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Biomedical subjects

J M Thorp

Publications and source records attributed to J M Thorp.

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

Prenatal diagnosis of renal agenesis in a twin gestation.

Bilateral renal agenesis is a lethal congenital anomaly. It appears to be transmitted in a polygenic pattern. The prenatal ultrasound findings consist of severe oligohydramnios, absence of the fetal bladder, and failure to identify fetal kidneys. Twin gestations with renal agenesis have been described in the paediatric literature. We detail a case of a patient with two prior affected pregnancies with bilateral renal agenesis. Her latest pregnancy was diagnosed prenatally, with one fetus with bilateral and the other fetus with unilateral renal agenesis. The ultrasound findings should be differentiated from the stuck twin phenomenon.

Adult↗
PubMed1994

Endometrial carcinoma arising within extensive intrauterine synechiae.

In patients with intrauterine adhesions severe enough to produce amenorrhoea, biologically active endometrium can undergo malignant change. To our knowledge, this is the first reported case of endometrial carcinoma arising within intrauterine synechiae. A 71-year-old woman receiving unopposed estrogen developed post-menopausal bleeding. At endovaginal sonography we detected a polypoid mass. Extensive intrauterine synechiae within the uterus were noted during hysteroscopy, and a polypoid lesion was seen adjacent to a synechia. Biopsy demonstrated endometrial adenocarcinoma arising from a synechia. Hysterectomy and bilateral salpingo-oophorectomy were performed. A well-differentiated adenocarcinoma of the endometrium was demonstrated. Asherman syndrome and endometrial adenocarcinoma can exist simultaneously. In such cases, hysteroscopy is essential for diagnosis of synechiae and for target biopsy.

Adenocarcinoma↗
PubMed1994

Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment.

OBJECTIVE: Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers. STUDY DESIGN: In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks' gestation. Women with positive cultures were treated with intravenous antibiotics in labor. Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status. RESULTS: During the first 2 years of this protocol 1681 women were delivered. Forty percent of the women were from the private practice, 32% were black, and 62% were married. The group B streptococcal carriage rate was 14%. During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics. CONCLUSION: We found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

Ampicillin↗
PubMed1994

Assessments of laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To assess laparoscopic-assisted vaginal hysterectomy (LAVH) by operative intervention, recovery time, morbidity, and patient satisfaction. DESIGN: A retrospective, cohort study conducted from 1990 to 1992. SETTING: Two community hospitals. PATIENTS: One hundred seventy-eight women thought to require abdominal hysterectomy. INTERVENTIONS: Three gynecologic surgeons performed the LAVHs. For each case, several features were tabulated and final pathologic diagnoses were recorded. Patient satisfaction was measured by survey. Data were divided into three time epochs, early, middle, and late, and the outcomes were compared. We also measured the impact of LAVH on th number of abdominal hysterectomies. MEASUREMENTS AND MAIN RESULTS: The mean operative time was 119.4 minutes (SD 34.1 min). The mean uterine weight was 153.4 g (SD 100.3 g), and only 29 patients (16.3%) had no pathologic condition. The mean length of hospital stay was 1.3 days (SD 0.92 days) and diminished over the 2 years of the study. Mean hemoglobin decrement was 2.6 g (SD 1.2 g). Thirteen patients had complications other than febrile morbidity and seven had febrile morbidity, for an overall complication rate of 11.2% There were no significant differences in blood loss, complication rate, uterine weight, or operative time among the three epochs. One hundred thirty-two patients (73.0%) responded to the survey and expressed high satisfaction. The proportion of hysterectomies performed abdominally diminished over the course of the study. CONCLUSIONS: Morbidity associatd with LAVH was similar to that reported for vaginal hysterectomy. The lack of controls precludes knowing whether patient satisfaction was related to type of procedure. Randomized, controlled trials of women not considered candidates for vaginal hysterectomy are necessary to assess this procedure.

Adnexal Diseases↗
PubMed1994

Postpartum myocardial infarction in a patient with antiphospholipid syndrome.

Myocardial infarction in association with pregnancy in patients with the antiphospholipid syndrome has been reported once previously. Our patient, a 22-year-old multiparous woman, experienced a myocardial infarction in the postpartum period. She fulfilled the criteria for the diagnosis of the antiphospholipid syndrome (elevated anticardiolipin antibody levels, false-positive syphilis serology, history of deep vein thrombosis). Cardiac catheterization demonstrated appropriate central filling pressures, cardiac output of 7.14 L/min, and normal-appearing coronary arteries. She was treated with corticosteroids and indomethacin and recovered. Our article is relevant to clinical practice for the following reasons. First, it is the second time myocardial necrosis has been reported in a recently pregnant woman with the antiphospholipid syndrome. Second, the finding of normal-appearing coronary arteries at the time of catheterization lends credence to the hypothesis that either vasospasm or thrombosis are the inciting events. We speculate on the utility of various treatment regimens.

