Normal fetal salivary glands at 14-16 weeks of gestation as observed by transvaginal ultrasound imaging.

OBJECTIVES: Absence or congenital anomalies of the parotid glands are associated with significant long-term morbidity. To date there are no published data on ultrasonographic detection of these defects in early pregnancy. We set out to demonstrate and measure the fetal parotid and submandibular salivary glands at 14-16 weeks using transvaginal ultrasound imaging. METHODS: During a routine fetal anomaly detection scan in 30 consecutive patients, an attempt was made to examine the fetal parotid and submandibular glands. The fetal head was scanned in transverse sections just below the fetal ears, and the area of the parotid and submandibular glands was inspected. The examination time was not prolonged for the purpose of measuring the salivary glands. The fetal biparietal diameter and the femur length were also documented. RESULTS: The median gestational age was 15.4 (range, 14.4-16.5) weeks. In all 30 patients examined, at least one pair of parotid and submandibular glands was clearly visualized and measured. In seven patients the parotid and submandibular glands were visualized on both sides. The median length of the parotid gland was 7.5 (range, 5.5-11.5) mm and that of the submandibular gland was 5.4 (range, 3.7-8.5) mm. CONCLUSIONS: The fetal salivary glands can be demonstrated by transvaginal ultrasound imaging at 14-16 weeks of gestation. This is the first reported study presenting the normal values of salivary gland measurements, which may be important in detecting fetuses with congenital absence or other malformations of the glands.

Dupuytren's disease in Oriental Jews.

Twelve month minimum follow-up was available for 19 Oriental Jewish patients who underwent surgery for Dupuytren's disease over a 10-year period. In this population, the disease is uncommon. The initial deformity, operative findings and results of surgery were similar to those described for North European Caucasian patients. Possible factors that may result in a low genetic predisposition to Dupuytren's disease amongst Jews are discussed.

Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia.

OBJECTIVE: To evaluate the accuracy of endometrial volume measurement and 3-dimensional power Doppler analysis (3D-PDA) in the diagnosis of endometrial carcinoma and endometrial hyperplasia in women with post- and peri-menopausal bleeding. METHODS: 56 women with post-menopausal and 89 with peri-menopausal bleeding were enrolled. All were scheduled for hysteroscopy, dilatation and curettage, endometrial sampling or hysterectomy, and the ultrasound was performed within 24 h before the procedure. Endometrial thickness, endometrial volume, vascularity index (VI), flow index (FI) and vascularity flow index (VFI) were measured. These parameters were compared between the group of women with normal histology (including endometrial polyps) and the pathologic group (carcinoma and hyperplasia with or without atypia). RESULTS: Ninety women (62%) had normal histology, 26 (17.9%) had an endometrial polyp, 18 (12.5%) hyperplasia and 11 (7.6%) had endometrial carcinoma. Mean endometrial thickness was 11 mm and 15.5 mm in the normal and pathologic groups respectively (p<0.005). The mean endometrial volume was 6.87 cc and 15.5 cc in the two groups respectively (p<0.001). The VI was 2.27% and 2.95% in the two groups respectively (p=0.022). The FI was 18.6 and 23.6 in the two groups respectively (p=0.014). The VFI was 0.68 and 0.89 in the two groups respectively (p=0.018). Using ROC the area under the curve was 0.698, 0.728, 0.621, 0.631, and 0.625 for endometrial thickness, endometrial volume, VI, FI and VFI respectively. The best predictor of endometrial carcinoma was an endometrial volume of 3.56 cc or more (sensitivity 93.1%, specificity 36.2%). CONCLUSIONS: Endometrial volume and 3D-PDA are good diagnostic tools in predicting endometrial carcinoma and hyperplasia in women with post- and peri-menopausal bleeding.

Peripheral polymorphonuclear leukocyte priming contributes to oxidative stress in early pregnancy.

