Search PubMed⌕ Search

Biomedical subjects

R L Berkowitz

Publications and source records attributed to R L Berkowitz.

At least 163 records · Page 9Linked to original sources
PubMed1982

Fetal echocardiography for evaluation of in utero congestive heart failure.

Thirteen fetuses with nonimmune hydrops (22 to 39 weeks of gestation) were evaluated with two-dimensional and M-mode echocardiography. Ten fetuses had cardiovascular abnormalities resulting in heart failure, and three had noncardiac causes of hydrops. In three cases, hydrops was caused by supraventricular tachycardia. One of these fetuses responded to cardioversion at birth, another responded to transplacental digoxin therapy, and the third died with atrial flutter and high-grade atrioventricular block before delivery. There were no cases of "idiopathic" hydrops. Our results show that fetal echocardiography is useful in determining cardiac causes of in utero heart failure resulting in hydrops fetalis. The fetal echocardiogram may also be used in monitoring transplacental therapy of heart failure.

Adolescent↗
PubMed1982

An evaluation of two equations for predicting fetal weight by ultrasound.

In an earlier study we presented a method of determining fetal weight from ultrasound measurements of abdominal circumference (AC) and biparietal diameter (BPD). From an equation with these two measurements as independent variables we generated tables of estimated fetal weights (E1). Although these tables have been very useful, we had the impression we were underestimating fetal weight. Therefore, we reconsidered an earlier unpublished table generated from a different equation (E2). While most estimates from E1 and E2 were likely to be within 10% of actual weight, there was significant underestimation with E1. E2 provides a better balance between the distribution of overestimations and underestimations.

Birth Weight↗
PubMed1982

A comparative evaluation of the level of concanavalin a binding by enriched plasma membrane fractions from developing soybean roots.

The Concanavalin A (Con A) binding capacity of plasma membranes isolated from meristematic and mature regions of four-day-old soybean (Glycine max L. Merr. cv. Wells) roots was compared. Con A binding was studied using a radiochemical assay with tritiated ((3)H)-Con A and by an electron microscope technique using Con A-ferritin (Con A-F). In both cases, plasma membranes isolated from meristematic tissue bound significantly more Con A than did corresponding membranes from mature tissue. The relative difference in reactivity, as determined by the two procedures, was approximately 49% ((3)H-Con A) and 46% (Con A-F). In contrast, K(m) values, determined from (3)H-Con A binding curves, were approximately the same, indicating that receptor sites on plasma membranes from both sources were qualitatively similar.Since Con A specifically interacts with saccharide-containing portions of membrane glycoproteins and/or glycolipids, the data suggests that there is a decrease in the concentration of those components in plasma membranes during development or that there are qualitative changes in the structure of their oligosaccharide side chains.

Journal Article↗
PubMed1982

Results of a management protocol for premature rupture of the membranes.

The results of a management protocol for women with premature rupture of the membranes (PROM) between 27 and 36 weeks' gestation is presented. Prior to 33 weeks' gestation patients were hospitalized and observed for signs of infection; labor was induced if amnionitis was diagnosed. After 33 weeks patients with vertex presentations underwent elective induction of labor after 16 hours of PROM. Amniocentesis was not performed, corticosteroids were not administered, and tocolysis was not used. The overall perinatal mortality rate was 2.8%. There was only 1 death in the group of 44 patients between 33 and 36 weeks' gestation with PROM for more than 16 hours. This neonate had moderate respiratory distress syndrome and a severe intracranial hemorrhage. The cesarean section rate in the group that underwent labor induction after 16 hours of PROM was 22.7% but only 1 of the 10 operations performed might possibly have been avoided if induction had not been a part of the protocol. In the group of 41 patients managed expectantly but delivered after 16 hours of PROM prior to 33 weeks' gestation, 21.9% were clinically believed to have amnionitis but only 12 neonate had documented sepsis. The implications of these results are discussed.

