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Biomedical subjects

J Ludmir

Publications and source records attributed to J Ludmir.

At least 37 records · Page 2Linked to original sources
PubMed1993

Expression of different potassium channels in cells isolated from human myometrium and leiomyomas.

OBJECTIVE: Electrophysiologic characteristics of human myometrial and leiomyomatous cells isolated in culture were investigated. Both types of cell were shown to be smooth muscle cells by immunofluorescence. STUDY DESIGN: Voltage-activated potassium currents were recorded by whole-cell patch-clamp techniques and analyzed for differences in expression, voltage-dependence, kinetics, and inactivation. RESULTS: Depolarizing-voltage steps from -90 mV to +30 mV elicited two types of noninactivating outward currents that differed in their kinetics in 83% (n = 36) of normal cells in culture for 3 to 5 days; 6% responded with fast (3.5 milliseconds) outward inactivating currents; 11% in culture for 1 day responded only with long-lasting inactivating currents (33.2 +/- 7.2 milliseconds). Cells isolated from leiomyomas responded preferentially (65%, n = 31) with fast (3.3 +/- 0.1 milliseconds) outward inactivating currents; 35% responded with noninactivating outward currents similar to those from normal cells. CONCLUSION: Different potassium channel currents, noninactivating and inactivating, are predominantly expressed in cells isolated from human myometrium and leiomyomas, respectively.

4-Aminopyridine↗
PubMed1993

Diabetic ketoacidosis in pregnancy resulting from insulin pump failure. A case report.

Ketoacidosis remains one of the most serious complications that can occur in the pregnant diabetic. A 36-year-old class D diabetic presented at 35 weeks' gestation with signs and symptoms of diabetic ketoacidosis. The etiology of her ketoacidosis was insulin pump malfunction. The normal physiologic changes associated with pregnancy placed the woman at increased risk for the development of ketoacidosis. The development of ketoacidosis is a well-known complication of insulin administered via pregnancy. We recommend that the insulin pump be used in selected patients in whom close surveillance can be maintained.

Adult↗
PubMed1992

Maternal glucose intolerance and the subcutaneous terbutaline pump.

OBJECTIVE: Our hypothesis was that use of the subcutaneous terbutaline pump does not affect maternal glucose tolerance. STUDY DESIGN: With the 1-hour glucose tolerance test, we examined the incidence of glucose intolerance in 37 patients using the pump compared with that of 54 patients receiving oral terbutaline and 634 control subjects without risk factors for gestational diabetes. The frequency of gestational diabetes and the need for insulin to maintain glycemic control were subjected to chi 2 analysis. RESULTS: The incidence of gestational diabetes was 6% in the control subjects, 5% in patients using the pump (p = 0.8), and 11% in those on the oral therapy regimen (p = 0.4). A total of 8% of controls who had gestational diabetes required both insulin and diet, compared with 100% using the pump (p less than 0.01) and 50% on the oral terbutaline regimen (p = 0.03). CONCLUSION: The incidence of gestational diabetes is not increased in patients receiving terbutaline via the subcutaneous pump. The use of terbutaline by any route significantly increases the need for insulin to achieve glycemic control.

Administration, Oral↗
PubMed1992

The accuracy of digital examination and ultrasound in the evaluation of cervical length.

Assessment of cervical status is an important component of the management of patients at risk for preterm delivery. Although digital examination is the most common method of cervical assessment, there has been recent interest in sonographic cervical examination. To compare the accuracy of digital examination and ultrasound, 20 nongravid women undergoing total hysterectomy for gynecologic indications had measurements of cervical length performed digitally and with both transabdominal and transvaginal ultrasound before surgery. These measurements were then compared with measurements made with a ruler immediately after hysterectomy. Separate examiners performed the digital, ultrasound, and ruler measurements, and each was blinded to the results of the others. Digital examination underestimated cervical length by an average of 13.6 mm and was significantly shorter than ruler measurement (P = .0001). Neither ultrasound method differed significantly from ruler measurement (P greater than .9 for each), and measurements were similar between the sonographic techniques (P greater than .9). These results validate the accuracy of sonographic estimation of cervical length. In addition, they suggest that sonographic measurement is more accurate than digital examination in predicting true cervical length. Finally, in the nonpregnant women, neither ultrasound technique seems superior to the other.

