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The authors suggest an indirect evaluation of the electrocortical activity of the fetus by looking at evidence of cyclical variations in fetal cardiac rhythm. These are shown up by periodic changes in the variability of the rhythm. The narrow association that has been established between small changes in episodes of cardiac rhythm and deep sleep--which is itself evidence of satisfactory cortical development--make this type of tracing, under certain conditions, an excellent sign of fetal wellbeing. This means that the value of small variabilities in fetal heart rhythm takes on greater importance as a prognostic feature.

We report the first direct NMR observation of transition metal-nucleotide complexes. The phosphorus and proton spectra of a cobalt-5' AMP complex were observed in water, pH 7, -- 10 degrees C. This complex is different from the high temperature species : for instance its 31P chemical shift is -- 50 ppm, whereas the published value obtained indirectly for the high temperature form corresponds to ca. -- 1200 ppm. The -- 50 ppm complex is present in significant proportion at 20 degrees C and possibly at higher temperatures. Multiple complexation modes are also observed for Co-ATP.

Thrombo-embolic disease can generally benefit from anticoagulant treatment. Nevertheless, there are circumstances that require surgical prevention of pulmonary embolism. The vena caval circulation can be interrupted using clips, which necessitates a general anaesthetic and laparotomy, or intravenous procedures such as Mobin-Udin or Greenfield filters may be inserted. The indications for these procedures depend on how advanced the pregnancy is. The authors point out the indications for interruption of the vena caval flow during pregnancy in the light of four recent case histories. The main one is failure of medical treatment. Interruption of the vena caval flow is to be recommended when there is impaired circulation or when a thrombus is threatening. The diagnosis of this condition does require invasive tests; and whether these are toxic for the fetus is discussed.

We have monitored the exchange of imino and amino protons by NMR after quick transfer of yeast tRNAAsp in 2H2O solvent. When the concentration of exchange-catalyzing buffer is not too high, one imino proton exchanges considerably more slowly than any other (e.g., 100 hr versus 4 hr for the second-slowest imino proton at 18 degrees C in 15 mM Mg). This provides excellent conditions for identification, by the nuclear Overhauser effect, of the slowest exchanging proton, which we show to be the imino proton of the U-8 . A-14 reverse Hoogsteen tertiary-structure base pair; other slowly exchanging protons are identified as imino protons from A . U-11 and G . psi-13. In preliminary experiments, we find that the exchange of these protons is catalyzed by cacodylate or Tris buffer. The lifetimes of two other imino protons, ca. 10 min at 28 degrees C, are buffer independent. Slowly exchanging amino protons have also been observed. Correlation with the exchange of the uracil-8 imino proton suggests that they may be from adenine-14.

As the importance of ovary and fimbria relationships is well admitted in the phenomenon of oocyte captation, it has seemed interesting to the authors to try and evaluate, on an experimental plane, how fertility varies in function of ovary-fimbria distance, in view of possible therapeutic applications.

Although endometriosis appears as a rare cause in long series of cases of extrauterine pregnancy, the study of pregnancies which survive after treatment of endometriosis show a significant increase of extrauterine pregnancy, especially in cases of proximal lesions. The authors thinks that careful anatomo-pathological examination of tubes resected because of extrauterine pregnancy undoubtedly permit a large number of endometriosis lesions to be found.

This is a preliminary report on an original method of local regional electronic analgesia. From it the first results can be deduced. The threshold for pain which was appreciated at 25 mmHg without electronic stimulation was raised to 48 mm Hg under electronic stimulation. Fetal ill-effects are nil.

