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1.
Science ; 180(4089): 963-4, 1973 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-4706685

RESUMO

The number of primordial germ cells in embryos of known genotypic sex was the same in XY males and XX females until the gonad became recognizable as testis or ovary. It has been claimed that the heterogametic sex chromosome causes the gonad to differentiate as a testis in mammals and as an ovary in birds as a result of earlier and more mitoses. This claim was not supported in the present study where a sex difference in numbers of germ cells was first noted during differentiation of oocytes in the XX embryos.


Assuntos
Peixes/embriologia , Células Germinativas , Análise para Determinação do Sexo , Animais , Diferenciação Celular , Feminino , Genótipo , Masculino , Ovário/embriologia , Fenótipo , Testículo/embriologia
2.
Biochim Biophys Acta ; 712(2): 356-64, 1982 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-7126609

RESUMO

To study the regulation of lamellar body acidic glycerophospholipid biosynthesis, fetal rabbit lung tissue obtained on day 23 of gestation was maintained in vitro. Tissues were cultured in serum-free medium with and without the addition of cortisol, thyroxine or a combination of both hormones. The addition of cortisol plus thyroxine to the medium resulted in the formation of lamellar bodies containing increased amounts of phosphatidylglycerol and decreased amounts of phosphatidylinositol. The addition of myo-inositol to culture medium containing cortisol plus thyroxine suppressed the incorporation of [14C]glycerol into both phosphatidylglycerol and bis(monoacylglycero)phosphate and enhanced the incorporation of [14C]glycerol into phosphatidylinositol. The effect of myo-inositol on the radioactive labeling of these lamellar body acidic glycerophospholipids was rapid, and was half-maximal at myo-inositol concentrations of approximately 0.10 mM.


Assuntos
Feto/metabolismo , Pulmão/metabolismo , Fosfatidilgliceróis/biossíntese , Animais , Feminino , Glicerol/metabolismo , Hidrocortisona/farmacologia , Inositol/farmacologia , Técnicas de Cultura de Órgãos , Gravidez , Coelhos , Tiroxina/farmacologia , Fatores de Tempo
3.
FEBS Lett ; 407(1): 78-84, 1997 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-9141485

RESUMO

Because of its ability to integrate chromosomally and its non-pathogenic nature, adeno-associated virus (AAV) has significant potential as a human gene therapy vector. Here we investigate the maximum amount of DNA which can be inserted into the AAV genome and still allow efficient packaging into an infectious virus particle. Altered wild-type AAV genomes were constructed with inserts, which increased in size by 100 bp, ligated at map unit 96. These large wild-type-plus genomes were able to replicate and produce infectious virus, at levels slightly reduced but comparable to normal sized wild type, until the insert size reached 1 kb. These data indicate that the maximum effective packaging capacity of AAV is approximately 900 bp larger than wild type, or 119%. Furthermore, it is demonstrated that these large AAV genomes are able to latently infect cells by chromosomal integration as does wild-type AAV. These data suggest that therapy vectors carrying a foreign gene of 900 bp or less can be generated from AAV, by ligation into non-essential locations, and result in a recombinant AAV virus with a fully wild-type phenotype. Such wild-type-plus AAV vectors will have both advantages and disadvantages over defective recombinant AAV virus - the most important advantages being the ease in which high titers of infectious virus can be generated and the ability to specifically integrate within chromosome 19. Once the concern subsides over the presence of wild-type AAV in clinical applications, wild-type AAV vectors may find specific application niches for use in human gene therapy.


Assuntos
DNA Recombinante , Proteínas de Ligação a DNA , Dependovirus/crescimento & desenvolvimento , Terapia Genética/métodos , Vetores Genéticos , Células Cultivadas , Cromossomos Humanos Par 19 , DNA Helicases , Dependovirus/genética , Estudos de Avaliação como Assunto , Humanos , Parvoviridae , Transativadores , Latência Viral
4.
FEBS Lett ; 397(1): 97-100, 1996 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-8941722

