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Biomedical subjects

K J Moise

Publications and source records attributed to K J Moise.

At least 55 records · Page 3Linked to original sources
PubMed1995

An animal model for hemolytic disease of the fetus and newborn. II. Fetal effects in New Zealand rabbits.

OBJECTIVE: The addition of ultrasonography and ultrasonographically directed fetal blood sampling was attempted in an effort to study the fetal effects of red blood cell alloimmunization in a rabbit model. STUDY DESIGN: Nineteen New Zealand does were alloimmunized to incompatible red blood cells. Sensitized does were bred twice, once with a homozygous buck of incompatible blood type and once with a homozygous buck of compatible blood type. Ultrasonographic examinations were performed on days 20 and 27 of gestation (term 28 to 31 days). Fetal blood sampling was undertaken on day 27 of gestation, and hematologic data were compared between compatible and incompatible litters. RESULTS: A total of 41 pregnancies occurred in 19 does. Fetal hemoglobin was higher in the compatible litters (9.7 gm/dl vs 5.8 gm/dl, p < 0.001), whereas no difference could be detected between the respective reticulocyte counts (31.9 vs 36.0/100 red blood cells, p = 0.2). Hydrops fetalis was noted in none of 18 compatible litters versus 12 of 19 incompatible litters (p < 0.01). CONCLUSION: A disease analogous to human hemolytic disease of the newborn can be induced in the rabbit fetus.

Animals↗
PubMed1995

Meconium inhibits the contraction of umbilical vessels induced by the thromboxane A2 analog U46619.

OBJECTIVE: Our objective was to study the direct effects of meconium on isolated umbilical artery and vein in vitro. STUDY DESIGN: Intact umbilical artery and vein rings were suspended in 5 ml organ baths containing kreb's solution (pH 7.2, 37 degrees C; bubbled with 2.5% oxygen and 8.07% carbon dioxide, balance nitrogen) for isometric tension recording. Meconium alone (final bath concentration 1%), centrifuged and filtered meconium, and meconium with the lipid fraction removed (separated into < 30,000 kd and > 30,000 kd) were added to the baths. Some vessels were also incubated in 1% meconium for 30 minutes, after which the meconium was washed out. Concentration-response curves to U46619 were obtained. The negative log of the concentration that evokes 50% of the maximal contraction was determined. RESULTS: Umbilical artery and vein had no sustained response to meconium. Tension that developed by rings exposed to meconium was significantly less than control at all concentrations of U46619. There was some loss of the efficacy of meconium after centrifugation-filtration and washing out. Meconium without the lipid fraction had less inhibitory effect than did native meconium. CONCLUSIONS: Meconium does not cause sustained contraction of umbilical artery and vein in vitro. It does, however, inhibit the contractile effect of U46619 in both umbilical artery and vein smooth muscle. The inhibitory activity of meconium appears to be concentrated in the lipid fraction.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1995

Hormonal status affects the reactivity of the cerebral vasculature.

OBJECTIVE: We compared the blood velocity and vascular resistance in the central retinal and ophthalmic arteries in healthy nonpregnant, pregnant, and postmenopausal women (before and after estrogen replacement therapy). STUDY DESIGN: Color flow Doppler ultrasonography was used to determine systolic, diastolic, and mean velocity, as well as the resistance index in the central retinal and ophthalmic arteries in 10 nonpregnant women, 10 third-trimester pregnant women, and 10 hypoestrogenic postmenopausal women. The postmenopausal patients were again studied 2 months after starting daily oral therapy with 2 mg of micronized 17 beta-estradiol. RESULTS: Pregnant women had a significantly (p < 0.05) higher diastolic blood velocity (4.2 +/- 0.8 cm/sec) and a lower resistance index (0.56 +/- 0.05) in the central retinal artery, when compared with nonpregnant women (diastolic velocity 2.8 +/- 0.8 cm/sec, resistance index 0.68 +/- 0.1), and hypoestrogenic postmenopausal women (diastolic velocity 2.6 +/- 0.9 cm/sec, resistance index 0.73 +/- 0.08). Significant differences were not seen in the ophthalmic artery. In the postmenopausal patients estradiol therapy was associated with an increase in diastolic velocity (2.6 +/- 0.9 cm/sec vs 4.1 +/- 1.6 cm/sec) and a decrease in the resistance index (0.73 +/- 0.08 vs 0.66 +/- 0.1) in the central retinal artery but not in the ophthalmic artery. CONCLUSIONS: The blood velocity and vascular resistance in the cerebral microcirculation appear to change according to the phases of a woman's reproductive life. This may be related, in part, to estrogen levels, because estradiol vasodilates small-diameter cerebral vessels in hypoestrogenic postmenopausal women.

