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Biomedical subjects

V L Katz

Publications and source records attributed to V L Katz.

At least 19 recordsLinked to original sources
PubMed1996

Decidualized umbilical endometriosis.

A case of umbilical endometriosis is presented to highlight the challenges in its diagnosis. The etiology, clinical findings, histologic evaluation, prognosis and treatment options are discussed. While cyclic symptomatology may lend evidence to the diagnosis of umbilical endometriosis, history and clinical findings are often equivocal. Decidualization of umbilical endometriosis can be initially confused with a malignant process on histologic evaluation. The potential for malignant degeneration appears low. Surgical intervention is the treatment of choice.

Adult↗
PubMed1996

Pharmacologic treatment of psychiatric disease in pregnancy and lactation: fetal and neonatal effects.

OBJECTIVE: To review published data pertaining to safety of psychoactive drugs used to treat psychiatric disorders during pregnancy and lactation. DATA SOURCES: A computerized search of articles published through July 1995 was performed on the MEDLINE data base. Additional sources were identified through cross-referencing. METHODS OF STUDY SELECTION: All identified references were reviewed with particular attention given to study design. DATA EXTRACTION AND SYNTHESIS: Each reference was reviewed to determine the safety of psychoactive agents to treat depression, bipolar disease, schizophrenia, and anxiety during pregnancy and lactation. Prospective or large retrospective studies were given more importance than case reports. CONCLUSION: Psychoactive medications may be used during pregnancy. Because data on safety are largely retrospective, treatment decisions must be weighed carefully.

Abnormalities, Drug-Induced↗
PubMed1996

Maternal and fetal outcomes in hyperemesis gravidarum.

OBJECTIVE: This study sought to evaluate maternal characteristics and pregnancy outcomes among women with hyperemesis gravidarum. METHODS: We performed a retrospective analysis of pregnancy records of obstetric admissions during a 6-year period. Women treated as out-patients for hyperemesis were also identified. Hyperemesis was defined as excessive nausea and vomiting resulting in dehydration, extensive medical therapy, and/or hospital admission. Statistical analysis was by t-test and chi square. RESULTS: We identified 193 women (1.5%) who developed hyperemesis among 13,053 women. Racial status, marital status, age, and gravidity were similar between the hyperemesis patients and the general population. However, there were less women with hyperemesis who were para 3 or greater. Forty-six women (24%) required hospitalization for hyperemesis, mean hospital stay 1.8 days, range 1-10 days. One patient required parenteral nutrition, two had yeast esophagitis, none had HIV infection, psychiatric pathology or thyroid disease. Pregnancy outcomes between hyperemesis patients and the general population were similar for mean birth weight, mean gestational age, deliveries less than 37 weeks, Apgar scores, perinatal mortality or incidence of fetal anomalies. Our incidence of hyperemesis (1.5%) is similar to that of other published reports. CONCLUSION: Women with hyperemesis have similar demographic characteristics to the general obstetric population, and have similar obstetric outcomes.

Adult↗
PubMed1996

Water exercise in pregnancy.

Exercise in the water offers several physiological advantages to the pregnant woman. The hydrostatic force of water pushes extravascular fluid into the vascular spaces, producing an increase in central blood volume that may lead to increased uterine blood flow. This force is proportional to the depth of immersion. The increase in blood volume is proportional to the woman's edema. A marked diuresis and natriuresis accompanies the fluid shifts. The buoyancy of water supports the pregnant women. Water is thermoregulating. Studies of pregnant women exercising in the water have shown less fetal heart rate changes in the water than on land in response to exertion. Pregnant women's heart rates and blood pressures during water exercise are lower than on land exercise, reflecting the immersion-induced increase in circulating blood volume. The physiology of water exercise offers some compensation for the physiological changes of exercise on land that may beneficially affect pregnancy.

Exercise↗
PubMed1996

An association between fetal parvovirus B19 infection and fetal anomalies: a report of two cases.

The association between fetal parvovirus B19 infection and hydrops was first reported in 1984. The virus has a predilection for the erythroid cell line, which in the fetus may produce anemia. Recent cases of parvovirus infection in other fetal cell lines have raised concern that the infection may induce fetal anomalies in rare cases. We report two pregnancies complicated by parvovirus B19 infection. In each instance the patient had normal second trimester ultrasounds but subsequently developed fetal abnormalities--disruptions of normal structure. One infant has myocardial infarction, splenic calcifications, and mild hydrocephalus. The other had moderate hydrocephalus with central nervous system scarring. There are two possible mechanisms in which parvovirus may induce fetal anomalies. Both direct infection of fetal organs and vascular inflammation have been documented in association with B19 parvovirus. Although fetal abnormalities associated with parvovirus are rare, continued study of this organism may indicate a greater pathologic potential than is now thought.

