Donald S. Gromisch

Teratogenicity of cocaine in humans

To study teratogenicity of cocaine in humans, we studied three groups of pregnant women and their offspring: group 1, 50 women who abused cocaine only; group 2, 110 women who were polydrug abusers; and group 3, 340 who were drug free. All three groups were similar for socioeconomic status, cigarette smoking, and ethnicity. Maternal age of group 1 was similar to that of group 3, but group 2 mothers were significantly older. Gravidity was significantly higher in groups 1 and 2 compared with group 3. No statistical difference was found in spontaneous abortion rate among the three groups, but the stillbirth rate was significantly higher in group 1 (chi 2 = 6.89, P less than or equal to 0.01). All stillbirths were related to abruptio placentae. Birth weight, length, and head circumference were significantly decreased in infants in groups 1 and 2 compared with group 3 (P less than or equal to 0.0001), but no statistical difference was found between groups 1 and 2. The congenital malformation rate was significantly higher in group 1 compared with group 3 (chi 2 = 7.07, P less than or equal to 0.01). We conclude that cocaine abuse in humans significantly reduces weight of the fetus, increases the stillbirth rate related to abruptio placentae, and is associated with a higher malformation rate.

Symptomatic cardiac dysfunction in children with human immunodeficiency virus infection

Eight children with human immunodeficiency virus (HIV) infection had symptomatic cardiac dysfunction. The median age was 1.4 years (range 0.2 to 7.9 years). All had hepatosplenomegaly, fever, pneumonia with tachypnea, and tachycardia ascribed to infection and anemia. An S3 gallop was present in six of eight. All had normal creatine phosphokinase values. Chest x-rays did not aid in the diagnosis of cardiac dysfunction. ECG showed flattened T waves in five of eight with left ventricular hypertrophy, right ventricular hypertrophy, or both in seven of eight. Results of echocardiography showed decreased left ventricular function in all eight, despite anemia, with dilated left ventricular myopathy in six, concentric left ventricular wall thickening in two of eight, an enlarged right ventricle in two, and pericardial fluid in three. Medical therapy improved cardiac function in all. All patients subsequently died of noncardiac causes. Results of autopsies on four of eight patients showed focal myocarditis in two (with cytomegalovirus inclusions in one) and dilated cardiomyopathy in two others. We conclude: (1) Preexistent hepatosplenomegaly, fever, infection, and anemia result in physical findings that mimic findings of heart failure, thereby masking the occurrence of cardiac dysfunction; (2) an S3 gallop may indicate the presence of impaired heart function when other clinical signs are masked; (3) confirmation of cardiac compromise may be accomplished by noninvasive evaluation with echocardiography and (4) medical therapy can improve cardiac dysfunction in HIV-infected children.

Light (phototherapy)-induced riboflavin deficiency in the neonate

Phototherapy with blue light decomposes riboflavin, which has a maximum absorption at 450 nm. A study was designed to determine whether riboflavin deficiency developed in neonates who received phototherapy for moderate hyperbilirubinemia. Twenty-one infants with normal erythrocyte glucose-6-phosphate dehydrogenase activity were investigated. Five infants with moderate hyperbilirubinemia who did not require phototherapy served as the controls. Riboflavin deficiency was determined from the degree of saturation of erythrocyte glutathione reductase, a method shown to reflect riboflavin nutritional status in the neonate. Sixteen of 21 infants who were exposed to phototherapy developed riboflavin deficiency; all who had phototherapy for 49 hours or more developed the deficiency. That the concentration of serum bilirubin or the duration of hyperbilirubinemia was not a factor is supported by the fact that none of the controls became deficient. This observation may have important metabolic and clinical consequences for the neonate.

Incidence of major congenital malformations in offspring of alcoholics and polydrug abusers

The incidence of major congenital malformations was compared in the offspring of mothers who abused alcohol only (group I), versus mothers who abused alcohol and opiates (group II) during pregnancy. In group I the percent of patients with malformations was 33, where as in group II it was 14. The prevalence of fetal alcohol syndrome was higher in blacks than Hispanics. Independent of race the alcohol-opiate combination seems less teratogenic to the fetus than alcohol alone.

