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Biomedical subjects

R H Schwarz

Publications and source records attributed to R H Schwarz.

At least 19 recordsLinked to original sources
PubMed1992

The physician and the social contract.

Expenditures for health care are growing at a staggering rate, yet over 30 million Americans lack access to care. A growing population with needs, increasing administrative costs, expanding biomedical technology, and the ever-increasing expectations of patients are among the explanations for this cost. To resolve the problem, we must establish priorities, evaluate technology more carefully before application, reassess our fees as they relate to effort, and evaluate what we do for our patients as it relates to society generally. Many of the problems in health care are societal problems, but physicians as a particularly responsible and knowledgeable part of society must take the lead in finding and implementing the solutions.

Health Care Costs↗
PubMed1986

Relation of private or clinic care to the cesarean birth rate.

The rising rate of cesarean births in the United States has been the focus of academic attention as well as attention from the media during the past decade. Although there is a consensus about the indications for cesarean delivery that have led to the increased rate (dystocia, malpresentation, fetal distress, and previous cesarean delivery), the influence of other key factors, such as whether the patient received care from a private physician or through a hospital clinic, has not been established. In a review of 65,647 deliveries in four Brooklyn hospitals between 1977 and 1982, we found that private physicians performed significantly more cesarean sections than house officers and attending physicians. Private patients giving birth to their first child were significantly more likely than clinic patients to undergo cesarean delivery if dystocia, malpresentation, or fetal distress was diagnosed, and private patients with one or more previous deliveries were significantly more likely to undergo cesarean delivery if dystocia or malpresentation was diagnosed. Private patients had fewer perinatal deaths, which were concentrated among infants with birth weights under 2000 g, but the infants of private patients had a significantly higher rate of low Apgar scores and birth injuries than the infants of clinic patients.

Adult↗
PubMed1986

Pneumococcal polysaccharide antibody levels in patients with term and preterm pregnancies.

Serum antibody levels against 12 serotypes of pneumococcal polysaccharide were assessed in pregnant women as well as in cord bloods of their infants. Twelve women were evaluated during the first trimester, second trimester, and in labor at term, and eight women were assessed in the first trimester and in preterm labor. Antibody levels significantly decreased from the first trimester to delivery both in patients with term (339 versus 281 ng AbN/mL; P less than .001), and preterm (448 versus 299 ng AbN/mL; P less than .001) deliveries. There was no significant difference in mean antibody levels or their rate of decline between term and preterm pregnancies.

Adult↗
PubMed1985

Relationship of vaginitis to the sex of conceptuses.

The relative viability of X-bearing and Y-bearing spermatozoa is influenced by factors in the vagina such as pH. The vaginal environment, in turn, is influenced by its flora. This study examined the relationship of the vaginal flora to the sex of conceptuses. It was found that women who carried Trichomonas vaginalis or Bacteroides sp or who had nonspecific vaginitis at first prenatal visit were significantly more likely to deliver females than women who carried none of these organisms (54 versus 37%, P less than .02).

Bacteriological Techniques↗
PubMed1978

An evaluation of cytogenetic analysis as a primary tool in the assessment of recurrent pregnancy wastage.

Cytogenetic evaluation of couples with recurrent pregnancy wastage is frequently performed only after other possible etiologic factors have been excluded. Previous reports of studies using conventional and G-banding chromosome techniques in these couples have shown a higher frequency of translocations than that found in the general population. In the study reported here, both conventional and G-banded chromosome analyses were performed as a primary method of evaluation in 34 couples with recurrent fetal loss not ascertained by the birth of a child with a diagnosed chromosome disorder. Balanced translocations were found in 5 partners of the 34 couples studied. In only 2 of these cases was the translocation detected by conventional chromosome analysis. These results suggest that G-banded chromosome analysis should be a useful tool in the initial evaluation of couples with recurrent fetal wastage, rather than being recommended only after extensive investigation of other factors is unrewarding. The reproductive counseling of couples with a translocation detected on this basis is discussed.

Abortion, Habitual↗
PubMed1977

Amniography for the early detection of neural tube defects.

Among the methods available for the midtrimester diagnosis of neural tube defects, it has been suggested that amniography be used to determine the presence of meningomyelocele. Twelve studies are reported in which the procedure was utilized. In 3 cases, a neural tube defect was present but was not detected by this method. The experience reported here challenges the value of this procedure and suggests that it should be evaluated further by utilizing it in cases where a positive diagnosis has been made by other methods and pregnancy termination is to be performed.

Adolescent↗
PubMed1976

Management of postoperative infections in obstetrics and gynecology.

A discussion of postoperative infections in obstetrics and gynecology has been presented with particular emphasis on soft tissue infections involving the operative site. It has been emphasized that the offending organisms are those normally found in the vagina and cervix and that mixed infections are common. The immediate life threats to the patient are endotoxin shock and clostridial sepsis; therefore, initial therapy should include coverage for those organisms. Because of the potential toxicity of clindamycin and chloramphenicol, as well as the usual protracted course of Bacteroides infections, the addition of one of these drugs can generally be deferred until its use is dictated by microbiologic data or a failure of clinical response. Persistent fever generally indicates a lack of the appropriate antibiotic, an undrained collection of pus, or concomitant pelvic thrombophlebitis, the latter being a special concern with anaerobic infections. Specific infections and their management have also been discussed as have urinary tract and pulmonary infections and drug fever.

Abscess↗
PubMed1976

Life-threatening infections in pregnancy.

Infection remains a major cause of maternal morbidity and mortality. Those entities that are most likely to threaten the life of the pregnant woman have been reviewed. Although intrapartum and postpartum pelvic infections consitute the majority such serious infections in pregnancy, attention has also been called to several less frequent but potentially lethal nonpelvic infections.

Endometritis↗
PubMed1976

Ultrasound assisted amniocentesis in prenatal genetic counseling.

Pre-amniocentesis ultrasonic placental localization and fetal age determination have greatly facilitated genetic counseling by helping to reduce the morbidity of the procedure and by providing an accurate gestational age. The indications for amniocentesis, a technique to indicate the best site for the procedure, and results in 33 patients are discussed.

Adult↗