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Unknown | 1992-06-06 | 405.4 KB |
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Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
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hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000410| 7e 10 00 00 37 33 00 00 | 00 01 d6 b3 04 00 8e 10 |~...73..|........|
|00000420| 00 00 37 34 00 00 00 01 | 64 c4 04 00 6a 13 00 00 |..74....|d...j...|
|00000430| 37 35 00 00 00 01 ce d7 | 04 00 82 0e 00 00 37 36 |75......|......76|
|00000440| 00 00 00 01 50 e6 04 00 | 21 11 00 00 37 37 00 00 |....P...|!...77..|
|00000450| 00 01 71 f7 04 00 c1 11 | 00 00 37 38 00 00 00 01 |..q.....|..78....|
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|00000470| 05 00 7f 08 00 00 38 30 | 00 00 00 01 43 1f 05 00 |......80|....C...|
|00000480| 00 0e 00 00 38 31 00 00 | 00 01 43 2d 05 00 af 10 |....81..|..C-....|
|00000490| 00 00 38 32 00 00 00 01 | f2 3d 05 00 87 0c 00 00 |..82....|.=......|
|000004a0| 38 33 00 00 00 01 79 4a | 05 00 ce 0c 00 00 38 34 |83....yJ|......84|
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|000004c0| 00 01 d7 65 05 00 d4 0e | 00 00 38 36 00 00 00 01 |...e....|..86....|
|000004d0| ab 74 05 00 57 12 00 00 | 38 37 00 00 00 01 02 87 |.t..W...|87......|
|000004e0| 05 00 d6 0e 00 00 38 38 | 00 00 00 01 d8 95 05 00 |......88|........|
|000004f0| a2 14 00 00 38 39 00 00 | 00 01 7a aa 05 00 7e 12 |....89..|..z...~.|
|00000500| 00 00 39 30 00 00 00 01 | f8 bc 05 00 9c 11 00 00 |..90....|........|
|00000510| 39 31 00 00 00 01 94 ce | 05 00 43 0d 00 00 39 32 |91......|..C...92|
|00000520| 00 00 00 01 d7 db 05 00 | 72 0d 00 00 39 33 00 00 |........|r...93..|
|00000530| 00 01 49 e9 05 00 60 0d | 00 00 39 34 00 00 00 01 |..I...`.|..94....|
|00000540| a9 f6 05 00 a8 0e 00 00 | 39 35 00 00 00 01 51 05 |........|95....Q.|
|00000550| 06 00 1c 10 00 00 39 36 | 00 00 00 01 6d 15 06 00 |......96|....m...|
|00000560| 73 11 00 00 39 37 00 00 | 00 01 e0 26 06 00 3a 0c |s...97..|...&..:.|
|00000570| 00 00 39 38 00 00 00 01 | 1a 33 06 00 0a 12 00 00 |..98....|.3......|
|00000580| 39 39 00 00 00 01 24 45 | 06 00 7a 10 00 00 00 00 |99....$E|..z.....|
|00000590| 00 00 00 00 9e 55 06 00 | 00 00 00 00 24 55 6e 69 |.....U..|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 37 31 30 30 7d |que_ID{Y|RB07100}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 54 68 65 20 4f 75 74 |..$Title|{The Out|
|000005c0| 63 6f 6d 65 20 6f 66 20 | 48 79 70 65 72 65 6d 65 |come of |Hypereme|
|000005d0| 74 69 63 20 50 72 65 67 | 6e 61 6e 63 69 65 73 20 |tic Preg|nancies |
|000005e0| 43 6f 6d 70 6c 69 63 61 | 74 65 64 20 62 79 20 54 |Complica|ted by T|
|000005f0| 72 61 6e 73 69 65 6e 74 | 20 48 79 70 65 72 74 68 |ransient| Hyperth|
|00000600| 79 72 6f 69 64 69 73 6d | 7d 0d 0a 24 41 75 74 68 |yroidism|}..$Auth|
|00000610| 6f 72 7b 4c 61 6f 2c 20 | 54 54 0d 0a 43 68 69 6e |or{Lao, |TT..Chin|
|00000620| 2c 20 52 4b 48 0d 0a 43 | 68 61 6e 67 65 2c 20 41 |, RKH..C|hange, A|
|00000630| 4d 5a 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |MZ}..$Af|filiatio|
|00000640| 6e 7b 43 68 69 6e 65 73 | 65 20 55 6e 69 76 20 6f |n{Chines|e Univ o|
|00000650| 66 20 48 6f 6e 67 20 4b | 6f 6e 67 2c 20 50 72 69 |f Hong K|ong, Pri|
|00000660| 6e 63 65 20 6f 66 20 57 | 61 6c 65 73 20 48 6f 73 |nce of W|ales Hos|
|00000670| 70 2c 20 48 6f 6e 67 20 | 4b 6f 6e 67 7d 0d 0a 24 |p, Hong |Kong}..$|
|00000680| 53 75 62 6a 65 63 74 7b | 50 72 65 67 6e 61 6e 63 |Subject{|Pregnanc|
|00000690| 79 20 68 79 70 65 72 65 | 6d 65 74 69 63 2c 20 77 |y hypere|metic, w|
|000006a0| 69 74 68 20 68 79 70 65 | 72 74 68 79 72 6f 69 64 |ith hype|rthyroid|
|000006b0| 69 73 6d 3b 0d 0a 48 79 | 70 65 72 74 68 79 72 6f |ism;..Hy|perthyro|
|000006c0| 69 64 69 73 6d 20 69 6e | 20 68 79 70 65 72 65 6d |idism in| hyperem|
