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Biomedical subjects

J D Bass

Publications and source records attributed to J D Bass.

At least 19 recordsLinked to original sources
PubMed2003

Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome.

OBJECTIVES: To compare the efficacy of dexamethasone and betamethasone to ameliorate the course of postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. METHODS: A prospective, mixed randomized/non-randomized clinical investigation of patients with postpartum HELLP syndrome. Treatment with either dexamethasone or betamethasone was continued until there was evidence of disease recovery. RESULTS: Baseline characteristics of both the dexamethasone (n=18) and betamethasone (n=18) groups were similar. Although the time to discharge from the obstetrical recovery room was not statistically significant between groups, reduction in mean arterial blood pressure was more pronounced in the dexamethasone group as compared with the betamethasone group (-15.3+/-1.4 mmHg vs. -7.5+/-1.4 mmHg, respectively, P<0.01). Patients in the dexamethasone group required less antihypertensive treatment than the betamethasone group (6% vs. 50%, P=0.01) and also had a decreased need for readmission to the obstetrical recovery room (0% vs. 22%, P=0.03). CONCLUSION: This investigation supports the use of dexamethasone as the superior glucocorticoid to use for patients with postpartum HELLP syndrome.

Adrenal Cortex Hormones↗
PubMed2001

A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

OBJECTIVE: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficacy end points included laboratory values (platelet count, lactate dehydrogenase activity, aspartate aminotransferase activity) and clinical parameters (mean arterial pressure, urinary output). RESULTS: Forty patients were enrolled in the study, 19 in the dexamethasone arm and 21 in the betamethasone arm. The adjusted time-averaged changes from baseline were significant for aspartate aminotransferase activity (dexamethasone, -20.4 +/- 9.6 U/L; betamethasone, 9.9 +/- 8.9 U/L; P =.029), mean arterial pressure (dexamethasone, -15.6 +/- 1.4 mm Hg; betamethasone, -8.1 +/- 1.4 mm Hg; P <.001), and urinary output (dexamethasone, 12.9 +/- 8.6 mL/h; betamethasone, -11.9 +/- 8.2 mL/h; P =.043). CONCLUSION: Intravenously administered dexamethasone appears to be more effective than intramuscularly administered betamethasone for the antepartum treatment of mothers with HELLP syndrome.

Adult↗
PubMed1999

Membrane sweeping versus dinoprostone vaginal insert in the management of pregnancies beyond 41 weeks with an unfavorable cervix.

OBJECTIVE: To determine the best method of cervical ripening to prevent postdate inductions in women with an unfavorable cervix at 41 weeks' gestation. STUDY DESIGN: Women presenting at 41 weeks' gestation with a Bishop score of < or = 4 received daily dinoprostone (Cervidil) vaginal inserts (group I) or daily membrane sweeping (group II). RESULTS: One-hundred and eighty-two women were prospectively randomized with 91 women in each arm. The women in group II, membrane sweeping, had Bishop scores significantly greater on admission for delivery (p < 0.001), had less time elapsed from admission to delivery (p = 0.018), and had fewer labor inductions at 42 weeks (p = 0.04) than the women in group I, the dinoprostone group. In addition, a greater number of women in group II were admitted in spontaneous labor (p = 0.006) than in group I. Total antenatal costs for the membrane sweeping group was $15,120 versus $59,540 for the dinoprostone group. CONCLUSION: Daily membrane sweeping was more effective than dinoprostone administration with fewer postdate inductions at one-fourth the cost.

Adult↗
PubMed1998

Effect of amniotic fluid volume on neonatal outcome in diamniotic twin pregnancies.

PROBLEM: We assessed neonatal outcome of normal diamniotic twin pregnancies with known amniotic fluid (AF) volume. METHOD: The AF volume was empirically determined in 39 diamniotic twin gestations. The neonates were stratified by AF volume and evaluated for clinical outcome, gestational age, lecithin-sphingomyelin (L/S) ratio, and birth weight. RESULTS: Neonatal complications did not significantly differ among infants delivered from pregnancies with low (155 to 404 mL), moderate (405 to 807 mL), or high (808 to 5,430 mL) volumes of AF. Relatively constant volumes of AF were maintained throughout the 27 to 38 week range of gestational age, with no apparent correlation between AF volume and gestational age. Variations in the L/S ratio and newborn birth weights were also independent of AF volume. Gestational age was the only significant determinant of the frequency of neonatal complications. CONCLUSION: Amniotic fluid volume does not greatly affect neonatal outcome in normal diamniotic twin pregnancies.

