Temperament characteristics of suicide attempters.
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Adolescent↗
Biomedical subjects
L Weinstein
Publications and source records attributed to L Weinstein.
Disseminated intravascular coagulation--the clinician's dilemma.
Disseminated intravascular coagulation is a complex syndrome involving inappropriate activation of the coagulation and subsequently fibrinolytic systems. It may occur in conjunction with a variety of disease states. The diagnosis must be based on a series of laboratory tests which provide indirect evidence of the process. Treatment consists of general supportive measures and elimination of the activating source of the coagulopathy. Additional therapy is dictated by individual circumstances.
Abortion, Induced↗
Bacterial meningitis. Specific etiologic diagnosis on the basis of distinctive epidemiologic, pathogenetic, and clinical features.
The purpose of this paper is to point out a clinical approach to the etiologic diagnosis of bacterial meningitis in cases in which it is not possible to define the cause by microscopic studies of spinal fluid in the very early stage of the disease. The striking differences in epidemiology, pathogenesis, clinical behavior, complications, and prognosis permit identification of the etiology in many instances.
Humans↗
Preeclampsia/eclampsia with hemolysis, elevated liver enzymes, and thrombocytopenia.
Data are presented to define a unique group of preeclamptic/eclamptic women with the findings of hemolysis, elevated liver enzymes, and a low platelet count. This syndrome is a variant of severe preeclampsia and may develop either antepartum or postpartum. A nonobstetric diagnosis such as gastrointestinal or hematologic disease is often made. When the patient presents with the hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, supportive therapy is used and delivery expedited to improve maternal and fetal outcome.
Adolescent↗
In vitro activity of clindamycin against strains of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum isolated from pregnant women.
Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum are genital agents that are being increasingly implicated in infectious pregnancy complications and abnormal pregnancy outcomes. We measured the in vitro activity of clindamycin against strains of these three agents which were isolated from pregnant women. For 30 strains of C. trachomatis, the median minimal inhibitory concentration was 1.0 microgram/ml (range, 0.25 to 2.0 micrograms/ml). For 27 strains of M. hominis, the median minimal inhibitory concentration was 0.12 microgram/ml (range, 0.06 to 0.25 microgram/ml) and the median minimal bactericidal concentration was 0.5 microgram/ml (range, 0.06 to 2.0 micrograms/ml). For 27 strains of U. urealyticum, the mean minimal inhibitory concentration was 4 micrograms/ml (range, 1.0 to 32.0 micrograms/ml) and the mean minimal bactericidal concentration was 32.0 micrograms/ml (range, 4.0 to 128 micrograms/ml). Thus in vitro clindamycin would appear to be highly active against pregnancy-associated strains of M. hominis, less active against strains of C. trachomatis, and least active against strains of U. urealyticum. Since M. hominis has been strongly linked to postabortal fever and to postpartum fever and endometritis, our results indicate that clindamycin should be evaluated in treatment trials in pregnancy aimed at prevention of M. hominis-induced morbidity as well as in treatment of the complications themselves.
Chlamydia Infections↗
Reproductive and fetal rights: a philosophical ideal or practical necessity?
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Child↗
A comparison of the effects of kainic acid on somatostatin, substance P and dopamine in the rabbit retina.
Groups of adult, male Dutch belted rabbits received intravitreal injections of varying doses (30-240 nmol) of the excitatory neurotoxin kainic acid (KA) into one eye and saline vehicle into the other. One week later a segment of each retina was examined histologically and the remainder was assayed for somatostatin-like immunoreactivity (SLI), substance P-like immunoreactivity (SPLI), dopamine (DA) and protein. Histologically, KA at doses of 120 and 240 nmol produced destruction of the inner layers of the retina, with preservation of the photoreceptors. This damage is correlated with a dose-related depletion of retinal protein content. At KA doses of 120 and 240 nmol, both SPLI and DA content were reduced to 5-10% of control values. Although KA significantly reduced the retinal content of SLI even at a dose of 30 nmol, the greatest mean depletion of SLI observed at any dose was 50%. This failure of KA to reduce retinal SLI content by more than 50% at doses of KA which produce severe histologic damage to the neural retina and dramatic depletions of SPLI and DA content demonstrates that the SLI-containing structures of the rabbit retina are partially resistant to the neurotoxic action of KA. We hypothesize that SLI in the rabbit retina is contained in two pharmacologic types of cells in about equal abundance; one type is sensitive to and one type resistant to KA. In contrast, substance P- and dopamine-containing retinal neurons are uniformly sensitive to destruction by KA.
