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Biomedical subjects

I Blickstein

Publications and source records attributed to I Blickstein.

At least 73 records · Page 4Linked to original sources
PubMed1994

External cephalic version after previous cesarean section--a clinical dilemma.

OBJECTIVES: To describe our limited experience with external cephalic version from breech to vertex presentation at term, with the use of ritodrine tocolysis, in women who had undergone a previous cesarean delivery. METHODS: Eleven parturients after previous cesarean delivery underwent external version after 36 gestational weeks, utilizing tocolysis with ritodrine, after excluding cases of low-lying placenta, severe oligohydramnion or ruptured membranes. Patients were then followed until delivery and scar examination was carried out after vaginal delivery, or at re-cesarean section, according to mode of delivery. RESULTS: All 11 attempted versions were successful. Six patients subsequently delivered vaginally and five by re-cesarean section. None of the uterine scars showed any signs of dehiscence. Three of the five infants delivered by re-cesarean section weighed over 4000 g, whereas all of the vaginally-delivered infants weighed under 3500 g. CONCLUSIONS: External cephalic version to vertex presentation after previous cesarean section was successful in all 11 carefully selected patients. No untoward effects were noted, and no signs of scar dehiscence were found. The safety and efficacy of this procedure after previous cesarean delivery should be examined further.

Adult↗
PubMed1994

A prospective randomized clinical trial comparing a new oral sustained-release ritodrine with conventional tablets.

OBJECTIVES: Evaluation of maternal metabolic and cardiovascular responses to treatment with the new sustained-release oral ritodrine as compared with the conventional tablets. METHOD: Thirty-two pregnant patients who had successful intravenous tocolysis were randomly assigned to treatment with either ritodrine tablets or sustained-release capsules. After 5 days of the randomly determined first oral treatment each patient was shifted to the alternate ritodrine formulation for a further 5-day course. Each patient underwent metabolic and non-invasive hemodynamic evaluation. RESULTS: Echocardiographic parameters during treatment with ritodrine tablets were not significantly different from during sustained-release capsules. Mean systolic blood pressure increased significantly during peak drug activity in patients treated with ritodrine tablets and not during treatment with the sustained-release form. Fasting plasma glucose levels were higher in patients on conventional tablets therapy than in patients on sustained-release ritodrine therapy (88.9 +/- 9 mg/dl vs. 78.7 +/- 8 mg/dl, P < 0.05) while levels following a 50-g oral glucose challenge test did not differ significantly (135 +/- 32 mg/dl vs. 124.5 +/- 27 mg/dl) CONCLUSIONS: Because of fewer metabolic and cardiovascular side-effects, the new oral therapy offers some advantages over the presently available tablets.

Administration, Oral↗
PubMed1994

The relation between different system gain settings and the accuracy of densitometric assessment of echogenicity.

Two mathematical transformations of the measured density of a sonographic image of the fetal liver were used in 19 patients at nine different system gain settings (G) (optimal G number [dB] and optimal G number +/- 2, +/- 4, +/- 8, +/- 12). A significant correlation was found between the film-corrected density (Dcor) and gain interval from the optimal gain (Dcor = 1.39-0.052 [G interval], R = -0.81, P < 0.00001, 95% confidence limits = -0.052 +/- 0.052). After standardization of the values to the arbitrary G number of 49 (Dcor 49), a gain-independent convergence of the values was found. In 79% of the 19 cases the accuracy of the method was very high, as estimated from a small coefficient of variation. No significant difference was found in comparing the mean standardized densities derived from paired measurements (i.e., optimal G number +/- 2, +/- 4, +/- 8, and +/- 12). The data support background assumptions for the quantitative assessment or echogenicity by transmission densitometry and provide highly confident accuracy estimates.

Densitometry↗
PubMed1994

The first-trimester growth-discordant twin: an ominous prenatal finding.

OBJECTIVE: To evaluate the clinical significance and the natural course of discordant twin growth found during the first trimester of pregnancy. METHODS: This was a retrospective survey between 1992-1993 of women presenting to the ultrasonographic unit with twin pregnancies in which considerable interfetal size variation was noted in the first trimester. Discordant embryonal growth was defined as a difference in crown-rump length corresponding to 5 or more days in the estimated gestational age. Only cases that presented with continued viability of both twins were reviewed. Cases were thoroughly followed by ultrasound examinations throughout pregnancy. Neonatal records provided the outcome data. RESULTS: Five cases with first-trimester discordant twin growth were identified. All had complications of major congenital anomalies in the smaller twin, ie, diaphragmatic hernia, ventriculomegaly, schizencephaly, critical aortic atresia, and sacral agenesis. CONCLUSIONS: The first-trimester growth-discordant twin is at increased risk for congenital anomalies. Meticulous sonographic search for congenital anomalies is indicated when inter-twin size variation is evident in the first trimester.

Adult↗
PubMed1993

Successful delivery following myocardial ischemia during the second trimester of pregnancy.

