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Biomedical subjects

J Laurin

Publications and source records attributed to J Laurin.

At least 37 records · Page 2Linked to original sources
PubMed1991

Placental morphology in relation to umbilical artery blood velocity waveforms.

The association between umbilical artery flow velocity waveforms, placental morphology and arterial vascular pattern was investigated in 30 pregnant women at risk for intra-uterine growth retardation. The blood velocity waveform was assessed in the umbilical arteries with pulsed Doppler ultrasound. Placentas from fetuses with an end-diastolic zero flow were small and thick with an extrachorial configuration, marginal cord insertion, magistral or mixed allantochorial vessel pattern and few cotyledons. The incidence and the extension of gross lesions were slightly increased in these placentas compared to placentas from fetuses with a normal S/D ratio (peak systolic velocity/minimum diastolic velocity). Placentas from fetuses with an increased S/D ratio (greater than +2SD) were large and thin with a high maximum diameter/maximum thickness ratio. Heavily smoking mothers were overrepresented in the group, with an increased S/D ratio and corresponding SGA infants. End-diastolic zero flow in the umbilical artery was strongly correlated with placental developmental abnormalities.

Angiography↗
PubMed1987

The efficacy of biochemical assays in assessing an IUGR risk-group, preselected with ultrasound fetometry.

Dehydroepiandrosterone sulphate, progesterone, estradiol, estriol and human placental lactogen (hPL) were biochemically assayed in a group of 92 pregnancies in which intra-uterine growth retardation was suspected. The group was selected with ultrasound fetometry at 32 weeks of gestation, and maternal blood was sampled at 33, 35, 37 and 39 weeks of gestation. The IUGR group consisted of 30 pregnancies resulting in the birth of an infant with a birthweight of 2 standard deviations or more below the mean for gestational age in the Malmö population. Intra-uterine growth trends were defined by serial ultrasound fetometry performed every second week. Both serum hormone and hPL content were examined in relation to birth-weight, occurrence of imminent asphyxia at delivery, Apgar score, and pH in the umbilical vein. Neither dehydroepiandrosterone sulphate, nor progesterone nor estradiol values correlated to any of the outcome variables. To some extent estriol values distinguished IUGR from non-IUGR fetuses but not until the 39th gestational week, whereas hPL was effective in this respect in all weeks studied. An hPL value below 4 mg/l predicted IUGR with a sensitivity ranging from 52% to 74%, and a specificity ranging from 85% to 78%. HPL correlated well with the subsequent intra-uterine growth rate, but not with the outcome variables studied.

Adult↗
PubMed1987

Ultrasound measurement of fetal blood flow in predicting fetal outcome.

The efficacy of fetal blood flow assessment in predicting fetal outcome was evaluated in 159 pregnancies suspected of intrauterine growth retardation (IUGR). Blood flow in the fetal aorta and umbilical vein was measured with imaging and pulsed Doppler ultrasound. Volume blood flow values and variables describing the waveform of the maximum aortic blood velocity were checked for relations to subsequent fetal outcome. A new semi-quantitative velocity waveform variable, blood flow class (BFC), was designed and tested. The occurrence of IUGR, imminent fetal distress, a low Apgar score at 1 and 5 min, and a low pH in the umbilical artery and vein were adopted to characterize fetal outcome. Receiver operating characteristic curves were used to demonstrate the sensitivity and false positive rate, and the Cohen's Kappa index was used to compare the predictive capacity of the various blood flow variables. BFC, describing the blood velocity waveform with emphasis on its end-diastolic part, was found to be the most powerful marker of imminent fetal asphyxia (Kappa = 0.66) and of intrauterine growth retardation (Kappa = 0.48).

Blood Flow Velocity↗
PubMed1987

Ultrasound screening for detection of intra-uterine growth retardation.

