Management of late induced abortions in France

OBJECTIVE: To evaluate the clinical results of comminuted patella fracture fixation after an extensile surgical approach by using a tibial tuberosity osteotomy. DESIGN: Prospective, clinical. PATIENTS: Six knees with displaced comminuted patella fractures had stable internal fixation after an osteotomy of the tibial tubercle. All had immediate postoperative continuous knee motion and were followed for an average of thirty-one months (minimum of eighteen months). OUTCOME MEASURES: Time to clinical and radiographic union, Hospital for Special Surgery (HSS) Knee Scores and comparisons with literature cohort studies. RESULTS: Clinical union of the osteotomy occurred at an average of eight weeks (range 6 to 12 weeks) and of the patella fractures at an average of eleven weeks (range 8 to 21 weeks). There was no radiographic evidence of osteotomy displacement, fracture implant loosening, migration, or failure. All patients had clinical residua, which included loss of motion, thigh muscle atrophy, and barometric complaints. HSS Knee Scores averaged 75 points with four good, one fair, and one poor result. These results were comparable to those of previously published reports of ablative surgery for this type of fracture. CONCLUSION: Comminuted patella fractures are severe injuries that usually result in some lingering morbidity. Internal fixation preserves bone stock, which facilitates future reconstructive procedures. The described tibial tuberosity osteotomy, patella eversion technique of fracture exposure improved visualization and reduction of the articular surface. The osteotomy healed in all cases and did not adversely affect the clinical results.     

Interrelation of fetal metabolism and late pregnancy in animals

Parameters of were determined for acid-alkali state of blood, energy, nitrogen, protein and mineral metabolism in fetuses and animals at the last period of pregnancy. It was established that one can observe the state of compensated acidosis, intensification of glycolytic and inhibition ot aerobic processes in animals with late pregnancy; that is evidenced by changes in the content of glucose, the level and the value of correlation of the components of lactate-, malate- and glutamate dehydrogenase systems, activity of lactate dehydrogenase, alkali phosphatase, alanine- and aspartate aminotransferase as well as electrolyte composition of the organism tissues. Analogous changes in metabolism are observe in the fetus tissues in late antenatal period of development.     

Rationale for systematic reviews

Systematic literature reviews including meta-analyses are invaluable scientific activities. The rationale for such reviews is well established. Health care providers, researchers, and policy makers are inundated with unmanageable amounts of information; they need systematic reviews to efficiently integrate existing information and provide data for rational decision making. Systematic reviews establish whether scientific findings are consistent and can be generalised across populations, settings, and treatment variations, or whether findings vary significantly by particular subsets. Meta-analyses in particular can increase power and precision of estimates of treatment effects and exposure risks. Finally, explicit methods used in systematic reviews limit bias and, hopefully, will improve reliability and accuracy of conclusions.     

Maternal smoking during pregnancy and psychiatric adjustment in late adolescence

Large-core (14g) needle biopsy (CNB) of the breast is a new diagnostic modality increasingly being used to evaluate patients with mammographic abnormalities. Two hundred twenty-four CNBs were performed on 198 patients. Surgical follow-up was available in 64 cases (28.6%). Overall concordance rate was 93.8% (60 of 64 cases). Of the four discordant cases, two were diagnosed as atypical ductal hyperplasia (ADH) on CNB; on excision, these cases showed cribriform ductal carcinoma in situ (DCIS); two remaining cases, diagnosed on CNB as ADH versus DCIS, showed invasive carcinoma (DCIS with invasive component and infiltrating cribriform carcinoma, respectively) on excisional biopsy. Malignancy, primary (52) or metastatic (5), was identified in 57 cases (25.4%); 47 of these patients underwent surgical excision, and the diagnosis was confirmed in all of these cases. Of 51 cases with radiographic evidence of microcalcifications, 48 (94%) had microcalcifications in the CNB: 30 (62.5%) were benign, 11 (22.9%) were malignant, and 7 (14.6%) were diagnosed as ADH. In the remaining three cases (1.3%), only benign breast tissue without microcalcifications was seen, and the lesion was considered to have been missed. Biopsy specimens were obtained from 173 lesions because of the presence of a mass: 125 (72.3%) were benign, 45 (26%) were malignant, and 3 (1.7%) were diagnosed as ADH. Follow-up was available in 118 patients with benign lesions: all were mammographically stable or decreased at 6 or 12 months; no follow-up was available for the remaining patients. CNB of the breast is a highly sensitive (96.9%) and specific (100%) technique for management of patients with mammographic abnormalities. The histologic findings should be correlated with the mammographic appearance, and an attempt should be made to achieve a specific diagnosis in all lesions, particularly masses. The diagnosis of ADH should always prompt excisional biopsy because of a high frequency of false-negative results caused by sampling errors or underestimation.     

