Biomedical subjects

J N Martin

Publications and source records attributed to J N Martin.

At least 55 records · Page 3Linked to original sources

PubMed1999

Expression of the placental cytokines tumor necrosis factor alpha, interleukin 1beta, and interleukin 10 is increased in preeclampsia.

OBJECTIVE: We sought to determine whether placental cytokine expression is altered in patients with preeclampsia. STUDY DESIGN: Whole placental tissue was collected at cesarean delivery, and total ribonucleic acid was extracted. Reverse transcriptase-polymerase chain reaction was performed to determine cytokine expression. Product bands were quantitated by scanning densitometry, and results were expressed as a ratio of cytokine/housekeeping gene (cytokine expression index). Statistical analysis was performed by the Student t test and the Mann-Whitney U test. RESULTS: Placentas from 6 patients with preeclampsia and 4 normotensive patients were analyzed. Placental expression of interleukin 1beta and interleukin 10 was greater in preeclamptic women than in normotensive subjects (median interleukin 1beta cytokine expression index, 0.675; range, 0.394-0. 953; vs 0.106; range, 0.084-0.166; P =.011; median interleukin 10 cytokine expression index, 1.042; range, 0.672-1.192; vs 0.126; range, 0.062-0.398; P <.011). Tumor necrosis factor alpha messenger ribonucleic acid was detected in placentas of preeclamptic subjects but not in normotensive control subjects. CONCLUSION: Placentas from preeclamptic patients demonstrated increased expression of interleukin 1beta, interleukin 10, and tumor necrosis factor alpha. This may be in association with placental hypoxia and may contribute to the global endothelial dysfunction observed in preeclampsia.

Adult↗

PubMed1999

Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

OBJECTIVE: The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. STUDY DESIGN: Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome. RESULTS: Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%). CONCLUSIONS: It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.

Adult↗

PubMed1999

Risk factors for secondary arrest of labor among women >41 weeks' gestation with an unfavorable cervix undergoing membrane sweeping for cervical ripening.

OBJECTIVE: To identify the risk factor(s) for secondary arrest of labor among women with an unfavorable cervix at > 41 weeks' gestation. METHODS: Prospectively all gravid women with a Bishop score of < or = 4 and no contraindication to a vaginal delivery were candidates for this study. Univariate analysis followed by logistic regression modeling were used to identify variables with a significant association. RESULTS: Over a 9-month period, 115 women entered into the study. In univariate analysis, variables with a significant association with cesarean delivery: (1) non-Caucasian race (P = 0.007), Bishop score < 7 at hospitalization; P = 0.001, and reason for admission (P = 0.017). Logistic regression analysis yielded OR 4.7 (1.6, 15) non-Caucasian race and 9.5 (3.2, 30.8) Bishop < 7 on admission. CONCLUSION: Pregnancies > 41 weeks with an unfavorable cervix, non-Caucasian race and a failure to achieve a Bishop score of > or = 7 prior to hospitalization were significant risk factors for abdominal delivery.

Cervical Ripening↗

PubMed1999

Detection of growth-restricted fetuses in preeclampsia: a case-control study.

OBJECTIVE: To determine the diagnostic accuracy of detecting growth-restricted fetuses in women with and without preeclampsia. METHODS: Over 2 years, parturients with reliable gestational ages, preeclampsia, and sonographic estimates of birth weights were matched (1:1) for gestational age with women without preeclampsia. Paired and unpaired t tests were used; P < .05 was significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Two hundred eighty-seven preeclamptic women were identified and matched. In each group, mean (+/- standard deviation [SD]) gestational age was 34.9 +/- 4.2 weeks, and 166 (57.8%) infants were born preterm. Fetal growth restriction (FGR) was significantly more common among women with preeclampsia (14.9%) than among controls (5.6%; OR 2.98, 95% CI 1.64, 5.44). The percentage of sonographic estimates within 10% of actual birth weight (57.5% versus 53.6%) was similar in the two groups (OR 1.16; 95% CI 0.84,1.62). Compared with normal growth, the mean (+/- SD) standardized absolute error was significantly higher among those with FGR regardless of group (preeclampsia 109 +/- 100 versus 158 +/- 152 g/kg; P = .009; control 117 +/- 103 versus 233 +/- 206 g/kg; P < .001). Fetal growth restriction was detected more commonly among preeclamptic women than among controls (11.6% versus 0%; OR 4.74 95% CI 0.25, 90.31). The sensitivity and positive predictive value of FGR detection were 10% and 50%, respectively, among women with preeclampsia and 0% each among controls. CONCLUSION: Although FGR was detected more frequently in fetuses of women with preeclampsia than in those of controls, the ability to predict it with sonography remained poor.

