Maternal and neonatal outcome in pregnancies with no risk factors.

Between November 1979 and April 1984, 790 consecutive pregnant women who considered themselves as having a "normal" pregnancy were followed in private practice from 9 weeks' gestation until 6 weeks post partum. The women had no pre-existing disease or problem classified as a risk to the pregnancy at the time of their first visit, had a singleton pregnancy and gave birth at Notre-Dame Hospital, Montreal. Maternal complications occurred during the course of pregnancy in 181 women (23%). Complications were mostly related to obstetric conditions (10%), such as preterm labour, intrauterine growth retardation (IUGR) and antepartum hemorrhage, or to medical conditions (12%), the most prevalent of which was hypertension (77% of medical conditions). Neonatal complications occurred in 183 infants (23%). The corrected perinatal death rate was 2.5 per 1000. Prematurity, IUGR and dysmaturity/postmaturity accounted for nearly half of the complications. Hyperbilirubinemia occurred in 7% of the cases. Among women without any maternal complications during pregnancy, the frequency rate of neonatal complications was 19%, compared with 23% among the entire group of 790 women. Our results suggest that the absence of maternal complications does not protect the infant from a neonatal complication. Further refinement is needed to identify markers of obstetric, medical and neonatal complications in pregnancies with no risk factors.     

Transcutaneous carbon dioxide measurements in the fetus during labor

Continuous transcutaneous carbon dioxide partial pressure (tcPco2) was monitored in 40 spontaneous labors. The electrode was attached by glue fixation. An interpretable tracing was obtained in 36 cases. All cases but 2 were normal pregnancies. Thirty-two patients had epidural analgesia while the others had no analgesia. All infants had an Apgar score above 7 at five minutes after delivery and only two had a pH of the umbilical artery of less than 7.16. Mean duration of the recordings was 116 minutes (range: 15-300) and mean time for reaching steady-state was 27 minutes (range: 10-45 minutes). Mean value of tcPco2 was 48 mmHg (SD: 6) before 6 cm of dilatation, 47 mmHg (SD: 8) between 6 and 10 cm, and 47 mmHg (SD: 15) at the second stage of labor. Mean umbilical artery Pco2 was 48 mmHg (SD: 14) and mean umbilical artery pH was 7.25 (SD: 0.06). The range of tcPco2 obtained in these normal cases was 20 to 62 mmHg. Comparison of the results with those of other authors and with previous studies of normal labor and epidural analgesia show a higher tcPco2 compared to scalp Pco2. In contrast to other studies in these series no correlation was found in the series between umbilical artery Pco2 and tcPco2 values. This lack of correlation could be explained either by the small number of cases in which both measurements were available (9 cases) and by the small range of variation or by some inaccuracy in the measurements.(ABSTRACT TRUNCATED AT 250 WORDS)     

Blood transfusions and survival after colectomy for colorectal cancer

This study was carried out to determine the effect of perioperative blood transfusions on the survival of patients operated on for colorectal cancers. Cox's regression analysis was applied to 281 patients operated for cure of Dukes' stage A, B or C disease. Other variables studied were age, sex, tumour location, and preoperative hemoglobin, lymphocyte and albumin values. Perioperative deaths, pre- and postoperative immunodepression, neoplasia in situ, nonresections and stage D disease were excluded. It was found that the number of units of blood transfused had a strong influence on the prognosis of patients with colorectal cancer, particularly colonic cancers, but the effect could not be demonstrated when rectal cancers were studied separately, perhaps because of the small number of cases. The mechanism of action of blood transfusions seems to be independent of the other analysed variables. The authors suggest that perioperative blood transfusions may have an immunomodulatory effect in patients with colonic cancer, as already shown in recipients of transfused kidney allografts.     

Replication of associations between LRP5 and ESRRA variants and bone density in premenopausal women

Summary  Replication is a critical step to validate positive genetic associations. In this study, we tested two previously reported positive associations. The low density lipoprotein receptor-related protein 5 (LRP5) Val667Met and lumbar spine bone density are replicated. This result is in line with results from large consortiums such as Genomos. However, the estrogen-related receptor alpha (ESRRA) repeat in the promoter is not replicated although the polymorphism studied was functional and could have been a causative variant. Introduction  We sought to validate associations previously reported between LRP5 V667M polymorphism and lumbar spine (LS, p = 0.013) and femoral neck (FN, p = 0.0002) bone mineral density (BMD), and between ESRRA 23 base pair repeat polymorphism and LS BMD (p = 0.0036) in a sample of premenopausal Caucasian women using an independent sample. Methods  For the replication sample, we recruited 673 premenopausal women from the Toronto metropolitan area. All women were Caucasian and had BMD measured. LRP5 V667M was genotyped by allele-specific PCR and ESRRA repeats by sizing of PCR products on agarose gels. Results  We reproduced the same association as we reported previously between LRP5 V667M and LS BMD (p = 0.015) but not with FN BMD (p = 0.254). The combined data from the two populations indicate an effect size of 0.28SD for LS BMD (p = 0.00048) and an effect size of 0.26 SD for FN BMD (p = 0.00037). In contrast, the association we reported earlier between ESRRA repeats and LS BMD was not replicated in the sample from Toronto (p = 0.645). Conclusions  The association between LRP5 V667M and LS BMD is confirmed but not that between ESRRA repeats and LS BMD. This result indicates that it is imperative to validate any positive association in an independent sample.     

