Dydrogesterone in threatened abortion: pregnancy outcome.

OBJECTIVE: To determine whether therapy with dydrogesterone in threatened abortion during the first trimester of pregnancy will improve pregnancy outcome. DESIGN: Prospective open study. SUBJECTS: Pregnant women presenting to the obstetric and gynaecology clinic admitting center with vaginal bleeding before 13 weeks gestation were evaluated for entry into the study. Women were excluded if they had a history of recurrent miscarriage. METHOD: Eligible subjects were randomized to receive either dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy. RESULTS: One hundred and 54 women were recruited. There was no statistically significant differences between the two groups with regard to pre-treatment status. The continuing pregnancy success rate was significantly (p=0.037) higher in women treated with dydrogesterone (95.9%) compared with women who received conservative treatment (86.3%). The odds ratio of the success rate between dydrogesterone treatment and non-treatment was 3.773 (95% confidence interval: 1.009-14.108). CONCLUSION: Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.

Sterilisation effect study on granular hydroxyapatite (HA).

Hydroxyapatite is a calcium phosphate bioceramic that has been shown by many authors to be biocompatible with bioactive properties. It is widely accepted as the best synthetic material available for surgical use as a bone graft substitute. HA granules produced by AMREC-SIRIM from local materials underwent 5 types of sterilisation techniques with different ageing periods. Samples were tested for chemical and phase composition and microbial contamination before and after being sterilised. From the microbiological tests done, none of the unsterilised positive control yielded a positive culture. Results from X-Ray diffraction studies found that all the sterilisation techniques did not chemically degrade or structurally change the HA granules significantly.

Histological evaluation of the early bone response to hydroxyapatite (HA) implanted in rabbit tibia.

This study is to qualitatively evaluate a locally produced hydroxyapatite (HA), made by AMREC-SIRIM in an experimental animal bone defect using New Zealand White (NZW) rabbits. HA cylindrical blocks measuring 2.5 mm (D) x 1.0 mm (H) were implanted in the rabbits' left tibia. The tibias were harvested within one to three weeks post-implantation. The implantion site was cut into thin undecalcified sections of about 30 microm to 60 microm and stained with Toluidine Blue and Goldner's Masson Trichrome. Microscopic examinations using standard light microscopy of these slides were performed.

Sterilisation effect study on granular hydroxyapatite (HA)

Hydroxyapatite is a calcium phosphate bioceramic that has been shown by many authors to be biocompatible with bioactive properties. It is widely accepted as the best synthetic material available for surgical use as a bone graft substitute. HA granules produced by AMREC-SIRIM from local materials underwent 5 types of sterilisation techniques with different ageing periods. Samples were tested for chemical and phase composition and microbial contamination before and after being sterilised. From the microbiological tests done, none of the unsterilised positive control yielded a positive culture. Results from X-Ray diffraction studies found that all the sterilisation techniques did not chemically degrade or structurally change the HA granules significantly.

Relationship between facial types and tooth and bone characteristics of the mandible obtained by CT scanning.

The purpose of this study was to evaluate relationships between morphological characteristics of vertical sections of the mandibular body and facial type. Of the correlation coefficients between tooth and bone inclination and facial type parameters, facial height index (FHI) was negatively associated with second premolar (P2), first molar (M1), and second molar (M2) inclinations. The angle represented by Frankfort horizontal plane to mandibular plane (FMA) was negatively associated with bone inclination of the M2 section. The buccal cortical bone was thicker in short-faced individuals than in the average and long-faced groups, while lingual cortical bone thickness of the M1 and M2 sections was greater. The basal cortical bone thickness of the L1 section was greater in the short-faced group, and the inclinations of the P2, M1, and M2 axes were significantly smaller. Teeth in the short-faced group inclined more lingually than in the average- and long-faced groups. The results of this study provide evidence that a significant but complex relationship exists between structures of the mandibular body and facial types. The morphological features that relate to masticatory function and facial types are associated with cortical bone thickness of the mandibular body and the buccolingual inclination of the first and second molars.

