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Biomedical subjects

S S Entman

Publications and source records attributed to S S Entman.

At least 37 records · Page 2Linked to original sources
PubMed1989

Umbilical artery velocimetry as a predictor of adverse outcome in pregnancies complicated by oligohydramnios.

Oligohydramnios is associated with increased perinatal mortality and morbidity. Traditional methods of in utero fetal evaluation have been unsuccessful in reliably distinguishing oligohydramnios with normal outcome from that associated with increased perinatal morbidity. A prospective study was undertaken to establish the predictive value of Doppler velocimetry in identifying the fetus with oligohydramnios at increased risk of adverse perinatal outcome. Twenty-two gravid women with subjective oligohydramnios on ultrasound had continuous-wave umbilical artery velocimetry. Subjects were divided into two groups based on the results of Doppler analysis. Group 1 (N = 13) had normal umbilical Doppler waveforms. In this group, 12 of 13 patients had normal perinatal outcome, defined by the absence of intrapartum fetal distress or evidence of intrauterine growth retardation. Group 2 consisted of nine subjects with abnormal waveforms. Perinatal morbidity occurred in 100% in this group. We conclude that an abnormal umbilical artery waveform may provide confirmatory evidence of impending fetal compromise when the antenatal sonographic diagnosis of oligohydramnios is made.

Amniotic Fluid↗
PubMed1988

Carcinoma of the fallopian tube.

Primary adenocarcinoma of the fallopian tube is a rare neoplasm that constitutes less than 1% of gynecologic malignancies. Although the triad of menorrhagia, leukorrhea, and pain is said to be pathognomonic, preoperative diagnosis of this lesion is most unusual. The radiographic appearance at hysterosalpingography has only rarely been described in the English literature previously. This therefore is an unusual documentation of the preoperative appearance of fallopian adenocarcinoma by hysterosalpingography and sonography.

Adenocarcinoma↗
PubMed1988

Transvaginal and transabdominal sonography of the endometrium.

The major applications of the sonographic depiction of the endometrium include the localization of the uterus relative to adnexal masses, determination of certain benign and malignant endometrial pathologies, and, potentially, as a parameter for consideration in gynecologic infertility. Transvaginal sonography affords detailed depiction of the endometrium and may provide future applications of sonography in endometrial disorders.

Endometrium↗
PubMed1987

Follicular fluid transferrin levels in preovulatory human follicles.

There is transferrin-like protein present in the follicular fluid of stimulated ovarian cycles. The transferrin concentration correlates with the follicular morphologic maturity and steroidogenesis, varies among follicles, and often exceeds serum concentrations. An intermediate range of transferrin concentration is associated with the highest likelihood of oocyte fertilization in vitro. The biological significance of these observations may relate to an optimum degree of follicle maturation.

Body Fluids↗
PubMed1987

Increased levels of carboxyhemoglobin and serum iron as an indicator of increased red cell turnover in preeclampsia.

Patients with severe preeclampsia are reported to have microangiopathic hemolytic anemia. This study demonstrates that increased red cell turnover with heme catabolism is also common in mild preeclampsia. Heme catabolism results in equimolar production of carboxyhemoglobin, iron, and bilirubin. A concomitant rise in these constituents of venous blood would support this hypothesis. Patients with antepartum preeclampsia had mean carboxyhemoglobin concentrations (2.72% total hemoglobin) greater than those of control patients (0.65%) (p less than 0.001) and serum iron concentrations (98.5 micrograms/dl) greater than those of control patients (66.1 micrograms/dl) (p less than 0.01). Bilirubin concentrations were not different. Post partum, carboxyhemoglobin and iron concentrations returned toward normal (1.38% and 50.2 micrograms/dl, respectively). Disparity in the magnitude of increase of heme catabolites produced in equimolar proportion is explained by differences in the kinetics of clearance. The data are most consistent with increased destruction of maternal red cells, even in mild preeclampsia. Potential implications of elevated carboxyhemoglobin on maternal and fetal oxygenation are discussed.

Carboxyhemoglobin↗
PubMed1987

Increased thromboxane biosynthesis in normal pregnancy is mainly derived from platelets.

Thromboxane biosynthesis was determined in normal pregnant subjects by measurement of its major urinary and plasma metabolites, 2,3-dinor-thromboxane B2 and 11-dehydro-thromboxane B2. Urinary 2,3-dinor-thromboxane B2 increased early in pregnancy (731 +/- 124 pg/mg creatinine) compared with nonpregnancy (less than 350 pg/mg creatinine; p less than 0.001) and the postpartum period (155 +/- 42 pg/mg creatinine, p = 0.015) and remained elevated throughout gestation. Similarly, plasma and urinary 11-dehydro-thromboxane B2 were increased in pregnancy. To determine the cellular origin of the increase in thromboxane biosynthesis in pregnancy, platelet cyclooxygenase was selectively inhibited with aspirin in a dose of 120 mg orally followed by 20 mg twice daily for 7 days (n = 4). Selectivity was confirmed by measurement of urinary 2,3-dinor-6-keto-prostaglandin F1 alpha, an index of prostacyclin biosynthesis. Coincident with a 97% inhibition of serum thromboxane B2, urinary 2,3-dinor-thromboxane B2 was almost completely inhibited and paralleled the recovery of platelet cyclooxygenase after withdrawal of aspirin. This study demonstrates that thromboxane biosynthesis is increased in pregnancy. The increase is mainly platelet derived and is consistent with increased platelet activation throughout pregnancy.