Cesarean Section↗
PubMed1981

Scalp--in search of the perfect donor site.

In many cases where a wound to be grafted is large, particularly in burns, the patient's condition may be aggravated by exposed donor sites. Adding thigh or even buttock scars to a patient must be carefully considered. The scalp, it appears, is a safe, reliable, and truly hidden donor site. For this and other reasons mentioned, its use should be promoted in plastic surgery.

Burns↗
PubMed1981

Characterization and quantitation of concanavalin a binding by plasma membrane enriched fractions from soybean root.

The binding of concanavalin A (Con A) to soybean root membranes in plasma membrane enriched fractions (recovered from the 34/45% interface of simplified discontinuous sucrose density gradients) was studied using a radiochemical assay employing tritiated ((3)H)-Con A. The effect of lectin concentration, time, and membrane protein concentration on the specific binding of (3)H-Con A by the membranes was evaluated. Kinetic analyses showed that Con A will react with membranes in that fraction in a characteristic and predictable manner. The parameters for an optimal and standard binding assay were established. Maximal binding occurred with Con A concentrations in the range of 8 to 16% of the total membrane protein with incubation times greater than 40 min at 22 C. Approximately 10(15) molecules of (3)H-Con A were bound per microgram of membrane protein at saturation. Binding was reversible. Greater than 92% of the total Con A bound at saturation was released by addition of alpha-methyl mannoside.A major peak of (3)H-Con A binding was also observed in fractions recovered from the 25/30% interface of a complex discontinuous sucrose density gradient when membranes were isolated in the absence of Mg(2+). When high Mg(2+) was present in the isolation and gradient media, the peak was shifted to a fraction recovered from the 34/38% sucrose interface. These results suggest that Con A binding sites are also present on membranes of the endoplasmic reticulum. The amount of Con A bound by endoplasmic reticulum membranes was at least twice the amount bound by membranes in plasma membrane enriched fractions when binding was compared on a per unit membrane protein basis. In contrast, mitochondrial inner membranes, which equilibrate at the same density as plasma membranes, had little ability to bind the lectin.

Journal Article↗
PubMed1981

Intrauterine transfusion utilizing ultrasound.

Thirty-seven intrauterine transfusions were performed on 17 severely Rh-sensitized women utilizing a technique entirely dependent upon ultrasound for needle insertion. The neonatal survival rate was 71%; 57% (4 of 7) of the hydropic fetuses and 80% (8 of 10) of those with no antenatal evidence of ascites survived. Twenty-five percent of the 12 neonatal survivors received their initial transfusion at 26.5 weeks or earlier. These results are comparable to the best of those in series relying on x-ray or fluoroscopy techniques for performing the procedure. Intrauterine transfusion continues to play an essential therapeutic role in the management of the severely affected erythroblastotic fetus. It is recommended that techniques relying on ultrasound be utilized in preference to those using x-ray to reduce radiation exposure in utero.

Blood Transfusion, Intrauterine↗
PubMed1980

Hemodynamics in patients with severe toxemia during labor and delivery.

Three patients with severe pre-eclampsia-toxemia were studied with thermodilution tip pulmonary artery catheters. All patients were delivered by cesarean section with general anesthesia and endotracheal intubation. The left ventricular stroke work indices (LVSWI) of these patients were higher than those of normal nonpregnant subjects. There was no evidence of myocardial depression in terms of either cardiac index or the LVSWi-pulmonary capillary wedge pressure (Frank-Starling) relationship. Pulmonary arteriolar resistance (PAR) was found to be within or below the normal nonpregnant range, suggesting that in severe toxemia the pulmonary vasculature is not involved in a primary vasospastic process. At delivery a rise in cardiac index (CI) and mean pulmonary capillary wedge pressure (PCWP) occurred. The PCWP was higher in the postpartum period than prior to delivery. This was felt to represent an increase in circulating blood volume. The therapeutic significance of these findings is discussed.

