Search PubMed⌕ Search

Biomedical subjects

S Lurie

Publications and source records attributed to S Lurie.

At least 55 records · Page 3Linked to original sources
PubMed1999

Uterine flora at cesarean and its relationship to postpartum endometritis.

OBJECTIVE: To evaluate the relationship between the presence of microorganisms at the time of cesarean at different sites of the genital tract and the development of postpartum endometritus. METHODS: One-hundred thirty-three healthy women who delivered by cesarean were enrolled in this prospective study. Cultures were obtained during the surgery and on days 3-5 postoperatively. Gram staining of uterine cavity fluid was done on days 3-5. Gram stains were examined under a high-power microscope for the presence of polymorphonuclear leukocytes. RESULTS: Twenty patients (15.0%) met the criteria for postpartum endometritis. Forty-five patients (33.8%) had one or more positive cultures (n = 133) at the time of surgery, resulting in 93 positive cultures and 123 bacterial isolates. Forty-four patients had positive postoperative uterine cavity cultures at days 3-5 postpartum, resulting in 65 isolates. Of 44 patients with a positive postoperative culture, 26 (59.1%) also had Gram stain positive for polymorphonuclear leukocytes in the uterine cavity fluid, whereas only six of 89 patients (6.7%) with negative postoperative culture had a positive Gram stain (P < .05). The relative risk of having a positive culture on postoperative day 3-5 if the culture at surgery was positive at any site was 15.6 (95% confidence interval [CI] 5.9, 42.2), and it was 19.5 (95% CI 6.8, 57.8) if the culture was positive at the lower uterine segment. CONCLUSION: The presence of bacteria in the lower uterine segment at the time of the surgery predicts their presence in the uterine cavity during puerperium. The Gram stain of uterine cavity fluid on postcesarean days 3-5 is another quick tool that can expedite the diagnosis of postpartum endometritis.

Adult↗
PubMed1999

Omphalocele delivery enigma: the best mode of delivery still remains dubious.

OBJECTIVE: To determine an optimal route of delivery for fetuses with prenatally diagnosed omphalocele. DATA SOURCE: MEDLINE search of years 1966-1996. RESULTS: Descriptive retrospective analyses do not support the idea that cesarean delivery of fetuses with omphalocele is associated with an improved survival rate. However, most of those studies do not control for confounding variables like type and severity of associated anomalies, omphalocele size, prematurity rate, presence of trial of vaginal delivery, rate of intrapartum sac rupture, tertiary treatment centers accessibility, time and type of surgical correction, and postoperative morbidity. There is no evidence that vaginal delivery is safer than cesarean for fetuses with isolated small omphalocele. Fetuses with giant (>5 cm) omphalocele should be delivered by cesarean section. Vaginal delivery at term is offered for fetuses with coexisting life-threatening anomalies. CONCLUSIONS: We propose that until randomized trial of vaginal and cesarean delivery for fetal omphalocele is available, the preferred mode of delivery would be the vaginal route as that is safer for the mother.

Abnormalities, Multiple↗
PubMed1999

Characteristics of normal lochia.

The objective of this paper is to determine the characteristics of each phase of lochia and how these may be influenced by a number of obstetric variables. Thirty-nine healthy women who had spontaneous vaginal delivery following uncomplicated pregnancy volunteered to complete a diary sheet immediately postpartum. The women were instructed to assess the color of their lochia by a color slide with differential gradation from dark red to white. The color was labeled as rubra (red, red-brown), serosa (brown-pink, brown), or alba (yellow, white). The overall duration of lochia was 36.0 +/- 7.5 days (range 17 to 51 days, median 37 days). Three types of lochia color patterns were identified: type 1--rubra-->serosa-->alba sequence (n = 20); type 2-rubra-->serosa-->alba sequence with prolonged rubra phase and short serosa and alba phases (n = 11); and type 3-with two rubra phases (rubra-->serosa/alba-->rubra-->serosa/alba sequence with near-equal duration of each phase) (n = 8). The rubra phase lasts 12.1 +/- 6.7 days in type 1, 24.8 +/- 5.0 days in type 2, and 5.5 +/- 2.5 days (the first rubra) in type 3 pattern (p < 0.05). There was a higher proportion of lactating women among women with type 1 pattern as compared with type 2 (11/20 and 2/11, p < 0.05, respectively). Women with type 2 pattern were of higher parity (2.8 +/- 1.3) as compared with those with type 1 (1.8 +/- 0.8) (p < 0.05). There were no significant differences in infants' birth weight between the various color types (3,276.0 +/- 379.8 g, 3,564.4 +/- 737.9 g, and 3,080.0 +/- 180.0 g for type 1, type 2, and type 3, respectively. There were no significant differences in overall duration of lochia or gestational age at delivery between the various color types. The results confirm the clinical impression that lochia persists longer than classically reported and is of diverse patterns. Three unique types of color patterns were identified. Type 1 is the most prevalent and is associated with prolonged breast feeding and thus can be considered as the classic type. Type 2 is associated with short or no breast feeding and higher parity. Type 3 may be a variant of type 2. We suggest that traditional teaching on lochia characteristics needs reappraisal.