|000006d0| 65 74 69 63 20 70 72 65 | 67 6e 61 6e 63 79 3b 0d |etic pre|gnancy;.|
|000006e0| 0a 48 79 70 65 72 65 6d | 65 74 69 63 20 70 72 65 |.Hyperem|etic pre|
|000006f0| 67 6e 61 6e 63 79 20 77 | 69 74 68 20 68 79 70 65 |gnancy w|ith hype|
|00000700| 72 74 68 79 72 6f 69 64 | 69 73 6d 7d 0d 0a 24 4a |rthyroid|ism}..$J|
|00000710| 6f 75 72 6e 61 6c 7b 41 | 75 73 74 20 4e 5a 20 4a |ournal{A|ust NZ J|
|00000720| 20 4f 62 73 74 65 74 20 | 47 79 6e 61 65 63 6f 6c | Obstet |Gynaecol|
|00000730| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 32 37 7d 0d 0a |}..$Volu|me{27}..|
|00000740| 24 50 61 67 65 7b 39 39 | 2d 31 30 31 7d 0d 0a 24 |$Page{99|-101}..$|
|00000750| 44 61 74 65 7b 4d 61 79 | 20 31 39 38 37 7d 0d 0a |Date{May| 1987}..|
|00000760| 24 59 42 56 6f 6c 7b 31 | 39 38 39 20 59 65 61 72 |$YBVol{1|989 Year|
|00000770| 20 42 6f 6f 6b 20 6f 66 | 20 4f 62 73 74 65 74 72 | Book of| Obstetr|
|00000780| 69 63 73 20 61 6e 64 20 | 47 79 6e 65 63 6f 6c 6f |ics and |Gynecolo|
|00000790| 67 79 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 33 2d |gy}..$Ch|apter{3-|
|000007a0| 35 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |5}..$YBE|ditor{Dr|
|000007b0| 73 2e 20 4d 69 73 68 65 | 6c 6c 2c 20 4b 69 72 73 |s. Mishe|ll, Kirs|
|000007c0| 63 68 62 61 75 6d 2c 20 | 61 6e 64 20 4d 6f 72 72 |chbaum, |and Morr|
|000007d0| 6f 77 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ow}..$Ta|ble{}..$|
|000007e0| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 54 2e 48 2e |Commenta|tor{T.H.|
|000007f0| 20 4b 69 72 73 63 68 62 | 61 75 6d 2c 20 4d 2e 44 | Kirschb|aum, M.D|
|00000800| 2e 7d 0d 0a 0d 0a 43 6f | 70 79 72 69 67 68 74 20 |.}....Co|pyright |
|00000810| 28 63 29 20 59 65 61 72 | 20 42 6f 6f 6b 20 4d 65 |(c) Year| Book Me|
|00000820| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|00000830| 2c 20 49 6e 63 2e 2c 20 | 31 39 38 39 0d 0a 0d 0a |, Inc., |1989....|
|00000840| 31 39 38 39 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1989 Yea|r Book o|
|00000850| 66 20 4f 62 73 74 65 74 | 72 69 63 73 20 61 6e 64 |f Obstet|rics and|
|00000860| 20 47 79 6e 65 63 6f 6c | 6f 67 79 20 28 52 29 0d | Gynecol|ogy (R).|
|00000870| 0a 0d 0a 4f 62 73 74 65 | 74 72 69 63 73 0d 0a 0d |...Obste|trics...|
|00000880| 0a 43 68 61 70 74 65 72 | 20 33 2d 2d 4d 65 64 69 |.Chapter| 3--Medi|
|00000890| 63 61 6c 20 43 6f 6d 70 | 6c 69 63 61 74 69 6f 6e |cal Comp|lication|
|000008a0| 73 20 6f 66 20 50 72 65 | 67 6e 61 6e 63 79 0d 0a |s of Pre|gnancy..|
|000008b0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|000008c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000900| 2d 2d 0d 0a 54 68 65 20 | 4f 75 74 63 6f 6d 65 20 |--..The |Outcome |
|00000910| 6f 66 20 48 79 70 65 72 | 65 6d 65 74 69 63 20 50 |of Hyper|emetic P|
|00000920| 72 65 67 6e 61 6e 63 69 | 65 73 20 43 6f 6d 70 6c |regnanci|es Compl|
|00000930| 69 63 61 74 65 64 20 62 | 79 20 54 72 61 6e 73 69 |icated b|y Transi|
|00000940| 65 6e 74 20 48 79 70 65 | 72 74 68 79 72 6f 69 64 |ent Hype|rthyroid|
|00000950| 69 73 6d 0d 0a 0d 0a 4c | 61 6f 20 54 54 2c 20 43 |ism....L|ao TT, C|
|00000960| 68 69 6e 20 52 4b 48 2c | 20 43 68 61 6e 67 65 20 |hin RKH,| Change |
|00000970| 41 4d 5a 0d 0a 28 43 68 | 69 6e 65 73 65 20 55 6e |AMZ..(Ch|inese Un|
|00000980| 69 76 20 6f 66 20 48 6f | 6e 67 20 4b 6f 6e 67 2c |iv of Ho|ng Kong,|
|00000990| 20 50 72 69 6e 63 65 20 | 6f 66 20 57 61 6c 65 73 | Prince |of Wales|
|000009a0| 20 48 6f 73 70 2c 20 48 | 6f 6e 67 20 4b 6f 6e 67 | Hosp, H|ong Kong|
|000009b0| 29 0d 0a 41 75 73 74 20 | 4e 5a 20 4a 20 4f 62 73 |)..Aust |NZ J Obs|
|000009c0| 74 65 74 20 47 79 6e 61 | 65 63 6f 6c 20 32 37 3a |tet Gyna|ecol 27:|
|000009d0| 39 39 2d 31 30 31 2c 20 | 4d 61 79 20 31 39 38 37 |99-101, |May 1987|
