Biomedical subjects

D Twickler

Publications and source records attributed to D Twickler.

7 recordsLinked to original sources

PubMed2000

Cerebral edema complicating eclampsia.

OBJECTIVE: This study was undertaken to describe and correlate clinical findings with computed tomographic and magnetic resonance imaging scan results in 10 women with eclampsia and widespread cerebral edema. STUDY DESIGN: This was a clinical descriptive study of 10 women with eclampsia and symptomatic cerebral edema who were encountered at Parkland Hospital from 1986 through 1998. During this 13-year period nearly 175 women had eclampsia from a total of >160, 000 women delivered. The clinical courses of these 10 women with eclampsia and symptomatic cerebral edema are described, along with findings from computed tomographic and magnetic resonance imaging scans. RESULTS: In 3 cases symptoms followed an acute and severe elevation of blood pressure while the patient was being treated for eclampsia. All 3 of these women had severe generalized edema with radiographic findings of impending transtentorial herniation. Herniation did occur in 1 of these women, and she died. The other 7 women had central nervous system symptoms that persisted after an initial eclamptic convulsion. Symptoms ranged from lethargy, confusion, and blurred vision to obtundation and blindness. Five of these women had multiple areas of edema mostly apparent at the gray matter-white matter junction. Two women demonstrated extensive unilateral brain involvement; however, their symptoms were similar to those of the women with multifocal areas of cerebral edema. CONCLUSION: Symptomatic cerebral edema developed in almost 6% of women with eclampsia. Its genesis probably represents a continuum of central nervous system lesions that result from eclampsia. We postulate that women with symptoms of extensive cerebral edema have a cytotoxic edema caused by ischemia that is intensified by a vasogenic edema associated with sudden or severe hypertension.

Adolescent↗

PubMed1999

Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy.

OBJECTIVE: Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. STUDY DESIGN: We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was </=37.5 degrees C for 48 hours. RESULTS: During the 3-year study period 44,922 women were delivered at Parkland Hospital; among these 8535 (19%) were delivered by the cesarean route. There were 69 women who met criteria for prolonged infection, and 15 (22%) of these were found to have septic pelvic thrombophlebitis. Four had infection after vaginal delivery and 11 had been delivered by the cesarean route. Of 14 women randomly assigned to therapy, 8 were assigned to receive continued antimicrobial therapy without the addition of heparin and the other 6 were assigned to receive heparin therapy in addition to the antimicrobial agents. According to an intent-to-treat analysis there was no significant difference between the responses of women with pelvic infection who were and were not given heparin therapy. Specifically, women not given heparin were febrile for 140 +/- 39 hours compared with 134 +/- 65 hours for women who received heparin (P =.83). Duration of hospitalization was also similar between the 2 groups at 10.6 +/- 1.9 days for those with thrombosis who were given antimicrobial agents alone and 11.3 +/- 1.2 days for women who also received heparin (P >.5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 +/- 4.1 days, compared with 10.9 +/- 2.9 days for women in whom thrombosis was diagnosed (P =.14). These women were followed up for >/=3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. CONCLUSIONS: The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection.

Adult↗

PubMed1998

Congenital glenoid dysplasia.

Glenoid dysplasia is an anomaly of the scapula characterized by underdevelopment of the bony glenoid and adjacent part of the scapular neck which may be seen as a primary isolated condition, in patients with multiple anomalies or ill-defined syndromes, in well-described syndromes, in mucopolysaccharidoses and related conditions, and in certain skeletal dysplasias. The general subject of glenoid dysplasia is reviewed with reference to descriptions in the literature and personal observations.

Abnormalities, Multiple↗

PubMed1993

Caudal regression versus sirenomelia: sonographic clues.

Seven cases with the pathologic/autopsy diagnosis of caudal regression or sirenomelia in which antenatal sonography had been performed were reviewed. The three patients with caudal regression had similar findings on antenatal sonogram, including normal or increased amniotic fluid, mild dilation or normal urinary systems, nonfused extremities, and sacral agenesis. In the four patients with sirenomelia, common sonographic findings included marked oligohydramnios, suspected renal agenesis, and sacral agenesis. A history of maternal diabetes was elicited in all patients with caudal regression and in none of the patients with sirenomelia. Findings confirm recent articles in pediatric pathology suggesting that caudal regression is a separate entity, distinct from sirenomelia.

Abnormalities, Multiple↗

PubMed1992

Esophageal achalasia in late pregnancy.

Esophageal achalasia is a rare disorder that may mimic nausea and vomiting of pregnancy. Presentation or persistence of these symptoms in the latter half of pregnancy is unusual. We describe a case of third-trimester weight loss due to the nausea and vomiting of achalasia. Pneumatic dilation of the esophagus is often necessary to improve oral intake. However, advances in nutritional supplementation may prevent malnutrition and allow treatment and its complications to be delayed until after delivery.

Adult↗

PubMed1991

Renal pelvicalyceal dilation in antepartum pyelonephritis: ultrasonographic findings.

The purpose of the present study was to determine whether pregnant women with pyelonephritis have differences of pelvicalyceal systems, compared with normal pregnant control subjects, that might predispose to upper urinary tract infection. Ultrasonographic examination of both kidneys in coronal and axial planes of 24 women with clinical pyelonephritis and positive urine cultures was compared with results in control subjects matched for gestational age, parity, and race. Women with right or bilateral pyelonephritis had increased dilation of the right calyceal system, compared with controls (1.7 cm vs 0.8 cm, p less than 0.001). Renal pelvis volume was increased as well (29.3 vs 5.5 cm3, p less than 0.001). Renal pelvicalyceal dilation in antepartum pyelonephritis was significantly increased compared with normal physiologic dilation of pregnancy. Follow-up nephrosonography in a small number of women (N = 10) after treatment of pyelonephritis did not reveal a consistent decrease in renal dilation, suggesting that dilation of the renal pelvis may antedate pyelonephritis. Further study of this phenomenon is warranted.

Dilatation, Pathologic↗

PubMedDate not supplied

Ultrasound anthropometric reliability.

Method errors and reliabilities were estimated for seven sonographic measurements in pregnancies of 106 women examined between January and July 1989. Teams of two experienced sonographers replicated the following measurements: biparietal diameter (BPD), occipital-frontal diameter (OFD), anterior-posterior diameter (APD), transabdominal distance (TAD), and femur diaphysis length (FDL). Multilevel modeling procedures were used to estimate the variance components. Significant (p < 0.01) covariates in the fixed part of the model included an increase in error with greater parity, estimated menstrual age (EMA), and maternal abdominal wall thickness (taken at the umbilicus). Intraobserver reliability ranged from 85.2% (AC) to 99.3% (FDL); interobserver reliability ranged from 80.8% (TAD) to 92.4% (FDL). Method errors, describing the expected error for 68% of the measurements taken, ranged from 0.8 mm to 7.7 mm (intraobserver) and from 1.2 mm to 7.8 mm (interobserver). These results suggest that large error components should be considered in the interpretation of the reliability of ultrasonographically obtained measurements.

Adolescent↗