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Biomedical subjects

S A Gall

Publications and source records attributed to S A Gall.

At least 55 records · Page 3Linked to original sources
PubMed1988

Multicenter comparison of cefotetan and cefoxitin in the treatment of acute obstetric and gynecologic infections.

Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections. The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic. The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively. The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group. Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated. These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

Acute Disease↗
PubMed1988

In vivo estimation of left ventricular wall volume in volume-overloaded canine hearts.

Several geometric algorithms have been applied to estimate left ventricular wall volume (Vwall) from two-dimensional echocardiograms but have not been validated in eccentrically hypertrophied hearts. These algorithms can be fitted to the general formula: Vwall = k.Ao.Lo = k.Ai.Li, where Ao and Ai are the outer (epicardial) and inner (endocardial) short-axis areas, Lo and Li are the corresponding long-axis lengths, and k is a constant. The simplifying assumption that Lo and Li are equal yields Vwall = k.Awall.Lo, where Awall = Ao - Ai. In 20 unsedated dogs (10-30 kg), including 10 with aortic regurgitation of 1-18 wk duration, the relationship between actual Vwall (determined postmortem) and Awall.Lo was not significantly different from the line of identity (Vwall = 1.01 Awall.Lo + 0.5 ml, r = 0.98, SEE = 3.5 ml), indicating k was not significantly different from 1. There was no significant difference between predicted and actual Vwall over a range of 31-105 ml, and interobserver variability was 4.1%. The simple area-length product, Awall.Lo, accurately predicts Vwall of both normal and volume-overloaded hypertrophied canine left ventricles and is thus suitable for serial observations of hypertrophic adaptation to volume overload.

Algorithms↗
PubMed1988

Influence of compression rate on initial success of resuscitation and 24 hour survival after prolonged manual cardiopulmonary resuscitation in dogs.

The influence of chest compression rate on initial resuscitation success and 24 hr survival after prolonged manual cardiopulmonary resuscitation (CPR) was investigated in 26 morphine-anesthetized dogs (17 to 30 kg). After placement of aortic and right atrial micromanometers and induction of ventricular fibrillation, manual CPR was commenced immediately and continued for 30 min. One group of 13 dogs underwent manual CPR at a compression rate of 60/min, and the other group at a rate of 120/min. The compression durations in the two groups were not significantly different (51.7 +/- 1.8% at 60/min vs 51.6 +/- 1.9% at 120/min). No drugs other than sodium bicarbonate were administered during CPR. A maximum of three attempts was permitted to defibrillate the heart. Successfully defibrillated animals were followed for 24 hr, during which time no treatment, other than naloxone, was given to reverse the effects of morphine. Arterial blood pH, PCO2, and PO2 were not significantly different in the two groups throughout the CPR period. When compared with the compression rate of 60/min, the compression rate of 120/min produced more successfully defibrillated animals (12/13 at 120/min vs 2/13 at 60/min, p less than .002) and more 24 hr survivors (8/13 at 120/min vs 2/13 at 60/min, p less than .03). All 24 hr survivors were conscious and able to sit, stand, and drink normally. One 24 hr survivor in each group had difficulty walking. Improved survival with the high-rate compression technique was consistent with the significantly higher mean aortic (systolic and diastolic) and coronary perfusion pressures attained with high-rate compressions (all p less than .002). Although the clinical applicability of these findings has yet to be demonstrated, they provide empirical support for the recent decision to increase the chest compression rate for manual CPR recommended by the American Heart Association, and indicate that the hemodynamic and survival benefits of faster compression rates in this experimental preparation were not dependent on covariant alterations in compression duration.

Animals↗
PubMed1988

Beneficial effects of endotracheal extubation on ventricular performance. Implications for early extubation after cardiac operations.