Animals↗
Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes.
In a prospective study of chlamydial and mycoplasmal infections in pregnancy, Chlamydia trachomatis occurred in 8.0%, Mycoplasma hominis in 23.5%, and Ureaplasma urealyticum in 72.3% of 1,365 enrollees. By multivariate analysis, C trachomatis was correlated with lower socioeconomic status, age 23 years or younger, and 12 years or less of schooling. Ureaplasma urealyticum was correlated with age 23 years or younger and lower socioeconomic status. Mycoplasma hominis was correlated with more than one recent sexual partner, first intercourse at age 17 years or younger, and higher socioeconomic status. These cervical infections did not predict low birth weight, abortion, stillbirth, prematurity, or premature rupture of membranes. Only M hominis predicted endometritis/fever after vaginal delivery (relative risk, 7.3). IgM-seropositive C trachomatis-infected women had more low-birth-weight infants and more premature rupture of membranes than either IgM-negative C trachomatis-infected women or C trachomatis culture-negative women. Thus, only certain subgroups of infected women may experience adverse pregnancy outcomes.
Adult↗
Ultraviolet light-induced mutation of diploid human lymphoblasts.
Ultraviolet irradiation (254 nm) of immortal diploid human lymphoblasts killed cells, caused mutation at three genetic loci studied, and transiently inhibited 3H-TdR uptake into DNA. A shoulder of about 6 J/m2 and a D0 of 6 J/m2 was observed for survival. Mutation rose in a monotonic non-linear fashion through 6 J/m2; above 6 J/m2, complex behavior approximating a plateau in induced mutation was observed. Irradiation at 4.4 J/m2 caused a transient increase in the number of cells synthesizing DNA and a decrease in the rate of DNA synthesis relative to mock-irradiated controls. The parameter of rate of DNA synthesis per cell in DNA synthetic phase showed a rapid recovery toward control values between 2 and 4 h after irradiation and a slower recovery to control values by 22 h post-irradiation. Fractionated dose schedules were used to measure the effects of allowing a time interval between doses at nontoxic fluences (2.2 J/m2), moderately toxic fluences (8.8 J/m2) and toxic fluences (17.6 J/m2). These measurements indicate that in the non-toxic range of fluences common to human exposure, mutational response is mediated by a post-irradiation process which seems to show an enhanced ability to protect against mutation induced by subsequent irradiation. However, at moderately toxic fluences there was little effect of dose fractionation, and at toxic fluences, a time-dependent increase in mutation fraction was observed at separation times greater than 7 h. We suggest that these latter observations arise primarily from cell cycle heterogeneity with regard to sensitivity to UV killing and mutation.
Cell Line↗
Radionuclide ventriculographic study of adaptations to exercise in aortic regurgitation.
Exercise-gated radionuclide ventriculography has been proposed as a method to evaluate cardiac reserve in patients with aortic regurgitation (AR). Characterization of ventricular function, however, in AR is complicated by the dynamic nature of the leak in individual patients and by variations in severity among patients. Twenty patients with isolated AR were studied to assess the effects of exercise on the regurgitant index. The regurgitant index (left ventricular divided by right ventricular stroke counts) estimates the severity of the leak. The regurgitant index at rest was significantly higher in patients with AR than in patients without AR (3.46 +/- 1.25 versus 1.08 +/- 0.16, p less than 0.001). In patients with AR, the regurgitant index decreased during exercise to 2.6 +/- 0.8 (p less than 0.001), whereas it did not change in the control group (1.16 +/- 0.21, difference not significant). Further, in patients with AR, the greater the regurgitant index at rest, the greater the decrease during exercise (y = 0.56x -- 1.08, r = 0.78, p less than 0.001). End-diastolic counts and stroke count responses from rest to exercise were highly variable, but were explained in part by the decreasing regurgitant index. These data support previous catheterization studies and confirm gated radionuclide ventriculography as a useful tool for monitoring adaptations to exercise in AR.
Adolescent↗
Malignant mesothelioma following radiation exposure.
Mesothelioma developed in proximity to the field of therapeutic radiation administered 10-31 years previously in four patients. In three, mesothelioma arose within the site of prior therapeutic radiation for another cancer. Mesothelioma in the fourth patient developed adjacent to the site of cosmetic radiation to a thyroidectomy scar. None of these four patients recalled an asbestos exposure or had evidence of asbestosis on chest roentgenogram. Lung tissue in one patient was negative for ferruginous bodies, a finding considered to indicate no significant asbestos exposure. Five other patients with radiation-associated mesothelioma have been reported previously, suggesting that radiation is an uncommon cause of human mesothelioma. Problems in the diagnosis of radiation-associated mesotheliomas are considered.
