Alternative medicine--the case of herbal remedies.
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Complementary Therapies↗
Biomedical subjects
R R Weiss
Publications and source records attributed to R R Weiss.
Contact urticaria from xylene.
Xylene is widely used in medical technology, but there are many concerns about its safety. A 52-year-old woman, employed as a histotechnician, presented with burning, swollen hands. Patch testing and a visit to her place of work confirmed exposure and sensitivity, in the form of contact urticaria, to xylene. The use of xylene-resistant gloves resulted in clearing of the dermatitis. Establishing the diagnosis of contact urticaria from xylene allowed the patient to be cured of her dermatitis and continue working.
Dermatitis, Allergic Contact↗
Allergic contact dermatitis from aromatherapy.
Allergic contact dermatitis secondary to aromatherapy has been only rarely reported. We present 39-year-old woman who had used aromatherapy products for approximately 2 to 3 years who presented with an erythematous eruption on her face and chest. Patch testing showed a positive reaction to neomycin and fragrance mix. On cessation of her aromatherapy products, her eruption rapidly resolved. Aromatherapy products containing essential oils may need to be considered as a cause of allergic contact dermatitis because of the increasing popularity of this treatment.
Adult↗
The advantages of using triple-marker screening for chromosomal abnormalities.
OBJECTIVE: Our purpose was to assess the utility of triple-marker serum screening for chromosomal abnormalities. STUDY DESIGN: Our laboratory received 10,605 samples that were between 15 and 22 weeks' gestation for maternal serum screening of chromosomal abnormalities. Triple-marker maternal serum screening consisted of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol in conjunction with maternal age. Women > or = 35 years old were first offered amniocentesis. If they refused amniocentesis, they were offered the screening test. A second-trimester risk for trisomy 21 > or = 1:270 was considered screen positive. Patients were screen positive for trisomy 18 if all three markers were low: alpha-fetoprotein < or = 0.75 multiples of the median, unconjugated estriol < or = 0.60 multiples of the median, and human chorionic gonadotropin < or = 0.55 multiples of the median. RESULTS: The initial screen-positive rate was 8.3% (880 women); amniocentesis was offered to 766 (7.2%). Twelve of 16 ascertained cases of trisomy 21 (75%), two of three cases of trisomy 18 (67%), five cases of 45,X karyotype, and one case each of 45,X/46,XX, 47,XXY, 47,XYY, 46,XX,ins(2)(q21p13p15)mat, and 69,XXX karyotypes were identified in the screen-positive patients. All four known cases of trisomy 21 in the 886 women > or = 35 years old who were screened were detected, with a 21% false-positive rate. Omitting unconjugated estriol from our screening program would have resulted in detecting nine of 16 trisomy 21 and six of 12 other chromosomal abnormalities. The false-positive rate would have remained the same. CONCLUSION: In our sample cohort addition of unconjugated estriol to the screening program resulted in an increased detection rate of chromosomal abnormalities with no change in the false-positive rate. Considering the advancement in screening for chromosomal abnormalities, maternal age alone as an indication for amniocentesis should be reevaluated.
Adolescent↗
Triple marker (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) versus alpha-fetoprotein plus free-beta subunit in second-trimester maternal serum screening for fetal Down syndrome: a prospective comparison study.
OBJECTIVE: Our purpose was to compare the efficacy of triple-marker screening (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) with alpha-fetoprotein plus free beta-human chorionic gonadotropin. STUDY DESIGN: Free beta-human chorionic gonadotropin was concurrently assayed in 2349 maternal serum samples. Trivariate and bivariate algorithms were used to calculate the risk for fetal Down syndrome by the two protocols. Free beta-human chorionic gonadotropin from 12 cases of fetal Down syndrome previously screened with the triple marker was retrospectively assayed. RESULTS: Mean maternal age of our study was 29.8 years (range 14 to 51 years). The initial screen-positive rate with the triple marker was 8.0% compared with 12.8% for alpha-fetoprotein plus free beta-human chorionic gonadotropin. All three cases of fetal Down syndrome ascertained in our prospective study were detected by the triple marker; in contrast, one of three was detected by alpha-fetoprotein plus free beta-human chorionic gonadotropin. By adding 12 additional cases of fetal Down syndrome, 12 of 15 (80%) were screen positive with triple marker and nine of 15 (60%) were screen positive with alpha-fetoprotein plus free beta-human chorionic gonadotropin. CONCLUSION: The detection rate of fetal Down syndrome was greater by use of a triple marker screen than when using alpha-fetoprotein plus free beta-human chorionic gonadotropin. Our data do not support the claims of other studies that suggest that alpha-fetoprotein plus free beta-human chorionic gonadotropin is superior to triple markers.
