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Biomedical subjects

L C Gilstrap

Publications and source records attributed to L C Gilstrap.

At least 127 records · Page 7Linked to original sources
PubMed1983

Ehlers-Danlos syndrome and pregnancy.

Ehlers-Danlos syndrome is a genetically transmitted disorder of connective tissue characterized by hyperelasticity of the skin, hyperflexibility and looseness of the joints, easy bruisability of the skin, and in the more severe forms of the disease, arterial fragility and tendency to rupture. Pregnant patients with Ehlers-Danlos syndrome are at increased risk for various complications, most serious of which is rupture of a major vessel. The present case report is the second known report of a maternal death from rupture of a major artery in a patient with the severe type IV variant of the syndrome. The advisability of pregnancy and genetic counseling are discussed.

Adult↗
PubMed1982

Fetal heart rate reactivity before and after maternal jogging during the third trimester.

A paucity of data exists concerning the fetal effects of exercise during pregnancy. Seven women who jogged at least 1.5 miles three times per week prior to and during pregnancy were studied during the third trimester of pregnancy (28 to 38 weeks' gestation). Fetal status was evaluated by the nonstress test (NST) before and immediately after maternal jogging of at least 1.5 miles. The seven pregnant women had a total of 30 NSTs--15 prior to and 15 immediately after jogging. All 30 tests were reactive, and there was no significant difference in the monitoring time required to obtain a reactive NST before and after jogging. The prejogging fetal heart rate (FHR) ranged from 140 to 150 bpm, and the postjogging FHR ranged from 180 to 204 in nine of the 15 NSTs. It took a mean of 22 minutes (range, 12 to 30 minutes) for the FHR to return to the prejogging baseline.

Female↗
PubMed1982

Conservative management of patients with premature rupture of fetal membranes.

The management of pregnant patients with premature rupture of membranes (PROM) prior to 32 weeks' gestation or at 32 to 34 weeks' gestation is controversial. In a retrospective analysis of 109 patients with PROM at or prior to 34 weeks' gestation, 53 (49%) were managed conservatively, and labor was eigher induced or occurred spontaneously within 24 hours in 56 (51%). Patients initially presenting with chorioamnionitis were excluded from this study, as were all patients with evidence of a fetal anomaly or a medical indication for delivery. The 53 patients managed conservatively had a mean pregnancy prolongation of 21 days (range, 2 to 105 days median, 7 days). The infants of patients managed conservatively had a lower incidence of respiratory distress syndrome (P less than .0025), mortality (P less than .05), and intracranial hemorrhage (P less than .03). Sixty-four percent of the conservatively managed group versus 45% of the induced/spontaneous labor group were found to be normal upon physical and neurologic examination when discharged from the hospital (P less than .035). The difference in incidence of neonatal sepsis between these 2 groups was not statistically significant (P = .42). Immediate induction of labor and/or delivery for patients with PROM at less than 32 weeks' gestation resulted in a significant increase in perinatal mortality and morbidity.

Female↗
PubMed1981

Renal infection and pregnancy outcome.

To evaluate the impact of renal infection on pregnancy outcome, we studied a group of pregnant women with asymptomatic renal bacteriuria and another group who had acute pyelonephritis. In 248 women with asymptomatic bacteriuria, infection was localized by the antibody-coated bacteria method. These women were prospectively matched with abacteriuric control subjects and we found no adverse effects of treated renal or bladder infection. Specifically, the number of women with hypertension and anemia in each group was similar, and infants born to these women were comparable regarding perinatal mortality, mean gestational age, and birth weight, as well as indices of maturity. A total of 487 women with acute pyelonephritis were evaluated in a case-control study and observations of the correlation of maternal anemia and pyelonephritis were confirmed. Women with antepartum infection had no increased adverse perinatal outcome; however, in some women with intrapartum infection, pyelonephritis appeared to have initiated premature labor. We concluded that treated renal infection, whether symptomatic or asymptomatic, does not significantly modify pregnancy outcome.

Acute Disease↗
PubMed1981

Bladder versus renal bacteriuria during pregnancy: recurrence after treatment.

Localization of bacteriuria has been shown to correlate with the pattern of recurrence after treatment. The immunofluorescent technique was used to localize infection in 233 pregnant women with asymptomatic bacteriuria to determine whether this would identify those who were at greater risk for recurrence. In both an indigent and a military population, the incidence of renal bacteriuria was 42%. Regardless of the site of infection, after one course of short-term (10-day) or long-term (21-day) antimicrobial therapy, almost two thirds of these women were abacteriuric for the remainder of gestation. Women given short-term treatment were more likely to have a recurrence within 2 weeks of completion of therapy than were women given long-term therapy (P less than 0.001). Moreover, these early recurrences were more frequent in women given short-term treatment for renal bacteriuria (P less than 0.05). Conversely, recurrences 6 or more weeks after completion of therapy, and regardless of site of infection, were more common in women given long-term treatment (P less than 0.01). Although the timing of recurrence varied significantly in relation to duration of treatment and site of infection, the ultimate risk of recurrence was not related to either. The conclusion is that localization of asymptomatic bacteriuria does not contribute to the management of pregnant women, since overall recurrence rates are independent of the site of infection.