|000009e0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|000009f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a30| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|00000a40| 0d 0a 20 20 20 20 20 50 | 72 65 67 6e 61 6e 63 79 |.. P|regnancy|
|00000a50| 2d 69 6e 64 75 63 65 64 | 20 74 68 79 72 6f 74 6f |-induced| thyroto|
|00000a60| 78 69 63 6f 73 69 73 20 | 68 61 73 20 62 65 65 6e |xicosis |has been|
|00000a70| 20 64 65 73 63 72 69 62 | 65 64 20 69 6e 20 61 73 | describ|ed in as|
|00000a80| 73 6f 63 69 61 74 69 6f | 6e 20 77 69 74 68 0d 0a |sociatio|n with..|
|00000a90| 68 79 70 65 72 65 6d 65 | 73 69 73 20 67 72 61 76 |hypereme|sis grav|
|00000aa0| 69 64 61 72 75 6d 2e 20 | 20 54 68 69 72 74 79 2d |idarum. | Thirty-|
|00000ab0| 6e 69 6e 65 20 70 61 74 | 69 65 6e 74 73 20 77 69 |nine pat|ients wi|
|00000ac0| 74 68 20 68 79 70 65 72 | 65 6d 65 73 69 73 20 67 |th hyper|emesis g|
|00000ad0| 72 61 76 69 64 61 72 75 | 6d 20 77 65 72 65 0d 0a |ravidaru|m were..|
|00000ae0| 73 74 75 64 69 65 64 2c | 20 61 6e 64 20 74 68 65 |studied,| and the|
|00000af0| 20 63 6f 75 72 73 65 20 | 61 6e 64 20 6f 75 74 63 | course |and outc|
|00000b00| 6f 6d 65 20 6f 66 20 70 | 72 65 67 6e 61 6e 63 79 |ome of p|regnancy|
|00000b10| 20 6f 66 20 77 6f 6d 65 | 6e 20 77 69 74 68 20 6e | of wome|n with n|
|00000b20| 6f 72 6d 61 6c 20 61 6e | 64 0d 0a 61 62 6e 6f 72 |ormal an|d..abnor|
|00000b30| 6d 61 6c 20 74 68 79 72 | 6f 69 64 20 66 75 6e 63 |mal thyr|oid func|
|00000b40| 74 69 6f 6e 20 77 65 72 | 65 20 63 6f 6d 70 61 72 |tion wer|e compar|
|00000b50| 65 64 2e 0d 0a 20 20 20 | 20 20 50 61 74 69 65 6e |ed... | Patien|
|00000b60| 74 73 20 77 68 6f 20 68 | 61 64 20 73 65 76 65 72 |ts who h|ad sever|
|00000b70| 65 20 76 6f 6d 69 74 69 | 6e 67 20 64 75 72 69 6e |e vomiti|ng durin|
|00000b80| 67 20 70 72 65 67 6e 61 | 6e 63 79 20 61 6e 64 20 |g pregna|ncy and |
|00000b90| 61 73 73 6f 63 69 61 74 | 65 64 20 77 69 74 68 0d |associat|ed with.|
|00000ba0| 0a 63 6f 6d 70 6c 69 63 | 61 74 69 6f 6e 73 20 28 |.complic|ations (|
|00000bb0| 65 2e 67 2e 2c 20 77 65 | 69 67 68 74 20 6c 6f 73 |e.g., we|ight los|
|00000bc0| 73 2c 20 63 6c 69 6e 69 | 63 61 6c 20 64 65 68 79 |s, clini|cal dehy|
|00000bd0| 64 72 61 74 69 6f 6e 2c | 20 61 6e 64 20 6b 65 74 |dration,| and ket|
|00000be0| 6f 6e 75 72 69 61 29 20 | 77 65 72 65 0d 0a 68 6f |onuria) |were..ho|
|00000bf0| 73 70 69 74 61 6c 69 7a | 65 64 2e 20 20 47 65 6e |spitaliz|ed. Gen|
|00000c00| 65 72 61 6c 20 73 75 70 | 70 6f 72 74 69 76 65 20 |eral sup|portive |
|00000c10| 74 72 65 61 74 6d 65 6e | 74 20 77 61 73 20 67 69 |treatmen|t was gi|
|00000c20| 76 65 6e 2c 20 77 69 74 | 68 20 69 6e 74 72 61 76 |ven, wit|h intrav|
|00000c30| 65 6e 6f 75 73 20 66 6c | 75 69 64 0d 0a 72 65 70 |enous fl|uid..rep|
|00000c40| 6c 61 63 65 6d 65 6e 74 | 20 61 6e 64 20 76 69 74 |lacement| and vit|
|00000c50| 61 6d 69 6e 73 2c 20 69 | 6e 63 6c 75 64 69 6e 67 |amins, i|ncluding|
|00000c60| 20 70 79 72 6f 64 6f 78 | 69 6e 65 2e 20 20 41 6c | pyrodox|ine. Al|
|00000c70| 6c 20 33 39 20 70 61 74 | 69 65 6e 74 73 20 77 65 |l 39 pat|ients we|
|00000c80| 72 65 20 64 69 73 63 68 | 61 72 67 65 64 0d 0a 77 |re disch|arged..w|
|00000c90| 68 65 6e 20 74 68 65 69 | 72 20 63 6f 6e 64 69 74 |hen thei|r condit|
|00000ca0| 69 6f 6e 20 69 6d 70 72 | 6f 76 65 64 20 61 6e 64 |ion impr|oved and|
|00000cb0| 20 74 68 65 79 20 68 61 | 64 20 72 65 67 61 69 6e | they ha|d regain|
|00000cc0| 65 64 20 77 65 69 67 68 | 74 2e 20 20 54 68 65 79 |ed weigh|t. They|
|00000cd0| 20 77 65 72 65 20 74 68 | 65 6e 0d 0a 66 6f 6c 6c | were th|en..foll|
|00000ce0| 6f 77 65 64 20 69 6e 20 | 74 68 65 20 61 6e 74 65 |owed in |the ante|
|00000cf0| 6e 61 74 61 6c 20 63 6c | 69 6e 69 63 20 75 6e 74 |natal cl|inic unt|
|00000d00| 69 6c 20 64 65 6c 69 76 | 65 72 79 2e 20 20 53 65 |il deliv|ery. Se|
