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Biomedical subjects

M Sharf

Publications and source records attributed to M Sharf.

At least 19 recordsLinked to original sources
PubMed2000

Interruptions to the physician-patient encounter: an intervention program.

BACKGROUND: Israeli physicians are very familiar with the problem of interruptions during encounters with patients. However, a thorough search of the medical literature revealed only one report of this problem from Israel, and none from other countries. OBJECTIVES: To characterize the phenomenon of interruptions to the patient-physician encounter in a clinic in Dimona and to assess the effect of an intervention program designed to reduce the magnitude of this problem. METHODS: During an 8 day work period in March 1997 all patient-physician encounters were recorded and characterized. An intervention program was then designed and implemented to reduce the number of interruptions. Data were again collected a year after the initial data collection. RESULTS: During the 8 day study period prior to the intervention program there were 528 interruptions to 379 encounters (mean of 1.39 per encounter). The main causes of interruptions were entrance of uninvited patients to the examination room (31%) and telephone calls (27%). Most of the interruptions occurred during the morning hours between 8 and 10 a.m. (45%) and at the beginning of the week (Sunday 30%). After the intervention program there were 402 interruptions to 355 encounters (mean of 1.13 per appointment, P = 0.21). CONCLUSIONS: There was no statistically significant improvement in the number of interruptions following the intervention program. This finding is either the result of a local cultural phenomenon, or it indicates a national primary care health system problem that may require a long-term educational program to resolve it. Further research is needed on the magnitude, causes and consequences of interruptions in family practice and, if warranted, methods will have to devised to cope with this serious problem.

Humans↗
PubMed1995

Brain stem auditory evoked potentials: effects of ovarian steroids correlated with increased incidence of Bell's palsy in pregnancy.

To investigate the effect of ovarian steroids on the brain stem during changes of estrogen and progesterone blood levels, we recorded brain stem auditory evoked potentials with increased stimulus rates from 26 women treated for sterility by menotropins (Pergonal and Metrodin). These women were divided into three groups according to their estrogen and progesterone blood levels. The brain stem auditory evoked potential results revealed a significant delay of peak III only, with an increased stimulus rate in the group with the highest estrogen level. Estrogen may cause a brain stem synaptic impairment, presumably because of ischemic changes, and thus also may be responsible for a higher incidence of Bell's palsy during pregnancy.

Adult↗
PubMed1994

Maternal plasma glucose levels and Doppler flow velocity waveforms in cerebral arteries of growth-retarded fetuses.

Doppler flow studies of the intracranial internal carotid artery and middle cerebral artery performed in 17 women at 30-36 weeks of gestation, referred for evaluation of small for gestational age fetuses, resulted in abnormally low pulsatility index values (below 2 SD). These patients were investigated when fasting and 1 h after a 100-gram glucose load. Increase of 20 ml/dl or more was followed by elevation of the mean pulsatility index in the internal carotid artery from 1.03 +/- 0.09 to 1.44 +/- 0.22 (p < 0.001), and in the middle cerebral artery from 1.12 +/- 0.16 to 1.83 +/- 0.24 (p < 0.001). Pulsatility index values returned to normal (within 2 SD for gestational age) in 15 of the subjects investigated after glucose load. These findings suggest the importance of standard fasting state or determination of maternal plasma glucose levels in patients undergoing Doppler flow evaluation of growth-retarded fetuses.

Birth Weight↗
PubMed1992

Neu-Laxova syndrome: prenatal ultrasonographic diagnosis, clinical and pathological studies, and new manifestations.

A diagnosis of the Neu-Laxova syndrome (NLS) was made by ultrasonography at 32 wks of gestation. Ultrasonographic examination showed intrauterine growth retardation (IUGR), Dandy-Walker anomaly, choroid plexus cysts, receding forehead and microcephaly, bilateral cataract without prominent eyes, scalp edema with no generalized edema, retrognathia, curved penis, and flexion deformities of limbs. The findings in this case are consistent with NLS; however, they did not fit any of Curry's [1982] groups. Massive swelling of hands and feet were among the main manifestations in classic NLS cases. In the case presented herein, edema was noted only in the scalp. This might shed further light on the question of variability vs. heterogeneity in the NLS. This case shows the existing possibility of an early diagnosis of NLS and adds Dandy-Walker anomaly and choroid plexus cysts as new findings to this syndrome.

