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Biomedical subjects

J R Barton

Publications and source records attributed to J R Barton.

At least 55 records · Page 3Linked to original sources
PubMed1997

The effect of vibroacoustic stimulation on fetal heart rate parameters utilizing computer analysis.

We examined the effect of vibroacoustic stimulation on periodic and nonperiodic fetal heart rate (FHR) parameters in fetuses not meeting Dawes-Redman criteria utilizing computerized analysis. Antepartum FHR analysis was performed using the Oxford Sonicaid System 8000 package (Oxford Sonicaid Ltd., Chichester, UK). Patients not meeting Dawes-Redman criteria for reactivity after 20 min of monitoring were recruited for the study. A 3-sec vibroacoustic stimulation (VAS) to the maternal abdomen was then performed over the fetal head. Each patient was again monitored using the System 8000. FHR parameters were compared before and after fetal VAS using the paired Student's t-test. Twenty patients met the study criteria. The average gestational age at testing was 36 weeks. Following fetal VAS, significant increases were observed in the number of fetal movements, number of accelerations, baseline FHR, overall variation, and short-term variation. No significant changes occurred in the number of decelerations. Dawes-Redman criteria were met in 16 patients after fetal VAS. In fetuses not initially meeting Dawes-Redman criteria, VAS is associated with increased long-term periodic changes in FHR, but not with changes in the number of fetal heart rate decelerations. Furthermore, by computerized analysis, VAS is also associated with increased overall and short-term FHR variability.

Acoustic Stimulation↗
PubMed1997

The effect of nifedipine on urinary excretion of calcium in preeclampsia.

Our objective was to determine if maternal urinary calcium excretion is altered during treatment of mild preeclampsia remote from term with the calcium channel blocker nifedipine. One hundred forty-eight women with mild preeclampsia were randomly allocated to treatment with either bed rest alone (n=64) or in combination with nifedipine (n=84) at 26-36 weeks' gestation. All women had 24 hr urine samples collected for creatinine clearance and calcium excretion determination prior to therapy and during treatment. There was no difference in gestational age at the time of urine collection between the two groups. There were no differences in 24-hr creatinine clearance and calcium excretion between the groups prior to therapy. When followed longitudinally, there was a significant reduction in calcium excretion within each group (p=0.0005 control group, p <0.0001 nifedipine group). Further, a significant reduction in calcium excretion was noted following nifedipine therapy (62+/-94 mg Ca/24 hr) compared to the control group (143+/-153 mg Ca/24 hr), p <0.001. Consistent with previous studies, we have shown that progressive hypocalciuria is a feature of preeclampsia. Further, urinary calcium excretion decreased despite nifedipine therapy. Altered urinary calcium excretion may be less reflective of the progression in severity of preeclampsia in patients treated with nifedipine.

Adolescent↗
PubMed1996

The management of placenta percreta: conservative and operative strategies.

OBJECTIVE: Our purpose was to assess preferences for the management of placenta percreta and identify aspects of care related to an improved outcome. STUDY DESIGN: Both an analysis of a questionnaire issued to members of the Society of Perinatal Obstetricians and a retrospective study at our institution were used to obtain case histories of women with placenta percreta during a recent 3-year period. RESULTS: Fifty-five of the 109 cases (50%) reported by members of the Society of Perinatal Obstetricians were suspected ante partum. Complications associated with this disorder included uterine rupture (3 cases), transfusion of > 10 units (44 cases, 40%), ureteral ligation or fistula formation (5 cases each, 5%), infection (31 cases, 28%), perinatal death (10 cases, 9%), and maternal death (8 cases, 7%). Management options included surgical removal of the uterus and involved tissues (101 cases, 93%) and conservative treatment with the placenta left in situ after delivery (8 cases, 7%). More members of the Society of Perinatal Obstetricians responding to our survey opted for conservative management if adjacent tissues were involved (69% with extension into the bladder or gastrointestinal tract) compared with 31% when the percreta was confined to the uterus, p < 0.001. Conservative therapy was also associated with less blood loss in reported cases (median units red blood cells transfused, 0 vs 7, p = 0.003). Two of the three cases of placenta percreta at our institution were identified ante partum. The third case represents the first reported with antepartum identification of percreta followed by deliberate conservative treatment. CONCLUSIONS: With greater involvement of surrounding tissues, conservative treatment was preferred in hemodynamically stable patients. If surgical excision of the placenta is attempted or necessary, physicians experienced in pelvic dissection must be involved because of the frequency of maternal morbidity and mortality.

