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Biomedical subjects

C Rosa

Publications and source records attributed to C Rosa.

At least 37 records · Page 2Linked to original sources
PubMed1996

The efficacy of intrathecal injection of sufentanil using a microspinal catheter for labor analgesia.

Intrathecal sufentanil can provide labor analgesia. We investigated the efficacy of multiple injections and the maternal and neonatal effects of intrathecal sufentanil during labor. Seventeen healthy women in active labor received multiple injections of intrathecal sufentanil of 5 micrograms each through microspinal catheters. Overall maternal satisfaction of analgesia was quantified using 10 cm visual analogue scales and side effects were evaluated. Neonatal outcome was also determined. Onset of analgesia was less than 5 min after the first injection and lasted approximately 148 min. Tolerance developed for the successive injections. The mean onset times were 12.9 and 20.1 min and the durations were 76.6 and 33.9 min for the second and third injections, respectively (P < 0.05). Failure to obtain analgesia developed in all patients after the forth injection. No motor blockade was observed in any of the patients. Mild or moderate pruritus developed in 88% of the patients. Mean systolic blood pressure decreased by a maximum of 11.3% at 30 min and up to 90 min (P < 0.05) after the first injection; three patients required ephedrine treatment. No significant hemodynamic changes were observed after subsequent injections. Five patients experienced transient decrease in sensation. Neonatal status, as evaluated by Apgar scores, Neurological Adaptive Capacity Scores (NACS), fetal heart rate (FHR), and umbilical cord acid-base status, were within normal limits. Results from our study suggest that multiple small doses of sufentanil administered intrathecally provided satisfactory analgesia for parturients with short duration of labor since acute tolerance developed with multiple injections. High incidence of mild or moderate pruritus was observed during the study. Close attention should be given to hemodynamically unstable patients when this technique is applied.

Adult↗
PubMed1996

Operative laparoscopy for the treatment of ectopic pregnancy in a residency program.

OBJECTIVE: To compare the effectiveness and safety of operative laparoscopy (OL) when used for the treatment of ectopic pregnancy in the setting of a residency training program. STUDY DESIGN: We retrospectively reviewed records of all patients with diagnostic laparoscopy documenting the presence of an ectopic pregnancy. Patients who met the following criteria were selected: hemodynamic stability, tubal distortion no greater than 5 cm and adequate visualization of the pelvis. The cases performed via OL were compared to the cases performed via laparotomy (LAP). All the surgery had been performed by resident physicians with the attending gynecologist as first assistant/supervisor. RESULTS: Ninety-five cases performed from March 1989 to April 1992 met the above criteria. Group 1 consisted of 61 patients treated with LAP. Group 2 consisted of 34 patients treated with OL. The operating time (76.8 +/- 19.0 vs 76.0 +/- 23.0 min, mean +/- SD) and the estimated blood loss (275.0 +/- 183.7 vs. 70.5 +/- 75.2 ml) were similar for both groups. The hospital stay for the LAP group was longer than for the OL group (3.7 +/- 1.2 vs. 1.4 +/- 0.6 days, P < .001). The surgical complication rate was also higher in the LAP group (23% vs 2.9%, P = .16). CONCLUSION: In our residency program the introduction of OL for the management of ectopic pregnancy has resulted in shorter hospital stays and lower morbidity without increased duration of the surgical episode or increased blood loss.

Blood Loss, Surgical↗
PubMed1996

Pregnancy after failed tubal sterilization.

OBJECTIVE: To review the pregnancy outcome in patients with failed tubal sterilization treated in our hospital and to compare the incidence of ectopic pregnancy in our study group with the experience at other military hospitals and with the incidence of ectopic pregnancy in similar patients reported in the literature. STUDY DESIGN: A registry of failed tubal sterilization was started at our hospital in 1989. We entered all information regarding the type of procedure and pregnancy outcome as the patients presented for care. Information on the experience at other military hospitals was obtained through review of data provided by the epidemiology section of the Health Services Command, San Antonio, Texas. RESULTS: From 1989 to 1991, 12 patients with failed tubal sterilization received care at our hospital. Eight patients (67%) had ectopic pregnancies. Of 137 patients identified through the Health Services Command, 49 (36%) had ectopic pregnancies. CONCLUSION: The literature reports a 5-90% incidence of ectopic pregnancy after failed tubal sterilization. The data from our registry and from the Health Services Command corroborate the increased likelihood of ectopic pregnancy in patients with failed tubal sterilization and underscore the need for close follow-up of these patients until the location of the pregnancy is documented.

Adult↗
PubMed1995

Exposure to oscillating magnetic fields influences sensitivity to electrical stimuli. II. Experiments on humans.

