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Biomedical subjects

G W Creasy

Publications and source records attributed to G W Creasy.

14 recordsLinked to original sources
PubMed1994

The effect of the oxytocin antagonist atosiban on preterm uterine activity in the human.

OBJECTIVE: The purpose of this study was to test the hypothesis that infusion of the oxytocin antagonist atosiban results in decreased preterm uterine activity in the human. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was performed. One hundred twenty women from 20 to 36 weeks' gestation with a complaint of labor who had more than four uterine contractions per hour after intravenous hydration but no evidence of cervical changes were randomized to receive a 2-hour intravenous infusion of atosiban at a rate of 300 micrograms/min or placebo. Ond hundred-twelve subjects (56 in each arm) were suitable for analysis of efficacy. Both groups remained at bed rest and received hydration. RESULTS: The mean percent decrease in contraction frequency was greater in atosiban subjects compared with controls (55.3% +/- 36.3% vs 26.7% +/- 40.4%, mean +/- SD, p < 0.001). A minimal (< 20%) decrease or an increase in contraction frequency was noted in 25 placebo subjects (45%) and seven atosiban subjects (13%). There was no clinically or statistically significant change in maternal blood pressure or heart rate during the infusion. The only adverse experiences possibly related to the drug were nausea and vomiting in one atosiban patient. CONCLUSION: A 2-hour infusion of the oxytocin antagonist atosiban resulted in a significantly greater decline in contraction frequency compared with controls. Oxytocin appears to play a role in the maintenance of preterm uterine activity in the human.

Adult↗
PubMed1992

Review of the endometrial effects of estrogens and progestins.

Several controversial areas have been reviewed. It would seem from the evidence at hand that progression from endometrial hyperplasia to endometrial carcinoma does occur in a significant percentage of women and that endometrial hyperplasia, particularly adenomatous hyperplasia and atypical hyperplasia, must be regarded as premalignant changes. Gambrell believes that all stages of hyperplasia should be regarded as premalignant. Previous and retrospective studies provide evidence implicating estrogens in the causation of both endometrial hyperplasia and endometrial carcinoma. Although some of these studies may have design flaws, the amount of data is substantial. Prospective studies have demonstrated an increased risk of hyperplasia in women treated with estrogens. An increased risk of endometrial carcinoma in estrogen users compared with nonusers has been suggested even more recently. Reviewed as a whole, the cumulative evidence provided by these studies clearly supports this association, and it would appear the only issue left to resolve may be the magnitude of the association. Cyclic administration of estrogens may decrease the risk of development of endometrial carcinoma. It would seem, however, that such administration does not totally eliminate risk under any circumstances, and in fact, a dose-related relationship appears to persist. It seems well established that progestogens do decrease the risk of both endometrial hyperplasia and endometrial carcinoma associated with the administration of estrogen to peri- and postmenopausal women. Such reduction in risk is significant and lower relative risks in estrogen/progestogen treated women have been reported compared to untreated women. This reduction in risk has been reported in a variety of studies. Whitehead and co-workers have provided a clear biochemical mechanism for progestogen protection of the endometrium in the antagonism of estrogen at the endometrial cellular level. The evidence at hand in the literature would suggest that progestogens should be administered for at least 10 days per cycle. In summary, there is good evidence that the addition of a progestin to estrogen therapy prescribed for the symptoms of menopause provides protection from endometrial hyperplasia and related carcinoma. The protection conferred is greater than that afforded by cyclical estrogen-alone therapy, and allows for continuous therapy, hereby providing greater symptomatic relief. There is little evidence for adverse effects caused by the added progestins, but further studies of women on combined therapy will undoubtedly be warranted.

Endometrial Neoplasms↗
PubMed1991

Endometrial morphology in asymptomatic postmenopausal women.

Few data are available regarding endometrial histologic features in asymptomatic perimenopausal and postmenopausal women. This study encompasses endometrial biopsy specimens obtained from 801 such women before enrollment in a multicenter study of estrogen-progestin replacement. One endometrial cancer was found (0.13%); four additional biopsy specimens showed atypia (total 0.63%). The endometrium was atrophic in 373 (46.9%), proliferative in 133 (16.7%), secretory in 54 (6.8%), and hyperplastic in 41 (5.2%). Insufficient tissue for diagnosis was obtained in 195 (24.5%). We conclude that the yield for neoplasia is so low that screening endometrial biopsy is not justified in asymptomatic perimenopausal and postmenopausal women.

Adult↗
PubMed1990

Gastric dysrhythmias and nausea of pregnancy.

