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Few studies of the histopathological features of the placenta in cases of fetal death are available. We will describe the placental findings from 24 midtrimester spontaneous abortions and 54 stillborn infants of more than 28 weeks' gestation. In almost 100% of midtrimester abortions and in 48% of the placentas from stillborn infants of more than 28 weeks' gestation, chorioamnionitis, deciduitis, and/or villitis were present. Because of this very high percentage of lesions, which suggests an infectious causation, it is mandatory that studies be performed that might identify pathogens. One third of the stillborn infants of more than 28 weeks' gestation were associated with maternal complications (diabetes, preeclampsia, and urinary tract infection), in addition to placental fetal vasculopathy, ischemia, infarcts, and chorangiosis (villous capillary hyperplasia). We emphasize the use of the placenta for the recognition of maternal diabetes.
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PMID:Pathological features of the placenta in fetal death. 94 56

Emphysematous pyelonephritis is a rare complication of urinary tract infection and generally occurs in patients with diabetes mellitus or urinary tract obstruction. We recently treated an 81-year-old diabetic woman with Klebsiella pneumoniae urinary tract infection and septicemia whose abdominal roentgenogram demonstrated a striking left pneumonephrogram as well as intraureteral and perirenal gas. The patient died despite intensive therapeutic efforts. Unfortunately, the prognosis for this severe necrotizing infection process remains unfavorable.
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PMID:Emphysematous pyelonephritis. 127 61

A retrospective study of 1989 records of 10,594 pregnant women registered at 47 primary health care (PHC) centers in Al-Hassa, Saudi Arabia, aimed to evaluate the performance of their prenatal care services and to gather baseline data to conduct future evaluations. These women represented 58% of pregnant women in Al-Hassa in 1989. The other pregnant women may have received prenatal care at medical facilities of the Arabian American Oil Company (ARAMCO), the National Guard, or the private sector. 53.1% of the registered women had made more than 5 prenatal care visits. 66.7% and 40.3% of all registered women received the first and second dose of tetanus toxoid, respectively. PHC center staff identified 46.2% of women as having high-risk pregnancies, but they only referred 17.5% of these women to King Fahad Hofuf Hospital for obstetric consultation. However, at least 6 major PHC centers had an obstetrician on staff. Causes in reproductive history were responsible for classifying 67.4% of the high-risk pregnancies. These causes included grandmultiparity (65%), abortion (12%; 8.3% - 2 abortions), previous Cesarean section (5.8%), RH negative (4.8%), young primipara (4.5%), and other causes, including history of preeclampsia, neonatal death, congenital anomalies, and low birth weight. Associated medical conditions made up the next highest class of high-risk pregnancies (25.4%). These conditions were sickle cell anemia (69.7%), diabetes (17.1%), hypertension (10.4%), and other causes (e.g., chronic bronchitis). Causes in current pregnancy comprised 7.2% of high-risk pregnancies and included non-sickle cell anemia (34.6%), bleeding (12%), malpresentation (17%), twins (14%), urinary tract infection (7%), and other causes (e.g., ectopic pregnancy). 67.7% of women with high-risk pregnancies delivered at King Fahad Hofuf Hospital, 28.8% at PHC centers, 7.1% at medical services of ARAMCO, and 2.4% outside of Al-Hassa area. 94% and 0.8% of high-risk pregnancy cases had unassisted and assisted vaginal births, respectively. The remaining cases delivered by Cesarean section.
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PMID:Prenatal care in primary health care centers of Al Hassa, Saudi Arabia. 129 49

The effect of double Malecot type polyurethane intraurethral catheter (IUC) was examined in 17 benign prostatic hypertrophy patients who were unfit for operation and suffered from urinary retention. Patients were aged 68 to 90 (mean 80.5) years old and the causes of IUC insertion were cardiac, cerebrovascular, respiratory and gastrointestinal diseases, diabetes mellitus and aging. IUC was selected among three types (55, 60, 65 mm) according to the length of prostatic urethra. Insertion of IUC was carried out easily under fluoroscopic guidance without endoscopy. All patients could void by themselves just after insertion of IUC and the longest indwelling period was 10 months. The length of IUC need not be longer than that of prostatic urethra and patients with normal or hypertonic bladder could void better than those with atonic bladder. Urinary tract infection did not get worse in any patients with indwelling IUC. Double Malecot type polyurethane IUC is a safe and an effective alternative method in place of urethral balloon catheter for inoperable prostatic hypertrophy patients in urinary retention.
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PMID:[The effect of intra-urethral catheter for prostatic hypertrophy patients who are unfit for operation and suffer from urinary retention]. 137 55

