True cadence and step accumulation are not equivalent: the effect of intermittent claudication on free-living cadence

'True cadence' is the rate of stepping during the period of stepping. 'Step accumulation' is the steps within an epoch of time (e.g. 1min). These terms have been used interchangeably in the literature. These outcomes are compared within a population with intermittent claudication (IC). Multiday, 24h stepping activity of those with IC (30) and controls (30) was measured objectively using the activPAL physical activity monitor. 'True cadence' and 'step accumulation' outcomes were calculated. Those with IC took fewer steps/d 6531±2712 than controls 8692±2945 (P=0.003). However, these steps were taken within approximately the same number of minute epochs (IC 301±100min/d; controls 300±70min/d, P=0.894) with only slightly lower true cadence (IC 69 (IQ 66,72) steps/min; controls 72 (IQ 68,76) steps/min, P=0.026), giving substantially lower step accumulation (IC 22 (IQ 19,24) steps/min; controls 30 (IQ 23,34) steps/min) (P<0.001). However, the true cadence of stepping within the blocks of the 1, 5, 20, 30 and 60min with the maximum number of steps accumulated was lower for those with IC than controls (P<0.05). Those with IC took 1300 steps fewer per day above a true cadence of 90 steps/min. True cadence and step accumulation outcomes were radically different for the outcomes examined. 'True cadence' and 'step accumulation' were not equivalent in those with IC or controls. The measurement of true cadence in the population of people with IC provides information about their stepping rate during the time they are stepping. True cadence should be used to correctly describe the rate of stepping as performed.

Intensity Non-uniformity Correction of Magnetic Resonance Images Using a Fuzzy Segmentation Algorithm

Artifacts in magnetic resonance images can make conventional intensity-based segmentation methods very difficult, especially for the spatial intensity non-uniformity induced by the radio frequency (RF) coil. The non-uniformity introduces a slow-varying shading artifact across the images. Many advanced techniques, such as nonparametric, multi-channel methods, cannot solve the problem. In this paper, the extension of an improved fuzzy segmentation method, based on the traditional fuzzy c-means (FCM) algorithm and neighborhood attraction, is proposed to correct the intensity non-uniformity. Experimental results on both synthetic non-MR and MR images are given demonstrate the superiority of the algorithm.

Risk of fetal loss in twin pregnancies undergoing second trimester amniocentesis(1)

OBJECTIVE

To assess the rate of fetal loss among bichorionic twin gestations undergoing genetic amniocentesis compared with singletons undergoing the procedure and untested twins.

METHODS

In a retrospective cohort study, three groups were compared: 476 women with twins undergoing amniocentesis, 489 women with singleton gestations undergoing amniocentesis, and 477 women with twins presenting at a similar gestational age for ultrasound studies only. All subjects were scanned at 17-18 weeks' gestation and again approximately 4 weeks after the procedure or first ultrasound scan. Excluded were twin pregnancies after fetal reduction or chorionic villus sampling, fetuses with structural anomalies, and cases in which one fetus had died at the time of examination or after fetal reduction.

RESULTS

Thirteen twin gestations in the tested group (2.73%) aborted spontaneously up to 4 weeks after the procedure compared with three twin controls (0.63%, P =.01) and three post-procedure singleton controls (0.6%, P =.01). An abnormal karyotype was discovered in 15 tested twin pregnancies (3%) and in six tested singletons (1.23%). All affected twin pairs were discordant for the chromosomal anomaly.

CONCLUSION

The risk of early fetal loss in twins undergoing amniocentesis appears to be higher than that of exposed singletons or unexposed twins.

Electrical stimulation of wrist extensors in poststroke hemiplegia

BACKGROUND AND PURPOSE

It has been suggested that cyclic neuromuscular electrical stimulation (ES) may enhance motor recovery after stroke. We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke.

METHODS

We recruited 60 hemiparetic patients (mean age, 68 years) 2 to 4 weeks after stroke into a randomized, controlled, parallel-group study comparing standard rehabilitation treatment with standard treatment plus ES of wrist extensors (3 times 30 minutes daily for 8 weeks). Isometric strength of wrist extensors was measured using a device built for that purpose. Upper-limb disability was assessed with use of the Action Research Arm Test (ARAT). Observations were continued for 32 weeks (24 weeks after the finish of ES or the control intervention phase).

