Biomedical subjects
Publications and source records attributed to L V Baxi.
A patient with type I Gaucher's disease had avascular necrosis of the right femoral head that resulted in an altered bony pelvis and marked restriction of right hip abduction. Enzyme replacement therapy with alglucerase prevented further deterioration and improved thrombocytopenia. Vaginal delivery was achieved with the patient in the left lateral position with exaggerated flexion at the contralateral hip.
BACKGROUND: Cerebral abscess in pregnancy is a rare event, with the etiology not well described. We present such a case in association with genetic thrombophilia. CASE: A 36-year-old primigravida with a prior history of bilateral popliteal vein thrombosis and pulmonary embolism presented in early gestation with right hemiparesis, aphasia, disseminated intravascular coagulation and a space-occupying lesion in the left temporal lobe. Stereotactic biopsy confirmed the presence of an abscess. The patient also had a homozygous methylene tetrahydrofolate reductase mutation (C677T), protein S deficiency and lupus anticoagulant, all of which possibly contributed to the thrombosis, infarct, infection and abscess. She was successfully treated with low-molecular-weight heparin and antibiotics and had a term vaginal delivery. CONCLUSION: Recently genetic thrombophilia was reported in association with various complications of pregnancy, but it has never before been described as occurring with a cerebral abscess.
BACKGROUND: Single fetal demise in a twin pregnancy is a rare event, the common causes being twin-twin transfusion syndrome, chromosomal or congenital anomalies and abnormalities of the umbilical cord and placenta. Umbilical vein thrombosis is a very rare cause of single fetal demise in twins. CASE: Three days after a reassuring biophysical profile, a 40-year-old primigravida with twin pregnancy presented at 38 weeks' gestation in early labor when demise of 1 of the twins was recognized. She underwent a cesarean section for arrest of labor, delivering twin A, a stillborn female weighing 2, 360 g and twin B, a liveborn male weighing 2,200 g. Umbilical vein thrombus was noted in twin A. CONCLUSION: Umbilical vein thrombosis is a rare and sudden cause of fetal demise.
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Chronic lymphocytic leukemia, a disease predominantly of elderly men, was incidentally diagnosed in a young pregnant patient. She did not require any chemotherapy and had a normal pregnancy outcome. However, she had repeated episodes of respiratory tract infections and anemia that required multiple antibiotics and transfusions. The placenta showed increased numbers of mature-appearing lymphocytes in the intervillous space, consistent with the diagnosis of chronic lymphocytic leukemia. To our knowledge this is the first reported case of chronic lymphocytic leukemia in pregnancy.
Pancreatic ganglia are formed by neural crest-derived precursors, are innervated by enteric neurons, and contain neuropeptides. In addition, the enzyme NADPH-diaphorase is located in a subset of enteric and pancreatic neurons. The expression of neural markers (GAP-43 and NC-1), neurotransmitter-related markers (including neuropeptide Y (NPY), vasoactive intestinal peptide (VIP), gastrin-releasing peptide (GRP), galanin (GAL), dopamine beta hydroxylase (DBH), substance P (SP), calcitonin gene-related peptide (CGRP)), and NADPH-diaphorase was studied in the fetal and neonatal rat gut and pancreas (E12-P28) in situ and in vitro. NC-1, GAP-43 and DBH-immunoreactive cells were found in the primordial stomach on day E12, and in the pancreas on day E13, along with NPY in endocrine cells. Pancreatic NPY-immunoreactive neurons were detected by day E18. CGRP was seen in the foregut at day E12 but not in the pancreas until day E14. Other neuropeptides (SP, GAL, GRP and VIP) all appeared in the foregut earlier than in the pancreas. NADPH-diaphorase activity was first found in situ in foregut neurons on day E13, and in the pancreas on day E14, but seen in explants a day earlier. These observations show that development of neurons occurs earlier in the gut than in the pancreas, and that NADPH-diaphorase activity appears earlier than the immunoreactivities of the neuropeptides.
A patient who had undergone cardiac transplantation for familial hypertrophic cardiomyopathy 4 years previously underwent a successful normal spontaneous vaginal delivery. Her immunosuppressive therapy consisted of cyclosporine, prednisone, and azathioprine. She showed some evidence of renal insufficiency and had pregnancy-induced hypertension.
