Transabdominal cerclage placement in patients with prior uterine incisions: risk of scar disruption.

The object of this study was to describe pregnancy outcomes in women who had a transabdominal cerclage (TAC) placed after a prior uterine incision due to caesarean section or hysterotomy. This is a retrospective observational study of 57 women referred to a maternal-fetal medicine specialist (JES) for TAC placement after a previous uterine incision from 1989-2012. Pregnancy outcomes post-TAC placement are reported, including gestational age at delivery, survival rate and complications directly related to labour and the previous uterine scar. Of 51 women who had a prior uterine incision and were pregnant at TAC, 49 (96.1%) delivered viable infants at a mean gestational age of 35.9 weeks. One patient had intrauterine fetal demise at 16 weeks for causes likely unrelated to TAC and another had uterine rupture associated with a unicornuate uterus and advancing labour at 31 weeks. This study includes women with low transverse incisions, classical uterine incisions and higher order multiples. It was concluded that in women with a prior uterine incision, placement of a TAC is associated with low risk (2%) of uterine rupture.

Robotic-assisted transabdominal cerclage (RoboTAC) in the non-pregnant patient.

The use of cerclage, either through vaginal or abdominal routes, to assist in delaying pre-term delivery among select women with cervical insufficiency may be beneficial, but can also carry significant morbidity. Robotic-assisted transabdominal cervical cerclage (RoboTAC) in the non-pregnant patient has the ability to not only reduce associated morbidity, but also offer the same benefits as the more traditional laparotomy and laparoscopic approaches, while removing the risk to an in situ fetus. We report the use of robotic-assisted transabdominal cervical cerclage in 24 non-pregnant women. Feasibility of the procedure is discussed along with a description of the technical surgical details. In addition, limited pregnancy outcomes are presented. Our results suggest that RoboTAC is a safe alternative to the traditional laparotomy procedure with quicker recovery time.

Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon.

This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks' gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.

Evaluation of lactobacillus preparation on eterotoxigenic E. coli-induced rabbit ileal loop reactions.

A commercially available lactobacillus-containing preparation has been used extensively in the treatment of diarrhea but few laboratory tests have been performed to determine the efficacy of this product. The rabbit ileal loop reaction was used here to determine the effect of the lactobacillus preparation and its ingredients on E. coli enterotoxin-induced loop fluid response. Enterotoxigenic E. coli cells grown overnight in shake cultures were washed and resuspended in saline to the original volume. They were then diluted in TSB suspensions of the lactobacillus preparation or its ingredients and injected into ileal loops. E. coli diluted in TSB served as positive controls. Fluid response was measured after 18 hours and the loop fluid ratio (LFR) (ml./cm.) of the lactobacillus preparations was compared to the positive controls. The positive controls always showed a high loop fluid ratio (greater than 1.1 ml./cm.) and negative saline controls showed no fluid response. The lactobacillus granules and tablets had low LFR's (0.08 and 0.05, respectively). Ingredients (whey, talc, sugar, evaporated milk, mineral oil) had variable LFR's (0.65, 0.78, 1.39, 1.46 and 1.54, respectively). Individual ingredients used to make this preparation show little antifluid response when used separately but the final product exhibits a significant antienterotoxin response.

Anaerobic utilization of phosphite and hypophosphite by Bacillus sp.

A Bacillus sp. capable of utilizing phosphite and hypophosphite under anaerobic conditions was isolated from Cape Canerval soil samples. The organism was isolated on a glucose-mineral salts medium with phosphate deleted. Anaerobic cultivation of this isolate resulted in decreases in the hypophosphite or phosphite concentration, increases in turbidity, cell count, and dry-cell weight, and decreases in pH and glucose concentration. The optimum hypophosphite concentration for this isolate was 60 microgram/ml, whereas the optimum phosphate concentration was greater than 1,000 microgram/ml, suggesting that higher concentrations of hypophosphite may be toxic to this isolate. Hypophosphite or phosphite utilization was accompanied by little or no detectable accumulation of phosphate in the medium, and 32P-labeled hypophosphite was incorporated into the cell as organic phosphate. When phosphate was present in the medium, the isolate failed to metabolize phosphite. In the presence of phosphite and hypophosphite, the isolate first utilized phosphite and then hypophosphite.

Response of terrestrial microorganisms to a simulated Martian environment.

