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D E Hickok

Publications and source records attributed to D E Hickok.

48 records · Page 3Linked to original sources
PubMed1988

Maternal serum alpha-fetoprotein is a marker for fetal anomalies in pediatric surgery.

Maternal serum alpha-fetoprotein (MS-AFP) screening has become part of routine obstetric care. Although elevated MS-AFP was originally associated with neural tube defects (NTD), it is also able to detect several fetal anomalies of interest to a pediatric surgeon, ie, ventral abdominal wall defects, intestinal atresias, and sacrococcygeal teratomas. Previously, decreased MS-AFP had only been associated with fetal trisomies, but not surgically correctable lesions. In the present study, we review our recent experience with both elevated and decreased MS-AFP as a marker to detect fetal anomalies of concern to the pediatric surgeon. Forty-one fetal anomalies were associated with 333 pregnancies referred for follow-up after abnormal MS-AFP screening results from November 1985 through November 1986. One hundred ninety-six were elevated and 139 were decreased. In most cases, evaluation included counseling, repeat MS-AFP, level II ultrasound, and amniocentesis. This revealed elevated MS-AFP to be associated with 32 (16.3%) anomalies (2 NTD, 5 anencephalics, 5 ventral abdominal wall defects, 1 stage IV-S neuroblastoma, 1 renal anomaly, 1 ventriculomegaly, 15 fetal demises, and 2 fetal-maternal bleeds). Decrease in MS-AFP was associated with nine (6.4%) anomalies (2 congenital diaphragmatic hernias, 3 Down's syndrome, 1 Turner's syndrome, 2 duodenal atresias, and 1 choroid plexus cyst). In this study, MS-AFP detected several fetal anomalies known to be associated with abnormal MS-AFP and three anomalies not previously described (congenital diaphragmatic hernia, neuroblastoma, and choroid plexus cyst). Elevated as well as decreased MS-AFP are significant and should be pursued by a full prenatal evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1987

Low material serum alpha-fetoprotein levels and congenital diaphragmatic defects.

We report on 2 cases of fetal congenital diaphragmatic defects with normal chromosomes among 105 patients referred for evaluation for low maternal serum alpha-fetoprotein (MSAFP) levels. The mechanism for this striking association is not clear. The association of low MSAFP levels and congenital diaphragmatic defects may have importance for MSAFP screening programs.

Adult↗
PubMed1987

The outcome of pregnancies diagnosed as having a fetus with meningomyelocele.

Forty-nine cases of meningomyelocele diagnosed in utero and another 10 cases delivered by prelabor cesarean section (N = 59) are compared to all other cases of meningomyelocele (N = 98) born following labor and seen during the same period. Prenatal diagnosis was established for 19 cases before and 30 cases after 24 weeks gestational age. Ten cases were delivered by prelabor cesarean section for maternal indications. Eight of 12 cases diagnosed before 24 weeks and given a guarded prognosis and one given a poor prognosis, elected cesarean section. One of the 8 was stillborn. Four of the 12 given a guarded prognosis and 6 an extremely poor prognoses elected termination of the pregnancy. Nineteen of the 30 cases diagnosed after 24 weeks were delivered by prelabor cesarean section and two by cesarean section after inadvertent labor. Of the 35 cases born by prelabor cesarean section, 48% have sacral levels or no loss of motor function compared to 14% of the 98 born after labor (P = 0.0001). We recommend prelabor cesarean section before onset of labor to preserve neural function of a baby with meningomyelocele and leg movement in utero when parents refuse termination or have a diagnosis made after 24 weeks gestational age.

Cesarean Section↗
PubMed1987

Tuboovarian sigmoid fistula after cesarean section. A case report.

Tuboovarian sigmoid fistulae are rare complications of pelvic inflammatory disease. A 31-year-old woman had a severe post-cesarean-section infection that formed a tuboovarian abscess and ruptured into the sigmoid colon. The abscess and subsequent fistula led to persistent pain and purulent diarrhea. A salpingo-oophorectomy with closure of the colon was performed. The patient was still asymptomatic 20 months after the surgery.

