Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis.

BACKGROUND: Prior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually. METHODS: This retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks' and 24 weeks' gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models. RESULTS: Charts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%. CONCLUSION: While blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.

A new context-based approach to assess marine mammal behavioral responses to anthropogenic sounds.

Acute effects of anthropogenic sounds on marine mammals, such as from military sonars, energy development, and offshore construction, have received considerable international attention from scientists, regulators, and industry. Moreover, there has been increasing recognition and concern about the potential chronic effects of human activities (e.g., shipping). It has been demonstrated that increases in human activity and background noise can alter habitats of marine animals and potentially mask communications for species that rely on sound to mate, feed, avoid predators, and navigate. Without exception, regulatory agencies required to assess and manage the effects of noise on marine mammals have addressed only the acute effects of noise on hearing and behavior. Furthermore, they have relied on a single exposure metric to assess acute effects: the absolute sound level received by the animal. There is compelling evidence that factors other than received sound level, including the activity state of animals exposed to different sounds, the nature and novelty of a sound, and spatial relations between sound source and receiving animals (i.e., the exposure context) strongly affect the probability of a behavioral response. A more comprehensive assessment method is needed that accounts for the fact that multiple contextual factors can affect how animals respond to both acute and chronic noise. We propose a three-part approach. The first includes measurement and evaluation of context-based behavioral responses of marine mammals exposed to various sounds. The second includes new assessment metrics that emphasize relative sound levels (i.e., ratio of signal to background noise and level above hearing threshold). The third considers the effects of chronic and acute noise exposure. All three aspects of sound exposure (context, relative sound level, and chronic noise) mediate behavioral response, and we suggest they be integrated into ecosystem-level management and the spatial planning of human offshore activities.

Assessing the contamination potential of freshly extracted Escherichia coli biofilm cells by impedancemetry.

Planktonic bacteria passing to a sessile state during the formation of a biofilm undergo many gene expression and phenotypic changes. These transformations require a significant time to establish. Inversely, cells extracted from a biofilm should also require a significant time before acquiring the same physiological characteristics as planktonic cells. Relatively few studies have addressed the kinetics of this inverse transformation process. We tested one aspect, namely, the contamination potential of freshly extracted Escherichia coli biofilm cells, precultured in a synthetic medium, in a rich liquid growth medium. We compared the time between inoculation and the beginning of the growth phase of freshly extracted biofilm cells, and suspended exponential and suspended stationary phase cells precultured in the same synthetic medium. Unexpectedly, the lag time for the extracted biofilm cells was the same as the lag time of the suspended exponential phase cells and significantly less than the lag time of the suspended stationary phase cells. The lag times were determined by an impedance technique. Cells extracted from biofilms, i.e., biofilms formed in canalizations and broken up by hydrodynamic forces, are an important source of contamination. Our work shows, in the case of E. coli, the high potential of freshly extracted biofilm cells to reinfect a new medium.

A radio frequency electric current enhances antibiotic efficacy against bacterial biofilms.

Bacterial biofilms are notably resistant to antibiotic prophylaxis. The concentration of antibiotic necessary to significantly reduce the number of bacteria in the biofilm matrix can be several hundred times the MIC for the same bacteria in a planktonic phase. It has been observed that the addition of a weak continuous direct electric current to the liquid surrounding the biofilm can dramatically increase the efficacy of the antibiotic. This phenomenon, known as the bioelectric effect, has only been partially elucidated, and it is not certain that the electrical parameters are optimal. We confirm here the bioelectric effect for Escherichia coli biofilms treated with gentamicin and with oxytetracycline, and we report a new bioelectric effect with a radio frequency alternating electric current (10 MHz) instead of the usual direct current. None of the proposed explanations (transport of ions within the biofilm, production of additional biocides by electrolysis, etc.) of the direct current bioelectric effect are applicable to the radio frequency bioelectric effect. We suggest that this new phenomenon may be due to a specific action of the radio frequency electromagnetic field upon the polar parts of the molecules forming the biofilm matrix.

Calibration and comparison of the acoustic location methods used during the spring migration of the bowhead whale, Balaena mysticetus, off Pt. Barrow, Alaska, 1984-1993.

Between 1984 and 1993, visual and acoustic methods were combined to census the Bering-Chukchi-Beaufort bowhead whale, Balaena mysticetus, population. Passive acoustic location was based on arrival-time differences of transient bowhead sounds detected on sparse arrays of three to five hydrophones distributed over distances of 1.5-4.5 km along the ice edge. Arrival-time differences were calculated from either digital cross correlation of spectrograms (old method), or digital cross correlation of time waveforms (new method). Acoustic calibration was conducted in situ in 1985 at five sites with visual site position determined by triangulation using two theodolites. The discrepancy between visual and acoustic locations was <1%-5% of visual range and less than 0.7 degrees of visual bearing for either method. Comparison of calibration results indicates that the new method yielded slightly more precise and accurate positions than the old method. Comparison of 217 bowhead whale call locations from both acoustic methods showed that the new method was more precise, with location errors 3-4 times smaller than the old method. Overall, low-frequency bowhead transients were reliably located out to ranges of 3-4 times array size. At these ranges in shallow water, signal propagation appears to be dominated by the fundamental mode and is not corrupted by multipath.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid with prominent mitotic activity and focal necrosis.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare, apparently low-grade spindle cell tumor of the thyroid gland occurring in young individuals and thought to be derived from thymic or branchial pouch remnants. Spindle epithelial tumor with thymus-like differentiation has little to no mitotic activity, and focal necrosis has been reported in one case. We present a case of SETTLE in a 29-year-old man that was initially evaluated by fine-needle aspirate biopsy and ultimately found to be consistent histologically with SETTLE. In this case, there were numerous mitotic figures among the spindle cells and focal necrosis. Spindle epithelial tumor with thymus-like differentiation has been considered to be a tumor of low malignant potential with metastases developing some years after diagnosis. This is the first case in which prominent mitotic activity and necrosis is reported perhaps representing an aggressive variant.