Using nuclear magnetic resonance line broadening, longitudinal relaxation and magnetization transfer from water, we have measured the imino proton exchange times in the duplex form of the 10-mer d-CGCGATCGCG and in seven other deoxy-duplexes, as a function of the concentration of exchange catalysts, principally ammonia. All exchange times are catalyst dependent. Base-pair lifetimes are obtained by extrapolation to infinite concentration of ammonia. Lifetimes of internal base-pairs are in the range of milliseconds at 35 degrees C and ten times more at 0 degrees C. Lifetimes of neighboring pairs are different, hence base-pairs open one at a time. Lifetimes of d(G.C) are about three times longer than those of d(A.T). The nature of neighbors usually has little effect, but lifetime anomalies that may be related to sequence and/or structure have been observed. In contrast, there is no anomaly in the A.T base-pair lifetimes of d-CGCGA[TA]5TCGCG, a model duplex of poly[d(A-T)].poly[d(A-T)]. The d(A.T) lifetimes are comparable to those of r(A.U) that we reported previously. End effects on base-pair lifetimes are limited to two base-pairs. The low efficiency of exchange catalysts is ascribed to the small dissociation constant of the deoxy base-pairs, and helps to explain why exchange catalysis had been overlooked in the past. This resulted in a hundredfold overestimation of base-pair lifetimes. Cytosine amino proteins have been studied in the duplex of d-CGm5CGCG. Exchange from the closed base-pair is indicated. Hence, the use of an amino exchange rate to evaluate the base-pair dissociation constant would result in erroneous, overestimated values. Catalyzed imino proton exchange is at this time the safest and most powerful, if not the only probe of base-pair kinetics. We propose that the single base-pair opening event characterized here may be the only mode of base-pair disruption, at temperatures well below the melting transition.

Enteral nutrition is best delivered via a small bore feeding tube whose tip lies in the proximal jejunum. A major obstacle to tube placement is the lack of a reliable means of assuring passage through the pylorus. A simple, quick method of tube placement using endoscopic assistance that was successful in 18 of 20 (90%) attempts is described.

The authors worked out a normal curve using 379 levels obtained over 9 months in 180 normal pregnancies. 6% (with a confidence level between 4.4% and 7.6%) was usual for haemoglobin A1c. Then they compared 42 levels of glycohaemoglobin obtained from 14 pregnant diabetic patients where the mean value was 8.34%. Glycohaemoglobin A1c therefore is a good indicator or the level of stabilisation in diabetic pregnancies in the two months before the estimation is taken. It is therefore possible to think that it does indicate chronic hyperglycaemia and does seem to have a future in screening diabetic pregnancies. On the other hand it does not seem to be of any supplementary value in monitoring the fetus of the diabetic mother in the third trimester of pregnancy because of the small variations in the levels that are obtained as compared with the suddenness of fetal complications.

This retrospective study concerns 13 patients in whom Hodgkin's disease was diagnosed during pregnancy or immediately after delivery (group I) and 12 patients with Hodgkin's disease who had one or several pregnancies while under treatment (group II). In group I, Hodgkin's disease was diagnosed in early pregnancy in 4 patients who all had therapeutic abortion: 3 remain in prolonged complete remission and 1 had a late relapse; 9 cases were diagnosed in late pregnancy or after delivery: 3 were treatment failures, 2 had a relapse and 4 remain in complete remission. In group II patients, 3 pregnancies occurred during initial chemotherapy and were interrupted; 5 pregnancies occurred during subsequent radiotherapy or (for earlier patients) maintenance chemotherapy, and 4 of them were interrupted; 9 pregnancies occurred within 2 years of completing treatment, and 7 after 2 years. Of the 12 patients in group II, only 2 had a relapse whereas 10 remain in complete remission. Although they should be interpreted with caution, these data suggest that Hodgkin's disease diagnosed in late pregnancy or after delivery might be more active, and they justify therapeutic abortion when diagnosis is made in early pregnancy. They do not indicate a high risk of relapse in treated Hodgkin's disease patients during a subsequent pregnancy, even if it occurs shortly after treatment.

The authors have carried out research in 58 cases to see whether the findings of high uric acid levels in the blood are of prognostic value in all cases of arterial hypertension in pregnancy whatever the aetiology. The material studied consisted of 30 true cases of toxaemia of pregnancy, 13 cases of recurrent toxaemia and 15 cases of the vasculo-renal syndrome on top of the pre-existing pathological condition. In 37 cases where the blood uric acid level was lower than 300 micromoles there were only 4 minor complications. Serious complications were found in 6 cases in which the patients had a blood uric acid level highthan 480 micromoles. This study confirms the prognostic value of blood uric acid levels. The estimation of these levels, however, seems to be of less value in making a differential diagnosis between the various kinds of toxaemia and hypertension found in pregnant women due to different aetiologies.