Adult↗

PubMed1999

Amniotic fluid volume assessment in singleton and twin pregnancies.

The best method of ultrasonic mensuration to identify abnormal AFV reliably in singletons and the individual sacs of diamniotic twins remains elusive. With respect to twins, localization of the dividing membrane seems to be necessary for AFV assessments of each amniotic cavity. The relationship of ultrasonic estimates, actual AFV, and pregnancy outcome remains undetermined. In the authors' opinion, the subjective assessment in twin gestation may be as accurate as semiquantitative ultrasonic estimates of AFV, similar to the situation in singleton pregnancies. The authors propose that further prospective research address the following questions: (1) What is the appropriate threshold for intervention when AFI decreases to lower ranges? (2) What other factors (e.g., cervical examination, fetal heart rate patterns, underlying obstetric conditions, fetal growth pattern) are important when the AFI falls to low values in making clinical decisions?

Amniotic Fluid↗

PubMed1999

A 12-hour urine collection accurately assesses proteinuria in the hospitalized hypertensive gravida.

OBJECTIVE: To determine whether a urine collection of < 24 hours duration accurately assesses the level of proteinuria in inpatients being evaluated for preeclampsia. STUDY DESIGN: Patients admitted to the University of Mississippi between January and June of 1998 for evaluation of preeclampsia underwent two consecutive 12-hour urine collections. Each collection was analyzed for total protein, total calcium, total volume, and urine creatinine. A concurrent serum creatinine value was obtained. The protein:creatinine ratio, calcium: creatinine ratio, and creatinine clearance were calculated. Pearson's correlation, sensitivity, specificity, and positive and negative predictive values were assessed. RESULTS: A total of 25 patients (86%) were preeclamptic. Total protein, the protein: creatinine ratio, and serum creatinine were significantly correlated between the first and second urine collection. The sensitivity and specificity of the 12-hour urine collection was 96% and 100%, respectively. CONCLUSION: A 12-hour urine collection accurately depicts the amount of proteinuria in hospitalized gravidas being evaluated for preeclampsia.

Adult↗

PubMed1999

A randomized clinical trial of mupirocin in the eradication of Staphylococcus aureus nasal carriage in human immunodeficiency virus disease.

Seventy-six human immunodeficiency virus (HIV)-infected patients with Staphylococcus aureus nasal carriage were randomized to treatment groups receiving intranasal mupirocin or placebo twice daily for 5 days. Nasal cultures for S. aureus were obtained at 1, 2, 6, and 10 weeks after therapy. At 1 week, 88% of mupirocin-treated patients had negative nasal cultures compared with 8% in placebo patients (P<.001). The percentage of mupirocin-treated patients with persistently negative nasal cultures decreased over time (63%, 45%, and 29% at 2, 6, and 10 weeks, respectively) but remained significantly greater than the placebo group (3% at 2, 6, and 10 weeks). In mupirocin-treated patients, most (16/19) instances of nasal recolonization were with pretreatment strains (determined by means of by pulsed field gel electrophoresis); mupirocin resistance was not observed. Five days of treatment with mupirocin eliminated S. aureus nasal carriage in HIV-infected patients for several weeks; however, since the effect waned over time, intermittent dosing regimens should be considered for long-term eradication.

AIDS-Related Opportunistic Infections↗

PubMed1999

Emergence of trimethoprim-sulfamethoxazole resistance in the AIDS era.

Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus (HIV)-infected patients, but little is known about the effects of this practice on the emergence of TMP-SMX-resistant bacteria. A serial cross-sectional study of resistance to TMP-SMX among all clinical isolates of Staphylococcus aureus and 7 genera of Enterobacteriaceae was performed at San Francisco General Hospital. Resistance among all isolates was <5.5% from 1979 to 1986 but then markedly increased, reaching 20.4% in 1995. This was most prominent in HIV-infected patients: resistance increased from 6.3% in 1988 to 53% in 1995. The largest increases in resistance were in Escherichia coli (24% in 1988 to 74% in 1995) and S. aureus (0% to 48%) obtained from HIV-infected patients. A rapid increase in the use of prophylactic TMP-SMX in HIV disease was also observed during this time in San Francisco and is likely responsible for the increase in TMP-SMX resistance.

Adult↗

PubMed1999

Kaposi's sarcoma-associated herpesvirus and sexual transmission of cancer risk.

