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Biomedical subjects

L Iffy

Publications and source records attributed to L Iffy.

At least 19 recordsLinked to original sources
PubMed1992

Rates of caesarean section and neonatal mortality.

A comparison of the yearly statistics of National Maternity Hospital (Dublin) and University Hospital (Newark) was undertaken for the years 1983-1989. The findings appear to indicate that after the elimination of major confounding factors, the substantially higher rates of Caesarean section in Newark (17.5% versus 5.8%) did not bring about a measurable reduction in the rate of neonatal losses. The impact of paediatric care upon the respective neonatal outcomes could not be assessed on the ground of the reviewed data.

Cesarean Section↗
PubMed1992

Infanticide: new medical considerations.

A relationship between disturbed hormonal and metabolic equilibrium during puerperium and ensuing mental and emotional imbalance has been postulated for a long time. In England and Wales this consideration has resulted in the crime of infanticide being reduced from murder to manslaughter. Recent data indicate that the therapeutic and even routine administration by physicians of powerful vasoactive agents during puerperium, and particularly that of ergot derivatives, is probably the most frequent factor leading to 'pure puerperal psychosis'. It is proposed, therefore, that this psychosis is in fact, in most instances, a form of ergotism and its signs and symptoms and consequences, including coincidental infanticide, themselves are actually manifestations of acute ergot poisoning. It is suggested that based on this information a thorough re-evaluation of the relevant legal concepts is necessary.

Ergotism↗
PubMed1991

Factors affecting perinatal mortality in an urban center.

In the Division of Obstetrics of the Statewide Perinatal Center, Newark, NJ, the rate of perinatal mortality fell from 51 in 1000, to 15 in 1000, between 1971 and 1986, and increased thereafter to 28 in 1000 by 1988. This development is analyzed against the background of changes in the environment and inside the Center. It is noted that during 2 study years (1983 and 1986) in our extremely high-risk patient population, the perinatal mortality rate was kept at, or under, the national average. It appears, therefore, that with well-coordinated management and optimum use of resources, marked nationwide differences in mortality rates between white and non-white populations can be greatly reduced or eliminated. An inverse relationship between the rates of caesarean section and perinatal mortality was documented, as the former increased from 4.5% to 17%. Paradoxically, a further increase of caesarean section rates was accompanied by a parallel increase of intrauterine fetal and neonatal losses.

Academic Medical Centers↗
PubMed1990

[Current trends in perinatal mortality statistics at the New Jersey Obstetric Center].

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.

Humans↗
PubMed1989

Puerperal psychosis following ablaction with bromocriptine.

Addiction in the context of drug abuse usually is perceived as habitual dependence on the part of the consumer of a potentially habit forming drug. Attention is drawn to an alternative pattern of drug abuse, namely, unwarranted prescription of drugs on the part of physicians. An example of what the writers perceive is the habitual distribution of a potentially harmful drug in the absence of a clear-cut indication. Attention is being drawn to the worldwide use of bromocriptine, an agent suspected of causing occasional vasospasm, hypertensive cerebral accident and myocardial infarction, for the purpose of ablactation. An additional observation is described where, following administration of bromocriptine in the puerperium manifestations consistent with ergotism developed. The clinical picture was also consistent with pure puerperal psychosis. Attention is also drawn to the likelihood of a cause-effect relationship between the abovementioned drug (an ergot derivative) and the ensuing psychotic reaction.

Adult↗
PubMed1989

Ergotism: a possible etiology for puerperal psychosis.

