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Biomedical subjects

D B Schwartz

Publications and source records attributed to D B Schwartz.

At least 37 records · Page 2Linked to original sources
PubMed1989

Conservative management of second-trimester post-amniocentesis fluid leakage.

During a 32-month period, 603 genetic amniocenteses were performed in our institution, and seven patients (1.2%) experienced fluid leakage within 24 hours of the procedure. All seven patients were hospitalized for strict bed rest and expectant management. Cessation of amniotic fluid leakage and reaccumulation of normal amniotic fluid occurred within 7 days in all cases. Six patients were delivered at term of appropriately grown infants without complication. One patient experienced an intrauterine death at 25 weeks' gestation (6 weeks after the occurrence of fluid leakage secondary to genetic amniocentesis). Although limited by the small number of patients, our experience suggests the following: 1) Appropriate respect for potential complications of genetic amniocentesis is still warranted; 2) expectant management of patients who experience membrane rupture after genetic amniocentesis may be associated with a good perinatal outcome; and 3) membrane rupture after genetic amniocentesis may represent a fundamentally different etiologic entity than spontaneous rupture of the membranes in the second trimester not associated with genetic amniocentesis.

Amniocentesis↗
PubMed1988

Genital condylomas in pregnancy: use of trichloroacetic acid and laser therapy.

Genital condylomas in pregnancy pose several management problems for the obstetrician, including the mechanical problems of large condylomas and the issues relating to transmission of the human papillomavirus to the fetus during delivery. Transmission of papillomavirus occurs infrequently, but respiratory papillomatosis can result in mortality or lifelong morbidity. We evaluate our experience in treating condylomas in 32 pregnant women, using carbon dioxide laser therapy and 85% trichloroacetic acid. Condylomas in 31 (97%) of 32 women were controlled with this combination therapy. The only maternal complication was an episode of acute pyelonephritis secondary to urethral catheterization. One patient had premature rupture of the membranes 4 days after laser therapy and subsequently was delivered of a healthy neonate at 36 4/7 weeks. Prenatal photovaporization of condylomas appears to offer a method of treatment with a low complication and recurrence rate and helps avert the dilemma of whether patients with extensive genital condylomas should be delivered by cesarean section.

Adolescent↗
PubMed1987

The management of genital condylomas in pregnant women.

Genital condylomas complicating pregnancy pose several management problems for the obstetrician, including the issues of mechanical difficulties in women with large lesions and possible viral transmission to the fetus during delivery. Although respiratory papillomatosis is infrequent, this complication can be catastrophic and produce significant long-term morbidity in affected children. Hence, we believe that condylomas in pregnancy should not be ignored. In view of the precision, high success rate, and low risk of complications, CO2 laser surgery appears to offer the best option in patients with extensive condylomas and those whose disease proves resistant to simpler therapies.

Condylomata Acuminata↗
PubMed1987

Medical disorders in pregnancy.

Although there is still controversy regarding the management of these patients, the therapy and testing that is now available enables us to formulate a reasonable individualized management plan. The maternal platelet count should be monitored carefully during pregnancy and treated according to the prior information. In addition, platelet antibodies may assist in predicting more effectively the potentially affected fetuses. In these cases, deliveries by cesarean section should be considered. If a fetal scalp platelet count is possible at the onset of labor, this should be performed, and if the count is less than 50,000 per mm3, the fetus should be delivered by immediate cesarean section. Clearly, it is necessary to have facilities available for immediate cesarean section prior to performing the platelet count. The use of steroid therapy near term appears to have a beneficial effect on the neonatal platelet count and should be strongly considered. Further information relating to the neonatal effects of high-dose intravenous immunoglobulin therapy may indicate this as a preferential prophylactic form of fetal therapy that may be available prior to delivery.

Asthma↗
PubMed1986

Motivations for adolescents' first visit to a family planning clinic.

Although family planning clinics routinely gather data on referral sources and primary reasons for visits, little is known about the "precipitating events" which motivate young women to make an appointment or show up at a clinic on a given day. In this study, 150 new patients at a large urban clinic were interviewed to determine what events or advice specifically led to their decision to approach a family planning clinic for the first time. The roles of pregnancy scares, advice from significant others, and situational factors in motivating service use are presented along with a discussion of the program implications of these findings.

