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S Rotmensch

Publications and source records attributed to S Rotmensch.

At least 19 recordsLinked to original sources
PubMed2004

The fetal esophagus: anatomical and physiological ultrasonographic characterization using a high-resolution linear transducer.

OBJECTIVE: To study the sonographic anatomy and physiology of the human fetal esophagus during the mid-trimester of pregnancy using a high-resolution linear transducer. METHODS: This was a prospective observational study of the fetal esophagus between 19 and 25 weeks' gestation. The study was performed in 60 consecutive fetuses, after a normal anatomy scan, using a 5-13-MHz matrix array wide-band transducer. During the examination the collapsed esophagus was first visualized, and followed by a 5-min video recording in order to demonstrate luminal patency and peristaltic waves. RESULTS: Complete anatomical visualization of the esophagus was possible in 52 (86.7%) patients and at least partial visualization in 58 (96.7%) patients. Three different patterns of esophageal motility were observed: a simultaneous and short opening of the whole esophagus was found in 35 (58.3%) fetuses; a segmental, peristalsis-like movement from the pharynx, through the mediastinum, and into the stomach was found in 18 (30%) fetuses; and in one fetus reflux-like passage of solid contents from the stomach was observed. The mean time required for demonstration of esophageal patency was 96.1 (range, 10-300) s. CONCLUSIONS: Demonstration of normal anatomy and physiological activity of the fetal esophagus is feasible using appropriate transducers. The most commonly observed pattern of esophageal motility in the mid-trimester of pregnancy is the simultaneous relaxation of the upper and lower esophageal sphincters with concurrent opening of the esophageal lumen from the upper thorax to the stomach. Demonstration of a patent esophagus may be helpful in fetuses with suspected esophageal atresia.

Esophagus↗
PubMed2004

Pregnancy in membranous glomerulonephritis--course, treatment and outcome.

BACKGROUND: The effect and outcome of pregnancy in women with preexisting glomerulonephritis is a controversial issue. CASE: We report the clinical course and treatment of a 23-year-old pregnant woman with biopsy-proven membranous glomerulonephritis. When she conceived, the patient had been in stable remission for 1 year. In the 14th week of pregnancy, the patient developed uncontrolled hypertension and nephrotic syndrome. Daily 1 g methylprednisolone intravenous pulses were administered for 3 days, followed by a 4-week course of oral prednisone, 50 mg/day. Clinical improvement and normalization of arterial blood pressure were achieved. Oral prednisone 60 mg was administered on alternate days for another 4 weeks following 3 days of pulse therapy. At the end of treatment (26th gestational week), we observed a decrease of proteinuria (from 10.6-4.8 g/24 h) and rise in serum albumin (from 2.1-2.9 g/100 ml). At this time, blood pressure was 130/85. In the 34th week, a normal healthy male newborn was delivered by cesarean section. One year later she felt well, her blood pressure was 140/90, serum albumin was 3.4 g/100 ml, urine protein was 1.65 g/24 h and renal function was normal. The patient's child was healthy and well developed. CONCLUSION: Judicious use of a specific therapy to the underlying renal disease during pregnancy, together with a continuous supervision, can improve outcomes of these particular high-risk conditions.

Adult↗
PubMed2002

A normal second-trimester ultrasound does not exclude intracranial structural pathology.

OBJECTIVE: To report the prenatal diagnosis and management of 34 fetuses with various intracranial structural pathologies diagnosed following a normal second-trimester ultrasound examination. METHODS: We retrospectively reviewed the images of 203 abnormal central nervous system ultrasound examinations performed between 13 and 37 weeks of gestation at our prenatal diagnosis unit. In 34 (16.7%) of them at least one previous second-trimester ultrasound examination had been performed and considered normal. These 34 fetuses represent the study group. RESULTS: The following intracranial pathologies were diagnosed: dysgenesis of the corpus callosum, ventriculomegaly, cerebral cysts or hemorrhage, migrational disorders, vermian dysgenesis, arachnoid cysts, macrocephaly, enlarged subarachnoid space, brain calcifications and microcephaly. CONCLUSION: A normal second-trimester ultrasound scan does not rule out significant intracranial anomalies. Parents and physicians should be informed about the limitations of second-trimester sonography as far as brain diagnosis is concerned. A repeat third-trimester scan may enable more accurate diagnosis and counseling.