|00000d10| 76 65 6e 74 65 65 6e 20 | 77 6f 6d 65 6e 20 28 34 |venteen |women (4|
|00000d20| 34 25 29 20 68 61 64 0d | 0a 74 72 61 6e 73 69 65 |4%) had.|.transie|
|00000d30| 6e 74 20 68 79 70 65 72 | 74 68 79 72 6f 69 64 69 |nt hyper|thyroidi|
|00000d40| 73 6d 2e 20 20 54 77 6f | 20 6f 66 20 74 68 65 73 |sm. Two| of thes|
|00000d50| 65 20 72 65 71 75 69 72 | 65 64 20 61 20 73 68 6f |e requir|ed a sho|
|00000d60| 72 74 20 63 6f 75 72 73 | 65 20 6f 66 20 61 6e 74 |rt cours|e of ant|
|00000d70| 69 74 68 79 72 6f 69 64 | 0d 0a 74 72 65 61 74 6d |ithyroid|..treatm|
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|000043c0| 67 65 73 74 61 74 69 6f | 6e 61 6c 20 61 67 65 2e |gestatio|nal age.|
|000043d0| 20 20 54 68 65 20 70 65 | 72 69 6e 61 74 61 6c 20 | The pe|rinatal |
|000043e0| 73 69 67 6e 69 66 69 63 | 61 6e 63 65 20 69 73 20 |signific|ance is |
|000043f0| 6d 69 6e 69 6d 61 6c 20 | 61 6e 64 0d 0a 6f 66 66 |minimal |and..off|
|00004400| 65 6e 64 69 6e 67 20 6f | 72 67 61 6e 69 73 6d 73 |ending o|rganisms|
|00004410| 20 61 72 65 20 64 69 66 | 66 69 63 75 6c 74 20 74 | are dif|ficult t|
|00004420| 6f 20 72 65 63 6f 76 65 | 72 20 61 6e 64 20 61 70 |o recove|r and ap|
|00004430| 70 65 61 72 20 68 61 72 | 6d 6c 65 73 73 2e 20 20 |pear har|mless. |
|00004440| 41 67 67 72 65 73 73 69 | 76 65 0d 0a 69 6e 74 65 |Aggressi|ve..inte|
|00004450| 72 76 65 6e 74 69 6f 6e | 20 70 72 6f 62 61 62 6c |rvention| probabl|
|00004460| 79 20 77 6f 75 6c 64 20 | 6e 6f 74 20 73 61 76 65 |y would |not save|
|00004470| 20 6c 69 76 65 73 20 6f | 72 20 6c 65 73 73 65 6e | lives o|r lessen|
|00004480| 20 74 68 65 20 6d 6f 72 | 62 69 64 69 74 79 20 6f | the mor|bidity o|
|00004490| 66 20 70 72 65 74 65 72 | 6d 0d 0a 62 69 72 74 68 |f preter|m..birth|
|000044a0| 2e 0d 0a 0d 0a 50 6f 73 | 74 2d 43 6f 6d 6d 65 6e |.....Pos|t-Commen|
|000044b0| 74 0d 0a 0d 0a 20 20 20 | 20 20 54 68 65 20 74 72 |t.... | The tr|
|000044c0| 69 63 6b 20 6f 66 20 6d | 61 6e 61 67 69 6e 67 20 |ick of m|anaging |
|000044d0| 70 72 65 74 65 72 6d 20 | 72 75 70 74 75 72 65 20 |preterm |rupture |
|000044e0| 6f 66 20 6d 65 6d 62 72 | 61 6e 65 73 20 69 73 20 |of membr|anes is |
|000044f0| 74 6f 20 62 65 20 61 62 | 6c 65 20 74 6f 0d 0a 69 |to be ab|le to..i|
|00004500| 64 65 6e 74 69 66 79 20 | 74 68 6f 73 65 20 70 61 |dentify |those pa|
|00004510| 74 69 65 6e 74 73 20 69 | 6e 20 77 68 6f 6d 20 72 |tients i|n whom r|
|00004520| 75 70 74 75 72 65 64 20 | 6d 65 6d 62 72 61 6e 65 |uptured |membrane|
|00004530| 73 20 73 74 65 6d 20 66 | 72 6f 6d 20 69 6e 61 70 |s stem f|rom inap|
|00004540| 70 61 72 65 6e 74 0d 0a | 63 68 6f 72 69 6f 61 6d |parent..|chorioam|
|00004550| 6e 69 6f 6e 69 74 69 73 | 20 61 6e 64 20 74 6f 20 |nionitis| and to |
|00004560| 68 61 6e 64 6c 65 20 74 | 68 65 6d 20 64 69 66 66 |handle t|hem diff|
|00004570| 65 72 65 6e 74 6c 79 20 | 66 72 6f 6d 20 74 68 6f |erently |from tho|
|00004580| 73 65 20 70 61 74 69 65 | 6e 74 73 20 69 6e 20 77 |se patie|nts in w|
|00004590| 68 6f 6d 0d 0a 72 75 70 | 74 75 72 65 64 20 6d 65 |hom..rup|tured me|
|000045a0| 6d 62 72 61 6e 65 73 20 | 61 72 65 20 6e 6f 74 20 |mbranes |are not |
|000045b0| 61 73 73 6f 63 69 61 74 | 65 64 20 77 69 74 68 20 |associat|ed with |
|000045c0| 63 68 6f 72 69 6f 61 6d | 6e 69 6f 6e 69 74 69 73 |chorioam|nionitis|
|000045d0| 2e 20 20 55 6e 74 69 6c | 20 77 65 20 63 61 6e 20 |. Until| we can |
|000045e0| 64 6f 0d 0a 74 68 69 73 | 2c 20 65 76 61 6c 75 61 |do..this|, evalua|
|000045f0| 74 69 6f 6e 20 61 6e 64 | 20 74 72 65 61 74 6d 65 |tion and| treatme|
|00004600| 6e 74 20 77 69 6c 6c 20 | 63 6f 6e 74 69 6e 75 65 |nt will |continue|
|00004610| 20 74 6f 20 62 65 20 63 | 68 61 6f 74 69 63 20 62 | to be c|haotic b|
|00004620| 79 20 76 69 72 74 75 65 | 20 6f 66 20 61 20 6d 61 |y virtue| of a ma|