RESULTS

The change in isometric strength of wrist extensors (at an angle of 0 degrees extension) was significantly greater in the ES group than the control group at both 8 and 32 weeks (P=0.004, P=0.014 by Mann Whitney U test). At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group (P=0.013 and P=0.02, respectively); a similar trend was seen for the total ARAT score (P=0.11). In the subgroup of 33 patients with some residual wrist extensor strength at study entry (moment at 0 degrees extension >0), the ARAT total score had increased at week 8 by a mean of 21.1 (SD, 12.7) in the ES group compared with 10.3 (SD, 9.0) in the control group (P=0.024, Mann Whitney U test); however, at 32 weeks the differences between these 2 subgroups were no longer statistically significant.

CONCLUSIONS

ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients. Upper-limb disability was reduced after 8 weeks of ES therapy, with benefits most apparent in those with some residual motor function at the wrist. However, it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued.

Prenatal exclusion of Stickler syndrome

Stickler syndrome is an autosomal dominant disorder of the connective tissue which includes ocular and systemic manifestations. We report on a large kindred in which we were able to demonstrate very tight linkage between the disease and the type II collagen gene (COL2A1) (LOD score 3.91 at theta = 0). In a family in which the father and one of his daughters were severely affected, DNA analysis from a chorionic villus sample demonstrated that the fetus possessed the normal allele of COL2A1. Thereafter a normal child was born.

Prenatal diagnosis of familial hypercholesterolemia caused by the ?Lebanese? mutation at the low density lipoprotein receptor locus

Here, we report the prenatal diagnosis of familial hypercholesterolemia in a Christian-Arab family that carries the "Lebanese" mutation, a single base substitution that creates a HinfI restriction site, at the low density lipoprotein (LDL) receptor locus. Polymerase chain reaction amplification and restriction analysis were performed on genomic DNA extracted from a chorionic villus sample. In conjunction with karyotype analysis, the fetus was identified as a heterozygous female. Analysis of LDL receptor restriction fragment length polymorphisms confirmed the presence of a male parent marker and revealed that the fetus inherited the mutant gene from its mother. This technique offers a simple and rapid diagnostic tool that can be carried out at an early stage of gestation. It is recommended for families and population groups with molecularly defined LDL receptor mutations.

The use of functional electrical stimulation to assist gait in patients with incomplete spinal cord injury

The use of FES (functional electrical stimulation) for gait reproduction in six patients with spinal cord injury is described. Following a detailed neuromuscular assessment the patients commenced a muscle conditioning programme using electrical stimulation applied via surface electrodes. Once patients were strong enough to stand, gait synthesis was initiated in the laboratory utilizing a programmable electrical stimulator. When a satisfactory gait pattern had been achieved, patients used their portable stimulator at home. All six patients became able to stand and walk using the FES system and completed the home phase of the programme. Three patients continue to use the system at home for exercise and walking; the other patients have discontinued using the system, preferring a wheelchair or their original orthoses. We conclude that FES-assisted walking is feasible in patients with incomplete spinal cord injury, even with severe motor loss. Further advances in technology are needed for the system to become applicable to a larger number of patients.

[Prenatal diagnosis of thalassemia: identification of mutations in conjunction with gene amplification in vitro]

Prenatal diagnosis of thalassemia and sickle cell anemia using DNA analysis has been performed in Israel since 1982. Until recently the tests involved analysis of polymorphic markers linked to the beta-globulin gene (RFLP). This method is not suitable for many of the families at risk. The recently developed technique of gene amplification in vitro (PCR) facilitates direct identification of the genetic lesions (mutations) using minimal amounts of DNA. The diagnosis is rapid, reliable and unambiguous and can be made early in pregnancy. Our experience in prenatal diagnosis during the past year is reported. Of 14 diagnoses, 13 were made by direct identification of mutations following PCR.

Antepartum fetal heart rate characteristics in cases of premature rupture of membranes

The present retrospective study investigates the effect of premature rupture of membranes on fetal neurocardiac maturation as reflected by the fetal heart rate (FHR) pattern. The FHR tracings of 41 cases involving premature rupture of membranes of at least 48 hours' duration at 24 to 37 weeks' of gestation were studied. Fifty-two cases of normal pregnancy who were matched for gestational age served as controls. The results demonstrate similar baseline FHR and variability in the study and control group. The incidence of FHR accelerations of 15 beats/min was significantly greater in cases of premature rupture of membranes, and their onset was detected at an earlier gestational age. In addition, the mean amplitude of FHR accelerations was significantly greater in the study group compared with the control group. As a result, patients with premature rupture of membranes have a reactive nonstress test at an earlier gestational age than do control patients. These findings support the concept that premature rupture of membranes causes accelerated neurocardiac fetal maturation, as reflected by FHR pattern, possibly by inducing a stressful intrauterine environment.

