Edgar O. Horger

Plasma fibronectin levels in preeclampsia: A possible biochemical marker for vascular endothelial damage

Fibronectin is a plasma glycoprotein which is involved in coagulation, platelet function, tissue repair, and the vascular endothelial basement membrane. We have found plasma fibronectin concentrations to be elevated in a group of preeclamptic patients. This finding is consistent with other evidence for a role of the vascular endothelium in preeclampsia.

Prenatal Diagnosis of Cystinosis

Abstract We diagnosed cystinosis in an 18-week-old fetus on the basis of an increased content of nonprotein cystine in cultured amniotic-fluid cells. These cells did not contain cystine crystals, a...

Effectiveness of 1% lidocaine dorsal penile nerve block in infant circumcision

A prospective, controlled, double-blinded investigation was conducted to evaluate whether infants undergoing circumcisions with 1% lidocaine dorsal penile nerve blocks experienced decreased stress as compared with those receiving saline solution injections or no injections. Stress was measured in terms of pulse rate and oxygen saturation on a pulse oximeter. A subjective grading scale was also developed to measure infant irritability. The total number in the study was 51 with 23 infants in the lidocaine group, 21 in the saline solution group, and 7 in the no injection group. The results of the study revealed an average increase of 28.8% in the pulse rate above baseline for the control infants (p less than 0.001) versus no significant change in the lidocaine group. The average oxygen saturation of the control groups decreased by 5.6% from baseline (p less than 0.001), and that of the lidocaine group decreased by 1.0%, which was not a significant change. The subjective data were gained by using a grading scale of 1 to 6 with 1 being the least irritable infant and 6 being the most irritable infant. The physician evaluation gave an average rating of 4.2 to the control group versus 2.4 for the lidocaine group (p less than 0.001). The nursing evaluation during the procedure gave an average rating of 4.2 to the control group versus 2.3 to the anesthetized group (p less than 0.001). The subjective evaluation of infants before and after the procedure was not significantly different. There were no major complications in any of the groups.

Management of sickle hemoglobinopathies in pregnant patients

During the past decade, pregnancy outcome has improved among patients with sickle hemoglobinopathies. The role of prophylactic exchange transfusion in this improvement is uncertain. This study reviews the experience in 64 pregnancies managed at the Medical University Hospital over a 7 year period. Prophylactic exchange transfusion was not associated with improved pregnancy outcome and was associated with significant antibody formation. Exchange transfusion may best be reserved as a treatment modality when infection, crisis, or symptomatic anemia occurs in patients with a sickle hemoglobinopathy.

Automated erythrocytopheresis for sickle cell anemia during pregnancy

Automated erythrocytopheresis allows for selective removal of erythrocytes from whole blood by means of extracorporeal centrifugation and separation. Remaining cellular and liquid fractions are returned to the patient, along with donor erythrocytes. Supertransfusion with the use of plasmapheresis and simultaneous direct transfusion of erythrocytes increases the hematocrit while maintaining stable intravascular volume. This technique was used in the prophylactic exchange transfusion in eight pregnant women with sickle hemoglobinopathies. Two patients required repeat procedures 7 and 13 weeks later for hemoglobin A concentration or hematocrit less than 25%. The results from the first five pregnancies are detailed. All pregnancies were carried to term, with the delivery of healthy infants. There was no fetal or neonatal morbidity, and the only maternal morbidity was a case of puerperal endometritis. Erythrocytopheresis has been established as a flexible and useful means of managing gravid patients with sickle hemoglobinopathies.