To assess the effect of a magnetic treatment on pain perception, we compared the sensory threshold in 18 healthy volunteers. We determined the threshold by noninvasive electrical stimulation of the tooth pulp and skin before and after exposure to an altered magnetic field of low intensity and to a sham treatment. Five different parameters were recorded: the sensory and pain thresholds for the tooth and the sensory, pain, and tolerance thresholds for the skin. Two hours of exposure to a weak, oscillating magnetic fields induced a significant decrease in three parameters (dental sensory and cutaneous pain and tolerance thresholds), whereas the other two parameters showed a similar tendency. When the same subjects were exposed to a sham treatment, only marginal, nonsignificant variations in all parameters were observed. These results represent the first piece of evidence that weak alterations of the magnetic field may induce hyperalgesia in humans.

Adult↗
PubMed1995

Fetal acoustic stimulation test: stimulus features of three artificial larynges recorded in sheep.

OBJECTIVE: The purpose of the current study was to evaluate the characteristics of vibroacoustic devices used for fetal stimulation. STUDY DESIGN: Intrauterine sound pressure levels over a frequency range of 40 to 5000 Hz were measured with hydrophones in anesthetized sheep. Stimulators included the AT&T (Martinsburg, W.V.) and Servox (Hearing Instruments, Piscataway, N.J.) artificial larynges, the Corometrics fetal acoustic stimulator (Wallingford, Conn.) and electric toothbrush. RESULTS: Intrauterine spectral patterns resulting from stimulation with the AT&T, Servox, and Corometrics devices were characterized by numerous high-level overtones above a fundamental frequency between 97 and 163 Hz. Fundamental frequencies recorded during toothbrush stimulation were 22 to 24 Hz with reduced but identifiable overtones up to 250 Hz. CONCLUSIONS: Fetal vibroacoustic stimulators that operate on the principle of the electronic artificial larynx produce very similar intrauterine sound pressure levels.

Acoustic Stimulation↗
PubMed1995

Maternal and umbilical serum concentrations of granulocyte colony-stimulating factor and its messenger RNA during clinical chorioamnionitis.

OBJECTIVE: To determine whether women with chorioamnionitis developed elevated serum granulocyte colony-stimulating factor (G-CSF) concentrations and, if so, whether the G-CSF crossed to the fetus. METHODS: We quantified G-CSF before, during, and after delivery and in the cord blood of 12 women with clinical chorioamnionitis and 12 matched controls. We also measured G-CSF messenger RNA (mRNA) transcripts in mononuclear cells isolated from maternal and cord blood at delivery. RESULTS: At study entry, G-CSF concentrations were much higher in women with chorioamnionitis (1397 +/- 950 pg/mL, mean +/- standard error of mean) than in controls (17 +/- 5 pg/mL, P < .05). At delivery, concentrations had increased in both groups (2752 +/- 1100 pg/mL in the chorioamnionitis group, 165 +/- 61 pg/mL in controls; P < .05). After delivery, G-CSF concentrations had diminished to 839 +/- 594 pg/mL in women with chorioamnionitis and to 83 +/- 16 pg/mL in controls (P < .05). Concentrations in the cord blood were 2729 +/- 974 pg/mL for the chorioamnionitis group and 51 +/- 17 pg/mL for controls (P < .05). Granulocyte colony-stimulating factor mRNA transcripts were more abundant in women with chorioamnionitis than in controls but were scarce in all matched cord blood samples tested. CONCLUSION: Serum G-CSF concentrations were elevated during clinical chorioamnionitis, and similar levels were found in maternal and cord serum. Because G-CSF mRNA levels were very low in cord mononuclear cells, the G-CSF in cord serum might be maternal in origin.

Adult↗
PubMed1995

Performance of a new DNA probe for the detection of group B streptococcal colonization of the genital tract.

OBJECTIVE: To test the performance characteristics of a new DNA probe designed for the rapid identification of heavy colonization of the genital tract with group B streptococci. METHODS: Vaginal and combined vaginal-perianal samples were collected from 193 pregnant women and cultured on colistin-nalidixic acid agar plates. Bacterial growth was classified semiquantitatively. Specimens were also tested by a new DNA probe in two formats: a direct assay performed on the swabs soon after collection and an assay performed after the swabs were incubated for 24 hours in an enriched culture medium. RESULTS: The agar cultures were positive in 36 of 193 patients (18.6%, 95% confidence interval 13.2-24). Nineteen women were lightly colonized, and 17 were heavily colonized (at least 10(4) colonies/mL). The combined vaginal-perianal swabs yielded positive results more often than the vaginal swabs alone (26 versus 16, chi 2 = 24, P < .01). In its direct form, the assay had only 8.3% sensitivity in identifying colonized women. In heavily colonized women, the sensitivity of the assay increased slightly to 12%. After a 16-24-hour incubation, the sensitivity of the assay was 81%. CONCLUSION: The direct assay is insufficiently sensitive for clinical use. The delayed assay offers no advantage over standard cultures.

