A new experimental model of acute osteomyelitis due to methicillin-resistant Staphylococcus aureus in rabbit.

AIMS: To assess the impact of antibiotic therapy on severe osseous infections, animal models of chronic bacterial infections have been developed; however, these models suffer from many experimental limitations. The aim of this work was to develop a new model system in which high levels of bacteria are obtained within femoral bone marrow and bone tissue, and such infections are maintained for at least 14 days. METHODS AND RESULTS: Experimental osteomyelitis was induced in 25 New Zealand white rabbits. A 10(9) CFU ml(-1) suspension of methicillin-resistant Staphylococcus aureus was injected into the knee after bone trepanation. On day 3, surgical debridement was performed to mimic a surgical procedure. Animals were euthanized 1, 2, 3, 9 and 14 days post-inoculation to determine the bacterial counts in marrow and bone, and to evaluate the stability of the infection. Inoculated lesions also were assessed for changes in histological parameters on days 3 and 7 post-inoculation. At days 1, 2, 3, 9 and 14 post-inoculation, we observed 6·50 ± 0·64, 7·30 ± 0·49, 7·82 ± 0·19, 8·00 ± 1·48 and 8·99 ± 0·20 log10 CFU g(-1) in bone marrow and 8·40 ± 0·68, 7·65 ± 0·27, 7·58 ± 0·30, 8·88 ± 0·52 and 8·28 ± 0·39 log10 CFU g(-1) in bone tissue, respectively. No statistical differences in bacterial count were found between bone marrow and bone tissue at any time point. CONCLUSION: This new model of acute osteomyelitis was validated by histological and microbiological changes in the absence of sclerosing agents, and these changes remained stable for 14 days. SIGNIFICANCE AND IMPACT OF THE STUDY: These results describe a new experimental model of acute osteomyelitis and demonstrate its usefulness in assessing the activity of antibacterial agents in vivo soon after bone infection.

Comparación del postoperatorio de dos colgajos en cirugía de terceros molares inferiores / Post operative comparison of two flap designs in lower third molar surgery

La cirugía de terceros molares constituye en la práctica de la cirugíaoral y maxilofacial, una de las intervenciones más realizadas. Las indicacionesson variadas, desde medidas profilácticas hasta grandes lesiones osteolíticas.Algunas de las consecuencias después de dicha intervención son;edema, trismus y dolor postoperatorio. En la técnica quirúrgica, el colgajocobra gran importancia a la hora de minimizar estas consecuencias. El objetivodel presente estudio es evaluar el postoperatorio de la cirugía de tercerosmolares mandibulares incluidos, utilizando un colgajo lineal en un ladoy un colgajo triangular en el otro lado del mismo paciente.Se realizó un estudio prospectivo en 15 pacientes de la Facultad de Odontologíade la Universidad Mayor. Se tomaron registros fotográficos estandarizadosy se midió la apertura bucal máxima pre-quirúrgica de cada paciente.Se registró el edema, la limitación de apertura bucal y el dolor a las 48horas y a los 7 días, además del tiempo intraoperatorio. Todos los datos fueronanalizados estadísticamente. No existen diferencias significativas en eledema, limitación de la apertura ni dolor al utilizar ambos colgajos. Tampocoexiste correlación entre el tiempo operatorio y las tres variables estudiadas.El postoperatorio de la cirugía de terceros molares mandibulares incluidos essimilar al utilizar un colgajo lineal o un colgajo triangular. El cirujano puedeoptar por uno o el otro indistintamente, según su preferencia(AU)

One of the most common procedures in the field of Oraland Maxillofacial Surgery is third molar surgery. From prophylacticmeasures to large osteolytic lesions, there are various indications.Some of the consequences of this procedure are; edema, trismusand postoperative pain. Flap design is an important feature ofsurgical technique that plays a vital role in minimizing theseconsequences. The objective of this study is a post operativeevaluation of included third molar jaw surgery using a linear flapon one side and a triangular flap on the other side of the samepatient.A prospective study of 15 patients from the Dentistry College at theMajor University was carried out. Before surgery standard photoswere taken and maximum oral opening was measured for eachpatient. The edema, maximum oral opening and pain were measured48 hours and 7 days after surgery. All of the data were analyzedstatistically. There are no significant differences in the edema, abilityto open the mouth or the level of pain using the two types of flap.There also is no correlation between the operation time and thethree variables studied.The postoperative edema, pain and trismus after included thirdmolar surgery are similar when using linear or triangular flap designs.The surgeon can choose one or the other indistinctly, accordingto his/her preference(AU)

