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Biomedical subjects

I Blickstein

Publications and source records attributed to I Blickstein.

At least 91 records · Page 5Linked to original sources
PubMed1992

The accuracy of the assessment of normal fetal intestinal echogenicity--electro-optical densitometry versus the ultrasonographer's eye.

Ten plates of normal fetal ultrasonography (at 16-20 weeks' gestation) showing fluid, liver, lung, bone and intestine were submitted to electro-optical transmission surface densitometry. A distinct echogenic gradient has been found and used as an 'internal standard' to evaluate intestinal echogenicity. Intestine had significantly different echogenic properties from bone, liver and fluid but similar to that of lung. Using this echogenicity scale for fetal bowel, observers were correct in 46%, overscored in 32.6% and underscored in 21.4%. These poor results may be due to the significant inconsistency in the interpretation of each plate compared to other plates (about 65%). Although the densitometry-derived grading scale seems valid at these gestational ages, interobserver variation is too large and precludes a simple ultrasonic diagnosis of the hyperechogenic fetal intestine. Densitometric evaluation may be indicated in suspected cases when fetal bowel seems to have increased echogenicity.

Amniotic Fluid↗
PubMed1991

Safe epidural anesthesia performed during labor by an obstetrician.

One thousand seven hundred eighty-seven epidural anesthesias during labor were performed by obstetricians well trained in the technique by the anesthesiology department. The course of labor was accelerated compared to control group. Vacuum extraction rate was 11.9%. Fetal outcome was favorable. Incidence of major complications was 0.16%. We conclude that in countries where an anesthetist is not routinely available at delivery wards, a safe and efficient epidural anaesthesia could be performed by an obstetrician well trained in administration of epidural anesthesia.

Anesthesia, Epidural↗
PubMed1991

The definition, diagnosis, and management of growth-discordant twins: an international census survey.

In order to establish a protocol considering the definition, diagnosis, and management of growth-discordant twin gestations, a questionnaire was sent to 96 authors of twin-related obstetric articles. The views of the 61 responders comprise this international census survey. The data suggest that a clear cut-off value for discordancy is still needed; however, the data indirectly supported a two-grade definition, namely, mild (greater than 15% and less than 25% birth-weight disparity) and severe (greater than 25%) growth discordants. Expectant management was advocated by the majority of participants with out-patient follow-up for mild discordants, while severe discordants may preferably be hospitalized. Follow-up should be done by non-stress testing (daily - 2/wk), biophysical profile (1-2/wk), Doppler velocimetry (1/wk - bi-weekly) and sonographic biometry (bi-weekly). The opinions considering termination of pregnancy because of intertwin growth discordancy were divided; however, discordancy per se, was not considered an indication for cesarean delivery. An adapted management flowchart that summarizes the survey's data is presented and may be used as a standard for future investigations.

Birth Weight↗
PubMed1991

Cesarean delivery of the second twin after the vaginal birth of the first twin: misfortune or mismanagement?

The perinatal characteristics of 16 vaginal-abdominal deliveries of twins were evaluated. The primary indication for the cesarean delivery was compound vertex presentation (n = 4), prolapsed umbilical cord (n = 4), transverse lie (n = 7), and mentoposterior face presentation (n = 1). Ther outcome of Twin A was not different from that of Twin B. About 90% of the twins were eventually discharged on time. A significant correlation (R = 0.9722, p less than 0.0003) was found between the reported rates of combined deliveries and cesareans in twins. The data suggest that a higher rate of combined deliveries is expected in practices where abdominal deliveries are performed more often in twin gestations, while in obstetric services with low cesarean rates in twins, combined deliveries seem to be unfortunate occurrences dictated by unexpected intrapartum events.

Adult↗
PubMed1991

Influence of epidural anaesthesia on the course of labour in patients with antepartum fetal death.

The course of labour in 22 patients with antepartum fetal death who received epidural anaesthesia was evaluated as compared to 22 controls matched for parity and gestational age, who received narcotic pain relief. Both groups had similar preinduction cervical dilatation and the induction was performed by amniotomy and oxytocin infusion. The mean first stage of labour was 5.4 hours in the epidural group, and 8.7 hours in the controls (p = 0.0192). The mean cervical dilatation rate was 3.3 cm/hour and 1.0 cm/hour respectively (p = 0.0142). The second stage was similar in both groups. We conclude, that parturients receiving epidural anaesthesia may benefit both emotionally and physically from excellent pain relief and a shorter delivery process when going through the distressing experience of delivering a dead fetus.

