Monitoring of the patient in a state of shock.

Patients in a state of shock require careful monitoring to carry out intelligently appropriate treatment. Many methods of monitoring are available. Some are required for all patients in a state of shock, some are only required in severe or refractory shock, some are of little value, some are valuable but difficult or expensive and some are confusing and may mean the opposite of what they seem to indicate.     

The role of coagulation and fibrinolysis system in pathogenesis of toxemia of pregnancy

It is well known that many pathophysiological findings in toxemia of pregnancy are explained by imbalance of coagulation and fibrinolysis system. The purpose of this study is to elucidate a precise role of coagulation and fibrinolysis system in pathogenesis of toxemia of pregnancy. Subjects and Methods: 1) Classification of toxemia of pregnancy. Three hundred and thirty seven of toxemia of pregnancy are classified based on the onset period, and incidence of severity of disease and IUGR, rate of genetic factor of hypertension are compared in each group. 2) Platelet factor 4 (pf4) and beta-thromboglobulin (beta-TG), Fibrinopeptide A (FPA), thrombin-ATIII complex, ATIII fibrinopeptide B beta 15-42, D dimer FDP and plasmin-alpha 2 PI complex are assayed. The levels of PGI2, tissue plasminogen activator (tPA) and thrombomodulin (TM) are measured after venous occlusion. Immunoreactivity and biological activity of TM in urine are analyzed. 3) Aminoacid sequence of TM from normal and toxemia of pregnancy are determined by analyzing cDNA for TM. Moreover, TM are synthesized from recombined DNA and enzymological properties of TM obtained from normal and toxemia of pregnancy are compared. 4) Release of PGI2, tPA and TM by addition of thrombin are observed using monolayer culture of endothelial cells from cord. Enzymological properties of purified placental TM are analyzed. Results: 1) The incidence of severe type, IUGR and the rate of patients who possess genetic factors for hypertension are higher in early onset type, suggesting that hypertension is the predominant characteristics in early onset type and that genetic factors for hypertension are tightly involved. 2) All parameters such as platelets, coagulation and fibrinolysis system are elevated in toxemia of pregnancy compared to those in normal pregnancy. Coagulation index that consists of above parameters is well correlated with clinical index that consists of clinical findings (r = 0.7006, p less than 0.0001). The net increase of PGI2, tPA and TM by venous occlusion are decreased along with severity of toxemia of pregnancy. The potency of production of PGI2 from endothelial cells in maternal omentum is impaired in the severe toxemia of pregnancy. Purified TM in urine from normal pregnancy and toxemia of pregnancy has 63K dalton of single band on SDS-PAGE. However, bioactivity/immunoreactivity ratio of TM in early onset type is lower than those in late onset type, and affinity of TM for thrombin and protein C is decreased in early onset type.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical aspects of antenatal enhancement of pulmonary maturation

The background, history, and physiologic basis for the use of corticosteroids to enhance fetal pulmonic maturation are presented. Clinical data relevant to this topic are discussed, and recommendations for the use of these agents are proposed. Finally, other pharmacologic agents that may become clinically useful for this indication are described.     

Update of Conservative Systemic Treatment of Uterine Fibroids

Uterine fibroids are a common disease in women and lead to different symptoms, like pain and bleeding disorders. Aside from surgical treatment, there are many medical treatment options, which are presented in this article. Combined oral contraceptives and Levonorgestrel-releasing intrauterine systems are possible options for bleeding disorders that are a consequence of uterine fibroids. Gonadotropin-releasing hormone agonists and the new selective progesterone receptor modulator Ulipristal acetate can effectively reduce myoma mass and vaginal bleeding rate. Ulipristal acetate should especially be considered in symptomatic women, as it has only a few noteworthy side effects.     

Perinatal management of meconium staining of the amniotic fluid

The pathogenesis of meconium passage and the pathophysiology of meconium aspiration are reviewed. Intrapartum and neonatal strategies for the prevention of meconium aspiration syndrome are presented in historical perspective, and newer interventions are appraised.     

