Biomedical subjects

E K Main

Publications and source records attributed to E K Main.

28 records · Page 2Linked to original sources

PubMed1987

Neonatal morbidity in pregnancy complicated by diabetes mellitus: predictive value of maternal glycemic profiles.

The relationship between glycemic control and perinatal outcome was assessed in a relatively uniform population of 75 White Class B through D pregnant diabetic women. All patients used glucose reflectance meter self-monitoring and performed a minimum of four determinations daily. Mean capillary blood glucose was calculated from a minimum of 16 weeks of determinations. Regression analysis confirmed a correlation between these values and third-trimester hemoglobin A1 (p less than 0.001). The study population was divided into two groups on the basis of mean capillary blood glucose values: group I, mean capillary blood glucose less than 110 mg/dl (43 patients) (mean = 96.8 +/- 7.1); group II, mean capillary blood glucose greater than 110 mg/dl (32 patients) (mean = 126 +/- 9.0). Of the 32 patients in group II, eight had mean capillary blood glucose greater than or equal to 130 mg/dl. The degree of maternal glycemic control appeared to affect perinatal outcome. At least one form of infant morbidity was present in 33% of group I infants compared with 53% of group II. Significant differences were observed for the incidence of hypoglycemia (p less than 0.05), macrosomia (p less than 0.05), and respiratory distress syndrome (p less than 0.01). One of six group I infants delivered at 35 to 36 weeks developed respiratory distress syndrome, compared with four of seven group II patients. The appearance of phosphatidylglycerol in amniotic fluid appeared delayed in group II patients at term. These data suggest that maintaining mean capillary blood glucose values less than 110 mg/dl may serve to reduce several major forms of morbidity in the infant of the diabetic mother. This information is helpful in establishing objectives for glycemic control in pregnant women using self-monitoring techniques.

Adult↗

PubMed1987

Chronic oral terbutaline tocolytic therapy is associated with maternal glucose intolerance.

Plasma glucose determinations were performed 1 hour after a 50 gm oral glucose load in 30 patients receiving long-term terbutaline therapy (20 to 40 mg/day for at least 1 week) and 247 normal control patients. A total of 63% of patients receiving terbutaline had an abnormal 1-hour value (greater than or equal to 140 mg/dl), an incidence much higher than that of control subjects (17.8%) (p less than 0.0001) for a relative risk of 3.54 (95% confidence intervals of 2.29 to 5.42). Mean 1-hour values were 112.1 mg/dl for control subjects and 149.8 mg/dl in the terbutaline group (p less than 0.0001). All abnormal values were followed by a 3-hour 100 gm oral glucose tolerance test. A total of 15.9% of the glucose tolerance tests performed in the control group (2.8% overall) were abnormal as opposed to 52.6% (33.1% overall) in patients receiving terbutaline (p less than 0.01). Nine patients were studied before and after terbutaline therapy. Results obtained during administration of terbutaline were significantly higher (102.2 mg/dl before therapy versus 145.2 mg/dl during therapy). We conclude that treatment with oral terbutaline appears to be associated with impairment of glucose tolerance in pregnancy.

Administration, Oral↗

PubMed1987

The origin of increased serum iron in pregnancy-induced hypertension.

Serum iron was measured in 30 patients with pregnancy-induced hypertension and 24 normal pregnant women. The mean iron concentration was significantly higher in the group with pregnancy-induced hypertension (111 +/- 26 micrograms/ml) than in the controls (69 +/- 17 micrograms/ml) (p less than 0.0001). Readily available laboratory variables were used to determine whether the increased serum iron was the result of (1) hemolysis, (2) hepatocellular injury, or (3) intravascular volume contraction leading to hemoconcentration. It appears that a clinically silent, ongoing hemolytic reaction is responsible for the increase in serum iron seen in patients with pregnancy-induced hypertension.

Adult↗

PubMed1987

HLA antigen expression and induction by gamma-interferon in cultured human trophoblasts.

The expression and regulation of HLA antigens were examined in isolated human trophoblasts. Immunocytochemical studies that used monoclonal antibodies against class I (HLA-A, B, and C) antigens revealed that both cytotrophoblasts and syncytiotrophoblasts can express HLA heavy chains and beta 2-microglobulin. Expression of these antigens increased with time in culture. The addition of recombinant gamma-interferon (1000 U/ml) to the cultures significantly increased cellular staining for these antigens over controls throughout the 72-hour time course studied. In addition, we noted that gene expression for HLA class I heavy chain was also markedly augmented by the addition of gamma-interferon. Expression of class II (HLA-DR) antigens was not detected in any of the experiments. These results suggest that during in vitro differentiation, cytotrophoblasts can express class I HLA antigens and the genes controlling their production can be regulated. Alterations in the expression or suppression of these antigens during pregnancy could be responsible for some pregnancy complications.

Cell Differentiation↗

PubMed1987

Abnormalities in platelet antiglobulin tests in preeclamptic mothers and their neonates.

