Haemophilus influenzae amnionitis with intact membranes: a case report.
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Adolescent↗
Biomedical subjects
F H Boehm
Publications and source records attributed to F H Boehm.
Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature.
A case of a 47-year-old man with weakness secondary to ossification of the posterior longitudinal ligament is presented. During removal of the ossified ligament, the patient's dominant right vertebral artery was injured. Although the bleeding from this artery was controlled intraoperatively, the patient developed an expanding cervical hematoma on the 3rd postoperative day. An angiogram demonstrated a large pseudoaneurysm of the right vertebral artery. The patient was taken back to the operating room where the cervical hematoma was removed, and direct repair of the pseudoaneurysm of the vertebral artery was performed. The previously reported cases of pseudoaneurysms of the extracranial vertebral artery are reviewed. We advocate the use of direct vascular repair as the treatment of choice in these lesions.
Hematoma↗
Ferning of amniotic fluid contaminated with blood.
The diagnosis of rupture of the membranes by traditional methods of nitrazine paper determination and fern crystallization has been reported to be 93-98% accurate. Although the presence of contaminants in amniotic fluid has been reported to reduce this accuracy, the literature is conflicting concerning these effects. We examined the effect of blood contamination on the accuracy of diagnosing ruptured membranes. Amniotic fluid was obtained from 38 patients between 16-38 weeks' gestational age who underwent amniocentesis. Amniotic fluid was immediately mixed with freshly obtained, heparinized fetal cord blood in varying concentrations (blood to amniotic fluid 1:5, 1:10, 1:20). The slides were examined microscopically for the presence of ferning. All samples were fern-positive, but many had atypical ferns described as "skeletonized." As the concentration of blood to amniotic fluid increased, the number of atypical ferns increased (32 of 38 at 1:5, 22 of 38 at 1:10, and nine of 38 at 1:20). We conclude that the presence of blood may alter the morphology of the fern, but does not act as a contaminant that would affect the accuracy of the test.
Amniotic Fluid↗
Solubilization and identification of human placental endothelin receptor.
Endothelin-1 (ET-1) receptor was identified on the membranes from human placenta and 66% of original binding activity in the membranes was solubilized with 0.75% (w/v) CHAPS. Binding studies of the solubilized membranes using 125I-ET-1 indicated the presence of a single class of high-affinity binding sites with an apparent Kd of 760 pM and a Bmax of 1.8 pmol/mg of protein. The binding was inhibited by addition of unlabeled ET-1 and ET-3 in dose dependent manner. The Ki values of solubilized membranes were 84 pM for ET-1 and 250 pM for ET-3, whereas particulate membranes had weaker affinities (Ki = 410 pM for ET-1, 2500 pM for ET-3). Calcium channel blockers such as nicardipine, verapamil and diltiazem did not affect the binding of 125I-ET-1. Affinity labeling of the particulate and solubilized membranes with CHAPS revealed a specific binding protein with a Mr of 32,000.
Autoradiography↗
Pure human inactive renin. Evidence that native inactive renin is prorenin.
To clarify contradicting observations on the identity of inactive renin and prorenin, inactive renin was completely purified from native human chorion laeve and the culture medium of human chorion cells. A 720,000-fold purification with 14% recovery was achieved from chorion laeve in 6 steps, including immunoaffinity chromatography on a monoclonal antibody to human renin coupled to Protein A-Sepharose CL-4B. A 3,100-fold purification with 40% recovery was achieved from chorion culture medium in 4 steps, including immunoaffinity chromatography. Inactive renin purified from the two different sources migrated as a single protein band with the same molecular weight of 47,000 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and consisted of multiple components that could be resolved by isoelectric focusing. Both had the same pI values which shifted downward upon activation by trypsin; however, relative peak heights were different between the two preparations. The purified inactive renin from chorion laeve was completely inactive and did not bind to pepstatin-aminohexyl-Sepharose; however, that from chorion culture medium was partially active and completely bound to the pepstatin gel, indicating that each molecule is partially activated. Trypsin-activated inactive renins from both sources were identical with human renal renin in terms of pH optimum and Km. Specific activities of trypsin-activated inactive renin from chorion laeve and chorion culture medium were 529 Goldblatt units/mg of protein and 449 Goldblatt units/mg of protein, respectively. Amino acid sequence analysis of both of the purified inactive renin preparations demonstrated a leucine residue at the amino terminus. The sequence of 11 additional amino acids was identical in both and agreed with that predicted from the base sequence of the renin gene. These findings indicate that preprorenin is converted to prorenin following removal of a 23-amino acid signal peptide and that the native inactive renin, whose amino acid sequence commences with Leu-Pro-Thr..., is prorenin.
Amino Acid Sequence↗
Fetal blood gas analysis from cordocentesis for abnormal fetal heart rate patterns.
We present three cases with abnormal fetal heart rate patterns and cordocentesis umbilical venous blood gas analyses. Conflicting heart rate patterns and cordocentesis and postnatal blood gas analyses prompt questions with regard to abnormal fetal heart rate pattern interpretation and suggest that cordocentesis blood gas analysis aids perinatal management only as a reflection of fetal status at sampling time.
