Unresolved pulmonary inflammation in hyaline membrane disease (HMD) may be a p recursor to the development of chronic lung disease of early infancy. We investi gated whether nuclear factor κB (NF-κB), a transcriptio...Unresolved pulmonary inflammation in hyaline membrane disease (HMD) may be a p recursor to the development of chronic lung disease of early infancy. We investi gated whether nuclear factor κB (NF-κB), a transcription factor that regulate s the inflammatory process, is activated in pulmonary leukocytes in tracheal asp irates from premature infants with HMD. A total of 172 samples were obtained fro m 59 infants, two thirds of whom showed NF-κB activation in lung neutrophils a nd macrophages on at least one occasion. Infants who had activated NF-κB showe d elevated tumor necrosis factor-αconcentrations in their tracheal aspirates. These infants also required a longer period of mechanical ventilation support. A lmost half of the infants with HMD had antenatal exposure to chorioamnionitis on the basis of placental histopathologic examination. These infants had evidence of activated NF-κB and elevated cytokines and were more likely to have Ureapla sma urealyticum colonization in their airways. Together, these observations sugg est that NF-κB activation in pulmonary leukocytes may be involved in the lung inflammatory process in infants with HMD.展开更多
OBJECTIVE: Extra-anmiotic saline infusion has been shown to be equal to or more efficacious than misoprostol, laminaria, dinoprostone, and prostaglandin estradiol for cervical ripening and labor induction. Because of ...OBJECTIVE: Extra-anmiotic saline infusion has been shown to be equal to or more efficacious than misoprostol, laminaria, dinoprostone, and prostaglandin estradiol for cervical ripening and labor induction. Because of the introduction of a foreign body into the uterus, extra-amniotic saline infusion may potentially cause increased rates of chorioamnionitis. This study examines the risk of chorioamnionitis with extra-amniotic saline infusion compared with other methods of induction and spontaneous labor. METHODS: A retrospective analysis was performed based on deliveries at Bellevue Hospital Center, a tertiary-care facility, from August 2000 to December 2002. Three groups were identified: estra-amniotic saline infusion, other methods of induction, and spontaneous labor. Differences in chorioamnionitis rates were analyzed by using analysis of variance and multivariable logistic regression as appropriate. RESULTS: Here were 625 charts evaluated: 171 extra-amniotic saline infusion, 190 other, and 264 with spontaneous labor. The rates of chorioamnionitis were 26.9%, 17.9%, and 13.3%, respectively. After adjusting for confounding variables, such as instrumentation, length of rupture, and number of exams, subjects who were induced with extra-amniotic saline infusion were significantly more likely to develop chorioamnionitis (relative risk = 2.2; 95%confidence interval 1.4, 4.0; P = .006). CONCLUSION: Extra-amniotic saline infusion may be associated with a greater risk of chorioamnionitis when compared with other methods of labor induction. Given the increased risk of chorioamnionitis associated with extra-amniotic saline infusion, its BSC should be in the context of a careful assessment of the risks and benefits of various methods of labor induction.展开更多
Background. Primary non- gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites. Case. Primary non- gestational uterine cervical choriocarc...Background. Primary non- gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites. Case. Primary non- gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug- resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non- gestational choriocarcinoma. Conclusion. Primary nongestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue.展开更多
