Biomedical subjects
Publications and source records attributed to J E Drumm.
A 29 year old expectant mother was critically ill at 27 weeks gestation with disseminated metastatic malignant melanoma and was treated with dacarbazine. A dramatic remission was induced and at 38 weeks gestation she went into labour spontaneously and delivered a healthy infant. She relapsed and died eight weeks post partum. This is the first reported use of dacarbazine in pregnancy.
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The cerebral circulation of 25 normal term infants was investigated using continuous wave Doppler ultrasound. Serial blood flow velocity signals were obtained from the common carotid and anterior cerebral arteries during the first week of life. The records were processed using a frequency spectrum analyser to provide cerebral blood velocity waveforms. The pulsatility index (PI), A/B ratio, and rise and fall slope of the waveforms were calculated. The results indicated that cerebrovascular resistance was raised appreciably on day 1 of life compared with later in the first week. In 18 of 25 infants (72%) there was no continuous carotid blood flow in the first hours of life. We suggest that the human cerebral circulation adapts to the process of birth in a similar fashion to that of animal models.
Continuous wave Doppler ultrasound has seldom been applied to the evaluation of the cerebral circulation of the newborn infant. Twenty-five term infants were studied and records taken from the common carotid and anterior cerebral arteries during the first week of life using a bidirectional Doppler instrument. The best Doppler signals obtained were audiofrequency analysed and sonagrams recorded. Analysis of the carotid sonagrams revealed a mean Pulsatility Index (PI) on the first day of life of 0.98 compared to 0.88 on Day 2 (p less than 0.001). An unexpected finding was the absence of continuous carotid blood flow in the majority of infants in the first hours of life. The PI on subsequent days did not differ significantly from Day 2. The PI of the anterior cerebral arteries on Day 1 was significantly elevated (p less than 0.001) compared to Day 2 and subsequent days. The significance of these findings and their importance in the further evaluation of pathological cerebral states in the neonate, especially birth asphyxia and intracranial haemorrhage are discussed.
Two otherwise comparable groups of patients, 27 of whom were non-smokers and 20 of whom smoked in excess of ten cigarettes per day, had serial fetal biparietal diameter measurements taken throughout pregnancy; from 21 weeks onwards, the fetal biparietal diameters increased significantly more slowly (p < 0.01) in mothers who smoked.
We combined two ultrasound techniques to develop a safe, non-invasive, transcutaneous method of observing the circulation in the umbilical arteries and vein in the fetus. The umbilical cord can be located by standard echo ultrasound procedures, and this information can be used to direct a Doppler ultrasound beam on to the vessels in the cord. The signals can be heard through audio headphones or recorded on a tape recorded and spectrum-analysed. The method was successful in each of 20 patients examined, whose pregnancies ranged from 12 to 40 weeks' gestational age, and was suitable for outpatient use. It should be useful in assessing such conditions as pre-eclampsia and intrauterine growth retardation.
Crown-rump lengths determined ultrasonically in vivo and in utero in cases of known postovulatory age (33-86 days) agree well with those in length/age tables in current embryological usage. Within the embryonic period proper, however, for a given age, the ultrasonic lengths are usually 1 to 5 mm longer than those of fixed specimens. The probable reasons for this are discussed.
The ultrasonic measurement of the fetal crown-rump lenght (CRL) in early pregnancy was utilized to predict the date of delivery in 220 patients with reliable menstrucal histories and in 186 patients with unreliable menstrual dates who began labour spontaneously; Ninety-five per cent and 96.2 per cent respectively were delivered within 12 days of the predicted date. The CRL was found to be better than biparietal diameter measurements (p greater than 0.001) and as good as a reliable menstrual history (p greater than 0.5) in predicting the time fo spontaneous onset of labour.
The fetal crown-rump length (CRL) was measured by means of pulsed ultrasound, and the normal values between 47 and 101 days from the onset of the last menstrual period were determined from cross-sectional data in 253 patients. For any given CRL, the range was found to be within three days of the menstrual age with a maximum variation for a given occasion of three days. Detailed statistical analysis showed that the acceleration in the rate of change in the CRL was a constant and that the intrapatient variability, where measured, was low. A close correlation between the measurement and the date of ovulation was demonstrated in a further 40 patients.
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Continuous wave Doppler ultrasound was used together with B-mode real time ultrasound to study feto-placental blood flow in utero. The results of 887 examinations on 221 patients are presented. The fetal heart rate acceleration slope and pulsatility index (P.I.) of the audiofrequency ultrasound display were analysed. There was a significant reduction in fetal heart rate (P less than 0.001) and P.I. (P less than 0.001) with advancing gestational age in normal pregnancy. In contrast, in retarded intrauterine growth a significant increase in P.I. values was observed in 77% of patients.