[A patient with mitral stenosis due to infective endocarditis].

A 51-year-old woman presented with mild stenosis of the mitral valve which had become thickened and rigid due to infective endocarditis, manifesting as persistent fever of up to 40 degrees C and general fatigue of a few days' duration. A harsh systolic murmur was heard. Multiple blood cultures revealed alpha-streptococcus. Echocardiography disclosed asymmetric septal hypertrophy (interventricular septal thickness/posterior wall thickness, 19/14 mm) and systolic anterior wall motion of the mitral valve. Continuous wave Doppler ultrasonography showed a peak left ventricular outflow tract pressure gradient of 170 mmHg. Transesophageal echocardiography revealed vegetations on the anterior mitral leaflet, aortic valve and interventricular septum along the left ventricular outflow tract. In particular, the anterior mitral leaflet was thickened and moved poorly. The calculated mitral valve areas was 1.5 cm2 and peak diastolic left atrium-left ventricle pressure gradient was 7 mmHg. A specimen of the mitral valve did not reveal commissural adhesion, but the anterior mitral leaflet showed marked fibrous thickening caused by scarred vegetation. Based on these findings, the diagnosis was hypertrophic obstructive cardiomyopathy complicated by infective endocarditis and "mitral stenosis". Valvular regurgitation is a common complication of active and healed infective endocarditis. In contrast, infective endocarditis rarely causes valvular stenosis except for stenosis caused by large fungus vegetation.

[Dobutamine stress causes left ventricular outflow tract obstruction].

Hypotension during dobutamine stress echocardiography is caused by ischemia as well as non-ischemic causes. Whether sigmoid interventricular septum seen in the aged can cause hypotension during dobutamine stress echocardiography was investigated in eight men and four women with sigmoid interventricular septum (aged 53 to 76 years, mean 67 +/- 7 years). At peak dobutamine dose, seven patients (group H) showed a hypotensive response (defined as 5 mmHg or greater decrease in systolic blood pressure from the peak systolic blood pressure; mean = - 17 +/- 13 mmHg), while five subjects (group N) did not. No subject showed regional wall motion abnormalities. Before dobutamine infusion, group H had smaller left ventricular end-systolic dimension (26 +/- 3 vs 30 +/- 3 mm) than group N, but no difference was found in left ventricular end-diastolic dimension (44 +/- 3 vs 47 +/- 4 mm), percentage fractional shortening (40 +/- 6% vs 34 +/- 7%), diastolic aorto-septal angle (82 +/- 10 vs 95 +/- 11 degrees), systolic aorto-septal angle (94 +/- 10 vs 101 +/- 11 degrees), peak left ventricular outflow velocity (1.3 +/- 0.2 vs 1.2 +/- 0.3 m/sec) or peak left ventricular outflow pressure gradient (7 +/- 2 vs 6 +/- 3 mmHg). Group H had a lower peak dobutamine dose than group N (33 +/- 8 vs 40 +/- 7 micrograms/kg/min), but under the peak dose of dobutamine infusion group H showed smaller left ventricular end-systolic dimension (20 +/- 3 vs 26 +/- 4 mm), systolic mitral annulus diameter (19 +/- 3 vs 23 +/- 2 mm), diastolic aorto-septal angle (72 +/- 16 vs 92 +/- 6 degrees), and systolic aorto-septal angle (84 +/- 12 vs 100 +/- 6 degrees), and higher heart rate (114 +/- 10 vs 79 +/- 16 bpm), percentage fractional shortening (53 +/- 8% vs 43 +/- 7%), peak left ventricular outflow velocity (3.2 +/- 0.8 vs 1.7 +/- 0.3 m/sec), and peak left ventricular outflow pressure gradient (43 +/- 23 vs 12 +/- 5 mmHg). In addition, systolic anterior motion of the mitral valve with septal contact developed in 86% of group H and 0% of group N. Thus, about half of the patients with sigmoid interventricular septum show hyperresponse to dobutamine and develop dynamic left ventricular outflow tract obstruction as well as systemic arterial hypotension even without regional left ventricular wall motion abnormalities.

