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16


Successful pregnancy with isolated herpes simplex virus encephalitis: case report and review of the literature [Case Report]

Frieden FJ; Ordorica SA; Goodgold AL; Hoskins IA; Silverman F; Young BK
Isolated herpes simplex virus encephalitis in pregnancy is a rare illness with an elusive diagnosis. We describe the second patient to survive this disease and the first to have no sequelae, because of prompt diagnosis and treatment with acyclovir
PMID: 2304724
ISSN: 0029-7844
CID: 18695

The clinical and biological significance of the bottom line

Silverman, F; Hutson, J M
PMID: 3955931
ISSN: 0009-9201
CID: 3693222

The Apgar score: is it enough?

Silverman F; Suidan J; Wasserman J; Antoine C; Young BK
One thousand thirty-two neonates were evaluated with umbilical venous and arterial blood samples drawn at delivery for assessment of pH, PO2, PCO2, and base deficit. These values were statistically correlated with Apgar scores in all of the neonates studied. Infants were divided into Apgar groupings (group A, greater than or equal to 7 at one and five minutes; group B, less than 7 at one minute, greater than or equal to 7 at five minutes; group C, less than or equal to 7 at both one and five minutes). Generally, umbilical artery and umbilical venous data were parallel. The differences in means for pH, PO2, PCO2, and base deficit was significant when group A was compared with group B in both umbilical artery and umbilical venous data. However, a severe degree of biochemical disturbance must take place before significant association with neonatal depression can be made. It appears that umbilical blood biochemical data are related to fetal metabolic status before birth but only modestly influence the one-minute Apgar score
PMID: 3927209
ISSN: 0029-7844
CID: 66858

Differences in twins: the importance of birth order

Young BK; Suidan J; Antoine C; Silverman F; Lustig I; Wasserman J
Despite the clinical impression that firstborn twins do better than second-born twins, recent reports have shown no difference in perinatal mortality between them. In order to evaluate differences in twins, more sensitive means than perinatal deaths are necessary. This study examines differences between 80 firstborn and second-born twin pairs with respect to Apgar score, umbilical venous and arterial blood gas, and acid-base data. The umbilical venous and arterial blood PO2, PCO2, base deficit, pH, and lactic acid concentration were measured in paired samples and compared with the paired t test and chi 2 when applicable. Statistically significant differences favoring twin A, the firstborn, were found in 1-minute Apgar score, umbilical venous pH, PO2, and PCO2, and umbilical arterial PO2. The other factors in umbilical venous and arterial blood did not show statistically significant differences. When these parameters were examined with respect to route of delivery, monochorionic and dichorionic twins, interval between twins, and vertex twins only, with the possible effects of malpresentation eliminated, the results persistently favored the firstborn twin. Thus it is unequivocally demonstrated that there are substantial differences at birth favoring the first twin, despite similar perinatal mortality for both. The data suggest that the second-born twin has potentially greater susceptibility to hypoxia and trauma
PMID: 3920911
ISSN: 0002-9378
CID: 66861

Simultaneous measurement of fetal tissue pH and transcutaneous pO2 during labor

Antoine C; Young BK; Silverman F
Simultaneous measurement of fetal heart rate (FHR), uterine contractions (UC), continuous fetal tissue pH (TpH) and transcutaneous pO2 (tcpO2) was attempted in 40 high-risk parturients monitored for an average duration of 117 +/- 74 min. There were only two failures (9%) in the last 23 cases, with satisfactory recording of all parameters in 78% of the total. At present, the feasibility of simultaneous biochemical monitoring is limited to the active phase of labor. Fetal scalp and umbilical arterial blood pH and pO2 were obtained as well. The biochemical data showed a good correlation between tcpO2, scalp capillary pO2 and umbilical artery pO2 (P less than 0.02). The correlation was not significant between similar pH comparisons, although an average difference of 0.04 pH units was observed between the final tpH and umbilical artery pH. Both fetal TpH and tcpO2 fell progressively during labor. Preliminary findings comparing TpH, tcpO2 and FHR suggest that changes in tcpO2 rapidly reflect changing maternal and fetal conditions, while TpH responds more slowly and less sensitively
PMID: 6734888
ISSN: 0301-2115
CID: 66867

