Surgical emergency in the fetus as indication for cesarean section.
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Adult↗
Biomedical subjects
N Samuel
Publications and source records attributed to N Samuel.
Spontaneous abortion in patients with insulin-dependent diabetes mellitus: the effect of preconceptional diabetic control.
Fifty-nine of 94 pregnant women with juvenile-onset insulin-dependent diabetes who attended a preconceptional clinic were periodically examined by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. These women were compared with the 35 pregnant women who did not receive preconceptual glycemic control. The initial glucose and maternal hemoglobin A1 values of the latter group experiencing spontaneous abortions were significantly higher (p less than 0.001) when compared with women receiving preconceptional diabetologic counseling whose pregnancies continued beyond 22 weeks' gestation. The frequency of spontaneous abortions among patients not seen before pregnancy was significantly higher (p less than 0.001), in contrast to attending women, whose rate represented the normal rate in the general population. We confirm the evidence accumulated in the recent literature that poor metabolic control around conception and in the early weeks of pregnancy may be the determining factor favoring abortion.
Abortion, Spontaneous↗
Pregnancy outcome in maturity onset diabetes at young age (MODY).
Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature. Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin. This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin-dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin-dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Caesarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.
Adolescent↗
The ultrasonic appearance of common pulmonary vein atresia in utero.
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Female↗
Transvaginal oocyte retrieval controlled by vaginal probe for in vitro fertilization: a comparative study.
Of 142 patients who initiated in vitro fertilization cycles, 52 underwent oocyte collection by laparoscopy, 58 by the ultrasonically guided transvesical route, both under general or local anesthesia and 36 by the ultrasonically transvaginal route under local anesthesia. When the three methods were compared the results did not differ significantly. An average of 6.4, 6.2, and 5.7 oocytes, respectively, were retrieved. Cleavage rates were 82.6, 79.4, and 81.6%, respectively, while 20.2, 22.6, and 21.1% clinical pregnancies per cycle were obtained. Complications with this procedure such as exacerbation of previous pelvic inflammatory disease, urinary tract infections, transient hematuria, and mild hemoperitoneum were rare. In general, patients greatly preferred the transvaginal method. In addition to providing greater comfort for the patient, this method requires no general anesthesia and is less expensive than other methods. Our initial experience demonstrates that in vitro fertilization can be performed successfully through this simplified alternative to oocyte retrieval.
Adult↗
Intrapartum management of insulin-dependent diabetes mellitus (IDDM) gestants. A comparative study of constant intravenous insulin infusion and continuous subcutaneous insulin infusion pump (CSIIP).
Two groups of insulin-dependent diabetes mellitus (IDDM) parturients were managed according to different intrapartum protocols and compared with a control group of normal women in labor. Thirty-seven patients received conventional intensified insulin therapy during pregnancy and intravenous continuous insulin infusion during labor. Twenty-eight women were managed by continuous subcutaneous insulin infusion pump (CSIIP) throughout gestation and this therapeutic approach was continued during labor. When the two glucose control techniques were compared, CSIIP was superior to achieving and maintaining intrapartum optimal metabolic control, reducing significantly the incidence of acute fetal distress, thus lowering the cesarean section rate and neonatal hypoglycemia. Consequently we concur with the recommendation that firm prepartum as well as intrapartum diabetic control is mandatory for successful management of labor in IDDM patients.
Blood Glucose↗
Pregnancy outcome in gestational diabetes with preconceptional diabetes counselling.
One hundred and thirty-six women with known previous gestational diabetes and normal glucose tolerance between pregnancies attended a preconceptional clinic at least 2 months before conception, and were regularly consulted by a diabetological team. Evaluation consisted of oral glucose tolerance test (OGTT), mean blood glucose, glycosylated haemoglobin and management by self-blood-glucose monitoring (SBGM) and nutritional counselling. When these patients were compared to a group of 154 patients with gestational diabetes who attended our clinic at different stages of pregnancy, the former had improved glucose homeostasis whereas the latter had more frequent elevations of fasting and postprandial glucose levels throughout pregnancy. This group had also more maternal complications and higher Caesarean section rates. Congenital anomalies were 0.65% among offspring of nonattenders, while none occurred in those with preconceptional counselling. Macrosomia and hypoglycaemia were significant neonatal complications in infants of nonattending mothers. We concur with the recommendation that preconceptional counselling in gestational diabetics is required to improve glucose homeostasis throughout pregnancy, and that appropriate evaluation of glucose intolerance should be included as part of prospective family planning.
