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J S Platt

Publications and source records attributed to J S Platt.

10 recordsLinked to original sources
PubMed2001

Delayed interval delivery military style.

INTRODUCTION: Intentionally delaying the delivery of a second twin from a previable state to a gestational age when survival is possible is a heroic measure whose outcome is unpredictable. We report the case of delayed interval delivery in a patient transported via air evacuation to a tertiary care center. CASE REPORT: A 31-year-old gravida 3 para 0020 at 18 weeks with a twin gestation presented to a medical treatment facility for evaluation of uterine cramps. She subsequently delivered Twin A. With cessation of labor, the patient was air evacuated to a medical center for continued care. Seven weeks later, she delivered a viable male infant. DISCUSSION: The treatment of multiple gestations presenting with preterm labor or rupture of membranes remains expectant. When delayed delivery of a previable second twin is undertaken, appropriate care includes the use of antibiotics, tocolytics, and cervical cerclage. Anticipation of preterm birth warrants continued care in a tertiary care center offering neonatal intensive care.

Adult↗
PubMed1999

Primary angiosarcoma of the ovary: a case report and review of the literature.

INTRODUCTION: Gynecological sarcomas are rare and have a poor prognosis. Uterine sarcomas are most common accounting for 4% of all uterine tumors. Ovarian sarcomas are less frequent and are usually carcinosarcomas. CASE REPORT: A previously healthy 40-year-old G2P2 presented for evaluation of 72 h of right upper quadrant pain and shortness of breath. A malignant right pleural effusion, ascites, and adnexal mass were found. Surgical staging and suboptimal debulking revealed pure angiosarcoma of the ovary Stage IV. DISCUSSION: There are 12 cases of ovarian angiosarcoma reported in the literature. Ten of these cases presented in advanced stages with survivals of 2-30 months. Various chemotherapy regimens have been tried on these tumors including the most recent recommendation of MAID (mesna, doxorubicin, ifosfamide, and dacarbazine) and prognosis remains poor. Our patient underwent elective right pleurodesis via video-assisted thorascopic surgery under local anesthesia for an early recurrent right pleural effusion and subsequently began MAID chemotherapy.

Adult↗
PubMed1999

Delayed interval delivery in multiple gestations.

The incidence of higher-order gestations is increasing primarily as a result of menstrual cycle manipulation, with concomitant increased risk in maternal and fetal complications. Perinatal mortality rates range between 47 and 120 per 1000 births for twins and 93 to 203 per 1000 births for triplets. The critical period of perinatal mortality and morbidity is between weeks 23 and 28 of gestation. Attention has recently turned to methods of delaying the birth of second and higher order fetuses to improve newborn survival and decrease neonatal morbidity in these high-risk pregnancies. We report two cases of delayed interval delivery. Neither pregnancy involved a monochorionic/monoamniotic gestation. The first case was a twin gestation delivered at 21 weeks with an interval of 5 days and extreme prematurity of both twins. The second case was a triplet gestation delivered at 21 weeks with an interval of 5 days. Triplet A was stillborn; triplets B and C succumbed in extreme prematurity. Preterm labor in multiple gestations usually results in delivery of all fetuses. On occasion, the uterus will spontaneously cease to contract after the birth of one or more premature infants. Review of the literature now reports 48 twin pregnancies exposed to delayed interval delivery with 40 surviving infants of 96 fetuses. Whereas delaying the delivery of remaining fetuses improves their prognosis, there is currently no consensus regarding technique nor is there statistical significance in techniques currently used. Furthermore, study is indicated to reduce preterm birth and associated costs.

Adult↗
PubMed1998

Interferon-gamma gene expression in cycling and pregnant mouse uterus: temporal aspects and cellular localization.

Interferon-gamma (IFN-gamma) is a potent pro-inflammatory cytokine that modulates hematopoietic cell maturation, differentiation, activation, and apoptosis. To evaluate the postulate that locally produced IFN-gamma could influence uterine hematopoietic cells, specific protein was detected by immunohistochemistry and messenger RNA (mRNA) was identified by in situ hybridization in cycling and pregnant mouse uteri. In cycling uteri, IFN-gamma was limited to luminal and glandular epithelial cells during the estrus phase of the cycle. In pregnant uteri, IFN-gamma was prominent at early (gestation day 6-10) and late (gestation day 18) stages. IFN-gamma-producing cells identified by in situ hybridization included uterine epithelial cells, natural killer cells, macrophages, placental trophoblast cells, and cells in the degenerating metrial gland. Collectively, the data indicate that programming of immune and other cells via autocrine and paracrine pathways could be achieved by locally produced IFN-gamma, and suggest that uteroplacental IFN-gamma may be most influential during early and late stages of pregnancy.