[Clinical utility of the 64-card version of the Wisconsin Card Sorting Test in patients with traumatic brain injury]. / Utilidad clinica de la versión de 64 cartas del test de clasificación de cartas de Wisconsin en pacientes que han sufrido un traumatismo craneoencefálico.

AIMS: To analyze the validity of the single deck 64-card Wisconsin Card Sorting Test (WCST-64) compared to the standard version (WCST-128), and to study the sensibility of both versions to identify changes over time in patients with traumatic brain injury (TBI). PATIENTS AND METHODS: The WCST was administered twice across a 6-month period to a sample of 50 patients with TBI. Pearson correlation coefficients were calculated to examine bivariate associations between WCST-128 scores and the corresponding WCST-64 scores at inclusion and at follow-up. Agreement in classification of impairment (z = -1) or normal performance was calculated for the two tests (kappa). Significant change over time was also analyzed for both versions of the test (paired-samples t test). RESULTS: The results revealed positive and significant correlations between both measures as well as a significant agreement in the classification of patients as having deficits or not. Moreover, the WCST-128 and the WCST-64 showed similar ability to identify changes over time. CONCLUSIONS: Our findings showed strong associations between scores derived from the two test and support the comparability of both versions when analyzing cross-sectional or longitudinal data. The findings support the use of the WCST-64 in evaluations of executive deficits of patients with moderate and severe TBI.

Utilidad clínica de la versión de 64 cartas del test de clasificación de cartas de Wisconsin en pacientes que han sufrido un traumatismo craneoencefálico / Clinical utility of the 64-card version of the Wisconsin card sorting test in patients with traumatic brain injury

Estudiar la relación entre las versiones estandarizada (WCST-128) y abreviada (WCST-64) del test declasificación de cartas de Wisconsin, con el fin de valorar su utilidad comparable y establecer la sensibilidad de ambas versiones para detectar cambios a lo largo del tiempo en una muestra clínica de pacientes con el diagnóstico de traumatismo craneoencefálico (TCE). Pacientes y métodos. La muestra estuvo compuesta por 50 pacientes con TCE, que fueron evaluadosen dos ocasiones, con un intervalo de aproximadamente seis meses. Se correlacionaron las puntuaciones entre ambas versiones tanto al inicio como al final (Pearson), así como su capacidad para detectar alteraciones (kappa) y cambios a lo largo del tiempo (t de Student para muestras pareadas). Resultados. Los resultados mostraron correlaciones positivas estadísticamentesignificativas entre las puntuaciones directas de la mayoría de los índices de ambas versiones, así como un significativo acuerdo en la clasificación de los pacientes en función de la presencia (z = –1) o no de déficit, tanto en la primera como en lasegunda valoración. Además, ambas versiones mostraron capacidad similar para detectar cambios a lo largo del tiempo. Conclusiones. Nuestros resultados demuestran la utilidad comparable entre el WCST-128 y el WCST-64, tanto transversal como longitudinalmente, de forma que ambas versiones se pueden considerar igualmente idóneas para la detección de déficit en funciones ejecutivas en pacientes que han sufrido un TCE. La versión abreviada, sin embargo, sería más apropiada cuando sequiera reducir el efecto fatiga teniendo la garantía de una detección del déficit adecuada

