The influence of the mode of anaesthesia in the incidence of neonatal morbidity after an elective caesarean section.

PURPOSE OF INVESTIGATION: We conducted a study of all the cases of elective caesarean section over a three-year period from 1 July 2001 to 30 June 2004, with the aim to compare general, epidural and spinal anaesthesia in respect to the incidence of neonatal respiratory morbidity. METHODS: It is an area-based retrospective study of all mothers who underwent elective caesarean section and delivered singleton infants at term gestation. Neonatal respiratory morbidity was recorded and compared between infants delivered with different anaesthetic techniques for caesarean section and those delivered vaginally. RESULTS: The rates of documented respiratory morbididy did not relate significantly to the anaesthesia mode (p > 0.05). Infants who were delivered at term by elective caesarean section were more likely to have respiratory problems than those who were delivered vaginally (8.1% vs 1.3%), p < 0.001). CONCLUSION: The different anaesthesia techniques in elective caesarean section do not seem to influence neonatal respiratory morbidity.

Induction of hepatic hematopoiesis with tenascin-C expression during the second trimester of development.

OBJECTIVE: To determine the role of tenascin-C in fetal hepatic hematopoietic proliferation and differentiation in different stages of development. STUDY DESIGN: We examined and compared the immunohistochemical expression of tenascin-C in the hepatic stromal portal fields in the first, second, and third trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells. RESULTS: Our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of tenascin-C in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (P<0.0001, t-test) and third trimester (P<0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 over the first (P<0.0001, t-test) and third trimesters (P<0.0001, t-test), suggesting a direct involvement of tenascin-C in the sustaining of hematopoietic activity. CONCLUSIONS: Our data provide evidence that an ECM glycoprotein component, tenascin-C, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

Chaotic and periodic analysis of fetal magnetocardiogram recordings in growth restriction.

OBJECTIVE: We studied how chaotic and periodic heart rate dynamics differ between normal fetuses (n = 19) and intrauterine growth restricted fetuses (n = 11) at 34 to 37 weeks of gestation. We quantified the chaotic dynamics of each heart rate time series obtained by fetal magnetocardiography (FMCG) using correlation dimension. METHODS: The FMCG was recorded digitally by a single-channel biomagnetometer in an electrically shielded room of low magnetic noise. The position of the fetal heart was determined using ultrasonography. RESULTS: The correlation dimension was significantly lower in IUGR than in normal fetuses (p < 0.001, t-test). The periodic dynamics were also obtained by FMCG and measured by power spectrum. The low-frequency components and therefore the periodicity of the low-frequency range were significantly higher in IUGR than in normal fetuses (p < 0.001, t-test). CONCLUSIONS: The analysis of FMCG recordings may offer important perspectives to understand significant features of the heart function of the fetuses. This technique improves the recognition of IUGR fetuses over healthy ones and may help improve perinatal morbidity and mortality.

Cystosarcoma phyllodes in a 13-year-old Muslim girl treated with conservative surgery: a case report.

Phyllodes tumor of the breast is an unusual tumor with an incidence of 1 in 100,000. In particular, it is a very rare neoplasm in adolescent girls and young women. The authors present a case of a 13-year-old adolescent girl with a large unilateral palpable mass in her right breast. The diagnosis of cystosarcoma phyllodes was made in a frozen section after wide local excision. The management and the cytological and histological characteristics are described with particular reference to the very unusual clinical presentation in this patient.

Correlation between biomagnetic and Doppler findings of umbilical artery in fetal growth restriction.

OBJECTIVE: To assess the value of biomagnetic recordings of the umbilical artery over Doppler ultrasound screening in order to predict complications of impaired uteroplacental blood flow in fetuses with intrauterine growth restriction (IUGR). METHODS: Our study population included 11 IUGR preeclamptic (34-37-weeks gestation; birth weight 1969 +/- 129 g) and 19 normal pregnancies (34-37-weeks gestation; birth weight 3195 +/- 229 g). Umbilical artery Doppler ultrasound waveform measurements were expressed in terms of pulsatility index (PI). Biomagnetic signals (waveforms) recorded from the IUGR umbilical artery were expressed in terms of magnetic power spectral amplitudes. RESULTS: In all cases, the frequency band considered was 2 to 7 Hz. The spectral amplitudes were low (mean: 117+/-24 fT/ radical Hz) in most (90.9%) IUGR pregnancies and high (mean: 224+/-37 fT/ radical Hz) in most normal pregnancies (89.5%). There was a statistically significant difference between normal and IUGR pregnancies with respect to spectral amplitudes (p < 0.0001), Doppler PI (p < 0.0005), pH (p < 0.0005) and Apgar score (p < 0.0005). Multiple linear regression analysis revealed an influence of PI, pH and Apgar scores on the biomagnetic values (ANOVA: p < 0.0005). CONCLUSION: Our data imply that biomagnetic values of the umbilical artery flow could prove to be a helpful method for the evaluation of fetal well being especially in pregnancies complicated with preeclampsia and growth restriction.

Small airway function in acromegaly.

Small airway function was studied in 21 acromegalic patients (13 females, 8 males) and quantitated as the maximal expiratory flow at 25 and 50% of vital capacity (VEmax25, VEmax50) breathing room air, as the difference of flow at 50% of VC breathing air and 80% helium 20% O2 (delta Vmax50) and as the volume of equal flows (VisoV). In addition, lung volumes were investigated by spirometry and body plethysmography. Static lung volumes were statistically significantly increased in both male and female acromegalic patients (p less than 0.05), but RV/TLC and FEV1/FVC did not change (p greater than 0.1). VEmax25, delta Vmax50 and VisoV showed an abnormal function of small airways in nonsmoking acromegalic patients. However, smoking acromegalics did not differ significantly from 'normal' smoking subjects, suggesting that the dysfunction of small airways is not a contributory factor to mortality from the disease. Maximal expiratory flows, when related to lung volume, were reduced in acromegalic women. Abnormal small airway function in acromegaly could either be due to obstruction or, more likely, to an exaggeration of dysanaptic lung growth.