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Biomedical subjects

F R Papsin

Publications and source records attributed to F R Papsin.

16 recordsLinked to original sources
PubMed1992

Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada.

In order to determine the prevalence of post-partum thyroid dysfunction in our region, 1,376 randomly selected mothers were enrolled immediately post-partum and followed prospectively over a 2 year period in a large single-center survey. Beginning at delivery, sequential clinical and laboratory assessments were conducted at 6-8 week intervals up to 1 year post-partum and a questionnaire was administered at 3 months post-partum. Among the 1,376 mothers who qualified for entry into this study, 495 (36%) completed at least 3 months follow-up and 300 (22%) completed at least 1 year of follow-up. Abnormalities in post-partum thyroid function (PTD) were detected in 82 of the 1,376 enrolled mothers for an overall minimum prevalence rate of 6.0%. Hyperthyroidism confirmed to be associated with a low 24h radioactive iodine thyroid uptake (RAIU), compatible with the post-partum painless thyroiditis syndrome (PPT) was documented in 44 (3.2% minimum prevalence of typical PPT) of which 39 (89%) had a typical biphasic (hyperthyroid to hypothyroid) PTD while 5 (11%) had only a hyperthyroid phase with a suppressed RAIU without a subsequent hypothyroid phase. Another 17 (1.2%) had transient hyperthyroidism likely due to PPT but were not confirmed by an RAIU test and did not evolve to a detectable hypothyroid phase; and, 17 mothers (1.2%) had hypothyroidism between 5-7 months post-partum without preceding hyperthyroidism, resulting in an overall minimum prevalence of 5.7% for all variants of PPT. Graves' hyperthyroidism occurred in 3 (0.2%) and toxic nodular goiter was present in 1 (0.07%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Antithyroid microsomal autoantibodies and HLA-DR5 are associated with postpartum thyroid dysfunction: evidence supporting an autoimmune pathogenesis.

Antithyroid microsomal antibodies (AMA) and human leukocyte antigen (HLA) haplotypes were assessed as markers for the occurrence of postpartum thyroid dysfunction (all forms) and postpartum painless thyroiditis with transient hyperthyroidism, respectively. AMA titers and thyroid function tests were measured sequentially in 261 mothers from delivery to up to 1 yr postpartum. To test for the association of HLA haplotypes in the subgroup of women with postpartum painless thyroiditis with hyperthyroidism, typing for HLA-A, -B, -C, -DR, and -DQ antigens was carried out in a selected group of 38 mothers with this syndrome. Their results were compared to those in 60 women with hypothyroid goitrous autoimmune thyroiditis and 98 regional controls. In the AMA study, 40 (15%) of the 261 mothers had positive AMA titers (titer, less than or equal to 1:80) at delivery, 54 (21%) 2-4 months postpartum, 69 (26%) 5-7 months postpartum, and 60 (23%) 1 yr postpartum. Among 55 mothers who developed postpartum thyroid dysfunction, 25 (47%) had positive AMA at delivery [relative risk (RR), 10.0; P less than 0.001; sensitivity, 45%; specificity, 95%]. Two to 4 months postpartum, 46 mothers had thyroid dysfunction, of whom 35 (76%) had positive AMA, while only 19 of the 215 euthyroid mothers (9%) had positive tests for AMA. Positive AMA tests at these times resulted in a RR for postpartum thyroid dysfunction of 32.8 (P less than 0.0001; sensitivity, 76%; specificity, 91%). Five to 7 months postpartum, 55 mothers had thyroid dysfunction, of whom 47 (86%) had positive AMA, while only 22 of 206 euthyroid mothers (11%) were positive (RR, 59.0; P less than 0.0001; sensitivity, 86%; specificity, 90%). In the HLA studies, DR5 occurred in 11 of 38 (29%) women with postpartum painless thyroiditis with hyperthyroidism vs. 12 of 98 (12%) controls, resulting in a RR of 2.9 (P less than 0.05). HLA-DR5 was present in 22 of 60 (37%) patients with goitrous autoimmune thyroiditis (RR, 4.2; P less than 0.01). HLA-DR4 and HLA-DQw3 were slightly but not significantly increased in women with postpartum painless thyroiditis with hyperthyroidism and goitrous autoimmune thyroiditis compared to those in normal controls. DQw1 was reciprocally decreased (P less than 0.025) in the women with goitrous autoimmune thyroiditis, but not in the women with postpartum painless thyroiditis with hyperthyroidism compared to that in normal controls...

