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Biomedical subjects

H Minakami

Publications and source records attributed to H Minakami.

At least 91 records · Page 5Linked to original sources
PubMed1997

Risks associated with cesarean sections in women with placenta previa.

OBJECTIVE: To investigate the risks associated with cesarean section performed because of placenta previa. METHODS: We retrospectively reviewed the records of 88 women with singleton pregnancies complicated by placenta previa who underwent cesarean sections and those of 176 (control) women with singleton pregnancies who required cesarean section because of complications other than placenta previa. RESULTS: The duration of gestation was 35.3 +/- 3.6 weeks for subjects with placenta previa and 36.9 +/- 3.8 weeks for the control subjects. The mean birth weight was 2,650 g +/- 75 g for infants of women with placenta previa and 2,644 g +/- 38 g for infants of the control subjects. Blood loss during surgery was greater for women with placenta previa than for the control subjects (1,154 ml +/- 924 ml vs 632 ml +/- 357 ml, p < 0.001). Blood transfusion was required in 13 of 88 (15%) women with placenta previa, compared with 4 of 176 (2.3%) of the control subjects (p < 0.001). An emergency cesarean hysterectomy was performed on 4 of the 88 (4.5%) women with placenta previa, and in none of the control subjects (p < 0.05). The Apgar score was < or = 7 at 5 minutes in 17 infants of the 88 (22%) women with placenta previa, compared with 17 infants of the 176 (11%) control subjects among infants born at > or = 33 weeks' gestation (p < 0.05); among infants with a birth weight > or = 2,000 g, the corresponding numbers were 15 (21%) and 13 (9.2%), respectively (p < 0.05). CONCLUSIONS: Cesarean section in the women with placenta previa was associated with increased blood loss, resulting in a blood transfusion rate 6.5 times higher than in the control subjects. These findings suggest that placenta previa might adversely affect the neonatal outcome.

Adult↗
PubMed1997

Fetal heart rate decelerations precede a decrease in fetal oxygen content.

To determine the relationship between abnormal fetal heart rate (FHR) patterns, fetal oxygen content by reflectance pulse oximetry, and the effects of maternal oxygen administration, 158 intrapartum women consisting of 120 women with normal FHR patterns, and 38 women with varying degrees of variable FHR decelerations were examined. A new reflectance pulse oximetry probe was attached to the fetal forehead to continuously monitor fetal oxygen saturation (SpO2) during labor. Oxygen was administered for 30 min at 5 liters/min by nasal canula in 32 women. No significant change in fetal SpO2 was seen in women with normal FHR patterns, but a significant decline in SpO2 was observed shortly before births. FHR decelerations less than 90 bpm occurred prior to the decline in fetal SpO2. Maternal oxygen administration was effective in increasing fetal SpO2 in fetuses with decreased SpO2 (SpO2 < 50%), but not in fetuses with high SpO2 (SpO2 > 60%). It is concluded that fetal SpO2 exhibits no change during normal labor but significantly declines shortly before birth, that relatively severe variable decelerations (<90 bpm) can decrease fetal SpO2, and that maternal oxygen treatment at 5 liters/min is effective in augmenting fetal oxygen tension in fetuses with decreased oxygen tension.

Female↗
PubMed1997

Elevation of the serum uric acid level preceding the clinical manifestation of preeclampsia in twin pregnancies.

To assess changes in the serum uric acid level in the third trimester of twin pregnancies, a total of 152 consecutive women with twin pregnancies were examined. Serum uric acid levels were analyzed in the women at varying gestational weeks in the presence or absence of preeclampsia. A receiver operating characteristic curve was used to determine the optimal cutoff value of serum uric acid between 30 and 31 weeks of gestation predicting subsequent development of preeclampsia. Forty-four women (29%) developed preeclampsia (preeclampsia group) at 33.2 +/- 1.9 weeks (mean +/- SD) and gave birth at 35.4 +/- 1.5 weeks of gestation. The remaining 108 women (71%) gave birth at 35.6 +/- 1.7 weeks of gestation (control group without preeclampsia). Serum uric acid levels rose gradually with advancing gestation in both groups. In the preeclampsia group, they were already increased at 30-31 weeks of gestation and corresponded to those seen in the control group at 37 weeks. The cutoff value at 30-31 weeks was 5.5 mg/dl, with a sensitivity of 73% and a specificity of 74%. These results suggest that an elevation in serum urate preceded the onset of preeclampsia. Determination of the serum level of uric acid between 30 and 31 weeks of gestation was useful for detecting a higher risk of late-onset preeclampsia in twin pregnancies.