OBJECTIVE: To compare umbilical cord and maternal serum peak gentamicin concentration, gentamicin elimination, and clinical outcomes between women who received once-daily compared with standard, thrice-daily dosing fo...OBJECTIVE: To compare umbilical cord and maternal serum peak gentamicin concentration, gentamicin elimination, and clinical outcomes between women who received once-daily compared with standard, thrice-daily dosing for clinical chorioamnionitis. METHODS: We randomly assigned 38 laboring women, at least 34 weeks gestation, with clinical chorioamnionitis, into 1 of 2 gentamicin dosing groups: 5.1 mg/kg every 24 hours (once-daily; n = 18), or 120 mg followed by 80 mg every 8 hours (standard; n = 20). We measured maternal serum peak and delivery gentamicin concentrations and cord serum levels at delivery. Polynomial curve fitting was used to summarize gentamicin elimination. We also compared maternal and neonatal outcomes. RESULTS: Demographic characteristics of the 2 groups were similar. Median maternal peak gentamicin levels were higher with once-daily (18.2 μg/mL) compared with standard dosing (7.1 μg/mL) (P < .001). Maternal serum levels decreased below 2 μg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group. Extrapolated peak cord serum levels were 6.9 μg/mL in the once-daily and 2.9 μg/mL in the standard dosing arm. Cord levels decreased below 2 μg/mL by 10 hours in the once-daily and by 5 hours in the standard dosing group. We found no differences in maternal or neonatal outcomes. CONCLUSION: Peak maternal serum gentamicin levels ranged from 13 to 25 μg/mL after a dose of 5.1 mg/kg. Single-dose gentamicin resulted in fetal serum peak levels that were closer to optimal neonatal values. Gentamicin clearance in the term fetus was similar to published values for the newborn infant. No adverse effects of high-dose therapy were noted.展开更多
Objective: To assess the association of neurodevelopmental outcome with the placental diagnosis of chorioamnionitis in very low-birth-weight infants. Methods: One hundred seventy- seven surviving very low-birth-weight...Objective: To assess the association of neurodevelopmental outcome with the placental diagnosis of chorioamnionitis in very low-birth-weight infants. Methods: One hundred seventy- seven surviving very low-birth-weight infants, 22 to 29 weeks’ gestational age, born after varying severity of chorioamnionitis, were evaluated at a mean± SD age of 19± 6 months’ corrected age with Bayley Scales of Infant Development II and neurologic examination. Select maternal and infant variables were abstracted from the medical records. Neonatal morbidities, Mental Developmental Index (MDI) score, Psychomotor Developmental Index (PDI) score, probability of normal MDI and PDI scores (>84), and cerebral palsy between the chorioamnionitis and the control groups were assessed, controlling for gestational age, sex, and the maternal use of steroids and antibiotics. Results: The chorioamnionitis group of 102 infants was compared with 75 control infants (mean± SD birth weight, 947± 236 g and 966± 219 g, respectively; mean± SD gestational age, 26.1± 2.8 weeks and 27.1± 1.5 weeks, respectively). Infants with chorioamnionitis, compared with controls, had a significantly higher incidence of intraventricular hemorrhage (30% vs 13% ) and retinopathy of prematurity (68% vs 42% ). Cerebral palsy was diagnosed in 8.6% of the infants with chorioamnionitis and 6.6% of the controls. The MDI and PDI scores were similar between the chorioamnionitis and control groups (mean± SD MDI score, 96± 16 vs 97± 18 and mean± SD PDI score, 94± 19 vs 92± 19, respectively). Conclusions: In very low-birth-weight infants we found a higher incidence of intraventricular hemorrhage and retinopathy of prematurity but similar MDI and PDI scores and risk of cerebral palsy associated with chorioamnionitis.展开更多
文摘Unresolved pulmonary inflammation in hyaline membrane disease (HMD) may be a p recursor to the development of chronic lung disease of early infancy. We investi gated whether nuclear factor κB (NF-κB), a transcription factor that regulate s the inflammatory process, is activated in pulmonary leukocytes in tracheal asp irates from premature infants with HMD. A total of 172 samples were obtained fro m 59 infants, two thirds of whom showed NF-κB activation in lung neutrophils a nd macrophages on at least one occasion. Infants who had activated NF-κB showe d elevated tumor necrosis factor-αconcentrations in their tracheal aspirates. These infants also required a longer period of mechanical ventilation support. A lmost half of the infants with HMD had antenatal exposure to chorioamnionitis on the basis of placental histopathologic examination. These infants had evidence of activated NF-κB and elevated cytokines and were more likely to have Ureapla sma urealyticum colonization in their airways. Together, these observations sugg est that NF-κB activation in pulmonary leukocytes may be involved in the lung inflammatory process in infants with HMD.
