Alterations in the maternal peripheral microvascular response in pregnancies complicated by preeclampsia and the impact of fetal sex

Copyright © 2006 SAGE PublicationsObjective: Peripheral microvascular function is altered in preeclampsia (PE). Recent studies suggest that maternal physiology varies with fetal sex. We wanted to examine if there were sex-specific differences in maternal peripheral microvascular function in normal pregnancy and pregnancy complicated by PE. Methods: Peripheral microvascular responses were examined using the noninvasive technique of laser Doppler flowmetry in normotensive healthy pregnant women and in women diagnosed with PE. We measured baseline perfusion, response to thermal hyperemia, post-occlusive reperfusion, and vasodilatation in response to corticotropin-releasing hormone (CRH), a potent vasodilator in human skin. Results: At 31 to 40 weeks' gestation those women with a male fetus exhibited increased vasodilatation in response to CRH (P <0.5) and greater baseline perfusion (P <.05) than those pregnant with a female fetus. PE women pregnant with a male fetus demonstrated a significantly reduced vasodilatation in response to CRH (P <.05), reduced baseline perfusion (P <.05), and reduced response to thermal hyperemia (P <.05) compared to normotensive women pregnant with a male fetus. Microvascular function was not significantly different between preeclamptic and normotensive women with a female fetus. Conclusion: These data show that there are differences in maternal peripheral microvascular function in relation to fetal sex.Michael J. Stark, L. Dierkx, V. L. Clifton and Ian M. R. Wrigh

Cost of detecting malignant lesions by endoscopy in 2741 primary care dyspeptic patients without alarm symptoms.

BACKGROUND & AIMS: Current guidelines recommend empirical, noninvasive approaches to manage dyspeptic patients without alarm symptoms, but concerns about missed lesions persist; the cost savings afforded by noninvasive approaches must be weighed against treatment delays. We investigated the prevalence of malignancies and other serious abnormalities in patients with dyspepsia and the cost of detecting these by endoscopy. METHODS: We studied 2741 primary-care outpatients, 18-70 years in age, who met Rome II criteria for dyspepsia. Patients with alarm features (dysphagia, bleeding, weight loss, etc) were excluded. All patients underwent endoscopy. The cost and diagnostic yield of an early endoscopy strategy in all patients were compared with those of endoscopy limited to age-defined cohorts. Costs were calculated for a low, intermediate, and high cost environment. RESULTS: Endoscopies detected abnormalities in 635 patients (23%). The most common findings were reflux esophagitis with erosions (15%), gastric ulcers (2.7%), and duodenal ulcers (2.3%). The prevalence of upper gastrointestinal malignancy was 0.22%. If all dyspeptic patients 50 years or older underwent endoscopy, 1 esophageal cancer and no gastric cancers would have been missed. If the age threshold for endoscopy were set at 50 years, at a cost of $500/endoscopy, it would cost$82,900 (95% CI, $35,714-$250,000) to detect each case of cancer. CONCLUSIONS: Primary care dyspeptic patients without alarm symptoms rarely have serious underlying conditions at endoscopy. The costs associated with diagnosing an occult malignancy are large, but an age cut-off of 50 years for early endoscopy provides the best assurance that an occult malignancy will not be missed