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Biomedical subjects

D A Nagey

Publications and source records attributed to D A Nagey.

At least 19 recordsLinked to original sources
PubMed1992

The general medical record. Concepts and suggestions for implementation.

Our view of a general medical record consists of a combination of distinct departmental- and specialty-specific medical records and an organizing kernel that contains arguably critical information. Because this system allows each clinical entity to evolve its own system, clinical priorities do not have to be negotiated or compromised. Additionally, subsystem or departmental medical records can be easily revised without disturbing the general medical record because of the modular design. Although the system seems robust with respect to design considerations, only implementation can provide adequate tests.

Bias↗
PubMed1992

Validity of self-reported pregravid weight.

Self-reported pregravid weight is a commonly used baseline indicator of nutritional status in prenatal weight gain studies. This study assesses the validity of self-reported pregravid weight in 1591 gravidas who entered into prenatal care within the first trimester of pregnancy from 1986 to 1988 at the University of Maryland Medical Systems. A significant difference of 4.3 lb (t = 25.56, P < 0.001) was found between self-reported pregravid weight and estimated pregravid weight. Limits of agreement (interval within which 95% of the differences between the self-reported and measured weights) were constructed by population characteristics. Multiple linear regression models with estimated pregravid weight as the dependent variable were estimated by self-reported pregravid weight, body weight, height, age, race, education, insurance status, and marital status groups. A model with self-reported pregravid weight as the sole independent variable was found to explain 88% of the variance in estimated pregravid weight. Results of this study suggest that the validity of self-report pregravid weight varies with sociodemographic and anthropometric factors. Adjustment by a simple regression equation can minimize error in self-reported pregravid weight.

Adult↗
PubMed1992

Plasma and erythrocyte magnesium changes following a glucose challenge during pregnancy.

This study examined the effects of pregnancy and glucose loading on plasma and erythrocyte (RBC) magnesium (Mg) concentrations. In a completely randomized design with repeated measures, 15 nonpregnant, 15 early pregnant (13-17 weeks) and 15 late pregnant (28-34 weeks) women ingested 100 g glucose. Blood was collected at 0, 30, 60, 120 and 180 minutes to evaluate changes in Mg levels. Fasting plasma Mg concentrations decreased slightly but not significantly as gestational age of the groups increased. Fasting RBC Mg concentrations were significantly higher (p less than 0.05) in late pregnant women compared with early pregnant and nonpregnant women. Plasma Mg responses to a glucose challenge in nonpregnant women exhibited a curvilinear pattern whereas responses in pregnant women appeared unaffected by the glucose challenge. RBC Mg concentrations for nonpregnant and early pregnant women failed to respond to the glucose challenge whereas it decreased in a linear pattern during late pregnancy. The diabetogenic effect of late pregnancy appears to affect RBC Mg. This redistribution of Mg during late pregnancy could suggest a possible role for RBC as a Mg pool.

Blood Glucose↗
PubMed1991

Effect of a glucose challenge on plasma copper levels during pregnancy.

This study examined the effect of pregnancy and glucose loading on plasma copper (Cu) levels. In a completely random design with repeated measures, 18 nonpregnant women, 16 early pregnant women (13-17 weeks), and 16 late pregnant women (28-34 weeks) ingested 100 g glucose with blood collected at 0, 30, 60, 120, and 180 minutes to evaluate changes in Cu levels in blood. Plasma Cu and plasma ceruloplasmin (CP) activity increased significantly (p less than 0.05) as pregnancy progressed, even though there were no significant differences in dietary Cu intakes. Plasma Cu and CP activity responses to the glucose challenge were similar for the three groups. Combined data from the three groups showed a significant (p less than 0.05) increase in plasma Cu by 30 minutes, which dropped significantly (p less than 0.05) by 180 minutes, and a significant decrease (p less than 0.05) in plasma CP activity from baseline to 180 minutes. Although plasma Cu and CP activity were altered with pregnancy, their responses to a glucose challenge did not appear to be associated with the diabetogenic state of pregnancy.

Adolescent↗
PubMed1990

Tocolysis in the management of third trimester bleeding.

Fifteen patients were identified in a retrospective analysis of one institution's experience with the use of tocolysis in selected patients with an admission diagnosis of placenta previa or abruptio placentae. There were no fetal deaths after admission, and the two neonatal deaths were related to prematurity. Eight of the 15 patients receiving tocolysis had their pregnancies prolonged by 2 weeks or more, and there were no fetal or neonatal deaths in this group. Both neonatal deaths occurred in patients who underwent tocolysis but who gave birth within 1 day of admission. These data suggest the safety of tocolysis in preterm patients with the diagnosis of placenta previa or abruption who are bleeding. A prospective, randomized trial is required to evaluate whether tocolysis is superior to expectant management or to immediate delivery. The clinical difficulty in differentiating between these two diagnoses, despite liberal use of ultrasonography, is discussed.

Abruptio Placentae↗
PubMed1990

An unusual presentation: placenta percreta with uterine conservation.

Placenta acreta is a rare complication of pregnancy characterized by abnormal placental adherence. In its extreme form, percreta, rupture of the uterus, and profound hemorrhage may occur. Aggressive resuscitation and early surgery provide the most favorable outcome. Conservative management plays an important role in individual cases where fertility must be preserved or the operative time needs to be reduced to a minimum.

Adult↗
PubMed1989

The content of prenatal care.