Adenocarcinoma↗
Prenatal diagnosis of occipital encephalocele by ultrasound scanning.
Fetal visualization in utero can be routinely accomplished using noninvasive ultrasound techniques that do not administer ionizing radiation. Image resolution with real time sonography is sufficient to demonstrate details of possible congenital central nervous system malformations before delivery. The case reported illustrates the advantages of advance warning in an infant with occipital meningoencephalocele for determining prognosis, planning delivery by cesarean section, and preparing for immediate neurosurgical repair.
Adult↗
The effects of cancer chemotherapeutic agents on the developing fetus.
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Abnormalities, Drug-Induced↗
Ectopic pregnancy--a new surgical epidemic.
Between March 1972 and September 1981, 154 patients with the diagnosis of ectopic pregnancy were treated at the University of Arizona. A retrospective review of these cases was performed to determine etiologic and demographic factors. Fertility follow-up was obtained in 58 women. Findings are discussed along with the presentation of various thoughts in an attempt to explain this proliferation of a surgical disease.
Adolescent↗
Balanced translocation karyotypes in patients with repetitive abortion. Case study and literature review.
Cytogenetic studies were conducted upon 100 consecutive couples with abortions. Eight balanced carrier translocation karyotypes were discovered (8%): three cases of Robertsonian translocations and five reciprocal translocations. Two structural variant karyotypes and a poly-X mosaic were also found. A review of the literature on repetitive abortion revealed 82 balanced translocations in 1,331 couples, a rate of 6.2%. Cytogenetic studied should be routine for patients with repetitive abortion. In the pooled series, 3.7% of couples with translocation had wastage, including some with normal offspring; 9.2% had malformed offspring; 62% of the carrier couples lacked the malformation history. Seventy-four percent of the translocations were reciprocal; risk rates for imbalanced progeny were undefined for 90% of the carrier couples. Only 11 imbalanced conceptuses were demonstrated cytogenetically in 262 pregnancies of the carrier group.
Abortion, Habitual↗
Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy.
Data are presented to define a unique group of preeclamptic/eclamptic patients with the finding of hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). This entity has been termed the HELLP syndrome and may occur when the usual clinical findings to diagnose severe preeclampsia are absent. Often the patient is given a nonobstetric diagnosis and treatment is withheld or modified. The possible pathophysiology of this syndrome, the management of the patient, and the maternal and neonatal outcomes are presented. Recognition of the clinical and laboratory findings of the HELLP syndrome is important if early, aggressive therapy is to be initiated to prevent maternal and neonatal death. The practicing obstetrician must be knowledgeable about this severe consequence of hypertension in pregnancy.
Adolescent↗
Irregular antibodies causing hemolytic disease of the newborn: a continuing problem.
The known antigens associathfed with hemolytic disease of the newborn, along with the grade of severity of the disease caused by each antigen, are presented in Table 11. The term "expectant" management means the obstetrician does not need to perform an amniocentesis and may deliver the patient at term. The obstetrician must notify the pediatrician about the delivery of te potentially sensitized infant so that proper nursery treatment of this infant can be initiated. Periodic screening of all antenatal patients for irregular antibodies can alert the physician to a potential problem with hemolytic disease of the newborn and allow the laboratory time to find acceptable donors for possible exchange transfusion. If the antibody is discovered before delivery, it is possible to obtain and store maternal blood to be utilized if a maternal transfusion is needed. When the antenatal patient with an irregular antibody is discovered, her partner should be tested for the antigen. If present, the physician can determine the severity of the disease than can be caused by this antibody from the data in Table 11 and manage the patient appropriately. The information presented should help the physician decide when further testing is needed and when unnecessary testing can be avoided.
Blood Group Antigens↗
Antepartum treatment of Listeria monocytogenes septicemia.
Maternal septicemia with Listeria monocytogenes is becoming a more prevalent problem for those dealing with obstetric patients. A flu-like illness is often present in the mother prior to delivery of the infected infant. Treatment regimens have included intravenous antibiotic therapy for the mother and induction of labor. The infant often dies of respiratory distress syndrome due to prematurity. Data from the literature tend to support the concept of antepartum therapy without delivery, unless the fetus shows signs of pulmonary maturity or has died in utero. It is believed that this approach to maternal Listeria septicemia will improve perinatal morbidity and mortality.
Adolescent↗