Abnormalities, Multiple↗
PubMed1992

Sonographic indications for karyotyping procedures. An international questionnaire.

An international survey was conducted to investigate attitudes to karyotyping procedures in cases of fetal anomalies detected by ultrasound. A questionnaire was sent to 111 current members of the International Society of Ultrasound in Obstetrics and Gynecology. The overall response rate was 48%. Analysis of the replies reflects a wide variation in the criteria for the definition of a sonographic abnormality, the indication for a diagnostic procedure, and the timing for intervention. The results emphasize the need for additional data on several sonographic findings (e.g. choroid plexus cysts, renal pyelectasis, short limbs) and for improved selection of patients for chromosomal investigation.

Journal Article↗
PubMed1992

Hair chromium content of women with gestational diabetes compared with nondiabetic pregnant women.

Hair chromium concentration (HCC) of normal and diabetic pregnant women was determined by atomic-absorption spectroscopy. For nondiabetic pregnant women the value from 68 hair samples was 472 +/- 61 ng/g (mean +/- 95% CI); for gestational diabetics it was 734 +/- 155 ng/g from 42 hair samples. The difference was highly significant (P less than 0.005). Intermediate hair chromium concentrations were observed in 20 pregnant women with pregestational, overt diabetes mellitus (mean: 575 +/- 182 ng/g). Fifty-two women had a second hair sample taken later during pregnancy that showed a significant decrease in HCC (P less than 0.05). However, this decrease was confirmed only for the diabetic pregnant group. Age and parity did not influence the HCC. The data suggest that impaired utilization of chromium may be a possible etiology for gestational diabetes mellitus.

Adult↗
PubMed1992

Doppler flow velocity waveforms in fetal surveillance of twins: a prospective longitudinal study.

In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty-five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.

Blood Flow Velocity↗
PubMed1992

The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications.

OBJECTIVE: We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 16-20 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. METHODS: The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.5 multiples of the median (MOM). The exclusion criteria were fetal anomalies, an abnormal karyotype, and a maternal serum alpha-fetoprotein (MSAFP) level greater than 2.5 MOM. A group of randomly selected women with normal hCG and MSAFP levels served as controls. RESULTS: Of the 6011 women screened, 284 (4.7%) had an unexplained elevated hCG level. Patients with elevated levels of hCG had a significantly higher risk for hypertension (odds ratio 4.4; 95% confidence interval [CI] 1.9-10) and fetal growth restriction (odds ratio 2.8; 95% CI 1-7). Women with hCG levels greater than 4 MOM also had an increased risk of preterm delivery (odds ratio 3.3; 95% CI 1.3-8.2). CONCLUSION: Pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies and managed accordingly.

Chorionic Gonadotropin↗
PubMed1991

[Fetal echocardiography].

Fetal echocardiography is an ultrasonic technique for the diagnosis of cardiac defects and fetal arrhythmias. During 1981-1990 we examined 1800 women referred for elective examinations from all over the country. Most, at high risk for fetal cardiac anomalies, were examined in the 22nd week of gestation. Others were examined whenever a fetal arrhythmia or a cardiac defect was suspected. In 251 fetuses (13.9%) pathological cardiac conditions were found, and structural heart defects in 51 (2.8%). When a cardiac defect with poor prognosis was diagnosed during the 2nd trimester, termination of pregnancy was suggested. In 35% of these cases termination of pregnancy was accepted. In 12% of the women examined spontaneous intra-uterine fetal death had occurred, while in 52% live babies were born, but half died within 6 months. In 215 fetuses (11.9%) a cardiac arrhythmia was found, which in 73% consisted of supraventricular premature beats. In 15.8% the fetus was endangered by the arrhythmia, mainly supraventricular tachycardia, atrial fibrillation or atrial flutter. Treatment was by drugs administered to the mother. In 1 case of complete A-V block echocardiographic follow-up demonstrated rapid deterioration of heart function. Delivery was induced and a pacemaker was implanted in the newborn.

Arrhythmias, Cardiac↗
PubMed1991

Fetal and uteroplacental flow velocity waveforms and placental grading.