Anti-Infective Agents, Urinary↗
PubMed1981

Cystitis during pregnancy: a distinct clinical entity.

Acute cystitis during pregnancy is a distinct clinical entity characterized by lower urinary tract symptoms, the absence of systemic symptoms, and a positive urine culture. Over a 6-year period there were 9734 deliveries at Wilford Hall USAF Medical Center and 126 patients with acute cystitis, for an incidence of 1.3%. The majority of cystitis patients had a negative initial screening urine culture, and most cases of bladder infection occurred in the second trimester. The most common bacterial isolate was Escherichia coli. Only 17% of cystitis patients had a recurrence of urinary tract infection. All women were treated as outpatients with oral antimicrobial agents.

Acute Disease↗
PubMed1981

Acute pyelonephritis in pregnancy: an anterospective study.

During a 4.5-year period, over 2% of 24,000 obstetric patients at Parkland Memorial Hospital were admitted for acute pyelonephritis. Chills accompanying back pain was the most common presenting complaint in the se 656 women; lower urinary tract symptoms and nausea and vomiting were also common. All women had fever and, with few exceptions, costovertebral angle tenderness. In most cases, the clinical impression was confirmed by bacteriuria. Significant transient renal dysfunction was demonstrated in 60 (21%) of 282 women tested. Of 501 of the 656 women with antepartum pyelonephritis who delivered at Parkland Hospital, 23% developed recurrent pyelonephritis; in half of these patients, this recurrence was antepartum. Of 393 and of the 501 women tested, 20% had asymptomatic bacteriuria at delivery. An 8- to 13-year follow-up study was done on 208 of the 501 women following the index pregnancy; 42% were treated for 1 or more episodes of symptomatic urinary infection when not pregnant. In 140 of the 501 women, a subsequent pregnancy was cared for at Parkland Hospital. Thirty-eight percent of these patients had at least 1 urinary infection during 1 of these pregnancies: 29% had pyelonephritis, and 9% had either asymptomatic bacteriuria or cystitis.

Acute Disease↗
PubMed1980

Cholecystectomy and abdominal hysterectomy.

Cholelithiasis is a common disease in women and can lead to serious complications. At Wilford Hall USAF Medical Center, we have performed 21 cholecystectomies at the time of abdominal hysterectomy. All patients had been asymptomatic with regard to gallbladder disease, but showed either preoperative or intraoperative evidence of gallbladder disease. The mean surgical time was 3.3 hours, mean blood loss was 474 mL, and only one patient had febrile morbidity (> 38.3 degrees C). Because of the low morbidity, we recommend that this combined surgical approach be considered by both the gynecologist and general surgeon.

Adult↗
PubMed1980

Cefamandole for treatment of obstetrical and gynecological infections.

Cefamandole nafate has been shown to have good in vitro activity against a wide spectrum of aerobic and anaerobic pathogens frequently isolated from women with obstetrical and gynecological infections. One hundred and twenty seven women with these infections were treated with cefamandole: 78 had post-cesarean section metritis; 24 acute pelvic inflammatory disease; 18 post-hysterectomy cuff cellulitis/abscess; and 7 had vulvar or abdominal wound abscesses. All but 13% of these women had either polymicrobial aerobic/anaerobic bacterial infections, or had an anaerobic infection alone. Of these 127 women, 116 responded to cefamandole administration alone, and in the other 11 chloramphenicol was added. Of these 11, surgical therapy was necessary to eradicate infection in six women. Phlebitis, mild to severe, was demonstrated in 14% of the women and responded to conservative measures. Of 402 bacterial isolates from these women, 94% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level. Anaerobic streptococci were the most common isolate and 94% of these organisms were sensitive at 32 microgram/ml. Of the 43 Bacteroides species isolated, 90% were susceptible at 32 microgram/ml; 84% of Bacteroides fragilis were susceptible ast this concentration. Data now presented indicate that cefamandole given alone is safe and effective for treatment of women with polymicrobial mixed aerobic/anaerobic pelvic infections and approximately 5% will require surgical therapy for eradication of these infections.

Aerobiosis↗
PubMed1980

Post-term pregnancy. I.

