WITHDRAWN: Active versus expectant management in the third stage of labour.

BACKGROUND: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord. OBJECTIVES: The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing active and expectant management of the third stage of labour in women who were expecting a vaginal delivery. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by the reviewers. MAIN RESULTS: Five studies were included. Four of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64.37); post partum haemorrhage of more than 500 millilitres (relative risk 0.38, 95% confidence interval 0.32 to 0.46); prolonged third stage of labour (weighted mean difference -9.77 minutes, 95% confidence interval -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (relative risk 1.83, 95% confidence interval 1.51 to 2.23), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby. AUTHORS' CONCLUSIONS: Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).

Artificial bowel markers: a novel method for measuring the accuracy of colonoscopy.

PURPOSE: Colonoscopy is the "gold standard" for assessing colonic mucosal abnormalities. An important component of this is complete examination to the cecum. However, the ability to detect abnormalities is equally important and has received less attention. This study was designed to assess the accuracy of detection of artificial bowel markers as surrogates for small polyps. METHODS: Patients were randomly assigned to receive between zero and four of each of two types of marker. Markers used were 5-mmx5-mm pieces of latex-free rubber or 12-mmx1.5-mm metallic bowel clips. These were placed on insertion of the colonoscope. At the limit of the colonoscopy, a second blinded endoscopist performed the extubation. Six endoscopists took part in the study. Data regarding the number, type, and position of the markers on insertion and withdrawal were recorded as were insertion and withdrawal times. RESULTS: A total of 179 markers (85 clips, 94 rubbers) were placed in 44 patients. The cecal intubation rate was 91 percent. Median intubation time was 20 minutes and withdrawal time was 15 minutes; 139 markers (77.7 percent) were detected on withdrawal (clips, 76.5 percent; rubbers, 78.7 percent). There was no correlation between insertion or withdrawal times and marker detection. Detection rates varied between endoscopists (71-87 percent), but there was no correlation with individual cecal intubation rates (P=0.96). Markers placed at flexures were missed more often (P=0.008). CONCLUSIONS: Artificial markers provide a novel method for assessing colonoscopic accuracy. The results obtained with this method are closely concordant with results from other studies. The technique is potentially useful in training, audit, and future research.

Foodservice yield and fabrication times for beef as influenced by purchasing options and merchandising styles.

Selected beef subprimals were obtained from fabrication lines of three foodservice purveyors to assist in the development of a software support program for the beef foodservice industry. Subprimals were fabricated into bone-in or boneless foodservice ready-to-cook portion-sized cuts and associated components by professional meat cutters. Each subprimal was cut to generate mean foodservice cutting yields and labor requirements, which were calculated from observed weights (kilograms) and processing times (seconds). Once fabrication was completed, data were analyzed to determine means and standard errors of percentage yields and processing times for each subprimal. Subprimals cut to only one end point were evaluated for mean foodservice yields and processing times, but no comparisons were made within subprimal. However, those traditionally cut into various end points were additionally compared by cutting style. Subprimals cut by a single cutting style included rib, roast-ready; ribeye roll, lip-on, bone-in; brisket, deckle-off, boneless; top (inside) round; and bottom sirloin butt, flap, boneless. Subprimals cut into multiple end points or styles included ribeye, lip-on; top sirloin, cap; tenderloin butt, defatted; shortloin, short-cut; strip loin, boneless; top sirloin butt, boneless; and tenderloin, full, side muscle on, defatted. Mean yields of portion cuts, and mean fabrication times required to manufacture these cuts differed (P < 0.05) by cutting specification of the final product. In general, as the target portion size of fabricated steaks decreased, the mean number of steaks derived from any given subprimal cut increased, causing total foodservice yield to decrease and total processing time to increase. Therefore, an inverse relationship tended to exist between processing times and foodservice yields. With a method of accurately evaluating various beef purchase options, such as traditional commodity subprimals, closely trimmed subprimals, and pre-cut portion steaks in terms of yield and labor cost, foodservice operators will be better equipped to decide what option is more viable for their operation.

Retail yield and fabrication times for veal as influenced by purchasing options and merchandising styles.

