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Biomedical subjects

W N Spellacy

Publications and source records attributed to W N Spellacy.

At least 37 records · Page 2Linked to original sources
PubMed1998

The effects of Betamethasone on white blood cells during pregnancy with PPROM.

OBJECTIVE: To determine the effects of Betamethasone injections on maternal white blood cell counts. STUDY DESIGN: Thirteen pregnant women without fever or clinical infection and with premature rupture of the membranes at less than 34 weeks gestation were studied. No subject had labor during the week of study. Daily complete blood counts were done before and on days one and two after two 12 mg intramuscular injections of Betamethasone given 24 hours apart. RESULTS: The steroid injections produced a significant increase in total white counts from 9.8 +/- 5.0 to 14.2 +/- 0.7 x 10(3) cells/cc. There was a significant increase in polymorphonucleocytes and a decrease in lymphocytes and monocytes. CONCLUSION: The use of Betamethasone injections to mature fetal lungs results in a leukocytosis, but total white cell counts remain less than 20 x 10(3) cells/cc.

Adolescent↗
PubMed1998

The OB/GYN clerkship rotation sequence. Does it affect performance on final examinations?

OBJECTIVE: To determine if the timing of the obstetric/gynecologic (OB/GYN) clerkship affects the final grade achieved. STUDY DESIGN: The final examination grades on the OB/GYN clerkship for 165 students over a three-year period were compared according to when in the year the clerkship was taken. Premedical Medical College Admission Test scores (MCAT) were used to determine the academic potential of each clerkship group. RESULTS: There was a statistically significant correlation between the MCAT scores and the National Board of Medical Examiners clerkship examination score (r = .22, P < .005). No differences were found in the clerkship examination scores for students doing their rotations early or late in the third year. CONCLUSION: These results suggest that students with similar academic potential will do equally well on OB/GYN clerkship examinations whether they take their rotation early or late in the third year of medical school.

Curriculum↗
PubMed1998

Urine protein dipstick measurements. A screen for a standard, 24-hour urine collection.

OBJECTIVE: To determine if the sum of urine protein dipstick values recorded during every void can be used to screen for patients who need a standard, 24-hour urine collection for determination of protein excretion. STUDY DESIGN: Thirty inpatient and 17 outpatient pregnant women undergoing 24-hour urine collection for protein concentration were enrolled. The volume, dipstick protein values and time of void were recorded. The 24-hour quantitative analysis of protein excretion performed by the laboratory was compared to the 24-hour sum of the products of each voided volume and dipstick value (dipstick factor). RESULTS: The dipstick factor significantly correlated with the total 24-hour protein excretion (correlation coefficient 0.84, P < 1 x 10(-7)). A dipstick factor of > or = 300 mg, indicated proteinuria with a sensitivity of 96%, specificity of 90%, positive predictive value of 92% and negative predictive value of 95%. Separately, we found differences in the amount of protein excretion when the 24-hour period was divided into six 4-hour periods, using analysis of variance. Paired t test analysis of the mean protein excretion from 16:00 to 04:00 showed significantly higher results than did the protein excretion from 04:01 to 16:00 (1,197 +/- 356 mg vs. 674 +/- 158 mg, P < .0001). CONCLUSION: The sum of dipstick factors in a 24-hour period is a reliable screening test for identifying patients who need the standard laboratory test for proteinuria.

Adult↗
PubMed1997

Reactive nonstress test despite severe congenital brain damage. What does the test measure?

BACKGROUND: Antenatal testing with the nonstress test is common in the evaluation of high-risk pregnancies. A reactive test gives the clinician reassurance of fetal well-being. CASE: A 19-year-old woman, gravida 1, para 0, delivered an infant with holoprosencephaly and multiple facial and limb abnormalities at 38 weeks' gestation. The fetal heart tracing was reassuring despite the infant's compromised neurologic status. CONCLUSION: The nonstress test is dependent only upon the fetal brainstem, and it predicts oxygenation at that site rather than normality of the entire central nervous system. This limitation of the nonstress test must be remembered when performing antenatal testing.

Adult↗
PubMed1996

Umbilical plasma erythropoietin correlations with blood gases and gestational age in appropriately grown infants.

Erythropoietin (EPO) levels were measured using an ELISA method in umbilical cord plasma from 68 appropriately grown neonates at 27 to 43 weeks of gestation (EGA). A consistent but small (5%) difference was found between the EPO levels in the umbilical artery (Ua), 21.0 +/- 2.5 mlU/mL (mean +/- SEM), and umbilical vein (Uv), 22.0 +/- 2.7 mlU/mL (p < 0.02, n = 30). Significant inverse correlations were found between Ua EPO levels and pO2 (r = -0.44, p < 0.002), pH (r = -0.68, p < 0.0001), as well as base deficit (r = -0.56, p < 0.0001). A significant correlation was found between EGA and Ua EPO from 27 to 43 weeks of gestation (r = 0.45, p < 0.001, n = 68). One and 5 minute Apgar scores did not correlate with EPO. These findings indicate that EPO correlates strongly with cord gas parameters and thus may serve as a clinically useful marker for both subacute fetal distress and chronic uteroplacental insufficiency.

Apgar Score↗
PubMed1996

Cerebral palsy, perinatal depression and low ponderal index.