Cervix Uteri↗
PubMed1992

Prenatal detection and management of quadruple nuchal cord. A case report.

As imaging techniques improve, nuchal cords are often being identified prior to labor. Nuchal cords are encountered in up to 25% of deliveries and are usually not clinically significant. They may, however, have devastating results. Nuchal cords may be associated with abnormal fetal activity and testing, but there is often no clinical warning of a nuchal cord during pregnancy, labor or delivery. We report a case of a quadruple nuchal cord discovered after the mother complained of decreased fetal movement. The clinical course of this patient highlights many of the difficulties encountered in the management of antenatally diagnosed nuchal cords, particularly in the preterm fetus.

Acidosis↗
PubMed1992

Neisseria sicca endocarditis complicating pregnancy. A case report.

Neisseria sicca, a commensal organism of the oropharynx, has rarely been implicated as a pathogen responsible for causing bacterial endocarditis. A pregnant woman developed N sicca endocarditis at 32 weeks' gestation. Although there was an initial delay in diagnosis and therapy, the maternal and fetal outcomes were excellent.

Adult↗
PubMed1991

Intrapartum course of fetuses with isolated hypoplastic left heart syndrome.

Once considered universally fatal, the hypoplastic left heart syndrome is now being surgically treated in the newborn period. To help formulate an appropriate management plan for the labor and delivery of these patients, we reviewed the intrapartum course and immediate neonatal outcome of 13 fetuses with known hypoplastic left heart syndrome. Eleven of 13 patients underwent labor, and only one had an abnormal fetal heart pattern. There were no cases with meconium staining of the amniotic fluid. All patients with spontaneous or induced labor were delivered vaginally. There were no Apgar scores less than 8 at 5 minutes, and all umbilical cord blood pH values were greater than or equal to 7.20. All infants survived to undergo initial reconstructive surgery. We conclude that labor does not appear to be a high-risk situation for the fetus with this disorder. Routine intrapartum fetal heart rate monitoring can be used, oxytocin can be used as indicated, and cesarean section should be reserved for traditional obstetric indications.

Female↗
PubMed1991

Transvaginal cerclage under ultrasound guidance in cases of severe cervical hypoplasia.

Transabdominal cervical cerclage has been advocated for patients with cervical incompetence whose cervix is flush against the vaginal wall. Although several series of successful transabdominal cerclage have been reported, the morbidity of this technique precludes its routine use. We describe five pregnancies in four patients with extreme cervical hypoplasia who underwent successful prophylactic transvaginal cerclage placement at 12-13 weeks' gestation. All patients had a history of intrauterine diethylstilbestrol exposure, and three patients had also undergone cervical conization. In each case, using continuous transabdominal ultrasound guidance, the supravaginal cervix was dissected and two nonabsorbable sutures were placed through the cervix at right angles at the level of the anatomical internal os. There were no perioperative complications, and except for one patient who developed severe preeclampsia at 33 weeks, all patients delivered at term. We believe that the use of ultrasound in cases of severe cervical hypoplasia allows safe transvaginal cerclage placement, obviating the need for abdominal cerclage.

Abnormalities, Drug-Induced↗
PubMed1990

Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetric setting.

