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Biomedical subjects

J H Grossman

Publications and source records attributed to J H Grossman.

At least 19 recordsLinked to original sources
PubMed1992

Evaluation of rapid diagnostic tests in the detection of microbial invasion of the amniotic cavity.

OBJECTIVE: We sought to determine and compare the value of several rapid diagnostic tests in the detection of intraamniotic infection. STUDY DESIGN: Gram stain, intraamniotic glucose level determination, leukocyte esterase assay, and the Limulus amebocyte lysate assay were performed on 144 amniotic fluid specimens retrieved by transabdominal amniocentesis in 136 patients with preterm premature rupture of the membranes or preterm labor. Diagnostic indices for a positive amniotic fluid culture and the development of clinical infection were calculated for each rapid test. Receiver-operator characteristic curves were generated to help select the optimal glucose level and combination of tests to detect intraamniotic infection. RESULTS: The greatest sensitivity for predicting either a positive culture or subsequent clinical infection in preterm labor patients and in predicting clinical infection in patients with preterm premature rupture of the membranes was demonstrated by a low glucose level. The Gram stain provided the greatest positive predictive value in patients with preterm labor. Combining the Gram stain and measurement of intraamniotic glucose levels did not improve sensitivity above glucose alone or positive predictive value above Gram stain alone. CONCLUSION: Leukocyte esterase determination and Limulus amebocyte lysate assay are insensitive indicators of intraamniotic infection. Selection of Gram stain or glucose level measurement alone or in combination as an appropriate screen for intraamniotic infection will depend on the clinicians' false-positive rate threshold.

Adult↗
PubMed1992

The future of health care.

Future changes in patient care to curb costs and refocus on health versus medical care are discussed, and efforts at the New England Medical Center (NEMC) to measure patient outcomes and reorganize the delivery of care are described. Medical care is not the only determinant of an individual's health; lifestyle choices and the community also play important roles. The rate of increase in the cost of medical care must be contained. The future of health-care reform will be predicated on packages for the administration of care; for any given condition, all of the elements of medical care would be combined so that clinical and functional outcomes are achieved at a given price (episode-of-illness pricing). The success of medical care should be determined on the basis of the patient's ability to function, not on clinical indicators alone. Also, the prices for new generations of drugs should be determined on whether the new drugs improve patients' quality of life. Health-care professionals in hospitals should not be divided according to their specialties; instead, they should compose multidisciplinary teams that can care for patients over time. NEMC is developing a process and structure in which various health-care professionals work together to design health-care plans that cover a full episode of illness. The future of health care will also be influenced by global trends, including international medical-care inflation, standardization of process and outcome measurements, and a shift in emphasis from medicine to health. The health-care industry is in transition as this country searches for the best way to improve the health and functioning of each citizen.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1992

Management and therapy of human immunodeficiency virus-infected pregnancies in maternal-fetal medicine fellowship training programs.

OBJECTIVE: To determine attitudes and practices of obstetricians in maternal-fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV) infection and the use of zidovudine during pregnancy. METHODS: We sent a questionnaire to the directors of all 78 approved maternal-fetal medicine fellowship programs. The responses, reflecting the consensus of the staffs of each program, were obtained and tabulated. RESULTS: Although their programs annually provide care for more than 2100 pregnant women infected with HIV, less than 25% of all maternal-fetal medicine fellowship directors reported that their patients participate in multicenter studies of HIV infection complicating pregnancy. Nearly two-thirds of the infected women are excluded from such multicenter studies. More than 70% of all program directors believe that zidovudine should be offered to symptomatic pregnant women infected with HIV; one-half question whether zidovudine poses short-term fetal risks. Nevertheless, nearly half of all HIV-infected pregnant women they manage are excluded from trials of zidovudine therapy during pregnancy. CONCLUSIONS: Many HIV-infected pregnant women who receive care in clinics of maternal-fetal medicine fellowship programs are excluded from multicenter studies. Consideration should be given to creating a national registry for this important, currently unreported, clinical resource.