|00004630| 6a 6f 72 0d 0a 75 6e 63 | 6f 6e 74 72 6f 6c 6c 65 |jor..unc|ontrolle|
|00004640| 64 20 76 61 72 69 61 62 | 6c 65 3a 20 20 70 72 65 |d variab|le: pre|
|00004650| 65 78 69 73 74 69 6e 67 | 20 63 68 6f 72 69 6f 61 |existing| chorioa|
|00004660| 6d 6e 69 6f 6e 69 74 69 | 73 2e 20 20 49 6e 20 74 |mnioniti|s. In t|
|00004670| 68 69 73 20 73 74 75 64 | 79 20 6f 66 20 35 38 38 |his stud|y of 588|
|00004680| 0d 0a 70 6c 61 63 65 6e | 74 61 73 20 66 72 6f 6d |..placen|tas from|
|00004690| 20 73 75 63 68 20 70 61 | 74 69 65 6e 74 73 2c 20 | such pa|tients, |
|000046a0| 74 68 65 20 69 6e 63 69 | 64 65 6e 63 65 20 6f 66 |the inci|dence of|
|000046b0| 20 69 6e 66 6c 61 6d 6d | 61 74 69 6f 6e 20 6f 66 | inflamm|ation of|
|000046c0| 20 74 68 65 20 6d 65 6d | 62 72 61 6e 65 73 2c 0d | the mem|branes,.|
|000046d0| 0a 70 6c 61 63 65 6e 74 | 61 2c 20 61 6e 64 20 75 |.placent|a, and u|
|000046e0| 6d 62 69 6c 69 63 61 6c | 20 63 6f 72 64 20 77 61 |mbilical| cord wa|
|000046f0| 73 20 61 62 6f 75 74 20 | 31 35 25 2d 2d 6e 6f 20 |s about |15%--no |
|00004700| 67 72 65 61 74 20 73 75 | 72 70 72 69 73 65 2e 20 |great su|rprise. |
|00004710| 20 54 68 65 20 69 6e 74 | 65 72 65 73 74 69 6e 67 | The int|eresting|
|00004720| 0d 0a 61 6e 61 6c 79 73 | 69 73 20 63 6f 6d 65 73 |..analys|is comes|
|00004730| 20 66 72 6f 6d 20 70 72 | 6f 6a 65 63 74 69 6e 67 | from pr|ojecting|
|00004740| 20 65 76 69 64 65 6e 63 | 65 20 66 6f 72 20 70 6c | evidenc|e for pl|
|00004750| 61 63 65 6e 74 61 6c 20 | 69 6e 66 6c 61 6d 6d 61 |acental |inflamma|
|00004760| 74 69 6f 6e 20 61 74 20 | 74 68 65 20 74 69 6d 65 |tion at |the time|
|00004770| 0d 0a 6f 66 20 70 72 65 | 74 65 72 6d 20 72 75 70 |..of pre|term rup|
|00004780| 74 75 72 65 20 6f 66 20 | 6d 65 6d 62 72 61 6e 65 |ture of |membrane|
|00004790| 73 20 62 61 63 6b 20 69 | 6e 20 74 69 6d 65 20 62 |s back i|n time b|
|000047a0| 65 66 6f 72 65 20 64 65 | 6c 69 76 65 72 79 2e 20 |efore de|livery. |
|000047b0| 20 54 68 69 73 20 61 70 | 70 72 6f 61 63 68 0d 0a | This ap|proach..|
|000047c0| 73 75 67 67 65 73 74 73 | 20 74 68 61 74 2c 20 77 |suggests| that, w|
|000047d0| 68 65 6e 20 61 6d 6e 69 | 6f 6e 69 74 69 73 20 69 |hen amni|onitis i|
|000047e0| 73 20 6e 6f 74 20 73 75 | 73 70 65 63 74 65 64 2c |s not su|spected,|
|000047f0| 20 69 6e 66 6c 61 6d 6d | 61 74 69 6f 6e 20 61 6e | inflamm|ation an|
|00004800| 74 65 64 61 74 65 73 20 | 72 75 70 74 75 72 65 0d |tedates |rupture.|
|00004810| 0a 6f 66 20 6d 65 6d 62 | 72 61 6e 65 73 20 69 6e |.of memb|ranes in|
|00004820| 20 31 30 25 20 6f 66 20 | 69 6e 66 61 6e 74 73 20 | 10% of |infants |
|00004830| 77 65 69 67 68 69 6e 67 | 20 6d 6f 72 65 20 74 68 |weighing| more th|
|00004840| 61 6e 20 31 2e 35 20 6b | 67 20 61 74 20 62 69 72 |an 1.5 k|g at bir|
|00004850| 74 68 20 61 6e 64 20 69 | 6e 20 33 30 25 20 6f 66 |th and i|n 30% of|
|00004860| 0d 0a 74 68 6f 73 65 20 | 77 65 69 67 68 69 6e 67 |..those |weighing|
|00004870| 20 6c 65 73 73 20 74 68 | 61 6e 20 31 2e 30 20 6b | less th|an 1.0 k|
|00004880| 67 2e 20 20 49 6e 63 6c | 75 64 69 6e 67 20 70 61 |g. Incl|uding pa|
|00004890| 74 69 65 6e 74 73 20 77 | 69 74 68 20 73 75 73 70 |tients w|ith susp|
|000048a0| 65 63 74 20 61 6d 6e 69 | 6f 6e 69 74 69 73 2c 0d |ect amni|onitis,.|
|000048b0| 0a 74 68 65 20 63 6f 72 | 72 65 73 70 6f 6e 64 69 |.the cor|respondi|
|000048c0| 6e 67 20 66 69 67 75 72 | 65 73 20 61 72 65 20 61 |ng figur|es are a|
|000048d0| 70 70 72 6f 78 69 6d 61 | 74 65 6c 79 20 31 32 25 |pproxima|tely 12%|
|000048e0| 20 6f 66 20 70 72 65 67 | 6e 61 6e 63 69 65 73 20 | of preg|nancies |
|000048f0| 77 69 74 68 20 66 65 74 | 75 73 65 73 20 6f 66 0d |with fet|uses of.|
|00004900| 0a 6d 6f 72 65 20 74 68 | 61 6e 20 31 2e 35 20 6b |.more th|an 1.5 k|
|00004910| 67 20 61 6e 64 20 61 62 | 6f 75 74 20 34 30 25 20 |g and ab|out 40% |
