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Biomedical subjects

B Kaplan

Publications and source records attributed to B Kaplan.

At least 307 records · Page 17Linked to original sources
PubMed1995

Use of erythropoietin in premature neonates: controversies and the future.

OBJECTIVE: To review and evaluate current research on the use of recombinant human erythropoietin (rhEPO) for the treatment of anemia of prematurity (AOP). DATA SOURCES: A MEDLINE search (1985-September 1994) was used to identify and retrieve pertinent data about erythropoietin's use in premature neonates. Bibliographies in the relevant literature and International Pharmacy Abstracts were reviewed as well. STUDY SELECTION: The authors extrapolated data from trials and other literature in which the entire paper or abstract was published. Because of the paucity of data on the use of rhEPO in neonates, all available literature was reviewed and cited, regardless of study methodology. DATA SYNTHESIS: Most data support that rhEPO is efficacious in treating AOP. Until recently, the published investigations have included only small numbers of patients. Larger, multicenter, placebo-controlled trials suggest that infants weighing less than 1500 g benefit from rhEPO therapy. Questions remain concerning the rhEPO dose and nutrient requirements for optimal efficacy. CONCLUSIONS: Published clinical trials that have examined the efficacy of rhEPO in the treatment of AOP vary considerably with regard to methodology, rhEPO dose, nutrient doses, and outcome measurement. At present, many questions remain to be answered including ascertaining rhEPO's long-term benefit versus cost/risk as well as its potential contribution to improving the care of the premature neonate.

Anemia, Neonatal↗
PubMed1995

The outcome of post-term pregnancy. A comparative study.

The aim of this study was to evaluate whether prolonged pregnancy was associated with dangers to the fetus, and to assess the incidence of cesarean section as well as fetal distress. The outcome for mother and baby in both groups of patients with post-term pregnancies was generally good. Furthermore, the improvement of prognosis for postdate pregnancy is due to the availability of electronic fetal monitoring and ultrasound, making possible the identification of fetal distress, as well as the use of prostaglandin to ripen a stubborn cervix, and induce labor successfully in most cases. Consequently, we feel that fetal jeopardy with continued intrauterine existence, as well as the excellent results of induction of labor, justify the active approach. The routine induction of labor in postdate pregnancy may reduce perinatal morbidity, as indicated in previous reports [2], and confirmed in this study.

Case-Control Studies↗
PubMed1995

Microalbuminuria following gestational diabetes.

BACKGROUND: Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: We examined the presence of MA in 72 women who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was used to compare data within the study group. RESULTS: Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p < 0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found. CONCLUSIONS: MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long-term follow-up of all GDM patients for MA and other markers of renal disease is strongly indicated.

Adult↗
PubMed1995

Topical metronidazole for arterial insufficiency ulcers.

The use of topical metronidazole has been limited to the treatment of acne rosacea, infected foot ulcers associated with diabetes mellitus, varicose veins, postirradiation ulcers, and dental conditions since the Food and Drug Administration approved the drug in 1988. Because of this agent's apparent effectiveness in treating anaerobic bacterial infections in such ulcers, the authors believed that treatment of arterial insufficiency ulcers with a solution of topical metronidazole would be a rational approach. They describe a 30-year-old man in whom bilateral lower extremity cellulitis developed as a result of arterial insufficiency. The patient's ulcers were unresponsive to intravenously administered antibiotics and whirlpool therapy. However, when a topical solution of metronidazole was administered, the ulcers began to heal and epithelialization at the ulcer sites occurred. The authors review others' studies concerning clinical use of topical metronidazole and suggest that further study is warranted. To the authors' knowledge, topical metronidazole solution for the treatment of arterial insufficiency and venous stasis ulcers has not been previously reported.

Administration, Topical↗
PubMed1995

The management of persistent occipito-posterior position.

Persistent occipito-posterior position (POP) is found in about 1% of labors, and its management is still controversial. A study group of 319 patients with POP deliveries were screened and analyzed for prepartum, intrapartum and postpartum parameters. A control group of the same size was matched for maternal age (mean 27-28 +/- 5.22 yrs), gravidit (mean 2.52 +/- 1.95) and parity (mean 1.13 +/- 1.67). Statistically significant differences were found between the study and the control groups regarding the incidence of instrumental (forceps/vacuum) deliveries, prolonged second stage, pregnancy-induced hypertension, prostaglandin E2 induction, premature rupture of membranes and episiotomy. A discussion is presented evaluating the possible significance of these findings. Although the high rate of instrumental deliveries encourages active management of POP labors, the authors advocate a more conservative approach.