RESUMO

The adeno-associated virus (AAV) terminal repeats (TR) are cis required, and the AAV encoded Rep78 protein is trans required, for AAV DNA replication. The Rep78 protein recognizes and interacts with at least three regions within the TR DNA. The major binding site, with the highest affinity for Rep78 binding, is within the TR stem (nt 36-16) and includes the 'core' GAGC trimer (GAGC3, nt 33-22; Fig. 2) sequence. In this study mutations were made within the GAGC trimer and these mutants assayed for their ability to allow for AAV double stranded (ds DNA, prepackaging DNA replication), and single stranded DNA (ss DNA, due to virion packaging) replication. Here, it is shown that when the two inside GAGC motifs are mutated, with only motif no. 1 left intact (see Fig. 2), the resulting AAV (mutA) genome was significantly defective for both ds DNA (17% of wild type) and ss DNA (9%). If the TRs contained only the two outside motifs intact (mutB), motifs no. 1 and 2, the AAV genome had a significant but reduced level of both ds (50%) and ss (34%) DNA replication. Finally, if only the middle motif no. 2 was mutated, with motifs no. 1 and 3 left intact (mutC), the resulting DNA replication for both ds and ss forms was essentially wild type (80% that of wild type). These data suggest that the GAGC trimer plays a role in AAV DNA replication, and that GAGC motif no. 3 is the most important of the three motifs for both ds and ss DNA replication.


Assuntos
Replicação do DNA , DNA Viral/metabolismo , Proteínas de Ligação a DNA/metabolismo , Dependovirus/metabolismo , Sequências Repetitivas de Ácido Nucleico , Proteínas Virais/metabolismo , Replicação Viral , Sequência de Bases , Sítios de Ligação , DNA de Cadeia Simples/biossíntese , DNA Viral/biossíntese , DNA Viral/química , Dependovirus/genética , Genoma Viral , Dados de Sequência Molecular , Mutação , Transfecção
5.
Am J Med Genet ; 49(4): 422-7, 1994 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-8160737

RESUMO

Routine amniocentesis for advanced maternal age led to the prenatal diagnosis of a fetus with a karyotype of a 46,XX,del(2)(p21p22). At delivery the baby had holoprosencephaly as the major clinical finding, which has been associated with a deletion of band 2p21 in several other case reports. Chromosome studies of the parents showed a normal 46,XY karyotype in the father, and a balanced interstitial insertion 46,XX dir ins (11;2)(p15.1;p21p22) in the mother. Subsequent chromosome studies of other relatives documented a 23-year-old half-brother of the proposita with a partial trisomy for the segment deleted in the proposita. The half-brother showed the derivative chromosome 11 from the mother, resulting in a 46,XY,der(11)dup(2)(p21p22) karyotype. Major clinical findings include short stature, mild developmental delay, and behavior abnormalities. A half-sister of the proposita is also a balanced carrier of the dir ins (11;2) (p15.1;p21p22.2). The association of the deletion chromosome band 2p21 and the clinical finding of holoprosencephaly is further supported by the findings in this family.


Assuntos
Deleção Cromossômica , Cromossomos Humanos Par 11 , Cromossomos Humanos Par 2 , Família Multigênica , Adulto , Aberrações Cromossômicas , Feminino , Holoprosencefalia/genética , Humanos , Recém-Nascido , Cariotipagem , Masculino , Linhagem
6.
Obstet Gynecol ; 62(1): 41-4, 1983 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-6687929

RESUMO

The concentration of myo-inositol in the serum of pregnant women (21.4 microM) remained unchanged throughout pregnancy and was not significantly different from that in the serum of nonpregnant women (24.5 microM). myo-Inositol concentrations in mixed cord serum averaged 125 microM at midgestation. At term, the concentration of myo-inositol was 60.2 microM in the umbilical artery and 45.4 microM in the umbilical vein. In every umbilical cord examined, the ratio of myo-inositol concentration in umbilical artery to that in umbilical vein exceeded 1.0. Activity of a putative regulatory enzyme in the biosynthesis of myo-inositol from glucose, ie, glucose 6-P:inositol 1-P cyclase (cyclase), was measured in placenta, fetal lung, and fetal liver. In placenta at midgestation and at term, cyclase activity was 87.8 and 90.7 nmol X g-1 tissue X h-1, respectively. Cyclase activity in fetal lung and liver at midgestation was 54.6 and 54.4 nmol X g-1 tissue X h-1, respectively. The gestational decline in the concentration of myo-inositol in fetal serum may represent a decreasing availability of myo-inositol to the fetal lungs and could be important in the mechanism whereby the amounts of phosphatidylglycerol and phosphatidylinositol in lung surfactant are regulated during fetal lung development.


