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Biomedical subjects

J Apuzzio

Publications and source records attributed to J Apuzzio.

At least 19 recordsLinked to original sources
PubMed2001

Is routine fetal karyotyping necessary for patients undergoing amniocentesis for elevated maternal serum alpha-fetoprotein?

OBJECTIVE: The object of the study was to determine the necessity of routine fetal karyotyping in patients undergoing amniocentesis for elevated maternal serum alpha-fetoprotein (AFP). METHODS: Data were collected retrospectively on patients under age 35 who underwent amniocentesis for elevated maternal serum AFP at the University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey, between 1 January 1986 and 31 March 1995. A total of 537 patients with maternal serum AFP values greater than 2.5 multiples of the median were included in the study. RESULTS: Of 509 patients in the group with normal amniotic fluid AFP, 505 had a normal karyotype (specificity 94.9%, negative predictive value 99.2%). One of 28 patients in the group with an elevated amniotic fluid AFP demonstrated an abnormal karyotype (sensitivity 20%, positive predictive value 3.6%). CONCLUSIONS: Routine fetal chromosomal analysis of amniotic fluid amniocytes may not be necessary in patients with a normal level of amniotic fluid AFP. A fetal karyotype is recommended in those patients with an elevated amniotic fluid AFP.

Adult↗
PubMed1998

HIV resources.

Explore the source record for details and available documents.

Female↗
PubMed1996

Clinical amnionitis and endometritis in patients with premature rupture of membranes: endocervical prostaglandin E2 gel versus oxytocin for induction of labor.

OBJECTIVE: To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor. METHODS: We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. RESULTS: The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant. CONCLUSION: Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Administration, Topical↗
PubMed1992

Rates of caesarean section and neonatal mortality.

A comparison of the yearly statistics of National Maternity Hospital (Dublin) and University Hospital (Newark) was undertaken for the years 1983-1989. The findings appear to indicate that after the elimination of major confounding factors, the substantially higher rates of Caesarean section in Newark (17.5% versus 5.8%) did not bring about a measurable reduction in the rate of neonatal losses. The impact of paediatric care upon the respective neonatal outcomes could not be assessed on the ground of the reviewed data.

Cesarean Section↗
PubMed1990

[Current trends in perinatal mortality statistics at the New Jersey Obstetric Center].

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.

Humans↗
PubMed1989

The intrapartum management of the HIV-infected mother and her infant.

The number of HIV-infected pregnant women in the United States is steadily increasing. While seroprevalence rates vary widely by geography, as many as 2 to 5 per cent of pregnant women in epicenters are seropositive. Medical management of the HIV-infected woman during labor and delivery depends on the clinical stage of her disease. Many will be asymptomatic or mildly symptomatic and can be managed as usual. For others, delivery may be complicated by concomitant infections and AIDS-related conditions. Between 25 and 40 per cent of infants born to HIV infected mothers will acquire HIV infection. Transmission of HIV from mother to her infant can occur in utero, intrapartum, or postpartum by breastfeeding. Infants who escape intrauterine infection are exposed to HIV-infected maternal blood and secretions at the time of delivery. Precautions should be taken to minimize intrapartum exposure by removing blood and secretions from the surfaces and mucous membranes of the infant as soon as possible after birth. In addition, procedures that involve disruption of the infant's intact skin should be avoided when possible until maternal blood and secretions have been removed. The risk of nosocomial transmission of HIV is low (less than 1 per cent following needlestick exposure). Nevertheless, labor and delivery represent times when exposure to blood and body fluids can be anticipated. Precautions that are designed to prevent parenteral exposure and exposure of mucous membranes and nonintact skin of health care workers to blood and body fluids should be used routinely for all patients.

Allied Health Personnel↗
PubMed1984

Use of the soft, silicone obstetric vacuum cup for delivery of the fetal head at cesarean section.

Delivery of the fetal head at cesarean section can sometimes be very difficult, and serious maternal and fetal complications may occur. Recently a new soft, silicone obstetric vacuum cup was introduced for use on the fetal head at vaginal delivery. In 35 cases the cup was used for delivery of the fetal head at cesarean section. It is an effective, harmless alternative to conventional devices, especially in aiding the delivery of the high-floating head occurring spontaneously or occurring after the head impacted deep in the pelvis is dislodged.

