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Biomedical subjects

M Phillippe

Publications and source records attributed to M Phillippe.

At least 37 records · Page 2Linked to original sources
PubMed1986

Pregnancy following renal transplantation in class T diabetes mellitus.

Nine cases of pregnancy complicated by diabetes and prior renal transplantation are reviewed. Maternal and fetal death occurred in a patient with foot and leg ulcers associated with preexisting peripheral vascular disease. Pregnancy-induced hypertension occurred in six cases. Spontaneous weight-bearing fractures occurred in two patients. No episodes of renal allograft rejection occurred. Evidence of fetal compromise was present in six cases. All fetuses were delivered by cesarean section prior to term, with live births occurring from 31 1/2 to 36 weeks' gestation. A single case of hypospadias was the only congenital defect. Prepregnancy screening for complications of diabetes and renal transplantation is advised and euglycemia should be achieved before and during pregnancy. Advanced diabetic vascular disease puts these gestations at significant risk.

Adult↗
PubMed1986

Acute thrombosis of a composite ascending aortic conduit containing a Bjork-Shiley valve during pregnancy: successful emergency cesarean section and operative repair.

A 31-year-old female had an ascending aortic conduit with a Bjork-Shiley valve placed for an aortic dissection. A year later she became pregnant and was placed on heparin instead of coumadin therapy. She then developed a distal aortic dissection and was hospitalized for close medical monitoring of fetal status and maturity. At 33 weeks of gestation the aortic valve thrombosed, resulting in pulmonary edema and cardiac arrest. Emergency cesarean section and replacement of the aortic valve and ascending aortic conduit was successful in salvaging mother and child. Both are well at 2 years followup. The case illustrates the hazards of prosthetic valves in pregnant patients and cardiac surgery during pregnancy. These issues are reviewed along with the details leading to successful surgical management.

Adult↗
PubMed1985

3H-dopamine clearance from the intravascular compartment of the maternal and fetal rhesus monkey.

The clearance of epinephrine and norepinephrine from the intravascular compartment has previously been demonstrated in both pregnant and nonpregnant models. With the use of the pregnant rhesus monkey, this study describes the clearance of dopamine from the fetal and maternal intravascular compartments. In both, the dopamine clearance was biphasic with an initial half-life of 1.5 minutes in fetal blood and 1.0 minute in maternal blood. These studies also confirmed that dopamine does not significantly cross the placenta in an intact form. These observations are consistent with those made for the other two major catecholamines.

Animals↗
PubMed1985

Clearance of 3H-dopamine from the amniotic fluid in the rhesus monkey.

Previous studies have suggested that dopamine is the major catecholamine in the amniotic fluid; however, there are few data available concerning the metabolism of this hormone in the amniotic fluid compartment. With the use of acute 3H-dopamine injection studies into the amniotic sac of pregnant rhesus monkeys, the dopamine half-life was observed to be 29 minutes, the amniotic fluid volume was 113 ml, the metabolic clearance rate was 164 ml/hr, and the calculated production rate was 436 ng/hr. The biphasic pattern of dopamine clearance from this compartment suggests that it is cleared from the amniotic sac by mechanisms similar to those used in the intravascular compartment.

Amniotic Fluid↗
PubMed1985

Elevated beta-human chorionic gonadotropin and testosterone in cord serum of male infants of diabetic mothers.

Leydig cell hyperplasia is a common histological finding in male infants of diabetic mothers. The functional correlates of this histological finding were investigated by measuring beta hCG, testosterone, androstenedione, dihydrotestosterone, and progesterone in mixed cord serum of male and female infants of diabetic mothers (n = 40) and normal mothers (n = 40) at term. Male and female infants of diabetic mothers had significantly higher cord serum beta hCG levels than male and female controls. Male infants of diabetic mothers had significantly higher cord serum testosterone concentrations than male controls, female controls, and female infants of diabetic mothers. Cord serum testosterone concentrations were similar in female infants of diabetic mothers and female controls. In the male infants of diabetic mothers, there was a significant positive correlation between beta hCG and testosterone (r = 0.64; P less than 0.01). There was no significant correlation between beta hCG and testosterone in the male controls (r = -0.15; P = NS). There was no significant difference in cord serum dihydrotestosterone in any group tested. Cord serum progesterone was significantly higher in the males than in the females. Cord serum androstenedione was lower in the infants of diabetic mothers than in the controls. This study suggests that the Leydig cell hyperplasia found in male infants of diabetic mothers is due, in part, to elevated concentrations of hCG and is accompanied by elevated testosterone concentrations in the fetal compartment.