Adult↗
PubMed1999

Human fetal-placental weight ratio in normal singleton near-term pregnancies.

OBJECTIVE: To determine the fetal-placental weight ratio in normal near-term singleton pregnancies. PATIENTS AND METHODS: 431 consecutive singleton near-term live deliveries following uncomplicated pregnancies were included in a prospective study. Mean maternal age was 28.6 years (range 17-50), mean parity was 2.9 (range 1-16). Mean gestation age at delivery was 39.7 weeks (range 33-42). RESULTS: Mean newborn weight was 3,382.1 +/- 486.7 g (range 2,180-4,810). Mean placental weight was 613.0 +/- 123.8 g (range 319-1,266). Mean fetal-placental weight ratio was 5.6 +/- 0.96 (range 2.9-10.6) with kurtosis of 3.6 and skewness of 1.05. The ratio did not differ significantly between male (n = 253) and female (n = 176) infants, 5.7 +/- 0.89 and 5.6 +/- 1.04, respectively. There was a progressive increase in the fetal-placental weight ratio with gestational age (r = 0.87): from 5.3 +/- 0.90 at 33-36 weeks to 5.9 +/- 1.06 at the 41st week and 5.7 +/- 0.71 at the 42nd week (p < 0.05) and with birth weight distribution (r = 0.85) from 5.0 +/- 1. 06 in newborns weighing 2,000-2,499 g to 5.9 +/- 0.94 in newborns weighing >4,000 g (p < 0.05). There was a positive relationship between the fetal-placental weight ratio in teenage and elder parturients (r = 0.98): 5.2 +/- 0.98 (age 17-19), 5.7 +/- 0.88 (age 20-29), 5.6 +/- 1.08 (age 30-39), and 5.7 +/- 0.96 (age 41-50) (p < 0.05). The most contributing variable was birth weight. CONCLUSIONS: The fetal-placental weight ratio tends to be low in teenage women, early near-term gestational age, and low fetal weight. There was a progressive increase in the fetal-placental weight ratio with gestational age and with birth weight distribution.

Adolescent↗
PubMed1998

Do Selye's mammalian "GAS" concept and "co-stress" response exist in plants?

Converging data indicate the possible existence of a general adaptation syndrome (GAS) in which different types of stress evoke identical coping mechanisms. In Selyean terms, this implies a "co-stress" response whereby one type of stress resistance may impart co-resistance to others. Common coping denominators may be physiological or morphological. The former include oxy-free radical scavenging, osmoregulation, ABA, jasmonates, chaperones, HSPs, and phytochelatins. Morphological GAS adaptations include leaf pubescence, movements and stance, and rooting characteristics. The feasibility, with certain reservations, of the GAS hypothesis is discussed here.

Abscisic Acid↗
PubMed1998

Transcutaneous electrical nerve stimulation (TENS) for adjuvant pain-relief during labor and delivery.

OBJECTIVE: We examined the efficacy of transcutaneous electrical nerve stimulation (TENS) in general and the new Freemom TENS device (LifeCare, Israel) in particular, for pain relief during labor and delivery. METHODS: The study group consisted of 104 women. Forty-six nulliparas (44.2%) and 58 multiparas (55.8%), all of whom used the TENS device for pain relief during labor. All participants completed a questionnaire on the degree of pain relief afforded them by TENS during the delivery and related questions. The objective evaluation was based on the documented labor and delivery parameters including medical interventions during delivery. RESULTS: The majority of subjects (72% of the nulliparas and 69% of the multiparas) considered TENS effective for the relief of pain during labor. Most of them (67% of the nulliparas and 60% of the multiparas) responded positively to the use of TENS in future deliveries. Sixty-five percent of the multiparas considered TENS at least as effective as the other pain relief methods they had used before. TENS significantly reduced the duration of the first stage of labor P < 0.001 for nulliparas, P < 0.005 for multiparas and it significantly decreased the amount of analgesics administered to individual patients. No significant difference was found in fetal heart rate tracings, Apgar scores and cord blood pH between the study group and an equal number of matched controls who used other forms of pain management. CONCLUSIONS: TENS is an effective non-pharmacological, non-invasive adjuvant pain relief modality for use in labor and delivery. TENS application reduced the duration of the first stage of labor and the amount of analgesic drug administered. There were no adverse effects on mothers or newborns.