Adult↗
PubMed1997

Amniotic fluid volume in normal singleton pregnancies.

OBJECTIVE: To evaluate the amniotic fluid (AF) volume in normal singleton pregnancies from 15 to 40 weeks. METHODS: This prospective study evaluated the AF volume in singleton pregnancies undergoing amniocentesis for genetic assessment of fetal karyotype, preterm labor, or fetal lung maturity. Amniotic fluid volume was determined using a dye dilution technique. To assess the relationship between AF volume and estimated gestational age, a nonlinear regression model was applied. RESULTS: One hundred forty-four normal singleton pregnancies had AF volume evaluated. There was wide variability in the measured AF volumes with a significant (P < .01) increase in AF volume as a function of gestational age. Growth curve modeling estimated that AF volume continued to increase until 40 weeks' gestation. Analyses of the observed AF volume indicated that AF volume nearly doubled after 30 weeks' gestation. CONCLUSION: In contrast to other reports indicating that maximal AF volume in singleton gestations is expected early in the third trimester, we observed the attainment of maximal AF volume near term.

Adult↗
PubMed1997

Survival of carcinoma of the prostate patients less than 55 years old compared to older patient groups.

Both incidence and death rate from cancer of prostate are rising. Prostate cancer is the most common malignancy in man and second most common cause of death in men. Lung cancer is the leading cause of death in men. Carcinoma of prostate is generally a disease of older men. Carcinoma of prostate can also occur in the middle-aged men. This study was performed to find whether the middle-aged men survived longer than older men when both groups of patients were compared according to equivalent stage of the disease. In this series, survival is slightly better in younger age groups when patients of all stages are pooled together. Due to small number of patients in younger age groups, survival difference cannot be calculated for each stage of the disease.

Age Distribution↗
PubMed1996

Durability of venous valve reconstruction techniques for "primary" and postthrombotic reflux.

PURPOSE: The durability of the variety of valve reconstruction techniques in "primary" reflux and postthrombotic reflux was studied. METHODS: A total of 423 valve repairs in 235 patients with a follow-up period ranging from 1 to 12 years were analyzed. End points for assessment consisted of ulcer recurrence and Doppler competence in serial duplex examination. Multivariate analysis with Cox proportional hazards model was used. RESULTS: Ulcer-free survival curves were similar for "primary" and postthrombotic reflux. No significant difference in ulcer recurrence was seen regardless of the technique used. Different results were obtained when valve competence instead of ulcer recurrence was used for assessment of durability. Reconstructions in "primary" reflux were more durable than those in postthrombotic reflux. Durability differences were also noted among different techniques. A cohort of posterior tibial repairs proved extraordinarily durable (0 failures in 23 repairs). CONCLUSION: Valve reconstruction in postthrombotic reflux can yield clinical results similar to those in "primary" reflux. Although any of the several described techniques can produce similar clinical results, Doppler competence suggests the following order for choice of procedures: (1) internal valvuloplasty, (2) prosthetic sleeve in situ, (3) external valvuloplasty, and (4) axillary vein transfer.

Axillary Vein↗
PubMed1996

The effect of levenogesterol (Norplant) contraception on coagulation as measured by antithrombin-III levels.

PURPOSE: To determine the effect of contraception given immediately postpartum on coagulation as measured by antithrombin III. STUDY DESIGN: In this prospective study, parturients (n = 85) self selected three means of postpartum contraception: levenorgesterol implants, oral contraceptives, or a barrier method. RESULTS: Baseline coagulation was assessed by antithrombin-III levels in each of the 85 women within 48 hours of delivery (100.35 +/- 1.61%) and at one (109.1 +/- 1.89%) and six (105.51 +/- 1.71%) weeks postpartum. There was a rise in antithrombin-III after delivery but there were no significant differences between the groups. CONCLUSION: The levenorgesterol implant system did not cause a decrease in antithrombin-III in normal parturients.

