Persistence of the fetal circulation

A 43-year-old woman with bilateral Adie's tonic pupils had a segment of one iris sphincter that contracted spontaneously every few seconds, but was not influenced by light, near vision, or eye movements.     

Measurement of fetal cells in the maternal circulation

There is evidence that the quantitation of fetal-maternal hemorrhage may be useful in reducing some of the RhoGAM failures in preventing Rh sensitization. The Betke-Kleihauer technique is a well-established method that has been used to estimate the amount of transplacental hemorrhage. Recently, a kit (Fetaldex) has become available for use in the detection and quantitation of fetal-maternal hemorrhage. Using control blood smears, we compared the results of the Fetaldex kit with those results obtained by the Betke-Kleihauer technique. The data indicate that the Fetaldex method is as accurate as the Betke-Kleihauer technique in detecting and measuring fetal red cells in the maternal circulation.     

Persistence of fetal circulation syndrome: an echocardiographic study

Serial echocardiograms were performed on 17 infants with persistence of fetal circulation syndrome to measure right ventricular systolic time intervals from pulmonic valve echograms and left ventricular systolic time intervals from aortic valve echograms. Right ventricular pre-ejection period/right ventricular ejection time ratio was prolonged in PFCS when compared to that in normal newborn infants, and diminished with clinical improvement. Left ventricular pre-ejection period/left ventricular ejection time ratio was prolonged in infants with PFCS. Echographic RPEP/RVET was consistent with the elevated pulmonary artery pressure and pulmonary vascular resistance of PFCS; elevated LPEP/LVET suggested left ventricular dysfunction.     

Transition from cold to hot thyroid nodules

We report three cases of autonomously functioning thyroid nodules (AFTNs) that appeared hypofunctioning at radioactive iodine (131I) thyroid scan carried out at initial observation. Since at that time thyroid hormones and thyrotropin (TSH) were also normal, they were initially classified as "cold" nodules and treated with levothyroxine (LT4). The correct diagnosis of AFTN was made years later when a thyroid scintigraphy was repeated. In two of these patients, re-evaluation of the nodule was done because of the development of LT4 intolerance. A possible explanation is that these AFTNs had undergone hemorrhagic/cystic degeneration when they were first studied, but in subsequent years, proliferation of residual AFTN tissue caused the recurrence of a typical functioning nodule.     

Laparoscopically treated extrauterine pregnancy

During a period of 12 months 55 women were treated for 56 ectopic pregnancies. Forty of the 56 (71%) procedures were performed laparoscopically. The duration of operation was 74 minutes when a conservative procedure was used, and 83 minutes where a salpingectomy was performed. The median duration of a diagnostic laparoscopy followed by laparotomy in 12 women was 83 minutes. Four women (13%) had persistent trophoblast, which necessitated a second operation. Two patients had a second laparoscopy because of lower abdominal pain, but did not need further treatment. Median hospitalization time (including diagnosis and second procedures) for the laparoscopically treated women was three days (range one to 16 days).     

The adaptation of the fetal red cells of newborn lambs to extrauterine life: the role of 2,3-diphosphoglycerate and and adult hemoglobin

The purpose of this study was to determine the interrelationship of the rise and fall of 2,3-diphosphoglycerate (DPG) with the increase in adult hemoglobin and the decrease in red cell oxygen hemoglobin affinity after birth in normal lambs. It was found that the mean maximum DPG level was 26.71 +/- 4.98 mol/g Hb at 7.5 +/- 1.1 days. At the same time the mean P50 and adult hemoglobin level was 27.0 +/- 1.4 mm Hg and 31.1 +/- 11.i%, respectively. In the individual lambs, the level of their maximum DPG correlated inversely with the amount of adult hemoglobin (r-0.77, P less than 0.05). Once the DPG began to decrease, there was an inverse correlation between the DPG and the adult hemoglobin present in the red cell (r = 0.68, P less than 0.001). It appeared that the rise in DPG postanatally is only a compensatory mechanism until an adequate amount of adult hemoglobin is present. This fact was borne out by the second part of the study in which exchange transfusions with adult red cells were performed on five newborn lambs during the first 24 hr after birth and aborted the rise in DPG.     

Transition from Nondeformable Projectile Penetration to Semihydrodynamic Penetration

With the increase of impact velocity, penetration mechanism may change at a transition point from nondeformable projectile penetration regime to semihydrodynamic penetration regime. Analysis is presented to predict this transition point. Good agreements between analytical predictions and experimental results are obtained.     