Gastric dysrhythmias have been recorded from patients with a variety of nausea syndromes. The aim of this study was to measure gastric myoelectric activity in women with and without nausea during the first trimester of pregnancy. In 32 pregnant women gastric myoeletric activity was recorded for 30-45 min with cutaneous electrodes that yielded electrogastrograms (EGGs). Frequencies of the EGG waves were analyzed visually and by computer. Subjects rated their nausea at the time of EGG recording on a visual analog scale with 0 representing no nausea and 300 mm severe nausea. Gastric dysrhythmias were found in 26 pregnant subject: Seventeen had tachygastrias (EGG frequencies of 4-9 cpm), five had 1- to 2-cpm EGG waves, and four had flat-line patterns Mean nausea scores of the subjects with tachygastrias, 1- to 2-cpm, and flat-line patterns were 64.8 +/- 13, 93.4 +/- 23, and 77.2 +/- 36, respectively. Six pregnant subjects had normal 3-cpm EGG patterns, and their nausea scores averaged 2.8 +/- 1.1 (P less than 0.05 compared with nausea scores in subjects with tachygastrias, 1- to 2-cpm, and flat-line rhythms). Six subjects with gastric dysrhythmias during pregnancy were restudied after delivery; each of these subjects had normal 3-cpm EGG patterns and none had nausea. Thus, gastric dysrhythmias are objective pathophysiologic events associated with symptoms of nausea reported during the first trimester of pregnancy.

Adult↗
PubMed1985

Influence of gestational age on prediction of fetal lung maturity by fluorescence polarization of amniotic fluid.

Compared are the amniotic fluid fluorescence polarization values and the neonatal outcomes of 201 pregnant women who delivered from 28 through 37 weeks of gestation within 48 hours of the fluorescence polarization determinations. Thirty-five neonates developed hyaline membrane disease. The corresponding fluorescence polarization values ranged from 0.275 to 0.391. Eight of those 35 tests results were less than 0.325. The predictiveness of the method was studied using different threshold fluorescence polarization values. At the authors' own threshold of less than or equal to 0.325, the overall predictive value was as follows: false mature predictions: 6.2%, false immature predictions: 62.5%, sensitivity: 77.1%, and specificity: 72.8%. However, the false mature prediction rate was 21 to 40% from week 28 through week 33 versus 3.4 to 5.8% from week 34 through week 37, depending on the selected cutoff fluorescence polarization value. The sensitivity and specificity before, at, or after week 34 were significantly different at all tested fluorescence polarization values (P less than .05 to P less than .01) with the exception of the sensitivity at 0.310 and at 0.316 (P = .057). Caution is advised against relying on the fluorescence polarization method to predict fetal lung maturity at least before 34 weeks of gestation.

Amniotic Fluid↗
PubMed1985

Maternal liver hemangioma in pregnancy as an incidental finding.

The detection of an asymptomatic liver hemangioma as an incidental finding in pregnancy is presented. At the present time a significant amount of data and experience in the diagnosis of hepatic hemangioma by ultrasound and bolus-enhanced sequential computed tomography exists. Although the natural history of liver hemangiomas is not understood completely, the course of asymptomatic, small, single lesions appears to be without any significant complication. Presently the routine use of angiography in liver hemangiomas is unnecessary. Guidelines for management of the asymptomatic liver hemangioma have been suggested.

Adult↗
PubMed1984

Sensitivity and specificity of the L/S ratio in relation to gestational age.

A review of the literature was made, and 762 titles relating to fetal lung maturity were screened. From these, 195 articles or abstracts on the L/S ratio were reviewed. Five articles met the following criteria: (1) L/S ratio by the method of Borer and Gluck including acetone precipitation; and silica-gel-H plates, (2) interval of the L/S ratio to delivery of 72 hours or less, (3) exclusion of diabetics (except for one patient with an L/S ratio greater than or equal to 2 whose baby developed hyaline membrane disease (HMD) who may have been diabetic), (4) HMD well defined and documented, and (5) a breakdown of the data by gestational age. From these five articles, the sensitivity, specificity, and predictive values were calculated for less than 34 weeks, 34 to 37 weeks, and greater than 37 weeks of gestational age. The sensitivity of the L/S ratio was good regardless of gestational age. The specificity was very poor before 34 weeks, somewhat better between 34 and 37 weeks, and best after 37 weeks. The predictive value of a negative test result was moderate before 34 weeks and became excellent after 37 weeks. The predictive value of a positive test result was moderate before 34 weeks and became very poor after 37 weeks. In conclusion, after 34 weeks, an L/S ratio of 2 or greater was a reliable indication of fetal lung maturity. However, an L/S ratio of less than two was only slightly better than an accurate assessment of gestational age at predicting HMD.

Amniotic Fluid↗
PubMed1984

A zomepirac reaction mimicking ectopic pregnancy.

A case is presented of a 29-year old woman who developed sudden onset of abdominal pain, vomiting, near syncope, abdominal tenderness, profound hypotension, and a late menstrual period. The patient was in good health and her only medication was zomepirac for musculoskeletal discomfort. An exploratory mini-laparotomy was performed for the suspicion of a ruptured ectopic pregnancy, but no evidence of hemoperitoneum or of ectopic pregnancy was found. A subsequent pregnancy test was negative, and the episode was attributed to a zomepirac reaction. A review of zomepirac and zomepirac reactions is included.

Adult↗