Intra-uterine growth retardation (IUGR) is a major problem in contemporary obstetrics. Early antenatal diagnosis is important if morbidity and mortality are to be minimized. We present the results of one years ultrasound fetometric screening for IUGR of the pregnant population in the city of Malmö. All pregnancies were dated by early biparietal diameter (BPD) measurement. From findings at 32 weeks of gestation, an IUGR risk-group (n = 436) was selected on the basis of predicted birthweight deviations with reference to standard curves, established at the Department, for BPD, abdominal diameter, femur length, and intra-uterine weight, all plotted against gestational age. The risk-group, which included 60 (77%) of the 78 IUGR infants eventually born, was subjected to additional fetometry examinations at 34, 36 and 38 weeks of gestation, in the total pregnant population of 2,068, each pregnancy was the subject of 2.3 examinations. Other fetometry variables were evaluated for their efficacy as IUGR markers, but were not found to be superior to the current screening procedure in which BPD and abdominal diameter are combined in a simple formula to assess intra-uterine growth. Overall, the screening procedure currently used at Malmö had a sensitivity of 64.1% and a specificity of 96.5%, the prevalence for IUGR being 3.8%.

Adult↗
PubMed1987

The effect of bedrest in hospital on fetal outcome in pregnancies complicated by intra-uterine growth retardation.

A prospective study was made to evaluate whether bedrest in hospital is beneficial in pregnancies where intra-uterine growth retardation (IUGR) was suspected. Diagnosis was based on routine fetometry at 32 weeks of gestation, in conjunction with general ultrasound screening. 107 patients with suspected IUGR-pregnancies were divided into two groups, 49 in a hospital bedrest group and 58 in an 'out-patient' group. Fifteen women in the bedrest group refused hospitalization, and 8 women in the out-patient group had to be hospitalized for medical reasons other than suspected growth retardation, leaving 79% of the women in their allocated group. The women in the bedrest group were hospitalized for a mean duration of 29.2 days (range 5-54). The results suggest that bedrest in hospital is not beneficial, either to fetal growth or to pregnancy outcome.

Bed Rest↗
PubMed1987

Perinatal outcome in growth retarded pregnancies dated by ultrasound.

To analyse the incidence of fetal growth retardation and its impact on perinatal mortality and neonatal morbidity, pregnancies complicated by intra-uterine growth retardation (IUGR) were compared with matched non-IUGR pregnancies. The IUGR group included all infants born in the city of Malmö during the study period and having a birthweight of 2 standard deviations or more below the mean birthweight for gestational age. The gestational age of all pregnancies was assessed with ultrasound in the first half of pregnancy. The IUGR fetuses were more vulnerable during delivery, and emergency cesarean section due to imminent fetal asphyxia was performed more frequently, but Apgar scores were similar in both groups. The frequency of respiratory disorders was lower in the IUGR group than in the non-IUGR group when corticosteroid-treated pregnancies were excluded. The IUGR group required slightly longer care on the neonatal ward than the non-IUGR group, but not more intervention. The IUGR group as a whole had an unexpectedly low neonatal complication rate, such complications as did occur being related to preterm birth rather than to growth retardation.

Adult↗
PubMed1987

Blood flow in the fetal descending aorta.

Doppler estimation of the blood flow in the descending aorta of the fetus and waveform analysis of the maximum aortic velocity provide valuable information on fetal circulation. When estimating fetal aortic flow, it is important to consider possible sources of error; even when recording the maximum aortic velocity for waveform analysis, to obtain reproducible results it is important to use a low high-pass filter, a well-defined angle of insonation, and a standardized site of measurement and to avoid periods of fetal breathing and activity. In normal pregnancy the time-averaged mean velocity in the descending aorta is stable throughout the third trimester. The weight-related flow is stable until 37 weeks, after which it falls slightly. The placental proportion of the flow in the thoracic descending aorta decreases toward term. In the aorta of normal fetuses there is positive flow throughout the whole heart cycle, which is due to the low vascular resistance in the placental circulation. The waveform of the aortic velocity can be characterized by the PI, which is stable during the last trimester of gestation. Caution is required when interpreting changes in the aortic PI, as it is not only affected by the peripheral resistance but also by the heart performance. Furthermore, PI is related to fetal heart rate. Near term different values of PI are found in different fetal behavioral states. In fetuses with retarded growth and in fetuses at distress, characteristic changes of the aortic velocity waveform have been reported by several researchers: the end-diastolic velocity diminishes and disappears, and in extreme cases a brief reversal of flow in diastole was observed. Consequently, the PI increases in such cases. The absence of the end-diastolic aortic velocity can easily be determined and is the best indicator of fetal status: in fetuses with absent end-diastolic velocity the incidence of perinatal mortality and morbidity is significantly higher than in fetuses with positive flow throughout the cycle. In pregnancies with hypertension or diabetes mellitus, normal aortic flow has been reported, as long as the fetuses were not growth retarded. In cases of severe Rh-isoimmunization, the mean aortic velocity correlates with fetal hematocrit. In hypoxic fetuses the mean velocity was reported to correlate with the degree of hypoxia, hypercarbia, and acidosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Aorta, Thoracic↗
PubMed1987

Fetal blood flow in pregnancies complicated by intrauterine growth retardation.