Androstenedione↗
PubMed1985

Pregnancy complicated by homozygous hypercholesterolemia.

The course of pregnancy in a woman with homozygous type IIa hypercholesterolemia is described. Despite prepartum cholesterol levels as high as 700 mg/dL, her cholesterol level increased further during gestation. Pathological examination of the placenta did not reveal insufficiency or vasculopathy.

Adult↗
PubMed1985

Continuous subcutaneous insulin therapy during early pregnancy.

Intensive metabolic control of diabetes is probably important during formation of the embryo early in pregnancy. The purpose of this study was to determine the efficacy and complications of continuous subcutaneous insulin infusion therapy during the fifth to the tenth week of gestation. Twenty-four insulin-dependent subjects were trained to use blood glucose self-monitoring and the Auto Syringe portable insulin infusion pump (AS6C). Regular insulin was administered as a basal infusion of 18 +/- 8 U/24 hours (+/- SD) (12.2 +/- 3.9 mU . kg-1 . h-1) and as bolus injections of 6 +/- 3 U before meals and 1.2 +/- 1 U before snacks. Reasonable control of fasting (119 +/- 30 mg/dL) and postprandial (133 +/- 34 mg/dL) hyperglycemia was achieved, accompanied by an average of 2.2 +/- 1.5 symptomatic hypoglycemic episodes per week. The frequency of complications with this new therapy declined as the authors gained experience in teaching the system. The persistence of good diabetic control in many of the subjects after they returned to conventional insulin therapy points to the need for a controlled trial of continuous subcutaneous insulin infusion therapy versus intensive conventional therapy in pregnancy.

Blood Glucose↗
PubMed1985

Use of the subcutaneous heparin pump during pregnancy.

Six patients requiring anticoagulation during pregnancy were managed with a continuous-infusion subcutaneous heparin pump. There were no cases of recurrent thrombosis; however, five of the six patients had major or minor bleeding complications despite therapeutic partial thromboplastin time levels.

Adolescent↗
PubMed1984

Recurrent inversion of the puerperal uterus managed with 15(s)-15-methyl prostaglandin F2 alpha and uterine packing.

The present report describes an unusual case of recurrent puerperal uterine inversion causing major postpartum hemorrhage. Blood replacement, oxytocin, and ergot therapy along with manual reduction failed to prevent immediate recurrence, but treatment with 15(S)-15-methyl prostaglandin F2 alpha (Prostin 15M) and uterine packing were successful. It is recommended that 15(S)-15-methyl prostaglandin F2 alpha be available in all obstetric suites for the management of similar emergencies.

Adult↗
PubMed1983

Fetal catecholamines.

Experimental data from fetal human and animal research suggest that the fetal sympathoadrenal system, composed of the adrenal medulla, sympathetic neurons, and extra-adrenal chromaffin tissue functions from early fetal life to maintain fetal homeostasis. The extra-adrenal chromaffin tissue undergoes maturation at 9 to 11 weeks of gestation, whereas the adrenal medulla and sympathetic nervous system mature later in fetal life. The fetal catecholamine response to hypoxia, mediated predominantly by norepinephrine, is an important component of the fetal cardiovascular response to hypoxia, i.e., through alpha-receptor stimulation, fetal cardiac output redistribution occurs. Fetal catecholamine secretion in response to substrate availability, through alpha- and beta-receptor stimulation, provide a mechanism by which the fetus can utilize its own substrate stores. Pulmonary beta-receptor stimulation by catecholamines has been demonstrated to increase lecithin synthesis, increase surfactant secretion, and decrease lung fluid production near term. beta-Receptor stimulation has also been demonstrated to have trophic effects on the development of thermogenic brown adipose tissue. Although the exact stimulus for the initiation of parturition in the primate is unknown, fetal catecholamines, through direct myometrial alpha-adrenergic or dopaminergic receptor stimulation and/or through the stimulation of prostaglandin production, have the potential of facilitating the onset of parturition.

Adrenal Glands↗
PubMed1982

Metabolism of 3H-dopamine by human chorioamnion in vitro.

