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Biomedical subjects

E Schiff

Publications and source records attributed to E Schiff.

At least 91 records · Page 5Linked to original sources
PubMed1994

Endothelin-1,2 levels in umbilical vein serum of intra-uterine growth retarded fetuses as detected by cordocentesis.

INTRODUCTION: The objective of this study was to determine whether the circulatory levels of endothelins, potent vasoconstrictor polypeptides produced mainly by endothelial cells, are increased in growth-retarded fetuses. STUDY DESIGN: Fetal venous serum samples, withdrawn by ultrasound-guided cordocentesis from 11 growth-retarded fetuses and 10 normally-growing fetuses who underwent the procedure because of other unrelated indications, were examined for immunoreactive endothelin-1,2 by radioimmunoassay. RESULTS: Higher mean endothelin-1,2 levels were found in the sera of growth-retarded fetuses than in controls (16.8 +/- 4.2 versus 10.9 +/- 4.3 fmol/ml, p = 0.008). Within the growth-retarded group, there were no differences in endothelin-1,2 levels in the presence of either abnormal umbilical Doppler, asymmetry of growth-retardation, maternal signs of preeclampsia, or fetal acidosis. CONCLUSION: High levels of endothelin-1,2 in the fetoplacental circulation may be pathophysiologically important in fetal growth retardation. However, the clinical significance of these elevated levels is yet to be determined.

Cordocentesis↗
PubMed1994

Obstetric characteristics among nulliparas under age 15.

OBJECTIVE: To describe and analyze the obstetric characteristics of adolescent women under 15 years of age. METHODS: A matched cohort design was used. The pregnancies of 261 nulliparous women under age 15 delivered at our institution between January 1990 and December 1992 were compared to 261 nulliparous controls aged 20-29, matched for race, infant gender, and year of delivery. Multiple gestation and delivery immediately after hospital admission were exclusion criteria. RESULTS: The number of antepartum admissions was identical (n = 35 in each group). There were no significant differences between the study and control groups in cervical dilatation at admission, frequency of labor induction (12.6% for each), epidural anesthesia (44.4 versus 49.4%), mean birth weight (2918 +/- 661 versus 2979 +/- 753 g), or preterm birth (24.1 versus 20.3%). Use of oxytocin was less common and magnesium sulfate more common in the adolescent group. Nevertheless, the duration of the active phase of labor and the rate of cesarean delivery were significantly lower in the adolescent group (4.5 +/- 2.7 versus 5.2 +/- 2.4 hours, P = .02; and 13.8 versus 25.3%, P = .001, respectively). The incidence of operative vaginal delivery was not different between the groups. Analysis of the data after controlling for fetal presentation, marital status, and insurance status did not alter these findings. Postpartum complications were similar. CONCLUSION: Pregnancy at the lower limit of reproductive age in an urban American population is not associated with an abnormal labor course, as is commonly believed.

Adolescent↗
PubMed1994

Conservative management of severe preeclampsia remote from term.

Traditionally, preeclamptic women who meet established criteria for severe disease are delivered expeditiously. Although delivery is always appropriate therapy for the mother, it may not be for the fetus remote from term. Two recent randomized clinical trials have demonstrated favorable neonatal outcomes after conservative management of severe preeclampsia remote from term. Nevertheless, because such management entails risk for both the mother and fetus, patients must be selected carefully. We consider women who have severe disease--by ACOG criteria for blood pressure (systolic persistently at least 160 mmHg or diastolic persistently at least 110 mmHg) or proteinuria (5 g/day or greater)--to be candidates for conservative management with close maternal and fetal surveillance. As long as maternal blood pressure can be controlled pharmacologically, maternal laboratory values are stable, and fetal biophysical profiles are normal, we manage these patients conservatively up to 34 weeks' gestation. Using these guidelines at our institution, we found that approximately two-thirds of patients with severe preeclampsia before 34 weeks were eligible for conservative management. We recommend that such management be performed only at tertiary perinatal centers.

Clinical Protocols↗
PubMed1993

Impaired binding properties of endothelin-1 receptors in human endometrial carcinoma tissue.