To analyze the validity of the single deck 64-card Wisconsin Card Sorting Test (WCST-64) compared to thestandard version (WCST-128), and to study the sensibility of both versions to identify changes over time in patients with traumatic brain injury (TBI). Patients and methods. The WCST was administered twice across a 6-month period to a sample of 50 patients with TBI. Pearson correlation coefficients were calculated to examine bivariate associations between WCST-128scores and the corresponding WCST-64 scores at inclusion and at follow-up. Agreement in classification of impairment (z = –1) or normal performance was calculated for the two tests (kappa). Significant change over time was also analyzed for both versions of the test (paired-samples t test). Results. The results revealed positive and significant correlations betweenboth measures as well as a significant agreement in the classification of patients as having deficits or not. Moreover, the WCST-128 and the WCST-64 showed similar ability to identify changes over time. Conclusions. Our findings showed strong associations between scores derived from the two test and support the comparability of both versions when analyzing crosssectionalor longitudinal data. The findings support the use of the WCST-64 in evaluations of executive deficits of patients with moderate and severe TBI

Desarrollo de un prototipo de bomba de flujo pulsátil para caracterizar las condiciones hidrodinámicas en un ambiente de circulación extracorpórea / Desarrollo de un prototipo de bomba de flujo pulsátil para caracterizar las condiciones hidrodinámicas en un ambiente de circulación extracorpórea

Es difícil generar con bombas convencionales las condiciones de flujo del sistema cardiovascular, con las cuales se emulen condiciones hemodinámicas para evaluar diferentes dispositivos interpuestos a la corriente sanguínea. Para resolver este inconveniente, se desarrolló un sistema automatizado de bombeo de flujo pulsátil, conformado por un controlador difuso que captura datos de los instrumentos de monitoreo de variables hidrodinámicas a través de una interfaz de adquisición, y aplica señales de control a una bomba de flujo pulsátil. Este sistema permite hacer pruebas hidromecánicas que brindan elementos para interpretar la influencia de las variables que intervienen en el flujo pulsante y simular condiciones hemodinámicas en un ambiente de circulación extracorpórea. Mediante técnicas de diseño asistido por computador, se construyó una bomba de diafragma accionada neumáticamente. El controlador se desarrolló mediante la técnica de Fuzzi Control (marca registrada), el cual regula el pulso y el flujo de acuerdo con parámetros y datos capturados con...

With conventional pumps, it is difficult to generate the cardiovascular system conditions that may emulate hemodynamic conditions for evaluating different devices interposed to the blood flow. In order to resolve this inconvenient, an automated pulsatile flow system formed by a diffuse controller that captures data from the monitoring instruments of hydrodynamic variables through an acquisition interface and applies control signals to a pulsatile flow pump, was developed. This system allows making hydromechanical tests that give elements for interpreting the influence of the variables that take part in the pulsatile flow and emulate hemodynamic conditions in an extracorporeal setting. Through computed assisted design techniques, a pneumatically operated diaphragmatic pump was constructed. The controller was developed by the Fuzzi Control® technique, which regulates pulse and flow according to the data captured by the acquisition interface. The prototype tests were realized in a fluids laboratory by varying frequency, hydraulic resistance, viscosity and pulse pressure, emulating hemodynamic adult conditions, and using as work fluid an aqueous solution with 5 cPo at 37°C for mimicking blood viscosity at corporal temperature. The reproduction of a pump that serves for analyzing the effect of variables in the pulsatile flow may be used in the study of different intravascular devices and help to refine technical and functional aspects in the preliminary study of extracorporeal circulation machines.

[Intergenerational study of the mutation that causes Myotonic Dystrophy Type 1 in Costa Rica]. / Estudio intergeneracional de la mutación que causa la distrofia miotónica tipo 1 en Costa Rica.

INTRODUCTION: Myotonic dystrophy type 1 is a neuromuscular, degenerative and progressive disease, with an autosomal dominant pattern of inheritance, variable expressivity and incomplete penetrance. The genetic defect is an unstable mutation due to the expansion of the triplet CTG in the 3 unstranslated region at the DMPK gene on chromosome 19q13.3. OBJECTIVE: The main objective was to study the intergenerational behavior of the DM1 mutation in order to evaluate the importance of this disease as a neurological problem that could be manageable by genetic counseling. PATIENTS AND METHODS: The study involved 84 patients with clinical diagnosis of DM1 and their relatives, which were confirmed through molecular diagnosis using Southern blot and PCR. RESULTS: Data analysis reveals the size of the mutation presents a positive correlation with the severity of the symptoms and a negative correlation with the age of onset. Transmission of the DM1 mutation is sex and size dependent among the Costa Rican patients. There is an important increment in the size of the mutation between generations and there are no differences in mutation size respect to the transmitting sex. CONCLUSION: The worldwide intergenerational behavior of the DM1 mutation is similar in Costa Rica

Crystallization at the polymer/calcium-phosphate interface in a sterilized injectable bone substitute IBS.

