Biomedical subjects
B N Walters
Publications and source records attributed to B N Walters.
Hypertension in the puerperium.
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Placental glycolysis and energy metabolism in preeclampsia.
We examined the possibility that in preeclampsia complicated by fetal growth retardation, placental energy state is low either because of impaired glycolysis or because of ischemia resulting from reduced maternal placental blood flow. Concentrations of pyruvate and lactate, but not of glycogen and glucose, were significantly low in placentas of mothers with severe preeclampsia, supporting previous indirect evidence of inhibited glycolysis. Nevertheless, direct measurements of adenine nucleotide concentrations did not indicate reduced placental energy level in the preeclamptic placentas. This along with a lack of change of the ratio of lactate/pyruvate concentration (an indication of the redox state of cytoplasmic reduced nicotinamide adenine dinucleotide/nicotinamide adenine dinucleotide) is also evidence against the hypothesis of general placental ischemia leading to energy deficiency. However, as glycolysis is an important source of precursors, particularly pyruvate, for synthesis of amino acids and lipids, these results suggest that there is a significant metabolic abnormality in placentas of mothers with severe preeclampsia.
Suppression of lactation.
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Blood pressure in the puerperium.
Blood pressure was measured by random zero sphygmomanometer in the morning and afternoon for 5 days after normal delivery in a group of 136 previously normotensive women. The number of women studied each day varied from 32 to 125. The afternoon blood pressure was higher than the morning blood pressure (differences: 1.7 mmHg systolic, 2.6 mmHg diastolic; P less than 0.05). Both systolic and diastolic blood pressures rose for the first 4 days after delivery. The average rise over the whole period was about 6 mmHg systolic and 4 mmHg diastolic (P less than 0.05). A considerable number of previously normotensive women displayed elevations of blood pressure in the puerperium. Twelve per cent of all patients exceeded a diastolic blood pressure of 100 mmHg.
Prophylaxis of thromboembolism in pregnancy: an alternative.
Twenty-six pregnancies in women who had one or more episodes of thromboembolism in the past were managed by a regimen in which routine antenatal prophylactic anticoagulation was not given, apart from during delivery which was covered with intravenous infusion of dextran 70. After delivery, these patients received either subcutaneous heparin for 6 weeks or subcutaneous heparin for 1 week, followed by 5 weeks of warfarin. One patient (4%) possibly developed an episode of thromboembolism in the antenatal period. There were no episodes of postnatal thromboembolism. There were two spontaneous mid-trimester abortions and no perinatal losses. There were no significant complications or reactions related to the use of dextran, heparin or warfarin.
alpha-Fetoprotein elevation and proteinuric pre-eclampsia.
In a retrospective study of pregnancy complicated by unexplained elevation of maternal serum alpha-fetoprotein (AFP), 60 patients were compared with 120 control subjects. Proteinuric pre-eclampsia occurred in 13% of the study patients compared with 1% of the control subjects. Primiparity, previous mid-trimester abortion and recurrent abortions were also significantly more common in the study group. It is proposed that an abnormality of the placenta predisposes to complications and that this abnormality is expressed early in pregnancy when the AFP level is first measured. This group of women is at high risk of adverse pregnancy outcome and requires careful monitoring.
Pain relief after episiotomy--a comparative study of suprofen and dihydrocodeine.
In a single-dose, randomized, double-blind study of 100 women, suprofen and dihydrocodeine were compared in the relief of pain after episiotomy. The drugs were equal in terms of analgesic efficacy, duration of analgesia and onset of action. Neither drug demonstrated any serious adverse effects.
Pseudoxanthoma elasticum and pregnancy. Two case reports.
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Treatment of severe pregnancy-associated hypertension with the calcium antagonist nifedipine.
The calcium antagonist, nifedipine, was given orally to 21 women with acute episodes of severe hypertension during pregnancy or in the puerperium. A rapid and significant fall in blood pressure by an average of 26/20 mmHg was seen at 20 min after administration. The hypotensive effect was not significantly enhanced in those women already taking medication to lower the blood pressure. The principal side effects were headache and cutaneous flushing. No adverse fetal effects were detected. This is the first study of the use of this drug to control hypertension in pregnancy. The apparent efficacy of nifedipine justifies its further investigation in controlled trials.
Bell's palsy and cytomegalovirus mononucleosis in pregnancy.
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Urgent treatment of acute hypertension.
Acute severe elevation of the blood pressure is a life-threatening event which requires prompt and effective action. Comparative studies of the agents discussed are lacking. Also, hypertensive crises occur in diverse clinical settings and afflict a heterogeneous group of patients. No single drug is ideal in all situations and treatment must be chosen to suit the individual patient.
Severe pre-eclampsia of early onset.
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Mineral content of the forearms of babies born to Asian and white mothers.
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Neonatal listeriosis: a summer outbreak.
Neonatal listeriosis, a condition associated with high morbidity and mortality, has been reported infrequently in Australia, with only seven isolated cases appearing in the literature. This paper describes 12 cases of neonatal listeriosis diagnosed in two Western Australian hospitals in the 22 months after January, 1978. These were the only cases diagnosed at these hospitals between 1970 and December, 1980. The early onset form of the disease was diagnosed in 11 infants, a group characterized by the frequent associations of low birthweight (mean, 1805 g; range, 1200 g to 2670 g), preterm delivery (gestational age: mean, 33 weeks; range, 28 weeks to 38 weeks), maternal fever at the onset of labour, meconium-stained liquor, low Apgar scores, respiratory distress and septicaemia. The delayed-onset form was diagnosed in one full-term infant (birth-weight, 3050 g) with probable meningitis at one week of age. The over-all mortality rate of 17% was low, perhaps as a result of the early institution of treatment and prompt transfer to a neonatal intensive care unit. Ten of the 12 cases presented during the hottest, driest period of the year. No other common epidemiological factor was identified.
Tetracycline and benign intracranial hypertension: report of five cases.
Benign intracranial hypertension occurred in four young women taking tetracycline for acne; two were also taking vitamin A. In a fifth case a 14-year-old boy developed papilloedema after taking a short course of tetracycline for bronchitis. All symptoms disappeared soon after stopping the drugs, though in two cases the papilloedema persisted for many months. Benign intracranial hypertension should be sought in any young woman complaining of headache during treatment with tetracycline. Moreover, young women given vitamin A and tetracycline in combination for acne may be at special risk and should be kept under surveillance.