Early endotracheal extubation has been shown to be a safe postoperative management option in patients having cardiac operations. However, few objective data exist on the response of ventricular performance to early termination of controlled ventilation. Seven patients undergoing routine elective coronary artery bypass grafting or adult repair of atrial septal defect were studied after intraoperative placement of left ventricular micromanometers, left ventricular minor axis dimension crystals, and left atrial and intrapleural pressure catheters. Physiologic data were recorded intraoperatively, during controlled mandatory ventilation in the intensive care unit, and during spontaneous respiration immediately after extubation. Extubation to spontaneous breathing was associated with a significant decline in intrapleural pressure and significant increases in left ventricular end-diastolic diameter, ejection diameter shortening, stroke work, and cardiac output. The augmented left ventricular diastolic filling seemed to result from the fall in intrapleural pressure and perhaps from normalization of right ventricular afterload. The preload recruitable stroke work relationship showed that myocardial contractility remained constant after extubation, and ventricular function improved primarily because of increased preload associated with shifting of the capacitance blood volume toward the chest. Thus endotracheal extubation enhances cardiac performance after uncomplicated cardiac surgical procedures, and by this mechanism early extubation may be clinically beneficial as a routine adjunct to postoperative care.

Cardiac Output↗
PubMed1988

A modified biophysical profile for antenatal fetal surveillance.

Three hundred thirty-seven high-risk pregnancies were screened using a modified biophysical profile consisting of nonstress testing (NST) and ultrasound evaluation of amniotic fluid volume. Ultrasound assessment of fetal breathing and body movements was performed only to evaluate the nonreactive NST. Decreased amniotic fluid volume and spontaneous fetal heart rate (FHR) decelerations were considered abnormal findings during antenatal testing, and served as indications for delivery regardless of FHR reactivity. Despite intervention, decreased amniotic fluid volume and spontaneous decelerations were associated with an increased incidence of meconium staining, decelerations during labor, cesarean section for fetal distress, and small for gestational age infants. Perinatal morbidity also occurred in patients with spontaneous decelerations and normal amniotic fluid volume. The search for spontaneous FHR decelerations by electronic fetal monitoring should continue during antepartum testing because FHR decelerations cannot be identified by conventional ultrasound assessment. The modified profile seems practical for routine assessment of fetal well-being in high-risk pregnancy, and affords insights unavailable with ultrasound surveillance alone.

Amniotic Fluid↗
PubMed1988

Incidence, morbidity and mortality, and diagnosis of twin gestations.

Twin gestations have higher morbidity and mortality than singleton pregnancies. This is related to the teratogenic event of twinning itself, as well as to physiologic changes associated with twinning. Early diagnosis, careful monitoring, and knowledge of potential problems may help the alert obstetrician to improve outcome.

Female↗
PubMed1987

Single-dose versus multiple-dose piperacillin prophylaxis in primary cesarean operation.

A prospective, randomized double-blind study was undertaken to determine the safety and efficacy of single-dose versus multiple-dose piperacillin for primary cesarean operation prophylaxis. After informed consent was obtained, patients received either 4 gm of piperacillin intravenously as a single dose or three 2 gm doses of piperacillin intravenously 4 hours apart. One hundred sixteen patients were evaluated for response; postoperative infection at the operative site was prevented in 52/60 (86.6%) who received the single dose and 53/56 (94.6%) who received multiple doses. The types of postoperative infections that occurred were similar in those patients in each group who developed infection and all responded well to therapeutic drugs. No adverse reactions to piperacillin were noted. Demographic characteristics and risk factors for infection were comparable for the two groups. These data support the efficacy of single-dose prophylaxis with an appropriate antibiotic agent.

Adult↗
PubMed1987

Sequence of mitral valve motion and transmitral blood flow during manual cardiopulmonary resuscitation in dogs.

