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Biomedical subjects

E Schiff

Publications and source records attributed to E Schiff.

At least 73 records · Page 4Linked to original sources
PubMed1996

Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.

A retrospective, descriptive study was conducted to evaluate the outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence. Thirty-two women with singleton pregnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine activity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (median 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated before 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks for the 19 who achieved viability. The mean birthweight of the live infants was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infants died during the neonatal period. The total survival rate was 47%, and the survival rate corrected for major anomalies was 48.4%. The perinatal mortality rate was significantly higher among patients with membranes protruding through the-cervix on admission, compared to those without (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate. Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.

Adult↗
PubMed1996

A controlled intervention in reduction of redundant hospital days.

BACKGROUND: Inappropriate use of hospital services, in the form of unjustified hospital stay days (HSD), constitutes a major burden on a health budget. Reduction of unjustified HSD was achieved in a medical ward in a previous intervention study. METHODS: A controlled intervention aimed at reducing unjustified hospital stay was performed on 155 paediatric inpatients and 248 controls, by applying pre-set criteria for hospitalization and comparing to results in previous studies. RESULTS: Unjustified stay was decreased from 32.6% to 14.8% on the study ward, and from 25.7% to 19.3% on the control ward. The children on both wards did not differ significantly in rates of subsequent out of hospital mortality, re-admission, and the subjective evaluation of health by their parents one month following discharge. CONCLUSIONS: This study demonstrates that despite the fact that the per cent of unjustified HSD on a paediatric wars is much lower than on medicine or surgery, a significant reduction in unjustified stay can be achieved by intervention programme.

Child↗
PubMed1996

Spontaneous ovarian hyperstimulation mimicking an ovarian tumour.

Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy is exceedingly rare. We report a case of ovarian hyperstimulation presenting as bilateral ovarian masses in association with spontaneous pregnancy, occurring in a woman with disturbed liver function. A possible mechanism is discussed.

Adult↗
PubMed1996

A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage.

OBJECTIVE: To determine the safety and efficacy of intramuscular oxytocin plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage. DESIGN: A prospective cohort study. SETTING: A university affiliated tertiary medical centre. PARTICIPANTS: Two thousand one hundred and eighty-nine women delivering singletons during 40 consecutive weeks. MAIN OUTCOME MEASURES: Postpartum haemorrhage (> 500 ml), prolonged third stage (> 30 min), retained placenta (> 60 min), elevated blood pressure (systolic > 150 mmHg, diastolic > 100 mmHg). RESULTS: The rate of postpartum haemorrhage was not significantly different for oxytocin-ergometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95% confidence interval (CI) 0.75-1.61) or after the third stage (odds ratio 0.95, 95% CI 0.68-1.34). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postpartum haemorrhage, for both oxytocin-ergometrine (odds ratio 0.69, 95% CI 0.49-0.98) and oxytocin (odds ratio 0.60, 95% CI 0.41-0.87), compared with those treated after the third stage. CONCLUSION: Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention of postpartum haemorrhage, but associated with a significantly lower rate of unpleasant maternal side effects. Oxytocics administered after delivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrhage.

Adult↗
PubMed1996

Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report.

OBJECTIVE: To evaluate the outcome of late selective fetal termination based on combined data from eight tertiary perinatal centres. DESIGN: Israeli law requires institutional committee approval for pregnancy termination. Moreover, after 24 weeks only a district superior committee can approve the termination. A total of 36 bichorionic twin pregnancies who underwent selective fetal termination after 24 complete gestational weeks were identified in eight Israeli centres. RESULTS: In 23 women (63.9%) the indication for selective termination was structural anomaly, and in 13 (36.1%) the indication was chromosomal abnormality. The mean gestational age at the time of diagnosis was 24.1 +/- 1.9 weeks. The termination procedure was performed at a mean gestational age of 25.5 +/- 2.0 weeks (median 25, range 24-33 weeks). There was one case of immediate procedure-related complication (i.e. amnionitis) and the unaffected infant died, which was the only perinatal death in this series. No evidence of coagulopathy was reported. Only five women (13.8%) delivered before 34 completed weeks. The mean gestational age at delivery was 36.9 +/- 2.9 weeks (28-41 weeks), and the mean procedure-to-delivery interval was 11.8 +/- 3.2 weeks (median 13, range 3-17 weeks). CONCLUSIONS: Late (> 24 weeks) selective termination in twin pregnancies is associated with favourable perinatal outcome of the healthy twin. In countries where the law permits late pregnancy termination, the parents should be informed of that possibility.

Adult↗
PubMed1995

Biochemical corroboration of endothelial involvement in severe preeclampsia.

