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Biomedical subjects

K Teramo

Publications and source records attributed to K Teramo.

At least 91 records · Page 5Linked to original sources
PubMed1987

Natural surfactant substitution in respiratory distress syndrome.

Natural surfactants consist of unique proteins and lipids. Their effectiveness in improving subnormal lung function in surfactant deficiency should be established prior to any clinical trials. Rigorous tests are required to document batch to batch variability in surface activity and to exclude toxic contaminants. Up to this date randomized clinical trials in small preterm infants have demonstrated a striking improvement in lung function, and a decrease in incidence of acute complications (pneumothorax, interstitial emphysema). Administration of human surfactant at birth or in severe RDS decreased deaths and incidence of bronchopulmonary dysplasia. Although homologous surfactant may not be more advantageous than the heterologous one in terms of its acute beneficial effects on lung function, the safety and efficacy of animal surfactant in improving the outcome remains to be established. Human surfactant may serve as a model for unlimited natural surfactant produced by gene technology. The pharmacodynamics aspects of surfactant substitution, the indications of exogenous surfactant, and the management of the patients undergoing surfactant substitution remain to be studied. Exogenous surfactant offers a potential to treat or prevent severe respiratory failure in infants, children and adults.

Animals↗
PubMed1986

The usefulness of micro- and macrochromatographic determinations of glycohemoglobin in diabetic patients with nephropathy.

Determination of glycohemoglobin in blood (HbA1) represents an established measure of glycemic control in diabetic patients. In patients with uremia, however, the determination can be subject to pitfalls which may limit its reliability. In order to evaluate the clinical usefulness of HbA1 determinations in diabetic patients with nephropathy, concentrations of HbA1 and its subfractions HbA1c and HbA1a+b were measured by micro- and macrocolumn chromatography in 58 diabetic and 80 non-diabetic patients with impaired renal function. Fifteen diabetic patients without nephropathy and 15 healthy subjects served as controls. The concentrations of HbA1 and its subfractions were significantly higher in non-diabetic patients with nephropathy than in healthy controls. A positive correlation was seen between HbA1 and plasma glucose concentrations in all subjects, and between HbA1 and serum urea and creatinine concentrations in the non-diabetic subjects. When measured repeatedly in the same patient there was a positive correlation between HbA1 and plasma glucose concentrations in diabetic patients with azotemia. There was no change in HbA1 concentrations measured immediately before and after hemo- or peritoneal dialysis. The increase of chromatographically determined HbA1 concentrations in azotemic patients is most likely due to the joint action of carbamylation of hemoglobin with urea derived cyanate and deterioration of glycemic control induced by azotemia. Despite these problems, chromatographically determined HbA1 is still a clinically useful measure of glycemic control in diabetic patients with nephropathy. This presumes repeated measurements in the same patient and the use of appropriate reference levels which consider the degree of renal impairment.

Adult↗
PubMed1985

Obstetric outcome in women with epilepsy.

A comparison of 150 pregnancies in women with epilepsy and 150 pregnancies in matched nonepileptic control women showed similar rates of pregnancy-induced hypertension, albuminuria, premature contractions, premature labor, and bleeding in pregnancy. Duration of labor, blood loss at delivery, cesarean section rates, and vacuum extraction rates were also similar among epileptic and control groups. There were five perinatal deaths in the epileptic group and two in the control group. A fetal heart rate tracing during a maternal grand mal seizure showed bradycardia, reduced short-term and long-term variability, and late decelerations suggesting asphyxia. It is concluded that grand mal seizures during pregnancy should be avoided by the use of antiepileptic drugs. Women with epilepsy require antenatal neurological and obstetric follow-up during pregnancy.

Anticonvulsants↗
PubMed1985

Cardiac rhabdomyomas in a newborn baby. Early diagnosis and treatment.

Cardiac tumours are rarities in newborn infants. The majority of them are rhabdomyomas as a manifestation of the basic disease-tuberous sclerosis. The clinical picture may vary from serious arrhythmias to A-V valve obstruction and gross myocardial dysfunction. Therefore these patients are extremely poor candidates for invasive diagnostic procedures and surgical treatment. Our patient had intrauterine cardiac arrhythmias, and a prenatal echocardiogram showed features of A-V septal defect malformation. Therefore the echocardiogram was repeated soon after birth and it revealed intracardiac tumours. The patient was operated on the first day of life and four intracavitary tumours were successfully removed.

Adult↗
PubMed1985

Effects of betamethasone and ritodrine on the fetal secretion of lung surfactant.

