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Biomedical subjects

M J Lucas

Publications and source records attributed to M J Lucas.

11 recordsLinked to original sources
PubMed1991

Doppler systolic-diastolic ratios in pregnancies complicated by syphilis.

Maternal infection with syphilis can result in focal areas of vasculitis and, similarly, placental villitis and obliterative arteritis. We hypothesized that Doppler systolic-diastolic ratios (S/Ds) in pregnancies complicated by maternal syphilis infection might reflect an increased resistance to placental perfusion. Doppler velocity waveform analysis was used to study the uterine and umbilical arteries in third-trimester pregnancies complicated by maternal syphilis infection. A control group of similarly studied normal pregnancies was used for comparison. Statistically significant increases were found in the mean S/Ds of both the uterine and umbilical arteries in the syphilis group compared with the normal group, indicating an increased resistance to perfusion of the placenta in pregnancies complicated by syphilis. This difference was even greater in association with the identification of spirochetes in the amniotic fluid by dark-field microscopy, indicating that the S/D results are related to the presence of intrauterine infection. Serial S/Ds in a small subgroup of patients correlated with the clinical courses, including an apparent acute vascular-resistance change associated with treatment, probably due to the Jarisch-Herxheimer reaction. Because of these post-treatment vascular events, the pre-treatment S/D alone may have a limited clinical predictive value for treatment efficacy in congenital syphilis.

Amniotic Fluid↗
PubMed1990

Ticarcillin/clavulanate in the treatment of pelvic infections.

Ticarcillin/clavulanate was used to treat 130 women with pelvic infections. The 129 who completed an initial course of treatment with ticarcillin/clavulanate were analyzed according to type and clinical severity of infection, and pretreatment and posttreatment endometrial bacteriology. There were 26 cases of pelvic inflammatory disease and 103 puerperal infections, 61 of which occurred in women who had delivered by cesarean section (46 elective with no antibiotic prophylaxis at the time of surgery). Of the 129 patients treated, 124 were clinically cured, and one improved (97%). There were four treatment failures, all of which were among a total of 20 cases classified as clinically severe. All the patients designated as treatment failures required prolonged treatment with other antibacterials to achieve a clinical cure, but a longer duration of treatment with ticarcillin/clavulanate might have effected a clinical resolution even in these cases. In vitro examination of endometrial isolates revealed a significant reduction of the minimum inhibitory concentrations (MICs) of beta-lactamase-producing bacteria with the addition of clavulanate to ticarcillin. The relationship of non-beta-lactamase-producing enterococci having relatively high MICs to clinical failure was examined.

Bacteria↗
PubMed1989

Thyrotoxicosis complicating pregnancy.

During the 12-year period from 1974 through 1985, nearly 120,000 women were delivered of infants at Parkland Hospital, and pregnancy was complicated by overt thyrotoxicosis in 60 of them (1:2000). Initial treatment was based on clinical assessment, and propylthiouracil was usually given in doses of 300 to 800 mg daily. In compliant women seen by midpregnancy, euthyroidism was achieved by a mean of 8 weeks; however, the daily dose was decreased to less than or equal to 150 mg by delivery in only 10%. Metabolic status at delivery correlated directly with pregnancy outcome, and women treated earlier in pregnancy were more likely to be euthyroid at delivery and to have good outcomes. Diagnosis of thyrotoxicosis antecedent to pregnancy was associated with earlier treatment, and 80% of 28 such women were euthyroid by delivery. Conversely, 32 women with a first diagnosis during pregnancy had the preponderance of morbidity, including five of six stillbirths and six of seven cases of heart failure. This group was characterized by a relative delay in gestational age at diagnosis. Preterm delivery, perinatal mortality, and maternal heart failure were more common in women who remained thyrotoxic despite treatment and in those who were never treated. Although we infrequently achieved maintenance doses recommended by most, because there were minimal adverse effects from therapy described here and because uncontrolled thyrotoxicosis caused significant maternal and perinatal morbidity, aggressive medical therapy seems appropriate, especially when pregnancy is advanced.

Adult↗
PubMed1989

Early pregnancy glycosylated hemoglobin, severity of diabetes, and fetal malformations.

