Comparison by race of total serum IgG, IgA, and IgM with CD4+ T-cell counts in North American persons infected with the human immunodeficiency virus type 1.

European patients with human immunodeficiency virus type 1 (HIV-1) infection have been reported to have lower titers of anti-p24 antibody than Central African HIV seropositive patients. Recently, black HIV positive patients in the United States were reported to be more likely to have detectable anti-p24 antibodies, less p24 antigenemia, and higher combined serum immunoglobulins than white HIV positive patients. We measured individual total serum immunoglobulins in 853 HIV positive patients (94% male; 58% white and 42% black) on their initial medical evaluation and compared them with CD4+ T-cell counts.

Mobile encapsulated lipomas.

Mobile encapsulated lipomas are a benign neoplastic process with pronounced mobility in the subcutaneous plane. Characteristic clinical and histologic features differentiate this distinctive entity from similar reactive adipose processes.

Coccidioides immitis presenting as a mycelial pathogen with empyema and hydropneumothorax.

A previously healthy Caucasian male developed hydropneumothorax and a pleural peel filled with pleomorphic, septate hyphae. The only organism grown from cultures of the lung and pleural fluid was Coccidioides immitis, confirmed by exoantigen testing. Spherule-endospore forms were produced, however, following injection of the arthroconidial tissue isolate into BALB/c mice.

Pulse oximetry. Application in the labor-and-delivery unit of a tertiary care center.

Pulse oximetry is a noninvasive early warning system capable of alerting the nursing and medical staff of the occurrence of arterial hemoglobin desaturation and resultant hypoxemia. This technology has already achieved widespread use intraoperatively, in the recovery area and in medical and surgical intensive care units. Application during labor and delivery, another acute care setting often involving emergency conditions, is a logical extension.

Preliminary experience with the Hutson-Russell loop cutaneous choledochojejunostomy.

In 1984, the use of a choledochojejunocutaneous fistula was described to allow balloon dilation of benign biliary strictures. Later, the use of the technique to obtain repeated access to the biliary tree in a larger series of patients was reported. The experience provided a foundation for the application of the technique in nine patients at Wilford Hall United States Air Force Medical Center.

Results of a prenatal screening program for the human immunodeficiency virus in a cross-sectional population.

A prenatal screening program for antibody to the human immunodeficiency virus (HIV) was examined prospectively in a cross-sectional population. Routine screening was performed on 3,241 women during the first trimester. Serum samples yielding repeatedly positive results on an enzyme-linked immunosorbent assay (ELISA) (n = 6) were subjected to confirmatory Western blot testing.

A prospective study of two dosing regimens of oxytocin for the induction of labor in patients with unfavorable cervices.

The ideal regimen for induction of labor with oxytocin with respect to the magnitude and frequency of dosage changes has not been defined. In spite of few data regarding labor induction with an unfavorable cervix, the initial dose recommended by the American College of Obstetricians and Gynecologists is lower than that of other commonly used protocols. Eighty patients with unfavorable cervices and unruptured membranes, without evidence of labor, were randomized to one of two protocols and met criteria for data analysis.

Marshall syndrome.

We report on a mother and daughter with Marshall syndrome, with the Robin sequence present in the daughter. Results of our efforts to link this syndrome to a defect in type II collagen are reported. We compare and contrast Marshall syndrome with the Stickler syndrome, and propose that enough phenotypic overlap exists to suggest that they are probably allelic expressions of the same locus.

The Blalock-Taussig shunt in the newborn infant.

Children with pulmonary oligemia often require palliation in the newborn period. The Blalock-Taussig shunt has been shown to offer adequate palliation in the older child, but its use in the newborn period remains controversial. A retrospective review of 51 neonates younger than age 2 weeks undergoing a Blalock-Taussig shunt (or modification) was performed.

Uterine contraction pressures achieved in parturients with active phase arrest.

An adequate trial of labor preceding cesarean delivery for arrest of cervical dilatation in the active phase of labor has not been defined precisely. We reviewed the records of 85 consecutive women at term who received oxytocin for induction or augmentation of labor and who subsequently delivered by cesarean for arrest of labor in the active phase. The mean duration of oxytocin infusion was 15 hours for induction of labor and 8.

The two-headed stethoscope: its use for ruling out airway foreign bodies.

Foreign body aspiration is a common concern for physicians and surgeons who care for children. Evaluating infants and toddlers to rule out this possible diagnosis is often fraught with difficulties. Specifically, the standard stethoscope is of limited use unless unilateral asymmetry of breath sounds can be appreciated.

Preoperative diagnosis of acromegaly by growth hormone-releasing factor radioimmunoassay.

Acromegaly was diagnosed in a 37-year-old woman with classical physical and biochemical findings; an enlarged sella on computed tomography suggested the presence of a pituitary macroadenoma. Radiologic evidence of a lung mass prompted radioimmunoassay of plasma growth hormone-releasing factor (7,500 pg/ml; normal less than 100 pg/ml). After resection of a bronchial carcinoid, which stained positive for growth hormone-releasing factor, circulating growth hormone-releasing factor levels normalized.