Cesarean Section↗
PubMed1981

Clinical evaluation of gallium 67 citrate scanning in noninflammatory and nonmalignant pelvic conditions.

Gallium 67 citrate scanning has recently been introduced in the detection and localization of malignant and inflammatory pelvic processes. A total of 26 obstetrical and gynecological patients with proven benign and noninflammatory pelvic processes were injected with gallium 67 citrate and scanned. All the patients showed normal studies. Our results indicate that benign and noninfectious pelvic conditions do not show an increased uptake of gallium 67 citrate. It is concluded that the presence of a positive scan during the postpartum or postoperative period strongly suggests the possibility of infection. Benign pelvic tumors did not show an increased accumulation of the gallium 67 citrate. As a consequence an increased uptake by a pelvic mass strongly suggests the possibility of malignancy. An important observation from a clinical point of view was the absence of gallium uptake at the site of noninfected surgical incisions in the postoperative period.

Diagnosis, Differential↗
PubMed1980

Use of dermal graft in the surgical repair of vaginal vault prolapse.

The use of dermal graft in the surgical repair of vaginal vault prolapse following hysterectomy is described. This tissue offers several advantages when compared with other materials frequently used. It is homologous, readily available, and easy to obtain; it has good strength and does not provoke foreign-body reactions or infections.

Female↗
PubMed1980

Combined use of ultrasonography and gallium scanning in the diagnosis of pelvic pathology.

Ultrasonography and gallium-67 citrate scanning are two relatively new noninvasive diagnostic aids that have proved useful in the evaluation of neoplastic and inflammatory processes. These two procedures have a complementary role rather than a competitive one in the diagnosis of infections and tumors. Both procedures can be used with mutual benefit and, as a consequence, improved accuracy in clinical diagnosis may be obtained. We consider this approach to be of value in the modern evaluation of patients with inflammatory and neoplastic pelvic processes, offering new possibilities for noninvasive diagnosis and management.

Cystadenocarcinoma↗
PubMed1980

Prospective evaluation of combinations of antimicrobial agents for endometritis after cesarean section.

Two hundred and thirty-six women were studied for the development of endometritis following cesarean section. Cultures were taken of the amniotic fluid and endocervix through the internal os during the operative procedure. Of the 236 patients, clinical evidence of endometritis developed in 105. Positive cultures of the amniotic fluid or the endocervix, or both, were not helpful in predicting significant clinical infection. The patients with endometritis were treated with a combination of either clindamycin and gentamicin or cefazolin and gentamicin. All of the 54 patients, receiving clindamycin and gentamicin improved, but eight of the 51 patients in the cefazolin group failed to respond but, subsequently, improved after the administration of clindamycin. No serious toxicity was observed in either group.

Amniotic Fluid↗
PubMed1980

Unexpected gallium 67 citrate accumulation in a hernia.

Gallium 67 citrate scanning has recently been introduced in the detection and localization of neoplastic and inflammatory processes. It has proved to be accurate when used properly, but occasionally problems in interpretation of the scans may occur due to false-positive or false-negative results. The unexpected accumulation of the radionuclide within a large benign umbilical hernia from a patient with endometrial adenocarcinoma in situ is presented. Careful clinical evaluation and the need of complementary diagnostic acids when unusual accumulations of gallium 67 citrate are found, especially in areas that could represent intestines, is emphasized.

Adenocarcinoma↗
PubMed1979

The "intra-abdominal version technique" for delivery of transverse lie by low-segment cesarean section.

Cesarean section is the delivery method of choice in all shoulder presentations of viable fetuses. The classic cesarean section is usually recommended when there is a transverse lie because of the potential technical difficulties associated with extraction of the fetus when a low-segment incision is used. This paper illustrates a technique that avoids the need of a classic cesarean section and permits the use of the more desirable low-segment cesarean section. The advantages of the procedure are discussed.

Cesarean Section↗