Does epidural analgesia cause dystocia?

STUDY OBJECTIVE: To analyze the effects of epidural analgesia for labor when dystocia occurs. DESIGN: Retrospective cohort study. SETTING: Academic health center. PATIENTS: 641 low risk, nulliparous women in spontaneous labor. INTERVENTIONS: 406 (63%) women received epidurals analgesia and 253 (37%) did not. Sixty women (9.4%) required an abdominal delivery for dystocia. MEASUREMENTS AND MAIN RESULTS: Women receiving epidural analgesia were more likely to be white, receive care from an attending physician, need labor augmentation, and deliver a heavier infant. Multivariate analysis identified five variables predictive of dystocia and abdominal delivery: pitocin augmentation odds ratio (O.R.) = 3.9 (2.0 to 7.6), duration of labor more than 20 hours O.R. = 2.4 (1.3 to 4.4), high epidural dose O.R. = 2.2 (1.2 to 4.1), birthweight over 4,000 grams O.R. = 2.0 (1.0 to 4.2), and early placement of epidural O.R. = 1. 9 (1.0 to 3.5). Repeating the regression after excluding the 20 women who developed abnormal labor prior to epidural placement (18 of 20 women had protracted dilatation) demonstrated that pitocin augmentation O.R. = 4.0 (1.8 to 4.), high epidural dose O.R. = 3.0 (1.9 to 6.2), duration of labor greater than 20 hours O.R. = 2.7 (1.3 to 5.7), and birthweight over 4,000 grams O.R. = 2.1 (0. 9 to 4.8) were associated with dystocia. CONCLUSION: Epidural analgesia appears to be a marker of abnormal labor rather than a cause of dystocia. High concentration anesthetics and epinephrine should be avoided, as they may influence labor. Randomized, controlled trials of this technique will be difficult to do; our work should reassure patients and their clinicians that epidural analgesia does not adversely affect labor.

Only 33% of visits for skin disease in the US in 1995 were to dermatologists: is decreasing the number of dermatologists the appropriate response?

The National Ambulatory Medical Care Survey conducted in 1995 provides an assessment of ambulatory medical practice including diagnoses, physician specialties, and insurance information. The National Center for Health Statistics collected data from non-federally employed physicians of all specialties using their standardized sampling technique. The database was reviewed for aspects of visits for skin diseases for all patients. The total number of visits for dermatologic disease in 1995 was estimated to be 22.0 million. 21.7% of these were first time visits and 24.3% were referrals. The leading dermatologic diagnoses in 1995 in order of frequency were acne, contact dermatitis, hypertrophic and atrophic conditions of skin, viral warts, malignant neoplasm of skin, benign neoplasm of skin, psoriasis, cellulitis and abscess, disorders of skin and subcutaneous tissue, and localized superficial swelling/mass/lump. Dermatology led all specialties in providing 32. 6% of the dermatologic outpatient care in 1995, followed by general/family medicine (22.7%), internal medicine (12.8%), pediatrics (11.2%), and all other specialties (20.7%). Of the visits to dermatologist in 1995, 3.78% were paid for by Medicaid. This paper presents dermatologic information pertaining to insurance, first time visits, referrals, diagnoses, and physician specialties.

Liposome-mediated delivery of gallium to macrophage-like cells in vitro: demonstration of a transferrin-independent route for intracellular delivery of metal ions.

Gallium (Ga) prevents the activation of macrophages and might be useful as an immunosuppressive agent. It is taken up by the malignant cells through the transferrin (Tf) receptor pathway, but this pathway may be insufficient in the case of non-malignant cells. We studied the Tf-independent, liposome-mediated delivery of Ga to macrophage-like cells in vitro by a growth inhibition assay. The growth inhibitory properties of Ga for other types of cells was also evaluated. Ga complexed with nitrilotriacetate (GaNTA) and encapsulated in DSPG-liposomes was 16 and 48 times more potent for RAW 264 cells than free GaNTA and Ga-nitrate, respectively. CV1-P cells were also somewhat sensitive to liposomal Ga, but other cell lines with lower endocytotic capacity were insensitive. The inhibition of RAW 264 cell growth induced by liposomal or free GaNTA was partially reversed with iron-loading of the cells, indicating that this form of Ga causes an intracellular iron deficiency similar to that produced by Tf-bound Ga. Our results indicate that encapsulation of Ga in negatively charged liposomes provides a transferrin independent route for intracellular delivery of the compound to macrophages, which is of special interest in the treatment of autoimmune diseases, such as rheumatoid arthritis.

