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Biomedical subjects

J P Elliott

Publications and source records attributed to J P Elliott.

At least 19 recordsLinked to original sources
PubMed1992

Maternal transport of patients with advanced cervical dilatation--to fly or not to fly?

Emergency maternal transport of women in advanced preterm labor often involves difficult decisions about whether to transport or not. A retrospective review of maternal transports performed in northern Arizona by Samaritan Air Evac covered a 21-month period. Of the 1080 patients transported for preterm labor, 54 calls for transport (5%) were received when the patient was 7 cm or more dilated. Five women were delivered at the referring hospital and 49 were transported, none of whom delivered en route. Only 21 (39%) of them delivered in the first hour after arrival at the tertiary center. The decision to transport patients in advanced preterm labor should be based on such factors as distance between hospitals, time required to cover that distance, personnel on the transport, facilities available at the transporting hospital, gestational age, and speed with which labor has progressed.

Aircraft↗
PubMed1992

Effects of feeding lactating dairy cows diets containing whole soybeans and tallow.

Four multiparous Holstein cows averaging 133 d postpartum and fitted with ruminal cannulas were utilized in a 4 x 4 Latin square design to investigate the effects of feeding diets containing whole soybeans and tallow. Treatments were 1) control, no added fat; 2) control and 10% whole raw soybeans; 3) control, 10% whole raw soybeans, and 2.5% tallow; and 4) control, 10% whole raw soybeans, and 4.0% tallow. Cows were fed for ad libitum intake a diet of alfalfa haylage, corn silage, and concentrate (45:5:50, DM basis). Intakes of DM and production of milk, milk CP, milk SNF, and 4% FCM were not affected by feeding supplemental fat. Production of milk fat and weight percentages and yields of long-chain fatty acids in milk fat were increased, whereas weight percentages and yields of short- and medium-chain fatty acids were decreased by feeding supplemental fat. Digestibilities of DM, OM, energy, cellulose, and fatty acids were decreased slightly when fat was added to the diet, but utilization of energy and N for production of milk was not altered. Supplemental fats increased concentrations of NEFA and cholesterol in plasma. These data indicate that relatively large amounts of unprotected fat can be added to the diet of lactating dairy cows without deleterious effects on milk composition, ruminal fermentation, or nutrient digestibilities.

Animal Feed↗
PubMed1992

Intracervical prostaglandin E2 gel. Safety for outpatient cervical ripening before induction of labor.

Cervical ripening prior to induction of labor is often necessary for medical complications of pregnancy. We proposed to prospectively determine the safety of administering prostaglandin E2 (PGE2) gel intracervically in an outpatient setting. Four hundred forty-six patients underwent 515 gel procedures as outpatients. Trained perinatal nurses placed 0.5 mg of PGE2, prepared in a standard methylcellulose base, in the intracervical canal. The PGE2 dose was administered every two hours for a total of three doses if labor did not start. The patient was sent home two hours after the last dose if she was not in active labor. Labor started in 90 patients (20%) during the gel procedure; they were admitted to the labor-and-delivery unit. The remaining patients were discharged. Eighty-eight patients (20%) were later admitted in active labor prior to scheduled induction. One patient (0.02%) was found to have occasional prolonged decelerations on admission and underwent a cesarean section two hours after admission; the Apgar scores were 8 and 9 and the arterial pH, 7.21. Hyperstimulation with excessive intrauterine activity caused significant deceleration of the fetal heart rate in four patients (0.8%), two of whom required transfer to the labor-and-delivery unit but none of whom needed a cesarean section for fetal distress. PGE2 gel can be administered safely intracervically as an outpatient procedure by trained perinatal nurses.

Ambulatory Care↗
PubMed1992

Quadruplet pregnancy: contemporary management and outcome.

Quadruplets are occurring more frequently as assisted-reproduction techniques improve fertility in couples previously unable to conceive. Ten quadruplet pregnancies cared for in one perinatal practice over 5 years had excellent outcome. The mean gestational age at delivery was 32.5 weeks, compared with approximately 30 weeks in the literature. There were no perinatal deaths and no long-term morbidity. Our patients were compared with a series of 57 consecutive patients with quadruplet pregnancies monitored by a home monitoring system. Parity of 1 or more appeared to improve outcome. Pregnancy-induced hypertension occurred in nine of our pregnancies and necessitated delivery in seven instances. Fetal distress was responsible for two deliveries and uncontrollable preterm labor for only one. Key points in our management protocol include prophylactic use of low-dose aspirin, home contraction monitoring, use of terbutaline pump tocolysis, and bed rest at home starting at 16 weeks.

Adult↗
PubMed1991

Cerebral metastases from ovarian carcinoma.