Brain↗
PubMed2001

Methotrexate versus hyperosomolar glucose in the treatment of extrauterine pregnancy.

The aim of this prospective, randomized, double blind study was to compare the efficacy of methotrexate and hyperosmolar glucose injected directly into the extra-uterine gestational sac under laparoscopic vision. The study included twenty women with ectopic pregnancy. Inclusion criteria were intact tubal pregnancy, not exceeding 4 cm in diameter, rising or plateauing betahCG levels, and no evidence of intra-abdominal bleeding. The patients were treated by laparoscopically guided injection of 3 mL fluid into the area containing the tubal pregnancy. The fluid contained either 25 mg methotrexate (n=9) or 50% glucose (n=9). Daily decrease in betahCG levels was faster in patients treated by methotrexate (median 8.7%) than in those treated by hyperosmolar glucose (median 4.8%), p=0.17. The study was discontinued due to a higher failure rate in the group treated by hyperosmolar glucose. In conclusion, local injection of methotrexate is superior to hyperosmolar glucose. It can be used as an alternative to salpingostomy or salpingotomy whenever laparoscopy is performed for the diagnosis and treatment of extra-uterine pregnancy.

Adult↗
PubMed2001

Value of vaginal culture in management of acute vaginitis.

OBJECTIVE: To evaluate the relative contribution of clinical assessment and vaginal discharge cultures in the treatment of acute vaginitis. METHODS: A prospective observational study of 75 consecutive sexually active women with acute vaginal symptoms was undertaken. Each patient underwent an evaluation that included a standardized history, interview a thorough pelvic examination and vaginal culture. The treatment was administered based upon patient symptomatology and macroscopic appearance of vaginal discharge. RESULTS: There was an agreement between initial diagnosis and culture isolates in 38 patients (50.6%). Of the 75 enrolled women 9 have not returned for reevaluation 8 days after initiation of the treatment. Fifty three (80.3%) of the remaining 66 women were free of symptoms 8 days after initiation of the treatment. The remaining 13 women were treated successfully in accordance with the vaginal culture result. CONCLUSION: A high cure rate of acute vaginitis could be achieved based upon physical examination. Vaginal cultures are valuable in initial therapy failures.

Adolescent↗
PubMed2001

The role of tamoxifen in the treatment of symptomatic uterine leiomyomata -- a pilot study.

OBJECTIVES: To determine the efficacy of tamoxifen in patients with leiomyomata complaining of abdominal pains and vaginal bleeding. STUDY DESIGN: Prospective, randomized, double blind study. A total of 10 patients received for 6 months 20 mg tamoxifen daily, and 10 women received placebo. All patients underwent serial pelvic and ultrasound exams and endometrial sampling was performed prior to initiation of treatment. After 5 years, the patients were interviewed again. RESULTS: Uterine size was not affected by the use of tamoxifen. Patients reported a blood loss decrease of 40--50% at the end of the study (P=0.0001). In the control group a slight increase in blood loss was reported. Hemoglobin levels remained unchanged in both groups. In the study group patients reported after 4 months of treatment a substantial decrease in the intensity of pain (P=0.018). Seven patients in the study group and one patient in the control group developed ovarian cysts. CONCLUSIONS: Treatment with tamoxifen added only marginal benefit while causing unacceptable side effects. Tamoxifen does not seem to be a useful adjunct in the treatment of symptomatic uterine leiomyomata and its use for this indication should be discouraged.

Abdominal Pain↗
PubMed2000

False diagnosis and needless therapy of presumed malignant disease in women with false-positive human chorionic gonadotropin concentrations.

