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Biomedical subjects

J W Goldkrand

Publications and source records attributed to J W Goldkrand.

At least 19 recordsLinked to original sources
PubMed1992

Prediction of respiratory distress syndrome by a new colorimetric assay.

OBJECTIVE: The purpose of this study was to evaluate the clinical performance of a new, simple, and rapid colorimetric assay for predicting respiratory distress syndrome. STUDY DESIGN: Ninety-four specimens obtained within 3 days of delivery were assayed with the new test. For 78 of these specimens, the lecithin/sphingomyelin ratio was also determined. Significant differences were calculated with chi 2 analysis. Cutoff points were selected by maximizing the corresponding sums of sensitivity and specificity and from receiver-operator-characteristic curves. RESULTS: The specificity of the new colorimetric test was better than 89%, and it yielded more than 86% correct diagnoses. Furthermore, the test had a significantly (p less than 0.05) lower percentage of false-immature results than that obtained with the lecithin/sphingomyelin ratio. Moreover, the new test performed relatively well in analyses of patients between 27 weeks and 36 weeks' gestation. CONCLUSION: We concluded that the new assay is reliable and that it can serve as a useful alternative to current methods for predicting respiratory distress syndrome.

Colorimetry↗
PubMed1991

Vibroacoustic stimulation and fetal hiccoughs.

Hiccoughs are a physiological phenomenon, beginning in the second trimester of pregnancy, increasing in frequency throughout gestation, and continuing into the neonatal period. There is concern about the safety of the use of vibroacoustic stimulation of the third-trimester fetus as part of the evaluation of fetal well-being. This study was directed to determine whether the evoked fetal startle response would accentuate or decrease the incidence of hiccoughs. Of the 342 nonstress tests (NSTs) performed, fetal hiccoughs were heard during 39 (11.4%) tests. The incidence of hiccoughs was 10.6% (25/236) of patients stimulated with sound and 13.2% (14/106) of these without sound (P = NS). Hiccoughs were found to increase in frequency throughout the third trimester. In all nonreactive NSTs, hiccoughs were absent. This vibroacoustic stimulation did not affect the fetal physiologic response of hiccoughs, and the absence of hiccoughs in nonreactive NSTs may be another indicator of fetal compromise.

Acoustic Stimulation↗
PubMed1991

Demonstration of fetal habituation and patterns of fetal heart rate response to vibroacoustic stimulation in normal and high-risk pregnancies.

Habituation is the decremental response to repetitive stimulation and is a learned response. One hundred five fetuses from 26 normal and 79 high-risk pregnancies were evaluated from 28 to 43 weeks' gestation and in labor as to the fetal heart rate response from repetitive vibroacoustic stimulation. Four patterns were observed: (1) habituation (H), (2) reactive nonhabituation (R-NH), (3) accelerative nonhabituation (A-NH), and (4) nonreactive (NR). Fetuses from normal pregnancies habituated significantly more often than those at greater risk. Of the high-risk group, only 6.4% who have habituated antenatally had a labor or nursery complication compared with 67.5% who exhibited the R-NH or A-NH pattern (P less than .001). This study has demonstrated the patterns of FHR response to vibroacoustic stimulation, as well as the ability to induce fetal habituation. Habituation may differentiate high-risk fetuses on the basis of labor complications or poor neonatal outcome. Further study of habituation is being conducted to ascertain if it should be added to standard fetal surveillance modalities of fetal movement, the non-stress test, contraction stress test, and biophysical profile.

Acoustic Stimulation↗
PubMed1990

Coronal biparietal diameter. A reliable alternative to the traditional transverse biparietal diameter.

The traditional ultrasonically derived fetal biparietal diameter (BPD) is important in the determination of fetal age, weight, and growth. This measure cannot be obtained, however, with direct occiput anterior or posterior or with a head in the pelvis. This study looked at the BPD utilizing coronal (anatomically at right angles to the traditional BPD through the thalami, third ventricle, and cavum septum pellucidum) rather than transverse section through the fetal head. In 265 patients at 14 to 41 weeks' gestation, simultaneous measurement of the coronal and transverse BPDs revealed that they were interchangeable (r = 0.99). The major drawback of the coronal BPD is the inability to obtain a head circumference because of the absence of the occipitofrontal diameter.