A noninvasive pulsed Doppler ultrasound technique was used to characterize blood flow in the descending thoracic aorta and the intra-abdominal part of the umbilical vein in 159 fetuses suspected of intrauterine growth retardation (IUGR) on the basis of ultrasound fetometry. From this group, 74 infants with IUGR (defined as gestational age-related birth weight of 2 standard deviations [SD] or more below the population mean) were born. The blood flow results were not available to the clinicians managing the pregnancies. Blood flow mean velocity in the fetal aorta was lower, pulsatility index and rising slope higher, and umbilical volume flow and umbilical flow per 100 g placental tissue were lower in the pregnancies with IUGR than in 21 normal pregnancies. The waveform of the maximum aortic velocity envelope was related to operative delivery for fetal distress, Apgar score, and umbilical cord blood pH. The pulsatility index and the configurational assessment of the diastolic part of the waveform were combined to form a new concept, the blood flow class. The blood flow class was abnormal in 57% of the fetuses classified as having IUGR at birth and in 93% of those growth-retarded fetuses who subsequently developed signs of fetal distress requiring operative delivery. Waveform analysis, in terms of blood flow class, seems to be a useful tool in the surveillance of fetuses when IUGR is suspected. Abnormal blood flow class is a marker of fetal distress and probably gives an earlier indication than antenatal nonstressed cardiotocography. The results of this study point to a strong association between IUGR and impaired fetal blood flow. The aortic volume blood flow, unlike waveform analysis, does not seem to be a variable sensitive enough to predict fetal outcome in the individual pregnancy.

Aorta, Thoracic↗
PubMed1987

[Contribution of pulmonary gallium scintigraphy to the diagnosis of pulmonary tuberculosis].

Radioisotope scanning of the lungs with gallium 67 was performed in 13 patients whose radiological images were suggestive of pulmonary tuberculosis. The purpose of the study was to assess the value of that method as a complement to bacteriology in active pulmonary tuberculosis. Provided the lung tissue is not totally destroyed, gallium 67 is strongly taken up by the tuberculous lesions. However, scanning cannot be regarded as a routine examination, as it is costly and delivers a non-negligible dose of radiations. All it can do is to serve as a guide for more invasive investigations.

Adult↗
PubMed1986

[Dynamic bone scintigraphy in osteoarticular pathology].

Three-phase radionuclide bone scanning was performed in patients with algodystrophy or osteonecrosis. This method is used to improve the specificity of ordinary bone scan. It explores vascularization and blood pool, then bone uptake in two symmetrical articulations. Non-focal hyperaemia and late diffuse uptake are in favour of algodystrophy, whereas a distinct focal hypervascularization and late uptake predominant in the femoral condyle area seem to be in favour of pre-radiological osteonecrosis.

Arthritis↗
PubMed1986

Circulatory changes in fetuses with imminent asphyxia.

Blood flow was measured in 11 term fetuses who were later delivered by means of emergency caesarean section because of cardiotocographic changes indicating imminent asphyxia. Blood flow was recorded in the fetal descending aorta and in the intraabdominal part of the umbilical vein by combined real-time and 2-MHz pulsed Doppler ultrasound method. In all 11 fetuses, the waveform of the maximum aortic blood velocity was changed in a typical way with elimination of the diastolic flow (zero flow). In 4 of the fetuses, a short-lasting reversal of the diastolic flow occurred. In 5 fetuses, the pulsatility index of the aortic flow was increased, and the aortic volume flow was pathologically low in 3 fetuses. In the umbilical vein, the volume flow was within normal limits in all cases. The umbilical flow, which normally is continuous and nonpulsatile, showed heart-synchronous pulsations in 3 of the fetuses. The typical changes in the aortic diastolic flow occurred 1-3 days before the onset of the cardiotocographic changes. This suggests that the changes in the fetal aortic blood velocity might be a clinically useful early sign of imminent asphyxia.

Amniotic Fluid↗
PubMed1985

Some notions about assumptions underlying health education.

