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Biomedical subjects

D J Sala

Publications and source records attributed to D J Sala.

10 recordsLinked to original sources
PubMed1995

Pregnancy after organ transplantation.

With the advent of new immunosuppressive agents in the 1980s, transplant recipients are living longer, healthier lives. Women who before did not have a chance to live, much less conceive, are now carrying and delivering healthy children. Obstetric management of such patients is discussed in this article. Two case reports of women who became pregnant after liver and heart transplants are presented. Perinatal nurses in the high-risk arena have the opportunity to collaborate with other health care specialists to care for this new group of patients.

Adult↗
PubMed1993

Controversies in the resuscitation of infants of borderline viability.

Advances in perinatal technology have led to a preponderance of ethical dilemmas regarding the resuscitation of extremely preterm infants weighing between 500 and 750 grams. Although a review of the literature indicates poor outcomes in many of these infants, an equal number of studies documenting positive outcomes has been reported. A point/counterpoint format is used to discuss the issues related to the borderline viable infant. Strategies for resolution are formulated based on the issues of concern. Prevention of preterm birth, discussion of the resuscitation plan before delivery and initial resuscitation with the option to withdraw treatment are critical solutions to consider. Additional strategies include the establishment of definitive care guidelines and a standardized definition of quality of life. Other options worthy of consideration are discussed.

Cost of Illness↗
PubMed1992

Continuous subcutaneous terbutaline pump therapy for premature labor: safety and efficacy.

To assess the usefulness of a continuous subcutaneous pump infusion of terbutaline for long-term tocolysis, we used this modality in 13 patients in whom other tocolytic regimens had failed. The mean (+/- standard deviation) maternal age was 29.9 +/- 3.8 years. The study population included 10 singleton gestations, two sets of triplets, and one twin pregnancy. In three cases, the terbutaline pump was thought to have been successful (duration of pump therapy, 52.7 +/- 20.9 days; gestational age at delivery, 37.1 +/- 1.3 weeks), whereas in six cases marginal success was achieved (duration, 42.2 +/- 27.7 days; gestational age at delivery, 33.8 +/- 2.6 weeks). In the remaining four patients, pump therapy was discontinued after 2 to 23 days because of maternal complications. In contrast to previous reports, we achieved only limited success with the subcutaneous terbutaline pump in the small number of patients studied.

Adult↗
PubMed1992

Myocardial infarction.

Myocardial infarction (MI) during pregnancy occurs approximately once in 10,000 pregnancies. The normal cardiovascular alterations associated with pregnancy may make the diagnosis of MI difficult. Nursing care focuses on astute assessment skills, provision of adequate oxygenation, and prolongation of the healing phase to prepare for the stress of delivery. Nurses caring for patients experiencing MI during the perinatal period require advanced cognitive knowledge and clinical skills to facilitate optimal maternal and fetal outcome.

Adult↗
PubMed1990

Resolution of severe thrombocytopenia in a pregnant patient with rhesus-negative blood with autoimmune thrombocytopenic purpura after intravenous rhesus immune globulin.

Treatment with 120 micrograms of intravenous rhesus immune globulin at 29 1/2 weeks' gestation resulted in an elevation of the platelet count from 38,000/mm3 to 73,000/mm3 in a patient with rhesus-negative blood with autoimmune thrombocytopenic purpura. Red blood cell immune blockade of the reticuloendothelial system is probably not the primary mechanism by which rhesus immune globulin elevates the platelet count.

Adult↗
PubMed1989

Relationship between human development and disappearance of unusually large von Willebrand factor multimers from plasma.

von Willebrand factor (vWF) multimers were examined in fetal, umbilical cord, and neonatal platelet-poor plasma (PPP) specimens. Sixty-five of 65 (100%) fetal PPP samples aged less than 35 weeks and seven of ten (70%) fetal samples aged greater than 35 weeks had unusually large vWF (ULvWF) multimers. Thirty of 46 (65%) cord PPP samples from neonates ranging in gestational age from 34 to 41 weeks had ULvWF. There was no significant relationship between either gestational age at time of delivery or birth weight and likelihood of finding ULvWF multimers in cord PPP samples. No maternal PPP sample contained ULvWF multimers. Serial heelstick samples from 16 preterm and term neonates were analyzed for 8 weeks. ULvWF multimers disappeared from the PPP of ten of the neonates during this time. The PPP of four neonates had vWF patterns similar to those in normal adult PPP throughout the sampling period. The ULvWF multimeric forms of fetal and neonatal PPP samples were similar to those constitutively released from endothelial cells. They were not as slowly migrating in a very porous 0.5% agarose gel system as the ULvWF multimers released from Weibel-Palade bodies in response to the calcium ionophore A23187. A vWF protomer was present in 97% of fetal samples, 83% of cord blood specimens, and 11% of neonatal heelstick samples, but was not found in any maternal sample. These results indicate that control mechanisms operative in older children and adults to prevent circulation of ULvWF multimers and vWF protomeric forms are normally acquired late in uterine life or during the neonatal period. ULvWF multimers, which are normal components of fetal, most cord, and some neonatal plasma samples, may contribute to in utero and postnatal hemostasis.

Autoradiography↗
PubMedDate not supplied

The treatment of preterm labor using a portable subcutaneous terbutaline pump.

The perinatal mortality rate related to preterm delivery has led researchers to investigate new methods of tocolysis. A new concept in managing preterm labor uses continuous administration of terbutaline sulfate via a portable subcutaneous infusion pump. Use of the terbutaline pump to treat 13 preterm labor patients at the Baylor College of Medicine demonstrated an efficacy rate of 9 for a population failing all other methods of tocolysis. This unique treatment modality offers new hope for patients experiencing recalcitrant preterm labor.

Female↗
PubMedDate not supplied

Maternal blood donation for intrauterine transfusion.

Pregnancy affected by erythrocyte alloimmunization often requires intrauterine transfusion for fetal survival. Because blood donated by a random donor has been associated with an increased risk of disease transmission, maternal blood donation has been advocated as an alternative blood source for intrauterine transfusion. Collaboration between medical, nursing, laboratory, and nutrition personnel optimizes the safety and success of the procedure. This article describes the collaborative care of the woman participating in maternal blood donation for intrauterine transfusion.

Blood Donors↗