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Biomedical subjects

I Delke

Publications and source records attributed to I Delke.

At least 37 records · Page 2Linked to original sources
PubMed1990

The relationship of cocaine use to syphilis and human immunodeficiency virus infections among inner city parturient women.

To study the relationship of cocaine use to syphilis and human immunodeficiency virus infections a blinded urine and serum survey was performed among parturient women at an inner city hospital. Discarded urine samples of 1206 parturient women were saved and given code numbers that were also assigned to data sheets containing nonidentifying information, including prenatal care status and syphilis serologic results. In the latter part of the study blood remaining after syphilis serologic tests were performed (n = 480) were tested for human immunodeficiency virus antibodies. Overall 12.9% of urine samples had cocaine derivatives, 1.4% opiates, 1.5% marijuana, 0.0% benzodiazepine, and 0.3% methadone. The prevalence of positive rapid plasma reagin tests was 18.7% among patients with positive urine toxicologic tests for cocaine and 2.41% for patients with negative urine tests (odds ratio = 9.3, 95% confidence interval 5.2 to 16.5, p less than 0.001). Fluorescent treponemal antibodies were also significantly more frequent among patients with positive urine samples. Four of 53 (7.6%) patients with positive urine toxicologic screens were human immunodeficiency virus antibody positive compared with six of 427 (1.4%) women with negative screens (odds ratio = 5.7, 95% confidence interval = 1.4 to 21.5, p = 0.019). Cocaine patients with positive cocaine screens and with syphilis or human immunodeficiency virus had prenatal care in 6 of 21 (28.6%) and 0 of 4 (0%) cases, respectively, while patients with negative cocaine screens and syphilis or human immunodeficiency virus had prenatal care in 13 of 18 (72.2%) and 5 of 6 (83.3%) cases, respectively (p = 0.010 and p = 0.048). Cocaine use appears to be associated with both the acquisition of human immunodeficiency virus and syphilis and the failure of infected individuals to utilize prenatal services.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Syphilis among parturients at an inner city hospital: association with cocaine use and implications for congenital syphilis rates.

The frequency of positive cord blood rapid plasma reagin (RPR) tests among newborns at an inner city hospital and associations with maternal cocaine use, prenatal care, and adequacy of syphilis therapy were retrospectively assessed. The incidence of positive cord blood RPRs increased from 1.1% of all live births in 1985 to 3.4% in 1988. In 1987, 98 babies were born with positive cord blood RPRs; 86 of their charts were available for review. Four infants had false positive RPRs, and one patient delivered twins, leaving 81 mothers who could be evaluated. Almost 37% of these patients had had no prenatal care. More than 55% had inadequate or not therapy for syphilis. Of these, only 17.4% had prenatal care. Slightly more than 40% of patients acknowledged using drugs during pregnancy, 87.9% of whom used cocaine. Among the patients who used drugs, 75.8% received no prenatal care, in contrast to 10.4% of mothers who did not use drugs (p less than 0.001). It appears that drug use, particularly use of cocaine, is associated with low levels of utilization of prenatal services and inadequate therapy for syphilis. This may lead to increased risk of congenital syphilis in newborns.

Cocaine↗
PubMed1989

Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis.

Opinions differ concerning the efficacy of prophylaxis against neonatal chlamydial and gonococcal conjunctivitis. From January 1986 through June 1988, we gave all infants born at Kings County Hospital Medical Center one of three prophylactic agents -- silver nitrate drops, erythromycin ophthalmic ointment, or tetracycline ophthalmic ointment. The treatments were rotated monthly. Gonococcal ophthalmia occurred in 8 of the 12,431 infants born during the study (0.06 percent), 1 in the silver nitrate group, 4 in the erythromycin group, and 3 in the tetracycline group (P not significant). Seven of these infants were born to women who had received no prenatal care. From September 1985 through December 1987, we screened 4357 pregnant women for cervical chlamydial infection, of whom 341 (8 percent) had positive cultures. Of their offspring, 230 were evaluated for neonatal chlamydial conjunctivitis; the incidence was 20 percent in the silver nitrate group, 14 percent in the erythromycin group, and 11 percent in the tetracycline group (P not significant). We conclude that neonatal ocular prophylaxis with either erythromycin or tetracycline ophthalmic ointment does not significantly reduce the incidence of chlamydial conjunctivitis in the offspring of mothers with chlamydial infection as compared with silver nitrate, and that better management of maternal chlamydial infection is therefore required. We also conclude that there is a small but appreciable incidence of neonatal gonococcal ophthalmia that could be prevented by better prenatal screening and treatment of maternal gonococcal infection.

Chlamydia Infections↗
PubMed1989

Screening with Doppler velocimetry in labor.