The authors carried out 49 estimations of amniotic fluid levels of insulin in 41 patients. 25 of these patients were non-diabetic and they were a control group, and 16 patients were diabetic (24 estimations). The liquor was collected by amniocentesis between the 32nd and the 42nd week of amenorrhoea. The mean of the control levels was 3.17 micro-units per ml. The mean of the values in diabetic pregnancies was 9.97 micro-units per ml. The difference between the two groups is statistically significant. We have studied this insulinaemia in relationship to the duration of the diabetes, the maternal weight increase, the levels of insulin used therapeutically, the blood glucose level, the rise in arterial blood pressure, the weight of the infant, the date of delivery, the presence of fetal distress and the control of blood sugar. There is a statistically significant difference between the insulinaemia of patients in whom the diabetes is well controlled (mean level of 7.08 micro-units per ml) and the patients in whom the diabetes is badly controlled (31.7 micro-units per ml). This new parameter for supervision of the third trimester of pregnancy in diabetics gives rise to the possibilities of a better approach to materno-fetal blood sugar regulation and to an adjustment of the therapeutic doses of insulin that are given which will result in lengthening of the duration of pregnancy, with the aim of achieving a spontaneous vaginal delivery at term.

The fetal crown rump length was measureed by means of pulsed ultrasound. The normal values between 49 and 94 days from the onset of the last menstrual period were determined in 72 patients. Statistical analysis showed a good correlation between gestationnal age and fetal crown rump length. The usefulness of this measure is so demonstrated: assessment of gestational age, within few days.

The structure of manganese - polynucleotide complexes is studied by phosphorous NMR. An average value for the phosphorus-manganese distance is derived from the longitudinal relaxation rate. It is larger than the distance for direct coordination and decreases as a function of temperature. An inner-sphere/outer sphere equilibrium is proposed. The outer-sphere dominates in the doublestranded polynucleotides, whereas the inner-sphere contribution is important in single-stranded species. The kinetic parameters of the model are derived from the transverse relaxation time. The similar properties of DNA fragments and tRNA argue strongly against entrapment of of manganese in special sites of tRNA.

The authors report eight cases of an intra-uterine pseudo-sac giving a wrong diagnosis of intra-uterine pregnancy. In two cases there was hypertrophy of the uterine mucosa and in six cases there was decidual change. The pseudo-sac corresponds to: either a blood clot held by the uterine mucosa; or a marked hypertrophy of the endometrium with intense decidualization and massive oedema. Certain characteristic criteria suggest that a pseudo-sac may be in the uterus; the oblong shape, dimensions which do not accord with the period of amenorrhoea, absence of peripheral and linear thickening, the variety of sites in which the picture is seen and in particular its disappearance, which makes it difficult to localise it in all sections. On the other hand it is not possible to diagnose between an intra-uterine pseudo-gestational sac and an early intra-uterine pregnancy which is not growing, in our present state of knowledge.

The authors analyse the ultrasound aspects of normal and abnormal corpora lutea after reviewing the techniques for studying ovaries. The abnormalities include unruptured luteal follicles, cystic corpora lutea, haemorrhage into corpora lutea and ovarian hyperstimulation.

Proton exchange is a probe of macromolecular structure and kinetics. Its value is enhanced when the exchanging protons can be identified by nmr. After dilution of tRNA-H2O samples in D2O, slowly exchanging imino protons are observed, with exchange times ranging from minutes to days. In many cases they originate from the dihydro-uracil region. Most slow exchangers are sensitive to buffer catalysis. Extrapolation to infinite buffer concentration yields the life-time of the closed form, in a two-state model of each base-pair. As predicted by the model, the lifetime obtained by extrapolation is independent of the buffer. Typical lifetimes are 14 minutes for CG11 of yeast tRNAPhe at 17 degrees C, or 5 minutes for U8-A14 of yeast tRNA(Asp) at 20 degrees C, without magnesium. For most slow exchangers, magnesium increases the lifetime of the closed form, but moderately, by factors never more than five. The exchange rates of other, fast-exchanging, imino protons, as determined by line-broadening, are found to depend on buffer concentration. Base-pair lifetimes are determined as above. For instance UA6 of yeast tRNA(Phe) has a lifetime of 14 ms at 17 degrees C. Base-pairs 4 and 6 have shorter lifetimes than the rest of the acceptor stem. Imidazole is a good catalyst for proton exchange of both the long-and the short-lived base-pairs, whereas phosphate is not. Tris is efficient except for cases where, possibly, access is impeded by its size; magnesium reduces the efficiency of catalysis by tris buffer. From the variation of exchange time vs buffer concentration, one determines the buffer concentration for which the exchange rate from the open state is equal to the closing rate. Remarquably, this concentration takes comparable values for most base-pairs, whether short-lived or long-lived. Buffer effects have also been observed in poly(rA).poly(rU), for which we derive a lifetime of 2.5 ms at 27 degrees C, and in other polynucleotides. Some of the exchange times identified in the literature as base-pair lifetimes may instead reflect incomplete catalysis.

