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Biomedical subjects

D Dicker

Publications and source records attributed to D Dicker.

At least 91 records · Page 5Linked to original sources
PubMed1989

Is elective cerclage justified in the management of triplet and quadruplet pregnancy?

The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial. Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed-rest, beta-mimetic drugs and dexamethasone for the enhancement of fetal lung maturity. Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p < 0.01). Furthermore, in the former group, the mean neonatal weight was significantly higher (p < 0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p < 0.05), perinatal mortality rate was significantly reduced (p < 0.01) and the mean hospitalization period was shorter (p < 0.025). It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.

Apgar Score↗
PubMed1989

Effect of cell cycle stages on the central density of Enterococcus faecium ATCC 9790.

Cultures of Enterococcus faecium growing at various rates were examined for timing of cell division cycle events by using the method of residual divisions and a morphological analysis. Both methods gave essentially the same timing for the onset of D1 (completion of chromosome replication) and of D2 (completion of septation). Frequencies of cells exhibiting a phase-reversed center in bovine serum albumin at various growth rates were determined. The data fit a model in which rapidly growing cells increase in refractive index (which is assumed to represent central density) at completion of the chromosome replication cycle involved in the ongoing division, whereas slowly growing cultures increase in central density at the time of completion of septation. There was no correlation between the timing of increase in central density and the timing of initiation of new sites of surface growth.

Cell Cycle↗
PubMed1989

The vanishing fetus. A report of 17 cases of triplets and quadruplets.

The incidence of multiple conceptions is higher than the incidence of multiple deliveries. The "vanishing fetus" is a relatively new concept being a direct result of the advent of ultrasonography. Early first trimester loss of one or more conceptuses accounts for this phenomenon. The patient may be symptomatic (bleeding, pain, abdominal cramps) but in most instances, the finding is fortuitous. We report 17 cases of a vanishing fetus in a multiple gestation of greater than twins. In 13 patients one fetus vanished in the course of pregnancy while in four cases two fetuses disappeared from each gestation. The phenomenon was observed up to the 16th week of pregnancy. It is our feeling that the finding of a vanishing fetus should be recorded early, as the prognosis for pregnancy bleeding is different than in the singleton pregnancy. Thus information regarding this phenomenon should be given to couples who consider artificial reduction of fetuses in the multiple gestation.

Female↗
PubMed1988

Ovarian cyst aspiration during in vitro fertilization/embryo transfer (IVF/ET) cycles.

Fifteen patients treated in an IVF program with ovarian cysts were retrospectively evaluated. Ten women with ovarian cysts formed during induction of ovulation were treated by puncture and aspiration and compared to a control group of five patients in whom the ovarian cysts could not be punctured. Induction protocols in both groups were based on hMG/hCG or pFSH/hCG administration. In patients in the study group the mean volume aspirated from cysts was 7.4 +/- 2.1 ml. Mean estrogene (E2) levels on the day of hCG were 1411 +/- 213 and 1036 +/- 177 pg/ml in the hMG and pFSH groups, respectively. Mean progesterone (p) levels were 1.6 +/- 0.4 and 1.9 +/- 0.3 ng/ml, respectively. Oocyte collection was done with the aid of a vaginal ultrasound transducer. A mean of 6.2 and 5 oocytes was picked up respectively, with a fertilization rate of 74.3 and 69.1%. In all cases embryo transfer was performed. Two clinical pregnancies were achieved, one in each of the induction protocol groups. In the control group, patients underwent early luteinization, i.e., requiring cancelation of the cycle, after the ovarian cysts had not been aspirated. It is suggested that puncture and aspiration of ovarian cysts occurring during induction of ovulation may be an efficient method to avoid early luteinization. It should be evaluated further.

Adult↗
PubMed1988

Spontaneous abortion in patients with insulin-dependent diabetes mellitus: the effect of preconceptional diabetic control.

Fifty-nine of 94 pregnant women with juvenile-onset insulin-dependent diabetes who attended a preconceptional clinic were periodically examined by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. These women were compared with the 35 pregnant women who did not receive preconceptual glycemic control. The initial glucose and maternal hemoglobin A1 values of the latter group experiencing spontaneous abortions were significantly higher (p less than 0.001) when compared with women receiving preconceptional diabetologic counseling whose pregnancies continued beyond 22 weeks' gestation. The frequency of spontaneous abortions among patients not seen before pregnancy was significantly higher (p less than 0.001), in contrast to attending women, whose rate represented the normal rate in the general population. We confirm the evidence accumulated in the recent literature that poor metabolic control around conception and in the early weeks of pregnancy may be the determining factor favoring abortion.

Abortion, Spontaneous↗
PubMed1988

Primary abdominal pregnancy: can artificial abortion, endometriosis and IUD be etiological factors?

Primary abdominal pregnancy is a very rare condition, accompanied by high rates of perinatal and maternal mortality. The etiology of this condition is not clear; nevertheless several theories have been proposed. We have reported three cases in whom the etiological factors may have been the presence of an IUD, and patches of endometriosis adjacent to the site of the pregnancy in two cases. It is suggested that in cases suspected of ectopic pregnancy, in the presence of IUD or other pelvic pathology, it should first be determined whether it is the dangerous condition of abdominal pregnancy, in view of the high mortality rates.

Abortion, Induced↗
PubMed1988

Mullerian adenosarcoma of the uterus: report of a rare case and review of the literature.