Adult↗
PubMed1996

Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).

OBJECTIVES: Our objective was to describe the hepatic imaging findings in selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of concurrent clinical and laboratory abnormalities. STUDY DESIGN: Patients with laboratory criteria for HELLP syndrome with complaints of severe right upper quadrant abdominal pain in association with either shoulder pain, neck pain, or relapsing hypotension underwent imaging of the liver. Clinical and laboratory parameters were then correlated with the hepatic imaging findings. RESULTS: Thirty-four patients were evaluated in this study. Computed tomographic scanning of the liver was used for 33 patients. Additional imaging evaluations included magnetic resonance imaging for 4 patients and ultrasonographic evaluation of the liver for 5 patients. In 15 cases (45%) the computed tomographic results were abnormal. The most frequent abnormal hepatic imaging findings were subcapsular hematoma (n = 13) and intraparenchymal hemorrhage (n = 6). There was no statistically significant correlation between the presence of an abnormal hepatic imaging finding and the severity of liver function test abnormalities. However, the severity of thrombocytopenia did correlate with hepatic imaging findings (p = 0.04). In particular, an abnormal hepatic imaging finding was noted for 10 of 13 patients (77%) with a platelet count of < or = 20 x 10(9)/L (p = 0.012). CONCLUSIONS: Abnormalities in liver function test results do not accurately reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. Patients with HELLP syndrome having complaints of right upper quadrant pain and neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the liver.

Adolescent↗
PubMed1995

Management of bile leaks after laparoscopic cholecystectomy.

The success of laparoscopic cholecystectomy has been tarnished by the increased risk of bile duct damage associated with the operation. Many of these injuries can be managed by endoscopic techniques. Experience of such injuries between 1991 and 1994 was reviewed. Twenty-four patients were referred: 11 with injuries to the cystic duct alone, five with complete hepatic duct obstruction and eight with high bile duct leaks. All patients with leaks from the cystic duct were managed successfully endoscopically (sphincterotomy, four; stent, seven) without recourse to further surgery. Patients with complete obstruction were aided in their recovery by endoscopic and percutaneous techniques, either for postoperative problems (two patients) or in preparation for surgery (three). The eight patients with high bile duct leaks were managed endoscopically by stenting (seven patients) or sphincterotomy (one). Stenting appeared to encourage leaks to heal better than sphincterotomy alone; stents should probably be left in situ for 2 months before removal. There were no deaths and all but one patient had normal biliary function at follow-up. It is suggested that all suspected injuries after biliary surgery require management by a combination of interventional radiology and endoscopic interventional techniques. Surgery may be required only if there is complete obstruction of the biliary tree.

Adult↗
PubMed1995

Monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies.

OBJECTIVE: Our purpose was to compare maternal and perinatal outcomes of teenage and adult pregnancies with mild gestational hypertension remote from term managed with an outpatient program. STUDY DESIGN: A matched cohort design was used. Maternal and perinatal outcomes of 60 teenage pregnancies with mild gestational hypertension remote from term were compared with 120 adult controls 20 to 42 years old. The groups were matched for race, gestational age, and proteinuria status at enrollment. All were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement. RESULTS: The mean gestational age at enrollment was 33.5 +/- 2.6 weeks for both groups (range 27 to 36 weeks). Only 60% of teenagers had a high school degree or equivalent compared with 76% of adults (p = 0.024). The teenagers were more likely than the adults to be of single marital status (75% vs 13%, p = 0.015). The mean gestational age at delivery (37.0 +/- 2.0 vs 37.0 +/- 2.2 weeks), mean pregnancy prolongation (23.5 +/- 19.0 vs 24.5 +/- 17.4 days), and mean birth weights (2915 +/- 669 vs 2879 +/- 678 gm) were not statistically different between the teenagers and adults (all p > 0.05). There were no stillbirths, neonatal deaths, or cases of eclampsia in either group. CONCLUSIONS: In spite of a study population characterized by limited education, single marital status, and young age at enrollment, monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies is associated with maternal and perinatal outcomes similar to those observed in adults.

