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Biomedical subjects

David M Sherer

Publications and source records attributed to David M Sherer.

At least 19 recordsLinked to original sources
PubMed2006

Acute onset of severe hemolysis, elevated liver enzymes, and low platelet count syndrome in a patient with a partial hydatidiform mole at 17 weeks gestation.

Preeclampsia is uncommon prior to 24 weeks gestation and has been associated with partial and complete hydatidiform moles. We present an unusual case in which a patient was diagnosed with preeclampsia at 17 weeks gestation. Ultrasound findings were consistent with a partial hydatidiform mole. Within 24 hours of the onset of symptoms, the patient developed severe hemolysis, elevated liver enzymes, and low platelet count syndrome, with a platelet count of 20 x 10 (9) cells/L. Termination of pregnancy was performed with rapid resolution of signs, symptoms, and laboratory abnormalities. Triploid 69,XXY was confirmed at karyotype analysis. This case demonstrates the acuteness in which life-threatening maternal conditions can arise with this uncommon complication of pregnancy, and the importance of correct identification of the characteristic ultrasonographic findings associated with a partial hydatidiform mole.

Abortion, Induced↗
PubMed2006

Do serum beta-human chorionic gonadotropin levels on day 4 following methotrexate treatment of patients with ectopic pregnancy predict successful single-dose therapy?

The purpose of this study is to assess whether serum beta-human chorionic gonadotropin (beta-hCG) levels on day 4 following methotrexate (MTX) treatment in patients with ectopic pregnancy predict successful single-dose therapy or the need for subsequent surgical intervention. Retrospective analysis of patients with ectopic pregnancies treated with MTX (50 mg/m (2)) was conducted. Inclusion criteria for MTX management were serum beta-hCG < 15,000 mU/mL, absent fetal cardiac activity, ultrasonographic gestational sac < 3.5 cm, normal liver function tests, hemodynamically stable patient with no evidence of hemoperitoneum, and informed consent. Day 1, 4, and 7 serum beta-hCG levels were obtained. Outcome parameters included successful single-dose MTX management, the requirement for multiple treatments, and whether subsequent surgery was required. Receiver operator characteristic (ROC) curves were used. P < 0.05 was considered significant throughout. Eighty-three patients were studied. Of these, 60 patients were treated successfully with single doses, 16 patients required two doses, and two patients required three doses of MTX, and five underwent surgical management. Mean day 1 serum beta-hCG levels of patients successfully treated with single-dose MTX was 3938.5 (+/- 589.2 [standard deviation]) versus 1767.65 (+/- 1237.8) mU/mL in patients requiring multiple doses of MTX therapy, ( P < 0.0001). ROC curves for serum beta-hCG levels on days 1, 4, and 7 were 0.449, 0.592, and 0.754, respectively, indicating that only day 7 serum beta-hCG levels were associated with successful single-dose MTX therapy. Serum beta-hCG levels on day 4 of MTX in patients with ectopic pregnancy do not predict successful single-dose therapy or the need for surgery.

Abortifacient Agents, Nonsteroidal↗
PubMed2006

Glucose challenge test threshold values in screening for gestational diabetes among black women.

OBJECTIVE: The objective of the study was to assess the incidence of gestational diabetes among black women according to various cut-off values of the glucose challenge test. STUDY DESIGN: We performed a retrospective chart review of black patients who had a 50-g, 1-hour glucose challenge test between 24 and 28 weeks' gestation of 130 mg/dL or higher followed by a 100-g, 3-hour glucose tolerance test. Results were categorized in 10-mg/dL increments. Gestational diabetes was diagnosed by 2 or more abnormal values using the Carpenter-Coustan criteria. RESULTS: The study included 387 patients. The incidence of gestational diabetes diagnosed overall in all patients with a glucose challenge test of 130 mg/dL or higher was 31.2%. The incidence of gestational diabetes in individuals with a challenge test in the range of 130 to 140 mg/dL was 10.7%. The incidence of gestational diabetes with a screening test of 180 mg/dL or higher was 72.0%. CONCLUSION: Our data support the use of 130 mg/dL as the threshold for a positive glucose challenge test and suggest the use of a glucose tolerance test to confirm the diagnosis of gestational diabetes for screening values up to 200 mg/dL.

