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Biomedical subjects

C M McCurdy

Publications and source records attributed to C M McCurdy.

12 recordsLinked to original sources
PubMed1997

Decreased expression of murine PPARgamma in adipose tissue during endotoxemia.

Infection-induced hyperlipidemia develops due to a combination of factors, one of which is decreased clearance of lipids from the bloodstream due to depressed synthesis of lipoprotein lipase (LPL). Recently, the peroxisome proliferator activated receptors (PPARs) have been shown to be important in the regulation of LPL, particularly PPARgamma. PPARgamma and its heterodimerization partner, RXR alpha have been shown to be transcriptional activators of LPL in co-transfection analysis. Therefore, we hypothesized that the decrease in LPL expression during endotoxemia may be a result of depressed PPARgamma expression. In these studies, we examined the effect of endotoxin or its proximal mediator, tumor necrosis factor (TNF), on the expression of PPARgamma in white (WAT) and brown adipose tissue (BAT) in CD-1 mice. We report that treatment with endotoxin, but not TNF, transiently decreased PPARgamma mRNA levels 4 hr after treatment. However, endotoxin or TNF treatment decreased PPARgamma protein levels after 18 hr, which was at a time when LPL mRNA levels were also depressed. These data suggest that decreased PPARgamma expression following endotoxin or TNF treatment may contribute to the hyperlipidemia due to decreased expression of LPL, which would impair triglyceride clearance.

Adipose Tissue↗
PubMed1996

Effect of intrapartum use of oxytocin on estimated blood loss and hematocrit change at vaginal delivery.

We hypothesized that exogenous oxytocin given for labor induction or augmentation results in a greater blood loss at vaginal delivery compared with spontaneous labor. Second, we theorized that duration of exposure, and maximum or final dosage of oxytocin, would be positively correlated with blood loss. We retrospectively studied records of 111 women undergoing labor induction or augmentation by oxytocin infusion along with those of 76 women who had spontaneous labor. The outcomes evaluated included clinically estimated blood loss (EBL), and a change of hematocrit from admission to postpartum. These were further compared to duration and dosage of oxytocin infused. A combination of chi-square and analysis of variance were used to compare the study group with the controls. Regression analysis was used to evaluate possible relationships within the study group. The demographics of the study group who received oxytocin were similar to those of the control group, with the exception of the percent who received an epidural (77% versus 29%, p < 0.0001) and length of labor (381 versus 277 min, p < 0.001). There was no demonstrated relationship between oxytocin use and EBL or hematocrit change. Within the study group of 111 patients, there was a statistically significant increase in EBL (p < 0.01) and hematocrit change (p < 0.0003) with increasing maximum dose of oxytocin. In addition, hematocrit change was greater with an increase in both duration (p < 0.001) and final dose of oxytocin (p < 0.0003). No relationship was demonstrated between exogenous oxytocin administration and increased blood loss, in a group of patients matched for variables other than spontaneous or oxytocin exposed labors. However, among those patients who received oxytocin, there was a correlation between amount of oxytocin exposure and blood loss. The initial hypothesis compared means between the two groups; however, the latter hypothesis sought to correlate increased exposure to oxytocin with increasing blood loss as measured by duration, maximum, and final dose.

Adult↗
PubMed1995

The relation between pulmonary hypoplasia and amniotic fluid volume: lessons learned from discordant urinary tract anomalies in monoamniotic twins.

BACKGROUND: Adequate amniotic fluid (AF) volume is one of several factors felt to be essential for normal lung development. Renal agenesis and urinary tract obstruction usually result in oligohydramnios and pulmonary hypoplasia. CASE: Two sets of monoamiotic twins with discordant urinary tract anomalies were seen. One twin in each set had anomalies that in a singleton or diamiotic pregnancy would likely have resulted in fetal pulmonary hypoplasia and subsequent death. However, neither of these infants had pulmonary hypoplasia. One infant is unique in being the first case reported of normal pulmonary function and survival despite the anomaly. CONCLUSION: Adequate AF provided by a monoamniotic twin environment may prevent pulmonary hypoplasia, which usually results from oligohydramnios due to certain fetal urinary tract anomalies.