Adolescent↗
PubMed1994

Acute fatty liver of pregnancy: an experience in the diagnosis and management of fourteen cases.

OBJECTIVE: Our purpose was to investigate the diagnostic problems and maternal-perinatal outcome in cases of acute fatty liver of pregnancy. STUDY DESIGN: Fourteen cases with acute fatty liver of pregnancy managed during the past 8-years were studied with emphasis on presenting symptoms, admitting diagnosis, laboratory findings, clinical course, maternal complications, and neonatal outcome. RESULTS: The mean gestational age at onset was 34.5 weeks (range 28 to 39). Only seven patients had acute fatty liver of pregnancy as a definite or suspected diagnosis on admission. Computed tomography of the liver was performed on 10 patients, with only two positive results. There were no maternal deaths; however, maternal morbidity was frequent: four patients had hepatic encephalopathy, three pulmonary edema, three ascites, four respiratory arrest, two diabetes insipidus, and 10 had transfusion of blood or blood products to correct either disseminated intravascular coagulation or excessive bleeding. Coagulation abnormalities were common: hypofibrinogenemia (< 300 mg/dl) in 13 patients (93%), prolonged prothrombin time in 12 (86%), and prolonged partial thromboplastin time in 11 (79%). The corrected perinatal mortality was 6.6%. CONCLUSION: Acute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclampsia in the presence of hypoglycemia, low fibrinogen, and prolonged prothrombin time, particularly in the absence of severe abruptio placentae. Computed tomography of the liver has a high false-negative rate in patients with acute fatty liver of pregnancy. In spite of the literature's dismal prognosis, our findings indicate that maternal and perinatal outcomes appear favorable in well-managed patients.

Acute Disease↗
PubMed1994

Monitored outpatient management of mild gestational hypertension remote from term.

OBJECTIVE: Our purpose was to test the hypothesis that monitored outpatient management of mild gestational hypertension remote from term reduces maternal hospitalization without adversely affecting maternal and perinatal outcome. STUDY DESIGN: Five hundred ninety-two patients at 24 to 36 weeks' gestation with mild gestational hypertension were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement. Maternal and perinatal outcomes were compared with previously published results from inpatient management of mild gestational hypertension. RESULTS: The mean gestational age at enrollment was 32.5 +/- 3.2 weeks with a mean gestational age at delivery of 36.7 +/- 3.6 weeks. The mean pregnancy prolongation was 27.4 +/- 3.3 days, which is similar to previously reported inpatient studies. The mean antepartum hospitalization for all patients during management was only 1.7 days. Three pregnancies were complicated by abruptio placentae, six by the syndrome of hemolysis, elevated liver enzymes, and low platelet count, and none by eclampsia. The mean birth weight was 2757 +/- 555 gm, with a birth weight of > or = 2000 gm achieved in 84% of managed patients. Eighty-seven percent of infants required a newborn hospitalization of < or = 7 days. Fifty-four percent of patients with significant proteinuria at enrollment were delivered at < 37.0 weeks' gestation, whereas only 29% of patients without proteinuria were delivered prematurely. The corrected perinatal mortality rate was 3.4 in 1000 total births. CONCLUSION: Properly monitored outpatient management of mild gestational hypertension remote from term reduces the number of days of maternal hospitalization with similar maternal and perinatal outcome compared with previously published results from inpatient management.