Amnion↗
PubMed1991

Dysplastic vulvar nevi.

Of several pigmented vulvar lesions, the dysplastic nevus, a know precursor of malignant melanoma, has been described only twice. Focusing on pigmented vulvar lesions, 18 were excised among approximately 500 unselected parturients. Three lesions showed clinical and histologic characteristics of a dysplastic nevus. The patients with a dysplastic vulvar nevus were 21, 27, and 30 years old, respectively; all three had multiple torso and limb nevi and two had anamnestic features of the dysplastic nevus syndrome. Only one was aware of her vulvar lesion. All dysplastic nevi were brown or black and were larger than 5 mm in diameter. Our cases suggest that dysplastic vulvar nevi may be more frequent than previously thought. We suggest that the puerperium is a suitable time for a definite histologic diagnosis of large-size lesions with variegated pigmentary patterns and irregular borders that occur on the vulvar skin. Likewise, in other patients with suspected dysplastic vulvar nevi, excisional biopsy is recommended.

Adult↗
PubMed1991

Placental abruption associated with air travel. A case report and an overview on safety of air travel in pregnant women.

A case of placental abruption during air travel is described. None of the known predisposing factors could be demonstrated. Although it may be a true coincidence, the connection between the abruption and the flight could not be totally excluded. Safety of air travel in pregnant women is discussed, and it may be summed-up that flying is not contraindicated in uncomplicated pregnancy.

Abruptio Placentae↗
PubMed1990

Birth weight discordancy in male-first and female-first pairs of unlike-sexed twins.

We studied 153 consecutive twin pairs of unlike sex. Comparison of 71 male-female pairs with 82 female-male pairs showed similar mean twin birth weight and rate of discordance. However, males were significantly heavier (p less than 0.04) compared with females in the male-first but not in the female-first combination. The rate of female discordance was significantly higher compared with male discordance in both fetal sex combinations. It is concluded that females of unlike-sexed pairs are at greater risk to be growth discordant. Fetal sex, therefore, should be included as one of several factors that produce divergent twin growth.

Birth Weight↗
PubMed1990

Ritodrine treatment for uterine hyperactivity during the active phase of labor.

Forty consecutive patients with uterine hyperactivity, defined as either tachysystole and/or hypertonus during the active phase of vertex delivery, were treated with intravenous ritodrine (50 up to 300 micrograms/min, in 50 micrograms increments/5 min). Thirty-four patients (85%) responded within 20 min with termination of the uterine dysfunction and all (21, 52%) concomitant fetal heart rate distress signs disappeared. The treatment did not prolong labor, as this was significantly correlated to parity and cervical dilation when treatment was initiated (P less than 0.0006 and P less than 0.008, respectively). Fifteen patients were delivered by cesarean section (37.5%) mainly for cephalopelvic disproportion. Multiparas were older and had shorter ritodrine initiation-delivery intervals, but these were the only significant differences when compared to primiparas. Ritodrine is therefore suggested as an effective treatment of uterine hypercontractility dysfunction.

Adult↗
PubMed1990

"Macrosomic" twinning: a study of growth-promoted twins.

We evaluated 56 twin pregnancies representing the tenth decile of the mean twin birth weight distribution to investigate whether larger twins face the same increased perinatal risk as do macrosomic singletons. Compared with pregnancies in the ninth decile, no significant difference was found between the means of maternal age, parity, and gestational age; between the rates of presentation combinations and cesareans; or between the neonatal sex ratios. However, the incidence of growth-discordant pairs was significantly higher in the heavier group (P = .034). Compared with the general twin population, the tenth-decile group contained significantly fewer primiparas (P = .0023). Maternal obesity and diabetes were infrequent and could not explain the increased birth weight. The neonatal outcome was excellent. Although the comparison revealed insignificant differences, it is possible that the combination of higher parity, malpresentation rate, and male-to-female ratio may be operative in the genesis of large twins.

Adult↗
PubMed1990

The gynaecological problems of neurofibromatosis.

The gynaecological problems of neurofibromatosis (NF) are not well documented. The present survey of the literature defines 3 main problems, namely: clitoral, vulvar and pelvic NF. The clinical suspicion of NF would in most cases improve patient care and prevent undue procedures. There remain some important unsettled questions to be answered.

Clitoris↗
PubMed1990

Immune modulation exerted by thymic humoral factor (THF-gamma 2), on T-cell subsets and IL-2 production of umbilical cord blood lymphocytes.

