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.     

Urinary undiversion: use in management of radiation induced bladder fistula.

Urinary undiversion was attempted and successful in two patients. The indication for prior diversion in both patients was extensive bladder fistula following pelvic radiation for cancer of the uterine cervix. Function of the urinary system has been essentially normal in both patients during the follow-up period of 6 months to 2.5 years. Review of the literature relevant to reconstruction of the urinary system in adults following previous ileal conduit formation revealed very scanty data, particularly after pelvic radiation. Reported methods are described. Although the experience is limited, ileocystostomy with undiversion of the ileal conduit after pelvic radiation appears not only feasible, but very rewarding for selected highly motivated patients.     

Arterio-enteric fistula following pelvic radiation: a case report.

Two cases of arterial perforation into the small bowel are reported. Etiology was not determined in one case, but surgical trauma leading to localized infection in the irradiated tissue seemed responsible in the other. After the initial episode of hemorrhage, there was a symptom-free interval before its reappearance and vascular collapse. This is believed to be due to the distensibility of the large bowel. The site of arterial perforation was determined pre-operatively in one case by selective arteriography. Review of the recent literature relevant to transcatheter arterial embolization suggests that it may have potential in management of the arterio-enteric fistula as an alternative to or an aid in surgical correction by stabilizing the patient in a favorable condition.     

Circulatory and renal effects of beta-adrenergic-receptor stimulation in pregnant sheep

The effects of beta-adrenergic-receptor stimulation with ritodrine on systemic and pulmonary hemodynamics and on renal handling of water and electrolytes were studied in unanesthetized, chronically instrumented pregnant sheep. Each animal was studied during control, ritodrine, and recovery periods, each lasting 60 minutes, with the use of three different modes of hydration. beta-receptor stimulation produced a significant increase in heart rate and cardiac output and a decrease in systemic vascular resistance. Pulmonary arterial and wedge pressures tended to increase. These circulatory effects were similar for the three types of hydration and they persisted after cessation of infusion. In terms of its renal effects, beta-receptor stimulation elicited a profound decrease in urine flow and in the excretions of sodium and potassium, irrespective of the mode of hydration. The antidiuresis and antinatriuresis were accompanied by no changes in plasma osmolality and sodium concentration, whereas plasma potassium levels decreased. All of these effects persisted for 60 minutes after the cessation of infusion. In the water-loaded experiments, the antidiuresis seemed to be related to increased antidiuretic hormone secretion; in the saline-loaded experiments, however, both the antidiuresis and antinatriuresis appeared to be related to increased renal reabsorption. The changes in renal hemodynamics seemed to have an insignificant role. The amount of fluid retained in the body was greater when ritodrine was infused with saline solution than with dextrose solution. These cardiovascular and renal studies suggest that a circulatory overload may be the major factor in the pathogenesis of pulmonary edema observed during beta-adrenergic-receptor stimulation.     

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.     

Clinical,pathologic, and genetic findings in a case of 46,XY pure gonadal dysgenesis (Swyer's syndrome): II. Presence of H-Y antigen

Evidence that expression of histocompatibility-Y (H-Y) antigen on human cells is determined by a Y-linked gene is provided by data demonstrating that male subjects with two Y chromosomes have higher antigen levels than male subjects with one Y chromosome. The widespread evolutionary conservation of H-Y antigen and its association with the Y chromosome suggest that the antigen has a specific, crucial function. We surmise that this function is the differentiation of the embryonic gonad into whichever mature gonad, testis or ovary, typifies the heterogametic sex of each species. Of particular interest are individuals whose gonadal sex does not correspond to their somatic genotype. In the present article, we report positive results in the first case of 46,XY pure gonadal dysgenesis (Swyer's syndrome) to be typed for H-Y antigen. This case suggests that the presence of H-Y antigen may not be sufficient to complete masculinization of the embryonic mammalian gonad. Alternatively, a mutant gene may govern expression of a cell surface component which cross reacts with H-Y antigen but which lacks the ability to function in the virilization of the gonad.     

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.     

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.     

Clinical,pathologic, and genetic findings in a case of 46, XY pure gonadal dysgenesis (Swyer's syndrome): I. Dysgerminoma and gonadoblastoma

Cytogenetic, pathologic, and clinical studies were conducted on a phenotypically female patient with primary amenorrhea and infertility. Analysis of blood cultures with routine and Giemsa-banded preparations indicated that the chromosomal complement of the patient was 46,XY. Buccal and peripheral blood smears prepared for fluorescent analyses confirmed the presence of a single F-body (Y chromosome). Pathologic examination of tissues removed at total hysterectomy and bilateral salpingo-oophorectomy revealed a gonadoblastoma of the right gonad, dysgerminoma of the left gonad, and an infantile hypoplastic uterus. The data were consistent with a diagnosis of 46,XY pure gonadal dysgenesis (Swyer's syndrome).     

Cytogenetics of methadone-managed and heroin-addicted pregnant women and their newborn infants.

Chromosomal damage was assessed prenatally and at delivery from 99 addicted pregnant women (80 from a methadone maintenance program and 19 heroin addicts) and their 101 off-spring at delivery. About 10% of the 27,907 cells scored showed chromosomal abberations. Chromosome damage was random, affected all chromosomes, and was mainly of the acentric fragment type. The per cent of hypodiploidy was significantly higher than the per cent of hyperdiploidy. In the mothers, no significant differences were found with respect to dosage and duration of methadone treatment and years of heroin abuse. No significant association was found between maternal variables and infant chromosome damage. Infants with low Apgar scores (1 to 6) had cells with significantly higher levels of chromosome damage than infants with higher scores (7 to 10).     

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.     

One-year follow-up of infants exposed to ultrasound in utero

Neonatal and infant follow-up data from the Amniocentesis Registry of the National Institute of Child Health and Human Development were analyzed for possible effects of diagnostic ultrasound exposure in the second trimester of pregnancy. A total of 297 infants of mothers receiving both amniocentesis and diagnostic ultrasound were compared with a similar group of 661 infants of mothers who had amniocentesis but not ultrasound and with 949 infants exposed to neither amniocentesis nor ultrasound. Results of newborn and 1 year examinations were similar for the amniocentesis with ultrasound group when compared to the other two groups. However, in view of the small sample size and other limitations of these data, larger and more detailed studies are needed to adequately assess possible effects of ultrasound in pregnancy.     

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.     

Histochemical demonstration of lysosomal hydrolase activity in endometrial mononuclear cells. II. Abnormal endometrium.

The mononuclear cells in the endometrial stoma change in reactivity for lysosomal hydrolases during the menstrual cycle. Lymphoid follicles may occur in the stroma in any phase of the cycle and have been found in gestational endometrium. However, these cells have no significant lysosomal activity. Alterations in the endometrium are reflected in modified patterns of activity. Endometritis, association with an intrauterine contraceptive device, pregnancy, and adenocarcinoma result in increased numbers and staining intensity of mononuclear cells. In contrast, no consistent changes were apparent in foci of glandular hyperplasia, and decreased staining was seen in atrophic areas of endometrium. These data suggest that interstitial mononuclear cells are a sensitive monitor of morphologic changes in the endometrium.     

Simultaneous in situ squamous cell carcinoma and microinvasive adenocarcinoma of the cervix

A case of simultaneously occurring carcinoma in situ of the cervix, and adenocarcinoma of the endometrium is presented. The diagnosis was made by examination of the pathological specimen, but was suspected pre-operatively because of Pap smear findings. A review of the recent literature is discussed.     

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.