Some reports in the medical literature have mentioned the occurrence of psychotic reactions in response to the use of certain ergot alkaloids in therapeutic doses. Prompted by these observations, we undertook a search for cases of "pure" puerperal psychosis (ie, typical manifestations 3-14 days postpartum) in order to evaluate the clinical background of this phenomenon. Special attention was paid to the medications that the patients had received peripartum. In the last 10 years, out of eight perinatal centers, we found only three cases that fulfilled the criteria of the quoted entity. In all instances, the manifestations of puerperal psychosis had been preceded by the administration of ergot derivatives. Based on the presented data, we hypothesize that typical postpartum psychosis may represent an idiosyncratic reaction to potent vasoactive drugs including ergot derivatives. The similarities between the clinical manifestations of ergotism and puerperal psychosis, and some of the epidemiologic features of the latter condition, appear to implicate ergot alkaloids as potential causative agents. Although the validity of the suggested interpretation requires further evaluation, we believe that the currently available data warrant caution with regard to the administration of ergot derivatives postpartum. These drugs should not be used in the absence of clear indication or in unnecessarily high doses. We suggest that ergotism be included in the differential diagnosis in cases of pure puerperal psychosis.

Adolescent↗
PubMed1988

Artificial double vagina in association with Rokitansky syndrome.

A case of Rokitansky syndrome is described where the typical anomalies of the entity were associated with cribriform hymen. The appearance of the external genitalia led to an erroneous diagnosis of complete vaginal agenesis and to surgical creation of an artificial vagina by the McIndoe technique at the patient's age of 19. She had a satisfactory sexual life subsequently. Ten years following the surgery, routine examination revealed that the patient had an essentially normal vagina with a blind upper ending. Prior to this, she and her husband had been unaware of the fact that their marital relations were conducted through her natural vagina during the years of their sexual activities.

Adult↗
PubMed1988

Disorders of follicular ripening and ovulation in human.

The authors review literary data and own investigations indicating that anomalies of follicular ripening and ovulation carry a substantial risk of ensuing reproductive abnormalities. Absence of ovulation is conducive to sterility, while delay of the follicular maturation process predispose to the development of an overripe ovum. The degenerative changes that characterize overripeness are conducive to the occurrence of chromosome and anatomic anomalies in the fertilized ovum. The same process predisposes to early abortion and, presumably, to monozygous twinning. Delayed ovulation is predictably associated with corpus luteum inadequacy. Clinically, this phenomenon is frequently associated with postconception bleeding, occult abortion, extrauterine pregnancy and implantation on the lower uterine segment (placenta praevia). Multiple ovulation predisposes to heterozygous twinning.

Female↗
PubMed1986

Abdominal rescue after entrapment of the aftercoming head.

Entrapment of the aftercoming head during breech delivery is generally perceived as a complication that must be resolved by a vaginal extraction procedure. The successful rescue by classical cesarean section described in this report was performed for entrapment of the deflexed fetal head following delivery of the body and the arms.

Adolescent↗
PubMed1986

Acute myocardial infarction in the puerperium in patients receiving bromocriptine.

Although described in the literature as a powerful vasodilator, bromocriptine has been noted to cause vasospasm and hypertension. Two cases are presented where administration of bromocriptine in the puerperium was associated with massive myocardial infarction. These incidents suggest the possibility that bromocriptine occasionally displays the vasoconstrictor effects of other (nonhydrogenated) ergot alkaloids.

Adult↗
PubMed1986

The role of obstetric factors in perinatal mortality trends.

In the Perinatal Unit of the New Jersey Medical School, Newark the combined neonatal mortality and stillbirth rates declined from more than 51 per 1000 to less than 17 per 1000 between 1971 and 1983. This change is comparable to the reduction of perinatal mortality rates nationwide since the Second World War. Because the improvement in the fetal and neonatal survival rates occurred in a static population and against well identifiable changes in the structure, equipment, policies and management patterns of the obstetric unit, it was possible to assess the impact of various factors upon perinatal outcome. In the environment of this institution adherence to conservative concepts of obstetric management, avoidance of manipulative and extraction procedures, an increase of the rate of cesarean sections from about 7 to 15% and emphasis upon infection control appeared to be the crucially important factors. Antepartum sonography and fetal stress and non-stress testing significantly impacted upon the results. The role of intrapartum electronic monitoring was less clearly definable and seemed to be effective only in the hands of experienced physicians. The results did not seem to be adversely affected by the fact that the program de-emphasized invasive procedures, including fetal scalp pH sampling.

Adolescent↗