Effects of volume loading, propranolol, and heart rate changes on pump function and systolic time intervals of the left atrium in open-chest dogs.

Left atrial (LA) pressure-dimension curve was constructed and the area of A-loop (AAL, in mm.mmHg) which reflected LA stroke work was measured in 14 open-chest dogs before and after saline infusion, in 14 dogs before and after propranolol administration under fixed heart rate and in 12 dogs while atrial pacing rate was increased stepwise. The peak +dP/dt of LA systolic pressure (LA +dP/dt, in mm Hg/s) and LA percent fraction shortening (LA %FS) were obtained as indices of LA pump function. The peak -dP/dt of X descent in LA pressure (LA -dP/dt, in mm Hg/s) was measured as an index of LA relaxation. From pulsed Doppler mitral flow velocities, A-wave acceleration (AC, in cm/s2), LA pre-ejection period corrected by P-wave duration (LA PEPc), and LA ejection time (LA ET) were measured. AAL, LA +dP/dt, AC, LA %FS, and LA -dP/dt increased after saline infusion (AAL; 2.2 +/- 1.6 to 5.1 +/- 3.3 (p < 0.05), LA +dP/dt; 34 +/- 16 to 52 +/- 23 (p < 0.05), AC; 320 +/- 90 to 472 +/- 98 (p < 0.05), LA %FS; 9 +/- 4 to 12 +/- 4 (p < 0.05), and LA -dP/dt; 38 +/- 28 to 60 +/- 32 (p < 0.05)) and decreased after propranolol administration (AAL; 2.9 +/- 1.9 to 1.2 +/- 0.7 (p < 0.05), and LA +dP/dt; 42 +/- 19 to 28 +/- 11 (p < 0.05), AC; 332 +/- 92 to 254 +/- 102 (p < 0.05), LA %FS; 14 +/- 5 to 8 +/- 5 (p < 0.05), and LA -dP/dt; 36 +/- 19 to 26 +/- 18 (p < 0.05)), but did not change significantly during heart rate increments. LA PEPc decreased after saline infusion (114 +/- 11 to 104 +/- 14 (p < 0.05)) and increased after propranolol administration (108 +/- 8 to 129 +/- 13 (p < 0.05)). As pacing rate was increased, LA PEPc and LA ET showed no significant changes. Both AAL and LA +dP/dt correlated significantly with LA PEPc (r = -0.76 and -0.66), but not with LA ET (r = -0.08 and -0.04). In conclusions, LA pump function was augmented by volume loading and decreased by propranolol, but unchanged by heart rate increments. These changes in LA pump function were reflected by LA PEPc, but not by LA ET. LA PEPc is a useful index of LA pump function which is not heart rate dependent.

[Correlation between morphologies of mandibular vertical sections and linear measurements of the skull].

The purpose of this study is to evaluate the relationships between the sectional forms of the mandible and the craniofacial morphology. Vertical sections were made at the symphysis (SY) and at the second molar region (M2R). Materials were dried human skulls which were measured in three dimensional co-ordinate system. The correlation matrix of 24 measurements was examined in the male and the female. The difference of these measurements between the low angle group and the high angle group of gonial angle was also examined. Results obtained were as follows: 1. Gonial angle was negatively correlated with the height, width, breadth of ramus and the breadth of second molars. SY form was related to the facial height and size of the mandible. On the other hand, M2R form was related to the height, width and breadth of ramus. 2. The differences of measurements between the low angle group and the high angle group of gonial angle were as follows: 1) The ramal height, ramal width, bicondylar width and breadth of second molars in the low angle group were significantly larger than those in the high angle group. 2) The measurements of SY in the high angle group and the low angle group showed no significant difference. 3) The height and area of M2R in the low angle group were significantly larger than those in the high angle group. This study demonstrated that SY form might relate to vertical factors of the face (facial height), the size of mandible and the types of occlusions. On the other hand, M2R form being nearer to the attachment of masseter and medial pterygoid muscles than SY was related to the form of ramus and the gonial angle.