BACKGROUND: 12 women were diagnosed of having postgestational choriocarcinoma on the basis of persistently positive human chorionic gonadotropin (hCG) test results in the absence of pregnancy. Most of the women had extirpative surgery or chemotherapy, or both, without significant diminution in hCG titre. Our aim was to assess whether the hCG concentrations were false-positive test results. METHODS: Samples were tested for hCG, hCG free beta subunit, and hCG beta-core fragment. Assay kinetics were also assessed, and samples were tested independently by competitive RIA. False-positive hCG concentrations were identified by two criteria: detection of hCG in serum and lack of detection of hCG and its degradation products in urine; and wide variations in results for different hCG assays. We corroborated false-positive hCG values by the lack of parallel changes in hCG results when serum was diluted, by false detection of other antigens, and by failure to detect hCG with in-house assays. FINDINGS: All 12 women met both criteria for false-positive hCG, and all had corroborating findings. In all 12 cases, a false diagnosis had been made, and most of the women had been subjected to needless surgery or chemotherapy. Assay kinetics indicated that heterophilic antibodies were responsible for the false-positive results. As a result of our findings all further therapy was stopped. INTERPRETATION: Current protocols for the diagnosis and treatment of choriocarcinoma should be modified to include a compulsory test for hCG in urine.

Adult↗
PubMed1999

Maternal infectious morbidity following multiple courses of betamethasone.

OBJECTIVE: the beneficial effects of antepartum corticosteroids on the reduction of morbidity and mortality in the premature neonate have been amply demonstrated. The NIH consensus statement has, therefore, endorsed their use in women at risk from pre-term delivery between 24 and 34 weeks gestation. Patients at persistent risk of pre-term delivery nay receive multiple weekly courses. However, increased susceptibility to infection is a well-recognized complication of prolonged high-dose steroid therapy. We examined infectious morbidity among women exposed to three or more courses of betamethasone. METHODS AND OUTCOMES MEASURES: thirty-seven patients at risk of pre-term delivery who received three or more courses of betamethasone (median = 6: range 3-10) and 74 normal controls, matched for maternal age, route of delivery, and year of delivery were included in the study. Data on medical care provided to study and control patients between 24 weeks gestation and 6 weeks postpartum were retrieved from centralized medical records. Incidences and types of infections were compared by Chi-square and Fisher's exact test, as appropriate. Only infections diagnosed at least 1 week after betamethasone therapy was initiated were included. Patients with pre-existing conditions predisposing to infectious morbidity were excluded. RESULTS: twenty-four of 37 patients (64.8%) exposed to betamethasone vs. 13 of 74 (17.5%) controls developed infectious diseases (P < 0.001). Symptomatic lower urinary tract infections occurred in 13 of 37 (35.1%) and two of 74 (2.7%) in the study and control groups, respectively (P < 0.001). Serious bacterial infections were found in nine of 37 (24.3%) vs. none of 74 (0%) patients, respectively (P < 0.001). These included sepsis (n=2), pneumonia (n=4), pyelonephritis (n=2), and cholangitis (n=1). Eight of nine serious infections occurred in patients exposed to five or more weekly courses of betamethasone. Postpartum endometritis related to Caesarean delivery was found in five of 37 patients (13.5%) vs. seven of 74 (9.4%), respectively (P=NS). CONCLUSIONS: Three or more courses of antepartum betamethasone in women at risk of pre-term delivery are associated with substantial infectious maternal morbidity. The excess morbidity consisted mainly of bacterial infections, some of which were associated with systemic and potentially life-threatening infections.

Adult↗
PubMed1999

Midtrimester maternal serum screening after multifetal pregnancy reduction in pregnancies conceived by in vitro fertilization.