BACKGROUND: Endothelins, potent stimulators of smooth muscle tissue activity, were recently shown to also function as mitogens for numerous cell types. The authors investigated the properties of endothelin-1 (ET-1) receptors in human endometrial tissue compared with human endometrial carcinoma tissue. METHODS: Tissue samples from 13 patients with endometrial carcinoma and from 12 women undergoing hysterectomy due to uterus myomatous were obtained immediately after surgical removal. Binding properties of the endothelin receptors were studied using 125I-labeled ET-1. RESULTS: A significant difference was demonstrated between binding properties of ET-1 receptors of these two groups. The mean maximal density (Bmax) value of the normal endometrial samples was 2029 +/- 341 fmol/mg protein, whereas that of the neoplastic samples was 356 +/- 121 fmol/mg protein. No differences were found, however, between the mean dissociation constant (Kd) values of these groups. CONCLUSIONS: These results might be compatible with the increased blood flow that characterizes malignant endometrial tissue. However, they do not indicate an important mitogenic role for ET-1 in the development of endometrial cancer.

Adult↗
PubMed1993

Currently recommended oral regimens for ritodrine tocolysis result in extremely low plasma levels.

OBJECTIVE: Our aim was to compare plasma drug levels in patients receiving ritodrine intravenously with those in patients receiving ritodrine orally at recommended dosages. STUDY DESIGN: Plasma samples from 20 pregnant patients treated with intravenous ritodrine (50 to 300 micrograms/min), 9 patients treated with oral ritodrine only (60 to 120 mg per 24 hours), and 9 patients treated first with intravenous and subsequently with oral ritodrine were analyzed for ritodrine concentration with the use of high-performance liquid chromatography. RESULTS: Average plasma ritodrine levels of patients receiving different intravenous dosages ranged from 27.8 +/- 3.5 to 113.3 +/- 38.8 ng/ml. Levels during oral therapy ranged between 9.8 +/- 3.2 and 13.8 +/- 4.4 ng/ml. In both modes of drug delivery, concentrations were significantly correlated with doses. In patients treated first with intravenous ritodrine and subsequently with the oral form, plasma concentrations during oral therapy averaged 27.7% +/- 18.8% of those obtained during intravenous infusion. CONCLUSION: Subtherapeutic plasma concentrations might be responsible for the failure to demonstrate clinical benefits of oral ritodrine in prevention of recurrent preterm labor. A twofold to threefold increase in the maximum recommended oral dosage of ritodrine should be considered, especially for patients who had previously required relatively high intravenous infusion rates (> 100 micrograms/min).

Administration, Oral↗
PubMed1993

Fetal lung maturity is not accelerated in preeclamptic pregnancies.

OBJECTIVE: Our purpose was to determine whether there is an increased incidence of pulmonary maturity in premature fetuses of preeclamptic women compared with fetuses of matched controls. STUDY DESIGN: A matched cohort study design was used. One hundred twenty-seven strictly defined preeclamptic women who had undergone amniocentesis for pulmonary maturity assessment were matched for gestational age, race, and infant gender to nonhypertensive women with preterm labor who had undergone the same procedure. Patients with multiple gestation, ruptured membranes, diabetes, or prior glucocorticoid treatment were excluded. Lung maturity was assessed with the Lumadex foam stability index test, the lecithin/sphingomyelin ratio, and the TDx fetal lung maturity assay. In addition, the occurrence of respiratory distress syndrome was assessed in 69 of the 127 matched pairs who were also matched for mode of delivery and amniocentesis-to-delivery interval. RESULTS: There was no significant difference in the incidence of an immature result between the preeclamptic and matched control groups (39.4% vs 38.6%). Likewise, women with mild (n = 63) and severe (n = 64) preeclampsia or with small-for-gestational-age (n = 26) and appropriate-for-gestational-age (n = 101) infants, when analyzed separately, showed no differences in comparison with their matched controls. When analyzed by gestational age subgroups, no specific gestational age range was associated with accelerated maturity. The incidence of respiratory distress syndrome in the 69 matched pairs was slightly, but not significantly, higher in the preeclampsia group (relative risk 1.43, 95% confidence interval 0.94 to 2.37). CONCLUSION: This study does not support the contention that fetuses of preeclamptic women exhibit accelerated lung maturation.

Adult↗
PubMed1993

Reduction of thromboxane A2 synthesis in pregnancy by polyunsaturated fatty acid supplements.