Adult↗
PubMed1996

Aneurysm of the vein of Galen: prenatal diagnosis and perinatal management.

An aneurysm of the vein of Galen is a rare arteriovenous malformation of the central nervous system. Fetal manifestations have included nonimmune hydrops, hydrocephalus, and intracranial hemorrhage. This anomaly may be diagnosed prenatally by several imaging modalities. A cystic cranial mass was identified by ultrasound in a fetus at 30 weeks gestation. Both pulsed-wave Doppler and color-velocity imaging studies suggested aneurysm of the vein of Galen was the most likely diagnosis. The fetus demonstrated no evidence of hydrops on serial ultrasound examinations. A 2430 g female infant was delivered vaginally at 35 weeks gestation. Postnatal management included transarterial embolization of the vessels feeding the aneurysm with craniectomy, an intra-aneurysmal balloon, and vascular microcoils. Hydrocephalus developed and a ventriculo-peritoneal shunt was placed. The infant has grown appropriately in the first year of life. An aneurysm of the vein of Galen may be diagnosed prenatally by real-time ultrasound, pulsed-wave Doppler, color-velocity imaging, or magnetic resonance imaging. The presence of this malformation should prompt close follow-up for the remainder of the pregnancy. Careful obstetric management and early postnatal intervention may lead to a favorable outcome.

Adolescent↗
PubMed1996

Metabolic and hormonal responses to low-impact aerobic dance during pregnancy.

This study examined the plasma glucose, free fatty acids (NEFA), lactate, triglyceride, cortisol, and insulin responses of pregnant women (22-28 wk) to a 40-min aerobic dance program and 40-min treadmill walking at similar heart rate intensities. The heart rates during exercise averaged 135 +/- 5 bt.min-1 for both trials. Immediate post-exercise plasma glucose levels were lower than resting levels for both exercise trials (P < 0.05), and remained below resting levels 20 min after exercise. Plasma triglycerides and NEFA were increased immediately post-exercise (P < 0.05), and returned toward rest 20 min after exercise. The NEFA responses at the end of the walking trials were significantly greater than at the end of the aerobic dance trials (P < 0.05). For both trials, immediate post-exercise plasma insulin levels were below resting levels (P < 0.05) and remained attenuated 20 min post-exercise. Plasma cortisol concentrations were unchanged throughout the aerobic dance trial. However, a mean increase of 105 nmol.l-1 immediately post-exercise was evident during the walking trials (P < 0.05). The results suggest that 40 min of walking or aerobic dance reduces blood glucose but does not cause hypoglycemia. Further, the results suggest that 40 min of walking or aerobic dance does not expose the mother to serious metabolic consequences that might adversely affect the fetus.

Adult↗
PubMed1996

Cancer in pregnancy: a review of the literature. Part I.

Cancer is an important cause of death in the United States in women of childbearing age. Approximately 1 per 1000 pregnant women will develop cancer. This review (Part II follows in this issue) examines the diagnosis, prognosis, and management of cancer during pregnancy; both in terms of the cancer's effect on the pregnancy, and the pregnancy's effect on the cancer. Some diagnostic modalities and some therapies are problematic to the fetus and placenta. However, in most cases and the pregnancy can be managed concurrently with a good outcome for the baby and without compromising the mother's prognosis.

Breast Neoplasms↗
PubMed1996

Cesarean delivery for fetal malformations.

We reviewed existing data on fetal abnormalities to provide guidelines to determine which conditions have an improved neonatal outcome by cesarean delivery. We used Medline database to search for English language papers on a variety of fetal conditions that could influence the mode of delivery. We reviewed these sources with particular attention to how the mode of delivery influenced neonatal outcome. Conflicting data exist regarding optimal mode of delivery for many fetal conditions. Cesarean delivery may improve neonatal outcome for fetuses with isolated meningomyelocele, hydrocephalus with concomitant macrocephaly, anterior wall defects with extracorporeal liver, sacrococcygeal teratomas, hydrops, and alloimmune thrombocytopenia with low platelet count at term. Hydrocephalus without macrocephaly, anterior wall defects without an extracorporeal liver, ovarian cysts, skeletal dysplasias, fetuses whose mothers have immune thrombocytopenic puer-pura and fetuses with alloimmune thrombocytopenia with acceptable platelet counts may safely be delivered vaginally.

