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OBJECTIVE: Midtrimester premature rupture of membranes causes significant perinatal morbidity and death. No effective treatment exists. We investigated (1) whether a needle puncture in the fetal membranes could be sealed in vitro and (2) the optimal composition of the sealant to be used. STUDY DESIGN: Membranes from second trimester pregnancies (16-24 weeks of gestation) were stretched over a modified syringe with a 2.5-cm open diameter. The syringe was filled with 20 mL of second trimester amniotic fluid, and the membrane was punctured with a 20-gauge needle. Sealants were injected into the amniotic fluid. The primary outcome variable was time for leakage of amniotic fluid. Median times for leakage for the formulations were compared by Wilcoxon exact rank sum test. RESULTS: Platelets alone failed to seal the puncture site. All other formulations stopped leakage temporarily. Tisseel (Baxter Corp, Glendale, Calif) and cryoprecipitate/thrombin preparations led to more prolonged sealing of punctured amniotic membranes than platelets (P <.01) and were not significantly different from each other. CONCLUSION: Of the sealants tested in vitro, amniotic membranes are best sealed by a fibrin/thrombin-based sealant.

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A new search for the gravitational lens effects of a significant cosmological density of supermassive compact objects (SCOs) on gamma-ray bursts (GRBs) has yielded a null result. We inspected the timing data of 774 BATSE-triggered GRBs for evidence of millilensing: repeated peaks similar in light-curve shape and spectra. Our null detection leads us to conclude that, in all candidate universes simulated, Omega(SCO)<0.1 is favored for SCO masses in the range 10(5)

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OBJECTIVE: The aim of this study was to determine the success rate of cytogenetic analysis from specimens obtained at the time of second-trimester termination of pregnancy by dilation and evacuation. STUDY DESIGN: All second-trimester dilation and evacuations performed by a single practitioner at a single institution from 1993 through 1995 were evaluated to pick out those patients in whom biopsy specimens were submitted for cytogenetic analysis. The main outcome studied was the ability to obtain karyotype results for these specimens. RESULTS: Cytogenetic studies were performed on 258 dilation and evacuation specimens with a median gestational age of 18 weeks (range 13-25 weeks). The indications for termination were fetal aneuploidy (n = 88, 34%), sonographically diagnosed fetal malformations (n = 82, 32%), intrauterine fetal death (n = 67, 26%), oligohydramnios or premature rupture of membranes (n = 16, 6%), and others (hematologic and metabolic disorders, n = 5, 2%). Successful karyotyping was achieved for 99% of specimens obtained at second-trimester dilation and evacuation, with 3 failures of growth (1% failure rate). The failures included a 14-week molar pregnancy, an 18-week fetus with Dandy-Walker malformation, and a 19-week intrauterine fetal death. Of the samples obtained in cases of intrauterine fetal death, 99% (66/67) provided adequate cytogenetic information. CONCLUSIONS: Karyotyping for abnormal second-trimester pregnancies and intrauterine fetal deaths at the time of a dilation and evacuation procedure has a success rate nearing 100%. In contrast to previous reports, our data indicate that it is unnecessary to perform pretermination invasive karyotyping in patients with abnormal second-trimester pregnancies or intrauterine fetal death who elect to undergo dilation and evacuation. Chromosome analysis at the time of termination of pregnancy by dilation and evacuation reduces patient discomfort, risk of infection, and cost while still providing reliable and vital cytogenetic information for future genetic counseling.

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OBJECTIVE: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility. METHOD: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case. RESULTS: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor. CONCLUSIONS: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.

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A patient with a disabling tic and a major depressive episode responded partially to phenelzine, but relapsed after medication was withdrawn because of hypertensive and hepatotoxic reactions. The patient's motor and affective symptoms resolved after electroconvulsive therapy, and he remains asymptomatic after 1 year.

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Multidisciplinary studies of adulthood have revolutionized thinking about developmental processes during the second half of life. These ideas are just beginning to be integrated with clinical theory and practice. The elaboration of the interface between the rapidly expanding developmental theory of normal adulthood and clinical intervention with older patients is a psychiatric frontier. Illustrating with clinical examples, the authors offer a rationale for using new diagnostic tools, suggest a revision of the theory of transference to include sources beyond childhood, and describe unique transference paradigms in older patients as well as equally phase-specific countertransference responses in their therapists.

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Direct access to fetal blood during the second and third trimesters of pregnancy opens new fields of prenatal diagnosis and in utero fetal treatment. Percutaneous umbilical blood sampling, a method that involves ultrasonographically guided needle insertion into the umbilical vein, appears to have an acceptable complication rate. This technique has tremendous potential for use in evaluating fetal status.

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The developmental framework, when applied to adulthood, emphasizes the continuing evolution of the personality at five or fifty and 'focuses on the formation of psychic structure in process and underscores the continuity of normal and pathologic outcomes.' (COPER 9, 1974, p. 14). Many of the events we have discussed here are experiences unique to the adult and outside the realm of the child. Their uniqueness and developmental significance need to be better accounted for in psychoanalytic theory. Confrontation with each adult developmental task or crisis produces basic change in the life of each individual. To quote Bibring (1959): 'We find them as developmental phenomena at points of no return between one phase and the next when decisive changes deprive former central needs and modes of living of their significance forcing the acceptance of highly charged new goals and functions.' (p. 119). One purpose of this paper has been to demonstrate that such developmental turning points of no return are not limited to childhood but occur throughout the life cycle.

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Plasma cortisol levels were studied in the cord blood and neonatal blood of the following vaginally delivered groups: (A) postmature; (B) postterm (but not postmature); and (C) term neonates. Significantly lower levels of 8 A.M. neonatal plama cortisol were found in postmature neonates when compared with term neonates (P LESS THAN 0.02) or merely postterm neonates (P LESS THAN 0.02). No difference was found in the cord blood cortisol levels in all three groups. Contrary to the traditional belief that postmaturity results from placental aging, our findings appear to indicate that postmaturity represents a specific fetal disorder. Fetal adrenal insufficiency may be a characteristic of this disorder. Prolonged pregnancy in these cases may be reflected inability of the affected fetus to initiate labor.

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