OBJECTIVE: High-dose supplements of fish oil reduce thromboxane synthesis in nonpregnant human subjects and were therefore proposed as a means of preventing various small-vessel disorders, including preeclampsia. The effect of fish oil on thromboxane metabolism in pregnancy was investigated in our study. STUDY DESIGN: Sixteen normal pregnant women in the third trimester of pregnancy were treated with a daily ingestion of 6 gm fish oil capsules containing 1.6 gm of n-3 fatty acid. In five patients the treatment was stopped because of severe-flavored reflux and hiccups. Eleven patients completed 3 weeks of treatment. Twenty-four-hour urinary 11-dehydro-thromboxane B2 was measured by means of radioimmunoassay before and after completion of the study protocol in these 11 patients and in seven control pregnant women who did not receive the oil treatment. RESULTS: A decrease ranging from 32% to 71%, in 24-hour urinary 11-dehydro-thromboxane B2 excretion (mean reduction from 1606 pg/mg creatinine to 779 pg/mg creatinine, p < 0.001) was found among the 11 fish oil-treated women. No change in excretion was found among the control women. No maternal, fetal, or neonatal bleeding disturbances occurred, and no laboratory changes in coagulation markers were observed. CONCLUSIONS: High-dose n-3 fatty acid intake in pregnancy significantly reduces maternal thromboxane A2 synthesis. These results may provide a basis for a possible role of fish oil in managing patients at risk for preeclampsia.

Adult↗
PubMed1993

Endothelin-1 receptors in the human myometrium: evidence for different binding properties in post-menopausal as compared to premenopausal and pregnant women.

OBJECTIVE: We investigated the binding properties of the endothelin receptors in the human myometrium in clinical situations associated with different ovarian steroid levels. SUBJECTS AND METHODS: Binding properties of the endothelin receptors were studied in myometrial membranes from post-menopausal women (n = 12), myomatous premenopausal women (n = 14) and pregnant women (n = 14), using 125I-labelled endothelin-1. RESULTS: The mean (+/- SD) maximal receptor density (Bmax) was significantly higher in samples from premenopausal and pregnant women than from post-menopausal women (983 +/- 196, 1116 +/- 201 and 490 +/- 145 pmol/g protein, respectively). Receptor affinity (Kd) did not differ significantly between these groups. Among the pregnant women, mean Bmax and Kd values were similar in those who electively underwent Caesarean section prior to the onset of labour and those operated on during the second stage of spontaneous labour. Binding properties of myometrial membranes of either pre or post-menopausal women were unaffected by the presence of high levels of beta-oestradiol or progesterone in the medium. Among samples of premenopausal women, no significant difference was found in binding properties between those operated on either during mid-follicular phase or during mid-luteal phase. CONCLUSIONS: In clinical situations associated with relatively high levels of ovarian steroids, the density of endothelin receptors in the myometrium is higher than in situations associated with low ovarian steroid level. Ovarian steroids may exert their influence via the production of other mediators. Changes in density of the endothelin receptor, induced by change in ovarian steroids activity, might play a role in the regulation of myometrial contractility.

Adult↗
PubMed1993

Immunoreactive endothelins in human follicular fluid.

Endothelin levels were measured by means of [125I]endothelin-1,2,3 radioimmunoassay in the follicular fluids of 22 mature ovarian follicles of 11 patients, obtained during ovum pickup. In all but 1 of the follicles, endothelin levels were detectable and ranged between 0.2 and 3.6 pg/ml (mean 1.47 +/- 0.99). In this preliminary study, no correlation was found between follicular endothelin levels and oocyte fertilization or the hormonal ovarian response during the follicular phase.

Endothelins↗
PubMed1993

Fetal circulatory endothelin-1,2 in the midtrimester.

Umbilical-vein blood from eight fetuses who underwent cordocentesis for rapid karyotyping at 19-22 gestational weeks was tested for immunoreactive endothelin-1,2 by means of radioimmunoassay. Endothelin was detected in the serum of all but one of these fetuses. Levels of endothelin-1,2 ranged from 8.5 to 19.2 fmol/ml (mean 13.4 fmol/ml). We speculate that endothelin in the fetoplacental circulation may play a role in the regulation of fetal hemodynamics in utero.

Cordocentesis↗
PubMed1993

Endothelin-1 receptors on the human placenta and fetal membranes: evidence for different binding properties in pre-eclamptic pregnancies.

Densities and affinities of tissue protein receptor sites for endothelin-1 in placental and fetal membranes of six preeclamptic and 16 normotensive women in the 36-41st week of gestation were determined by the use of a binding assay with [125I]endothelin-1. The mean maximal density of receptor sites (Bmax) was significantly higher in the placentas of the pre-eclamptic than of the normotensive women (905 +/- 107 vs. 539 +/- 140 fmol/mg protein, p < 0.0001). No differences were found between the two groups with respect to the mean affinity (Kd) of placental receptors, or the mean Bmax and the mean Kd of fetal chorionic samples. In the normotensive group, there were no differences in mean placental Bmax values or in mean Kd values between women who went into spontaneous labor (whether delivered vaginally or abdominally) and those who were electively operated on prior to labor onset. No binding sites were detected in the fetal amniotic membranes of any of the women. Our results suggest that an increase in the maximal density of receptor sites to endothelin-1 in the placenta may play a role in the pathophysiology of pre-eclampsia by contributing to the placental insufficiency that characterizes this disorder.

