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Biomedical subjects

H L Galan

Publications and source records attributed to H L Galan.

29 records · Page 2Linked to original sources
PubMed1997

Fetal drug therapy.

As prenatal diagnosis has become more sophisticated, avenues for a variety of intrauterine therapies have been opened. Considerable experience has been gained with surgical and pharmacologic approaches. This article provides a review of intrauterine drug therapy aimed at preventing fetal and neonatal disease and treating existing fetal conditions. The future awaits the exciting applications of intrauterine hematopoietic transplants and genetic therapy.

Bone Marrow Transplantation↗
PubMed1997

Laparoscopy during pregnancy. A survey of laparoendoscopic surgeons.

OBJECTIVE: The purpose of this study was to survey the Society of Laparoendoscopic Surgeons (SLS) for their experience with laparoscopy during pregnancy and to develop a database on the safety and complications of laparoscopy in pregnancy. STUDY DESIGN: A survey questionnaire was mailed to 16,329 laparoscopic surgeons from the SLS mailing database. Seven questions were asked: number of laparoscopic procedures in pregnancy, type of operation, gestational age, intraoperative and postoperative complications, insufflation agent and insufflation pressure. Only surgeons who had performed laparoscopic procedures in pregnancy were asked to return surveys. RESULTS: One hundred ninety-two (1.2%) surveys were returned. Complete information was available on 413 laparoscopic cases. There were five intraoperative complications, including inadvertent placement of a Veress needle into a pregnant uterus. There were 10 postoperative complications. CONCLUSION: This is the first report to specifically address the safety and complications of laparoscopy in pregnancy. This study suggests that laparoscopy may be safe during pregnancy; however, it was limited by the biases of surveys and retrospective studies.

Databases, Factual↗
PubMed1996

Fresh frozen plasma prophylaxis for hereditary angioedema during pregnancy. A case report.

BACKGROUND: Hereditary angioedema (HAE) is an uncommon disorder of the complement system due to a deficiency or dysfunction of the inhibitor of the first component of complement (C1 INH). Clinically, HAE is characterized by episodic abdominal pain or edema of the extremities, face, larynx and vulva. Laryngeal edema is potentially lethal and accounts for mortality rates as high as 30%. Therapy is divided into short-term (fresh frozen plasma) and long-term (antifibrinolytic agents, hormonal therapy) prophylaxis, or acute treatment (epinephrine, steroids, antihistamines). CASE: An 18 year-old, primiparous woman presented with a history of multiple episodes of abdominal pain, swelling of abdomen and extremities. A diagnosis of hereditary angioedema was made based on the patient's and family's history and on decreased levels of C1 INH and complement component 4. Standard prophylactic methods were contraindicated due to potential teratogenic effects. Fresh frozen plasma given twice weekly over 2.5 months resulted in reduction in the number and severity of attacks and allowed successful completion of pregnancy. CONCLUSION: This is the first report of fresh frozen plasma therapy as a means of long-term prophylaxis in a pregnant woman. Fresh frozen plasma may serve as an alternate mode of long-term prophylaxis if the standard agents (antifibrinolytic, hormone) are unsuccessful or contraindicated.

Adolescent↗
PubMed1995

The squirrel monkey: an animal model of pelvic relaxation.

OBJECTIVE: Casual observations of pelvic prolapse have previously been made in adult female squirrel monkeys. We objectively observed and described the pelvic findings of the adult females in our colony to evaluate their potential as an animal model for studies of pelvic relaxation. STUDY DESIGN: Subsets of a group of 28 adult female squirrel monkeys were examined on three separate occasions and photographed to document perineal findings. Four areas of loss of support in the vagina were described, including the urethra, anterior segment, cervix, and posterior segment. The degree of loss of support at each specific site was documented. Also, three measurements were obtained from each animal, including the distance from the base of the clitoris to the posterior edge of the perineal body and the length and width of the introitus. The length of the perineal body was calculated. RESULTS: Fifty percent of the animals had at least one site of pelvic prolapse at rest or on straining. With straining 50% had urethral prolapse, 21% had anterior segment prolapse, and 11% had posterior segment prolapse. None of the animals had evidence of cervical prolapse. Of the animals with findings of pelvic relaxation, 43% had combined prolapse at two or more sites. Of the measurements obtained, only the width of the introitus was significantly different between the group of normal animals and those found to have pelvic prolapse (p < 0.0005). CONCLUSION: On the basis of observations of our colony of squirrel monkeys, a significant number of animals demonstrated findings of pelvic support loss with defects similar to those observed in humans. Although limitations to some techniques of evaluation and surgical intervention exist, the squirrel monkey is an animal model that may provide new opportunities for basic investigation of the pathophysiologic features and the management of pelvic relaxation.

