[Management of spinal cord injuries in pregnant women].
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Delivery, Obstetric↗
Biomedical subjects
B Kaplan
Publications and source records attributed to B Kaplan.
Exclusion of linkage between alcoholism and the MNS blood group region on chromosome 4q in multiplex families.
Polymorphic DNA markers on the long arm of chromosome 4 were used to examine linkage to alcoholism in 20 multiplex pedigrees. Fifteen loci were determined for 124 individuals. Lod scores were calculated assuming both dominant and recessive disease modes of inheritance, utilizing incidence data by age and gender that allow for correction for variable age of onset and frequency of the disorder by gender. Under the assumption that alcoholism is homogeneous in this set of pedigrees, and that a recessive mode with age and gender correction is the most appropriate, the total lod scores for all families combined were uniformly lower than -2.0. This suggests an absence of linkage between the putative alcoholism susceptibility gene and markers in the region of the MNS blood group (4q28-31), a region for which we had previously found suggestive evidence of linkage to alcoholism. The 100 cM span of chromosome 4 studied includes the class I alcohol dehydrogenase (ADH) loci. Using the recessive mode, no evidence for linkage to alcoholism was found for the markers tested, which spanned almost the entire long arm of chromosome 4. Under the dominant mode, no evidence for linkage could be found for several of the markers.
Alcoholism↗
Monoclonal antibodies against native ovarian tumor cells: specificity and characterization of the antigen. A preliminary report.
Monoclonal antibodies were prepared against native human ovarian carcinoma cells derived from the ascitic fluid of a patient (BH). One antibody, HC7R7, was selected on the basis of its binding to tumor BH cells, to other ovarian tumor cell lines (CAOV-3 and GZL-8), but not to the patient's fibroblasts. One hundred cell smears from ascitic and pleural effusions of tumor-suspected patients were immunostained with HC7R7. All serous ovarian carcinomas and half of the breast carcinomas stained positive with HC7R7; cells from noncancer ovarian aspirates were negative. Mesothelial cells were also stained with HC7R7. A correlation was noted between HC7R7 and OC-125 staining of ovarian tumor cells but not between HC7R7 and c-neu staining of breast tumor paraffin sections. The location of HC7R7-positive material in ovarian tumor cell lines (CAOV-3 and GZL-8) differed from that in the breast tumor cell line (MCF-7). CAOV-3 and GZL-8 showed membrane binding while, in MCF-7, not fully identified intracellular organelles were stained. Sodium dodecyl sulfate/polyacrylamide gel electrophoresis and immunoblots from membrane and cytosol fractions of GZL-8 and MCF-7 showed HC7R7 binding to three protein bands in the membrane fraction and to three other bands in the cytosol, all in the 29- to 68-kDa range. Two of the bands were glycoproteins. The only band that was different in the GZL-8 and MCF-7 cells was a 43-kDa glycoprotein, which was more pronounced in the MCF-7 cells. The possible significance of the new HC7R7 antibodies for detection and survey of ovarian malignancies is discussed.
Aged↗
Viability of embryos following second polar body removal in a mouse model.
PURPOSE: Our purpose was to evaluate the effect of the second polar body removal on the viability and development potential of the resulting embryos. METHOD: The second polar body was removed in 343 mouse oocytes and the development potential of the resulting embryos was compared in vitro to that in 223 intact mouse embryos and 222 controls which were placed under the same conditions as those micromanipulated. RESULTS: The proportion of morphologically normal blastocysts formed by polar body biopsied oocytes (70.8%) was not significantly different from that obtained from the control (81.1%) and intact (85%) oocytes. Cell counts of blastocysts obtained from the manipulated and non-manipulated oocytes were also not statistically different. CONCLUSION: The second polar body biopsy does not have a significant adverse effect on preimplantation development and may be applied for genetic evaluation of oocytes.
Animals↗
Great grand multiparity--beyond the 10th delivery.
