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Biomedical subjects

A Golichowski

Publications and source records attributed to A Golichowski.

18 recordsLinked to original sources
PubMed1999

Is a third-trimester antibody screen in Rh+ women necessary?

OBJECTIVE: To determine the need for routine third-trimester antibody screening in Rh+ women. STUDY DESIGN: An analytic case-control study. METHODS: We identified Rh+ pregnant women who had received prenatal care and retrospectively analyzed their laboratory data. Patients were grouped into those with a positive third-trimester antibody screen (cases) and those with a negative third-trimester screen (controls). Because entry into a group was decided by the investigators, it could not be randomized. We reviewed the maternal medical records for antibody identification and final pregnancy outcome. We also reviewed the neonatal medical records for evidence of direct Coombs-positive cord blood, anemia, need for transfusion or phototherapy, other medical complications, and death. RESULTS: Using a computerized laboratory database from 2 teaching hospitals, we identified 10,581 obstetric patients who underwent routine first- and third-trimester antibody screening between 1988 and 1997. Of these, 1233 patients were Rh- and 9348 were Rh+. Among the Rh+ patients, 178 (1.9%) had 1 or more atypical antibodies at the first-trimester screen, and 53 (0.6%) had a positive third-trimester antibody screen despite a negative first-trimester screen. Although 6 of these 53 patients (0.06% of the study population) had clinically relevant antibodies for hemolytic disease of the new-born, no significant neonatal sequelae occurred among these 6 patients. CONCLUSION: Based on the patient and hospital records studied, a repeat third-trimester antibody screen for Rh+ patients is clinically and economically unjustified. Eliminating this laboratory test from clinical practice will not adversely affect pregnancy outcomes and will decrease the costs of prenatal care.

Autoantibodies↗
PubMed1997

Chlamydia trachomatis and febrile complications of postpartum tubal ligation.

OBJECTIVE: Our goal was to determine whether chlamydia-infected women have a higher rate of febrile complications after postpartum tubal ligation. STUDY DESIGN: Cross-sectional analysis of 1447 women tested for chlamydial infection within 2 weeks of delivery and who underwent postpartum tubal ligation was performed. Subjects were identified with the Regenstrief Institute for Health Care database. Infected subjects were compared with uninfected subjects for incidence of fever not explained by nongynecologic sources. RESULTS: Women infected with Chlamydia trachomatis at delivery were more likely to experience febrile postoperative complications after tubal ligation (p < 0.0001, relative risk 9.5, 95% confidence interval 4.5 to 20.1). CONCLUSION: Women undergoing postpartum tuba ligation may benefit from prompt diagnosis and preoperative treatment of chlamydial infection.

Adult↗
PubMed1997

Gestational diabetes mellitus and gene mutations which affect insulin secretion.

We investigated whether genetic mutations known to impair insulin secretion and glucose tolerance are operative in a group of American women with gestational diabetes mellitus. Study groups were comprised of elderly non-diabetic controls (n = 55) with normal glucose tolerance and patients with gestational diabetes (n = 50), together with one family with maturity-onset diabetes of the young (three controls and three affected). No mutations were detected in any exon of the human glucokinase gene or the mitochondrial tRNA[Leu](UUR) gene by single strand conformational analysis and direct exon sequencing. Also, chi2 analysis showed no significant association with gestational diabetes for a polymorphism at position -30 (G --> A) of the beta-cell-specific glucokinase gene promoter. We have determined that glucokinase and mitochondrial tRNA[Leu](UUR) gene mutations, which are known to impair insulin secretion are relatively uncommon and do not constitute a large component of genetic risk for gestational diabetes in the study population.

Adult↗
PubMed1997

Gestational diabetes: should it be added to the syndrome of insulin resistance?