Calcium phosphate (CaP) ceramics are the main raw materials used to elaborate blocks or granules for bone substitutes. In this study, injectable bone substitutes (IBS) were developed for applications in orthopedic or dental surgery. Sterile, ready-to-use composite containing CaP granules (biphasic calcium phosphate, BCP) and polymer (hydroxypropylmethylcellulose, HPMC) was prepared. Steam sterilization produced new phenomena at the CaP/polymer interface, resulting in crystal growth. These phenomena may constitute a model for the biomineralization study. Scanning electron microscopy showed that the formed crystallites organize themselves into a three-dimensional structure. Currently, the mechanisms of crystal growth are unknown and have been observed with only one combination of polymer/BCP ceramics after steam sterilization.

Snakebites and ethnobotany in the northwest region of Colombia: Part I: traditional use of plants.

In Antioquia and Chocó, traditional healers attend 60% of snakebites. With the aim to produce an inventory of the plants used by the healers to treat snakebites and to document the methods of preparation, administration, the dosage, number of patients treated throughout their years of practice with treatment results, 20 healers with experience in Bothrops, Porthidium and Bothriechis envenomations were interviewed between August, 1996 and November, 1998. They belong to nine black and three indigenous rural communities located near the towns of Bojayá, Vigía del Fuerte, Unguía (Atrato river valley), Nuquí and Bahía Solano (Pacific coast). Based on field interviews, 101 species of plants were identified as used to treat snakebites. The part used of each plant varies according to the species. Sixty plants are used in the form of drinks prepared by infusion, decoction or maceration; 78 as external baths on the affected extremity; 11 for steam application and 39 for poultices; the latter is used mainly when the bite is complicated by local necrosis. In mild and moderate envenomations, they generally use a mixture of three plants, while in severe cases they mix from five to 12, a handful of each one. Treatment is generally performed for 1-3 days, when the patient reacts positively. They reported to have treated 454 patients during their years of experience, 20 of them (4.4%) died. With the guidance of the healers, 77 species of plants were collected and photographed. These plants belong to 41 families, of which Piperaceae (13 species), Araceae (six species), Asteraceae (five species) and Gesneriaceae (three species) have the highest number of species.

Randomized trial of two doses of the prostaglandin E1 analog misoprostol for labor induction.

OBJECTIVE: Our purpose was to compare the safety and effectiveness of intravaginally administered misoprostol at doses of 25 micrograms and 50 micrograms for indicated labor induction in patients with an unfavorable cervix. STUDY DESIGN: Three hundred ninety-nine patients received either 25 micrograms or 50 micrograms of misoprostol, placed intravaginally in the posterior fornix, in this randomized double-blind trial. The dose was repeated every 3 hours until adequate labor was achieved (at least three contractions in 10 minutes). RESULTS: Among 399 patients evaluated, 192 patients were allocated to the 25 micrograms group and 207 patients to the 50 micrograms group. The start-to-delivery interval was shorter in the 50 micrograms group (826 minutes vs 970 minutes, p = 0.02). The incidence of vaginal delivery after one dose was higher in the 50 micrograms group (38.2% vs 25.0%, p = 0.007). Patients receiving 25 micrograms required oxytocin augmentation more frequently than did those receiving 50 micrograms (27.1% vs 16.9%, p = 0.02). No differences were noted in the cesarean or other operative delivery rates among patients in the two treatment groups. The incidence of newborns with a cord pH < 7.16 was greater in the 50 micrograms group (13.0% vs 6.8%, p = 0.04). Although the incidence of hyperstimulation was similar between the groups, the incidence of tachysystole was higher in the 50 micrograms group (32.8% vs 15.6%, p = 0.0001). CONCLUSIONS: Although a dose of 50 micrograms is associated with a shorter start-to-delivery interval and a higher incidence of vaginal delivery after one dose, 25 micrograms of intravaginal misoprostol is effective and associated with a lower incidence of tachysystole and cord pH values < 7.16.

