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Biomedical subjects

E A Reece

Publications and source records attributed to E A Reece.

At least 199 records · Page 11Linked to original sources
PubMed1984

Glycosylated hemoglobin (HbA1) and hemoglobinopathies in pregnancy.

Glycosylated hemoglobin (HbA1) is considered to be representative of prior blood-glucose levels and is being used in pregnant and nonpregnant diabetic patients as a possible index of both long and short-term glucose-control. Factors other than blood-glucose concentration have been reported to affect its value. Variant hemoglobin is one of them. HbA1 and blood-glucose levels were measured in pregnant patients at high risk for diabetes for screening for abnormal carbohydrate metabolism. HbA1 was measured by cation exchange column chromatography and glucose was measured by hexokinase reaction. The mean HbA1 in patients with normal blood sugars was 6.17 +/- 0.6 percent. A value of HbA1 of less than 5 percent as measured by cation exchange column chromatography was highly predictive (P less than 0.001) of hemoglobinopathies (S or C). The mean HbA1 of randomly selected matched patients with "normal" Hb was 5.94 +/- 0.72 percent. In patients with thalassemia, HbA1 values as measured by cation exchange column chromatography were elevated despite normal carbohydrate tolerance. While interpreting the results of HbA1 in the management of pregnant diabetics, the above fact should be kept in mind.

Blood Glucose↗
PubMed1984

Amniotic fluid arborization: effect of blood, meconium, and pH alterations.

The effects of blood and meconium at various dilutions and pH alterations on the fern test were evaluated in an in vitro study. Thirty-six specimens of amniotic fluid across gestational ages (16 to 42 weeks) were tested. The fern test was unaffected by meconium at any concentration and by blood at dilutions of 1:10 or greater. When blood and amniotic fluid were mixed in equal amounts, ferning was not present. Arborization of amniotic fluid was unaffected by pH alterations. These findings support the clinical usefulness of the fern test for the determination of ruptured membranes, even in the presence of blood or meconium contamination, and of pH alterations.

Amniotic Fluid↗
PubMed1984

Coagulopathy associated with factor VIII inhibitor. A literature review.

Coagulopathy associated with factor VIII inhibitor is a potentially serious medical condition that may mimic the hemostatic failure seen in hemophilia A. This disorder may be detected first during pregnancy or the postpartum period and may cause life-threatening hemorrhagic diathesis. Thirty-three cases of coagulopathy associated with factor VIII inhibitor in the peripartum period have been reported.

Adolescent↗
PubMed1984

Use of glycosylated hemoglobin as a screen for macrosomia in gestational diabetes.

Glycosylated hemoglobin and blood sugar levels in the fasting state and two hours after oral 100 g glucose load were measured in 180 patients. Glycosylated hemoglobin was measured by cation exchange column chromatography, and blood sugar was measured by hexokinase reaction. Patients with an elevated postprandial and/or fasting blood sugar level (positive screen) subsequently underwent three-hour glucose tolerance test. The mean value of glycosylated hemoglobin in patients with a negative screen and normal hemoglobin was 6.17 +/- 0.61%; and the value for glycosylated hemoglobin in patients with class A diabetes and normal hemoglobin electrophoresis was 6.85 +/- 0.73% (P less than .001). A glycosylated hemoglobin value greater than 6.78 (mean + 1 SD) was considered elevated. Glycosylated hemoglobin values were elevated in 21 of 33 patients with gestational diabetes and in 27 of 147 patients with normal blood sugar levels. The sensitivity and specificity of glycosylated hemoglobin for the diagnosis of gestational diabetes were 63.6 and 81.6%, respectively. Fifty percent of patients with an initially elevated glycosylated hemoglobin value delivered macrosomic infants, whereas no patient with a normal glycosylated hemoglobin value had a macrosomic infant. An elevated glycosylated hemoglobin value may alert the obstetrician of a potentially elevated mean blood sugar level and may warrant aggressive management of gestational diabetes.

Birth Weight↗
PubMed1983

Combined intrauterine and extrauterine gestations: a review.

In a review of the world's literature on combined intrauterine and extrauterine pregnancies, 589 cases, including five cases currently reported from the Sloane Hospital for Women, were documented. Analysis of the literature revealed abdominal pain to be the most frequent presenting symptom. A combination of signs and symptoms, including abdominal pain, adnexal mass, peritoneal irritation, and an enlarged uterus, was the most significant finding in support of a presumptive diagnosis of combined gestations. At the Sloane Hospital for Women, the occurrence of both pelvic inflammatory disease and combined pregnancy is approximately three times the reported world incidence. This proportionate increase in both disease states may support a potential etiologic association between pelvic inflammatory disease and simultaneous intrauterine and extrauterine gestations.

