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Biomedical subjects

S E Carpenter

Publications and source records attributed to S E Carpenter.

15 recordsLinked to original sources
PubMed2000

Obstetric emergencies precipitated by malignant brain tumors.

OBJECTIVE: Our goal was to present a case series of pregnancy-associated malignant brain tumors. STUDY DESIGN: A review was conducted from 1978-1998 at 5 hospitals. RESULTS: Ten women were diagnosed with a malignant brain tumor during pregnancy (n = 8) or post partum (n = 2). Patients diagnosed antenatally exhibited severe symptoms, manifest between 27 and 32 weeks' gestation. Six were emergently delivered of their infants because of maternal deterioration, and 2 were delivered electively in the early third trimester after documentation of fetal pulmonary maturity. There were 4 maternal deaths and 1 neonatal death; all of the other infants maintained viability. CONCLUSIONS: Malignant brain tumors rarely occur in pregnancy. In contrast to reports that describe an indolent course, each of the 8 antenatal patients experienced a neurologic crisis. If symptoms are amenable to pharmacologic control, we advocate delivery in the early third trimester after documentation of fetal pulmonary maturity. To minimize temporal lobe or cerebellar herniation in neurologically unstable patients, a consideration should be made for cesarean delivery with the patient under general anesthesia, followed by immediate neurosurgical decompression.

Adult↗
PubMed1998

Papillary thyroid carcinoma manifesting as thyroid storm of pregnancy: case report.

A patient with known hyperthyroidism was seen at 25 weeks' gestation with a rapidly growing neck mass. She was initially in thyroid storm and received aggressive medical therapy. Two subsequent episodes of thyrotoxicosis occurred during pregnancy in spite of large doses of propylthiouracil. Post partum the patient was diagnosed with a locally advanced thyroid malignancy.

Adenocarcinoma, Papillary↗
PubMed1996

Management of genital prolapse in neonates and young women.

The presence of genital prolapse in neonates and young women poses a challenging management problem to the gynecologist. Neonatal uterine prolapse is associated with congenital spinal defects, and successful correction has been achieved mainly with simple digital reduction or the use of a small pessary. Uterine prolapse can also occur in young or nulliparous woman who wish to preserve their fertility. Operations using sling, sacral cervicopexy, or transvaginal sacrospinal fixation techniques seem to provide excellent repair for these patients, including the possibility of childbearing. A review of the pathophysiology of genital prolapse in neonates and young women with emphasis on the surgical and nonsurgical options for management is presented.

Adolescent↗
PubMed1996

Inhibition of oxidative modification of proteins by RU486.

OBJECTIVES: To elucidate further the antioxidant properties of RU486. We determined whether it can protect biologic molecules such as proteins (albumin, low-density lipoprotein [LDL] and oxidized LDL) from damage by pre-existing lipid peroxides. DESIGN: In vitro study. INTERVENTIONS: We tested the effects of RU486 on the formation of fluorescent oxidatively modified proteins by pre-existing lipid peroxides. We used two model systems, the incubation of oxidized linoleic acid with serum albumin and the incubation of human LDL with copper. MAIN OUTCOME MEASURES: The formation of modified protein was established by determining fluorescence at excitation wavelength of 330 nm and emission wavelength between 390 and 500 nm. Modified protein has a characteristic emission between 425 and 430 nm. RESULTS: The addition of increasing amounts of RU486 inhibited the formation of fluorescent oxidatively modified protein products in both model systems. CONCLUSION: These results provide evidence that RU486 not only can prevent the formation of lipid peroxide, but also can block the formation of fluorescent protein adducts in the presence of pre-existing lipid peroxides.

Antioxidants↗
PubMed1995

The effect of regular exercise on women receiving danazol for treatment of endometriosis.

OBJECTIVE: To determine the effects of regular exercise on women receiving danazol for the treatment of endometriosis. METHODS: Thirty-nine patients were randomized to a danazol-only or a danazol/exercise regimen in a prospective clinical trial carried out at tertiary care institutions. Patients in the danazol/exercise group were instructed to exercise four times per week, for 40 min per session, at an intensity of 20 metabolic units. Side effect profiles, pelvic symptoms, aerobic fitness, strength and hormone levels were compared for all subjects. The number of side effects of danazol was analyzed by the method of generalized estimating equations. RESULTS: The number of side effects reported during a 4-week period was 1.09-2.17 times greater for the danazol-only than for the danazol/exercise group. All patients had improvement of symptoms during treatment. The danazol/exercise group had significantly lower testosterone levels during treatment. The time to recurrence of endometriosis was not different between groups. CONCLUSIONS: Exercise during danazol therapy reduces the number of androgenic side effects. Relief of pain and time to recurrence are unaffected.

Adult↗
PubMed1994

Reconstruction of the external genitalia in females with bladder exstrophy.

OBJECTIVES: A very characteristic genital anomaly accompanies bladder exstrophy in females. This includes anterior displacement and narrowing of the vagina and separation of the clitoris into two distinct bodies. The authors have had a relatively large experience with correction of this rare genital anomaly. From this experience, it began to appear that certain procedural details were associated with improved outcomes. The objective of this article was to review this experience and detail the reconstruction of the external genitalia in these patients. METHODS: All cases of bladder exstrophy in females presenting from January 1, 1970 to December 31, 1992 were reviewed. A total of eight patients who underwent surgical correction of the external genitalia were included. Data was obtained regarding urologic treatment, associated anomalies, corrective gynecologic procedures, complications and subsequent course. RESULTS: Corrective gynecologic surgery included enlargement of the vaginal orifice in all eight patients. Five patients had reapproximation of the bifid clitoris. Three patients performed postoperative dilatation therapy. Postoperatively, one patient experienced dyspareunia requiring a repeat procedure to enlarge the vaginal orifice. No patient had complications related to pelvic organ prolapse. CONCLUSIONS: Care should be taken not to extend the perineal incision too far posteriorly in reconstruction of the external genitalia in females with bladder exstrophy. Failure to do so may further predispose the patient to uterine prolapse. Post-operative dilator therapy may be an important adjunctive technique.

