The origin and clinical behavior of the parovarian tumor

This study of 132 benign parovarian cysts and eight parovarian neoplasms demonstrated that the majority of such lesions are of paramesonephric or mesothelial origin. Furthermore, adnexal neoplasms, not histologically associated with the tube or ovary, may arise in such parovarian structures or de novo from the pelvic mesothelium.     

Single-dose and multidose prophylaxis in vaginal hysterectomy: a comparison of sodium cephalothin and metronidazole

A total of 79 patients underwent vaginal hysterectomy and were randomly assigned to three regimens of prophylactic antibiotics: multidose intravenous sodium cephalothin, single-dose intravenous sodium cephalothin, and single-dose oral metronidazole. Control groups were selected from two previous studies conducted at our institution. The incidence rates of infectious morbidity following all three regimens of antibiotics were substantially lower than in the control groups. There was no statistically significant difference in the incidence of standard febrile morbidity and serious pelvic infections among the three groups. The fever index was lowest in the single-dose sodium cephalothin group.     

Lymphoma of the ovary: Report of twenty new cases and update of previous series

Ovarian lymphoma is a rare entity. This review of 55 cases, including 35 that were previously reported, updates and reclassifies the cases from the Ovarian Tumor Registry and the Gynecologic Pathology Laboratory. The problems of differential diagnoses are stressed.     

Purification of lamellar bodies from human amniotic fluid

Lamellar bodies were purified from human amniotic fluid obtained from pregnancies at 17, 31, and 40 weeks' gestation by means of Sephacryl S-300 column chromatography. Fractions were labeled with diphenylhexatriene and two peaks of phospholipid were identified at each gestational age. The size of peak I increased relative to that of peak II with advancing gestational age. Further study of the two peaks from 40-week pregnancies showed that peak I contained lamellar bodies that could be identified by electron microscopy. The ratio of the concentration of protein to phospholipid for peak I varied from 0.2 to 1.1. There were four proteins which could be identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis (130K, 80K, 50K, and 20K), and there was 90-degree scattering of 400 nm light. Peak II also contained phospholipid. However, bilayer structures could not be visualized by electron microscopy, and there was no 90-degree scattering of 400 nm light. Peak II had a much higher ratio of protein to phospholipid (approximately 100) and two broad bands of protein on sodium dodecyl sulfate electrophoresis (80K, 50K). The anisotropy of diphenylhexatriene in both peaks decreased with advancing gestational age. The anisotropy in peak I was always lower than that in peak II, indicating that the microenvironment in peak I was more fluid. Peak I may represent mature surfactant and peak II, precursors of surfactant.     

Posterior cervical rupture following prostaglandin-induced mid-trimester abortion

Two cases of transverse posterior cervical rupture in association with mid-trimester abortion induced by prostaglandin F_2α (PGF_2α) are reported. The mechanism of rupture is described. It is suggested that the effects of PGF_2α upon cervical dilatation must be further explored.     

Endocrine-metabolic response to acute starvation in human gestation

During a 72 hour fast in pregnant women, significant decrements in the maternal plasma glucose concentrations, accompanied by a significant increase in the plasma placental lactogen (hPL) concentration, occur. At the same time, utilization of glucogenic amino acids, principally alanine, takes place. The mean postprandial glucose concentration in pregnancy is significantly lower than that of comparable nonpregnant women (70.5 ± 1.7 versus 79.5 ± 1.3 mg. per 100 ml., p < 0.001). There appears to be a significant sparing effect on the maternal plasma glucose concentration during acute fasting which may be mediated through hPL. Concentrations of amniotic fluid and fetal plasma glucose from women undergoing fasting decrease in a manner parallel to that of the mother. Fasting provokes a mean rise in plasma hPL of 33.2 per cent over basal levels. This rise is still evident 72 hours after refeeding, after which it gradually returns to pretest concentrations. The infusion of alanine or arginine to pregnant women at the end of the fast produced increments in the peripheral maternal glucose concentration. The response was much greater with alanine than with arginine, demonstrating the increased gluconeogenic potential of this amino acid. The increment in human growth hormone (hGH) following alanine infusion was significantly greater than that observed after arginine administration. Hypoaminoacidemia was present in nonpregnant and pregnant women in response to fasting, but the decline was greater in pregnancy. Acute fasting in the first half of gestation appears to produce significant alterations in carbohydrate metabolism evidenced by profound hypoglycemia, hypoinsulinemia, and hypoaminoacidemia. This maternal deficit can be reflected in fetal substrate concentrations. The effect of these changes on fetal growth and development is speculative at this time.     

