Embolic stroke in a pregnant patient with a mechanical heart valve on optimal heparin therapy.

A 28-year-old woman with a mechanical aortic heart valve experienced an embolic stroke in early pregnancy after her anticoagulation therapy was changed from warfarin to heparin. This occurred despite use of a subcutaneous heparin infusion pump and optimal anticoagulation. Thromboembolism can occur in pregnant patients with mechanical heart valves despite optimal heparin therapy.

Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures.

Neuromuscular blocking agents, used to arrest fetal motion for invasive intrauterine procedures, may cause temporary fetal heart rate changes. After 21 invasive procedures using either pancuronium bromide or vecuronium bromide, post-procedure fetal heart rate tracings were retrospectively compared. Pancuronium was associated with an increased fetal heart rate and decreased beat-to-beat variability for 2.

Bilateral fetal chylothorax: results of unilateral in utero therapy.

The optimal method for antenatal treatment of pleural effusions from congenital chylothorax unknown. A fetus with bilateral congenital chylothorax and hydrops had a pleural catheter placed in utero on only one side of the fetal chest for 14 days prior to delivery. The fetal hydrops partially resolved.

Polyhydramnios-oligohydramnios in a twin pregnancy complicated by fetal glomerulocystic kidney disease.

Polyhydramnios and oligohydramnios in twin gestation is most often caused by twin-twin transfusion syndrome. Presented is a monozygotic twin pair with polyhydramnios and oligohydramnios, in which both twins had glomerulocystic kidney disease of differing severity. The more severely affected donor twin died of renal failure in the neonatal period.

Inventory management to reduce costs: a case study.

This paper presents the 2-year goals that were set by the Department of Pharmaceutical Services at Sioux Valley Hospital in 1992 regarding inventory cost savings. These goals included decreasing inventory by 10%, increasing turnover rate, controlling formulary additions, removing low-usage drugs from the formulary, ensuring compliance with group contracts, and the appropriate selection of generic equivalents for all multisource drugs. By using available computer technology offered by the prime vendor wholesaler, these objectives were accomplished.

MealMate: improving the nutritional status of elders using a milk-based nutritional supplement.

MealMate was a longitudinal research project conducted by the staff at the Geriatric Health Institute, a joint venture between Sioux Valley Hospital and the University of South Dakota School of Medicine. During Fall 1994, 64 older adults enrolled in this nutrition study at a Sioux Falls congregate dining site and drank a half-pint of whole milk combined with Carnation Instant Breakfast daily for one month. Pre-test and post-test data collected included anthropometric measures, specific blood tests from a venipuncture blood draw and use of standardized instruments to assess nutritional risk, depression, mental status and general demographic information.

Pressor response to cycle ergometry in the midtrimester of pregnancy: can it predict preeclampsia?

Ninety-seven primigravid patients were prospectively studied to assess the predictive value of the pressor response to aerobic exercise as a screening test for preeclampsia. The blood pressure response to cycle ergometry exercise to a maternal pulse of 140 beats/min was recorded on each subject. Each subject was studied in the second trimester of pregnancy at a mean gestational age of 23 weeks (range, 18 to 27).

Amniotic fluid analysis in a fetus with laryngeal atresia.

Complete laryngeal atresia is a rare congenital malformation that is known to cause hypertrophy of the fetal lung in utero. A fetus with laryngeal atresia was found to have markedly immature amniotic fluid lung maturity studies at term. Inappropriately low amniotic fluid lung maturity studies may be an important clue to the diagnosis of this condition.

Fetal thyrotoxicosis associated with nonimmune hydrops.

The reported manifestations of thyrotoxicosis in the fetus include tachycardia, preterm birth, intrauterine growth retardation, and increased perinatal mortality. Presented is a twin pregnancy in a euthyroid mother with a history of Graves' disease and high levels of thyroid-stimulating immunoglobulin G antibodies, which resulted in nonimmune hydrops in one of the twins.

Sonographic assessment of amniotic fluid in normal twin pregnancy.

A sonographic standard for assessment of amniotic fluid volume in normal twin pregnancy is provided. In 210 uncomplicated twin pregnancies, amniotic fluid volume was assessed sonographically, by measuring the total amniotic fluid index (AFI), as well as the deepest single vertical pocket in each sac. The mean AFI was greater than values found in singleton gestations; the AFI increased up to 27 weeks' gestation, and decreased thereafter.

Intrauterine infection with coxsackievirus: is it a cause of congenital cardiac malformations?

Background: Although maternal infections with coxsackievirus during pregnancy are relatively common, fetal infections are quite rare. Coxsackievirus infection in utero has been associated with myocarditis, but has not been proven a teratogen.

Case: A patient whose fetus had structural cardiac anomalies and hydrops was found to have an intrauterine infection with Coxsackie B-1 virus, proven by virus isolation from the amniotic fluid.

Removal of epicardial pacing wires: an expanded role for nurses.

Temporary epicardial pacing wire removal (EPWR) is a procedure performed postoperatively on open heart surgery patients once the cardiac rhythm is stable. Historically, EPWR is performed by the cardiovascular surgeon, however policies of certain institutions permit nurses to carry out this procedure. In the last twelve months at Sioux Valley Hospital (SVH), a team of five telemetry nurses have been removing epicardial pacing wires (EPW) safely and effectively.

Caring and the health professions.

This study analyzes patient descriptions of what constitutes caring in the physician and nurse. We propose that health care students can be taught caring behavior through the use of patient narratives.