Animals↗
PubMed1998

Hormonal regulation of uterine macrophages.

Macrophages are major cellular inhabitants of cycling and pregnant mammalian uteri. Their densities and patterns of tissue distribution in this organ fluctuate in concert with levels of circulating female sex steroid hormones, estrogens and progesterone, and their production of various effector molecules also may be hormonally regulated. Hormonal control may be achieved by direct binding to receptors or by indirect pathways where hormones modulate production of various autocrine and paracrine cytokines and growth factors that then target to resident macrophages and influence their secretory profiles. In this paper, we marshall evidence supporting the concept that progesterone acts as a powerful negative regulator of these versatile cells, reducing their migration into the uterus and impairing their ability to produce potent effector molecules such as nitric oxide that could interfere with the success of pregnancy.

Animals↗
PubMed1997

Female steroid hormones regulate production of pro-inflammatory molecules in uterine leukocytes.

Estrogens and progesterone could be among the environmental signals that govern uterine immune cell synthesis of pro-inflammatory substances. In order to investigate this possibility, we first mapped expression of the inducible nitric oxide synthase (iNOS) and tumor necrosis factor-alpha (TNF-alpha) genes in the leukocytes of cycling and pregnant mouse uteri, then tested the ability of estradiol-17 beta (E2) and progesterone to influence gene expression. Immunohistochemistry, in situ hybridization, and other experimental approaches, revealed that the iNOS and TNF-alpha genes are expressed in mouse uterine mast cells, macrophages and natural killer cells (uNK). Gene expression in each cell type was noted to be dependent upon stage of the cycle or stage of gestation, implying potential relationships with levels of female hormones and state of cell differentiation or activation. Further in vivo and in vitro experiments showed that individual hormones have cell type-specific effects on synthesis of iNOS and TNF-alpha that are exerted at the level of transcription. In uterine mast cells, iNOS and TNF-alpha are promoted by E2 whereas preliminary studies in macrophages suggest that transcription and translation of the two genes are unaffected by E2 but are inhibited by progesterone. Uterine NK cell production of iNOS and TNF-alpha is strongly related to cell differentiation, which is initiated and sustained by progesterone. Collectively, the results indicate that regulation of synthesis of pro-inflammatory molecules by hematopoietic cells in cycling and pregnant uterus comprises a new and potentially critical role for female steroid hormones.

Animals↗
PubMed1996

Missed diagnoses among elderly patients discharged from an accident and emergency department.

OBJECTIVE: To investigate how often elderly patients are discharged from an accident and emergency (A&E) department with unrecognized but remediable problems. METHODS: Over a period of six months, 174 elderly patients fulfilling inclusion criteria for the study were discharged from A&E, and of these 97 (56%) agreed to be reviewed in the day hospital. They were assessed by a doctor, nurse, physiotherapist, occupational therapist, speech therapist, and social worker. A full blood count, urea and electrolytes, liver and thyroid function tests, a chest radiograph, and an electrocardiogram were performed. A Barthel activity of daily living index was performed on the first visit and before discharge. RESULTS: 28% had missed diagnoses which benefited from day hospital attendance and a further 13 patients had been admitted before they could attend day hospital. Those patients presenting with falls and living alone constituted a high risk group. CONCLUSIONS: Elderly patients attending A&E merit special consideration to detect underlying medical or social problems.

Aged↗
PubMed1992

Alcohol and acute medical admission of elderly people.

In a prospective study of 539 consecutive elderly medical admissions (mean age 77.3 years; 275 men), 42 patients (7.8%; 36 men) were identified as alcohol abusers, 41 by an alcohol intake history and one by a positive response to the CAGE questionnaire; none was identified by laboratory screening (gamma glutamyltransferase and red cell mean corpuscular volume) alone. Thirteen admissions (2%) were alcohol-related. In alcohol abusers, 24% of admissions (n = 10; p less than 0.001) were alcohol-related. Alcohol abusers were predominantly men (86%; p less than 0.001) and independently mobile (88%; p less than 0.001), suggesting greater physical fitness. In these more active men (n = 167), the prevalence of alcohol abuse was 19.8% and 6% of admissions were alcohol-related. While the sensitivities of the CAGE questionnaire and laboratory screening were too low to be clinically useful, an alcohol intake history may allow for a significant opportunity in preventive medicine in this age group, particularly in the fitter men.

Aged↗