Adult↗
PubMed1995

The pregnancy rates of cohorts of idiopathic infertility couples gives insights into the underlying mechanism of infertility.

OBJECTIVES: To determine causes of "idiopathic" infertility, the IVF-ET experience of three cohorts of couples with this diagnosis was examined. DESIGN: Three cohorts of idiopathic infertility couples undergoing IVF-ET: a "failed IUI" group, three previous controlled ovarian hyperstimulation (COH)-IUI cycles with no pregnancies; a "conversion" group, patients converted during a COH-IUI cycle to IVF-ET because of excess follicle numbers; and a "direct IVF" group, patients proceeding directly to IVF-ET were compared. SETTING: A tertiary referral reproductive medicine unit. PARTICIPANTS: Forty-one idiopathic infertility couples. INTERVENTION: In vitro fertilization-ET. MAIN OUTCOME MEASURES: Number of oocytes retrieved, percent oocytes fertilized, number embryos per ET, implantation rate, percent pregnancy per cycle. RESULTS: The cohorts had similar fertilization rates and mean (+/- SD) number of pre-embryos transferred. The conversion group demonstrated a higher pregnancy rate (PR) per cycle and a higher E2 concentration than the other groups. The PR of 35.0% in the direct IVF group appeared higher than the 16.7% rate observed in the failed IUI group. CONCLUSIONS: Our observation of a lower PR in couples in the failed IUI group (16.7%) than in couples in the direct IVF group (35.0%) suggests pre-embryo developmental problems or implantation problems as likely important etiologies for a large proportion of idiopathic infertility couples. However, as the conversion group demonstrated both a significantly higher E2 concentration ([E2]) and per cycle PR than the other cohorts with similar fertilization and pre-embryo transfer rates. Subjects converted in a COH-IUI cycle to IVF-ET are thus either more likely to produce pre-embryos more genetically capable of continued development to implantation stage (i.e., better oocytes recruited and fertilized) or due to the higher [E2] to have endometrium more receptive to implantation. Neither undiagnosed tubal factors nor fertilization problems appear to be major etiologic contributors.

Adult↗
PubMed1995

Image engine: an integrated multimedia clinical information system.

Image Engine is a microcomputer-based system for the integration, storage, retrieval, and sharing of digitized clinical images. The system seeks to address the problem of integrating a wide range of clinically important images with the text-based electronic patient record. Rather than create a single, integrated database system for all clinical data, we are developing a separate image database system that creates real-time, dynamic links to other network-based clinical databases. To the user, this system will present an integrated multimedia representation of the patient record, providing access to both the image and text-based data required for effective clinical decision making.

Abstracting and Indexing↗
PubMed1995

An evaluation model for clinical information systems: clinical imaging systems.

1. INTRODUCTION. Electronic patient records and other complex clinical information systems are difficult to evaluate. Integrated clinical imaging systems are a case in point. This paper suggests five criteria for a comprehensive evaluation of a complex clinical computer information system: 1) focus on a variety of technical, economic, and organizational concerns; 2) use multiple methods; 3) be longitudinal; 4) be formative as well as summative; and 5) be modifiable. 2. A MODEL COMPREHENSIVE EVALUATION PLAN. A model evaluation plan based on these criteria was developed for evaluating a clinical imaging system, but it provides a useful approach for a comprehensive evaluation of other complex clinical information systems. This plan consisted of three major phases. Phase 1 was to identify evaluation research questions and issues through literature synthesis and ethnographic interviews and observations. Evaluators interviewed key system users, potential users, developers, and other stakeholders. Also, evaluators observed the system being used. Phase 2 was to document system use through critical incident reporting and also by generating user profiles or by survey questionnaires. Phase 3 was to evaluate the system in context, so as to study it in different units and departments, in different wards and clinics, and at meetings, conferences, and rounds, etc. The proposed plan meets the above criteria. The plan employs multiple methods, intended to address a variety of evaluation questions and issues. It allows for longitudinal evaluation because phases should be repeated at periodic intervals so as to capture data at different times. The plan provides feedback for formative evaluation because each phase of the plan results in a product or output for individuals to use when making decisions concerning the system. These outputs can also serve as input to other phases and to a periodic refinement and validation of the evaluation plan. These modifications would also help ensure that the evaluation captures both anticipated and unanticipated concerns. In addition, the phases need not be performed sequentially. The order may be rearranged and some phases can be conducted concurrently. 3. AN EXAMPLE. A preliminary evaluation was conducted at the 700-bed Washington D.C. medical center run by the United States Department of Veterans Affairs [1, 2]. The evaluation used interviews and observations to document benefits of the imaging system--particularly clinical benefits--as identified by clinicians who used it. The clinical staff identified benefits they believed occurred in all the areas of an academic medical center: patient care, education, research, and administration. These benefits can be translated into cost savings, productivity improvements, and managerial and organizational benefits.