Pyruvate carboxylase activity in chorionic villi: possibility of application to prenatal diagnosis

Pyruvate carboxylase (PC) activity was assayed in 27 chorionic villi samples (CVS) obtained at 9-12 weeks of gestation. The kinetic properties of the CVS enzyme were similar to those of liver PC; more than 75% of PC activity was recovered in the mitochondrial fraction of CVS. Apparent Km for pyruvate, ATP, acetyl CoA and HCO3- in the presence of saturation concentrations of the other reactants, were 0.3, 0.44, 0.015 and 6.0 mmol/l, respectively. The optimum pH was 7.5-8.0. The activity of PC in CVS was 3.2 +/- 0.3 nmol/min/mg protein, which is severalfold higher than that of amniotic fluid fibroblasts.

Pathological confirmation of cystic fibrosis in the fetus following prenatal diagnosis

Prenatal diagnosis of cystic fibrosis is presently based on the determination of microvillar enzyme activities in the amniotic fluid. However, there seems to be no accurate means for confirming the diagnosis of the aborted fetus. During the past year we performed pathological and histopathological examinations on 7 fetuses diagnosed in the second trimester of pregnancy to be affected by cystic fibrosis and compared them with 4 control age-matched fetuses. Glycol-methacrylate-embedded 2-3-mu thick sections of the pancreas, lungs, bronchial tree, and GI tract were stained with toluidine blue, H&E, PAS, and AB-PAS, and examined microscopically. In the controls, PAS-positive granules were dispersed throughout the cytoplasm of most pancreatic acinar and tracheal submucosal glandular cells. In the affected fetuses 2 distinct groups were identified. In one group of 4 fetuses, the pancreatic and tracheal submucosal glands were dilated and contained a weak PAS-positive material. The glandular epithelial cells had very little PAS-positive granules. In this group, the tracheal epithelium was either atrophic or metaplastic and devoid of microvilli. In the second group of 3 fetuses there was less dilation of the glands, and both pancreatic acinar cells and tracheal submucosal glandular epithelial cells contained few PAS-positive granules, which were confined mainly to a perinuclear location. The tracheal epithelial cells contained few microvilli which, when present, appeared thicker and shorter as compared to controls. We feel that histochemical evaluation of pancreatic and bronchial tissue may be of help in the pathological confirmation of cystic fibrosis in human fetuses where the results of the biochemical studies are suggestive of the disease.

Insufficient transplacental digoxin transfer in severe hydrops fetalis

A case of severe nonimmune hydrops fetalis caused by supraventricular tachycardia is presented. Maternal treatment with digoxin and the subsequent addition of verapamil and propranolol failed to be effective. Simultaneous measurement of maternal serum and cord blood digoxin levels showed insufficient transplacental digoxin transfer. Other modalities of treatment are discussed.

Alterations of pathological fetal heart rate patterns in labor following vibroacoustic stimulation

Vibroacoustic stimulation of the fetus in labor was previously shown to result in a transient fetal heart rate (FHR) tachycardia followed by a return to prestimulation FHR pattern. We presently report 3 cases in which FHR patterns of repeat decelerations were changed to normal following vibroacoustic stimulation. These changes may be related to the strong fetal movements evoked by the stimulation and removal thereby of a mechanical problem such as cord compression.

Advanced ultrasonic placental maturation in twin pregnancies

The mean length of twin pregnancies is shorter than that of singleton pregnancies. The possibility that the shorter gestation of twins is associated with advanced fetal maturational changes was studied in relation to placental maturation. For this purpose, the sonographically determined placental gradings of 158 twin pregnancies and 474 singleton pregnancies were compared at different gestational ages. The percent distributions of placental grades, from I to III, were significantly different throughout the third trimester, with a preponderance of Grade III placentas in the twin group (p less than 0.001). Considering the reported association of Grade III placentas with advanced gestation as well as fetal lung maturity, the present study suggests earlier maturational changes in twin fetuses compared with singleton fetuses.

