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Biomedical subjects

W F O'Brien

Publications and source records attributed to W F O'Brien.

At least 91 records · Page 5Linked to original sources
PubMed1988

Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management.

Fifty-four cases in which surgical intervention during pregnancy was required for definitive therapy of adnexal masses were reviewed. The calculated incidence of adnexal masses that required surgical intervention during pregnancy in our primary population (patients who were not referred for evaluation of an already identified mass) was one case per 1300 live births. A malignant tumor was found in 5.9% of the pregnant patients who underwent exploratory celiotomy for therapy of an adnexal mass. Those pregnant women who underwent emergency celiotomy because of hemorrhage or torsion as a complication of an adnexal mass spontaneously aborted or underwent premature delivery more frequently than those patients who underwent elective celiotomy for removal of the mass (p less than 0.001). On the basis of this review, we recommend that pregnant women with persistent adnexal masses undergo elective extirpation of the mass in the second trimester of pregnancy.

Adnexal Diseases↗
PubMed1988

The sequential use of estradiol and prostaglandin E2 topical gels for cervical ripening in high-risk term pregnancies requiring induction of labor.

We compared the safety and efficiency of 200 mg of estradiol valerate prepared as a topical cervical gel as a preripening agent when used 6 hours before the application of 2 mg of prostaglandin E2 gel for the purpose of cervical ripening in 40 high-risk obstetric patients before indicated oxytocin induction of labor. When compared with a placebo prostaglandin E2 dosage, the estradiol had no effect on the change of Bishop score, length of labor, amount of oxytocin required, or the cesarean delivery rate. While no uterine contractions were noted after the application of the estradiol, 85% of patients had recordable uterine activity after the application of prostaglandin E2, suggesting that even at the 2 mg dosage this sequential regimen is not appropriate for local cervical ripening.

Administration, Topical↗
PubMed1988

Serum prostacyclin binding and half-life in the umbilical circulation.

Serum prostacyclin binding and half-life was measured in twenty pairs of maternal and umbilical venous samples and in twenty non-pregnant controls. When compared to non-pregnant values both umbilical and maternal samples demonstrated significantly lower albumin concentrations, percentage of prostacyclin binding and shorter prostacyclin half-life.

Epoprostenol↗
PubMed1988

The effect of prostaglandin D2 on angiotensin converting enzyme.

Intravenous administration of prostaglandin D2 (2, 4 and 8 micrograms/kg) in the rat resulted in a dose-dependent decrease in arterial pressure with partial recovery occurring during the course of the experiment. Hematocrit and hemoglobin decreased in all groups, probably related to the blood withdrawal and volume replacement. Increase in serum glucose is not specific to prostaglandin D2 and a progressive increase occurred even in the vehicle controls. Despite the fact that arterial pressure decreased with the injection of this prostanoid, angiotensin-converting enzyme did not change significantly. The results of this study demonstrate no association between the administration of prostaglandin D2 and angiotensin-converting enzyme within the concentrations we have used in these experiments.

Animals↗
PubMed1988

Carbohydrate intolerance in patients receiving oral tocolytics.

This prospective study was designed to evaluate the effects on glucose metabolism of terbutaline used as an oral tocolytic agent. Eighty-six patients were studied when admitted for preterm labor from 24 to 35 weeks' gestation. After intravenous tocolysis, these patients were maintained on 5 mg of terbutaline every 4 or 6 hours. An oral 50 gm, 1-hour glucose challenge test was done 48 hours after terbutaline dosing began. All abnormal glucose challenge test results (greater than or equal to 135 mg/dl) were followed by a standard 100 gm oral glucose tolerance test. Sixty-three percent (54 of 86) of the terbutaline group had an abnormal 1-hour screening result, which was significantly different than the 26.7% (23 of 86) observed in the control group (p less than 0.001). The mean fasting blood sugar and 1-hour postchallenge values were significantly higher in the study than in the control group (p less than 0.0001). Ten of 86 in the treated group (11.6%) and 2 of 86 in the control group (2.3%) with abnormal results met the criteria for gestational diabetes. These numbers achieve statistical significance at p less than 0.05. This study shows a significant effect of oral terbutaline therapy on glucose tolerance during pregnancy. Patients receiving oral terbutaline therapy for suppression of preterm labor should undergo screening for gestational diabetes.

