Search PubMed⌕ Search

Biomedical subjects

R L Berkowitz

Publications and source records attributed to R L Berkowitz.

At least 127 records · Page 7Linked to original sources
PubMed1985

Twin pregnancy: routine use of ultrasound examinations in the prenatal diagnosis of intrauterine growth retardation and discordant growth.

A prospective study was undertaken in 42 normal twin pregnancies to determine the value of routine ultrasound evaluation in the prenatal diagnosis of intrauterine growth retardation (IUGR) and intra-pair growth discordancy in twin gestations. Use of multiple sonographic parameters significantly improved diagnostic accuracy when compared with the use of single parameters, such as biparietal diameter (BPD) alone in the prepartum diagnosis of these two entities.

Adolescent↗
PubMed1985

Intrauterine treatment: meeting the psychosocial needs of the family.

Recent advances in diagnostic ultrasound have made in-utero treatment of the fetus possible. This article identifies the stresses experienced by families engaged in such treatment and presents a detailed protocol for intervention at each stage of the process--from the decision to undergo treatment to the postpartum period and discharge.

Delivery, Obstetric↗
PubMed1985

Prospective study of side effects associated with the use of silver sulfadiazine in severely burned patients.

We report the results of a prospective study of 45 burn patients in whom serum and urine levels of cream constituents (sulfadiazine and propylene glycol) were determined and correlated with clinical parameters and the presence of an immune response to sulfadiazine. Propylene glycol, measured by gas chromatography, was found in the serum of 53% of study patients. Sulfa, determined by spectroscopy, was found in the serum of all patients, with values as high as 9.1 mg/dl within 24 hours of topical application. Ninety percent of tested patients had circulating sulfadiazine antibodies, predominantly IgG. Fourteen patients died, 11 of whom had interpretable renal biopsies. Five of these biopsies showed positive immunofluorescent linear or granular staining for IgG, IgM, IgA, or C'3; none of these 5 patients had clinical evidence for the nephrotic syndrome. The association between antisulfadiazine antibodies, circulating immune complexes, immunoglobulin disposition on glomerular basement membranes, and topical application of silver sulfadiazine provides evidence for sulfadiazine sensitization in patients with severe burns.

Administration, Topical↗
PubMed1985

Diagnosis and management of fetal holoprosencephaly.

The holoprosencephalies are a spectrum of cerebral and facial malformations resulting from incomplete division of the embryonic forebrain. Using ultrasound to search for structural defects in the fetal brain and to measure interorbital distances, the alobar variety can be diagnosed antenatally. A series of seven cases is presented. Criteria for diagnosis and guidelines for obstetric management are presented.

Brain↗
PubMed1985

Diagnosis and management of fetal teratomas.

Teratomas are the most common neoplasms in newborns. It is now possible to detect these lesions with ultrasound before birth. Presented are six teratomas in a variety of locations diagnosed in utero (three sacrococcygeal, two oral cavity, and one intracranial). As these lesions are usually benign and often curable, the authors believe an aggressive, combined obstetric, pediatric, and surgical approach is warranted.

Brain Neoplasms↗
PubMed1985

Intrapartum management of twin gestation.

Neonatal mortality and morbidity were analyzed in 362 pairs of twins delivered at Yale-New Haven Medical Center during a five-year period. Of the 154 (42.5%) pairs in vertex-vertex presentations, 125 (81.2%) were delivered vaginally. No difference in the occurrence of low five-minute Apgar scores was found in relation to the length of time interval between delivery of the twins. Of the 139 (38.4%) twins in vertex-nonvertex presentations, 99 (71.2%) were delivered vaginally. In the entire series, there was one case of significant birth trauma related to vaginal delivery of a nonvertex second twin. The one instance of neonatal death clearly related to birth asphyxia resulted after cesarean section. A protocol for the intrapartum management of twin gestations is presented based upon intrapartum fetal presentation and sonographically determined estimated fetal weight.

Apgar Score↗
PubMed1984

Outcome of fetal ventriculomegaly.

Ventriculomegaly was diagnosed in 50 fetuses in the perinatal ultrasound unit of Yale-New Haven Medical Center. The outcomes were elective abortion, 13 (26%); antepartum death, 0 (0%); intrapartum death, 7 (14%); neonatal death within 24 h, 11 (22%); neonatal death after 24 h and within 28 days, 3 (6%); death after 28 days, 2 (4%); survival, 14 (28%). 70% of the deaths were associated with severe congenital anomalies or intrapartum cephalocentesis. Of the 14 survivors, 6 (43%) had Bayley mental or Stanford-Binet scores of over 80, 2 (14%) had scores from 65 to 80, and 6 (43%) had scores of less than 65. The differences in outcome between this antenatal population and previously described neonatal populations with ventriculomegaly may result from the high rate (84%) of abnormalities in association with ventriculomegaly in this study and selection biases in neonatal studies.

Abnormalities, Multiple↗
PubMed1984

The diagnosis of fetal microcephaly.

