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J J Botti

Publications and source records attributed to J J Botti.

At least 19 recordsLinked to original sources
PubMed1996

Prediction of spontaneous preterm birth by fetal fibronectin and uterine activity.

OBJECTIVE: To evaluate the usefulness of fetal fibronectin and home uterine contraction assessment in predicting preterm birth (before 34 weeks) in at-risk asymptomatic women. METHODS: One hundred fifty women were enrolled prospectively; five were lost to follow-up, leaving 145 women available for analysis. Because patients with preterm labor before 34 weeks' gestation most commonly develop this problem after 28 weeks, the period of 26-28 weeks' gestation was selected prospectively as the first window for prediction and study analysis. Eighty-five of 145 asymptomatic women at high risk for preterm birth had both home uterine contraction assessment of 2 hours per day and one or more cervical sampling(s) for fetal fibronectin measurement at 26-28 weeks. A positive home uterine contraction assessment was defined as contractions exceeding two per hour averaged over the 2-week study interval. Positive fetal fibronectin was defined as greater than 50 ng/mL. RESULTS: Fourteen of the 85 women (16.5%) delivered before 34 weeks. Home uterine contraction assessment alone had a sensitivity, specificity, positive predictive value, and negative predictive value for preterm birth of 64, 85, 45, and 92%, respectively; fetal fibronectin alone was associated with values of 43, 89, 43, and 89%, respectively. A positive home uterine contraction assessment was associated with a relative risk (RR) for preterm birth of 5.9% (95% confidence interval [CI] 2.4-14.2), whereas a positive fetal fibronectin demonstrated an RR of 3.8 (95% CI 1.5-9.4). When both assessments were positive, all patients delivered before 34 weeks and there was an RR of 27.0 (95% CI 8.7-84.1) compared with those with both tests being negative. Only two patients with both tests negative delivered before 34 weeks (negative predictive value 96%). CONCLUSION: Both the home uterine contraction assessment and fetal fibronectin accurately predicted preterm birth before 34 weeks. When both tests were combined, the predictive ability improved substantially.

Adult↗
PubMed1993

Neutrophil attractant/activating peptide-1/interleukin-8: association with histologic chorioamnionitis, preterm delivery, and bioactive amniotic fluid leukoattractants.

OBJECTIVES: The goals of this study were (1) to determine immunoreactive neutrophil attractant/activating peptide-1/interleukin-8 levels in amniotic fluid from patients with preterm labor and (2) to compare neutrophil attractant/activating peptide-1/interleukin-8 levels, amniotic fluid culture, Gram stain, and the leukotaxis bioassay for their ability to predict histologic chorioamnionitis and clinical outcome. STUDY DESIGN: Amniotic fluid was collected by amniocentesis from 55 patients with idiopathic preterm labor and three patients with preterm labor and clinical chorioamnionitis. Gram stain, culture (aerobic, anaerobic, and Mycoplasma species), leukotaxis bioassay, and a commercially available neutrophil attractant/activating peptide-1/interleukin-8 enzyme-linked immunosorbent assay (sensitivity 1 ng/ml) were performed on the amniotic fluid samples. Placentas and chorionic membranes were evaluated for evidence of histologic chorioamnionitis in patients delivered preterm. RESULTS: All patients with detectable leukoattractants by the leukotaxis bioassay had neutrophil attractant/activating peptide-1/interleukin-8 levels above the threshold of the assay. The presence of amniotic fluid neutrophil attractant/activating peptide-1/interleukin-8 is a more sensitive marker for histologic chorioamnionitis and delivery before 34 weeks than is amniotic fluid culture (100% vs 59%, p < 0.01; and 95% vs 56%, p < 0.01, respectively). Also, of patients in idiopathic preterm labor those without amniotic fluid leukoattractants (group 1) had the lowest amniotic fluid levels, followed by patients with amniotic fluid leukoattractants and a negative culture (group 2) and patients with amniotic fluid leukoattractants and a positive culture (group 3) who had the highest levels (group 1 vs group 2, p < 0.001; group 2 vs group 3, p < 0.01). CONCLUSIONS: Amniotic fluid neutrophil attractant/activating peptide-1/interleukin-8, like the leukotaxis assay, is an accurate antepartum predictor of histologic chorioamnionitis and subsequent early delivery in patients with preterm onset of labor. This study supports the role of neutrophil attractant/activating peptide-1/interleukin-8 in the recruitment of neutrophils into chorionic membranes and placenta during developing intrauterine infection.