Antithrombin III↗
PubMed1995

Tumor necrosis factor alpha gene expression in human peritoneal macrophages is suppressed by extra-abdominal trauma.

BACKGROUND: Trauma is believed to activate immunocytes but paradoxically also increases the risk of intraperitoneal infection. OBJECTIVE: To investigate these events by evaluating changes in the cytokine control networks of human peritoneal macrophages (PM phi) early after trauma. DESIGN: Case-control study comparing cytokine messenger RNA (mRNA) expression by PM phi from patients with extra-abdominal trauma with that of both peripheral blood mononuclear cells (PBM) and PM phi obtained from healthy individuals. SETTING: Level I trauma center and basic science laboratory in a university hospital center. PATIENTS: Six patients with polytrauma (Injury Severity Score, > or = 15) with clinically negative diagnostic peritoneal lavages performed on routine indications at admission to the emergency department and six healthy age- and sex-matched individuals undergoing inguinal herniorrhaphy under local anesthesia. INTERVENTIONS: Peritoneal macrophages were isolated from diagnostic peritoneal lavages in trauma patients. Identical lavages were performed through the hernia sac in the control group. MEASUREMENTS: Cellular RNA was assayed for tumor necrosis factor alpha (TNF-alpha), interleukin-1 beta, IL-6, and IL-10 message by semiquantitative reverse-transcription polymerase chain reaction. RESULTS: Normal PM phi expressed high levels of TNF-alpha mRNA relative to PBM, but expression of the other proinflammatory cytokines was equivalent to that of PBM. Peritoneal macrophage expression of TNF-alpha mRNA was markedly (64-fold) decreased after trauma (P < .001), when PBM expression of IL-10 mRNA was increased (P = .03). CONCLUSIONS: Human PM phi constitutively show high levels of TNF-alpha message expression, and this is down-regulated by polytrauma. This might constitute a functionally "primed" state. If so, TNF-alpha down-regulation might contribute to functional PM phi suppression after systemic injury.

Adult↗
PubMed1995

Cervical ripening before medical induction of labor: a comparison of prostaglandin E2, estradiol, and oxytocin.

OBJECTIVE: Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin E2 intracervical gel, and estradiol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term. STUDY DESIGN: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score < 4) requiring induction of labor. The patients received prostaglandin E2 gel (0.5 mg) intracervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump. RESULTS: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demographics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E2 groups was similar (3.90 +/- 3.02 cm, 3.63 +/- 2.79 cm, and 4.65 +/- 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 minutes were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement in Bishop score over baseline (p = 0.023) with an improvement of 7.08 +/- 2.42. CONCLUSION: No differences were detected among prostaglandin E2 gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions.

Adult↗
PubMed1995

Amniotic fluid volume of third-trimester diamniotic twin pregnancies.

OBJECTIVE: To define the normal range of amniotic fluid (AF) volume in third-trimester diamniotic twin gestations. METHODS: The AF volume of third-trimester diamniotic twin pregnancies was measured prospectively. An AF sample was drawn from both amniotic cavities of diamniotic twins either for diagnosis of subclinical chorioamnionitis with preterm labor and/or assessment of fetal lung maturity. Actual AF volume was determined in each amniotic cavity by a dye-dilution technique. RESULTS: The AF volume of 45 diamniotic twin pregnancies of 27-38 weeks' gestation was assessed. The AF volume per amniotic sac ranged from 155-5430 mL, with a mean (+/- standard deviation) of 877 +/- 860 mL. The AF volume in individual amniotic cavities and the total of both cavities in a diamniotic twin pregnancy were unchanged across the entire gestational age range (27-38 weeks). Neither fetal positioning within the uterus (lower twin versus upper twin) nor fetal weight were determining factors in the AF volume variability (P = .846 and P = .726, respectively). Based on absolute volumetric differences between the larger- and smaller-sac AF volume, we observed that as the AF volume of the larger sacs increased proportionately (P < .001), the AF volume of the smaller sacs remained relatively constant across the entire range of differences (P = .687) between 27-38 weeks. CONCLUSIONS: The average AF volume of 877 mL for each diamniotic twin is similar to the AF volume reported for third-trimester singletons. The AF volumes of diamniotic twin gestations relate neither to fetal position nor fetal weight, but instead develop independently without relation to the other amniotic cavity. Ninety percent of the AF volumes were 215-2500 mL.

