Biomedical subjects

J L Angel

Publications and source records attributed to J L Angel.

At least 19 recordsLinked to original sources

PubMed1997

In utero lysis of amniotic bands.

Amniotic band syndrome is a sporadic condition that occurs in approximately 1:1200 to 1:15,000 live births and that may result in amputations, constrictions and other deformities of the fetus. Although some cases present with congenital anomalies that are beyond surgical repair, a selected group of fetuses may show isolated limb constriction. It has been speculated that, without treatment, amputation or severe dysfunction of the limb may occur. Despite these potential complications, surgical treatment for this selected group of fetuses has not been previously performed. We report two cases that were successfully treated using novel minimally invasive surgical techniques. The cases involved fetuses with amniotic band syndrome with associated limb constriction in which the amniotic band was surgically interrupted to avoid spontaneous amputation of the extremity. Adequate blood flow distal to the obstruction was preserved and significant functional improvement of the extremity occurred in both cases, preserving the limbs. These cases represent the first prenatal surgical intervention successfully used to treat constricting amniotic bands in humans. In addition, these cases represent the first time that a non-lethal fetal entity has been surgically treated in utero. The results of this innovative therapy will encourage the efforts to continue developing minimally invasive techniques for the correction of birth defects.

Adult↗

PubMed1996

The extent of private and public health insurance coverage among adult Hispanics.

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

Adult↗

PubMed1996

Nativity, declining health, and preferences in living arrangements among elderly Mexican Americans: implications for long-term care.

This study employs data from the 1993-94 Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE) to assess the impact of nativity on preferences in living arrangements for a sample of 3,046 Mexican American individuals over the age of 65. Our results reveal great differences between the native and foreign-born in their desire to live with their children. A larger fraction of the foreign-born than native-born currently live with their children and state that they would care to continue living with their children in the event that they could no longer care for themselves. The data also reveal that the foreign-born face more serious economic constraints than the native-born and suggest that living with children may be motivated in part by economic need. We end by speculating on the implications of these findings for community-based care for elderly Mexican Americans.

Acculturation↗

PubMed1995

Motive and the geographic mobility of very old Americans.

The proposition that motives for migration are important in explaining geographic mobility of very old persons was explored in this study. Data from the biennial 1984 through 1990 rounds of the Longitudinal Study on Aging were used to predict the move/not-move behavior of a nationally representative sample of noninstitutionalized respondents aged 70 years and over in 1984. Six motives for elderly migration were identified: health, affiliation, economic security, comfort, functional independence, and getting on with life after family crisis. When incorporated within this motivational framework, reason-for-move data showed that health was not the dominant motive; responses were divided among the five other motive categories. The logistic regression analysis showed that increasing disability was positively related to mobility for respondents in only one of six motive categories. The results suggest that a motive-for-migration perspective broadens the debate on types of, and explanations for, migration behavior of noninstitutionalized very old Americans.

Aged↗

PubMed1993

Elective cesarean hysterectomy for treatment of cervical neoplasia. An update.

From January 1, 1979, to March 31, 1991, 37 patients underwent elective cesarean hysterectomy for early cervical neoplasia. Thirty-four patients had cervical intraepithelial neoplasia III, and three patients had stage IA-1 squamous cell carcinoma of the cervix. Twenty-eight were primary cesarean sections; nine had obstetric indications. The mean operative time was 128 minutes; mean estimated blood loss was 1,400 mL. One patient experienced an intraoperative hemorrhage (3,500 mL). There were no other recognized intraoperative complications. Four significant postoperative complications included a vaginal cuff abscess, a wound dehiscence and pelvic abscess, one patient with febrile morbidity and an ileus and ligation with partial transection of a ureter. Patients were discharged on a mean of postoperative day 5.7. Although significant complications occurred, we believe that the noncompliant nature of our patient population justifies elective cesarean hysterectomy for treatment of cervical neoplasia.

Adult↗

PubMed1992

Carbohydrate metabolism after three months of using a gestodene-containing monophasic oral contraceptive.

Carbohydrate metabolism was prospectively evaluated in twenty-one normal women prior to and during their use for three months of a monophasic oral contraceptive containing the progestin gestodene plus ethinyl estradiol. The women had a three-hour oral glucose tolerance test using a 75 gram glucose load, measuring serum glucose and insulin levels. The results demonstrate no significant changes in either of the carbohydrate metabolic indices between the two tests. These data support the safety of this new progestin-containing contraceptive.

Adult↗

PubMed1992

Six-month carbohydrate metabolism studies in women using oral contraceptives containing gestodene and ethinyl estradiol.

