Biomedical subjects

Burton Rochelson

Publications and source records attributed to Burton Rochelson.

9 recordsLinked to original sources

PubMed2006

Magnesium sulfate suppresses inflammatory responses by human umbilical vein endothelial cells (HuVECs) through the NFkappaB pathway.

Dysfunctional endothelial cell activation and cytokines are implicated in preterm labor, a condition commonly treated with the tocolytic agent, magnesium sulfate (MgSO(4)). Based on recent findings showing the inflammatory effects of magnesium deficiency, we examined the effect of MgSO(4) on human umbilical vein endothelial cell (HuVEC) inflammatory responses in vitro. HuVECs isolated from term umbilical cords were incubated with MgSO(4) prior to stimulation with lipopolysaccharide (LPS) and then assessed for endothelial cell activation. Endothelial cell supernatants were assayed for inflammatory mediator production (interleukin-8; IL-8), and endothelial cell-associated intercellular adhesion molecule (ICAM-1) expression was determined. In the absence of LPS stimulation, MgSO(4) had no effect on HuVEC responses. Treatment of HuVECs with MgSO(4) prior to LPS stimulation inhibited inflammatory mediator production (p<0.05) and cell adhesion molecule expression (p<0.05) in a dose-dependent manner. Mechanistic studies showed that MgSO(4) reduced NFkappaB nuclear translocation and protected cytoplasmic IkappaBalpha from degradation in LPS-treated HuVECs. In conclusion, MgSO(4) inhibits endothelial cell activation, as measured by levels of IL-8 and ICAM-1 expression, via NFkappaB. Our results support the hypothesis that MgSO(4) treatment may function as an anti-inflammatory agent during preterm labor.

Active Transport, Cell Nucleus↗

PubMed2006

Umbilical cord stricture and overcoiling are common causes of fetal demise.

Although umbilical cord stricture and umbilical cord overcoiling have been established as causes of intrauterine fetal demise, relatively few studies addressed this issue, most of them being case reports. We reviewed a total of 268 fetal autopsies during a 3-year period from 1998 to 2001. One hundred thirty nine cases of fetal demise including spontaneous abortion were identified. Nineteen percent (26 of 139) were associated with umbilical cord stricture, overcoiling, or a combination of both. Stricture of the umbilical cord was defined as a decrease in diameter in relation of the remaining umbilical cord; overcoiling as 0.3 coil/cm or greater. Fetal demise most commonly occurred in the second trimester, with a mean gestation age of 21 weeks. The average maternal age was 33 years; 15% had a prior fetal demise. We found that 77% (20 of 26) of these cases had umbilical cord stricture only or with overcoiling, 23% (6 of 26) had umbilical cord overcoiling alone. Localized deficiency of Wharton's jelly and increased collagen were found in all cases with umbilical cord stricture with or without overcoiling. In patients with umbilical cord overcoiling alone, 25% had Wharton's jelly deficiency; half of them had increased collagen deposition in the umbilical cords. The placenta was reviewed for secondary thrombosis of the vessels of the chorionic plate. Thrombosis of the vessels of the chorionic plate was noted in 54% of the patients. Our study suggests that umbilical cord stricture and cord overcoiling may represent two distinct pathological entities commonly causing fetal demise. This observation reinforces the importance of a fetal autopsy with careful examination of the placenta and umbilical cord with documentation of the cord coil index.

Adult↗

PubMed2005

Failure of selective termination and dexamethasone rescue therapy to arrest HELLP syndrome in a midtrimester triplet gestation with one triploid fetus.

We present a case of a patient with a triplet pregnancy at 22 weeks with one triploid fetus (69XXX) who developed severe preeclampsia that did not reverse with dexamethasone rescue therapy and selective termination. With multiple gestations on the rise and the early diagnosis of abnormal pregnancies being accomplished through ultrasound, serum markers, and invasive procedures, the question remains if there is a point in gestation before which selective termination of an abnormal fetus would allow the pregnancy to continue without preeclampsia developing or progressing. Appropriate counseling as to the maternal risk in cases of trisomy 13 or triploidy is essential as early in pregnancy as possible.

Adult↗

PubMed2005

Previous preterm cesarean delivery: identification of a new risk factor for uterine rupture in VBAC candidates.

