Fetal aortic blood flow assessment from the relationship between fetal aortic diameter pulse and flow velocity waveforms during fetal development.

BACKGROUND: Blood flow is calculated from mean velocity across the vessel and its cross-sectional area and is related to the fetal growth. AIM: To investigate the relationship between diameter pulse waveform (DPW) and flow velocity waveform (FVW) in the fetal descending aorta during fetal development. STUDY DESIGN: Doppler ultrasound and a phase-locked loop echo tracking system were used to measure the FVW and DPW in the fetal descending aorta, respectively. SUBJECTS: We studied 137 normal-growth fetuses (normal group, 20-40 weeks) and 51 fetuses with high umbilical artery pulsatility index (umbilical placental insufficiency, UPI group, 26-40 weeks). OUTCOME MEASURES: We measured the systolic (Sd), diastolic (Dd) diameters, time diameter integral (TDI) and time velocity integral (TVI) and then calculated the TVI x TDI and TVI to TDI ratio. RESULTS: Normal fetal growth was associated with an increase in Sd, Dd, pulse amplitude, TVI, TDI and TVI x TDI. The FVW began to resemble the DPW with decreasing downstream resistance produced by growth of the placenta. The TVI was increased relative to the TDI. The differences in Sd, Dd, TDI and TVI x TDI between the normal and UPI groups were not significant. The TVI was decreased relative to the TDI. There was a decrease in the TVI as a ratio of the TDI. The Dd per unit fetal weight was high in the compromised fetuses. Fetal outcome was examined in relation to the TVI to TDI ratio. Those with a low ratio (below 10th centile) exhibited significantly more adverse indices of fetal outcome. CONCLUSIONS: In fetal compromise there is an increase in diastolic pressure in association with high placental resistance, which causes a major increase in afterload. The efficient circulation associated with fetal growth might be represented by an increase in the ratio of the TVI to the TDI (an index of efficient circulation) when these waveform shapes resemble each other.

[A case of ALL complicated with acute pancreatitis and pancreatic pseudocyst caused by L-asparaginase ].

We reported a case of ALL complicated with acute pancreatitis caused by L-asparaginase (L-Asp). The patient was a 42-year-old man, who showed eosinophilia in peripheral blood and an increase of lymphoblast in bone marrow. He was diagnosed as ALL (L2) and treated by JALSG '87 protocol. Remission induction chemotherapy including L-Asp was administered by 5,000 IU i.v. for 10 days. The day after giving all dose of L-Asp, slight epigastralgia developed and then became severe. After two days, s-amylase was markedly elevated, and the patient was diagnosed as acute pancreatitis caused by L-Asp. He was treated conservatively, but hyperglycemia occurred. The epigastrial tumor was palpable and gradually grew in size. CT-scan and abdominal ultrasonography revealed pancreatic pseudocyst, so he was treated by percutaneous cyst drainage. The patient died of a relapse of ALL. The prophylaxis and early diagnosis of the pancreatitis and hyperglycemia caused by L-Asp are very difficult. We have to examine more cases and pay greater attention to the chemotherapy, including L-Asp.

[Twenty years' follow-up study of asbestos workers].

This report describes a cohort study conducted on workers who were employed in a factory mainly manufacturing asbestos yarn and cloth and were followed from 1964 to 1981. A total of 208 workers (73 males and 135 females) could be traced and 15 deaths were observed by the end of 1983. Among them, three had lung cancer and its relative risk was 6.8 (p less than 0.05) computed based on the age, sex and year specific death rates of Osaka Prefecture. One case of peritoneal mesothelioma was also found. The period from first asbestos exposure to death of these four cases of asbestos-related malignancies was more than 25 yr. In the analysis of the employees who had more than 1 yr of exposure to asbestos and those who had already been engaged in this factory at the beginning of the observation, the relative risk of lung cancer was 8.1 and 13.6, respectively.

[Urinary alkylphosphate levels as an index of exposure to organophosphorus insecticides in pest control operators].

In pest control operations, organophosphorus compounds (OP) have been sprayed as insecticides, blood cholinesterase (ChE) activities and urinary alkylphosphate levels were measured for both OP-sprayers (n = 102) and non-sprayers (n = 35) in pest control companies, and the relationship between the analytical results and spraying conditions was investigated. Plasma ChE activities of the OP-sprayers and of the non-sprayers, as well as blood cell ChE activities of the OP-sprayers, were significantly lower than those of employees of chemical factories who served as controls (n = 103). Urinary alkylphosphates were not detected in the controls at all but were detected in 83% of the sprayers and in 57% of the non-sprayer employees of pest control companies. A significant negative correlation (r = -0.34, n = 137, p less than 0.01) between the plasma ChE activities and urinary total alkylphosphate levels was observed in employees of pest control companies. In the case of the employees whose urinary total alkylphosphate levels were 0.1 mumol/g creatinine or more, the plasma ChE activities were 25% decreased compared to the control group. The OP-sprayers showed significantly higher urinary total alkylphosphate levels than the non-sprayers. The OP-sprayers were further divided into two groups. One was sprayers engaged in both cockroach- or fly-control and termite-control operations (sprayers I, n = 54) and the other was sprayers engaged in only cockroach- or fly-control operations (sprayer II, n = 48).(ABSTRACT TRUNCATED AT 250 WORDS)

[A questionnaire study on health of taxi drivers--relations to work conditions and daily life].

A questionnaire survey was conducted on 5,523 taxi drivers in Osaka Prefecture to investigate their working conditions and daily life as well as characteristics of their health condition and various effects on health, especially on their cardiovascular system. The major results of this survey were as follows: 1) The rate of subjective symptoms, morbidity rate and rate of poor physical condition over the past year in the taxi drivers were higher than those of the control group. Among the subjective symptoms, the rate of gastrointestinal disorders, fatigue, musculoskeletal system disorders, sensory system disorders, hemorrhoids, etc. was especially high. 2) Work shift, density of work, years of experience in taxi-driving, frequency of fright while driving, pattern of taking meals, way of recuperation on rest days or holidays, obesity, smoking, and intake of coffee and alcohol were found to be factors affecting the health of taxi drivers. 3) Nearly half of the respondents said that they would like to quit or change their job with as much as 62% giving "condition of health" as reason. On the other hand, the rate of heart-related symptoms such as palpitation, and breathlessness did not differ from that of the control group. The possible reason for this deduced from the foregoing results, is that there were some who had changed or quit the job at an early stage for health reasons such as heart trouble and severe physical and mental burden resulting from taxi driving. 4) Many taxi driver are obese and the rate of those with heart-related symptoms was considerably high among those classified as obese. In addition, the results showed that those with longer driving experience tended to be obese.