PIP: The safety and effectiveness of 25 and 50 mcg of intravaginally administered misoprostol for cervical ripening and labor induction were evaluated in a randomized double-blind trial involving 395 US women. The most frequent indications for labor induction in both dosage groups were pregnancy-induced hypertension and premature rupture of the membranes. The prostaglandin dosage was repeated every 3 hours until labor was induced. The mean start-to-delivery interval among the 192 women in the 25 mcg group was 970 minutes, compared to only 826 minutes among the 207 women in the 50 mcg group. 82% of women in the 25 mcg group and 84% of those in the 50 mcg group were delivered within 24 hours. The incidence of vaginal delivery after 1 dose was higher in the 50 mcg group (38.2%) than in the 25 mcg group (25.0%) and women in the lower-dose group required oxytocin administration more frequently than those in the 50 mcg group (27.1% and 16.9%, respectively). On the other hand, the incidence of newborns with a cord pH under 7.16 was greater in the 50 mcg group (13.0%) than in the 25 mcg group (6.8%), and the incidence of tachysystole was higher (32.8% and 15.6%, respectively). Thus, despite the greater effectiveness of the 50 mcg dosage, a regimen of 25 mcg of misoprostol administered intravaginally every 3 hours is indicated to minimize neonatal morbidity.

Interpretation of the TDx-FLM fluorescence polarization assay in pregnancies complicated by diabetes mellitus.

The objective of this paper is to determine the applicability of the Abbott TDx-FLM fluorescence polarization assay in pregnancies complicated by diabetes mellitus. Retrospective review of records of women with pregnancies complicated by diabetes who underwent amniocentesis for fetal lung maturity using the Abbott TDx-FLM assay within 3 days of delivery was considered. Maternal diabetic control, neonatal birth weight, Apgar scores, umbilical cord gases, admissions to Neonatal Intensive Care Unit (NICU), development of respiratory distress syndrome (RDS) were evaluated. One hundred twenty-one patients with diabetes mellitus were identified. Thirteen (10.7%) had an FLM < or = 70 mg/g and 108 patients had > or = 70 mg/g. All obstetrical and diabetic variables were similar. RDS was not observed in neonates who had an FLM of > or = 70 mg/g. One neonate had RDS (FLM = 7.2 mg/g). The TDx-FLM > or = 70 mg/g may be interpreted as mature when obtained from transabdominal amniocentesis.

Group B streptococcus colonization in pregnant diabetic women.

OBJECTIVE: To evaluate the influence of maternal diabetes on the risk of group B streptococcus colonization during pregnancy. METHODS: We prospectively analyzed data on 105 pregnant women with diabetes mellitus, both pregestational and gestational, and a control group of 300 pregnant women without carbohydrate intolerance. All had singleton gestations, negative tests for human immunodeficiency virus, and intact membranes at enrollment. Culture specimens for group B streptococcus were obtained from the lower vaginal walls and rectum. Two-tailed unpaired Student t test, Mann-Whitney U test, and chi 2 test were used as appropriate. Multiple logistic regression analyses were performed to evaluate the independent influence of maternal diabetes on the rate of group B streptococcus colonization. RESULTS: Compared to controls, diabetic women had a higher colonization rate (43.8 versus 22.7%, odds ratio [OR] 2.56, 95% confidence interval [CI] 1.6, 4.1). The prevalence of group B streptococcus colonization in pregestational diabetic women was 54.1% and in women with gestational diabetes it was 35.1% (P = .05). Among women with pregestational diabetes, the prevalence of group B streptococcus colonization was 59.1% in class B and 50.0% in class C to R (P = not significant). After we adjusted for maternal age, race, and obesity, diabetic women continued to be at increased risk of group B streptococcus colonization (OR 3.1, 95% CI 1.8, 5.2). CONCLUSION: Carbohydrate intolerance appears to be an independent risk factor for group B streptococcus colonization during pregnancy.