Doppler studies were performed on umbilical, fetal internal carotid, and arcuate arteries within 36 to 40 weeks of gestation in 85 women (66 with healthy pregnancies and 18 complicated by growth retardation, and results were analyzed by calculating the pulsatility index. In each case the placenta was examined and graded sonographically. No significant correlation was found between pulsatility index in fetal and uteroplacental vessels and placental grading in normal pregnancies. This suggests that tissue changes responsible for the echogenicity of maturing placenta are not directly related to vascular impedance of the placental vascular bed.

Adult↗
PubMed1991

Stress-related hormones affect human chorionic gonadotrophin secretion from the early human placenta in vitro.

The effect of a physiological range of concentrations of three stress-related hormones, oxytocin (OT), arginine-vasopressin (AVP) and prolactin (PRL) was tested upon human chorionic gonadotrophin (HCG) secretion by placental explants from early pregnancy in static and superfusion cultures. In static cultures, OT and AVP significantly increased HCG secretion, whereas PRL had no effect. In superfusion, 1-min pulses of OT induced a significant (two- to 10-fold) rise in HCG pulse amplitude compared to the control. This effect of this neuropeptide was blocked by coadministration of a specific receptor antagonist. AVP also increased the glycoprotein pulse amplitude by two- to five-fold, but only with every second pulse administered. PRL pulses caused a progressive inhibition of spontaneous HCG pulsatility. In conclusion, stress-related hormones affect placental HCG secretion in vitro. The involvement of these factors in impairing early pregnancy development is suggested.

Arginine Vasopressin↗
PubMed1991

Flow-velocity profiles of the fetal aorta and umbilical artery in pregnancies complicated by pregnancy-induced hypertension and fetal growth retardation.

Sixty-seven women undergoing ultrasonographic evaluation in the high-risk clinic were randomly recruited to be examined by a newly developed computerized method that presents flow-velocity profiles derived from pulsed Doppler-generated flow-velocity waveforms. Each woman had pulsed Doppler flow velocimetry of the fetal aorta and umbilical arteries done. Subjects were either normal controls (N = 20) or had pregnancies complicated by pregnancy-induced hypertension (N = 29), fetal growth retardation (N = 11), or both (N = 7). Distinct patterns of flow-velocity distribution across the fetal aorta and proximal umbilical arteries were identified in the pregnancies characterized by increased placental resistance. At peak systole, normal velocity was maintained only at a narrow area around the center of the vessel, whereas velocity in the rest of the vessel area was markedly reduced. These changes were present in 40 of 47 subjects (85.1%) with complicated pregnancies, whereas 27 of 47 (57.4%) had umbilical artery systolic-diastolic ratios above the 95th percentile. No significant differences between normal and complicated pregnancies were seen during diastole. Our findings suggest that increased placental resistance results in a redistribution of velocities within fetal blood vessels, often before maximal end-diastolic velocity is decreased.

Adult↗
PubMed1991

Fetal internal carotid artery pulsed Doppler flow velocity waveforms and maternal plasma glucose levels.

Eighteen women at 32-36 weeks' gestation were studied by pulsed Doppler (duplex) for recording blood flow velocity waveforms from the umbilical artery and fetal intracranial internal carotid artery. The pulsatility index was calculated for each artery separately. Each subject was investigated when fasting and 1 hour after a 100-g glucose load. Increases in maternal plasma glucose concentration of 30 mg/dL or more were followed by elevation of the mean pulsatility index in the umbilical artery from 0.9 +/- 0.22 to 1.08 +/- 0.18 (P less than .01) and in the internal carotid artery from 1.17 +/- 0.19 to 1.8 +/- 0.47 (P less than .001). The findings suggest a compensatory increase in cerebrovascular resistance during increases in glucose levels.

Blood Flow Velocity↗
PubMed1990

Early spontaneous rupture of the post myomectomy gravid uterus.

Rupture of a pregnant uterus is a serious threat to the mother's life and her fetus. Most of these cases have predisposing factors of which a post myomectomy scar is rare. Rupture of a post myomectomy gravid uterus usually occurs in the third trimester of pregnancy or during labor. We present a case of a very early spontaneous rupture which occurred at the 20th week of gestation in a post myomectomy uterus. To the best of our knowledge no previous report of a ruptured myomectomy scarred uterus has been described at such an early stage.

Adult↗