PubMed Health⌕ Search

Biomedical subjects

J M Lang

Publications and source records attributed to J M Lang.

At least 19 recordsLinked to original sources
PubMed1997

The association of fetal sex with the rate of cesarean section.

OBJECTIVE: Our purpose was to evaluate the rate of cesarean deliveries according to fetal sex. STUDY DESIGN: We evaluated method of delivery, indication for cesarean section, and infant outcome according to fetal sex in 2439 low-risk nulliparous women in spontaneous labor. Crude odds ratios and 95% confidence intervals were calculated. Confounding was controlled with use of logistic regression. RESULTS: The overall cesarean section rate was 13.2% among 1246 women carrying male fetuses compared with 9.6% among 1193 women carrying female fetuses (odds ratio 1.4, 95% confidence interval 1.1 to 1.8). There was a 30% increase in cesarean sections for failure to progress (odds ratio 1.3, 95% confidence interval 1.0 to 1.8) and a 70% increase in those for fetal distress (odds ratio 1.7, 95% confidence interval 1.0 to 3.0). When adjusted for gestational age and fetal size, male fetal sex no longer predicted the risk of cesarean delivery for failure to progress (adjusted odds ratio 1.04, 95% confidence interval 0.8 to 1.4) but continued to predict the risk of cesarean section for fetal distress (adjusted odds ratio 2.2, 95% confidence interval 1.3 to 4.0). Among infants delivered by cesarean section for fetal distress, males were more than three times as likely than females to have an Apgar score < or = 7 at both 1 and 5 minutes. CONCLUSION: Increased cesarean deliveries for failure to progress among women with male fetuses is related to the larger size of males, whereas the increase for fetal distress is not, and may relate to other developmental differences between male and female fetuses.

Birth Weight↗
PubMed1997

Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation.

OBJECTIVE: Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics. METHODS: We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4 degrees F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors. RESULTS: Intrapartum fever >100.4 degrees F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors < or = 6 hours to 36% for labors >18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group. CONCLUSIONS: Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.

Analgesia, Epidural↗
PubMed1997

[Tsukamurella infections. Review of the literature apropos of a case].

The genus Tsukamurella belongs to the family Nocardiaceae, and is an environmental saprophyte. The type species is Tsukamurella paurometabola. Its microbiological identification and differentiation from the other species containing mycolic acids can be difficult. There has been a few cases of human infections reported, usually in patients with special conditions, such as chronic lung pathology, immuno-suppression (leukemia, solid tumors, maybe HIV-infection) or the long-term use of indwelling catheters. The treatment of choice, despite the lack of adequate guidelines, is an antibiotherapy combining a beta-lactam and an aminoglycoside; catheter removal appears to be essential for cure.

AIDS-Related Opportunistic Infections↗
PubMed1996

Association of epidural analgesia with cesarean delivery in nulliparas.

OBJECTIVE: To evaluate whether epidural analgesia during the first stage of labor is associated with an increased risk of cesarean delivery. METHODS: The association of epidural analgesia and cesarean delivery was examined in a retrospective study of 1733 low-risk, term nulliparas with singleton infants in vertex presentations, in which labor began spontaneously. To evaluate the effect of epidural analgesia on cesarean deliveries, independent of other factors influencing the use of epidural analgesia, we used propensity scores to create five subgroups (quintiles) of women who, based on characteristics discernible at admission, appeared equally likely to receive epidural analgesia. Multivariate logistic regression analysis was used to control for confounding. RESULTS: Overall, the cesarean rate among women receiving epidural analgesia was 17% (168 of 991), compared with 4% (30 of 742) among those who did not receive epidural analgesia. An increased cesarean rate among women receiving epidural analgesia was present in all propensity quintiles. In an adjusted logistic regression analysis, women receiving epidural analgesia were 3.7 times more likely to undergo a cesarean (95% confidence interval 2.4, 5.7). The greatest increase in cesarean risk was noted when epidural analgesia was administered earlier in labor, but there was a more than twofold increase regardless of the dilation and station at administration of epidural analgesia. CONCLUSIONS: Epidural analgesia may increase substantially the risk of cesarean delivery. Although the causal nature of this association remains open to debate, prenatal care providers should routinely discuss the risks and benefits of epidural analgesia with women during their pregnancies so that they can make informed decisions about the use of pain relief during labor.

Adult↗
PubMed1996

A comparison of risk factors for preterm labor and term small-for-gestational-age birth.