OBJECTIVE: The cause of elevated blood leukocyte count in pregnancy is unknown. We hypothesized that priming of peripheral polymorphonuclear leukocytes (PMNL) caused this elevation. METHODS: Eleven women in the first trimester of pregnancy were included in this prospective study. Peripheral venous blood was drawn twice from each woman, before and after a medical abortion (pregnant and nonpregnant, respectively). Complete blood cell count, plasma alkaline phosphatase (ALP), and rate of superoxide release from separated phobrol 12-myristate-13-acetate (PMA)-stimulated PMNL were determined. RESULTS: The PMNL count in early pregnancy was significantly higher, with a significant increase in the PMNL rate of superoxide release compared to the nonpregnant state. A linear correlation between the rates of superoxide release and PMNL counts before and during pregnancy was found. ALP levels were significantly elevated in early pregnancy. CONCLUSION: The increased PMNL count is probably a compensatory response to PMNL priming. The increased rate of superoxide release from primed PMNL may contribute to oxidative stress in early pregnancy.

Uterine artery embolization for management of interstitial twin ectopic pregnancy: case report.

Interstitial pregnancy is rare and dangerous variation of ectopic pregnancy. We describe a case of unilateral interstitial viable twin pregnancy treated by selective uterine artery embolization. A 23-year-old women with clinical and ultrasonic diagnosis of viable twin interstitial pregnancy was treated by selective uterine artery embolization after failure of systemic methotrexate treatment. Her serum beta-HCG was undetectable 2 months after the procedure and the ultrasound scan 70 days after embolization showed only multiple echogenic spots in the right uterine cornua. This therapeutic modality seems to be effective for conservative management of interstitial ectopic pregnancy, and as a prophylactic measure before surgical intervention to prevent major bleeding.

Cutaneous blood flow in the pigeon Columba livia: its possible relevance to cutaneous water evaporation.

The heat-acclimated rock pigeon is thought to use cutaneous water evaporation (CWE) as the 'preferred' route for heat dissipation, and this mechanism is controlled by adrenergic signaling. In the present study, we tested the hypothesis that adjustments in skin blood flow are a crucial component of this adaptation. Skin blood flow was measured by laser Doppler flowmetry and by ultrasonic flowmetry in heat-acclimated (HAc) and non-acclimated (NAc) pigeons. Skin blood flow, CWE and rectal and skin temperatures were measured under heat exposure (T(a)=50 degrees C) or following propranolol (1.3 mg kg(-1)) or clonidine (80 microg kg(-1)) administration. Using laser Doppler flowmetry, we found a significant increase (1.3-fold) in skin blood flow in the dorsal skin of HAc pigeons following propanolol administration. In contrast, a significant decrease (0.7-fold) was observed in NAc birds. Injection of clonidine resulted in a significant decrease in skin blood flow in both HAc and NAc pigeons (0.4- and 0.5-fold, respectively). Heat exposure increased blood perfusion in both groups (2.5- and 1.8-fold, respectively). Using ultrasonic flowmetry, we showed that both propanolol and clonidine increase the arterial blood flow (Q(a)) in HAc pigeons, while venous blood flow (Q(v)) decreases. In contrast, no significant changes were found in NAc pigeons. As shown by the effect of clonidine, augmentation of skin blood flow is not a prerequisite for CWE, but normally coincides with a greater difference in arterial-venous pressure. Possible regulatory mechanisms are discussed.

Cardiovascular responses to adrenergic agents in different acclimation states in the rock pigeon (Columba livia).

The effect of propranolol on heart rate (fH) was measured in season-acclimatized pigeons. Propranolol treatment decreased fH in winter-acclimatized pigeons, accelerated fH in summer-acclimatized pigeons, but had no effect on fH in spring-acclimatized pigeons. The effect of propranolol in summer-acclimatized pigeons is opposite to that observed in mammals. Interestingly, isoproterenol produced a propranolol-like cardioacceleration in heat-acclimated pigeons. We suggest that propranolol affects fH in summer-acclimatized pigeons via two opposing routes-a direct and a peripheral indirect route. We also suggest that the cardiovascular effects of propranolol are involved in the capacity of the pigeon to evaporate water from its skin.

Induction of labor in women with previous cesarean section using the double balloon device.