Acute myocardial infarction during pregnancy is considered to be associated with approximately 50% mortality of both mother and fetus. However, there are not enough data regarding the role of acute myocardial ischemia. We present a 36-year-old, pregnant, white female who was admitted twice at 18 and 20 weeks of gestation with acute myocardial ischemia. Cardiac catheterization revealed 70-80% stenosis of the mid left anterior descending artery (LAD) with normal antegrade flow and very good retrograde filling of the LAD from distal collaterals of the right coronary artery. Therefore, due to angiographic suggestion of protected LAD territory, we recommended medical therapy and scheduled a vaginal delivery that was successfully completed without cardiovascular complications. A stress thallium test performed 6 months later was normal, supporting our clinical judgment. In conclusion, every case of a pregnant woman with coronary insufficiency should be treated according to individual coronary anatomy and blood supply to the territory of the diseased artery, and should not be based on the old data in the literature. The decision for revascularization prior to delivery versus medical therapy, or Caesarean section versus natural delivery, should be made by a team of a cardiologist and an obstetrician.

Acute Disease↗
PubMed1993

Localization of estrogen receptors in long bones and vertebrae of human fetuses.

In order to investigate the possible role of estrogen in the development of cartilage and bone we studied by immunofluorescence immunohistochemistry and autoradiography 26 human embryos and fetuses 7-22 weeks in gestational age associated with pregnancy interrupted for non-medical reasons. In order to demonstrate the presence of estrogen receptors (ERs) in human fetal cartilage, cryostat sections of long bones and lumbar and thoracic vertebrae were prepared for (1) fluorescent immunocytochemistry using an antiidiotypic monoclonal antibody to anti-estradiol receptor monoclonal Ab labeled with fluorescein isothiocyanate (FITC), (2) immunohistochemistry using monoclonal antihuman estradiol receptor antibody, labeled with strept. A-B immunoperoxidase, and (3) autoradiographic localization of estradiol using labeled (3H) 17 beta estradiol. In fetuses aged 10 weeks or older, intranuclear and perinuclear localization of ER was demonstrated by all methods, mainly amongst chondrocytes of the proliferating and higher hypertrophic zones of the epiphyses and in the cartilage of vertebral bodies. These data suggest that estrogen acts directly on chondrocytes of human fetuses through an ER-mediated mechanism.

Antibodies, Monoclonal↗
PubMed1993

The influence of birth order and presentation on intrauterine growth of twins.

In order to evaluate the influence of birth order and fetal presentation on antenatal growth of twins we conducted a comparison of prospective measurements of five fetal biometric indices in 50 vertex-vertex and 47 vertex-breech twins. We compared (a) twin A to twin B in both groups; (b) the second and (c) the first twins of both groups. Both groups had similar maternal and neonatal characteristics. The growth curves of the twins were also very similar except for three significant (p < 0.05) deviations: (a) Twin A of the vertex-vertex group, had larger femur length (FL) at 18-19 weeks, abdominal circumference (AC) and estimated fetal weight (EFW) at 29 weeks, and EFW measurements at 36 weeks. (b) Second breech twins, compared to their second vertex cohorts, had significantly smaller biparietal diameter (BPD), head circumference (HC) and FL at 18-19 weeks, BPD and HC at 29 weeks, and EFW at 37 weeks. (c) First twins of the vertex-breech group, as compared to first twins of the vertex-vertex group, had significantly smaller BPD and AC at 18-19 weeks, FL and AC at 21-22 and 29 weeks, FL at 31 weeks, and EFW at 27-28 and 36 weeks' gestation. We concluded that significantly different sonographic fetal indices may be measured at about 20 and 30 weeks' gestation, but not later. An adaptive mechanism attributed to fetal presentation is suggested to explain similar birthweights in spite of these antepartum differences.

Adult↗
PubMed1993

Persistent discordant twin growth following IVF-ET.

We observed persistent first trimester growth disparity in a twin pregnancy following IVF-ET. The crown-rump length of the two fetuses was substantially different at 7 and 11 weeks and from the 20th week discordant growth was observed by intertwin differences in abdominal circumferences and estimated fetal weights. Birth weight discordance was 26.6% (1600/2180). This is apparently the first documentation of first trimester growth discordance persisting throughout pregnancy.

Adult↗
PubMed1993

Age distribution of erythrocyte population in women with twin pregnancy.

An evaluation of the age distribution of erythrocytes in twin gestation was performed. Based on previous studies on age distribution of erythrocytes in late pregnancy, we have proposed that a more pronounced shift in age distribution of erythrocytes in twin pregnancy may be expected. We have used the density distribution of cells method for evaluation of age distribution of erythrocytes in women with twin pregnancies. Control curves for pregnant and nonpregnant women were obtained from our recently published studies. The cumulative density distribution of cells curve of erythrocytes of women with twin gestation was evidently shifted to the right as compared with the curve of erythrocytes of women with single gestation. The shift in age distribution of erythrocytes may suggest that erythrocytes in women with twin gestation have a shorter life span as compared to the life span of erythrocytes in women with singles. The age distribution shift of erythrocytes in women with twin gestation may be attributed to human placental lactogen augmentation of erythropoietin action.