Adolescent↗
PubMed1998

The choice of anesthesia in Segawa's syndrome.

Segawa's syndrome is a rare hereditary progressive dystonia with diurnal fluctuation, which, in contrast to other types of chronic dystonia in children, responds dramatically to levodopa therapy. We present a case of a patient, suffering from Segawa's syndrome who underwent two cesarean sections, and we describe our experience in providing anesthesia to that patient. The first cesarean section was performed with general anesthesia, while the second was accomplished with epidural anesthesia. On both occasions the anesthesia was uneventful.

Adult↗
PubMed1998

Low values on 50 gram glucose challenge test or oral 100 gram glucose tolerance test are associated with good perinatal outcome.

We set out to reevaluate the hypothesis that high normal (negative) results of 50 g oral glucose challenge test or high normal glucose level on 100 g oral glucose tolerance test are associated with complications of pregnancy and delivery. This was a prospective study involving 735 nondiabetic women. The first group (n=352) was made up of pregnant women with normal 50 g oral glucose challenge test without previous history of diabetes mellitus or gestational diabetes. The second group (n=383) was made up of pregnant women without previous history of diabetes mellitus or gestational diabetes with an abnormal 50 g oral glucose challenge test and with normal 100 g oral glucose tolerance test and not more than one previous delivery. In nondiabetic women, we demonstrated a positive correlation between high normal 50 g glucose challenge test values and the incidence of preeclampsia, caesarean section rate, macrosomia, neonatal hyperlipidaemia and minor congenital abnormalities. We failed to confirm any relationship to any pregnancy complication in pregnant women with 2-hour glucose levels in the range 6.7-9.1 mmol/l on the 100 g oral glucose tolerance test. We have demonstrated a positive relationship between the incidence of premature rupture of membranes and 1-hour glucose level, caesarean section rate and maternal 1-hour glucose level or 1-hour glucose level minus fasting glucose level of 4.2 mmol/l, instrumental delivery rate and maternal 3-hour glucose level, incidence of neonatal macrosomia and 1-hour glucose level, and incidence of neonatal hyperlipidaemia and at least one high but normal glucose level on the 100 g oral glucose tolerance test. With regard to pregnancy and delivery complications there were no significant difference if the high normal value is on the 50 g glucose challenge test or on the 100 g oral glucose tolerance test. It is concluded that one high normal 100 g oral glucose tolerance test or high normal 50 g glucose challenge test are associated with adverse pregnancy and delivery outcome. Nondiabetic women with 50 g glucose challenge test value of 6.1 mmol/l and/or 100 g oral glucose tolerance test values of 5 mmol/l have a favourable pregnancy and delivery outcome.

Journal Article↗
PubMed1998

The threat of type IV Ehlers-Danlos syndrome on maternal well-being during pregnancy: early delivery may make the difference.

We describe a successful management of a pregnancy in a woman with type IV Ehlers-Danlos syndrome that included an elective caesarean section and tubal ligation at 32 weeks' gestation. We identified 26 women (including ours) who had been pregnant with well-documented characteristics of type IV Ehlers-Danlos syndrome in the literature. These 26 women had 50 pregnancies. Ten (38.5%) died during pregnancy or in the immediate postpartum period. The maternal mortality rate per pregnancy in type IV Ehlers-Danlos syndrome was therefore calculated to be 20.0%. Pregnancy, continuing pregnancy, or subsequent pregnancy are all contraindicated in patients with type IV Ehlers-Danlos syndrome. Termination of pregnancy before 16 weeks' gestation should be strongly advised. If the patient proceeds with pregnancy, restriction of physical activity at the beginning of third trimester, frequent evaluation of the patient, and an elective caesarean delivery at 32 weeks' gestation after an appropriate antenatal steroid therapy should be advised.

Journal Article↗
PubMed1998

Dose-response of ketorolac as an adjunct to patient-controlled analgesia morphine in patients after spinal fusion surgery.