Adolescent↗
PubMed1994

Psychosocial menstrual disorders: stress, exercise and diet's effect on the menstrual cycle.

Diet, exercise and stress are widely acknowledged to affect the timing and course of pubertal development and menstrual cyclicity in girls. However, the mechanisms by which this occurs and the long-term effects of such alterations are incompletely understood. Several recent reports which contribute to our understanding of normal events and alterations from normal are reviewed.

Adolescent↗
PubMed1993

Abdominal myomectomy in the treatment of infertility.

OBJECTIVE: To determine the effect of abdominal myomectomy as a treatment for infertility in women with uterine leiomyoma. METHODS: Records were reviewed for 37 women at Johns Hopkins Hospital who underwent myomectomy as a primary procedure for infertility between 1975 and 1990. RESULTS: Kaplan-Meier life-table analysis demonstrated a cumulative pregnancy rate of 57% and live birth rate of 48%. The size or number of myomas did not affect either the pregnancy rate or the myoma recurrence rate. The presence of pelvic adhesions at the time of myomectomy significantly reduced the chance of conception (P < 0.05). Adhesions were documented in 13 (68%) of 19 patients who underwent abdominal surgery at a later date. CONCLUSIONS: Nearly half of the infertile women with uterine leiomyoma were able to bear children following abdominal myomectomy. Adhesion formation appears to be a common occurrence following myomectomy and reduces its effectiveness when present before surgery.

Adult↗
PubMed1989

Extrapelvic endometriosis.

Extrapelvic endometriosis has been reported in nearly every organ system of the human female body. The etiology of this disease may well be due to one or more factors. Though less common than pelvic disease, extrapelvic endometriosis is often difficult to diagnose and more difficult to treat. Our experience combined with a review of world literature is presented focusing on diagnosis and management.

Endometriosis↗
PubMed1987

Procidentia in the newborn.

Complete uterine prolapse was noted shortly after birth in a female infant with a meningomyelocele at the level of the iliac crest with a palpable dimpled defect caudal to the primary lesion. The vagina and uterus were restored to their normal position with a rubber nipple placed into the vagina. The prolapse resolved on the sixth day of life after a repair of the meningomyelocele. Thus, conservative therapy with temporary support provides a satisfactory solution for newborn procidentia.

Female↗
PubMed1986

Epithelioid leiomyosarcoma of the uterus.

Uterine epithelioid leiomyosarcoma is an unusual smooth muscle neoplasm. It is distinguished on cytoarchitectural grounds from the majority of leiomyosarcomas that arise in the uterus. Three cases of this atypical lesion are presented and the pathologic features are discussed. One patient is alive with no evidence of disease at 3.5 years, one patient has persistent disease at 4 years, and the third patient died of disease at 8 months. Fundamental differences in biologic behavior of this subset of uterine smooth muscle tumors cannot be discerned.

Adult↗
PubMed1982

Primary afferent units from the hairy skin of the rat hind limb.

The properties of cutaneous units in the saphenous nerve of the rat have been surveyed. We studied 137 units with myelinated (A-fibre) axons conducting at 4-44 m/s. Of the A-fibre units 66% gave a rapidly adapting discharge following hair movement and could be classified into categories similar to those described previously in cat and rabbit. Two categories predominated: (1) D-hair units with slowly conducting axons and relatively large receptive fields that responded to slow movement of hairs, including down hairs when these were present and (2) G-hair units with larger axons and relatively small fields that were only excited by fast movement of guard hairs. Of the A-fibre units 20% were high threshold mechanoreceptors. As in other species, these had a wide range of conduction velocities and multi-point receptive fields. Other types of A-fibre units found were (a) sensitive, RA units not excited by hair movement, (b) relatively insensitive RA units with diffuse receptive fields and (c) slowly adapting mechanoreceptor units. We studied 149 units with unmyelinated (C-fibre) axons conducting at 0.49-0.89 m/s. Of the C-fibre units 73% were of the polymodal nociceptor type. They had small receptive fields and responded to pressure and heating. The average heat threshold was 47 degrees C (+/- 6 degrees C, S.D.). Units were often not sensitized by suprathreshold heating unlike similar units in cat and rabbit. Other C-fibre units found were sensitive mechanoreceptors (12%), cold thermoreceptors (4%) or were very insensitive or inexcitable (11%). The pattern of innervation of rat limb hairy skin resembles previously studied mammalian species. A notable feature is the large proportion of C-polymodal nociceptor units. In this respect the rat resembles the primate and differs from the cat.

Afferent Pathways↗
PubMed1981

Vascular and sensory responses of human skin to mild injury after topical treatment with capsaicin.

1 Immediately after several topical applications of capsaicin at 2-hourly intervals, human forearm skin would no longer develop flare (vasodilation) around a small injury. At the same time heat pain thresholds were reduced on average by 3.5 degrees C. These results are consistent with block by capsaicin of the effector side of the axon reflex, perhaps by depleting nerve terminals of substance P. 2 Over a period from several days to several weeks after treatment, flare was diminished and heat pain thresholds were slightly elevated. These changes may be due to long-lasting damage of cutaneous nerve terminals by capsaicin.

Administration, Topical↗