Abscess↗
PubMed1985

Genital herpes in pregnancy: risk factors associated with recurrences and asymptomatic viral shedding.

One hundred forty-seven women with recurrent symptomatic genital herpes simplex virus acquired prior to the start of pregnancy (group 1) and 15 women whose first symptomatic episode of genital herpes was acquired during pregnancy (group 2) were followed weekly during the course of gestation. Among women with recurrent genital herpes antedating pregnancy, the mean number of recurrences per trimester increased from 0.97 to 1.26 to 1.63 in the first through third trimester, respectively (p less than 0.05 for comparison between each trimester). The median number of symptomatic recurrences of genital herpes during gestation was four in women in group 1 compared to one in women in group 2 (p less than 0.01). Asymptomatic viral excretion from the genital tract was, however, more common in women in group 2 (33%) than in women in group 1 (12.9%) (p less than 0.05). Herpes simplex virus was isolated at 5.5% of routine visits in group 2 women compared to 1% of routine visits among group 1 women. Logistic regression analysis indicated young age also was associated with more frequent asymptomatic viral shedding. Asymptomatic herpes simplex virus excretion was more common from the vulvar area than the cervix, and women in group 2 were more likely to shed virus from both sites simultaneously than women in group 1. Age and recent acquisition of genital herpes are risk factors for asymptomatic excretion of herpes simplex virus during pregnancy.

Adult↗
PubMed1982

Recurrent genital herpes simplex virus infection in pregnancy: infant outcome and frequency of asymptomatic recurrences.

Eighty pregnant patients with a history of recurrent genital herpes simplex virus (HSV) infection were followed up with frequent genital examinations and cultures for HSV during their pregnancies. Recurrences of genital HSV during pregnancy were documented in 67 patients. Ninety-six percent of these had external genital lesions noted at some time during their pregnancy. One hundred eighty-six (93%) of the 199 recurrences of the disease were associated with external genital lesions. Of 13 episodes of asymptomatic viral shedding documented in this patient population, six were from the vulva alone, five were from the cervix alone, and two were from both the vulva and the cervix. Of 11 episodes of cervical HSV shedding, seven were asymptomatic and four were associated with external symptomatic lesions. Despite frequent recurrences of genital HSV infection during pregnancy, all study patients were delivered at term, and although they had a high rate of delivery by cesarean section (32.5%), the outcome of their infants was good.

Adolescent↗
PubMed1980

Midlevel personnel in obstetrics and gynecology practices--cost-effectiveness and consumer benefits.

Two private obstetrics-gynecology practices, in adjacent Northwest cities, which employ midlevel nurse practitioners for routine obstetric and gynecologic care were the subject of this study. At site A fees charged by the practitioner were 44 percent less than those for identical services provided by the physician. This was an attempt to pass cost savings directly to patients. At site B, fees were the same for both physician and practitioner, yielding a significant net income to the practice. At this latter site a proportion of the income was passed to patients by not increasing office fees for the years 1975 (when the practitioner was hired) through 1977, during which time the average fees of ten other physicians increased. The study shows that the use of midlevel personnel in private offices is highly cost-effective and profitable. Ideally, this profit can be passed on to patients by reduced overall office fees.

Cost-Benefit Analysis↗
PubMed1977

Ultrasonic placental localization and bloody taps in midtrimester amniocentesis for prenatal genetic diagnosis.

In a prospective study, a small team of obstetricians concurrently performed midtrimester amniocentesis for prenatal genetic diagnosis on 32 patients after ultrasonic placental localization and on 50 patients without prior ultrasound. The use of ultrasound did not affect the red cell count in the fluid samples. Furthermore, the 2 patient groups had similar rates of grossly bloody taps. The average number of viable clones after culture was lower both after bloody taps and when ultrasound had been used, but in neither case was the difference significant. There were no postamniocentesis complications in the entire patient population. These results suggest that ultrasonic placental localization is not helpful in avoiding bloody taps, and that bloody taps may not necessarily be dangerous. Therefore, since the long-range hazards of in utero exposure to ultrasound may not yet be known, it would seem judicious to use preamniocentesis ultrasound selectively and on specific indication, rather than routinely.

Amniocentesis↗