Fetal outcome following primary herpetic gingivostomatitis in early pregnancy. Morphological study and updated appraisal

Three women presented with acute primary herpetic gingivostomatitis during the first half of their pregnancy. Herpes simplex virus (HSV) was isolated by culture from the buccal lesions in two cases, and a serological confirmation of primary HSV infection was evident in the third case. One fetus, delivered during the second trimester of pregnancy, had a central nervous system anomaly, which was probably not related to the infection. The placenta exhibited mild diffuse deciduitis and focal villitis. The other two fetuses were normal and born at term. Microscopic examination of the placentas and membranes disclosed deciduitis and basal placentitis in one, which may have been caused by the herpes virus. The literature on intrauterine infection with HSV is reviewed, focusing on the significance of Type I virus as a possible teratogen. At present, there seems to be insufficient evidence to indicate pregnancy interruption following nongenital primary HSV infection in early pregnancy.

Epidural haemangiomas during pregnancy

Two cases of vertebral haemangiomas are reported which presented as spinal cord syndromes during pregnancy. Eleven additional cases of epidural haemangiomas in the literature which became symptomatic during pregnancy are reviewed. In 11 out of 13 cases symptoms presented during the third trimester of pregnancy and in all but two cases the epidural lesions were in the upper six thoracic vertebrae. These features can be explained by the effect of the gravid uterus on the relatively sparse vascular supply of the upper thoracic spinal cord.

Artificially induced endometrial cycles and establishment of pregnancies in the absence of ovaries

In eight women with ovarian failure, we induced histologically normal endometrial function during a preparatory cycle consisting of sequential administration of estrogen and progesterone. During a subsequent cycle, endometrial stimulation was synchronized with surrogate-embryo transfer performed on days 16 to 21. Among the eight women, two pregnancies were established by embryo transfer on days 18 and 19. In both women, ovarian tissue was absent, and these patients therefore serve as an in vivo model for the isolated effects of estrogen and progesterone on implantation and maintenance of pregnancy. Treatment with exogenous estrogen was mandatory up to the 11th week of gestation, and treatment with progesterone until the 18th to 22nd weeks. We conclude that it is biologically feasible to simulate the essential hormonal and endometrial milieu of a fertile menstrual cycle and early gestation solely by the administration of estrogen and progesterone. Days 18 to 19 of the cycle are recommended for successful embryo implantation with this treatment program.

Antepartum diagnosis of monoamniotic twin pregnancy

A case of monoamniotic twin pregnancy complicated by preeclampsia is presented. Early diagnosis was achieved at the 16th gestational age by ultrasonography. The pregnancy was terminated at term by a cesarean section. Both twins survived with excellent outcome. The importance of antepartum diagnosis of this rare condition is discussed.

Recurrent molar pregnancies associated with clomiphene citrate and human gonadotropins

A 34-year-old patient, gravida 7, para 0, with three consecutive spontaneous abortions followed by four recurrent molar pregnancies is described. The patient conceived only with clomiphene citrate or human gonadotropin treatment. The occurrence of molar pregnancies succeeded spontaneous abortions with one remaining pregnancy progressing to gestational trophoblastic disease. The role of clomiphene citrate and human gonadotropins in the pathogenesis of this disease is discussed.

Dysgerminoma of the ovary: incidental finding during cesarean section

Two cases are presented of dysgerminoma found incidentally at the time of cesarean section. The first was an elective repeat operation and in the second case operation was carried out for fetal distress. In both cases a unilateral salpingooophorectomy was performed. Both patients have been free of recurrence 3 years following the diagnosis. One of them delivered a healthy baby 2 years after the operation. Since dysgerminoma is more prevalent among young females, its coexistence with pregnancy is more expected. Early diagnosis and treatment for pure dysgerminoma provides a good prognosis and fertility can be preserved in selected cases.

Acute feto-maternal transfusion--diagnostic considerations

A sinusoidal fetal heart rate pattern followed by severe deceleration was encountered in a fetus at 39 weeks' gestation during antepartum fetal nonstress testing. The only indication for fetal monitoring was a maternal complaint of cessation of fetal movements. The abdominally-delivered newborn was found to be severely anaemic and the cord was tightly wrapped round its body. A pathophysiological mechanism for massive feto-maternal transfusion is suggested. Various laboratory tests were utilized to identify the condition, quantitate the amount of transfusion, and estimate the time of its occurrence. Globin synthesis studies in maternal blood indicated that a significant fetal blood loss had occurred within 24 hours of delivery. The significance of these findings as applied to the clinician is discussed.

