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Biomedical subjects

R Santos-Ramos

Publications and source records attributed to R Santos-Ramos.

At least 19 recordsLinked to original sources

Nomograms for rapid estimation of intravascular intrauterine exchange transfusion.

Fetal exchange transfusion is complicated by the fact that vascular access must be maintained while the number of exchanges needed to achieve a desired post-transfusion hematocrit is calculated. A rapid method for estimating the number of exchange transfusions would greatly simplify fetal exchange transfusion for blood group isoimmunization. In this report, we present a graphic method for determining the number of exchange transfusions necessary to achieve a post-transfusion hematocrit of 45%, using a nomogram for 5- and 10-mL exchange transfusion volumes.

Blood Transfusion, Intrauterine

Endocrine studies in a pregnancy complicated by ovarian theca lutein cysts and hyperreactio luteinalis.

Severe virilization developed in a pregnant woman in association with the occurrence of theca lutein cysts and hyperreactio luteinalis of the ovaries. At term, maternal serum levels of androstenedione (58 ng/mL) and testosterone (20 ng/mL) were elevated massively; estrone (24 ng/mL) and estradiol-17 beta (23 ng/mL) levels were increased moderately. Maternal serum levels of human chorionic gonadotropin (hCG) just before delivery, 22,276 mlU/mL, though twice the mean for normal women at term, were within the normal range. The levels of androstenedione (1.06 ng/mL) and testosterone (0.26 ng/mL) in umbilical cord serum of her normal newborn female infant were normal. The levels of androstenedione and testosterone in serum of this woman declined slowly, but progressively, during the first two months after delivery; the serum levels of androstenedione and testosterone increased substantially, however, after she was treated with hCG eight weeks postpartum. These results are suggestive that, for reasons unknown, markedly increased androgen production with theca lutein cysts and hyperreactio luteinalis in some pregnant women results ultimately because of increased ovarian sensitivity to hCG.

Adult

Cefotaxime treatment for women with community-acquired pelvic abscesses.

Forty-one women with pelvic abscesses complicating salpingitis were treated with parenteral cefotaxime, a newer cephalosporin. Abscesses ranged in size from 4 by 4 to 13 by 15 cm, and in 10 women (24%) they were greater than or equal to 10 cm. Neisseria gonorrhoeae was recovered from the endocervix in 17 women (41%). A mean of 26.7 gm of cefotaxime was given over a mean of 6.5 days, and operation was not required during initial therapy. Only two women (5%) required the addition of another antimicrobial. Chronic pelvic pain and recurrent infection were infrequent during the 31- to 43-month follow-up period. Five women (12%) were readmitted for elective surgical therapy because of persistent or recurrent adnexal mass 1 to 33 months following study entry. Six (15%) women became pregnant and were delivered of their infants a mean of 25 months following cefotaxime therapy.

Abscess

Ultrasound prediction of fetal weight in prolonged pregnancy.

In this study we applied two commonly used birth weight prediction equations to a sample of 121 women with prolonged pregnancies. Subjects had sonographic measurements of biparietal diameter and abdominal perimeter taken within 2 days of delivery at Parkland Memorial Hospital. Although the two prediction equations were obtained from a population of women in New Haven, Connecticut, who delivered over a wide range of gestational ages, when the equations were applied to the sample of prolonged pregnancies in Dallas, Texas, there was a strong correlation (0.71) between predicted and actual birth weight. Moreover, reestimation of the New Haven equations with use of the Dallas data yielded similar regression coefficients. Finally, birth weight prediction equations for black, white, and Hispanic patients in Dallas were not significantly different. These findings suggest a remarkably constant relationship between fetal head and abdominal dimensions and birth weight over different gestational ages and for different population groups.

Birth Weight

Magnetic resonance imaging in obstetric diagnosis.

Five patients with abnormal pregnancies were examined with ultrasound (US) and magnetic resonance imaging (MR). Three had a malformed fetus, 1 had a molar pregnancy, and 1 had an ovarian mass. Both maternal and fetal structures were clearly shown, although fetal motion may have resulted in image degradation in some cases. The authors suggest that MR may be useful in obstetric diagnosis.

Abnormalities, Multiple

Magnetic resonance imaging in human pregnancy.

Magnetic resonance imaging is a new noninvasive diagnostic technique that involves no ionizing radiation, has no known significant adverse biologic effects, and produces high resolution cross-sectional body images. When compared with sonography and x-ray computed axial tomography, magnetic resonance imaging may have several advantages. To investigate its clinical role in obstetrics, magnetic resonance imaging was used to examine 11 women with abnormal pregnancies. Prior ultrasound examination showed abnormal appearing fetuses in five, abnormalities of the amnionic fluid volume in five, and one each with a large adnexal mass and a molar pregnancy. Examples of images obtained from these women are presented and described. Maternal anatomy was well visualized in all women studied. Based on the preliminary experience, the authors believe that magnetic resonance imaging will be a useful adjunct for diagnostic visualization of normal and abnormal maternal anatomy. Detailed fetal imaging was also possible, and it is anticipated that magnetic resonance imaging will prove useful for fetal evaluation, especially fetal intracranial anatomy and fetal anatomy in pregnancies complicated by oligohydramnios. Because fetal subcutaneous fat is prominently depicted with magnetic resonance imaging, this technology may be useful for assessment of fetal nutritional status.

Female

Sonar cephalometry in twins: a table of biparietal diameters for normal twin fetuses and a comparison with singletons.

In 123 normal twin pregnancies, 589 biparietal diameter (BPD) measurements were obtained between 16 and 40 weeks' gestation and mean values for each week were computed. A table of BPDs for normal twin pregnancies based on these data is proposed. Mean twin BPDs were consistently smaller than those of singletons, the difference averaging 3.5 mm between 16 and 40 weeks' gestation. The development of a twin BPD table now permits a more accurate assessment of twin gestational age and fetal growth.

Cephalometry

The value of sonography in suspected ectopic pregnancy.

Of 356 women undergoing sonography to diagnose or rule out an ectopic gestation, data sufficient to assign a final diagnosis were available on 260 of them. Ectopic gestation was diagnosed in 25 cases in this group and intrauterine pregnancy in 99, while the remaining 136 patients were found not to be pregnant. During sonography, ectopic gestations were suspected or diagnosed in 27 instances: In 17 cases this was in agreement with the final diagnosis, but neither an intrauterine nor an extrauterine gestation existed in 10 cases, although neoplastic or inflammatory masses were present. Of the 25 patients with the final diagnosis "ectopic pregnancy," this was not detected with sonography in 8 instances. Intrauterine pregnancies were diagnosed by sonar in 94 of the 99 cases. Although reliable sonar identification of ectopic gestation is not always possible, sonography is helpful in diagnosing intrauterine pregnancy so that surgical intervention can be avoided.

Adolescent

A paired controlled study of vaginal and abdominal delivery of the low birth weight breech fetus.

In a paired, controlled, retrospective study, 44 low birth weight breech fetuses delivered vaginally were compared with 44 breech fetuses delivered by cesarean section. Seven deaths occurred in the vaginal delivery group, compared with only 1 in the abdominal delivery group. Asphyxia, trauma, and intracranial hemorrhage were also found more frequently among vaginally delivered fetuses. The authors conclude that for the low birth weight breech fetus, delivery by cesarean section is preferable.

Asphyxia Neonatorum