Adolescent↗
PubMed1985

Transbronchial fine needle aspiration of bronchogenic cysts.

Transbronchial fine needle aspiration (TBFNA) was used to confirm the diagnosis of bronchogenic cyst in two asymptomatic patients with mediastinal masses who declined surgical exploration. Both masses were located subcarinally but differed in computed tomographic density (7 and 59 Hounsfield units). Aspirate cytology demonstrated predominately bronchial columnar epithelial cells in mucus, without the lymphocytes and polymorphonuclear leukocytes normally seen in intrabronchial secretions. The denser cyst additionally contained some alveolar macrophages with ingested surfactant. While benignity cannot be absolutely assured, it is corroborated by serial evaluation of these patients, which has revealed no interval change in symptoms or roentgenographic size for two and three years, respectively. Under selected circumstances, it appears that TBFNA can be used to extend bronchoscopic diagnosis to benign mediastinal masses if the cytologic features of such aspirates are unique.

Biopsy, Needle↗
PubMed1983

Placental vascular responses to 6-keto-prostaglandin E1 in the near-term sheep.

6-Keto-prostaglandin E1 (6-keto-PGE1) is a biologically active, stable metabolite of prostaglandin I2 (PGI2). It has vasoactive properties similar to those of PGI2 and it has been shown to decrease the resistance of the renal, mesenteric, and pulmonary vascular beds. PGI2 is synthesized by the pregnant uterus and is vasoactive in the ovine placenta. The effects of 6-keto-PGE1 on uterine and placental blood flow in pregnant ewes were determined for comparison with those of PGI2. Near-term ewes and their fetuses were chronically catheterized to permit the measurement of regional blood flow by the radioactive microsphere method. In six sheep a 5-minute maternal jugular infusion of 3.25 micrograms/kg/min of 6-keto-PGE1 decreased mean arterial blood pressure from 89 +/- 4.8 to 63 +/- 7.1 mm Hg. Uterine vascular resistance decreased from 0.55 +/- 0.11 to 0.35 +/- 0.05 peripheral resistance units (PRU), but maternal cotyledonary resistance increased from 0.19 +/- 0.04 to 0.27 +/- 0.03 PRU. In five sheep a fetal intravenous infusion of 18 micrograms/min of 6-keto-PGE1 decreased mean fetal blood pressure from 43 +/- 2 to 29 +/- 2 mm Hg. Cotyledonary vascular resistance increased from 0.30 +/- 0.02 to 0.55 +/- 0.09 PRU . kg-1. In these sheep there were no significant changes in maternal uterine, renal, or cotyledonary blood flows. These results indicate that 6-keto-PGE1 is similar to PGI2 in that it produces maternal cotyledonary vasoconstriction, hypotension, and vasodilation in other organs.

Alprostadil↗
PubMed1983

Fetoscopic visualization in second-trimester pregnancies.

Fetoscopic visualization may be required for the prenatal diagnosis of external fetal malformations which cannot be clearly defined by ultrasound. The synchronous use of real-time ultrasound guidance during the fetoscopic procedure has permitted successful visualization to be achieved in pregnancies of greater than 18 weeks' gestation. The chances of successful visualization and the influence of advancing gestational age have been critically evaluated. Between 18 and 23 weeks', when these techniques were used, advancing gestational age did not appear to exert a significant effect on the chances of successful visualization. Analysis of placental position indicated that an anterior placenta did not significantly affect bloodstaining of the fluid or preclude access to placental vessels for blood sampling.

Adolescent↗
PubMed1983

Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps.

In a population of 1065 singleton, low birth weight infants (1000 to 2500 g) delivered vaginally from vertex presentation, the neonatal mortality and morbidity of 394 delivered by low forceps were compared with those of 671 delivered spontaneously. There were no significant differences between the groups, either across the population as a whole or among any of the following birth weight subgroups: 1000 to 1500 g, 1501 to 2000 g, and 2001 to 2500 g. The data in the current study, as well as those from previous reports, argue against the routine use of prophylactic low forceps delivery and in favor of a more individualized approach to the vaginal delivery of infants in vertex presentation in this weight group.