Adult↗
PubMed1994

A technique for intrapartum monitoring of fetuses with congenital bradycardias.

Our objective was to construct from readily available components a system that would allow determination of P-wave to P-wave intervals in fetuses with congenital heart block. Using a fetal monitor, bedside patient monitor, spiral electrode, and a special cable described herein, we obtained direct fetal electrocardiograms from two fetuses with autoimmune heart block. Measurement of the atrial rate was made by determining the P-wave to P-wave interval. These determinations were compared to atrial rates measured by M-mode echocardiography in utero and neonatal electrocardiograms. Atrial rates determined by direct fetal electrocardiogram were identical to rates obtained by M-mode echocardiography and within 10 beats/min of rates calculated from neonatal electrocardiograms. Premature ventricular contractions in one fetus were also detected. It is possible to perform continuous and accurate assessments of sinoatrial node activity in fetuses with congenital heart block using components readily available to most obstetricians.

Adult↗
PubMed1994

Estrogen mediates the pregnancy-enhanced cardiotoxicity of cocaine in the isolated perfused rat heart.

OBJECTIVE: To determine whether pregnancy enhances cocaine toxicity in the isolated perfused whole rat heart model and whether this enhanced toxicity can be simulated by pre-treatment with either estrogen or progesterone. METHODS: Hearts excised from 65 female Sprague-Dawley rats were attached to a Langendorff apparatus for measurement of left ventricular systolic pressure, heart rate, and contractility. Before excision, the animals were assigned to one of five groups: 1) nonpregnant, 2) pregnant, 3) nonpregnant pretreated with progesterone, 4) nonpregnant pretreated with estrogen, and 5) nonpregnant pretreated with estrogen and progesterone. Each group was exposed serially to the following cocaine concentrations: 5 x 10(-6), 1 x 10(-5), and 6 x 10(-5) mol/L. RESULTS: Heart rate declined at all doses of cocaine (9.2, 6.9, and 31.0%, respectively). The lowest dose of cocaine had positive inotropic effects, with a 23.2% increase in left ventricular pressure and a 15.3% increase in contractility. Exposure to the two higher doses resulted in negative inotropic effects (a 24.8% decrease in left ventricular pressure and a 39.7% decrease in contractility for the highest dose). Although pre-treatment with estrogen, alone or with progesterone, resulted in responses similar to those seen in pregnant animals, progesterone pre-treatment alone failed to do so. CONCLUSIONS: Cocaine displayed cardiotoxicity in isolated rat hearts similar to that in other animal models. This toxicity was enhanced by pregnancy. We were able to simulate changes by pretreating the animals with estrogen. Perhaps the enhanced cardiotoxicity of cocaine in pregnancy is partially mediated by estrogen.

Animals↗
PubMed1994

Central hemodynamic effects of cocaine and ritodrine in the isolated, perfused rat heart.

OBJECTIVE: To explore the cardiac interactions of cocaine and ritodrine in pregnancy. METHODS: Using the isolated, perfused rat-heart model, hearts from pregnant Sprague-Dawley rats were exposed to increasing concentrations of ritodrine: 25, 50, 100, and 250 ng/mL. Hearts of half of the animals, the experimental group, were exposed to cocaine (5 x 10(-6) mol/L). Left ventricular systolic pressure, heart rate, and contractility were measured. RESULTS: Ritodrine had marked positive inotropic and chronotropic effects. Cocaine exposure resulted in smaller increases in all indices. CONCLUSION: Cocaine blunted but did not obliterate the cardiac stimulatory effects of ritodrine in this model.

Animals↗
PubMed1993

Do nifedipine and verapamil potentiate the cardiac toxicity of magnesium sulfate?

We hypothesized that verapamil and nifedipine would potentiate the cardiac toxicity of magnesium in a dose-dependent manner. The hypothesis was tested in the isolated perfused rat heart model (Langendorff's apparatus) with Sprague-Dawley rats. After excision of hearts, each heart was exposed to increasing doses of verapamil and nifedipine followed by magnesium sulfate. Heart rate, contractility, and left ventricular systolic pressure were measured. Nifedipine and verapamil infusion in this model caused dose-dependent decreases in all three parameters measured (p values 0.05 to 0.01). The addition of magnesium sulfate potentiated these dose-dependent decreases (p values 0.01 to 0.0002). Nifedipine and verapamil caused similar depression at equivalent doses. Nifedipine and verapamil cause dose-dependent cardiac depression that is potentiated by the addition of magnesium sulfate in the isolated perfused rat heart. Caution is called for when magnesium sulfate and calcium channel blockers are administered in combination.

Animals↗
PubMed1993

Personality traits as predictors of anxiety prior to caesarean section under regional anaesthesia.