During an 8-year period, we managed 42 women with 101 pregnancies with previously diagnosed but uncorrected uterine malformations referred to our institution for high-risk obstetric care. All patients were managed under the same standardized protocol requiring weekly visits and decreased physical activity. The population studied consisted of four groups of pregnancies with the following uterine anomalies: unicornuate (five), bicornuate (61), septate (25), and didelphys (ten). Sixty percent of the pregnancies in the unicornuate and didelphys group reached term, 39% in the bicornuate group, and 48% in the septate group. Preterm labor requiring tocolysis occurred in 21% of the pregnancies in the bicornuate group and 15% of the pregnancies in the septate group. Cerclage was placed in 5% of the pregnancies in the bicornuate group. Before our care, the fetal survival rate for pregnancies in the bicornuate and septate groups was 52 and 53%, respectively; with our management protocol, it was 58 and 65%, differences that were not statistically significant. Our experience suggests that high-risk obstetric intervention does not obviate the potential benefit of metroplasty, especially for patients with a bicornuate or septate uterus. We believe that traditional indications for metroplasty should continue to be used.

Abortion, Spontaneous↗
PubMed1989

Shoulder soft tissue width as a predictor of macrosomia in diabetic pregnancies.

Sonographic evaluation of 43 pregnant women with diabetes mellitus was performed in the third trimester of gestation for evidence of fetal macrosomia. The width of the soft tissues of the shoulder from the skin surface to the proximal humerus was compared with previously reported measurements for their ability to predict fetal macrosomia. The abdominal circumference and shoulder soft tissue measurements were the best individual predictors of macrosomia, but a combination of an abdominal circumference greater than the 90th percentile for gestational age or a shoulder soft tissue width greater than 12 mm was the best predictor with a sensitivity of 96%, specificity of 89%, and accuracy of 93%. The shoulder soft tissue width should be evaluated for evidence of macrosomia in diabetic pregnancies.

Female↗
PubMed1989

Doppler umbilical artery velocimetry in pregnancy complicated by insulin-dependent diabetes mellitus.

The mean peak systolic to end-diastolic (S/D) umbilical artery ratio was measured in 291 Doppler studies performed during pregnancy in 35 insulin-dependent diabetic women. A normal decline was observed in the umbilical artery S/D ratio, from 4.2 +/- 0.21 at 18 weeks to 2.18 +/- 0.22 at 38 weeks. There was no significant correlation between mean third-trimester S/D and either glycosylated hemoglobin (r = 0.25) or mean blood glucose levels (r = 0.15). Fetuses of women with vascular disease (class F/R or chronic hypertension) had a mean third-trimester S/D of 3.0 or higher in five of ten cases, compared with three of 25 in patients with uncomplicated diabetes (P less than .03). Mean second- and third-trimester S/D ratios differed significantly in patients with and without vascular disease: 4.34 +/- 0.7 and 3.2 +/- 0.65 versus 3.72 +/- 0.42 and 2.55 +/- 0.32, respectively (P less than .03). Two of three women without vascular disease who demonstrated an elevated mean S/D ratio developed preeclampsia and delivered appropriate for gestational age infants. In women with vascular disease, four of five with an abnormal mean third-trimester umbilical artery S/D ratio were delivered of growth-retarded infants, whereas all five with normal umbilical artery S/D ratios had appropriate for gestational age infants. In three of the abnormal cases, elevated S/D ratios were present in the second trimester before ultrasound documentation of fetal growth retardation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1989

Spontaneous small bowel obstruction associated with a spontaneous triplet gestation. A case report.

Spontaneous bowel obstruction in pregnancy is a rare event and usually associated with a prior history of surgical procedures or infection. Its symptoms can mimic physiologic changes in pregnancy or preterm labor. We treated a woman who had a triplet gestation and whose lack of predisposing factors delayed the diagnosis of obstruction. The patient delivered prematurely at 22 weeks and required surgery to alleviate the obstruction. The possibility of intestinal obstruction should be entertained in any pregnant woman presenting with nausea, vomiting and an overdistended uterus.

Adult↗
PubMed1988

Cerebrospinal fluid shunts in pregnancy. Report of two cases and review of the literature.