The epidemiology of AIDS-related Kaposi's sarcoma (KS) predicted that a nonubiquitous sexually transmitted agent was central to its etiology. An assessment of Hill's criteria for causality reveals there is now sufficient evidence to declare Kaposi's sarcoma-associated herpesvirus (KSHV), or human herpesvirus 8, a necessary, albeit not sufficient, cause of KS. The most compelling evidence comes from longitudinal studies presented in the past year that demonstrate that KSHV infection temporally precedes and is independently associated with AIDS-related KS even after adjustment for other potential etiologic factors. In the United States and Northern Europe, many studies have now shown that KSHV can be sexually transmitted among homosexual men, but determining specific routes of sexual transmission is methodologically challenging, and initial results are conflicting. Data are also emerging that demonstrate nonsexual modes of transmission. Spread via renal allograft appears to occur, and in endemic areas of Europe and Africa, nonsexual horizontal and perhaps vertical spread are the dominant modes of transmission.

Herpesviridae Infections↗

PubMed1999

Twelve steps to optimal management of HELLP syndrome.

The early diagnosis and treatment of HELLP syndrome remains problematic for the obstetric health care provider. The nonspecific signs and symptoms of this disorder early in the disease process make the accurate diagnosis difficult and delays early treatment, which has the best prognosis for both maternal and perinatal outcome. The introduction of high-dose nonmineralocorticosteriods to assist in the treatment of these patients is an exciting new development. Use of the 12-step approach to the diagnosis and management of pregnancies complicated by HELLP syndrome has proven to be a successful tool to help us achieve the best possible maternal and perinatal outcome.

Anticonvulsants↗

PubMed1999

Preeclampsia-associated hepatic hemorrhage and rupture: mode of management related to maternal and perinatal outcome.

This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conducive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event.

Antibodies, Monoclonal↗

PubMed1999

The impact of leiomyomas on pregnancy.

In this retrospective case control investigation, 51 pregnant patients who were diagnosed by ultrasound with uterine myomas were compared to 102 randomly selected control patients to determine if the ultrasound diagnosis of one or more leiomyoma is associated with increased untoward pregnancy outcomes compared to controls. Women with uterine myomas were older (p = 0.001), more likely to be African American (p = 0.001), and undergo Caesarean delivery (p = 0.03) than controls. However, when women who underwent abdominal delivery for previous myomectomy (n = 5) were excluded from analysis, there was no significant difference in the incidence of Caesarean delivery. Overall, there was no difference in the incidence of obstetric complications between groups even when the data was stratified for large and/or multiple leiomyomas. The discovery of uterine leiomyomas by gestational ultrasound does not appear to place the patient at increased risk for preterm labour, early delivery, or other untoward pregnancy outcomes.

Adult↗

PubMed1999

Amniotic fluid index in normal pregnancy: a longitudinal study.

OBJECTIVE: This longitudinal study was undertaken to characterize the change in the amniotic fluid volume in normal pregnancy. METHODS: Prospectively, patients with uncomplicated gestations underwent serial amniotic fluid index by a single sonographer. RESULTS: Fifty-six patients underwent a total of 378 determinations of amniotic fluid volume (6.8 +/- 2.5 examinations per patient). The variation in mean amniotic fluid index between 24 and 40(+6) weeks was not significantly different (p = 0.381). Among the 42 patients who delivered at term there was no significant decrease in the amniotic fluid index between their first and last measurement (p = 0.86). However, in the 14 patients who delivered after 41 weeks, there was a significant decrease in the index over time (p = 0.04). CONCLUSION: The longitudinal study on amniotic fluid volume in normal pregnancy reveals that amniotic fluid index does not change significantly with gestational age.

Adult↗

PubMed1999

Dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.

OBJECTIVE: Patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial. METHOD: A single case report and review of the literature. RESULT: We report a patient with HELLP syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum. CONCLUSION: Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with HELLP syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.

Adult↗

PubMed1998

Sexual transmission and the natural history of human herpesvirus 8 infection.

BACKGROUND: Although human herpesvirus 8 (HHV-8) has been suspected to be the etiologic agent of Kaposi's sarcoma, little is known about its seroprevalence in the population, its modes of transmission, and its natural history. METHODS: The San Francisco Men's Health Study, begun in 1984, is a study of a population-based sample of men in an area with a high incidence of human immunodeficiency virus (HIV) infection. We studied all 400 men infected at base line with HIV and a sample of 400 uninfected men. Base-line serum samples were assayed for antibodies to HHV-8 latency-associated nuclear antigen (anti-LANA). In addition to the seroprevalence and risk factors for anti-LANA seropositivity, we analyzed the time to the development of Kaposi's sarcoma. RESULTS: Anti-LANA antibodies were found in 223 of 593 men (37.6 percent) who reported any homosexual activity in the previous five years and in none of 195 exclusively heterosexual men. Anti-LANA seropositivity correlated with a history of sexually transmitted diseases and had a linear association with the number of male sexual-intercourse partners. Among the men who were infected with both HIV and HHV-8 at base line, the 10-year probability of Kaposi's sarcoma was 49.6 percent. Base-line anti-LANA seropositivity preceded and was independently associated with subsequent Kaposi's sarcoma, even after adjustment for CD4 cell counts and the number of homosexual partners. CONCLUSIONS: The prevalence of HHV-8 infection is high among homosexual men, correlates with the number of homosexual partners, and is temporally and independently associated with Kaposi's sarcoma. These observations are further evidence that HHV-8 has an etiologic role in Kaposi's sarcoma and is sexually transmitted among men.

