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Biomedical subjects

R A Munsick

Publications and source records attributed to R A Munsick.

At least 19 recordsLinked to original sources
PubMed2000

A faculty development course in obstetrics and gynecology.

Sponsored by the nonprofit Berlex Foundation, this 6-day Faculty Development Course introduces small groups of new faculty to research design, critical appraisal of the literature, scientific writing, and evidence-based medicine. The course includes didactic presentations, small group discussions, and individual protocol development. Its influence on academic careers is impossible to determine, because defining an appropriate comparison group is not feasible. However, the cumulative effect should be to increase the research expertise of some young faculty in academic departments nationwide. In addition, many participants have introduced the principles of evidence-based medicine in their own teaching programs.

Curriculum↗
PubMed1996

Cervical dilation from multiple laminaria tents used for abortion.

OBJECTIVE: To quantify the cervical dilation achieved from multiple medium-thick laminaria tents used for 16-26 hours in single applications before abortion. METHODS: In a practice setting, cervical dilation was studied from all abortions done at greater than 8 weeks in which one or more medium-thick laminaria tents were used in a single application for 16-26 hours. Multiple regression analysis was used to quantify results. RESULTS: There was a positive linear regression of dilation against weeks of gestation for all numbers of tents. The more tents, the greater the dilation; the more weeks, the greater the dilation. CONCLUSION: Approximate cervical circumferential dilation from medium-thick laminaria tents under the constraints listed is provided by the formula: Pratt dilation = 12.36 + (2.35 x tents) + (1.79 x weeks).

Abortion, Induced↗
PubMed1995

Cervical dilation from laminaria tents and synthetic osmotic dilators used for 6 hours before abortion.

OBJECTIVE: To compare thick laminaria tents with two synthetic osmotic devices for softening and dilating the cervix before abortions. METHODS: This was a randomized clinical trial comparing cervical dilation by thick laminaria tents with two commercially made devices, 3-mm Hypan and 3-mm anhydrous magnesium sulfate-impregnated plastic tents, used for 6 hours. Subjects were 7-14 weeks pregnant, and all 93 were assigned to devices in permuted randomized groups of three. Physicians and patients were not blinded to the type of device used. Need for a tenaculum for insertions, ease of introduction, cramps, removal ease, hourglassing, achieved dilation, and ease of forced dilation were compared. The effects of parity and gestational length on achieved dilation were also analyzed. RESULTS: Parity did not affect dilation. Significant positive, linear slopes of regression were found for achieved dilation versus weeks of gestation for thick laminaria tents and magnesium sulfate devices but not for Hypan tents. Forcible dilation was easiest with thick laminaria tents and most difficult with magnesium sulfate devices. CONCLUSION: All devices provided safe cervical dilation and softening, but thick tents were most effective.

Abortion, Induced↗
PubMed1992

Fetomaternal hemorrhage in threatened abortion.

In this study, we compared the incidence of fetomaternal hemorrhage between patients with threatened abortion and a control population of similar gestational age. The study population comprised pregnant patients at less than 20 weeks' gestation who presented to our emergency room with a history of vaginal bleeding without cervical dilatation or passage of tissue. The control population consisted of women presenting for elective pregnancy termination; they were excluded from the study if they gave a history of any antepartum bleeding. The amount of fetomaternal hemorrhage was evaluated using the Kleihauer-Betke acid elution assay. A positive result in our laboratory, as determined by a nonpregnant control group, was a value of 0.07% or more fetal cells. Using this criterion, 11% of the study population had a positive Kleihauer-Betke test, compared with 4% in the pregnant control group. Rho(D) immunoglobulin may be indicated in Rho(D)-negative patients who present with threatened abortion.

Abortion, Threatened↗
PubMed1987

Similarities of Negro and Caucasian fetal extremity lengths in the interval from 9 to 20 weeks of pregnancy.