Antepartum fetal heart rate pattern associated with major congenital malformations

Antenatal fetal heart rate monitoring of 20 fetuses with major congenital malformations revealed loss of long-term variability in 11 (55%) and an isolated, abrupt-onset fetal heart rate deceleration in 13 (65%). In ten (50%), loss of variability coexisted with periodic fetal heart rate decelerations. These fetal heart rate changes were significantly more prevalent in the malformed group than in a control population. There was also a significantly increased incidence of fetal distress in labor and in the requirement for primary cesarean section delivery. Perinatal mortality was 75%, reflecting the lethal nature of the malformations. Loss of long-term fetal heart rate variability associated with isolated, abrupt occurrence of fetal heart rate deceleration should raise the possibility of congenital malformations in an apparently normal pregnancy.

Reduction of peritoneal adhesion formation by colchicine: a comparative study in the rat

Colchicine inhibits processes known to be involved in the pathogenesis of peritoneal adhesions. Daily administration of 50 micrograms of colchicine to 22 rats significantly diminished adhesion formation, as compared with dexamethasone-treated and untreated rats. Rats that developed at least three adhesions of grade 3 (scale 0 to 4) were strikingly less prevalent among the colchicine-treated animals than the untreated group (9.1% versus 40.9%, P less than 0.001). The double product of the number and grading of adhesions was significantly lower (P less than 0.05) in the colchicine group. Colchicine is more effective than dexamethasone in inhibiting adhesion formation in the rat.

Familial gonadal germinative failure: endocrine and human leukocyte antigen studies

Two primary amenorrheic sisters were diagnosed as 46,XX pure gonadal dysgenesis. Their brother, a normal phenotypic and genotypic male, was azoospermic due to primary germinative failure. Parental consanguinity was observed, suggesting an autosomal recessive inheritance. This is the first reported family in which both an otherwise healthy male and two females were affected by gonadal germinative failure. Endocrine studies showed impaired gonadal function in the three affected siblings. The two females with gonadal dysgenesis and the azoospermic male shared one human leukocyte antigen haplotype; the second haplotype, however, was different. The common haplotype was also found in the oligomenorrheic sister whose gonadotropin-releasing hormone test was compatible with normal ovarian function, in the mother, and in one of her offspring who had a normal spermiogram. Hence, linkage between human leukocyte antigens and gonadal failure in this family had been excluded. The possible etiology of familial, chromosomally competent, gonadal failure is discussed.

Effects of dexamethasone on proliferation of autologous fibroblasts and on the immune profile in women undergoing pelvic surgery for infertility

Dexamethasone (DEX) was administered postoperatively to six patients undergoing lysis of pelvic adhesions. During therapy the proportion of T cells among the peripheral blood lymphocytes sharply declined from 60% to 20%. Response to T- and B-cell mitogens decreased to 20% to 40% of the original response prior to surgery. DEX-containing serum had an enhancing effect on the growth of autologous fibroblasts derived from pelvic adhesions (50% more than the effect of pretreatment serum). Pure cortisol and DEX induced a similar enhanced growth. The enhancing ability of the patients' sera disappeared 48 hours after discontinuation of DEX, corresponding to the recovery of the lymphoid system. If there is any benefit in steroid treatment to prevent pelvic adhesion formation, it is apparently not via an inhibitory effect on fibroblast proliferation. Such treatment, however, clearly suppresses the immune response of the patients during the early postoperative course.

Effect of dexamethasone on serum transcobalamin II concentration in women undergoing pelvic surgery

Dexamethasone (120 mg/day for 2 days) was administered intramuscularly to young females undergoing pelvic surgery for infertility. The therapy was shown to cause a transient increase in the serum level of the granulocyte-produced transcobalamins (TCI and TCIII) and more significantly in the monocyte-produced transcobalamin (TCII), from 1220 +/- 70 to 1980 +/- 158 pg/ml (P less than 0.001). The change closely followed a transient elevation of EA rosette forming cells in the peripheral blood (from 20 to 50% of the total mononuclear cell population), which are mainly monocytes. The observed effects were shown to be independent of the surgical trauma. The results indicate that the increase in serum TCII can be attributed to an effect of dexamethasone on monocytes.