A previously healthy 24 year old woman presented a progressive paraplegia during the third trimester of her second pregnancy. Partial improvement occurred after caesarian. The neuroradiological study revealed spinal cord compression by an extensive corporeo-pedicular angioma of the T2 vertebrae. Almost total recovery occurred after selective embolization. The occurrence of neurological complications of vertebral angiomas during pregnancy is rarely reported in the literature. Mechanisms of the spinal cord compression and their relations with the pregnancy are discussed and difficulties for diagnosis and treatment are emphasized. When technically possible, the embolization appears to be the most adapted treatment, especially for these extensive types of vertebral angioma.

Examination of some published values suggests that the concentration of most tRNAs can be evaluated on the basis of epsilon 260 = 7200/base, in magnesium buffer.

Fifty-four patients who had consulted because of their sterility had a laparoscopy carried out with bacteriological, cytological and biochemical studies of the peritoneal fluid as well as a histological assessment of the peritoneal adhesions. The purpose of this prospective study was to show the usefulness of laparoscopy in pre-operative assessment of tubal sterility and to look for objective criteria of the progress of inflammation. To do the study, two groups of women in different clinical stages (29 patients with no pelvic infection and 25 patients who had salpingitis) were divided into three sub-groups: 25 free of disease, 4 subsiding salpingitis patients and 25 with tubo-peritoneal sequellae. Different samples taken with the laparoscope made it possible to decide whether the inflammatory process was carrying on or not in these 25 cases. Using swabs for bacteriological examinations we had to employ transport medium and this showed bacteria in 7 cases. We found a significant correlation between the serum and peritoneal levels of anti chlamydia antibodies and the levels of AC antibodies when there was a tubal lesion. There was little value in carrying out cytology on the peritoneal fluid except when the histology showed that this was necessary. The level of serum and peritoneal orosomucoid was found to be different in the two groups of patients. This study shows that it is necessary to assess several different parameters to exclude pelvic inflammatory disease before resorting to reparative tubal surgery.

Studying the fetal heart rate is the method of choice for monitoring fetal wellbeing. All the same, when repeated records are made, but only over a short time, no permanent control is carried out and this means that some very high risk fetuses are not monitored properly. but all these involved using electrocardiograms to record the fetal heart rate and this was not a practical proposition because of the number of artifacts that were produced. the authors suggest using a new method of observing the fetal heart rate over a long period of time based on telemetric transmission of the rate using an ultrasound machine. They show the results and also the difficulties of using this apparatus as well as the prospects for studying fetal physiology in this way.

Proton exchange of poly(rA).poly(rU) and poly(rI).poly(rC) has been studied by nuclear magnetic resonance line broadening and saturation transfer from H2O. Five exchangeable peaks are observed. They are assigned to the imino, amino and 2'-OH ribose protons. The aromatic spectrum is also assigned. Contrary to previous observations, we find that the exchange of the imino proton is strongly buffer sensitive. This property is used to derive the base-pair lifetime, which is in the range of milliseconds at 27 degrees C, 100 times smaller than published values. The enthalpy for the base-opening reaction (-86 kJ/mol) and the insensitivity of the reaction to magnesium suggest that the open state involves a small number of base-pairs. The similarities in the exchange from the two duplexes indicate that the same open state is responsible for exchange of purine and pyrimidine imino protons. For the lifetime of the open state and for the base-pair dissociation constant, we obtain only lower limits. At 27 degrees C they are three microseconds and 10(-3), respectively. The analysis that yields the much larger values published previously is based on the assumption that amino protons exchange only from open base-pairs. But theory and preliminary experiments indicate that it may occur from the closed duplex. The exchange of amino protons is slower than that of the imino protons. Exchange of the 2'-OH protons from the duplexes is much slower than from single-stranded poly(rU), and it is accelerated by magnesium. This could indicate hydrogen-bonding to backbone phosphate. Discrepancies between our results and those of previous studies are discussed.