Adolescent↗
PubMed1980

An evaluation of the usefulness of x-ray pelvimetry: comparison of the Thoms and modified Ball methods with manual pelvimetry.

One hundred studies by x-ray pelvimetry of cephalic presentations were retrospectively analyzed. The Thoms method of interpretation was compared to the modified Ball technique, and both were then contrasted with manual assessment of the pelvis, as prognostic indicators for safe vaginal delivery. Uneventful nonoperative vaginal deliveries occurred in 28.6% of patients with either inlet or midpelvic disproportion by the Thoms method, and in 22.5% of women with absolute disproportion in either plane by the modified Ball method. Neither of the two pelvimetric techniques was significantly more accurate than manual assessment of the pelvis in predicting obstetric outcome. The modified Ball technique offered no improvement over the Thoms method. In view of the high rate of false positives in this series, and the potential oncogenic risk of fetal irradiation, argument is presented for a full trial of labor in vertex presentations, except in the most clinically obvious cases of cephalopelvic disproportion (CPD). The data from this study suggest that there is no significant role for x-ray pelvimetry in the diagnosis and management of CPD in cephalic presentations.

Adolescent↗
PubMed1980

Invasive hemodynamic monitoring in critically ill pregnant patients: role of Swan-Ganz catheterization.

Pulmonary artery flow-directed (Swan-Ganz [SG]) catheters are widely accepted as an integral part of the modern management of critically ill patients. Their use permits rational therapeutic decisions to be made on the basis of continuously evolving indices of ventricular function. The information which may be derived from these monitors and the complications associated with their use are outlined. The related reports in the obstetric literature and the authors' 3-year experience are discussed. It is concluded that SG catheterization can be of value in the hemodynamically unstable parturient patient.

Adult↗
PubMed1980

The amylase/creatinine clearance ratio in normal pregnancy and pregnancies complicated by pancreatitis, hyperemesis gravidarum, and toxemia.

The Cam/Ccr% has been suggested to be of value in the diagnosis of pancreatitis. The Cam/Ccr% was determined throughout gestation in normal pregnant and nonpregnant patients. The Cam/Ccr% was lower (p less than 0.05) throughout pregnancy and was a function of increased creatinine clearance. The Cam/Ccr% was increased in pregnant patients with pancreatitis. Two of four patients with the clinical diagnosis of hyperemesis gravidarum demonstrated elevations of the Cam/Ccr%. Toxemia with epigastric pain was noted to be associated with an elevated CamCcr% in all patients, whereas toxemia without epigastric pain was not routinely noted to be associated with an elevated ratio. The normal Cam/Ccr% in pregnancy is lower than the nonpregnant value, and this should be taken into consideration when evaluating a patient with suspected pancreatitis who is pregnant. Patients with the clinical diagnosis of hyperemesis gravidarum and toxemia should be screened with serial Cam/Ccr% for possible evolving pancreatitis.

Adult↗
PubMed1980

Tight metabolic control of overt diabetes in pregnancy.

Seventy-three patients with overt diabetes were followed during pregnancy with tight control of carbohydrate metabolism and frequent measurement of glucose levels. During the last 12 weeks of pregnancy, mean plasma glucose levels averaged 108 mg/dl. Mean fasting plasma glucose levels averaged 98 mg/dl. Of the 73 patients, 77 per cent had mean plasma glucose levels of less than 120 mg/dl. Perinatal mortality rate was 4 per cent; this was corrected to 1.4 per cent when congenital anomalies incompatible with life were removed from consideration. Patients were allowed to go as close to term as possible, with 51 per cent being delivered at or beyond 38 weeks. Only two babies (2.8 per cent) were delivered because of deterioration of fetoplacental function test results. The results of this suggest that tight metabolic control may prevent some of the fetal morbidity associated with overt diabetes in pregnancy.

Adolescent↗