Maternal attitude and psychophysical adaptation of women undergoing primary and secondary cesarean section

BACKGROUND: The increase of cesarean sections, which is typical of the most industrialised countries, resulted in a higher rate of repeat cesarean sections. The previous CS is the main indication for cesarean delivery. The purpose of this study is to compare women who had a primary cesarean with women who had a repeat cesarean section in order to assess their different emotional reactions as well as their psychophysical consequences. METHODS: A questionnaire was administered to 36 patients who had a primary cesarean section and to 34 patients who had a repeat cesarean section, 6-12 months after birth. All these women were similar for age and gestational age of the birth. RESULTS: Results underline that patients are more disposed to accept the operation in repeat cesarean rather than in primary cesarean. Women who have a repeat cesarean section are more likely to accept this kind of delivery since the beginning, with positive effects on their postoperative course. Women who have a repeat cesarean section face more serenely not only prenatal but also post-natal period and show less serious psychophysical sequelae with respect to primary cesarean section because of their previous experience. CONCLUSIONS: As a result, an appropriate psychological support coupled with adequate information can reduce discomfort in cesarean patients.     

The turnaround of the London Ambulance Service Computer-Aided Despatch system (LASCAD)

The implementation of the Computer-Aided Despatch system at the London Ambulance Service has been one of the most notorious cases of failure within the information systems (IS) literature. What is less well known is that there followed, some time later, a much more successful implementation, described as a turnaround. This paper, based on a case study approach, describes the context and detail of that implementation. A framework from the literature, used in an analysis of the initial failure, is used to analyse and compare the similarities and differences in the development of the two systems. The framework provides four interacting elements and relationships for analysis. These elements are Supporters, Project Organisation, Information System, and the Environment in which they operate. The turnaround system was found to address directly almost all the issues identified as problematic in the failure. These included the approach taken by management to understand the needs of users, including issues unrelated to the system itself, their involvement in the development process, an improvement in the availability of resources (brought about in some part because of the previous failure), the ability to follow a relaxed timeline driven by users' acceptance levels, the preparation of infrastructure projects to develop confidence, participation and prototyping, thorough testing, phased and simple implementation, and trust building. Certain environmental factors could not be so directly addressed but nevertheless were overcome by attention to detail and internal needs. Conclusions indicate that the factors addressed are not new and are to be found in the success literature. What is unusual is that they were implemented in this case in such unlikely circumstances.     

Time-dependent pharmacokinetics of high dose thiopental infusion in intensive care patients

PURPOSE: In patients with severe head injuries receiving long-term infusion for reducing intracranial pressure, a decline in concentrations was apparent following attainment of an initial steady state. This could be explained by an increased rate of elimination. An adequate modeling of the plasma disposition curves was used to demonstrate clearly the metabolic induction. METHODS: The concentration-time data of 17 patients were fit by a one compartment pharmacokinetic model in which the decline of plasma concentration during infusion was due to an increase in the clearance rate of thiopental following a latency period. This time-dependent clearance model provided estimates of initial and final clearance rates. RESULTS: This study demonstrated that large interindividual variations were observed during the course of the thiopental time-dependent pharmacokinetics. Depending on the patient, one or two steps of induction occurred. The mean initial and final clearance rates were 1.22 +/- 0.82 mL/min/kg and 10.5 +/- 23 mL/min/kg. The latency period for the first induction averaged 69 +/- 56 h. For 6 subjects, the rate of thiopental metabolism continued to change with time and there was a second step of induction. CONCLUSIONS: Induction of thiopental metabolism occur within therapeutic ranges, but it was not established that attainment of individual limits in dosing rate, total dose, or treatment duration occur in the process. Thus, monitoring is needed for achievement of a target plasma concentration.     

Pathological staging and biochemical recurrence after neoadjuvant androgen deprivation therapy in combination with radical prostatectomy in clinically localized prostate cancer: results of a phase II study

OBJECTIVES: To assess the pathological staging and biochemical progression-free survival (assessed using serum prostate-specific antigen level) of patients with clinically localized prostate cancer using neoadjuvant androgen deprivation therapy (ADT) in combination with radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: A prospective study was carried out on 69 patients with localized prostate cancer who were enrolled in a trial of 3 months of ADT followed by RRP (group 1). These patients were compared with 72 patients matched for age and clinical stage who declined ADT therapy and had RRP concurrently (group 2). Assignment to the individual treatment groups was thus determined by the patient's preference and not the physician's selection. Pathological staging and biochemical progression-free recurrence were compared between the groups. RESULTS: The rate of organ-confined (pT2) tumours was 74% in group 1 and 49% in group 2 (P < 0.01), and the rate of margin-negative tumours was 87% in group 1 and 64% in group 2 (P < 0.01). Within a median follow-up of 35 months, there was no significant difference in biochemical failure between the groups (P = 0.37). Patients with pT2 disease, regardless of treatment, had similar biochemical failure rates. In the patients with margin-positive disease, there was a significantly higher biochemical failure rate in group 1 (P = 0.02). CONCLUSIONS: The rates of organ- and specimen-confined disease were higher among the patients treated with ADT. The preliminary follow-up suggested that patients with pT2 disease after ADT have a biochemical progression-free recurrence rate similar to pT2 patients treated with RRP alone. Additionally, high biochemical failure rates in patients with margin-positive disease after ADT may identify a subset of more biologically aggressive tumours in need of early adjuvant treatment.     