Blood Platelets↗
PubMed1987

Myometrial invasion by endometrial carcinoma: sonographic assessment.

The depth of myometrial invasion by endometrial carcinoma was evaluated using real-time sonography (US) in 20 patients with histologically proved adenocarcinoma of the endometrium. In 14 of 20 (70%) cases, US-based estimation of the depth of myometrial invasion was within 10% of the actual measurement in the gross specimen. The US-based estimation of tumor invasion was low in seven patients, high in four patients, and agreed with pathologic findings (+/- 5%) in nine patients. In four patients with polypoid intraluminal extension of tumor, a deeply invasive tumor was suspected on US but was not found on pathologic examination. In 12 superficially invasive tumors, the continuity of the demarcating subendometrial halo was intact in nine and incomplete in three. In six patients with deeply invasive tumors, this zone was partially disrupted in four, totally disrupted in one, and intact in one. Errors of estimation of the depth of myometrial invasion on US most frequently occurred when a tumor had a significant intraluminal polypoid extension. Demonstration of a subendometrial halo usually indicated superficial invasion, whereas the absence of a halo was frequently associated with deep invasion.

Adenocarcinoma↗
PubMed1987

Decreased prostacyclin biosynthesis preceding the clinical manifestation of pregnancy-induced hypertension.

Patients who develop pregnancy-induced hypertension exhibit a lesser increment in prostacyclin biosynthesis than healthy pregnant subjects. Whether this precedes the development of clinical disease and therefore may be important in the pathogenesis of pregnancy-induced hypertension or is a secondary event is unknown. We prospectively determined prostacyclin biosynthesis in pregnant subjects at risk of developing pregnancy-induced hypertension by use of noninvasive approach, measurement of the urinary metabolite 2,3-dinor-6-keto-prostaglandin F1 alpha. Patients were recruited at less than 20 weeks gestation. After delivery, patients were retrospectively allocated by use of preset criteria, to one of four groups: pregnancy-induced hypertension (n = 12), hypertension in labor (n = 22), chronic hypertension (n = 9), and normotension (n = 24). There was a significant increase in prostacyclin biosynthesis in all study groups during gestation. However, patients who developed pregnancy-induced hypertension exhibited a lesser increment and this difference persisted throughout gestation. These results are consistent with a pathophysiologic role for altered prostacyclin biosynthesis in women with pregnancy-induced hypertension. In addition, decreased prostacyclin formation identifies a population at risk of developing pregnancy-induced hypertension. Such information would assist the design of clinical trials of drugs, such as aspirin, that might prevent the development of this disease.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Automated enzymatic measurement of lecithin, sphingomyelin, and phosphatidylglycerol in amniotic fluid.

We describe methods for automated enzymatic measurement of lecithin, sphingomyelin, and phosphatidylglycerol in amniotic fluid. Phospholipase C (EC 3.1.4.3) and sphingomyelin phosphodiesterase (EC 3.1.4.12) are reacted with lecithin and sphingomyelin, respectively, to liberate phosphocholine. Phosphocholine is then reacted with alkaline phosphatase, choline oxidase, peroxidase, and 4-aminoantipyrine to form a colored complex, for which the absorbance at 500 nm is measured with a centrifugal analyzer. Phosphatidylglycerol is hydrolyzed by phospholipase D (EC 3.1.4.4) to form glycerol, which is subsequently reacted with ATP and NAD+ in the presence of glycerol kinase and glycerol-3-phosphate dehydrogenase to yield NADH. The absorbance of the NADH formed is measured at 340 nm. These methods provide a simple, rapid, and accurate alternative to thin-layer chromatography for determination of phospholipids in amniotic fluid for assessment of fetal lung maturity.

Amniotic Fluid↗
PubMed1986

Increased risk of endometritis and wound infection after cesarean section in insulin-dependent diabetic women.

To determine if diabetic women have an increased risk for post-cesarean section endometritis and/or wound infection, all insulin-requiring diabetic women who were delivered by cesarean section between 1977 and 1981 were compared with a group of nondiabetic patients delivered by cesarean section. Patients were divided into low-risk or high-risk groups on the basis of labor and ruptured membranes. Compared with control subjects, diabetic patients were at significantly greater risk for postoperative infectious morbidity. Among diabetic patients, risk for postoperative infections was independent of White's classification of diabetes and gestational age at delivery. The increased rate of infection among the diabetic patients suggests that prophylactic antibiotics might be efficacious for insulin-requiring diabetic patients undergoing cesarean section.

