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Biomedical subjects

M W Varner

Publications and source records attributed to M W Varner.

At least 55 records · Page 3Linked to original sources
PubMed1991

A randomized study of closure of the peritoneum at cesarean delivery.

This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N = 59) or no peritoneal closure (N = 54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication(s), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P = .014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P = .03). The average operating time was shorter for the open group than for the closure group (P less than .005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure.

Adult↗
PubMed1990

Neuroophthalmologic effects of intravenous magnesium sulfate.

To test the hypothesis that visual disturbances are more common during intravenous magnesium sulfate administration than at 1 to 4 days after discontinuation of the drug, 13 women underwent bedside neuroophthalmologic examinations during intravenous magnesium sulfate tocolysis at 2.0 to 3.0 gm hr and again at 1 to 4 days after cessation of therapy. Visual symptoms were common during intravenous magnesium sulfate administration. Blurred vision was present in 12 of 13 patients and diplopia was present in 10 of 13 patients. Abnormal findings during neuroophthalmologic examination occurred in all patients during intravenous magnesium sulfate administration. Findings included ptosis, accommodative and convergence insufficiency, and abnormal pupillary responsiveness to light and near. All patients were symptom-free and had normal examinations after magnesium sulfate was discontinued. These findings suggest that visual disturbances with therapeutic magnesium sulfate are common.

Accommodation, Ocular↗
PubMed1989

Amaurosis fugax associated with antiphospholipid antibodies.

In more than 50% of amaurosis fugax patients under 45 years of age no cause for the episodes of visual loss is identifiable. We have encountered 6 young adults (4 women and 2 men) with episodes of amaurosis fugax associated with elevated levels of antiphospholipid antibodies. Splinter hemorrhages of the nail beds were present in most patients. Treatment with antiplatelet medications and anticoagulants appeared to reduce the frequency of episodes and might prevent central retinal artery occlusions or stroke.

Adult↗
PubMed1989

Relationship of admissions for false labor to perinatal outcome.

While false labor is a common clinical problem, little information exists for correlating hospital visits (for false labor) with the subsequent labor course or perinatal outcome. We evaluated the obstetric and perinatal outcomes in 112 consecutive patients with one or more hospital visits for false labor and compared them with those in matched controls. The only statistically significant difference was the incidence of oxytocin induction following premature rupture of the membranes in the false-labor group (16 vs. 6, chi 2 = 5.05, P less than .05). This study suggests that a previous false-labor admission does not increase the risk of a labor abnormality or suboptimum perinatal outcome.

Delivery, Obstetric↗
PubMed1989

Maternal mortality in Iowa from 1952 to 1986.

The frequency of maternal death is decreasing in Iowa, particularly in the category of direct obstetric causes, such as hemorrhage, infection, pre-eclampsia and eclampsia. Unfortunately, concurrent linkage of vital statistics records was not performed during the study period, precluding any certain conclusion that all maternal deaths were actually identified (29). In addition, there has been, at best, only a modest decrease in the proportion of direct obstetric deaths that are preventable, suggesting that the educational goals of the maternal mortality review process are as yet far from fulfilled. In particular, the number of embolic deaths, both from pulmonary emboli and amniotic fluid emboli, has remained constant. We now appreciate many predisposing risk factors for pulmonary embolization and must seriously consider prophylactic anticoagulation in pregnant or puerperal women at increased risk. We also need further studies in the pathogenesis, treatment and prevention of amniotic fluid emboli. Although associated with lower proportions of preventability than with direct causes of obstetric deaths, the indirect and nonobstetric categories of maternal deaths have also been associated with a less dramatic decline in numbers. In particular, trauma remains a persistent cause of preventable maternal death. Continued public education as well as legislation for mandatory safety restraints in automobiles may reverse this trend. This suggests that considerable room for improvement exists in the field of education of patients and of health care professionals who routinely care for patients with complicated obstetric problems.

Adolescent↗
PubMed1988

Maternal orbital hematoma associated with labor.

We examined two women with orbital hematomas that occurred during labor. Both women developed sudden diplopia, proptosis, and orbital pain. The location of the hematoma was confirmed by orbital echography and computed tomography. The patients were observed without surgical intervention. Neither patient developed clinical or echographic signs of compressive optic neuropathy. Clinical resolution occurred during the following two weeks. Serial standardized orbital echographic examinations documented resolution of the hematomas.

Adult↗
PubMed1988

Origin of deoxycorticosterone and deoxycorticosterone sulfate in human pregnancy: absence of steroid 21-sulfatase activity in sulfatase-deficient placenta.

