Ureteral obstruction secondary to posterior spinal fixation rods.
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Adult↗
Biomedical subjects
M Monga
Publications and source records attributed to M Monga.
Mini-percutaneous antegrade endopyelotomy.
Antegrade endopyelotomy is the endourologic treatment of choice for ureteropelvic junction obstruction with a coexisting renal calculus. We report the use of a mini-percutaneous procedure that allows us to perform an antegrade endopyelotomy and stone extraction through a 20F nephrostomy sheath.
Endoscopy↗
Acute fatty liver in the second trimester of pregnancy.
Objective: Acute fatty liver of pregnancy (AFLP) is an uncommon, potentially fatal disorder that usually occurs in the late third trimester of pregnancy. We present the first reported case of acute fatty liver in the second trimester of pregnancy.Methods: We report the clinical and laboratory findings in a patient with AFLP who presented in the second trimester of pregnancy.Results: A 37-year-old G5P4 woman presented at 22 weeks gestation (by 18 weeks ultrasound) with nausea and vomiting. She was normotensive, had no proteinuria, had elevated SGOT and SGPT (266 and 261, respectively), negative hepatitis studies and a normal platelet count. She was managed conservatively for presumed cholelithiasis until 24 weeks gestation when she was transferred to our facility because of worsening SGPT and SGPT (368 and 505, respectively), jaundice (total bilirubin of 8.9 mg/dL), hypoglycemia, and laboratory evidence of disseminated intravascular coagulation (DIC) (PT = 18.6, PTT = 56, hypofibrinogenemia and presence of fibrin split products). Ultrasound showed singleton fetus (EFW 450 g) with total placenta previa. Computed tomography scan of the abdomen revealed decreased hepatic density consistent with AFLP. Delivery of a nonviable fetus was effected after transfusion of fresh frozen plasma. Postoperatively, the patient had rapid resolution of DIC, jaundice, and hypoglycemia; liver transaminases normalized 5 days postoperatively and the patient was discharged home in good condition 5 days later.Conclusion: It has been traditionally stated that AFLP occurs in the late third trimester of pregnancy. This case demonstrates that, even in the second trimester of pregnancy, the diagnosis of AFLP should be considered as a cause of deteriorating liver function, jaundice, and DIC.
Journal Article↗
Molecular mechanisms regulating the effects of oxytocin on myometrial intracellular calcium.
Oxytocin stimulates an increase in intracellular calcium in uterine myometrium by several mechanisms. Several lines of evidence indicate that the oxytocin receptor is functionally coupled to GTP-binding proteins of the G alpha q/11 class which stimulate phospholipase C activity. The IP3 generated as a result of phospholipase C activation can trigger release of calcium from intracellular stores. The finding that the oxytocin-stimulated increase in intracellular calcium in myometrial cells is greater in the presence of extracellular calcium than that in its absence indicates that oxytocin also has effects on calcium entry. This action is nifedipine-insensitive but may involve indirect stimulation of calcium entry through release-operated channels. An anti-G alpha q/11 antibody inhibits both oxytocin-stimulated GTPase activity and phospholipase C activity in myometrial membranes. The stimulation by oxytocin of phosphoinositide turnover in COS cells transfected with a plasmid expressing the oxytocin receptor is enhanced by cotransfection of G alpha q. Co-transfection of intracellular domains of the oxytocin receptor causes varying degrees of interference with oxytocin-stimulated phosphoinositide turnover. The data suggest that more than one intracellular domain is involved in oxytocin receptor/G-protein coupling. Oxytocin receptor stimulation of phospholipase C is inhibited by cAMP. This occurs in myometrial cells and in COS cells transfected with a plasmid expressing the receptor. The inhibitory mechanism involves the action of protein kinase A and is probably targeted indirectly at the G alpha q/11 /phospholipase C coupling step.
Animals↗
Endopyelotomy. Retrograde ureteroscopic approach.
Ureteroscopy is a natural extension of a urologist's practice. This article describes technical details and results using the ureteroscopic approach to treat ureteropelvic junction obstruction. With a variety of treatment options available, this approach compared favorably.