A comparison of the 3 H glucose tolerance test and the 2 H value in identifying risk for excessive fetal growth.

The objective of this study was to determine if the 2 h value of the glucose tolerance test (GTT) is as reliable as the complete GTT in identifying risk for excessive fetal growth. Five hundred eighty-eight patients underwent a 3 h oral GTT at 26-28 weeks' gestation. The 2 h value of the test was compared to the results of the GTT. The incidence of large for gestational age (LGA) infants was compared for patients who had an abnormal GTT or an abnormal 2 h value only. A normal 2 h value was associated with a normal GTT in 98.5% of cases, while an abnormal 2 h value was associated with an abnormal GTT in 70% of cases. An abnormal GTT was associated with a 22% incidence of LGA, while a 2 h value > or = 165 mgm/dl was associated with a 20% incidence of LGA. This difference was not statistically significant. A single 2 h value GTT is more cost-effective and as predictive as a complete 3 h GTT in identifying risk for excessive fetal growth.

Use of misoprostol (prostaglandin E1 methyl analogue) to expedite delivery in severe preeclampsia remote from term.

Intravaginal misoprostol was used for labor induction in 2 patients with severe preeclampsia remote from term. Both patients had an uneventful vaginal delivery within 14 h of the initial application. Misoprostol appears to be effective for labor induction in cases where expeditious vaginal delivery is necessary.

Preinduction cervical ripening with commercially available prostaglandin E2 gel: a randomized, double-blind comparison with a hospital-compounded preparation.

OBJECTIVE: Our purpose was to compare the efficacy, safety, and cost of commercially available dinoprostone cervical gel 0.5 mg with a hospital-compounded formulation. STUDY DESIGN: One hundred thirty-four patients undergoing labor induction were randomly assigned to one of two cervical ripening groups. Commercially available dinoprostone gel 0.5 mg or a compounded formulation of 0.5 mg of prostaglandin E2 gel was administered endocervically. On the basis of cervical scores, gel was reapplied at 6-hour intervals for a maximum of three doses. Physicians managing labor were blinded as to treatment group allocation. RESULTS: Among 134 patients evaluated, 70 were allocated to the commercially available gel and 64 to the compounded gel. No statistically significant differences were noted between the treatment groups with respect to start-to-delivery interval, number of doses, amount of oxytocin, or neonatal adverse outcomes. However, cesarean delivery was performed less frequently in patients in the group receiving the commercially available gel (12.9%) than in the group receiving the compounded gel (28.1%) (p = 0.03). Because of the higher cesarean delivery rate in the compound group, use of this formulation was not associated with cost savings. CONCLUSIONS: The two prostaglandin E2 formulations appeared equivalent with respect to efficacy. An unexplained higher cesarean section rate, however, was associated with the use of the compounded preparation.

Predicting fetal lung maturity by visual assessment of amniotic fluid turbidity: comparison with fluorescence polarization assay.

We prospectively studied 159 patients having clinically indicated amniocentesis. Amniotic fluid (3 to 5 mL) was placed in a nonheparinized glass tube. This sample was then classified as turbid (indicating maturity) or clear (indicating immaturity) on the basis of a single examiner's ability to read newspaper print through the glass tube. These results were then compared with fluorescence polarization values for the same sample. A value of 70 mg/g was considered positive evidence of fetal lung maturity. By study criteria, 62 samples (39%) indicated immaturity and 97 (61%) indicated maturity. Turbidity correctly identified 89 samples that produced fluorescence polarization values of at least 70 mg/g. Turbidity as a predictor of fetal lung maturity when compared with fluorescence polarization assay has a 91% positive and 87% negative predictive value. Visual inspection of amniotic fluid may be of value in areas where sophisticated methods are unavailable.

Viridans streptococcal bacteraemia in patients with neutropenia.