Serum concentrations of beta-melanocyte-stimulating hormone in human pregnancy

β-Melanocyte-stimulating hormone (β-MSH) has been measured in pregnant women with the use of a sensitive tube radioimmunoassay technique which does not require prior extraction. This peptide rises progressivley throughout pregnancy with its highest concentration at term. Measurable quantities exceeding maternal levels were observed in both cord blood and amniotic fluid and elevated levels of β-MSH were found in lactating women. The role and possible chorionic origin of β-MSH remain to be determined, as well as the possible clinical use.     

A problem-oriented gynecology clinic for patients with sexually transmitted diseases

A problem-oriented clinic designed to provide continuity of care for female patients with sexually transmitted diseases (STDs) is described. The primary goal of the clinic is to ensure adequate follow-up care for individuals diagnosed as having pelvic inflammatory disease. Functions of the clinic also include follow-up care for patients with positive gonorrhea cultures and consultation for individuals with other STDs. From the time of initiation of the clinic in January, 1976, until November 15, 1979, 4,305 patients were seen. A stratified random sample of 190 of these patients revealed the reasons for attending the clinic to be: (1) follow-up for PID, 85 patients (44.7%), (2) positive gonorrhea culture, 63 (36.3%), (3) unsatisfactory gonorrhea culture, 14 (7.4%), (4) gonorrhea contact, 10 (5.3%), and (5) other, 12 (6.3%). Complete follow-up has been obtained on 3,935 (91.4%) of the patients. Of the 370 patients who did not return for follow-up visits, 336 were reported to the local health department for retrieval. There were 34 patients in whom the follow-up status could not be determined. The establishment, operation, advantages, and disadvantages of the clinic are discussed.     

Latent ectopic pulmonary choriocarcinoma associated with renal cell carcinoma

A case of latent ectopic pulmonary choriocarcinoma associated with renal cell carcinoma is reported. The pulmonary choriocarcinoma appeared in a 48-year-old woman, 26 years after her last pregnancy and 8 years after a total hysterosalpingo-oophorectomy. The various possible mechanisms of latent ectopic choriocarcinoma are discussed.     

The estimation of fetal weight by computer-assisted analysis

The need for a quick and easy method for estimating fetal weight in utero has been clearly established. Estimates by abdominal palpation and fetal hormone production have proved to be of limited value. Eighty-five patients, ranging from 17 to 41 weeks' gestation, were ultrasonically scanned within 48 hours of delivery. Statistical analysis and multiple multivariant linear regressions were performed employing the BMD statistical packages. Our results show that birth weight is a logarithmic function of fetal body parameters and that the abdominal circumference has the single best correlation with the log₁₀ birth weight. Our best linear regression with the use of two fetal dimensions (abdominal circumference and biparietal diameter) had a standard deviation of 106 grams per kilogram fetal weight. Since this derived formula is very cumbersome to manipulate, tables have been prepared with computer assistance to read the estimated fetal weight directly. Prospective estimates in 32 cases of both normal and pathologic gestations have proved to be within our expected accuracy.     

The influence of aspirin on the course of induced midtrimester abortion

Prostaglandins appear to mediate the uterine contractions of abortion and labor, and aspirin has been shown to be an inhibitor of prostaglandin synthesis. In this double-blind, placebo-controlled, prospective, and randomized study, aspirin was administered orally in doses of 600 mg. every 6 hours to patients undergoing induced midtrimester abortions with hyperosmolar urea and oxytocin augmentation. The mean injection-abortion interval was significantly prolonged by aspirin in nulliparous patients (aspirin 32.3 ± 3.3 hr. vs. placebo 21.5 ± 3.5 hr.) and no aspirin-treated nullipara aborted in less than 18 hours. There was no significant difference between treatment groups in the mean injection-abortion interval in the multiparous patients at the dose of aspirin used. The effectiveness of aspirin in the prolongation of the injection-abortion interval has potential therapeutic implications for the treatment of premature labor.     

Stage II ultrasound examination for the diagnosis of fetal abnormalities with an elevated amniotic fluid alpha-fetoprotein concentration

Previous studies have indicated that patients with elevated levels of amniotic fluid alpha-fetoprotein (AFAFP) are at very high risk for fetal neural tube defects. Twenty-eight patients whose levels of AFAFP were greater than 3 standard deviations above the mean were evaluated with a Stage II ultrasound examination for detailed assessment of fetal anatomy. In 16 patients with AFAFP levels greater than 5 SD above the mean, six fetuses with open spina bifida were identified (37.5%). Moreover, in four fetuses in this group, the diagnosis was ventral wall defects (two with gastroschisis and two with omphalocele), and one fetus had multiple lethal anomalies. The other 5 patients had normal scans, and, with the exception of one patient who was delivered of a nondysmorphic stillborn infant at 28 weeks, all had normal infants at birth. Among the other 12 patients with AFAFP levels between 3 and 5 SD above the mean, there were only two adverse findings--an intrauterine death and an omphalocele. A Stage II ultrasound examination performed when AFAFP levels are elevated enables one to distinguish between conditions which are lethal or associated with significant impairment and those which are amenable to surgical procedures. Morphologically normal fetuses can also be identified. Since this diagnostic technique will allow salvage of many pregnancies that otherwise would be aborted, it should be an integral part of any alpha-fetoprotein screening program.     