Ambulatory Surgical Procedures↗
Maternal-fetal transfers: indications, appropriateness, and cost.
The objective of this study was to assess the indications, appropriateness, and cost of maternal-fetal transfers to a tertiary care facility in an era of managed care. Our perinatal database was reviewed from January 1, 1996 through June 30, 1997 to determine maternal and fetal indications for transfer, referring institution characteristics, utilization of tertiary level services, and cost of transfer. There were 273 transfers from 53 referring hospitals ranging in distance from <20 miles (n = 102) to >100 miles (n = 41). Thirty-one patients were transferred by air (average cost $7656), 238 by ground (average cost $920), 4 by private car. The referring diagnosis was preterm premature rupture of membranes (PPROM) (n = 80), preterm labor (n = 76), preeclampsia (n = 42), medical complications (n = 25), or other (n = 50). Mean gestational age (GA) at transfer was 28.5+/-5.5 weeks. Patients were referred from hospitals with a self-designated nursery level I (n = 115), II (n = 111), III (n = 45), or none (n = 2). In 42 patients, (15%) no maternal or fetal indication for hospital transfer was identified after evaluation at the tertiary center. The most common referring misdiagnoses were preterm labor (n = 25), PPROM (n = 10) and preeclampsia (n = 3). One hundred and sixty-five patients delivered during transfer admission (mean GA = 29.6+/-4.8 weeks); 79 infants (48%) required admission to a level III, and 52 (31%) to a level II nursery. Most patients require the services of a tertiary facility after maternal fetal transfer. If delivered during transfer admission, the majority of neonates require care in an intermediate or intensive care nursery.
Costs and Cost Analysis↗
Efficacy and safety of luteinizing hormone-releasing hormone antagonist cetrorelix in the treatment of symptomatic benign prostatic hyperplasia.
As the life expectancy for men increases, more cases of benign prostatic hyperplasia (BPH) will be expected. Symptomatic BPH causes morbidity and can lower the quality of life. We investigated whether short term administration of the LH-releasing hormone antagonist cetrorelix could provide an improved treatment for men with BPH. Thirteen patients with moderate to severe symptomatic BPH were treated with cetrorelix (5 mg, s.c., twice daily for 2 days followed by 1 mg/day, s.c., for 2 months). Patients were evaluated at baseline, during treatment, and up to 18 months after therapy. We determined the effects of cetrorelix on the International Prostate Symptom Score (IPSS), Quality of Life score, sexual function, prostate size, uroflowmetry, and hormonal levels. Treatment with cetrorelix produced a decline of 52.9% (P < 0.0001) in IPSS, a 46% improvement in the Quality of Life score (P < 0.001), a rapid reduction of 27% (P < 0.006) in prostatic volume, and an increase in peak urinary flow rates by 2.86 mL/s. Serum testosterone fell to castrate levels on day 2, but was inhibited only by 64-74% during maintenance therapy, and after cessation of treatment returned to normal. During long term follow-up, most patients continued to show a progressive improvement in urinary symptoms (decline in IPSS from 67% to 72% at weeks 20 and 85, respectively) and an enhancement of sexual function, and prostatic volume remained normal. Our study demonstrates that in patients with symptomatic BPH, treatment with cetrorelix is safe and produces long term improvement.
Aged↗
Women with sickle cell trait are at increased risk for preeclampsia.