BACKGROUND AND METHODS: To evaluate the efficacy and safety of labor induction by the double balloon device in women with previous cesarean section. Induction of labor was carried out in 37 women with previous cesarean section for various indications. All the inductions of labor were performed using the Atad double balloon device (ARD). RESULTS: Cervical ripening (Bishop scores above 5) was achieved in 82.3% of the induced women with subsequent vaginal delivery in 78.6% and repeat cesarean section in 22.3%. An important observation of the results was the chances to achieve a vaginal delivery according to the second Bishop score that was recorded 12 hours following the insertion of the device. When the second was above 5 the chances for vaginal delivery were 79.4%. The mean time from removal of the device to delivery was 10.8 hours. No complications were noted using the device. CONCLUSIONS: The double balloon device appears to be a safe and effective method of inducing labor in women with a previous lower segment cesarean section. Wide scale studies and further use of the device for induction of labor in women who have had previous cesarean sections are warranted.

Induction of labor in breech presentation.

OBJECTIVE: Induction of labor in breech presentation, although not contraindicated, has rarely been reported. We have undertaken to evaluate the safety and outcome of this practice in two Israeli institutions along with a literature review of this controversial subject. METHOD: The research design was a retrospective case control study covering the years: 1980-1999. We have studied 53 term (>37 weeks) breech deliveries induced for various medical and obstetrical reasons, in two major regional hospitals in Israel. Induction was performed with prostaglandin E(2) for the unripe cervix and with oxytocin for induction or augmentation when the cervix was ripe. Six women were induced by nipple stimulation. Controls were 53 women with spontaneous labor in breech presentation that had a trial of vaginal delivery, and 54 women with breech presentation who delivered by elective cesarean section. RESULT: No significant difference in the various maternal and fetal outcomes was observed. CS rate was comparable in both study and control groups (34% vs. 32%) and two-thirds gave birth vaginally. CONCLUSIONS: In properly selected and carefully managed cases of breech presentation, induction of labor seems a safe and reasonable option.

Maternal obesity and pregnancy outcome.

BACKGROUND: Obesity, a common condition in developed countries, is recognized as a threat to health. OBJECTIVES: To describe the distribution of weight in pregnant women and evaluate the influence of obesity on pregnancy outcome in a high parity northern Israeli population. METHODS: The study included 887 women who gave birth in the Western Galilee Medical Center during the period August to November 1995. The patients were classified as underweight, normal weight, overweight, or obese according to body mass index. Maternal demographic, obstetric, and perinatal variables were compared. A control group of 167 normal weight women were matched with the obese group for maternal age, parity, and gestational age. RESULTS: Obese mothers had a higher incidence of gestational diabetes and pregnancy-induced hypertension compared to normal weight mothers (5.4% vs. 1.8%, and 7.2% vs. 0.6% respectively, P < 0.01), a higher rate of labor induction (20.4% vs. 10.2%, P < 0.01), and a higher cesarean section rate (19.6% vs. 10.8%, P < 0.05). There was also a significant difference in the prevalence of macrosomia in the offspring (16.8% vs. 8.4%, P < 0.05). CONCLUSION: Obese pregnant women are at high risk for complications during delivery and therefore need careful pre-conception and prenatal counseling, as well as perinatal management.

The role of beta-adrenergic receptors in the cutaneous water evaporation mechanism in the heat-acclimated pigeon (Columba livia).

The effects of selective and non-selective beta-adrenergic agents on cutaneous water evaporation (CWE) were studied in hand-reared rock pigeons (Columba livia). CWE was measured by the vapor diffusive resistance method, using a transient porometer. Intramuscular and subcutaneous injections of a non-selective beta-adrenergic antagonist (propranolol) or a selective beta(2)-adrenergic antagonist (ICI-118551) to heat-acclimated (HAc) pigeons at ambient temperature (T(a)) of 24 degrees C resulted in intensive CWE. The CWE values that were triggered by propranolol and ICI-118551 (18.59+/-0.73 and 16.48+/-0.70 mg cm(-2) h(-1), respectively) were close to those induced by heat exposure (17.62+/-1.40 mg cm(-2) h(-1)). Subcutaneous administration of propranolol produced local response. Intramuscular injection of salbutamol (selective beta(2)-adrenergic agonist) to HAc pigeons drastically diminished CWE induced by either propranolol, metoprolol or heat exposure. Such manipulations also enhanced panting at relatively low T(a)s (42 degrees C). The inhibition of beta(1)-adrenergic receptors by metoprolol increased CWE, while inhibition by atenolol produced no change from basal values. This difference may be attributed to their distinctive nature in penetrating the blood-brain barrier. Our findings indicate a regulatory pathway for CWE consisting of both beta(1)- and beta(2)-adrenergic receptors. We suggest that the beta(1)-adrenergic effect is restricted mainly to the CNS, while the beta(2)-adrenergic effect takes place at the effector level. We postulate this level to be either the cutaneous microvasculature or the epidermal layer.

