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E Hernandez

Publications and source records attributed to E Hernandez.

At least 181 records · Page 10Linked to original sources
PubMed1983

Comparison of urinary estrogens, contraction stress tests and nonstress tests in the management of postterm pregnancy.

In a retrospective review of 697 postterm pregnancies we attempted to validate three tests used to identify the fetus at increased risk: the 24-hour urinary estrogen per gram creatinine (E/Cr), the nonstress test (NST) and the contraction stress test (CST). Using the corrected perinatal mortality rate (PMR) among term pregnancies (0.23%) as a standard for comparison, we found the PMRs among postterm patients with negative screening tests to be as follows: 0.23% with normal E/Crs, 0.65% with negative CSTs (not significantly different) and 2.4% with reactive NSTs (p less than 0.005). When we used intrapartum fetal distress as a standard for comparison, the E/Cr exhibited the highest sensitivity (88%) whereas those of the CST and NST were much lower (7-10%). The specificities were 63%, 98% and 92%, respectively. From this retrospective study the E/Cr appears to be of most assistance in identifying fetuses at increased risk, the CST is of intermediate assistance, and the NST is of least assistance.

Estrogens↗
PubMed1982

Multimodality treatment of patients with advanced ovarian carcinoma.

A multimodality treatment program has been applied to ovarian carcinoma at the Johns Hopkins Hospital since August 1975. Forty-nine patients were subdivided into 23 patients with maximally resected Stage III micrometastatic, and 26 patients with significant retained disease, 20 with Stage III macrometastatic and 6 with Stage IV. After initial pilot studies, those patients with minimally retained disease entered a randomized prospective study. Antiovarian antiserum was used in one arm of the study; in both study arms colloidal P-32, delayed split whole abdominal irradiation, and maintenance melphalan were used. For the 23 patients with micrometastatic disease the cumulative survival and survival without evidence of disease at four years is 78 and 34% respectively. Twenty-six patients with macrometastatic disease were treated with or without intraperitoneal antiserum and multiagent chemotherapy; their cumulative one year survival is 50%. The lack of significant toxicity of intraperitoneal antiovarian antiserum and the results of multimodality therapy indicate the feasibility of this therapeutic approach to further improve ovarian cancer therapy.

Adenocarcinoma, Mucinous↗
PubMed1982

Roentgenographic pelvimetry in single vertex pregnancies.

Of the 4,529 women delivered of infants at The John Hopkins Hospital during 1976 and 1977, 212 (5%) had roentgenographic pelvimetry. An analysis of a subgroup of 142 single vertex pregnancies with radiographic pelvimetry during this two-year period is presented. The cesarean section rate was 40% among patients selected for roentgenographic pelvimetry whose pelvis was found to be adequate. Vaginal delivery in women with a pelvis radiographically shown to be small was accomplished in 27% of patients with failure to progress in labor and in 22% of the patients with a fetus in the floating vertex presentation. Patients with a small pelvis who delivered vaginally had significantly smaller infants than those delivered by cesarean section (2,785 +/- 399 gm vs 3,146 +/- 433 gm). The only significant difference in pelvic measurements between these two groups occurred in the AP diameter of the inlet (11.5 +/- 1.1 cm vs 10.5 +/- 1.0 cm). Roentgenographic pelvimetry of single pregnancies as evaluated in this study appears to have limited clinical usefulness.

Adolescent↗
PubMed1982

Insulin is present in chicken eggs and early chick embryos.

We showed that insulin appears in the chick embryo before beta-cells are recognizable, as well as in the egg constituents even before fertilization. Acid-ethanol extracts of 2- to 8-day-old embryos were gel-filtered on Sephadex G-50. The peak of immunoreactive insulin chromatographed in a position corresponding to that of authentic insulin. The immunoreactive insulin extracted from embryos was approximately 2 ng/g wet wt during early embryogenesis (days 2, 3, and 4), with a 2- to 3- fold increase by days 5 and 6, in conjunction with pancreatic development. The heads of the embryos contributed 22-23% of the total insulin on days 3 and 4, but only 5% by day 5. Based on its reactivity in a pork insulin RIA, chicken insulin RIA, and rat adipocyte bioassay, we concluded that the material is very similar to avian (chicken or turkey) rather than mammalian type insulin. Similar immunological and biological insulin-like activity [but at much lower concentrations (0.2-0.8 ng/ml)] were recovered from the gel-filtered acid-ethanol extracts of yolk and white of unfertilized and fertilized eggs. This study, which shows that insulin is present at a very early stage in ontogeny, extends observations that insulin is native to organisms that lack pancreatic islets, including flies, worms, and microbes.

Adipose Tissue↗
PubMed1982

An ominous undulating fetal heart rate pattern.

Three cases of severely compromised fetuses are reported in which a similar FHR tracing was observed: an undulating pattern describing a "sinusoidal" shape, a frequency of 0.5-1 cpm, amplitude of 10-15 bpm, and flattened baseline varying between 60-120 bpm. This pattern appears to differ significantly from the sinusoidal pattern described previously and appears to identify an agonal or pre-agonal fetus that nonetheless may be salvageable and, therefore, requires maximal obstetric intervention.

Adolescent↗
PubMed1982

Insulin resistance associated with androgen excess in women with autoantibodies to the insulin receptor.