According to the thoracic pump model of cardiopulmonary resuscitation (CPR), the heart serves as a passive conduit for blood flow from the pulmonary to the systemic vasculature, necessitating an open mitral valve and anterograde transmitral blood flow during chest compression. To assess the applicability of this model to manual CPR techniques, two-dimensional echocardiograms were recorded from the right chest wall and/or the esophagus in nine dogs (18 to 26 kg) during manual CPR. The aortic valve opened with chest compression and closed with release, while the pulmonary and tricuspid valve leaflets closed with compression and opened during release. The mitral valve remained open during ventilation alone and during abdominal compressions. With the onset of brief, high-velocity (high-impulse) chest compressions, the mitral valve closed rapidly and the left ventricle was deformed, whether compressions were applied to the sternum or the left mid-chest wall. The mitral valve reopened with release of each compression. Left atrial echocardiographic contrast injections confirmed the absence of anterograde transmitral blood flow during high-impulse compression and its presence during release. Failure of mitral leaflet approximation during chest compression was observed only when a very low-velocity, prolonged (low-impulse) compression technique was used, or when regions that did not directly overlie the heart were compressed. Consistent with these observations, simultaneous recordings of the left ventricular and left atrial pressures during high-impulse sternal compressions in five dogs (19 to 25 kg) demonstrated peak and mean left ventriculoatrial pressure gradients of 38.5 +/- 4.0 and 13.5 +/- 2.9 mm Hg, respectively, and these pressure gradients declined with less impulsive compressions. The observations made during all but low-impulse chest compressions are inconsistent with the thoracic pump model, and support direct cardiac compression as the primary mechanism of forward blood flow with more impulsive manual chest compression techniques.

Animals↗
PubMed1987

Family history of diabetes mellitus and oral glucose tolerance testing criteria.

A review of 185 obstetrical patients, having a family history of diabetes mellitus without medical history of glucose intolerance in the non-pregnant state was conducted. A 3-hour 100-g oral glucose tolerance test was performed on all patients between 20 and 34 weeks of gestation. According to O'Sullivan's criteria for glucose tolerance testing, normal glucose tolerance occurred in 89.7%, while Class A diabetes was identified in 10.3% of patients tested. 3.8% of the study population fulfilled the O'Sullivan criteria for abnormal glucose intolerance and required insulin treatment during pregnancy. The Division of Perinatal Medicine at Duke University has traditionally defined the abnormal glucose tolerance test at glucose values lower than O'Sullivan's internationally accepted criteria. An intermediate group, having abnormal glucose values according to the Duke criteria, was classified as "Carbohydrate Intolerance", comprised 32.4% of the patients tested and were managed identically to O'Sullivan Class A Diabetes. Analysis or perinatal outcome, including macrosomia, birth trauma and neonatal morbidity, revealed that Carbohydrate Intolerance patients fulfilling O'Sullivan criteria, being similar to patients with 'normal' GTT test results. Patients having a family history of diabetes mellitus, appeared as a group to be at increased risk for macrosomia, fetal distress and cesarean delivery, compared with the general population.

Blood Glucose↗
PubMed1986

Efficacy of human lymphoblastoid interferon in the therapy of resistant condyloma acuminata.

The efficacy and tolerance of human lymphoblastoid interferon (Wellferon) were studied in an open label trial of 17 patients with resistant and persistent condyloma acuminata. Patients were treated intramuscularly with 5 X 10(6) U (5 MU)/m2 daily for 28 days followed by thrice weekly injections for two weeks. Sixteen patients were considered evaluable; eight experienced complete clearance, seven had significant reduction (greater than 50%) in lesion size, and one showed no response during the course of this trial. Biologic side effects of interferon occurred in all patients during initial dosing and diminished during thrice weekly therapy. Intramuscular injections and associated side effects were tolerated well. This study shows that systemic human lymphoblastoid interferon is active in treating severe recurrent genital warts in women with a history of recalcitrant disease.

Adolescent↗
PubMed1986

Human lymphoblastoid interferon (Wellferon) in primary therapy of two children with condylomata acuminata.

Human lymphoblastoid interferon (Wellferon) was administered parenterally to two prepubertal girls as primary therapy for genital condylomata acuminata. One child probably had contracted the disease as the result of sexual molestation. Both patients experienced minimal side effects during therapy and underwent complete remission within six weeks. These cases support use of interferon as primary therapy in young patients with extensive condylomata and in those who may have contracted the disease as the result of sexual abuse.