The finding of more luteinized unruptured follicles in women who are under investigation for unexplained infertility compared with fertile women suggests that the syndrome does exist and probably plays a causative role in the infertility of these patients. The levels of oestradiol 17-beta and progesterone found in the peritoneum in the early luteal phase showed a much higher figure when there has been rupture of the follicle with a haemorrhagic corpus luteum and a stigma as compared with luteinized unruptured follicles. It does seem to us worth while to obtain some of the peritoneal fluid in order to estimate the levels of hormones and to diagnose more often the unruptured follicle syndrome whenever laparoscopy in undertaken in the early luteal phase.

Fluid was collected from the Ponch of Douglas at laparoscopy or laparotomy in 104 women. Macrophages were always present. The Schiff's histochemical reaction was positive inside the cytoplasm in cases of pelvic endometriosis in our study. This technique allows characterization of the cell population in cases of chronic pelvic inflammation and confirmation of the diagnosis of mild endometriosis.

The authors report two cases of post-partum cortical renal necrosis. The diagnosis was made on clinical and biological criteria (severe, prolonged oliguria, the signs of intra-vascular coagulation defects, a rise in L.D.H. and anaemia with micro-angiopathy. It is confirmed by selective renal arteriography and renal punch-biopsy. There is a threefold method of treatment: --of the kidney condition by repeated haemodialysis and diuretics; --antihypertensive treatment; --treatment aimed at the aetiological pathology (heparin, anti-platelet aggregation and fresh plasma). Functional recovery of the kidney was obtained in both cases (after an interval of 1 year and an interval of 1 1/2 year). The authors review the diagnostic, physiopathological, morphological and therapeutic elements in the condition of cortical renal necrosis.

The native structure of tRNA is not achieved in low salt (4.5 mM Na+, 25 degrees C), but can be restored by addition of divalent ions. We have explored the structure of the central region in Escherichia coli tRNAfMet by absorption and emission spectroscopy of 4-thiouracil, and the structure of the anticodon loop in yeast tRNAPhe by fluorescence of the 'Y' base, versus the number of manganese ions bound to tRNA, which was derived from electron spin resonance. The fluorescence of the reduced 8-13 photoproduct (in which 4-thiouracil at position 8 is crosslinked to cytosine at position 13) was also analysed. In low salt (e.g. 4.5 mM Na+), the region of 4-thiouracil is affected strongly as the first eight Mn2+ bind to tRNA, whereas the fluorescence of the 'Y' base is affected only after four Mn2+ are bound. Considering the structural similarities of the two tRNAs, this suggests that the reorganisation brought about by divalent ions starts in the central region, the anticodon loop being affected later. The binding of divalent ions to each region starts together with its restructuration. Monovalent ions can substitute for divalent ions in this process, a 15 mM sodium concentration being equivalent to the binding of the first five Mn2+. If divalent ions are then added, even the first ones distribute themselves between both the central and the anticodon region. Alternatively, the renaturation may be achieved by monovalent ions only, implying that no sites exist whose occupancy by divalent ions is crucial for the native structure. These observations suggest that the role and means of divalent ion binding to tRNA are largely explainable in terms of a simple maganese-phosphate binding supplemented by electrostatic interaction with distant phosphates.