Assuntos
Sangue Fetal/análise , Feto/metabolismo , Homeostase , Inositol/sangue , Feminino , Sangue Fetal/enzimologia , Humanos , Mio-Inositol-1-Fosfato Sintase/metabolismo , Fosfatidilgliceróis/metabolismo , Fosfatidilinositóis/metabolismo , Gravidez , Surfactantes Pulmonares/análise
7.
Obstet Gynecol ; 78(3 Pt 2): 482-5, 1991 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-1870800

RESUMO

Landry Guillain-Barré Strohl syndrome complicating pregnancy is a rare occurrence, with only 31 cases previously reported in the obstetric literature. Cytomegalovirus as a potential etiologic agent has been documented in only two of these cases. In the past, symptomatic treatment of pregnant patients with severe and progressive symptoms has been associated with an unacceptably high rate of maternal morbidity and mortality. Recent studies have shown convincingly that plasmapheresis is the treatment of choice for nonpregnant patients acutely ill with Guillain-Barré syndrome, but data regarding its use in pregnancy are limited. We report three patients, two of whom had positive cytomegalovirus titers, in whom aggressive plasmapheresis prevented the need for ventilatory support and its inherent increase in maternal morbidity and mortality.


Assuntos
Plasmaferese , Polirradiculoneuropatia/terapia , Complicações na Gravidez/terapia , Adulto , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Gravidez , Transtornos Puerperais/terapia
8.
Obstet Gynecol ; 64(3): 353-8, 1984 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6205335

RESUMO

During a two-year period, 83 discolored fluids (77 green, six brown) were obtained during genetic amniocenteses of 1227 patients. When compared with case-matched control subjects, those patients with discolored fluid had no differences in the incidence of spontaneous abortions, abnormal fetal karyotypes, infant abnormalities, occurrence of preterm labor, or requirement for delivery by cesarean section. The only statistically significant difference between control and test patients was that one in 83 versus 32 of 83 reported bleeding before amniocentesis (P less than .001). Both green and brown fluids had spectrophotometric peaks at 400 to 408 nm, similar to that reported for meconium. However, discolored fluid had measurable free hemoglobin, whereas meconium-stained fluid from term gestations did not, suggestive of an in utero hemorrhage. Further, when fetal blood, in concentrations calculated to yield a hemoglobin content similar to those measured in the discolored fluids, was incubated in amniotic fluid the spectrophotometric peak and absorbance units at 400 to 408 nm were similar to those for the discolored fluids. These observations are supportive of the hypothesis that blood breakdown products from an episode of intrauterine bleeding are responsible for the discolored fluid. Discolored amniotic fluid during second trimester, as an isolated finding, does not prognosticate a poor pregnancy outcome.


Assuntos
Amniocentese , Líquido Amniótico/análise , Testes Genéticos , Feminino , Sangue Fetal , Hemoglobina Fetal/análise , Humanos , Gravidez , Segundo Trimestre da Gravidez , Espectrofotometria
9.
Obstet Gynecol ; 64(3 Suppl): 21S-25S, 1984 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-6472745

RESUMO

Two pregnancies complicated by severe Rh-isoimmunization and the development of sinusoidal fetal heart rate patterns immediately after intrauterine transfusions are presented. An intermittent sinusoidal pattern resolved, in one fetus, with sonographic evidence of delayed but complete absorption of transfused red blood cells. In contrast, the second fetus exhibited a continuous sinusoidal pattern coincident with cardiac decompensation detected by echocardiography, severe anemia, and failure to absorb transfused red blood cells. Possible pathophysiologic mechanisms for the development of sinusoidal patterns after fetal transfusions are discussed. It is concluded that a sinusoidal fetal heart rate pattern may occur after fetal transfusion and that the subsequent course of this pattern provides meaningful information about fetal condition as well as the success of intrauterine transfusion.


Assuntos
Transfusão de Sangue Intrauterina/efeitos adversos , Eritroblastose Fetal/terapia , Coração Fetal/fisiopatologia , Adolescente , Adulto , Ecocardiografia , Eritroblastose Fetal/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Gravidez , Prognóstico
10.
Obstet Gynecol ; 82(1): 37-42, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8515923

