PubMed Health⌕ Search

Biomedical subjects

C L Cetrulo

Publications and source records attributed to C L Cetrulo.

At least 19 recordsLinked to original sources
PubMed2000

Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique.

Carbon dioxide (CO2) laser blepharoplasty with orbicularis oculi muscle tightening and periorbital skin resurfacing is a safe procedure that produces excellent aesthetic results and diminishes the occurrence of complications associated with skin and muscle resection in the lower lid, particularly permanent scleral show and ectropion. The authors present a review of 196 cases of carbon dioxide laser blepharoplasty and periocular laser skin resurfacing performed at their center from April of 1994 to September of 1998. Of these cases, 113 patients underwent four-lid blepharoplasty, 59 underwent upper lid blepharoplasty only, and 24 underwent lower lid blepharoplasty only. Prophylactic lateral canthopexy was performed in 24 patients. Concomitant procedures (brow lift/rhytidectomy/rhinoplasty) were performed in 92 patients. The carbon dioxide laser blepharoplasty procedure resulted in no injuries to the globe, cornea, or eyelashes. Combined with laser tightening of the orbicularis oculi muscle and septum and periocular skin resurfacing, the transconjunctival approach to lower blepharoplasty preserves lower lid skin and muscle. Elimination of the traditional scalpel skin/muscle flap procedure results in a dramatically lower complication rate, particularly with regard to permanent ectropion and scleral show. Laser shrinkage of the orbicularis muscle and septum through the transconjunctival incision enables the correction of muscle aging changes such as orbicularis hypertrophy and malar festoons. The addition of periocular resurfacing enables the correction of skin aging changes of the eyelid that are not addressed by traditional scalpel blepharoplasty. In addition, lateral canthopexy constitutes an important adjunct to the laser blepharoplasty procedure for the correction of lower lid canthal laxity.

Blepharoplasty↗
PubMed1999

Tubulation repair of peripheral nerves in the rat using an inside-out intestine sleeve.

This study compared the regeneration of peripheral nerves in the Sprague-Dawley rat through a nerve guide prepared from rat small intestine to nerve regeneration using a standard autogenous nerve-graft repair strategy. In one experimental group (n = 15), inside-out rat intestine sleeves were used as nerve guides to bridge a 10-mm defect created in the right sciatic nerve. These nerve guides were prepared by harvesting 14-mm segments of small intestine from Sprague-Dawley rats not otherwise used in the study. The segments were turned inside-out to expose the serosa as the lumen of the guide, and transected nerve stumps were secured 2 mm into the guide on each end with an epineural-to-guide stitch. The control group (n = 15) had an identical gap repaired with a standard autologous nerve graft. Five animals from each group were sacrificed at 4, 8, and 12 weeks. The extent of axonal regeneration was assessed by axon-counting, retrograde tracer analysis, electromyography, and qualitative histologic assessment. The inside-out intestine sleeve group exhibited faster conduction velocities and greater axon counts when compared to the autologous nerve-graft controls. These novel nerve guides proved simple to manufacture and were completely absorbed by 12 weeks.

Animals↗
PubMed1999

Suction-assisted lipectomy for lipodystrophy syndromes attributed to HIV-protease inhibitor use.

The addition of HIV-protease inhibitors to the arsenal of therapies for the treatment of HIV infection has resulted in significant suppression of viral load such that HIV-positive individuals experience reduced morbidity and extended life expectancy. Recently, a number of syndromes have been described involving abnormal fat distribution that may be associated with prolonged HIV-protease inhibitor therapy. These syndromes include hypertrophy of the cervicodorsal fat pad ("buffalo hump"); a tendency toward increased central adiposity ("protease paunch"); adiposity in the submental, mandibular, and lateral cheek regions of the face; and hypertrophy of adipose tissue in the breast in women. A peripheral lipodystrophy, or fat-wasting, in the extremities and face (particularly the malar and nasolabial fold regions) has also been observed. As these patients live longer and healthier lives, many are beginning to seek surgical correction of the disfigurements. In this regard, we present a review of the literature regarding these recently described syndromes to familiarize plastic and reconstructive surgeons with the unique deformities encountered in this ever-increasing patient population. We also present our results with suction-assisted lipectomy for treatment of these deformities. Physical findings, pathogenesis, and surgical management are discussed.

Adult↗
PubMed1998

Hyaluronic acid enhances peripheral nerve regeneration in vivo.