PURPOSE: Data about the effect of multifetal pregnancy reduction on midtrimester maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) are scarce and contradictory. Differing gestational ages at fetal reduction, transvaginal versus transabdominal needle insertion, and injection of different feticidal agents compound the analysis of published data. METHODS: We examined clinical and laboratory data about 27 high-order gestations that were reduced to twins in the first trimester. Fetal reductions were performed transabdominally at 11.41 +/- 1.15 weeks' gestation by fetal intrathoracic injection of KCl, and maternal blood sampling was performed at 16.48 +/- 1.05 weeks. "Pseudo-risks" for singleton pregnancies were calculated by correcting serum analyte levels for twins. RESULTS: Twenty-four (88.9%) of 27 patients had maternal serum AFP levels above 2.0 MoM (mean, 4.60 +/- 3.48 MoM; range, 1.49-14.85 MoM), however, none of the newborns had structural anomalies. AFP serum levels did not correlate with the number of reduced fetuses or with adverse obstetric outcome. The mean hCG levels were 1.22 +/- 0.49 MoM (range, 0.14-2.47), and the mean uE3 levels were 1.15 +/- 0.31 MoM (range, 0.56-1.84). Based on maternal age alone, seven patients (25.9%) would have been offered amniocentesis for a term Down syndrome risk greater than 1:384, whereas combined risk calculations with hCG and uE3 levels resulted in 1 (3.7%) screen-positive case (P < 0.01).

Adult↗
PubMed1999

Screening efficacy of the subcutaneous tissue width/femur length ratio for fetal macrosomia in the non-diabetic pregnancy.

BACKGROUND: Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non-diabetic population at term. STUDY DESIGN: Intrapartum sonographic measurements were performed in 178 well-dated gravidas at 37-41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut-off points of the examined parameters or estimated fetal weights. RESULTS: Macrosomia occurred in 27 newborns (15.1%). The SCT/FL ratio was independent of gestational age (r = -0.017). Maternal age, gravidity, parity, gestational age and the ratio of male-to-female infants were similar in pregnancies resulting in appropriate-for-gestational-age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (theta) revealed that the abdominal circumference had the best sensitivity-specificity trade-off (theta = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (theta = 0.8773; p < 0.0005), the Shepard formula (theta = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (theta = 0.6872; p < 0.01) and the SCT/FL ratio (theta = 0.6303). CONCLUSIONS: We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non-diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters.

Adolescent↗
PubMed1999

Prenatal diagnosis of interrupted inferior vena cava as an isolated finding: a benign vascular malformation.

We report two cases of interrupted inferior vena cava with azygous continuation diagnosed as an isolated finding during routine prenatal scans. Visualization of the venous vasculature of the abdomen and thorax in the mid-sagittal plane failed to visualize the segment of the inferior vena cava between the kidneys and the liver. A vessel with venous flow was observed parallel, adjacent and posterior to the aorta between the kidney and the right atrium. This blood vessel connected with the superior vena cava. Axial planes of the thorax confirmed the presence of two vessels running paravertebrally. A detailed ultrasound examination of the fetal anatomy failed to demonstrate other anomalies. The neonatal course of both fetuses was uneventful. Isolated interruption of the inferior uena cava can be a vascular malformation without known pathological consequences.

Adult↗
PubMed1999

The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial.

UNLABELLED: BACKGROUND; Contradictory findings on the effect of betamethasone versus dexamethasone on antenatal tests of fetal well-being have been reported. The purpose of this study was to compare the effects of these steroid compounds on fetal heart rate patterns and biophysical activities in a prospective. randomized trial. STUDY DESIGN: Forty-six pregnant women (gestational age range 27-34 weeks) at risk for preterm delivery were randomized to receive betamethasone or dexamethasone for enhancement of fetal lung maturity. Fetal heart rate was recorded for 60 minutes and analyzed with the Sonicaid System 8000 before (0 hours), and 48 hours and 96 hours after steroid administration. Subsequently, fetal limb, body and breathing movements were sonographically observed and quantified for 30 minutes. To account for fetal circadian rhythms, all examinations were performed between 1 p.m. and 5 p.m., at least one hour after maternal meals. RESULTS: Fetal heart rate accelerations (p<0.001; p<0.01), short-term variation (p<0.0001; p<0.05), long-term variation (p<0.01; p=NS), duration of high episodes (p<0.001; p<0.05), total movement count (p<0.001; p<0.05), and duration of breathing time (p<0.0001; p<0.0001) were substantially reduced 48 h after betamethasone and dexamethasone administration, respectively, with percent reduction being larger for the betamethasone group, except for breathing movements (p<0.05; p<0.001; p<0.001; p<0.005; p<0.05; p=NS; respectively). In 68.2%( and 45.5% of fetuses, less than 30 seconds of continuous breathing movements were found in the betamethasone and dexamethasone groups, respectively. In 71.8% and 12.5%, of fetuses, respectively, less than 2 body/limb movements were observed. Therefore five and two fetuses in the betamethasone and dexamethasone study group, respectively, had both nonreactive fetal heart rate monitors for 60 minutes and biophysical profiles of < or =4/10. All parameters returned to baseline values at 96 h. Baseline fetal heart rate and numbers of decelerations remained unchanged (p=NS). CONCLUSIONS: Both betamethasone and dexamethasone induce a profound, albeit transient, suppression of fetal heart rate characteristics and biophysical activities in the preterm fetus. However, the effect of betamethasone is more pronounced. Awareness of these phenomena might prevent unwarranted iatrogenic delivery of preterm fetuses.