|00004920| 77 69 74 68 20 66 65 74 | 75 73 65 73 20 6f 66 20 |with fet|uses of |
|00004930| 6c 65 73 73 20 74 68 61 | 6e 20 31 20 6b 67 2e 20 |less tha|n 1 kg. |
|00004940| 20 54 68 65 73 65 20 64 | 61 74 61 0d 0a 73 75 70 | These d|ata..sup|
|00004950| 70 6f 72 74 20 74 68 65 | 20 68 69 67 68 20 6c 69 |port the| high li|
|00004960| 6b 65 6c 69 68 6f 6f 64 | 20 74 68 61 74 20 70 72 |kelihood| that pr|
|00004970| 65 74 65 72 6d 20 72 75 | 70 74 75 72 65 20 6f 66 |eterm ru|pture of|
|00004980| 20 6d 65 6d 62 72 61 6e | 65 73 20 61 6e 64 20 64 | membran|es and d|
|00004990| 65 6c 69 76 65 72 79 20 | 6f 66 0d 0a 76 65 72 79 |elivery |of..very|
|000049a0| 2d 6c 6f 77 2d 62 69 72 | 74 68 2d 77 65 69 67 68 |-low-bir|th-weigh|
|000049b0| 74 20 69 6e 66 61 6e 74 | 73 20 69 6e 20 61 70 70 |t infant|s in app|
|000049c0| 72 6f 78 69 6d 61 74 65 | 6c 79 20 6f 6e 65 20 74 |roximate|ly one t|
|000049d0| 68 69 72 64 20 74 6f 20 | 6f 6e 65 20 68 61 6c 66 |hird to |one half|
|000049e0| 20 6f 66 20 61 6c 6c 0d | 0a 70 61 74 69 65 6e 74 | of all.|.patient|
|000049f0| 73 20 6f 63 63 75 72 20 | 62 65 63 61 75 73 65 20 |s occur |because |
|00004a00| 6f 66 20 61 6e 74 65 63 | 65 64 65 6e 74 20 69 6e |of antec|edent in|
|00004a10| 61 70 70 61 72 65 6e 74 | 20 69 6e 66 65 63 74 69 |apparent| infecti|
|00004a20| 6f 6e 2c 20 66 6f 72 20 | 77 68 69 63 68 20 65 78 |on, for |which ex|
|00004a30| 70 65 63 74 61 6e 74 0d | 0a 6d 61 6e 61 67 65 6d |pectant.|.managem|
|00004a40| 65 6e 74 20 69 73 20 75 | 73 65 6c 65 73 73 20 61 |ent is u|seless a|
|00004a50| 6e 64 20 61 63 74 69 76 | 65 20 69 6e 74 65 72 76 |nd activ|e interv|
|00004a60| 65 6e 74 69 6f 6e 20 6e | 6f 74 20 6c 69 6b 65 6c |ention n|ot likel|
|00004a70| 79 20 74 6f 20 62 65 20 | 68 69 67 68 6c 79 0d 0a |y to be |highly..|
|00004a80| 73 75 63 63 65 73 73 66 | 75 6c 2e 2d 2d 54 2e 48 |successf|ul.--T.H|
|00004a90| 2e 20 4b 69 72 73 63 68 | 62 61 75 6d 2c 20 4d 2e |. Kirsch|baum, M.|
|00004aa0| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00004ab0| 52 42 30 37 31 30 34 7d | 0d 0a 24 54 69 74 6c 65 |RB07104}|..$Title|
|00004ac0| 7b 43 6f 72 6f 6e 61 72 | 79 20 41 6e 67 69 6f 70 |{Coronar|y Angiop|
|00004ad0| 6c 61 73 74 79 20 69 6e | 20 50 72 65 67 6e 61 6e |lasty in| Pregnan|
|00004ae0| 63 79 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 43 6f 77 |cy}..$Au|thor{Cow|
|00004af0| 61 6e 2c 20 4e 43 0d 0a | 64 65 20 42 65 6c 64 65 |an, NC..|de Belde|
|00004b00| 72 2c 20 4d 41 0d 0a 52 | 6f 74 68 6d 61 6e 2c 20 |r, MA..R|othman, |
|00004b10| 4d 54 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |MT}..$Af|filiatio|
|00004b20| 6e 7b 54 68 65 20 4c 6f | 6e 64 6f 6e 20 48 6f 73 |n{The Lo|ndon Hos|
|00004b30| 70 2c 20 4c 6f 6e 64 6f | 6e 7d 0d 0a 24 53 75 62 |p, Londo|n}..$Sub|
|00004b40| 6a 65 63 74 7b 50 72 65 | 67 6e 61 6e 63 79 20 61 |ject{Pre|gnancy a|
|00004b50| 6e 67 69 6f 70 6c 61 73 | 74 79 20 64 75 72 69 6e |ngioplas|ty durin|
|00004b60| 67 2c 20 63 6f 72 6f 6e | 61 72 79 3b 0d 0a 43 6f |g, coron|ary;..Co|
|00004b70| 72 6f 6e 61 72 79 20 61 | 6e 67 69 6f 70 6c 61 73 |ronary a|ngioplas|
|00004b80| 74 79 20 64 75 72 69 6e | 67 20 70 72 65 67 6e 61 |ty durin|g pregna|
|00004b90| 6e 63 79 3b 0d 0a 41 6e | 67 69 6f 70 6c 61 73 74 |ncy;..An|gioplast|
|00004ba0| 79 20 63 6f 72 6f 6e 61 | 72 79 2c 20 64 75 72 69 |y corona|ry, duri|
|00004bb0| 6e 67 20 70 72 65 67 6e | 61 6e 63 79 7d 0d 0a 24 |ng pregn|ancy}..$|
|00004bc0| 4a 6f 75 72 6e 61 6c 7b | 42 72 20 48 65 61 72 74 |Journal{|Br Heart|
|00004bd0| 20 4a 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 35 39 7d | J}..$Vo|lume{59}|
|00004be0| 0d 0a 24 50 61 67 65 7b | 35 38 38 2d 35 39 32 7d |..$Page{|588-592}|
|00004bf0| 0d 0a 24 44 61 74 65 7b | 4d 61 79 20 31 39 38 38 |..$Date{|May 1988|