Clinical Trials as Topic↗
PubMed1992

Pathfinder direct fluorescent antigen test for diagnosing maternal chlamydial infections. An evaluation.

Chlamydia trachomatis is a frequent cause of genital infections in young women. Chlamydial infections may adversely affect perinatal outcome. We compared the Pathfinder direct fluorescent antigen (DFA) test for chlamydial infections to tissue culture isolation in an obstetric population. Among 984 samples, 152 (15.4%) were inadequate for evaluation using the Pathfinder DFA test. Among 783 evaluable specimen pairs, the sensitivity, specificity, and positive and negative predictive values of the Pathfinder, as compared to tissue culture isolation, were 25%, 97.5%, 32.1% and 96.4%, respectively. On the basis of that experience, we do not recommend the Pathfinder DFA test as a clinical screening device for detecting chlamydial infections complicating pregnancy.

Chlamydia Infections↗
PubMed1992

TORCH infections. Diagnosis in the molecular age.

TORCH agents cause a varied spectrum of disease. Advances in ultrasound, invasive perinatal procedures and molecular diagnostics have allowed in utero evaluation. Infected fetuses, especially those which are sonographically abnormal, may be treated in utero depending upon the pathogen and attendant pathophysiology. Subclinical perinatal infections may lead to later childhood deficits. Such infected fetuses may benefit from early diagnosis and prompt initiation of rehabilitative measures.

Abbreviations as Topic↗
PubMed1991

Diagnosis of chlamydial infection in pregnant women using the Testpack Chlamydia diagnostic kit.

We compared the performance of Testpack Chlamydia to tissue culture isolation for detection of endocervical chlamydia in an obstetric clinic population at high risk for infection. Among 227 evaluable patients, 30 tissue culture-confirmed chlamydial infections were found (13.2%). The sensitivity, specificity, and positive and negative predictive values of Testpack compared with tissue culture isolation were 66.7, 95.4, 69.0, and 94.9%, respectively. This test can be performed on a desktop within 30 minutes by staff with limited laboratory experience and no special equipment. Based upon our preliminary experience, we believe that Testpack Chlamydia offers promise as a screening device for the detection of endocervical chlamydial infections in high-risk obstetric populations.

Chlamydia Infections↗
PubMed1990

Persistent vaginitis caused by metronidazole-resistant trichomonas.

Persistent trichomonal vaginitis is usually considered the result of either patient noncompliance with therapy or reinfection. Drug-resistant trichomoniasis may also cause continued infection despite repeated courses of conventional metronidazole therapy. We report two cases of exceptionally persistent and prolonged infection despite repetitive and varied treatments, including parenteral metronidazole. An unconventional approach combining oral and topical therapy resulted in clinical and microbiologic cure in both cases.

Administration, Intravaginal↗
PubMed1989

Herpes simplex virus.

Genital herpes simplex infection remains an infectious disease having widespread consequences for both adult and neonatal populations. Physicians must understand that the psychologic impact of genital HSV infections frequently is more disabling than the physical manifestations. Sensitivity, compassion, and support are necessary from members of the medical community, and psychologic counseling may help patients cope with HSV and all its implications. Similarly, physicians must downplay the hysteria that has been associated with herpesvirus infections, emerging as a result of intense media coverage in the 1970s and 1980s. Minimizing the number of cases of neonatal herpes through identification of infected women during parturition continues to be important. Recent guidelines suggest a rationale for the management of women at risk for genital HSV. Nevertheless, until newer immunologic and serologic techniques become clinically reliable and allow a correct and rapid diagnosis of herpes simplex infection, identification of the infected woman in labor must be made using detailed clinical history, physical examination, and viral culture.

Acyclovir↗
PubMed1988

The effect of chronic steroid therapy on glucose tolerance in pregnancy.