This prospective, nested, case-control study investigated whether elevated plasma cellular fibronectin concentrations previously reported in preeclamptic women likely reflect endothelial dysfunction. In addition to higher maternal plasma concentrations of cellular fibronectin, we found higher levels of von Willebrand factor, tissue plasminogen activator, and plasminogen activator inhibitor-1 in maternal plasma, providing biochemical corroboration of endothelial dysfunction in severe preeclampsia.

Case-Control Studies↗
PubMed1995

Plasma and placental calcitonin gene-related peptide in pregnancies complicated by severe preeclampsia.

OBJECTIVE: Our purpose was to determine the concentration of calcitonin gene-related peptide, a potent vasodilator, in maternal plasma, fetal plasma, and placental tissue from pregnancies complicated by severe preeclampsia. STUDY DESIGN: The following groups were studied: severe preeclampsia (group 1, n = 21), normal pregnancies matched for mode of delivery (group 2, n = 21), and nonpregnant women (group 3, n = 17). Maternal venous blood samples were drawn before labor, and fetal venous samples were drawn from the chorionic plate immediately after delivery. Calcitonin gene-related peptide was also quantified in placental tissue samples from 15 patients in group 1 and 15 patients in group 2. Calcitonin gene-related peptide was measured with a sensitive and specific radioimmunoassay. RESULTS: No differences were found between maternal plasma calcitonin gene-related peptide concentrations in groups 1 and 2 (29.8 +/- 4.2 and 30.4 +/- 4.3 pmol/L, respectively). Both had levels similar to those in group 3 (28.5 +/- 5.4 pmol/L). Maternal plasma concentrations in the preeclamptic group were unchanged 3 days post partum (29.1 +/- 3.6 pmol/L). Fetal plasma calcitonin gene-related peptide concentrations were similar in groups 1 and 2 (30.2 +/- 3.9 and 32.2 +/- 8.8 pmol/L, respectively). A significant correlation was found between maternal and fetal calcitonin gene-related peptide concentrations (r = 0.43, p < 0.01). Like plasma levels, calcitonin gene-related peptide levels in the supernatants of placental extracts were not different in preeclamptic and normal pregnancies (108.0 +/- 70.4 and 100.9 +/- 56.1 fmol/gm, respectively). CONCLUSION: On the basis of plasma and placental concentrations, calcitonin gene-related peptide does not seem to play an important role in the pathophysiologic mechanisms of preeclampsia.

Biomarkers↗
PubMed1995

Neonatal outcome after preterm delivery for preeclampsia.

OBJECTIVE: Our purpose was to determine whether maternal preeclampsia per se has a beneficial effect on neonatal outcome after delivery before 35 weeks. STUDY DESIGN: A matched cohort study design was used. Two hundred twenty-three infants of strictly defined preeclamptic women were matched for gestational age, race, gender, and mode of delivery with infants of normotensive women with preterm labor and delivery. Pregnancies with multiple gestation, premature rupture of membranes, known fetal anomalies, diabetes, or maternal medical disease were excluded. Information was obtained by review of maternal and neonatal charts. Paired categoric and continuous data were compared by McNemar's test and the Wilcoxon signed-rank test, respectively. RESULTS: There was no difference in the incidence of neonatal death (4.5% vs 4.5%, p = 0.82), respiratory distress syndrome (22.0% vs 22.0%, p = 0.88), grades 3 and 4 intraventricular hemorrhage (2.2% vs 2.2%, p = 0.72), grades 2 and 3 necrotizing enterocolitis (5.8% vs 4.0%, p = 0.48), and culture-proved sepsis (9.0% vs 9.0%, p = 0.85). Results were similar when analysis was limited to infants born at < or = 32 weeks, infants born to mothers with severe preeclampsia, and infants with intrauterine growth restriction. CONCLUSION: Maternal preeclampsia per se does not have a beneficial effect on the postnatal course of infants born at 24 to 35 weeks' gestation.

Betamethasone↗
PubMed1995

Low-dose, titratable interferon alfa in decompensated liver disease caused by chronic infection with hepatitis B virus.

BACKGROUND & AIMS: Interferon therapy has been associated with a number of severe side effects when administered to patients with decompensated cirrhosis caused by chronic hepatitis B. The safety and potential efficacy of a low-dose, titratable regimen of interferon alfa-2b in patients with decompensated liver disease caused by chronic hepatitis B virus infection were studied. METHODS: Twenty-six patients were treated at five medical centers. Five patients had Child's class A status, 15 had Child's B status, and 6 had Child's C status. Treatment was continued for 24 weeks whenever possible. Dose adjustments were made according to predefined safety criteria. RESULTS: All patients with Child's A status responded with a sustained loss of serum hepatitis B virus DNA, reduction in aminotransferase activity, and clinical stabilization. Only 5 patients with Child's B (33%) and no patients with Child's C status reached similar end points. The probability of survival was greater in responders than in nonresponders (P = 0.017). Three patients each developed serious infections or greater than twofold increases in serum aminotransferase levels during therapy. CONCLUSIONS: Low-dose, titratable interferon therapy is safer than previously reported regimens. Nonetheless, serious infections were observed relatively frequently, and this therapy should be reserved for individuals with mild to moderate hepatic decompensation, preferably patients with Child's A status.