Cephalometry↗
PubMed1990

Cis-platinum combination chemotherapy during pregnancy for advanced epithelial ovarian carcinoma.

Epithelial carcinoma of the ovary, a rare complication of pregnancy, was diagnosed at 16 weeks' gestation after presentation as an acute abdomen. Exploration with conservative surgery was done, and cis-platinum-based combination chemotherapy was administered for the remainder of the pregnancy. Induction and vaginal delivery resulted in a successful outcome for mother and fetus. Postpartum laparotomy was negative.

Adult↗
PubMed1987

Angiotensin-converting enzyme activity in hypertensive subjects after magnesium sulfate therapy.

Angiotensin-converting enzyme is a peptidase involved in the formation of angiotensin II and the inactivation of bradykinin. In a previous study we found elevated angiotensin-converting enzyme activity in women with pregnancy-induced hypertension prior to magnesium sulfate therapy and lower levels during therapy. This prospective study was undertaken in order to determine if angiotensin-converting enzyme activity indeed decreased after magnesium sulfate therapy. Sixteen patients with pregnancy-induced hypertension were studied before and during magnesium sulfate therapy. Angiotensin-converting enzyme activity was found to decrease 1 to 8 hours into therapy and then plateau between 9 and 24 hours. Possible mechanisms for this observation are discussed.

Adult↗
PubMed1987

Large for gestational age: dilemma of the infant of the diabetic mother.

A retrospective analysis was undertaken of 128 pregnancies (131 infants) complicated by diabetes; 66 (51 per cent) were Class A and 62 (49 per cent) Class B-D-F-R. 53.9 per cent of all infants were large for gestational age (LGA) and there were no differences between the classes of diabetics. LGA infants occurred with equal frequency in those diabetic patients with pregnancy-induced or chronic hypertension. Congenital anomalies occurred in 9.7 per cent with 11/12 in Class A, B, or C. Major neonatal morbidity included: 1) hypoglycemia: two (3 per cent) Class A and 21 (32.8 per cent) insulin-dependent mothers (P less than 0.01); and 2) respiratory distress syndrome: seven (5.3 per cent) and all were in classes B-F (P less than 0.05). Modern management of diabetes in pregnancy has, for unknown reasons, increased the incidence of LGA infants.

Adult↗
PubMed1986

Role of ultrasound in obstetric management.

This is a retrospective, noncomparative study of the impact of routine and indicated ultrasound examinations on 163 private and 125 clinic patients, respectively. Management decisions (delivery, nonintervention, tocolysis) based on indicated ultrasound were made in 36.7% of the private and 63% of the clinic patients. Ultrasound was important in assigning and altering the EDC where dates were unsure. Serendipitous findings were especially important in finding fetal anomalies. Routine ultrasound provided the obstetrician with reassurance in normal pregnancies.

Adult↗
PubMed1986

The relation of angiotensin-converting enzyme to the pregnancy-induced hypertension-preeclampsia syndrome.

Angiotensin-converting enzyme, the polypeptide that converts angiotensin I to angiotensin II, was measured in the serum of 114 pregnant women who had normal blood pressure, pregnancy-induced hypertension-preeclampsia, and chronic hypertension with or without pregnancy-induced hypertension. Angiotensin-converting enzyme levels were unrelated to weeks of gestation. The angiotensin-converting enzyme levels were similar in normotensive women (21.1 +/- 6.9 units/ml), women with chronic hypertension without pregnancy-induced hypertension (23.1 +/- 2.7 units/ml), and patients with pregnancy-induced hypertension where magnesium sulfate (22.6 +/- 8.7 units/ml) had been administered prior to angiotensin-converting enzyme assay, but these values were significantly less than those in patients with pregnancy-induced hypertension with no magnesium sulfate (29.1 +/- 6.5 units/ml) therapy and in women with chronic hypertension with superimposed pregnancy-induced hypertension (30.7 +/- 4.4 units/ml) (p less than 0.005). Maternal venous and umbilical venous and arterial angiotensin-converting enzyme levels were as follows: The maternal venous level was less than the cord venous level and greater than the cord arterial value. Neither neonatal size nor twin gestation influenced the angiotensin-converting enzyme levels. Patients with diabetes mellitus had variable angiotensin-converting enzyme values regardless of the status of the blood pressure. The physiologic theories of blood pressure control in pregnant women are discussed in relation to the renin-angiotensin, bradykinin, and prostaglandin systems.