Adolescent↗
PubMed1995

Acute tocolysis for suspected intrapartum fetal distress: maternal effects of terbutaline versus magnesium sulfate.

This study was undertaken to determine the maternal hemodynamic impact of terbutaline versus magnesium sulfate in the acute treatment of fetal distress prior to cesarean delivery. Forty-six women were prospectively randomized to receive 0.25 mg subcutaneous terbutaline or 4.0 g intravenous magnesium sulfate for in utero fetal resuscitation before cesarean delivery. There were no significant differences between groups in baseline mean arterial pressure, arterial pressure before and after induction of anesthesia, maternal heart rate, maternal oxygen saturation, estimated blood loss, and pre- and postoperative hematocrits. Magnesium sulfate-treated women received significantly more intraoperative intravenous fluids (2365 +/- 877 ml) than the terbutaline group (1624 +/- 564 ml; P < 0.001). However, mean urine output was significantly greater in the terbutaline group (88 +/- 42 ml/h) than in those treated with magnesium sulfate (61 +/- 26 ml/h; P < 0.03). Terbutaline, the superior agent for acute tocolysis, is not associated with an increase in maternal cardiovascular side effects during anesthesia.

Journal Article↗
PubMed1995

Donor specific bone marrow cells suppress lymphocyte reactivity to donor antigens and differentially modulate TH1 and TH2 cytokine gene expression in the responder cell population.

Previous studies have shown that post-transplantation infusion of donor specific bone marrow following a non-specific potent immunosuppressive agent such as antilymphocyte globulin (ALG) can significantly enhance graft survival compared to ALG alone. This enhancement remains variable and is thought to occur through the induction of specific partial tolerance to the renal allograft, but the underlying cellular mechanisms have not been clearly identified. In order to improve the efficacy of this specific immunosuppressive treatment and to study the events leading to enhanced allograft survival, we sought to establish a simple in vitro model based on a mixed lymphocyte reaction (MLR). We show that cellular proliferation seen in a normal MLR can be suppressed by addition of donor specific bone marrow cells (BMC). Significantly, this suppression is not observed with either third party BMC or donor specific peripheral blood mononuclear cells (PBMC). We have defined the optimum conditions of bone marrow infusion regarding number of BMC, their handling and culture, and simple enrichment procedures. Using a semiquantitative polymerase chain reaction assay, we have studied the cytokine gene expression in MLR modulated by donor specific BMC. In an unmodified allogeneic response, the responder cells show increased expression of interleukin-2 (IL-2) gamma-interferon IFN-gamma and receptor (IL-2R) mRNA, and no IL-10 mRNA. When responder cells are cultured with BMC of the stimulator, there is a 256-fold decrease in IL-2 mRNA, and a 64-fold decrease in IFN-gamma and IL-2R mRNA. There is also a 64-fold increase in IL-10 mRNA. This effect is even more marked when the BMC are depleted of CD3+ cells. The kinetics of addition of donor specific BMC to the normal allogeneic MLR culture and specificity of the action of BMC are also elucidated. Our data suggest that the enhancement of graft survival observed with donor BMC may operate through decreased proliferation of reactive T cell clones (due to decreased IL-2/IL-2R) and suppressed monocyte functions (due to decreased IFN-gamma and increased IL-10 gene expression).

Bone Marrow↗
PubMed1995

Does level of ligation influence results in a murine biliary obstruction model?

BACKGROUND: Despite advances in perioperative management, patients with extrahepatic biliary obstruction still experience a high rate of complications and death after surgery. The rat is commonly used as an experimental animal for research in obstructive jaundice. Ligation of the rat bile duct high in the liver hilum is assumed to produce a more severe model of biliary obstruction than low ligation. The differences are attributed to the ability of the rat bile duct to dilate. Differences in level of ligation may, thus, explain some discrepancies between studies. MATERIALS AND METHODS: To test this hypothesis, female Lewis rats underwent high ligation (HL), low ligation (LL), and sham celiotomy. Colloidal carbon clearance, bilirubin, total serum bile acids, and hematocrit were measured 12 days later. Liver and spleen weight, presence or absence of ascites, infection, and adequacy of ligation were noted and the liver was processed for routine histology and electron microscopy. RESULTS: Although bilirubin levels were higher after HL than after LL, liver and spleen weight, total serum bile salts, and phagocytic constants K and alpha were not different between these two groups. Gross, histologic, and ultrastructural appearance did not differ between HL and LL groups. CONCLUSION: High ligation causes greater hyperbilirubinemia than low ligation, but does not alter other parameters including phagocytic constants. The present study does not confirm the hypothesis that HL creates a more severe model than LL; therefore, it is unlikely that differences in level of ligation explain variability in results between studies.