Soil samples from Cape Canaveral were subjected to a simulated Martian environment and assayed periodically over 45 days to determine the effect of various environmental parameters on bacterial populations. The simulated environment was based on the most recent available data, prior to the Viking spacecraft, describing Martian conditions and consisted of a pressure of 7 millibars, an atmosphere of 99.9% CO2 and 0.1% O2, a freeze-thaw cycle of -65 degrees C for 16 h and 24 degrees C for 8 h, and variable moisture and nutrients. Reduced pressure had a significant effect, reducing growth under these conditions. Slight variations in gaseous composition of the simulated atmosphere had negligible effect on growth. The freeze-thaw cycle did not inhibit growth but did result in a slower rate of decline after growth had occurred. Dry samples exhibited no change during the 45-day experiment, indicating that the simulated Martian environment was not toxic to bacterial populations. Psychotrophic organisms responded more favorably to this environment than mesophiles, although both types exhibited increases of approximately 3 logs in 7 to 14 days when moisture and nutrients were available.

Evaluation of a new microquantity blood collector.

A new device for collecting small amounts of blood from laboratory animals offer distinct advantages over standard syringes during the collection of serum or plasma.

Dry-heat resistance of selected psychrophiles.

The dry-heat resistance characteristics of spores of psychrophilic organisms isolated from soil samples from the Viking spacecraft assembly areas at Cape Kennedy Space Flight Center, Cape Canaveral, Fla., were studied. Spore suspensions were produced, and dry-heat D values were determined for the microorganisms that demonstrated growth or survival under a simulated Martian environment. The dry-heat tests were carried out by using the planchet-boat-hot plate system at 110 and 125 degrees C with an ambient relative humidity of 50% at 22 degrees C. The spores evaluated had a relatively low resistance to dry heat. D(110 degrees C) values ranged from 7.5 to 122 min, whereas the D(123 degrees C) values ranged from less than 1.0 to 9.8 min.

Isolation and characterization of omnitherms and facultative anaerobes from Cape Canaveral soil samples.

In a bacterial population profile of interplanetary spacecraft environments based upon temperature and oxygen requirements, several isolates demonstrated the ability to grow over a temperature range from 3 degrees C to 55 degrees C, and most grew aerobically and anaerobically. Because of the adaptability of these organisms, they may be of significance to planetary contamination. To verify that these were actively growing in this range of temperatures, they were streaked onto trypticase soy agar (TSA) and incubated at the extreme temperatures (3 degrees C and 55 degrees C). Isolated colonies were transferred to fresh TSA and immediately incubated at the opposite extreme temperatures. Almost all of the isolates grew quite well at both temperatures. Because these have been subcultured numerous times and still possess the ability to grow over a broad temperature range, this appears to be a stable characteristic. Many of these isolates possess the ability to grow anaerobically at 3, 32 and 55 degrees C. All of these organisms are sporeformers, and data are presented concerning their heat resistance and biochemical activity.

Anaerobic utilization of phosphite/phosphine as a sole source of phosphorus: implication to growth in the Jovian environment.

The objective of the investigation was to isolate anaerobic micro-organisms which had the ability to utilize inorganic phosphorus in forms other than phosphate. The first part of this investigation was to isolate from Cape Canaveral soil micro-organisms capable of utilizing phosphite as their phosphorus source under anaerobic conditions. In an attempt to demonstrate this ability, a medium was prepared which contained hypophosphite as the phosphorus source. This was inoculated with soil samples, and growth was subcultured at least four times. To verify that these isolates could use hypophosphite, they were inoculated into defined hypophosphite medium, and samples were removed periodically and killed with formalin. Growth was determined by turbidity measurements and the sample was then filtered. The filtrate was separated by chromatography and the total amounts of hypophosphite, phosphate and phosphate in the filtrate were measured. By this procedure it appeared that the hypophosphite level began decreasing after 14 hr of incubation suggesting utilization of the hypophosphite under anaerobic conditions. The third part of this investigation used labeled (32P) hypophosphite in a defined medium; the cells were then lysed and the metabolic compounds separated by the use of paper chromatography and autoradiograms, demonstrating the presence of 32P in intermediate metabolic compounds. Similar investigations are now being performed with phosphine as the phosphorus source.

Psychrophilic microorganisms from areas associated with the Viking spacecraft.

Microorganisms capable of growth at 7 C were enumerated and isolated from soil samples from the manufacture and assembly areas of the Viking spacecraft. Populations ranging from 4.2 X 10(3) to 7.7 X 10(6)/g of soil were isolated from the 15 soil samples examined. Temperature requirements were determined, and those growing at 3 C, but not at 32 C, were designated as obligate psychrophiles in this investigation. Populations of soil bacteria, including aerobic sporeformers, ranging from 1.5 X 10(2) to 9.8 X 10(5)/g were capable of growth at 3 C, but not at 32 C. Bacterial isolates were identified to major generic groups. No psychrophilic sporeformers were isolated from soil from the manufacture area, but psychrophilic sporeformers ranged from 0 to 6.1 X 10(3)/g from soil from the assembly area.