Adult↗
PubMed1995

Treatment of pelvic peritoneal cysts by drainage and ethanol instillation.

We performed this study to assess the feasibility and effectiveness of ultrasound-guided drainage and ethanol instillation for the treatment of pelvic peritoneal cysts. Six women had pelvic peritoneal cysts after previous pelvic surgery; when the cysts recurred after simple drainage, the patients underwent transvaginal ultrasound-guided drainage and instillation of 20-30 mL of ethanol into the cyst cavity. All patients except one presented with abdominal pain. All cysts had clinical and ultrasonic benign characteristics. Drainage and ethanol instillation were performed successfully in all patients without severe side effects or complications. After a mean follow-up time of 13.6 months, a recurrence was found in only one patient, who was successfully retreated. These preliminary results indicate that transvaginal ultrasound-guided fluid drainage and ethanol instillation is an effective treatment for pelvic peritoneal cysts.

Adult↗
PubMed1995

Expectant management of twin pregnancies discordant for anencephaly.

OBJECTIVE: To study the clinical course and perinatal outcome of twin pregnancies discordant for anencephaly, without selective termination. METHODS: We conducted a descriptive retrospective study of 14 cases of dichorionic twin pregnancies discordant for anencephaly, which were managed expectantly in five Israeli perinatal centers. RESULTS: None of the patients miscarried. The mean gestational age at delivery was 35.9 +/- 2.8 weeks (range 29-39). Only three patients (21%) delivered before 35 weeks' gestation. Polyhydramnios occurred in six of the anencephalic amniotic sacs. Nevertheless, most occurrences were mild and none necessitated therapeutic amniocentesis. The mean birth weight of the normal fetus was 2610 +/- 690 g (range 1100-3200). One apparently normal twin had a cardiac anomaly and died shortly after birth, and one was electively delivered at 33 weeks because of severe intrauterine growth retardation and subsequently developed cerebral palsy. The rest had normal short- and long-term outcomes. CONCLUSION: Expectant management of a twin gestation discordant for anencephaly diagnosed at the second trimester is associated with a favorable outcome for the unaffected fetus.

Adult↗
PubMed1994

Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial.

OBJECTIVE: Our purpose was to determine whether aggressive or expectant management of severe preeclampsia at 28 to 32 weeks is more beneficial to maternal and neonatal outcome. STUDY DESIGN: Ninety-five eligible patients were randomly assigned to either aggressive (n = 46) or expectant management (n = 49). Aggressive management patients were prepared for delivery, either by cesarean or induction, 48 hours after glucocorticoids were administered. Expectant management patients were managed with bed rest, oral antihypertensives, and intensive antenatal fetal testing. RESULTS: At the time of randomization there were no differences between the two groups in mean systolic blood pressure (170 +/- 9.7 vs 172 +/- 9.4 mm Hg), diastolic blood pressure (110 +/- 5.4 vs 112 +/- 4.2 mm Hg), proteinuria (3.0 +/- 2.3 vs 3.6 +/- 2.3 gm per 24 hours), and gestational age (30.4 +/- 1.6 vs 30.7 +/- 1.5 weeks) for the aggressive and expectant management groups. The average latency period in the expectant management group was 15.4 days (range 4 to 36), and this period was not affected by the amount of proteinuria at randomization. There was no eclampsia or perinatal death in either group. The two groups had similar incidences of abruptio placentae (4.1% vs 4.3%) and similar days of postpartum hospital stay. The expectant management group had a significantly higher gestational age at delivery (32.9 +/- 1.5 vs 30.8 +/- 1.7 weeks, p < 0.0001), higher birth weight, lower incidence of admission to the neonatal intensive care unit (76% vs 100%, p = 0.002), lower mean days of hospitalization in the intensive care unit (20.2 +/- 14 vs 36.6 +/- 17.4, p < 0.0001), and lower incidence of neonatal complications. CONCLUSION: Expectant management, with close monitoring of mother and fetus at a perinatal center, reduces neonatal complications and neonatal stay in the newborn intensive care unit.

Adolescent↗
PubMed1994

Tumor necrosis factor-alpha in pregnancies associated with preeclampsia or small-for-gestational-age newborns.

