Life support: the doctor's dilemma--legal issues.

This paper examines the legal rights of a patient and his family in a situation where the patient's life is maintained by a life support system. It examines the duty and liability of a doctor who is of the view that the life-support should be terminated and, whether, in such situations the consent of the patient or his family or the Court is required.

The hot plasma environment at jupiter: ulysses results.

Measurements of the hot plasma environment during the Ulysses flyby of Jupiter have revealed several new discoveries related to this large rotating astrophysical system. The Jovian magnetosphere was found by Ulysses to be very extended, with the day-side magnetopause located at approximately 105 Jupiter radii. The heavy ion (sulfur, oxygen, and sodium) population in the day-side magnetosphere increased sharply at approximately 86 Jupiter radii. This is somewhat more extended than the "inner" magnetosphere boundary region identified by the Voyager hot plasma measurements. In the day-side magnetosphere, the ion fluxes have the anisotropy direction expected for corotation with the planet, with the magnitude of the anisotropy increasing when the spacecraft becomes more immersed in the hot plasma sheet. The relative abundances of sulfur, oxygen, and sodium to helium decreased somewhat with decreasing radial distance from the planet on the day-side, which suggests that the abundances of the Jupiter-derived species are dependent on latitude. In the dusk-side, high-latitude region, intense fluxes of counter-streaming ions and electrons were discovered from the edge of the plasma sheet to the dusk-side magnetopause. These beams of electrons and ions were found to be very tightly aligned with the magnetic field and to be superimposed on a time- and space-variable isotropic hot plasma background. The currents carried by the measured hot plasma particles are typically approximately 1.6 x 10(-4) microamperes per square meter or approximately 8 x 10(5) amperes per squared Jupiter radius throughout the high-latitude magnetosphere volume. It is likely that the intense particle beams discovered at high Jovian latitudes produce auroras in the polar caps of the planet.

Termination of second trimester pregnancy with laminaria and intramuscular 16 phenoxy-omega-17, 18, 19, 20 tetranor PGE2 methylsulfonylamide (sulprostone)-A randomised study.

16 phenoxy-omega-17, 18, 19, 20 tetranor PGE2 methylsulfonylamide (Sulprostone) was used for termination of second trimester pregnancy in four groups of 30 patients. The drug was administered in intramuscular doses of either 0.5 mg four hourly or 1.0 mg 8 hourly. In two groups of 30 patients a medium size sterile laminaria was inserted into the cervical canal eight hours before the start of prostaglandin treatment. In the group treated with 1.0 mg sulprostone eight hourly, 96.7% of those with laminaria and 86.7% without laminaria aborted in respective mean times of 11.2 hrs and 17.5 hrs. All 30 patients (100%) in the laminaria group treated with 0.5 mg sulprostone four hourly aborted within 30 hours in a mean time of 10.4 hours compared with 26 patients (86.7%) in a mean time of 16.7 hours in the group without laminaria. One patient receiving 0.5 mg sulprostone four hourly (no laminaria) sustained a cervical tear requiring repair. The incidence of nausea, vomiting, diarrhoea, cold and shivering was low an similar in the four groups.

Safety of postabortion sterilisation compared with interval sterilisation. A controlled study.

406 women--about one-fifth of those requesting an induced abortion and sterilisation over a thirty-three-month period--volunteered to be allocated randomly to either a concurrent induced-abortion/sterilisation group or a group which was sterilised six weeks after abortion. The abortion-attributable and sterilisation-attributable complication rates of 3.8% and 5.2%, respectively, for the concurrent group did not differ significantly from the 6.7% and 6.9% rates for the interval group. The estimated 2%-10% of women who would have changed their minds must be set against the 4% of women who became pregnant again before being sterilised. Efforts should be made to identify women likely to regret sterilisation.

PIP: In order to determine the optimal time for performing sterilizations on women requesting both abortion and sterilization, a prospective, comparative study of 406 women, who agreed to be randomly allocated to either a postabortion or an interval sterilization group, was undertaken at the Kandang Kerbau Hospital in Singapore. The combined immediate and delayed complication rate for the interval groups was higher than for the postabortion group, but the difference was not significant. Among the women in the interval group, 6.7% had complications stemming from the abortion and 6.8% had complications attributable to the sterilization procedure. For the postabortion sterilization group, the respective rates were 3.8% and 5.2%. Initially 195 women were allocated to the interval abortion group, but 64 of these women changed their minds and did not keep their sterilization appointments. 51 of these 64 women were contacted from 3 months to 3 years later, and 20 of the women, at last contact, still did not want to be sterilized. Given this data, the investigators estimated that 2-10% of the women who undergo postabortion sterilization can be expected to regret their decision. On the other hand, women electing interval sterilization have a 4% risk of becoming pregnant before the sterilization is performed. There were no sterilization failures reported in the study. The postabortion and interval groups were comparable in terms of age, parity, and gestation duration prior to abortion. Tables included 1) distribution by age, family size, ethnic affliation, and gestation duration for postabortion and interval groups and for those women who did not appear for their interval sterilization appointments; and 2) distribution of types of complications associated with abortion and sterilization for both the interval and the postabortion groups.

Termination of second trimester pregnancy with intra-muscular administration of 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide.