A rare case of Mullerian adenosarcoma of the uterus is described, found during diagnostic curettage. Panhysterectomy was performed. These rare tumors have a low potential for malignancy and are characterized by benign epithelial and malignant stromal elements. They should be distinguished from the highly malignant mixed Mullerian tumors which contain, by definition, both carcinomatous and sarcomatous elements. The literature on the subject has been reviewed.

Female↗
PubMed1988

Fetal surveillance in insulin-dependent diabetic pregnancy: predictive value of the biophysical profile.

Ninety-eight insulin-dependent diabetic pregnancies underwent monitoring by means of 978 biophysical profiles from 28 weeks' gestation until parturition. Only 2.9% of the 978 tests had abnormal results (score less than or equal to 7). When performed within 2 days before birth, a normal biophysical profile predicted the 1-minute Apgar score to be normal in 92% and 5-minute Apgar score in 99%. When all biophysical profiles ever performed were included, the predictive value improved to 100%. The baby's first cry within 1 minute after birth was predicted in 95%. Furthermore, the predictive value of a normal biophysical profile regarding the absence of ominous intrapartum cardiotocographic patterns was excellent (95%). The specificity was in general good (80% to 90%), but the predictive value of abnormal test results and sensitivity were almost without exception poor. It seems that the very low rate of abnormal biophysical profiles indicates that obstetric interventions were made immediately after the occurrence of the first sign of fetal jeopardy; thus improved results were obtained.

Amniotic Fluid↗
PubMed1988

Comparison of a fixed and dynamic protocol for embryo replacement in an IVF/ET programme.

Implantation after embryo transfer is considered a major obstacle in terms of pregnancy rates after in-vitro fertilization. A flexible approach to the date of replacement, based on the fact that the most suitable embryonic structure for proper implantation is the four- to eight-cell embryo, has been studied. One-hundred-and-twenty patients with various aetiologies of infertility were stimulated with HMG or combined HMG and FSH, then treated by three different methods of embryo replacement. In group I embryos were replaced in mothers 48 h after ovum retrieval; in group II replacements were carried out 72 h after retrieval; and in group III replacements were related to embryonic cleavage development. Mean levels of oestradiol when HCG was given averaged 1301 +/- 121 pg/ml, 1016 +/- 96 pg/ml and 1182 +/- 101 pg/ml in the three groups, respectively. There was no significant difference in the average number of embryos transferred among the various groups. The pregnancy rates per transfer were 21.8, 24.2 and 38.7%, respectively (P less than 0.001). Although more investigation is required, a dynamic approach to embryo replacement might significantly improve pregnancy rates, because of improved interactions between the embryos and the uterus.

Chorionic Gonadotropin↗
PubMed1988

First trimester bleeding in clinical IVF pregnancies.

First trimester bleeding has been investigated in 72 pregnant women undergoing in-vitro fertilization and embryo transfer and was compared to 70 pregnant patients in whom ovulation was induced, in addition to 70 spontaneous pregnancies. Abortion rates did not differ significantly between the first two groups but were significantly higher in comparison to normal pregnancies. Furthermore, among IVF pregnancies that continued, a high incidence of first trimester bleeding occurred (P less than 0.01). This complication was mainly related to luteal insufficiency and multiple pregnancies, whereas hyperstimulation was the major risk factor for bleeding in pregnancies arising from HMG-induced ovulation. Other currently unknown, aetiological factors for first trimester bleeding in IVF pregnancies remain to be investigated.

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1988

Pregnancy outcome in maturity onset diabetes at young age (MODY).

Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature. Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin. This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin-dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin-dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Caesarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.

Adolescent↗
PubMed1988

Transvaginal oocyte retrieval controlled by vaginal probe for in vitro fertilization: a comparative study.

Of 142 patients who initiated in vitro fertilization cycles, 52 underwent oocyte collection by laparoscopy, 58 by the ultrasonically guided transvesical route, both under general or local anesthesia and 36 by the ultrasonically transvaginal route under local anesthesia. When the three methods were compared the results did not differ significantly. An average of 6.4, 6.2, and 5.7 oocytes, respectively, were retrieved. Cleavage rates were 82.6, 79.4, and 81.6%, respectively, while 20.2, 22.6, and 21.1% clinical pregnancies per cycle were obtained. Complications with this procedure such as exacerbation of previous pelvic inflammatory disease, urinary tract infections, transient hematuria, and mild hemoperitoneum were rare. In general, patients greatly preferred the transvaginal method. In addition to providing greater comfort for the patient, this method requires no general anesthesia and is less expensive than other methods. Our initial experience demonstrates that in vitro fertilization can be performed successfully through this simplified alternative to oocyte retrieval.

Adult↗
PubMed1988

Intrapartum management of insulin-dependent diabetes mellitus (IDDM) gestants. A comparative study of constant intravenous insulin infusion and continuous subcutaneous insulin infusion pump (CSIIP).

Two groups of insulin-dependent diabetes mellitus (IDDM) parturients were managed according to different intrapartum protocols and compared with a control group of normal women in labor. Thirty-seven patients received conventional intensified insulin therapy during pregnancy and intravenous continuous insulin infusion during labor. Twenty-eight women were managed by continuous subcutaneous insulin infusion pump (CSIIP) throughout gestation and this therapeutic approach was continued during labor. When the two glucose control techniques were compared, CSIIP was superior to achieving and maintaining intrapartum optimal metabolic control, reducing significantly the incidence of acute fetal distress, thus lowering the cesarean section rate and neonatal hypoglycemia. Consequently we concur with the recommendation that firm prepartum as well as intrapartum diabetic control is mandatory for successful management of labor in IDDM patients.

Blood Glucose↗