Preinduction cervical ripening techniques compared

OBJECTIVE: To assess the clinical efficacy of pharmacologic, mechanical and combination techniques of cervical ripening. STUDY DESIGN: From March 1997 to August 1998, all cervical-ripening patients at Lehigh Valley Hospital were randomly assigned to three groups: intravaginal misoprostol, intracervical Foley catheter, or combination prostaglandin E2 (PGE2) gel and Foley catheter. Inclusion criteria included Bishop score < or = 5 and no contraindication to labor. The remaining delivery process was actively managed according to established guidelines. Multiple variables in perinatal outcome were analyzed, with the cesarean section rate and time from ripening to delivery as the main outcome variables. RESULTS: Of the 205 patients, 65 were randomized to the misoprostol group, 71 to the Foley group and 69 to the catheter-and-gel group. There were no differences between groups in delivery indications, maternal demographics, ultrasound findings, labor interventions, intrapartum times, mode of delivery, postpartum complications or neonatal outcomes. The misoprostol group demonstrated a higher rate of uterine tachysystole and required oxytocin less when compared to the two catheter groups. CONCLUSION: The higher rate of uterine tachysystole with misoprostol did not increase the cesarean section rate. The higher rate of oxytocin required by the two catheter groups did not increase the delivery time intervals. There appears to be no benefit to adding intracervical or intravaginal PGE2 gel to the intracervical Foley balloon. The misoprostol and catheter ripening techniques have similar safety and efficacy.     

Intratympanic gentamicin for intractable Meniere's disease: 5-year follow-up

OBJECTIVE: To determine the efficacy and morbidity of intratympanic gentamicin titration therapy on patients with incapacitating unilateral Meniere's disease. METHOD: The study consisted of a retrospective chart review and patient interviews. Sixty-eight patients had been followed for a minimum of 24 months and were reported on in an earlier study. Forty-six of these individuals were available for detailed follow-up at 5 years post-gentamicin therapy. MAIN OUTCOME MEASURES: Vertigo frequency, hearing status, personal disability ratings, and tinnitus level before and after gentamicin therapy were measured. RESULTS: Seventy-four percent of patients showed complete vertigo control and an additional 7% showed substantial vertigo control. There was also significant improvement in personal ratings of social and economic functioning. Overall, the group showed no combined statistically significant changes in any of the hearing parameters. CONCLUSION: Intratympanic gentamicin titration therapy provides excellent vertigo control, with a similarly significant improvement in both personal and occupational functioning.     

Interaction between LIS1 and doublecortin, two lissencephaly gene products

Mutations in either LIS1 or DCX are the most common cause for type I lissencephaly. Here we report that LIS1 and DCX interact physically both in vitro and in vivo. Epitope-tagged DCX transiently expressed in COS cells can be co-immunoprecipitated with endogenous LIS1. Furthermore, endogenous DCX could be co-immunoprecipitated with endogenous LIS1 in embryonic brain extracts, demonstrating an in vivo association. The two protein products also co-localize in transfected cells and in primary neuronal cells. In addition, we demonstrate homodimerization of DCX in vitro. Using fragments of both LIS1 and DCX, the domains of interaction were mapped. LIS1 and DCX interact with tubulin and microtubules. Our results suggest that addition of DCX and LIS1 to tubulin enhances polymerization in an additive fashion. In in vitro competition assays, when LIS1 is added first, DCX competes with LIS1 in its binding to microtubules, but when DCX is added prior to the addition of LIS1 it enhances the binding of LIS1 to microtubules. We conclude that LIS1 and DCX cross-talk is important to microtubule function in the developing cerebral cortex.     

In vivo acquisition of Fc gamma RII expression on polyoma virus-transformed cells derived from tumors of long latency.

