摘要:

AbstractsOne of the most striking features of the sudden infant death syndrome (SIDS) is its age-related pattern. The incidence of SIDS peaks at 2 to 4 months after delivery, and it is rare after 9 months. Research into specific mechanisms frequently suggests an association between SIDS and cardiopulmonary deficiences, defective central respiratory control, or both.This study was undertaken to determine whether levels of fetal hemoglobin (hemoglobin F) are elevated in patients with SIDS, as compared with the levels in age-matched controls. By eliminating (at autopsy) known clinical conditions associated with sustained elevations in hemoglobin F apparent in older infants (i.e., older than 1 month), such as sickle cell disease, hereditary persistence of fetal hemoglobin, thalassemia, hypoplastic anemia, leukemia, and trisomy 13, the authors found that hemoglobin F was substantially increased in the majority of patients with SIDS.Blood samples were collected at autopsies during a 5-year period (1981–1986). Control samples were collected from normal living infants. In all cases of death from SIDS or other known causes, complete autopsies were performed. The percentage of hemoglobin F (relative to hemoglobin A) was determined by hemoglobin-subunit analysis with a high-voltage vertical-slab isoelectric focusing procedure.Known relative amounts of hemoglobin F and hemoglobin A were compared for their relative proportions of γ-and β-globin chains, as measured with the isoelectric focusing protocol. The data showed good linearity (r= 0.9917) between the proportion of γ-globin chain and the total hemoglobin F between 0 and 97.5 per cent. The use of subunit analysis of denatured samples eliminated the problems associated with heterogenicity in the charge of the heme ring in native hemoglobiin tetramers.The results of an analysis of a representative gel are shown in Figure 1.Lane Acontains a hemoglobin A and hemoglobin S standard with both the β and βs(sickle) isoforms, whereas B and C contain mixed hemoglobin F and hemoglobin A standards. The standards served as internal controls, withlane Bcontaining a high proportion of hemoglobin F (85 per cent), andlane Ca low proportion (10 per cent).Lanes 1 to 4demonstrate the globin profiles of living controls, matched for the postconceptional ages of 51 and 63 weeks (lanes 1 and 3) with infants with SIDS(lanes 2 and 4). The hemoglobin F levels were substantially higher in the blood from patients with SIDS than in the blood from controls at both 51 and 63 weeks of postconceptional age. TheGγ/Aγ ratios were calculated from den-sitometric scans. Previous studies have shown that the ratio is normally 3:1 at birth and approximately 2:3 at 6 months of age. The control samples had normalGγ/Aγ ratios for their respective ages. Although the patients with SIDS had normal ratios for the percentage of hemoglobin F present, these ratios were elevated for their postconceptional ages.The percentage of hemoglobin F in the SIDS and control groups was plotted against increasing postconceptional age. All samples in both groups were from infants born at least 2 weeks before the sample was taken. Ten infants in the control group had been born 4 to 14 weeks prematurely. The mean (± 2 SD) value for the normal decline in hemoglobin F with increasing age was derived from 432 different determinations of the percentage of hemoglobin F by means of alkali denaturation,59Fe labeling, and globin analysis. The authors assumed a term delivery to be one that occurred at least 39 weeks after conception.The data on the infants with SIDS and the controls are summarized in Table 1, according to age group (less than 50 weeks, below the midpoint of the normal steep decline in hemoglobin F, and more than 50 weeks) and in the total population (39–75 weeks). The hemoglobin F levels in each of the populations with SIDS were significantly elevated as compared with those in the controls and the published normal ranges, particularly those after 50 weeks of postconceptional age.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

AbstractsCandida vulvovaginitis is characterized by a protean symptomatology and uncertainty as to the pathological significance of Candida species in the vagina. Various authorities have stated that the use of antibiotics predisposes to an increased prevalence of vaginal yeasts and sometimes to symptomatic candidosis. Careful surveys, however, have failed to show such an association. The present study was undertaken to reexamine relationships between prevalences and quantities of vaginal yeasts in a group of patients broken down according to age, antibiotic clinical evidence of Candida infection occurred in relatively low numbers. The highest prevalence of vaginal yeasts and the highest yeast counts per sample were associated with the most severe clinical forms of candidosis. The distribution of Candida species andC. albicansbiotypes also varied significantly according to the patients' clinical scores (Table 2), although the significance was only just below the chance level (P = 0.01). Species other than C.albicansand its biotypes in group A (mainly types 200 and 400) were less commonly associated with high clinical scores, whereas biotypes in groups C and F appeared to be more commonly associated with high clinical scores (biotypes 055, 057, 153, 157, and 357 were the dominant individual biotypes in these groups).Clinical score did not vary significantly with a patient's age, season of the year, stage of the menstrual cycle, antibiotic use, or contraceptive use. This finding corroborates the lack of association between Candida carriage and the variables in question.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