Adult↗
PubMed2006

Hyperreactio luteinalis presenting with marked hyperglycemia and bilateral multicystic adnexal masses at 21 weeks gestation.

We present an unusual case in which a 23-year-old nulliparous patient was noted to have bilateral multicystic adnexal masses at 21 weeks gestation. Subsequent severe nausea, vomiting, and hyperglycemia with a serum glucose level of 450 mg/dL led to the diagnosis of gestational diabetes. Gradual development of marked maternal virilization ensued and was associated with a serum testosterone level of 4030 ng/mL (free testosterone level of 224 pg/mL), with normal serum dehydroepiandrostendione, estriol, and cortisol levels, leading to the diagnosis of hyperreactio luteinalis. Following vaginal delivery at 38 weeks gestation, gradual and complete spontaneous resolution of signs, symptoms, adnexal masses, diabetes, and testosterone levels were documented.

Adult↗
PubMed2006

Small bowel volvulus after uterine artery embolization requiring bowel resection: a case report.

BACKGROUND: Previously described surgical complications following uterine artery embolization for leiomyomata include sequelae of uterine aberrant embolization (buttock and labial necrosis, vesicouterine fistula), prolapsed cervical myoma, uterine necrosis, ischemic uterine rupture and sepsis. CASE: A 43-year-old woman presented with severe abdominal pain, nausea and vomiting 7 days after bilateral uterine artery embolization for symptomatic leiomyomata. Mechanical obstruction of the distal ileum was diagnosed and did not respond to conservative measures. At laparotomy, volvulus of the distal ileum, which adhered to omental and uterine adhesions, required resection and end-to-end anastomosis. CONCLUSION: Volvulus may occur following uterine artery embolization for leiomyomata.

Adult↗
PubMed2005

Intrapartum repetitive maternal heart rate deceleration pattern simulating nonreassuring fetal status.

Uterine contraction-associated accelerations of the maternal heart rate are considered to reflect both a transient contraction-related increase in cardiac output and endogenous catecholamine secretion. Uterine contraction-associated decelerations of the maternal heart rate are rare and remain unexplained. A young multiparous patient with systemic lupus erythematosus (postrenal transplant for lupus nephropathy-related renal failure) presented in early labor at 39 weeks gestation, prior to elective repeat cesarean section. Intrapartum continuous maternal heart rate monitoring demonstrated repetitive uterine contraction associated decelerations of the maternal heart rate of 60 beats per minute, each lasting 2 minutes, simulating nonreassuring fetal status. Simultaneously depicted fetal heart rate was reassuring. This case demonstrates an unusual marked early intrapartum affect of uterine contractions upon the maternal heart rate. In addition, this case illustrates the potentially dangerous similarity of an intrapartum maternal heart rate to an abnormal fetal heart rate pattern, and emphasizes the importance of correct identification of the maternal and fetal heart rates, respectively.

Cardiotocography↗
PubMed2005

Thrombotic thrombocytopenic purpura in a patient with acquired immunodeficiency syndrome at 28 weeks gestation.

An increased incidence of thrombotic thrombocytopenic purpura has been reported among human immunodeficiency virus-infected patients or those with acquired immunodeficiency syndrome (AIDS). Despite this association, hitherto only a single case of thrombotic thrombocytopenic purpura has been reported in an HIV-infected patient during pregnancy. We describe a young multiparous patient with long-standing AIDS who presented with lower abdominal pain. Following findings of thrombocytopenia, microangiopathic hemolytic anemia, renal failure, low-grade fever, and mental status changes, thrombotic thrombocytopenic purpura was diagnosed after initially considering the diagnosis of severe preeclampsia, and the patient was delivered by cesarean section. The patient required multiple plasma exchanges during a protracted postpartum course, and was discharged in good health. This first report of thrombotic thrombocytopenic purpura and AIDS in pregnancy demonstrates that when encountering preeclampsia in patients with AIDS, thrombotic microangiopathy should be strongly considered. In addition, these patients may exhibit an attenuated response to plasma exchange therapy and despite previous reports in nonobstetric patients, a favorable outcome is attainable in these critically ill patients.

Acquired Immunodeficiency Syndrome↗