DNA Probes↗
PubMed1995

Epitope mapping of the NS4 and NS5 gene products of hepatitis C virus and the use of a chimeric NS4-NS5 synthetic peptide for serodiagnosis.

Specific domains of the NS4 and NS5 gene products of hepatitis C virus have been identified using hydrophilicity profiles for the prediction of potential immunogenic regions, and epitope scanning techniques. Peptides synthesised on the basis of such data show excellent reactivity in the ELISA format. Introduction of a glycine-glycine spacer between two peptides (NS4-12 and NS5-44) to give a single chimeric peptides does not appear to impair immunoreactivity. An ELISA based on the chimeric peptide and a Core-NS3 recombinant protein correctly diagnoses a cohort of haemodialysed patients, three commercial HCV panels and the sera of a negative control population.

Amino Acid Sequence↗
PubMed1995

Clomiphene-induced quintuplets with a failed attempt at delayed-interval delivery.

Clomiphene citrate is widely used for ovulation induction. It is associated with a 6 to 17% incidence of multiple gestation. We report on a 27-year-old para 0010 patient who, after an initial evaluation for secondary infertility of 2 years' duration, was deemed to have oligo-ovulation. She conceived during the second cycle of clomiphene citrate administration. An early obstetric sonogram identified five fetuses with cardiac activity. The patient experienced preterm premature rupture of the membranes at 19 weeks gestation. A delayed-interval delivery was attempted, but all five fetuses were born over a period of 15 days. No maternal complications occurred. Multiple pregnancies of high order are commonly associated with human menopausal gonadotropins but rarely with clomiphene citrate. This is the seventh reported case of quintuplets related to clomiphene citrate, and possibly the first on whom no other fertility-enhancing medication was utilized. In this case, attempted delayed-interval delivery was not successful.

Adult↗
PubMed1994

Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy.

OBJECTIVE: To compare azithromycin and erythromycin in regard to side effects, intolerance, and cure rate in a pregnant population with chlamydial cervicitis. METHODS: Thirty women were randomized to receive either erythromycin, 500 mg orally four times a day for 7 days, or azithromycin, 1 g orally as one dose. All subjects completed questionnaires identifying the incidence of nausea, vomiting, diarrhea, abdominal pain, and anorexia. Post-treatment cultures were taken from all subjects. RESULTS: All subjects receiving erythromycin reported two or more gastrointestinal side effects, versus none in the azithromycin group (P < .001). Five of 15 subjects in the erythromycin treatment arm were intolerant to the 500-mg dose given four times a day, compared to none in the azithromycin group (P < .025), so the dosage was lowered to 250 mg four times a day to complete the course. Repeat cervical testing demonstrated similar cure rates for both medications: 100 and 93% (14 of 15) for azithromycin and erythromycin, respectively. CONCLUSION: These data suggest that azithromycin is a valid treatment option in pregnant patients who cannot tolerate erythromycin because of side effects.

Administration, Oral↗
PubMed1994

Relationship between increased blood pressure and hypoalgesia: additional evidence for the existence of an abnormality of pain perception in arterial hypertension in humans.

An association between hypertension and decreased pain perception (hypoalgesia) has been shown in experimental hypertension and confirmed in humans by electrical tooth pulp stimulation. The aim of this study was to confirm, using two other techniques, whether hypertension is associated with hypoalgesia in humans. In 77 untreated essential hypertensive outpatients, 37 normotensive outpatients and 27 normotensive volunteers subjective cutaneous sensitivity was assessed by an electrical stimulator. Thirty-three measurements were repeated after one month. In addition, in eight normotensive volunteers and eight hypertensives the thresholds of the polysynaptic components R2 and R3 of the blink reflex to electrical stimulation of the supraorbitalis nerve were evaluated. Tooth pulp stimulation was done in 85 of the subjects who measured cutaneous sensitivity and in all of the blink reflex study. Cutaneous perceptive, pain and tolerance thresholds were significantly higher in the hypertensives compared with both normotensive groups, with no significant difference between these two. The results were identical when age and sex-matched subgroups were compared and a high reproducibility was found for all three parameters. Similar findings were obtained for the tooth pulp thresholds and highly statistically significant correlations were found between cutaneous and tooth pulp sensitivity and between these indices and blood pressure. The thresholds of R2 and R3 were also significantly higher in the hypertensives and a significant correlation was found between R3 threshold and diastolic pressure. These results confirm that hypertension is associated to hypoalgesia in humans.