Of 16 fetuses in whom microcephaly was suspected, nine (56.2%) were affected with microcephaly, and seven (43.8%) were unaffected. Subsequently, nomograms with mean and SDs for biparietal diameter, occipitofrontal diameter, head perimeter: bdominal perimeter, biparietal diameter:femur length, and femur length:head perimeter we derived. With the use of the data from 27 sonograms of the 16 fetuses, different thresholds of abnormality were tested. Three standard deviations from the mean for biparietal diameter, occipitofrontal diameter, head perimeter, and femur length:head perimeter were sensitive thresholds for the diagnosis of fetal microcephaly with no false negative diagnoses. Four standard deviations from the mean for occipitofrontal diameter, head perimeter:abdominal perimeter, and femur length:head perimeter were specific tests with no false positive diagnoses. The use of multiple diagnostic tests was necessary to improve accuracy in the diagnosis of fetal microcephaly. Further clinical studies are needed to delineate more clearly optimal tests and thresholds of abnormality.

Anthropometry↗
PubMed1984

Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy.

During a 5-year period, a diagnosis of obstructive uropathy was made in 25 fetuses. Eight of them had unilateral obstruction and 17 were affected bilaterally. The most common condition encountered was urethral obstruction by posterior valves. The site and nature of the obstruction were correctly identified in 22 of the 25 fetuses. Among the 17 who had bilateral obstruction, only three survived. In contrast, only one infant with unilateral obstruction died (of unrelated causes). Oligohydramnios in low-level (urethral) obstruction was a uniformly lethal finding. Relief of urethral obstruction in two fetuses after 20 weeks of gestation did not result in survival of the infant, whereas shunting prior to 20 weeks in one fetus seemed to have a beneficial effect. On the basis of this experience, we suggest that unilateral obstruction would be treated best by conservative management, while in bilateral obstruction invasive treatment may be effective if initiated early in gestation, before significant oligohydramnios occurs.

Female↗
PubMed1984

Is routine cesarean section necessary for vertex-breech and vertex-transverse twin gestations?

Ninety-three vertex-breech and 42 vertex-transverse twin gestations were managed at Yale-New Haven Medical Center during a 5-year period. Antepartum diagnosis of twin gestation occurred in 93% of the cases, and diagnosis was made before delivery of the second twin in 97% of the cases. Seventy-two (78%) of the vertex-breech and 22 (53%) of the vertex-transverse twins were delivered vaginally. Breech extraction was used for delivery of 76 second twins. Below a birth weight of 1,500 gm, there were six neonatal deaths, four cases of documented intraventricular hemorrhage, and a 67% occurrence of depressed 5-minute Apgar scores. Above a birth weight of 1,500 gm, there were no cases of neonatal death or documented intraventricular hemorrhage and a 5% occurrence of moderately depressed 5-minute Apgar scores. Birth trauma occurred in a 3,420 gm second twin delivered by breech extraction. This infant suffered a greenstick fracture of the right clavicle and a nondisplaced fracture of the right humerus that was not associated with permanent residual injury. We think that, for birth weights greater than 1,500 gm, routine cesarean section for vertex-breech or vertex-transverse twin gestation may not be necessary.

Apgar Score↗
PubMed1984

Use of sonographic estimated fetal weight in the prediction of intrauterine growth retardation.

The value of sonographic estimated fetal weight (SEFW) in the antenatal detection of intrauterine growth retardation (IUGR) was tested in a population of 179 patients, at risk for IUGR, who had a SEFW determination within 15 days of delivery. A nomogram was developed and three zones of SEFW were defined. Sixty percent of the population had an SEFW determination in Zone I, and no IUGR occurred in this group. Thirty-one percent of the scanned population fell into Zone II, with a 24% prevalence of IUGR. Nine percent of referred patients were in Zone III; 82% of these were growth retarded at birth. SEFW is a useful tool in the antenatal diagnosis of IUGR.

Birth Weight↗
PubMed1984

Antepartum diagnosis of goitrous hypothyroidism by fetal ultrasonography and amniotic fluid thyrotropin concentration.

Ultrasonography of a 26-week-old fetus suggested the presence of a goiter. Amniocentesis was performed at 26 and 38 weeks gestation to evaluate thyroid function. An elevated amniotic fluid TSH level was found on both occasions, though amniotic fluid T4, T3, and rT3 levels were similar to those of euthyroid fetuses. The diagnosis of goitrous hypothyroidism was confirmed at birth. Therapy with thyroid hormone was instituted on the first day of life. Growth and development of the infant have been normal during the first year of his life. We suggest that the measurement of amniotic fluid TSH can be useful in the diagnosis of intrauterine primary hypothyroidism.

Amniotic Fluid↗
PubMed1984

Diagnosis of ventriculomegaly before fetal viability.

Thirteen cases of documented ventriculomegaly were diagnosed between 19 and 24 weeks of gestation. In 11 cases, the lateral ventricle/hemispheric width ratio was abnormally increased at the time of the first ultrasound examination, and in two, the lateral ventricle/hemispheric width ratios were initially in the high normal range. Severe ventriculomegaly was observed in both of the latter cases when repeat examinations were performed two weeks later. In 12 cases (92%), the biparietal diameter (BPD) was appropriate for gestational age, whereas the BPD was increased in only one. Two of the affected fetuses were found in conjunction with normal twins. This series suggests that fetal ventriculomegaly can be accurately diagnosed before fetal viability using the lateral ventricle/hemispheric width ratio.

Brain↗