Abdomen↗
PubMed1982

Colonic pseudo-obstruction following obstetrical surgery. A review.

Colonic pseudo-obstruction denotes an apparent intestinal obstruction occurring in the absence of a demonstrable lesion or luminal occlusion. This syndrome is distinct from adynamic ileus, and parturition accounts for a major category of reported cases. The purpose of this paper is to 1) review the literature on the subject, 2) emphasize the severity of this condition and the need for early diagnosis and prompt management and, 3) to outline guidelines for the improved management of this disorder.

Cesarean Section↗
PubMed1982

Congenital uterovesical fistula.

An example of congenital uterovesical fistula is presented. The cardinal diagnostic feature is monthly painless macroscopic hematuria with onset at menarche. It is possible that a delay in prompt diagnosis and corrective surgery may lead to undesired consequences. The literature has revealed only one other recorded case of the congenital type of uterovesical fistula.

Abnormalities, Multiple↗
PubMed1982

A successful gestational outcome in the presence of genitourinary abnormalities and severe medical complications of pregnancy.

Müllerian duct dysgenesis may result in various genitourinary abnormalities and a high incidence of associated gestational losses. The bicornuate uterus (with either one or two cervices) and a single vagina are the most common genital variations, whereas an ectopic pelvic kidney and unilateral renal agenesis are the most common associated renal malformations. Inspite of the high incidence of fetal wastage resulting from pregnancies associated with congenital uterine abnormalities, aggressive perinatal and neonatal therapy may improve the gestational outcome.

Adolescent↗
PubMed1977

Insulin in the management of the diabetic surgical patient: continuous intravenous infusion vs subcutaneous administration.

A prospective randomized study comparing constant intravenous infusion of regular, low-dose insulin versus conventional subcutaneous administration of neutral protein Hagedorn (NPH) insulin in insulin-requiring patients undergoing orthopedic procedures under general anesthesia was undertaken. The degree of diabetic control was better in those receiving constant 2 units/hour of regular insulin than in those receiving two thirds of daily maintenance doses of NPH insulin. However, in two of eight patients receiving 2 units/hour, decreased insulin infusion rates and increased dextrose infusion rates were required to avoid hypoglycemia. Preoperative NPH insulin and 1 unit/hour insulin administration resulted in equivalent diabetic control.

Anesthesia, General↗
PubMedDate not supplied

Early fetal growth delay: is it really predictive of congenital anomalies in infants of diabetic women?

It has been reported that the congenital anomalies frequently observed in offspring of diabetic women may be predicted by first-trimester ultrasound findings that reveal diminution in growth of the embryo/fetus. The aim of the current study was to examine the relationship between early growth delay and congenital anomalies in pregnancies complicated by diabetes. We conducted a retrospective study of 38 patients with insulin-requiring pregestational diabetes mellitus and 81 control pregnancies who had first-trimester ultrasound examinations. A cross-sectional survey of all patients revealed a congenital anomaly rate of 18.4% among the diabetic pregnancies compared to 4.9% among controls (P < 0.02). Early fetal growth delay was defined as a difference of six or more days between the menstrual gestational age and the sonographic gestational age (menstrual age minus ultrasound age). Early growth delay was exhibited in fifteen control pregnancies (18.5%) and eleven insulin-requiring pregestational diabetic pregnancies (28.9%) (P = 0.02). However the incidence of congenital anomalies in these two groups was significantly different, but there was no difference between groups with and without growth delay. The longitudinal growth of two anomalous fetuses of the diabetic group and three anomalous fetuses from the control group was studied. Both groups of fetuses remained within the normal growth range for their respective groups. This study described herein fails to confirm the association of early fetal growth delay with the occurrence of congenital malformations in insulin-requiring pregestational diabetic pregnancies.

Adult↗
PubMedDate not supplied

Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes.