The clinical heterogeneity of Diabetes Mellitus (DM) is also evident during the gestational period and thus, pregnancy could be complicated by a previously diagnosed DM or by diabetes that is first diagnosed during pregnancy (gestational diabetes or gestational alteration of the oral glucose tolerance test according with the degree of hyperglycemia). Independently of the stage at time of maternal diagnosis, the conceptus is at greater risk (probably since the time of conception) for abortion, genetic malformations, perinatal metabolic complications and death; these risks are apparently directly related with the time at diagnosis, duration and degree of metabolic alteration on the mother (mainly hyperglycemia) and the adaptive mechanisms on the product (hyperinsulinemia). Retrospectively, 412 pregnancies complicated with any type of carbohydrate metabolism alteration were studied in our service. The results demonstrated a high frequency of Gestational diabetes (42.2%) and of type II diabetes (35.9%); there was a good agreement with previous reports regarding the personal and family histories in the patients already known diabetic before pregnancy. The types of obstetric complications were similar to previous reports, but some of them with a greater frequency in our patients, namely hydramnios, toxemia, and urinary tract infection, and ketoacidosis with a minor frequency. We also observed an increased frequency of congenital malformations on the products. On the other hand, the metabolic complications of the newborn were similar to other reports with a slight predominance on the babies of known diabetic mothers prior to gestation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Changes in glucose metabolism during pregnancy: hospital experience]. 139 3

Previous studies suggesting that maternal undernutrition increases the risk of preterm birth have suffered from several methodological shortcomings, including use of total gestational weight gain rather than net rate of gain in maternal tissue, inclusion of induced preterm deliveries, and error-prone gestational age measurements based solely on menstrual dates. The authors have attempted to overcome these shortcomings by investigating the potential etiologic roles of prepregnancy body mass index, net rate of maternal weight gain, height, and a number of other potential biological and sociodemographic determinants of spontaneous (i.e., noninduced) preterm birth in a cohort of 13,102 women with early ultrasound-confirmed gestational age who delivered at the Royal Victoria Hospital in Montreal, Quebec, Canada, between January 1, 1980 and March 31, 1989. Total weight gain, but not body mass index, was highly significantly associated with spontaneous preterm birth, averaging 14.6, 12.5, 9.9, and 9.1 kg, in women delivering at 37 or more, less than 37, less than 34, and less than 32 completed weeks, respectively. Although the relation persisted when weight gain was expressed as an overall rate, it disappeared when the analysis was based on net rate; mean net rates of gain were 0.28, 0.29, 0.27, and 0.27 kg/week, respectively. On the basis of multiple logistic regression analyses, significant determinants of birth at less than 37 weeks included maternal short stature; noncompletion of high school; unmarried status; smoking; diabetes; urinary tract infection within 2 weeks of delivery; prepregnancy hypertension; severe pregnancy-induced hypertension; and previous history of preterm delivery, low birth weight, or neonatal death. Most of these factors retained their significance for birth at less than 34 and less than 32 weeks. In fact, the effect of low maternal education was even stronger at these more severe "levels" of preterm birth. The authors conclude that prepregnancy weight-for-height and gestational weight gain are not important determinants of spontaneous preterm birth and that some previous studies have mistaken an effect of shortened gestation for its cause. Other biologic and social determinants, however, indicate priorities for future research and intervention.
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PMID:Maternal nutrition and spontaneous preterm birth. 144 21