Effect of clomiphene citrate treatment on endometrial estrogen and progesterone receptor induction in women.

A direct adverse effect of clomiphene citrate on the endometrium has been presumed, and interference with estrogen receptor-mediated endometrial estrogen receptor and progesterone receptor induction has been implicated as the mechanism responsible for an increased incidence of luteal phase deficiency in association with clomiphene citrate treatment. To clarify the net influence of clomiphene administration on endometrial steroid receptor induction, we studied five normal ovulatory women, in both a spontaneous and clomiphene-induced (150 mg/day, cycle days 5 to 9) ovulatory cycle. From cycle day 11 blood samples were obtained daily and urinary luteinizing hormone determinations were performed twice daily.

Adult respiratory distress syndrome in obstetrics.

Despite the advances in medical technologies, ARDS is highly lethal. In the management of patients with ARDS, certain clinical conditions are common predisposing factors to the development of the syndrome. Infection, sepsis syndrome, and conditions requiring massive transfusion are the most common causes in patients initially managed by obstetricians and gynecologist.

Amniotic cavity accumulation of magnesium with prolonged magnesium sulfate tocolysis.

In seven women, continuous intravenous tocolysis with magnesium sulfate for 4-28 days resulted in high amniotic fluid magnesium levels (10.54 mg% +/- 1.83 SD).

Thallium-201 scintigraphy after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease.

Adenosine is an endogenously produced compound that has significant effects as a coronary and systemic vasodilator. Previous studies suggest that intravenous infusion of adenosine, coupled with thallium-201 scintigraphy, may have specific value as a noninvasive means of evaluating coronary artery disease. The purpose of this study was to compare the diagnostic value of adenosine thallium testing with that of standard exercise thallium testing.

Umbilical arterial and venous acid-base and blood gas values and the effect of chorioamnionitis on those values in a cohort of preterm infants.

Umbilical arterial and venous acid-base and blood gas values in uncomplicated premature births are similar to values that are reported in term infants and are unaffected by birth weight or gestational age. In this group of patients chorioamnionitis had no significant effects on umbilical arterial acid-base or blood gas values or on the percentage of patients that were born with acidemia. Apgar scores were significantly lower in the group with chorioamnionitis in spite of a virtual absence of acidemia, which again suggests that low Apgar scores alone do not confirm a diagnosis of birth asphyxia.

Results of infrainguinal revascularization with reversed vein conduits: a modern control series.

To determine the outcome of infrainguinal reversed vein bypasses in the modern era, we reviewed the results of 120 consecutive reversed vein grafts performed from March, 1986 to March, 1990. Forty-nine bypasses were to tibial, peroneal, or pedal arteries, 46 grafts to the below-knee popliteal artery, and 25 grafts to the above-knee popliteal artery. Limb salvage was the indication for revascularization in 70% of patients.

Validation of the 1988 ACOG forceps classification system.

In February 1988, an ACOG Committee Opinion substantially revised the classification of forceps operations. The revision addressed two significant shortcomings of the old system: Outlet forceps had been defined too narrowly and midforceps too imprecisely. We now report the results of a prospective study of 357 forceps deliveries classified using each system.

Elective mutism: origins in stranger anxiety and selective attention.

Through a focus on the events of early infancy, the author interprets elective mutism on the basis of the infant's responses to discrepancies from expected stimuli. Initially, the child's silence derives from a "freezing" of action when exposed to perceived danger. Subsequently, aberrant or fearful stimuli are minimized by the child's apparent unresponsiveness.

Reality therapy with rape victims.

Rape is a violent act that inflicts injury on the very essence of the self. Reality therapy offers an applicable conceptual framework for the treatment of rape victims. Reality therapy groups minimize attention to the concept of mental illness.

Tracheal reconstruction with polytetrafluoroethylene graft in dogs.

Use of prosthetic materials for long-segment tracheal reconstruction has been limited owing to infection, graft migration, ingrowth of fibrous tissue, and stenosis. Polytetrafluoroethylene (PTFE) is flexible and porous, and it may resist infection more than previously used materials. We evaluated PTFE for use in long-segment tracheal reconstruction.

Necrotizing myonecrosis and polymicrobial sepsis. The role of adjunctive hyperbaric oxygen.

A 19-year-old man, who was involved in a motorcycle accident, sustained a combined bony and vascular injury to his right lower extremity that required emergency surgery. Postoperatively, the patient developed a life-threatening, necrotizing, soft-tissue infection and sepsis. Hyperbaric oxygen therapy was used with surgery and antibiotics to control this rapidly progressive infection and to limit the extent of debridement needed.

Human papillomavirus associated with poor healing of episiotomy repairs.

A retrospective case-control investigation was conducted for risk factors in 47 parturients whose episiotomies dehisced in the immediate postpartum period. Data were extracted from the inpatient, outpatient, and pathology records of each of these 47 patients, as well as from the same records for each of the next two patients who delivered with the same type and degree of episiotomy. No difference between subjects and controls was found for age, parity, or medical history.