BALB/c 3T3 cells transformed in vitro with polyoma virus were cloned and passaged once in syngeneic mice. Resulting tumors from each clone were explanted and recultured. Expression of receptor for Fc of IgG (Fc gamma RII) in the original in vitro maintained clones and in cells derived from tumors elicited by the respective cells was measured at the protein level as well as at the mRNA level. Clones were assayed in pairs. The ancestor in vitro maintained clones [designated cultured cells (C)] were compared with cells derived from the same clones after a single passage in vivo followed by explantation and reculturing [designated cultured-tumor-cultured cells (CTC)]. C cells of any of the tested clones did not express Fc gamma RII. On the other hand, certain CTC cells were positive. The Fc gamma RII-positive cells were derived from tumors appearing after a long precancer latency period (greater than 140 days). CTC cells derived from tumors that appeared after shorter latency periods (less than 80 days) were Fc gamma RII negative. These results were obtained both by using radioimmunoassay and monoclonal antibodies against mouse Fc gamma RII as well as by Northern blot analysis using the Fc gamma RII complementary DNA probe. The involvement of macrophages as the Fc gamma RII-expressing cells in CTC cells was excluded. Fc gamma RII expression was down-regulated in CTC cells as a function of time following their explantation into culture. Fc gamma RII expression could be up-regulated in these cells and induced on C cells by maintaining the cultured cells in the presence of normal mouse serum or recombinant interferon. We also tested the expression of Fc gamma RII on CTC cells following their inoculation into syngeneic mice for a second time (CTCx2 cells). The results showed a positive correlation between Fc gamma RII expression in the inoculated ancestor CTC cells and on the CTCx2 cell progeny.     

Magnetic resonance imaging diagnosis of disseminated necrotizing leukoencephalopathy

Disseminated necrotizing leukoencephalopathy is a rare syndrome of progressive neurologic deterioration seen most often in patients who have received central nervous system irradiation combined with intrathecal or systemic chemotherapy in the treatment or prophylaxis of various malignancies. Magnetic resonance imaging was more sensitive than computed tomography in detecting white matter abnormalities in the case of disseminated necrotizing leukoencephalopathy reported here. Magnetic resonance imaging may be useful in diagnosing incipient white matter changes in disseminated necrotizing leukoencephalopathy, thus permitting early, appropriate therapeutic modifications.     

Adult supratentorial tumors

MR imaging has represented a significant advance in the diagnosis and management of adult supratentorial neoplasms, and indeed MR has become the modality of choice for the initial diagnosis and follow-up in these cases. It is clear that the overall sensitivity has increased significantly, due to both the use of MR itself and to the implementation of IV contrast agents. It appears that some inroads have been made with regard to specificity, but significant overlap still exists in the imaging appearance of many of these entities. A thorough knowledge of neuroanatomy, pathophysiology, and neuropathology aid markedly in the imaging diagnosis of these processes.     

Play in assessment and intervention in the childhood psychoses

Diagnostic and therapeutic uses of play in the childhood psychoses are described. A play procedure suitable for consultative use with children is outlined, and research relating to identification of subgroups of childhood psychoses is reviewed. Case vignettes are employed to illustrate differential therapeutic uses of play with subgroups.     

An endogenous, non-catecholamine clonidine antagonist increases mean arterial blood pressure

We report here that topical application of clonidine displacing substance (CDS), an endogenous brain extract, directly in the nucleus reticularis lateralis (NRL) region of anaesthetized cats regularly produced hypertension. CDS (5 units) increased the mean blood pressure by 40 +/- 8%. Pretreatment of anaesthetized rabbits with intracisternal CDS (500 units) shifted to the right the dose-response curve obtained with clonidine alone injected the same way. This brain extract might be considered as an endogenous antagonist for the hypotensive effects of clonidine at least in the NRL region.     

Anaphylactoid syndrome of pregnancy immediately after intrauterine pressure catheter placement

A 35-year-old multipara woman underwent intrauterine pressure catheter placement during labor. Immediately afterwards, she had severe dyspnea develop, became unresponsive, and had a prolonged fetal bradycardia. During emergency cesarean section, she required cardiopulmonary resuscitation repetitively. She then had disseminated intravascular coagulopathy develop and underwent hysterectomy. Anaphylactic reaction may be associated with intrauterine pressure catheter placement.