Twenty-nine selected styles of subprimals or sections of veal were obtained from a commercial facility to assist in the development of a support program for retailers. They were fabricated into bone-in or boneless retail cuts and associated components by trained meat cutters. Each style selected (n = 6) was used to generate mean retail yields and labor requirements, which were calculated from wholesale and retail weights and processing times. Means and standard errors for veal ribs consisting of five different styles (n = 30) concluded that style #2, 7-rib 4 (10 cm) x 4 (10 cm), had the lowest percentage of total retail yield (P < .05) owing to the greatest percentage of bone. Furthermore, rib style #2 required the longest total processing time (P < .05). Rib styles #3, 7-rib chop-ready, and #5, 6-rib chop ready, yielded the greatest percentage of total retail yield and also had the shortest total processing time (P < .05). Within veal loins, style #2, 4 (10 cm) x 4 (10 cm) loin kidney fat in, had the greatest percentage fat (P < .05). Loin styles #2 and #3, 4 (10 cm) x 4 (10 cm) loin special trimmed, generated more lean and fat trimmings and bone, resulting in lower percentage of total retail yields than loin style #1, 0 (0 cm) x 1 (2.5 cm) loin special trimmed (P < .05). Results indicated that bone-in subprimals and sections required more processing time if fabricated into a boneless end point. In addition, as the number of different retail cuts increased, processing times also increased.

Influence of wholesale lamb marketing options and merchandising styles on retail yield and fabrication time.

Lamb carcasses (n = 94) from five packing plants, selected to vary in weight class and fat thickness, were used to determine retail yield and labor requirements of wholesale lamb fabrication. Carcasses were allotted randomly according to weight class to be fabricated as whole carcasses (n = 20), three-piece boxes (n = 22), or subprimals (n = 52). Processing times (seconds) were recorded and wholesale and retail weights (kilograms) were obtained to calculate retail yield. Subprimals were fabricated into bone-in retail cuts or boneless or semi-boneless retail cuts. Retail yield for subprimal lamb legs decreased from 85.3 +/- .6% for bone-in to 68.0 +/- .7% for a completely boneless retail product. Correspondingly, processing times increased from 126.1 +/- 5.4 s to 542.0 +/- 19.2 s for bone-in and boneless legs, respectively. For all subprimals, retail yield percentage tended to decrease and total processing time increase as cuts were fabricated to boneless or semi-boneless end points compared with a bone-in end point. Percentage retail yield did not differ (P > .05) among whole carcass, three-piece box, and subprimal marketing methods. Total processing time was shorter for subprimals (P < .05) than for the other two marketing methods.

Subprimal purchasing and merchandising decisions for pork: relationship to retail yield and fabrication time.

Boxed pork was obtained to represent four different purchase specifications (different anatomical separation locations and[or] external fat trim levels) common in the pork industry to conduct a study of retail yields and labor requirements. Bone-in loins (n = 180), boneless loins (n = 94), and Boston butts (n = 148) were assigned randomly to fabrication styles within subprimals. When comparing cutting styles within subprimals, it was evident that cutting style affected percentage of retail yield and cutting time. When more bone-in cuts were prepared from bone-in loin subprimals, retail yields ranged from 92.80 +/- .61 to 95.28 +/- .45%, and processing times ranged from 222.57 +/- 10.13 to 318.99 +/- 7.85 s, from the four suppliers. When more boneless cuts were prepared from bone-in loin subprimals, retail yields ranged from 71.12 +/- 1.10 to 77.92 +/- .77% and processing times ranged from 453.49 +/- 8.95 to 631.09 +/- 15.04 s from the different loins. Comparing boneless to bone-in cuts from bone-in loins resulted in lower yields and required greater processing times. Significant variations in yields and times were found within cutting styles. These differences seemed to have been the result of variation in supplier fat trim level and anatomical separation (primarily scribe length).

Subprimal purchasing and merchandising decisions for pork: relationship to retail value.