Adult↗
Preconceptional diabetes control in insulin-dependent diabetes mellitus patients with continuous subcutaneous insulin infusion therapy.
Preconceptional diabetes management is an important prerequisite for pregnancy planning and its value has been well-documented. Glucose control and the outcome of pregnancy, managed in the preconceptional period, with continuous subcutaneous insulin infusion therapy to those receiving insulin injections are compared. Fifty-two juvenile onset insulin dependent diabetic women contemplating pregnancy were regularly consulted by a diabetology team starting at least two months before conception. Glucose control was achieved by continuous subcutaneous insulin infusion pumps (CSIIP) in 18 patients, and 34 women received intensive insulin therapy (IIT). In both groups, normal glucose levels and normal HbA1 were achieved at conception, maintained during the period of organogenesis and throughout pregnancy. In view of the fact that perinatal results, such as the occurrence of malformations, mean gestational age, mean birth weight and neonatal complications were not significantly different in both groups, we believe that both methods are equally effective. Consequently, the less costly and yet effective IIT may be the method of choice, while the more expensive pump should be used mainly in selected cases.
Diabetes Mellitus, Type 1↗
Immunochemical homology between elasmobranch scale and tooth extracellular matrix proteins in Cephaloscyllium ventriosum.
Studies were designed to test the hypothesis that homologous proteins are expressed in elasmobranch scale, tooth enameloid, and mammalian enamel. Using indirect immunohistochemistry and high-resolution two-dimensional gel electrophoresis with immunoblotting, mouse enamel proteins were compared with placoid scale and enameloid proteins from the swell shark, Cephaloscyllium ventriosum. Swiss Webster mouse molar teeth show a characteristic enamel protein pattern consisting of two anionic enamel proteins of 72 kDa (pI 5.8) and 46 kDa (pI 5.5) and several more basic and lower-molecular-weight enamel polypeptides. Both anionic and basic classes of enamel proteins cross-reacted with either antiamelogenin or antienamelin antibodies. Placoid scale and tooth enameloid contained two anionic proteins identified as 58 kDa (pI 5.7) and 46 kDa (pI 5.5), which cross-reacted with either antimouse amelogenin or antihuman enamelin IgG antibodies. A minor antigenically related protein of 43 kDa (pI 6.2) was detected. Immunochemical staining showed localization within placoid scale, swell shark inner enamel epithelia, enameloid, and mouse inner enamel epithelia and enamel. We interpret these results to suggest that both placoid scale and enameloid proteins share epitopes and that these epitopes are also shared with mammalian enamel proteins. Based on molecular weights, isoelectric pH values, and amino acid compositions, placoid scale and enameloid ECM proteins do not contain amelogenin proteins. We suggest that enamelinlike proteins are highly conserved during vertebrate evolution and that these relatively anionic macromolecules may serve a primary function in the initiation of calcium hydroxyapatite formation during enameloid biomineralization.
Animals↗
Pregnancy outcome in patients with insulin-dependent diabetes mellitus with preconceptional diabetic control: a comparative study.
Forty-four of 75 pregnant women with juvenile-onset insulin-dependent diabetes, who attended a preconceptional clinic, were seen regularly by a diabetologic team. Glycemic control was obtained by intensified insulin therapy and monitored by blood glucose self-monitoring. When these patients were compared with a group of 31 nonattenders of the preconceptional clinic, in the former normoglycemia and normal hemoglobin A1 values were achieved before conception, whereas in the latter good control was reached by the second trimester. This group had also more maternal complications, such as preeclampsia, and higher cesarean section rates. Congenital anomalies were 9.6% among offspring of nonattenders, while none occurred in those with preconceptional counseling. We confirm the evidence accumulated in the recent literature that congenital malformations in pregnancy complicated by diabetes may be linked to disturbances in maternal metabolism during the period of embryogenesis. Consequently we concur with the recommendation that tight diabetic control is required before the patient attempts to conceive.
Adolescent↗
The management of prolapsed submucous fibroids.
Prolapsed submucous fibroids, are not an uncommon finding in young women of fertile age. They may be either ordinary fibromyomas of any size, or else occur as necrotic or degenerated tumours. They are expelled by the uterus, and usually present in the vagina on a pedicle, following uterine contractions. In a retrospective study of 142 patients seen over a 10-year period at the Golda Meir Medical Center, 46 were managed by vaginal myomectomy, 12 by abdominal myomectomy, 68 by abdominal hysterectomy, usually following vaginal removal of the fibroids, and in 16 women vaginal hysterectomy was performed. The postoperative course and morbidity in these patients was comparable to that of abdominal and vaginal hysterectomy, performed for intramural or subserous fibromyomas.