Erythroblastosis fetalis due to anti-S antibody

Summary Hemolytic disease of the newborn infantdue to isosensitization by the S blood group factor in an Rh-positive mother resulted in postnatal hyperbilirubinemia and a “late anemia” syndrome in the infant. In our case, as well as in two of the three previously reported cases, the isosensitized pregnancy followed previous blood transfusions.

The improvement of faculty teaching through evaluation: A follow-up report

Abstract A follow-up on a program to improve the quality of faculty teaching through evaluation has been presented. Sixteen faculty members who participated in an evaluation, learned the results of that evaluation, and then were reevaluated demonstrated statistically significant improvement in their overall teaching profiles and in four of the five separate teaching categories.

Effect of erythrocyte glucose-6-phosphate dehydrogenase (G-6-PD) deficiency on light-induced riboflavin deficiency in the neonate.

Summary Five neonates with moderate hyperbilirubinemia and G-6-PD deficiency underwent phototherapy for periods of 48 to 120 hr. No biochemical evidence of ribo-flavin deficiency resulted. This contrasts with evidence of riboflavin deficiency observed in 15 of 16 infants with moderate hyperbilirubinemia but no G-6-PD deficiency who were exposed to light for periods of 48 hr or longer. The elevated FAD levels of the erythrocyte of the G-6-PD-deficient infants may have protected them from the light-induced vitamin deficiency.

Improvement of faculty teaching performance in a department of obstetrics and gynecology by student evaluation.

The primary purpose of a faculty evaluation program is to upgrade the over-all quality of teaching and to identify the strengths and weaknesses of the individual teacher. Effective medical educators can thereby be suitably identified by objective and subjective criteria. Improvement of faculty teaching performance enhances student learning and can improve recruitment into our discipline.

Recurrent Meningitis Due to Staphylococcus aureus Secondary to a Dermoid: Case Report and Review

a leukocyte count of 2,840 cells/cu mm, 78% polymorphonuctear leukocyte. The spinal fluid contained a protein of 315 mg/ dl, a glucose of 9 mg/ dl, with a Mood glucose level of 187 mg/dl. Lactic dehydrogenase was 88 ~.1,11. Gram stain revealed gram-positive cocci in clusters. Counter-immuno~l~ctrc~phc~resis (CIE) was positive for Streptococcus pneumonia. Hyland Antigen ~ounter-imrnunt~~lectrophoresis apparatus was employed using standard barbital buffer (pH 8.43), disposable buffer wells and standard agar electrophoresis for the CIE (Hyland, Deerfield, IL, and Omniserum from the Staten Island Serum Institute, Copenhagen, Denmark). Blood, urine, and spinal fluid cultures were obtained and therapy with intravenous ampicillin 300 mg/kg/day and chloramphenicol 100 mgfkg/day was instituted. Forty-eight hours after admission, Staphylococcus aureus, sensitive to methicillin, was identified in the spinal fluid culture. Intravenous nafcillin therapy, 200 mg/kg/day, was started, and both arrxpicillin and chlnrarr~pheniccrl were discontinued. A repeat lumbar puncture, 48 hours after admission, revealed 990 l~ukocyt~s/~cu mm, 32% pc~ly_ morphonuclear luekocytes, and 68% lymphocytes, a protein of 65 and a of 79 mg/dl (with a blood glucose concentration of 96 mg/di). The spinal fluid culture again grew S. oMf~M. Blood and urine cultures showed no growth. The patient imcimicaily and Quid obtained on day 15 of admission was sterile. Immunoiogic studies done at that time showed an IgG of 874 mg/di, IgA of 134 mg/dl, and IgM of 192 mg/dl (normal for age). The chemotactic index, random initial migration, and the nitroblue t~tra~c~~iu~n tests were within normal limits. Nafcillin therapy was continued for

Leukocyte and Neutrophil Counts in Healthy Puerto Rican Children and Children with Acute Appendicitis

Blood counts were performed on 107 healthy Puerto Rican children aged 1 to 5 years to establish normal ranges of leukocyte and neutrophil counts and were compared with preoperative counts in 30 Puerto Rican children with acute appendicitis and also with values published in healthy black and white children of the same age. In healthy Puerto Rican patients and in patients with acute appendicitis, the mean leukocyte and neutrophil counts were significantly higher than in blacks.