Treatment of community-acquired acute uncomplicated urinary tract infection with sparfloxacin versus ofloxacin. The Sparfloxacin Multi Center UUTI Study Group.

The efficacy and safety of a 3-day regimen of sparfloxacin were compared with those of a 3-day regimen of ofloxacin for the treatment of community-acquired acute uncomplicated urinary tract infections. Four hundred nineteen women were enrolled in a randomized, open-label, observer-blinded, multicenter study; 204 received sparfloxacin as a 400-mg loading dose on the first day and 200 mg once daily thereafter, and 215 received ofloxacin as 200 mg twice daily. A total of 383 patients met the criteria for clinical evaluability, and 174 were also bacteriologically evaluable; all treated patients were included in the safety analysis. Escherichia coli (86%) and Staphylococcus saprophyticus (4.6%) were the organisms most commonly isolated. Positive clinical responses were obtained 5 to 9 days after therapy in more than 92% of the patients in each group; sustained clinical cure rates 4 to 6 weeks after therapy were 78.3 and 76.9% in the sparfloxacin and ofloxacin groups, respectively. A positive bacteriologic response was observed in 98% of the bacteriologically evaluable patients in each treatment group at 5 to 9 days posttherapy and in 88.2 and 92.6% of the patients in the sparfloxacin and ofloxacin groups, respectively, 4 to 6 weeks after therapy. Almost 90% of all adverse events were of mild or moderate severity; the most frequent events at least possibly related to drug treatment were those common to the fluoroquinolones, namely, nausea, diarrhea, headache, insomnia, and photosensitivity. Photosensitivity was more frequent in the sparfloxacin group (6.9% versus 0.5% in the ofloxacin group); insomnia was more frequent in the ofloxacin group (3.7% versus 1.0% in the sparfloxacin group). These data suggest that a once-daily, 3-day regimen of sparfloxacin is effective and generally well tolerated in the treatment of acute uncomplicated urinary tract infections.

Mathematical analysis of the upper respiratory tract from an anthropometric study.

In order to design a new, performed tracheal tube adapted to the shape of the upper respiratory tract, we have undertaken an anthropometric study from lateral x-rays of the neck in 130 patients with the head in a fixed position. In order to assess different clinical situations, we studied three groups of patients: group 1 = sitting, no tracheal tube; group 2 = supine, no tracheal tube; group 3 = supine, trachea intubated. We defined a standard coordinate system and determined mathematical curves for segments of the upper respiratory tract by a polynomial regression method. With these data it was possible to study the effects of physiological variations on the shape of the curves. It was then possible to determine at which region changes occur and the factors influencing these changes. We found that the relative position of the larynx was constant, whereas the hypopharynx exhibited the greatest change with the position of the head. These observations should allow us to construct a new, performed tracheal tube with elastic compliance properties to fit the changes occurring in the region of the hypopharynx.

Safety and efficacy of lomefloxacin versus cefaclor in the treatment of acute exacerbations of chronic bronchitis.

In two multicenter trials, lomefloxacin and cefaclor were compared as treatments for acute bacterial exacerbations of chronic bronchitis. In total, 522 adult outpatients were enrolled at 50 centers in the United States. Patients were randomized to treatment groups receiving either 400 mg lomefloxacin orally once daily (n = 259) or 250 mg cefaclor every 8 hours (n = 263) for 7-10 days. Both groups were comparable in terms of age, severity of exacerbation, smoking history, theophylline use, and baseline pathogens. The most common baseline pathogens were Haemophilus influenzae, found in 32% of patients in the lomefloxacin group and in 29% in the cefaclor group, Pseudomonas aeruginosa (13% and 16%, respectively), Moraxella (Branhamella) catarrhalis (12% and 13%), and Streptococcus pneumoniae (10% in both groups). Bacterial eradication rates 1-4 days after the completion of treatment for all patients with baseline pathogens were 81.8% in the lomefloxacin group and 62.7% in the cefaclor group (p less than 0.001). Clinical success (disappearance or improvement of presenting signs and symptoms) was noted in 80.0% of patients in the lomefloxacin group and 64.7% in the cefaclor group (p = 0.002). Eradication rates for the subgroup of patients who had pathogens susceptible in vitro to both study drugs and who completed treatment were 97.1% for lomefloxacin and 84.6% for cefaclor (p = 0.002). Clinical success rates in this subgroup were 92.4% for lomefloxacin and 90.1 for cefaclor (p = 0.585). Treatment-related adverse events were reported for 7% of patients in the lomefloxacin group and 5% in the cefaclor group. The most common adverse events in both groups were nausea and diarrhea. Six patients were withdrawn from treatment with lomefloxacin and four from the cefaclor group because of adverse events. There was no clinical or laboratory evidence of theophylline interaction with either treatment. Once-daily oral administration of 400 mg lomefloxacin was an effective, well-tolerated alternative to 250 mg of cefaclor three times daily in the treatment of acute exacerbations of chronic bronchitis.

