Search

A 19-year-old phenotypic female with primary amenorrhea and 45X,0/46X,Y chromosomal mosaicism was found to have asymmetrical gonadal dysgenesis. Her lack of virilization precludes her precise categorization in the current nomenclature of gonadal dysgenesis and she is considered a unique variant of the syndrome of mixed gonadal dysgenesis.

A test that circumvents the complex methodology needed for the determination of L/S ratios has been developed. It has been observed that the optical density, measured at 400 nm, of supernatants collected from fresh amniotic fluids centrifuged at 2000 g for 10 minutes correlates with L/S ratios.

Prolactin response to various pharmacologic agents was tested and hypocycloidal polytomograms of pituitary sellae were performed in 77 women with galactorrhea. Polytomographic findings of pituitary sellae and the results of hypothalamic-pituitary tests were analyzed retrospectively in 18 patients with pituitary adenoma. Of the patients with pituitary tumor, 94% had abnormal polytomograms of sellae turcica, 89% had serum prolactin levels greater than 160 ng/ml (range, 170 to 264 ng/ml), and 78% showed abnormal response to thyrotropin-releasing hormone (TRH) stimulation test. Transsphenoidal excision of the tumor was complete in all 14 patients with microadenoma (10 mm or less in diameter) but was incomplete in 4 patients with macroadenoma and evidence of extrasellar extension. Galactorrhea ceased and normal ovulatory menses resumed after surgery in all patients with microadenoma. Twenty-five patients received bromocriptine. Twenty-three of them had hyperprolactinemia and 21 had normal sellar polytomograms. Galactorrhea ceased and normal menses occurred in 18; 6 patients conceived. Two patients with abnormal polytomography and euprolactinemia responded to bromocriptine treatment and 1 of them conceived. The findings suggest that serial prolactin levels and hypocycloidal polytomography of sella turcica are helpful in diagnosis of pituitary prolactinomas. The TRH stimulation test is also useful in evaluating these patients. Because the natural course of the prolactinomas and the long-term results of the surgical and pharmacologic treatments are unknown, ideal management has yet to be established.

One hundred forty-six breast biopsies in 143 patients were done on outpatient basis, without general anesthesia, on a gynecologic service between 1975 and 1980. This procedure has advantages over in-hospital biopsy in terms of cost, time, reduced immediate risk, and patient acceptance. Greater long-term risk, if carcinoma is found, has not been substantiated. Gynecologists need this procedure as an adjunct to the management of benign breast conditions and should be trained to do it.

A full-time liason psychiatrist can work within a department of obstetrics and gynecology. The full-time position described here includes administrative, clinical, teaching and research aspects within a general hospital affiliated with a medical school. The liason role can be established within a department outside psychiatry where medical and psychologic treatment can be rendered to patients simultaneously and the mediating role between psychiatry and medicine is truly a viable phenomenon.

The influence of pregnancy, pregnancy plasma, and pregnancy-associated lhormones on the response of peripheral blood lymphocytes to two phytomitogens (PHS and PWM) was examined in a group of 17 healthy women during pregnancy and the postpartum period. No consistent disparity between pregnancy, postpartum, and control tests was noted in either intrinsic lymphocyte responsiveness or in the effect of autologous plasma or four pregnancy-associated hormones (estriol, progesterone, hPL, and estradiol-17 beta) on lymphocyte responsiveness.

The steroid response of testes to exogenous gonadotropin administration was studied before castration in a patient with the complete form of the testicular feminization syndrome. Urinary steroid determination were made along with measurements of plasma testosterone during adrenal suppression with dexamethasone and after stimulation with human menopausal gonadotropin (HMG) and HMG plus human chorionic gonadotropin (HCG). Our data provide evidence that the gonads in the testicular feminization syndrome synthesize steroids normally. Estrogens and testosterone are secreted by the testes, and the Leydig cells of the testes are capable of responding to exogenous HMG and HCG stimulation. These findins are consistent with the hypothesis that there is no abnormal testicular steroidogenesis in these genotypic males. Additional evidence is provided that these gonads secrete testosterone in amounts comparable to those of normally functioning testes. Failure of virilization in the presence of androgen secretion as indicated by previous authors is probably the result of a deficiency of androgenic action at the end organs. The presence of sparse pubic and axillary hair in the mother and the finding of the same type of karyotype (46,XY) in a sibling suggest that hereditary factors play a role in this disorder.