Apart from choriocarcinoma, involvement of the central nervous system (CNS) by gynecologic malignancy is rare. A 10-year retrospective review at the University of Washington Medical Center (Seattle, WA) and Swedish Hospital and Medical Center Tumor Registry (Seattle, WA) identified 14 patients with cerebral metastases from ovarian carcinoma. Median age at diagnosis of cerebral metastases was 52.5 years. Median interval from the diagnosis of ovarian carcinoma to the diagnosis of CNS metastases was 14.5 months. Seven patients had received cisplatin therapy before CNS relapse. Seven patients underwent second-look procedures before developing CNS metastases; in three, results were negative. Eight patients had evidence of extraperitoneal spread to other sites at the time of CNS relapse. Clinical manifestations included motor weakness, seizures, headache, confusion, and speech disturbance. All lesions were contrast enhancing on computed tomography (CT) scans and were located in the cerebral hemispheres. Nine patients had single lesions, five of whom underwent surgical resection of the lesion with histologic confirmation of metastases from the primary site. Median survival was 2 months in patients receiving radiation therapy alone and 17 months in patients who received surgery and radiation. Median survival of the entire series was 3 months. The presence of multiple cerebral metastases or evidence of extraperitoneal spread elsewhere in the body was adversely associated with survival. The prognosis of patients with cerebral metastases from ovarian carcinoma appears poor. However, early diagnosis by routine CT scanning followed by surgical resection and radiation may improve overall survival in a select group of patients.

Adult↗
PubMed1991

Left flank retroperitoneal exposure: a technical aid to complex aortic reconstruction.

Over the last 5 years an extended left flank retroperitoneal approach was used in 85 of 531 (16%) aortic reconstructions deemed technically complex. Abdominal aortic aneurysm repair was performed in 70 patients (82%), bypass of aortoiliac occlusive disease was performed in 11 (13%), and aortic endarterectomy for mesenteric and/or renovascular disease was performed in 4 (5%). Indications for use of this approach included a "hostile" abdomen (43 patients), juxta/suprarenal abdominal aortic aneurysm (35), large (greater than 10 cm) abdominal aortic aneurysm (12), extreme obesity (10), associated renal and/or visceral artery stenosis requiring endarterectomy (9), inflammatory abdominal aortic aneurysm (2), and horseshoe kidney (2). Suprarenal or supraceliac aortic clamping, averaging 31 minutes, was required in 43 patients (50%). Postoperative recovery was rapid (average length of stay, 10.2 days), and morbidity was minimal despite the complex nature of these reconstructions. The perioperative mortality rate in elective operations was 1.2%. This approach facilitated proximal abdominal aortic exposure and anastomosis, especially in large, pararenal aneurysms or in situations unfavorable to a transabdominal approach. Whereas a left flank retroperitoneal approach can be used in most aortic reconstructions, it seems especially suited to those that pose significant technical challenges.

Abdomen↗
PubMed1991

Massive fetomaternal hemorrhage treated by fetal intravascular transfusion.

Two cases of massive fetomaternal hemorrhage are presented. Both women noted a decrease in fetal movement and were advised to come to the hospital for fetal heart rate monitoring. Sinusoidal fetal heart rate patterns were observed and Kleihauer-Betke testing was positive for fetomaternal hemorrhage. The fetuses were preterm and therefore funipuncture was done, which confirmed profound anemia in both. Fetal intravascular transfusion was performed. Shortly after conclusion of the transfusion, prolonged bradycardia occurred in both fetuses and delivery was accomplished by cesarean. Both infants survived.

Adult↗
PubMed1991

Aggressive therapeutic amniocentesis for treatment of twin-twin transfusion syndrome.

Acute severe twin-twin transfusion syndrome occurs in about 1% of monochorionic twin gestations. In the most severe form, acute hydramnios develops in the recipient twin's sac and fetal hydrops may be present. The donor twin is anemic and oligohydramnios is present, so that the donor appears "stuck" in a cocoon made by its adherent amnion. In this report, aggressive therapeutic amniocentesis restored amniotic fluid volume to normal in both sacs in all pregnancies. Fetal hydrops resolved in three of five (60%) of the fetuses affected. Pregnancy was extended a mean 80 +/- 33 days (+/- 2 SD) and perinatal survival was 79%. These findings contrast dramatically with the virtual 100% mortality reported in the literature with no therapy. Repeated aggressive amniocentesis effectively reversed the physiology of twin-twin transfusion syndrome and should be the treatment of choice for acute hydramnios, which previously had no recommended therapy.

Acute Disease↗
PubMed1991

Post prostatectomy bladder neck contractures.

An 8% and 7% incidence of bladder neck contractures (BNC) requiring relief by transurethral incisions (TUI), (124) was found after review of 1471 TURP's and 71 retropubic prostatectomies. Prevention of BNC was attempted by leaving a one centimeter strip at the time of TURP (62), incising the bladder neck alone (42), or incising the bladder neck and interureteric ridge (65). Bladder neck obstruction occurred in 4.8% of the strips, 14% of the incised bladder necks only, and 3% of the incised bladder neck and contiguous interureteric ridges. A significant cost savings is possible.

Contracture↗
PubMed1990

Intraoperative autotransfusion in vascular surgery.