We analyzed the records of 26 pregnant patients receiving chronic steroids to assess the combined effect of pregnancy and glucocorticoid administration on glucose tolerance. Five patients (19.2%) developed diabetes mellitus, four of whom required insulin. In a pregnant control group of 1325 patients, 53 patients (4.0%) developed diabetes mellitus, five of whom required insulin. Glucose intolerance was significantly higher in the steroid-treated group (p = 0.003). Comparison with a nonpregnant steroid-treated control group (47 patients, 15% of whom developed diabetes mellitus) showed no significant different (p = 0.23) between the two. All pregnant steroid-treated patients developing diabetes mellitus began steroid therapy after conception, whereas none of the patients receiving steroid therapy before conception developed glucose intolerance (p = 0.012). There does not appear to be an additive effect of steroid treatment and pregnancy on glucose intolerance; however, all patients receiving steroids should undergo periodic glucose screening.

Adult↗
PubMed1987

A rapid screening test for the diagnosis of endocervical group B streptococci in pregnancy: microbiologic results and clinical outcome.

Four hundred thirty-one parturient women were tested for cervical infection with group B streptococcus using standard bacterial culture and a commercially available latex particle agglutination test. The total time required to perform each latex test was 30 minutes or less. The prevalence of endocervical group B streptococcus by culture was 4.4%, half of whom developed clinically significant group B streptococcus infection; all such cases were identified correctly by the latex test. The predictive value of a negative latex test for a negative group B streptococcus culture was 98%. This method seems promising as a rapid intrapartum diagnostic test for ruling out group B streptococcus infection and thus avoiding unnecessary antibiotic treatment.

Female↗
PubMed1986

Multiple peripheral pulmonic stenosis in pregnancy.

Multiple peripheral pulmonic stenosis is a rare congenital cardiac disorder. The clinical course of this disease in pregnancy is not established. We report the benign obstetric course of a patient whose pregnancy was complicated by peripheral pulmonic stenosis and pulmonary hypertension.

Adult↗
PubMed1986

Diagnostic techniques for evaluating herpes simplex virus infections. Laboratory considerations.

Recent advances in the management and treatment of genital herpes simplex virus (HSV) infections underscore the importance of timely and accurate diagnosis of the disease. Moreover, increased physician awareness of the importance of accurately diagnosing herpes has led to a better understanding of its natural history. Like all diagnostic medical devices, microbiologic tests used to diagnose HSV infections are subject to governmental regulations. Based on the current status of available testing and our knowledge of the nature of HSV, clearly there is still much to be learned about HSV infections. The answers to some key questions will provide advances in diagnostic expertise and, ultimately, in the effective treatment and prevention of HSV-associated illness.

Antibodies, Viral↗
PubMed1986

Successful management of varicella pneumonia complicating pregnancy. A report of three cases.

Although varicella is a common infection in the United States, pregnant women are infrequently infected. Varicella pneumonia is an even rarer though potentially fatal complication during pregnancy. Fulminant respiratory collapse often ensues and is associated with greater than 40% mortality. We successfully treated three patients for varicella pneumonia in pregnancy. Critical points of management include prompt diagnosis of the disease and recognition of the complications, rapid transfer to a facility capable of providing intensive care (including ventilatory support) and early initiation of aggressive antiviral chemotherapy.

Adult↗
PubMed1986

Comparison of cefoxitin and clindamycin-gentamicin for pelvic infections.

Cefoxitin and clindamycin-gentamicin were compared in a randomized study of antibiotic therapy for infections of the pelvis in 91 women. Clinical diagnoses included pelvic inflammatory disease (53), endomyometritis after cesarean section (24), and cellulitis following gynecological surgery (14). Treatment failures occurred in four (10%) of the 41 patients treated with cefoxitin compared with eight (16%) of the 50 patients treated with the clindamycin-gentamicin combination. Single-drug therapy with cefoxitin was shown to be as effective as the combination of clindamycin and gentamicin.

Adolescent↗
PubMed1985

Topical heparin for recurrent genital herpes simplex virus infections. A proposed model for subsequent therapeutic trials.

A randomized, prospective, placebo-controlled, double-blind study was done of topical heparin for recurrent genital herpes simplex virus (HSV) infections. Our experience can serve as a model for those interested in studying their own approaches to the outpatient treatment of genital HSV in virtually any clinical setting, from standard test dose clinic to private practice.

Administration, Topical↗