In this study, we have attempted to correlate optical density measurements of amniotic fluids with L/S ratios. We may conclude, with over a 98 per cent accuracy, that fluids having optical density readings of 0.15 and above, at 650 nm. will have an L/S ratio over 2.0. Fluids having optical density readings up to 0.05 will have L/S ratios of about 1.3. Finally, amniotic fluids having optical densities greater than 0.05 and less than 0.15 will have L/S ratios of approximately 1.5.

Partial atresia of the fallopian tube was discovered in two patients with double uteri of the bicornuate variety. The abnormal tube in each case was ipsilateral to a noncommunicating, nonfunctioning, rudimentary uterine horn. A normal fimbriated end led to a short, patent ampullary portion that ended blindly in the mesosalpinx. Realization of the potential for the coexistence of congenital malformation of the fallopian tubes with various uterine malformations suggests that extreme caution be exercised during adnexal surgery in patients with anomalous development of the müllerian ducts.

To determine the most significant secretory source of their androgens, 13 hirsute nonvirilized women underwent selective bilateral adrenal and ovarian venous catheterization to obtain effluent blood for the assay of testosterone and delta4-androstenedione. In three patients the testosterone and delta4-androstenedione gradients were significantly greater in the adrenal venous effluents. Testosterone and delta4-androstenedione gradients were significantly greater in the ovarian venous effluents in four patients. In six patients there were no significant differences in the testosterone gradients between the adrenal and ovarian venous effluents. The delta4-androstenedione gradients were greater in the adrenal venous effluents in three of these patients, greater in the ovarian venous effluents in one, and not significantly different in two of these patients. The fact that the measurement of urinary 17-ketosteroid excretion, the suppressibility of peripheral plasma androgens with dexamethasone, and the stimulation of peripheral plasma androgens with human chorionic gonadotropin correlated poorly with the selective catheterization data suggests that the former modalities are imprecise in the diagnostic evaluation of hirsutism in women.

Optical density readings of amniotic fluids of 0.15 or greater at 650 nm have been noted to correlate with fetal pulmonary maturity. The amniotic fluid absorbance has been shown to be due not only to lecithin and sphingomyelin but also to other surfactants, including phosphatidyl glycerol and inositol. The addition of lecithin and sphingomyelin to previously centrifuged amniotic fluid (i.e., optical) density less than 0.001: L/S ratio, nondetectable) results in an increase in absorbance. At any simulated L/S ratio, the addition of phosphatidyl glycerol and/or phosphatidyl inositol results in a further increase in optical density. It is suggested that optical density readings represent more closely the surfactant composition of amniotic fluid than L/S ratios; therefore, it appears that optical density measurements are a better predictor of fetal pulmonary development than are L/S ratios.

A simple and rapid test that correlates with L/S ratios has been developed. By centrifuging fresh, unfrozen amniotic fluids at 200g for 10 minutes and measuring the optical density at at 650 nm, correlation with L/S ratios is obtained. Optical density readings of 0.15 or greater correlate 100% with L/S ratios of 2.0 or greater. Optical readings below 0.15 correlate 94% with L/S ratios below 2.0.

A patient with partial vaginal agenesis and a urinary-vaginal fistula is presented together with a review of the 12 cases reported previously. This unusual anomaly presents with cyclically recurrent hematuria; hypothetically, it results from failure of formation or canalization of the primitive vaginal plate together with partial persistence of the urogenital sinus. Surgical correction, ideally performed after puberty, requires resection of the fistula and mobilization of the apical vaginal segment for its anastomosis to the inferior vaginal pouch.

This study was initiated to examine the ability of a new device to take transcervical cultures of the endometrial cavity in the normal and postpartum uterus. Quantitative bacteriologic assessments were made. The results show there is a millionfold increase in the mean concentration of bacteria cultured from the infected puerperal uterus when contrasted with cultures from nonpregnant women and those who have just undergone repeat cesarean section. The authors conclude that the new device obtains cultures transcervically with marked reduction in contamination; however, some method for quantification of bacterial populations must complement the culture so that results differentiate between colonization and infection.

