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Biomedical subjects

D A Davey

Publications and source records attributed to D A Davey.

At least 19 recordsLinked to original sources
PubMed1992

The variability of urinary protein and creatinine excretion in patients with gestational proteinuric hypertension.

OBJECTIVE: To determine the variability of protein excretion in patients with proteinuric hypertension and the accuracy of either a urinary protein/creatinine ratio or a Multistix examination for the estimation of a 24 h protein excretion. DESIGN: An indwelling urinary catheter was placed for 24 h and successive 8 h specimens examined. SETTING: A tertiary referral hospital in Cape Town, South Africa. SUBJECTS: 22 women with significant proteinuria in pregnancy were studied. MAIN OUTCOME MEASURES: The urine volume, protein excretion and creatinine excretion in eight hourly periods were measured. Multistix examination of each specimen was recorded. RESULTS: A large coefficient of variation in urine volume (41%), amount of protein excreted (44%) and the amount of creatinine excreted (22%) in the eight hourly specimens were noted. The protein creatinine ratio did not accurately predict the 24 h protein excretion. The Multistix examination was less accurate with increasing amounts of proteinuria. The amount of creatinine excreted correlated with the volume of urine passed (r = 0.43). CONCLUSION: The analysis of a 24 h specimen or urine for protein excretion remains the best method of monitoring proteinuria in pregnancy. The amount of creatinine excreted in 24 h cannot be used as an index of completeness of collection of the 24 h specimen.

Circadian Rhythm↗
PubMed1979

Choriocarcinoma and invasive mole. A review of 10 years' experience.

Experience gained in the management of 24 patients with choriocarcinoma and invasive mole admitted to Groote Schuur Hospital, Cape Town, during the past 10 years is analysed. Three high-risk patients died and 21 patients recovered without any known recurrence, giving a 'cure' rate of 87%. The modes of presentation, methods of diagnosis, and treatment, including cytotoxic therapy and the place of hysterectomy, are discussed. Patients with choriocarcinoma require special facilities, including beta-subunit human chorionic gonadotrophin assay, ultrasonography and arteriography, together with skilled treatment, and a plea is made for the referral of all patients to special treatment centres.

Adolescent↗
PubMed1979

The use of ultrasound in the diagnosis of pelvic masses.

Two hundred and two patients were referred to the ultrasound department for evaluation of a pelvic mass during 1977, and of these only 120 underwent an operation enabling a definitive diagnosis to be made. The diagnostic accuracy of ultrasound was compared with the final operative diagnosis. The great majority (98%) of pelvic masses could be detected, and ultrasound was accurate in predicting the antatomical site of a pelvic lesion in 88% of cases. Uterine lesions were precisely diagnosed in 87% of cases, but only 30% of adnexal conditions could be specifically recognized. Numerous situations in which ultrasound provided additional information of great clinical value were noted.

Adnexal Diseases↗
PubMed1979

Oral and intravaginal prostaglandin E2 for cervical ripening and induction of labour.

The effect of prostaglandin E2 (PGE2) in 'ripening' the cervix was studied in 33 patients who required surgical induction of labour. Patients included primigravidas and parous subjects between 36 and 42 weeks of gestation. Sixteen patients received a total oral dose of 5 mg PGE2 and 17 received 4 - 6 mg PGE2 intravaginally in the form of a gel. There was significant improvement in 'ripeness' of the cervix in all groups, the intravaginal route giving slightly better results than the oral route. Ten patients remained unsuitable for induction because of inadequate dilatation of the cervix or a high fetal head. Four patients on oral therapy developed late decelerations of the fetal heart and 3 of these were delivered by immediate caesarean section. The implications of this and the reasons for the inability to perform inductions after 'ripening' are discussed.

Administration, Oral↗
PubMed1979

Serum ferritin estimation in the assessment of iron stores in severe iron deficiency anaemia in pregnancy and the response to treatment.

Serum ferritin estimation was used to determine the iron stores in 55 patients with severe iron deficiency anaemia in pregnancy. The response to oral or intravenous iron therapy was monitored in 18 of these patients. The results in all cases indicated deficient iron stores. Replenishment of iron stores was significantly greater in those patients treated with parenteral iron. This may be the treatment of choice for severe iron deficiency anaemia during pregnancy.