Prenatal care consists of patient education, evaluation of the pregnant woman for physical or historic factors requiring special care, careful assessment of gestational age, and determination of the success with which the mother and fetus(es) are tolerating the pregnancy. These elements of care during pregnancy are reviewed in turn. Additional, less tangible components of care may help explain the salutary effects of prenatal care on pregnancy outcome. The obstetric health care provider's expression of caring for the woman and her pregnancy adds to her existing social support and is a vital aspect of prenatal care.

Cost-Benefit Analysis↗
PubMed1988

Cerebral blood flow velocity in term newborn infants: changes associated with ductal flow.

The effects of ductal closure on range-gated pulsed Doppler cerebral blood flow velocity (CBFV) patterns in the internal carotid, anterior cerebral, and middle cerebral arteries were studied in 10 normal term infants (mean birth weight 3302 +/- 294 g (SD) and mean gestational age 39.6 +/- 1.3 weeks). Pulsatility was calculated from flow velocities and used as an estimate of cerebral blood flow (CBF). Ductal closure was associated with a rise in mean blood pressure from 45.0 +/- 4.2 to 51.3 +/- 6.5 mm Hg (P less than 0.05) and a significant decrease in pulsatility in all three vessels (mean = 0.77 +/- 0.07 vs 0.70 +/- 0.05 (P less than 0.02]. Changes in pulsatility were correlated with changes in mean blood pressure (P less than 0.02), providing evidence that systemic blood pressure may influence postnatal cerebral arterial pulsatility indices. We also noted significant differences in the velocity and pulsatility of individual vessels that were independent of blood pressure, suggesting that Doppler flow studies may be useful in describing regional CBF patterns. The temporal association between ductal closure and decreased pulsatility suggests that CBFV patterns reflect ductal shunting in normal term newborn infants. Diastolic runoff and reduced systemic blood pressure in the presence of ductal shunting appear to reduce diastolic flow velocity and increase CBFV pulsatility in normal term infants during the first days of life. Normal mechanisms of cerebral autoregulation compensate for decreased flow with vasodilation; therefore the increased pulsatility associated with ductal shunting may be due to diastolic runoff rather than increased cerebrovascular resistance.

Blood Pressure↗
PubMed1988

Blood and urinary zinc changes after a glucose challenge in early and late pregnancies.

This study was undertaken to investigate the effect of pregnancy and glucose loading on zinc metabolism. In a completely random design with repeated measures, 18 non-pregnant women, 16 early-pregnant women (13-17 wk), and 16 late-pregnant women (28-34 wk) had blood collected at 0, 30, 60, 120, and 180 min after ingesting 100 g glucose to evaluate changes in variables of Zn nutriture. Fasting plasma Zn concentrations decreased significantly as pregnancy progressed. Late-pregnant women had significantly higher erythrocyte Zn levels and greater 24-h urinary Zn and glucose excretions. Erythrocyte Zn responses to glucose loading were unaffected by gestational age. Plasma Zn after a glucose load in nonpregnant women exhibited a curvilinear response whereas pregnant women showed no change. This lack of response by pregnant women may be related to their lower plasma Zn concentrations. Plasma Zn in pregnant women may not be as readily available to assist in glucose utilization.

Adult↗
PubMed1988

Conservative management of placenta accreta. A case report.

Placenta accreta is a rare complication of pregnancy. Traditional therapy has centered upon total abdominal hysterectomy to prevent serious hemorrhagic and infectious sequelae. Conservative management, however, may preserve reproductive function without jeopardizing maternal welfare.

Adult↗
PubMed1987

Magnesium sulfate and ritodrine hydrochloride: a randomized comparison.

The efficacy of magnesium sulfate was analyzed in relation to ritodrine hydrochloride. Patients presenting in preterm labor between 20 and 35 weeks' gestation were prospectively randomized. Tocolysis was achieved for more than 72 hours in 35 of 40 cases (88%) where magnesium sulfate was administered and 31 of 39 cases (79%) in which ritodrine hydrochloride was infused. Delay of greater than or equal to 7 days was achieved in 75% and 72% of cases, respectively. The mean dosage to achieve tocolysis was 4.5 gm/hr, in the magnesium sulfate group and 210.0 micrograms/hr in ritodrine hydrochloride-treated patients. The mean magnesium level to achieve tocolysis was 6.60 mg/dl. Side effects in the two groups were similar in number but less alarming in the magnesium sulfate group. Magnesium sulfate was found to be easy to administer and clinically efficacious. Its tocolytic action was found to be dose dependent and drug concentrations are easily determined. On the basis of this work and data from other investigators, magnesium sulfate should be used as the first line of tocolytic therapy with ritodrine hydrochloride as its pharmacologic backup.

Clinical Trials as Topic↗
PubMed1987

Indicators of perinatal asphyxia.

Creatinine phosphokinase and its isoenzymes (myocardial-specific MB and brain-specific BB) are elevated in the presence of specific tissue injury. The value of this serum marker as an objective indicator of perinatal asphyxia was studied. Forty-nine patients with gestational ages ranging from 36 to 42 weeks were prospectively studied. Patients who by interpretation of the fetal heart rate tracing alone were diagnosed as having fetal distress demonstrated significantly lower pH (p = 0.001) and base excess (p less than 0.0001) in umbilical venous blood. Umbilical venous cord MB (p less than 0.05) and BB (p less than 0.01) were increased in this group. Abnormal fetal heart rate patterns correlate well with acid-base abnormalities and elevated creatinine phosphokinase values. These tests may demonstrate more efficient and improved indicators of tissue injury and damage from perinatal asphyxia than clinical observation alone.

Acid-Base Equilibrium↗