Child↗
PubMed1986

Pregnancy-induced hypertension and postpartum maternal morbidity.

Prospective evaluation of 80 patients experiencing preeclampsia/eclampsia was conducted. Traditional antepartum clinical presentation, classification, and laboratory evaluation were found to be imprecise for the prediction of postpartum maternal morbidity. Serial urine samples were collected from all patients during the antepartum, intrapartum, and postpartum period. Urine albumin and immunoglobulin G (IgG) concentrations were measured by rate nephelometry. The degree of albumin and IgG excretion before and after standard treatment modalities correlates with the occurrence of postpartum morbidity. The nephelometric urinalysis appears to be of assistance in the evaluation of disease severity, the effectiveness of treatment modalities on renal function, and the identification of patients destined to develop postpartum morbidity. In addition, rapid nephelometric urinalysis makes the collection of 24-hour urine samples unnecessary for evaluation of renal function in pregnancy-induced hypertension.

Albuminuria↗
PubMed1986

Rupture of the pregnant uterus: a 53-year review.

A 53-year (1931-1983) review of 48 patients who experienced uterine rupture and were cared for at Duke University Medical Center was conducted. The observed incidence was one uterine rupture per 1424 deliveries. From January 1, 1963, through December 31, 1983, 24 cases of ruptured uterus were identified; a detailed review of these patients is presented.

Cesarean Section↗
PubMed1985

Preinduction cervical ripening with prostaglandin E2 (Prepidil) gel.

The effect of preinduction cervical ripening with Prepidil, a commercially prepared prostaglandin E2 gel (0.5 mg), on the outcome of induction of labor with intravenous oxytocin was investigated. Fifty-nine pregnant women were randomized either to receive intracervical application of the gel or to undergo sham application. Compared to control subjects, patients in the group given Prepidil had significant increases in cervical Bishop scores, shorter induction-to-delivery intervals, lower maximum doses of oxytocin, and fewer days of induction. Systemic side effects were minimal, but 37% (11 of 30) of the gel-treated patients experienced labor prior to receiving oxytocin and 20% (six of 30) were actually delivered during the 12-hour ripening period. No differences in route of delivery or fetal outcome were found between the two groups.

Adult↗
PubMed1985

Interferon for the therapy of condyloma acuminatum.

Lymphoblastoid interferon, Wellferon, was used to treat patients with resistant and persistent condyloma acuminatum at initial doses of 5, 3, and 1 million unit/square meter (Mu/M2). The objectives of this study were to evaluate the efficacy and toxicity of, and tolerance to, intramuscular and intralesional interferon. Seventeen patients were treated with 5 Mu/M2, 14 patients with 1 Mu/M2, and 37 patients with 3 Mu/M2; daily administration was followed by three-times-a-week dosing. The complete response rate in patients receiving initial dose of interferon of 5 Mu/M2 was 69%, that for doses of 1 Mu/M2 was 43%, and that for doses of 3 Mu/M2 was 57%. All patients given interferon developed initial elevations of temperature of limited duration, whereas all patients given the 5 Mu/M2 dose had to have the amount reduced because of biologic side effects. However, only five of 37 (14%) of the patients given 3 Mu/M2 required a reduction in the dosage, and no patient given 1 Mu/M2 needed to have the dosage reduced. These studies suggest that interferon is efficacious in the treatment of resistant and persistent condyloma acuminatum, and that the biologic side effects were dose-related, well tolerated, and not life-threatening.

Adult↗
PubMed1985

Education in electronic fetal heart rate monitoring using the IBM Personal Microcomputer.

An IBM Personal Computer was used to collect digitally fetal heart rate and uterine contraction data from an electronic fetal monitor. Patient history, physical examination, and pertinent clinical data were also stored electronically. The information was reviewed in an educational format including prospective clinical assessment and patient management. In addition, questions, graded responses and text discussion with references were presented during prospective patient management.

Computer-Assisted Instruction↗