Hyaluronic acid has been shown to enhance peripheral nerve regeneration in vitro. It has been proposed that, during the fibrin matrix phase of regeneration, hyaluronic acid organizes the extracellular matrix into a hydrated open lattice, thereby facilitating migration of the regenerating axons. Hyaluronic acid solutions and saline control solutions were injected into a nerve guide spanning a transected gap in the sciatic nerve of Sprague-Dawley rats (five in each group). Nerve conduction velocities were measured at 4 weeks by electromyography (EMG) before sacrifice of the animals. These studies demonstrated increased conduction velocities in the hyaluronic acid group compared with control animals (P = 0.006). After the animals were sacrificed, regenerated axon cables were quantified histologically, and axon branching was delineated by retrograde tracer analysis. In addition, the hyaluronic acid group showed an increase in myelinated axon counts at 4 weeks (P= 0.03). An increase in retrograde flow was demonstrated in the hyaluronic acid groups compared with animals receiving saline solution.

Animals↗
PubMed1996

Collection and cryopreservation of cord blood for the treatment of hematopoietic disorders: the obstetrician's overview.

Bone marrow transplantation provides successful treatment for many diseases of the immune and hematopoietic systems. The main therapeutic ingredient in this procedure is stem cells collected from the bone marrow. Recently, it has been demonstrated that stem cells from human umbilical cord blood can serve as an alternative to bone marrow transplantation in children. Although cord blood transplantation in adults has not yet been attempted, it appears that there are enough stem cells present in cord blood for successful engraftment in adults. Obstetric health care providers should be aware that many familial conditions are treatable by cord blood stem cell transplantation in children. Obstetric health care providers caring for patients with familial disorders should consider counseling such patients regarding the collection and storage of cord blood for potential future uses in autologous or allogeneic transplantation.

Adult↗
PubMed1996

Twin transfusion syndrome: reassessment of ultrasound diagnosis.

OBJECTIVE: To assess the antenatal ultrasonic diagnosis of the twin transfusion syndrome, an enigmatic disorder that results in an imbalance in the blood flow between monochorionic twins. STUDY DESIGN: Retrospective review of 16 cases of twin transfusion syndrome confirmed by placental pathology and neonatal data. RESULTS: A disparity in antenatal fetal weights, size difference between the two amniotic sacs and a single placenta were present in 81% (13/16) of confirmed cases. The finding of two separate umbilical cords with a disparity in the size or number of vessels was rare. Evidence of hydrops in either fetus or findings of congestive cardiac failure in the recipient twin were uncommon. CONCLUSION: Our data strongly suggest that the twin transfusion syndrome can be diagnosed in a significant number (81%) of cases. The syndrome is variable, and it is rare to observe all the diagnostic criteria in one case.

Adult↗
PubMed1993

Double-blind; placebo-controlled trial of piperacillin prophylaxis in preterm membrane rupture.

OBJECTIVE: We attempted to test whether antibiotic therapy prolongs pregnancy in preterm premature rupture of membranes, because preterm premature rupture of membranes is frequently associated with chorionic-decidual infection. STUDY DESIGN: Women with preterm premature rupture of membranes and a singleton gestation at 24 to 34 completed weeks were randomized to receive either piperacillin 3 gm or placebo intravenously every 6 hours for 72 hours and were managed conservatively until spontaneous delivery, chorioamnionitis, or fetal distress. RESULTS: Between January 1987 and January 1992, a total of 75 patients were randomized to receive piperacillin (n = 38) or placebo (n = 37). There were no differences between the piperacillin group and the placebo group in mean gestational age at randomization (30.2 +/- 3 vs 30.3 +/- 2.9 weeks). However, a greater number of patients had pregnancy prolonged beyond 7 days (42.1% vs 10.8% p = 0.005) and the mean latency period was significantly prolonged (11.4 +/- 18.8 vs 6.1 +/- 13.6 days, p = 0.001) in the piperacillin group compared with the control groups. CONCLUSIONS: Use of intravenous piperacillin for 72 hours in preterm premature rupture of membranes significantly prolongs the latency period between membrane rupture and delivery.

Adult↗
PubMed1993

Indomethacin in severe twin-to-twin transfusion syndrome.

Despite advances in maternal fetal medicine, the management of severe twin-to-twin transfusion syndrome in the second trimester presents a significant challenge. Presently, there is no uniformly accepted management protocol that is available for the treatment of this syndrome. We report the use of indomethacin in three cases of severe twin-to-twin transfusion syndrome in the second trimester. In the three cases of severe twin-to-twin transfusion syndrome no reduction of amniotic fluid in either sac was demonstrated. Two cases were complicated by single intrauterine fetal death within 72 hours of initiating indomethacin therapy. Because of our experience with these three cases, we conclude that indomethacin does not prevent perinatal mortality in patients with severe twin-to-twin transfusion syndrome.

