Biomedical subjects
J L Greenwald
Publications and source records attributed to J L Greenwald.
Evaluation and management of postdate pregnancy.
Postdate pregnancy (more than 42 weeks' gestation) accounts for about 10 percent of obstetric deliveries. Maternal and fetal assessment in anticipation of postdate pregnancy must begin early in the pregnancy. Gestational age must be accurately determined through judicious use of historical, physical and laboratory data. Familiarity with the physiologic changes associated with pregnancy, both near and after term, can help in predicting the possibility of neonatal morbidity from fetal macrosomia or dysmaturity, placental insufficiency and meconium-stained amniotic fluid. Management of the postdate pregnancy includes antenatal testing to measure fetal well-being. If testing indicates fetal distress or absent amniotic fluid, immediate delivery should be initiated. Cervical ripening should be considered if the Bishop score indicates an unfavorable chance of successful induction and if there is no need for immediate delivery. When labor commences after 42 weeks' gestation, continuous fetal monitoring is essential.
Premature rupture of the membranes: diagnostic and management strategies.
Premature rupture of the membranes is associated with considerable neonatal and maternal morbidity when it leads to premature birth. In most cases, this condition occurs at term, does not require medical intervention and has a benign course. Although few effective preventive measures are available, the family physician should screen pregnant patients for remediable risk factors, including smoking and certain vaginal infections, such as trichomoniasis. Diagnostic strategies include assessment of the amniotic fluid and laboratory tests to evaluate fetal and maternal welfare. Management options include expectant treatment, induction of labor or initiation of corticosteroids, antibiotics and/or tocolytics. These options must be carefully evaluated because of the morbidity associated with prematurity and the increased incidence of sepsis in prolonged rupture of the membranes.
Evaluation of a communication skills course for second-year medical students.
A five-year evaluation and redesign of the communication skills component of the Introduction to Clinical Medicine course was undertaken at the State University of New York Health Science Center at Syracuse College of Medicine. The objectives of the evaluation were to determine the effectiveness of the component in teaching communication skills, identify areas of the component in need of change, and monitor the effectiveness of previous changes. In the first three years, the evaluation focused on the students' perceptions of the importance of communication skills in their training as physicians. Based on the evaluations for those three years, the component was modified substantially. One of the changes was the introduction in years four and five of simulated patients for practicing interviewing skills. The evaluations in years four and five focused on the effectiveness of using the simulated patients and the students' perceptions of how well the course objectives were met.
Hyperbilirubinemia in otherwise healthy infants.
Treatment of hyperbilirubinemia in otherwise healthy infants is controversial, since hyperbilirubinemia in the absence of hemolytic disease, hepatobiliary disease or prematurity is not clearly associated with kernicterus or other long-term morbidity. Phototherapy, exchange transfusion and the withholding of breast milk are the only treatments that have proved effective. Home phototherapy may be useful in treating infants for whom hospitalization is otherwise unnecessary.
A new hypothalamic substance, and not luteinizing hormone-releasing hormone, is detected immunocytochemically by antibody to luteinizing hormone-releasing hormone.
Adjacent paraffin sections of rat hypothalami fixed in Bouin's fluid were treated either with buffer or with luteinizing hormone-releasing hormone (LHRH) before immunocytochemical staining with anti-LHRH. Upon buffer pretreatment, pituitary gonadotrophs were unstained and hypothalamic fibers were stained. Upon LHRH pretreatment, pituitary gonadotrophs were stained (receptor reaction) and hypothalamic fibers were unstained. Extension of washes and use of series of neutralizing antisera between LHRH application and immunocytochemical staining, as well as the absence of inhibiting concentrations of LHRH in the later washes and neutralizing antisera removed from the sections, excluded the possibility that the disappearance of visualization of hypothalamic fibers was due to blockage of anti-LHRH in immunocytochemical staining. The results suggested that LHRH removed from the sections an immunocytochemically stainable but as yet unknown analog of LHRH and replaced it with LHRH, which in turn became lost during subsequent immunocytochemical processing. This idea was confirmed by the isolation by high-pressure liquid chromatography of a peak, distinct from LHRH, upon treatment of hypothalami with LHRH. It is suggested that the new substance may be carrier-held and that this substance, rather than LHRH, is normally detected by immunocytochemistry with anti-LHRH. Added LHRH binds not only to high-affinity pituitary receptors but also to low-affinity hypothalamic carriers.