Foot, leg, and arm measurements were compared from 599 electively aborted fetuses of Negro and Caucasian women who had reliable menstrual dates and agreement between dates and uterine size. When compared by week, no significant racial differences were detected in the means of any of these measurements between 9 and 20 menstrual weeks of pregnancy. The combined, corrected data provided smoother curves than those previously published. The following formulas are recommended for weeks 9 to 20 of pregnancy, where W = weeks and F, L, and A are the foot, leg, and arm measurements in centimeters: W = 4.5261 + 11.937(F) - 4.4895(F2) + 0.71583(F3); W = 5.9957 + 5.7279(L) - 1.2246(L2) + 0.11880(L3); W = 5.4007 + 5.0305(A) - 0.93540(A2) + 0.079022(A3).

Black People↗
PubMed1986

Pancreatic amylase expression in human pancreatic development.

Enzymatic and immunologic methods were used to study amylase expression in amniotic fluid and human pancreatic tissue from fetuses of various gestational ages. A starch-coated slide assay was used to quantitate amylase activity in amniotic fluids, and samples with activity were studied by electrophoresis to determine the presence of salivary amylase (Amy1) and pancreatic amylase (Amy2) isozymes. Immunohistochemical studies were performed with both a rabbit anti-human Amy1 antibody and a murine anti-human Amy2 antibody (Amy2/SP2/1). Amy2/SP2/1 was used to discriminate between Amy1 and Amy2. Both Amy1 and Amy2 activities were present in amniotic fluid from 14 weeks' gestation, and immunologic activity was present in pancreatic tissue sections from 15.9 weeks' gestation.

Amniotic Fluid↗
PubMed1986

Distribution of catecholamines between fetal and maternal compartments during human pregnancy with emphasis on L-dopa and dopamine.

This study was undertaken to determine the differential distribution of catecholamines, in particular L-dihydroxyphenylalanine (L-dopa) and dopamine, between the fetal and maternal compartments during human pregnancy. Amniotic fluid and fetal and maternal blood were obtained from two groups of pregnant women with uncomplicated pregnancies. One group was at 15-20 weeks of gestation and the second group was in labor after 36-41 weeks of gestation. Samples were analyzed for L-dopa, dopamine, norepinephrine, and epinephrine by radioenzymatic assays. L-Dopa constituted about 80% of the total circulating fetal catecholamines, and levels were 2- to 3-fold higher in fetal than maternal plasma. Marked increases in norepinephrine, small rises in epinephrine, but no changes in L-dopa or dopamine concentrations occurred in fetal plasma from mid- to late gestation. Maternal plasma catecholamines did not change. Towards the end of gestation, dopamine in the amniotic fluid increased 15-fold, and norepinephrine increased 5- to 6-fold; L-dopa remained high and unchanged. We conclude that L-dopa is the predominant catecholamine in fetal plasma and amniotic fluid during human pregnancy. No significant changes in its concentrations occur in either compartment between mid- and late gestation. In contrast, dopamine levels, which are 30- to 50-fold lower than those of L-dopa in amniotic fluid during midgestation, show a striking elevation toward the time of labor. Neither the sources nor the possible physiological functions of either L-dopa or dopamine during fetal life are known.

Amniotic Fluid↗
PubMed1986

Rh0(D) and Du cord blood typing during elective abortion operations.

During dilatation and suction or evacuation abortion operations, the umbilical cord can be delivered and sufficient fetal blood can be sampled to type for the Rho(D) and Du factors in about 30% of cases at 14 menstrual weeks of pregnancy. By 16 weeks, more than 75% can be sampled successfully. When cord blood can be Rh typed, about 40% of the fetuses of Rh negative women were found also to be Rh negative. In these cases, anti-Rho(D) immunoglobulin prophylaxis is unnecessary.

Abortion, Induced↗
PubMed1985

Dickinson's sign: focal uterine softening in early pregnancy and its correlation with the placental site.

Focal uterine softening, characteristic of early pregnancy, is usually known as Piskacek's or von Braun-Fernwald's sign but should be attributed to Robert Latou Dickinson, who first described it in 1982. The presence or absence of Dickinson's sign was carefully noted in 1040 pregnant patients seeking abortions. The weeks of gestation, location of uterine softening, and correlation with placental site were also studied. This sign reliably showed the placental site, hence its unequivocal presence nearly proves the presence of intrauterine pregnancy and precludes the existence of tubal pregnancy. It was present in most pregnancies between 6 and 11 menstrual weeks, and its presence after 14 weeks should make menstrual dates suspect or signal the possibility of a septate or bicornuate uterus.