Adolescent↗
PubMed1979

Incidence of aerobic and anaerobic infection in patients with incomplete abortion.

The incidence of infection in 100 cases of abortion was studied. Intra-uterine swabs and products of conception were cultured both aerobically and anaerobically. Significant potentially-pathogenic organisms were cultured from 94 of 100 intra-uterine swabs and from all 100 samples of the products of conception. Anaerobes were cultured from 70 intra-uterine swabs and from 56 products of conception. The spectrum and relative proportion of organisms isolated resemble those found in the normal vagina and cervical os. In addition, positive blood cultures were obtained from 24 patients, 8 on admission and 17 after evacuation. With this high incidence of infection, routine antimicrobial therapy for aerobic and anaerobic organisms should be given to all patients with abortion.

Abortion, Illegal↗
PubMed1978

Effects of prenatal fenoterol, phenobarbitone and dexamethasone administration on the total phospholipid content of amniotic fluid.

The effect of prenatally administered phenobarbitone, fenoterol (a beta-sympathomimetic drug) and dexamethasone on fetal pulmonary maturity, as measured by the total phospholipid (TPL) content of amniotic fluid, was assessed. Compared with control values, there was a significantly greater rise after fenoterol (P less than 0,01) and dexamethasone (P less than 0,01), but not after phenobarbitone administration. The ability of dexamethasone to convert the TPL value to mature levels (greater than or equal 2,0 microgram/ml) was significantly greater than that of fenoterol (P less than 0,05).

Amniotic Fluid↗
PubMed1978

Technical problems and early complications of laparoscopic sterilization done on a day-case basis.

Two hundred and sixteen patients were selected for laparoscopic sterilization on a day-case basis. Patients were sterilized by electrocautery, by applying Silastic bands (Falope rings), and by means of Hulka-Clemens clips. Three patients required laparotomy and 35 patients were discharged the day after the operation. By the 3rd day 146 (69%) and by the 5th day 184 (86%) patients had returned to their routine work. From the technical and immediate postoperative point of view, there appears to be relatively little difference between the three techniques. There may be slightly more risk of thermal complications with bipolar cauterization, a slightly highly incidence of postoperative abdominal pain with the Silastic band applicator, and slightly more difficulty in applying the Hulka-Clemens clip. These problems are all reduced by experience and proper training of the operator, which is essential. Our experience confirms that laparoscopic sterilization is safe, efficient, and feasible as a day-case procedure, and that it has major advantages in terms of patient convenience and acceptability as well as reduction in hospitalization costs.

Adult↗
PubMed1978

Effect of the duration of dexamethasone treatment on the total phospholipid content of amniotic fluid.

Obstetric patients requiring premature termination of pregnancy with low levels of surfactant in the amniotic fluid were given dexamethasone for 2 or 7 days to assess the effect of the duration of treatment on the total phospholipid content of the amniotic fluid. A significant rise in lung surfactant occurred in both groups, but dexamethasone administered for 7 days was not more effective than 2 days' administration. It is suggested that it is not the duration of treatment, but the stage of pregnancy or the functional maturity of the fetus at the time of administration of dexamethasone that affects the outcome.

Amniotic Fluid↗
PubMed1978

Stature and weight of Coloured primigravidas in Cape Town.

The stature and weight of Coloured primigravidas delivering at term in Cape Town were investigated. When compared with White mothers they were found to be significantly shorter, lighter and thinner. It is postulated that both childhood undernutrition and an inadequate diet during pregnancy are responsible for these findings.

Black or African American↗
PubMed1978

Effect of premenopausal castration and incremental dosages of conjugated equine estrogens on plasma follicle-stimulating hormone, luteinizing hormone, and estradiol.

Plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were measured serially in 11 premenopausal patients before and after hysterectomy with bilateral salpingo-oophorectomy. One week after operation an incremental dosage regimen of conjugated estrogens (CEE) in tablet form was commenced on a basis of two weeks with therapy (0.3, 0.625, 1.25, and finally 2.5 mg.), with each dose interspersed by two weeks without therapy. FSH, LH and E2 levels were measured at the end of each period with and without therapy. E2 levels fell within 24 hours of operation while FSH and LH levels rose gradually. CEE therapy produced an elevation of E2, but circulating concentrations comparable to the premenopausal values were only maintained during the dosage periods of 0.625 and 1.25 mg. of CEE. In only one instance did CEE succeed in reducing FSH to premenopausal levels, and that was at a dosage of 2.5 mg., in which instance the E2 level was higher than the premenopausal value. LH was never reduced to a premenopausal level. Thus, the data indicate that CEE alone in dosages up to 2.5 mg. per day was unable to reproduce in postmenopausal women the gonadotropin and E2 blood serum levels shown to exist prior to oophorectomy. Usual CEE treatment after menopause, therefore, in itself does not represent physiologic "hormone replacement therapy," if defined as the dosage required to maintain premenopausal circulating concentrations of reproductive hormones.

Castration↗
PubMed1978

Growth-retarded fetuses and pulmonary maturity.

The amniotic fluid of 250 patients in the third trimester of pregnancy was examined for surfactant content by means of the bubble test and total phospholipid estimation. No evidence was found that intra-uterine growth retardation accelerates pulmonary maturity in the fetus, and the finding of early pulmonary maturity does not indicate intrauterine growth retardation.

Amniotic Fluid↗
PubMed1978

The bubble test as a measure of amniotic fluid surfactant and as a predictor of hyaline membrane disease.

The bubble test was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipids (TPL) test as a measure of fetal lung surfactant in the amniotic fluid. Of 161 patients, all but 1 with a bubble score of 2 + or more also had mature L/S ratios and TPL values, whereas those with a bubble score of 0 - 1 + had L/S ratios and TPL values ranging from immature to mature. A total of 161 patients who delivered within 72 hours of TPL test and bubble test were assessed for the presence of hyaline membrane disease (HMD). No cases of HMD were associated with a bubble score of 2+ or more. However, the fetuses of 10 of 66 patients with a bubble score of 0 or 1 + developed HMD.

Amniotic Fluid↗
PubMed1978

The association between the fat cell count of amniotic fluid and tests of fetal lung maturity.

The fat cell count in amniotic fluid samples from 100 patients was compared with the lecithin-sphingomyelin (L/S) ratio and total phospholipid content. When the fat cell count was over 10%, the L/S ratio indicated maturity in all cases and the total phospholipids indicated maturity in all but 1 case. When the presence of blood or meconium in the amniotic fluid renders lung surfactant tests unreliable, an indication for the fat cell count exists.

Amniotic Fluid↗
PubMed1978

Postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250).

The results obtained from postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250) are presented. The study was prompted by a pilot study in the Netherlands which showed that few expulsions occurred with "postplacental" insertion of the multiload intra-uterine device. Seventy-five patients had devices inserted between 6 and 72 hours postpartum, and the patients were followed up for 6 months after insertion, with an overall continuation rate of 77,6%. This study showed that the postpartum insertion of this device is a safe and acceptable form of contraception, particularly in patients who are unlikely to continue with other forms of contraception.

Female↗
PubMed1978

The safety of amniocentesis in relation to site and method.

A method of low suprapubic amniocentesis after elevation of the fetal head during vaginal examination has been found to be a safe and valuable obstetric procedure. The incidence of the only complication in 1 362 consecutive amniocenteses, viz. rupture of the membranes, was similar to the spontaneous rate and could well be unrelated to the procedure. Failure to obtain amniotic fluid occurred in 13 patients and in a further 18 patients the amniotic fluid was blood-stained. High, peri-umbilical amniocentesis without ultrasonic control is not justified in obstetric practice because of the possible complications.

Amniocentesis↗
PubMed1978

The midwife obstetric unit.

The urgent need for an alternative to domiciliary delivery in Cape Town has been met by the development of midwife obstetric units (MOUs). These units are situated in suburbs with a high population density. They are staffed entirely by midwives and are linked by telephone to the base hospital. A flying squad service is available at the regional centre (the maternity block at Groote Schuur Hospital). Regular visits are made to the units by the medical staff. Strict criteria for delivery at the MOUs have resulted in a very low perinatal mortality rate, and the units have at the same time relieved the serious overcrowding in the teaching hospitals. The concept of the MOU is particularly suited to Africa and indeed to any developing country.

Delivery, Obstetric↗