Adult↗
PubMed1984

Antepartum fetal heart testing: a clinical appraisal.

A prospective noncomparative study was designed to test the ability of the nonstress test (NST) and the contraction stress test or oxytocin challenge test (CST/OCT) to predict neonatal morbidity or impending mortality. Two hundred nine pregnancies tested within eight days of delivery were studied. The only two perinatal deaths occurred in association with the postmaturity syndrome, and both had a preceding reactive NST. Some patients (37.5%) with a positive CST/OCT had fetal distress in labor. Ninety-six percent of infants with distress in labor had an antecedent reactive NST. In the study, 25.8% of the patients had a major antepartum, intrapartum, or postpartum complication that was not predicted by the NST. Therefore, electronic antepartum fetal heart rate surveillance was used as only one facet of the overall patient analysis. Management of patients was based upon the combination of antepartum monitoring, real-time ultrasound evaluation of amniotic fluid, and placental morphology, as well as the clinical suspicion of increased risk (using fetal activity testing, etc).

Adolescent↗
PubMed1979

Patterns of pulmonary maturation in normal and abnormal pregnancy.

Fetal pulmonary maturation may be a variable event depending on various feto-maternal environmental and biochemical influences. The patterns of maturation were studied in 211 amniotic fluid samples from 123 patients (normal 55; diabetes 23; Rh sensitization 19; preeclampsia 26). The phenomenon of globule formation from the amniotic fluid lipid extract and is relation to pulmonary maturity was utilized for this analysis. Validation of this technique is presented. A normal curve was constructed from 22 to 42 weeks; gestation and compared to the abnormal pregnancies. Patients with class A, B, and C diabetes and Rh-sensitized pregnancies had delayed pulmonary maturation. Patients with class D diabetes and preclampsia paralleled the normal course of maturation. A discussion of these results and their possible cause is presented.

Amniotic Fluid↗
PubMed1978

Unconjugated estriol and cortisol in maternal and cord serum and amniotic fluid in normal and abnormal pregnancy.

This study investigated unconjugated E3 and cortisol in normal and abnormal (diabetes and chronic stress) pregnancies and the compartmental (maternal, fetoplacental, amniotic fluid) concentrations and relationships in simultaneous samples. It was demonstrated that in labor both steriods are higher in all compartments than in patients having an elective cesarean section. Diabetic pregnancies do not differ radically from normal, but the stressed gestations have lower E3 and elevated fetal cortisol levels. That the maternal serum unconjugated E3 reflected fetoplacental function was confirmed. Twin pregnancies that were studied presented some conflicting data.

Adrenal Glands↗
PubMed1977

Surface tension of amniotic fluid lipid extracts: prediction of pulmonary maturity.

The surface tension (ST)-lowering properties of an amniotic fluid lipid extract can provide a rapid and reliable means of predicting pulmonary maturity. One hundred and eleven samples from 91 patients were analyzed. A surface tension of less than 56 dynes per centimeter at 120 microliter of extract and less than 46 dynes per centimeter at 220 microliter of extract denoted pulmonary maturity. Values greater than these indicated immaturity. Among fluid samples studied within 48 hours of delivery for the presence or absence of respiratory distress syndrome (RDS) in 71 patients, there were no false positive ST values, while 7 of 22 patients with immature values developed RDS. Surface tension correlates well with the lecithin/sphingomyelin (L/S) ratio but provides clearer definition than the L/S ratio when compared to outcome. Blood and meconium contamination make the surface tension of fluid from babies with pulmonary immaturity appear mature. Identical twins with dissimilar ST values and outcome, as well as serial samples from individual patients, are analyzed and discussed.