OBJECTIVE: To investigate the perinatal outcome and obstetric complications of women delivering for the 10th time or more. METHODS: Four hundred twenty women of great grand multiparity were analyzed in a modern health care setting and compared with our general population of obstetric patients, with regard to past history, maternal age, gestational age, mode of delivery, fetal outcome and intercurrent medical/obstetric problems. RESULTS: The study group showed significantly lower rates of low birth weight infants and instrumental delivery. No significant difference was seen in the incidence of cesarean section, pathologic fetal presentation, maternal hypertension, gestational diabetes, hemorrhage, or perinatal morbidity or mortality. There was a slightly higher incidence of twin births compared with the general population. CONCLUSION: It is probable that women capable of reaching their 10th delivery are basically healthy. If offered adequate perinatal care, they are not a high-risk group during subsequent deliveries.
Adult↗
Successful external version of B-twin after the birth of A-twin for vertex--non-vertex twins.
OBJECTIVE: To determine the optimal intrapartum management of twins, especially those in vertex--non-vertex presentation. STUDY DESIGN: The study population consisted of 408 sets of twins delivered between 1988 and 1992, weighing at birth over 1500 g. According to our protocol, vaginal delivery was attempted in the vertex-vertex presentations. If non-vertex presentation was first, we performed cesarean section. In vertex--non-vertex cases, the first was delivered vaginally and external cephalic version or breech delivery was performed on the second. Apgar scores were compared according to presentation and delivery mode. RESULTS: Vaginal delivery was accomplished in 122 (73%) of 169 vertex--vertex presentations, 96 (68%) of 142 vertex--non-vertex presentations, and 4 (5%) of 99 non-vertex--other presentations. External cephalic version (ECV) of the second twin and subsequent vaginal delivery in vertex--non-vertex was successful in 75% of cases, and internal podalic version and assisted breech delivery were performed in 20 cases, and the remaining two were delivered by cesarean section. Apgar scores were not significantly different among the various groups, and no complications arose from external cephalic version performed on second non-vertex twins. CONCLUSIONS: External cephalic version was found safe for delivering second non-vertex twins in cases where the first twin is in vertex presentation. In our opinion routine cesarean section is thus no longer justified in such cases.
Delivery, Obstetric↗
Membranous dysmenorrhea: the forgotten entity.
BACKGROUND: Membranous dysmenorrhea involves the spontaneous slough of the endometrium in one cylindrical or membranous piece that retains the shape of the uterine cavity. Because this entity is rarely mentioned in the medical literature, the purpose of this report is to describe two such cases. CASES: An 18-year-old nullipara with regular menstrual cycles presented with membranous dysmenorrhea after taking the contraceptive Gynera (Gestodene 0.075 mg, ethinyl estradiol 0.030 mg). Symptoms disappeared when the medication was discontinued. The second patient, a 26-year-old woman, gravida 1, para 1, was on a 10-day monthly regimen of Provera (medroxyprogesterone acetate) 2.5 mg/day for dysfunctional uterine bleeding. When the Provera dose was increased to 10 mg/day, the symptoms disappeared. CONCLUSION: Membranous dysmenorrhea is "a disease of theories" with various recommended medications. When this condition is caused by iatrogenic treatment, the best approach is to discontinue the offending drug or change its dosage.
Adolescent↗
Surgical pearl: manual dermabrasion.
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Cicatrix↗
Hepatic infarction in a hemodialysis patient with systemic lupus erythematosus.
Hepatic infarction remains a rare and dramatic presentation of an acute abdomen in patients with systemic lupus erythematosus. It can be recognized preoperatively only with a high index of suspicion. Imaging studies such as abdominal computed tomography may aid in making the diagnosis. The tendency for thrombosis in these patients often can be associated with the presence of circulating anticoagulants from a group of antiphospholipid antibodies. The finding of lupus anticoagulant or anticardiolipin antibodies can help identify those patients more prone to thrombotic episodes, although at present it cannot be assumed that these antibodies cause the thromboses. Hemodialysis patients are said to have a decreased tendency for vascular thrombosis, but this may not be true in the presence of circulating antiphospholipid antibodies. We report a case of histologically documented hepatic infarction secondary to thrombosis in an end-stage renal disease patient on hemodialysis with systemic lupus erythematosus and a circulating lupus anticoagulant.