To assess retail value and profitability, cutting test data were obtained in a simulated retail cutting room for boxed pork subprimals, bone-in loins (n = 180), boneless loins (n = 94), Boston butts (n = 148), fresh hams (n = 28), and boneless hams (n = 23). Processing times (seconds) and retail weights (kilograms) were used to determine relative value. Cutting style affected (P < .05) value differential (US$/subprimal) for bone-in and boneless loins. When cutting styles within subprimals were pooled, value differential was affected (P < .05) by purchasing specification for bone-in loins, boneless loins, Boston butts, and inside fresh hams. Processing bone-in loins to a boneless end point produced a greater (P < .05) value differential and percentage of gross margin than a bone-in retail end point. Bone-in loins fabricated to a boneless retail end point produced a greater (P < .05) value differential and percentage of gross margin than boneless loins fabricated to the same end point. The increase in retail value can be attributed to the increased number and weight of retail cuts produced from bone-in loins. The thick, boneless loin cutting style produced a greater (P < .05) value differential and percentage of gross margin as a result of a lower (P < .05) cost of fabrication and increased value of retail cuts than the thin, boneless cutting style. In general, boneless pork cutting methods were more profitable than bone-in cutting methods regardless of subprimal.

Estimation of genotype distributions and posterior genotype probabilities for beta-mannosidosis in Salers cattle.

beta-Mannosidosis is a lethal lysosomal storage disease inherited as an autosomal recessive in man, cattle and goats. Laboratory assay data of plasma beta-mannosidase activity represent a mixture of homozygous normal and carrier genotype distributions in a proportion determined by genotype frequency. A maximum likelihood approach employing data transformations for each genotype distribution and assuming a diallelic model of inheritance is described. Estimates of the transformation and genotype distribution parameters, gene frequency, genotype fitness and carrier probability were obtained simultaneously from a sample of 2,812 observations on U.S. purebred Salers cattle with enzyme activity, age, gender, month of pregnancy, month of testing, and parents identified. Transformations to normality were not required, estimated gene and carrier genotype frequencies of 0.074 and 0.148 were high, and the estimated relative fitness of heterozygotes was 1.36. The apparent overdominance in fitness may be due to a nonrandom sampling of progeny genotypes within families. The mean of plasma enzyme activity was higher for males than females, higher in winter months, lower in summer months and decreased with increased age. Estimates of carrier probabilities indicate that the test is most effective when animals are sampled as calves, although effectiveness of the plasma assay was less for males than females. Test effectiveness was enhanced through averaging repeated assays of enzyme activity on each animal. Our approach contributes to medical diagnostics in several ways. Rather than assume underlying normality for the distributions comprising the mixture, we estimate transformations to normality for each genotype distribution simultaneously with all other model parameters. This process also excludes potential biases due to data preadjustment for systematic effects. We also provide a method for partitioning phenotypic variation within each genotypic distribution which allows an assessment of the value of repeat measurements of the predictive variable for genotype assignment.

Bioeconomic evaluation of embryo transfer in beef production systems: I. Description of a biological model for steer production.

Concepts used to derive a deterministic model for evaluating embryo transfer for commercial steer production taking into consideration genetic merit for growth and mature size, herd feed supply, and recipient maternal environment are discussed. Genetic potential of an embryo is used to derive optimal growth rates that can be sustained by available herd feed per animal per day. Equations are provided for various measures of performance as functions of the feed, genotype of the embryo, and recipient maternal contribution. To assess the value of a particular line of embryos, interactions between genotype and nutrient environment are quantified, so that the benefits of embryos of high genetic merit are evaluated objectively. Product quality and weight are predicted from the model to provide a framework that will allow commercial beef producers to determine marketing strategies likely to result in optimal return.

Bioeconomic evaluation of embryo transfer in beef production systems: II. Economic evaluation of steer production.

A bioeconomic model was developed and used to evaluate economic implications of embryo transfer for steer production. Sensitivity analysis indicated that the net returns were strongly influenced by pregnancy and growth rates. Matching of recipient and embryo sizes reduced dystocia prevalence and resulted in as much as a $98 saving per transfer in costs associated with dystocia. Optimal weight and age and net returns at slaughter were found to be a function of mature size and growth rate. Varying growth rates resulted in optimal slaughter weight and net present value (NPV) ranging from 403 to 494 kg and $156 to $273, respectively, for medium-sized steer genotypes characterized by a mature size of 600 kg. The optimal slaughter weight ranged from 456 to 607 kg and NPV from $182 to $344 for large-sized steer genotypes characterized by a mature size of 750 kg. The results showed that high pregnancy rates and embryos with high growth rates generated the greatest profitability from investment in embryo transfer. The model has a wide potential application in formulating optimal biological and economic strategies for matching embryo genetic resources to physical and economic environments for commercial beef production.