Abnormalities, Multiple↗
PubMed1995

Sonographic assessment of amniotic fluid in normal twin pregnancy.

A sonographic standard for assessment of amniotic fluid volume in normal twin pregnancy is provided. In 210 uncomplicated twin pregnancies, amniotic fluid volume was assessed sonographically, by measuring the total amniotic fluid index (AFI), as well as the deepest single vertical pocket in each sac. The mean AFI was greater than values found in singleton gestations; the AFI increased up to 27 weeks' gestation, and decreased thereafter. It correlated well with measurement of the deepest vertical pocket in each sac (r = 0.71; p < 0.0001). In twin pregnancy at 26 to 32 weeks' gestation a fluid pocket of at least 8 cm was found in 9.8% of cases and did not indicate pathologic states. Either AFI or measurement of the deepest fluid pocket in each sac can be used to assess fluid volume in twin pregnancy. A table specific to twin pregnancy should be used when evaluating twin gestations sonographically.

Amniotic Fluid↗
PubMed1993

Basic technique of fetal echocardiography.

The fetal heart is the organ system most commonly affected with congenital disease. Though risk factors exist for congenital heart disease (eg, family history, toxin exposure, maternal illness, abnormal karyotype, and other fetal anomalies), the fetal heart is most often examined as part of a routine evaluation of the fetal anatomy in the fetus with no identifiable risk factors. The importance of a systematic, complete assessment of the cardiac axis cannot be overemphasized. All aspects of sonography (ie, real time, M-mode, pulsed, and color Doppler) can provide unique and integral information in evaluating the fetal heart and thorax.

Echocardiography↗
PubMed1993

Oligohydramnios: problems and treatment.

Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. Ultrasound detection of this complication should prompt the clinician to thoroughly evaluate the gravida for hypertension, diabetes, or other significant illness. In addition, a thorough fetal anatomic survey focusing on the genitourinary tract and an attempt at visualizing free amniotic bands should be performed with ultrasound. Karyotype should be considered. The role of amnioinfusion to assist in diagnosis should be considered. Once diagnosed, oligohydramnios with or without associated conditions should lead to intensive fetal biophysical surveillance including frequent ultrasound evaluation. Delivery in the term patients must be considered. The role of amnioinfusion as an adjunct to continuous fetal monitoring in labor to improve neonatal outcome appears beneficial in select series. The role of repetitive amnioinfusion in the preterm patient remote from term may offer marginal clinical benefit to neonatal outcome and is considered experimental at this time.

Congenital Abnormalities↗
PubMed1993

Syncope and sudden arrhythmic death complicating pregnancy. A case report of Romano-Ward syndrome.

Romano-Ward syndrome is a subtype of prolonged QT syndrome with autosomal dominant inheritance. Stress-induced syncope and sudden death are secondary to ventricular tachydysrhythmias. A case report of Romano-Ward syndrome complicating pregnancy is presented. Successful therapy with propranolol for life-threatening dysrhythmias was achieved. An excellent neonatal outcome occurred.

Adrenergic beta-Antagonists↗
PubMed1993

Blood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision.

The current study was undertaken to determine if blood loss at the time of cesarean section is affected by method of placental removal (spontaneous versus extracted) or uterine position for repair (in situ versus exteriorized). This prospective randomized study involved 100 women who were undergoing a cesarean section. The patients were placed into one of four groups--1, spontaneous placenta detachment, in situ uterine repair; 2, spontaneous placental detachment, exteriorized uterine repair; 3, manual placental removal, in situ uterine repair, and 4, manual placental removal, exteriorized uterine repair. Patients with spontaneous placental separation (groups 1 and 2) compared with manual removal (groups 3 and 4) revealed a significant decrease in blood loss (p < 0.001). Uterine position did not significantly affect blood loss in the spontaneous group (1 and 2; p = 0.971) or the manual placental removal groups (3 and 4; p = 0.061). The hematocrit values for all groups were similar preoperatively, but postoperatively, were significantly lower in the manual removal groups when compared with the spontaneous placental separation groups (p < 0.001). The method of placental removal and not the position of the uterus at the time of its repair has a significant role in blood loss during cesarean birth.

Adult↗
PubMed1993

Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique.