Adult↗
PubMed1995

Postpartum thrombotic thrombocytopenic purpura complicated by Budd-Chiari syndrome.

BACKGROUND: Thrombotic thrombocytopenic purpura is an infrequent but devastating complication of pregnancy, often difficult to differentiate from severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). To our knowledge, the combination of thrombotic thrombocytopenic purpura and hepatic vein thrombosis has not been reported previously in pregnancy. CASE: A 33-year-old woman, a multigravida, was delivered at 36 weeks' gestation because of pregnancy-induced hypertension and HELLP syndrome. Postpartum, the patient became obtunded, disoriented, and anuric. Her laboratory values revealed a Coombs-negative, microangiopathic hemolytic anemia, modestly abnormal coagulation studies, and thrombocytopenia. She also had elevated liver enzymes, lactate dehydrogenase, and creatinine. The largest plasma von Willebrand factor multimeric forms were relatively decreased in her ethylenediaminetetra-acetic acid-platelet-poor plasma. A diagnosis of thrombotic thrombocytopenic purpura was made. The patient received plasma exchange, hemodialysis, blood transfusion, and glucocorticoids. She responded to therapy, but was later noted to have increasing hepatosplenomegaly, rising levels of bilirubin, and elevated alkaline phosphatase. A Doppler study and magnetic resonance imaging demonstrated the absence of flow in the middle and left hepatic veins, secondary to thrombosis (Budd-Chiari syndrome). She was maintained on warfarin therapy and was discharged on postpartum day 50. CONCLUSION: The early recognition of thrombotic thrombocytopenic purpura is crucial for the initiation of appropriate treatment as soon as possible. The avoidance of platelet transfusion and early plasma-exchange therapy may be lifesaving.

Adult↗
PubMed1995

Successful urokinase treatment of massive pulmonary embolism in pregnancy.

BACKGROUND: Thrombolytic agents have been used successfully to treat patients with massive pulmonary embolism and cardiorespiratory insufficiency, but experience with these drugs in pregnancy is limited. CASE: A 20-year-old woman at 21 weeks' gestation was admitted with a massive pulmonary embolism. She was initially given intravenous heparin therapy but because of worsening clinical condition, urokinase was used. After two 12-hour periods of therapy, the urokinase was discontinued and the heparin restarted. She remained on subcutaneous heparin therapy for the remainder of her pregnancy, which was otherwise uncomplicated. She delivered a healthy male infant at term without complications and was discharged on warfarin therapy. CONCLUSION: Thrombolytic therapy can be life-saving and should be considered in the treatment of hemodynamically significant pulmonary embolism in pregnancy.

Adult↗
PubMed1995

Pre-eclampsia does not alter the response to endothelin-1 in human omental artery.

Endothelin-1 (ET-1), known to be present in high concentrations in serum from pre-eclamptic compared with normotensive pregnant women, may contribute to the increased vascular reactivity seen in pre-eclampsia. Experiments were designed to compare the contractile activity of ET-1 in isolated omental arteries from menopausal women (n = 6), normotensive pregnant women (n = 7), and pre-eclamptic patients (n = 7). Intact rings (3-mm width) were suspended for isometric tension recording in organ chambers filled with modified Krebs/bicarbonate buffer aerated with 95% air and 5% CO2, 37 degrees C, pH 7.35-7.4, under tension of 1 g. No significant differences were found in either the sensitivity to (concentration producing 50% of contraction) or efficacy of (maximal increase in tension, normalized to reference contraction to KCl) ET-1 in the vessels of all three groups of patients studied. These data argue against ET-1 as a primary factor in pre-eclampsia. The modulatory role of ET-1 on the effects of other contractile factors of human blood, as a possible cause of pre-eclamptic changes, remains to be elucidated.