Animals↗
PubMed1995

Factors adversely affecting pregnancy outcome in the military.

This prospective study was undertaken to identify the significant risk factors associated with adverse pregnancy outcome in active-duty women. The deliveries of 300 consecutive pregnancies of active-duty women were assessed for maternal-fetal outcome. The risk factors evaluated were: marital status, parity, race, smoking and alcohol consumption while pregnant, maternal weight gain during pregnancy, maternal height, and educational level. Two-thirds of these women were junior enlisted personnel (rank E-4 or below) and worked under demanding job conditions over which they had little control. Increased age as a risk factor was associated with a significant increase in pregnancy-associated complications of cesarean birth, operative vaginal delivery, pregnancy-induced hypertension, preterm labor, maternal transport for fetal indications, intrauterine growth restriction, intrauterine fetal death, postpartum hemorrhage, placenta previa, and 5-minute Apgar scores < 7 (p = 0.039). In gravidas more than 65 inches in height with a weight gain more than 42 pounds, there was a significant increase in the complications of pregnancy (p = 0.022). Interactions of these risk factors yielded a significant age (p = 0.025), maternal height (p = 0.007), and height times weight gain interaction (p = 0.006) association with pregnancy complications. The risk factors of advancing maternal age and tall stature with a maternal weight gain of more than 42 pounds are associated with increased pregnancy complications of active-duty women.

Adult↗
PubMed1995

Single daily dose of methimazole compared to every 8 hours propylthiouracil in the treatment of hyperthyroidism.

This study to compare single-dose and multiple-dose antithyroid therapy was prompted by a perceived lack of compliance in our University Medical Clinics by those patients using multidose regimens. Twenty-two hyperthyroid patients were randomly assigned to two therapy groups. Twelve received methimazole (Tapazole) 30 mg once daily in the morning; 10 received propylthiouracil 100 mg every 8 hours. Patients were seen every 4 weeks for 3 months and assessed clinically, as well as having the appropriate thyroid tests done. Univariate analysis revealed no difference in the two groups at baseline. Posttreatment assessment revealed the once-a-day methimazole therapy to be just as effective as propylthiouracil in improving thyroid indices and clinical markers. Compliance with methimazole was 83.3% compared to 53.3% with propylthiouracil. In conclusion, once-a-day methimazole was just as effective as propylthiouracil every 8 hours in this population. Compliance was also improved with the once-a-day therapy.

Drug Administration Schedule↗
PubMed1995

Human peripheral mononuclear cells do not show proinflammatory patterns of cytokine transcription in early trauma: a preliminary report.

Injury has been hypothesized to cause inflammation through systemic release of lipopolysaccharide and pro-inflammatory cytokines, but this has proved difficult to demonstrate in humans. We looked for evidence of an inflammatory pattern of cytokine gene expression by peripheral blood mononuclear cells (PBM) in six polytraumatized patients (ISS = 25 +/- 8) upon ER admission, and in six matched healthy controls. PBM tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-4, IL-6, IL-10, and interferon (IFN)-gamma message was assessed by semi-quantitative reverse-transcription polymerase chain reaction. No increase in expression of any of the pro-inflammatory cytokines (tumor necrosis factor-alpha, IL-1 beta, or IL-6) was found after trauma, and IFN-gamma tended to decrease. Of the immunosuppressive cytokines, IL-10 expression increased 5-fold (p < .05) but no change in IL-4 was discerned. This pattern is fundamentally different from the cytokine expression patterns expected with sepsis or exposure to lipopolysaccharide. These findings are inconsistent with the occurrence of systemic endotoxemia and subsequent global immunocyte activation early after trauma.

Adolescent↗