Postpartum stroke: a twenty-year experience.

OBJECTIVE: The aim of this study was to characterize the clinical presentation, etiology, and acute and subsequent outcomes of postpartum stroke. STUDY DESIGN: This 20-year, single-center, retrospective review included 20 women without previous neurologic deficit with clinical and neuroimaging diagnoses of postpartum stroke. RESULTS: Eight of 20 women (40%) were delivered abdominally. Conduction anesthesia was induced in 9 of 20 women (45%). Causes of stroke included cerebral infarction (n = 13; 7 venous, 6 arterial), intracerebral hemorrhage (n = 5; 1 cocaine-induced, 1 anatomic malformation), cerebritis (n = 1), and cerebral atrophy (n = 1). The median time at onset of stroke was 8 days post partum (range, 3-35 days). Headache, seizures, visual change, and hemiparesis were the most common presenting findings but were neither specific to the underlying pathologic condition nor predictive of ultimate maternal outcome. There were 2 maternal deaths, both caused by severe intracerebral hemorrhage. Intracerebral hemorrhage was associated with the poorest outcome (2 deaths and 1 residual neurologic deficit). Eight women had residual neurologic deficit. There was no correlation between a trial of labor (P =.4; odds ratio, 0.4; 95% confidence interval, 0.01-6.5) or vaginal versus cesarean mode of delivery (P =.6; odds ratio, 1.3; 95% confidence interval 0.1-16.8) and ultimate neurologic diagnosis (cerebral infarction or intracerebral hemorrhage). However, the incidence of cesarean delivery was greater in the cohort of women with postpartum stroke than in the overall obstetric population (P =.015; odds ratio, 3.2; 95% confidence interval, 1.2-8.5). One of the 20 women received methergine; 1 received bromocriptine. All women were either normotensive or had well-controlled hypertension at postpartum discharge. New-onset hypertension or exacerbation of existing hypertension occurred after the acute neurologic insult; subsequent mean (+/-SD) arterial blood pressure was 128.9 +/- 24.0 mm Hg. CONCLUSION: Postpartum stroke is a multifactorial, uncommon, and nonpreventable complication of pregnancy. There was an association between postpartum stroke and hypertensive disorders of pregnancy and cesarean delivery. However, this study refutes any etiologic association between conduction anesthesia and postpartum stroke.

Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation.

OBJECTIVE: We sought to characterize predictors of neonatal outcome in women with severe preeclampsia or eclampsia who were delivered of their infants preterm. STUDY DESIGN: We performed a retrospective analysis of 195 pregnancies delivered between 24 and 33 weeks' gestation because of severe preeclampsia or eclampsia. Multiple logistic regression and univariate chi(2) analysis were performed for the dependent outcome variables of survival and respiratory distress syndrome by use of independent fetal and maternal variables. A P value of <.05 was considered significant. RESULTS: In the multivariate analysis, respiratory distress syndrome was inversely related to gestational age at delivery (P =.0018) and directly related to cesarean delivery (P =.02), whereas survival was directly related to birth weight (P =.00025). There was no correlation in the multivariate analysis between respiratory distress syndrome or survival and corticosteroid use, composite neonatal morbidity, mean arterial pressure, eclampsia, or abruptio placentae. In the univariate analysis respiratory distress syndrome was associated with cesarean delivery (odds ratio, 7.19; 95% confidence interval, 2. 91-18.32). The incidence of intrauterine growth restriction increased as gestational age advanced. Furthermore, intrauterine growth restriction decreased survival in both the multivariate (P =. 038; odds ratio, 13.2; 95% confidence interval, 1.16-151.8) and univariate (P =.001; odds ratio, 5.88; 95% confidence interval, 1. 81-19.26) analyses. CONCLUSION: The presence of intrauterine growth restriction adversely affected survival independently of other variables. Presumed intrauterine stress, as reflected by the severity of maternal disease, did not improve neonatal outcome.

Eclampsia. VIII. Risk factors for maternal morbidity.