Adolescent↗
Human dermal endothelial cells express membrane-associated mast cell growth factor.
Mast cell growth factor (MGF), a molecule that serves as a ligand for the receptor tyrosine kinase c-kit, is important in mast cell differentiation, migration, and activation. Previous studies of paraffin-embedded human skin using antibody to murine MGF and reverse transcription-polymerase chain reaction have demonstrated MGF protein and mRNA expression in keratinocytes and isolated dermal cells. We utilized a monoclonal antibody to human MGF to further define patterns of immunoreactivity in frozen specimens of neonatal and adult skin from normal individuals and from patients with urticaria pigmentosa. In addition to keratinocytes and isolated dermal cells in normal and urticaria pigmentosa skin, MGF was detected in cells lining superficial and mid-dermal vessels. Co-expression of MGF and the vascular antigen CD31, and immunoelectron microscopy, identified MGF-positive cells as endothelial cells. Patterns of endothelial MGF expression were not influenced by mast cell degranulation and endothelial E-selectin induction in vitro. By ultrastructure, unfixed specimens demonstrated MGF expression both within the endothelial cytoplasm and in association with lumenal, but not ablumenal, surfaces. Specimens fixed with Nakane's solution had diminished endothelial cytoplasmic MGF reactivity, but lumenal expression was maintained, suggesting persistence of a membrane-associated reactivity. MGF mRNA was also detected in cultured dermal microvascular endothelial cells using reverse transcription-polymerase chain reaction. These data establish human dermal endothelial cells as sites of MGF production and expression in human skin. Mast cell precursors must home to skin via vascular channels and differentiate in the immediate perivascular space. Thus, endothelial MGF may be an important determinant of adhesion and differentiation of mast cell progenitors expressing receptors for MGF.
Adult↗
Prenatal diagnosis of conjoined twins.
A case of conjoined twins with open spina bifida prenatally diagnosed at the twenty-third week of gestation is presented. The early detection of this rare and unusual malformation was initiated by the observation of markedly elevated maternal serum alphafetoprotein values. Ultrasound evidence of a misshaped cephalic pole and the appearance of one fetal body on real-time ultrasound was strongly suggestive. Elective midtrimester termination confirmed the prenatal diagnosis and was followed by a benign postpartum course.
Female↗
Prenatal diagnosis of triploidy.
Two cases of late midtrimester triploid gestation are presented. This unusual condition might be suspected in cases of first and second trimester bleeding when the uterus appears to be unusually large as estimated by the menstrual history. Early presence of gestational hypertension also points suggestively toward a triploid fetus. Ultrasound examination of the placenta typically shows multiple sonolucent areas. Confirmation of diagnosis is made by karyotyping cells obtained from amniotic fluid. The condition is incompatible with life and termination of pregnancy is indicated. It is considered prudent to follow HCG levels for evidence of persistent trophoblastic tissue.
Adult↗
Comparison of lidocaine and 2-chloroprocaine in paracervical block: clinical effects and drug concentrations in mother and child.
