Biomedical subjects
Publications and source records attributed to L Nathan.
The anatomic and physiologic changes of pregnancy make the diagnosis and management of abdominal pain difficult. Abdominal conditions both related and unrelated to the pregnancy may be life threatening for mother or fetus; therefore, accurate diagnosis and proper management are essential. This article reviews the most common conditions presenting as acute abdominal pain during pregnancy.
BACKGROUND: Cerebellar hemangioblastomas are unusual benign neoplasms that may go undetected for years. When associated with pregnancy, however, these tumors may undergo rapid expression and promote progression of symptomatology. CASE: A 28-year-old woman with ataxia and left-sided weakness was diagnosed with cerebellar hemangioblastoma in the second trimester of pregnancy following repeated hospital admissions for nausea and vomiting. Surgical removal was uneventful, and she delivered vaginally at term. CONCLUSION: Cerebellar hemangioblastomas, although rare, should be considered in the differential diagnosis of persistent nausea and vomiting when accompanied by an abnormal neurologic examination.
OBJECTIVE: To compare the measured volume of amniotic fluid (AF) in term gestations to the volume predicted sonographically. METHODS: One hour before elective cesarean delivery, 40 women had sonographic measurement of the AF index and largest vertical pocket diameter. At surgery, a suction catheter was placed into a 1-cm uterine incision and a second catheter was used to aspirate AF from the operative field. Hemoglobin concentration was measured in the collected AF to determine the extent of blood contamination. RESULTS: The mean measured AF volume was 532 mL (range 40-1692). The correlation coefficient between AF index and AF volume was 0.744 (P < .001). A similar value (r = 0.755, P < .001) was observed for the largest vertical pocket measured with ultrasound. CONCLUSION: Sonographic measurements of the largest vertical pocket and the AF index have similar positive correlations with measured AF volumes at term. Current methods of estimating AF volume have low sensitivity for detecting oligohydramnios.
A 23-year-old, pregnant woman with an arteriovenous malformation of the left brachial artery developed worsening symptomatology that demanded early delivery. The puerperium was significant for persistent debilitating symptoms that resolved partially four months following delivery.
The goal in the management of patients with pregnancy-induced hypertension is delivery of infants who will thrive physically and mentally without compromising maternal health in the process. Many therapeutic approaches have been recommended; however, none except delivery are curative. In the interest of maternal health, delivery is essential regardless of gestational age when severe preeclampsia or eclampsia is diagnosed. Conversely, women with mild pregnancy-induced hypertension remote from term may be managed conservatively with efforts directed toward prolonging gestation in order to maximize perinatal outcome. The regimen used at Parkland Memorial Hospital has proven to be safe and effective. We will continue to use this method of inpatient management until well-controlled studies are designed and conducted and yield comparably safe and efficacious outcomes.
OBJECTIVE: To quantify the current perinatal consequences associated with intrapartum detection of meconium in the amniotic fluid (AF). METHODS: We compared retrospectively the outcomes in 8136 term singleton cephalic pregnancies with meconium and 34,573 similar pregnancies with clear AF. RESULTS: Virtually all measures of adverse fetal-neonatal outcomes were significantly increased with meconium. For example, perinatal mortality increased from 0.3 per 1000 births with clear AF to 1.5 deaths per 1000 with meconium (P < .001). Most of these deaths resulted from meconium aspiration. Other unwanted outcomes also increased; eg, severe fetal acidemia at birth (umbilical artery blood pH 7.00 or less) increased from three per 1000 to seven per 1000 when meconium was diagnosed (P < .001). Delivery by cesarean also increased with meconium, from 7 to 14% (P < .001). CONCLUSION: Meconium in the AF is an obstetric hazard with small but significantly increased risks of adverse fetal-neonatal outcomes.
A dramatic decline in the prevalence of serious puerperal infection caused by group A beta-hemolytic streptococci has been observed throughout most of the twentieth century, and it is currently a very uncommon cause of maternal morbidity and mortality. We report on two term pregnancies complicated by profound multisystem organ failure caused by group A streptococcal puerperal sepsis. This report serves to highlight the apparent return of serious group A streptococcal puerperal sepsis and to emphasize the clinical implications and sequelae attributable to an old yet virulent enemy.
Fetal syphilis is the presumed diagnosis when the sonographic findings of fetal hydrops are found in the presence of maternal syphilis. In the absence of fetal hydrops, the diagnosis of fetal infection is difficult. We hypothesized that intra-amniotic infection would be accompanied by anatomic placental and fetal abnormalities that could be detected by ultrasonography. Rabbit infectivity testing (RIT), intratesticular inoculation of rabbits with amniotic fluid, can be used to confirm intra-amniotic infection with Treponema pallidum. Twenty-one gravidas with untreated early (primary, secondary, and early latent) syphilis underwent sonography and amniocentesis for RIT at 24 weeks of gestation or later. Antenatal sonographic findings were compared to their amniotic fluid RIT results. Hepatomegaly was significantly (P < 0.01) associated with amniotic fluid infection detected by RIT. Antenatal detection of hepatomegaly, which is probably the initial sonographic manifestation of hydrops fetalis, may ultimately identify the fetus affected with congenital syphilis.