OBJECTIVE: This study was undertaken to identify risk factors associated with adverse maternal outcome in pregnancies complicated by eclampsia. STUDY DESIGN: This was a descriptive study of 399 consecutive women with eclampsia whose cases were managed at one perinatal center between August 1977 and July 1998. Data were collected. Risk factors studied included maternal age, race, parity, preexisting medical complications, and clinical and laboratory findings. Outcome variables were maternal morbidities. Data were analyzed by either chi(2) analysis or the unpaired Student t test as appropriate. RESULTS: In the entire cohort of women with eclampsia major maternal complications included abruptio placentae (10%), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (11%), disseminated intravascular coagulopathy (6%), neurologic deficits and aspiration pneumonia (7%), pulmonary edema (5%), cardiopulmonary arrest (4%), acute renal failure (4%), and death (1%, n = 2 patients with antepartum onset). Women with antepartum eclampsia had significantly higher incidences of abruptio placentae (12% vs 6%; P <.05) and HELLP syndrome (14% vs 4%; P =. 005) than did those in whom eclampsia developed post partum. In contrast, women with postpartum eclampsia were more likely to have neurologic deficits develop (9% vs 2%; P =.0006) than were those with antepartum eclampsia. In addition, women in whom eclampsia developed at

Presentation of venous thromboembolism during pregnancy.

OBJECTIVE: We sought to characterize the presentation, recurrence, and outcome of venous thromboembolism during pregnancy. STUDY DESIGN: We performed a 12-year, single-center, retrospective review of 38 patients with venous thromboembolism during pregnancy. The independent variables were subjected to univariate analysis (unpaired t test for normally distributed continuous variables and Fisher exact test for discrete variables). P <.05 was considered significant. RESULTS: There was no significant difference for the following variables according to time of presentation (antepartum vs post partum): gestational age at delivery (37.4 +/- 6.6 wk vs 38.1 +/- 2.4 wk; P =.7), birth weight (3257 +/- 458 g vs 3093 +/- 719 g; P =.3), and mode of delivery (2 vs 4 cesarean deliveries; P =.15). There were 2 maternal deaths. All 3 women with antepartum recurrent venous thromboembolism (despite heparin prophylaxis) had findings of protein C deficiency, protein S deficiency, and lupus anticoagulant-anticardiolipin antibody, respectively. CONCLUSION: The gestational age at presentation appears more equally distributed throughout gestation than previously reported. Notwithstanding limited numbers, the recurrence of venous thromboembolism despite use of prophylactic heparin therapy suggests the need to reexamine the current recommendations for heparin dosing.

[Epilepsy and cerebral tumor]. / Epilepsia y tumor cerebral.

OBJECTIVE: To determine clinical and pathological features with seizures associated brain tumors. PATIENTS AND METHODS: This was a retrospective study through of an Epilepsy Program Protocol where we studied fifty patients admitted at Hospital Universitário Cajuru of Curitiba, Brazil, in 1996-1997. RESULTS: We studied 36 males and 14 females, aged 6 and 81 years old (mean 40.5). Twenty six patients had tonic-clonic seizures, 13 had simple partial secondarily generalized, 8 had simple partial, 2 complex partial and one with simple partial progressing to complex partial seizure. CT showed parietal expansive lesion on 14 cases, frontal expansive lesion on 14 cases, frontoparietal on 5; intraventricular tumor, sella turcica, temporal temporoparietal and fronto-temporo-parietal expansive lesion 2 on each case, and suprasellar lesion, centrum semiovale, cerebello-pontine angle, ventricular trigone, fronto-naso-etmoidal and brain stem 1 on each case. All patients were submitted to a biopsy and/or resection of the lesion. The principal brain tumors were meningioma in 30%, astrocytoma in 22%, glioblastoma multiform in 14%, oligodendroglioma in 4% and pituitary adenoma in 4%.

Risk factors for abruptio placentae and eclampsia: analysis of 445 consecutively managed women with severe preeclampsia and eclampsia.

OBJECTIVE: Our purpose was to characterize the clinical presentation or laboratory variables predictive of either abruptio placentae or eclampsia in women with severe preeclampsia. STUDY DESIGN: Prospective collection of perinatal data from 445 consecutively managed women with severe preeclampsia and eclampsia. Univariate analysis was used to determine which of the independent variables were significantly different between the groups (abruptio placentae vs no abruptio placentae; eclampsia vs no eclampsia). Those with significant differences were then entered into multiple logistic regression analysis to determine those characteristics that were independently related to the outcome variable (abruptio placentae or eclampsia). Before multivariate analysis, the independent variables with an interval scale of measurement were converted to a dichotomous scale, with the receiver-operator characteristic curve used to determine a cutoff level. RESULTS: Univariate analysis revealed statistical significance for the following variables associated with eclampsia: uric acid concentration, > 8.1 mg/dL; proteinuria (>3+); headache; visual symptoms; deep tendon reflexes >3+; serum albumin concentration, <3 mg/dL; and serum creatinine concentration, >1.3 mg/dL. However, with subsequent multivariate analysis, only headache and deep tendon reflexes >3+ remained significant. Univariate analysis for variables associated with abruptio placentae revealed an association between bleeding and platelet count <60,000/mm3. There was no association between abruptio placentae and eclampsia and systolic, diastolic, or mean arterial pressure, quantitative proteinuria, epigastric pain, bleeding, gestational age at delivery, history of preeclampsia, or chronic hypertension. CONCLUSION: Quantitative proteinuria and degree of blood pressure elevation were not predictive of either abruptio placentae or eclampsia, as has previously been suggested. The greatest morbidity associated with eclampsia occurred in women with preterm gestations not receiving medical attention.