Adult↗
The grand multipara.
Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, women with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.
Adult↗
Cervical polyp in the menopause and the need for fractional dilatation and curettage.
OBJECTIVE: To investigate the need for fractional dilatation and curettage following excision of symptomatic versus asymptomatic cervical polyps. STUDY DESIGN: A prospective study was carried out on 467 women who were referred for treatment of symptomatic (accompanied by vaginal bleeding or discharge) or asymptomatic cervical polyps, from January 1, 1990 to December 31, 1992. Of these, 204 were premenopausal and 263 postmenopausal. Every excision of a cervical polyp was followed by a dilatation and curettage. The histological data were evaluated statistically using the chi 2-test. RESULTS: Postmenopausal women had more asymptomatic than symptomatic cervical polyps (P = 0.004). Cervical polyps were associated with more endometrial polyps in the postmenopausal than in the premenopausal women (P = 0.0009). Postmenopausal women with symptomatic cervical polyps had more endometrial abnormalities on histological examination than those with asymptomatic ones (P < 0.0001); this difference was not significant in the premenopausal group (P = 0.49). CONCLUSIONS: While neither symptomatic nor asymptomatic cervical polyps are an indication for dilatation and curettage (following excision) in women in their reproductive years, and do not affect their management or prognosis, this is not the case in postmenopausal women. Symptomatic cervical polyps after the menopause must be excised and followed by mandatory fractional dilatation and curettage, because there is a marked incidence of associated severe pathological conditions in this age group.
Adult↗
Objectification and negotiation in interpreting clinical images: implications for computer-based patient records.
This paper concerns the role of images and visualization in clinical practice and decision making. In particular, how physicians talk about and use images are discussed. Findings from evaluation studies of clinical imaging computer information systems suggest that the role and interpretation of images is negotiated, an example of how what is seen is influenced by the practice community, and, therefore is situated in specific instances of clinical decision making. An understanding of professional vision with respect to how physicians use and think about images may aid in developing clinical imaging systems, computer-based patient records, and other clinical information systems that could integrate well with clinical work practice.
Decision Support Techniques↗
The molecular basis of reactive amyloidosis.
Reactive amyloidosis is a disease occurring in patients suffering from chronic infections, inflammation, and certain malignant conditions that are characterized by a considerable elevation of the acute phase reactant serum amyloid A (SAA). It is defined by the presence of extracellular deposits of fibrillar material containing amyloid A (AA) as its main component. AA is an 8.5-kd protein structurally identical to the NH2-terminal of the acute phase reactant SAA. SAA consists of a group of evolutionally conserved amphipathic proteins, encoded by a large number of genes and produced abundantly during inflammation, all suggesting an important role, probably of a neutralizing (anti-inflammatory) nature. An analysis of various aspects of SAA provides no clues to the mechanism of amyloid production, its occurrence in only selected individuals, and its preferential relationship to one isotype of SAA. Until more data is available, the present view on AA amyloidogenesis remains hypothetical.
Amino Acid Sequence↗
Correlations between lipid peroxide and glutathione levels in vitamin C supplemented fasting guinea pigs.
The object of this study was to investigate correlations between lipid peroxide (MDA) and glutathione (GSH) levels in liver, kidney, heart and brain of guinea pigs during fasting (24 h, 48 h, 120 h) and respectively by supplementation (A single dose, 500 mg/kg bw, ip) of vitamin C (AA, Ascorbic acid) on fasting (24 h, 48 h, 120 h). MDA and GSH levels of various tissues by fasting and AA supplemented fasting were dependent on the function of each tissue during the fasting period. Lipid peroxide (LP) levels of kidney, heart and brain decreased for the AA supplemented fasting period. However, LP levels of liver increased in the AA supplemented 48 h and 120 h fasting groups. GSH levels of all tissues were affected differently in all of the AA supplemented fasting periods.
