Biomedical subjects
Publications and source records attributed to L C Schussman.
Hemorrhoids are a common medical problem that usually can be managed conservatively with dietary changes, stool softeners, and local hydrocortisone creams. Acutely thrombosed external hemorrhoids require excision of the entire hemorrhoidal mass and the overlying skin. Persistently bleeding or painful internal hemorrhoids are best managed by the technique of band ligation.
Neonatal polycythemia occurs in 2 to 12 percent of all newborn infants. It may be the result of placental transfusion but may also be associated with placental insufficiency, congenital abnormalities and endocrine or metabolic disorders. Polycythemia of the newborn requires treatment because the associated blood hyperviscosity may lead to permanent neurologic impairment. Central hematocrits over 65 percent necessitate reduction transfusion using an umbilical venous or arterial catheter.
Diagnostic x-ray studies during any stage of gestation have been shown to increase the risk of childhood cancer in the irradiated fetus. This study reviews those risks and examines the uses of pregnant abdomen and x-ray pelvimetry studies. The abdominal films appear to have provided useful and necessary information in the management of labors and deliveries; however, the x-ray pelvimetry results appear to have provided much less usable information. The predictive values of both positive and negative x-ray pelvimetry studies were low, .57 and .66, respectively. The predictive values were low for both vertex and breech presentations. The definite hazards of prenatal diagnostic radiation studies should be carefully weighed against their possible benefits.
The use of epidural anesthesia in obstetrics has increased markedly in the last decade, and some authorities are now stating that epidural block may be the anesthetic method of choice for most women. In spite of this growth in popularity, no studies have been reported that deal with the outcomes of epidural anesthesia in low-risk obstetrical patients, that group of women for whom family physicians are most likely to provide care. A retrospective cohort study of factors associated with epidural anesthesia in a low-risk obstetrical population was performed. Epidural anesthesia was administered by obstetrical anesthesiologists, and patients were monitored by nurses experienced with epidural anesthesia. Although retrospective studies cannot establish cause-and-effect relationships, it was found, when compared with deliveries without epidural anesthesia, that epidural anesthesia deliveries were associated with changes in several parameters of labor and delivery. Although epidural anesthesia was observed to be a very safe procedure, three of the variables (higher use of low forceps, increased use of oxytocin, and greater total costs) may be of some clinical importance and should be considered by both the delivering physician and the patients when choosing obstetrical anesthesia.
Aspiration of meconium by the fetus at or near delivery may be associated with high infant morbidity and mortality. The meconium aspiration syndrome (MAS) is often preventable, yet cases of MAS continue to occur. This paper describes the pathophysiology of MAS. The development of MAS involves passage of meconium by a compromised fetus and the subsequent aspiration of that meconium. Respiratory tract obstruction, hypoxia, hypercapnia, and acidosis may all result. Treatment of MAS is primarily supportive, and high mortality rates have been reported with the more severe cases. There is good evidence that careful suctioning of the infant's upper respiratory tract can in most cases prevent MAS. The suctioning, performed while the infant's head is still on the mother's perineum and prior to the first inspirations, is both a safe and effective preventive procedure.