With the introduction of silicone indwelling cerebrospinal fluid (CSF) shunts in the 1960s, the prognosis for children with hydrocephalus changed dramatically. These individuals are leading normal and productive lives today. Many women with CSF shunts are not entering the childbearing years. Previously, only 13 cases of pregnancy occurring in patients with CSF shunts have been reported. We present two cases here and review the complications and outcome of the other reported cases. Shunt malfunction appears to be common in pregnancy due to increased intraperitoneal pressure and the enlarging uterus. Rarely is surgical correction or premature delivery necessary. A successful pregnancy ending in the vaginal delivery of a term infant can be expected in the majority of these patients.

Adult↗
PubMed1988

Sonographic detection of cervical incompetence.

The diagnosis of cervical incompetence is based primarily on prior obstetrical history and clinical findings. Sonographic evaluation of the cervix and lower uterine segment does offer an objective means of establishing this diagnosis during gestation. Bulging of the membranes into a partly dilated cervical canal seems to be the most reliable sign of cervical incompetence. Standardization of the scanning techniques and large prospective studies will be necessary in order to determine the value of this diagnostic tool.

Cervix Uteri↗
PubMed1988

Amniotic fluid cholesteryl palmitate in pregnancies complicated by diabetes mellitus.

Amniotic fluid cholesteryl palmitate, as measured by thin-layer chromatography, appears to be a very sensitive and specific predictor for the risk of respiratory distress syndrome (RDS) in newborns of normal pregnancies. To assess the effect of diabetes mellitus on fetal pulmonary maturation, we measured cholesteryl palmitate concentration, the lung profile, and total phosphatidylcholine in amniotic fluid obtained from 35 well-controlled diabetic and 39 control pregnancies at term. In women with diabetes, the mean (+/- SD) third-trimester glycosylated hemoglobin level was 6.96 +/- 2.3% (normal 6-8%). Mean cholesteryl palmitate concentration in the diabetic population was 79.12 +/- 13.17 micrograms/mL, versus 153.71 +/- 16.77 micrograms/mL in the control group (P less than .001). The mean cholesteryl palmitate concentration was also significantly different for gestational diabetics and class B-R gravidas (112.75 +/- 26.2 versus 54.45 +/- 7.34 micrograms/mL; P less than .005). Cholesteryl palmitate was decreased despite the presence of a mature lecithin/sphingomyelin ratio and, in most cases, phosphatidylglycerol. These data suggest that even in well-controlled diabetic pregnancies, alterations in maternal metabolism may affect either the biosynthesis or degradation of cholesteryl palmitate.

Amniotic Fluid↗
PubMed1987

Management of the diethylstilbestrol-exposed pregnant patient: a prospective study.

Over a 5-year period we have managed 63 diethylstilbestrol-exposed pregnant patients with a standardized protocol requiring weekly cervical examination and decreased physical activity of the patient. Twenty-six patients (42%) underwent a prophylactic cerclage for a history of second-trimester loss or a hypoplastic cervix on initial clinical examination (group I). Thirty-six patients (58%) were followed expectantly (group II). Sixteen patients (44%) in group II demonstrated cervical change and required an emergency cerclage. Twenty-one patients were managed expectantly with no cerclage. The gestational age at delivery for group I was 37.7 +/- 2.80 versus 34.5 +/- 6.9 weeks for patients without a cerclage (p = 0.04). There were no perinatal deaths if a cerclage was performed, whereas there were five deaths (24%) in the group without cerclage. The five deaths occurred at a mean gestational age of 24.40 +/- 4.0 weeks and a mean birth weight of 614.00 +/- 441.73 gm. Patients with a hypoplastic cervix or prior reproductive loss had a better outcome with early cerclage than patients with a normal cervix followed expectantly. We presently lack a reliable method to detect the diethylstilbestrol-exposed patient at greatest risk for perinatal loss. Based on our experience we believe that placement of a cerclage early in pregnancy should be a strong consideration.

Adult↗