Abruptio Placentae↗
PubMed1994

Late postpartum eclampsia revisited.

OBJECTIVE: To describe the clinical and neurologic findings in patients with late postpartum eclampsia (convulsions beginning more than 48 hours, but less than 4 weeks, after delivery). METHODS: This study evaluated all patients with the diagnosis of late postpartum eclampsia managed at our institution between August 1977 and July 1992. RESULTS: There were 54 cases of late postpartum eclampsia among a total of 334 cases of eclampsia during the study period. Late postpartum eclampsia constituted 56% of total postpartum eclampsia and 16% of all cases of eclampsia. Convulsions began from postpartum days 3-23 (mean 6). Thirty women (56%) had been identified as preeclamptic before their convulsions. A history of either severe headache or visual disturbances before convulsion was elicited in 83% of the patients. During the study period, eight women not included in the study group had late postpartum seizures attributed to other causes. CONCLUSIONS: Severe headache or visual disturbance frequently antedates late postpartum eclampsia. Only eight of 62 patients with late postpartum seizures had identifiable etiologies other than eclampsia.

Adult↗
PubMed1994

Dietary sodium intake, airway responsiveness, and cellular sodium transport.

Both epidemiologic and experimental evidence suggest that a high dietary sodium intake may increase airway responsiveness, but no adequate explanation exists of how changes in sodium intake might lead to increased responsiveness. This investigation was carried out to study dietary sodium intake and airway response to methacholine in relation to cellular sodium transport in 52 young men. Airway response to methacholine was associated with urinary sodium excretion when subjects were on normal sodium intake. Airway responsiveness in patients with mild asthma correlated with the furosemide-insensitive influx of sodium into peripheral leukocytes stimulated by autologous serum, but there was no relation between this influx and 24-h urinary sodium excretion. In a separate investigation, serum from subjects with increased airway responsiveness caused an increase in the sodium influx and sodium content of leukocytes from nonatopic subjects. The magnitude of the furosemide-insensitive, serum stimulated influx was related to the degree of airway responsiveness of the serum donor, as was the increase in intracellular sodium content. Neither was related to the 24-h urinary sodium excretion of the donor. Patients with airway hyperresponsiveness have an increased sodium influx into cells stimulated by a serum-borne factor. This is independent of the effect of added dietary sodium on airway responsiveness.

Adolescent↗
PubMed1994

Investigation and surgery in irritable bowel syndrome--a cautionary series.

Irritable bowel syndrome is a common problem, and, with a broad symptom complex, likely to present to a wide variety of clinicians. Lack of awareness of these manifestations may lead to inappropriate investigation, and surgery. Six patients with irritable bowel syndrome who had multiple investigations and operations are reported. There was a median of seven years delay in diagnosis, patients seeing a median of six different consultants. Over 13 years of follow-up symptoms were unchanged, but patients had undergone a median of eight (often invasive) investigations, and six operations. Several operations were for complications of, or resulted from, a previous procedure. There were far fewer operations after diagnosis, four over 33 patient-years, than prior to diagnosis, 25 over 43 patient-years (chi-squared = 8.074, 1 df, p < 0.0025). All clinicians should be aware of the diffuse symptomatology of irritable bowel, and its potential to mimic other diseases. Surgery should be avoided.

Adolescent↗
PubMed1993

Urinary endothelin-1: not a useful marker for preeclampsia.

Urinary endothelin-1 levels were assayed from 50 gravidas with preeclampsia and 11 with normotension in the third trimester of pregnancy. Urinary endothelin-1 levels (mean +/- SEM) were similar between gravidas with normotension and preeclampsia (62.7 +/- 7.5 vs 79.8 +/- 9.3 fmol/mg urinary creatinine, respectively). Urinary endothelin-1 excretion is not significantly increased in patients with preeclampsia and therefore not a good marker for preeclampsia.

Endothelins↗
PubMed1993

Mode of ascertainment is critical in assessing safety of percutaneous umbilical blood sampling.