Doppler flow velocimetry was performed on 273 nonselected patients in labor. All patients were at least 2 cm dilated and 80% effaced (58% greater than 4 cm) and were delivered of infants within 24 hours. Fetal heart rate tracing performed at the same time was read by another observer and compared with Doppler flow velocity measurements (systolic/diastolic ratio, pulsatility index). A significant correlation was noted (r = 0.234, p less than 0.001) between the two modalities. Both fetal heart rate tracings and umbilical flow velocity measurements were correlated with fetal outcome. Significant associations were noted between the umbilical systolic/diastolic ratio and fetal distress. 5-minute Apgar scores, the need for intubation independent of gestational age, and umbilical arterial cord pH and base excess. It appears that the information obtained from flow velocimetry had additional benefits compared with that of fetal heart rate tracings alone.

Adult↗
PubMed1989

Vaginally administered cocaine overdose in a pregnant woman.

The deleterious effects of cocaine have been described in the adult population and in the neonate. Documentation of adverse effects in pregnant patients has been limited. We report the first known fatal vaginal administration of cocaine.

Administration, Intravaginal↗
PubMed1988

Avoidable causes of perinatal death at or after term pregnancy in an inner-city hospital: medical versus social.

A retrospective analysis of 174 consecutive singleton perinatal deaths at or after term pregnancy in an inner-city hospital was undertaken to determine avoidable causes of death. Adequate material was available in 161 cases. Twenty-eight infants with major malformations were excluded. The remaining 133 infants (95 stillbirths and 38 neonatal deaths) constituted the study population. An avoidable cause was defined as departure from the recognized standards of perinatal care that contributed to the deaths. Avoidable factors were present in 69 of 95 (73%) stillbirths. Contributing maternal/social and obstetric factors were present in 40 of 69 (58%) and 29 of 69 (42%) cases, respectively. Avoidable factors were found in 34 of 38 (89%) neonatal deaths. Contributing obstetric, maternal/social, and pediatric factors were present in 20 of 34 (59%), 12 of 34 (35%), and 2 of 34 (6%) cases, respectively. These results suggest that maternal/social causes were present more often than medical causes as a contributing factor in avoidable perinatal deaths at or after term pregnancy.

Adult↗
PubMed1987

Percutaneous drainage of fluid collections in the bladder flap of febrile post-cesarean-section patients. A report of seven cases.

Post-cesarean-section infections are a common cause of fevers on obstetric wards. Patients whose fevers are refractory to antibiotics often have pelvic collections. The contents of these collections and course of patients with collections have not been reported on before in detail. The development of sophisticated imaging techniques has led to the frequent use of percutaneous drainage in the management of abdominal collections. We used percutaneous drainage of collections in febrile post-cesarean-section patients. Hematomas were the most common collections associated with post-cesarean-section infection, and percutaneous drainage was a useful technique for obtaining material for culture and for distinguishing hematomas from abscesses. Most patients defervesced shortly after percutaneous drainage.

Abscess↗
PubMed1985

Effect of Lamaze childbirth preparation on maternal plasma beta-endorphin immunoreactivity in active labor.

Previous studies have documented a reduction in plasma beta-endorphin levels with the use of various analgesic techniques in labor, such as segmental epidural anesthesia or intrathecal morphine. The Lamaze method of childbirth preparation, which has been found to reduce the need for medication during childbirth and to decrease the subjective perception of pain during labor and delivery, has not been studied in this regard. In this study plasma beta-endorphin immunoreactivity levels were measured during the active phase of labor in 26 patients who had Lamaze classes and in 28 patients who did not have Lamaze classes. The Lamaze group had significantly lower plasma beta-endorphin immunoreactivity (37.2 vs. 68.5 pg/ml; P less than 0.001) and significantly shorter first stages of labor (8.28 hrs. vs. 9.86 hrs; P less than 0.02). It can be theorized that both lower beta-endorphin immunoreactivity and shorter labor in patients in the Lamaze group were related to the reduction of fear, tension, and the emotional stress of labor.

Adult↗
PubMed1985

Diagnosis of intracranial hemorrhage in utero after a maternal seizure.

Reported is a patient who noted decreased fetal movements after a seizure at 32 weeks' gestation. Sonography revealed fetal death and findings consistent with an intraventricular hemorrhage. The possible explanations for and the significance of an association between a maternal seizure and fetal intraventricular hemorrhage are discussed.

Adult↗
PubMed1983

Cervical cerclage: an aggressive approach to threatened or recurrent pregnancy wastage.