Endothelins↗
PubMed1993

Patterns of unjustified pediatric hospital stay.

We examined the pattern of hospital stay in a pediatric division of a major teaching medical center in terms of justification of the hospital stay. Hospital stay days of all children admitted during 3 consecutive weeks were assessed prospectively according to predetermined criteria. Of the 2,048 hospital stay days 26% were unjustified, primarily due to unnecessary in-hospital follow-up and diagnostic evaluation that should have been carried out on an ambulatory basis. Logistic regression analysis revealed that neurological disorders and trauma, age younger than 3 years, specific ward, and the attending physician were significant predictors for unjustified hospital stay days. This method is proposed as a means for optimal reduction of redundant hospital stay and concomitant unnecessary economic burden.

Child↗
PubMed1992

Immunoreactive circulating endothelin-1 in normal and hypertensive pregnancies.

OBJECTIVE: The purpose of this study was to measure the circulatory levels of endothelin-1 in the serum of pregnant women with hypertension. STUDY DESIGN: Endothelin-1 levels were measured by means of radioimmunoassay in the serum of 26 pregnant women with hypertension (14 with pregnancy-induced preeclamptic toxemia, 12 with chronic hypertension) and in the serum of 17 control pregnant women and 18 control nonpregnant women. The mean levels in the different groups were subject to statistical analysis with the analysis of variance. RESULTS: The mean level among the women with preeclampsia (29.9 +/- 13.2 fmol/ml) was significantly higher than those of the chronically hypertensive women (16.1 +/- 7.3 fmol/ml, p = 0.002) and of the control pregnant women (19.7 +/- 9.2 fmol/ml, p = 0.011). The mean level of the control nonpregnant women (26.9 +/- 9.3) was significantly higher than that of the control pregnant women (p = 0.029). Among the patients with preeclampsia there was no correlation between endothelin-1 levels and the mean arterial blood pressure. Six to 10 weeks after delivery the mean levels of 15 studied patients (7 with preeclampsia, 8 with chronic hypertension) were similar to the levels of the nonpregnant control women. CONCLUSION: We conclude that increased endothelin-1 production may play a role in the pathogenesis of preeclampsia.

Adult↗
PubMed1992

Improved detection of antibodies to hepatitis C virus in dialysis patients using a second-generation enzyme immunoassay.

We tested serum samples from 99 patients undergoing maintenance hemodialysis for hepatitis C virus (HCV) antibodies using a first-generation, licensed anti-HCV enzyme immunoassay (EIA) and a second-generation anti-HCV EIA that detect three gene products c100-3, NS3, and core. Specimens that were repeatedly reactive by either or both screening assays were further evaluated by testing with supplemental EIAs and a dot blot immunoassay. There was 87.9% agreement between the licensed HCV EIA and the HCV EIA second generation. HCV EIA Second Generation detected 10 more positive specimens than HCV EIA, for an increase in detection from 33.3% (33/99) to 43.4% (43/99). We conclude that HCV EIA Second Generation improves detection of HCV infection in hemodialysis patients.

Adult↗
PubMed1992

Acoustic stimulation as a diagnostic test: comparison with oxytocin challenge test.

The usefulness of an acoustic stimulation test as a marker of fetal well-being was evaluated in a randomized controlled study of 121 pregnant women exhibiting a non-reactive fetal non-stress test at term. The women were randomly divided into two groups; those in the first group (n = 62) underwent an acoustic stimulation test immediately prior to an oxytocin challenge test, while those in the second (n = 59) underwent an oxytocin challenge test only. Fetal response to the acoustic stimulation was non-reactive in 22.5% of the women tested in the first group. The incidence of abnormal oxytocin challenge test among the women who were previously subjected to an acoustic stimulation was somewhat lower than among those who did not (14.5% vs. 23.7%), but the difference was not significant. In the prediction of an abnormal oxytocin challenge test, a non-reactive acoustic stimulation test had a sensitivity of 100%, a positive predictive value of 64% and a specificity of 91%. As a single test for the prediction of fetal distress in labor (n = 62), the acoustic stimulation test had a specificity and a positive predictive value similar to those of the oxytocin challenge test (n = 121), and its sensitivity was even higher (88% vs. 71%). We conclude that the acoustic stimulation test is at least as reliable as the oxytocin challenge test in the evaluation of fetal well-being in women exhibiting a non-reactive non-stress test at term.

Acoustic Stimulation↗