RESUMO

OBJECTIVE: To identify factors influencing pregnancy management decisions following identification of a perinatal lethal condition. METHODS: One hundred thirty pregnancies with perinatal lethal conditions diagnosed before 24 weeks' gestation were examined. Information collected included demographic data, estimated gestational age at presentation, referral indication, nature of the defect, and performance of autopsy. RESULTS: Eighty-seven families elected to abort affected pregnancies and 43 elected to continue. Demographic factors did not influence decision making, nor did gestational age at diagnosis or referral indication. When comparing the diagnosis of one lethal condition with diagnoses of all other lethal conditions, pregnancies with a central nervous system defect or severe urinary tract defect were more often aborted; those with unexplained severe oligohydramnios and twin pregnancies in which at least one twin was affected were more often continued. Autopsy was obtained much more often in pregnancies that were aborted than in those that were continued. CONCLUSION: The type of defect correlates well with the pregnancy management decision. It is important to consider the type of malformation, certainty of the diagnosis, and level of medical understanding when counseling patients after the diagnosis of a lethal fetal defect. Because many patients will continue pregnancies diagnosed with a perinatal lethal condition, the physician should convey understanding and acceptance of a decision not to abort such a pregnancy. The importance of follow-up testing, including autopsy when appropriate, should be stated clearly.


Assuntos
Aborto Eugênico , Anormalidades Congênitas/diagnóstico , Doenças Genéticas Inatas , Gestantes , Diagnóstico Pré-Natal , Aborto Espontâneo/etiologia , Adulto , Tomada de Decisões , Feminino , Morte Fetal , Doenças Fetais/diagnóstico , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Gravidez , Gravidez Múltipla , Fatores Socioeconômicos
11.
J Soc Gynecol Investig ; 1(1): 89-96, 1994.
Artigo em Inglês | MEDLINE | ID: mdl-9419754

RESUMO

OBJECTIVE: We studied the relation between epidermal growth factor (EGF)/epidermal growth factor receptor (EGFR) and CA125 production in WISH cells. METHODS: We investigated quantitatively and immunohistochemically EGF-stimulated CA125 release from WISH cells and the effect of EGF on CA125 phosphorylation. RESULTS: Immunohistochemical staining demonstrated that CA125 and EGFR expression on the plasma membrane of the WISH cells was closely correlated with cell density. The WISH cell monolayers (day 4) stained for CA125 in both the cytoplasm and plasma membrane. By day 8, cells began to form clumps in the surrounding monolayer that were positive for membrane-associated CA125 and EGFR, while the monolayer was almost negative for both molecules. Four-day and 8-day cells exposed to EGF demonstrated a loss of both CA125 and EGFR staining. Epidermal growth factor increased the secreted CA125 levels by 50% in day-4 cells but had no effect on day-8 cells. CA125 from WISH cells was phosphorylated, and EGF further enhanced this phosphorylation.


Assuntos
Âmnio/imunologia , Antígeno Ca-125/fisiologia , Fator de Crescimento Epidérmico/farmacologia , Ovário/imunologia , Âmnio/citologia , Antígeno Ca-125/análise , Linhagem Celular , Feminino , Humanos , Imuno-Histoquímica , Fosforilação , Taxa Secretória/efeitos dos fármacos
12.
Clin Perinatol ; 9(2): 363-80, 1982 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-6749377

RESUMO

All physicians responsible for the care of gravidae at high risk for preterm labor and delivery must be expert in the management of these pregnancies. Only a fraction of women who present in labor remote from term are candidates for long-term tocolysis. Whatever treatment regimen is utilized, the clinician must be familiar with their risks as well as their benefits. The majority of women who present with preterm labor will require delivery or will deliver despite efforts to the contrary. If delivery is imminent or indicated, intensive intrapartum monitoring of these fetuses, especially those weighing less than 1500 gm, is mandatory. The mother should be transferred to a facility that contains both expert obstetric care and a neonatal intensive care unit staffed with individuals experienced in the management of these very low birth weight infants. Attempts at pharmacologic induction of lung maturation should be reserved for those situations in which: (1) the fetal membranes are intact, (2) the fetal lungs are likely to be immature, (3) delivery of the infant may be delayed without undue risk for 48 hours following initiation of therapy, and finally, (4) the informed consent of the parents has been obtained. (By the same token, the probable efficacy of glucocorticoids should not serve as license to deliver the preterm infant.) Preterm infants are viable, even at 25 to 26 weeks of gestation, provided that labor and delivery are managed expertly. When vaginal delivery is contemplated, labor, if induced, should not be forceful. Fetal heart rate and uterine contractions should be monitored continuously. Evidence of fetal jeopardy must be dealt with expeditiously. Nontraumatic delivery, including the liberal use of cesarean section, into the hands of an experienced neonatologist will reduce the number of asphyxiated premature infants and, therefore, the risk of hyaline membrane disease. For the very low birth weight infant presenting as a breech, abdominal delivery is recommended. It is important that the uterine incision, regardless of type, be large enough to allow for nontraumatic delivery of the infant. If greater improvements in the survival and outcome of low birth weight infants are to continue, it is mandatory that there be close collaboration not only between obstetrician and pediatrician, but also between all physicians and nursing staff who care for this group of high-risk patients.