Adult↗
PubMed1994

Nimodipine in the management of preeclampsia: maternal and fetal effects.

OBJECTIVE: Our purpose was to determine the effects of orally administered nimodipine on selected maternal and fetal parameters in patients with preeclampsia. STUDY DESIGN: Ten consecutive patients were given 30 mg of nimodipine orally every 4 hours from admission until 24 hours after delivery. Maternal and fetal cerebral blood velocity, umbilical artery blood velocity, fetal heart rate variability, maternal blood pressure and heart rate, and transplacental passage of the drug were studied. All 10 patients were delivered within 24 hours of the first dose of nimodipine. RESULTS: There was an acute and significant reduction in the pulsatility index in the smaller diameter maternal cerebral arteries (ophthalmic and central retinal) and in the fetal middle cerebral artery. The umbilical artery systolic/diastolic ratio was also significantly reduced. Maternal blood pressure was controlled without the need for other antihypertensive medication, and although there was an increase in heart rate after administration of the drug, it was well tolerated. Nimodipine reached significant maternal and fetal levels within 2 hours. CONCLUSIONS: Nimodipine is rapidly absorbed after oral administration and has significant maternal and fetal cerebral vasodilator activity. It is an effective, easily administered antihypertensive agent when used in patients with preeclampsia.

Adult↗
PubMed1994

Rapid echocardiographic assessment of left and right heart hemodynamics in critically ill obstetric patients.

OBJECTIVE: Our purpose was to compare noninvasive two-dimensional and Doppler echocardiography and right heart catheterization with a pulmonary artery catheter in the estimation of stroke volume, cardiac output, cardiac index, left ventricular filling pressure, pulmonary artery systolic pressure, and right atrial pressure in a heterogeneous group of critically ill obstetric patients. STUDY DESIGN: Eleven critically ill obstetric patients requiring invasive monitoring for clinical management were prospectively studied. Simultaneous Doppler and pulmonary artery catheter readings of stroke volume, cardiac output, cardiac index, left ventricular filling pressure, pulmonary artery systolic pressure, and right atrial pressure were acquired. Mean +/- SD or median and range, as appropriate, of each parameter were compared, and data for all parameters were subjected to regression analysis. A two-tailed p value < 0.05 was regarded as significant. RESULTS: There was no significant difference between the two techniques in the estimation of cardiac index, intracardiac pressures, or pulmonary artery systolic pressure. There was a good correlation between the two methods for stroke volume (R2 = 0.98), cardiac output (R2 = 0.98), cardiac index (R2 = 0.96), left ventricular filling pressure (R2 = 0.79), pulmonary artery systolic pressure (R2 = 0.85), and right atrial pressure (R2 = 0.86). CONCLUSION: Two-dimensional and Doppler echocardiography allow rapid, reliable, noninvasive assessment of hemodynamic parameters in critically ill obstetric patients and may give the clinician valuable information that may influence therapeutic and clinical management.

Adolescent↗
PubMed1994

Molecular analysis of human platelet antigen system 1 antigen on single cells can be applied to preimplantation genetic diagnosis for prevention of alloimmune thrombocytopenia.

OBJECTIVE: Our purpose was to develop a molecular assay to determine the human platelet antigen system 1 status on single nucleated cells, including human blastomeres. STUDY DESIGN: Eighty single cultured lymphoblasts of known human platelet antigen system 1 genotype and 24 media blanks were mixed in blinded fashion. Amplification of a 246 bp deoxyribonucleic acid fragment and subsequent Nci I restriction digestion were performed to distinguish human platelet antigen system 1a from 1b alleles. Specificity and sensitivity of the technique were determined. Eight blastomeres were also tested. RESULTS: Deoxyribonucleic acid amplification at the human platelet antigen system 1 locus was successful in 95% of the reactions. No media blanks showed amplified deoxyribonucleic acid. The diagnosis was correct in all homozygous human platelet antigen system 1a or 1b cells; three of 23 heterozygous cells amplified but failed to digest with Nci I. Overall specificity was 95%. All blastomeres successfully amplified. CONCLUSIONS: The human platelet antigen system 1 status determination is reliable from a single cell and can be used for preimplantation genetic diagnosis for the prevention of alloimmune thrombocytopenia.