OBJECTIVE: A major risk of trials of labor in patients with prior cesarean delivery is uterine rupture. We evaluated the question of whether a previous cesarean delivery at an early gestational age predisposes the patient to subsequent uterine rupture. METHODS: This was a retrospective chart review of patients delivering at North Shore University Hospital with a trial of labor after previous cesarean delivery to ascertain all cases of uterine rupture. Patients who had had a previous cesarean delivery at our institution who did not suffer uterine rupture during a trial of labor served as controls. RESULTS: Twenty-five patients suffered a uterine rupture. The incidence of prior preterm cesarean delivery (PPCD) in this group was 40%, compared to 10.9% of 691 laboring vaginal birth after cesarean (VBAC) patients without rupture (p < 0.001). Patients in the rupture group with a PPCD were less likely to have experienced labor in the index pregnancy and more likely to have had an interdelivery interval of less than two years. CONCLUSIONS: An undeveloped lower segment in the preterm uterus represents a risk for later rupture, even if the incision is transverse.

Birth Intervals↗

PubMed2003

D-O-G years.

Explore the source record for details and available documents.

Humans↗

PubMed2003

Insulin resistance complicating pregnancy in a human immunodeficiency virus-infected patient treated with protease inhibitors and corticosteroids.

BACKGROUND: Protease inhibitor therapy in human immunodeficiency virus (HIV)-infected adults has been associated with onset or aggravation of glucose intolerance. We report a case of a pregnant HIV-infected woman receiving highly active antiretroviral therapy who developed acute onset of severe insulin resistance during treatment for preterm labor. CASE: A 26-year-old multigravida with HIV infection treated with highly active antiretroviral therapy presented in preterm labor. During treatment, including corticosteroids for fetal lung maturity, severe hyperglycemia and ketonemia suggestive of diabetic ketoacidosis were detected. Aggressive intravenous fluid and insulin therapy was necessary to correct hyperglycemia. CONCLUSION: We found that HIV-positive pregnant women receiving highly active antiretroviral therapy may be at increased risk for development of glucose intolerance. The use of medications that impair glucose tolerance, for example, corticosteroids, may have a synergistic effect in aggravating insulin resistance. Additional screening for glucose intolerance later in the third trimester should be considered in these patients.

Adult↗

PubMed2003

Three-dimensional sonographic findings in congenital (harlequin) ichthyosis.

Harlequin ichthyosis is a lethal autosomal recessive disorder characterized by an extremely thickened keratin layer of skin, flattened ears, and diffuse platelike scales. Prenatal sonographic diagnosis has been described, with findings of a persistently open mouth, echogenic amniotic fluid, and fixed flexion of the extremities. Here we describe a case of harlequin ichthyosis in which the syndromic features were shown best on three-dimensional (3D) and four-dimensional (4D) real-time sonography.

Adult↗

PubMed2003

Low prepregnancy ideal weight:height ratio in women with hyperemesis gravidarum.

OBJECTIVE: To determine if a low prepregnancy weight:height ratio is a risk factor for hyperemesis. STUDY DESIGN: A retrospective chart review was conducted on 38 patients admitted to North Shore University Hospital for hyperemesis over a 5-year period. Prepregnancy weight, body mass index and percent ideal weight:height ratio in this group were compared to findings on 79 randomly selected control patients not admitted for hyperemesis. RESULTS: There was a significantly higher incidence of prepregnancy underweight women (low percent ideal weight for height) in patients admitted for hyperemesis as compared to controls (P < .01). Thyroid-stimulating hormone was low in 19% of patients tested. CONCLUSION: A low prepregnancy percent ideal weight:height ratio may predispose women to the development of hyperemesis.

Adult↗

PubMed2003

Use of a temporary vena cava filter in a woman with septic abortion and inferior vena cava thrombosis. A case report.

BACKGROUND: Ovarian vein and inferior vena cava (IVC) thrombosis are rare but life-threatening complications of severe obstetric infections. IVC filters have been used to reduce the risk of pulmonary embolus in patients who have recurrent thrombotic and embolic events or underlying risk factors. More recently, retrievable IVC filters have been used in patients in whom the risk is transient. CASE: At 18 weeks' gestation a multigravida with a fetus with anencephaly became septic after Laminaria placement and rupture of the membranes. She developed ovarian vein and IVC thrombosis and was treated successfully with a retrievable IVC filter, anticoagulation and antibiotics. The filter was removed after 9 days. CONCLUSION: In young patients at transient risk for emboli and requiring placement of an IVC filter, a retrievable filter should be considered to reduce the long-term risks of an indwelling filter.

Abortion, Induced↗