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.     

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.     

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.     

Glucocorticoids and the rhesus fetal lung.

The effects of glucocorticoids on primate fetal lung function have not been clearly delineated. In this prospective study of preterm rhesus fetuses exposed in utero to betamethasone for 72 hours, the most significant alteration was a striking increase in maximum lung volumes. Functionally less significant increases in residual lung volumes were also noted. The lungs of the treated fetuses did not exhibit lower extract surface tensions or increased phospholipid concentrations. These findings suggest that the major effect of betamethasone is on lung connective tissue elements, with minimal effects on alveolar surfactant. Additional evidence of the multisystemic effects of glucocorticoids was obtained in that significant differences in fetal, adrenal, hepatic, and placental weights also were observed.     

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.     

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.     

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.     

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.     

The inhibition of premature labor with indomethacin

We administered indomethacin orally for the treatment of premature labor in a prospective, randomized, double-blind fashion, and all infants were followed up. Indomethacin was significantly more effective than placebo in inhibition of premature labor during a 24-hour course of therapy, with treatment failure during therapy occurring in only one of 15 indomethacin-treated patients compared to nine of 15 placebo-treated patients (p < 0.01). Mean plasma concentrations of indomethacin were approximately 0.8 μg/ml at both 4 and 12 hours after administration. Mean plasma levels of 15-oxo-13, 14-dihydroprostaglandin F_2α (PGFM) were similar in the two groups before treatment, decreased markedly in the indomethacin group by 4 hours, and were not detected at 12 hours in all but the one indomethacin-treated patient who was delivered within 24 hours. Patients in the placebo group who were delivered prematurely had higher pretreatment PGFM levels (mean ± SE, 83 ± 18 pg/ml, n = 9) than the patients who responded to placebo (25 ± 6 pg/ml, n = 6) (p < 0.05). There was no difference between the indomethacin and placebo groups with respect to gestational age at delivery, birth weight, and neonatal morbidity and deaths. In particular, we found no evidence of premature closure of the ductus arteriosus, pulmonary hypertension, or increase in bleeding problems among the infants exposed to indomethacin in utero. Although no difference in neonatal outcome was observed in this small number of patients, it would seem prudent still to consider indomethacin as an experimental therapy.     

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.     

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.     

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.     

Plasma methotrexate levels in patients with gestational trophoblastic neoplasia treated by two methotrexate regimens

Plasma methotrexate levels were measured in six patients with nonmetastatic and three patients with "low-risk" metastatic gestational trophoblastic neoplasia who were treated by two different methotrexate regimens. Five patients were treated with 16 cycles consisting of methotrexate, 1 mg/kg (days 1, 3, 5, and 7) followed in 24 hours by citrovorum factor, 0.1 mg/kg (days 2, 4, 6, and 8). Cycles alternated between intravenous and intramuscular administration. Statistical differences in plasma levels were found at 1 and 48 hours between the two routes of administration but probably were not of clinical importance. The plasma levels at the time of citrovorum factor administration were below that necessitating citrovorum factor rescue. Four patients were treated with alternating cycles of intravenous or intramuscular methotrexate, 0.5 mg/kg for 5 consecutive days without citrovorum factor. A total of 15 cycles demonstrated no difference in plasma levels at 1, 12, and 24 hours between intravenous and intramuscular administration. Statistical differences in plasma methotrexate levels were noted between the two methotrexate regimens only with intramuscular administration but were not of clinical importance. The reduced toxicity of the methotrexate-citrovorum factor may be due to the scheduling of the methotrexate and not to the citrovorum factor.     

Differences in some clinical and laboratory parameters in acute salpingitis related to culture and serologic findings

Women with laparoscopically verified acute salpingitis (AS) were studied, and 151 were classified as having: chlamydia-associated AS (C-AS), gonococcal-associated AS (G-AS), and nonchlamydial, nongonococcal-associated AS (NCNG-AS). Patients with G-AS were more often febrille (rectal temperature > 38°C) and more often had a moderately elevated erythrocyte sedimentation rate (ESR) (16 to 30 mm/hr) compared to other patients. Women with NCNG-AS were more likely to have a normal ESR and a mild inflammatory reaction laparoscopically. C-AS women were more likely to have had pelvic pain for more than 3 days before seeking treatment and to have an ESR of > 30 mm/hr on admission. Predisposing factors to AS, such as insertion of intrautenine device, hysterosalpingography, and curettage within 4 weeks of admission, were more common in the C-AS group. The tubal inflammatory changes in the C-AS group were generally more severe than expected from the relatively benign clinical course.     

Histochemical demonstration of lysosomal hydrolase activity in endometrial mononuclear cells. I. Normal endometrium.

Interstitial cell reactivity for lysosomal hydrolases was demonstrated in 67 endometrial specimens with histochemical techniques. Cyclic changes in the number of reactive cells corresponded to the stage of the menstrual cycle. Techniques for galactosidase and glucuronidase showed increasing numbers of reactive cells through the late secretory stage. Staining for glucosaminidase and nonspecific esterase also increased in late secretory endometrium. In contrast, acid phophatase activity was biphasic, and that of leucine aminopeptidase remained relatively constant. Only minimal interstitial staining was seen in prepubertal and postmenopausal specimens.