RESUMEN
OBJECTIVE: To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital. STUDY DESIGN: Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought. RESULTS: Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert. CONCLUSION: This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.
Asunto(s)
Dinoprostona/administración & dosificación , Hospitales Comunitarios , Trabajo de Parto Inducido , Administración Intravaginal , Adolescente , Adulto , Cesárea , Dinoprostona/efectos adversos , Dinoprostona/uso terapéutico , Femenino , Rotura Prematura de Membranas Fetales , Frecuencia Cardíaca Fetal , Humanos , Trabajo de Parto , Embarazo , Factores de Tiempo , Resultado del Tratamiento , Contracción UterinaRESUMEN
BACKGROUND & AIMS: Biliary epithelial cells are the target of numerous immune-mediated liver diseases, yet their role in pathogenesis remains unclear because of difficulties in obtaining pure preparations. The aim of this study was to establish pure clones of immortalized murine intrahepatic biliary epithelial cells. METHODS: The transgenic mouse harboring the SV40 thermosensitive immortalizing mutant gene TsA58 under the control of the major histocompatibility complex class I promoter was used to establish conditionally immortalized intrahepatic bile duct cells by countercurrent centrifugal elutriation and clonal dilution. RESULTS: Immortalized clones of cells expressing cytokeratin 19, which organized themselves into ductlike structures, were obtained. On electron-microscopic sections, cells were well differentiated and polarized. Cells proliferate in response to epidermal growth factor, interleukin 1 alpha, and tumor necrosis factor alpha. Using the reverse-transcriptase polymerase chain reaction technique, these cells were found to contain messenger RNA, which encodes for the interleukin 1 and tumor necrosis factor receptors. CONCLUSIONS: The availability of unlimited numbers of pure bile duct cells that behave in an identical fashion to biliary epithelial cells from "normal" mice will allow for more rigorous studies of the behavior and function of this epithelium.