Effects of topical low-dose preservative-free hydrocortisone on intraocular pressure in patients affected by ocular surface disease with and without glaucoma.

PURPOSE: This study aims to investigate the safety and efficacy of short-term treatment for ocular surface disease (OSD) with topical low-dose (1,005 mg) preservative-free hydrocortisone in one hundred patients with and without glaucoma. METHODS: This was an open label non-randomized clinical trial. Patients with OSD with and without primary open-angle glaucoma (POAG) received topical low-dose (1,005 mg) preservative-free hydrocortisone twice daily in each eye for 2 weeks. All patients underwent a complete ophthalmological examination at baseline (T0) and at 1 (T1) and 2 (T2) weeks post-treatment. At each visit, the intraocular pressure (IOP) and the ocular surface disease index (OSDI) questionnaire scores were recorded; the Schirmer test was performed only at T0 and T2. RESULTS: The OSDI score significantly decreased in both the POAG and no-POAG groups (both p < 0.0001) after hydrocortisone treatment, with no difference between the two groups (p = 0.72). There were no significant differences in IOP and Schirmer test results between T0 and T2 in both treatment groups (p = 0.68 and p = 0.83, respectively). CONCLUSIONS: Topical low-dose (1,005 mg) preservative-free hydrocortisone is safe and effective for improving OSD symptoms both in patients with and without POAG. TRIAL REGISTRATION: The trial was registered at clinicaltrials.gov under NCT04536129 on 01/09/2020 ("retrospectively registered").

The effects of hypoxia and hyperoxia on fetal-placental vascular tone and inflammatory cytokine production.

OBJECTIVE: To determine the effects of fetal hypoxia and hyperoxia on placental vascular tone and production of interleukin-6 and tumor necrosis factor-alpha. STUDY DESIGN: The maternal and fetal circulation of 2 cotyledons from 5 human placentas were perfused for 4 hours. The fetal circulation of 1 cotyledon was perfused with hypoxic Hanks' balanced salt solution; the other was perfused with hyperoxic Hanks' balanced salt solution. Fetal vascular pressures were recorded every 10 minutes, and fetal vein effluents were collected hourly. RESULTS: Fetal-placental vascular perfusion pressure was reduced from baseline during hypoxic conditions. Cytokine concentrations were elevated during hyperoxic conditions compared with hypoxic conditions, with significant differences achieved at 2, 3, and 4 hours for interleukin-6 and at 4 hours for tumor necrosis factor-alpha. CONCLUSION: Fetal-placental vasodilation may be a compensatory mechanism to improve hypoxic conditions. Supraphysiologic oxygenation may contribute to the fetal inflammatory response syndrome and to the development of cerebral palsy.

Influence of gestational age and maternal height on fetal femur length calculations.

OBJECTIVE: To determine whether current methods of detecting Down syndrome based on fetal femur length calculations are influenced by gestational age or maternal height. METHODS: Four formulas were used to calculate expected femur length (FL) based on the fetal biparietal diameter (BPD) between 15 0/7 weeks' gestation and 19 6/7 weeks' gestation. For each gestational age, the BPD:FL ratio for women shorter than one standard deviation (SD) below the mean height was compared with the ratio for women taller than one SD above the mean height. A measured:expected FL ratio of 0.91 or less and a BPD:FL ratio greater than 1.5 SD above the mean was considered abnormal. RESULTS: The four formulas used to calculate measured:expected FL ratios were significantly more likely to be abnormal at 15--16 weeks' gestation, compared with 18-19 weeks' gestation (P <.05). Maternal height correlated with femur lengths at 18 and 19 weeks' gestation (P <.05) but not at earlier gestational ages. At 18 and 19 weeks' gestation, women shorter than one SD below the mean were twice as likely to have an abnormal BPD:FL ratio compared with women taller than one SD above the mean (relative risk 2.38; 95% confidence interval 1.21, 4.69). CONCLUSION: Early gestational age increases a woman's risk of having an abnormal measured:expected FL ratio, whereas short stature increases a woman's risk of having an abnormal BPD:FL ratio at later gestational ages. These findings indicate that risk assessment for fetal Down syndrome for such patients might be inaccurate. (Obstet Gynecol 2001;97:742-6.

Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report.