Protein S deficiency is uncommon, may cause recurrent thrombosis, and may complicate pregnancy. A patient with protein S deficiency presented with a stillbirth followed by postpartum pulmonary embolism. She then had a successful pregnancy managed by anticoagulation and close fetal monitoring.
Factor IX deficiency (hemophilia B, Christmas disease) is an X-linked recessive coagulation disorder. It occurs in one out of every 25,000-30,000 male births and requires even rarer genetic circumstances for phenotypic expression in females. We report the occurrence of a large, late-trimester subchorionic hematoma in a gravida with factor IX deficiency and with laboratory evidence of consumptive coagulopathy during treatment. The patient was managed conservatively and had a successful outcome at term. The only four reported cases of antepartum management of factor IX deficiency in the English literature are reviewed.
Five cases of subchorionic hematoma detected by ultrasonography in patients with threatened abortion are presented. Three of these subjects had antinuclear antibodies, and the remaining two subjects had anticardiolipin antibodies. We recommend that patients with subchorionic hematomas be tested for autoantibodies regardless of their obstetric history.
A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the placentas of the last three pregnancies revealed varying grades of villositis. Symptoms improved with oral corticosteroids.
The effect of epidural anesthesia on neonatal acid-base status, before, during, and after labor, was determined by review of funic blood-gas values from 142 women with normal term pregnancies and normal fetal heart rate patterns. Funic acid-base parameters were compared by type of anesthesia when stratified by mode of delivery (vaginal, cesarean section in the active phase of labor, or elective cesarean section). Use of epidural analgesia for vaginal delivery was associated with significantly longer labor, lower umbilical arterial pH, higher arterial PCO2 and arterial bicarbonate values. In women who had cesarean section in the active phase of labor, use of epidural anesthesia was associated with significantly lower arterial and venous PO2 values when compared with women who received general anesthesia. Patients who had elective cesarean section with epidural anesthesia had funic acid-base values similar to women who had general anesthesia. Epidural analgesia-anesthesia offers no clear advantage to the uncompromised term fetus.
The concentration of prolactin in the amniotic fluid (AFPRL) was measured in 75 samples obtained in the third trimester of 14 isoimmunized women. There was a uniform decline in prolactin levels with advancing gestation in each pregnancy (r = -0.89 to -0.99). The decline in AFPRL was similar in uncomplicated pregnancies. AFPRL levels were not predictive of umbilical cord hemoglobin or bilirubin levels and amniotic fluid lecithin/sphingomyelin ratio.
Response of the fetal heart rate to instillation of normal saline solution 5 ml through an intrauterine pressure catheter was observed on 50 occasions. The test was performed only in those patients in whom an intrauterine pressure catheter had been placed. When the fetal capillary pH was greater than 7.24, accelerations of fetal heart rate by 15 beats/min were observed in 39 of 50 occasions. On the other hand, no fetal heart rate accelerations were observed when the fetal capillary was less than or equal to 7.24.
Fetal tcPo2 levels were measured in 10 patients following maternal administration of 50 mg of meperidine by intravenous route. About 3 minutes following injection of meperidine, tcPo2 values started to decline to reach the lowest value of 37 +/- 25% by 7 mins of injection. tcPo2 values recovered by about 15 mins following injection. These changes in fetal tcPo2 levels preceded transient minimal increase in FHR variability. The increase in FHR variability was followed immediately by a decrease in the indices of the FHR variability. The uterine activity began to decline below the predicted positive slope values shortly following injection of meperidine. This decline was maximum 15 mins post-injection, subsequently establishing a trajectory toward the positive values expected for unmedicated labor. Two patients receiving 25 mg intravenous meperidine demonstrated no decline in tcPo2 levels; however, in the patient receiving 75 mg of intravenous meperidine, the changes noted were similar to those observed following 50 mg of meperidine.
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Fetal heart rate monitoring was first used as a clinical tool for the assessment of fetal danger and well-being. In the past decade, basic research has demonstrated the physiologic events associated with most heart rate changes. This review has demonstrated that study and semiquantification of the five analyzable features of an FHR recording can provide a strong reassurance of fetal health. The method has not proven as predictable for defining fetal disease, so additional parameters are needed to define clearly the significance of an abnormal FHR tracing.