|00004c00| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 38 39 20 59 |}..$YBVo|l{1989 Y|
|00004c10| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 4f 62 73 74 |ear Book| of Obst|
|00004c20| 65 74 72 69 63 73 20 61 | 6e 64 20 47 79 6e 65 63 |etrics a|nd Gynec|
|00004c30| 6f 6c 6f 67 79 7d 0d 0a | 24 43 68 61 70 74 65 72 |ology}..|$Chapter|
|00004c40| 7b 33 2d 39 7d 0d 0a 24 | 59 42 45 64 69 74 6f 72 |{3-9}..$|YBEditor|
|00004c50| 7b 44 72 73 2e 20 4d 69 | 73 68 65 6c 6c 2c 20 4b |{Drs. Mi|shell, K|
|00004c60| 69 72 73 63 68 62 61 75 | 6d 2c 20 61 6e 64 20 4d |irschbau|m, and M|
|00004c70| 6f 72 72 6f 77 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |orrow}..|$Table{}|
|00004c80| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 54 |..$Comme|ntator{T|
|00004c90| 2e 48 2e 20 4b 69 72 73 | 63 68 62 61 75 6d 2c 20 |.H. Kirs|chbaum, |
|00004ca0| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|00004cb0| 68 74 20 28 63 29 20 59 | 65 61 72 20 42 6f 6f 6b |ht (c) Y|ear Book|
|00004cc0| 20 4d 65 64 69 63 61 6c | 20 50 75 62 6c 69 73 68 | Medical| Publish|
|00004cd0| 65 72 73 2c 20 49 6e 63 | 2e 2c 20 31 39 38 39 0d |ers, Inc|., 1989.|
|00004ce0| 0a 0d 0a 31 39 38 39 20 | 59 65 61 72 20 42 6f 6f |...1989 |Year Boo|
|00004cf0| 6b 20 6f 66 20 4f 62 73 | 74 65 74 72 69 63 73 20 |k of Obs|tetrics |
|00004d00| 61 6e 64 20 47 79 6e 65 | 63 6f 6c 6f 67 79 20 28 |and Gyne|cology (|
|00004d10| 52 29 0d 0a 0d 0a 4f 62 | 73 74 65 74 72 69 63 73 |R)....Ob|stetrics|
|00004d20| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 33 2d 2d 4d |....Chap|ter 3--M|
|00004d30| 65 64 69 63 61 6c 20 43 | 6f 6d 70 6c 69 63 61 74 |edical C|omplicat|
|00004d40| 69 6f 6e 73 20 6f 66 20 | 50 72 65 67 6e 61 6e 63 |ions of |Pregnanc|
|00004d50| 79 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |y....---|--------|
|00004d60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004d90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004da0| 2d 2d 2d 2d 2d 0d 0a 43 | 6f 72 6f 6e 61 72 79 20 |-----..C|oronary |
|00004db0| 41 6e 67 69 6f 70 6c 61 | 73 74 79 20 69 6e 20 50 |Angiopla|sty in P|
|00004dc0| 72 65 67 6e 61 6e 63 79 | 0d 0a 0d 0a 43 6f 77 61 |regnancy|....Cowa|
|00004dd0| 6e 20 4e 43 2c 20 64 65 | 20 42 65 6c 64 65 72 20 |n NC, de| Belder |
|00004de0| 4d 41 2c 20 52 6f 74 68 | 6d 61 6e 20 4d 54 0d 0a |MA, Roth|man MT..|
|00004df0| 28 54 68 65 20 4c 6f 6e | 64 6f 6e 20 48 6f 73 70 |(The Lon|don Hosp|
|00004e00| 2c 20 4c 6f 6e 64 6f 6e | 29 0d 0a 42 72 20 48 65 |, London|)..Br He|
|00004e10| 61 72 74 20 4a 20 35 39 | 3a 35 38 38 2d 35 39 32 |art J 59|:588-592|
|00004e20| 2c 20 4d 61 79 20 31 39 | 38 38 0d 0a 2d 2d 2d 2d |, May 19|88..----|
|00004e30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004e70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00004e80| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|.... |
|00004e90| 20 4d 79 6f 63 61 72 64 | 69 61 6c 20 69 6e 66 61 | Myocard|ial infa|
|00004ea0| 72 63 74 69 6f 6e 20 69 | 6e 20 70 72 65 67 6e 61 |rction i|n pregna|
|00004eb0| 6e 63 79 20 69 73 20 72 | 61 72 65 2e 20 20 41 20 |ncy is r|are. A |
|00004ec0| 70 61 74 69 65 6e 74 20 | 77 61 73 20 73 65 65 6e |patient |was seen|
|00004ed0| 20 77 69 74 68 20 61 6e | 0d 0a 61 6e 74 65 72 69 | with an|..anteri|
|00004ee0| 6f 72 20 69 6e 66 61 72 | 63 74 20 61 74 20 32 30 |or infar|ct at 20|
|00004ef0| 20 77 65 65 6b 73 27 20 | 67 65 73 74 61 74 69 6f | weeks' |gestatio|
|00004f00| 6e 2c 20 66 6f 6c 6c 6f | 77 65 64 20 62 79 20 74 |n, follo|wed by t|
|00004f10| 72 6f 75 62 6c 65 73 6f | 6d 65 20 61 6e 67 69 6e |roubleso|me angin|
|00004f20| 61 2e 0d 0a 0d 0a 20 20 | 20 20 20 57 6f 6d 61 6e |a..... | Woman|
|00004f30| 2c 20 33 30 2c 20 70 72 | 69 6d 69 67 72 61 76 69 |, 30, pr|imigravi|