Perioperative factors associated with late septic arthritis after knee and hip arthroplasties were prospectively investigated. All patients received a short course of perioperative cefuroxime. After a follow-up of 1 year, septic arthritis was diagnosed in 9/362 patients (2.5 percent) after knee arthroplasty and in 17/2651 patients (0.64 percent) after hip arthroplasty. For the knee, factors associated with septic arthritis after arthroplasty were rheumatoid arthritis, wound infection, an unhealed wound, and a painful, limited knee function at discharge from the hospital. For the hip, corresponding risk factors were diabetes, failed fracture osteosynthesis, a breakdown of sterility during operation, wound infection, postoperative urinary tract infection, and an unhealed wound at discharge from the hospital or a difficult rehabilitation course. Reoperation after knee and hip arthroplasty was also clearly associated with a higher incidence of septic arthritis.
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PMID:Perioperative factors associated with septic arthritis after arthroplasty. Prospective multicenter study of 362 knee and 2,651 hip operations. 147 19

125 hospitalized patients (56 men and 69 women) suffering from urinary tract infection (UTI) and 15 women with endometritis or pelvic inflammatory disease were treated with ofloxacin 6 mg/kg/d i.v. divided into 2 doses. Two thirds of the patients were switched to oral ofloxacin using the same dose regimen after 4 days. The median duration of treatment was 10 days. 98 patients were evaluable for efficacy: 45 had complicated lower UTI, 32 had upper UTI (75% of them with complications), 13 had endometritis and 8 an uncomplicated lower UTI. The most frequent complications of UTI were: obstruction (n = 27), indwelling catheters (n = 23), urinary concrements (n = 12), residual urine (n = 8) and a neurogenic bladder (n = 6). 22 patients had diabetes mellitus. A total of 103 pathogens was isolated from the urine of 85 patients, the most frequent being E. coli, Proteus spp. and Enterococcus faecalis. 98% of patients with UTI and 85% of patients with endometritis were clinically cured. Adverse drug events were observed in 6 patients.
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PMID:[Sequential parenteral and oral therapy with ofloxacin in urogenital infections]. 148 44

A case of emphysematous pyelonephritis with disseminated intravascular coagulation (DIC) is presented. A 54-year-old woman was admitted to our hospital because of unclear consciousness and extremely high blood glucose level. The laboratory data suggested uncontrolled diabetes mellitus (DM) and urinary tract infection with sepsis and DIC. The plain abdominal X-P and abdominal CT revealed the existence of gas in the right renal parenchyma, perinephric tissue and the upper part of the right ureter. Right nephrectomy was performed after the improvement of the patient's condition by the echo-guided drainage of the right kidney and the treatment for infection, DM and DIC. We reviewed 71 cases of emphysematous pyelonephritis in the Japanese literature and the choice of treatment was discussed.
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PMID:[A case of emphysematous pyelonephritis with disseminated intravascular coagulation]. 154 72

Eight women with insulin-dependent diabetes mellitus (IDDM) with low creatinine clearance rate (CCR) and normal urinary albumin excretion (UAE) were compared with three other groups of diabetic women: 19 with normal creatinine clearance rate (CCR) and UAE, 7 with normal CCR and microalbuminuria, and 7 with low CCR and microalbuminuria. The four groups were similar in age, duration of diabetes, HbA1, incidence of urinary tract infection, prevalence of bladder neuropathy, and urinary urea nitrogen excretion rate. The prevalence of hypertension was similar among the groups, although mean arterial pressure was higher in the low CCR and microalbuminuria group. Renal area index was lower in the low CCR and normal UAE groups than in the other groups of diabetic patients, but was not different from normal. Morphometric measures of mesangial expansion and estimates of arteriolar hyalinosis and global glomerulosclerosis were increased to a similar degree in the low CCR and normal UAE, normal CCR and microalbuminuria, and low CCR and microalbuminuria groups compared with the group without abnormalities of renal function. Therefore, it is likely that diabetic glomerulopathy is, at least in part, responsible for the loss of glomerular filtration rate seen in the low CCR and normal UAE patients. Thus, the definition of incipient nephropathy may have to be expanded beyond the concept of microalbuminuria if longitudinal study of such patients reveals an increased risk of the subsequent development of overt nephropathy. Finally, screening for diabetic kidney disease among IDDM patients should include determination of glomerular filtration rate and measurement of UAE and blood pressure, especially among women.
Diabetes 1992 May
PMID:Glomerular structure in IDDM women with low glomerular filtration rate and normal urinary albumin excretion. 156 27


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