Definitions of high risk in pregnancy and evaluation of their predictive validity

The predictive validity of Hobel's criterion (score of 10 or more) for high prenatal and intrapartum risk and two alternative definitions was evaluated in two sociodemographically similar samples from two different institutions. At one institution, intrapartum risk was associated with neonatal morbidity independently of prenatal risk; at the second institution, both were related to neonatal morbidity, depending on the definition of high risk. Definition of high risk as a score of 15 or more improved the prognostic ability of Hobel's method at the first institution, but not at the second. Grouping prenatal and intrapartum risk as low (0 to 9), medium (10 to 19), and high (20 or more) provided a clearer understanding of the association between prenatal/intrapartum risk and neonatal morbidity, although differences between the two institutions presisted. Modifications and validation of risk assessment methods are necessary when used in populations other than the one for which they were originally developed.     

Tubo-ovarian abscess: A retrospective review

The charts of 160 patients with tubo-ovarian abscesses (TOAs) were reviewed. Patients were divided into two groups according to their response to initial medical therapy. Predictive factors were identified for the two groups. Prognosis was predictable on the basis of extent of disease at diagnosis and the initial response to medical therapy. There was no apparent association between a unilateral TOA and the use of an intrauterine contraceptive device. A minimum pregnancy rate of 8% was observed in patients maintaining reproductive function. No patient with a bilateral TOA conceived. Of all patients admitted to the hospital with TOA, 53% ultimately required surgical therapy. High residual morbidity and/or resultant infertility mandates more aggressive attempts at prevention.     

Antibody to type III group B Streptococcus in the rhesus monkey

Susceptibility to infection due to intra-amniotic type III group B streptococcal infection was studied in 27 rhesus monkeys. Sera from mothers and their offspring were tested to determine the concentration of antibody to the native type III group BStreptococcus antigen. Among 17 controls there was a statistically significant association between the concentration of maternal antibody prior to infection and both the neonatal survival rate and survival time (P < 0.05). Neonatal survival was decreased to ≤6 hours (P = 0.005) if the maternal antibody concentration was <0.5 μg/ml. Modified immune serum globulin was given intravenously to the mothers prior to intra-amniotic infection with (five animals) or without (five animals) neonatal modified immune serum globulin. Neither of the modified immune serum globulin groups demonstrated a significant reduction in the neonatal mortality rate; however, the addition of the modified immune serum globulin provided protection against rapid neonatal death among those animals born to mothers which had low or no detectable antibody. All maternal groups developed a significant increase in the concentration of antibody in postpartum sera. These results indicate that both naturally acquired and passive (modified immune serum globulin) antibodies to type III group BStreptococcus antigen are partially protective against intra-amniotic infection.     

The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity.

A practical classification of placental maturity changes has been developed based on a review of multiple ultrasound evaluations of placental texture over a 4 year period. This classification grades placentas from 0 to 3 according to specific ultrasonic findings at the basal and chorionic plates as well as within the substance of the organ itself. The placentas of 129 patients were graded according to this system at the time of ultrasound evaluation. Eighty-six patients had placentas classified as Grade 1 or greater and all of these had lecithin-sphingomyelin (L/S) ratio determinations performed. Mature L/S ratios (2.0) were found in 68% of Grade I (21/31), 88% of Grade II (28/32), and 100% of Grade III placentas (23/23). These results suggest a correlation between maturational changes of the placenta as seen by ultrasound and fetal pulmonic maturity as indicated by L/S ratio.     

Antenatal diagnosis of renal anomalies with ultrasound: I. Obstructive uropathy

During a 5-year period, a diagnosis of obstructive uropathy was made in 25 fetuses. Eight of them had unilateral obstruction and 17 were affected bilaterally. The most common condition encountered was urethral obstruction by posterior valves. The site and nature of the obstruction were correctly identified in 22 of the 25 fetuses. Among the 17 who had bilateral obstruction, only three survived. In contrast, only one infant with unilateral obstruction died (of unrelated causes). Oligohydramnios in low-level (urethral) obstruction was a uniformly lethal finding. Relief of urethral obstruction in two fetuses after 20 weeks of gestation did not result in survival of the infant, whereas shunting prior to 20 weeks in one fetus seemed to have a beneficial effect. On the basis of this experience, we suggest that unilateral obstruction would be treated best by conservative management, while in bilateral obstruction invasive treatment may be effective if initiated early in gestation, before significant oligohydramnios occurs.