Metronidazole prophylaxis to prevent infections after total abdominal hysterectomy.

METHODS: In a randomized double-blind study, 134 patients were given 500 mg metronidazole as an intravenous infusion immediately before operation for abdominal total hysterectomy and again 8 hours later and 124 patients received placebo. RESULTS: There was more wound infection, postoperative hospitalization was longer and the sedimentation rate on the sixth postoperative day was significantly higher in the placebo group. There was no difference in postoperative temperature. Postoperative wound infections occurred in 12% in the placebo group and 6% in the metronidazole group. Eight percent in the total material had urinary tract infections, the diagnosis was based on urine cultures. CONCLUSIONS: Prophylaxis with intravenous infusion of metronidazole is recommended in total hysterectomies.

Modern oral contraceptives and dysmenorrhoea.

Women with primary dysmenorrhoea not sufficiently helped by triphasic oral contraceptives (OCs) were offered a modern, low-dose monophasic OC containing 30 micrograms of ethinylestradiol and 150 micrograms of desogestrel. The study shows that for these women, the monophasic pill was the better alternative. The fact that 19 of 23 women who continue treatment on the monophasic OC indicates that this type of pill may be chosen as the first alternative for women with primary dysmenorrhoea.

PIP: The effectiveness of a monophasic oral contraceptive was compared to that of a triphasic for relief of primary dysmenorrhea in an open crossover study in 30 women who had been previously taking triphasics. The pills formerly used contained ethinyl estradiol and either norethisterone (3) or levonorgestrel (27). Women took the monophasic pill containing 150 mcg desogestrel and 30 mcg estradiol [sic] for 3 months, then resumed their former prescription. Dysmenorrhea pain, marked on 10 mm scale, was lessened in 18 and increased in 4 women during monophasic intake (p0.01). Total duration of pain was reported as 2081 hours on the monophasic, and 2237 hours on the triphasic. The amount of bleeding reported as light, medium or heavy on a calendar was less on the monophasic for 18 women, the same in 2 and less on the triphasic for 4 women. Analgesic use during the monophasic was reported as less by 13, the same by 1, and more by 6 women. 19 women expressed a desire to continue with the monophasic after the study. It is likely that monophasic pills relieve dysmenorrhea more effectively because of their more consistent inhibition of ovulation.

Enzyme histochemistry on skeletal muscle of the human foetus.

The differentiation of fibre types in developing human skeletal muscle was studied. The material consisted of muscle samples from different muscles of 86 foetuses (abortions) between 12 weeks gestation and delivery and 50 children 1 day to 7 years old. The latter samples were obtained at surgery. Histochemical stains for myofibrillar ATPase were made after preincubations at pH 4.3, 4.6 and 10.3 in order to identify the subgroups A and B of type II fibres and undifferentiated fibres (type II C). Stains for glycogen and lipids were also performed as well as for NADH-diaphorase and alpha-glycerophosphate dehydrogenase. After 20 weeks gestation a few large size type I fibers could be found in some muscles, but not until after the 30th week were some type II A fibres seen. During the last 3 months of gestation a very rapid further differentiation occurred, but at delivery the differentiation process was still not completed. At birth 15-20% of the fibres were classified as undifferentiated. This picture only gradually changed with a slow increase in the number of type I, II A and II B fibres. The stains for metabolic enzymes and substrates were pale until late in foetal life when some distinction between fibre types became discernible.

Some quantitative biochemical evaluations of developing skeletal muscles in the human foetus.

This study was performed to obtain a more precise quantitative estimation of oxidative and glycolytic potentials and stores of various substrates of the muscles in the human foetus. The material consisted of muscle samples from different muscles, a total of 166 muscle specimens from 65 foetuses and 55 skeletal muscle specimens from 53 infants and children. The latter samples were obtained at surgery. The activities for succinate dehydrogenase and phosphofructokinase were chosen as markers for mitochondrial and cytoplasmatic enzymes respectively. Glycogen, triglyceride and phosphagen levels were studied. Water and protein content of the muscle tissue undergo continuous changes during foetal life and were therefore also included in the study. The SDH activity was low during gestation and reached a value of 2-3 mmoles/kg w.wt. X min at delivery. The PFK activity was also low during gestation, but around 25 weeks gestation a value of 3-4 mmoles/kg w.wt. X min was common, and around delivery time about 7 mmoles/kg w.wt. X min. At 1-5 years the PFK activity was around 11-12 mmoles/kg w.wt. X min, which is similar to adult muscles. Glycogen content varied, but increased during gestation. In the last trimester of gestation a value of 62-92 mmoles units/kg w.wt. was found. The triglyceride content at the end of the gestation time was 3-16 mmoles glycerol/kg w.wt. The phosphagen levels were quite low all through foetal life, averaging between 0.5 and 3 mmoles/kg for ATP and CP concentrations.

Cytological differentiation of human fetal skeletal muscle.

The ultrastructural differentiation of several different muscles was investigated in human fetuses ranging in age from 13 weeks to neonatal. At approximately 16 weeks of gestation cell cluster containing both myotubes and satellite cells lie enclosed by a newly formed basal lamina and show evidence of fusion. The development of organelles is evident in myoblasts, proceeds as the cells transform into myofibers, and continues in the neonate. Filament synthesis occurs primarily in the cell periphery where thin filaments appear to align themselves in relations to parallel arrays of ribosome-studded thick filaments: Z line formation follows the appearance of thin filaments. Intermediate filaments, approximately 10-12 nm thick, were also consistently observed in perinuclear regions and distal to filament assembly. Although sarcoplasmic reticulum (SR) development is closely related to fibril formation, connections between Z lines and SR are not consistent, thus supporting the conclusion that SR does not evoke the formation of the Z line. Bristlecoated vesicles appear to be the precursors of elements of the SR, possibly the lateral sacs. Development of the transverse tubules, as invaginations of the sarcolemma, is closely associated with the formation of lateral sacs since the latter occur along the sarcolemma as soon as transverse tubules appear. Cytological differentiation is similar, though not identical, in several different muscles. During the last trimester muscle fibers show some evidence of diversity mainly of variation in Z line width. In gerneral the results suggest that the sequence and stages of human myogenesis are similar to those of other species.