The microbiology of premature rupture of the membranes

The foregoing discussions bring to mind several salient facts: Although numerous barriers to infection exist, this aspect is understood incompletely. Conclusions on the pathogenicity or nonpathogenicity of certain organisms are often made from studies with very small numbers of patients, or in very specific patient populations. When such entities as low birth weight, premature labor, and PROM, which are all obviously related to some extent, are studied, very complicated analyses on large numbers of patients are required. Most of the organisms discussed are considered to be sexually transmitted. Because STDs are generally recognized to travel together in the same patient populations, the statistics necessary to separate one organism from another are complex indeed. The previous discussion notwithstanding, it is extremely difficult to form a solid conclusion about relation of these organisms to PROM with confidence. Many more patients need to be studied through many more pregnancies. In addition, differences among population subgroups make extrapolation extremely difficult. Currently the Louisiana State University is participating in a large, multicenter, collaborative study under the auspices of the National Institutes of Health. This study should provide an adequate data base concerning most of the isolates discussed and potential adverse outcomes of pregnancy. Then definitive statements may be made regarding both the screening of pregnant women and initiation of selective therapy. Specific management recommendations are discussed by Nagey and Saller in this symposium.     

Radiation Treatment of Invasive Cancer of the Cervix in Queensland

Summary: Results of treatment of 476 consecutive patients with invasive carcinoma of the cervix treated at the Queensland Radium Institute are reported, the crude 5-year survival rate being 57.4%. Distribution according to histology, stage and age are recorded. Details of the treatment policy in existence at the time of the survey are given as are modifications which have occurred since.     

The role of vitrification techniques of cryopreservation in reproductive medicine

Traditional cryopreservation methods allow ice to form and solute concentrations to rise during the preservation process: both ice and high solute concentrations can cause damage. Cryoprotectants are highly soluble, permeating compounds of low toxicity; they reduce the amount of ice that crystallises at any given temperature and thereby limit the solute concentration factor. Vitrification methods use cryoprotectant concentrations that are sufficient to prevent the crystallisation of ice altogether: the material solidifies as an amorphous glass and both ice and solute concentration are avoided. However, the concentrations of cryoprotectant required are very high indeed and therefore are potentially, and often actually, harmful to cells. Optimisation of the temperature and the rate of introduction and removal of such high cryoprotectant concentrations are critical. The necessary concentration can be lowered if very rapid cooling, and even more rapid warming, are used. This paper draws on experience in other fields of cryobiology to discuss these basic phenomena and to consider the place of vitrification techniques in the cryopreservation of human gametes, embryos and gonads.     

The role of vitrification techniques of cryopreservation in reproductive medicine

Traditional cryopreservation methods allow ice to form and solute concentrations to rise during the preservation process: both ice and high solute concentrations can cause damage. Cryoprotectants are highly soluble, permeating compounds of low toxicity; they reduce the amount of ice that crystallises at any given temperature and thereby limit the solute concentration factor. Vitrification methods use cryoprotectant concentrations that are sufficient to prevent the crystallisation of ice altogether: the material solidifies as an amorphous glass and both ice and solute concentration are avoided. However, the concentrations of cryoprotectant required are very high indeed and therefore are potentially, and often actually, harmful to cells. Optimisation of the temperature and the rate of introduction and removal of such high cryoprotectant concentrations are critical. The necessary concentration can be lowered if very rapid cooling, and even more rapid warming, are used. This paper draws on experience in other fields of cryobiology to discuss these basic phenomena and to consider the place of vitrification techniques in the cryopreservation of human gametes, embryos and gonads.     

An overview of the role of the nurse-midwife

The nurse-midwife's past, present, and future roles in the primary care of women are explored using a recent Institute of Medicine report on primary care as a framework for discussion. Primary care, the scope of services, and the role of the primary care clinician are described, and specific strategies for a primary care emphasis in basic nurse-midwifery education are addressed. The nurse-midwife's future roles in collaborative practice for the primary care of women and the need for continuing education opportunities in primary care are also discussed.     

Pharmacology of drugs of abuse

The pharmacology of most addictive substances is being studied extensively, not just for their acute effects but also the mechanisms that lead to drug seeking and addiction. The understanding of how these drugs alter their effects at the molecular level with continuing use gives promise toward investigation of novel substances that may be used for treatment. Genetic predisposition and gender differences are also some of the areas where more research is needed. Women who are addicted are likely to continue drug use during pregnancy, which can have an impact on the next generation. Prevention measures at the population level are as important. Programs need to address risks, social issues, and environmental factors that promote drug use and addiction.     

Clinical aspects of grave pyogenic abscesses of the liver.