Twenty-five women had their carbohydrate metabolism prospectively evaluated during the six months that they used a gestodene and ethinyl estradiol monophasic oral contraceptive. Serum glucose and insulin levels were measured during a 75-gram three-hour oral glucose tolerance test. At the six-month test, the three-hour glucose and the fasting and three-hour insulin values were significantly elevated. The literature on carbohydrate metabolism during gestodene oral contraceptive use is also reviewed.

Adult↗

PubMed1992

Patterns of illicit drug use at the time of labor in a private and public hospital.

The majority of prevalence data on perinatal substance abuse describe low socioeconomic patient populations. This study of illicit drug use at the time of labor was done to identify patterns of drug use in both private and nonprivate patients. Anonymous urine samples were collected from 1000 patients, 500 admitted in labor to a private hospital and 500 admitted to a public hospital. All samples were screened for cocaine, opiates, cannabinoids, and amphetamines. A positive result of screening for any drug was detected in 8.2% of patients. More positive results of screening for any drug were found in nonprivate patients (11.4%) than private patients (5%), with nonprivate patients significantly more likely to test positive for cocaine or cannabinoids or both. Black patients contributed 64.5% of the positive tests for cocaine, significantly more than white (17.6%) or Hispanic patients (17.6%), whereas white patients contributed significantly more positive tests for cannabinoids (85%) than black (5.4%) or Hispanic patients (7.1%). Assessment of patterns of perinatal drug use in communities will support appropriate allocation of resources and targeting of patient and provider education.

Amphetamines↗

PubMed1991

Cocaine and indomethacin: fetal anuria, neonatal edema, and gastrointestinal bleeding.

A case is reported in which exposure to cocaine and indomethacin was associated with development of fetal anuria, anasarca, and neonatal gastrointestinal hemorrhage. Cocaine and indomethacin may act synergistically to adversely affect renal, cardiovascular, and platelet function. It may be prudent to obtain a drug history and urine screen for cocaine before instituting indomethacin therapy for preterm labor or polyhydramnios.

Adult↗

PubMed1991

Cervical cerclage in early pregnancy.

A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed. For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage: group 1 less than or equal to 13 weeks; group 2 greater than 13 weeks, but less than 18 weeks; group 3 greater than or equal to 18 weeks. There was no difference among groups in mean age, gravidity, history of diethylstilbestrol exposure (DES), prior pregnancy loss at or before 20 weeks, or prior dilation and curettage procedure. There were 24 modified McDonald and 14 modified Shrodkar procedures performed. The mean gestational age of cerclage placement in group 1 was earlier than in group 2 and group 3 by 3.5 and 10.5 weeks, respectively. There were no major surgical complications in any of the three groups. The overall incidence of preterm labor and preterm birth were 48.6% and 37.8%, respectively. Analysis of variance demonstrated a trend toward differences in the incidence of preterm labor, preterm birth, and estimated gestational age at delivery, with the earlier group favored. None of these, however, reached the level of statistical significance. Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups. The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks' gestational age.

Adult↗

PubMed1991

Human fetal response to vibroacoustic stimulation as a function of stimulus duration.

The effect of stimulus duration on the initial fetal heart rate (FHR) acceleration response was evaluated by assessing its amplitude and span following a single vibroacoustic stimulation with durations of 0 (sham), 1, 3, or 5 seconds. Statistically significant differences were observed in the mean amplitude and duration of acceleration in groups 3 and 5 when compared with groups 0 and 1 (P less than .05). In addition, groups 3 and 5 demonstrated significantly greater fetal reactivity than group 0 and a decrease in testing time over groups 0 and 1 (P less than .05). Our results suggest that the magnitude of the FHR acceleration response is dependent on the duration of the stimulus. Furthermore, a 3-second sound stimulus appears to be adequate for a shift to the fetal behavioral "awake" state.

Acoustic Stimulation↗

PubMed1991

Shoulder dystocia.

Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. Infant complications of shoulder dystocia include traumatic brachial plexus injury, humeral fracture, clavicular fracture and severe birth asphyxia. With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.

Delivery, Obstetric↗

PubMed1991

Sequential outpatient application of intravaginal prostaglandin E2 gel in the management of postdates pregnancies.