Total percent glycosylated hemoglobin (A1a + b + c) was measured before 16 weeks' gestation in 105 insulin-treated diabetic women enrolled for prenatal care at Parkland Memorial Hospital. Seventy-three of the infants were normal, 14 had malformations, and there were 18 spontaneous abortions. The mean glycosylated hemoglobin level for the entire study group was 9.2%, compared with 9.4% for those pregnancies ending in abortion, 8.9% for those resulting in normal infants, and 10.3% when malformations occurred. The mean glycosylated hemoglobin value for women delivered of normal infants was significantly lower than the mean of those with malformed infants. Ten of the 14 malformations occurred in mothers whose early pregnancy values exceeded the mean of the entire study group. There was also an association between malformations and White classification of maternal diabetes since 10 of the 14 fetal anomalies occurred in women assigned to White Classes C, D, F, H, and R. When the distribution of malformations was analyzed according to both glycosylated hemoglobin level and White Class, there was evidence of an interaction to suggest that hyperglycemia increases the relative risk of fetal malformations when associated with maternal diabetes of longer duration and or with vascular complications.

Abortion, Spontaneous↗
PubMed1986

Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events?

During a 12-year period, when more than 106,000 women were delivered, 28 women with peripartum heart failure of obscure etiology that initially was diagnosed as peripartum cardiomyopathy were studied. None had obvious underlying cardiac disease or iatrogenic fluid overload, and in all an assiduous search for underlying cardiovascular disease was launched. In 21 of these 28 women, heart failure was attributed to chronic underlying disease (chronic hypertension in 14, forme fruste mitral stenosis in four, and morbid obesity in one) or viral myocarditis. Importantly, these women also had multiple compounding cardiovascular factors--preeclampsia, cesarean section, anemia, and infection--which, when superimposed on those of pregnancy, acted in concert to cause heart failure. In seven women, the cause for cardiomegaly and global hypokinesis was not found, and peripartum cardiomyopathy was diagnosed. Compared with women with explicable causes of peripartum heart failure, these women did poorly: six had persistent cardiomegaly and heart failure, and four of these died within four months to eight years. From these observations, the authors conclude that idiopathic peripartum cardiomyopathy is uncommon, and that in most women with peripartum heart failure of obscure etiology, underlying chronic disease will be identified. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are amplified further by common pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy.

Adult↗
PubMed1977

Asylums revisited.

The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.

Activities of Daily Living↗
PubMed1976

Brief treatment of sexual problems.

Brief, behaviorally oriented treatment of sexual dysfunction is gaining increasing acceptance in medicine and psychiatry. However, relatively few clinics have published their treatment results. During a 2 1/2-year period, 36 couples with diagnoses of sexual dysfunction were treated with a modified Masters and Johnson protocol. The initial success rate was 83%, but the degree of improvement reported by the couples varied from marked to equivocal. Eighty-nine percent of the male partners and 83% of the female partners manifested psychologic signs or symptoms that either warranted a psychiatric diagnosis or were noted as significant traits or symptoms. With an average of 7.9 months of follow-up, the failure rate increased from 17% to 38%. This increase was attributed in part to the degree of combined psychosexual disorder identified in the patients. The etiologic relationships between psychiatric conditions and sexual dysfunctions are not fully understood and will require further study.

Adult↗
PubMed1975

Short-term treatment of Sexual problems: interim report.

Of 52 couples requesting treatment for sexual disorders, 16 were treated in accordance with the protocol of Masters and Johnson except that most were seen once a week for 10 or more weeks rather than daily for a briefer period. The treatment results were less successful than those obtained by Masters and Johnson. The authors believe that the successes of this approach nonetheless suggest a need to reevaluate the degree to which sexual problems may be conditioned responses. They also stress the need for specifying the degree of improvement among nonfailures for purposes of comparison and follow-up.

Adult↗
PubMed1975

Impotence.

The first and most important assistance the physician can give to the patient who complains of impotence is to take him seriously. In most cases organic causes can be ruled out. Primary or total psychogenic impotence is also a rarity, and most cases are secondary and amenable to appropriate therapy.

Erectile Dysfunction↗