Assuntos
Monitorização Fetal , Trabalho de Parto Prematuro/terapia , Analgesia , Anestesia Obstétrica , Betametasona/uso terapêutico , Peso Corporal , Cesárea , Dexametasona/uso terapêutico , Feminino , Sangue Fetal/análise , Coração Fetal/fisiopatologia , Maturidade dos Órgãos Fetais/efeitos dos fármacos , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Apresentação no Trabalho de Parto , Pulmão/efeitos dos fármacos , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez
13.
J Matern Fetal Neonatal Med ; 13(6): 408-13, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12962267

RESUMO

OBJECTIVE: To determine whether the fetal admission test is predictive of intrapartum complications. METHODS: We studied the fetal heart rate tracings of women in spontaneous labor at 37-42 weeks' gestation from 1 November 2001 to 31 March 2002. The study population was subdivided based on reactivity defined as > or = 15 beats/min for > or = 15 s, reactivity redefined as > or = 10 beats/min for > or = 10 s, variability, presence of late and/or variable decelerations, and reassuring fetal admission test; and compared for various labor outcome variables. Student's t test, the chi2 test and Fisher's exact test were used for analysis. RESULTS: A total of 426 women met our inclusion criteria. There were no differences between groups when compared for maternal age, parity, gestational age, birth weight, labor analgesia and length of labor. Irrespective of the definition of reactivity, women with a non-reactive fetal admission test were more likely to be delivered by Cesarean section, to have fetal distress resulting in Cesarean section and to have a longer neonatal hospital stay. In addition, redefining reactivity improved the specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio with regard to development of fetal distress. Similar results were obtained when variability and decelerations were used as criteria for comparisons. CONCLUSION: The fetal admission test is useful in predicting the absence of intrapartum fetal distress irrespective of the criterion used for evaluation. Redefined reactivity appears to be most predictive of intrapartum fetal distress.


Assuntos
Cardiotocografia , Cesárea/estatística & dados numéricos , Sofrimento Fetal/diagnóstico , Viabilidade Fetal , Trabalho de Parto , Adulto , Estudos de Coortes , Feminino , Sofrimento Fetal/terapia , Humanos , Tempo de Internação/estatística & dados numéricos , Funções Verossimilhança , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
J Matern Fetal Neonatal Med ; 12(2): 118-22, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12420842

RESUMO

OBJECTIVE: To determine whether in utero exposure to magnesium sulfate was associated with increased neonatal morbidity and mortality among premature neonates, and secondarily to determine the relationship, if any, between duration of magnesium sulfate exposure and neonatal morbidity and mortality. METHODS: We studied 401 neonates at our institution who were born between 23 and 34 weeks' gestation following preterm labor or preterm premature rupture of membranes. The population was stratified by exposure to magnesium sulfate and compared by various neonatal outcome variables. Similarly, the magnesium-exposed population was stratified by duration of exposure and compared for various neonatal outcome variables. Student's t test, chi2 test, Fisher's exact test and logistic regression were used for analysis. RESULTS: A total of 190 neonates were exposed to magnesium sulfate, while 211 neonates were not. The magnesium-exposed neonates were delivered at a significantly lower gestational age compared to the unexposed neonates (28.2 +/- 3.0 vs. 29.3 +/- 3.1 weeks, p = 0.001). Univariate analysis revealed no differences between groups with regard to rates of respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosus, histological and clinical chorioamnionitis, neonatal sepsis or neonatal death. However, magnesium-exposed neonates were more likely to have received antibiotics (71.6% vs. 45.0%, p = 0.0001) and antenatal steroids (95.8% vs. 61.6%, p = 0.0001), factors known to affect perinatal morbidity and mortality. Controlling for antenatal confounding factors, magnesium sulfate use was not independently associated with neonatal mortality (odds ratio (OR) = 0.66; 95% confidence interval (CI) = 0.28, 1.54; p = 0.34). Seventy-nine neonates were exposed to magnesium sulfate therapy for more than 24 h, while 111 neonates were exposed for 24 h or less. There were no significant differences between groups with respect to neonatal outcomes, with the exception of an increased rate of clinical chorioamnionitis in the group exposed to magnesium for more than 24 h (22% vs. 8.2%, p = 0.005). After adjusting for gestational age at delivery, magnesium sulfate exposure for over 24 h was independently associated with a 2.8-fold increased rate of clinical chorioamnionitis (OR = 2.8, 95% CI = 1.14, 6.90; p = 0.02). CONCLUSION: Prenatal exposure to magnesium sulfate was not associated with increased neonatal morbidity or mortality. However, prolonged exposure to magnesium sulfate may be associated with an increased risk of clinical chorioamnionitis.