OBJECTIVE: The significance of gestational diabetes mellitus (GDM) results from its short-term detrimental effects on the fetus and its long-term prediction of NIDDM in the mother. We compared several variables associated with insulin resistance between GDM and non-GDM pregnant women to show the similarities between GDM and NIDDM (and thus insulin resistance). RESEARCH DESIGN AND METHODS: On the basis of a 3-h oral glucose tolerance test (OGTT), 52 GDM patients and 127 non-GDM patients were recruited from pregnant, non-diabetic women who had a nonfasting 1-h-50-g glucose screening test > or = 7.2 mmol/l (130 mg/dl) performed between 16 and 33 weeks of gestation (a total of 518 of 3,041 women drawn from six community health care prenatal clinics were screened positive). During the OGTT, several potential markers of insulin resistance were measured at fasting and 2-h time points, in addition to the standard glucose measurements. The relationship of these variables with the diagnosis of GDM was studied. RESULTS: GDM patients, compared with non-GDM patients, had 1) higher prepregnancy weight (P = 0.011), prepregnancy BMI (P = 0.006), C-peptide at fasting (P = 0.002) and at 2 h (P < 0.001), insulin at fasting (P = 0.001) and at 2 h (P < 0.001), triglycerides at fasting (P = 0.005) and at 2 h (P = 0.003), free fatty acids at fasting (P = 0.017), beta-hydroxybutyrate at fasting (P = 0.007); and 2) lower HDL cholesterol at fasting (P = 0.029). These variables were all predictive of GDM (P < 0.036) individually. Using stepwise logistic regression with all of these variables available, fasting (P = 0.019) and 2-h (P < 0.001) insulin levels, fasting free fatty acids (P = 0.031), and fasting beta-hydroxybutyrate (P = 0.036) were statistically significant as jointly predictive of GDM. Comparisons between GDM patients and non-GDM patients matched by BMI confirmed that the metabolic abnormalities persisted when difference in BMI was taken into account. Concomitant blood pressure measurements in women with GDM did not differ significantly from those without GDM. CONCLUSIONS: Our results show that many of the known metabolic components of the syndrome of insulin resistance (syndrome X) are predictive of GDM. These results are in keeping with the argument that GDM is one phase of the syndrome of insulin resistance. We suggest that GDM be looked upon as a component of the syndrome of insulin resistance that provides an excellent model for the study and prevention of NIDDM in a relatively young age-group.

Adolescent↗
PubMed1992

Care of diabetic pregnant women by primary-care physicians. Reported strategies for managing pregestational and gestational diabetes.

OBJECTIVE: To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management. RESEARCH DESIGN AND METHODS: Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail. RESULTS: When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM (P = 0.03), use multiple-injection insulin regimens (P = 0.004) or self-monitoring of blood glucose (SMBG) (P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical (P = 0.01) or ophthalmologic (P less than 0.001) care. FPs were more likely to implement insulin therapy (P = 0.003), SMBG (P = 0.02), and examine eyes for retinopathy (P less than 0.001) when treating gestational patients. CONCLUSIONS: These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.

Blood Glucose Self-Monitoring↗
PubMed1991

Pregnancy associated with lupus anticoagulant and heparin induced thrombocytopenia: management with a low molecular weight heparinoid.

The management of pregnant patients with coagulopathies and heparin induced thrombocytopenia is difficult and poorly defined. We report the case of a patient who was treated with a low molecular weight heparinoid. The treatment was complicated by the delayed occurrence of thrombocytopenia and a thrombotic event. This is the first report of thrombocytopenia caused by heparinoid. It is possible that this complication could have been avoided by a shorter duration of treatment with heparinoid and the use of Vitamin K antagonists during the second trimester of pregnancy.

Adult↗
PubMed1991

Pregnancy-associated aplastic anemia--report of 3 cases.

3 patients with pregnancy-associated aplastic anemia are reported. Management throughout most of the pregnancy consisted of supportive care. In 2 patients an improvement in blood counts occurred after delivery and, in 1 of these, the pancytopenia recurred during a subsequent pregnancy. In 1 case no improvement occurred after delivery and the patient ultimately required an allogeneic bone marrow transplantation. The outcome of these 3 cases demonstrates that pregnancy-associated aplastic anemia can be managed successfully. The improvement that often occurs after delivery suggests a pathogenetic role for pregnancy in the development of this disease.