Patients at high risk for recurrent pregnancy wastage may not always provide a typical history of cervical incompetence. Seventy-five pregnancies were managed with a cervical cerclage, with tocolytic agents used adjunctively in some. The pregnancies were divided into three groups on the basis of past obstetric history and statistically analyzed with respect to outcome. Patients in categories 1 and 2 showed significant improvement in mean birth weight and maximum gestational age attained with a shift in the ratio of term to premature births after intervention. In category 3, a trend of improvement in mean birth weight and maximum gestational age was seen but fetal salvage was not improved. Maternal morbidity was low with a cerclage-related cesarean section rate of 6.8% and only 8% infectious morbidity. It is concluded that cervical cerclage should be considered in the management of recurrent pregnancy wastage even if the obstetric history is atypical.

Abortion, Habitual↗
PubMed1982

Abdominal pregnancy: review of current management and addition of 10 cases.

Ten cases of abdominal pregnancy managed at the Brookdale Hospital Medical Center over a 17-year period are presented. An incidence of 1 abdominal pregnancy in 7095 deliveries occurred in this series; another institution reported 1 in 7931. A perinatal mortality rate of 80% and no maternal mortality in the study are contrasted to rates of 75 to 95% and 2 to 18%, respectively, from the world literature. Recurrent abdominal pain in the gravid patient with a prior history of infertility, tubal pregnancy, and/or surgery may signal abdominal pregnancy. Similarly, the management of fetal death should include consideration of the presence of abdominal pregnancy. The role of ultrasonography in diagnosis and the importance of immediate surgical intervention with minimal disturbance of the placenta are stressed.

Adult↗
PubMed1981

A fifteen year experience with ectopic pregnancy.

The increasing importance of an ectopic pregnancy as a cause of maternal death presents a challenge that will be met when primary care physicians combine a high index of suspicion with the ability to recognize the patient most at risk. The major symptoms, abdominal pain, secondary amenorrhea and abnormal vaginal bleeding are well known, as are the major signs, abdominal tenderness, adnexal mass and tenderness on motion of the cervix. Less well known are factors in the clinical history which indicate the patient to be at high risk. These include primary or secondary infertility, previous abortion or ectopic pregnancy and previous tubal operation, either reconstructive or sterilizing. In addition, the use of an intrauterine contraceptive device or its recent removal because of abdominal pain or bleeding, or both, is highly significant. Of major importance is a history of recent uterine evacuation. Should the diagnosis of ectopic pregnancy be under consideration, procrastination by observation is no longer acceptable. An active effort must be made to confirm or deny the diagnosis, Culdocentesis should be performed in the emergency department or clinic. If positive, prompt laparotomy is indicated. Should the result of culdocentesis be unsatisfactory or negative, laparotomy should be undertaken with further delay.

Adult↗
PubMed1981

Reproductive performance of DES-exposed female progeny.

The reproductive performance of 106 patients exposed in utero to diethylstilbestrol by maternal ingestion is described. Fetal wastage is high, apparently because of spontaneous abortion during the first and second trimesters. Recommendations are made for preconception counseling of exposed progeny to increase fetal salvage.

Abortion, Spontaneous↗
PubMed1981

Accuracy of colposcopically directed biopsy in patients with cervical neoplasia.

The histologic diagnoses of premalignant and malignant lesions of the cervix obtained by examining the colposcopically directed biopsy material from 643 patients were compared with those of the surgical material subsequently obtained. The procedures during which samples were acquired included hysterectomy (370), cervical conization (263), cervical amputation (2), and removal of a retained cervical stump (8). The diagnostic accuracy of colposcopically directed biopsy was 93.0% in those patients with satisfactory colposcopy, ie, the final diagnosis did not differ by more than 1 grade from that of the directed biopsy diagnosis. Two patients with widespread stage III cervical intraepithelial neoplasia on directed biopsy had microinvasive carcinoma in the therapeutic cone specimen. All invasive carcinomas (stage IB, occult) were diagnosed by directed biopsy and confirmed by subsequent examination of the surgical specimen.

Adolescent↗
PubMed1981

Sweet syndrome with involvement of the female genital tract.

Acute febrile neutrophilic dermatosis, otherwise known as Sweet syndrome, usually occurs in women after prior respiratory infections. The first case of Sweet syndrome with involvement of the female genital tract is reported here. The woman recovered completely, and no evidence of other underlying disease has appeared.

Acute Disease↗
PubMed1981

Delayed onset of clear cell adenocarcinoma of the vagina in DES-exposed progeny.

Clear cell adenocarcinoma of the vagina occurred in a diethylstilbestrol (DES)-exposed patient in the fourth year of continuous observation for adenosis. Diagnosis was suspected by digital and colposcopic examination and confirmed by target biopsy. Cytology was negative. The development of malignancy in a patient who has been known to have adenosis has been previously described but is very rare. The necessity for careful regular follow-up using cytology, digital palpation, and colposcopy at 6-month intervals is emphasized.

Adenocarcinoma↗