Seasonal variation of the terpenes of the leaves, buds, and twigs of balsam fir (Abies balsamea)

The variation in the percentages of the volatile terpenes of the leaves, buds, and twigs of balsam fir from Saskatchewan was determined during the course of 2 years. Very little variation was found in mature leaves and twigs throughout the year and also in the buds during winter. Major changes were recorded in the percentages of the main terpenes of the buds 4–6 weeks before bud burst, the newly formed buds in midsummer, and somewhat smaller ones in those of the new leaves from first measurements to midsummer. Except in the newly formed twigs, the twig oil composition varied little through the year, but it was subject to differences outside of the experimental error from one sample to another. The chemosystematic implications are discussed briefly.

The effect of intraperitoneal colchicine on the formation of peritoneal adhesions in the rat

A double blind study was carried out to determine the effect of colchicine on the formation of intraperitoneal adhesions in the rat. Adhesions were produced by a standard method in 92 rats. The animals were than divided at random into two groups. One group (47 rats) was treated with intraperitoneal colchicine, whilst the other, the control group (45 rats) was treated with intraperitoneal normal saline in the same volume, frequency and duration. Four weeks later the animals were killed for assessment and measurement of adhesions. Two kinds of adhesions were found. 1. "Surface adhesion" - consisting of two serosal surfaces attached together; their area was significantly smaller (p less than 0.00003), and their number was lower (p less than 0.03) in the colchicine group than in the control group. 2. "Filamentous adhesions" - thin, elastic cords connecting omentum or pelvic fat bodies to other viscera; there was no significant difference in their number between the colchicine and the control group. We concluded that post-operative treatment with colchicine reduces the formation of intraperitoneal adhesions in the rat.

Phaeochromocytoma and pregnancy--an updated appraisal

Phaeochromocytoma in pregnancy carries a considerable risk to the mother and is even more dangerous to the fetus. It should, therefore, be kept in mind as a possible cause of hypertension in pregnancy and appropriate laboratory tests undertaken. The data presented in the literature indicate that the early diagnosis of phaeochromocytoma in pregnancy decreases maternal mortality markedly and fetal mortality less significantly. Diagnostic measures to localize the tumour before delivery are limited; radiation exposure to the fetus will be minimized by the adjunctive use of ultrasound and CAT scanning. If the diagnosis is made before 20-24 weeks, the tumour should be excised without delay and pregnancy interrupted or allowed to continue, depending on circumstances. After the 24th week, the pregnancy should usually be continued under adequate adrenergic blockade until fetal maturity is achieved. Labour and vaginal delivery should generally be avoided. Caesarean section and careful removal of the tumour at the same time are recommended.

Postoperative analgesia by percutaneous electrical stimulation in gynecology and obstetrics

Percutaneous electrical stimulation (PES) for relief of acute postoperative pain was applied in 10 patients after cesarean section and in 20 women who had undergone various gynecological operations. Thirty other women, subjected to identical surgical interventions, served as controls. In the latter group, the electrodes were attached to a nonfunctioning apparatus. In all patients, including the controls, the two electrodes were introduced intradermally, one on each side of the incision. Implantation was carried out at the end of the surgical procedure while the patient was still anesthetized, and stimulation was commenced immediately. The electrical stimulation was applied continuously for 1 to 3 postoperative days. The generation of pulses was perceived by the patients as a tingling sensation. Complete pain relief was obtained in 40% of the patients treated with PES, whilst in 27% the pain was markedly diminished. Postoperative analgesic medication in this group was reduced by 50-80% as compared to the analgesic requirements in the control group. Other beneficial effects observed in the treated patients included early ambulation, early peristalsis, postpartum uterine contractions and absence of respiratory complications.

Utilization of antiparkinson drugs in Norway, Sweden, Denmark and Finland 1975-1979

Defined daily doses per day and 10(3) inhabitants [Formula: see text] of the different types of antiparkinson agents have been compared in the period 1975-1979 for Norway, Sweden, Denmark and Finland. A marked increase in the utilization of L-DOPA containing drugs has taken place especially in Sweden following the introduction of the "combined drugs" (L-DOPA + decarboxylase inhibitor). Statistically, nearly all patients with parkinsonism in Sweden have since 1977 been treated with L-DOPA, while in the other nordic countries about 10% of the patients are not on this therapy. These data are discussed in relation to the current concept of pharmacotherapy of parkinsonism. Further, many patients treated with neuroleptic drugs do in addition take anticholinergic agents. Drug utilization figures indicate this method of treatment to be most common in Denmark and Sweden.