Adult↗
PubMed1988

The use of antenatal vitamin K in the prevention of early neonatal intraventricular hemorrhage.

To establish the effect of antenatal vitamin K on the incidence and severity of intraventricular hemorrhage, 92 patients destined to deliver infants less than 32 weeks' gestation were, in a prospective fashion, randomly assigned to two groups. Group I received 10 mg of vitamin K1 intramuscularly every 5 days until delivery. Group II received no antenatal vitamin K1 therapy. There were 100 neonates less than 1500 gm, equally divided between groups I and II with respect to gestational age, birth weight, race, sex, presentation, route of delivery, duration of labor, Apgar scores, and arterial umbilical cord acid-base balance. The antenatal use of vitamin K resulted in significant reduction in the prothrombin time (12.7 versus 15.2 seconds) and partial thromboplastin time (42.6 versus 58.9 seconds; p less than 0.05). Furthermore, group I experienced a lower incidence of total (16% versus 36%) and severe (0% versus 11%) grades of intraventricular hemorrhage (p less than 0.05). This study suggests that the antenatal use of vitamin K may result in a reduction and severity of intraventricular hemorrhage in the neonate less than 1500 gm.

Blood Coagulation↗
PubMed1988

A randomized study of antibiotic therapy in idiopathic preterm labor.

A randomized study was undertaken to test the effects of antibiotics as an adjunct to established methods of tocolysis. One hundred fifty patients with cervical dilation of 1 cm or more and no clinically identifiable cause for preterm labor qualified for the study. Fifty-three (35%) received 500 mg ampicillin orally every 6 hours, 50 (33%) received 500 mg erythromycin orally every 6 hours, and 47 served as controls. Antibiotics were prescribed for 10 days, and the treatment was not altered by the results of cervical cultures. Of these 150 patients, 16 (11%) had positive amniotic fluid cultures. The pregnancies with positive amniotic fluid culture were characterized by significantly less time gained after admission (2.6 versus 28.7 days) and lower birth weight (1262 versus 2470 g) than in those with negative cultures. Histologic studies of the placenta revealed chorioamnionitis in 22 (16%) of 134 patients with negative amniotic fluid cultures; these pregnancies were associated with less time gained after admission (12.5 versus 31.9 days) and lower birth weight (1680 versus 2618 g) compared with pregnancies without histologic chorioamnionitis. In patients with similar gestational age and cervical dilation, the adjunctive use of antibiotic therapy resulted in a statistically significant delay from admission to delivery (30 versus 17 days). In cases of negative amniotic fluid cultures, cervical colonization with group B streptococcus and/or Gardnerella vaginalis increased the risk of prematurity, which improved significantly when ampicillin was given.

Adolescent↗
PubMed1988

Elevated maternal serum alpha-fetoprotein in triploidy.

We report two cases of greatly elevated maternal serum alpha-fetoprotein (MSAFP) in pregnancies associated with a triploid fetus. The concentration of AFP in amniotic fluid and fetal serum was within the normal range. Determination of fetal karyotype provides the only definitive method of diagnosis. Prompt recognition is warranted in view of the high rate of severe preeclampsia in triploid pregnancy.

Adult↗
PubMed1988

ST segment depression in paired electrocardiograms and serum electrolytes in pregnant women receiving intravenous ritodrine.

Forty-three women admitted for preterm labor had electrocardiograms and serum potassium and glucose levels determined before and two and four hours after the initiation of intravenous ritodrine tocolysis. The ST segment depression found at two and four hours was significant but not dependent upon a fall in potassium or increase in the heart rate or glucose level. Such symptoms as chest pain and dyspnea were also not dependent upon potassium, glucose or heart rate changes. These findings support the concept of an intrinsic drug effect.

Blood Glucose↗
PubMed1988

Postcoital pneumoperitoneum.

Acute abdominal and shoulder pain in association with a pneumoperitoneum are common signs and symptoms of perforation of a hollow viscus. We report a case that describes the development of a postcoital pneumoperitoneum in an otherwise healthy postpartum patient. The literature is discussed, and supports this case as pneumoperitoneum in association with vigorous coital activity.

Adolescent↗
PubMed1987

Dose-dependent effects of prostaglandin D2 on hemodynamics, renal function, and blood gas analyses.