Hirsutism, polycystic ovaries, and elevated levels of plasma testosterone are characteristic clinical features in women with extreme insulin resistance and acanthosis nigricans. Extreme insulin resistance resulting from autoantibodies to the insulin receptor (type B extreme insulin resistance) had been considered an exception to this generalization. A woman with type B extreme insulin resistance developed clinical evidence of masculinization in association with a markedly elevated level of plasma testosterone (1000 ng/dL). In nine women with autoantibodies to the insulin receptor, excessive ovarian production of testosterone was a common feature among the premenopausal patients. Postmenopausal patients rarely developed elevated levels of plasma testosterone, presumably as a result of ovarian failure. Overproduction of testosterone may result from a direct effect of hyperinsulinemia on the ovary.

Acanthosis Nigricans↗
PubMed1982

Modification of fracture repair with selected pulsing electromagnetic fields.

We assayed different pulsing electromagnetic fields for their effects on the mechanical and histological repair properties of an osteotomy of the radius of the rat fourteen days postoperatively. Highly significant differences were found in the control and experimental initial load values and their decay as a function of time. These results correlate well with the histological pattern in the bridging callus. A pulse that produces an increase (above the control level) in initial load by a factor of 2.4 and a slower decay was characterized by more extensive calcification of fibrocartilage and its replacement by fibrous bone at this early, but important, stage in fracture-healing.

Animals↗
PubMed1982

Ip immunotherapy and chemotherapy in advanced epithelial ovarian cancer.

Nine patients with advanced epithelial ovarian cancer, classified as either stage III with macrometastatic residual disease or stage IV, received combination chemotherapy in conjunction with ip rabbit-derived human ovarian antitumor serum (HOATS). The HOATS regimen consisted of the ip instillation of 100 ml of ovarian antitumor serum on Days 1 and 3 of the first chemotherapy cycle. Side effects attributable to HOATS were low-grade fever in three patients and diffuse skin rash in two. The 1-year cumulative survival was 87%, with a clinical response rate of 80%. No significant toxic reactions to HOATS have been observed. Continuation of the present study seems justified.

Adenocarcinoma↗
PubMed1981

Urinary estrogens in postterm pregnancy.

A 40-month retrospective review of 677 postterm pregnancies was undertaken to determine the usefulness of 24-hour urinary estrogen per gram of creatinine (E/Cr) in monitoring such pregnancies. The cutoff value between normal and low E/Cr values was chosen at the tenth percentile (18 mg/gm). The corrected perinatal mortality rate (PMR) in post-term pregnancies with normal E/Cr was 0.23% (1/426) and was not different from that at term (0.23%; 4/1,775). However, in post-term pregnancies with low E/Cr, the corrected PMR was 9.2% (4/43), representing a 40-fold increase (P less than 0.001). The incidence of fetal distress was also significantly higher in patients with low E/Cr (57%) than in those with normal E/Cr (5.5%; P less than 0.001). It was worrisome to note that three of four stillborn infants had antepartum fetal heart testing within 4 days, which indicated fetal well-being. The E/Cr appears to be a reliable test for identifying those postterm pregnancies at risk that might benefit from obstetric intervention.

Adolescent↗
PubMed1981

Bedside recognition, incidence and clinical course of right ventricular infarction.

To evaluate the incidence, clinical characteristics and course of right ventricular infarction, 96 patients with an established diagnosis of acute myocardial infarction were evaluated during a 10 month study period. Of the 44 patients with acute inferior wall myocardial infarction, 16 had bedside evidence of right ventricular dysfunction. All had a positive Kussmaul's sign, and 12 had either a right ventricular third or fourth heart sound. Inspiratory elevation of right atrial and right ventricular end-diastolic pressures was documented in nine patients. Ventricular fibrillation developed in one patient and advanced atrioventricular block in three. All 16 patients survived and were alive 3 months after infarction. The hospital course and 3 month survival rate were not different from those of the usual patient with inferior wall infarction. Approximately one third of the patients with inferior wall myocardial infarction have bedside evidence of right ventricular infarction, which usually does not alter short-term prognosis.

Acute Disease↗
PubMed1981

Sarcoma complicating von Recklinghausen disease in pregnancy.

Several cases of benign enlargment of neurofibromata during pregnancy are reported in the literature. We believe the present case to be the first report of malignant schwannoma occurring in such a tumor during pregnancy. As this case illustrates, malignant sarcomatous change must be carefully considered in such patients. Prompt diagnosis and radical therapy offer the only chance of survival in malignant schwannoma.

Abdominal Neoplasms↗
PubMed1980

Endometrial adenocarcinoma arising in adenomyosis.

Endometrial adenocarcinoma and adenomyosis are both common problems arising in the uterus. Interestingly, there are few reports of the combination of these two pathologic entities. A recent experience with eight cases found in the files of the Gynecologic Pathology Laboratory at The Johns Hopkins Hospital between the years 1955 and 1974 are reported. Of significance is the differential in prognosis between such cases with deep involvement and true invasive disease.

Adenocarcinoma↗
PubMed1980

Asthma in pregnancy: current concepts.

Asthma complicates pregnancy with the same frequency as cardiac disease (1%) does. Although the incidence of severe asthma during pregnancy is low, its effect on the mother and fetus can be disastrous. Recent advances have improved the management of this problem. Representative cases and a review of asthma treatment in pregnancy are presented.

Acute Disease↗