Adult↗
PubMed1990

Bone dysplasias: the prenatal diagnostic challenge.

The prenatal diagnosis of bone dysplasias presents difficult challenges for the clinician involved in monitoring pregnancies. Such diagnoses highlight delicate ethical issues and may require difficult decision-making when the differential diagnosis includes a lethal bone dysplasia. Despite the rapid technological advances in ultrasonography, the ability to make prenatal diagnoses within this group of disorders is limited by the restricted ultrasonographic capability to appreciate fully the detailed fetal anatomy. However, we perceive that a significant further limitation involves the lack of a systematic protocol to guide the clinician in the ultrasonographic evaluation of a fetus suspected of having a skeletal dysplasia. In an attempt to aid the clinician who is evaluating these suspected pregnancies, we report here 8 cases and propose a model protocol for the ultrasonographic diagnostic approach to fetal skeletal problems in utero.

Adolescent↗
PubMed1990

Secretion of nizatidine into human breast milk after single and multiple doses.

Disposition of the H2-receptor antagonist nizatidine was studied in serum, urine, and breast milk. Five lactating women and five nonlactating women participated; the disposition of nizatidine was studied in three of the lactating women. Single and multiple doses of 150 mg nizatidine were administered orally. The disposition of nizatidine (half-life, 1 1/2 hours; apparent serum clearance, 40 L/hr; renal clearance, 27 L/hr; and apparent volume of distribution, 1.4 L/kg) was similar in lactating and nonlactating women. These pharmacokinetic results were analogous to observations for men in other studies. Nizatidine breast milk concentrations were directly proportional to corresponding serum concentrations. On average, 96 micrograms nizatidine, less than 0.1% of the maternal dose, was secreted into milk during a 12-hour interval after either single or multiple doses.

Adult↗
PubMed1987

Hydrops fetalis.

Explore the source record for details and available documents.

Blood Group Incompatibility↗
PubMed1981

Respiratory distress associated with elective repeat cesarean section. A two-year experience in one medical community.

One hundred and forty-five elective repeat cesarean sections performed in one large medical community during a two-year period were studied. Ninety-nine of the patients had no prenatal test for determination of pulmonary or fetal maturity; 18 patients had an amniocentesis for L/S ratio. Only two infants were thought to be delivered prematurely, at 37 weeks gestational age. One of these infants had no respiratory distress. The other infant was delivered before the EDC by menstrual dates because a single ultrasound measurement performed one week before delivery suggested a "term fetus", and this infant had severe hyaline membrane disease. Six other infants had mild respiratory distress compatible with transient tachypnea or aspiration. In this medical community, one must question whether the risk of routine amniocentesis for L/S ratio before every elective repeat cesarean section might outweigh the potential benefits of the procedure.

Amniocentesis↗
PubMedDate not supplied

Image acquisition context: procedure description attributes for clinically relevant indexing and selective retrieval of biomedical images.

OBJECTIVE: To support clinically relevant indexing of biomedical images and image-related information based on the attributes of image acquisition procedures and the judgments (observations) expressed by observers in the process of image interpretation. DESIGN: The authors introduce the notion of "image acquisition context," the set of attributes that describe image acquisition procedures, and present a standards-based strategy for utilizing the attributes of image acquisition context as indexing and retrieval keys for digital image libraries. METHODS: The authors' indexing strategy is based on an interdependent message/terminology architecture that combines the Digital Imaging and Communication in Medicine (DICOM) standard, the SNOMED (Systematized Nomenclature of Human and Veterinary Medicine) vocabulary, and the SNOMED DICOM microglossary. The SNOMED DICOM microglossary provides context-dependent mapping of terminology to DICOM data elements. RESULTS: The capability of embedding standard coded descriptors in DICOM image headers and image-interpretation reports improves the potential for selective retrieval of image-related information. This favorably affects information management in digital libraries.