By definition, the objective of health education is to change health behavior. One assumption underlying this objective is that changed health behaviors will result in improved health status. Both the objective and its assumption are based largely on experience with acute health problems. However, health education is now changing its focus towards chronic diseases. This paper examines a number of chronic disease health education studies. Investigation reveals that although there is often an improvement in health status, the associations between changed health behaviors and improved health status are not clear and at times do not appear to exist. In light of this evidence, the authors suggest that there is, in some cases, a need to reevaluate the assumptions that underlie health education and a need in health education programs to study factors other than, or in addition to, behavior change as mediators of health status.

Behavior↗
PubMed1984

Arthritis self-management. A five-year history of a patient education program.

There are several lessons to be learned from the ASM experience. First, and most outstanding, is the willingness of large numbers of people across the United States to participate in both the ASM course and the research. Second, we have found that lay leaders can be trained to offer a rather complex arthritis course. They have proved to be reliable and, most important, are acceptable to the public and most health professionals. When their acceptance has been questioned, it is usually by persons with little or no experience with either the course or the lay leaders. Third, a national organization, in this case the Arthritis Foundation, has been able to disseminate the course widely and, to some extent, to conduct evaluations. From the national evaluation experience, we have learned that local areas are much more interested in service than evaluation and almost too readily accept an unproven yet hopeful arthritis education program. However, this acceptance of a new innovation before thorough testing is no different than that seen with other new medical technologies from medication to coronary bypass. Finally and most intriguing, we have found that such standard arthritis treatments as exercise and relaxation seem to directly contribute only slightly to the reductions in pain experienced by ASM participants. This unexpected lack of correlation has led us to begin studying other mediating factors such as self-efficacy, depression or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Treatment of urinary tract infections in gynecological patients. A randomized study comparing pivampicillin-pivmecillinam with trimethoprim-sulphamethoxazole.

Eighty-two gynecological patients with clinical signs of a lower urinary tract infection (UTI) were randomized to 10 days' treatment with either a fixed combination of pivampicillin-pivmecillinam (PAPM) or trimethoprim-sulphamethoxazole (TMPS). The effect of treatment could be evaluated in 25 patients on PAPM and in 19 on TMPS, who had bacteriologically verified UTI and who completed treatment and check-ups. All strains were sensitive in vitro to the respective antibiotic combination used. Treatment eradicated the original pathogen in 75-80% of the cases, 64% of the patients on PAPM and 47% on TMPS having sterile urine 3 weeks after end of treatment. Side effects could be evaluated in 76 patients. Two patients on PAPM and 8 on TMPS had to discontinue treatment due to side effects. Including abnormal values for hematology, liver and renal parameters, significantly fewer side effects (p = 0.038) were noted on PAPM (7/40) than on TMPS (15/36).

Adolescent↗
PubMed1982

Pelvic infection after elective abortion associated with Chlamydia trachomatis.

Two groups in Denmark and Sweden, totalling 943 healthy women in the first trimester of pregnancy who were undergoing elective abortion, were examined in a prospective study. Group 1 consisted of 432 women from Denmark, all examined prior to and 2 weeks after the operation. At the first examination, samples were taken from the cervix for the isolation of chlamydiae and gonococci. Chlamydia trachomatis was isolated from 23 (5.3%) of the women. Postoperatively, 15 patients developed acute pelvic inflammatory disease (PID). Five of these patients harbored C trachomatis before the operation, and all 5 developed a significant change in the titer of immunoglobulin G microimmunofluorescence antibodies to the organism. In group 2, 25 (4.9%) of the 511 women from Sweden harbored C trachomatis before the intervention. Patients with chlamydiae were treated, before or in conjunction with the operation, with antibiotics active against chlamydiae. None of the women with cultures positive for chlamydiae showed signs of PID postoperatively. The difference in the postoperative frequency of PID in chlamydia-positive patients between groups 1 and 2 was significant (2P = .0393, Fisher exact test). Gonorrhea was diagnosed in 1% of the women in both groups. Only 1 of these patients developed PID postoperatively, but no pili antibodies to Neisseria gonorrhoeae were found during the course of the disease. It is concluded that women applying for abortion should be examined and treated not only for gonorrhea but also for infection with C trachomatis either before or, at the latest, in conjunction with the abortion.

Abortion, Induced↗