Biomedical subjects
Publications and source records attributed to R K Chin.
A prospective, double-blind randomized trial was carried out at the Department of Obstetrics and Gynaecology, the Chinese University of Hong Kong, involving 4 groups of patients receiving a single intravenous dose of placebo, ampicillin, ampicillin and metronidazole, and ampicillin and sulbactam before operation. No difference in postoperative morbidity was present between the 4 groups of patients.
Plasma concentrations of thyroxine (T4) and thyroxine-binding globulin (TBG) as well as triiodothyronine uptake (T3U) were measured in 32 proteinuric pre-eclamptic patients and 24 normotensive pregnant women at similar gestations in the third trimester. The pre-eclamptic patients had slightly lower TBG, and significantly lower T4, concentrations, which were significantly correlated. They also had significantly lower infant birth weight which was correlated to the TBG and T3U values. There was no correlation between T4 and TBG or between birth weight and TBG or T3U in the normotensive women. It is likely that the correlation between TBG and birth weight in the pre-eclamptic patients reflects the severity of proteinuria in pre-eclampsia.
The maternal and newborn renal function in 84 normal pregnant women delivering at term was investigated. There was no difference between maternal and newborn plasma concentrations of urea (3.9 +/- 1.0 vs. 3.9 +/- 1.2 mmol/l) and creatinine (65.8 +/- 13.3 vs. 65.3 +/- 11.6 mumols/l). The plasma sodium and potassium concentrations were significantly higher in the newborn (139.6 +/- 4.1 vs. 136.8 +/- 5.1 mmol/l, p less than 0.001, and 5.1 +/- 1.3 vs. 4.2 +/- 0.9 mmol/l, p less than 0.001, respectively). Significant correlations were found between newborn sodium (p less than 0.02) and potassium (p = 0.0001) with maternal potassium concentrations, newborn urea with maternal urea concentrations (p = 0.0001), and newborn creatinine with maternal creatinine concentrations (p = 0.0001), gestation of delivery (p less than 0.05) and birth weight (p = 0.025).
Plasma total T4 (TT4), T3 (TT3), free T4 (FT4), free T3 (FT3), thyroxine binding globulin, hCG, and erythrocyte zinc content were measured in 43 women with uncomplicated pregnancy and in 71 patients admitted with hyperemesis gravidarum. Plasma concentration of thyroid hormones in hyperemesis subjects showed wide variability and 32% of subjects had high TT4 (higher than mean +2 SD of normal pregnant subjects), 33% had high FT4, 20% had high TT3, and 20% had high FT3. Red cell zinc content, a tissue marker of thyroid status, in the hyperthyroxinemic subjects was not different from that of normothyroxinemic hyperemesis subjects or of subjects with uncomplicated pregnancy. The elevated TT4 concentration decreased spontaneously in all but two of the hyperemesis subjects to normal pregnant levels. The plasma FT4 concentration at presentation correlated with plasma hCG in hyperemesis gravidarum (partial correlation coefficient r = 0.411, P less than 0.01), but not in normal pregnancy (partial correlation coefficient r = 0.043) after allowing for the effect of gestational age. We conclude that approximately one third of hyperemesis subjects show transient hyperthyroxinemia and suggest that hCG or a molecular variant of hCG may stimulate the thyroid gland.
A group of patients suffering from severe hyperemesis gravidarum is defined. In contrast to what is reported in the literature, these women gave birth to babies with lower birth weight when compared to the hospital population and also to women who had a milder degree of hyperemesis gravidarum. This indicates that the metabolic disturbance created by hyperemesis may have an adverse effect on the growth potential of the fetus.