Adolescent↗
Effect of maternal heme degradation on fetal carboxyhemoglobin concentration in pregnancy-induced hypertension.
Increased red cell destruction with consequent heme catabolism results in accumulation in carboxyhemoglobin in women with pregnancy-induced hypertension. Temporally associated with this is a significant shift in the oxyhemoglobin dissociation curve to the left. In this study we assessed the relationship between carboxyhemoglobin concentration and oxyhemoglobin dissociation curve in simultaneously obtained maternal and fetal venous blood in which patients with pregnancy-induced hypertension were compared with normotensive patients. Maternal and fetal carboxyhemoglobins were significantly higher in patients with pregnancy-induced hypertension than in control subjects. Fetal carboxyhemoglobin was significantly higher than maternal carboxyhemoglobin in both clinical groups. Furthermore, maternal and fetal oxyhemoglobin dissociation curves were significantly shifted to the left in patients with pregnancy-induced hypertension compared with controls. The fetal-maternal gradient of carboxyhemoglobin was similar in both groups. The maternal-fetal gradient of oxyhemoglobin dissociation curve position was significantly reduced in pregnancy-induced hypertension. The concentrations of carboxyhemoglobin measured do not fully explain the magnitude of the shift in oxyhemoglobin dissociation curve, but the data suggest a potential impact on fetal oxygenation in pregnancy-induced hypertension.
Carboxyhemoglobin↗
A modified scheme for biophysical profile scoring.
A modified scheme for biophysical profile scoring based exclusively on real-time ultrasonographic examination is proposed and includes expanded scores of fetal movements and fetal breathing and only qualitative assessment of accelerated placental maturation, subjective ultrasonographic impression of oligohydramnios, and decreased fetal tone. This method was compared with the method of Vintzileos et al. in the first phase of this observational study and was found to have good correlation in different score categories. This method was then applied in the second phase of the study to 180 high-risk pregnancies to examine correlation with perinatal outcome variables. The relationship between results of the last total score and perinatal outcome variables shows good predictive values. Results of this preliminary study suggest that real-time ultrasonographic evaluation-based scoring of acute fetal events, namely, movements and breathing alone, may have an important role in perinatal management.
Embryonic and Fetal Development↗
Umbilical artery velocimetry as a predictor of adverse outcome in pregnancies complicated by oligohydramnios.
Oligohydramnios is associated with increased perinatal mortality and morbidity. Traditional methods of in utero fetal evaluation have been unsuccessful in reliably distinguishing oligohydramnios with normal outcome from that associated with increased perinatal morbidity. A prospective study was undertaken to establish the predictive value of Doppler velocimetry in identifying the fetus with oligohydramnios at increased risk of adverse perinatal outcome. Twenty-two gravid women with subjective oligohydramnios on ultrasound had continuous-wave umbilical artery velocimetry. Subjects were divided into two groups based on the results of Doppler analysis. Group 1 (N = 13) had normal umbilical Doppler waveforms. In this group, 12 of 13 patients had normal perinatal outcome, defined by the absence of intrapartum fetal distress or evidence of intrauterine growth retardation. Group 2 consisted of nine subjects with abnormal waveforms. Perinatal morbidity occurred in 100% in this group. We conclude that an abnormal umbilical artery waveform may provide confirmatory evidence of impending fetal compromise when the antenatal sonographic diagnosis of oligohydramnios is made.
Amniotic Fluid↗
Hydrops fetalis.
Sonography has a major role in the identification, evaluation, and treatment of the hydropic fetus. Although the prognosis of the NIH fetus is generally poor, the IIH fetus can frequently be treated effectively by transfusions performed by percutaneous needling of the umbilical vein. In addition, sonographic guidance of percutaneous umbilical vein sampling affords an accurate assessment of the etiology of NIH by facilitating karyotyping of the fetal blood.
Female↗
Treatment of dolichoectasia of the middle cerebral artery with bypass and exclusion.
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Adolescent↗
Elevated alpha-fetoprotein and a normal fetal sonogram: association with placental abnormalities.
This report documents the outcome of 25 pregnancies with elevated serum alpha-fetoprotein levels on two separate samplings despite normal anatomic appearance of the fetus on a detailed "consultative" sonographic examination. Six of these also had elevated amniotic fluid alpha-fetoprotein. All fetuses in this series were anatomically normal at time of delivery; one aborted fetus was triploid. Of the 25 pregnancies, 16 had sonographically demonstrable placental hemorrhage, eight retroplacental and eight subchorionic. One had hydropic changes in the placenta associated with triploidy. Of the subgroup of six pregnancies in which both serum and amniotic fluid values were elevated, one had a retroplacental hemorrhage, one had a subchorionic hemorrhage, and one had diffuse hydropic changes in the placenta. A control group of 112 patients with normal alpha-fetoprotein levels yielded four with small (less than 2 cm3) subchorionic hemorrhage. The occurrence rate of placental hemorrhage in women with elevated alpha-fetoprotein and normal fetus was 64%, whereas the control group of patients with normal alpha-fetoprotein had a 3.6% occurrence rate of placental hemorrhage. Sonographically detectable placental abnormalities may be associated with elevated alpha-fetoprotein in serum and/or amniotic fluid samples. Such abnormalities may occur because of fetomaternal admixture associated with placental hemorrhage and/or intraamniotic bleeding resulting from subchorionic hemorrhage.