Ultrasound in the diagnosis of fetal malformation

The prenatal diagnosis of congenital malformations through ultrasonography leads to major considerations regarding subsequent pregnancy management. These diagnoses are useful in reaching decisions concerning elective abortion, planning the time and method of delivery, and arranging for appropriate support personnel. Although the possibility of fetal anomaly must be considered in all obstetric ultrasonograms, review of 56 malformations diagnosed prenatally found that 31 were studied because of uterine size incompatible with gestational age. Polyhydramnios was associated with 24 of these cases. Multiple fetal abnormalities were found postnatally in 24 of the 51 cases in which one or more malformations were diagnosed through ultrasonography, emphasizing the need for careful counseling and follow-up examination.The prenatal diagnosis of congenital malformations through ultrasonography leads to major considerations regarding subsequent pregnancy management. These diagnoses are useful in reaching decisions concerning elective abortion, planning the time and method of delivery, and arranging for appropriate support personnel. Although the possibility of fetal anomaly must be considered in all obstetric ultrasonograms, review of 56 malformations diagnosed prenatally found that 31 were studied because of uterine size incompatible with gestational age. Polyhydramnios was associated with 24 of these cases. Multiple fetal abnormalities were found postnatally in 24 of the 51 cases in which one or more malformations were diagnosed through ultrasonography, emphasizing the need for careful counseling and follow-up examination.

Ultrasound and the Prenatal Diagnosis of Congenital Anomalies: A medicolegal perspective

A survey was conducted to determine the frequency of obstetric ultrasonography use, its value in detecting fetal anomalies, and the frequency with which ultrasound errors lead to malpractice allegations. Questionnaires were sent to one-fifth of The American College of Obstetricians and Gynecologists Fellows in District IV and were returned by 68%. Ultrasound equipment is housed in the offices of nearly 64% of the responding obstetricians, and ultrasound scanning is used in 69% of pregnancies in the district. Over 67% of obstetricians have detected one or more fetal anomalies by ultrasonography, and over 51% have overlooked anomalies. Ultrasound-related lawsuits were reported by 4.7% of the respondents.

Practice activities and career satisfaction among fellows of the South Atlantic Association of Obstetricians and Gynecologists.

OBJECTIVE The practice activities and career satisfaction of obstetricians and gynecologists in private practice were compared with those in a teaching faculty setting. STUDY DESIGN The 475 fellows of the South Atlantic Association of Obstetricians and Gynecologists were surveyed; 314 responses (66.1%) were received. Private practice and teaching faculty respondents were compared regarding practice description, factors influencing choice of practice type, practice activities, and career satisfaction. Data were examined by chi 2 testing and analysis of variance. RESULTS Patient care involvement was the primary influence in practice choice by 86.0% of private practitioners; interest in teaching was the most important single factor for 58.2% of the teaching faculty. Significantly more teaching faculty than private practitioners had done research work during residency (81.2% vs 53.4%, p < 0.001). There were no differences regarding presentations at medical meetings during residency or publications from work performed during residency. The private practice group recorded more nights on call and more scheduled time off. The teaching faculty showed more publications, continuing medical education credits, hours worked per week, and medical meeting attendance. There were no differences in vacation days, malpractice charges, or expert witness appearances. The group showed no significant differences in their ratings of career satisfaction, but more of the teaching faculty group would elect again to enter obstetrics and gynecology if completing school today (82.4% vs 55.3%, p < 0.001). CONCLUSION Professional activities of private practice physicians differ from those of teaching faculty physicians. The great majority of both groups are satisfied with their careers.

Low serum α-fetoprotein level and sex chromosome monosomy

A case of 45,X karyotype in association with low maternal serum α-fetoprotein levels is reported. Previous cases of trisomy have been linked to low α-fetoprotein levels. Cases of sex chromosome aneuploidy may be included in the group of aneuploidies with low levels of maternal serum α-fetoprotein.

Use of indigo carmine for twin amniocentesis and its effect on bilirubin analysis

Indigo carmine is used commonly to mark the first-entered amniotic sac in twin amniocenteses. The presence of this dye significantly affects amniotic fluid bilirubin analysis. A method of chloroform extraction is recommended for determination of bilirubin in amniotic fluid previously contaminated by indigo carmine.