Cesarean Section↗
PubMed1986

Sonographic depiction of the endometrium during normal cycles.

Pelvic sonograms were performed every 2-3 days in 10 volunteers in order to study changes in thickness and texture that occur in the normal endometrium. A total of 75 sonograms were performed. The accuracy of sonographic estimates of endometrial thickness was also evaluated in eight patients who underwent hysterectomy for reasons unrelated to the uterus. The majority of sonographic measurements of endometrial thickness in these patients were within 1 mm of the actual thickness as measured in the unfixed specimen. In all of the individuals studied, sonography was able to depict changes in the thickness and texture of the endometrium which corresponded to the various phases of its development. Specifically, the average thicknesses of the endometrium were greater in the secretory phase (3.6 +/- 1.4 mm) than in the proliferative phase (2.9 +/- 1.0 mm) (p less than or equal to 0.05). The texture of the endometrium varied throughout the cycle with the hypoechoic texture slightly more common than echoic in the proliferative phase, whereas the echogenic appearance was most common in the secretory phase. Those technical factors which optimized sonographic depiction of the endometrium are discussed, as well as the possible clinical applications of the sonographic depiction of normal and abnormal endometria.

Adult↗
PubMed1986

Sonography of the endometrium during conception and nonconception cycles of in vitro fertilization and embryo transfer.

The thickness of the endometrium was compared in 15 patients who conceived and 15 who did not with an in vitro fertilization and embryo transfer (IVF-ET) protocol after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG). There was no statistically significant difference (P = 1.0) in the endometrial thickness in the conception versus the nonconception group. Average estradiol (E2) values and number of mature follicles were also not statistically different in the two groups (P = 0.78, P = 0.81). There was a slightly significant difference in the number of embryos transferred in the conception versus nonconception groups (2.5 versus 1.9, P = 0.005). However, the most significant difference between the conception and nonconception groups was the total number of oocytes retrieved (4.4 versus 2.8, P = 0.005). These findings indicate that there are no sonographically detectable differences in the endometrial thickness in patients who achieve pregnancy versus those that do not when given a similar ovulation induction regimen of hMG/hCG for IVF-ET.

Chorionic Gonadotropin↗
PubMed1986

Correlation of the one-minute Apgar score and umbilical cord acid-base status.

The one-minute Apgar score has proven useful by ensuring rapid assessment of the neonate, but is often poorly correlated with other indicators of intrauterine well-being. Since fetal asphyxia is directly associated with neonatal acidosis, a low Apgar score in the face of normal pH and base deficit does not indicate an asphyxiated infant. In a study to ascertain the feasibility of combining umbilical artery pH with the one-minute Apgar score for neonatal assessment, umbilical artery pH and Apgar scores were obtained on 212 singleton pregnancies. When the Apgar score was less than 7, more than half (60%) of the neonates had a normal umbilical artery pH. Fifty-one percent of this group had had intubation and nasopharyngeal suctioning, procedures known to be associated with lowered Apgar scores. When reviewing the umbilical artery gas values and base deficit in those neonates with a pH less than 7.20, we found that of the eight patients with an Apgar score of 7 or greater, seven (87.5%) were classified as having metabolic acidosis, with only one having respiratory acidosis. In the neonates with Apgar scores of less than 7, approximately two thirds had blood gas values compatible with metabolic acidosis, while the others displayed respiratory acidosis. We recommend, therefore, that neonates with a one-minute Apgar score less than 7 have umbilical artery pH determinations to confirm the presence or absence of acidosis. We also recommend that when the pH is less than 7.20, a complete set of gas values be evaluated with that specimen. This information offers more precise confirmation of the diagnosis of fetal distress and neonatal asphyxia, both for treatment and more reliable follow-up data, as well as for medicolegal purposes.

Acid-Base Equilibrium↗
PubMed1986

Sonographic depiction of normal and abnormal endometrium with histopathologic correlation.

The sonographic appearance of the endometrium was correlated to histopathologic findings in 38 patients who underwent hysterectomy. The thickness was accurately assessed by sonography (within +/- 1 mm) in 33 of 38 patients. The hypoechoic halo which surrounds the endometrium was found to represent the inner third of the myometrium which is relatively vascular and compact. In postmenopausal patients who are not receiving hormonal replacement, an endometrium of greater than 5 mm should be considered abnormal. Several causes of abnormally thick endometrium were encountered in this study, including endometrial carcinoma, hyperplasia, adenomyosis, hematometria, mucometria, and pyometria. Sonography was found to be accurate in determining the depth of myometrial invasion in adenocarcinoma.

Adult↗