Adult↗
PubMed1999

The effect of betamethasone on fetal biophysical activities and Doppler velocimetry of umbilical and middle cerebral arteries.

OBJECTIVE: Preliminary reports suggest that antenatal steroid administration may confound the assessment of fetal well-being by suppressing biophysical activities, consequently drug-induced effects could prompt unwarranted delivery of premature fetuses. The purpose of this study was to examine the effect of antenatal betamethasone administration on fetal biophysical activities and Doppler flow indices of the umbilical and middle cerebral circulation. METHODS: Forty women at risk of premature delivery between 27-32 weeks gestation (mean 30.2 weeks) received two consecutive doses of intramuscular betamethasone, 24 hours apart. Ultrasonographic observations of fetal behavior for 30 minute periods and Doppler examination of the umbilical and cerebral arteries were performed prior to (0 hours), 48 hours after, and 96 hours after administration of the first dose. To account for fetal circadian rhythms and maternal prandial status, all examinations were carefully timed and performed between 1-4 pm. Analysis of Variance, chi-square test and Fisher's Exact test were used for statistical analysis, as appropriate. RESULTS: Nine patients were excluded from analysis due to delivery prior to completion of all examinations. Number of breathing episodes as well as total breathing time at 48 hours decreased by 83.0% (p<0.01) and 90.4% (p<0.01), respectively, at 48 hours in comparison to baseline. Fetal limb and trunk movements decreased by 53.2% (p<0.01) and 48.6% (p<0.01), respectively. Amniotic fluid volume and fetal tone were normal in all patients. At 48 hours, 14 of 31 fetuses and 4 of 31 fetuses had a biophysical profile score of 6/8 and 4/8, respectively, in comparison to 0 of 31 and 0 of 31 at 0 hours (p<0.05 and p<0.001, respectively). All parameters returned to baseline values at 96 h. Pulsatility indices of umbilical and middle cerebral arteries remained unchanged at 48 hours and 96 hours (p=NS). CONCLUSIONS: Betamethasone induces a profound, albeit transient, suppression of fetal breathing, limb and trunk movements, resulting in decreased biophysical profile scores. Awareness of this drug-induced effect might prevent unnecessary iatrogenic delivery of preterm fetuses.

Adult↗
PubMed1999

The effect of antenatal steroid administration on the fetal response to vibroacoustic stimulation.