Cohort Studies↗
PubMed1997

Hyperamylasemia in response to ritodrine or ephedrine administered to pregnant women.

BACKGROUND: Ritodrine and ephedrine can induce hyperamylasemia in pregnant women. The incidence of these beta-agonist-induced hyperamylasemias and their interaction on serum amylase activity are not known. STUDY DESIGN: Serum amylase activity was determined 12 to 24 hours after the administration of ritodrine alone (n = 140), ephedrine alone (n = 160), ephedrine and ritodrine simultaneously (n = 34), and ephedrine after prolonged (> or = 7 days) use of ritodrine (n = 101). RESULTS: A significantly higher incidence of hyperamylasemia (amylase > 215 IU/L) was seen in a group treated with ritodrine alone (60/140, 43 percent), ephedrine alone (54/160, 34 percent), or ephedrine plus ritodrine (24/34, 71 percent) compared with untreated pregnant women (21/426, 4.9 percent). There was no difference in the incidence of hyperamylasemia among the untreated pregnant women and women who received ephedrine after long-term ritodrine (8/101, 7.9 percent). Isozyme patterns, examined in 72 out of the 146 women with hyperamylasemia after such medications, indicated that salivary-type amylase exclusively was hypersecreted. CONCLUSIONS: Clinical doses of beta-agonists such as ephedrine or ritodrine induce hypersecretion of salivary-type amylase in approximately one-third of women who are pregnant. Desensitization to beta-agonists may occur after prolonged use of ritodrine.

Adolescent↗
PubMed1997

Fetal ventricular rate in case of congenital complete heart block is increased by ritodrine. Case report.

We encountered a case of fetal bradycardia (57 bpm) induced by heart block. The continuous intravenous administration of ritodrine to a mother to treat fetal brady-cardia at 28 weeks of gestation successfully increased the fetal ventricular rate by 15 bpm (from 57 to 72 bpm). Pregnancy was continued for 10 weeks, and fetal cardiac failure did not occur. The fetal ventricular rate gradually decreased to 52 bpm after discontinuation of the ritodrine infusion. It is suggested that maternal administration of ritodrine can be considered in a case of life-threatening fetal bradycardia induced by complete heart block.

Adult↗
PubMed1997

Digitalization of the mother in treating hydrops fetalis in monochorionic twin with Ebstein's anomaly. Case report.

Hydrops fetalis thought to be due to Ebstein's anomaly was seen at 22 weeks' gestation in one of two fetuses with a monochorionic placenta. Hydrops was treated with maternal digitalization and resolved by the 28th week of gestation. Hydrops did not recur while maternal digitalization continued. A clinical diagnosis of twin-to-twin transfusion syndrome required termination of the pregnancy at 33 weeks of gestation. The twin with Ebstein's anomaly died 22 hours after birth. The other twin survived and was normal at 19 months of age. Thus, administration of digitalis to the mother controlled hydrops fetalis in one fetus, and ultimately led to the survival of the healthy infant.

Adult↗
PubMed1997

Release of superoxide anion from polymorphonuclear leukocytes stimulated by rubella viral antigen-antibody complex in vitro.

Using a highly sensitive and specific chemiluminescence (CL) method, we detected the release of superoxide anion (O2-.) from human polymorphonuclear leukocytes (PMNLs) stimulated by rubella viral antigen-antibody complex (VAAC) adsorbed on latex particles. The amount of superoxide anion produced by PMNLs was proportional to the amount of VAAC. Neither rubella virus alone nor antibody alone, adsorbed on latex particles, stimulated production of superoxide anion by PMNLs. It is likely that rubella virus requires the presence of antibody in order to be recognized by PMNLs, and that the superoxide anion is somehow involved in the disease process of rubella.

Antibodies, Viral↗
PubMed1996

Reestimating date of delivery in multifetal pregnancies.

