Biomedical subjects
Publications and source records attributed to S Lurie.
Two patients with declining serum concentrations of beta-human chorionic gonadotropin (beta-hCG) and a ruptured tubal pregnancy with hemoperitoneum are described. Declining beta-hCG does not rule out the possibility that the ectopic pregnancy will rupture.
Diabetic ketoacidosis during pregnancy is frequently associated with fetal distress that may result in fetal death in utero. A patient at 33 weeks of pregnancy with diabetic ketoacidosis and evidence of fetal distress is presented. Following intensive medical treatment, maternal metabolic state improved along with improvement of fetal heart rate tracing. A healthy infant was delivered by cesarean section at 36 weeks of gestation.
In this retrospective study we analyzed our experience in management of 76 consecutive cases of shoulder dystocia. In most cases (N = 67, 88.2%) McRoberts' maneuver was sufficient in order to deliver the impacted shoulders. In 2 cases (2.6%) in addition to McRoberts' maneuver suprapubic pressure was applied. In 7 cases (9.2%) Woods' maneuver was performed after the McRoberts' maneuver and the suprapubic pressure. Based on our experience and upon careful review of the literature we propose the optimal "ABC" for the management of shoulder dystocia. It includes A) McRoberts' maneuver, B) Suprapubic pressure, C) Woods' maneuver, D) Delivery of posterior arm. We emphasize that the shoulder dystocia situation is a major emergency in obstetrics and that its management requires prompt resuscitation of the fetus during the process of its delivery.
A case of uterine rupture caused by extraovular PGE2 in a sequence with intravenous oxytocin during midtrimester termination of pregnancy is presented. It teaches us that when oxytocin is used after prostaglandins in patients having a scarred uterus, the lowest effective dose should be applied.
The efficacy of extraovular prostaglandin E2 and intra-amniotic prostaglandin F2 alpha for pregnancy termination in midtrimester was compared. A retrospective review of pregnancy termination in midtrimester using intra-amniotic instillation of 40 mg of prostaglandin F2 alpha (n = 133) or extraovular instillation of prostaglandin E2 at a rate of 500 micrograms/hour (n = 81) was performed. Both groups had a similar mean induction-to-abortion interval (19.5 +/- 19.9 and 20.9 +/- 18.2 hours for extraovular PGE2 and intra-amniotic PGF2 alpha, respectively) and a similar success rate of abortion within the first 24 hours of initial treatment (84.0% for extraovular PGE2 and 76.7% for intra-amniotic PGF2 alpha). The two groups had a similar and low (9.8%) incidence of complications. It is concluded that either of the methods used in the study (i.e. extraovular PGE2 or intra-amniotic PGF2 alpha) can be used safely and effectively for pregnancy termination in midtrimester.
Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.
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This prospective study was undertaken to evaluate age distribution of erythrocytes longitudinally throughout pregnancy. Serial estimates of density distribution of cells (DDC), reticulocyte count, red cell distribution width (RDW), and mean corpuscular volume (MCV) in a group of healthy pregnant women at 12, 16, 20, 24, 28, 32 and 36 weeks gestation and during the latent phase of labor (39.04 +/- 1.5 weeks). MCV increased constantly during pregnancy; however, the increase was not statistically significant. The mean reticulocyte percentage rose significantly at the 28th week, thereafter it remained at high levels until delivery. RDW increased significantly at the 20th week, remained at high levels until the 32nd week and thereafter declined towards the delivery. The cumulative DDC curve gradually shifted to the right during pregnancy, indicating a less dense cell population as the pregnancy progressed. In conclusion, a continuous alteration in age distribution of erythrocytes towards a younger cell population takes place from early pregnancy until the delivery of the fetus.
An evaluation of the age distribution of erythrocytes in twin gestation was performed. Based on previous studies on age distribution of erythrocytes in late pregnancy, we have proposed that a more pronounced shift in age distribution of erythrocytes in twin pregnancy may be expected. We have used the density distribution of cells method for evaluation of age distribution of erythrocytes in women with twin pregnancies. Control curves for pregnant and nonpregnant women were obtained from our recently published studies. The cumulative density distribution of cells curve of erythrocytes of women with twin gestation was evidently shifted to the right as compared with the curve of erythrocytes of women with single gestation. The shift in age distribution of erythrocytes may suggest that erythrocytes in women with twin gestation have a shorter life span as compared to the life span of erythrocytes in women with singles. The age distribution shift of erythrocytes in women with twin gestation may be attributed to human placental lactogen augmentation of erythropoietin action.