OBJECTIVE: Our purpose was to determine the rate of preeclampsia in women who are positive for sickle cell trait. STUDY DESIGN: All African-American women were tested for sickle cell trait with the "sickledex" screen at the fist prenatal visit and prospectively enrolled in this study from March 1994 to June 1995. "Sickledex" screens were confirmed with hemoglobin electrophoresis. Demographic data were collected at the time of enrollment. Outcome data, including preeclampsia (as defined by The American College of Obstetricians and Gynecologists criteria), gestational age at delivery, birth weight, and postpartum endometritis were collected immediately post partum. Assuming a 10% rate of positive sickle cell trait, 1100 patients were required to demonstrate a doubling in the rate of preeclampsia with 80% power and p < 0.05. The Student t test, the Mann-Whitney U test, chi 2 analysis, and Fisher's exact tests were used for statistical analysis. RESULTS: Of 1584 women enrolled in the study, 162 were positive for sickle cell trait. Sickle cell trait-positive women were older than the sickle cell trait-negative women (24.4 +/- 4.6 vs 23.0 +/- 4.4 years, p < 0.001), but there was no significant difference in parity. The rate of preeclampsia was significantly increased in sickle cell-positive women (24.7% vs 10.3%, p < 0.0001). There was no significant difference in the rate of chronic hypertension, diabetes, or smoking. Parous sickle cell-positive women more frequently gave a history of preeclampsia in a previous pregnancy (21.4% vs 9.3%, p < 0.0001). There was a statistically significant decrease in gestational age at delivery and birth weight in sickle cell trait-positive women (36.7 +/- 2.7 vs 37.7 +/- 3.0 weeks, p < 0.0001; and 3082 +/- 591 vs 3369 +/- 573 gm, p < 0.0001). The rate of postpartum endometritis was significantly increased in the women positive for sickle cell trait (12.3% vs 5.1%, p < 0.001), although both groups had a similar cesarean section rate (14.8% vs 12.6%, not significant). CONCLUSION: This is the first prospective study to demonstrate that sickle cell trait-positive women are at significantly higher risk for development of perinatal complications that have traditionally been associated with sickle disease.
Adult↗
Combined percutaneous antegrade and cystoscopic retrograde ureteral stent placement: an alternative technique in cases of ureteral discontinuity.
We describe an alternative method of double J stent placement for ureteral transection following the failure of traditional antegrade and retrograde approaches. Cystoscopically, a guidewire was placed across the distal ureteral segment and was advanced into a urinoma cavity at the level of the transected ureter. Subsequently, an antegrade approach was used to place a gooseneck snare through the proximal ureteral segment into the urinoma cavity. The guidewire was grasped with the snare and pulled through the percutaneous access site. A double J ureteral stent was then placed using the typical antegrade method.
Adult↗
Penile calciphylaxis.
Calciphylaxis is a condition of cutaneous necrosis secondary to small- and medium-sized vessel calcification that may progress rapidly and is often fatal. Patients with end-stage renal disease and hyperparathyroidism are almost exclusively at risk. Only 1 case of penile involvement has been previously described. At our institution, a 56-year-old man with end-stage renal disease presented with penile calciphylaxis. The patient received a series of treatments including circumcision, partial penectomy, amputation of necrotic phalanges, and a subtotal parathyroidectomy after which the patient's parathyroid hormone level normalized and the disease progression abated.
Calcinosis↗
Vitamin A and its congeners.
Vitamin A (retinol) is a fat-soluble vitamin that is necessary for cell growth and differentiation. Excess vitamin A has been associated with teratogenic effects in animals and humans. Because vitamin A deficiency is very uncommon in the industrialized world, the current recommendation is that routine vitamin A supplementation is not necessary. If vitamin A supplements are used, they should be limited to less than 5,000 IU per day. Systemic administration of the naturally occurring retinoid tretinoin has been associated with birth defects, fetal resorption, and stillbirths in animals; however, topical use is not associated with increased birth defects and is classified as a category B drug during pregnancy. The synthetic retinoids isotretinoin, etretinate, and etretin are strictly contraindicated during pregnancy (category X) as they have been associated with teratogenic syndromes in humans. In addition, owing to the prolonged elimination half-life of aromatic retinoids, effective contraception should be used for at least 2 years following discontinuation of treatment with these drugs.
Abnormalities, Drug-Induced↗
Bartter's syndrome in pregnancy: a case report and review.