Solitary hepatic abscess has a favorable prognosis in contrast with multiple abscesses which generally are fatal. As compared with the classical cause of appendicitis, at present, abscesses are frequently related to biliary tract and diverticular disease. Occult or temporally remote processes are responsibile for many solitary abscesses. Lethality of multiple abscesses is related to fulminant hepatic and source sepsis, atypical syndromes, late diagnosis and difficult, complex treatment. Causative organisms are predominantly gram-negative and increasingly anaerobic, requiring special bacteriology for isolation. Various laboratory data are useful in diagnosis and prognosis, but liver scans and celiac angiography are critical procedures. Treatment aimed at lowering the mortality of multiple liver abscesses includes early diagnosis, surgical exploration and abscess drainage, direct bacterial identification emphasizing anaerobic techniques, intense specific antibiotic therapy and identification and definitive therapy of the seeding focus with special attention being given to the biliary tract.     

Mucinous tumors of the appendix presenting as primary tumors of the ovary. Report of two cases

Primary tumors of the appendix are rare and most of them are unrecognized preoperatively, presenting as appendicits, pelvic masses or with no typical abdominal pain. Two cases of mucinous tumors of the appendix presenting as primary ovarian tumors are described. It is important for the gynecologist-oncologist to include mucinous tumors of the appendix into the differential diagnosis of any case of mucinous ovarian tumor and peritoneal pseudomyxoma, especially when these tumors are associated with extraovarian disease.     

Clinical aspects and results of therapy of endometrial cancer at the Department of Medicine of the Friedrich Schiller University in Jena 1964-76. II: Results of primary radiotherapy

In this paper results of irradiation only at 235 patients are reported and discussed, different treatment methods are applicated. The 5-year-survival rate of all cases amounted 35.7 per cent, the rate of complications 6.2 per cent. Measures of improvement of therapeutic results are investigated.     

Prevention of sterility

An overview is given about possibly preventable causes of infertility. The best chances for prevention are in tubal sterility and ectopic pregnancy. Methods of "primary prevention" are reduction of STD by health education and epidemiologic actions, by reduction and improvement of intrauterine operations in young women. The most important methods in "secondary prevention" are early and optimal treatment of PID and organ preservation in ectopic pregnancy. The difficulties in prophylaxis of endocrine infertility are discussed. For prevention of male infertility some procedures are necessary: Prevention resp. optimal treatment of genital infections, early treatment of development disorders and varicocele and elimination of chemical and physical noxes on male fertility.     

Pathology of uterine leiomyosarcomas and smooth muscle tumours of uncertain malignant potential

Uterine leiomyosarcomas are the most common uterine sarcomas. For clinicians, they are difficult tumours to manage. Preoperative detection is difficult because of the similarity in clinical presentation to ordinary fibroids. They are highly aggressive tumours and the effectiveness of adjuvant therapy remains controversial with surgery remaining the mainstay of treatment. Despite treatment, disease frequently recurs. For pathologists, diagnosis of most leiomyosarcomas using current diagnostic criteria is usually straightforward, as most tumours often possess two or more diagnostic microscopic features, including diffuse atypia, high mitotic count and tumour cell necrosis. Diagnostic difficulties usually relate to tumours having only one of these worrisome features, with or without other additional unusual morphologic findings. These latter tumours have been labelled as uterine smooth-muscle tumours of uncertain malignant potential. Those that are followed by a recurrence are biologically low-grade leiomyosarcomas. Epithelioid and myxoid leiomyosarcomas are less common, and their diagnostic criteria are different to tumours of usual spindle cell differentiation. In this review, we discuss the pathology of leiomyosarcomas, including an update on smooth-muscle tumours of uncertain malignant potential, with emphasis on the controversy of labelling of atypical leiomyomas. The problems with histologic diagnosis, immunohistochemical studies and molecular pathology are reviewed.     

Angiokeratoma of the vulva: diagnosis and review of the literature

Angiokeratomas of the vulva are uncommon benign lesions. They are usually unilateral, multiple in number, and occur before the age of 50 years. Angiokeratomas are papular lesions measuring less than 1 cm in diameter and are purple in color. In most patients the lesions are asymptomatic; however, intermittent bleeding, pruritis, and pain have been reported. Histologically, hyperkeratosis, papillomatosis, acanthosis, and dilated vasculature in the papillary dermis are characteristic features. Degenerative changes in the perivascular elastic tissue is observed and may contribute to the pathogenesis of vulvar angiokeratomas. In asymptomatic patients, management need only include reassurance and follow-up observation; surgical excision, electrodesiccation, or argon laser for local removal of the lesions may be useful in symptomatic women. Clinically, infections, inflammatory lesions, vascular conditions, and epithelial tumors must be differentiated.