Cardiotocogram compared to Doppler investigation of the fetal circulation in the premature growth-retarded fetus: longitudinal observations

It was our objective to compare computerized fetal heart rate analysis with blood flow velocity waveform analysis of the arterial and venous fetal circulation in intrauterine growth retardation. We report five illustrative cases with longitudinal observations of fetal Doppler findings and fetal heart rate between 23 and 32 weeks of gestation. Blood flow waveforms were recorded from the umbilical artery, middle cerebral artery, descending aorta, ductus venosus and inferior vena cava. Fetal heart rate was analyzed by a computer system according to the Dawes-Redman criteria. The time sequence of deterioration is described individually for each fetus. An abrupt increase in pulsatility of ductus venosus waveforms with loss of forward flow velocity during atrial contraction preceded abnormally low short-term variation of fetal heart rate. With advanced gestational age and concomitant maternal disease, we observed severe alterations of flow velocity waveforms within 12 h of normal Doppler measurements, which is in contrast to findings in the second trimester, in which severely abnormal venous waveforms were observed over a period of several weeks before intrauterine death occurred. In a fetus with terminally low short-term variation, normal venous waveforms indicated fetal well-being despite an abnormal cardiotocogram (CTG). We challenge the current concept that the CTG is the best available parameter to determine the optimal time for elective delivery of premature growth-retarded fetuses. Deterioration in ductus venosus blood flow seems to precede an abnormal CTG and thus heralds the need for delivery.     

Activity of alkaline phosphatase in mouse brain at various periods of extrauterine life and following ethylnirosourea administration during fetal life]

It has been possible by seeing twenty cases of cholestasis in pregnancy to define certain characteristics of the condition. This pathology of pregnancy is frequently associated with twin pregnancy. The prognosis for the fetus is especially affected by prematurity. There is no evidence of small-for-dates babies, but the neonate gains weight slowly. Anaemia and jaundice in the neonates are common. The treatment of threatened premature labour using beta-mimetic drug is useful and of no danger to the mother.     

腹腔镜手术治疗异位妊娠的护理

异位妊娠是妇产科常见的急腹症之一,若不及时诊断和积极抢救,可危及患者生命,异位妊娠近年来有上升趋势,其中以输卵管最常见,随着医学不断发展,腹腔镜手术治疗异位妊娠具有创伤小,术后恢复快,痕疤小,早出院等特点,逐渐被患者接受,我科2008年以来异位妊娠采用腹腔镜手术治疗122例,手术均成功,现将护理体会介绍如下.     

药物联合治疗异位妊娠临床分析

目的:观察异位妊娠采用甲氨蝶蛉联合米非司酮治疗的临床效果.方法:选择异位妊娠病人62例,随机分为对照组与观察组各31例,观察组给予甲氨蝶蛉联合米非司酮联合治疗,对照组仅仅采用甲氨蝶蛉治疗;观察两组治疗后的临床情况并进行统计学分析.结果:一疗程后,两组的血β-HCG值、包块大小及住院时间各项指标比较,观察组明显小于对照组(P<0.05);观察组的有效率为93.5%明显高于对照组的80.6%,两组比较差异有显著性(p<0.05).结论:甲氨蝶蛉联合米非司酮治疗异位妊娠疗效明显高于单独的甲氨蝶蛉治疗,值得在临床中推广应用.     

Changes in blood velocities of fetal circulation in association with fetal heart rate abnormalities: effect of sublingual administration of nifedipine

Nifedipine has been used to treat hypertension in pregnancy, and does not influence fetal or uteroplacental circulations in patients with preeclampsia. A 29-year-old multi-gravid woman presented at 32 weeks' gestation with significant elevation of her blood pressure. After sublingual administration of nifedipine, the blood pressure decreased from 208/122 to 136/96 mm Hg at 30 minutes. In her growth-retarded fetus with abnormal flow velocity waveforms, pulsatility index values for middle cerebral artery and umbilical artery did not change; however, peak systolic velocities, end-diastolic velocities, and time-averaged mean peak velocities for these arteries became significantly elevated. Simultaneously, severe variable decelerations and late decelerations occurred. The adverse effect of nifedipine on fetal circulation might occur in a growth-retarded fetus with abnormal flow velocity waveforms.     

Transition from graduate school to internship: A potential crisis.

Notes that the transition from graduate school to a professional internship provokes considerable unexpected turmoil in the lives of psychology graduate students. Some individuals may display symptoms often associated with an emotional crisis. The clinical, institutional, and personal stressors created by this transition are discussed. Personal stressors involving the loss of meaningful relationships and difficulties in mourning are perceived to be of paramount importance. Because of the instability experienced in this transition, new interns may not function at their best, and supervisors should be wary of establishing base rates of competency for interns. Recommendations are presented on how graduate programs and professional internships can help students deal with the turmoil of this period. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)