endogenous opiate levels in the pituitary and hypothalamus.

Streptozocin diabetes alters immunoreactive beta-endorphin levels and pain perception after 8 wk in female rats.

Plasma, pituitary, and hypothalamic levels of the endogenous opioid peptide beta-endorphin were measured by radioimmunoassay and column chromatography in female rats 8 wk after the induction of diabetes with streptozocin (STZ) and in control female rats. In addition, pain perception was determined by measuring the latency to paw lick or jump after being placed on a hot plate. Plasma levels of immunoreactive beta-endorphin (IR-BE) were significantly reduced in STZ-induced diabetic female rats, as were the content and concentration of IR-BE in the neurointermediate lobe of the pituitary (NIL) and the content of IR-BE in the hypothalamus. The concentration but not the content of IR-BE in the anterior pituitary (AP) of the STZ-induced diabetic rats was increased significantly. Streptozocin-induced diabetes also resulted in a significant reduction in the total protein content of the AP, NIL, and hypothalamus. Column chromatography indicated that the decrease in IR-BE in the plasma, NIL, and hypothalamus represented a decrease in beta-endorphin, whereas the increase in IR-BE in the AP represented an increase in both beta-endorphin and beta-lipotropin. Diabetic animals consistently showed decreased latencies to paw lick or jump when subjected to hot-plate testing after 7 wk. These findings suggest that in female rats, central and peripheral endogenous opiate levels and tolerance to nociceptive thermal stimulation were diminished by 8 wk of chemically induced diabetes.

Growth-promoting effects of relaxin and related compositional changes in the uterus, cervix, and vagina of the rat.

Although the precise role of relaxin has yet to be elucidated, it has been implicated in the regulation of physiological and biochemical processes in the reproductive tract during pregnancy and parturition. In this study, the growth-promoting effects of relaxin and related compositional changes in the uterus, cervix, and vagina of immature ovariectomized estrogen-primed rats were examined. Relaxin increased the wet weight of the uterus, cervix, and vagina in a significant and linear manner over the log of the dose range (1-30 micrograms; 6 h). The increase in uterine weight was due to increases in both dry weight and water content at all doses. A dose of 1 microgram relaxin induced maximal increases in dry weights in the cervix and vagina over control values; higher doses increased wet weight, but these changes were due solely to increases in water content. Thirty micrograms of relaxin were found to increase total soluble protein and glycogen content of the vagina above control values after 6 h. Relaxin did not alter the total collagen levels of the uterus or cervix, and collagen concentrations were significantly reduced in these organs 6 and 24 h after treatment. Total glycosaminoglycan levels were elevated by relaxin in the uterus (6 h) and cervix (24 h). Total vaginal collagen was increased 24 h after relaxin injection, but the collagen concentration was decreased over the time interval studied, and glycosaminoglycan levels in the vagina were unaltered. In summary, relaxin stimulates growth of the uterus, cervix, and vagina by increasing water content and tissue mass. The increases in distensibility that relaxin induces in these organs appear to be related to changes in the fluid matrix and proteoglycan metabolism rather than alterations in collagen concentration, at least 6-24 h after a single injection. These results support the hypothesis that relaxin plays a significant role in the maintenance of pregnancy through its contribution to fetal accommodation and in the facilitation of parturition through expansion of the entire birth canal.

Demonstration of relaxin precursors in pregnant rat ovaries with antisera against bacterially expressed rat prorelaxin.

The existence of rat 18-kilodalton (kDa) prorelaxin, which has been postulated from the coding sequence of cloned cDNA and the results of cell-free translation studies, has been directly demonstrated in rat ovaries with antibodies against bacterially expressed rat prorelaxin. The peptide expressed in E. coli from a rat prorelaxin cDNA construct was comprised of the B- and A-chains of relaxin and a 105-amino acid connecting region. Immunoreactive bands of 18 and 16.5 kDa were shown in ovaries from day 20 pregnant rats. Partial amino acid sequence analysis of both peptides revealed that they had identical N-terminal sequences, corresponding to rat prorelaxin. Both 18- and 16.5-kDa bands were present only from midpregnancy until near term, when they declined sharply. These changes in the concentration of 18-kDa prorelaxin match changes in preprorelaxin mRNA levels, suggesting that relaxin synthesis is regulated at the transcriptional level and not by protein processing. Prorelaxin was transiently secreted by COS-1 cells transfected with preprorelaxin cDNA. Treatment of culture medium with trypsin resulted in the appearance of material corresponding in size to mature relaxin. Thus, correctly folded prorelaxin appears to be a suitable precursor for relaxin. The combined concentrations of 18- and 16.5-kDa peptides in ovaries on day 20 of pregnancy were considerably more than 30 times greater than that of relaxin, however, suggesting that prorelaxin might also be more than a precursor per se.

