Objective To determine the expression of VEGF in the placental tissue from pregnancies complicated by hypertension disorders of different clinical severity.
Design Prospective cohort study.
Setting Polyclinic of Careggi, University of Florence, Italy.
Sample Placentas from women with gestational hypertension (n= 20), pre‐eclampsia (n= 20) and pre‐eclampsia with HELLP syndrome (n= 20) and from normotensive women (n= 20), as control group (gestational age comprised between 35 and 38 weeks).
Methods An immunohistochemical technique and a quantitative analysis to measure mRNA levels (RT‐PCR) were employed.
Main outcome measures Intensity of immunoreactivity and mRNA levels in the placental components. Differences between the data.
Results VEGF immunoreactivity was observable in all the placental components in the gestational hypertension cases as in the control ones. In the cases with pre‐eclampsia and pre‐eclampsia with HELLP syndrome, some placental components were not immunoreactive. However, the VEGF positive components of all the pathological groups showed a higher intensity of reactivity with respect to that of the control group. The levels of VEGF mRNA were higher in the gestational hypertension cases and lower in the cases of pre‐eclampsia with HELLP syndrome with respect to the control ones; in the cases of pre‐eclampsia, the levels were the same as the control ones.
Conclusion The different expression of VEGF in the placenta of the pathological cases is probably related to haemodynamic changes that take place in these disorders, in order to attempt restoration of a normal uteroplacental flow.
We evaluated the efficacy and safety of a single injection technique with a small volume of anesthetic for ocular peribulbar anesthesia. We included 857 patients undergoing various ophthalmic procedures. Anesthesia consisted of a medial percutaneous injection of 5-6.5 mL of 2% lidocaine. At 2 min 85.6% of the patients had a motor block of at least 50% and at 5 min 78.6% had a motor block >80%. After 5 min 100% of the patients had adequate surgical anesthesia. There were no serious block-related complications. The described technique is a simple and satisfactory alternative to the classical techniques.
A workshop in the clinical anatomy of the female pelvic viscera has been part of the training program for the first year residents in Gynecology and Obstetrics at the University of Padova since the 1999-2000 academic year. The purpose of the workshop is to offer a direct experience of practical anatomy despite a shortage of cadavers. It is designed for six residents who work in three teams on three specimens. The anatomical specimens are unembalmed, unfixed, female pelvic visceral blocs that are harvested from the cadavers 24 hr after death. They are stored at -12 degrees C and removed from the freezer 12 hr before the workshop. The workshop is 3 hr in length and has two parts: one on theory and one practical. In the theoretical section (30 min), the teacher presents the topographical anatomy of the specimens and the residents analyze a clinically oriented worksheet. In the practical section (2 hr), the residents identify viscera, vessels, and nerves through inspection and palpation, and then a step-by-step dissection is carried out. In the last section (30 min), the workshop includes presentations on the three specimens that illustrate anatomical variability and assess knowledge of topographical anatomy. For many residents, this is the first practical experience of the anatomy of the female pelvic viscera because the anatomical courses for medical students do not include direct dissection by students. The unfixed viscera preserves the natural characteristics of the different tissues that exhibit the aspects of living organs, such as color, softness, and pliability, enhancing the knowledge of anatomy. The worksheet is structured as a guide to the anatomical basis of physical examination through inspection and palpation of the viscera. It also introduces the residents to the surgical anatomy of the female pelvis through a brief and selective dissection focused on the relationship between the different regional systems.
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