Bioeconomic evaluation of embryo transfer in beef production systems: III. Embryo lines for producing bulls.

A model was developed for the economic evaluation of embryos for producing bull lines for use in commercial beef production. The fundamental concept underlying the model is that a cloned and sexed embryo of known genetic characteristics for beef traits is used to produce a bull. After reaching physiological maturity, the bull is used in natural matings. Equations relating feed energy requirements and growth rates based on NRC requirements and costs and returns discounted to present value allow investigation of expected economic merits of progeny from different embryo bull lines. The model has the flexibility to determine optimal embryo characteristics for different production environments. Model sensitivity to variation in progeny sex ratios, growth rates, yield and quality grades, and herd fertility characteristics was examined. Net present values (NPV) per embryo transferred were determined at the optimal marketing age of progeny produced from mating the bull to 30 cows per year for 5 yr. Relative to the lowest NPV of $18,209 for progeny with an expected quality grade of Select and yield grade of 4 at 400 d, increments in NPV ranged from $329 to $22,708 depending on differences in expected progeny carcass grade characteristics. The difference between NPV for 100% male and 40% male sex ratios was $7,518. The NPV differences between progeny growth rates of 1.6 and .9 kg/d holding herd conception rate constant at .9 and .5 were $8,311 and $4,611, respectively. The model evaluates relative economic values of embryo lines for producing bulls, accommodating interactions among progeny characteristics, and environments.

Sagittal magnetic resonance imaging in the design of lateral radiation treatment portals for patients with locally advanced squamous cancer of the cervix.

Twenty-five patients with FIGO clinical Stages IB-IVA squamous cancers of the uterine cervix underwent pelvic magnetic resonance imaging to assist in the design of radiation therapy portals. Magnetic resonance imaging was used primarily to define the treatment volume required to encompass the primary disease and its direct regional extensions, and only secondarily to assess the presence or absence of lymph node metastases. The sagittal scans revealed that use of "conventional" or "standard" lateral radiation portals would have resulted in a failure to encompass all gross cancer extensions (marginal miss) in 6 patients (24%). The beam edge of standard portals would have traversed tissue within 1 cm or less of gross cancer in an additional 8 patients (32%), increasing the risk of regional underdosage of subclinical disease extensions. Use of conventional lateral portals would have resulted in incomplete coverage of the uterine fundus in 15 of 24 patients (62.5%), of whom 3 had gross cancer extension to involve the uterine cavity or the myometrium of the lower uterine segment. Conventional lateral portal design, as described and illustrated in standard radiation oncology texts, may be suboptimal for a significant percentage of patients with locally advanced or bulky cervical cancer, and could be a contributing cause of failure to control pelvic disease. Design of lateral treatment portals should be based on imaging the morbid anatomy in the treatment position, rather than on an assumption of normal anatomic relationships.

Computerized chronothermodynamic breast examinations under ambulatory conditions.

A new approach to the assessment of breast health was developed based upon continuous ambulatory recording of breast temperature for 24 hrs. A new data acquisition system consisting of a portable, multi-channel, microprocessor-based recorder worn on a belt was developed to record temperatures. Dramatic thermal fluctuations were noted during the recordings in response to multiple stimuli (physiological, behavioral, environmental). Specific algorithms and software programs were developed to process the thermobiologic and chronobiologic information. Data processing was fully automatic and included an examination report indicating a score and a chronothermodynamic class for each of the five areas examined on each breast. The preliminary clinical studies have concerned more than 450 patients with healthy or diseased breasts.

Mesoblastic nephroma presenting as a haemorrhagic cyst.

Two cases of haemorrhagic renal cyst presenting in the neonatal period are described. Ultrasound examination, excretory urogram, and MRI, gave diagnosis in the second case. The remarkable histopathologic pattern of these two cases has led to propose correct diagnosis of pure cystic mesoblastic nephroma, an unusual variety of mesoblastic nephroma.

Modeling net energy efficiencies as quantitative characteristics in lactating cows.