Bartter's syndrome is a rare autosomal recessive disorder characterized by hypokalemia, hyperaldosteronism, sodium wasting, normal blood pressure, hypochloremic alkalosis, and hyperplasia of the juxtaglomerular apparatus. We present a 21-year-old African-American nulliparous patient who was referred to our clinic at 9 weeks' gestation with a history of Bartter's syndrome. Her antenatal course was complicated by muscle cramps, which required increasing potassium supplementation. She developed hypomagnesemia in the third trimester of pregnancy, which necessitated magnesium therapy. She delivered an unaffected infant at term. Bartter's syndrome, although extremely rare in pregnancy, requires prompt recognition and careful management, as it may have significant maternal and neonatal implications.
Adult↗
The rate of severe preeclampsia is increased in triplet as compared to twin gestations.
The objective of this study was to determine if the rate of preeclampsia is increased in triplet as compared to twin gestations. Fifty-three triplet pregnancies between 1986 and 1993 at The New York Hospital-Cornell Medical Center were reviewed. These were matched for maternal age, parity, and race to twin gestations (N = 53) from the same population. Severe preeclampsia was defined by standard criteria. Student's t-test, Fisher exact test, and Chi-square were used for statistical analysis. The rate of severe preeclampsia was increased significantly in the triplet group 12 of 53 (22.6%) as compared with the twin group 3 of 53 (5.7%) (OR = 4.9, 95% CI 1.2-23.5, p = 0.02). The rate of overall preeclampsia was not significantly different in the triplet 18 of 53 (33.96%) or twin 12 of 53 (22.6%) groups. In this retrospective, case-controlled study, the rate of severe pre-eclampsia was significantly increased in triplet gestations as compared to twins although the overall rate of preeclampsia was not. This information may be useful in counseling patients with high order multifetal gestations.
Adult↗
Preterm premature rupture of the membranes associated with recent cocaine use.
The objective of this study was to determine the rate of recent cocaine use among a metropolitan population of predominantly Hispanic and African-American women with preterm premature rupture of the membranes (PROM) and to ascertain the impact of cocaine on the latency period between rupture of membranes and delivery. Urine toxicology screens were prospectively obtained on 147 women with preterm PROM. The urine screen did not influence management decisions. All women were expectantly managed without tocolytics until 37 weeks' gestation unless they developed clinical chorioamnionitis, or nonreassuring fetal heart rate tracing or biophysical profile. Demographic information, hours from rupture of membranes to delivery, gestational age, and birth weight at delivery were compared using Fisher's exact, Mann-Whitney U, and randomization tests where appropriate. The rate of positive urine drug screens for cocaine was 8.2%. Women in the cocaine positive group were of higher parity (3, [0-7]vs. 1, [0-6], p = 0.001) and tended to be older (27, [23-42]vs. 25, [14-40]). There was a higher rate of recent cocaine use among African-American women (20.4%) as compared to non-African-Americans (1.2%, p = 0.0001). Cocaine-positive women presented at an earlier gestational age (32 weeks', [24-34]vs. 33 weeks', [23-36], p = 0.02) and had a significantly longer membrane rupture to delivery interval than women with a negative urine drug screen (174 hr, [6-475]vs. 33 hours [1-833], p = 0.01). There was no significant difference in the reason for delivery between the two groups of patients. Recent cocaine use among women with preterm PROM is common in only some segments of an urban population. Women with recent cocaine use present with ruptured membranes at an earlier gestational age and may actually have a longer latency period than women who do not use cocaine.
Cocaine↗
Fetal acidemia in the absence of fluid observed at amniotomy.
The objective of this study was to determine the rate of pathological fetal acidemia in the absence of fluid observed at amniotomy. Thirty-nine consecutive patients with no fluid observed at the time of amniotomy were prospectively enrolled in this study. Ultrasound measurement of amniotic fluid index was performed. Umbilical cord gases were performed on arterial and venous samples at the time of delivery. Patient name and medical record number were noted and delivery data were extracted from review of the medical record. The median gestational age at admission was 41 weeks (range 38 to 42 weeks). Sixteen patients (41%) were subsequently noted to have meconium at the time of delivery. The median amniotic fluid index was 2.0 cm with a range of 0 to 9.0 cm. Thirty patients (76.9%) had an amniotic fluid index of less than 5.0 cm. The median umbilical artery pH in this patient population was 7.21 with a range of 6.75 to 7.42. Only one infant had an umbilical artery pH less than 7.00. The rate of cesarean section for documented fetal distress was 2.6%. The absence of observed fluid at amniotomy, while commonly associated with subsequent meconium at delivery, is not predictive of fetal acidemia or operative delivery for fetal distress.