Amniocentesis↗
PubMed1992

The presence of amniotic fluid leukoattractants accurately identifies histologic chorioamnionitis and predicts tocolytic efficacy in patients with idiopathic preterm labor.

OBJECTIVES: We tested these hypotheses: (1) that amniotic fluid from patients with idiopathic preterm labor and histologic chorioamnionitis contains leukoattractants and (2) that the detection of amniotic fluid leukoattractants is an accurate predictor of tocolytic efficacy. STUDY DESIGN: Amniotic fluid from 86 patients in idiopathic preterm labor was evaluated by microbiologic tests and leukotaxis assay. The tests' ability to predict histologic chorioamnionitis and response to tocolysis (51 tocolytic candidates) is established. Statistical analysis was performed with Fisher's exact test and unpaired Student t test. RESULTS: The detection of amniotic fluid leukoattractants was a better predictor of histologic chorioamnionitis (97%) than were amniotic fluid microbiologic tests (62%) (p less than 0.01). Also, in patients with detectable amniotic fluid leukoattractants tocolysis failed significantly more often than in patients without detectable leukoattractants (93% vs 7%, p less than 0.01). CONCLUSION: The presence of leukoattractants in amniotic fluid detected by the leukotaxis assay accurately identifies histologic chorioamnionitis and can additionally predict tocolytic efficacy in patients with idiopathic preterm labor.

Amniotic Fluid↗
PubMed1992

Amniotic fluid levels of substance P.

The presence of substance P (SP) in the amniotic fluid (AF) from 88 obstetric patients was determined with a radioimmunoassay. AF was collected from each patient in EDTA-coated tubes. Cross-reactivity of anti-SP antibody with methionine, met-enkephalin, leu-enkephalin, beta-endorphin, eledoisen and physalemin was less than 1%. The SP levels during the midtrimester were not significantly lower than those of late gestation. Data on the late-gestation group were evaluated further as per the clinical problem. The only statistically significant finding was between the diabetics with fetal maturity and the non-diabetic group. This preliminary study identified the presence of SP in AF in mid and late gestation.

Amniotic Fluid↗
PubMed1990

Gastric dysrhythmias and nausea of pregnancy.

Gastric dysrhythmias have been recorded from patients with a variety of nausea syndromes. The aim of this study was to measure gastric myoelectric activity in women with and without nausea during the first trimester of pregnancy. In 32 pregnant women gastric myoeletric activity was recorded for 30-45 min with cutaneous electrodes that yielded electrogastrograms (EGGs). Frequencies of the EGG waves were analyzed visually and by computer. Subjects rated their nausea at the time of EGG recording on a visual analog scale with 0 representing no nausea and 300 mm severe nausea. Gastric dysrhythmias were found in 26 pregnant subject: Seventeen had tachygastrias (EGG frequencies of 4-9 cpm), five had 1- to 2-cpm EGG waves, and four had flat-line patterns Mean nausea scores of the subjects with tachygastrias, 1- to 2-cpm, and flat-line patterns were 64.8 +/- 13, 93.4 +/- 23, and 77.2 +/- 36, respectively. Six pregnant subjects had normal 3-cpm EGG patterns, and their nausea scores averaged 2.8 +/- 1.1 (P less than 0.05 compared with nausea scores in subjects with tachygastrias, 1- to 2-cpm, and flat-line rhythms). Six subjects with gastric dysrhythmias during pregnancy were restudied after delivery; each of these subjects had normal 3-cpm EGG patterns and none had nausea. Thus, gastric dysrhythmias are objective pathophysiologic events associated with symptoms of nausea reported during the first trimester of pregnancy.

Adult↗
PubMed1990

Eicosanoid production and transfer in the placenta of the diabetic pregnancy.