Animals↗
Pregnancies following pre-conception diagnosis of common aneuploidies by fluorescent in-situ hybridization.
Chromosomal aneuploidies contribute considerably to the low pregnancy rate in in-vitro fertilization (IVF). The objective of this experimental work was to explore the possibility of detecting common aneuploidies in oocytes by polar body sampling. The study included 45 infertile patients of advanced maternal age participating in an IVF programme. The first polar body was removed prior to fertilization or both the first and second polar bodies were removed after fertilization and studied by fluorescent in-situ hybridization (FISH) using chromosome-specific probes for chromosomes X, 18 and/or 13/21. Of 155 oocytes with FISH results, 36 demonstrated chromosomal abnormalities. Of 119 oocytes predicted to be free from aneuploidy of chromosomes X, 18 and/or 13/21, 72 were normally fertilized, cleaved and transferred in 23 treatment cycles, which resulted in two healthy deliveries and three ongoing pregnancies confirmed to be unaffected by chorionic villous sampling. The method may appear useful for the detection of oocytes with common chromosomal aneuploidies in IVF patients of advanced maternal age.
Adult↗
The specificity of monoclonal fluorescence polarization immunoassay for cyclosporine in recipients of simultaneous pancreas-kidney transplants.
Simultaneous kidney-pancreas transplant (SPK) recipients have a higher rate of acute organ rejection than do recipients of a kidney-alone transplant. The etiology of this increased number of rejection episodes is unknown. Cyclosporine (CsA) monitoring in SPK recipients is an important tool in the care of these patients. Many centers use the monoclonal fluorescence polarization immunoassay (mFPIA) to monitor CsA levels in this group of organ recipients. The reported specificity of the mFPIA for the CsA parent compound has varied in several studies but has not been systematically studied in recipients of an SPK transplant. Twelve recipients of an SPK transplant from 1 month to 3 months after surgery had serial simultaneous whole blood high-performance liquid chromatography (HPLC) and mFPIA CsA concentrations evaluated. A control group of 15 nondiabetic kidney-alone recipients underwent a similar evaluation. The average mFPIA/HPLC ratio in recipients of an SPK was 1.71 +/- 0.05 (r = 0.94), whereas it was 1.56 +/- 0.03 (r = 0.98) in the kidney-alone group (p > 0.01). Interpatient variability (range, 1.41 to 2.13) was very high in the SPK group, whereas intrapatient variability was lower. Seven patients had AUC profiles. The average AUC mFPIA/HPLC ratio was not significantly different from each patient's respective trough ratios. Our study suggests that the mFPIA overestimates CsA parent compound to a greater extent in SPK recipients than in kidney-alone recipients. In addition, the large interpatient variability in the specificity of the mFPIA makes assessing individual patient's levels problematic.
Adult↗
Analytic requirements for immunosuppressive drugs in clinical trials.
Essential to the evaluation of (1) the pharmacokinetics, (2) concentration-effect relationships, and (3) the application of therapeutic drug monitoring, during new immunosuppressive drug clinical trials, is the development of validated analytical methodology for the measurement of pharmacologically active drug and metabolites in biofluids and tissues. The characteristics of analytical methodology developed for cyclosporines A and G, FK-506, mycophenolate mofetil, and rapamycin during clinical trials will be described. The advantages of establishing validated analytical methodology as early as possible during clinical trials include: (a) early identification of metabolites and their quantitative and pharmacological significance; (b) early development of interpretable PK and PK-PD data; (c) accrual of experience that will be directly useful in patient monitoring after drug approval; (d) optimization of analysis conditions; and (e) early development of reference methodology for therapeutic drug monitoring tests. A suggested set of performance criteria for drug analysis during clinical trials and thereafter will be presented.
Clinical Trials as Topic↗
Flaps and grafts for facial reconstruction.
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Ear, External↗