Creatine kinase as a biochemical marker in diagnosis of placenta increta and percreta.

We describe 1 case of placenta increta and 1 of placenta percreta, both associated with elevated maternal serum creatine kinase concentration. In patients with placenta previa and ultrasonographic findings of an abnormally adherent placenta, an unexplained elevation in maternal serum creatine kinase level should alert the clinician to the possibility of placenta increta or placenta percreta, with an attendant increase in maternal morbidity.

Beta-HCG concentration in peritoneal fluid and serum in ectopic and intrauterine pregnancy.

OBJECTIVE: To evaluate the significance of beta-HCG levels in peritoneal fluid and serum in the diagnosis of ectopic pregnancy. STUDY DESIGN SETTING: Obstetrics and Gynecology department of a regional general hospital. SUBJECTS: Sixty-two women who presented with a differential diagnosis of ectopic pregnancy vs. nonviable intrauterine pregnancy. INTERVENTIONS: All patients underwent D & C and culdocentesis. beta-HCG was measured in simultaneously obtained peritoneal fluid (PF) and serum (S), and the PF/S ratio calculated. RESULTS: Twenty-three patients had an ectopic pregnancy (Group I). All 23 had higher beta-HCG concentrations in the PF than in the serum, with a mean PF/S ratio of 19.1 +/- 16.9. Twenty-four patients had an intrauterine pregnancy (Group II). The beta-HCG levels in the PF and serum were similar (mean PF/S 1.1 +/- 0.2). The difference in PF/S ratio between groups I and II was statistically significant (p < 0.001). CONCLUSION: The measurement of beta-HCG in peritoneal fluid and serum is a useful diagnostic tool in differentiating ectopic from intrauterine pregnancy.

Is removal of the tube mandatory after coagulation in ectopic pregnancies.

Laparoscopic treatment of ectopic pregnancy is gaining wide acceptance. We report a new simple laparoscopic technique involving grasping the tube with forceps and coagulating on both sides of the ectopic pregnancy site, leaving the fertilized ovum in situ. This method is suitable for multiparous women and women who request tubal sterilization. Sixteen patients (mean age 32.6 +/- 4.4 years) were treated by using this method. The mean duration of hospitalization was 1.94 +/- 1.12 days. No complications occurred.

Silver halide fiber optic radiometric temperature measurement and control of CO2 laser-irradiated tissues and application to tissue welding.

Tissue heating by laser irradiation has attained importance in many clinical applications. Accurate temperature measurements of laser-irradiated tissues are difficult to achieve, and experiments have produced conflicting results. Fiber optic radiometry allows temperature measurement of laser-irradiated tissues by remote sensing of the emitted infra red (IR) radiation. We have developed an IR fiber optic radiometer capable of accurate tissue temperature measurements (+/- 0.2 degrees C) and utilized it to monitor and control the heating of tissues by CO2 laser irradiation. Tissue temperature control of +/- 2.5 degrees C was achieved. This system was used to control tissue temperature during CO2 laser-assisted welding of urinary bladders in rats. The strength of the welds was recorded for different welding temperatures. A temperature of 55 degrees C was found to be optimal.

Sonographic diagnosis of fetal congenital cataracts.

Five fetuses with congenital cataracts diagnosed in utero by ultrasound are reported. The fetuses, who were between 14 and 27 weeks' gestation, also had other severe malformations. The sonographic features of the cataracts are presented.