Search PubMed⌕ Search

Biomedical subjects

J T Repke

Publications and source records attributed to J T Repke.

70 records · Page 4Linked to original sources
PubMed1987

Renal cell carcinoma in pregnancy.

A rare case of renal cell carcinoma occurring during pregnancy is described. The modalities used to make the diagnosis and the antepartum management of the patient are discussed. The case reported herein demonstrates the major diagnostic challenge of the young pregnant patient with a rare disease.

Adult↗
PubMed1987

The Johns Hopkins Adolescent Pregnancy Program: an evaluation.

The obstetric component of The Johns Hopkins Adolescent Pregnancy Program is described and the pregnancy outcome for adolescents delivering between 1976 and 1981 is compared with that of similar young women who were delivered in the same facilities, by the same staff, but who received their prenatal care in other Hopkins-related programs. The adolescent program is comprehensive, providing intensive psychosocial support and patient education in addition to medical care, using a team approach coordinated by an individual case management system. Enrollees had fewer pregnancy complications and lower perinatal mortality. Between 1979 and 1981, the frequency of birth weight below 2500 g was 9.9%, and below 1500 g, 1.9% for program adolescents, compared with 16.4 and 3.9%, respectively, for controls. Younger adolescents in the program entered prenatal care significantly later than older ones. However, those aged 14 years and below had infants with the highest average birth weight and no greater risk of perinatal death than those of older adolescents.

Adolescent↗
PubMed1986

Fetal supraventricular tachycardia refractory to digoxin cardioversion. A case report.

Fetal cardiac arrhythmias are being diagnosed with increased frequency through ultrasonography and electronic fetal heart rate monitoring. Although many of them are benign, some, particularly supraventricular fetal tachycardia, have been associated with a poor outcome. Fetal hydrops and other evidence of fetal cardiac failure resulting from the elevated heart rate have been reported on. Although several modes of treatment have been described, the mainstay of cardioversion in utero continues to be digoxin. This case report demonstrates the need for prompt delivery when in utero cardioversion fails.

Administration, Oral↗
PubMed1985

Cost-effective criteria for glucose screening.

To study cost-effective screening criteria for gestational diabetes, a prospective study of 1012 patients was completed. All patients underwent a glucose screen between 26 and 30 weeks of gestation, consisting of a 50-g oral glucose load followed by a one-hour plasma glucose determination. Patients with a glucose screen greater than or equal to 130 mg/dL were studied with a standard three-hour oral glucose tolerance test. The incidence of gestational diabetes was 2.4% (24 of 1012). Only one gestational diabetic was identified with a glucose screen below 150 mg/dL. Twenty-two of the 24 cases were at least 24 years old. Twenty-one of the 24 (88%) gestational diabetes had a glucose screen greater than or equal to 150 mg/dL and were 24 years old or greater. The cost of the diagnosis in these latter patients was 40% of the cost of diagnosis of universal screening with a threshold of 130 mg/dL. It is concluded that screening with a threshold of 150 mg/dL only patients who are at least 24 years old should be considered an alternative to universal screening.

Adult↗
PubMed1984

Risk factors in the development of cesarean section infection.

Fifty consecutive patients undergoing cesarean section were evaluated prospectively. A data collection form was developed and 113 variables relating to demographic features, antepartum care, intrapartum events and postpartum course were evaluated. All of the patients were seen and evaluated within 24 hours of delivery and all forms were completed when the patients were discharged from the hospital. Twenty-five of the 50 patients had postpartum febrile morbidity develop. There were 14 instances of endometritis; five, wound infections; two, urinary tract infections; two, upper respiratory tract infections; three pulmonary infections; one patient with phlebitis, and two with febrile morbidity and no apparent source. Factors significantly associated with an increased risk of developing febrile morbidity included antepartum infections, resident staff as primary surgeon, extension of the uterine incision and positive endometrial culture at the time of the operation. Patients undergoing elective repeat cesarean section had less febrile morbidity than others (p less than 0.025). Statistically significant differences between the two groups were not found for the variables obesity, anemia, rupture of membranes, number of pelvic examinations, fetal monitoring, fetal tachycardia, general anesthesia and skin preparation. Operative blood loss was greater in the patients having febrile morbidity develop, but this difference was not statistically significant.