Adult↗
PubMed1983

Premature rupture of membranes: the role of C-reactive protein in the prediction of chorioamnionitis.

A group of 52 patients with premature rupture of the membranes (PROM) before 34 weeks' gestation were evaluated prospectively and managed expectantly. Of 42 patients who were delivered of their infants, 26 (61.9%) had significant chorioamnionitis on histopathology, and 18 had positive microbial cultures at delivery. However, only seven patients (16.7%) developed clinical signs of chorioamnionitis. There were no maternal deaths or perinatal deaths attributable to sepsis. Only two infants (less than 5%) had positive blood cultures. All patients were assessed daily for the development of chorioamnionitis. Amniocenteses were not routinely performed. White blood cell counts, band neutrophil counts, and erythrocyte sedimentation rate determinations were found to be unreliable. C-reactive protein determinations were found most reliable with a high sensitivity and specificity. Elevated C-reactive protein levels correlated better with pathologic confirmation of chorioamnionitis than with the clinical febrile morbidity. Clinical implications for the management of PROM are discussed.

Amnion↗
PubMed1983

Short-term antibiotic prophylaxis in high-risk patients following cesarean section.

A prospective, blinded, placebo-controlled study was performed to determine the minimum effective duration of short-term antibiotic prophylaxis following cesarean section. Cefoxitin was selected as the study drug, and 189 women at high risk for postoperative infectious morbidity were randomly assigned to three cohorts, each receiving intravenous infusions at cord clamping and at 4 and 8 hours postoperatively. The incidence of endometritis in the placebo group was 29.3% versus 9.4% in patients receiving one dose of cefoxitin (2 gm) at cord clamping and 5.0% in patients receiving three doses of cefoxitin (p less than 0.0001). Cefoxitin prophylaxis significantly reduced the incidence of endometritis in patients with postoperative anemia. There were no serious complications or drug reactions in the treated groups.

Adult↗
PubMed1982

Twin pregnancies--a continuing perinatal challenge.

A 5-year retrospective analysis of the management of 177 twin pregnancies was undertaken. Despite increased use of bed rest and ultrasonography as currently recommended, the perinatal mortality among twins (13.2%) remained almost 10 times that for singleton births. Although elective hospitalization for bed rest prolonged the pregnancy, it did not decrease the perinatal mortality. The authors believe this was attributable to bed rest being instituted too late, as 70% of perinatal mortality occurred before the 30th week of gestation, which was also the period of greatest neonatal morbidity. Suggested recommendations for improving management of twin pregnancies are discussed.

Bed Rest↗
PubMed1981

Risk factors associated with infection following cesarean section.

A retrospective study by means of multivariant discriminant analysis was performed on 496 deliveries (250 vaginal and 246 cesarean sections) is identify risk factors which predispose to postoperative febrile morbidity, in particular, endometritis. The infection rates for endometritis by type of delivery were: vaginal, 3.6%; elective repeat cesarean section, 6.0%; nonurgent primary cesarean section, 22.2%; and emergency cesarean section, 38.4%. No patient-related risk factors were identified for elective repeat cesarean section, and bacterial isolates were most frequently Staphylococcus aureus. However, four statistically significant risk factors were associated with the occurrence of endometritis after primary cesarean section. In increasing order of significance, they were duration of labor, number of preoperative vaginal examinations, time membranes were ruptured prior to delivery, and postoperative anemia. Internal fetal monitoring was not a risk factor. The clinical relevance of these findings to the use of prophylactic antibiotics and other attempts aimed at decreasing postoperative morbidity is discussed.

Anti-Bacterial Agents↗
PubMed1979

Organ culture model for the study of HVH-II infections in carcinoma of the cervix.

An experimental model is described whereby human and monkey cervical tissues may be maintained as organ cultures for 21 and 40 days, respectively. Inclusion of sodium carboxymethyl cellulose in the culture medium prolongs the survival time of tissues considerably. The sequential cytologic changes associated with herpesvirus hominis type II (HVH-II) infection are reported. These changes are considered in relation to the possible causal role of HVH-II infection in cervical carcinogenesis.

Animals↗
PubMed1979

Ascending infection following cervicovaginal exposure to herpesvirus hominis type II.

An animal model is presented that demonstrates that following cervicovaginal inoculation, infective doses of herpesvirus hominis type II induce a form of herpetic encephalitis. Immunofluorescent results indicate that there is both neural and hematogenous spread of the herpes infection. The possible role of a latent viral infection in the genesis of an acute disease of the central nervous system is investigated in this experimental system.