37 cases of maternal hypothyroidism in 92,130 births (0.04%) were studied: post surgical (40%) or congenital (35%) hypothyroidism or after-effects of thyroiditis (11%) or of undetermined etiology (14%). The past history of these women, shows a sterility (11%) and spontaneous abortions (18%). Substitute hormonal therapy was usually well monitored, with almost always a stable thyroid function. These pregnancies progressed without any specific problems, the children's birth weight was normal and only one presented a hypothyroidism. 94 cases of goiters (0.10%) were reported including 1 out of 3 received an inhibiting hormonal therapy. Here also the pregnancies developed without problems and there was no difference with regards to the stability of the goiter and the development of the pregnancy between treated and non-treated women. The authors insist on strict monitoring of the treatment with assays of FT3, FT4, TSH and anti-thyroid antibodies, performed one or twice per trimester. The interest of thyroid hormones assays in the amniotic fluid or the blood cord may occur.

Gynecological and obstetrical pathologies are considered in 155 pregnancies involving uterine deformity. Evaluation of their relative importance shows that maintenance of pregnancy is more important than pregnancy per se. Certain rules are proposed for treatment and obstetrical management of such pregnancies.

Using proton relaxation and magnetization transfer from water we have measured the imino proton exchange kinetics in two dodecadeoxynucleotide duplexes. One is formed by the self-complementary sequence 5'-d(C-C-T-T-T-C-G-A-A-A-G-G), the other by the inverse sequence. The imino proton exchange rates are found to depend on the concentration of ammonia or imidazole, acting as basic catalysts of proton exchange. Extrapolation of exchange times to infinite catalyst concentration yields the base-pair lifetimes, for instance 40 milliseconds for the central G.C base-pair of the 5'-d(C-C-T-T-T-C-G-A-A-A-G-G) duplex and four milliseconds for its A.T neighbour, at 15 degrees C. These results differ markedly from those reported by other laboratories for similar deoxy compounds. An explanation of the discrepancy has been proposed recently. Differences between base-pair lifetimes indicate that opening is not co-operative. From the catalyst efficiency relative to exchange from isolated nucleosides, we estimate the dissociation constant of each base-pair, e.g. 0.3 x 10(-6) and 1.5 x 10(-5) at 15 degrees C, for the same G.C and A.T base-pairs. The lifetime and dissociation constant of corresponding base-pairs of the two duplexes are similar, except for the central G.C base-pair. This correlates with differences in the solution structures reported by others. We have completed the assignments of the imino protons and of the six cytosine amino protons of the 5'-d(G-G-A-A-A-G-C-T-T-T-C-C) 12-mer. A new base-pair numbering scheme is proposed.

A retrospective study of 241 case histories of essential hypertension in pregnancy treated in the Salengro Maternity Hospital of Lille from 1976 to 1981 was carried out. Looking at 450 readings of blood pressure in pregnancy it has been possible to work out a profile for these patients. These patients have as singular factors: They are often fat or very fat. They often have raised cholesterol levels in the blood. They often have a family history of hypertension or of diabetes. Many use oestro-progestogen birth control pills and had trouble in glucose regulation far more than women who had normal blood pressures in pregnancy.

The authors studied 43 cases of arterial hypertension in pregnancy in an attempt to determine the efficiency and safety of different anti-hypertensive drugs. The patients were divided into two major groups: arterial hypertension which revealed itself during pregnancy (true toxaemias of pregnancy and relapsing toxaemias), and arterial hypertensions which were added on to a pre-existing pathology (arterial hypertension, diabetes, chronic nephritis). The cases in these different classes were then divided into two definite groups according to the need for therapy: the first group was treated by rest and hydrallazine as a single therapeutic agent. In the second group multiple agents were needed because of the arterial hypertension, and one was a beta-blocker. Complications were found particularly in the second group of true toxaemias of pregnancy where unfortunately 5 fetal deaths occurred that were attributable to the severity of the hypertension more than to the beta-blockers, which were administered for longer and in higher doses without major complications in recurrent toxaemias and pre-existing arterial hypertension cases.

The authors, having studied a case of Meadows syndrome, confirm that this cardiomyopathy is a specific entity in pregnancy and the puerperium. They point out the difficulties in diagnosis, as Meadows syndrome seems to be diagnosis of elimination. They point out that a paraclinical balance has to be drawn up very fully on the biological and haemodynamic planes to confirm this condition. Finally, after a short discussion about the therapy, they tackle the problem of the prognosis for life and for future childbearing in these patients, which is determined by the persistence or absence of cardiac enlargement.