Biomedical subjects
J Mestman
Publications and source records attributed to J Mestman.
Calcium/creatinine ratio and microalbuminuria in the prediction of preeclampsia.
Eighty-eight normotensive gravid women between 24 and 34 weeks of gestation underwent urine evaluation for the presence of microalbuminuria and urinary calcium excretion (calcium/creatinine ratio). Preeclampsia subsequently developed in 83% of patients with a high level of microalbuminuria (greater than or equal to 11 micrograms/ml) and a low calcium/creatinine ratio (less than or equal to 0.04). Conversely, 94% of women who did not demonstrate high microalbuminuria and a low calcium/creatinine ratio remained normotensive at the time of delivery. These results suggest that changes in renal function are present in gravid women who are otherwise free of symptoms in whom preeclampsia will eventually develop. Testing for microalbuminuria and a calcium/creatinine ratio may be a useful screening tool in predicting the subsequent development of preeclampsia.
Transient ventricular dysfunction associated with cesarean section in a patient with hyperthyroidism.
Pulmonary artery catheterization was performed prior to surgery in a severely hyperthyroid patient undergoing cesarean section. A transient but significant decline in left ventricular performance was observed in conjunction with the stress of operation. A parallel is suggested between this phenomenon and the documented exercise-induced reduction of left ventricular function in nonpregnant hyperthyroid patients.
Insulin receptors and placental proteins in normal and gestational-diabetic pregnancies.
We studied 125I-insulin binding to monocytes and plasma levels of two trophoblastic proteins from 38 pregnant patients with varying degrees of carbohydrate intolerance, including 10 pregnant controls (PC), 17 Class A diabetics (A), 6 Class B diabetics - prior to insulin therapy (B-noRx) and 5 different Class B diabetics studied 1-6 weeks following initiation of insulin therapy (B-Rx). All studies were performed in the second half of pregnancy. In comparison to six age- and weight-matched nonpregnant controls (NPC), insulin binding to monocytes was somewhat higher in both PC and A. B.noRx patients had significantly lower tracer binding than did PC (0.71 +/- 0.3 vs 2.6 +/- 0.6%/10(7) cells, p less than 0.01). Insulin treatment of Class B patients restored insulin tracer binding levels to above normal. Levels of human placental lactogen (HPL) were significantly elevated in B-noRx patients compared to PC and A and were lowered to levels comparable to normal in insulin-treated B patients. A highly significant inverse relationship existed between HPL levels and the tracer binding of insulin for all patients studied (r = -0.52, p less than 0.005). Elevations of pregnancy-specific beta 1 glycoprotein were observed in patients with mild carbohydrate intolerance (A) as well as Bno-Rx, but were comparable to normal in those B-patients receiving insulin therapy. There were no significant differences of insulin binding or receptor number in the patient groups in the postpartum state. This further supports the hypothesis that placental factors may be responsible for the insulin binding defects seen in gestational diabetes.
The effect of plasma glucose variability on neonatal outcome in the pregnant diabetic patient.
Maternal glucose variability was studied in 154 pregnant diabetic patients hospitalized during the last month of their pregnancies. By means of several statistical analyses of the coefficient of variation for within-day plasma glucose variability, we found as follows. (1) There was a significant association between maternal glucose variability and neonatal outcome. (2) Patients with greater glucose variability had more episodes of hyperglycemia, but not hypoglycemia. (3) There was no correlation between maternal glucose variability and the birth weight of the infant. We are proposing the use of an index for glucose variability to monitor glucose control in pregnancy and predict neonatal outcome. Although absence of glucose variability will not ensure prevention of neonatal complications, there is a clear association between greater glucose variability and neonatal complications.
Monocyte insulin binding studies in normal and diabetic pregnancies.
Monocyte insulin receptor binding was studied in six nonpregnant control patients and in 40 pregnant patients with varying degrees of carbohydrate tolerance. Competitive binding assays were performed to determine insulin binding to monocytes. Fasting insulin levels were determined. We obtained the following results: (1) When compared to values not associated with pregnancy, the number of insulin receptor sites per cell increases twofold (31,000 versus 16,300); (2) Class A diabetic patients have higher numbers of receptor sites than normal pregnant patients (80,800 versus 31,000; (3) untreated Class B diabetic patients have markedly reduced receptor sites (4,575) and bind less insulin at physiologic concentrations (p less than 0.01); (4) insulin therapy of previously untreated Class B diabetic patients restored the number of receptor sites to normal pregnant levels (29,700); and (5) Classes C and D diabetic patients had similar numbers of receptor sites (30,140) and showed a greater receptor affinity for insulin than pregnant control subjects (p less than 0.01).
Bilateral luteomas of pregnancy with virilization. A case report.
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