Human maternal-fetal lactate relationships

Suidan JS; Antoine C; Silverman F; Lustig ID; Wasserman JF; Young BK
This study attempts to determine the major source of lactate in the normal and in the depressed human fetus, in order to assess the applicability of fetal blood lactate measurement for the evaluation of fetal stress during labor. We obtained umbilical arterial and venous blood samples at delivery in 132 liveborn infants, together with simultaneous maternal radial arterial samples. All samples were analyzed immediately for pH, blood gases, and lactate. In vigorous newborns (1-minute Apgar score greater than or equal to 7), umbilical arterial and venous lactate levels were lowest with elective cesarean section done before the onset of labor, higher with cesarean section performed during labor, and highest at the time of vaginal delivery (p less than 0.001, Tab. I). Fetal lactate levels were also significantly higher than maternal levels in vigorous newborns (p less than 0.01), the lactate difference between umbilical artery and maternal artery being lowest with elective cesarean section, higher with cesarean section performed during labor, and highest with vaginal delivery (p less than 0.02, Tab. II). Depressed newborns (1-minute Apgar score less than 7) had higher umbilical lactates and higher fetal-maternal lactate differences than vigorous newborns (p less than 0.01, Tab. III). Our results indicate that the blood lactate levels in both mother and fetus increase with labor and reach their highest values at the time of vaginal delivery. The lactate levels are highest in the umbilical artery, lower in the umbilical vein, and lowest in the maternal artery before the onset of labor.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 6512664
ISSN: 0300-5577
CID: 66868

Sonographic anatomy of the fetal cerebral ventricles, with reference to the early diagnosis of hydrocephaly

Lustig-Gillman I; Snyder JR; Silverman F; Young BK
Real time ultrasound was used to evaluate the anatomy of the fetal brain at different gestational ages. Anatomical correlation with the gross brain was utilized for more accurate identification of the neuroanatomical structures. The normal growth of the ventricular system was studied. Transaxial measurements of the anterior horn (AH) and maximum ventricular length (MVL) and width (MVW) were made, and enlarged as pregnancy progressed. The ratios of MVW/MVL, MVL/BPD, and MVW/BPD provide guides to the early diagnosis of hydrocephalus and intracranial abnormalities. Specific measurements of the cerebral ventricles at various gestational ages may be made accurately by utilizing the anatomical landmarks. The anterior horn and midbrain measurements are of little value in the early diagnosis of hydrocephaly. Maximum ventricular length and width are the most useful determinants of hydrocephaly, even as early as 20 weeks. A set of discordant twins in which twin B was found to be hydrocephalic by these studies in the twentieth week is presented with serial measurements for both twins. Multiple measurements of the cerebral ventricular system in utero permit early and precise diagnosis of fetal hydrocephaly
PMID: 6392501
ISSN: 0300-5577
CID: 66869

Fetal intraventricular hemorrhage: sonographic diagnosis and clinical implications [Case Report]

Lustig-Gillman I; Young BK; Silverman F; Raghavendra BN; Wan L; Reitz ME; Aleksic S; Greco A; Snyder JR
PMID: 6409939
ISSN: 0091-2751
CID: 66872

Effects of temperature on arterial and cutaneous pO2 in the rabbit

Silverman F; Young BK
Continuous transcutaneous measurement of pO2 (tcpO2) has been adapted to fetal and neonatal use, utilizing a noninvasive miniaturized modified Clark pO2 electrode attached to the skin by adhesive. The unprepared ear of the adult female Flemish Giant rabbit was used for attachment of the electrode, and blood for arterial pO2 (apO2) was taken from the auricular artery. The rabbits were gently restrained and unanesthetized. The tcpO2 and pO2 were compared at environmental temperatures of 20-23, 50, and 60 degrees C, in separate experiments. The data demonstrated that tcpO2 is not the same as pO2. It is most clearly related to local blood flow. tcpO2 only indirectly reflects apO2, when peripheral flow is comparable to central flow. Proper use of tcpO2 in the fetus and neonate requires cognizance of blood flow conditions for correct interpretation. tcpO2 is not indicative of apO2 when reduced peripheral circulation is present, in the rabbit ear
PMID: 6852648
ISSN: 0378-7346
CID: 66874

Current status of continuous fetal pH monitoring

Antoine C; Silverman F; Young BK
PMID: 6749380
ISSN: 0095-5108
CID: 66875