[The effect of vascular risk factors in arteriopathy of the legs in women]. / Influence des facteurs de risque vasculaire dans l'artériopathie des membres inférieurs de la femme.

Here the analysis of the results of a multicentered prospective epidemiologic study that has counted only the new cases of chronic atherosclerosis obliterans of the lower extremities. Included have been 989 patients (659 men and 330 women). Critical analysis of data allows a comparative study between the sexes. Thus, specifics of arteriopathy among women can be drawn. It appears that they are only the consequences of the fact that men and women reflect a different level of tobacco use in the two populations.

[Reproducibility of venous occlusion plethysmography. Value of a computerized system of calculation]. / Reproductibilité de la pléthysmographie à occlusion veineuse. Intérêt d'un système de calcul automatisé.

The manual interpretation of identical occlusive venous plethysmography curves by different technicians is subject to a wide variation. The object of this study is to verify this state of affairs and to propose an automatic calculation of the different parameters usually used: the percentage volume increase (delta V), the time taken to half empty (t V/2) and the maximal venous outflow (MVO). We compared the variations, due to the operators, in the measurement of the parameters characterising identical curves obtained by occlusive venous plethysmography. Sixty curves from 30 patients, were photocopied and each was measured independently by four different operators. The results were compared with the measurements obtained automatically from a micro-computer connected to the plethysmograph. The measurements of the percentage volume increase and the time taken to half empty differed among the operators and the computer by less than 2%. However, the maximal venous outflow was subject to very large variations amongst the operators (up to 60%). This uncertainty is due to the operators choice of the point on the curve where the tangent is measured. The micro-computer, by fixing this point at 0.3 second after releasing the cuff allows a standardisation of this parameter.

Opiate withdrawal and electro-stimulation. Double blind experiments.

A rapid detoxification technique for heroin addicts is described. The technique uses an impulsional electric current developed by Limoge. The treatment is nonaggressive, very well tolerated by the addicts and leads to a good psychotherapeutic relationship with the medical staff. A successful physical detoxification is achieved in more than 80% of the cases (this figure is based on 400 patients treated by the method). The technique was subjected to two double-blind experiments. The first experiment tested the real efficacity of the electrical stimulation. The difference between the group of subjects stimulated and the unstimulated control group had a "p-value" which was significant at the 0,5% level. This leads us to believe that the electrical stimulation has a real positive effect. The second experiment reconfirmed the efficacity of the stimulation and showed that 24 hour continuous stimulation was not sufficient to produce a lasting effect. After about 50 hours stimulation a Naloxone test produced little or no reaction in the patients.

[In situ venous bypass using the great saphenous vein: analysis of the 5 year outcome of 129 procedures]. / Pontages veineux in situ par veine saphène interne: analyse des résultats a 5 ans a propos de 129 interventions.

One hundred and twenty nine in situ vein bypasses have been reviewed with a five year follow-up. Cumulative patency rates at five year are 71% (+/- 21%) for above-knee femoro-popliteal bypasses, 69% (+/- 11.5%) for below-knee anastomosis and 94% (+/- 35%) when distal anastomosis is performed on tibial or peroneal vessel. Global cumulative graft patency rate is 71% (+/- 9.4%). It is 72% (+/- 11%) in limb salvage.

Lactate as a precursor of fatty acids in bovine adipose tissue.

In vitro experiments were conducted to determine the rates of lactate, acetate, and glucose conversions to glycerol, CO2, and fatty acids by subcutaneous adipose tissue of cattle. To study the pathway for lactate utilization as a carbon source for lipogenesis, the effect of each of four substates (lactate, acetate, pyruvate, and glucose) on the rate of conversion of the other three was determined. The rates of lactate conversion to fatty acids and to glycerol were greater than those for acetate and glucose. Acetate, however, was oxidized to CO2 at greater rates than either lactate or glucose. Acetate was used for fatty acid synthesis at greater rates than pyruvate was less than that from lactate but greater than that from glucose. Acetate additions to the incubation media decreased the synthetic rates from lactate, pyruvate, and glucose. Pyruvate decreased rates of fatty acid synthesis from glucose but slightly (not statistically significant) stimulated synthesis from lactate and acetate. Lactate decreased glucose and pyruvate utilization but had no effect upon that of acetate. Our results clearly demonstrated that lactate can be used for fatty acid synthesis as well as for glycerogenesis by bovine adipose tissue.