Prevention of preeclampsia.

Preeclampsia is a multisystem disorder of unknown cause. Efforts to prevent the disease or reduce its incidence have utilized pharmacological intervention as well as dietary supplementation. Recent, large, randomized trials have not shown a benefit from the use of aspirin. Calcium supplementation has also been studied extensively and found to be similarly ineffective in reducing the incidence or severity of preeclampsia in healthy women. The studies regarding the use of magnesium, zinc, and fish oils for the prevention of preeclampsia are fewer in number, but have also found minimal to no benefit. In the same respect, numerous randomized trials have been performed using antihypertensive agents, diuretics, and low-salt diet. Results of these studies have not shown any beneficial effect. Prevention of preeclampsia is unlikely as long as the underlying origin remains unknown.

Effects of aging and antioxidants on glucose transport in rat adipocytes.

The free radical theory of aging postulates that free radicals are the underlying cause of aging. One of the well-established age-associated disorders is the decrease in the insulin-stimulated glucose transport through the cell membrane which was reported to be a major mechanism underlying insulin resistance in old rats. The present study investigates the protective capacity of two known antioxidants, vitamin C and butylated hydroxytoluene (BHT), against age-associated free radical damage, which could be the reason behind the decreased insulin-stimulated glucose transport in old animals. Maximum insulin-stimulated glucose transport has been estimated in adipocytes isolated from adult 6-month-old Fischer rats and from senile 24-month-old control rats as well as from 24-month-old rats that were fed either vitamin C or BHT for 18 months. A significant increase in maximum insulin-stimulated glucose transport was observed in the BHT (p = 0.015) and the vitamin C groups (p = 0.039) compared with the control group of the same age. Significant stimulations with insulin over basal activities were also observed in the BHT group (p = 0.0001) as well as the vitamin C group (p = 0.009), while a nonsignificant stimulation (p = 0.097) was observed in the old control group. This study suggests a protective role that BHT (fat soluble) may have on the lipid moiety of the cell membrane and vitamin C (water soluble) on one or more of the intracellular cytoplasmic constituents concerned with glucose transport.

Radioprotective effect of vitamins C and E.

Albino rats were treated with aqueous vitamin C solution and vitamin E solution dissolved in olive oil at two concentrations, 100 and 300 mg/kg/day, for 6 months. Some of the animals were then subjected to whole-body irradiation. Chromosomal aberrations and mitotic activity in non-irradiated and irradiated groups were recorded. Both vitamins were found to be non-mutagenic. Vitamin C exerted a radioprotective effect but vitamin E was not radioprotective and it suppressed the radioprotection otherwise produced by olive oil.

Observation of continuous-wave on-resonance "self-focusing".

We report what to our knowledge are the first observations of an increase in the on-axis intensity of an intense cw on-resonance beam resulting from nonlinear absorption and diffraction during its propagation through a highly absorbing medium (sodium vapor). This "self-focusing" is not a self-lensing; instead it is modeled well by placing an aperture part way through the cell: The stripping by the aperture approximates the effect of the nonlinear absorption, and then Fresnel diffraction results in on-axis minima and maxima.

Morphological changes and the requirements for macromolecule synthesis during excystment of acanthamoeba castellanii.

Light and phase-contrast microscopic observations of excystment in Acanthamoeba castellanii have been used to classify cells in excysting populations as free trophozoites, or mature, activated, or preemergent cysts. These categories have been used to describe the kinetics of excystment. A pH of 7 and a temperature of 30 degrees C have been found to be optimal for the activation of mature cysts. Both activation and emergence are inhibited by cycloheximide and actinomycin D, but neither process is much affected by hydroxyurea. Cell-free extracts of high molecular weight components of cyst cytoplasm can support protein synthesis in vitro, although less efficiently than similar extracts from trophozoites. Evidence indicates that some of the functional RNA in the cyst extracts is synthesized before excystment.