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Biomedical subjects

L I Mann

Publications and source records attributed to L I Mann.

At least 55 records · Page 3Linked to original sources

Urinary excretion of meperidine by the fetal lamb.

The renal excretion of meperidine by the fetus was determined in five chronic, unanesthesized fetal lamb preparations. Chronic indwelling catheters were implanted in the maternal aorta and vena cava, the fetal aorta, amniotic sac and allantoic sac. Via laparotomy, two catheters were implanted in the fetal bladder; the urachus and urethra were ligated. After intravenous administration of 2.5 mg/kg to the mother, meperidine rapidly appears in fetal urine. Approximately 0.02 to 0.05% of the maternal dose was excreted into fetal urine as unchanged meperidine in 300 min. The elimination half-life of meperidine in the fetus is 32.6 +/- 3.7 min when calculated from the urinary excretion rates, and 28.6 +/- 3.9 min when estimated from the plasma decay curve. The renal clearance of meperidine by the fetus ranged from 2.8 to 16.7 ml/min. Although the urachus and urethra were ligated, meperidine is found in samples of amniotic and allantoic fluid, indicating that the drug can diffuse across the placental membranes from the mother into these fluids. We have demonstrated that renal elimination of meperidine is a route of drug elimination by the fetus. These data support a pharmacokinetic model that describes the disposition of meperidine in the maternal-fetal unit by use of a two-compartment open model with elimination from both maternal and fetal compartments.

Animals↗

Modern management of hypertensive disorders of pregnancy.

Hypertensive disorders of pregnancy contribute significantly to perinatal mortality. Successful application of modern tests of antepartum fetal status and appropriately timed delivery, with monitored labor and liberal use of cesarean section led to significantly improved fetal and neonatal salvage in 242 patients with hypertensive disorders of pregnancy between 1973 and 1975. The reduction in perinatal mortality to a corrected rate of 12/1000 in the years 1973-1975, compared to a previous rate of 75/1000 between 1970 and 1972, justifies the modern aggressive management of hypertensive disorders in pregnancy.

Acute Disease↗

The effect of umbilical vein occlusion on fetal oxygenation, cardiovascular parameters, and fetal electroencephalogram.

In 11 fetal sheep experiments, the blood pressure in the fetal aorta (FA) and in the umbilical vein (UV) was measured following umbilical vein occlusion (UVO), as was the fetal heart rate (FHR), pH, Pco2, and oxygen saturation (So2) in both fetal vessels, and umbilical blood flow (Qumb) of the common UV. The fetal electroencephalogram was recorded continuously throughout the experiment. The results (No. = 17) were grouped according to the response of FA So2 into moderate (So2greater than40 per cent, mean 49.8, S.D. 6.3, and severe So2less than40 per cent, mean 20.4, S.D. 9.2). After 8 to 10 seconds, the fetal blood pressure in FA increased. Umbilical vein blood pressure increased to 25 mm. Hg (S.D. 8) and 35 mm. Hg (S.D. 9) in the moderate and severe groups, respectively. As a result of the decreased perfusion pressure (FA-UV blood pressure) across the fetal side of the placenta, the Qumb fell from 147 ml. per kilogram per minute (S.D. 57) and 30 ml. per kilogram per minute (S.D. 55) to 84 ml. per kilogram per minute (S.D. 48) and 120 ml. per kilogram per minute (S.D.22), respectively. The fall in FA So2 was related to the decrease in Qumb: FA So2=37.6 x log Qumb - 22.8 (2alphaless than 0.001). There was a mild decrease in So2 from 70 to 55 per cent when Qumb fell from 250 to 120 ml. per kilogram per minute. Below 80 to 120ml. per kilogram per minute, the fall in FA So2 was almost linear. The So2 in the UV remained constant so that arteriovenous difference for oxygen (AV Do2) increased. Oxygen consumption decreased almost linearly when Qumb fell below 80 to 120 ml. per kilogram per minute. The fetal electroencephalogram showed no significant change in voltage and the faster activities. From these observations, it is concluded that a decrease in Qumb following UVO jeopardizes the fetus only if a critical Qumb of 80 to 120 ml. per kilogram per minute and fetal artery So2 of 50 to 60 per cent is achieved.

Animals↗

Inhibition of premature labor: a multicenter comparison of ritodrine and ethanol.

A randomized controlled study was carried out at three medical centers to compare the efficacy and side effects of ethanol and ritodrine in the treatment of threatened premature labor. One hundred and thirty-five patients judged to be between the twentieth and thirty-sixth week of gestation and presenting with clinical symptoms of premature labor were included. Sixty-seven patients were treated with intravenous infusion of 10 per cent ethanol. Sixty-eight patients were treated with intravenous infusion of ritodrine for 12 hours followed by oral ritodrine. If labor recurred prematurely, up to two additional courses of ethanol or ritodrine were given. Delivery was postponed for more than 72 hours in 49 of 67 patients (73 per cent) with ethanol and in 61 of 68 patients (90 per cent) with ritodrine; this difference was significant. Patients in the ethanol group gained a mean of 27.6 days while patients in the ritodrine group gained a mean of 44.0 days. Fifty-four per cent of the ethanol group and 72 per cent of the ritodrine group carried their infants to 36 weeks of gestation. Five infants in the ethanol group and one infant in the ritodrine group died from respiratory distress syndrome. The most frequent side effect of ethanol were nausea and vomiting. The most frequent side effects of ritodrine were tachycardia and blood pressure changes which were easily controlled by lowering the infusion rate. Ethanol and ritodrine were both found to be effective inhibitors of premature labor with ritodrine giving the most favorable results.