Previous investigation has demonstrated biologically significant concentrations of catecholamines in amniotic fluid, which increase with gestation. The half life, metabolic clearance rate, and metabolic fate of these hormones in the amniotic compartment are yet to be established. This study was undertaken to demonstrate the ability of human chorioamnion to metabolize dopamine in vitro. Incubation experiments demonstrated that 3H-dopamine is rapidly metabolized to dihydroxyphenylacetic acid, 3-methoxy, 4-hydroxyphenylacetic acid, and 3-methoxy, 4-hydroxyphenylethanol-all products of monoamine oxidase. No significant 3-methoxytyramine, a catechol-o-methyltransferase product, was observed. Incubation experiments with pargyline, a monoamine oxidase inhibitor, resulted in significant reduction in 3H-dopamine metabolism. Catecholamines and their interaction with prostaglandin synthesis have been theorized to be a fetal signal for the initiation of parturition. The ability of chorioamnion to metabolize catecholamine could, therefore, provide another control mechanism by which fetal catecholamines are modulated.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1982

Randomized clinical trial of perioperative cefoxitin in preventing maternal infection after primary cesarean section.

To determine the efficacy of perioperative cefoxitin in preventing infections after primary cesarean section, a randomized placebo-controlled, double-blind clinical trial was performed. Among 266 participants, those who received three perioperative 2 gm doses of cefoxitin (138) had significantly fewer serious infections (19.5% vs. 4.3%), fewer urinary tract infections (10.7% vs. 4.4%), less standard febrile morbidity (9.4% vs. 3.6%), and fewer courses of antibiotics postoperatively (23.4% vs. 11.6%). There was no reduction in the length of hospitalization. Use of perioperative cefoxitin umbilical cord is clamped are safe and efficacious in preventing infection after primary cesarean section.

Cefoxitin↗
PubMed1982

High risk antenatal hospitalization.

High risk, antenatal units have been established to provide highly sophisticated obstetric care for women with complications of pregnancy. In an effort to more precisely define the patients requiring this care, and to begin to document the benefits of antenatal hospitalization, a 2-year prospective evaluation of the Antenatal Unit (AU) at the Brigham and Women's Hospital was performed. Between July 1, 1978 and June 30, 1980, 1488 consecutive patients were admitted to the AU. Demographic data, antenatal hospitalization time, hospitalization outcome, and delivery data were determined for these patients. Diabetes mellitus, premature labor, hypertensive disorders, premature rupture of the membranes, and late pregnancy bleeding disorders resulted in over 60% of the admissions. Follow-up data demonstrated that among these 1488 patients admitted to the AU, there occurred 32 stillbirths (21.5/1000), 50 neonatal deaths (33.6/1000), and no maternal deaths. This study demonstrated that a broad spectrum of medical, surgical, and obstetric complications necessitate antenatal hospitalization, resulting in an overall perinatal survival rate of 95%.

Boston↗
PubMed1982

Delivery of the second twin.

A retrospective chart review of all twin deliveries between April 1, 1977, and March 20, 1980, at the Boston City Hospital and the Brigham and Women's Hospital revealed corrected neonatal mortality rates of 0 for 74 twins in nonvertex presentation delivered by cesarean section and 0 for 76 second-born twins extracted vaginally. Breech extraction of 76 second-born twins weighing more than 1499 g at birth was not associated with a statistically significant increase in the incidence of 5-minute Apgar scores of 7 or less when compared to 74 similarly asymptomatic twins in nonvertex presentation delivered by cesarean section. Vaginal delivery may be considered when the second twin, weighing more than 1500 to 2000 g, is in breech presentation.

Apgar Score↗
PubMed1982

The effects of vaginal contamination on two pulmonary phospholipid assays.

During the examination to confirm premature rupture of membranes, amniotic fluid unavoidably contaminated with cervical mucus and other vaginal debris can often be obtained from the posterior fornix. This study was undertaken to determine the validity of phospholipid measurements on contaminated amniotic fluid. Fifteen paired amniocentesis and vaginally contaminated samples of amniotic fluid were used to measure the lecithin/sphingomyelin ratio and saturated phosphatidylcholine (SPC). The amniocentesis specimens had a mean L/S ratio of 3.94 +/- 0.22 (mean +/- SEM), and contaminated samples had a mean L/S ratio of 3.82 +/- 0.29 (mean +/- SEM). Paired t-test was unable to demonstrate a significant difference (p greater than 0.10), and the correlation coefficient between paired L/S samples was r = 0.79. SPC measurements on the amniocentesis fluid had a mean value of 1,243 microgram/DL +/- 217 (mean +/- SEM) as compared to the contaminated-specimen mean of 1.375 micrograms/dl 223 (mean +/- SEM). Paired t-test likewise was unable to demonstrate a significant difference (p greater than 0.10), and the correlation coefficient between paired SPC samples was r = 0.93. Within the design of this study, we were unable to demonstrate a statistically significant effect of brief vaginal contamination on the measurement of the L/S ratio or SPC.

Amniocentesis↗