OBJECTIVE: Our purpose was to determine the presence and concentration of tumor necrosis factor-alpha in maternal and fetal plasma in pregnancies associated with preeclampsia and small-for-gestational-age newborns. STUDY DESIGN: Maternal and fetal plasma tumor necrosis factor-alpha concentrations were measured in nonpregnant women (n = 12), women with normal pregnancies (n = 24), and women with pregnancies associated with severe preeclampsia (n = 23), small-for-gestational-age newborns newborns (n = 14), or both preeclampsia and small-for-gestational-age newborns (n = 12). Tumor necrosis factor-alpha was measured with a sensitive and specific enzyme immunoassay. RESULTS: Tumor necrosis factor-alpha was detected in 89% of the samples studied. Concentrations ranged from < 1.5 to 30 pg/ml. Similar levels were found in women with severe preeclampsia with or without small-for-gestational-age newborns, women who were delivered vaginally or abdominally in the control group, and nonpregnant women. Maternal and fetal tumor necrosis factor-alpha in the group with idiopathic small-for-gestational-age newborns were in general lower than those of all other groups. The route of delivery did not affect tumor necrosis factor-alpha concentrations in both the maternal and fetal plasma. There was a significant correlation between fetal venous and arterial plasma concentrations (r = 0.51, p = 0.01). CONCLUSIONS: Our study is the first to demonstrate a decrease in maternal and fetal plasma concentrations of tumor necrosis factor-alpha in pregnancies associated with idiopathic small-for-gestational-age newborns. This reduction may have endocrinologic importance or may reflect widespread paracrine and autocrine events. On the other hand, our findings do not support a fundamental endocrine role of tumor necrosis factor-alpha in preeclampsia.

Case-Control Studies↗
PubMed1994

Autoantibodies in sclerosing cholangitis against a shared peptide in biliary and colon epithelium.

BACKGROUND/AIMS: A strong association exists between ulcerative colitis and primary sclerosing cholangitis (PSC). Previously, the presence of a unique epitope shared by colon and biliary epithelial cells was shown by using the novel monoclonal antibody (MAb) 7E12H12 developed against a colonic epithelial protein. In the present study, the presence of circulating autoantibody in PSC against this peptide was examined. METHODS: Sera from 16 patients with PSC, 13 with primary biliary cirrhosis, 6 with secondary biliary stricture, and 6 with chronic liver diseases and 10 normal subjects were used. An inhibition immunoperoxidase assay using the 7E12H12 MAb was developed against sections of bile duct and gallbladder. Sera were also examined in an enzyme-linked immunosorbent assay (ELISA) against the gallbladder extract enriched in 7E12H12-reactive protein. RESULTS: About two thirds of the sera from patients with PSC blocked the binding of 7E12H12 MAb on the bile duct and gallbladder, whereas non-PSC sera did not. In the ELISA, 93% of PSC sera had circulating immunoglobulin G antibodies against the enriched gallbladder extract. The reactivity of sera from the PSC group was significantly (P < 0.01 to P < 0.0001) higher than in each of the non-PSC groups. CONCLUSIONS: Sera from patients with PSC contains autoantibodies against a cross-reactive peptide shared by colon and biliary epithelial cells.

Adult↗
PubMed1994

Hepatitis C in liver transplantation: preliminary study of prognostic factors.

At the University of Miami liver transplantation for chronic liver disease in HCV-positive patients has shown good results, with a 92% patients survival rate (follow up 8 to 57 months, median 21). None the less, we found that a large number of patients are expected to develop serious histological graft damage and may need retransplantation, which may place a further strain on the already scarce donor resources. We have conducted a preliminary investigation on the importance of parameters which may correlate with the prognosis of HCV grafts. We found no impact of HLA match or typing. An interesting hypothesis, which deserves further investigation, is that some HCV strains could be more virulent than others and play a role as an independent risk factor. We have identified six strains among our patients and the BK serotype shows a trend to be associated with a worse outcome. We have found that patients developing and maintaining higher liver enzyme levels (ALT and GGT) after transplant and those with higher levels of viremia may be at risk to develop serious damage to their grafts.

Adolescent↗
PubMed1994

Outpatient endometrial sampling with the Pipelle curette.

This study compares outpatient endometrial sampling using the Pipelle endometrial sampling curette with conventional dilation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with the Pipelle curette was performed in 172 and D&C in 97 women. No complications were encountered with either of these procedures. One hundred and seventy (98.8%) of the Pipelle aspirations attempted were successfully completed. Sufficient material for histological assessment was obtained in 154 (90.6%) of the women who underwent Pipelle endometrial sampling and in only 66 (68%) of those who underwent D&C (p < 0.0001). In postmenopausal women, adequate specimens were obtained in 74 of 88 (84.1%) by Pipelle and in only 22 of 48 (45.8%) by D&C. In 45 cases the histologic diagnosis of the endometrium obtained by Pipelle sampling was compared with the one of endometrium obtained by D&C or hysterectomy performed shortly thereafter. The diagnosis was identical in 43 (95.5%) cases. Endometrial sampling with the Pipelle was well tolerated causing occasionally only slight discomfort.

Ambulatory Surgical Procedures↗