Adult↗

The effects of fetal thyroidectomy in the ovine fetus.

Cerebral function and metabolism, morphology and histology of the nervous system, and lung maturity in terms of surfactant production were studied at term in five sheep fetuses thyroidectomized at gestational ages ranging from 104 to 111 days. Compared to age-matched controls, body weight (thyroidectomized animals, 2.8 +/- 0.11 kilograms; controls, 3.9 +/- 0.2 kilograms; P less than 0.0005) and brain weight (thyroidectomized animals, 43.51 +/- 1.38 grams; controls, 48.49 +/- 1.75 grams; P less than 0.05) were significantly reduced. In the nervous system, morphology, histology, brain function, and metabolism were not significantly different from those of the controls. Lung weight was less, but not significantly, and surfactant production was not deficient as compared to that of age-matched controls. The failure to find any disturbance of maturation in the brain and lungs of fetuses thyroidectomized at 104 to 111 days may be related to the relative maturity of the sheep fetus at this age.

Animals↗

The association of umbilical cord complications and variable decelerations with acid-base findings.

Variable decelerations during the last 2 hours of labor were associated with an abnormally positioned umbilical cord at delivery in 52% of cases. In cases where an abnormally positioned umbilical cord was seen at delivery, 89% had been preceded by variable decelerations. Cord compression resulted in an A-V difference in pH that was significantly increased when compared to a control group. This was mainly due to a decrease in the pH of the umbilical artery. The pathophysiology of cord compression is discussed.

Acid-Base Equilibrium↗

Modern management of the diabetic pregnancy.

The effect of modern antepartum and intrapartum fetal monitoring technics on the outcome of the pregnancy complicated with diabetes was studied by comparing the perinatal mortality of 2 groups of patients whose management differed primarily by the use of these tests. The perinatal death rate was halved to 9.2%, and when corrected for major congenital defects and referred fetal deaths it was 5.3%. Modern fetal diagnostic tests clearly add a degree of objectivity in the management of the diabetic pregnancy not previously available.

Amniocentesis↗

Liver as the primary site of erythropoietin formation in the fetus.

Fetal sheep produced significant amounts of erythropoietin in response to bleeding. Bilateral nephrectomy prior to bleeding failed to influence the formation of erythropoietin. Removal of the spleen, in addition to kidneys, was also without effect. Subtotal hepatectomy prior to bleeding, however, inhibited erythropoietin formation in these fetuses. In situ perfusion of the liver, but not the kidney, resulted in the appearance of significant quantities of the hormone in the perfusate. These results suggest that the liver is the primary site of erythropoietin production in the mammalian fetus.

Animals↗

Colposcopic evaluation of patients with abnormal cervical cytology.

A total of 1580 new patients underwent colposcopic evalution in the Dysplasia Clinic at Nassau County Medical Center. Of these patients, 186 had abnormal Papanicolaou smears associated with pregnancy, 150 were referred because of in utero exposure to diethylstilbestrol, and 1244 were referred because of abnormal cervical cytologic smear or suspicious cervical or vaginal lesion. Further analysis of this latter group revealed that 1184 (95%) patients had satisfactory colposcopic evaluation, and directed biopsy showed the following: 10 cases of invasive cervical carcinoma, 9 of carcinoma in situ with microinvasion, 118 of cervical carcinoma in situ, 110 of severe dysplasia, and 424 cases of mild to moderate cervical dysplasia. All of these patients subsequently were treated accordingly. Evaluation of final histologic specimen revealed a very high correlation with colposcopically guided biopsies. In 54 patients, where colposcopic evaluation was unsatisfactory, diagnostic cold knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in 30 patients (or 56%) of this group. The result of this study shows that satisfactory colposcopic evaluation is a highly accurate method of evaluation of abnormal cervical and vaginal cytologic smear.

Adolescent↗

Erythrocyte 2,3-diphosphoglycerate in normal and hypertensive gravid women and their newborn infants.

Red blood cell 2,3-diphosphoglycerate (2,3-DPG) levels were studied in 227 normal gravid women in all stages of pregnancy, active labor, and early post partum. An increase to peak levels was observed at 19 to 22 weeks followed by a gradual fall toward normal. During labor and early post partum, 2,3-DPG again rose significantly above levels observed at term. Serial 2,3-DPG values through the third trimester, labor, and postpartum period in 11 hypertensive mothers and 20 normal gravid control subjects and their newborn infants were studied. Maternal 2,3-DPG levels were significantly higher in the hypertensive mothers when compared to control mothers at similar gestational stages. However, no difference in 2,3-DPG levels was observed when newborn infants of hypertensive mothers were compared with those of normal control subjects.