Adult↗
PubMed1991

A rapid visual test for predicting fetal lung maturity.

A rapid bedside test has been devised that enables an untrained observer to predict (p less than 0.001) when amniotic fluid will be greater than or equal to 0.15 at an optical density of 650 nm, lecithin/sphingomyelin ratio will be greater than or equal to 2.0, or when phosphatidylglycerol will be present. By a visual comparison of the turbidity of unspun amniotic fluid against positive (mature) or negative (immature) controls, technicians and resident physicians who had had no special training were able to classify correctly 87.2% (82/94) of unknown amniotic fluid samples. The sensitivity of the new test is 90.8% (58/65); the specificity is 70.3% (23/29). Thus, when more sophisticated methods are not readily available, we believe that this easily performed and accurate test can provide supplemental or preliminary data for patient management. In remote geographic areas our method could serve as the primary source of information about fetal lung maturity.

Amniotic Fluid↗
PubMed1990

Antepartum management of twin gestation.

Twin gestation is now an area of vital concern to the perinatologist. Within the last decade a substantial reduction in perinatal mortality has been achieved, largely through advances in neonatal intensive care. However, preterm birth and its consequences remain the most important causes of perinatal morbidity and mortality. Twin pregnancy accounts for approximately 10% of all premature deliveries. From the data currently available, there is no justification for the routine use of hospital bedrest, prophylactic tocolytic agents, or elective cerclage in the management of twin pregnancy. Programs directed at the prevention of perterm delivery in twin pregnancy will be the focus of more scientific research. The use of ultrasound and antepartum testing in the form of the nonstress test, the biophysical profile, and Doppler ultrasound may lead to major advances in the diagnosis of intrauterine growth retardation and the twin-to-twin transfusion syndrome in twins. Therefore, it is reasonable to expect that fetal death and neonatal death from intrauterine growth retardation can be prevented.

Female↗
PubMed1989

The legal liability of the medical consultant in pregnancy.

The potential for professional liability that accompanies complications associated with obstetric care can be minimized by an understanding of the roles and responsibilities of both the consultant and the obstetrician. Critical to this is a fundamental knowledge of the medical malpractice action from a legal perspective. This article discusses several issues involved in professional liability as it relates to the obstetrician/gynecologist.

Clinical Competence↗
PubMed1988

Antimicrobial activity of amniotic fluid against Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum.

Amniotic fluids obtained by amniocentesis at 16 weeks to term were examined for the presence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. Of 140 fluids tested, none harbored chlamydiae, and only one harbored mycoplasma, M. hominis. A number of amniotic fluids were subsequently tested for their ability to inhibit the growth of these microorganisms. Amniotic fluids and chlamydial suspensions in a 2:1 ratio were incubated 30 to 90 minutes before their inoculation in McCoy cells. Procedures were followed for chlamydial isolation. Genital mycoplasmas were incubated with amniotic fluid samples for 24 or 48 hours at 35 degrees C. Growth in amniotic fluid specimens was compared with growth in pseudoamniotic fluid and broth controls. Fourteen amniotic fluid specimens collected from gestations of 16 to 40 weeks, were found to be inhibitory to the formation of inclusions of C. trachomatis in McCoy cells. Ten amniotic fluid specimens (16 to 39 weeks, gestation) demonstrated various degrees of inhibition against M. hominis, and three fluids were inhibitory to the growth of Ureaplasma. The inhibitor was heat and protease resistant and activity was proportional to concentration. The molecular weight of the inhibitor was probably greater than 10,000 daltons, and pH, although perhaps a contributing factor, was not the cause of the inhibition.

Amniotic Fluid↗
PubMed1988

Bulimia nervosa in pregnancy: a case report.

Bulimia nervosa is an eating disorder characterized by secretive binge eating and purging with induced vomiting, laxatives, and diuretics. The disorder primarily afflicts young white women between 18-35 years of age. We report the case of a 30-year-old pregnant woman with a 17-year history of bulimia that involved up to six episodes of binging and purging daily. A multidisciplinary approach enabled outpatient management throughout gestation. The pregnancy resulted in the delivery of a normal 3000-g female infant at term. The ramifications for maternal and fetal well-being and the goals of therapeutic management are discussed.

Adult↗
PubMed1987

Obstetric diagnosis and perinatal mortality.