Computer Systems↗
PubMed1995

External cephalic version at term using broad criteria: effect on mode of delivery.

We sought to determine whether external cephalic version (ECV) with tocolytic agents in term patients with breech presentation could safely reduce the incidence of breech-related cesarean sections and vaginal breech deliveries. Four hundred and thirty-two patients with breech presentation at term who fulfilled broad criteria for attempted ECV and a control group of 330 patients with breech presentation at term in whom ECV was not attempted, were retrospectively reviewed. ECV was attempted following an infusion of ritodrine hydrochloride, using either the back flip of Saling and Muller-Holve or the classic forward roll. Following successful ECV, an infusion of oxytocin was administered to fix the head in the pelvis. Of the 432 patients, 311 (72%) underwent successful ECV; 86% delivered vaginally. Cesarean sections were performed in 76% of the patients with unsuccessful ECV and in 64% in whom the version was not attempted (control group). We conclude that ECV at term, using tocolytic agents, when applied to a broad spectrum of patients, is a safe and useful procedure for reducing the incidence of breech presentation, and as a direct consequence, for reducing the incidence of cesarean sections.

Breech Presentation↗
PubMed1995

Intrapartum management of the low-birth-weight breech fetus.

Breech presentation is prevalent among preterm deliveries and contributes to neonatal mortality far beyond its prevalence. The management of a preterm breech delivery is controversial. We present our retrospective experience with 185 consecutive preterm breech deliveries, part delivered by cesarean section and part delivered vaginally as assisted breech delivery or total breech extraction), and compare the perinatal outcome between these two groups in terms of perinatal mortality (PPD) and perinatal morbidity (neonatal asphyxia). No statistically significant difference was found for either variable in the two examined groups. We therefore conclude that the method of delivery of low birth weight (1000-2500) breeches has no effect on perinatal outcome.

Asphyxia Neonatorum↗
PubMed1995

Mood and hormonal changes during late pregnancy and puerperium.

The present study was designed to assess the relationship between puerperal hormonal changes and mood. Twenty-five postpartum physically and mentally healthy, drug-free women were included in the study; seven later dropped out. Blood samples 'were drawn between 8 and 9 a.m. just prior to delivery, and again three days after delivery, before discharge. Blood levels of LH TSH, FSH, estrogen and prolactin were determined. Three days after delivery, a psychiatric interview was conducted during which psychometric rating scales (Brief Psychiatric Rating Scale, Hamilton Depression and Hamilton Anxiety Rating Scales, and Beck Depression Inventory) were completed. The rate of change in hormonal blood levels was analyzed in relation to the scores on the rating scales. Results showed that the rise in prolactin plasma levels had a negative and significant correlation with the scores on the Hamilton anxiety scale. This may indicate that high prolactin plasma levels, associated with milk production, may lead to lower anxiety levels in lactating women.

Adult↗
PubMed1994

Postmenopausal intrauterine fluid collection: correlation between ultrasound and hysteroscopy.

Postmenopausal intrauterine fluid is an alarming sign related to malignancy. Twenty postmenopausal women with intrauterine fluid were prospectively studied by means of sonographic evaluation, and hysteroscopic and histological examinations, to determine the correlation between ultrasound and hysteroscopy. All patients underwent endovaginal sonography, followed by hysteroscopy. Biopsies were performed on all patients with abnormal endometrium, and randomly on selected patients with normal or atrophic endometrium. In patients with abnormal endometrial structure and thickness (< 4 mm), two cases of endometrial cancer were histologically detected and one was revealed by cytology (Pup smear). Seventeen patients with thin endometrium (<or= 4 mm) had no pathology. Sonographic, hysteroscopic and histological findings correlated well in all cases.

Journal Article↗
PubMed1994

Determination of amyloid type by ELISA using milligram amounts of tissue.

A new procedure was developed for isolation and immunochemical identification of amyloid proteins. This procedure involves extraction of amyloid proteins from tissues with aqueous acidic acetonitrile, their purification by HPLC and identification by ELISA. In this way the type of amyloid proteins was defined in amyloid-containing tissues obtained from 15 patients. The technique is simple, rapid and enables typing of amyloid proteins using only milligram amounts of tissue. This is in contrast to the conventional amyloid isolation and chemical identification technique which is laborious, time consuming and requires gram amounts of tissues. The procedure may enable the identification of the type of amyloid in biopsy specimens and thus help in evaluation of prognosis and determination of the therapeutic policy.

Amyloid↗