Dose-response effects of prostaglandin D2 (0.125, 0.25, 0.5, and 0.75 micrograms/kg/min) infused intravenously in pentobarbital-anesthetized dogs were studied with particular reference to renal, pulmonary, and systemic effects. Another group receiving the vehicle alone served as controls. Prostaglandin D2 administration resulted in a significant dose-dependent increase in renal artery flow, urine output, creatinine clearance, plasma renin activity, sodium excretion, potassium excretion, and pulmonary artery pressure. A significant decrease occurred in renal resistance and arterial PO2. There were no appreciable changes in mean arterial pressure, heart rate, hematocrit, platelet count, arterial pH, and PCO2. In the vehicle control group, all other parameters remained relatively stable, except for some increase in the mean arterial pressure, plasma renin activity, and potassium excretion. The results of this study suggest that prostaglandin D2 administered intravenously at levels lower than those required to produce adverse pulmonary and systemic effects will improve the renal blood flow and function.

Animals↗
PubMed1987

A prospective randomized study of the aggressive management of early labor.

The aggressive management of early labor has been suggested as a means to lower the cesarean section rate for dystocia. The aim of our study was to prospectively evaluate a protocol of early intervention in primigravid women with infrequent uterine contractions during early labor in relation to the course of labor, the cesarean section rate, and the perinatal morbidity. In our population the active management of labor did not alter the mode of delivery or the perinatal outcome. Furthermore, the course and duration of labor were not significantly different between the management and control groups.

Adult↗
PubMed1987

A group B streptococcal extract reduces neutrophil counts and induces neutrophil aggregation.

The possibility that group B streptococci (GBS) may induce neonatal neutropenia by promoting neutrophil aggregation and the entrapment of aggregates in the lung was studied in vivo and in vitro utilizing a cell free GBS extract [(GBS)-trichloroacetic acid (TCA)]. The intravenous infusion of the extract into neonatal lambs induced reductions of circulating white blood cells (0 time, 3.1 X 10(3)/mm3 +/- 0.5 versus 2.2 X 10(3)/mm3 +/- 0.7) 5 min after infusion (p less than 0.01). At necropsy these lambs had prominent accumulation of polymorphonuclear leukocytes in their pulmonary interstitium. Subsequently, neutrophil aggregation was studied by incubating GBS-TCA in human serum or phosphate-buffered saline with subsequent addition to human polymorphonuclear leukocytes in an aggregometer. GBS-TCA incubated in human serum induced prompt polymorphonuclear leukocyte aggregation (mean delta T 12.3% +/- 2.8 in human serum versus delta T 2.5% +/- 2.1 in phosphate-buffered saline, p less than 0.001). Preincubation of GBS-TCA followed by incubation in human serum with human GBS hyperimmune IgG significantly reduced aggregation (GBS-TCA in serum mean delta T 14.9 +/- 2.44 versus 5.42 +/- 1.80, p = 0.002). Cell-free GBS products may induce polymorphonuclear leukocyte aggregation in the presence of whole serum. This phenomenon might contribute to the pulmonary injury experienced by infants with GBS pneumonia and sepsis.

Animals↗
PubMed1987

Platelet inhibitory activity in placentas from normal and abnormal pregnancies.

Retroplacental blood flow requires inhibition of coagulation in the absence of an endothelial lining. We confirmed that trophoblast releases an inhibitor of platelet aggregation which functions via degradation of adenosine diphosphate. This inhibitor appears to be deficient in some pregnancies with abruptio placentae and intrauterine growth retardation. Unimpeded retroplacental blood flow may depend upon the local inhibition of platelet aggregation. Placental tissue contains an inhibitor of platelet aggregation which appears to be an adenosine diphosphatase distinct from heat-stable alkaline phosphatase. Placental tissue from patients with abruptio placentae contains abnormally low amounts of this enzyme.

Abruptio Placentae↗
PubMed1986

Psychiatric rehabilitation: past myths and current realities.

Psychiatric rehabilitation treatment has a unique and complementary contribution to make to the treatment of persons with a severe psychiatric disability. However, the development of the psychiatric rehabilitation field, and the adoption of its philosophy and techniques by mental health agencies, has been hampered by past myths. Research carried out in the 1960s and 1970s has exposed these myths as a part of the past, no longer relevant to the present practice of rehabilitating persons with severe psychiatric disabilities.

Combined Modality Therapy↗