To determine whether asymmetric growth restriction, abnormally lean body morphology, is associated with cerebral palsy (CP) in infants born with perinatal depression, perinatally depressed Collaborative Perinatal Project infants were assessed. Rates of ponderal index less than 5% for gestational age and race (low PI), a marker for asymmetric growth, were compared in infants either neurologically normal or having CP at 7 years of age. Low PI was associated with CP in infants with Apgar scores of 0 to 3 at 10, 15 or 20 minutes in both of these groups, after exclusion of small-for-gestational-age infants, and was a significant individual correlate of cerebral palsy with multiple logistic regression. The attributable risk of cerebral palsy related to low Pl was 12.4%.

Apgar Score↗
PubMed1995

Estrogen-induced guinea pig model for uterine leiomyomas: do the ovaries protect?

A guinea pig model was used to study the hormonal control of uterine leiomyomas. Twenty female guinea pigs were divided into four groups--young, old, ovariectomized (OVX), and non-OVX animals--and were given two estradiol-17 beta (E2) silastic implants each for 3-10 mo; another four older OVX animals served as controls and received empty implants. After 3 mo, 100% (8 of 8) of the OVX animals, but none of the OVX controls, developed tumors, mainly on the uterine serosa and the abdominal wall. Electron microscopy and desmin immunostaining demonstrated that the tumors were leiomyomas. In E2-treated animals, E2 levels in serum, leiomyomas, or leiomyoma-free uterine segments rose significantly while serum progesterone (P4) was negligible. Surprisingly, only 8% (1 of 12) of the non-OVX animals developed a tumor. This apparent "ovarian protection" was transient: after 6-9 mo, 50% of the remaining non-OVX animals developed leiomyomas, but these were smaller and fewer than in OVX animals. On the basis of this model, we propose the hypothesis that some factors from the ovaries suppress leiomyoma growth in response to estrogen but that as the ovaries age this protection is diminished, allowing the clinical development of leiomyomas.

Animals↗
PubMed1995

Human peritoneal macrophage and T lymphocyte populations in mild and severe endometriosis.

PROBLEM: The aim of this study was to characterize the phenotype of peritoneal lymphocyte and macrophage populations in mild versus severe endometriosis. METHOD: Using dual staining, antigen expression on peritoneal leukocytes from 24 women with endometriosis and 21 control patients was analyzed by flow cytometry. RESULTS: All groups had CD4:CD8 ratios of 0.6, with subpopulations of CD8+ cells expressing cytotoxic marker S6F1. Mild and severe endometriosis patients had increased CD3/DR+ cells, relative to controls. Two populations of macrophages were identified by size in all groups. Mild endometriosis patients had increased percentages of small macrophages expressing CD14 and HLA DQ, compared to controls and severe disease patients. In severe disease patients, antigen expression on small macrophages did not differ from controls, but decreased percentages of large macrophages expressed CD14 relative to controls and mild disease patients. CONCLUSION: All women with endometriosis exhibit activated peritoneal lymphocytes, whereas macrophage expression of CD14 is differentially expressed as a function of disease stage. Alterations in the functional capacity of these cells may contribute to the pathophysiology of this disease.

Adult↗
PubMed1995

The Zavanelli maneuver for fetal shoulder dystocia. Three cases with poor outcomes.

BACKGROUND: There are several reports on the management of severe fetal shoulder dystocia by pushing the head back into the vagina and delivering the infant by cesarean section; this procedure is called the Zavanelli maneuver. CASES: Three cases were reviewed to determine the outcomes of the infants. The three neonates all demonstrated severe perinatal hypoxia that ultimately resulted in brain damage and/or death. CONCLUSION: Management of shoulder dystocia using the Zavanelli maneuver carries a high risk of severe infant perinatal hypoxia and damage.

Adult↗
PubMed1994

Fractured clavicle is an unavoidable event.

OBJECTIVES: The three purposes of this study were to determine the incidence of fractured clavicle in newborns delivered at our hospital, to identify preventable risk factors associated with these fractured clavicles, and to identify the acute sequelae of fractured clavicle in these infants. STUDY DESIGN: We performed a retrospective chart review of all women delivered during an 8-month period. Newborns with radiologically proved fractured clavicles were compared with a control group of infants delivered immediately before and immediately after the study patient. Maternal, labor, delivery, and newborn factors were analyzed statistically. RESULTS: A fractured clavicle occurred in 0.9% (34/3880) of vaginally delivered newborns; none occurred with an abdominal delivery. The only statistically significant risk factors were gestational age, shoulder dystocia, and newborn weight. No infant with fractured clavicle had a 5-minute Apgar score < 7, an abnormal cord blood pH, or an abnormal neurologic examination. CONCLUSIONS: We did not identify a specific perinatal factor that can be changed to avoid clavicle fracture. The injury appears to be an unavoidable event without permanent sequelae. Thus it is not an indicator for quality improvement.

Birth Injuries↗
PubMed1994

Carbohydrate metabolism studies after one year of using an oral contraceptive containing gestodene and ethinyl estradiol.

UNLABELLED: The objective of the study is to evaluate the effects of a gestodene-containing oral contraceptive on carbohydrate metabolism. The design of the study is prospective. The setting is at University of South Florida Outpatient Unit. The patients consisted of twenty-three normal women desiring contraception. Serum glucose and insulin levels were measured during a three-hour glucose tolerance test at control time and after one year of drug use. RESULTS: All of the one-year glucose values were significantly elevated as well as the fasting and three-hour insulin values. These changes were mostly confined to women over 26 years of age and not in the younger 18 to 23 year olds. An oral contraceptive containing 75 micrograms of gestodene and 30 micrograms of ethinylestradiol can significantly alter carbohydrate metabolism in older women.

Adolescent↗