To date, researchers have measured net efficiencies of energy conversion using data from animals in energy chambers. The expense of this approach prevents the establishment of a large data base for quantitative studies. Our purpose was to investigate models that would enable us to use data collectable in normal field conditions to compare dairy cattle for their net energetic efficiency. Data from 357 Holstein cows in seven herds and in various parities consisted of daily measures of DM intake, net energy intake, milk production, biweekly measures of milk components, and bimonthly BW. Eighteen alternative multiple regression models were fitted to each of the cows to estimate simultaneously net efficiency of energy conversion for maintenance, lactation, pregnancy, and BW change during positive energy balance period, negative energy balance period, and whole lactation. Results from several fitted models approximated closely literature results based on data from cows in energy chambers. These comparative results suggest that it is possible to estimate efficiency of energy conversion on individual cows using data obtained from normal animal management situations.

[Pseudotumoral aspect of stress fracture of the pubis]. / Aspect pseudo-tumoral des fractures de contrainte du pubis.

Stress fractures of the symphysis pubis are usually due to bone insufficiency. After describing two cases which caused diagnostic difficulties, the authors relate how these fractures may simulate tumor with deceptive bone destruction. The existence of predisposing factors, namely post-menopausal osteoporosis and a history of pelvic radiation therapy, together with the radiological characteristics associating bone destruction with peripheral sclerosis suggest the diagnostic. Awareness of this pathology may avoid unnecessary biopsies which can cause delay in bone consolidation.

Thermovascular changes associated with in situ and minimal breast cancers. Results of an ongoing prospective study after four years.

A four-year prospective study was conducted on more than 25,000 women, both asymptomatic (59%) and symptomatic (41%), with a view to investigating the thermal and vascular disorders associated with early stages of breast malignancy. All the patients underwent thermographic, mammographic and physical examinations performed under standard conditions and, when indicated, complementary radiographic (spot/magnified pictures), ultrasound and cytologic tests. Of the 294 in situ, microinvasive and nonpalpable cancers diagnosed in this study, 60-70% generated significant thermal anomalies that, in most cases, consisted of distorted thermovascular patterns. A tentative explanation for these clinical observations was formed from intramammary measurements of temperature and blood flow performed on seven patients and was based on recent experimental data on the origin of vascular reactions associated with cancer growth. This study clearly showed that thermography may contribute to the early detection of breast cancer and to the identification of women at high risk of developing breast cancer. Two hundred four (21.3%) of the 958 patients who, on their first visit, had an abnormal thermogram but no findings at physical examination or mammography developed cancer within the next three years (length of follow-up, 4-41 months).

Midtrimester screening for open neural tube defects: correlation of sonography with amniocentesis results.

Eight pregnancies with open neural tube defects were detected in 70 midtrimester patients referred for sonography and amniocentesis because of elevated maternal serum alpha-fetoprotein levels. Two cases of anencephaly were detected by sonography, aborted without amniocentesis, and confirmed by pathologic examination. Six cases of open spina bifida were detected through amniocentesis by elevation of alpha-fetoprotein and acetylcholinesterase levels. In only three of these six was the abnormality seen on sonography. All six pregnancies were terminated, and open spina bifida defects were confirmed on pathologic examination. Amniocentesis was 100% sensitive for diagnosis of open spina bifida, while sonography was only 50% sensitive. Our results indicate that, in patients with elevated serum alpha-fetoprotein and a normal fetal sonogram, amniocentesis should be performed to rule out open spina bifida.

Portable real-time sonographic and needle guidance systems for aspiration and drainage.

One hundred and two aspiration or drainage procedures were reviewed to determine the value of portable sonographic and real-time needle guidance systems. While the majority of thoracenteses or abdominal paracenteses were performed without the aid of real-time guidance, these systems were instrumental in the development of new procedures such as percutaneous cholecystostomy and in the drainage of small fluid collections in critical areas. Portable sonographic guidance was used in 32 cases, mostly for thoracentesis or abdominal paracentesis, but it had its greatest value in guiding drainage procedures at the bedside in critically ill patients. These portable drainage procedures included four cholecystostomies, one nephrostomy, drainage of two abdominal abscesses, and two empyema drainages. Complications included one case of an enterocutaneous fistula and one case of hemoptysis after thoracentesis. The failure rate was less than 7%. The use of portable real-time sonographic and needle-guidance systems has a direct impact on improving patient care.