文摘OBJECTIVE: Extra-anmiotic saline infusion has been shown to be equal to or more efficacious than misoprostol, laminaria, dinoprostone, and prostaglandin estradiol for cervical ripening and labor induction. Because of the introduction of a foreign body into the uterus, extra-amniotic saline infusion may potentially cause increased rates of chorioamnionitis. This study examines the risk of chorioamnionitis with extra-amniotic saline infusion compared with other methods of induction and spontaneous labor. METHODS: A retrospective analysis was performed based on deliveries at Bellevue Hospital Center, a tertiary-care facility, from August 2000 to December 2002. Three groups were identified: estra-amniotic saline infusion, other methods of induction, and spontaneous labor. Differences in chorioamnionitis rates were analyzed by using analysis of variance and multivariable logistic regression as appropriate. RESULTS: Here were 625 charts evaluated: 171 extra-amniotic saline infusion, 190 other, and 264 with spontaneous labor. The rates of chorioamnionitis were 26.9%, 17.9%, and 13.3%, respectively. After adjusting for confounding variables, such as instrumentation, length of rupture, and number of exams, subjects who were induced with extra-amniotic saline infusion were significantly more likely to develop chorioamnionitis (relative risk = 2.2; 95%confidence interval 1.4, 4.0; P = .006). CONCLUSION: Extra-amniotic saline infusion may be associated with a greater risk of chorioamnionitis when compared with other methods of labor induction. Given the increased risk of chorioamnionitis associated with extra-amniotic saline infusion, its BSC should be in the context of a careful assessment of the risks and benefits of various methods of labor induction.
文摘Background. Primary non- gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites. Case. Primary non- gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug- resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non- gestational choriocarcinoma. Conclusion. Primary nongestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue.
文摘OBJECTIVE: To compare umbilical cord and maternal serum peak gentamicin concentration, gentamicin elimination, and clinical outcomes between women who received once-daily compared with standard, thrice-daily dosing for clinical chorioamnionitis. METHODS: We randomly assigned 38 laboring women, at least 34 weeks gestation, with clinical chorioamnionitis, into 1 of 2 gentamicin dosing groups: 5.1 mg/kg every 24 hours (once-daily; n = 18), or 120 mg followed by 80 mg every 8 hours (standard; n = 20). We measured maternal serum peak and delivery gentamicin concentrations and cord serum levels at delivery. Polynomial curve fitting was used to summarize gentamicin elimination. We also compared maternal and neonatal outcomes. RESULTS: Demographic characteristics of the 2 groups were similar. Median maternal peak gentamicin levels were higher with once-daily (18.2 μg/mL) compared with standard dosing (7.1 μg/mL) (P < .001). Maternal serum levels decreased below 2 μg/mL by 10 hours in the once-daily group and by 5 hours in the standard dosing group. Extrapolated peak cord serum levels were 6.9 μg/mL in the once-daily and 2.9 μg/mL in the standard dosing arm. Cord levels decreased below 2 μg/mL by 10 hours in the once-daily and by 5 hours in the standard dosing group. We found no differences in maternal or neonatal outcomes. CONCLUSION: Peak maternal serum gentamicin levels ranged from 13 to 25 μg/mL after a dose of 5.1 mg/kg. Single-dose gentamicin resulted in fetal serum peak levels that were closer to optimal neonatal values. Gentamicin clearance in the term fetus was similar to published values for the newborn infant. No adverse effects of high-dose therapy were noted.
文摘Objective: To assess the association of neurodevelopmental outcome with the placental diagnosis of chorioamnionitis in very low-birth-weight infants. Methods: One hundred seventy- seven surviving very low-birth-weight infants, 22 to 29 weeks’ gestational age, born after varying severity of chorioamnionitis, were evaluated at a mean± SD age of 19± 6 months’ corrected age with Bayley Scales of Infant Development II and neurologic examination. Select maternal and infant variables were abstracted from the medical records. Neonatal morbidities, Mental Developmental Index (MDI) score, Psychomotor Developmental Index (PDI) score, probability of normal MDI and PDI scores (>84), and cerebral palsy between the chorioamnionitis and the control groups were assessed, controlling for gestational age, sex, and the maternal use of steroids and antibiotics. Results: The chorioamnionitis group of 102 infants was compared with 75 control infants (mean± SD birth weight, 947± 236 g and 966± 219 g, respectively; mean± SD gestational age, 26.1± 2.8 weeks and 27.1± 1.5 weeks, respectively). Infants with chorioamnionitis, compared with controls, had a significantly higher incidence of intraventricular hemorrhage (30% vs 13% ) and retinopathy of prematurity (68% vs 42% ). Cerebral palsy was diagnosed in 8.6% of the infants with chorioamnionitis and 6.6% of the controls. The MDI and PDI scores were similar between the chorioamnionitis and control groups (mean± SD MDI score, 96± 16 vs 97± 18 and mean± SD PDI score, 94± 19 vs 92± 19, respectively). Conclusions: In very low-birth-weight infants we found a higher incidence of intraventricular hemorrhage and retinopathy of prematurity but similar MDI and PDI scores and risk of cerebral palsy associated with chorioamnionitis.