Cesarean Section↗
PubMed1996

Methotrexate and angiographic embolization for conservative treatment of cervical pregnancy.

Cervical pregnancy has traditionally been treated by hysterectomy. Recent reports of the use of methotrexate have been encouraging as a potential conservative approach. We present a case of a cervical pregnancy diagnosed at 8 weeks' gestation in a woman who greatly desired fertility. She was treated successfully with a combination of multidose intramuscular methotrexate (1 mg/kg/day) and citrovorum rescue. When profuse bleeding developed on day 8, angiographic embolization was used to obviate surgery. The beta-hCG titer peaked at 58,362 IU/mL and was undetectable by postchemotherapy day 30. No blood transfusion was required, and reproductive capacity was spared. Four months after the cervical pregnancy, the patient became pregnant and had a healthy infant. Medical management of cervical pregnancy is an option when reproductive capacity is desired in selected patients with appropriate counseling.

Adult↗
PubMed1996

Fatal lupus pleuritis presenting in pregnancy. A case report.

BACKGROUND: Lupus, one of the most common autoimmune diseases in pregnancy, may involve multiple organ systems with varying severity. The diagnosis and treatment of the disease may be complicated by the physiologic changes of pregnancy. CASE: A 22-year-old woman presented at 29 weeks' gestation with a 4-week history of dyspnea and mild hypertension. She was found to have large bilateral pleural effusions. Her antinuclear antibody level was 1:640, with a speckled pattern, and her complement levels were low. Her urine had 2+ hemoglobin and 2+ protein with hyaline casts. Over the next three days, respiratory compromise increased despite high-dose steroids. A cesarean delivery was performed for fetal compromise. The infant did well after moderate respiratory distress. The mother developed worsening respiratory distress with adult respiratory distress syndrome, and she could not be weaned from the ventilator. Bilateral chest tubes were placed to control her effusions. Urine output remained poor despite pressors and diuretics. Staphylococcal sepsis occurred on postoperative day 5 and precluded our use of other antiinflammatory agents. Over the next 14 days the mother developed seizures, hypotension and eventual respiratory collapse. Autopsy was notable for lupus nephritis and serositis. CONCLUSION: The diagnosis and management of systemic lupus in pregnancy may be extremely difficult. Serositis and nephritis may lead to maternal compromise despite early diagnosis and treatment.

Adult↗
PubMed1995

Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen.

Until very recently cervical pregnancies have been treated with surgery, usually hysterectomy. The development of endovaginal ultrasound, which allows early diagnosis, and methotrexate chemotherapy have opened up new therapeutic options. A 45-year-old multigravida presented at 8 weeks' gestation with vaginal bleeding. Endovaginal ultrasound demonstrated a cervical pregnancy with a fetal pole, 1.2 x 1.4 cm sac, no cardiac pulsations, and an empty uterus. After discussion with the patient, single low dose methotrexate 1.5 mg/m2 was given intramuscularly. The patient's hCG titre was 5882 IU-(Third International Standard). Over a 5-week period the hCG titres fell, and the gestational sac disappeared. The patient experienced intermittent vaginal bleeding and cramping but was managed as an outpatient. Single low dose methotrexate may be a successful management option in selected cases of cervical pregnancy.

Cervix Uteri↗
PubMed1995

Prenatal diagnosis and management of massive bilateral axillary cystic lymphangioma.

BACKGROUND: Fetal lymphangiomas can occur in many different anatomic locations, including the most commonly seen nuchal cystic hygroma. CASE: A fetus at 18 weeks' gestation was found to have a massive right axillary hygroma. The fetal karyotype was normal. Serial ultrasound examinations indicated progressive enlargement, but no hydrops. At 32 weeks' gestation, a left axillary hygroma was also diagnosed. The patient underwent cesarean delivery. CONCLUSION: Prenatal diagnosis of nuchal cystic hygromas has a high association with karyotypic abnormalities, hydrops, and fetal demise; however, this association may not apply to cystic lymphangiomas at other locations.

Adult↗
PubMed1995

Non-immune hydrops after 20 weeks' gestation: review of 10 years' experience with suggestions for management.