Manpower requirements for radiologic technologists.

A report from a conjoint committee of the American College of Radiology and the American Society of Radiologic Technologists indicates that sufficient personnel are being educated for the profession. It is estimated that there are 130,000 persons operating radiographic equipment of which 100,000 are licensed or certified. On the average, a radiologic technologist performs 2,597 examinations per year. Manpower needs are highest in the South, South-west and Plains regions, with an excess in the West and Northeast. Most registered technologists who leave the profession do so for personal reasons, such as family commitments.

New presentation of alpha heavy chain disease: North American polypoid gastrointestinal lymphoma. Clinical and cellular studies.

Alpha Heavy Chain Disease has generally been described in the Mediterranean area in young people with a diffuse gastrointestinal lymphoma and malabsorption. We describe a patient from the United States with polypoid lymphoma of the gastrointestinal tract and a prolonged clinical course, who had the characteristic alpha heavy chain disease protein. He did not have malabsorption, and the gastrointestinal tract, though containing multiple discrete lymphomatous polyps had little plasmacytic reaction. Lymphosarcoma cell leukemia developed late in the course and the malignant cells had the characteristics of B lymphocytes but did not contain alpha heavy chains. The data support the contention that the lymphoma in this form of alpha heavy chain disease may involve B lymphocytes but that the abnormal protein may be produced by other cells. Polypoid varieties of gastrointestinal lymphoma in North America must now be considered part of the spectrum of alpha heavy chain disease and the diagnostic protein searched for diligently.

Role of a University Medical Center in the education of radiologic technologists: advanced education in radiologic technology.

The development of new and sophisticated imaging equipment, the rapidly changing medical diagnostic techniques, and larger and busier radiology departments put increasingly heavy demands on radiologic technologists. To cope with these demands, superficial knowledge and experience is not enough. The technologist who wished to advance on the career ladder must have more solid facts at his disposal and know how and when to use them if he is to perform efficiently and satisfactorily. The program described here provides a type of education that will permit the technologist to so advance with a feeling of security in the knowledge that he has the foundation needed to meet the challenges of his profession.

Fractionated dose of 35-MEV fast neutrons and hypoxic tumor cell survival curve.

The determination of the RBE for the MANTA fast neutrons produced by NRL is inprogress, with the model system using tumor cell population kinetic response patterns assayed in vitro after irradiation in vivo. Ascites tumor cells BW-5147 were irradiated with a clinically usable fast neutron beam from the NRL cyclotron, which is produced by accelrating deuterons to 35 MeV and using htem to bombard a thick berylliumtarget. The comparison of dose-effect relationships was made for doses ranging from30 to 1000 rads. The doses required for an isoeffect on BW-5147 hypoxic tumor cell survival and impairment of its reproductive capacity from fast neutron exposure were not different wheither it was given a single dose or the same dose given in three fractions separated by long recovery periods in situ. No intracellular repair of sublethal injury when the dose was given in three fractions, although the hypoxic BWp5147 tumor cells haveno effective reoxygenation or repopulation in this time interval. The RBE for the fast neutron beam is 4 relative to x rays for fractionated doses at the surviving fractionlevel of 0.6-0.7, while the RBE IS 2.5 FOR SINGLE DOSES. However, at a surviving fraction of 0.1, the RBE is 1.9 for single and 2.8 for fractionated doses. Analysis of thedaily cell population rate or mitotic delay between the two types of radiations at a similiar level of survival.

An evaluation of an automated radiographic table.

Results of an official field trial of an automated radiographic film-handling system for horizontal Bucky radiography without cassettes, complete with vacuum exposure magazine are reported. An integral tube stand may limit usefulness of the equipment; a fast film/screen combination and delayed film transport protects the x-ray tube. No film transport problems were found.

Where we stand on proficiency testing.

Because of the lack of comprehensive information in radiologic technology publications on the history, purpose and future implications of a process technologists hear talked about as "proficiency testing," and because of a lack of understanding of the role The American Society of Radiologic Technologists is playing in the project, the authors responded to a request by the editor to prepare this article. Since evaluation of the proficiency testing concept is still going on, this article is only a beginning and cannot be conclusive as to possible implementation, but it serves to provide substantial understanding through which the reader can evaluate future information.