Sandwich excision in patients with placenta percreta involving maternal bladder.

OBJECTIVE: Our aim is to describe and assess a Sandwich Excision (placenta-uterine-bladder excision together) surgical technique for women with clinically confirmed placenta percreta involving the maternal bladder. PATIENTS AND METHODS: A retrospective cohort study was performed on all patients with clinically confirmed placenta percreta involving the maternal bladder who underwent Sandwich Excision at our large academic institution from January 1, 2014, to June 30, 2019. RESULTS: Twenty-three patients were included. Four patients underwent hysterectomy, and one patient underwent subhysterectomy. The mean duration of surgery was 228.04 ± 85.59 minutes (range, 90.00-503.00 minutes). The mean estimated blood loss was 5,269.57 ± 2,745.81 mL (range, 1,000.00-12,500.00 mL). No thromboembolic events occurred, and there were no maternal or neonatal deaths among the subjects in this study. CONCLUSIONS: Sandwich excision is associated with a low rate of hysterectomy in women with placenta percreta involving the maternal bladder. The procedure is a relatively safe technique and can be performed safely by experienced obstetricians who are familiar with the uterus-bladder space. Meanwhile, the success rates and complications of the Sandwich Excision in these patients also need to be evaluated in prospective studies.

Free radical scavenging active components from Cedrus deodara.

An activity-directed fractionation and purification process was used to identify the antioxidant components of Cedrus deodara. Dried heartwood powder of C. deodara was first defatted with petroleum ether and then extracted with chloroform. The chloroform extract showed strong antioxidant activity on 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical. This fraction was then subjected to separation and purification using silica gel column chromatography. Three compounds with potent antioxidant activity were isolated in significant yields and identified by spectroscopic methods ((1)H NMR, (13)C NMR, IR, and MS). They were identified as (-)-matairesinol, (-)-nortrachelogenin, and a dibenzylbutyrolactollignan (4,4',9-trihydroxy-3,3'-dimethoxy-9,9'-epoxylignan). This is the first report of the occurrence of these compounds in C. deodara.

Oxanthrone esters from the aerial parts of Cassia kleinii.

From the aerial parts of Cassia kleinii two new oxanthrone esters, kleinioxanthrone-1 and kleinioxanthrone-2 have been isolated. Their structures were established as 1,8-dihydroxy-3-methyl-6-methoxy-9(10H)-anthracenone-10-oxydecanoate 1 and 1,8-dihydroxy-3-methyl-9(10H)-anthracenone-10-oxytetradecanoate 2 respectively based on degradative and spectroscopic evidence.

Correct assembly of human normal adult hemoglobin when expressed in transgenic swine: chemical, conformational and functional equivalence with the human-derived protein.

Structural and functional investigations of recombinant human hemoglobin A (HbA) isolated from the erythrocytes of transgenic swine coexpressing human alpha- and beta-globins have been carried out to authenticate its correct expression, post-translational processing and assembly. The HbA expressed in transgenic swine (TgHbA) is indistinguishable from the human-derived HbA in terms of its isoelectric pH, mass and elution pattern on a Mono S column. The chemical identity of the alpha- and beta-globin chains of TgHbA with the corresponding chains from human-derived HbA has been established by tryptic peptide mapping and amino acid sequencing. The proton NMR spectra of TgHbA have demonstrated that the conformational aspects of the protein around the heme pocket are indistinguishable from those of the control sample of HbA. The equivalence of the hydrogen bond pattern of TgHbA (in particular the inter-subunit surfaces) with that of authentic HbA has also been established by NMR studies. Consistent with these structural and conformational analyses, the TgHbA also exhibits complete functional equivalence with the human-derived HbA with respect to oxygen affinity, cooperativity, Bohr effect and allostery. Hence the studies presented here demonstrate that the transgenic swine system correctly transcribes the alpha- and beta-globin transgenes, translates the respective alpha- and beta-globin mRNA to generate the corresponding globin chains, carries out the correct cotranslational processing of the translated globin chains, inserts the heme into the globin chains in the same orientation as in the human-derived HbA and assembles the alpha- and beta-subunits into a functionally cooperative tetramer that exhibits a response to allosteric effectors identical with that of human-derived HbA. Thus, in the transgenic swine system, in vitro chemical manipulation steps such as those needed in the Escherichia coli and the yeast systems, to convert the rHbA expressed in these systems into forms functionally identical with that of the human-derived protein, are not needed. An additional advantage of the transgenic swine system is the stability of the transgenes over many generations. Hence the transgenic swine could serve as an excellent system for the production of human HbA (or its variants) for structure-function studies and for therapeutic applications.

The association between Coffin-Lowry syndrome and psychosis: a family study.

This paper discusses a family presenting with features of Coffin-Lowry syndrome, namely abnormal facies, skeletal abnormalities and mental handicap. Two of the mildly affected females had psychotic illness with predominant depressive features, and all the severely affected males had profound sensorineural deafness.

A population-based study of mild mental handicap in children: preliminary analysis of obstetric associations.

