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Biomedical subjects

A I Goldstein

Publications and source records attributed to A I Goldstein.

At least 19 recordsLinked to original sources
PubMed1984

Safety and efficacy of vaginal prostaglandin E2 suppositories in the management of third-trimester fetal demise.

Prostaglandin E2 vaginal suppositories are well established in the management of intrauterine fetal demise in the second trimester of pregnancy. However, approval for their use in the third trimester has been withheld pending evaluation of safety and efficacy. In this study 46 patients with intrauterine fetal demise in the third trimester were managed in a similar fashion except that only a 10-mg dose of prostaglandin E2 was employed. Forty-four of the 46 patients were delivered successfully. One patient experienced a cervical laceration that necessitated a hysterectomy; in her, oxytocin was used to supplement the prostaglandin. It appears that prostaglandin E2 vaginal suppositories can be used safely in the management of fetal demise in the third trimester of pregnancy. Use of a lower dose of the medication as well as tocodynamometry is recommended because the absorption of and sensitivity to this medication vary from patient to patient. The frequency of administering the medication should depend on the patient's response rather than on any given formula.

Adolescent↗
PubMed1983

Midtrimester amniocentesis in twin pregnancies.

Twenty-two twin pregnancies were subjected to second-trimester genetic amniocentesis. Arguments for and against tapping both sacs were discussed. Nineteen of the 22 patients studied underwent amniocentesis because of advanced maternal age (35 years or greater). The remaining indications included previous omphalocele, previous Down's syndrome, and previous neural tube defect. Except for one instance, amniotic fluid was obtained from both sacs. There were no other adverse sequelae other than transient leakage of fluid in one case. Two sets of twins were stillborn; in neither case was there a temporal relationship between the procedure and the fetal loss. Furthermore, there was no clinical or postmortem evidence that in any way could implicate the procedure as the cause of the fetal death. Based on literature review and the cases cited in the present investigation, it is the opinion of the authors that these procedures are safe when performed by experienced personnel under ultrasonic guidance.

Adult↗
PubMed1983

Preoperative cervical dilatation with a single long-acting prostaglandin analog suppository. An alternative to traumatic mechanical dilatation before surgical evacuation.

A single vaginal suppository containing 1 mg of 15-methyl prostaglandin F2 alpha methyl ester induced cervical dilatation in 60 patients requesting surgical termination of pregnancy. Forty-two percent of the patients required no further dilatation. Even when further dilatation was required, it was performed with considerable ease due to the softening effects of the prostaglandin on the cervix. The use of this agent may be of value in preventing complications resulting from mechanical dilatation of the cervix.

Abortion, Induced↗
PubMed1981

Oral contraceptives and hepatic vein thrombosis.

The purpose of this paper is to report on three cases of the Budd-Chiari syndrome in young women who were taking oral contraceptives. Two patients survived, with gradual resolution of hepatomegaly and ascites following discontinuance of the birth control pills. One death occurred soon after the patient's admission to the hospital. The pathophysiology of this phenomenon involves two major aspects. Oral contraceptives are known to cause a hypercoagulation state as well as a direct effect on the blood vessels. In this series the combination of hypercoagulation and progressive occlusion of the vessels in patients on oral contraceptives appeared to lead to the development of thrombosis of the liver vessels.

Adult↗
PubMed1981

Unilateral renal agenesis associated with vaginal or cervical fistula and anomalous uterine development.

Two patients with unexplained profuse vaginal discharge were noted to have anomalous uterine development associated with renal agenesis. Fistulous communication between a mesonephric duct remnant and the vagina or cervix was noted as the cause of the discharge. A previous report by one of the authors described two similar cases. Physicians should be alert to this syndrome as a cause of leukorrhea.

Adolescent↗
PubMed1980

Clinical evaluation of a single antibody RIA assay for alpha-fetoprotein.

Open neural tube defects have been associated with elevated levels of alpha-fetoprotein in maternal serum and amniotic fluid. In the present study, specimens were collected during 14 to 20 weeks of gestation in five laboratories. Dates were confirmed by ultrasound. Among 1,049 subjects included in total serum alpha-fetoprotein determinations, 25 infants were born with neural tube defects, one patient had intrauterine fetal demise, and 1,023 delivered normal infants. The false-negative rate for serum alpha-fetoprotein was 0.38%, and the false-positive rate was 0.29%. For the total 1,211 amniotic fluid specimens, 23 infants were born with neural tube defects. The false-negative rate for amniotic fluid alpha-fetoprotein was 0.25%. All were closed lesions. There were no false-positive values. This study reaffirms the value of screening for neural tube defects by means of serum alpha-fetoprotein RIA. It also negates the argument that serum screening would promote excessive amniocentesis.