Adult↗
PubMed1993

Quantitative assessment of sonographic image echogenicity by transmission densitometry: fetal liver model.

A mathematical method is proposed to compare density values of different sonographs of the same tissue. Two transformations were needed: (1) calibration of the gray scale according to the maximal range of scanning for a given tissue, and (2) comparison of the effect of two time-compensated gains on the difference in density and standardizing this effect to an arbitrary gain. To verify these relationships, 12 fetal livers were scanned at 38 weeks' gestation, at three different gains corresponding to the optimal gain and to the minimal and maximal gains that allowed a clear image to be obtained. After the mathematical transformations, the initially completely different densities were nearly identical (t-test: P = 0.9998; Wilcoxon test: P > 0.5; Pearson's R = 0.8933). This method permits an accurate quantitative assessment of the echogenicity of any parenchymatous organ.

Densitometry↗
PubMed1993

Vaginal delivery of breech-vertex twins.

The safety of vaginal birth for breech-vertex twins has not been addressed directly before. We retrospectively compared the perinatal outcome of two groups of breech-vertex twins: 24 delivered vaginally and 35 delivered abdominally. Vaginal delivery was allowed under the same protocol developed for singletons in breech presentation. Both groups had similar maternal and neonatal characteristics except for a significantly higher rate (P = .003) of pregnancies after infertility in the abdominal delivery group. Intergroup differences in perinatal outcome, as measured by Apgar scores and morbidity and mortality cases, were not significant. Our data suggest that if measures for safe vaginal delivery are taken, this route appears to incur no morbidity and mortality for breech-vertex twins.

Adult↗
PubMed1993

The accuracy of endometrial Pipelle sampling with and without sonographic measurement of endometrial thickness.

OBJECTIVE: To evaluate the accuracy of Pipelle endometrial sampling with and without sonographic measurement of endometrial thickness. METHODS: We studied prospectively 176 consecutive patients (23% after and 77% before menopause) scheduled for D&C. Sonographic measurement of the endometrium and endometrial biopsy with the Pipelle were performed before the curettage. RESULTS: In 159 cases (90%), the endometrial histologic results of curettage agreed with those of the Pipelle biopsy. All three cases of endometrial cancer were identified by Pipelle aspiration. In seven cases (4%), the Pipelle aspiration failed to detect hyperplasia. Sonographic endometrial thickness of more than 5 mm slightly increased the sensitivity and slightly decreased the specificity of Pipelle aspiration from 82 to 92% and from 99 to 96%, respectively. In postmenopausal patients admitted for bleeding, the sensitivity and specificity reached 100%. CONCLUSIONS: Our data suggest that normal Pipelle aspirates in premenopausal patients with abnormal uterine bleeding are highly accurate. In postmenopausal patients with sonographic endometrial thickness of 5 mm or less, the accuracy reached 100%.

Adult↗
PubMed1992

Self-induced abortion--the peril is still real.

A new immigrant from Romania tried to induce abortion by intrauterine self-administration of hypertonic sucrose at 7 weeks' gestation. Complete abortion did not occur and bleeding, infection and pregnancy residua persisted for 13 weeks. Evacuation by uterine curettage had failed, but a second curettage under real-time sonographic guidance was successful. Self-induced chemical abortions are rarely encountered in modern medicine. However, elevation of the iron curtain and mass immigration may increase the frequency of self-induced abortions in Western countries. Since the management, course, and outcome of each type of self-induced abortion are somewhat different, the pertinent differentiation is between chemical and mechanical and between various agents used for chemical-induced abortions. Mechanical abortions are best treated 12 to 24 hours after antibiotic therapy, while in chemically-induced abortion early evacuation of the uterus is indicated.

Abortion, Induced↗
PubMed1992

Interrupted extra-ovular infusion may not be reversible.

Late abortion ensued 9 days after discontinuation of extra-ovular PGE2 infusion for mid-trimester termination of pregnancy in a 15-year-old unmarried primigravida. This observation, which has no precedent in the literature, may suggest that once extra-ovular PG infusion has been started, its discontinuation may not be considered reversible.

Abortion, Induced↗
PubMed1992

Perinatal outcome of twin pregnancies complicated with preeclampsia.

Twenty-five mild and 19 severe preeclampsia cases in twin pregnancies (12.5%) were compared to 44 matched for gestational age controls. All three groups were similar with respect to maternal age, intertwin birthweight differences, and rates of abdominal deliveries and low (less than 7) 5-minute Apgar scores. The frequency of primiparas in the severe preeclampsia group was significantly higher compared with controls (p less than 0.03). Severe preeclampsia patients delivered at a significantly earlier gestational age (p less than 0.005) and had a significantly lower mean twin birthweight (p less than 0.003) compared with the mild preeclamptic group. The mean twin birthweight of the severe preeclamptic cases was also significantly lower compared with that of controls. All three neonatal deaths occurred in severely discordant second twins born to severe preeclamptic patients. It is concluded that adverse perinatal outcome is associated with severe but not with mild preeclampsia in twin gestations.

Adult↗