Amniotic Fluid↗
Reassessment of White's classification and Pedersen's prognostically bad signs of diabetic pregnancies in insulin-dependent diabetic pregnancies.
The classification systems developed over 20 years ago by White and Pedersen identified diabetic pregnancies at increased risk for perinatal mortality. To assess whether these same criteria would currently be valid, 199 diabetic pregnancies with deliveries from 1977 to 1983 were reviewed. Perinatal mortality rates for White's Classes B gestational (n = 72), B (n = 27), C (n = 67), and D + F + R (n = 33) were 2.9%, 11.1%, 14.9%, and 21.1%, respectively (p less than 0.05). White's classes were also predictive of pulmonary morbidity (12.5%, 18.5%, 22.4%, and 42.4%, respectively). The presence of one or more of the prognostically bad signs of pregnancy (n = 76) increased the perinatal mortality rate to 17.1% versus 7.3% among insulin-dependent diabetic pregnancies without prognostically bad signs (p less than 0.05). The presence of any prognostically bad signs of pregnancy was also predictive of pulmonary morbidity in general (31.6% versus 16.3%, respectively) and hyaline membrane disease in particular (13.2% versus 4.1%, respectively). Thus with use of modern obstetric management and medical care of the pregnant diabetic patient, both White's classification and Pedersen's prognostically bad signs of pregnancy continue to be predictive of perinatal mortality.
Adult↗
Conservative management of a severely Rh-sensitized pregnancy.
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Adult↗
The indirectly obtained fetal heart rate: comparison of first- and second-generation electronic fetal monitors.
Fetal heart rate variability has become an essential component in evaluation of the fetus during continuous electronic fetal monitoring. Because of technical deficiencies of monitoring equipment, fetal heart rate variability may not always be available, such as during indirect monitoring of the fetus. In lieu of integration, a mathematical procedure called autocorrelation has, with the use of microprocessors, been incorporated into the fetal monitor, creating the "second generation" of electronic fetal monitoring. This study examined the accuracy of the first- and second-generation monitors by comparing simultaneously obtained indirect and direct real-time fetal heart rate data. The second-generation monitor produced an indirectly obtained fetal heart rate that was more accurate when compared with the directly obtained data than that with the first-generation fetal monitor. In addition, the variation in data from the first-generation monitor was substantially higher than that with the second-generation monitor. It is concluded that the fetal heart rate tracing from the second-generation monitor is more accurate when compared with the fetal electrocardiogram and may facilitate a truer interpretation of fetal heart rate variability than that obtained with the first-generation monitor.
Electrocardiography↗
Increased risk of endometritis and wound infection after cesarean section in insulin-dependent diabetic women.
To determine if diabetic women have an increased risk for post-cesarean section endometritis and/or wound infection, all insulin-requiring diabetic women who were delivered by cesarean section between 1977 and 1981 were compared with a group of nondiabetic patients delivered by cesarean section. Patients were divided into low-risk or high-risk groups on the basis of labor and ruptured membranes. Compared with control subjects, diabetic patients were at significantly greater risk for postoperative infectious morbidity. Among diabetic patients, risk for postoperative infections was independent of White's classification of diabetes and gestational age at delivery. The increased rate of infection among the diabetic patients suggests that prophylactic antibiotics might be efficacious for insulin-requiring diabetic patients undergoing cesarean section.
Cesarean Section↗
Advanced abdominal pregnancy associated with fetal pulmonary hypoplasia: report of a case.
Delaying delivery of a premature abdominal pregnancy may allow for fetal pulmonary maturation. Prolonged extreme oligohydramnios, however, resulting in significant pulmonary hypoplasia would frustrate any effort to wait for pulmonary maturation. Little mention of this complication is found in the literature. Therefore, two cases of abdominal pregnancy are presented, one with fetal pulmonary hypoplasia and one without. Assessing the volume of amniotic fluid is suggested when a decision is being made to deliver this type of pregnancy.
Adult↗
Transabdominal and transvaginal endosonography: evaluation of the cervix and lower uterine segment in pregnancy.
The clinical value of conventional transabdominal and transvaginal sonography (endosonography) for the evaluation of the cervix and lower uterine segment between 14 and 36 weeks' gestation was evaluated in 20 unselected obstetric patients. Sonographic evaluation of the cervix and lower uterine segment was adequately depicted in 76% with the transabdominal technique compared to 83% with the transvaginal approach. According to set guidelines, these preliminary results suggest that the transvaginal technique may be superior in obtaining an adequate evaluation of the lower uterine segment and cervix and may offer an advantage of not depending on a fully distended bladder for evaluation.
Abdomen↗