Animals↗
PubMed1979

Relation of HVH-II to carcinoma of the cervix.

An animal model is described that demonstrates the development of varying degrees of basal cell hyperplasia, metaplasia, and dysplasia following cervicovaginal herpesvirus hominis type II (HVH-II) infection. Although the study spanned a period of 30 months, the equivalent of 60 human years, there was no evidence of anaplasia. These results are considered in relation to the role of HVH-II as an initiator in the multistep process leading to cervical carcinoma.

Animals↗
PubMed1978

Cesarean section in the management of breech presentation.

In a retrospective analysis of 275 consecutive deliveries of singleton infants in a breech presentation, the liberal use of cesarean section (58.2 per cent) resulted in a corrected perinatal mortality rate of zero for both vaginal and abdominal deliveries of infants weighing over 2,500 grams although perinatal morbidity was greater for vaginal deliveries (5.6 per cent) compared to cesarean section (0.8 per cent). Comparison of perinatal morbidity for delivery of infants weighing between 1,000 and 2,500 grams in a breech presentation suggests that cesarean section is the method of choice for delivery of infants in this weight range in a breech presentation.

Apgar Score↗
PubMed1978

Relation of herpesvirus hominis type II to carcinoma of the cervix. An animal model for the induction of long-term latency of herpesvirus hominis type II.

Proof of latency of herpesvirus hominis type II (HVH-II) following acute vaginocervical infection must be validated if it is to be considered an etiologic factor in carcinoma of the cervix. An animal model is presented which demonstrates acute HVH-II vaginocervical infection. Following the primary acute infection, animals maintained for an equivalent of 60 human years display persistance of the herpesvirus in the pelvic sensory ganglia. Evidence of the specificity of HVH-II as the infectious agent is presented.

Acute Disease↗
PubMed1977

A new uterine mobilizer for laparoscopy: its use in 518 patients.

A new instrument for manipulating the uterus during laparoscopy has added the dimension of uterine version to increase the mobility of the uterus. Allowing elevation, rotation, and version of the uterus, the instrument has increased the case and efficacy of visualization of pelvic viscera in an experience of 518 cases in seven hospitals where it underwent assessment.

Female↗
PubMed1977

Creatine kinase and its isoenzymes in the serum of women during pregnancy and the peripartum period.

In serum obtained from 28 women before, during, and after normal labor and delivery, creatine kinase activity was seen to be distinctly elevated immediately after labor and 24 h later, but had returned to normal six weeks later. In most cases the increase was due to the MM isoenzyme and was attributed to skeletal-muscle damage associated with labor. In 15 cases, the BB isoenzyme was observed, and in three patients the MB isoenzyme. Cord blood, which contains all three isoenzymes, may be the source of the MB and BB isoenzymes. Uterine muscle contains exclusively BB isoenzyme, and therefore uterine muscle damage is a likely source of the serum BB isoenzyme. The relationship among these isoenzymes in serum after delivery must be recognized, to avoid misdiagnosing myocardial infarction at this critical time.

Creatine Kinase↗
PubMed1976

The relative paucity of IgE in human milk.

The levels of IgE were determined in paired samples of serum and milk when whey obtained 3 to 8 days of postpartum, from 16 human lactating mothers who had reported a history of allergy to a variety of common allergens. Two assay procedures were employed to measure total IgE, a double-antibody assay and a commercially available solid phase assay (RIST). In addition, each sample of serum and whey was tested for specific IgE antibodies to a variety of allergens by the RAST test. The levels of total serum IgE were between 30 and 2300 I.U./ml and relatively good agreement was observed for both the double-antibody and RIST methods. In contrast, total IgE levels in milk whey were either undetectable (less than 3.0 I.U./ml in 14 of 16 subjects) or very low when analyzed by the double-antibody method, but were very high (400 to 1650 I.U./ml when analyzed by the RIST method. However, IgE added to milk whey could be measured by the double-antibody procedure indicating that the low levels detected in milk were not a fault of the double-antibody assay. It was assumed that the RIST test was subject to nonspecific interference by factors in milk whey which caused the determination of high, but incorrect, levels of IgE. Specific IgE antibodies were detected in the serum of 10 of 16 subjects but were not present in milk whey. A comparison of the whey/serum ratios of albumin, IgA, and IgE suggested that little, if any, IgE is selectively synthesized or secreted in the mammary gland.

Animals↗