Adult↗
PubMed1984

Markedly elevated serum testosterone in pregnancy without fetal virilization.

A 37-year-old woman with a history consistent with polycystic ovarian disease became pregnant and developed exceedingly high levels of serum testosterone. The female fetus showed no evidence of virilization. A clinical diagnosis of bilateral theca lutein cysts was made. Modes of fetal protection from maternal androgenemia as well as suggestions for future investigations are discussed.

Adult↗
PubMed1984

Supraventricular tachycardia in pregnancy: cardioversion with verapamil.

Cardiac arrhythmias are not uncommon during pregnancy. The supraventricular tachyarrhythmias have been treated successfully with digoxin, propranolol, overdrive atrial pacing, electrocardioversion, and most recently with verapamil. Verapamil is the prototype calcium channel blockers. Its use in pregnancy has been limited though the experimental effects of verapamil on fetal heart activity and uterine contractility have been studied. Reported is a case of a digitalized hyperthyroid pregnant patient successfully treated with verapamil for supraventricular tachycardia. Continuous electronic fetal monitoring was used during the period of cardioversion. The excellent response to verapamil with its apparent absence of adverse maternal or fetal side effects would suggest that the use of verapamil in the treatment of supraventricular arrhythmias in pregnancy is safe and effective.

Adult↗
PubMed1984

Electroconvulsive therapy in pregnancy.

The optimal treatment for depressive disorders in pregnancy remains controversial. Clinicians are often hesitant to prescribe pharmacologic agents during pregnancy, especially in the first trimester, and the effects of electroconvulsive therapy in pregnancy have not been prospectively evaluated. The present case reports on the apparent safety and efficacy of electroconvulsive therapy for the treatment of depression in pregnancy when used in carefully selected and carefully monitored patients. Fetal heart rate monitoring and real-time ultrasonography were performed, and the results suggest that maternal electroconvulsive therapy has little effect on fetal status.

Depressive Disorder↗
PubMedDate not supplied

Preeclampsia prevention and management.

Preeclampsia is a multisystem disorder specific to pregnancy with a high maternal and perinatal morbidity and mortality. The cause of this disorder is unknown. Preeclampsia likely represents the clinical end point of multiple contributory factors, and it is unlikely that any single cause will be found. The blueprint for the development of preeclampsia is laid down early in pregnancy, and delivery of the fetus and placenta remains the only effective treatment. Efforts to prevent preeclampsia in women at high risk have been largely unsuccessful. Until the pathogenesis of preeclampsia is well defined, it is unlikely that effective preventive strategies will be developed.

Female↗
PubMedDate not supplied

Human immunodeficiency virus infection in women attending an inner-city prenatal clinic: ineffectiveness of targeted screening.

Women attending an inner-city prenatal clinic between February, 1987 and August, 1988 completed a questionnaire to assess risk factors for human immunodeficiency virus (HIV) infection. Women with risk factors were offered HIV testing. Testing was available to women without risk factors upon their request. Stored sera were obtained for anonymous HIV testing on patients not consenting for testing. Overall, 30 of 622 women (5%) tested HIV positive. Ten per cent of women acknowledging risk factors were seropositive vs 3% denying risk factors (P less than .001). Intravenous (IV) drug use was reported in 40% of seropositive women. However, 47% (14/30) of HIV seropositive women denied risk factors for infection. Limiting prenatal HIV screening to women acknowledging risk factors may fail to identify a substantial number of infected women. Screening for HIV infection, counseling, and education on risk reduction should be offered to all pregnant women.

Adolescent↗