Rubella immunity in a cohort of pregnant women.

To assess the rubella immune status of a cohort of high-risk pregnant women visiting a Midwestern clinic, we retrospectively studied 50 random pregnancies per year from 1990 through 1996. Of 350 patients analyzed, 53 (15.1%) were not immune to rubella, and vaccination opportunities were missed.

Effects of long- and short-term vasectomy on structural and functional parameters of the rat.

The effects of vasectomy were examined by comparing various parameters from sham operated and vasectomized rats that had undergone surgery at 90 days of age and were killed at 190 or 390 days of age. Significant alterations in the vasectomized rats from sham rats included: testicular and epididymal hypertrophy, formation of pathologic vas deferens granulomas, decreased total serum protein, lowered alpha-globulin levels as shown by serum electrophoresis, and increased sperm agglutinin antibody titers. For vasectomized rats, the differential white blood cell count showed increased numbers of neutrophils and large lymphocytes and decreased numbers of small lymphocytes and basophils. Both the number and extent of many vasectomy-induced alterations were greater in long-term vasectomized than in short-term vasectomized rats.

Variance cardiography for emergency department evaluation of chest pain patients.

OBJECTIVE: To determine the test performance of 24-lead variance cardiography (VC), an ECG technique that measures QRS morphologic variability, for ED evaluation of chest pain associated with coronary artery disease (CAD). METHODS: A prospective, single-blind study of VC was performed in a community teaching hospital ED. All chest pain patients (> 30 years of age) who, after initial emergency physician evaluation, were believed to have pain of potential cardiac etiology and were admitted to the hospital were eligible. Exclusion criteria included obvious noncardiac etiology for discomfort, bundle-branch block, atrial fibrillation, and incomplete subsequent cardiac evaluation. After initial evaluation and stabilization, VC was obtained. The numerical output of VC was a CAD index (CADI). Serum myoglobin and creatine kinase (CK)-MB levels were obtained at the time of presentation and after one, two, and six hours. Hospital records were reviewed to determine final diagnosis and in-hospital evaluation results. RESULTS: Fifty-two of 75 eligible patients had complete data. Final diagnoses were as follows: 27/52 (52%), noncardiac; 13/52 (25%), acute myocardial infarction (AMI); and 12/52 (23%), unstable angina due to CAD. Twenty-three percent (12/52) of the patients had CADIs < 75. Eleven of these were found to have noncardiac origins for their chest pain. The twelfth patient had a 12-lead ECG revealing AMI and had been given thrombolytic therapy with subsequent reperfusion prior to VC. Using a CADI < 75 as the cutoff for a negative study, VC alone had a negative predictive value of 92%, a sensitivity of 96%, a positive predictive value of 60%, and a specificity of 41%. CONCLUSION: A CADI < 75, in addition to clinical impression and initial ECG, may identify chest pain patients who do not have significant CAD. Further prospective assessment of VC is warranted.

Laparoscopic tubal sterilization. The potential for thermal bowel injury.

One of the most severe complications of laparoscopic tubal sterilization is bowel burns, although they often go undetected at the time of laparoscopy. Controversy remains over whether these injuries are caused directly by operator error or indirectly from a hot oviduct's or instrument's inadvertently touching and burning the intestine. A study was performed to determine the potential for direct or indirect bowel burns using bipolar electrocoagulation in rabbits. The results indicate that neither a hot tube nor hot (recently used) forceps could cause injuries to the serosal surface of the intestine. That was true both of immediate injury and after one to five days of recovery. It was observed that the hot uterine tube caused significant bowel adhesions by five days after the procedure. Direct electrocoagulation of the bowel using 40 W for three seconds caused a minor, noticeable blanch on the bowel that was not detectable with gross or histologic means after one day of recovery. A direct bowel injury did result when 80 W was used for three seconds; the bowel became perforated after one day. These findings indicate that it is unlikely that one can produce a bowel burn indirectly from a hot uterine tube or instrument and that only a direct insult to the bowel appears to cause an injury. However, adhesions could be a complication of the procedure and should be considered.

A new and simple method of measuring menstrual blood loss.