One hundred and fifteen patients scheduled for elective Caesarean section under regional anaesthesia were questioned to determine their personality profiles and anxiety state. Positive correlations were found between neuroticism and anxiety scores (p < 0.05). Patients with tendencies towards both neuroticism and introversion had higher pre-operative anxiety scores than other personality types (p = 0.015). In general, previous experience did not reduce pre-operative anxiety and personality appeared to be a better predictor of anxiety prior to Caesarean section under regional anaesthesia. Some personality types might benefit from additional support to improve their ability to cope with this stressful event.

Adult↗
PubMed1993

Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries?

OBJECTIVE: To explore the association between midline episiotomy and the risk of third- and fourth-degree lacerations during operative vaginal delivery with either vacuum extractor or forceps. METHODS: This retrospective cohort study analyzed all operative vaginal deliveries at a university hospital in 1989 and 1990. Univariate analysis of the relationships between perineal lacerations and obstetric variables was performed. Stratified analysis using the relevant variables was used to calculate relative risk (RR) estimates. RESULTS: Episiotomy, birth weight, and whether the index birth was the first vaginal birth were associated with third- and fourth-degree perineal lacerations. Stratified analysis demonstrated an RR of 2.4 with a 95% confidence interval of 1.7-3.5 for rectal injury with episiotomy, adjusting for parity and birth weight. CONCLUSION: Midline episiotomy is associated with an increased risk of third- and fourth-degree perineal lacerations in operative vaginal deliveries.

Birth Weight↗
PubMed1993

The Mueller-Hillis maneuver: can it be used to predict dystocia?

OBJECTIVE: To assess prospectively the utility of intrapartum Mueller-Hillis maneuvers in predicting labor abnormalities. METHODS: Patients underwent Mueller-Hillis maneuvers upon admission in active labor. Outcomes of each labor were assessed, and correlations were sought between the degree of descent and outcome. Labor curves were constructed for each patient, and labor abnormalities were described by an observer blinded to descent and outcome. The relationship of labor abnormality to outcome also was evaluated. RESULTS: One hundred six patients had Mueller-Hillis maneuvers performed. The distribution of results was as follows: no descent (N = 25) 23.6% one station (N = 33) 31.1%, two stations (N = 46) 43.4%, and three stations (N = 2) 1.9%. Lack of descent failed to indicate increased risk of abdominal delivery, operative vaginal delivery, need for oxytocin augmentation, prolonged second stage, or labor curve abnormality. Analysis of parity (nulliparous versus multiparous) did not alter these findings. CONCLUSION: We present normative data for the results of Mueller-Hillis maneuvers performed in active labor. To our knowledge, no such data exist. We also failed to find a relationship between dystocia and descent with the maneuver. Until this test is demonstrated to be useful, it should not be used to predict dystocia.

Adolescent↗
PubMed1992

Treatment of persistent postpartum HELLP syndrome with plasmapheresis.

Thrombocytopenia, associated with microangiopathic disease, is one characteristic of severe preeclampsia. Thrombocytopenia and intravascular hemolysis usually resolve by postpartum days 4 to 5. When thrombocytopenia secondary to microangiopathic disease persists, plasmapheresis may be used to arrest and reverse the process. Three patients over a 24-month period were successfully treated with plasma exchange with fresh frozen plasma. Several investigators who have cared for patients with persistent thrombocytopenia associated with preeclampsia have concluded that early plasmapheresis may be useful therapy. Plasma exchange should also be considered as a therapeutic option when clinical deterioration occurs due to microangiopathic disease.

Adult↗
PubMed1992

Prenatal sonographic findings of massive lower extremity lymphangioma.

A massive lymphangioma was detected sonographically in the lower extremity of a fetus at 28 weeks' gestation. On ultrasound study, the mass had multiple cysts and extended from the left lower abdomen to the left knee. The differential diagnosis and obstetric management following prenatal diagnosis of a fetal lower extremity mass are presented.

Adult↗
PubMed1992

Antepartum diagnosis of placenta previa percreta by magnetic resonance imaging.

BACKGROUND: Placenta previa percreta is a rare but highly morbid condition usually diagnosed intraoperatively. Placental manipulation results in severe bleeding. Magnetic resonance imaging (MRI) might allow antepartum diagnosis of this condition. CASE: A multiparous woman with five previous abdominal deliveries had complete placenta previa diagnosed at 16 weeks' gestation. Bleeding ensured at 29 weeks and she was managed with bed rest. Before planned abdominal delivery, MRI was performed and placenta percreta was diagnosed, which allowed her physician to avoid placental manipulation. Hysterectomy was accomplished with an estimated blood loss of only 2000 mL. CONCLUSION: Antepartum diagnosis of placenta previa percreta by MRI altered the usual diagnostic and surgical approach, diminishing blood loss and morbidity.

Adult↗