We prospectively studied 40 women with preeclampsia and 26 women with normal pregnancy for the presence of platelet-bound and circulating platelet-bindable immunoglobulin and complement. Although only 12 patients with preeclampsia had a platelet count less than 150,000/mm3, 36 of 40 demonstrated an abnormal direct antiglobulin test, compared with only three of 26 control subjects (p less than 10(-8]. An abnormal indirect test was also detected in 30 of 40 patients with preeclampsia compared with five of 26 healthy pregnant control women (p = 9.3 X 10(-6]. Abnormal antiglobulin tests persisted for 2 to 6 weeks after delivery. Although each neonate had a platelet count greater than 200,000/mm3 at the time of delivery, 10 of 18 had an abnormal direct antiglobulin test compared with one of 14 control subjects (p = 0.0049). The high frequency of abnormal platelet antiglobulin tests in women with preeclampsia and their neonates may indicate an immune cause of certain aspects of the syndrome or may reflect the extent of platelet activation.

Adolescent↗

PubMed1985

The effect of oral ritodrine therapy on glucose tolerance in pregnancy.

Intravenous ritodrine therapy can cause significant deterioration of maternal glucose homeostasis. We investigated the effect of full maintenance oral ritodrine therapy (120 mg/day) on glucose tolerance in the early third trimester with the use of 50 gm 1-hour screens followed by 100 gm 3-hour oral glucose tolerance tests if the screen level was greater than or equal to 140 mg/dl. Four hundred ninety-one patients were studied, 42 of whom were receiving oral ritodrine therapy. Twenty-one percent of the ritodrine-treated women had an abnormal 1-hour screen, which was not different from the 20% observed in women not receiving therapy. None of the treated group and 13% of the untreated group who had abnormal screens had abnormal oral glucose tolerance tests. The probability of an abnormal test after an abnormal 1-hour screen was also determined.

Administration, Oral↗

PubMed1985

Human neuroblastoma cell lines are susceptible to lysis by natural killer cells but not by cytotoxic T lymphocytes.

The susceptibility of human neuroblastoma cells to direct cellular cytotoxicity has not been previously established. This is of particular interest because of their aggressive growth and low HLA expression. Neuroblastoma lines CHP 100 and CHP 126 were found to be excellent targets in 4-hr CML assays. Natural killer (NK) cells from fresh PBL and from an NK clone, 3.3, have high lytic activity against both cell lines. We also studied mixed lymphocyte culture-generated cytotoxic lines containing allo-specific cytotoxic T lymphocytes (CTL) directed against HLA antigens present on the neuroblastoma target cell lines. These lines did show excellent lytic activity, but cold target competition studies indicated that all of the lysis resulted from NK activity. This was verified by using inhibition studies with the use of monoclonal antibodies. OKT 3 and anti-HLA antibodies that block CTL function caused no reduction in kill. In contrast, anti-lymphocyte function antigen-1 (anti-LFA-1), which blocks both NK and CTL function, significantly inhibited lysis. These results serve as a functional confirmation of earlier findings of a very weak expression of HLA-A,B,C and beta 2-microglobulin on neuroblastoma cells.

Antibodies, Monoclonal↗

PubMed1983

Cesarean section versus vaginal delivery for the breech fetus weighing less than 1,500 grams.

Although previous studies have suggested that the breech infant weighing less than 1,500 gm benefits from cesarean section, the published results have not demonstrated statistically significant differences. We have evaluated pediatric outcome data for 240 breech infants and 525 vertex infants who weighed less than 1,500 gm, to determine whether route of delivery affects infant morbidity and mortality. Twenty-nine percent of these very small breech infants who were delivered by cesarean section died, as compared to 58% of breech infants of similar weight who were delivered vaginally (p less than 0.001). Comparable significant differences were found for the infants delivered at a university hospital as well as for those delivered at a group of nonuniversity hospitals. Apgar scores and the incidence and severity of intraventricular hemorrhage were not different for the cesarean section and vaginally delivered breech infants. Furthermore, the survival rate of the breech infants delivered by cesarean section equaled that of the vertex infants delivered either by cesarean section or vaginally.

Apgar Score↗

PubMed1983

Treatment of chloroquine-resistant malaria during pregnancy.

A pregnant 36-year-old Vietnamese refugee with chloroquine-resistant Plasmodium falciparum infection was treated with pyrimethamine and a sulfonamide. This treatment produced rapid clearance of the patient's parasitemia and was associated with a resumption of normal fetal and uterine growth. Because the other drugs effective against chloroquine-resistant P falciparum may produce uterine stimulation (quinine sulfate) or damage the fetal skeleton (tetracyclines), the pyrimethamine-sulfonamide combination (with folinic acid supplementation) may be the best available choice for the treatment and prophylaxis of chloroquine-resistant P falciparum infection in pregnancy, despite its theoretical risk of teratogenicity.

Adult↗

PubMedDate not supplied

The identification of suppressor cells in the murine fetal liver.

Fetal suppressor cells are potentially important for maintenance of pregnancy and for the immune regulation of the identification of self. We have identified and partially characterized a population of murine fetal liver cells which are active suppressors of a variety of immune responses, including mixed lymphocyte responses (MLR), responses to mitogens, and plaque-forming cell responses to heterologous erythrocytes. The suppression is non-H-2-restricted and can act via a factor. The cell is preactivated in fetal liver and may represent a T-cell precursor. The suppression of MLR is maximal (approximately 100%) if cells are added within the first 48 h of culture initiation. The characteristics of this suppressor cell are compared to other known MLR and perinatal suppressor systems.

Animals↗