OBJECTIVE: To analyze the etiologies and outcomes for a southeastern section of the United States, and to organize an efficient approach to evaluation. METHODS: We reviewed 82 cases of non-immune hydrops presenting after 20 weeks' gestation over a 10-year period. RESULTS: Overall perinatal mortality was 86.6%. Fetuses diagnosed with hydrops before 24 weeks' gestation had a perinatal mortality of 95%, with nearly one-third having abnormal karyotypes. The etiology of hydrops diagnosed after 24 weeks' gestation was more likely to remain idiopathic or to be related to cardiothoracic abnormalities. CONCLUSION: Before 24 weeks' gestation, the high risk of mortality and abnormal karyotype justifies offering families funipuncture in the hope of finding a treatable cause of non-immune hydrops. After 24 weeks' gestation, when fewer abnormal karyotypes are found, funipuncture may also be pivotal in diagnosing the cause of non-immune hydrops.

Adult↗
PubMed1995

Cesarean delivery: a reconsideration of terminology.

The terminology we employ influences our perceptions. Thus, we believe in reviewing terminology regularly. The term "cesarean section" should be abandoned. A medical procedure is rarely named after a historic figure, and almost never after an ancient Roman law. Cesarean section has recently been amended to cesarean birth; however, the term is still inadequate. The word "hysterotomy" more appropriately describes the procedure we regularly perform. The adjectives used to describe cesarean birth should also be reevaluated. If we are to keep the term "classical" for the original fundal vertical uterine incision, then the other designations of hysterotomy should retain the same architectural context. Contemporary hysterotomy should be used in reference to a low transverse cesarean. Neoclassical hysterotomy might be used to describe the low vertical procedure. Transitional hysterotomy may be an appropriate term for the "hockey stick" or "J" incision. Cesarean delivery best describes a postmortem cesarean. Vaginal birth after cesarean (VBAC) is inappropriate because a vaginal birth after a cesarean section would not occur if cesarean section refers to a perimortem procedure. Vaginal birth after hysterotomy should be substituted for VBAC. Such revision of our terminology will keep obstetrics at the forefront of medical science and bring us most efficiently into the 21st century.

Cesarean Section↗
PubMed1995

Outcome of pregnancies with elevation of both maternal serum alpha-fetoprotein and human chorionic gonadotropin.

We evaluated the pregnancy outcome of all patients with elevations of both maternal serum alpha-fetoprotein and human chorionic gonadotropin since institution of combined serum screening at our program. After analysis of 34,404 samples, 99 patients were found to have significant elevations of both maternal serum alpha-fetoprotein and human chorionic gonadotropin. The ultrasound findings, amniocentesis results, and pregnancy outcomes were determined in each case. Sixty-six patients with singleton gestations met entry criteria. Pregnancy outcome information is available for 63 of these patients, 60% of whom had at least one complication. Thirty-three patients with multiple gestations met inclusion criteria. Pregnancy outcome information is available for 31 of these, 81% of whom had at least one complication. These patients had a high incidence of pregnancy related complications. This group would appear to be at higher risk than women with elevation of either maternal serum alpha-fetoprotein or human chorionic gonadotropin alone.

Amniocentesis↗
PubMed1995

Course of Crohn's disease during pregnancy and its effect on pregnancy outcome: a retrospective review.

The purpose of our study was to review the effects of Crohn's disease on pregnancy outcomes. Over a 6-year period, we identified 17 women with pregnancies complicated by Crohn's disease. The mean age of the women was 26 years, with a mean age of diagnosis at 17 years. Crohn's disease worsened only slightly during the pregnancy. Exacerbations of diarrhea were the main problems. Weight gain, unadjusted for gestational age at delivery, was 18 pounds. Three babies had low birthweight; two were both premature and growth retarded. One woman with active disease and no prenatal care had a fetal death at 30 weeks' gestation with subsequent disseminated intravascular coagulation. Among women with active perianal disease, one was delivered vaginally without exacerbation of symptoms. Four women with histories of perianal disease had prophylactic primary elective cesarean sections to avoid worsening of symptoms. Three of these women developed recurrent perianal disease despite the abdominal delivery. One of these developed an abdominal fistula trait in the wound. Our findings suggest that active disease at the onset of pregnancy tends to remain active, and quiescent disease tends to remain quiescent. Mode of delivery in our series was not protective against perineal disease. Although our series is small, it suggests that delivery may occur vaginally, with operative delivery reserved for obstetric indications.

Adolescent↗