Percutaneous umbilical blood sampling (PUBS) is increasingly utilized for cytogenetic assessment of the fetus. In the present study, outcome of 109 PUBS-derived fetal blood samples were analyzed according to mode of ascertainment: ultrasound-detected anatomic anomalies or intrauterine growth retardation (IUGR). Abnormal chromosome complements were found in 6 of 47 (12.8%) fetuses with anomalies but in only 1 of 62 (1.6%) fetuses with IUGR alone. Perinatal loss in fetuses with anatomic anomalies was 64.4%, compared with only 1.6% in fetuses with IUGR alone. Mode of patient ascertainment is an important factor that must be considered in determining procedure-related risks for PUBS.

Blood Specimen Collection↗
PubMed1993

Selection for oesophagectomy and postoperative outcome in a defined population.

OBJECTIVE: To measure the extent of use of, and perioperative mortality from, oesophagectomy for carcinoma of the oesophagus, and to examine the association between oesophagectomy and long term survival. DESIGN: Retrospective cohort study of cases of oesophageal carcinoma notified to the Thames Cancer Registry. SETTING: South East Thames and South West Thames health regions. PATIENTS: 3273 patients first registered with carcinoma of the oesophagus during 1985-9, 789 of whom were excluded because of incomplete data, leaving 2484 (75.9%) for further analysis. MAIN MEASURES: Treatment of oesophagectomy, mortality within 30 days of oesophagectomy, and duration of survival from date of diagnosis to death, according to patient and tumour characteristics. RESULTS: Oesophagectomy was performed in 571(23.0%) patients. Its use decreased with increasing age (odds ratio (95% confidence interval) 0.935(0.925 to 0.944) per year) and was less common for tumours of the middle or upper third of the oesophagus than the lower third (0.56(0.42 to 0.75)). The proportion of patients undergoing oesophagectomy varied threefold among the 28 districts of residence. The perioperative mortality rate was 15.1(86/571) (12% to 18%); it increased with age (odds ratio 1.05(1.02 to 1.08) per year) and for tumours of the middle or upper third of the oesophagus compared with the lower third (2.52(1.31 to 4.84)). Long term survival was slightly higher for patients undergoing oesophagectomy (0.5% v 0.2%). CONCLUSIONS: Despite a high perioperative mortality rate patients selected for oesophagectomy showed better long term survival than those who were not, suggesting that clinical judgements used in selection were independent markers of a better prognosis. The nature of this selection needs to be more completely characterised to permit a valid evaluation of outcome of oesophagectomy.

Choice Behavior↗
PubMed1992

Successive pregnancies complicated by idiopathic sideroblastic anemia.

Sideroblastic anemias are a diverse group of hypoproliferative anemias characterized by defective iron use within erythropoietic cells and a defect in heme biosynthesis. This report describes the first case of successive pregnancies in a patient with idiopathic sideroblastic anemia. Periodic transfusions with washed erythrocytes and oral pyridoxine resulted in normal maternal and perinatal outcome.

Adult↗
PubMed1992

Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)

OBJECTIVE: Our objective was to categorize the histologic findings in the liver in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of clinical laboratory abnormalities. STUDY DESIGN: Eleven patients with laboratory criteria for HELLP syndrome who required cesarean delivery underwent needle biopsy of the liver under direct visualization. RESULTS: Eight patients had periportal hemorrhage, and six had fibrin deposition. Fatty infiltration was seen in four, one with large-droplet fat, three with microvesicular fat. There was no statistically significant correlation between the severity of the histologic findings of periportal hemorrhage and fibrin deposition and the clinical laboratory findings. Fatty infiltration did not correlate with the severity of the HELLP syndrome's histologic condition, but, in contrast, did correlate with thrombocytopenia and aminotransferase elevations. CONCLUSIONS: Laboratory abnormalities do not accurately reflect the severity of the underlying histopathologic condition in HELLP syndrome. We propose that all patients with HELLP syndrome, regardless of the degree of their laboratory abnormalities, be treated aggressively, primarily with delivery.

Adolescent↗