Viridans streptococcal bacteraemia is frequent in neutropenic patients. 25 neutropenic patients with viridans streptococcal bacteraemia were compared with 64 control patients. Exposure to repeated chemotherapy or cytarabine were independent risk-factors for streptococcal bacteraemia. The use of carboxyureidopenicillins and a stay in laminar-airflow rooms were protective. In a further cohort study of 49 patients, oral streptococci with the same ribotype as blood isolates were recovered from all 7 bacteraemic patients. The oral cavity is a portal of entry for viridans streptococci bacteraemia in neutropenic patients, especially after oral mucosal damage induced by repeated chemotherapy.

Calcium supplementation in mild preeclampsia remote from term: a randomized double-blind clinical trial.

OBJECTIVE: To determine whether calcium supplementation prevents progression to severe disease in preterm nulliparous women with mild preeclampsia. METHODS: Seventy-five women hospitalized at 24-36 weeks' gestation because of mild preeclampsia were randomized to receive either 2 g/day of elemental calcium (36 women) or placebo (39). Both groups had similar demographic characteristics, initial blood pressure measurements, and amount of proteinuria. Diagnostic criteria and clinical management for severe preeclampsia were applied consistently. RESULTS: Eighteen of 36 calcium-treated subjects (50%, 95% confidence interval [CI] 33-67) developed severe preeclampsia, compared with 19 of 39 (48.7%, 95% CI 32-65) in the placebo group (relative risk 1.03, 95% CI 0.64-1.03; P = 1.00). Blood pressure values, gestational age at delivery, newborn weights, incidence of low Apgar scores, and umbilical arterial blood gases were similar for the two groups. CONCLUSION: Calcium supplementation does not prevent severe preeclampsia in preterm patients with mild disease.

Comparison of three types of ultrasound transducers in evaluating the amniotic fluid index.

The purpose of this study was to determine whether there was good correlation between amniotic fluid index measurements obtained with different types of ultrasound transducer. Women undergoing obstetric ultrasonography for multiple indications between 26 and 40 weeks' gestation had the four-quadrant amniotic fluid index measured with three ultrasound transducers: 3.5-MHz linear, 3.5-MHz sector and 3.5-MHz convex. Pearson product-moment correlation and linear regression analysis were utilized to compare the amniotic fluid index values. Sixty-five women participated in the study. A statistically significant correlation was noted between the three ultrasound transducers evaluated (P < .001). Placental location did not appear to affect the results. Amniotic fluid index values obtained with the sector or convex transducers were as reliable as those obtained with the "gold standard" linear transducer and may be interpreted in the same manner.

Cervical ripening in women with previous cesarean deliveries.

OBJECTIVE: To evaluate the safety and efficacy of preinduction cervical ripening in women with previous cesarean deliveries undergoing induction of labor. METHODS: Retrospective study of women with previous low transverse cesarean deliveries who underwent ripening of an unfavorable cervix prior to induction of labor (n = 89). Multiparas without previous cesarean deliveries undergoing ripening and induction of labor during the same time period were used for comparison (n = 61). Ripening was performed with prostaglandin E2 (PGE2) gel, or an osmotic dilator, or both. Induction of labor with oxytocin followed the American College of Obstetricians and Gynecologists' guidelines. Outcome data were analyzed using the unpaired Student's t-test or chi 2-test as appropriate. Significance was established at P < 0.05. RESULTS: The mean gestational age was 39.6 +/- 2.6 and 38.2 +/- 2.9 weeks for the study and comparison groups, respectively. There were no differences between the groups in Bishop score, duration of the first stage of labor, maximum dose of oxytocin, indications for cesarean delivery, puerperal morbidity, birthweight, Apgar scores or NICU admissions. Sixty-four percent (57 of 89) of study women delivered vaginally compared with 82% (50 of 61) of women in the comparison group (P < 0.03). The data were analyzed separately for those women undergoing cervical ripening with PGE2 gel only. No differences were observed between the groups in any of the categories mentioned above. CONCLUSION: Cervical ripening appears to be safe and effective in women with previous low transverse cesarean deliveries undergoing induction of labor with an unfavorable cervix.