Transcriptional down-regulation of myogenin expression is associated with v-ras-induced block of differentiation in unestablished quail muscle cells

This study examined the distribution of muscarinic acetylcholine receptor-immunoreactive neurons in the amygdaloid complex of the rat, with emphasis on the central nucleus. The monoclonal antibody M35 raised against purified muscarinic acetylcholine receptor protein was used to visualize muscarinic acetylcholine receptor-immunoreactive cells. Muscarinic acetylcholine receptor immuno-reactivity was high in the central nucleus and low to moderate in all other regions of the amygdaloid complex. Within the central nucleus, the muscarinic acetylcholine receptor-immunoreactive neurons were found predominantly in the lateral subdivision. This region contained medium-sized neurons (largest diameter ranging from 10 to 15 microns), with a round or slightly ovoid cell shape. At the subcellular level, however, the labeled neurons revealed relatively few muscarinic acetylcholine receptor-immunoreactive postsynaptic densities. Immunofluorescent double-labeling demonstrated that nearly all of the muscarinic acetylcholine receptor-immunoreactive neurons (98.6%) in the central nucleus expressed abundant amounts of nicotinic acetylcholine receptors, further substantiating the cholinoceptive character of these cells. In addition, the vast majority of these muscarinic acetylcholine receptor-immunoreactive neurons (94.3%) were GABAergic neurons. The muscarinic acetylcholine receptor-immunoreactive neurons expressed moderate levels of protein kinase gamma, one of the likely intracellular mediators between muscarinic acetylcholine receptors and their elicited physiological response. The number and staining intensity of muscarinic acetylcholine receptor-immunoreactive neurons in the central nucleus varied dramatically among rats. This individual variation correlated positively with the rat's expression of conditioned immobility and correlated negatively with active shock avoidance performance. These results suggest that the GABAergic/cholinoceptive neuronal elements in the central nucleus are involved in the expression of fear-induced behaviors. This interpretation is further elaborated in a forthcoming paper.     

Evaluation and characterization of micronuclei in early spermatids of mice exposed to 1,3-butadiene

The 18S rRNA gene (Rns) phylogeny of Acanthamoeba is being investigated as a basis for improvements in the nomenclature and taxonomy of the genus. We previously analyzed Rns sequences from 18 isolates from morphological groups 2 and 3 and found that they fell into four distinct evolutionary lineages we called sequence types T1-T4. Here, we analyzed sequences from 53 isolates representing 16 species and including 35 new strains. Eight additional lineages (sequence types T5-T12) were identified. Four of the 12 sequence types included strains from more than one nominal species. Thus, sequence types could be equated with species in some cases or with complexes of closely related species in others. The largest complex, sequence type T4, which contained six closely related nominal species, included 24 of 25 keratitis isolates. Rns sequence variation was insufficient for full phylogenetic resolution of branching orders within this complex, but the mixing of species observed at terminal nodes confirmed that traditional classification of isolates has been inconsistent. One solution to this problem would be to equate sequence types and single species. Alternatively, additional molecular information will be required to reliably differentiate species within the complexes. Three sequence types of morphological group 1 species represented the earliest divergence in the history of the genus and, based on their genetic distinctiveness, are candidates for reclassification as one or more novel genera.     

Low selenium status in the elderly influences thyroid hormones

The synthetic retinoid, N-(4-hydroxyphenyl)retinamide (4-HPR; Fenretinide), is a cancer chemopreventive and antiproliferative agent whose mechanism of action is unknown. 4-HPR alone is a poor inducer of differentiation of HL-60 cells compared to all-trans-retinoic acid (RA). Here, we found that combinations of 4-HPR and RA synergistically induced differentiation of HL-60 cells. In addition, 4-HPR increased the level of retinoylation, the covalent binding of RA to proteins. Retinoylation occurs in many eukaryotic cell lines and may be involved in RA-induced differentiation. These results suggest that 4-HPR may be a member of a class of retinoids that are active because they displace RA from extracellular and intracellular sites or because they inhibit RA catabolism. On the basis of these proposed mechanisms, retinoids that do not cause differentiation as sole agents may have utility in the clinic in combination with RA.     

Ocular sequelae of BB injuries to the eye and surrounding adnexa

BACKGROUND: BB injuries continue to be one of the most common causes of severe ocular injury among adolescent males. Extraocular and nonperforating anterior globe injuries most commonly result in favorable visual outcomes. The appropriate medical management of both perforating and nonperforating anterior globe injuries resulting from BB trauma and their potential ocular sequelae are reviewed. CASE REPORTS: Three cases illustrating typical as well as atypical anterior globe injuries caused by BBs are presented. Two cases involve nonperforating anterior globe injuries--one with intracranial and one with intraorbital involvement. The third involves a retained intraocular foreign body. The biomicroscopic and ophthalmoscopic features of these injuries are discussed, as are potential complications and management strategies associated with these types of trauma. CONCLUSIONS: Injuries associated with intraocular BBs often result in enucleation if functional vision is not salvageable. Sequelae to such injuries include endophthalmitis, traumatic hyphema, ocular siderosis, and sympathetic ophthalmia. Plain-film radiography and axial computed tomography are critical first steps in determination of the position of any intracranial or intraorbital metallic foreign body. Routine observation for the development of ocular sequelae resulting from retained intraocular, intracranial, and intraorbital BB injuries is recommended.