Abstracting and Indexing↗
PubMedDate not supplied

Pregnancy following renal transplantation in a patient with insulin-dependent diabetes mellitus.

Renal transplantation and peritoneal or hemodialysis are therapeutic options increasingly available to diabetic patients with uremia. We report a patient with insulin-dependent diabetes mellitus (IDDM) and advanced retinopathy and nephropathy who had three pregnancies. Her first pregnancy resulted in a living female with Pierre-Robin syndrome and arthrogryposis. The second pregnancy, 8 mo post-kidney transplantation, necessitated a therapeutic abortion for an anencephalic fetus. Her third pregnancy, 22 mo after kidney transplantation, was associated with intensive diabetes management and resulted in delivery by cesarean section of a healthy boy. Renal and retinal function remained stable during both her second and third pregnancies. As more patients with IDDM achieve fertility post-renal transplantation, aggressive principles of diabetes regulation need to be expanded to include consideration of the interaction of the post-kidney-transplant state and diabetes mellitus during pregnancy.

Adult↗
PubMedDate not supplied

Insulin-like growth factors I and II peptide and messenger RNA levels in macrosomic infants of diabetic pregnancies.

OBJECTIVE: Fetal macrosomia is a common complication of maternal diabetes mellitus and is associated with substantial morbidity, but the precise cellular and molecular mechanisms that induce fetal macrosomia are not well understood. We hypothesized that the macrosomia or accelerated fetal growth seen in infants of diabetic mothers is due to a perturbation of a putative placental-fetal growth axis involving growth hormone and insulin-like growth factors. Insulin-like growth factors I and II (IGF-I and IGF-II) are ubiquitous peptides that share structural homology with insulin and have been implicated in processes that control fetal growth. Studies of IGF levels in pregnancies complicated by diabetes and macrosomia have shown conflicting results. We set out to resolve these inconsistencies using molecular techniques to measure the placental IGF-I and IGF-II messenger RNA levels in placentas and a specific radioimmunoassay to measure IGF-I and IGF-II peptide levels in cord serum of normal and diabetic pregnancies. METHODS: Placentas and cord blood were collected immediately after delivery at term from patients from each of three study groups: 1) nonmacrosomic infants of nondiabetic mothers (controls), 2) macrosomic infants of diabetic mothers, and 3) nonmacrosomic infants of diabetic mothers. Both IGF-I and IGF-II levels were measured in cord serum and placental tissue by a specific radioimmunoassay. Total RNA was extracted and analyzed by Northern gels hybridized to IGF-I or IGF-II riboprobes. RESULTS: Levels of IGF-I in cord serum from the macrosomic diabetic group (83 +/- 4.2 ng/mL) were significantly higher than levels from either the nonmacrosomic nondiabetic group (38 +/- 1.9 ng/mL) or the nonmacrosomic diabetic group (13 +/- 3.5 ng/mL). There was a direct linear correlation between cord serum IGF-I and infant birth weight, independent of diabetes (r2 = 0.61, P < .01). On the other hand, IGF-II cord serum levels were elevated in diabetic pregnancies (337 +/- 12.2 ng/mL) compared with nondiabetic women (172 +/- 19.8 ng/mL), but there was no correlation with birth weight (r2 = 0.035, P = .52). In contrast to cord blood levels, IGF-II peptide levels were significantly decreased in the placentas from mothers with diabetes compared with nondiabetic controls (116 +/- 3.2 versus 158 +/- 5.3 ng/mL, respectively). Levels of IGF-I peptide in placentas from both nondiabetic controls and diabetic mothers were below the sensitivity of the assay. Levels of IGF-I and IGF-II mRNA did not differ in placentas from diabetic mothers versus nondiabetic controls. CONCLUSION: Cord serum IGF-II levels are elevated in diabetic pregnancies without a concomitant increase in placental IGF-II levels. This novel finding, combined with the finding that IGF-I levels are correlated with macrosomia independent of the diabetic state, contributes to our understanding of the possible mechanisms involved in fetal growth in pregnancies complicated by diabetes.

Birth Weight↗