UNLABELLED: This randomized, blind study was designed to determine the appropriate dose of ketorolac (a drug used as a supplement to opioids) to administer to patients who have undergone spinal stabilization surgery. The ketorolac was administered every 6 h, in addition to patient-controlled analgesia (PCA) with morphine, to 70 inpatients undergoing spine stabilization by one surgeon. The study was performed to determine the analgesic efficacy and incidence of side effects with different doses of ketorolac. The patients were divided into seven groups. They were given either i.v. saline (control group) or i.v. ketorolac (5, 7.5, 10, 12.5, 15, or 30 mg) every 6 h. The outcomes measured included pain scores, 24-h morphine usage, level of sedation, and side effect profile six times during the first 24 h postoperatively. The total dose of morphine was significantly larger in the control and 5 mg ketorolac groups than in the other five groups. Morphine consumption was similar in all groups receiving > or = 7.5 mg of ketorolac. The pain scores were significantly higher in the control group than in some of the larger dose groups at three of the study intervals. The 5 mg group had higher pain scores than the other groups at most of the time intervals studied. There were no significant differences in pain scores among the other five groups. Sedation scores were higher (i.e., patients were more sedated) in the control group than in the other six groups at three of the time periods. We conclude that the administration of ketorolac 7.5 mg every 6 h has a morphine-sparing effect equivalent to that of larger doses in patients undergoing spine stabilization surgery. Using larger doses of ketorolac did not result in less somnolence, lower morphine use, or less pain. We recommend that ketorolac 7.5 mg be given every 6 h to patients undergoing spinal fusion surgery in addition to PCA morphine. IMPLICATIONS: Using smaller doses of ketorolac (e.g., 7.5 mg every 6 h) as a supplement to morphine patient-controlled analgesia is as effective as larger doses in patients who have undergone spine stabilization surgery.

Adult↗
PubMed1998

Expression of small heat-shock proteins at low temperatures. A possible role in protecting against chilling injuries.

We previously reported that short exposure of tomato (Lycopersicon esculentum L.) fruits to high temperature protects them from chilling injury. To study the involvement of heat-shock proteins (HSPs) in the acquisition of low-temperature tolerance, we cloned two heat-shock-induced genes that are also expressed at low temperatures. The cloned cDNAs belong to the small HSP group. Sequence analyses of the clones showed perfect homology to the tomato-ripening gene tom66 and to the tomato chloroplastic HSP21 gene tom111. The expression of both genes was induced by high temperature in fruits, flowers, leaves, and stems, but not by low or ambient temperatures or by other stresses such as drought and anaerobic conditions. When the heated fruits were transferred to low temperature, tom66 and tom111 mRNA levels first decreased but were then reinduced. Induction was not observed in nonheated fruits at low temperature. Immunodetection of tom111-encoded protein indicated that this protein is present at low temperatures in the heated fruits. The results of this study show that the expression of tom66 and tom111 is correlated with protection against some, but not all, symptoms of chilling injury.

Acclimatization↗
PubMed1998

Comparison of the differential distribution of leukocytes in preeclampsia versus uncomplicated pregnancy.

OBJECTIVE: To describe leukocyte count and differential distribution in preeclampsia and uncomplicated pregnancy. STUDY DESIGN: Blood samples were obtained from 46 consecutive preeclamptic patients and 46 controls with uncomplicated pregnancy. Thirty met the criteria for mild preeclampsia and 16 for severe. The blood was tested within 1 h of venepuncture. An aliquot of the blood was tested in the Cell-Dyn 2000 for complete blood cell count. MAIN RESULTS: The absolute neutrophil count was significantly elevated in preeclamptic patients as compared with that of controls with uncomplicated pregnancy (9,410.1+/-3,066.9 vs. 7,498.6+/-2,354.0 x 10(6)/l, p < 0.05). In neutrophils, the elevation was more prominent in severe preeclamptic patients as compared with mild preeclamptic patients (10,658.8+/-3520.4 vs. 8,694.4+/-2,561.9 x 10(6)/l, p < 0.05). The absolute lymphocyte and eosinophil counts declined in patients with preeclampsia as compared with uncomplicated pregnancy, whereas monocyte and basophil counts did not differ. CONCLUSION: Our results suggest that preeclampsia is associated with an increase in the absolute neutrophil count.

Adult↗
PubMed1998

Cervical balloon for dysfunctional labor following amniotomy.

The conventional treatment for arrest of protracted active phase dilatation is amniotomy and oxitocin. This kind of labor dystocia is associated with an increased incidence in Cesarean delivery. We describe the use of cervical balloon after amniotomy for protracted active phase dilatation. We have used this approach in five parturients. All five patients had a spontaneous vaginal delivery. Intrapartum cervical balloon in patients with dysfunctional labor may reduce the need for Cesarean delivery.

Catheterization↗