Biomedical subjects

R R Snyder

Publications and source records attributed to R R Snyder.

24 records · Page 2Linked to original sources

PubMed1987

Nuchal cords and neonatal outcome.

To assess the significance of nuchal cords, 110 affected woman-infant pairs at term gestation were compared with 110 control pairs. Newborns with a nuchal cord had an increased prevalence of umbilical artery acidemia (22 of 110 versus 13 of 110; P less than .05) and more variable fetal heart rate (FHR) decelerations in the first stage of labor (mild = 41 versus 20; P less than .0001; moderate-severe = 21 versus 5; P less than .0001) and the second stage of labor (moderate-severe = 46 versus 21; P less than .0001). In newborns with a nuchal cord, the umbilical artery acidemia was usually mixed (68%) or respiratory (23%) in origin, and pure metabolic acidemia was infrequent (9%). We conclude that nuchal cords are associated with an increased prevalence of variable FHR decelerations in the first and second stages of labor and with an increased incidence of umbilical artery acidemia.

Acidosis, Respiratory↗

PubMed1987

Trophoblastic embolization during molar evacuation: central hemodynamic observations.

We evaluated prospectively the extent of trophoblastic embolization and its central hemodynamic effects during and after evacuation of large molar pregnancies in six women. A pulmonary artery catheter was inserted to obtain hemodynamic measurements as well as to obtain blood samples to identify trophoblasts before, during, and six hours after evacuation. Small numbers of both multinucleated giant cells and of large mononuclear cells with abundant cytoplasm were identified in the buffy coat of blood, aspirated in two cases before evacuation and for all six cases, during evacuation. There were no significant changes in heart rate or mean systemic arterial, pulmonary arterial, central venous, and pulmonary capillary wedge pressures; or cardiac output, stroke volume, and pulmonary or systemic vascular resistance when preevacuation preanesthetic values were compared with those six hours after evacuation. However, significant decreases in heart rate, mean arterial pressure, and pulmonary vascular resistance were observed during evacuation, which returned to preevacuation levels by completion of anesthesia.

Female↗

PubMed1986

Ovarian strumal carcinoid: immunohistochemical, ultrastructural, and clinicopathologic observations.

A review of 13 ovarian strumal carcinoids in the files of the Armed Forces Institute of Pathology has established further evidence that these tumors have both endocrine and neuroendocrine differentiation. The two functional routes of differentiation occur even within individual tumor cells. Immunohistochemical reaction for thyroglobulin was positive in the strumal regions of all 12 cases tested. This positivity was also present in transitional zones where the thyroid follicles merged with nests of carcinoid cells. Electron microscopy performed in six cases showed cells with neuroendocrine granules in the thyroid follicles; these cells resemble the C-cells of the normal thyroid gland. An immunoperoxidase reaction for calcitonin, however, revealed no positivity in any of the cells corresponding to the neuroendocrine cells within the follicles or those in the carcinoid component. Variable positivity for serotonin was observed, however. It is proposed that cells within the struma that have morphologic similarities to the C-cells of the thyroid give rise to the carcinoid component. These cells appear capable of producing thyroglobulin as well as neuroendocrine granules.

Adult↗

PubMed1986

Etiology and management of acute fatty liver of pregnancy.

Acute fatty liver of pregnancy (AFLP) remains a problem for which there is no discernible cause. Therefore, a precise definition awaits the discovery or elucidation of its exact etiology. AFLP is best described as acute hepatocellular dysfunction that occurs in pregnancy, generally during the third trimester or the early puerperium. It is characterized histopathologically by changes in the liver consistent with microvesicular fatty infiltration but occurring in a pregnant women with no clearly identifiable etiology. Management tenets include prompt delivery and supportive care of the mother.

Diagnosis, Differential↗

PubMed1986

Acute pyelonephritis in pregnancy.

Acute pyelonephritis is one of the most common serious medical complications of pregnancy and may result in significant maternal morbidity. E. coli and Klebsiella are the two most common causative organisms. Pregnant women with acute pyelonephritis should be hospitalized and treated with parenteral antibiotics. Clinical response is usually dramatic, with the majority of patients being asymptomatic within 48 to 72 hours of therapy. Recurrent infection is common, and these women must be followed closely with frequent surveillance cultures. Detection and eradication of bacteriuria at the initial prenatal visit is important in preventing this complication.

Acute Disease↗

PubMed1983

Ehlers-Danlos syndrome and pregnancy.

Ehlers-Danlos syndrome is a genetically transmitted disorder of connective tissue characterized by hyperelasticity of the skin, hyperflexibility and looseness of the joints, easy bruisability of the skin, and in the more severe forms of the disease, arterial fragility and tendency to rupture. Pregnant patients with Ehlers-Danlos syndrome are at increased risk for various complications, most serious of which is rupture of a major vessel. The present case report is the second known report of a maternal death from rupture of a major artery in a patient with the severe type IV variant of the syndrome. The advisability of pregnancy and genetic counseling are discussed.

Adult↗