This study estimates the effects of 23 factors on the prevalence of premature labor and fetal growth retardation across the entire birthweight spectrum. We studied risk factors for premature labor within the domain of babies of appropriate size for their gestational age (N = 9,490). We also studied risk factors for fetal growth retardation among babies born at term (N = 10,889). Preterm labor was associated independently with young maternal age, low pre-pregnant weight, low weekly weight gain, nulliparity, previous preterm birth, histories of two or more induced abortions, spontaneous abortions, or stillbirths, uterine exposure to diethylstilbestrol (DES), incompetent cervix, uterine anomaly, and pyelonephritis. Odds ratios ranged from 1.7 to 5.9. Fetal growth retardation, as estimated by small-for-gestational-age birth, was associated independently with black race, young maternal age, short maternal height, low prepregnancy weight, low weekly weight gain, and smoking, as well as nulliparity, previous preterm birth, three or more abortions, uterine anomaly, and uterine exposure to DES. Odds ratios ranged from 1.6 to 2.8. Our study shows the importance for etiologic understanding of separating diverse routes to low birthweight and considering the occurrence of adverse pregnancy outcomes along the entire birthweight spectrum. The findings reinforce the need for comprehensive control of confounding in studies of pregnancy outcome.

Boston↗
PubMed1996

Filgrastim to treat neutropenia and support myelosuppressive medication dosing in HIV infection. G-CSF 92105 Study Group.

BACKGROUND: Patients with HIV infection frequently experience disease or treatment-related myelosuppression leading to neutropenia. Neutropenia often leads to dose-reduction or discontinuation of important myelosuppressive therapy. OBJECTIVE: To examine the efficacy and safety of filgrastim for reversing neutropenia and determine the effect of this on use of myelosuppressive medications. DESIGN: Open-label, non-comparative, multicentre study in 200 HIV-positive patients with neutropenia [absolute neutrophil count (ANC) < 1.0 x 10(9)/l]. Filgrastim was started at 1 microgram/kg/day subcutaneously for 28 days. This initial treatment phase was followed by a maintenance phase, using 300 micrograms on 1-7 days/week. In both phases the dose of filgrastim was adjusted to achieve an ANC of 2-5 x 10(9)/l. RESULTS: Filgrastim reversed neutropenia in 98% of patients (ANC > or = 2 x 10(9)/l), with a median time to reversal of 2 days (range 1-16) and a median dose of 1 microgram/kg/day (range 0.5-10). Most patients (96%) achieved reversal of neutropenia with a filgrastim dose of < or = 300 micrograms/day (< or = 1 vial/day). Normal ANCs were then maintained with a median of 1 microgram/kg/day (range 0.22-10.6) during the treatment phase and 3 x 300 micrograms vials/week (range 1-7) during the maintenance phase. Ganciclovir, zidovudine, co-trimoxazole and pyrimethamine were the drugs most frequently considered to be causing neutropenia, and 83% of patients received one or more of these in the study. Filgrastim allowed > 80% of patients to increase or maintain dose-levels of these four medications or add them to their therapy. The number of these four medications received per patient increased by > 20% during filgrastim therapy. Filgrastim was well tolerated. CD4, CD8 and total lymphocyte counts all increased slightly, and there was no difference in HIV-1 p24 antigen levels. CONCLUSION: Filgrastim rapidly reverses neutropenia and maintains normal ANC in patients with HIV infection. This allows greater use of myelosuppressive medications without the potentially life-threatening complications of neutropenia.

Adolescent↗
PubMed1996

Abnormal urinary coproporphyrin levels in patients infected by hepatitis C virus with or without human immunodeficiency virus. A study of 177 patients.