Beta-sympathomimetic drugs and glucocorticoid agents are given in preterm labor to prevent severe consequences of prematurity. It is unclear whether beta-sympathomimetics accelerate lung maturation, or whether they only tend to delay preterm delivery. We have evaluated the effects of betamethasone and ritodrine in rabbits on alveolar lavage phospholipids in premature rabbits, a mean of 28.7 days from conception. Betamethasone given to 26-day-old fetuses increased the surfactant phospholipids, phosphatidylinositol and disaturated phosphatidylcholine; increased disaturated phosphatidylcholine/sphingomyelin ratio, and phosphatidylinositol (percent of phospholipids), as compared to untreated littermates, or to saline treated controls. A low dose of ritodrine given to the pregnant doe, and a high dose given at premature birth had no detectable effects on alveolar lavage phospholipids. However, a high dose of ritodrine given one day before the delivery to the fetus and at premature birth decreased the disaturated phosphatidylcholine/sphingomyelin ratio and phosphatidylinositol in alveolar lavage. While glucocorticoid administration increases the synthesis and secretion of surfactant phospholipids, a high dose of a betasympathomimetic drug may decrease the surfactant. However, spontaneous premature labor is associated with accelerated lung maturation, and accordingly the present results do not contradict the use of a low dosage of betasympathomimetic drug to delay preterm delivery.

Animals↗
PubMed1984

Risk of minor and major fetal malformations in diabetics with high haemoglobin A1c values in early pregnancy.

Maternal haemoglobin A1c (HbA1c) values were measured before the end of the 15th week of gestation in 142 pregnancies in women with insulin dependent diabetes. In pregnancies complicated by fetal malformations (n = 17) the mean initial HbA1c value was 9.5 (SD 1.8)% of the total haemoglobin concentration, which was significantly (p less than 0.001) higher than in pregnancies without malformations (8.0 (SD 1.4)%; n = 125). HbA1c values did not differ between pregnancies complicated by minor and major fetal malformations, but the rate of malformations showed a positive relation to the HbA1c value in early pregnancy (chi 2 = 11.9; p = 0.001). Fetal malformations occurred in six out of 17 pregnancies (35.3%) in mothers whose initial HbA1c value was 10% or more, in eight out of 62 pregnancies (12.9%) in mothers with initial values between 8.0% and 9.9%, and in only three out of 63 pregnancies (4.8%) in mothers with an initial value below 8.0%. These data support the hypothesis that the increased incidence of fetal malformations in mothers with insulin dependent diabetes is associated with maternal hyperglycaemia during organogenesis. Hence diabetic women who are planning to have a child--especially those with a high HbA1c value--should receive intensified metabolic control.

Adult↗
PubMed1984

Rapid chromatographic quantitation of glycosylated haemoglobins.

We have developed a rapid chromatographic method for determination of glycosylated haemoglobins by high-performance liquid chromatography with a new cation-exchange column. The haemoglobins are eluted with a three-step gradient in 7 min, and total assay time including re-equilibration of the column is 15 min. The method permits separation and quantitation of HbAlc, even in the presence of elevated levels of HbF. HbA1a, A1b and A2 can also be determined. The results correlate well (r = 0.94) with those obtained by the macro-column method of Trivelli et al. [New Engl. J. Med., 284 (1971) 353] for determination of HbA1c. The method has been fully automated by the use of an automatic injector. The within-assay and between-assay coefficient of variation of the method is 2-3%.

Buffers↗
PubMed1984

Antithyroid treatment of maternal hyperthyroidism during lactation.

Eleven pregnant women were treated for hyperthyroidism with carbimazole (CZ) and one with propylthiouracil (PTU). Based upon a previous study it was decided that lactation should be permitted if the dose required after delivery did not exceed 15 mg of CZ or 150 mg of PTU. In the patients studied here the daily dose of CZ varied from 5 to 15 mg and that of PTU was 125 mg. TSH was measured in cord blood and in the blood of the newborn infants usually after 2 and 3 weeks of lactation. Serum T4 was measured serially in the infants' blood from day 4 up to 21 day of age, at least. In all instances the TSH concentration in cord blood remained below 45 mU/l the level used in screening for neonatal hypothyroidism. Serum TSH and T4 were all within the appropriate reference limits during the 3 weeks of study with only one exception. In the infant whose mother was treated with PTU the serum T4 measured 5 d after birth was slightly below the lower limit but later returned to normal. Since serum TSH and T4 did not deviate from the reference range in newborn infants during lactation, we conclude that breast-feeding can be permitted if the daily dose of CZ does not exceed 15 mg (or 150 mg of PTU) and if facilities are available for measuring neonatal serum TSH and T4.

Carbimazole↗
PubMed1984

Fetal heart rate patterns and perinatal outcome of very-low-birthweight infants.

