Design, rationale, and baseline characteristics of a randomized controlled trial evaluating a mobile relational agent to enhance atrial fibrillation self-care.

Atrial fibrillation (AF) is a chronic cardiovascular disease that frequently causes disruptive symptoms, adverse outcomes, and poor health-related quality of life (HRQoL). We have developed a mobile health application for individuals with AF which provides a longitudinal, patient-centered program to improve self-care. The defining feature of the application is the use of a relational agent, which uses synthetic speech accompanied by animation to provide health education, empathic counseling, and monitoring.

Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: a single-blinded, randomized controlled effectiveness trial.

Aims: The aim of this study is to assess the effect of brief motivational enhancement intervention postpartum alcohol use.

Design: This study is a single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10-30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum.

Setting: The setting is in a large, urban, obstetrics clinic.

Ritodrine treatment for uterine hyperactivity during the active phase of labor.

Forty consecutive patients with uterine hyperactivity, defined as either tachysystole and/or hypertonus during the active phase of vertex delivery, were treated with intravenous ritodrine (50 up to 300 micrograms/min, in 50 micrograms increments/5 min). Thirty-four patients (85%) responded within 20 min with termination of the uterine dysfunction and all (21, 52%) concomitant fetal heart rate distress signs disappeared. The treatment did not prolong labor, as this was significantly correlated to parity and cervical dilation when treatment was initiated (P less than 0.

[Ultrasonically-guided aspiration of clear pelvic cysts].

In 33 women aged 13-80, clear pelvic cysts were aspirated. The diameter of the cysts was between 4-11 cm and the aspiration, by either the vaginal or abdominal routes, was ultrasonically guided. In 25 cases (76%) there was no recurrence of a cyst during continuing follow-up.

Endolymphatic stromal myosis (endometrial low-grade stromal sarcoma) presenting with hematuria: a diagnostic challenge.

In this case of a 41-year-old white woman who presented with hematuria, the diagnosis of metastatic endolymphatic stromal myosis (ESM) in the urinary bladder was reached on the basis of the histologic pattern and with the aid of intermediate filament typing. In the hysterectomy specimen the tumor foci of ESM were of minute size. To the best of our knowledge, this is the first report of such an unusual clinical presentation of this lesion.

Solitary thick intra-uterine membranes not associated with the amniotic band syndrome; three case reports.

Three cases in which a single intra-uterine membrane with a free and thickened edge was identified by ultrasound antenatally are presented. The bands turned out to be thickenings of the fetal membranes. In one case intra-uterine adhesions were documented by hysterosalpingography (HSG) and hysteroscopy before conception.

Isolated necrosis of the tubal fimbriae in a prepubertal girl.

A report of haemorrhagic necrosis of the tubal fimbriae in a prepubertal girl is presented. The presumptive aetiology for this is the isolated torsion of the fimbrial end which, to the best of our knowledge, has not been previously described. A high index of suspicion of torsion and early intervention is emphasised.

Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984.

Data from a study on malignant ovarian tumors in pregnancy in Israel are presented. During the 25-year period of the survey, 23 new cases of malignant ovarian tumors during pregnancy were diagnosed, representing an incidence of 0.12/100,000 females over the age of 14; over half of the patients were in their third decade of life at the time of diagnosis of the tumor.

Ultrasonic prediction of growth discordancy by intertwin difference in abdominal circumference.

Intertwin abdominal circumference (AC) and femur length (FL) differences were studied in 24 growth-discordant (greater than or equal to 15% birth weight difference) and in 32-growth concordant twin pairs delivered within 2 weeks of the last ultrasonic examination. Both groups were of similar gestational age but differed significantly in the mean twin birth weight and intertwin AC difference (P = 0.01 and P = 0.

Second-breech presentation in twins--a possible adaptive measure to promote fetal growth.

Two hundred eighty-three longitudinally lying twin pairs were evaluated for the possible etiology of breech presentation in twins. Breech-breech pairs were delivered at a significantly earlier gestational age (P less than .02), because of significantly more deliveries (P less than .

[Metroplasty in congenital uterine malformations].

44 women with congenital uterine malformations, aged 22-39, underwent metroplasty during a 19-year period. They constituted 7.3% of all patients with such malformations diagnosed during that period.

The outcome of pregnancies complicated by preterm rupture of the membranes with and without cerclage.

Thirty-two patients with cerclage were compared to 76 patients without cerclage. All pregnancies were complicated with preterm (less than 36 weeks) rupture of the membranes (PTROM). The management following removal of the cerclage was the same for the two groups and consisted of conservative treatment unless chorioamnionitis ensued.

Lupus-like syndrome in a mother and newborn following administration of hydralazine; a case report.

A very-low-birth-weight infant died from pericardial effusion and cardiac tamponade confirmed by the post-mortem findings. The mother suffered from lupus-like syndrome consequent to hydralazine treatment for pregnancy-induced hypertension. The possible relationship between mother-infant pathology and hydralazine administration is discussed.

Effectiveness of silicone sheeting in preventing the formation of pelvic adhesions.

The uterine horns of 35 female rabbits were subjected to injury by cautery. Ten days later the adhesions were scored and lysed, and in 30 animals the lesion on one side was covered with a segment of silicone. The contralateral uterine horn served as an internal control.

Complications associated with genital colonization in pregnancies with and without cerclage.

Cultures from the cervical milieu were taken from 24 antibiotic-treated patients (group A) and from 25 patients with no antibiotic treatment (group B). Both groups had undergone cerclage and were compared to 30 randomly chosen pregnant patients without cerclage (group C). Positive cultures were obtained in 70.

Growth discordancy in appropriate for gestational age, term twins.

We compared 14 term (37 weeks or more), discordant (15% or more birth weight difference), but not growth-retarded (2500 g or larger) twin pairs with 28 randomly selected term and appropriate for gestational age twin pairs without discordancy. The comparison of the two subgroups showed no significant difference in maternal age, parity, gestational age, incidence of maternal hypertension, or perinatal outcome. It is suggested that discordancy is not a risk factor when the twin pair has reached term and the lighter twin weighs at least 2500 g.

The growth discordant twin.

The study of growth discordancy in twin gestation has gathered great momentum in recent years. Divergent intertwin growth is believed to be a direct result of the process of twinning and of the inability of the uterine environment to provide for the increased demand of multiple fetuses. The smaller twin faces increased risk of perinatal mortality and morbidity as well as reduced physical and mental development in later life.

Ritodrine-induced pulmonary edema unmasking underlying peripartum cardiomyopathy.

Pulmonary edema was induced by an increase in the dose of ritodrine in a patient receiving the drug for 28 days because of preterm contractions. After initial therapy, the cardiologic evaluation revealed peripartum cardiomyopathy. This is the first report of ritodrine causing pulmonary edema by unmasking underlying asymptomatic cardiomyopathy.

Management of labor with umbilical cord prolapse: a 5-year study.

Fifty-one cases of cord prolapse, in which delivery was not imminent and the fetus was still alive, were managed by filling the bladder with 500-700 mL of saline and by intravenous ritodrine. Delivery was by cesarean section as soon as possible. Among the cases so managed, there were no perinatal deaths.