OBJECTIVE: Many cases of porphyria cutanea tarda have been described in association with human immunodeficiency virus (HIV) infection in young individuals. The link between hepatitis C virus (HCV) and porphyria cutanea tarda is even stronger as more than 50% of patients who have this diagnosis in Italy, France, or Spain are also infected by HCV. To study the role of viral infections on the metabolism of porphyrins, we measured the urinary porphyrin levels in patients with HIV and HCV infections. DESIGN: Survey; prospective study. SETTING: University Hospital of Strasbourg, France. PATIENTS: Sixty-one HIV-positive patients, 56 HCV-positive patients, 60 HIV- and HCV-positive patients, and 51 HIV- and HCV-negative control subjects were randomly selected. None had clinical signs of porphyria or a familial history of porphyria. MAIN OUTCOME MEASURES: The porphyrin-excretion profile was determined by high-performance liquid chromatography on fresh urine samples. The HIV and HCV viremias were quantified in the serum by the branched DNA assay. Measures were planned before data collection began. RESULTS: The porphyrin-excretion profile typical of porphyria cutanea tarda was found in only 1 of 177 patients. In the remaining 176 patients, the mean coproporphyrin level was significantly raised in HCV-positive patients and even higher in patients who were HIV- and HCV-positive. The coproporphyrin level was not correlated to the alanine aminotransferase level, the CD4+ cell count, or the HCV and HIV viremias. CONCLUSIONS: In cases of infection with HIV, HCV, or both, the development of a porphyria cutanea tarda urinary profile is a rare event (0.56% in this study), but coproporphyrin excretion is increased. This could be related to hepatic changes induced by the viruses. Our results do not support the hypothesis of a direct viral effect on the porphyrin metabolism. Infection with HIV, HCV, or both may be a major triggering factor, but is not sufficient to induce porphyria.

Adolescent↗
PubMed1995

A clinical trial of active management of labor.

BACKGROUND: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies. METHODS: We randomly assigned 1934 nulliparous women at low risk of complications of pregnancy, before 30 weeks' gestation, to active management of labor or to a usual-care group. The components of active management were customized childbirth classes; strict criteria for the diagnosis of labor; standardized management of labor, including early amniotomy and treatment with high-dose oxytocin; and one-to-one nursing. A low-risk subgroup was defined as including women with full-term, uncomplicated pregnancies who spontaneously went into labor (the protocol-eligible subgroup). Women meeting these criteria who had been randomly assigned to the active-management group were admitted to a separate unit where their labor was managed by trained, certified nurse-midwives. RESULTS: There was no difference between groups in the rate of cesarean section either among all women (active management, 19.5 percent; usual care, 19.4 percent) or in the protocol-eligible subgroup (active management, 10.9 percent; usual care, 11.5 percent). In the protocol-eligible subgroup, the median duration of labor was shortened by 2.7 hours by active management (from 8.9 to 6.2 hours), and the rate of maternal fever was lower (7 percent vs. 11 percent, P = 0.007). The percentage of women in whom labor lasted longer than 12 hours was three times higher in the usual-care group than in the active-management group (26 percent vs. 9 percent, P < 0.001). CONCLUSIONS: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.

Adult↗
PubMed1995

High hepatitis C viraemia and impaired antibody response in patients coinfected with HIV.

OBJECTIVE: To compare hepatitis C virus (HCV) load in patients infected with HCV alone and those coinfected with HIV, and to evaluate the antibody response to HCV in the case of HIV infection. DESIGN: Patients coinfected with both HCV and HIV have been shown to develop hepatic changes more rapidly, which may be due to an interaction between HCV and HIV. In a prospective study, serum samples were taken from 150 patients. METHODS: Using reverse transcription followed by polymerase chain reaction and the branched DNA assay, we detected HCV RNA in 75 patients coinfected with HIV and HCV and in 75 patients infected with HCV alone. The HIV RNA was also quantified by the branched DNA assay and the p24 antigenaemia was determined by enzyme-linked immunosorbent assay. The immune response to HCV was studied in the 150 patients by the use of third generation recombinant immunoblot assay (RIBA). RESULTS: Although a comparable number of patients had detectable HCV viraemia in both groups, HCV RNA was quantifiable in 79% of HIV-positive patients and in only 43% of HIV-negative patients (P < 10(-5)), and the mean HCV RNA level was much higher in the HIV-positive group than in the HIV-negative group (P < 10(-7)). The quantity of HCV RNA did not correlate with the CD4 count, p24 antigenaemia or HIV RNA level. The analysis of RIBA showed 14.7% indeterminate or negative results in the HIV-positive group and only 4% indeterminate results in the HIV-negative group. HIV-positive patients had reactivity to less antigen bands than HIV-negative patients (P < 10(-3)), and they had a weaker reactivity to c100, c33c and NS5 antigen bands than HIV-negative patients. CONCLUSION: Our results show that in the case of HIV infection, the HCV RNA levels are strongly increased, but HCV load is not linked to the immunosuppression induced by HIV; therefore, the present data do not support the hypothesis of a direct interaction between HIV and HCV.

Adolescent↗
PubMed1995

[Study on objective parameters of syndrome differentiation of diabetic nephropathy].