BACKGROUND: Betamethasone transiently suppresses multiple fetal biophysical activities, including breathing movements, limb and trunk movements, heart rate variability, and heart rate accelerations. Unnecessary iatrogenic delivery of preterm fetuses due to the false diagnosis of fetal compromise has been described in this setting. The sonographically observed startle response of the fetus to vibroacoustic stimulation has been described as another modality to provide reassurance about fetal well-being. It is unknown, however, whether the startle response is also suppressed by betamethasone. The purpose of this study was to examine the effect of betamethasone on this biophysical parameter. METHODS: A prospective cohort study. Vibroacoustic stimulation was applied to the maternal abdomen and fetal movement responses were sonographically observed prior to (0 hours), 48 hours after, and 96 hours after betamethasone administration. We recorded the presence or absence of the fetal startle response, and, if a response was present, graded semi-quantitatively the intensity of the movements (vigorous versus sluggish). RESULTS: Twenty-two of 26 fetuses (84.6%) displayed a vigorous vibroacoustic startle response prior to betamethasone administration, in comparison to three of 26 fetuses (11.5%) at 48 hours after exposure (p<0.0001). Eleven fetuses and eight fetuses displayed no startle response at all (p<0.0005), or a sluggish response only (p<0.0005) at 48 hours, respectively. At 96 hours after betamethasone exposure, no differences in the number of fetuses with a vigorous, sluggish, or absent response were observed in comparison to 0 hours. Stratification of cases by gestational age groups of 28-30 weeks versus 31-34 weeks showed similar response patterns. CONCLUSION: Antenatal betamethasone exposure transiently suppresses the sonographically observed fetal startle response to vibroacoustic stimulation. Accordingly, this modality cannot be used for the ascertainment of fetal well-being of steroid exposed fetuses. Betamethasone seems to suppress central nervous system dependent biophysical activities. including the brain-stem dependent vibroacoustic startle reflex.

Acoustic Stimulation↗
PubMed1997

Prenatal sonographic findings in 187 fetuses with Down syndrome.

We determined the type and frequency of abnormal sonographic findings in 187 Down syndrome fetuses. Examinations were performed transvaginally or transabdominally between 9 and 28 weeks' gestation. Consecutive scans performed prior to knowledge of the fetal karyotype (n = 144) were analysed separately for one of the participating centres. In 93 fetuses (49.7 per cent), a total of 138 abnormalities were observed. The most commonly detected anomalies were cystic hygroma and increased nuchal fold thickness (30.5 per cent), hydrops (9.6 per cent), cardiac defects (7.5 per cent), pyelectasis or hydronephrosis (5.9 per cent), echogenic bowel (4.8 per cent), and a large variety of internal organ abnormalities (16.0 per cent) which are not typically associated with Down syndrome. Two anomalies or three anomalies in the same fetus were observed in 21 and 5 fetuses, respectively. No patterns of concurrent malformations were apparent among these fetuses. Sensitivity for Down syndrome detection by ultrasound scans performed without knowledge of the fetal karyotype was 24.1 and 42.6 per cent before 13 weeks and between 14 and 23 weeks, respectively. We conclude that structural abnormalities are frequently observed in Down syndrome fetuses, but many sonographic findings are not typically associated with this syndrome.

Abdomen↗
PubMed1997

Activated protein C resistance and adverse pregnancy outcome.

OBJECTIVE: Activated protein C resistance is a genetic disorder that predisposes to thrombosis. Hyperestrogenism strongly increases the risk of thrombosis in affected individuals. Other thrombophilic disorders, such as the antiphospholipid antibody syndrome, have been associated with adverse pregnancy outcome, probably mediated by abnormal clotting in the placental circulation. The purpose of this series is to present clinical and laboratory data on individuals with a poor obstetric history and activated protein C resistance. STUDY DESIGN: Within an 18-month period seven patients with more than five early pregnancy losses, recurrent intrauterine fetal deaths, intrauterine growth restriction, and early severe preeclampsia in association with activated protein C resistance came to our attention. The initial diagnosis was made by activated protein C ratios, and molecular diagnoses of activated protein C resistance genotypes were made by polymerase chain reaction for the factor V Leiden mutation. All patients had an extensive diagnostic workup for known etiologies of the above complications and other thrombophilic disorders. RESULTS: All patients had activated protein C ratios <1.7. Six patients were heterozygous for the Leiden mutation, and one patient was homozygous. A personal or family history of thromboembolism was present in one case and three cases, respectively. The diagnostic workup was otherwise unrevealing. One newborn was diagnosed of bilateral renal vein thrombosis on day 1 of life. CONCLUSIONS: Activated protein C resistance was found in association with extremely poor obstetric outcomes. A family or personal history of thromboembolism was suggestive in many cases. A population-based study is needed to determine the role of activated protein C resistance in adverse pregnancy outcome.

Adult↗