The activity of steroid 21-sulfatase, the enzyme that catalyzes the hydrolysis of deoxycorticosterone sulfate (DOC-SO4) is demonstrable in human placenta. Thus, it is possible that this placental enzyme, by way of the hydrolysis of either DOC-SO4 or 21-hydroxypregnenolone mono- or di-sulfate of fetal origin, may be important in the biosynthesis of DOC, which is present in the plasma of pregnant women in high concentration. To investigate this issue further, we evaluated steroid 21-sulfatase activity in microsomal preparations of a sulfatase-deficient placenta. Immediately after delivery, at term, of a living male fetus with sulfatase deficiency, a microsome-enriched fraction of placental tissue was prepared; sulfatase activity was evaluated by use of three substrates, viz. dehydroisoandrosterone sulfate (DS), estrone sulfate (E1-SO4), and DOC-SO4, in various concentrations. Similar incubations were conducted with aliquots of a microsome-enriched fraction prepared from placental tissue of a normal fetus that was delivered, at term, within minutes of the time of delivery of the infant with sulfatase deficiency. In microsomal fractions from the normal placenta, each of the steroid sulfates was hydrolyzed. In the absence of microsomes, and in the presence of microsomal fractions from the sulfatase-deficient placenta, the hydrolysis of DOC-SO4 and DS was not detected. Moreover, in microsomes prepared from the sulfatase-deficient placenta, E1-SO4 was hydrolyzed at a rate that was only 10% of that in incubations with microsomal preparations of the normal placenta. We conclude that with sulfatase deficiency, the placenta is deficient not only in sulfatase activity for steroid-3-sulfates but for steroid 21-sulfates, e.g. DOC-SO4, as well.

17-alpha-Hydroxypregnenolone↗
PubMed1987

Abnormal pregnancy sonogram: selective indication for fetal karyotype.

The inability to make a definitive diagnosis in the fetus with a sonographically identified abnormality often results in parental and physician uncertainty. An antenatal chromosome evaluation could resolve this uncertainty. Forty-one fetuses with an abnormal ultrasound examination were tested for karyotypic abnormality using a variety of specimens. Nearly one-third (13 of 41) of these fetuses had various chromosome abnormalities. There were only seven survivors in this series, underscoring the often poor prognosis when a significant ultrasound defect is detected antenatally. Knowledge of the fetal chromosome constitution in the setting of an abnormal ultrasound has important epidemiologic, cost-benefit, counseling, and pregnancy management implications.

Adult↗
PubMed1987

Maternal obesity and pregnancy.

We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor.

Adolescent↗
PubMed1987

Cranial magnetic resonance imaging in eclampsia.

Although the precise neuropathologic basis for eclamptic convulsions remains unclear, intracranial hemorrhage is frequently associated with fatal cases. Magnetic resonance imaging (MRI) is a recently developed neuroimaging technique that appears superior to other processes for defining intracranial anatomy and pathophysiology. This technique has not yet been reported in eclampsia. The authors performed serial MRIs on an eclamptic woman, with findings compatible with previously described neuropathologic changes.

Adult↗
PubMed1986

Comparison of cefotetan and cefoxitin as prophylaxis in cesarean section.

A study comparing the efficacy of cefotetan versus cefoxitin for prophylaxis in patients undergoing cesarean section was carried out at the University of Iowa. After institutional review, 36 subjects who met the study criteria and agreed to participate were entered into the study; of these, 29 were evaluable for efficacy. Twenty subjects received a single 2 gm dose of cefotetan, and nine subjects received three 2 gm doses each of cefoxitin. Both antibiotics were administered intravenously at the time the umbilical cord was clamped. The subsequent doses of cefoxitin were given intravenously at four and eight hours after the initial dose. Clinical and bacteriologic responses were evaluated; there were no statistically significant differences between the two groups, and both antibiotics provided effective prophylaxis against infection. It appears that cefotetan is a satisfactory antibiotic choice for cesarean section prophylaxis. Further, in this small study it appears that a single dose of cefotetan is as effective as three doses of cefoxitin. This implies that cefotetan would not only decrease administration time and supplies but would decrease the cost to the patient while maintaining very acceptable infection rates.

Adolescent↗
PubMed1985

Triplet gestation: maternal and neonatal implications.

Triplet pregnancy of over 20 weeks gestation occurred 20 times during 75,506 deliveries at a referral hospital. Commonly occurring maternal complications included premature delivery (75%), antepartum anemia (35%), postpartum hemorrhage (35%), preeclampsia (20%), and premature spontaneous rupture of the membranes (20%). Malpresentation was common. Neonatal complications were also common and included respiratory distress syndrome (45%), presumptive sepsis (36.6%), hyperbilirubinemia (33%), and neonatal death (21.6%). These high complication rates emphasize the importance of early identification and referral center care for these vulnerable pregnancies.

Adult↗