Adolescent↗

The effect of methadone on fetal brain function.

The effect of methadone on fetal brain function in terms of the electroencephalogram (EEG) was studied in eight short-term fetal sheep experiments by single injections of 5 to 20 mg. of methadone into the fetal circulation. Plasma methadeone concentrations (determined by radioimmunoassay) greater than 0.065 mg. per cent were associated with an immediate brief decrease in carotid blood flow, a rapid decrease in frequency and amplitude in the EEG that occasionally became isoelectric but recovered, and immediate and relatively prolonged bradycardia. Similar cardiovascular observations were obtained with plasma methadone concentrations less than 0.065 mg. per cent, but the EEG changes were either minimal or not observed. These results indicate that uptake of methadone by the fetal brain is rapid and that electrical activity and heart rate are affected.

Animals↗

Correlation of the oxytocin challenge test with perinatal outcome.

A total of 234 oxytocin challenge tests (OCT) were performed on 100 high-risk patients. The results were negative (N) in 68 of these 100 patients, suspicious (S) in 22, and positive (P) in 10. The incidence of late decelerations during labor was N, 5%; S, 40%; P, 86%; and meconium staining of the amniotic fluid was N, 4%; S, 5%; and P, 30%. The cesarean section rate was N, 16%; S, 36%; and P, 60%; and of these the cesarean section rate for fetal indications was N, 9%; S, 25%; and P, 67%. The overall perinatal mortality in the study group was 2% (N, 1.5%; S, 0%; P, 10%). The results confirm the negative OCT as innocuous and positive OCT as the most ominous. They also indicate that the majority of patients with positive OCT can be delivered vaginally without endangering the fetus if fetal scalp blood pH determinations can be performed.

Cesarean Section↗

"Second generation" prostaglandins: midtrimester pregnancy termination by intramuscular injection of a 15-methyl analog of prostaglandin F2alpha.

Eighty midtrimester gravid patients were treated with prostaglandin 15(S)-15-methyl Fa alpha by repeated intramuscular injections of 250 mug at 2-hour intervals for the elective termination of pregnancy. A success rate of 97.5% was achieved, with a mean initiation-to-abortion time of 17.2 +/- 1.0 hours. Gastrointestinal side effects were prominent but no serious complications occurred. Serial serum progesterone determinations and continuous intra-amniotic pressure recording were carried out in selected cases and correlated with abortifacient activity. This method of pregnancy termination appears particularly suitable for use in the early midtrimester of gestation.

Abortion, Induced↗

Antenatal diagnosis and management of the small-for-gestational-age fetus.

The small-for-gestational-age fetus continues to account for a large proportion of fetal demise in late pregnancy. Delivery at 37 to 38 weeks' gestation to preempt this is our recommended mode of management. Prenatal diagnosis was made in only 33% of cases in this study. The course of 101 growth-retarded pregnancies has been critically evaluated towards improving the rate of prenatal diagnosis.

Birth Weight↗

Colposcopic evaluation of patients with abnormal cytologic smears during pregnancy.

One-hundred thirty-two patients with abnormal Papanicolaou smears of the cervix uteri during pregnancy underwent colposcopic evaluation. Seventy-five patients had biopsies during pregnancy, and 34 patients had colposcopic evaluation without performing any biopsy. Postpartum colposcopic evaluation was performed on 95 patients. In 93 patients of this group, the postpartum cytologic and histologic information obtained was the same or less than that obtained in antepartum evaluation. In only 1 case, antepartum colposcopically guided biopsy at 38 weeks' gestation revealed moderate dysplasia, and postpartum cold conization showed carcinoma in situ. In another case, colposcopic evaluation and biopsy during pregnancy showed mild dysplasia while colposcopic biopsy as well as examination of a hysterectomy specimen taken at 16 months after delivery revealed severe dysplasia. No case of invasive carcinoma was missed during pregnancy. The results of this study, in support of previous reports, show that colposcopic evaluation is a simple, safe, and accurate method of investigating abnormal Papanicolaou smears during pregnancy.

Adolescent↗

Laminaria augmentation of midtrimester pregnancy termination by intramuscular prostaglandin 15 (S) 15-methyl F2 alpha.

A group of 15 midtrimester gravid patients underwent intracervical laminaria tent insertion prior to repeated intramuscular injections of 250mu g of prostaglandin 15 (S) 15-methyl F2 alpha at two-hour intervals for elective termination of pregnancy. This group was compared with a previously reported group of 80 patients who had received identical treatment without laminaria insertion. A significant reduction in mean abortion time and an increased 24-hour abortion rate were observed with the addition of laminaria. There was a proportionate decrease in gastrointestinal side effects as well as a reduced need for analgesia in the laminaria group with no complications attributable to the laminaria insertion.

Abortifacient Agents↗