A new prostaglandin analogue, 16 phenoxy-omega-17,18,19,20 tetranor PGE2 methylsulfonylamide was used for the termination of second trimester pregnancy in 60 patients. The drug was injected intramuscularly in doses of 0.5 mg 4 hourly, 1 mg 8 hourly or 1 mg 6 hourly for a maximum of 36 hours. Fifty five patients aborted. The incidence of gastrointestinal side effects was low and there were no complications.

Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients.

Dilatation of the cervix with prostaglandin analogues prior to vaginal termination of pregnancy was attempted in 125 nulliparous women in the first trimester of pregnancy. The patients were divided into five groups (25 in each group) and given a single extra-amniotic dose of one of the following prostaglandin analogues 14-16 hours prior to the evacuation of the uterus by vacuum aspiration. (Group A) 15 (S) 15 methyl PGE2 (free acid); (Group B) 15 (S) 15 methyl PGE2 methyl ester; (Group C) 15 (S) 15 methyl PGF2alpha (free acid); (Group D) 15 (S) 15 methyl PGF2alpha methyl ester and(Group E) a mixture of 15 (S) 15 methyl PGE2methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester. Evacuation of the uterus without mechanical dilatation of the cervix was possible in 111 (90%) of the patients. In an additional 10 patients (8%) there was some degree of cervical dilatation and further mechanical dilatation could be performed easily. With the combination of 15 (S) 15 methyl PGE2 methyl ester and 15 (S) 15 methyl PGF2alpha methyl ester the incidence of gastrointestinal side effects and pyrexia were considerably reduced.

PIP: 125 nulliparous women were divided into 5 groups of 25 each to study the efficacy of various prostaglandin (PG) analogs for cervical dilatation preparato to medical termination of pregnancy. All subjects were in the first trimester of pregnancy, and abortions were to be performed vaginally. All patients received their dosages and analogs as a single extraamniotic infusion 14-16 hours prior to evacuation of uterine contents. The 125 women, 62% of whom were teen-agers, were randomly divided into the following groups: 1) 25 mcg of 15(S)-methyl PGE2 (free acid); 2) 25 mcg of 15(S)-methyl PGE2 methyl ester; 3) 250 mcg of 15(S)-methyl PGF2 alpha (free acid); 4) 250 mcg of 15(S)-methyl PGF2 alpha methyl ester; and 5) a mixture of 125 mcg of 15(S)-methyl PGF2 alpha methyl ester plus 12.5 mcg of 15(S)-methyl PGE2 methyl ester. Overall, cervical dilatation was achieved in 111 patients (90%) for aspiration or curettage of the uterine contents. 10 more required mechanical dilatation as a supplement. More patients treated with 15-methyl PGF2 alpha analogs (groups 3 and 4) expelled the fetus before the scheduled time of evacuation compared with those treated with PGE2 analogs (groups 1 and 2) (42% and 22%, respectively). Only 8% (2 patients) of the mixture group (group 5) aborted. Side effects included vomiting, diarrhea, cold and shivering, and pyrexia. Incidence varied with analog; the mixture group (Group 5) had the lowest incidence of gastrointestinal side effects and pyrexia.

Intrauterine administration of prostaglandin 15 (S) 15 methyl E2 methyl ester in the management of patients with a hydatidiform mole.

PIP: The use of a synthetic analogue PGE2 (15(S)15 methyl PGE2 methyl ester) in the management of hydatidiform mole was evaluated in 20 affected patients, gestational age ranging from 8 to 20 weeks, parity from 0 to 6. A portex 16 gauge epidural catheter was used to administer a 30 mcg dose of the PG analogue contained in 3 ml of water. A second dose was administered 8 hours later following failed expulsion of molar tissue. Curettage was performed in all patients following expulsion of the hydatidiform mole. Side effects included vomiting, pyrexia, shivering, and diarrhea. The treatment was successful in all patients, with 15 aborting with the single dose and 5 with the 2nd dose 8 hours later. Interval between the 1st dose to expulsion of the hydatidiform mole ranged from 2 3/4 hours to 16 hours with a mean of 9 hours 4 minutes for the 20 patients. This study suggests that the PGE2 analogue is a safe and reliable drug in treating hydatidiform mole.^ieng

Changing trends in mortality and morbidity from abortion in Singapore (1964 to 1970).

PIP: The number of abortions treated in Kandang Kerbau Hospital and Thomson Road Hospital from 1964-70 were obtained from the operation registers. The number of abortion deaths were obtained from the hospital death registers. A retrospective study shows the incidence of total abortions have remained fairly constant, but the incidence of septic abortion and mortality from abortions have been declining over the past 7 years. The decline is attributed to the declining incidence of criminal abortions performed by nonmedically qualified abortionists. The incidence of total abortions each year between 1964-70 have remained at a constant level of 8% or 80/1000 deliveries. The average number of obstetric deaths was about 18 per year; the average number of abortion deaths is 5 each year. Singapore has about 22% of maternal deaths attributed to abortion. There appeared a falling trend in mortality from 12/1000 in 1964 to 8/1000 in 1970. The liberalization of abortion laws has brought about a decline in deaths from abortion complications.^ieng