Assuntos
Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Sulfato de Magnésio/efeitos adversos , Tocolíticos/efeitos adversos , Adulto , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , New York/epidemiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Resultado da Gravidez , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Estudos Retrospectivos
15.
J Reprod Med ; 33(7): 645-8, 1988 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-3172064

RESUMO

Autonomic hyperreflexia, a potentially life-threatening condition, can appear during labor, delivery or cesarean section in a woman with a spinal cord injury. A case of autonomic hyperreflexia in a parturient was managed with regional neural blockade.


Assuntos
Anestesia Obstétrica , Doenças do Sistema Nervoso Autônomo , Cesárea , Complicações do Trabalho de Parto/terapia , Complicações na Gravidez , Reflexo Anormal , Traumatismos da Medula Espinal , Traumatismos da Medula Espinal/complicações , Adulto , Doenças do Sistema Nervoso Autônomo/terapia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/terapia , Gravidez , Complicações na Gravidez/fisiopatologia , Reflexo Anormal/etiologia , Reflexo Anormal/terapia , Traumatismos da Medula Espinal/fisiopatologia
16.
J Clin Anesth ; 5(2): 154-7, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-7503809

RESUMO

A 23-year-old female was referred to the University of Arkansas for Medical Sciences at 32 weeks' gestation with a history of aortic stenosis following aortic valve replacement. Evaluation by echocardiography showed an approximately 90 mmHg transvalvular pressure gradient. Pregnancy progressed to 36 weeks' gestation without problem, at which time the patient underwent cesarean section with lumbar epidural anesthesia. Invasive hemodynamic monitors were used to assess cardiac performance and as a guide for anesthetic management. The impact of aortic stenosis on pregnancy is discussed, as are management aspects of lumbar epidural anesthesia in such patients.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Estenose da Valva Aórtica/fisiopatologia , Cesárea , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Valva Aórtica/cirurgia , Pressão Sanguínea/fisiologia , Débito Cardíaco/fisiologia , Feminino , Próteses Valvulares Cardíacas , Humanos , Gravidez , Artéria Pulmonar/fisiologia , Resistência Vascular/fisiologia
17.
J Neonatal Perinatal Med ; 7(1): 1-12, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24815700

RESUMO

The neonatal intensive care unit (NICU) is a high-stress environment for both families and health care providers that can sometimes make appropriate medical decisions challenging. We present a review article of non-medical barriers to effective decision making in the NICU, including: miscommunication, mixed messages, denial, comparative social and cultural influences, and the possible influence of perceived legal issues and family reliance on information from the Internet. As examples of these barriers, we describe and discuss two cases that occurred simultaneously in the same NICU where decisions were influenced by social and cultural differences that were misunderstood by both medical staff and patients' families. The resulting stress and emotional discomfort created an environment with sub-optimal relationships between patients' families and health care providers. We provide background on the sources of conflict in these particular cases. We also offer suggestions for possible amelioration of similar conflicts with the twin goals of facilitating compassionate decision making in NICU settings and promoting enhanced well-being of both families and providers.


Assuntos
Conflito Psicológico , Anormalidades Congênitas/psicologia , Tomada de Decisões , Negação em Psicologia , Aconselhamento Genético , Unidades de Terapia Intensiva Neonatal , Pais/psicologia , Adulto , Barreiras de Comunicação , Anormalidades Congênitas/etnologia , Anormalidades Congênitas/mortalidade , Cultura , Eutanásia Passiva , Feminino , Humanos , Recém-Nascido , Masculino , Poder Familiar , Gravidez , Relações Profissional-Família , Prognóstico , Estresse Psicológico
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