OBJECTIVE: To clarify the optimal estimated date of delivery for multifetal pregnancies. DESIGN, SUBJECTS, AND SETTING: A retrospective study of all 88,936 infants born of multifetal pregnancies and all 6,020,542 infants born of singleton pregnancies that occurred at 26 weeks or more of gestation between 1989 and 1993 in Japan. MAIN OUTCOME MEASURE: Incidence of stillbirth and early neonatal death according to gestational age at delivery. RESULTS: The mean +/- SD duration of pregnancy was 37.0 +/- 2.7 weeks for multifetal pregnancies and 39.6 +/- 1.6 weeks for singleton pregnancies. In multifetal pregnancies, the incidence of stillbirth and of early neonatal death gradually declined until 37 to 38 weeks' gestation and then increased. These parameters in singleton pregnancies declined until 39 weeks' gestation before increasing. The lowest incidence of perinatal death (Stillbirth plus early neonatal death) seen at 38 weeks' gestation in multifetal pregnancies corresponded to that seen at 43 weeks' gestation in singleton pregnancies (10.5 vs 9.7 per 1000 infants). The fist of perinatal death was more than 6 times as high for fetuses of multifetal pregnancies born at 37 weeks or later than for singleton fetuses born at 40 weeks or later (relative risk, 6.6; 95% confidence internal, 6.1 - 7.1). CONCLUSION: Fetuses of multifetal pregnancies are at an increased risk of death after reaching the normative gestational age for singleton pregnancies. Limiting the estimated date of delivery to 37 to 38 weeks may be appropriate in multifetal pregnancies.

Delivery, Obstetric↗
PubMed1996

The problem of relating fetal outcome with breech presentation to mode of delivery.

We retrospectively analyzed 546 consecutive singleton pregnancies with breech presentations that ended at > or = 36 weeks of gestation for the relationship between the intended mode of delivery and fetal outcome. Twelve patients were excluded from the analysis because these infants had major malformations. Of the 534 remaining patients, 124 (23%) were delivered by elective cesarean section. The other 410 women (77%) went into spontaneous labor. Intrapartum emergency cesarean section was required in 112 (27%) of these 410 women; the other 298 (73%) were delivered vaginally. There were 5 poor neonatal outcomes: 3 perinatal deaths and 2 cases of cerebral palsy probably due to intrapartum asphyxia. The risk of poor outcome was thus 1.2% (5/410), in the intended vaginal delivery group vs. no such outcome in the group of 124 patients that had an elective cesarean section. Three of 5 infants with poor outcome were actually born by emergency cesarean section and comparisons of results according to ultimate method of delivery rather than according to intended method of delivery may be misleading and in our case would have been biased against cesarean section.

Asphyxia Neonatorum↗
PubMed1995

Release of superoxide radicals by mouse macrophages stimulated by oxidative modification of glycated low density lipoproteins.

Diabetic patients have high levels of glycated LDL. Although glycated LDLs are implicated in the development of atherosclerosis in such patients, convincing data are lacking. We observed release of superoxide radicals (O2-) from mouse resident peritoneal macrophages stimulated by an oxidized/glycated LDL by using a highly sensitive and specific chemiluminescence method. Oxidized/glycated LDL was achieved by an addition of low concentration of Fe3+ to glycated LDL. Macrophages took up an appreciable amount of the glycated LDL oxidized by iron, leading to the development of foam cells, while they did not take up untreated glycated LDL or the native LDL. These observations clearly indicate that the oxidized/glycated LDL reacts well with macrophages. Since an oxidation of glycated LDL may occur in vivo, the oxidized/glycated LDL might play an important role in atherogenesis.

Adenosine Diphosphate↗
PubMed1995

When is the optimal time for delivery?--Purely from the fetuses' perspective.

To determine when the extrauterine environment becomes safer than the intrauterine environment with respect to fetal (neonatal) life, we analyzed all 4,896,505 livebirths, all 21,222 stillbirths, and all 7,513 early neonatal deaths after 26 weeks gestation that were recorded between 1989 and 1992 in Japan. Although the risk of early neonatal death ( < 1 week of age) and of neonatal death ( < 4 weeks of age) greatly exceed the risk of stillbirth at 26 weeks of gestation, those risks declined sharply by 39 weeks of gestation, then increased, while the risk of stillbirth within 1 and 4 weeks exceeded the risks of early neonatal death and of neonatal death at and beyond gestational weeks 40 and 38, respectively, for a singleton pregnancy. A similar reversal occurred at 37 and 35 weeks of gestation for multiple pregnancy. Neonates born at 39 and 37 weeks of gestation for singleton and multiple pregnancies, respectively, had the best outcome. It is concluded that the chance of survival for fetuses reaching 40 and 37 weeks of gestation for singleton and multiple pregnancies, respectively, were higher in the extrauterine than the intrauterine environment in Japan today.