AIDS-Related Opportunistic Infections↗

PubMed1998

Individually determined postpartum magnesium sulfate therapy with clinical parameters to safely and cost-effectively shorten treatment for pre-eclampsia.

OBJECTIVE: The purpose of this study was to investigate the safety of treating pre-eclampsia with magnesium sulfate, with clinical determinants used for drug discontinuation. STUDY DESIGN: One hundred sixty-eight patients were enrolled. After delivery, women with mild pre-eclampsia received a minimum of 6 hours of intravenous magnesium sulfate, whereas women with severe pre-eclampsia received a minimum of 12 hours. Magnesium sulfate was discontinued in the absence of clinical symptoms associated with spontaneous diuresis, minimal protein by urinary dipstick, and satisfaction of predetermined blood pressure criteria. RESULTS: Patients with mild pre-eclampsia required significantly less magnesium sulfate (mean 9.5 +/- 4.2 hours) than did those with severe pre-eclampsia alone (mean 16 +/- 5.9 hours); pre-eclampsia superimposed on chronic hypertension (mean 16 +/- 5.8 hours); or hemolysis, elevated liver enzyme, and low platelet count syndrome (mean 20 +/- 6.7 hours). With this protocol there was no eclampsia, and recovery room time was reduced by 50%. CONCLUSION: Individual determination of postpartum magnesium sulfate therapy for pre-eclampsia appears to be a safe approach that carries minimal risk of eclampsia.

Adolescent↗

PubMed1998

Aplastic anemia and immune-mediated thrombocytopenia: concurrent complications encountered in the third trimester of pregnancy.

BACKGROUND: Aplastic anemia has been described rarely in pregnancy. The etiology is uncertain, and the treatment of choice, bone marrow transplant, is contraindicated in pregnancy. Thus, the occurrence of this complication during gestation presents a management challenge. Concurrent immune-mediated thrombocytopenia further complicates an already complex situation. CASE: Our patient with aplastic anemia and immune-mediated thrombocytopenia was diagnosed during the third trimester of pregnancy and treated with prednisone/high-dose intravenous (i.v.) immunoglobulin (Ig) and multiple transfusions of packed red blood cells and platelets. Fetal surveillance included twice-weekly non-stress tests coupled with sequential sonographic pregnancy evaluation. A successful term vaginal delivery was achieved with good maternal and perinatal outcomes. CONCLUSION: Selective transfusion of blood products, therapy with prednisone, high-dose i.v. Ig, and intensive fetal surveillance resulted in a successful maternal and perinatal outcome for a pregnancy complicated with aplastic anemia and immune-mediated thrombocytopenia.

Adult↗

PubMed1998

Intrapartum amniotic fluid index: a poor predictor of abnormal fetal size.

OBJECTIVE: Using receiver-operating characteristic (ROC) curves, we tried to determine the diagnostic threshold of amniotic fluid index (AFI) that will identify abnormal fetal size (birth weights under 2500 g or at least 4000 g) at 37 weeks or beyond. METHODS: We analyzed prospectively over 2 years all parturients with intact membranes and known AFI in early labor. Patients with the following conditions were excluded: pregestational or gestational diabetes, known anomalies, and preterm labor. Two ROC curves were constructed, and the areas (+/- standard error of the mean [SE]) under the curves were calculated. P < .05 was considered significant. RESULTS: Of the 1038 subjects meeting study criteria, 3.6% and 11.5% gave birth to infants who were small for gestational age (SGA) or macrosomic, respectively. Overall, 28.7% had oligohydramnios (AFI at most 5.0 cm) and 3.6% had hydramnios (AFI at least 24.0 cm). Small for gestational age was more common in patients with AFI at most 5.0 cm (6.4%) than in those with adequate fluid (AFI 5.1-23.9; 2.5%), or hydramnios (2.7%; P = .012). Macrosomic newborns were less likely to be born to women with oligohydramnios (7.7%) than to those with adequate amniotic fluid (13.1%) or hydramnios (13.5%). Areas under ROC curves are not significantly different from the area under the nondiagnostic line, indicating that AFI (0-34 cm) cannot differentiate between newborns under 2500 g and at or over 2500 g or under 4000 and at or more 4000 g. CONCLUSION: Intraparterium AFI appears to be a poor screening test to identify risk for delivery of SGA or macrosomic fetus.

Adult↗