A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor.

INTRODUCTION: Different society guidelines diverge regarding oral intake in labor. Our goal was to assess practices and opinions in Israeli labor and delivery units, comparing different disciplines. METHODS: An anonymous Google Forms survey was sent to anesthesiologists, obstetricians and midwives in all Israeli labor and delivery units. RESULTS: Responses were collected from all 27 labor and delivery units contacted, with a total of 501 respondents comprising 161 anesthesiologists, 102 obstetricians and 238 midwives. Forty-eight per cent stated there were no institutional guidelines for oral intake. The most common oral intake permitted was light food (60%). Midwives were significantly more likely than anesthesiologists and obstetricians to consider that women who are both low risk for cesarean delivery (P <0.00001) and high risk for cesarean delivery (P=0.001) should eat. Epidural analgesia did not impact recommendations regarding oral intake. The most common reasons for restricting oral intake were obstetric. Sixty-two per cent identified aspiration as the main risk associated with eating during labor, but 19% of midwives compared with 4% of anesthesiologists and obstetricians stated there were no risks (P <0.00001). The annual delivery volume of the unit did not impact staff practices. CONCLUSIONS: There was a discrepancy between opinions and practices across all disciplines. Permissive practices identified in this survey should be addressed to find the safe middle ground between restrictive and permissive policies for low- and high-risk women.

Modulation of ultraviolet light-induced epidermal damage: beneficial effects of tocopherol.

Oxygen free radicals have been shown to result from and mediate deleterious effects of ultraviolet radiation on the skin. The purpose of this study was to determine if topical DL-alpha-tocopherol (vitamin E) could reduce ultraviolet-induced damage to the epidermis. Twenty mice were treated with either ethanol or a 1:1 mixture of tocopherol and ethanol. Treatments consisted of once-daily 0.1-ml topical applications for 1 week, followed by irradiation with 0.30 mW/cm2 of ultraviolet B irradiation. A statistically significant decrease in Schiff base formation was noted between tocopherol-treated animals and their controls. Histologic study revealed a statistically significant increase in epidermal thickness in tocopherol-treated skin versus controls or vehicle alone. The thicker epidermis was accompanied by the presence of parakeratosis, implicating increased proliferation as the cause of the increasing thickness. The number of sunburn cells was decreased by tocopherol treatment. Tocopherol protection from ultraviolet irradiation may have been due to both direct protection from free radicals and indirect protection by means of increased epidermal thickness. The demonstration of beneficial effects of tocopherol administration suggests that further studies in clinically relevant models to define optimal dosage, frequency of administration, vehicle, and quantitation of the possible protective effects afforded to Langerhans cells may be useful.

Incidental detection of adult polycystic kidney disease on routine bone scan.

A routine bone scan performed on a 36-y old male incidentally demonstrated enlarged kidneys with multifocal areas of radionuclide concentration suggestive of polycystic kidneys. Further evaluation using ultrasonography, CT scan, and a 99mTc-GHA renal scan confirmed the initial impression. The routine evaluation of the kidneys on a bone scan is emphasized as a simple method of identifying previously unsuspected renal structural abnormalities.

Effects of dietary fish oil on renal insufficiency in rats with subtotal nephrectomy.

We studied the effects of fish oil on the progression of renal insufficiency in rats with subtotal nephrectomy. Five weeks after a 1-2/3 nephrectomy, sixteen rats were fed two different diets which differed only in fat composition. Lipid in the control diet was primarily beef tallow; that of the experimental diet, menhaden oil. Fish oil-fed rats had significant increases in plasma creatinines, decreases in urinary PGE2 and accelerated death rates. An additional twelve rats underwent 1-1/3 nephrectomies, and the same dietary manipulations, followed by renal clearance, histologic and biochemical studies after 12 weeks on the diets. Fish oil-fed rats again did worse, with decreased glomerular filtration rates and filtration fractions, more proteinuria and more glomerular sclerosis. Glomeruli and slices of cortex, medulla and papillae from rats fed fish oil produced much less PGE2 and TXB2 than dietary controls. Fish oil-induced suppression of renal PGE2 may be deleterious in this model and may outweigh the beneficial effect derived from TXA2 suppression. In contrast to fish oil's potentially therapeutic role in cardiovascular and immune-mediated renal disease, this diet is detrimental in rat renoprival nephropathy. This illustrates the importance of examining the effects of fatty acid manipulation individually for each disease entity.