An evaluation of plasma and erythrocyte magnesium concentration and the activities of alkaline phosphatase and creatine kinase as indicators of magnesium status

Rats were fed diets containing magnesium at concentrations ranging from 3.3 to 26.7 mmol/kg of diet (80 to 650 mg/kg). The magnesium concentration of their plasma and erythrocytes, and the activities of plasma alkaline phosphatase and creatine kinase were investigated to determine their usefulness as indices of magnesium status. All the indices increased with increasing dietary magnesium levels. The best correlations were observed between dietary intake and plasma concentration of magnesium (r = 0.846, p less than 0.001) and between intake and femur concentration (r = 0.811, p less than 0.001). There was an extremely high correlation between plasma concentration and femur concentration (r = 0.930, p less than 0.001). Although significant, the correlations between intake and the enzyme activities were not strong. It is concluded that plasma magnesium concentration is the most useful indicator of magnesium status and that the activities of the two magnesium-requiring enzymes can only be used for the purpose of diagnosing severely deficient magnesium status.     

Multidrug resistance genes (MRP) and MDR1 expression in small cell lung cancer xenografts: relationship with response to chemotherapy

Intrinsic or acquired drug resistance is a major limiting factor of the effectiveness of chemotherapy. Increased expression of either the MRP gene or the MDR1 gene has been demonstrated to confer drug resistance in vitro. In this study, we examined MRP and MDR1 gene expression in a panel of 17 small cell lung cancers (SCLC) xenografted into nude mice from treated and untreated patients using an RT-PCR technique. For some of them, the outcome of the corresponding patients was known and we related MDR1/MRP expression with the xenograft response to C′CAV (cyclophosphamide, cisplatin, adriamycin and etoposide) combined chemotherapy. Fifteen (88%) of the 17 cases of SCLC were found to be positive for either MDR1 or MRP. MRP gene expression was present in 12 (71%) of 17 cases, whereas MDR1 gene expression was detected in eight (50%) of 16 cases. For six SCLC, the survival duration of patients differed, with three patients surviving for more than 30 months after therapy. Among these six tumours, five expressed MRP and/or MDR1. These six xenografts responded to the C′CAV treatment but a significant rate of cure was obtained in only three cases. No obvious relationship was observed between the response to this treatment and MRP or MDR1 expression. However, the remarkably high levels and frequency of MRP expression in some SCLC samples indicate that future developments in chemotherapy of this tumour type should anticipate that drugs which are substrates of MRP may be of limited effectiveness.     

Painful shoulder in the hemiplegic and unilateral neglect

Shoulder pain is a frequent and debilitating problem in hemiplegic patients, and its etiology remains poorly understood. The role played by hemineglect in the appearance of shoulder pain was studied. During two years, 94 hemiplegic subjects were involved in a rehabilitation program after cerebrovascular accidents. Their average age was 68 years; 45 (47.9%) subjects had shoulder pain, and 24 subjects (22.5%) had hemineglect. The subjects with shoulder pain were compared to those without pain (the control group) with respect to gender, age, diabetes, heart failure, cardiac ischemia, scapulohumeral arthritis, and calcified tendinitis of the rotator cuff. We were unable to demonstrate a relationship between hemineglect and shoulder pain in the hemiplegic (X2 (1) = 2.03, p = .15), although pain was significantly more frequent in subjects with right hemispheric cerebrovascular accident (X2 (1) = 5.0, p less than .025). The subjects with shoulder pain had significantly more spasticity of the affected limb (X2 (1) = 26.3, p less than .01), less sensitivity to pinprick of the upper paralyzed extremity (X2 (1) = 10.8, p less than .01), and a more severe subluxation of the affected shoulder (t(51) = 14.0, p less than .01).     

Nongaussian distribution curve of heterophorias among children

The purpose of this study was to measure the distribution curve of horizontal and vertical phorias among children. Kolmogorov-Smirnov goodness of fit tests showed that these distribution curves were not Gaussian among (N = 2048) 6- to 13-year-old children. The distribution curve of horizontal phoria at far and of vertical phorias at far and at near were leptokurtic; the distribution curve of horizontal phoria at near was platykurtic. No variation of the distribution curve of heterophorias with age was observed. Comparisons of any individual findings with the general distribution curve should take the nonGaussian distribution curve of heterophorias into account.     

Comparisons between surface electrodes and intramuscular wire electrodes in isometric and dynamic conditions

The purpose of this study was to compare EMG surface electrodes (SE) and intramuscular wire electrodes (IWE) for isometric and dynamic contractions during an occupational cervico-brachial working task (OCWT). Six normal adult male subjects were tested on two days (two conditions with three trials each). Raw EMG signals from middle deltoid, anterior deltoid and trapezius muscles were recorded by both IWE and SE for two conditions (isometric and dynamic contractions). Full wave rectified and low pass filtered EMG, and integrated EMG were processed from raw EMG signals. The statistical analysis performed on the integrated EMG was a factorial analysis model with repeated measures. Statistical results confirmed that EMG signals, from both SE and IWE, are reliable between trials on the same day. These statistical results also confirmed that SE are more reliable than IWE on day-to-day investigations. Both electrodes recorded statistically similar signals, although the coefficient of variability between electrodes was very high (STDE%; 48% and 84%, for isometric and dynamic conditions respectively).