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N Jacobs

Publications and source records attributed to N Jacobs.

46 records · Page 3Linked to original sources

The role of nonstress tests, fetal biophysical profile, and contraction stress tests in the outpatient management of insulin-requiring diabetic pregnancies.

Antepartum fetal surveillance methods applicable in a home glucose-monitored population of pregnant diabetic women have been evaluated. A testing sequence of nonstress heart rate testing, backed up by either the fetal biophysical profile or contraction stress testing employed at a twice weekly interval, in 107 outpatients was compared with the management of 140 historic control patients by weekly nonstress tests and daily plasma estriols. There were 617 of 672 (91.8%) reactive nonstress tests in outpatients compared to 566 of 626 (90.4%) reactive tests in hospitalized control patients. Of 13 contraction stress tests performed in the outpatient group, only one was positive. Although 2,670 estriol determinations were done on hospitalized control patients, none was used for outpatients. No losses were attributed to unexplained antenatal stillbirth in either group. A fetal biophysical score of 8 was found to be at least as reliable as a reactive nonstress test. Antenatal surveillance in the well-controlled, insulin-requiring diabetic woman can be safely achieved with a testing sequence that consists of twice weekly nonstress tests backed up by the fetal biophysical profile and contraction stress tests.

Diabetes Mellitus, Type 1↗

Beta-adrenergic blocking drugs and renal function.

A baboon model was used to investigate the effects of atenolol, nadolol, sotalol and labetalol on renal function. The glomerular filtration rate (GFR) and renal blood flow (RBF) were measured, using radionuclides and a gamma camera, before and after 1 week's oral administration of these drugs. All the drugs caused an increase in the GFR, but this reached statistical significance only in the cases of sotalol (P less than 0,025) and labetalol (0,05 less than P less than 0,10). The RBF was not significantly changed, although it decreased in all cases.

Adrenergic beta-Antagonists↗

Clostridium septicum infection associated with colonic carcinoma and hematologic abnormality.

Six patients with Clostridium septicum sepsis seen at Duke University Medical Center over a two-year period also had other abnormalities, consisting of hematologic disorders in 3 and colon tumors in 3. Three patients died of sepsis; 2 survived following disarticulation of the arm to control gas gangrene, while the sixth patient survived the sepsis but died of metastatic disease. When anaerobic cultures are positive for C. septicum, antibiotics should be given immediately. The high incidence of underlying colon tumor, especially in the cecum, should prompt consideration of a barium-enema examination.

Adenocarcinoma↗

Normal human locomotion.

A study of normal locomotion requires an understanding of both the movements and the force actions involved. This is equally true in appreciating the problems of pathological gait. The gait cycle is described in terms of the significant events which occur during both the stance and swing phases. The basic principles underlying the analysis of force actions in walking are briefly described. A simple example of force actions in the elbow joint is considered and the analysis extrapolated to provide a general statement regarding locomotion. This relates to the muscle actions required to resist turning actions at joints due to the force effects in walking and the corresponding forces in the joints themselves. The conventional display of information relating to joing actions is considered and compared with the actual situation, "Stick diagrams" of motion in the sagittal plane are used to identify and discuss the actions at the joints of the leg in walking. Comparisons are made between this and pathological gait--in particular that of the above-knee amputee.

Amputees↗

Management of asymptomatic neonates with prolonged rupture of membranes.

Guidelines for management of asymptomatic term and preterm neonates born to mothers with prolonged rupture of membranes (PROM) have not been clearly established. A survey was conducted to identify current management practice of neonatologists in midwestern states and to find if there is consensus among physicians with regard to management of PROM without chorioamnionitis, with chorioamnionitis but without treatment prior to delivery, and with intrapartum maternal antibiotic therapy prior to delivery. One hundred thirty seven responses to the questionnaire were received. Management of asymptomatic at risk neonates varied in different clinical scenarios. Preterm neonates were screened (94% vs 82%, p < 0.001) and treated (64% vs 41%, p < 0.001) more often than term babies. In the absence of maternal symptoms of chorioamnionitis, term neonates were usually observed or treated based on screening test results. With maternal symptoms, 94% of physicians ordered screening test. Prematurity and perceived severity of maternal illness significantly influenced the decision to treat routinely irrespective of screening test results. Physicians favour routine treatment of infants born to mothers who had received intrapartum antibiotic therapy; opinion was divided about management of term asymptomatic infant born to mothers with chorioamnionitis without intrapartum antibiotic therapy. Lumbar punctures were not routinely done for term or preterm neonates prior to antibiotic therapy. Further studies are needed to answer questions regarding the benefits and risks of routine therapy of high risk neonates vs routine clinical observation and selective therapy of only infants who develop symptoms.

Female↗