The determination of human placental lactogen (HPL) for hormonal supervision in late pregnancy

In the serum of 145 women between the 34th and 42nd weeks of pregnancy, 209 radioimmunological determinations of human placental lactogen were made, using the Pharmacia, Uppsala, Sweden, HCS Phadebas Test. Following the determination of normal HPL levels in late pregnancy, the HPL values of high-risk pregnancies were investigated in relation to normal values and compared with the clinical pattern. A satisfactory relation was found between low HPL levels and fetal growth retardation. To some extent the HPL data can also be used in monitoring severe EPH-gestosis and postmaturity. Light cases of gestosis and pregnancies involving Rh-incompatibility do not affect HPL production. The clinical findings regarding HPL levels should not be overestimated in attempting to diagnose placental insufficiency.     

Predicting risk for pregnancy by late adolescence: A social contextual perspective.

To evaluate a model of social contextual influences on risk for adolescent pregnancy, 368 target adolescents (52% female, 48% male) and their mothers, fathers, and closest age siblings were assessed 6 times over a 7-year period beginning when the target adolescents were in 7th grade. Two pathways were found to increase risk for involvement in a pregnancy by late adolescence. Middle adolescent risk-taking behavior mediated the influence of early adolescent parental warmth–involvement and deviant-peer affiliations on involvement in a pregnancy by 12th grade. Also, early adolescent academic competence mediated the relationship between parental warmth–involvement and involvement in a pregnancy by 12th grade. Theoretical and practical implications of the results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of position on autonomic nervous activity in late pregnancy

We investigated the effect of three different recumbent positions on autonomic nervous activity in late pregnancy. Thirty pregnant and 24 nonpregnant aged-matched women were studied, and measures of heart rate variability in both time and frequency domains were compared using supine, right and left lateral decubitus positions. In the nonpregnant women, the normalised high-frequency power was greatest in the right lateral decubitus position. In the pregnant women, the normalised high-frequency power was lowest and the low/high-frequency power ratio was greatest in the supine position. Both the percentage decrease of normalised high-frequency power and the percentage increase of low/high-frequency power ratio in the supine and right lateral positions were greater than those in the left lateral position. For women in late pregnancy, the left lateral decubitus position may be beneficial because cardiac vagal activity is least suppressed and cardiac sympathetic activity is least enhanced. Aortocaval compression might be the mechanism underlying the change in cardiac autonomic nervous activity when supine and right lateral decubitus positions are assumed in late pregnancy.     

Diagnostic and prognostic significance of arterial pressure in late toxemia in pregnancy

Manganese content in blood sera of healthy subjects fluctuates within the interval of 0.008 mkg/ml to 0.032 mkg/ml--hence the requirement of especially sensitive methods for manganese determination. Atom-absorption methods are very suitable in this case because a minimal preparation of the sample is required. The authors intended the elaboration of a direct atom-absorption method, tracing manganese content in blood and urine. Manganese content in blood serum is rather close to the detectable minimum for manganese in its determination with the applied two-beam atom-absorption spectro-photometer. In the present work, the results from the prophylactic examinations of workers are presented, being in occupational contact with manganese (occupational-pathological screening) as well as from a control group of practically healthy volunteers--blood donors. Values in the interval 0.1017--0.032 mkg/ml with a standard deviation of 0.003 mkg/ml were obtained for the control group. The group of the workers examined, being in contact with manganese aerosols has an average value of 0.034 mkg/ml. Eighty eight per cent of all examined are in the interval from 0.01--0.05 mkg/ml. The rest 12 per cent work in shops where manganese elimination is higher. The method proposed is productive (up to 100 manganese determinations in diluted 1:1 serum per hour).     

Seasonal variation in spontaneous abortions

Using a national sample of hospital discharges, we found identical seasonal patterns for spontaneous abortions and conceptions but no significant seasonal variation in the rate of spontaneous abortions per 1,000 conceptions. The differences between our findings and those of previous investigators of spontaneous abortion may reflect our more comprehensive definition of spontaneous abortion, our more complete estimate of the monthly number of conceptions, and our more rigorous statistical analysis. The periodic regression analysis (PRA) reported in our study may be useful in other studies that monitor short-term trends.