A multidisciplinary team composed of obstetricians, pediatricians, and pathologists examined the causes of 453 consecutive perinatal deaths, which occurred between 1978 to 1982. A clear distinction between obstetric diagnosis and infant cause of death was made, and a prinicpal obstetric and infant diagnosis was assigned to each death. Perinatal death rates by obstetric category were calculated. The rates varied from 6.1 per 1000 births in uncomplicated cases to 217.4 per 1000 births in isolated intrauterine growth retardation. The causes of perinatal death within obstetric categories were tabulated. Nonviability or the complications of prematurity (65%) were the leading causes of death when there was third-trimester bleeding, premature labor, or premature rupture of membranes. Anoxia (59%) was the most frequent cause of death when there was hypertension/pre-eclampsia or other uteroplacental insufficiency states. Death from congenital abnormality accounted for 17.7% of all perinatal deaths. A focus on the causes of perinatal death with obstetric diagnostic categories helps weigh the risk of prematurity versus the risk of anoxia in the management of high-risk gravidas.

Boston↗
PubMed1987

Effect of bacterial growth on the bursting pressure of fetal membranes in vitro.

By mounting a layer of chorioamniotic membrane on a specially designed reaction vessel, we studied the effect of Escherichia coli and/or group B streptococcus growing on the decidual surface of the membranes in tissue culture or bacteriologic medium. The organisms grew equally well in either medium. When growing in tissue culture medium, either organism significantly weakened the membranes as compared with controls (membranes incubated in the absence of either organism). Membranes derived from pregnancies delivered vaginally or abdominally responded similarly. When organisms were grown in bacteriologic medium, bursting pressures did not decrease. Addition of bacteriologic medium (20-60%) to tissue culture medium did not affect bacterial growth, but inhibited significantly the lowering of bursting pressures. Bacteriologic medium also inhibited the peroxidase-H2O2-halide system in vitro. Heat-killed bacteria and/or supernatants of culture medium previously inoculated with bacteria were not effective in weakening membranes. The results suggest that live bacteria in conjunction with active membrane metabolism lead to a weakening and eventual rupture of the membranes.

Culture Techniques↗
PubMed1986

Phenotypic and functional evaluation of suppressor cells in normal pregnancy and in chronic aborters.

To evaluate the potential role of immunoregulatory cells modulating the maternal immunologic response during pregnancy, we carried out phenotypic and functional studies in patients with normal obstetrical histories during each trimester and in patients with chronic idiopathic spontaneous abortions. Using monoclonal antibodies (Ortho), total numbers of T cells (T3+) and T4+ cells progressively increased during pregnancy (compared to nonpregnant controls) and then declined in the third trimester. Increased percentages of T8+, T10+, and Ia+ cells were found in the third trimester. The relative decline in numbers of T4+ cells, with increased numbers of T8+ cells, led to a significantly reduced T4/T8 ratio in the third trimester. Histamine receptors on T cells were quantitated by an immunofluorescent technique. Significantly reduced numbers of H1-type receptors were noted during the second trimester of pregnancy and this was associated with a decreased H1/H2 ratio. Functionally, histamine-induced suppression was measured in a lymphocyte proliferation assay. Patients in the first and second trimester of pregnancy had greater histamine-induced suppression of phytohemagglutinin (PHA)-stimulated proliferation at high concentrations of histamine (10(-3) to 10(-7)) but less suppression at the lower concentrations (10(-9) to 10(-11) M), compared to nonpregnant controls. In contrast, patients studied in the third trimester failed to respond to any concentration of histamine. MLC-induced suppressor activity was generated by incubating the maternal cells with either paternal or third-party mononuclear cells for 2 or 6 days and assaying the cell-free supernatant for its suppressive effects on PHA-stimulated proliferation. Maternal responses to paternal cells did not result in significant suppression in 2-day supernatants during any trimester but by 6 days the suppressive activity was equivalent to non-pregnant controls in patients during the first and second trimester. Maternal responses to third party cells was greater during the second trimester than either the first or third trimesters in both 2- and 6-day supernatants. Patients with histories of chronic idiopathic spontaneous abortions, who were not pregnant at the time of study, exhibited normal numbers of T-cell subsets and T4/T8 ratios. Numbers of both H1 and H2 receptor bearing T cells were proportionally reduced, resulting in a normal H1/H2 ratio. Despite having decreased numbers of H1 and H2 receptor bearing cells, histamine-induced suppression of PHA-stimulated proliferation was comparable to nonpregnant controls over the concentration range (10(-3) to 10(-11) M) employed.(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Habitual↗