Nutritional therapy of galactosemia. Management success depends on rigid exclusion of all galactose-containing foods.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
E Lieberman
Publications and source records attributed to E Lieberman.
No free lunch on labor day. The risks and benefits of epidural analgesia during labor.
Epidural analgesia provides effective pain relief for women during labor. However, like all medical interventions, it also has potential side effects such as longer labor and a higher rate of intrapartum fever and operative vaginal delivery. A recent meta-analysis of randomized studies by Halpern et al concluded there was no association between epidural use and cesarean delivery. A critique of that meta-analysis, included in this paper, concludes that there are currently insufficient data to determine whether epidural analgesia leads to increased rates of cesarean delivery. This paper also presents results from several recent studies related to epidural analgesia conducted at Brigham and Women's Hospital in Boston. One study demonstrates a significant influence of prenatal planning on use of epidural during labor. Additional studies examine the strong association of epidural analgesia with intrapartum fever and the consequences of that fever for mother and infant. Epidural analgesia should remain an option available to women during labor. A more complete understanding of the risks and benefits that accompany its use is essential so that women and their care providers can make informed choices about pain relief during labor.
Analgesia, Epidural↗
Perinephric abscess in renal transplant recipients: report of seven cases and review.
The experience of four kidney transplantation programs from 1975 to 1986 was reviewed to determine the prevalence and clinical characteristics of perinephric abscess in renal transplant recipients. Seven cases were found, with a prevalence of 0.3% in 1,945 patients seen over a 12-year period in one program. Current prevalence appears markedly less than in older studies. Despite immunosuppression, signs and symptoms of perinephric abscess were prominent and included fever, flank and abdominal pain and tenderness, and abdominal mass. Perinephric abscesses were diagnosed 2 weeks to 52 months after transplantation and were associated with lymphoceles in two patients. Abdominal ultrasound and computed tomography were useful in diagnosis. Staphylococci (36%) and aerobic gram-negative rods (32%) were the most common pathogens in our seven patients combined with patients identified in a review of the English-language literature. Also of note were the presence of anaerobes (28%) and Candida albicans (4%). Therapy was successful in all of our seven patients.
Abscess↗
Malformations reported in chorionic villus sampling exposed children: a review and analytic synthesis of the literature.
PURPOSE: To determine whether the frequency of vascular disruption defects, other than limb defects, is increased in reports of chorionic villus sampling (CVS) exposed children compared with an unexposed population. METHODS: Only studies that reported the total number of CVS-exposed pregnancies and details of pregnancy outcome, including all the malformations, were included. Twenty-five articles met these criteria. RESULTS: The frequencies of gastroschisis, intestinal atresias, and clubfoot were significantly increased among the CVS-exposed infants as compared with the baseline unexposed population. The frequencies of other vascular disruption defects, including Poland sequence, amniotic band sequence, and cleft lip/cleft palate, were not increased. CONCLUSION: CVS-exposed children have an increased frequency of intestinal atresia, gastroschisis, and clubfoot compared with the nonexposed population. The fact that an increased frequency of other defects attributed to vascular disruption was not found may be due to under-ascertainment, misclassification, or "lumping" of the defects identified in previous studies.
Chorionic Villi Sampling↗
ABO and rhesus blood groups and adverse outcomes of pregnancy.
Interview and medical-record data of 11,659 nondiabetic, non-asthmatic women were analyzed to evaluate the relationship between ABO and Rh blood groups and adverse outcomes of pregnancy. No statistically significant associations were found in logistic regression analyses that controlled for age, race, smoking and parity. The results of our study demonstrate the importance of controlling for confounding variables, and do not support a relationship between maternal blood group and adverse pregnancy outcomes including malformations.
ABO Blood-Group System↗
Short stature: new challenges in growth hormone therapy.
Until recently, the limited supplies of pituitary derived growth hormone (GH) enabled us to treat only those patients who were classical GH deficient. With the unlimited supplies of recombinant GH available, there is no limitation to the number of patients we can treat. It becomes necessary, however, to select those patients who will most benefit from GH therapy. Our preliminary results demonstrate that the short-term growth response to growth hormone is not an all-or-none phenomenon. The lower the growth velocity and the growth hormone reserve, the better the growth response to therapy. On the other hand we do not recommend institution of GH therapy for children with a normal growth rate and a normal GH spontaneous secretion. In children with classical GH deficiency (GHD) and in children with a subnormal spontaneous secretion of GH (NSD) adult height prediction decreases when GH therapy is started at an age older than 12. We have found that GHD and NSD boys differ in their growth pattern. Pubertal maturation and bone age maturation progress more rapidly in NSD patients. Therefore special caution is needed in NSD patients older than 12 years. The older the patient and the longer the treatment period, the faster the pubertal process can advance. Further studies are needed before recommendations for therapy in non-classical GHD patients can be made. Until patients involved in clinical trials reach final height, recommendations for new indications cannot be made.
Body Height↗