A randomized blinded investigation was undertaken to determine the efficacy and safety of sequentially applied intravaginal prostaglandin E2 (PGE2) gel for accelerating cervical ripening in an outpatient setting in low-risk prolonged pregnancies. Fifty women with uncomplicated pregnancies at or beyond 41 weeks' gestation and Bishop scores below 9 received twice-weekly outpatient administration of gel containing 2.0 mg of PGE2 or placebo. Thirty nulliparas and 20 multiparas were enrolled. The PGE2 gel failed to improve cervical ripening over placebo, as judged by Bishop scores. There was no difference between the groups in gestational age on admission to the labor and delivery suite, number of gel applications, requirement for oxytocin, incidence of cesarean delivery, or neonatal outcome. Only two patients (4%) experienced regular uterine contractions after gel insertion; these subsided spontaneously in both. None of the subjects experienced labor, tetanic contractions, evidence of fetal distress, or any other side effects related to gel insertion. We conclude that PGE2 gel in this dosage may be used safely in an outpatient setting, but more frequent application or earlier initiation may be required to produce a clinical effect.

Administration, Intravaginal↗

PubMed1990

Amniotic fluid alpha 1-antitrypsin concentration in premature rupture of the membranes.

Premature rupture of the membranes is probably a result of a loss in amniotic membrane collagen. A recent report that the concentration of alpha 1-antitrypsin was decreased in patients with premature rupture of the membranes suggested a generalized defect in such pregnancies. In this study we compared the concentration of alpha 1-antitrypsin in samples from pregnancies with premature rupture of the membranes and from pregnancies with preterm labor at similar gestational age. No difference in alpha 1-antitrypsin concentration was noted between these groups or between samples with or without intrauterine infection. These results support a localized inflammation and necrosis of the membranes at the site of rupture.

Amniotic Fluid↗

PubMed1990

Acute pyelonephritis in pregnancy: a prospective study of oral versus intravenous antibiotic therapy.

Ninety pregnant women admitted to the high-risk pregnancy unit with a diagnosis of acute pyelonephritis were randomized to receive either oral (cephalexin 500 mg every 6 hours) or intravenous (IV) (cephalothin 1 g every 6 hours) antibiotic therapy. All patients were initially hydrated with 1 L of normal saline IV over 4 hours. Neither parenteral analgesics nor antiemetics were used. Bacteremia was noted in 13 (14.4%) of the 90 patients and mandated IV therapy. There was no difference between the oral and IV groups concerning predefined criteria for successful therapy (91.4 versus 92.9% successful therapy, respectively). No characteristic available at presentation predicted bacteremia or ultimate failure of therapy. Two patients (2.2%) experienced significant complications. These data suggest that in nonbacteremic patients, oral antibiotics are both safe and effective for the treatment of acute pyelonephritis in pregnancy.

Acute Disease↗

PubMed1990

Late diagnosis of nonconjoined monoamniotic twins using computed tomographic imaging: a case report.

Monoamniotic twin gestations, although rare, are associated with a high perinatal mortality rate. Early antenatal diagnosis is important to ensure optimal perinatal care. However, the diagnosis can be difficult to confirm, especially in late gestation when a dividing membrane may be difficult to visualize. Intra-amniotic injection of Renografin followed by a single-slice computed tomographic scan at the level of the umbilicus is described. This imaging method assisted in the confirmation of monoamniotic twinning.

Adult↗

PubMed1990

Cephalocele involving the oral cavity.

A cephalocele is an uncommon neural tube defect that rarely involves the oral cavity. We present a case of an oral cephalocele associated with polyhydramnios discovered on antenatal ultrasound. The differential diagnosis includes epignathus and epulis. The prognosis is dependent not only on the extent of brain involvement and associated anomalies, but also on the exact location of the herniated mass. If the oral cavity is extensively involved, airway management at birth may be difficult. Therefore, preparations for delivery may include maternal tertiary site referral, antenatal neurosurgical and pediatric consultation, and anticipation of complications such as rupture of the sac, dystocia, or the need for immediate tracheostomy if intubation is not possible.

Abnormalities, Multiple↗

PubMed1989

Short course of antibiotic therapy in treatment of postpartum endomyometritis.

To evaluate the safety and efficacy of an abbreviated course of antibiotic therapy in postpartum endomyometritis, 109 patients with endomyometritis were randomized to three study groups. All were treated with clindamycin and tobramycin until afebrility and clinical signs of disease were absent. Patients in group I received antibiotics for greater than or equal to 24 hours, group II received therapy for greater than or equal to 48 hours, and group III received antibiotic therapy for greater than or equal to 48 hours that preceded a 7-day course of oral Augmentin. The groups were similar in size and in demographic and clinical parameters. Two patients from each group required a third antibiotic, and no patient required rehospitalization. Group III required more days of antibiotic therapy than did group I, 2.9 versus 2.1 days (p less than 0.01), and cost $412.00 more per patient. This data strongly suggest that a short course of antibiotic therapy is efficacious and safe and would result in substantial monetary savings.

Adult↗