Abortion, Induced↗
PubMed1984

Human fetal extremity lengths in the interval from 9 to 21 menstrual weeks of pregnancy.

Fetal arm, leg, and foot lengths were freshly measured with vernier calipers on all fetuses aborted by me from 1975 to 1983. With the use of these measurements from the 575 patients with reliable menstrual or conception dates and uterine size in agreement (+/- 2 weeks) with dates, statistical analyses were performed to determine the polynomial regressions of menstrual weeks of pregnancy for each extremity length. The data best fit the following formulas, where W represents weeks and F, L, and A are foot, leg, and arm lengths in centimeters: W = 3.03 + 17.4(F) - 10.8 (F2) + 3.36(F3) - 0.367(F4); W = 5.74 + 6.49(L) - 1.90(L2) + 0.305(L3) - 0.0161(L4); W = 5.19 + 5.65(A) - 1.45(A2) + 0.203(A3) - 0.00934(A4). Mean foot lengths at each week agreed well with those of Streeter, and when corrected for bias, all foot lengths were in near perfect agreement with his data.

Anthropometry↗
PubMed1984

Brief clinical report: neural tube defects in dup(11q).

We describe clinically and cytogenetically a fetus with multiple congenital anomalies and partial dup(11q) born to a phenotypically normal mother with a 3:1 translocation. Fetal anomalies included complete cleft of lip and palate, small penis, myelomenigocele, and abnormal palmar creases. We think chromosome analysis should be performed when neural tube defects are observed in otherwise dysmorphic neonates, stillbirths, and abortuses.

Abnormalities, Multiple↗
PubMed1983

An evaluation of four serum tests for pregnancy.

We evaluated four pregnancy tests (Biocept-G, Beta-CG, Preg/Stat, and HCG-Beta Screen), using sera from 59 nonpregnant subjects and 77 patients with serum human choriogonadotropin beta-subunit (beta-hCG) concentrations ranging from 4 to 100 000 int. units/L. The results obtained for each test were compared with the results predicted on the basis of the sample's beta-hCG concentration and the beta-hCG concentration the manufacturer claimed necessary for a positive result (the test's analytical sensitivity). Biocept-G had the best sensitivity (100%), specificity (98.9%), and accuracy (99.2%). Beta-CG had the poorest sensitivity (86.4%), Preg/Stat the poorest specificity (87.5%), and accuracy (92.6%). We confirmed the manufacturer's claimed analytical sensitivity (200 int. units/L) for the Biocept-G procedure, but our calculated analytical sensitivity for the other tests was significantly different from that claimed by their manufacturers. Best results were obtained with Biocept-G, but with its analytical sensitivity of 200 int. units/L, samples from early pregnancy will give negative results. None of the pregnancy tests evaluated here will establish the presence or absence of early pregnancy with certainty.

Chorionic Gonadotropin↗
PubMed1983

Five recent urinary tests for early pregnancy evaluated.

We evaluate five tests developed for the earlier detection of pregnancy, either in the clinical laboratory or by the patient in her home. These tests offer no advantage over other urinary pregnancy tests, and the results are distinctly inferior to those reported (Clin. Chem. 29: 561-563, 1983) for some serum tests for pregnancy.

Chorionic Gonadotropin↗
PubMed1982

Clinical test for placenta in 300 consecutive menstrual aspirations.

Results of menstrual aspirations in 300 consecutive patients were analyzed. The infection rate (1.4%) and incomplete abortion rate (1.4%) were acceptably low. Results support previous recommendations that pregnancy tests be positive before aspiration, and that it should be restricted to women with 7 or fewer weeks of amenorrhea. A method is described of grossly assessing the aspirate for placenta along with a microscopic method when the gross test is questionable or negative. When hemorrhage occurs 3 to 6 days after aspiration, provided that the placenta was recognized grossly, curettage is usually unnecessary. With bed rest, bleeding subsides in 12 to 24 hours. The placental tests were found to by nearly 100% reliable and their use improves not only the practice of early abortion but also the diagnosis and management of suspected ectopic pregnancy and problematic situations in which tissue is passed vaginally.

Abortion, Induced↗