This is a study about objective parameters of Syndrome Differentiation of diabetic nephropathy (DN) using radio immunoassay (RIA) technique. The result showed that beta 2-microglobulin (beta 2-mG), alpha 1-microglobulin (alpha 1-mG) in blood rose significantly in both groups. The group of Spleen-Kidney Deficiency and Qi-Blood Deficiency as well as the group of Yang Deficiency caused edema and upward gush of turbid Yin, there was significant difference between two groups, also there was significant difference between the two groups in measuring on atrial natriuretic factor (ANP), pancreatic glucagon (PG) in blood and beta 2-mG. Immunoglobulin G (IgG), albumin (Alb), secretory immunoglobulin A(SIg A) in urine. So above-mentioned parameters offered us some objective data on Syndrome Differentiation of DN. It is vital in guiding the Syndrome Differentiation and treatment of DN.

Adult↗
PubMed1995

Monocular acuity norms for the Teller Acuity Cards between ages one month and four years.

PURPOSE: To derive norms for monocular grating acuity and interocular acuity differences that are appropriate for clinical applications using the acuity card procedure (ACP) and Teller Acuity Cards (TAC). METHODS: Monocular acuities were measured in 460 children in 12 age groups between 1 month and 4 years. Inclusion criteria were term birth, good general health and normal development, normal eyes, and cycloplegic refraction within specific limits. Each child was tested by two ACP testers who were aware of TAC spatial frequency but not grating location during testing. RESULTS: Three monocular tests were completed in the first session in 99% of children. Median time to complete the tests of both eyes ranged from 3.2 to 8.4 minutes. Monocular acuity norms were calculated using 95% and 99% prediction limits. The new norms spanned higher spatial frequencies than the preliminary ACP norms between ages 1 month and 18 months but were similar between 24 and 36 months. The lower normal 2.5% limits were similar to lower limits of other normative studies. The interocular acuity difference was zero or 0.5 octave in 99% of subjects of all ages. Acuities obtained by the same tester on different days and by different testers on the same day were within 0.5 octave in at least 90% of subjects, comparable to previous studies. CONCLUSIONS: This study provides monocular acuity norms that are appropriate for clinical settings in which the ACP and TAC are used and should replace the preliminary ACP norms.

Child, Preschool↗
PubMed1995

Zidovudine plus interferon-alpha versus zidovudine alone in HIV-infected symptomatic or asymptomatic persons with CD4+ cell counts > 150 x 10(6)/L: results of the Zidon trial. Zidon Study Group.

OBJECTIVE: To evaluate the efficacy and safety of zidovudine (ZDV) and lymphoblastoid interferon (IFN)-alpha combination therapy compared with ZDV monotherapy in HIV-infected subjects with CD4+ cell counts between 150 and 500 x 10(6)/l. DESIGN: Open, randomized controlled trial with subjects stratified by the Centers for Disease Control and Prevention (CDC) 1986 classification of HIV disease (group II/III or IV). The study was amended to a sequential design in February 1992 to allow interim analyses to be conducted. SETTING: Outpatient clinics in 45 hospitals in Europe, Australia and Canada. PARTICIPANTS: A total of 402 previously untreated subjects with symptomatic HIV infection (CDC group IV) and CD4+ count 150-500 x 10(6)/l or asymptomatic HIV infection (CDC group II/III) with CD4+ count 150-350 x 10(6)/l. INTERVENTIONS: ZDV 250 mg twice daily with or without 3 MU subcutaneous injections of lymphoblastoid IFN-alpha three times per week. MAIN OUTCOME MEASURES: Time to development of a study endpoint defined as: progression from CDC group II/III to group IV, group IV non-AIDS to AIDS, or group IV AIDS to a second AIDS-defining condition; also CD4+ count to < 50 x 10(6)/l on two occasions at least 1 month apart or HIV-related death irrespective of CDC group on entry. RESULTS: There was no reduction in the rate of disease progression for patients receiving ZDV plus IFN-alpha compared with patients receiving ZDV alone. No major differences between the groups were seen for CD4+ counts or percentages, or p24 antigenaemia. In a subset of 70 patients, a similar proportion from both dose groups showed evidence of ZDV resistance after 48 weeks of treatment. More adverse experiences were seen in the ZDV/IFN-alpha group. CONCLUSIONS: Combination therapy with low dose lymphoblastoid IFN-alpha and ZDV revealed no clinical benefit compared with ZDV monotherapy.

Adolescent↗