The metabolism of arachidonic acid (AA) and the transfer of its metabolites was determined in in vitro perfused placental tissue from normal pregnancies and those complicated by maternal insulin-dependent diabetes mellitus (IDDM). 14C-labelled AA was recirculated in the fetal circulation for 60 min while 3H-AA was recirculated in the maternal circulation. Placental effluent was subjected to high performance liquid chromatography (HPLC) and analysis of dual-label scintillation counts. Placentae from IDDM pregnancies converted 3-6 times more radiolabelled AA to eicosanoids than did normal placentae. In addition, the transfer of eicosanoids into the opposing circulation was doubled in placentae from IDDM pregnancies compared to normal placentae. The predominant direction of eicosanoid transfer in both groups of placentae was in the fetal-to-maternal direction. The relative amounts of eicosanoids produced was also altered in placentae from IDDM pregnancies. Increased amounts of thromboxane (Tx) B2 and hydroxyeicosatetraenoic acids (HETEs) were present in both circulations of placentae from IDDM pregnancies. Levels of 6-keto prostaglandin F1a (6KPGF1a) were significantly reduced in both circulations in placentae from IDDM pregnancies. Thus, the ratio of TxA2 to PGI2 and the ratio of HETEs to PGI2 were both significantly increased in placentae from IDDM pregnancies. These results suggest an imbalance in eicosanoid production which may be relevant to abnormal placental structure and function in IDDM pregnancies.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

Alterations in transfer and lipid distribution of arachidonic acid in placentas of diabetic pregnancies.

Placental tissue from nondiabetic term pregnancies and pregnancies complicated by maternal insulin-dependent diabetes mellitus (IDDM) was perfused in vitro to compare the transfer and lipid distribution of arachidonic acid (AA). Radiolabeled albumin-bound AA was administered into the maternal afferent circulation, and samples of fetal and maternal effluent were collected at 10-min intervals. Perfused placental tissue was collected at the end of each experiment. The effluent was analyzed for total radioactivity, and extracts were subjected to thin-layer chromatography for the assessment of radioactivity associated with various lipid fractions. Placental AA uptake was significantly increased in perfused tissue from diabetic pregnancies (0.88 vs. 1.72 nM.min-1.g-1 in nondiabetic and IDDM, respectively; P less than 0.01), as was AA transfer (0.22 vs. 0.42 ml/min in nondiabetic and IDDM, respectively; P less than 0.01). However, transfer of the highly diffusible marker substance antipyrine was significantly reduced in IDDM placentas (1.79 vs. 2.49 ml/min in IDDM and nondiabetic, respectively; P less than 0.01). Compared with nondiabetic placentas, incorporation of AA into triglyceride was significantly increased in both maternal and fetal effluents and in placental tissue from IDDM pregnancies, whereas the percentage of AA remaining unesterified was reduced in both placental tissue and fetal effluent. Incorporation of AA into phosphoglycerides was significantly reduced in placental tissue but increased in fetal effluent in placentas from IDDM pregnancies. The results of these studies suggest that transfer and lipid distribution of AA are significantly altered in placentas from IDDM pregnancies. These findings may be relevant to the increased incidence of abnormal fetal growth and development associated with IDDM pregnancies.

Arachidonic Acids↗
PubMed1989

Amniotic fluid leukotaxis assay as an early indicator of chorioamnionitis.

A characteristic feature of histologic chorioamnionitis caused by ascending infection is the amniotropism displayed by polymorphonuclear leukocytes in the placental membranes. We tested the hypothesis that amniotic fluid from patients with histologic chorioamnionitis and intact membranes without clinical infection contains leukoattractants detectable by an in vitro leukotactic assay. Leukoattractants were detected in 13 cases (87%) and absent in 2 cases (13%) with histologic chorioamnionitis (p less than 0.005). The two cases with histologic chorioamnionitis that had negative leukotaxis were classified as stage l/mild severity. A positive leukotactic response was a better predictor of histologic chorioamnionitis (87%) than positive Gram stain (33%), amniotic fluid culture (53%), gas-liquid chromatography (40%), or a combination of these three methods (60%). These results suggest that demonstration of leukoattractants in amniotic fluid is an earlier and more sensitive predictor of chorioamnionitis than is presently available.

