Search PubMed⌕ Search

Biomedical subjects

D M Sherer

Publications and source records attributed to D M Sherer.

At least 127 records · Page 7Linked to original sources
PubMed1995

An additional imaging sign preceding spontaneous fragmentation and embolization of an implanted subclavian vein catheter.

Analysis of chest roentgenograms performed before spontaneous fragmentation and distal embolization of an implanted subclavian vein catheter revealed discontinuity of the catheter's radiopaque marker in addition to kinking of the area proximal to the breakage point. To the authors' knowledge the case presented in this article is the first report of this imaging sign before catheter fragmentation. Lateral catheter placement and early recognition of subtle imaging signs may assist in decreasing the incidence of this significant complication.

Catheterization, Central Venous↗
PubMed1995

Ultrasonographic diagnosis of catheter-induced combined subclavian and internal jugular vein thrombosis.

Catheter-induced subclavian and internal jugular vein thrombosis in a patient with unresectable ovarian carcinoma was diagnosed by sonography following subtle clinical symptomatology. Ultrasonographic diagnosis of central vein thrombosis offers applicable, noninvasive bedside diagnosis. The case we describe suggests that a low threshold should be maintained for application of this technique in the diagnosis of this potentially life-threatening complication, especially with the current widespread application of invasive monitoring.

Carcinoma↗
PubMed1994

Failure of methotrexate treatment for term placenta percreta.

Placenta percreta is a severe condition associated with maternal morbidity and mortality even when surgery is performed electively. Methotrexate has been suggested as a possible treatment modality for adherent placenta to avoid catastrophic surgery. The purpose of this report is to present a case where the placenta was left in situ to avoid cystectomy at the time of cesarean section, with subsequent failure of treatment with methotrexate.

Adult↗
PubMed1994

Placental metastases in a patient with recurrent breast carcinoma.

We present an unusual case of extensive placental micrometastases of recurrent breast carcinoma. The discrepancy between the gross and histopathologic findings in this case suggests that in the absence of gross metastases, meticulous microscopic examination may reveal a higher incidence of metastases than has been reported previously.

Adult↗
PubMed1994

Pedunculated uterine fibroid simulating an incarcerated inguinal hernia in pregnancy.

A bulging 5 x 5 cm tender mass appearing intermittently in the left groin in association with vigorous physical activity between 20 and 24 weeks' gestation was thought clinically and ultrasonographically to represent an inguinal hernia. Surgery after acute continuous pain and concern for incarceration revealed a nonherniated pedunculated uterine fibroid.

Adult↗
PubMed1994

Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity.

OBJECTIVE: Our purpose was to evaluate the efficacy of prophylactic amnioinfusion in decreasing neonatal morbidity associated with labor complicated by particulate meconium-stained amniotic fluid and to assess potential complications of this procedure. STUDY DESIGN: One hundred five laboring pregnant women with particulate (moderate or thick) meconium by subjective clinical analysis were randomly assigned to receive amnioinfusion or to receive standard obstetric care without amnioinfusion. Patients with any antepartum complications, other than the presence of meconium, were excluded from the study. Statistical analyses consisted of the two-tailed and paired Student t tests, Pearson chi 2 test, and Wilcoxon nonparametric test. Significance was set at p < 0.05. RESULTS: The study included 47 patients in the study group and 58 patients in the control group. A significantly greater proportion of study patients demonstrated decreased meconium concentration between rupture of membranes and delivery (46 of 46 vs 15 of 58, p < 0.001). The relative dilution of meconium consistency by objective analysis was significantly different between the study group and the control group (77.1% decrease vs 9.3% increase, p < 0.001). The proportion of neonates with meconium below the vocal cords was reduced in the study group (two of 47 vs 36 of 58, p < 0.001). Umbilical artery pH was increased in the study group neonates (7.29 +/- 0.01 vs 7.25 +/- 0.009, p < 0.05). The rate of neonatal acidemia was reduced in the study group (4 of 45 vs 12 of 50, p < 0.05). The rate of meconium aspiration syndrome was reduced in the study group (1 of 47 vs 8 of 58, p < 0.05). Maternal and neonatal morbidity rates were similar. CONCLUSION: Prophylactic amnioinfusion should be considered a possible addition to the intrapartum management of patients with particulate meconium-stained amniotic fluid.

Acidosis↗
PubMed1994

Meconium analysis for improved identification of infants exposed to cocaine in utero.

We screened anonymously all mothers and infants born during a 3 1/2-month period to determine the prevalence of intrapartum cocaine use, test the maternal characteristics that are specific predictors of intrauterine cocaine exposure (IUCE), and compare the sensitivity of infant urine versus meconium samples for identification of IUCE. Of 1237 live births during the study period, a sample was obtained from 1201 mother-infant pairs. The overall prevalence of documented intrapartum cocaine exposure was 66 (5.5%) of 1201 pairs. Previously developed drug screening guidelines had a sensitivity of 89% for detecting IUCE in infants. Direct comparisons of samples from the same mother-infant pair revealed that there were no cases in which cocaine was found in infant urine but not in meconium; however, infant urine testing missed 25% of the infants who had positive findings in meconium. We conclude that (1) meconium testing was more likely than urine testing to identify an infant with IUCE, detecting an additional 33%; (2) there was significant maternal cocaine use (5.5%) in a teaching hospital with a mixed patient population; (3) maternal characteristics known to identify infants at risk of having IUCE were useful in our population; and (4) IUCE of neonates admitted to the neonatal intensive care unit was more common than that of infants admitted to the regular newborn nursery.

Cannabis↗
PubMed1994

Marked twin-twin transfusion in the absence of nonimmune hydrops.

The precise pathophysiology of development of nonimmune hydrops in either the recipient or donor twin associated with twin-twin transfusion syndrome is not entirely clear. At times the recipient twin may develop nonimmune hydrops, but at other times the donor twin, and infrequently both, may develop this ominous complication. We present an unusual cases of this syndrome in which discordant twins, despite neonatal hematocrit levels of 86 and 21% were both nonhydropic and discuss the possible underlying pathophysiology of this occurrence.

Adult↗