Postpartum tetany and Crohn's disease.
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Biomedical subjects
Publications and source records attributed to R L Goldenberg.
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A case of toxemia misdiagnosed as idiopathic thrombocytopenic purpura is presented. An unusual temporal relationship between the fall in platelets and the appearance of hypertension was the cause of the confusion. A rise in platelets following glucocorticoid administration is discussed.
Physicians who deliver babies in Alabama were surveyed to determine their level of knowledge about the survival of low--birth weight/early gestational age infants. These estimates of neonatal survival were compared to the actual neonatal survival rates at local hospitals and at the regional perinatal centers in Alabama. In addition, the physicians' knowledge of survival rates was correlated with their management decisions in hypothetical cases of premature labor. Our findings indicate that physicians who perform deliveries tended to underestimate the potential for neonatal survival in premature infants. Equally as important, the range of responses varied markedly. In the hypothetical cases, management decisions often appeared to be based on incorrect information about neonatal survival. These decisions, including not electronically monitoring fetuses, not performing a cesarean section for fetal distress, and not transferring women in premature labor to a perinatal center, if made in actual cases, would result in potentially viable fetuses receiving less than optimal management.
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The use of prostaglandin E2 vaginal suppositories is an effective method of uterine evacuation for patients with intrauterine fetal demise. Advanced extrauterine gestation, because of its rarity, is usually not a primary consideration for patients presenting with fetal death. This report presents 4 such cases and strongly suggests that, when this drug is used for the treatment of fetal death, failure to induce contractions and to effect uterine evacuation within a reasonable time should prompt the consideration of extrauterine pregnancy.
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Twelve women with galactorrhea-amenorrhea and prolactin levels greater than 100 ng/ml were evaluated with dynamic pituitary challenge testing. Forty-two per cent of the patients had positive findings on polytomography and subsequent surgical confirmation of a pituitary tumor. Patients with tumors had a delayed elevation of growth hormone (GH) and cortisol following induction of insulin hypoglycemia. Patients had increased thyroid-stimulating hormone levels after injection of thyrotropin-releasing factor, but showed blunting of prolactin secretion. Patients with tumors had decreased basal levels of GH and showed a blunted response to luteinizing hormone-releasing hormone (LRF) stimulation. These patients had normal elevations of follicle-stimulating hormone after LRF challenge. Patients with tumors showed a delay in elevation of GH levels following l-dopa treatment. They also failed to show prolactin suppression following this treatment. There are consistently predictive changes that occur in pituitary functions in the presence of a pituitary tumor. However, absolute prolactin levels and sellar polytomography are more reliable in diagnosing the presence of a pituitary tumor in the patient with galactorrhea-amenorrhea.
The ethical decisions involved before and after the prenatal diagnosis of a 47, XYY karyotype in the fetus of a 32-year-old woman are discussed. It was decided that the parents should be presented with all the known facts about XYY-associated abnormalities and allowed to choose whether pregnancy should continue; the physician's role would be to support them in their decision and help them carry it out.
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The perinatal outcome of all vaginal breech deliveries weighing less than 2,500 grams was evaluated retrospectively. Results indicated that labor and delivery in the breech position had a morbidity and mortality rate far greater than could be attributed to prematurity alone. Serious consideration should be given to prophylactic cesarean section for all premature breech fetuses when delivery is anticipated.
Artificial insemination with homologous (AIH) and heterologous (AID) samples is discussed. Specific emphasis is placed on the indications and timing of the procedure, the type of specimens available, the technique and the expected results. The legal and emotional ramifications of AID are discussed.
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Ovarian biopsies from five women with the syndrome of hypogonadotropic hypogonadism and anosmia who had not previously received exogenous gonadotropins were evaluated with special emphasis on follicular morphology. Follicular development past the primordial stage was rarely observed, suggesting that early stages of follicular maturation require amounts of gonadotropins in excess of those secreted in these women.