The effect of a synthetic thymic humoral factor, THF-gamma 2, on the immune competence of T-cells was investigated in vitro on lymphocytes from human cord blood (UCBL). It was found that preincubation of UCBL with THF-gamma 2 caused an increase in the percentage of cells expressing the CD4 or the CD8 differentiation antigens, but did not affect the percentage of CD3 cells. The effect of THF-gamma 2 on PHA-induced IL-2 secretion was also studied and found that a 3hr preincubation with THF-gamma 2, prior to suboptimal PHA stimulation caused an increase in the IL-2 activity of the treated UCBL cultures. This effect was THF-gamma 2 dose dependent with an optimum in the range of 300-600 ng/ml and was not influenced by irradiation of the UCBL. These results indicate that THF-gamma 2, a synthetic octapeptide, modulates the immune state and response of human umbilical cord blood lymphocytes.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1990

The twin-twin transfusion syndrome.

Twin-twin transfusion syndrome is a complication of monozygotic-monochorionic twinning with serious perinatal implications. An extensive literature review revealed that our current understanding of the anatomy and pathogenesis of the syndrome has not changed over the last 3 decades. However, modern diagnostic modalities, such as sonography and Doppler studies, allow antenatal diagnosis and therefore may change the current definition of the syndrome. Based on these data, a new composite definition of the syndrome is suggested. This definition includes the following criteria: 1) sonographic signs (inter-twin differences in abdominal circumference greater than 18 mm, polyhydramnios-oligohydramnios, and signs of monozygosity), 2) Doppler velocimetry of the umbilical arteries (inter-twin difference in systolic/diastolic ratios above 0.4), 3) demonstration of a transplacental vascular shunt, 4) inter-twin birth weight difference of 15% or more, and 5) inter-twin hemoglobin difference of 5 g/dL or more. In addition, prenatal diagnosis may help in the management of this complication, and it seems that intrauterine treatment of the placental vascular anomalies may be more effective than other antenatal therapeutic options.

Female↗
PubMed1989

[Metroplasty in congenital uterine malformations].

44 women with congenital uterine malformations, aged 22-39, underwent metroplasty during a 19-year period. They constituted 7.3% of all patients with such malformations diagnosed during that period. Indications were a high rate of spontaneous abortions (78.3%), and low rates for term deliveries (9.3%) and live children (11.8%) among 163 pregnancies. The operations were tailored to the uterine malformations; some were by the abdominal route and others involved hysteroscopic resection of a uterine septum (13 cases). After metroplasty, in 52 pregnancies the abortion rate was reduced to 26.9%, and term deliveries increased to 59.6% and neonatal survival to 69.2% (for all 3, p less than 10(-8)). It is concluded that a poor obstetric history is an indication to search for uterine malformations, and that if found, there is a clear indication for metroplasty. The surgeon must know the types of malformations and should be well acquainted with the different operative techniques.

Abortion, Spontaneous↗
PubMed1989

The outcome of pregnancies complicated by preterm rupture of the membranes with and without cerclage.

Thirty-two patients with cerclage were compared to 76 patients without cerclage. All pregnancies were complicated with preterm (less than 36 weeks) rupture of the membranes (PTROM). The management following removal of the cerclage was the same for the two groups and consisted of conservative treatment unless chorioamnionitis ensued. It was found that under similar conditions and treatment there was no significant difference between the outcomes of PTROM-complicated gestations with and without a cerclage. The low added risk of cerclage to PTROM should not deter its use when indicated.

Adult↗
PubMed1989

Ultrasonic prediction of growth discordancy by intertwin difference in abdominal circumference.

Intertwin abdominal circumference (AC) and femur length (FL) differences were studied in 24 growth-discordant (greater than or equal to 15% birth weight difference) and in 32-growth concordant twin pairs delivered within 2 weeks of the last ultrasonic examination. Both groups were of similar gestational age but differed significantly in the mean twin birth weight and intertwin AC difference (P = 0.01 and P = 0.00009, respectively). A cutoff value (greater than or equal to 18 mm) for AC difference was found to discriminate significantly (P less than 0.0009) between concordant and discordant pairs with sensitivity, specificity, positive predictive value and negative predictive value of 66.7%, 78%, 69.5% and 75.7%, respectively. These data may suggest that an intertwin difference of 18 mm or more in AC effectively screens for the diagnosis of 15% or more birth weight difference in twin pregnancies.

Abdomen↗