BACKGROUND: Fetal acardia is a rare entity that complicates twin gestation. Reported survival of the normal or "pump" twin is below 50%. Perinatal mortality and morbidity typically result from heart failure in the pump twin caused by the circulatory demands of perfusion of the abnormal twin. Conservative management has not improved perinatal survival. CASE: A 30-year-old woman with a twin gestation at 18 weeks was diagnosed with acardia acephalus. Congestive heart failure of the pump twin led to an intrauterine endoscopic attempt to ligate the umbilical cord of the acardiac twin. Both twins ultimately died. CONCLUSION: A variety of invasive techniques have been reported to accomplish occlusion of the acardiac twin's umbilical cord, with inconsistent results. Maternal morbidity was minimal and technical success was achieved with an endoscopic intrauterine technique of umbilical cord ligation. Despite the poor fetal outcome in this case, endoscopic ligation of the acardiac twin's umbilical cord should be considered for treating this unusual complication of twinning.

Abnormalities, Multiple↗
PubMed1993

Route of delivery of infants with congenital anomalies.

Obstetric delivery may be accomplished by only two methods, vaginally or abdominally. In the management of the pregnancy complicated by a fetal malformation, the choice of delivery method may be made on obstetrical grounds or in belief that one method offers the fetus benefit over the other. That choice must be based on knowledge of the nature of the individual malformation in question, the presence or absence of associated fetal malformations, the presence or absence of fetal karyotype abnormalities, fetal maturity, and fetal presentation. Clear evidence of benefit from cesarean delivery is not available in the case of many malformations that are often considered for abdominal delivery. The infrequency of many of these anomalies typically precludes the accumulation of sufficient experience in any one center or successful completion of randomized trials to evaluate treatment modalities. Most studies therefore are retrospective or flawed by small numbers of patients. Logic dictates that certain malformations that produce sufficient enlargement of fetal structures are at probable risk for dystocia of labor (e.g., severe hydrops, severe hydrocephalus, large sacrococcygeal teratoma) and may benefit from abdominal delivery. Other malformations may predispose the affected fetus to trauma or decompensation during labor and vaginal delivery. It is these anomalies that have the most controversy surrounding the "best" mode of delivery and of which we have attempted to address. Table 4 includes proposed criteria for choosing abdominal versus vaginal delivery in the gestation complicated by congenital anomaly. The birth method in the context of a fetal malformation is a choice optimally made after careful discussions with the patient, pediatrician, and pediatric surgeons. Such discussion should include a careful review of the nature of the anomaly, the optimal prognosis, and the evidence of benefit for a specific birth method. Once the pregnancy in question has been evaluated, appropriate consultations obtained, and the available data reviewed with the patient, the obstetrician again assumes a role of patient advocate. The obstetrician is the counselor, the educator, and the friend the patient needs during such a difficult time. The discussion of birth method in the case of a fetal malformation creates a conflict of interest for the patient, but typically a paradoxic result of this conflict occurs. The patient's welfare, which is usually best served by vaginal delivery, may be in conflict with the fetal concerns, which might benefit from abdominal delivery. The data might be clear but more often the data are less than convincing.(ABSTRACT TRUNCATED AT 400 WORDS)

Congenital Abnormalities↗
PubMed1992

The effect of placental management at cesarean delivery on operative blood loss.

OBJECTIVES: The effect of alternative methods of placental delivery at cesarean section on blood loss has not been reported. The hypothesis of this study was that spontaneous expulsion of the placenta would reduce operative blood loss, compared with that of manual extraction during cesarean delivery. STUDY DESIGN: We prospectively randomized and compared outcomes of 62 gravid women with manual (n = 31) or spontaneous (n = 31) placental delivery at cesarean section. Operative blood loss was measured directly. RESULTS: Blood loss measured at cesarean delivery was greater in the manually delivered group (967 +/- 248 ml) than in the spontaneously delivered group (666 +/- 271 ml, p < 0.0001). The incidence of postpartum endometritis was sevenfold greater in the manual than the spontaneous group (23% vs 3%, respectively; p < 0.05). CONCLUSIONS: We conclude that spontaneous expulsion of the placenta at cesarean delivery results in less operative blood loss and a lower incidence of postoperative endometritis.

Adult↗