Amnion↗
The effect of cocaine on mitogen-induced lymphyocyte proliferation in pregnant women.
Cocaine use during pregnancy is associated with increased risk of sexually transmitted diseases, including syphilis and HIV. Many sociological and economic factors related to cocaine use have been shown to contribute to this increased risk. Cocaine may also affect immunological function thereby increasing risk for sexually transmitted diseases. The objective of this study was to determine if cocaine suppresses mitogen-induced lymphocyte proliferation in pregnant women. Peripheral blood mononuclear cells were obtained from 39 pregnant women. Lymphocyte proliferation was stimulated with concanavalin A (conA, 1 microg/mL). Cocaine was added at time zero to one set of cultures and at 0, 24, and 48 hr to a second set of cultures (to correct for cocaine degradation in culture). Three doses of cocaine were used: 0.1, 1 and 10 microg/mL. The cells were pulsed with 1 microCi 3H thymidine at 72 hr and harvested 19 hr after addition of the isotope. Lymphocyte proliferation, as determined by radioactivity (cpm) was assessed. Cocaine had no statistically significant effect on conA-stimulated lymphocyte proliferation when added at time = 0 or when added daily. Cocaine, in concentrations similar to those found in clinical experiments with drug users, does not suppress in vitro concanavalin A-induced lymphocyte proliferation in cells obtained from pregnant women.
Cell Division↗
Correlation of urine and serum benzoylecgonine levels in pregnant women.
The objective of this study was to evaluate the correlation between urine and serum benzoylecgonine (BE) levels in pregnant women who use crack cocaine. Ten women who had recently smoked crack cocaine were recruited from a prenatal substance abuse clinic to participate in this study. Urine and serum were obtained concurrently for quantitative determination of BE, (the major metabolite of cocaine), using gas chromatography/mass spectrometry. Pearson correlation was used for statistical analysis. The median reported interval since most recent crack use was 35 hours (range 9.5 to 63 hr). The median gestational age of the subjects was 31 weeks (range 22 to 38 weeks). Urine benzoylecgonine levels ranged from 1038 ng/mL to 1,950,563 ng/mL and serum BE levels ranged from 2.5 to 3074.3 ng/mL. Pearson correlation for urine and serum BE levels was 0.92, p < 0.001. This is the first study to report the correlation between urine and serum BE levels in pregnant women who use crack cocaine.
Cocaine↗
Ineffectiveness of latex condoms in preventing contamination of the transvaginal ultrasound transducer head.
The efficacy of condoms in preventing contamination of the transvaginal ultrasound transducer head and possible transmission of blood-borne pathogens is unknown. Our objective was to determine the rate of contamination of the transvaginal ultrasound probe after use in the emergency department. After indicated transvaginal ultrasound scans, the latex condom was removed and the transducer head was inspected for contamination. The presence of vaginal bleeding and the duration of the ultrasound scan were noted. Ten milliliters of hydrogen peroxide (H2O2) was placed in the condom. Bubbling, which occurs in the presence of blood or cervicovaginal secretions, was considered a positive test. Exposure of a clean condom or coupling gel to H2O2 did not cause bubbling. Two-tailed Fisher's Exact and Student's t tests were used for statistical analysis. Of 173 cases, 8 (5%) had a positive H2O2 test for contamination. In only 3 of these 8 cases was gross contamination seen. Latex condoms are ineffective in preventing contamination of the transvaginal ultrasound transducer head. Visual inspection of the transducer head often fails to identify the presence of blood or body fluids. This suggests that additional measures should be taken to prevent transmission of blood-borne pathogens.
Condoms↗