Antigens, Human Platelet↗
PubMed1994

The relation between magnesium sulfate therapy and fetal heart rate variability.

OBJECTIVE: To determine the relation between magnesium sulfate therapy and fetal heart rate (FHR) variability. METHODS: Twelve women diagnosed with preeclampsia who were to receive magnesium sulfate for seizure prophylaxis were recruited. Exclusion criteria included delivery anticipated within 2 hours, gestational age less than 28 weeks, abnormal fetal testing, fetal growth retardation, and use of illicit drugs or medications. Six grams of magnesium sulfate in 100 mL 0.9% saline was administered intravenously over 20 minutes, followed by a continuous infusion of 2 g/hour. A cardiotocogram analysis computer system was used to analyze various elements of the FHR pattern before, during, immediately after, and 60 minutes following magnesium sulfate loading. For each time interval, the basal heart rate, number of accelerations and decelerations, number of minutes of high and low variability, mean minute range variation, and the short-term (3.75-second interval) variability were measured. RESULTS: There was a statistically significant decrease in short-term variability 60 minutes after initiation of therapy (6.7 +/- 2.0 versus 9.8 +/- 3.3 milliseconds; P = .003). Long- and medium-term variability did not change significantly after magnesium sulfate was administered. CONCLUSION: Although magnesium sulfate therapy was associated with an objectively measured, statistically significant decrease in short-term variability, the decrease was not clinically significant; furthermore, it was not associated with a decrease in long-term variability or in the number of accelerations measured.

Cardiotocography↗
PubMed1994

Massive hemoptysis in Takayasu's arteritis during pregnancy.

Takayasu's arteritis is an uncommon condition affecting predominantly young women. Because the disorder affects women in childbearing age, it may be recognized the first time during pregnancy. Various cardiovascular events may occur in the perinatal period. We describe a patient with Takayasu's arteritis who presented with massive hemoptysis. To our knowledge, this manifestation has not been documented previously.

Acute Disease↗
PubMed1994

Inaccurate noninvasive mitral valve area calculation during pregnancy.

OBJECTIVE: To compare two different Doppler echocardiographic techniques for the assessment of the transmitral area in pregnant patients with native mitral valve stenosis or prosthetic mitral valves. METHODS: Eight consecutive gravid women with prosthetic mitral valves or obstructive native mitral valve disease were evaluated using both the pressure half-time and the continuity equation Doppler echocardiographic methods. Heart rate, cardiac output, and transmitral valve gradient and area were calculated. These studies were repeated postpartum in five women. Differences between the two methods were assessed by characterizing the absolute differences between the mean and standard deviation and by paired t tests. Linear regression analysis was also applied. RESULTS: For the five women who also had postpartum studies, antepartum data were similar to those of the full set of eight patients. Postpartum heart rate, cardiac output, and transvalvular gradient were lower than antepartum measurements. Calculations using the continuity equation yielded comparable antepartum and postpartum estimates of transmitral areas (1.31 +/- 0.41 versus 1.32 +/- 0.44 cm2, respectively, r = 0.96). These estimates were also consistent with the initial clinical presentation. In contrast, antepartum transmitral valve areas calculated using the pressure half-time technique (2.67 +/- 0.61 cm2) were markedly higher than postpartum (1.94 +/- 0.58 cm2). The correlation between the estimates of antepartum valve area given by the two methods was not statistically significant (r = 0.02). In contrast, there was excellent postpartum correlation of transmitral area between the methods (r = 0.99), despite a significant difference (P < .001) in the transmitral area calculated with each technique. CONCLUSIONS: The results indicate that Doppler echocardiographic estimates of the transvalvular area using the continuity equation technique during pregnancy are valid. In contrast, estimates of area using the pressure half-time technique in pregnant patients are dubious and could result in life-threatening consequences.