Adult↗
Early diagnosis and intrauterine therapy of meconium plug syndrome in the fetus: risks and benefits.
Two cases are reported of patients in the third trimester of pregnancy in whom routine ultrasound examination revealed progressive dilatation of the fetal intestines. Intestinal obstruction was suspected and amniocentesis as well as amniography with Urografin were done. In both cases a regression in dilatation of bowel was noted on ultrasonography. The Urografin swallowed by the fetus was deemed to have relieved the obstruction of the fetal intestine. The babies were delivered in good condition and passed large amounts of watery meconium per rectum. In spite of the risks inherent in the use of Urografin amniography, as well as of amniocentesis, there appear to be a great number of advantages to the treatment of meconium obstruction of the fetus in utero.
Adult↗
Congenital anterior urethral diverticulum associated with bilateral urinomas and dysplastic kidneys.
Congenital anterior urethral diverticulum (AUD) is a rare condition. We report a case of AUD associated with urinary ascites, bilateral urinomas and dysplastic kidneys. The diagnosis of urethral obstruction was established in utero by means of ultrasound. The right perirenal urinoma appeared "septated", and we believe that this is related to its hemorrhagic content. Improvement of the clinical condition and renal function was noted after decompression by bilateral cutaneous loop ureterostomy.
Diverticulum↗
Hematoma of the umbilical cord with acute antepartum fetal distress. A case report.
In a case of spontaneous hematoma of the umbilical cord, no pathologic lesion was found in the umbilical blood vessels. However, an extremely short cord (14 cm) may have contributed to the vessel rupture. A prolonged deceleration discovered during a routine nonstress test led to emergency cesarean section, with delivery of a healthy neonate.
Cesarean Section↗
Acute urinary retention as presenting symptom of torsion of a wandering spleen.
A case has been reported of acute torsion of a wandering spleen in a young woman. The presenting symptom was acute urinary retention, most probably due to pressure of the enlarged, ptotic spleen on the bladder. Acute abdomen with signs of peritonitis made laparotomy with resection of a necrotic spleen imperative, with complete recovery of the patient.
Adult↗
Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study.
In a prospective study of two 5-yr periods two groups of patients undergoing pelvic operative procedures were compared. Iatrogenic femoral neuropathy occurred in 282 patients who underwent pelvic abdominal surgery in the first group of women, an overall incidence of 7.45%. The neuropathy was associated with the use of self-retaining retractors during surgery. Femoral nerve neuropathy occurred only in two patients in the second group in whom no retractors were used during operation. No other contributing factors were found. The duration of complaints ranged from 3 to 90 days. Spontaneous recovery occurred in 265 patients, while in 17 there were residual mild symptoms for up to 116 days. No serious sequelae have been observed. Prevention of this mostly mild yet annoying syndrome may be achieved if no retractors are used in gynecological operations, or, if they are necessary, due to difficult conditions at surgery or if the operation is long, they should be used with care and loosened from time to time. It is estimated that the incidence of iatrogenic femoral nerve neuropathy is higher than reported, since in very mild cases the patient fails to mention her complaints. The prognosis is usually rather good.
Female↗
Pelvic kidney presenting as tumor praevia: report of a case diagnosed by ultrasound.
A case is described in whom pelvic kidney presented as tumor praevia in early labor. Ultrasound examination revealed that the mass was a ptotic, functioning pelvic kidney, indicating that abdominal delivery should be resorted to in order to avoid its damage.
Adult↗
Etiology of cervical pregnancy. Association with abortion, pelvic pathology, IUDs and Asherman's syndrome.
Five cases of cervical pregnancy were treated with hysterectomy. In addition to previous pelvic pathology, iatrogenic interventions can be possible predisposing factors in this type of pregnancy. The association of cervical pregnancy and induced abortion, with traumatic curettage damaging the endometrium, rendering it unsuitable for nidation, is well documented. The two cases of severe intrauterine adhesions in our series suggest that partial or complete obliteration of the uterine cavity by such adhesions might be an important cause of cervical pregnancy. The presence of an IUD and the administration of hormonal therapy for the treatment of Asherman's syndrome might have contributed to our cases of cervical pregnancy.
Abortion, Induced↗