The obstetric records of 125 infants weighing 500-1250 g who were born in 1978 and 1979 at the Helsinki University Central Hospital were studied retrospectively to find out any associations between fetal heart rate (FHR) patterns and perinatal outcome. FHR recordings of 79 fetuses were available for study. Normal reactive patterns were observed in nine, nonreactive in 54, decelerations in 58, silent patterns in 45 and combined distress patterns in 36 fetuses. The interval from the first pathological sign to delivery was up to 27 days. Five fetuses in the monitored group died in utero, 26 infants died neonatally and two later. The risk of neonatal death after pathological FHR patterns was lower than after an FHR pattern without abnormality. Idiopathic respiratory distress syndrome (RDS) was diagnosed in 32 infants, of whom 16 died. Forty-seven fetuses (59%) of the monitored group were delivered abdominally and 32 vaginally. The risk of RDS was not significantly associated with FHR patterns and mode of delivery. We conclude that unlike term fetuses, low-birthweight fetuses seem to benefit from a period of intrauterine stress reflected in abnormal FHR patterns, if caesarean section is used liberally.

Birth Weight↗
PubMed1984

Women on thyroid hormone therapy: pregnancy course, fetal outcome, and amniotic fluid thyroid hormone level.

Thirty-four hypothyroid women on thyroid hormone substitution were followed through 37 pregnancies, and 16 women having previous surgery for thyroid carcinoma and thereafter placed on suppressive thyroxine treatment were followed through 19 pregnancies. The thyroxine treatment needed readjustment in 13 pregnancies (23%) to maintain euthyroidism. At delivery, the maternal free thyroxine index was 126 nmol/L in the group of patients treated for hypothyroidism and 146 nmol/L in the patients with treated thyroid carcinoma. The amniotic fluid thyroxine level in normal pregnancies was 6.7 nmol/L, in hypothyroid patients 6.7 nmol/L, and in patients with thyroid carcinoma 5.6 nmol/L. The amniotic fluid reverse triiodothyronine level in normal pregnancies was 0.51 nmol/L, in hypothyroid patients 0.66 nmol/L, and in patients with thyroid carcinoma 0.70 nmol/L. All infants were euthyroid.

Adenocarcinoma↗
PubMed1983

Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentrations, number of seizures, and fetal outcome.

Serum folate concentrations, blood counts, and antiepileptic drug concentrations were measured during 133 pregnancies of 125 women with epilepsy. There was an inverse correlation between serum folate concentrations and concentrations of phenytoin and phenobarbitone. The number of epileptic seizures during pregnancy showed no association with serum folate concentrations. No cases of maternal tissue folate deficiency or fetal damage attributable to low maternal serum folate were observed. Maternal serum folate concentrations for infants with structural birth defects, "fetal hydantoin syndrome," or perinatal death were similar to those for healthy babies. A low dose (100 to 1000 micrograms daily) of folate supplement appeared sufficient for pregnant women with epilepsy despite the antifolic action of antiepileptic medication. Monitoring folate concentrations in pregnant women with high serum concentrations of phenytoin or phenobarbitone is recommended.

Carbamazepine↗
PubMed1983

Intrauterine hydrops caused by premature closure of the foramen ovale.

Intrauterine hydrops was diagnosed by two dimensional echocardiography. The fetus had a pericardial effusion and a thick interatrial septum without a foramen ovale flap. The condition was treated by giving the mother digitalis. Postnatally, the effusion had disappeared and a parachute mitral valve was found.

Digitalis↗
PubMed1983

Pathologic fetal heart rate associated with poor metabolic control in diabetic pregnancies.

Nonstress fetal heart rate (FHR) recording was used as a primary test to detect fetal distress in 145 pregnant women with insulin-dependent diabetes. Testing was performed every second day beginning with the 32nd week of pregnancy and daily after the 34th week until delivery. One hundred eighteen (81.4%) had normal, nine (6.2%) suspicious, and 18 (12.4%) pathologic FHR recordings. Poor metabolic control of diabetes was observed in 25 (17.2%) of the 145 pregnancies during the last trimester of pregnancy. Nine of these 25 women (35%) with poor metabolic control had a suspicious or pathologic FHR recording, which was significantly more frequent (P less than .02) than in women with good metabolic control (18 of 120, 15%). The mean value (+/- SD) of hemoglobin AIc during the last trimester in diabetic women with pathologic FHR records was 7.63 +/- 0.87%, which was significantly higher (P less than .02) than in diabetic women with normal FHR records (6.91 +/- 0.83%). None of the 145 fetuses monitored died in utero. It was concluded that no obvious iatrogenic morbidity was caused by early intervention in cases with pathologic FHR recordings.

Blood Glucose↗