OBJECTIVE: To investigate the distribution of penicillin in the maternal-placental-fetal unit at term gestation. METHODS: Twenty-five healthy gravidas at 38-39 weeks' gestation scheduled for elective repeat cesarean delivery under spinal anesthesia received benzathine penicillin G, 2.4 million units intramuscularly (IM) preoperatively. Ten women delivered 1 day after injection, five delivered 2-3 days after, and ten delivered 7 days after. We collected maternal serum and cerebrospinal fluid, amniotic fluid (AF), and cord serum at delivery. Penicillin levels were measured using a validated agar disc diffusion method (sensitivity 0.006 micrograms/mL) with Micrococcus lutea as the test organism. RESULTS: There was no significant difference in mean penicillin levels at day 1, day 2-3, or day 7 for maternal serum, maternal cerebrospinal fluid, cord serum, or AF. The mean (+/- standard error) penicillin concentration (range 0.005-0.59 micrograms/mL) in maternal serum declined from 0.14 +/- 0.04 micrograms/mL 1 day after injection to 0.08 +/- 0.06 micrograms/mL 7 days after injection. The proportion of patients with a penicillin concentration at or above 0.018 micrograms/mL in the maternal serum declined significantly from day 1 to day 7 (P = .03). Overall, nine of 25 women (36%) had serum penicillin levels that were less than 0.018 micrograms/mL. CONCLUSION: A wide range of penicillin levels were observed in gravidas at term in the maternal serum, cerebrospinal fluid, umbilical cord serum, and AF within 1 week after 2.4 million units of benzathine penicillin G IM. We speculate that altered pharmacokinetics may affect the efficacy of this drug for prevention of congenital syphilis in the near-term gestation.
Explore the source record for details and available documents.
Oxidant stress has been proposed as the initiating pathogenetic mechanism in pancreatitis, hence micronutrient antioxidant therapy has been assessed in patients with recurrent attacks and/or constant pancreatic pain. In a 20-week double-blind double-dummy crossover trial active treatment was given as two types of tablets providing daily doses of 600 micrograms organic selenium, 9000 IU beta carotene, 0.54 g vitamin C, 270 IU vitamin E and 2 g methionine. Of 28 patients enrolled, 20 adhered to the full protocol (idiopathic chronic 8, alcoholic chronic 7, idiopathic acute 5). Six patients had an attack whilst on placebo but none whilst on active treatment (P = 0.032). Analysis of visual analogue scoresheets to compare background pain in the 10-week period before entry and during each phase of the trial, using a 10-cm scale for each of 11 best descriptors, endorsed the beneficial effect of active treatment (placebo v baseline, P = 0.073; active v baseline, P less than 0.001; active v placebo, P = 0.049). The same trend emerged from analysis of pain-score diaries by conventional and time series methods. Micronutrient antioxidant therapy thus offers a new approach to the treatment of recurrent (non-gallstone) pancreatitis and/or pancreatic pain.
Explore the source record for details and available documents.
A syndrome of intracranial hemorrhage with gross prolongation of the prothrombin and partial thromboplastin times, with normal thrombin time, fibrinogen concentrations, and coagulation factor assays is described in four children with homozygous beta-thalassemia. Mixing experiments and plasma thromboplastin inhibition tests revealed a persistent abnormality which was consistent with the presence of a circulatory prothrombinase inhibitor. The origin of this previously unreported inhibitor in thalassemia remains speculative.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: This study was designed to investigate the relationship between fetal heart rate patterns before delivery and periventricular-intraventricular hemorrhage in the very low birth weight infant. STUDY DESIGN: The last 30 minutes of electronic fetal heart rate data preceding delivery were analyzed for 84 singleton infants weighing between 700 and 1500 gm. All these infants received serial cranial ultrasonographic examinations commencing within 24 to 48 hours of birth. RESULTS: Thirty-three fetuses had normal heart rate patterns, and 51 had fetal heart rate abnormalities. Periventricular-intraventricular hemorrhage was not associated with fetal heart rate abnormalities. Univariate and multivariate regression analysis demonstrated that only gestational age < 28 weeks was a significant contributing factor to periventricular-intraventricular hemorrhage (odds ratio 2.2, 95% confidence interval [CI], 1.0 to 4.8). CONCLUSION: Fetal heart rate patterns immediately preceding delivery are not predictive of periventricular-intraventricular hemorrhage in the very low birth weight infant.