Oxidant controlled regio- and stereodivergent azidohydroxylation of alkenes via I2 catalysis.

A novel, I2 catalyzed regio- and stereodivergent vicinal azidohydroxylation of alkenes leading to 1,2-azidoalcohols in high yields (up to 92%) and excellent dr (up to 98%) has been developed. This unprecedented transformation employs NaN3 and DMF as N- and O-nucleophiles respectively. The role of DMF as the O-source in the reaction has been unequivocally proven by (18)O labelling studies.

Cisapride improves gallbladder emptying and bile lipid composition in patients with gallstones.

BACKGROUND AND AIM: Biliary cholesterol supersaturation, gallbladder stasis and delayed intestinal transit are the key events in cholesterol gallstone formation. We studied the effect of cisapride, a prokinetic drug, on gallbladder emptying and bile composition in patients with gallstone disease undergoing cholecystectomy. METHODS: Gallbladder emptying, cholesterol saturation index (CSI) and nucleation time were studied in 21 patients with gallstone disease. Eleven patients (cisapride group, age 41.9 +/- 2.9 years) received tablet cisapride 10 mg t.i.d. for 2 weeks, while 10 patients (placebo group, age 42.1 +/- 1.9 years) received placebo for the same duration. Gallbladder emptying was repeated in all patients after a 2-week treatment with cisapride or placebo. Gallbladder bile was obtained at the time of surgery for the measurement of CSI and nucleation time. RESULTS: Residual volume of the gallbladder decreased (mean +/- SE, 18.6 +/- 2.5 mL vs 10.0 +/- 1.1 mL, P = 0.007), and the ejection fraction increased (43.5 +/- 5.3% vs 60.0 +/- 3.2%, P = 0.007) in patients in the cisapride group, while no change was observed in placebo group patients. Nucleation time was higher in the cisapride group than in the placebo group (14.9 +/- 1.3 days vs 8.0 +/- 0.9 days, P = 0.003). Patients in the cisapride group had a significantly lower cholesterol concentration (molar percentage, 5.1 +/- 0.3% vs 6.8 +/- 0.8%, P = 0.049) and CSI (1.0 +/- 0.1 vs 1.36 +/- 0.11, P = 0.034) than patients in the placebo group. CONCLUSION: Cisapride improves gallbladder emptying and bile lithogenicity in patients with gallstone disease.

Fertility outcome after reversal of sterilization.

OBJECTIVE: The study was designed to evaluate the fertility outcome in sterilization reversals and a variety of factors that have been suggested to influence the successful outcome of sterilization reversal procedures. METHOD: It is a retrospective study involving all sterilization reversals performed between January 1991 and December 1995 in our hospital. A total of 58 cases were treated. Tubal anastomosis was performed according to rules of microsurgery. The loupe microsurgical technique with 4 x magnification comprising two main phases, preparation of healthy tubal segments and anastomosis carried out in two layers. RESULTS: It was possible to study subsequent fertility of 50 patients in all, as 8 patients were lost to follow-up (13.76%). The overall conception rate was 68% (34 cases), out of which intrauterine pregnancy rate was 62% (31 cases), ectopic pregnancy rate was 6% and the abortion rate was 6%. Fifty percent of patients conceived within first 12 months of reversal of sterilization. The isthmic-isthmic type of anastomosis has maximum incidence of pregnancies (88.88%). CONCLUSION: Laparoscopic (Falope ring) sterilization should be preferred in women who are willing for interval sterilization and it should be done at isthmic segment of the tube, whereas the Pomeroy's method is to be reserved for occasional postpartum procedure. Reversal of sterilization should be done with strict adherence to principles of microsurgery.

Antinuclear antibodies in the serum of normal pregnant women: a prospective study.

A prospective study was performed to determine the incidence of antinuclear antibodies in 214 normal pregnant women and in 50 age-matched controls. Serum samples of 23 pregnant women (10.7%) yielded positive results (1 + or more at a dilution of 1:20) in contrast with only one sample (2%) in the control group (p less than 0.05). Of the pregnant women found to be positive, five (9.2%) were in the second trimester, and 18 (13.4%) were in the last trimester. Only two also had positive anti-DNA antibodies. A review of their hospital records disclosed no reason to suspect systemic lupus erythematosus or other rheumatologic diseases nor any significant increase in neonatal morbidity of their infants. We conclude that the incidence of antinuclear antibodies in pregnant women is significantly higher than in nonpregnant women and that the finding probably does not correlate with any adverse clinical effect.

Neurobehavioral effects of neonatal hypermagnesemia.

To investigate the effects on the newborn infant of maternal magnesium therapy for treatment of pre-eclampsia, we studied 36 hypermagnesemic infants born to pre-eclamptic mothers treated with MgSO4, 18 neonates born to untreated pre-eclamptic mothers, and 25 infants born to normal mothers. Impairment of neuromuscular transmission, as well as neurobehavioral differences when compared to controls, were found in hypermagnesemic infants. Awareness of the changes produced in the neonate by magnesium is important for accurate clinical assessment of the infant's condition, as well as for anticipating the postnatal interaction of magnesium with other drugs administered during labor and delivery.

Simplified irradiation dosimetry in carcinoma of the cervix (external irradiation and one radium insertion).

Gynecologic radiation oncologists have long desired a single unit by which radiation doses to specific reference points in the pelvis can be summed. The Patterns of Care Studies, Marcial's 1976 report to the Conference on Radiation Oncology of the American Cancer Society, and other radiation oncologists advise summed doses to Point A, Point B, or the pelvic side wall. Since there is a difference in the biologic effect of high intensity, long time interval teletherapy and low intensity, short time interval brachytherapy, the rad dose obtained from each modality cannot be simply added. Ellis and Sorenson in the Nominal Standard Dose (NSD) concept have described radium conversion factors that can be used to normalize brachytherapy rads at selected reference points to equivalent teletherapy rad. The two rad doses can then be summed. A simple method found useful in 50 cases of carcinoma of the cervix, and used with a computer or readily available reference tables and with any radium system, is described and discussed. Further clinical uses of the method are suggested.

Low-dose preoperative radiation therapy in carcinoma of the supraglottic larynx.

Seventy patients treated for all stages of carcinoma of the supraglottic larynx were analyzed retrospectively. A preoperative dose of 3,000--3,600 rads was given in 15 to 18 treatments over three to four weeks and surgery carried out four weeks later. The 5-year disease-free survival rates were approximately 75% in patients with early disease and 50% in those with more advanced disease. Survival with early disease was similar to that achieved by radical radiotherapy alone, while survival with advanced disease was similar to that achieved by surgery alone. These results suggest that low-dose preoperative irradiation is of limited value.