The perinatal mortality and morbidity of 185 post-term pregnancies managed by weekly trial inductions starting at 42 weeks' gestation were compared to those of 119 post-term pregnancies with spontaneous labor before a trial induction was accomplished. One stillbirth occurred in the spontaneous labor group and one in the induced group. There was no statistical difference in the maternal or fetal morbidity in terms of bradycardia in labor, meconium-stained amniotic fluid, meconium aspiration, 1-minute Apgar scores less than 4, macrosomia (more than 4000 g), neonatal pneumonia, and the incidence of cesarean section. This retrospective analysis suggests that standard clinical management is sufficient to assure optimal perinatal outcome in post-term pregnancies.

Female↗
PubMed1979

Appraisal of "rigid" blood glucose control during pregnancy in the overtly diabetic woman.

The degree of maternal glucose control achieved during the third trimester of pregnancy was evaluated for 120 overtly diabetic women hospitalized on a high-risk pregnancy ward. "Rigid" blood glucose control, defined as a mean preprandial plasma glucose concentration less than 115 mg/dl was achieved in only 14% of these women. Although mean preprandial plasmal glucose concentrations ranged between 115 and 172 mg/dl in 66% of women and exceeded 172 mg/dl in 20%, the perinatal salvage rate was greater than 95%. Pregnancies of those women whose mean plasma glucose levels exceeded 172 mg/dl required earlier intervention for signs of fetal jeopardy, but the degree of glucose control was not significantly related to either perinatal death or neonatal morbidity. These results suggest that maternal hyperglycemia exceeding a mean preprandial glucose concentration of 172 mg/dl is to be avoided, whereas, at the other extreme, mean glucose levels less than 115 mg/dl or "rigid" control is unnecessary for a successful perinatal outcome.

Adult↗
PubMed1979

Treatment of obstetric and gynecologic infections with cefamandole.

Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.

Abscess↗
PubMed1979

The bacterial pathogenesis of infection following cesarean section.

To further define the bacterial pathogenesis of infections following cesarean section, amnionic fluid was obtained transabdominally at the time of surgery from 56 women whose membranes were ruptured for more than 6 hours. In all specimens, bacterial growth was demonstrated, and 53 of these women developed postoperative myometritis. A mean of 2.5 pathogenic bacteria was isolated from each specimen. More than 90% of the amnionic fluid specimens had polymicrobial anaerobic/aerobic growth (63%) or anaerobes only (30%). Aerobic and anaerobic streptococci accounted for 72% of all bacterial isolates; Bacteroides and Escherichia coli were the next most commonly recovered species. In women treated for myometritis and who subsequently developed a wound or pelvic abscess, cultures from these wounds or abscesses were positive for 1-3 organisms present in amnionic fluid. These data indicate that ascending colonization of flora from the lower genital tract and inoculation into surgically traumatized tissues usually result in polymicrobial pelvic infection with a predominance of anaerobic pathogens. Moreover, abscess development in these women is probably associated with organisms identified in amnionic fluid. Bacterial isolates from these women are remarkably similar to those from women with other pelvic infections.

Adolescent↗
PubMed1978

The bacterial pathogenesis of acute pelvic inflammatory disease.

To study the bacterial pathogenesis of acute pelvic inflammatory disease, peritoneal fluid was obtained by culdocentesis in 133 of 344 women with this disease. In 104 of the specimens bacteria were identified both in the gram-stained smear and culture. Neisseria gonorrhoeae was isolated from the lower genital tract in over half of these women, and there were 3 patterns of bacterial recovery from peritoneal fluid: N gonorrhoeae alone (22%), N gonorrhoeae and other organisms (32%), and nongonococcal organisms alone (46%). In women without cervical gonorrhea only nongonococcal organisms were identified from peritoneal fluid. In both groups of women a similar number of nongonococcal organisms were isolated. The results of this study supported those reported prior to availability of antimicrobials and suggest that N gonorrhoeae initiates most cases of pelvic inflammatory disease. A significant number of these women have superinfection with nongonococcal organisms which may preclude recovery of gonococci.

Acute Disease↗
PubMed1977

Gonorrhea screening in male consorts of women with pelvic infection.

Neisseria gonorrhoeae was isolated from 39% of male contacts of women with acute gonococcal pelvic inflammatory disease (PID); 22% of these men were asymptomatic. More than half of those women with gonococcal PID had at least one male sexual consort with gonorrhea. Neisseria gonorrhoeae was isolated from 15% of male contacts of women with nongonococcal PID; 30% were asymptomatic. Since a substantial number of male contacts of women with acute PID will have cultures positive for N gonorrhoeae and are asymptomatic, all male sexual consorts should be examined and have cultures grown for gonorrhea.

Disease Reservoirs↗