2-Chloroprocaine (CP) has recently been recommended as a less toxic alternative to amide-type local anesthetics due to its rapid metabolism. A double-blind, randomized study comparing CP to lidocaine when used for paracervical block was carried out. Twenty-nine patients received CP, while 31 received lidocaine. None of the 60 mothers developed adverse side effects. Adequate pain relief was achieved in 28 cases in each group, with a mean duration of 40 min regardless of the anesthetic. No change in uterine activity was observed. In the CP group one fetus had mild bradycardia, while two in the lidocaine group had severe, and three mild bradycardia within 5-7 min after the block. Low concentrations of CP were detected in the venous blood of 2 of 29 mothers and in the umbilical venous blood of their babies. Measurable amounts of its metabolite, 2-chloro-4-aminobenzoic acid (CABA), were found in all 13 samples of maternal blood 5 min after PCB and in 6 of 27 maternal samples at birth. Traces of CABA were found in umbilical venous blood in three neonates; in a fourth, a level of 1,000 ng/ml was found. In contrast, unmetabolized lidocaine was found in all maternal samples and in all but one of the cord samples at birth. Concentration of lidocaine in cord blood at delivery ranged from less than 100 to 4,000 ng/ml and were similar for both arterial and venous samples. No correlation could be demonstrated between levels of local anesthetics in the cord samples and the frequency or severity of fetal bradycardia regardless of the anesthetic.
Adolescent↗
Prenatal serum alpha-fetoprotein screening for neural tube defects.
Twenty-two cases of open neural tube defect were found in a population of 17,703 unselected pregnancies (1.2 per 1000) within the Long Island, New York, region. Voluntary screening of maternal serum alpha-fetoprotein levels identified 20 of the 22 cases (91%). Six hundred ninety-two participants demonstrated serial elevations in maternal serum alpha-fetoprotein. Of this group, which was designated at increased risk for open neural tube defect, 24% had underestimated gestational age, 13% had multiple gestations, and 53% were candidates for amniocentesis. In the amniocentesis group, the detection yield of neural tube defect was 20 per 365 (5.5%). Neither false-negative amniotic fluid evaluations nor termination of normal pregnancy due to false-positive amniotic fluid levels occurred. Perinatal outcome data, including pregnancy complications, date, mode of delivery, sex, birth weight, Apgar score, and congenital malformations of the neonate other than neural tube defect, are reported for the first 9300 consecutive participants of the 17,703 population study. These data identify a correlation between rate of perinatal loss and maternal serum alpha-fetoprotein levels.
Amniocentesis↗
Prenatal diagnosis of diastrophic dwarfism.
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Adult↗
Amniography in prenatal diagnosis.
The increasing use of prenatal diagnostic methods, including sonography and amniotic fluid analysis, has made it possible to suspect certain fetal defects at an early gestational age. In selected cases, accurate diagnosis of the specific malformation may have an effect on fetal and neonatal prognosis, and on prenatal counseling of the parents. As part of a large regional screening program for neural tube defects, we performed 28 midtrimester amniograms. We found 14 neural tube defects (nine spina bifida, four anencephaly, one Meckel syndrome), four abdominal wall defects, two tumors, and eight normal examinations. Radiographic examples of these malformations are presented, including previously undescribed findings in meningomyeloceles. The place of amniography in prenatal diagnosis is discussed.
Abdominal Muscles↗
Maxillary brown tumor of secondary hyperparathyroidism in a hemodialysis patient.
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Adolescent↗
Prenatal detection of neural tube defects.
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Amniocentesis↗
Maternal serum alpha-fetoprotein screening.
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False Positive Reactions↗
Sinusoidal fetal heart rate patterns in severe Rh disease.
Four patients with severe Rh isoimmunization are presented in whom sinusoidal fetal heart rate patterns were recorded. In 2 cases in which the pattern was seen intermittently in the postintrauterine transfusion period, the perinatal outcome was good. In the 2 cases in which the pattern was seen spontaneously and continuously, the outcome was poor, confirming the ominous and possibly agonal significance of the latter pattern.
Blood Transfusion, Intrauterine↗
Screening for SGA by the roll-over test.
The roll-over test (ROT) was evaluated in normal pregnant patients between 28 and 34 weeks' gestation and found to be an accurate method of screening for small-for-gestational age (SGA) infants and for preeclampsia. Patients with a positive ROT had a significant risk of SGA or preeclampsia or both. In patients with a positive ROT, the development of SGA may be further predicted by an examination of maternal prepregnancy weight and weight gain. Patients with a prepregnancy weight of 50 kg or less, total weight gain of 10 kg or less, and/or differential weight gain of 20% or less have a highly significant risk of developing an SGA fetus. In contrast, patients with a negative ROT have a significantly decreased risk for SGA and/or preeclampsia.
Body Weight↗