To examine the significance of proteinuria in pre-eclampsia, we studied 87 nulliparous patients in whom pre-eclampsia was diagnosed clinically and whose blood pressure and urine findings returned to normal after delivery. There was no difference in the gestation at diagnosis, highest systolic and diastolic blood pressures before treatment/delivery, or the number given antenatal hypotensive therapy between patients with proteinuria (group A, n = 46) and without proteinuria (group B, n = 41). Group A patients had higher plasma urea concentration (p less than 0.02), but similar creatinine and urate concentrations to group B patients. Group A patients had a higher rate of induction of labour (p less than 0.04) and Caesarean section before labour (p less than 0.04), and the mean gestation at delivery as well as the birth weight were less (p less than 0.03 and p less than 0.004, respectively). The results suggest that proteinuria in pre-eclampsia is associated with more severe fetal involvement and growth retardation only, but not with an increased severity of the maternal condition such as hypertension and a higher plasma urate concentration.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Thyroid function was studied in 24 proteinuric pre-eclamptic patients and 24 gestation-matched controls. The pre-eclamptic patients had significantly lower mean total (TT4) and free thyroxine (FT4), and thyroxine-binding globulin (TBG) concentrations, and the concentration of thyroid-stimulating hormone was significantly higher. The mean total triiodothyronine (TT3) concentration, however, was similar to the controls. This is at variance with the classical low T3 syndrome reported previously for pre-eclamptic patients. Compared to the controls, 33.3% and 29.2% of the pre-eclamptic patients had low TT4 and TT3 concentrations respectively. Pre-eclamptic patients with low TT4/TT3 had significantly higher plasma urate concentrations. Thyroid hormone concentrations may reflect the severity of pre-eclampsia.
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Plasma total thyroxine (TT4) and free thyroxine (FT4) were measured in 23 women with hyperemesis gravidarum at presentation, on average at about 10 weeks, in the second trimester, and before delivery. The first TT4 was raised abnormally in eight women and the FT4 in nine, but by the second trimester the TT4 was abnormally high in only three although in eight the FT4 remained high. By the third trimester all measurements, except one slightly raised FT4, were normal. Birthweight was not related to the thyroxine levels but there was a weak significant negative correlation between FT4 in the second trimester and gestational age at delivery.
In a group of normal pregnant women, erythrocyte and plasma zinc concentrations were assessed at 8, 15, 25 and 35 weeks. Erythrocyte zinc concentration showed an increasing trend with a peak value at 25 weeks, although the increase did not reach a significant level. Plasma zinc concentration showed a significant decrease with the lowest value at 35 weeks. Erythrocyte and plasma zinc concentrations were not correlated, and there was no correlation between either of these concentrations and human chorionic gonadotrophin at 8-15 weeks. The value of zinc measurements in the management of complicated pregnancies is discussed.
Low zinc concentrations in plasma have been reported in pregnancy complications such as pre-eclampsia and intra-uterine growth retardation, as well as in non-pregnant individuals with gastrointestinal and eating disorders. The present study looked at the plasma zinc concentration in hyperemetic and normal pregnant women at the same stage of gestation, as well as total thyroxin concentration in these two groups, since abnormal thyroid function is a common phenomenon in hyperemetic women. No difference in plasma zinc concentration was found between normal and hyperemetic women, which suggests that hyperemesis gravidarum is not associated with a low plasma zinc concentration. Hyperemetic women did have, however, significantly higher total thyroxin concentrations, and on further examination, a significant correlation was found between plasma zinc concentration and total and free thyroxin, free tri-iodothyronin, and human chorionic gonadotropin. The significance of our findings is discussed.
The development of a pharmacy and nursing committee to improve communication and interdepartmental relations is described. Too often pharmacists and nurses avoid talking about concerns or procedures until they become problems that must be resolved quickly. The purpose of the committee is to resolve issues using a cooperative approach. 1. To discuss the problems in an objective manner, in an attempt to diffuse the emotional component of the problem. 2. To permit discussion from each department's perspective. 3. To identify methods to resolve the problems that would be mutually agreeable. Both the departments of pharmacy and nursing are usually represented on many hospital committees and thus it would be mutually beneficial for both departments to work as a team rather than as adversaries. The logistics in committee formation is discussed. It is also suggested that other departments such as education and risk management may assist the pharmacy and nursing committee in its implementation and assessment of procedures. Since its development, the pharmacy and nursing committee has identified numerous problems and proposed solutions. The establishment of the pharmacy and nursing committee at our institution has assisted in improving the relationship between the two departments. Other hospital pharmacies are encouraged to develop a committee similar to the one described in this article.
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