Birth Weight↗
PubMed1983

Transplantation of T-lymphocyte-depleted bone marrow between HLA-mismatched individuals.

Four patients with acute leukemia received transplants from HLA-mismatched, related donors. Marrow cells that had been depleted of T lymphocytes using a monoclonal anti-T-lymphocyte antibody and rabbit complement were used. In vitro studies showed that 80-97% of the mature T lymphocytes were removed using this procedure. Infusion of the treated marrow was accomplished without complications, and engraftment occurred in each case. Graft-versus-host disease occurred in 3 of the 4 patients. These results show that additional manipulations of the marrow will be required to allow complete T lymphocyte removal from the marrow before the feasibility of this approach in HLA-mismatched patients can be determined.

Acute Disease↗
PubMed1983

Fetoscopic photography.

Fetoscopic visualization may be used for the prenatal diagnosis of external structural malformations of the fetus. Objective documentation of these fetoscopic findings would be desirable. The photographic equipment and techniques required for fetoscopic photography have been investigated, and the results of these investigations with standard fetoscopic instruments in current clinical usage are described. The factors evaluated include the light source, camera equipment, camera settings and film.

Female↗
PubMed1983

Interrelationships among human chorionic gonadotropin (hCG), 17 beta-estradiol, progesterone, and estriol in maternal serum: evidence for an inhibitory effect of the fetal adrenal on secretion of hCG.

In normal pregnancy, maternal serum hCG reaches a maximum concentration about 8-10 weeks after the last menstrual period and then decreases. To investigate the possibility that this decrease in hCG is produced by an inhibitory effect of steroids originating in the feto-placental unit, hCG, progesterone, 17 beta-estradiol, and estriol were determined by specific RIAs in 341 serum specimens obtained from 229 different pregnancies. Expressions for predicted hCG as a function of estimated trophoblastic mass and percent predicted hCG were determined to correct for the increase in hCG with increasing trophoblastic mass. The relationships between hCG and progesterone, 17 beta-estradiol, estriol, or estimated trophoblastic mass were not linear. Expression of the hCG data as percent predicted hCG produced linear relationships between hCG and each of the above steroids. Both hCG itself and percent predicted hCG were shown to have a negative regression on estriol (P less than 0.001) and a positive regression on progesterone (P less than 0.001), but not on 17 beta-estradiol (P greater than 0.05), in a multiple linear regression on all three steroids. These data suggest that hCG production is inhibited by a steroid originating in the fetal adrenal. This inhibitory effect plateaus in late pregnancy, allowing a minor late increase in hCG due to increasing trophoblastic mass.

Adrenal Glands↗
PubMed1983

A mechanism for the hypoprothrombinemia of the acquired hypoprothrombinemia-lupus anticoagulant syndrome.

Antibodies that bind prothrombin without neutralizing its coagulant activity were demonstrated in the plasma of two patients with the acquired hypoprothrombinemia-lupus anticoagulant syndrome. The first patient's plasma contained less than 1% prothrombin activity and no detectable prothrombin antigen. The second patient's plasma contained about 6% of both prothrombin activity and antigen. Neither patient's plasma neutralized the prothrombin coagulant activity of normal plasma or of purified prothrombin added in vitro. Nevertheless, double immunodiffusion studies and binding experiments utilizing 125I-prothrombin demonstrated the presence of prothrombin antibodies in each patient's plasma. A Scatchard analysis of the binding data obtained with different concentrations of 125I-prothrombin and the first patient's plasma indicated the presence of a high affinity antibody, apparent Kd approximately 10(-10)M, and a lower affinity antibody, apparent Kd approximately 10(-9)M. Studies utilizing purified cleavage products of prothrombin suggested that the antibodies were directed against an epitope or epitopes located on the carboxyl-terminal, latent thrombin segment of the prothrombin molecule. We postulate that the acquired hypoprothrombinemia in these two patients and in other reported patients with the acquired hypoprothrombinemia-lupus anticoagulant syndrome stems from rapid clearance from the circulation of prothrombin antigen-antibody complexes.

Antibodies↗