Amniotic Fluid↗
PubMed1978

Perinatal outcome in the diabetic pregnancy: a retrospective analysis.

A retrospective analysis was done of all pregnancies in class B through R diabetics over a two-and-one-half-year period. This study demonstrates that early hospitalization, assessment of fetal status via estriols and oxytocin challenge test, fetal maturity studies, close medical supervision of the diabetes problem and advances in neonatology have combined to significantly reduce perinatal morbidity and mortality. The expense of prolonged maternal hospitalization is justified by the savings in newborn and child care, which would otherwise be increased. This approach can be used in any obstetric center. The philosophic question is discussed of the increased incidence of congenital malformations and diabetes in offspring of diabetic mothers.

Apgar Score↗
PubMed1977

Minimizing the risk of amniocentesis for prenatal diagnosis.

Although the risk of amniocentesis in the second trimester of pregnancy is small, untoward sequelae can be further reduced. One hundred twenty amniocenteses were attempted during a two-year period. In eight instances, the patient had to return for a second tap because of bacterial contamination, inadequate number of fetal cells, or inability to obtain amniotic fluid. These eight patients all underwent repated amniocentesis and successful karyotyping. There were no major complications and one minor complication. Two spontaneous abortions were not apparently related to the procedure. In both these cases, fluid could not be obtained because one patient had a blighted ovum with a small sac and the other had large uterine fibromyomas.

Adult↗
PubMed1976

Abnormal cervical cytology in the teen-ager: a continuing problem.

Abnormal cervical cytology is being discovered in an alarming number of sexually active teen-agers. Over an 18 month period, cytology consistent with mild dysplasia or worse was noted in 188 of 2,655 teen-agers screened. This represents a rate of 70.8 per thousand. Colposcopically directed biopsies in 65 patients revealed 15 cases of severe dysplasia-carcinoma in situ. Cryosurgery was the principle method of treatment and, combined with colposcopy, is a safe and effective means of managing these patients.

Adolescent↗
PubMed1976

The making of a colposcopist. A safe and sensible approach.

A program was established to determine the accuracy of colposcopy at our institution. Forty-three patients with cytologic or histologic evidence of severe dysplasia or worse underwent diagnostic conization following satisfactory colposcopy. Thirty patients subsequently had either therapeutic conization or hysterectomy preceded by biopsy only. In all 73 cases, the surgical specimen did not reveal a more advanced lesion. However, when the colposcopy was unsatisfactory, the rate of error was 20.8%. It is our opinion that colposcopy is a safe and valuable technique as long as one recognizes the need for training and understands the indications for further diagnostic studies. The use of the colposcope for the evaluation of abnormal cervical cytology has increased steadily over the last few years, and several excellent courses are now offered throughout the United States. Armed with a certificate from such a course, many gynecologists then become self-proclaimed colposcopists in spite of warnings to the contrary by the instructors. In addition, supervision by experienced personnel is not always available. How, then, does one indeed become an accomplished colposcopist to the point that he or she can safely spare the patient the risk, inconvenience and expense of diagnostic cervical conization? Although several recent publications 2,5,6,9,11 document the diagnostic accuracy of colposcopically directly biopsies, we feel each individual should develop and evaluate his or her own skill before altering or abandoning conventional methods of diagnosis and management. The purpose of this report is to present our experience with colposcopy utilizing a program which can perhaps serve as a model to other clinicians.

Biopsy↗
PubMed1976

Experience with the use of the Carboflator for establishing pneumoperitoneum.

Safe and adequate pneumoperitoneum is dependent upon intraperitoneal pressure and not upon the number of liters of gas insufflated. Volume of gas delivered depends upon the size of the patient and whether there is any possible leakage. The Carboflator is a useful instrument for establishing controlled insufflation of gas and fail-safe intraperitoneal pressure.

Laparoscopes↗
PubMed1976

Prostaglandin E2 induction of labor for fetal demise.

Intrauterine fetal demise is a source of anxiety to both patient and physician. Heretofore, the standard treatment was either careful observation until the patient went into labor or attempt at induction of labor with oxytocin. Unfortunately, oxytocin stimulation has not proven to be uniformly successful for this problem. Prostaglandin E2 suppositories have been shown to be effective in inducing uterine evacuation after intrauterine fetal demise. In the opinion of the authors, this approach will in the future replace the sometimes dangerous and emotionally laden convention of watchful delayed therapy.

Adolescent↗