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Biomedical subjects

J M Thorp

Publications and source records attributed to J M Thorp.

137 records · Page 8Linked to original sources
PubMedDate not supplied

Transcranial Doppler findings of cerebral vasospasm in preeclampsia.

The objective of this study was to evaluate the effect of preeclampsia and its severity on maternal mean middle cerebral artery blood flow velocity (mean MCA-CBFV) using transcranial doppler sonography (TCD), as well as the effect of magnesium on mean MCA-CBFV in preeclampsia. This study used a prospective, comparative design. TCD was used to examine maternal mean MCA-CBFV in both healthy subjects (controls) and preeclamptic subjects (cases). The two groups were similar in age, gestational age, and parity. Healthy subjects were categorized into three groups: Group I, 6-14 weeks, n = 10; Group II, 24-40 weeks, n = 27; Group III, postpartum n = 15, 12-36 h. Serial TCD examinations of the middle cerebral artery were completed in 21 preeclamptic subjects at four different points in time: Time I is an initial measurement before delivery; Time 2 is also before delivery but after magnesium had been administered. Time 3 is postpartum while on magnesium (12-24 h), Time 4 is postpartum off magnesium, (24-48 h). Preeclamptic subjects had significantly increased mean MCA-CBFV when compared to healthy subjects: antepartum (mean 78.2 vs. 55.1 cm/sec, P < 0.0005); postpartum (mean 101.3 vs. 69.8 cm/sec, P < 0.0001). Severe preeclamptics had significantly higher mean MCA-CBFV than mild preeclamptics at each point in time: Time 1: P < 0.016; Time 2: P < 0.040; Time 3: P < 0.002; and Time 4: P < 0.028. These data support the theory that cerebral vasospasm of the smaller diameter vessels is a major component of preeclampsia.

Adult↗
PubMedDate not supplied

Diagnosis of early acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) is usually diagnosed at autopsy, with severe hepatic failure, or after the appearance of extrahepatic disease. We present an atypical patient with mild AFLP in whom hepatic biopsy allowed earlier diagnosis. A low threshold for liver biopsy in patients not experiencing fulminant disease can afford diagnostic information prior to the onset of serious sequelae.

Acute Disease↗
PubMedDate not supplied

Predictors of symptomatic urinary tract infection after 20 weeks' gestation.

OBJECTIVE: To identify predictors of symptomatic urinary tract infection (UTI) after 20 weeks' gestation. STUDY DESIGN: A retrospective cohort analysis was conducted of all deliveries at three North Carolina hospitals between 1990 and 1993. A total of 7403 deliveries remained after exclusions (pre-pregnancy diabetes, HIV-positive, structural urologic abnormalities, no prenatal care) and restrictions (black or white race, county of residence). Cystitis and pyelonephritis were identified by clinician diagnosis. Multiple logistic regression was conducted. RESULTS: Prior UTIs (both before and earlier in pregnancy), nonprivate clinics, and a history of chlamydia (white women only) doubled the risk of symptomatic UTIs after 20 weeks' gestation. The strongest predictor of pyelonephritis was prior antenatal UTIs (adjusted incidence odds ratio = 5.3, 95% confidence interval of 2.6-11.0), followed by less education (< 12 years), a history of chlamydia, nonprivate clinics, illicit drug use, sickle cell hemoglobinopathy, and being unmarried. CONCLUSION: Medical history and demographic factors predict cystitis and pyelonephritis after 20 weeks' gestation. Prospective studies of pyelonephritis predictors and screening strategies are warranted.

Adult↗
PubMedDate not supplied

Determinants of hormone replacement therapy duration among postmenopausal women with intact uteri.

OBJECTIVE: To investigate factors associated with hormone replacement therapy (HRT) duration among postmenopausal women with intact uteri. DESIGN: A Cox proportional hazard model on time to HRT discontinuation is estimated for 2,632 postmenopausal HRT users with intact uteri who began a new episode of treatment between January 1990 and December 1994 in Saskatchewan, Canada. RESULTS: Major contraindicating medical events were highly associated with HRT discontinuation among postmenopausal women. Women who were diagnosed with uterine cancer while taking HRT were almost four times as likely to discontinue HRT, and women who were diagnosed with breast cancer while taking HRT were nearly five times as likely to discontinue HRT. Other statistically significant factors associated with the duration of HRT episodes include administration mode and the ability to try different types and strengths of HRT. Women initiating HRT with a transdermal patch were 50% more likely to discontinue it. Women who were willing and able to experiment with different HRT reduced their likelihood of discontinuing by one-half to three-fourths. CONCLUSIONS: Although some of the factors associated with the hazard of HRT discontinuation among postmenopausal women who are taking the treatment for preventive benefits are immutable, clinicians may influence HRT continuation rates through initial drug choice or modifications in drug type or regimen over the course of therapy.

Estrogen Replacement Therapy↗
PubMedDate not supplied

A survey of infection in an intensive care unit. "Forewarned is forearmed".

The infection (36%) and mortality rates (28%) were investigated in 433 patients admitted to a Respiratory Intensive Care Unit. It was found that the mortality rate was higher (45%) in the infected group than in the non-infected group (19%) and particularly so in patients who had had intra-abdominal surgery or who remained in the unit for longer than a week.

Abdomen↗
PubMedDate not supplied

Central hemodynamic effects of an oxytocin receptor antagonist (atosiban) in the isolated, perfused rat heart.

OBJECTIVE: Atosiban is a selective oxytocin receptor antagonist capable of inhibiting oxytocin-induced contractility of the uterus. Trials of this agent in intact animals and women as a tocolytic agent for preterm labor have shown atosiban to be devoid of cardiac effects. This is in contrast to other tocolytic agents, which have profound hemodynamic effects. We conducted this study to determine the cardiac effect of atosiban in the isolated, perfused rat heart model. METHODS: Hearts were excised from 60 female Sprague-Dawley rats and attached to a Langendorff apparatus. Left ventricular systolic pressure, heart rate, and contractility were measured. Hearts from half of the animals were exposed serially to 300 micrograms/min, 600 micrograms/min, and 1200 micrograms/min of atosiban. The remaining hearts formed the control group and were exposed to aerated Krebs solution. RESULTS: There were no significant differences between hearts exposed to atosiban and hearts within the control group for heart rate, left ventricular systolic pressure, and contractility. P values ranged from .12 to .73. CONCLUSIONS: Using a classic physiologic model to study cardiac performance and drug effects, we were unable to detect any central hemodynamic effects of atosiban. This is in contrast to oxytocin, which we previously studied and found negative chronotropic and positive ionotropic effects.

Animals↗