A 50-year overview of perinatal medicine.

Infant mortality in 1990 was approximately one-tenth that of 1950 in most of the industrialized countries of the world. The forces of change included the social-political climate, advent of neonatal intensive care, better insight into nutritional requirements of preterm infants and application of basic science to the study of events around the time of birth, and illnesses of the neonate. Attention has been paid to the advantages of human milk for the newborn infant, the importance of maternal bonding and involvement of both parents in care of the infant.

Advanced nurse-midwifery practice.

The Clinical Practice Committee of the American College of Nurse-Midwives is frequently confronted with questions related to clinical practice. Many questions relate to specific clinical procedures and the position of the College as to their appropriateness for nurse-midwifery practice. This paper presents a discussion of a document developed to assist nurse-midwives when such questions arise.

Pulmonary surfactant as a vehicle for intratracheal delivery of technetium sulfur colloid and pentamidine in hamster lungs.

Tracheal instillation of pentamidine in a surfactant vehicle may be an effective direct method of antibiotic delivery to the lungs. In 10 healthy hamsters, we compared the pulmonary distribution of 99mTc sulfur colloid (TcSC) mixed with pentamidine, using as a vehicle either surfactant (n = 5) or saline (n = 5). Each animal was instilled with 0.

The care of infants and children.

The growth and development of pediatrics took place principally in the twentieth century. One result has been the reduction in deaths in the first year of life 165/1000 live births to 10/1000 live births in 1987. The birth rate was reduced by one-half during the same period.

Synthesis and antiinflammatory activity of novel 12 beta-substituted analogues of betamethasone.

A series of 9 alpha-halo-12 beta-hydroxy and 12 beta-acyloxy analogues of betamethasone 17,21-dipropionate were synthesized and tested for topical antiinflammatory potency in the croton oil ear assay. The compounds were assayed for systemic absorption in the contralateral ear assay, in which it was found that 12 beta-hydroxy analogues 9, 13, and 15 were all absorbed but the corresponding 12 beta-esters 11a-e, 14, and 16 were not. On repeated high-dose applications to the mouse ear, there was no evidence of systemic absorption of any 12 beta-propionate ester as gauged by thymus weights (thymic involution) and plasma cortisol levels (adrenal suppression).

Synthesis and testing of 17a beta-hydroxy-7 alpha-methyl-D-homoestra-4,16-dien-3-one: a highly potent orally active androgen.

The title compound, 17a beta-hydroxy-7 alpha-methyl-D-homoestra-4,16-dien-3-one (3), was synthesized in five steps (17% overall yield) from 7 alpha-methylestrone methyl ether (5) and was found to possess oral androgenic activity, in excess of other known androgens, without using 17 alpha-alkyl substitution.

11 beta-nitrate estrane analogues: potent estrogens.

Various estrane derivatives 1 reacted with cerium ammonium nitrate (CAN) selectively and efficiently to provide 9 alpha,11 beta-defunctionalized derivatives 2, which were subsequently deoxygenated at C-9 with triethylsilane/boron trifluoride etherate to the desired target 11 beta-nitratoestranes 3a, 3b, and 5. When examined for estrogenic and postcoital antifertility activity, 11 beta-nitrates 2c, 2d, and 3b most notably displayed more potent oral activity than did ethynylestradiol.

17-Desoxy estrogen analogues.

A series of 17-substituted, 17-desoxyestratrienes have been synthesized and tested as potential postcoital antifertility agents. Estrogen-relative binding affinities were determined, in vivo assays for estrogenic and postcoital antifertility activity were conducted in rats, and selected candidate compounds were further tested for estrogenic activity in monkeys. In the rat, the 17-desoxyestratriene derivatives 8a, 8b, and 30 have shown low estrogenic activity while retaining potent antifertility activity.

Analogues of [(triethylsilyl)ethynyl]estradiol as potential antifertility agents.

Various 17 alpha-ethynylsteroids were prepared and derivatized as the corresponding triethylsilyl compounds 2-35, which were examined for a ratio of antifertility to estrogenic activity that would be more beneficial than that of the presently used agent. Among the triethylsilyl compounds evaluated, only 23 displayed this desired ratio, although two other compounds without the triethylsilyl moiety, 18 and 26, shared similar characteristics.

An interlaboratory evaluation of the Syrian hamster embryo cell transformation assay using eighteen coded chemicals.

Eighteen coded chemicals were evaluated in the Syrian hamster embryo (SHE) cell transformation assay in three different laboratories using the same basic experimental protocol with minor modifications. In addition, individual cell and serum sources were selected. Major factors influencing intra-and interlaboratory reproducibility were the source of cells and serum, the toxicity of the chemicals, and the dose-range selected for transformation evaluation.

Sperm-epithelium relationships in relation to the time of insemination in little brown bats (Myotis lucifugus).

Copulation lasted for up to 46 min in little brown bats. Spermatozoa were stored in both the uterus and the utero-tubal junction, although intimate relationships between spermatozoa and the epithelium were particularly evident in the utero-tubal junction, and were established at the beginning of the period of sperm storage. Polymorphonuclear leucocytes were present in all uteri irrespective of whether or not they had been inseminated but were not generally present in the utero-tubal junction or oviduct.

Steroidal silicon side-chain analogues as potential antifertility agents.

A number of silicon-substituted analogues of ethynylestradiol that exhibit modified and enhanced biological activities have been synthesized. Particularly noteworthy are a group of [(trialkylsilyl)ethynyl]estradiol analogues that exhibit high antifertility potency and markedly reduced estrogenic activity. The best compounds synthesized are 17 alpha-[(triethylsilyl)ethynyl]estradiol (5) and 17 alpha-[(tert-butyldimethylsilyl)ethynyl]estradiol (33), which show a separation of antifertility from estrogenic activity in the rat.

Is chronic lung disease in low birth weight infants preventable? A survey of eight centers.

Chronic lung disease in prematurely born infants, defined as the need for increased inspired oxygen at 28 days of age, was thought to be more common in some institutions than in others. To test this hypothesis, we surveyed the experience in the intensive care nurseries at Columbia and Vanderbilt Universities, the Universities of Texas at Dallas, Washington at Seattle, and California at San Francisco, the Brigham and Women's Hospital in Boston, Texas Children's Hospital in Houston, and Mt Sinai Hospital in Toronto. The survey included 1,625 infants with birth weights of 700 to 1,500 g.