One hundred and twenty-nine children in the 8- to 12-year-old age group in Cardiff were ascertained to have mild mental deficiency. Detailed obstetric data were obtained which indicated that nearly 69% of the children were associated with adverse obstetric factors. Fifty-five per cent had the combined pathogenetic risk factors of pre-, peri- and neonatal adversities. Forty-two per cent of the cases had non-optimal perinatal factors and 45% were considered to have prenatal causation. There were four children with chromosomal anomalies. The various adverse obstetric influences are discussed separately.

Lithium-induced changes in the body mass index.

A total of 117 manic-depressives who had been on lithium for a mean duration of 4.7 years were examined before lithium therapy and subsequently at intervals. Information relating to pre-lithium height and weight and current weight were determined and used to calculate the body mass index (BMI) for each individual. Other relevant variables such as age, sex, cumulative lithium dose, duration of therapy, thyroid profile and serum lithium levels were recorded. The results indicated that, although there was a nonsignificant increase in BMI for the whole population, lithium and sex were not significant predictors of any increase in BMI. In nearly 27% of patients BMI actually slightly decreased during lithium therapy. The overall conclusions from this study are that, in the population studied, lithium may not have exerted any pharmacological effects to increase BMI.

Akathisia in neuroleptic medicated mentally handicapped subjects.

Sixty-six neuroleptic medicated mentally handicapped subjects in a hospital were studied to determine the prevalence of drug-induced akathisia. Tardive dyskinesia was also rated on the AIMS scale. Only motor manifestations of akathisia could be assessed as the subjective component of akathisia was difficult to elicit in this population with difficulties in verbal communication. As all the subjects had been on neuroleptics for at least 3 years, only chronic akathisia could be studied. Five subjects had akathisia. Correlational analysis did not reveal any specific associations with any of the demographic, clinical and pharmacological variables studied. A step-wise multiple regression analysis indicated that younger age could be a predictor. Tardive dyskinesia was associated in two of the subjects. The overall conclusion was that 7% of the subjects had chronic akathisia and no specific risk factors could be identified.

Neuroleptic-induced parkinsonian side effects in the mentally handicapped.

Sixty-seven neuroleptic-mediated mentally handicapped subjects in a hospital were studied to determine the prevalence of Parkinsonian side effects. A Parkinsonism scale was devised and administered. Sixty-one per cent of the sample had mild to moderately severe side effects. Sex, age, cumulative and current chlorpromazine doses, cumulative and current anticholinergic doses and anti-epileptic medication status did not predict the Parkinsonism scores. Overt brain damage was not a predictor. The difference between the neuroleptic medicated group and neuroleptic free matched controls was highly significant indicating that the Parkinsonian type of movement disorder was related to neuroleptic medication.

Tardive dyskinesia in neuroleptic medicated mentally handicapped subjects.

Sixty-seven neuroleptic medicated mentally handicapped subjects in a hospital were rated on two occasions for abnormal involuntary movements on three scales: Abnormal Involuntary Movements (AIMS), Rockland and Parkinsonism scales, with 6 months between each assessment. Inter-rater and test-retest reliabilities were high. The data from the second assessment was analyzed. Prevalence of tardive dyskinesia (TD) was 21% on AIMS, 42% on the Rockland scale; 60% had parkinsonism. Multiple stepwise regression analysis revealed that age, sex, current neuroleptic and anticholinergic dose, antiepileptic medication, psychosis, cumulative anticholinergic dose were not significant predictors of TD as determined by AIMS. Parkinsonism and cumulative neuroleptic dose were significant predictors of and correlated positively with AIMS score. TD subjects formed 35% of the parkinsonian group. Overt brain damage was not a significant predictor of AIMS score and the difference between the neuroleptic medicated and neuroleptic free group on AIMS scores was highly significant.

Drug use in pregnancy: how to avoid problems.

PIP: The Obstetric Drug Information Service at the Queen Victoria Medical Center in Melbourne, Australia aims to provide relevant information relating to drug use in pregnancy. A preliminary study conducted by the Center revealed that 62.5% of pregnant women consumed drugs during their pregnancies (excluding iron and vitamins), with an average of 3 drugs per woman. Certain drugs are relatively safer than others, and the selection of the appropriate drug for a pregnant patient is very important to the future health and well-being of the child. At least 5% of all birth defects are drug induced. The drugs that produce fetal abnormalities are called "dysmorphogens" or "teratogens". General principles of drug use in pregnancy are outlined. These include the following: 1) no drug should be considered 100% safe to the developing fetus, including topical preparations; 2) a true indication must be present for the administration of any drug; 3) the potential benefits should always be weighed against the possible hazards of that drug to the mother and the fetus; and 4) the effect of a drug on the fetus may not necessarily be the same as the intended pharmacological effect on the mother. The following specific drug induced embryopathies are reviewed: fetal alcohol syndrome; Warfarin syndrome; fetal hydantoin syndrome; stilbestrol (diethylstilbestrol, DES) syndrome, VACTERL syndrome, and thalidomide embryopathy. Drugs which are safe for use in pregnancy are analgesics, hypnosedatives, antibiotics, antiemetics and antihistamines, psychotherapeutic drugs, antihypertensive drugs, antituberculous drugs, antimalarial drugs, antithyroid drugs, and antidiabetic drugs.^ieng