To evaluate maternal-fetal outcomes in pregnancies complicated by diabetic nephropathy were evaluated. Nephropathy was defined as proteinuria of >300 mg/24, or albuminuria >300 mg/24 hr in the absence of infection. Twenty-seven pregnant women with variable degrees of diabetic nephropathy were included in the study. Prenatal care included stringent metabolic control and management of hypertension. Fetal and maternal outcomes were obtained by medical record review. There were no fetal deaths. One neonatal death occurred in a fetus delivered at 29 weeks gestation. IUGR and major congenital malformations were observed in 9% of the neonates; 26% of the infants were delivered preterm. Chronic hypertension (77%) and preeclampsia (53%) were common maternal complications; 63% of women required delivery by cesarean section. Successful pregnancy outcomes were achieved in >95% of the women in our population. Modern management of the pregnancy complicated by diabetes has substantially improved the outcome of class F/FR diabetic mothers and their infants.

Abnormalities, Multiple↗
PubMedDate not supplied

Effect of medical therapy on progressive nephropathy: influence of pregnancy, diabetes and hypertension.

Nephropathy is a complication of diabetes mellitus that can affect women in their reproductive years. This article reviews the effects on treatment on the main factors associated with short- and long-term complications in pregnant women with diabetic nephropathy. Tight glycemic control, adequate treatment of elevated blood pressure, and renal function in early pregnancy are the most significant predictors of maternal and perinatal outcomes. Contemporary methods of perinatal care and adequate treatment of blood pressure allow fetal survival rates of 95%. Furthermore, pregnancy per se does not appear to worsen the natural progression to end-stage renal disease for most women with renal insufficiency. However, patients with moderate to severe renal impairment may experience acceleration of renal disease.

Albuminuria↗
PubMedDate not supplied

Factors associated with fetal macrosomia in offspring of gestational diabetic women.

OBJECTIVE: To determine whether there is a relationship between birthweight and interval between 1-h and 3-h glucose tolerance test (GTT) as well as other factors. METHODS: We performed a retrospective analysis of our computerized diabetes database for the years 1992-1997. Ninety-four women with gestational diabetes fulfilled the inclusion criteria (i.e., singleton gestation, term delivery, absence of medical conditions, and known interval between 1-h and 3-h GTT). They were evaluated based on prepregnancy body mass index (BMI), mean glucose values, interval between diagnostic testing, and gestational age of 3-h GTT. RESULTS: Subjects with GDM had a mean glucose value of 96.8 mg/dl and average prepregnancy BMI of 29.3 kg/m2. When GDM subjects with and without macrosomic infants were compared, mean glucose values (97.4 vs. 96.6 mg/dl) and mean interval (18.1 vs. 17.0 days) between diagnostic testing did not significantly differ. However, maternal prepregnancy BMI was higher in the group of women who gave birth to macrosomic infants (32.2 vs. 28.22 kg/m2, P = 0.008). Using stepwise multiple regression, maternal prepregnancy BMI was the only variable found to be predictive of macrosomia. CONCLUSION: We were unable to show a statistical relationship between interval of diagnostic testing and rate of macrosomia. However, we demonstrated a clear relationship between maternal BMI and infant birthweight.

Adult↗
PubMedDate not supplied

Neonatal transverse cerebellar diameter in normal and growth-restricted infants.

OBJECTIVE: To assess the transverse cerebellar diameter (TCD) in preterm and term neonates with normal growth or growth restriction. METHODS: TCD was sonographically measured after birth in 404 neonates born between 23 and 42 weeks of gestation. The study included two groups: Group 1: 334 appropriately grown for gestational age (AGA) neonates (both birthweight (BW) and head circumference (HC) were between the 3rd and 97th centiles), which were subdivided into two subgroups according to the HC measurements. Group 2: 70 small for gestational age (SGA) neonates (BW <3rd centile), were further divided into three subgroups according to HC measurements. RESULTS: In Group 1 of AGA neonates, a linear growth function was observed between the TCD and GA (R = 0.914, P < 0.00001, TCD = 0.279 + 0.142 X GA), and between TCD and HC (R = 0.886, P < 0.00001, TCD = -0.333 + 1.777 X HC). The percentage of neonates with normal TCD (> or =10th centile) was more than 85% of the AGA and asymmetric SGA subgroups, and 60.7% of the microcephalic SGA subgroup (P < 0.02). CONCLUSIONS: This study provides normative data of neonatal TCD across gestational age. TCD measurement via sonography is a new adjunctive criterion for objectively assessing gestational age in infants when a precise determination of gestational age is necessary. This is very important since utility of the TCD is effective for both AGA and asymmetric SGA infants.

Cephalometry↗