Adult↗
PubMed1994

In vitro comparison of four tocolytic agents, alone and in combination.

OBJECTIVE: To compare the tocolytic effects of magnesium sulfate, ritodrine, terbutaline, and nifedipine on human myometrial strips. METHODS: Myometrial strips were suspended in organ chambers for isotonic measurements and contracted with KCI. STrips from nonpregnant patients were used to obtain concentration-response curves. Myometrial strips from pregnant uteri were then exposed to the molar concentrations causing 50% relaxation in the nonpregnant tissues. RESULTS: In strips from nonpregnant patients, nifedipine was found to be the most potent tocolytic. Using strips from nonlaboring patients, nifedipine caused relaxation similar to ritodrine, and both were more effective than magnesium sulfate or terbutaline. Combinations were more effective than single agents. These agents were found to be equally less effective in myometrial strips from laboring patients. CONCLUSIONS: Nifedipine, alone or in combination, relaxes myometrial strips more effectively than the other agents studied. Myometrial strips from laboring patients are more resistant to inhibition, with none of the agents being superior.

Adult↗
PubMed1994

Changing trends in the management of red blood cell alloimmunization in pregnancy.

PROBLEM: Review the current management of red blood cell alloimmunization in pregnancy. METHODS: Retrospective review of the literature and 8-year experience at Baylor College of Medicine, Houston, Tex. RESULTS: Rhesus alloimmunization continues to affect one in 1000 pregnancies. Newly diagnosed disease can be managed with serial anti-human globulin titers until a critical value is achieved. Thereafter diagnostic modalities include ultrasound, amniocentesis, and percutaneous umbilical blood sampling. Patients with a history of a previously affected pregnancy should be managed in a more aggressive fashion. Newer methods of intravascular intrauterine transfusion can result in neonatal survival in more than 75% of cases. Long-term evaluation of these neonates indicates a good neurologic outcome. CONCLUSIONS: New approaches to therapy using preimplantation diagnosis or selective suppression of the maternal immune system appear promising for the future.

Blood Transfusion, Intrauterine↗
PubMed1993

The oxygen consumption/oxygen delivery curve in severe preeclampsia: evidence for a fixed oxygen extraction state.

OBJECTIVE: Increased total body oxygen consumption requirements are usually met by increased oxygen delivery and increased oxygen extraction. In certain conditions (e.g., adult respiratory distress syndrome) the ability to increase oxygen extraction is lost, and any increase in oxygen consumption depends on increased oxygen delivery. The objective of this study was to investigate the oxygen delivery/oxygen consumption relationship in severe preeclampsia. STUDY DESIGN: Thirty-two patients with severe preeclampsia (blood pressure > 160/110 mm Hg; 3 to 4+ proteinuria) were monitored with a pulmonary artery catheter. Baseline oxygen consumption and delivery in a group without volume expansion or pharmacologic vasodilatation were compared with those in a group who had received a magnesium sulfate infusion. RESULTS: Oxygen consumption, oxygen delivery, arterial-venous-oxygen difference, and the oxygen extraction ratio were low when compared to that for normal 32 to 38 week pregnancy. The oxygen extraction ratio, defined as the ratio of oxygen consumption to oxygen delivery, was abnormally low for pregnancy, especially considering the low oxygen delivery levels in these patients. Oxygen consumption was dependent on oxygen delivery over the entire range of values seen. CONCLUSIONS: Severe preeclampsia is associated with an abnormality of tissue oxygen extraction, as evidenced by a low and unresponsive oxygen extraction ratio. Oxygen consumption increases proportionately with increases in oxygen delivery without reaching an oxygen delivery-independent state. Even at high oxygen delivery levels the oxygen consumption in preeclamptic patients is still abnormally low for pregnancy.

Adolescent↗