Amniotic Fluid↗
PubMed1989

Diagnosis and management of susceptibility to malignant hyperthermia in pregnancy.

A case of susceptibility to malignant hyperthermia, diagnosed by muscle biopsy during the first trimester of pregnancy, is presented. Pertinent medical history that might raise this suspicion is reviewed. The pathophysiology of malignant hyperthermia is discussed. Recent reports documenting the placental transfer of dantrolene and complications associated with dantrolene administration during labor are described. The pharmacology of dantrolene sodium is presented. Guidelines regarding the management of labor and delivery in patients susceptible to malignant hyperthermia are outlined. Suggestions for counseling patients and their children with this syndrome are reviewed.

Adult↗
PubMed1989

New strategies for preterm labor.

Preterm birth is the leading cause of perinatal mortality and morbidity despite the technological advances in neonatology and maternal-fetal medicine. Risk factors have been tabulated that can help identify the woman at risk for preterm birth. Past medical history, present pregnancy events, and demographic/environmental characteristics can help the practitioner select women who need special care to help prevent or reduce the effects of premature delivery. Recently, new concepts of risk have been identified through research, and emphasis needs to shift from intervention to prevention of the low birth weight infant. Past and present management of premature labor is discussed. New research protocols are presented. Strategies for nurses working in family planning or obstetrical areas are discussed, demonstrating areas for interventions from a prevention-oriented nursing base.

Family Planning Services↗
PubMed1988

Erythropoietin stimulates a rise in intracellular free calcium concentration in single early human erythroid precursors.

Erythropoietin and granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulate the differentiation and proliferation of erythroid cells. To determine the cellular mechanism of action of these growth factors, we measured changes in intracellular free calcium concentration [( Cac]) in single human erythroid precursors in response to recombinant erythropoietin and GM-CSF. [Cac] in immature erythroblasts derived from cultured human cord blood erythroid progenitors was measured with fluorescence microscopy digital video imaging. When stimulated with erythropoietin, [Cac] in the majority of erythroblasts increased within 3 min, peaked at 5 min, and returned toward baseline at 10 min. The percentage of cells that responded to erythropoietin stimulation increased in a dose-dependent manner. Additional stimulation with GM-CSF in cells previously exposed to erythropoietin resulted in a second [Cac] increase. Immature erythroblasts treated with GM-CSF followed by erythropoietin responded similarly to each factor with a rise in [Cac]. The source of transient calcium is intracellular since erythroblasts were incubated in medium devoid of extracellular calcium. Our observations suggest that changes in [Cac] may be an intracellular signal that mediates the proliferative/differentiating effect of hematopoietic growth factors.

Body Fluids↗
PubMed1988

Skin preparation methods before cesarean section. A comparative study.

Preoperative skin preparation before cesarean section using a one-minute alcohol wash followed by application of an iodophor-impregnated adhesive film was evaluated in a prospective, randomized, controlled study of 79 patients. The iodophor film was as effective as the five-minute iodophor scrub followed by an iodophor wash, as determined by a reduction in skin bacterial counts. Clinical infectious morbidity was no different between the treatment and control groups, although the study was too small to draw statistically significant conclusions in this respect. This study demonstrated the antimicrobial effectiveness of a new, more rapid method of pre-operative skin preparation before cesarean section as compared to a longer, traditional method. This new, rapid method offers advantages for many patients undergoing abdominal delivery.

Adhesives↗
PubMed1987

Antibacterial activity of amniotic fluid in the early third trimester. Its association with preterm labor and delivery.