Adult↗
PubMed1993

A human monoclonal antibody specific for the N terminus of the hepatitis C virus nucleocapsid protein.

PBMC from a patient with chronic hepatitis C virus (HCV) infection were immortalized with EBV and plated by limiting dilution. Cultures secreting antibodies reactive in a commercial HCV II generation ELISA, which incorporates Ag derived from the nucleocapsid, NS3, and NS4 regions, were repeatedly cloned in the presence of feeder cells and growth factors. Of 23 initially immunoreactive cultures, only one cloned line, designated B12.F8, secreted HCV nucleoprotein-specific IgG1(kappa), whereas no reaction with recombinant polypeptides derived from NS3, NS4, and NS5 regions were documented. Human mAb (hmAb) B12.F8 was shown to recognize the native HCV nucleoprotein expressed in eukaryotic cells transfected with a core cDNA construct by immunofluorescence. The fine specificity of this hmAb was evaluated using synthetic oligopeptides covering the entire HCV nucleocapsid region. A weak but consistent reactivity was observed by PEPSCAN using a 12-mer encompassing residues 34-45 of the HCV-deduced amino acid sequence. Such weak reactivity is indicative for conformational epitopes and, in concurrence with this assumption, we found that longer peptides from the region containing residues 27-59 were more efficiently recognized and effectively inhibited binding of hmAb B12.F8 to recombinant nucleocapsid protein. Several overlapping immunoreactive fragments from the nucleocapsid region were selected from a random cDNA library consisting of DNase I fragments of recombinant core Ag. Best reactive recombinants were identified within residues 1-78 of the HCV sequence, in agreement with the results obtained using synthetic peptides. Comparative experiments on the fine specificity of sera from HCV-infected patients with anticore antibodies invariably showed recognition of peptides 8-40 and 27-59, as well as recombinant fragments spanning from residues 1 to 73, suggesting that hmAb B12.F8 identifies a major B cell epitope within the immunodominant nucleoprotein amino terminal subregion.

Amino Acid Sequence↗
PubMed1993

Expression in E. coli and purification of a chimeric p22-NS3 recombinant antigen of hepatitis C virus (HCV).

A recombinant antigen (p22-NS3), possessing putative HCV nucleocapsid protein (p22) and non-structural protein 3 (NS3) epitopes, was heavily expressed in E. coli and purified. The p22-NS3 purified recombinant antigen strongly reacts with sera containing human antibodies directed against p22 and NS3 providing a starting point for the design of an HCV single all-encompassing antigen for a blood screening assay.

Antigens, Viral↗
PubMed1993

Properties of a human monoclonal antibody specific for the NS4 region of hepatitis C virus.

A human monoclonal IgG1(kappa) antibody (hmAb) specific for a sequential epitope comprised within the 5-1-1 fragment of the NS4 region of hepatitis C virus (HCV) has been recently generated (1). In this study, B-cell clone supernatant containing the hmAb was purified by passage over a protein A affinity column. Preincubation with synthetic oligopeptides containing the epitope recognized by the hmAb resulted in complete inhibition of binding to the whole recombinant protein, attesting to its specificity. Calculation of the dissociation constant (Kd) using a synthetic 20-mer as antigen gave a value of 3.3372 x 10(-8) M, consistent with that of a human IgG. We predict that this hmAb will be helpful in characterizing the as yet unidentified native NS4 protein of HCV.

Antibodies, Monoclonal↗
PubMed1993

Neurologic involvement in patients with rheumatoid arthritis with atlantoaxial subluxation--a clinical and neurophysiological study.

Anterior subluxation of the atlantoaxial joint (AAS) is a frequent and potentially serious complication of rheumatoid arthritis (RA). The results of neurological evaluation, obtained in 30 patients with RA with AAS, and of somatosensory evoked potentials (SEP) studies, accomplished in 25 of these patients, were compared with the findings observed in 20 patients with RA without AAS, all of whom underwent neurological evaluation and SEP studies. Abnormal plantar responses were found only in patients with RA with AAS. There were more frequent SEP abnormalities in patients with RA with AAS than in patients without AAS, namely increased latencies of the N13 potentials evoked by stimulation of the median and radial nerves, which correspond to conduction delays at the cervical spinal cord level. A sensitivity of 56% and a specificity of 90% for SEP studies in the diagnosis of AAS in patients with RA were found. On the other hand, the observation that the mean values for the latencies of the N11 and N13 potentials evoked by stimulation of the radial nerves were significantly higher in patients with RA with AAS compared to patients with RA without AAS may suggest the existence of a frequent subclinical involvement of the cervical spinal cord caused by AAS.

Adult↗