BACKGROUND: Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus. A multispecialty approach and alternative medicine are often effective. Recently, the FDA announced the use of acupuncture and acupressure as officially recognized modalities for treatment of chronic pain in oncology patients. CASE: Chronic pelvic pain in a 23 year-old primigravida at 27 weeks' gestation was incapacitating on narcotics. After organic causes were ruled out, acupuncture was employed successfully. Outpatient management for the duration of the pregnancy included acupuncture and narcotics for breakthrough pain while maintaining activities of daily living. Spontaneous vaginal delivery without complications at 38 5/7 weeks produced a 3,305-g female infant. The pain resolved immediately following delivery. CONCLUSION: This case demonstrates the benefit of combined allopathic with alternative forms of medicine. With the use of acupuncture, narcotic use was limited in this gravida while adding to her quality of life by allowing her to maintain normal activity.

Fetoplacental vascular tone during fetal circuit acidosis and acidosis with hypoxia in the ex vivo perfused human placental cotyledon.

OBJECTIVES: Our purpose was to determine the effects of acidosis and acidosis-hypoxia on fetoplacental perfusion pressure and its response to angiotensin II. STUDY DESIGN: Perfused cotyledons from 14 placentas were studied with either an acidotic fetal circuit perfusate (n = 7) or an acidotic-hypoxic fetal circuit perfusate (n = 7). Each cotyledon's fetal vasculature was initially perfused under standard conditions and bolus injected with 1 x 10(-10) moles of angiotensin II. Fetoplacental perfusate was then replaced with either an acidotic medium (pH 6.90 to 7.00 and Po2 516 to 613 mm Hg) or an acidotic-hypoxic medium (pH 6.90 to 7.00 and Po2 20 to 25 mm Hg) followed by an angiotensin II injection. The vasculature was subsequently recovered with standard perfusate and again injected with angiotensin II. Perfusion pressures within each group were compared by one-way analysis of variance, and results were expressed as mean pressure +/- SEM. RESULTS: Resting fetoplacental perfusion pressure did not change when the fetal circuit perfusate was made acidotic (28 +/- 1 mm Hg vs 25 +/- 2 mm Hg) or acidotic-hypoxic (26 +/- 2 mm Hg vs 25 +/- 2 mm Hg). The maximal fetoplacental perfusion pressure achieved in response to angiotensin II did not differ with an acidotic perfusate (41 +/- 2 mm Hg vs 38 +/- 1 mm Hg) or with an acidotic-hypoxic perfusate (39 +/- 2 mm Hg vs 36 +/- 2 mm Hg). CONCLUSIONS: In the perfused placental cotyledon fetoplacental perfusion pressure and pressor response to angiotensin II are not affected by fetal circuit acidosis or acidosis-hypoxia. This suggests that neither fetal acidosis nor fetal acidosis combined with hypoxia has a direct effect on fetoplacental vascular tone.

The fetoplacental pressor effects of low-dose acetylsalicylic acid and angiotensin II in the ex vivo cotyledon model.

OBJECTIVE: Our purpose was to investigate perfusion pressure changes ex vivo induced by angiotensin II on fetoplacental vasculature pretreated with low-dose acetylsalicylic acid. STUDY DESIGN: Two cotyledons from each of 12 placentas were perfused. The intervillous space of one cotyledon was infused with acetylsalicylic acid (5 x 10(-5) mol/L) similar to the serum concentration of women receiving daily low-dose aspirin therapy (60 to 81 mg). The control cotyledon was infused with an equivalent amount of normal saline solution. Two doses of angiotensin II, 1 x 10(-11.5) and 1 x 10(-10) moles, were injected as boluses into the chorionic arteries of each cotyledon. A 3 x 10(-7) mole dose of angiotensin II was also injected into the intervillous space. Statistical analysis was performed with analysis of variance, and results are expressed as mean pressure change in millimeters of mercury +/- SEM. RESULTS: Perfusion pressure response did not vary between cotyledons pretreated with acetylsalicylic acid and control cotyledons when 3 x 10(-7) moles of angiotensin II was injected into the intervillous space (8.0 +/- 1.9 mm Hg vs 9.8 +/- 1.6 mm Hg, p = 0.59). There were no differences between cotyledons in pressure response to 1 x 10(-11.5) moles of angiotensin II injected into the fetal circuit (5.9 +/- 0.8 mm Hg vs 6.7 +/- 0.9 mm Hg, p = 0.51). However, in the cotyledons pretreated with acetylsalicylic acid there was a decrease in the pressor response to 1 x 10(-10) moles of angiotensin II (14.1 +/- 1.4 mm Hg vs 21.5 +/- 3.3 mm Hg, p = 0.05). CONCLUSIONS: Low-dose aspirin infused into the intervillous space decreases vasoconstriction elicited by angiotensin II in the fetoplacental compartment. This suggests that maternal low-dose aspirin therapy has effects in the fetoplacental circulation in addition to its effects in the maternal circulation.