Delivery, Obstetric↗
PubMed1995

Evaluation of latex agglutination test for alpha-fetoprotein in diagnosing rupture of fetal membranes.

To assess the utility of a latex agglutination test for alpha-fetoprotein in vaginal fluid for diagnosing rupture of the fetal membranes, we tested 91 pregnant women, including 32 with an established rupture, 19 with no evidence of rupture and 40 with a suspected rupture. Results were compared with those of the pH indicator and the fern tests. The latex agglutination test had better sensitivity, specificity, or both, than the pH indicator and the fern tests. We conclude that the latex agglutination test is more accurate than either the pH indicator or the fern test for diagnosing premature rupture of fetal membranes.

Adult↗
PubMed1995

[Clinical assessment for prognostic factors related to recurrence and progression in superficial bladder cancer].

PURPOSE: The objective of this assessment is to identify prognostic factors of recurrence and disease progression of primary superficial transitional cell carcinoma of the bladder. PATIENTS AND METHODS: TUR-Bt was performed in 150 patients with initial superficial bladder cancer, of which pathological diagnosis was pTa or pT1 transitional cell carcinoma. The recurrence and progression free survival was examined. The clinicopathological factors analyzed were as follows: grade, pT, tumor size, tumor number and tumor form. RESULTS: Median follow-up period was 39 months (range 3-184). The age distribution was from 25 to 98 years old with the average of 67. The patients were 122 males and 28 females. Recurrence was observed in 72 patients. The 5-year recurrence free rate for all cases were 41.6%. The factors found to be of significance for the prognosis for recurrence were tumor size (1 cm <) and tumor multiplicity (p < 0.01). Progression was seen in 15 patients; 8 invasive tumors, 2 lymph node metastases and 5 distant metastases. Twelve cases of those died of cancer. The 5-year progression free rate for all cases were 87.0%. The prognostic factors related to progression found in this study were G3, pT1 and sessile form (p < 0.01). There was no significant difference in recurrence free rate between cases with and without postoperative therapy; UFT p.o., ADM i.i. (intravesical instillation), ADM + Ara-C i.i. and PEP + 5-FU + Ara-C i.i. CONCLUSION: Tumor size more than 1 cm and tumor multiplicity were the high risk factors about recurrence. So were G3, pT1 and sessile form about progression.

Adult↗
PubMed1994

HELLP syndrome: CT evaluation.

Patients with the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) require careful observation and expedient delivery. However, those who develop this syndrome peripartum do not always fulfill its diagnostic criteria before labor begins. We investigated the potential usefulness of liver and spleen CT evaluation in identifying such patients. Seven patients with this syndrome were studied by CT scanning on postpartum days 0-3 and again 3-4 weeks after delivery. Although 3 patients with severe thrombocytopenia had a reduced liver-spleen CT number ratio (< 1.1) and subsequent normalization, the remaining 4 with less severe thrombocytopenia demonstrated no CT changes. Thus, antepartum evaluation of liver and spleen by CT may not be sensitive enough to detect patients who develop HELLP syndrome during the peripartum period. Serial examination of platelet counts may be more useful than CT in detecting patients at risk for this peripartum syndrome.

Adult↗
PubMed1994

[A case of Rubinstein-Taybi syndrome with bilateral vesicoureteral reflux].

The case was in a 7-month-old boy. Rubinstein-Taybi syndrome was diagnosed from the broad halluces and the characteristic physiognomy noticed since birth. He was brought to us at 7 months of age with fever as the chief complaint. Voiding cystourethrogram showed bilateral vesicoureteral reflux. The testis was palpable in the inguinal canal on either side, but could not be brought to the scrotum. No abnormalities were detected in the penis. From the above findings, he was diagnosed to have bilateral 4th degree vesicoureteral reflux and undescended testes as complicating Rubinstein-Taybi syndrome. The condition was treated by bilateral anti-reflux repair and bilateral orchidopexy at 8 months of age. There has been no recurrence of vesicoureteral reflux for 3 years. A brief discussion was made about the urological complications of Rubinstein-Taybi syndrome.

Cryptorchidism↗
PubMed1994

Active lupus and preeclampsia: a life threatening combination.

A patient with active systemic lupus erythematosus presented with generalized convulsions and acute myocardial infarction during the first trimester. Serial determinations of biochemical variables and liver histology indicated that preeclampsia might be responsible for the life threatening episodes.

Abortion, Therapeutic↗