|00004f40| 64 61 2c 20 63 6f 6d 70 | 6c 61 69 6e 65 64 20 6f |da, comp|lained o|
|00004f50| 66 20 70 61 72 65 73 74 | 68 65 73 69 61 20 61 6e |f parest|hesia an|
|00004f60| 64 20 73 65 76 65 72 65 | 20 70 61 69 6e 20 69 6e |d severe| pain in|
|00004f70| 20 68 65 72 0d 0a 6c 65 | 66 74 20 61 72 6d 20 61 | her..le|ft arm a|
|00004f80| 6e 64 20 68 61 6e 64 2e | 20 20 54 68 69 73 20 77 |nd hand.| This w|
|00004f90| 61 73 20 66 6f 6c 6c 6f | 77 65 64 20 62 79 20 61 |as follo|wed by a|
|00004fa0| 20 64 75 6c 6c 20 66 65 | 65 6c 69 6e 67 20 6f 66 | dull fe|eling of|
|00004fb0| 20 69 6e 74 65 6e 73 65 | 20 72 65 74 72 6f 73 74 | intense| retrost|
|00004fc0| 65 72 6e 61 6c 0d 0a 70 | 72 65 73 73 75 72 65 20 |ernal..p|ressure |
|00004fd0| 72 61 64 69 61 74 69 6e | 67 20 64 6f 77 6e 20 62 |radiatin|g down b|
|00004fe0| 6f 74 68 20 61 72 6d 73 | 20 61 6e 64 20 61 73 73 |oth arms| and ass|
|00004ff0| 6f 63 69 61 74 65 64 20 | 77 69 74 68 20 70 72 6f |ociated |with pro|
|00005000| 66 75 73 65 20 73 77 65 | 61 74 69 6e 67 2c 20 6e |fuse swe|ating, n|
|00005010| 61 75 73 65 61 2c 0d 0a | 61 6e 64 20 76 6f 6d 69 |ausea,..|and vomi|
|00005020| 74 69 6e 67 2e 20 20 41 | 6e 20 65 6c 65 63 74 72 |ting. A|n electr|
|00005030| 6f 63 61 72 64 69 6f 67 | 72 61 6d 20 28 45 43 47 |ocardiog|ram (ECG|
|00005040| 29 20 72 65 76 65 61 6c | 65 64 20 75 6e 65 71 75 |) reveal|ed unequ|
|00005050| 69 76 6f 63 61 6c 20 53 | 54 20 65 6c 65 76 61 74 |ivocal S|T elevat|
|00005060| 69 6f 6e 20 69 6e 0d 0a | 6c 65 61 64 73 20 49 20 |ion in..|leads I |
|00005070| 61 6e 64 20 56 32 2d 56 | 36 2e 20 20 53 79 6d 70 |and V2-V|6. Symp|
|00005080| 74 6f 6d 73 20 70 65 72 | 73 69 73 74 65 64 2c 20 |toms per|sisted, |
|00005090| 61 6e 64 20 74 68 65 20 | 70 61 74 69 65 6e 74 20 |and the |patient |
|000050a0| 77 61 73 20 67 69 76 65 | 6e 20 64 69 61 6d 6f 72 |was give|n diamor|
|000050b0| 70 68 69 6e 65 0d 0a 69 | 6e 74 72 61 76 65 6e 6f |phine..i|ntraveno|
|000050c0| 75 73 6c 79 2e 20 20 43 | 61 72 64 69 61 63 20 76 |usly. C|ardiac v|
|000050d0| 65 6e 74 72 69 63 75 6c | 61 72 20 66 69 62 72 69 |entricul|ar fibri|
|000050e0| 6c 6c 61 74 69 6f 6e 20 | 6f 63 63 75 72 72 65 64 |llation |occurred|
|000050f0| 20 64 75 72 69 6e 67 20 | 68 65 72 0d 0a 65 78 61 | during |her..exa|
|00005100| 6d 69 6e 61 74 69 6f 6e | 2c 20 61 6e 64 20 63 61 |mination|, and ca|
|00005110| 72 64 69 6f 70 75 6c 6d | 6f 6e 61 72 79 20 72 65 |rdiopulm|onary re|
|00005120| 73 75 73 63 69 74 61 74 | 69 6f 6e 20 77 61 73 20 |suscitat|ion was |
|00005130| 70 65 72 66 6f 72 6d 65 | 64 2e 20 20 46 6f 75 72 |performe|d. Four|
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|00005ba0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00005bd0| 20 41 20 50 72 6f 73 70 | 65 63 74 69 76 65 20 53 | A Prosp|ective S|
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|00005c50| 78 20 34 33 3a 31 32 2d | 31 38 2c 20 4a 61 6e 75 |x 43:12-|18, Janu|
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|00005c70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005c90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ca0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005cb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
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|00005e00| 2e 20 20 57 68 65 74 68 | 65 72 0d 0a 61 73 74 68 |. Wheth|er..asth|
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|00005e50| 20 6f 66 0d 0a 63 6f 6d | 70 6c 69 63 61 74 69 6f | of..com|plicatio|
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|00005e80| 20 69 6e 20 31 38 31 20 | 61 73 74 68 6d 61 74 69 | in 181 |asthmati|
|00005e90| 63 20 77 6f 6d 65 6e 20 | 6d 6f 6e 69 74 6f 72 65 |c women |monitore|
|00005ea0| 64 0d 0a 64 75 72 69 6e | 67 20 31 39 38 20 70 72 |d..durin|g 198 pr|
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