Measurement of effective renal plasma flow: a comparison of methods.

We have compared two in vitro methods and three variations of kidney background (BG) subtraction within a gamma camera method (41 examinations, 31 patients) for determination of effective renal plasma flow (ERPF) using 131I orthoiodohippurate (OIH). Method I: plasma samples at 20 and 45 min after OIH injection, ERPF = dose X slope/intercept; Method II: 45-min plasma sample, ERPF = -51.1 + 8.21x + 0.019x2, x = dose/45-min plasma activity/I. Individual kidney and total ERPF were determined from gamma camera (GC) methods using renal uptake 1-2 min after injection. All methods were compared against Method I (previously validated against paraaminohippurate (PAH) clearances). Method II, which requires one blood sample is more accurate than GC methods. GC methods are insensitive to operator variability in placement of renal and BG regions of interest. They may be useful to follow changes in relative or total ERPF, but accurate depth correction of renal data is suggested. In vitro, blood sample-based methods are more accurate.

The implications of decreased performance of new generation gamma-cameras on the interpretation of 131I-Hippuran renal images.

Several patients with renal failure in whom the kidneys were more clearly imaged with 99Tcm-DTPA than 131I-Hippuran were recently observed. We have postulated that our newer generation gamma-cameras have a reduced capacity to image 131I in comparison to older generation cameras. This hypothesis was tested by comparing representative older and newer imaging systems. Full-width tenth-maximum 99Tcm linespread functions were 1.20 and 1.55 cm for the older and newer cameras, respectively. The 99Tcm count rate on the newer camera was 111% that of the older camera, and the observed kidney to background count ratios in a phantom model were virtually identical for the two cameras imaging a number of simulated 99Tcm count distributions. Full-width tenth-maximum 131I linespreads were 1.55 and 4.78 cm, respectively, on the older and newer cameras and the 131I count rate on the newer camera was 27% of the count rate on the older system. The phantom model demonstrated a consistently lower 131I perceived kidney to background count ratio on the newer gamma-camera compared to the older system. These findings should be considered in the interpretation of 131I-Hippuran studies on newer-generation equipment until revised criteria of interpretation have been established. Non-visualization of the kidney may not have the same prognostic implication using modern cameras as has been reported from studies with older generation detector systems.

Coexistence of chronic myelogenous leukemia and chronic lymphocytic leukemia.

A 55-year-old man is reported who initially developed chronic lymphocytic leukemia. Seven years later, after chemotherapy with chlorambucil, chronic myelogenous leukemia was diagnosed in addition to the chronic lymphocytic leukemia. Four previously reported cases with the same sequence of events are reviewed as well as cases of chronic myelogenous leukemia following chemotherapy alone.

Attitudes toward women physicians in medical academia.

To determine attitudes toward women physicians within medical academia, we administered a survey to a probability sample of male and female senior medical students, faculty, and top-level administrators in a randomized, stratified subset of ten medical schools. Of the 984 respondents (65% response rate), men were much less supportive overall than women of female leaders. While women strongly disagreed with the idea that women physicians who spend long hours at work neglect home and family, men were almost equally divided on this issue. Each group rated the "typical" faculty member as "strong, fair, and progressive," but male faculty also were characterized as "egotistical" while female faculty were rated more "sensitive and altruistic." Male students were least likely to support a search for a female dean, hiring more female faculty members, or accepting an incoming class in which the majority were women.

[The fate of psychotic delinquents. Follow-up study]. / Le sort des malades psychotiques délinquants. Etude catamnestique.

This work is a study of the fate of psychotic delinquents. In the first part, several family, individual, social and professional dates are examined in a number of 106 patients. It appears that, in addition to the psychosis, a weak intellect and a previous dissocial behaviour are the most promoting factors to delinquency. In the second part, the author reviews the evolution of psychosis among 90 patients, during an average catamnestic period of 27.85 years. She arrives to the conclusion that the illness develops in an unfavourable way. This however seems not to depend on the delinquency itself, nor on the forensic medicine measures, but is much more correlated to the form of the psychosis.

Indicine-N-oxide: the antitumor principle of Heliotropium indicum.

Extracts of Heliotropium indicum Linn. (Boraginaceae) showed significant activity in several experimental tumor systems. The active principle is isolated and shown to be the N-oxide of the alkaloid, indicine, previously isolated from this plant. Supporting structural data and anti-tumor data are provided.