Amniotic Fluid↗
PubMed1977

Rapid prediction of pulmonary maturity by amniotic fluid lipid globule formation.

Utilizing the surface tension (ST) lowering properties of an amniotic fluid lipid extract, it was noted that the amniotic fluid lipid layer formed a subsurface globule when the ST reached 36.9 dynes/cm +/- 0.1877 (SEM). The amount of required extract to achieve globule formation varied with the degree of fetal pulmonary maturity and the volume required could be used to differentiate pulmonary maturity (less than or equal to 320 microliter), transitional status (340 to 440 microliter), and pulmonary immaturity (greater than 460 microliter), as related to fetal outcome (amniotic fluid obtained within 48 hours of delivery). Of the 70 patients studied, the 7 (100%) who developed respiratory distress syndrome (RDS) were predicted correctly. Nine of 70 (12.1%) gave false negative results (predicted pulmonary immaturity, no RDS developed); there were no false positives. Globule measurements of a separate series of 74 samples were compared with their L/S ratios. Twenty-two of 24 (91.7%) samples termed mature had an L/S greater than 2.0, while 32 of 42 with a value termed immature had an L/S less than or equal to 1.9. The physical events in the establishment of the monolayer and subsequent globule formation are discussed. This method now provides a rapid and reliable screening indicator of fetal pulmonary maturity.

Amniotic Fluid↗
PubMed1976

Maternal and fetal plasma cortisol levels at parturition.

Fetal adrenal function during pregnancy has a probable role in parturition. Ninety-five mothers and fetuses were evaluated to ascertain maternal or fetal plasma cortisol interrelationships under various clinical situations. When mode of delivery was evaluated, maternal cortisol levels showed no differences. However, the fetuses from vaginal delivery (mean, 43.7 mug/100 ml) had higher levels than those from cesarean section (mean, 34.7 mug/100 ml). Induction of labor showed a rise in maternal cortisol from preinduction levels (mean, 40.2 mug/100 ml) to delivery (mean, 49.6 mug/100 ml), probably reflecting the maternal stress of labor. The fetal cortisol level after induced labor (mean, 35.2 mug/ml) supporting the adrenal contribution to the initiation of labor. Gestational age of the fetus was significant in the fetal cortisol levels: 36 weeks or less (mean, 34.1 mug/100 ml); 37 weeks or more (mean, 44.5 mug/100 ml). This again supports the development of adrenal maturity. Fetal weight, postdatism, acute and chronic fetal distress, hypertensive disease in pregnancy, and race were evaluated without revealing any significant intergroup differences. Two anencephalic pregnancies were also studied.

Adrenal Glands↗
PubMed1976

Assessment of fetal pulmonic maturity by measurement of the surface tension of amniotic fluid lipid extract.

Fetal pulmonic maturity is currently predicted by the lecithin/sphingomyelin (L/S) ratio which utilizes the changes with increased gestation in the lecithin component of amniotic fluid surfactant. The surface tension lowering property of lipids extracted from the amniotic fluid of 45 patients was measured directly. The surface tension (gamma) of various aliquots of the amniotic fluid lipid extract was measured by a modification of the Wilhelmy plate method. At 80 gamma of the extract, a gamma of 67 dynes/cm or less indicated pulmonic maturity, while a gamma of greater than 67 dynes/cm suggested immaturity, provided that the gamma at 200 gamma was greater than 56 dynes/cm. The fluid was termed transitional if the gamma was greater than 67 dynes/cm at 80 gama, but less than 56 dynes/cm at 200 gamma. A comparison was made with the L/S ratio; there were no false positive values and only 13.6% false negative surface tension values. Addition of blood to amniotic fluid, mature and immature, yielded the same results as with the L/S ratio. Two infants with respiratory distress syndrome had both immature L/S ratios and surface tension results. Results indicate that the surface tension of the amniotic fluid lipid extracts is a reliable and rapid means of antenatally predicting fetal pulmonic maturity.

Amniotic Fluid↗