Animals↗
PubMed1995

Maternal and fetal effects of laparoscopic insufflation in the gravid baboon.

STUDY OBJECTIVE: To test the hypothesis that intraabdominal pressures (IAP) associated with abdominal insufflation for laparoscopic procedures can alter pulmonary and hemodynamic values in the pregnant baboon and hemodynamic values in the fetus. DESIGN: A descriptive physiologic study. SETTING: Animal research facility at Scott and White Memorial Hospital, Temple, TX. PARTICIPANTS: Four pregnant baboons at 120 +/- 7 days' gestation. INTERVENTIONS: The baboons underwent general anesthesia, Swan-Ganz and arterial catheter placement, and abdominal insufflation at 10 and 20 mm Hg IAP for 20-minute intervals at each pressure. The following end points were measured: maternal heart rate (MHR), mean arterial pressure (MAP), cardiac output (CO), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressures (PAP), central venous pressure (CVP), systemic vascular resistance (SVR), ventilator rate (VR), oxygen saturation, and end-tidal carbon dioxide (CO2). Fetal heart rate and fetal growth values were measured, and umbilical artery Doppler flow studies were performed. MEASUREMENTS AND MAIN RESULTS: The PCWP (p <0.026), CVP (p <0.0012), and PAP (p <0.046) were significantly increased at 20 mm Hg IAP; CO decreased as IP increased. The MAP, MHR, and SVR did not change significantly with increased IAP. The only significant change in pulmonary values was the increase in peak airway pressure (p <0.001). The VR was increased from an average of 18 to 41 breaths/minute in an attempt to maintain adequate oxygen saturation and to normalize end-tidal CO2 when IAP was increased to 20 mm Hg. Respiratory acidosis (pH <7. 35, partial pressure of carbon dioxide >50 torr) was demonstrated in three of four animals within 20 minutes at an IAP of 20 mm Hg. Results of Doppler flow studies on the effects of the fetuses were unaltered immediately after this procedure compared with baseline measurements. Normal interval growth was demonstrated 2 weeks after the procedure. CONCLUSION: The baboon mothers and fetuses had no adverse effects at an IAP of 10 mm Hg, but may have significant cardiovascular and respiratory alterations associated with IAP of 20 mm Hg.

Acidosis, Respiratory↗
PubMed1995

Puerperal cerebral venous thrombosis associated with decreased free protein S: a case report.

BACKGROUND: Cerebral venous thrombosis is a rare event with multiple risk factors. This condition can be associated with a hypercoagulable state, such as that seen with dysfunctional or decreased plasma protein C and protein S. Both plasma proteins are naturally occurring, vitamin K-dependent anticoagulants that are important for regulation of the clotting cascade. CASE: A postpartum patient presented with complaints of a severe headache and hypertension and later developed status epilepticus. She was found to have superior sagittal sinus and right internal jugular vein thrombosis and protein S deficiency. CONCLUSION: The combination of protein S deficiency and the further reduction due to pregnancy may enhance the risk of major thrombotic episodes in the peripartum period.

Anticoagulants↗
PubMed1994

Acute pelvic inflammatory disease after tubal sterilization. A report of three cases.

Pelvic inflammatory disease (PID) is considered to be rare or nonexistent following tubal sterilization. The purpose of this report is to describe three cases of surgically diagnosed acute PID in women previously sterilized by bilateral tubal ligation who presented over a one-year period. All three patients presented with an acute abdomen, fever and elevated white blood cell count. Our experience suggests that PID following tubal sterilization is more common than previously described and can present a diagnostic dilemma.

Abdomen, Acute↗
PubMed1993

Surfactant replacement therapy in utero for prevention of hyaline membrane disease in the preterm baboon.