Pregnancy after failed tubal sterilization.

OBJECTIVE: To review the pregnancy outcome in patients with failed tubal sterilization treated in our hospital and to compare the incidence of ectopic pregnancy in our study group with the experience at other military hospitals and with the incidence of ectopic pregnancy in similar patients reported in the literature. STUDY DESIGN: A registry of failed tubal sterilization was started at our hospital in 1989. We entered all information regarding the type of procedure and pregnancy outcome as the patients presented for care. Information on the experience at other military hospitals was obtained through review of data provided by the epidemiology section of the Health Services Command, San Antonio, Texas. RESULTS: From 1989 to 1991, 12 patients with failed tubal sterilization received care at our hospital. Eight patients (67%) had ectopic pregnancies. Of 137 patients identified through the Health Services Command, 49 (36%) had ectopic pregnancies. CONCLUSION: The literature reports a 5-90% incidence of ectopic pregnancy after failed tubal sterilization. The data from our registry and from the Health Services Command corroborate the increased likelihood of ectopic pregnancy in patients with failed tubal sterilization and underscore the need for close follow-up of these patients until the location of the pregnancy is documented.

PIP: Various research studies have documented post-sterilization ectopic pregnancy rates ranging from 5% to 90%. To investigate this complication further, the pregnancy outcomes of the 12 women with failed tubal sterilizations who received care during 1989-91 at the Beaumont Army Medical Center in El Paso, Texas, and of 137 such patients at other Texas military hospitals during 1984-88 were reviewed. Ectopic pregnancies occurred in 8 (67%) women in the former group and 49 (36%) in the latter. The incidence of ectopic pregnancy was similar for minilaparotomy, cesarean section-associated sterilization, and laparoscopy, indicating that there is no significant advantage associated with any one procedure. A post-sterilization pregnancy may be due to tubal recanalization or to a proximal fistula. Recommended is the practice of electrocoagulating both cornual regions to cause scarring of the myometrium and closing of any fistula.

Vaginal mucositis in measles.

BACKGROUND: Measles (rubeola), a common childhood exanthema, occurs infrequently in adults. Vaginal mucositis in association with measles is not commonly described. CASE: During a recent measles epidemic, 2 female patients presented with high fever, myalgia, exanthema, and prostration. On examination, each patient had marked inflammation and tenderness of the vaginal mucosa, prompting the presumptive diagnosis of toxic shock syndrome. The evolution of the illness was consistent with measles. Cervicovaginal cultures were negative for pathogens. Acute and convalescent antibody titers for Rocky Mountain spotted fever, rubella, leptospirosis, and Proteus Ox-19 were not consistent with a recent infection. The sera also were negative for anti-toxic shock toxin-1 and anti-streptolysin. Measles antibody titers were consistent with a recent infection. CONCLUSION: Vaginal mucositis is an unusual manifestation of measles that may mimic toxic shock syndrome.

Lymphoblastoid interferon in chronic hepatitis C patients who were "non responders" to recombinant interferon alpha (rIFN alpha).

The aim of this study was to investigate whether there is a variable responsiveness of the hepatitis C virus and/or of the affected host to different types of interferon. We treated 21 patients affected by chronic hepatitis C who failed to respond to recombinant alpha interferon, after a four-month interval, with lymphoblastoid interferon. Alanine transaminase (ALT) serum level was normal in 9 patients (43%) at the end of treatment. At the end of a 12 months treatment-free follow-up serum ALT remained normal in 3 patients, 4 patients relapsed and 2 dropped-out. As yet there are no reports of differences in the therapeutic efficacy of the two types of interferon used in our study. The good response to the lymphoblastoid interferon in our non responders to recombinant alpha interferon may be due to the immune modulation induced by the four-month wash-out interval between the two therapies or to a different virus sensitivity to this interferon.

[On the analysis of population distribution over a predetermined territory]. / Sul metodo di analisi delle distribuzioni di popolazioni su un territorio prefisso.

PIP: Methods for analyzing spatial distribution over a predetermined territory using computer-generated statistical maps are discussed. Some properties of an index of dissimilarity based on distance are discussed. (SUMMARY IN ENG AND FRE)^ieng