To determine the impact of intraoperative autotransfusion on vascular surgical care, data related to 304 major vascular surgical operations performed over a 42-month period were retrospectively analyzed. Procedures included abdominal aortic aneurysmectomy (N = 152), aortobilateral femoral bypass (N = 60), thoracoabdominal aortic aneurysmectomy (N = 20), and other vascular procedures (N = 68). Fifty percent of the transfusion requirement was met by autotransfusion for the average patient. The per patient average volumes (liters) autotransfused were as follows: elective abdominal aortic aneurysmectomy, 0.87 L and nonelective, 1.45 L; elective aortobilateral femoral bypass, 0.63 L; elective thoracoabdominal aortic aneurysmectomy, 2.47 L, and nonelective, 2.15 L; and elective other, 0.53 L and nonelective, 1.30 L. Results of immediate postoperative and hospital discharge hemoglobin, hematocrit, and coagulation studies (prothrombin time, partial thromboplastin time, and platelets) did not differ from results of preoperative studies in any group. Neither mortality nor morbidity was related to intraoperative autotransfusion. These data suggest that intraoperative autotransfusion is a safe blood replacement method during major vascular surgical operations.

Adult↗
PubMed1990

Twin-twin transfusion syndrome.

Twin-twin transfusion syndrome associated with acute polyhydramnios in one sac and severe oligohydramnios in the other, which characteristically is diagnosed between 18 and 28 weeks, is associated with a high mortality rate for the involved twins. Patients who are managed without intervention have essentially 100% perinatal mortality. Nineteen patients with this diagnosis were treated at Good Samaritan Medical Center over a 5-year period. Because of the known perinatal mortality and because of early experiences with the twin-twin transfusion syndrome, we began to actively intervene in such patients with various modes of therapy. As experience was gained, it was found that repeated therapeutic amniocenteses, if performed before severe maternal abdominal distention or labor, appears to be beneficial.

Amniocentesis↗
PubMed1990

Reliability of ultrasonographic formulary in the prediction of fetal weight and survival of very-low-birth-weight infants.

Antenatal management of very-low-birth-weight infants often requires difficult obstetric decisions. This study was designed to evaluate the predictive value for neonatal outcome of antenatally acquired estimation of gestational age and ultrasonographically estimated fetal weight or a combination of both in very-low-birth-weight infants. Sixty-seven fetuses with estimated gestational ages between 22 0/7 and 28 6/7 weeks were studied ultrasonographically to estimate fetal weight. A comparison of accuracy of estimated fetal weight with actual birth weight showed good correlation (r = 0.93). Neonatal outcome of these infants was analyzed by estimated gestational age and estimated fetal weight. Estimated gestational age and estimated fetal weight greater than 25 weeks and greater than 750 gm were associated with 50% survival, respectively. However, when both of these conditions were met survival reached 85%. This information may be useful to guide antepartum management decisions in this very-low-birth-weight group.

Birth Weight↗
PubMed1990

Intraoperative angiography and temporary balloon occlusion facilitating surgical obliteration of a traumatic carotid cavernous fistula: a case report.

A patient with a traumatic carotid cavernous fistula was successfully treated by a direct surgical approach after failed endovascular balloon occlusion. Surgical identification of the fistula and confirmation of its obliteration were achieved with intraoperative angiography. Dissection, control of bleeding, and carotid blood flow were facilitated by temporary balloon occlusion of the cavernous carotid artery. The combination of surgery, intraoperative angiography, and interventional radiologic techniques may improve the management of intracavernous vascular lesions.

Aged↗
PubMed1990

Chronic cerebral blood flow changes following experimental subarachnoid hemorrhage in rats.

Experimental subarachnoid hemorrhage was induced in 52 adult male Wistar rats by microsurgical transclival basilar artery puncture. Telencephalic blood flow measured in 24 rats with subarachnoid hemorrhage was compared with that in 23 sham-operated rats and 10 unoperated control rats using the [14C]butanol indicator fractionation technique. Telencephalic blood flow was significantly less in the rats with subarachnoid hemorrhage than in the sham-operated rats 3 (78.7 +/- 6.9 [n = 7] and 112.0 +/- 8.5 [n = 8] ml/100 g/min, respectively; p less than 0.01), 7 (74.9 +/- 5.1 [n = 9] and 112.6 +/- 4.6 [n = 8] ml/100 g/min, p less than 0.001), and 14 (81.9 +/- 6.0 [n = 8] and 104.1 +/- 5.4 [n = 7] ml/100 g/min, p less than 0.01) days after surgery. Telencephalic blood flow in unoperated controls (114.7 +/- 4.9 ml/100 g/min) did not differ significantly from sham-operated rats. Clinically, the 52 rats with subarachnoid hemorrhage were indistinguishable from 32 sham-operated rats. Postmortem examinations in 10 rats used in a preliminary investigation demonstrated significant blood clot in the basal cisterns 2 hours after basilar artery puncture. Intracranial pressure was slightly elevated (2.3 mm Hg over baseline) 30 minutes after the hemorrhage (n = 7), but when measured 3 (n = 3) or 7 (n = 3) days after surgery it had returned to baseline. Histologic examination of the brains from 10 rats subjected to subarachnoid hemorrhage 7 (n = 5) or 14 (n = 5) days before sacrifice revealed no evidence of cerebral ischemia or vasculopathic changes in the cerebral arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