OBJECTIVE: A previous study of intraamniotic administration of surfactant in preterm rabbit fetuses demonstrated that exogenous surfactant can be taken up into the lungs from amniotic fluid in quantities sufficient to alter pulmonary mechanical properties. On the basis of these findings we chose to test the hypothesis that intraamniotic administration of surfactant to the preterm baboon 24 hours before delivery will prevent the development of clinical and pathological aspects of hyaline membrane disease. STUDY DESIGN: Characteristics of hyaline membrane disease in the preterm baboon model include atelectasis, the formation of hyaline membranes in the airways and distal air saccules, overexpansion of distal airways, and disruption of airways by barotrauma associated with neonatal intensive care practices. Nine preterm baboons were treated with either saline solution (n = 4) or surfactant (n = 5) by intraamniotic injection on 136 to 137 days' gestation. One day later fetuses were delivered by cesarean section and maintained for 24 hours with standard neonatal intensive care techniques. RESULTS: All neonates completed the protocol, and surfactant-treated animals had better clinical courses as documented by Pao2/PAO2 (p < 0.05), FIO2 (p < 0.005), and Paco2 (p < 0.05). Significant radiographic differences (p < 0.02) were noted to be the result of surfactant treatment. No differences in ventilator pressures or neonatal cardiovascular parameters were found. Significant differences in pulmonary pathologic conditions (p < 0.01) were also found, but all animals had some degree of pathologic pulmonary changes associated with hyaline membrane disease. CONCLUSION: Therefore a single treatment with surfactant in utero significantly improved the clinical course but did not completely prevent hyaline membrane disease in an established animal model.

Amniocentesis↗
PubMed1992

Effect of intra-amniotic administration of Exosurf in preterm rabbit fetuses.

OBJECTIVE: Currently, treatment of respiratory distress syndrome (RDS) of the preterm newborn incorporates exogenous surfactant administration. Because fetuses make breathing motions, we proposed that intra-amniotic administration of an exogenous surfactant, Exosurf, to the preterm rabbit fetus results in uptake of Exosurf into the lungs and improves pulmonary mechanical properties compared with post-delivery treated and untreated litter mates. METHODS: Ten preterm rabbit fetuses were used in a labeling study. A mixture of iron dextran and Exosurf was given in utero, and the minimum dose required to assure delivery of the mixture into the distal airways was 5 mL. In a lung function study, 30 rabbit pups received either 5 mL Exosurf in utero, 0.2 mL Exosurf post-delivery, or no treatment. Pressure-volume curves, opening pressures, and lung volumes at 50 cm H2O were compared among the three groups. RESULTS: Those rabbit pups receiving Exosurf either in utero or after delivery had significantly better pressure-volume relationships (P less than .001) and lower opening pressures (P less than .005) than the rabbit pups with no treatment. There were no differences between the animals treated intra-amniotically and post-delivery. CONCLUSIONS: Intrauterine administration of exogenous surfactant results in uptake of the surfactant solution into the lungs and alters the pulmonary characteristics of the preterm rabbit pup. Potential adverse effects of this means of surfactant administration must be evaluated further. Intrauterine surfactant delivery may provide an additional means of RDS prophylaxis in the antepartum period.

Amnion↗
PubMedDate not supplied

Placental expression of VEGF, PlGF and their receptors in a model of placental insufficiency-intrauterine growth restriction (PI-IUGR).

Placental development requires adequate and organized interaction of vascular growth factors and their receptors, including vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). Both VEGF and PlGF, acting through the tyrosine kinase receptors VEGFR-1 and VEGFR-2, have been implicated in playing a role in ovine placental vascular development. The present studies describe the placental expression of components of the VEGF family at two maturational time points (55 and 90 days post coitus, dpc) in a hyperthermic-induced ovine model of placental insufficiency-intrauterine growth restriction (PI-IUGR). Both caruncular and cotyledonary VEGF and PlGF mRNA concentration increased with gestational age (P< 0.05), whereas only cotyledonary VEGF and PlGF protein concentration increased over gestation (P< 0.002). At 55 dpc, VEGF mRNA concentration was elevated in hyperthermic (HT) ewes, compared to control thermoneutral (TN) animals (TN; 0.52+/-0.08 vs HT; 1.27+/-0.17 VEGF/GAPDH, P< 0.001). At 90 dpc, expression of PlGF and VEGF mRNA was not altered by the HT treatment. Both TN cotyledonary VEGFR-1 and VEGFR-2 mRNA expression levels rose significantly over the period studied (P< 0.05 and P< 0.01 respectively). Receptor mRNA concentration in HT cotyledonary tissue was significantly reduced at 90 dpc (VEGFR-1; TN 0.21+/-0.02 vs HT 0.11+/-0.01 VEGFR-1/actin, P< 0.05, VEGFR-2; TN 0.18+/-0.05 vs HT 0.07+/-0.01 VEGFR-2/actin, P< 0.01). Soluble VEGFR-1 (sVEGFR-1) mRNA was not detected in these tissues. These alterations in growth factor and growth factor receptor mRNA expression, as a result of environmental heat stress early in placental development, could impair normal placental vascular development. Furthermore, alterations in VEGF, VEGFR-1 and VEGFR-2 mRNA expression, during the period of maximal placental growth, may contribute to the development of placental insufficiency, and ultimately intrauterine growth restriction.

Adult↗