AbstractsThe authors of this report present a series of 21 women with unicornuate uteri, giving the outcomes of their pregnancies and the results of therapy. The women were followed from 1975 to 1984. The malformation was identified and classified according to the Buttram and Gibbons criteria. In this classification, the unicornuate uterus is subdivided into four subclasses, according to the presence or absence of a rudimentary horn and whether it is cavitary and/or communicating. For precise classification of the patients, hysterosalpingography and laparoscopy or laparotomy were performed on each woman, with the following results: one patient in subclass A1a(with cavitary communicating rudimentary horn), six in subclass A1b(with cavitary noncommunicating rudimentary horn), seven in subclass A2(with noncavitary rudimentary horn), and seven in subclass B (without rudimentary horn). The contralateral adnexum was absent in three cases, all of which were in subclass B.Intravenous urography was performed on 16 patients, and an associated unilateral renal malformation was seen in seven (43.7 per cent): renal ptosis in two cases, renal agenesis in three, double renal pelvis in one, and horseshoe kidney in one.Two patients of subclass A1awere excluded from the study because of their ages (14 and 15 years, respectively, at the time of diagnosis). The obstetrical histories of the other 19 patients were evaluated retrospectively, and the evolution of fertility was followed prospectively for 2 to 10 years.Six patients had primary infertility of 2 to 16 years' duration, and 13 women had had 25 pregnancies, one of them in a rudimentary horn (4 per cent). Abortions occurred in 16 instances (64 per cent), premature live births occurred in three (12 per cent), and term deliveries occurred in five (20 per cent), with a live birth rate of 32 per cent.Endometriosis was detected in three women (one at American Fertility Society (AFS) stage I and two at AFS stage II) and ovulation defects were detected in two others. Danazol was given to the women with endometriosis, and clomiphene citrate was given to those with ovulation disorders. Rudimentary horns were removed from five patients. In one of these, the operation was indicated because of a pregnancy in the horn, and in the other four, the operation was elective. Pregnancy was achieved in these four women, resulting in term live infants in three cases and an abortion in one (Table 1).Delivery was by cesarean section in nine of the 11 pregnancies (81.8 per cent) because of breech presentation in six, intrauterine growth retardation in two, and a previous cesarean birth in one.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

AbstractsOne hundred and thirty-eight patients were treated at New York Medical College and affiliated hospitals from 1974 to 1979 for endometrial carcinoma. A total of 38 patients had received 4500 rad of preoperative x-ray therapy to the pelvis.All patients underwent exploratory laparotomy. One hundred twenty-nine patients underwent extrafascial total abdominal hysterectomy with bilateral salpingo-oophorectomy and nine patients with stage II disease underwent radical hysterectomy with bilateral salpingo-oophorectomy. The pelvic and paraaortic nodal regions were examined. All palpable nodes that were suspicious for malignancy were biopsied.All patients without evidence of gross or microscopic nodal disease had no adjunctive therapy. Those patients with evidence of pelvic nodal metastases only received 4500 rad of x-ray therapy to the pelvis postoperatively. When histologically confirmed paraaortic disease was appreciated, the patients were offered 5000 rad of x-ray therapy to the paraaortic region as well as 4500 rad of x-ray therapy to the pelvis. Only two of 20 patients refused this adjunctive therapy. In addition, a daily dose of 160 mg of Megace was administered to all patients that accepted x-ray therapy to the paraaortic fields.One hundred ten of 138 patients had stage I disease (79.7 per cent), 15 had stage II disease (10.8 per cent), 11 had stage III disease (7.9 per cent), and two had stage IV disease (1.4 per cent). Of the 110 patients with stage I endometrial carcinoma, 49 had well-differentiated tumor (44.5 per cent of all stage I cases), 38 had moderately differentiated tumor (34.5 per cent), and 23 had poorly differentiated tumor (21 per cent). The histology for these tumors was identified as either adenocarcinoma or adenocanthoma.Positive pelvic nodes were identified in 10 per cent of stage I and 22 per cent of stage II patients. The incidence of pelvic nodal metastases by grade in stage I disease was 2 per cent G1, 8 per cent G2, and 30 per cent G3.Paraaortic nodes were positive in 12.7 per cent of stage I cases, 33 per cent of stage II cases, 45 per cent of stage III cases, and 100 per cent of stage IV cases. Those stage I patients with G1 histology had 2 per cent positive paraaortic nodes, G2, 11 per cent; and G3, 39 per cent. The incidence of paraaortic metastases, with respect to either microscopic or gross disease, increased with worsening grade—G1,0 per cent; G2,25 per cent; G3, 44.5 per cent.The individual results of a minimum of 5-year follow-up for all patients with histologically proven and treated paraaortic disease is illustrated in Table 1. One patient with stage I G2 microscopic disease developed small bowel obstruction and eventually necessitated laparotomy. Another patient with stage I G3 gross nodal disease developed small bowel obstruction but responded to therapy with a long tube. Two patients refused adjunctive radiotherapy; one patient (stage IG3) was lost to follow-up and the other patient (stage I G2) died at 33 months.There was no evidence of disease in five of eight patients (62.5 per cent) with stage I microscopic paraaortic disease. In stage I gross nodal disease, there were no survivors (0/ 4). Of those patients with stage I microscopic nodal disease who did not survive, all had a grade 3 tumor. Two of three patients with stage II microscopic nodal disease after treatment are no evidence of disease. Most strikingly only one of six (17 per cent) patients who had gross paraaortic disease and received adjunctive therapy is alive at follow-up, whereas eight of 12 (67 per cent) patients with microscopic nodal disease and adjunctive therapy had no evidence of disease at follow-up.

ISSN:0029-7828    

出版商:OVID    

年代:1987

数据来源: OVID