Although it is difficult for women to make reliable judgments about their menstrual blood loss, the direct measurement of such blood loss is useful in diagnosis and in evaluation of therapy. We developed a new and simple procedure for measuring blood on sanitary materials. The procedure is a modification of previous alkaline hematin methods but overcomes some of their major drawbacks. The method involves the separate extraction of blood using a detergent solution and color development of sample aliquots with sodium carbonate. The standard curves obtained for four products tested--regular maxi pads, thin maxi pads and two brands of tampons--were significantly linear over the range of 1-10 mL of blood. The extraction efficiency varied with the four products; tampons exhibited the highest extraction efficiency and thin maxi pads the lowest. Blood loss in normally menstruating women was estimated to be 41.8 +/- 3.9 mL, which correlates well with other estimates reported. Furthermore, the procedure can be used to measure both very low and very concentrated levels of blood on pads or tampons and thus can be used to assess both functional and dysfunctional uterine bleeding.

Management of gestational diabetes by family physicians and obstetricians.

BACKGROUND: Studies suggest that there are differences between family physicians' (FPs) and obstetricians' (OBs) management of women with low-risk pregnancies. This study was conducted to examine outcomes in women with gestational diabetes mellitus (GDM) to see if similar patterns exist between those cared for by FPs and those cared for by OBs. METHODS: A retrospective chart review was undertaken and analyzed by prenatal care provider. Eight hundred thirteen women were identified as having a pregnancy complicated by GDM. Management outcome data of FPs and OBs were compared. RESULTS: Eighteen percent of patients were cared for by FPs. The percentage with a prior history of GDM did not differ between groups. Patient groups were similar demographically except that FPs cared for a significantly higher percentage of patients on public assistance (60% vs 38%, P < .001). Average prepregnancy weight and body mass index were equal, as were average weight gain, gestational week at entrance to care, and number of prenatal visits. Class instruction on diabetes was given to 83% of FP patients and 85% of OB patients. A greater percentage of OB patients were placed on insulin therapy (33% vs 24%, P < .05). Complications of pregnancy, labor, and delivery were equal, but a higher number of OB patients had a cesarean section (33% vs 11% for FPs). Despite the equal occurrence of preterm labor/delivery and low birthweight, OBs used tocolysis in significantly more women than did FPs (10.3% vs 4.7%, P < .03). Average birthweight of infants delivered by FPs and OBs (3259 g and 3356 g, respectively), macrosomia rate (12% and 13%, respectively), length of pregnancy, fetal complication rate, Apgar scores, and length of hospital stays were all equivalent. CONCLUSIONS: Although there are variations in the care of women whose pregnancy is complicated by gestational diabetes mellitus, there are no significant differences in neonatal outcome. There is, however, an overall lower rate of both cesarean section and tocolysis use among women cared for by FPs.

[The mechanism of skeletal musculature contraction induced by pulses of a high-intensity magnetic field]. / K mekhanizmu sokrashcheniia skeletnoi muskulatury, vyzvannogo impul'sami magnitnogo polia vysokoi intensivnosti.

Acute experiments on nembutal-anesthetized cats (50 mg/kg) were employed to investigate the effect of 1 T pulsating magnetic field (PMF) on neuromuscular system of the leg. Special techniques (tubocurarine administration, PMF exposure of the isolated nerve before and after cold blockade, immersion of the isolated nerve into the media with different surface area and electrical conductance) furnished evidence on muscular contractions resultant exclusively from stimulation of the motor fiber. The generation of the potential effect was recorded under the conditions of the nerve trunk contact with a conducting medium with surface area sufficient for appearance of the threshold potential difference in its periphery.

The effects of nifedipine on pregnancy outcome and morphology of the placenta, uterus, and cervix during late pregnancy in the rat.

OBJECTIVE: Although the calcium antagonist nifedipine has been reported to suppress preterm labor, little is known of the effects of long-term nifedipine use in late pregnancy. In this study the effects of nifedipine on pregnancy outcome and the morphologic features of the reproductive tract in the late-pregnant rat were investigated. STUDY DESIGN: From days 14 to 21 of gestation pregnant rats were administered three or 30 times the maximum human dose of nifedipine reported to suppress preterm labor. Analysis was performed on day 21. RESULTS: Blood vessel dilatation, increased vascularization of the uterus and placenta, and trophoblast hypertrophy were seen in both nifedipine-treated groups. Placental weight was increased in the higher-dose group, but neither dose of nifedipine resulted in any change of fetal survival or malformations. Pup weight was not different from that of controls in the lower-dose group but was significantly reduced (p less than 0.001) with the higher dose. Histologic changes in uterine musculature and cervical collagen were consistent with the inhibitory effects of nifedipine on uterine contractions. CONCLUSION: The results suggest that, in addition to tocolysis, nifedipine can cause vascular dilatation in both the uterus and the placenta. The use of nifedipine within the normal dose range does not appear to adversely affect fetal outcome and may potentially improve fetal outcome in some disorders of pregnancy.