The purpose of this study was to determine the bacterial growth inhibitory property of amniotic fluid (AF) from patients in the early third trimester and to examine its relationship to preterm labor and delivery. A total of 38 AF samples from patients between 27 and 35 weeks gestation with intact membranes were studied. Antibacterial activity was tested against Escherichia coli, Staphylococcus aureus, and Bacteroides fragilis. Fifteen fluids were from patients in preterm labor who delivered near term after successful inhibition of labor. Five of these fluids (33%) were inhibitory to E. coli, five (33%) to S. aureus, and 11 (73%) to B. fragilis. Nine fluids were from patients who failed inhibition of labor and delivered preterm; none of these were inhibitory to E. coli, two (22%) to S. aureus, and only one (11%) to B. fragilis (P less than 0.005). Two of the nine fluids from patients who failed inhibition of labor also yielded fusobacteria. The remaining 14 fluids were obtained from patients without preterm labor and exhibited antibacterial activity similar to that from patients with successful labor inhibition. Results suggest a relationship between the absence of AF antibacterial activity against B. fragilis and preterm delivery in patients with preterm labor and intact membranes.

Amniocentesis↗
PubMed1986

Role of prenatal genetic counseling before amniocentesis. A survey of genetics centers.

Although prenatal genetic amniocentesis is an accepted procedure for certain high-risk pregnancies, there is no standard approach to prenatal counseling, timing of counseling, materials used and location of the procedure. This survey of 126 genetics centers offering prenatal genetic amniocentesis reviewed aspects of 48,502 counseling events and a total of 61,174 samples processed in 1982. Eighty-three percent of the samples were obtained after counseling at the centers. Of the patients counseled, 88.5% chose amniocentesis, but the utilization rates varied widely between the centers. The choice of amniocentesis varied measurably with the educational materials used but not with the center size. Educational materials, written or audiovisual, were used by genetics centers in counseling 82% of the patients. There was a wide variation in center size, counseling methods used, the timing and use of counseling, and patient responses in the survey population.

Amniocentesis↗
PubMed1985

Encouraging patients to undergo prenatal genetic counseling before the day of amniocentesis. Its effect on the use of amniocentesis.

The purpose of this study was to determine if encouraging in-depth prenatal genetic counseling before the day of possible genetic amniocentesis affected the use of amniocentesis. Five hundred two patients were referred to our center for prenatal genetic services during a 15-month period. All patients were scheduled for genetic counseling before possible amniocentesis. During the initial three months (group I), patients were routinely scheduled for counseling on the same day of the procedure unless they requested earlier counseling. During the subsequent 12 months (group II), patients were encouraged to undergo counseling before the day of planned amniocentesis, and 48% agreed. When early counseling was encouraged, the use of amniocentesis decreased from 85% (group I) to 73% (group II) (P less than .025). Among patients with advanced maternal age as the only indication for testing (n = 375), utilization of amniocentesis decreased from 93% (group I) to 78% (group II) (P less than .005). A policy of encouraging early prenatal genetic counseling appears to be a significant factor in the use of genetic amniocentesis.

Amniocentesis↗
PubMed1985

Thermoregulation during aerobic exercise in pregnancy.

To characterize maternal thermal balance during pregnancy, the authors recorded the thermal response to moderate weight bearing exercise stress in four aerobically conditioned pregnant women. Studies were performed in a climate-controlled environment in each trimester of pregnancy and postpartum after modifying the exercise protocol for changes in maternal exercise condition. Core, vaginal, and mean skin temperatures were recorded at rest and during maximum exercise. Mean resting skin temperature increased during pregnancy; mean resting core and vaginal temperatures did not change. Core temperatures did not exceed 39C during exercise. Heat storage (heat content/kg) was not increased as a result of exercise with advancing pregnancy. According to these findings, thermal balance can be maintained with advancing gestation when exercise prescriptions are appropriately modified for conditioned women.

Body Temperature Regulation↗
PubMed1985

The frequent occurrence of false-positive results in phleborheography during pregnancy.

In this study, none of 25 pregnant women without any past history of venous thromboembolic disease had a positive phleborheogram sometime during their pregnancy or within six weeks post partum. In contrast, zero of ten nonpregnant women, also screened for venous thrombophlebitis, had a positive test finding during the same time interval. No clinical parameters, including weight gain, leg circumference, leg swelling, development of varicose veins, leg pain or use of support stockings, correlated with the occurrence of a positive test result. While there is conflicting evidence from other studies, our data suggest the need for caution in interpreting a positive phleboroheogram as an accurate indicator of thrombophlebitis in pregnant women.

Adult↗