Over a 2-year period, ultrasound-guided aspiration of painful, presumptively benign ovarian cysts was performed in 18 women < 40 years old. Aspiration was performed either transvaginally (12 patients) or transabdominally (6 patients) depending on the cyst location. Neither anaesthesia nor analgesia were used, and all patients had immediate pain relief, and escaped immediate surgical intervention. None had complications or evidence of malignant cells on cytologic examination, and all were discharged within 24 h of the procedure. The recurrence rate within 1 year of the procedure was 11.1%. The procedure appeared to be a good and safe alternative to surgery.
An unusual case of acute abdomen as a distinct manifestation of severe preeclampsia is described. At laparotomy all other causes of the abdominal emergency were excluded. Among the many manifestations of preeclampsia one must now include the diagnosis of acute surgical abdomen.
Among the 960 women who successfully delivered by vaginal route after previous cesarean section, 10 (1.04%) had complete lower segment scar rupture over a 9 year period. All were sufficiently symptomatic in order to suspect a ruptured uterus prior to scar exploration. We conclude that lower uterine segment palpation should be reserved only for symptomatic patients.
From its indirect reference by Abulcasis (936-1013) and until the 19th century the ectopic pregnancy was known as a universally fatal accident. By reporting successful treatment of tubal pregnancy with salpingectomy in 1884 Robert Lawson Tait (1845-1899) started an era of almost 70 years of exclusively extirpative treatment of ectopic pregnancy. The technologic revolution of the 20th century improved diagnostic capabilities so that diagnosis of unruptured ectopic pregnancy becomes feasible and even mandatory. Side by side our understanding of the natural history of ectopic pregnancy improved. Many patients with early-resolving ectopic pregnancies escape surgical treatment. Preservation of future fertility became possible with the introduction of conservative surgical procedures and with the use of methotrexate. The main achievement in the treatment of ectopic pregnancy over the past 110 years is the dramatic decrease in mortality rate: from 72-90% in 1880 to 0.14% in 1990.
The appearance of excessive lipids in amniotic fluid during Caesarean section raised the suspicion of a hyperlipidaemic fetus. The amniotic fluid had elevated cholesterol (53 mg/dl) and triglycerides (81 mg/dl). At the age of 2 months, the infant was hyperlipidaemic (cholesterol of 161 mg/dl and triglycerides of 84 mg/dl). The case suggests the possibility of prenatal diagnosis of hyperlipidaemia, a major risk factor for atherosclerosis.
Determination of density distribution of erythrocytes in preeclampsia in late pregnancy was performed using a method in which blood cells are separated according to their density by differential flotation. The cumulative density distribution curve of the erythrocytes of preeclamptic patients was evidently shifted to the left, representing a denser cell population as compared with healthy women prior to delivery. The density distribution curve of preeclamptic women resembled the curve of nonpregnant young women. The largest differences were observed in separating fluids No. 9 of specific gravity 1.106 (p = 0.0351), No. 11 of specific gravity 1.098 (p = 0.0018) and No. 13 of specific gravity 1.090 (p = 0.0026). The resemblance of the density distribution curve of erythrocytes of preeclamptic patients with that of nonpregnant women may indicate a similar age distribution of erythrocytes or may reflect cellular dehydration resulting in higher density of erythrocytes in preeclampsia.
OBJECTIVE: Based on previous studies that demonstrated lighter and larger erythrocytes in late pregnancy, we hypothesized that the life span of erythrocytes in late pregnancy is shorter than in nonpregnant women. METHODS: We used the density distribution of cells to evaluate the age distribution of erythrocytes in pregnant versus nonpregnant women and rats. The life span of erythrocytes was compared between pregnant rats and nonpregnant syngeneic rats of the same age using 51Cr for labeling erythrocytes. RESULTS: Based on the density distribution of cells, a similar shift to lighter erythrocytes was found comparing pregnant to nonpregnant women and rats. The pregnant rat erythrocytes had a shorter life span by 9.2% (33.6 versus 36.9 days; P = .0010). CONCLUSIONS: The life span of erythrocytes in pregnant rats is shorter than in nonpregnant ones. A similar shift in the age distribution of pregnant rat and pregnant human erythrocytes is probably associated with a similar life span of pregnant rat and pregnant human erythrocytes. The shorter life span of erythrocytes in late pregnancy may be attributed to higher erythropoietin levels in pregnancy, which induce "emergency hematopoiesis" resulting in younger reticulocytes and macrocytic erythrocytes, which are known to have a shorter life span.
A case of invasive papillary serous adenocarcinoma of the endocervix in pregnancy is described. The pure papillary pattern appears rarely, and to the best of our knowledge has never been described previously in pregnancy.
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