Previous investigators have demonstrated that polymorphonuclear neutrophils exhibit intense chemiluminescence (CL) during phagocytosis and the CL response can be used to study the cellular and humoral aspects of the phagocytic process. A microtechnique that used 10 microliters of whole blood as a source of phagocytes was developed and used to measure the phagocytic CL response during pregnancy. Increased sensitivity was achieved by the use of a high concentration of luminol (0.5 mM), prepared by sonication, as a CL amplifier. The high intensity of CL produced with luminol permitted the use of a scintillation counter in the IN coincidence mode, avoiding the necessity of dark-adapting the counting vials and reagents and working under subdued red light. The CL response was dose dependent on the number of phagocytes and/or particles (polystyrene spherules, opsonized zymosan, and E coli). The CL response was decreased by inhibitors that prevent particle uptake (iodoacetate and fluoride), inhibitors that prevent free-radical production (sodium benzoate and superoxide dismutase), and by inhibitors that inactivate myeloperoxidase (cyanide and azide). Results suggested that the phagocytic CL response in our assay system was dependent on O2 activation followed by the activated O2 species reacting with myeloperoxidase and chloride. The new technique was used to demonstrate a progressive increase with gestation in the phagocytic CL response in pregnancy and a rapid decrease to normal values at 1 week postpartum.

Free-flowing amniotic fluid collected vaginally can be used in a reliable way for determination of fetal pulmonary maturity. Lavaging the vaginal/cervical area with sterile saline and examining the lavage fluid for lecithin/sphingomyelin (L/S) spots showed no detectable spots in the supernatants (one exception) and barely detectable L/S spots in the sediment. Vaginal-cervical saline-wash fluids did not affect fluid L/S ratios. Lavaging the vaginal-cervical area with abdominal amniotic fluid did not affect the L/S ratio of the original amniotic fluid.

Over a five-year period from 1977 to 1982, 120 patients with locally advanced carcinomas of the uterine cervix were surgically staged by lymphadenectomy and laparotomy. Radiotherapy was then administered according to the pelvic extent of disease, and all patients underwent extrafascial total hysterectomy with adnexectomy at ten weeks after completing radiation therapy. The presence or absence of residual tumor in the hysterectomy specimen appeared to be an important prognostic factor in treatment success or failure. Patients with no residual tumor were found to have an excellent prognosis. Those with residual tumor clear of the resection margins were at risk for distant metastases. Only one survivor was noted in the group of patients in whom the margins of resection were involved with tumor, nearly all of these patients dying from local recurrences. Major operative morbidity in the series was minimal, and consisted of a single ureterovaginal fistula, which required urinary diversion.

A discussion of the management of ovarian cancer invariably involves the problems of death and dying faced by the patient, her family, and her physician. This paper attempts to deal with the general fears, anxieties, and problems of terminality, and also places attention on specific issues involved in living with the ongoing disease and its treatments. Focus is on the effects of the disease on the woman's self-image, on her family and relationships, on life outside the hospital, and on her relationship with her attending physician. Specific problems relating to the periods of (1) diagnosis, (2) operative management and treatment, and (3) terminality are discussed. Understanding the psychosocial realities of the patient provides the physician with added insights into methods to assist the patient in adaptation and coping with this ultimately fatal disease.

Although suprapubic catheterization is a useful technique in managing the postoperative patient who requires prolonged urinary drainage, the potential exists for iatrogenic damage to the abdominal contents. Two cases of perforation of the distal ileum occurring during catheter placement after vaginal procedures are presented. Such complications may be kept at a minimum by adequate bladder distention, careful bladder palpation, placement of the patient in the Trendelenburg position before filling the bladder, and catheter insertion before closure of the surgical incision.

Complete duplication of the uterus and cervix with a unilaterally imperforate vagina must be suspected when a unilateral pelvic mass terminates in a purpuric bulge of the lateral vaginal wall in a young woman with severely progressive dysmenorrhea. Intravenous pyelography will reveal renal agenesis ipsilateral to the imperforate vagina. The prompt and accurate diagnosis of this unusual anomaly should lead to transvaginal drainage of the retained menstrual fluids prior to irreversible damage of the pelvic viscera from chronic cryptomenorrhea.

Congenital release thrombocytopathy must be included in the differential diagnosis of bleeding diatheses in women. A review of the coagulation profiles of 7 patients with congenital release thrombocytopathy suggests that more sophisticated platelet aggregation studies must be performed when routine screening procedures fail to determine the cause of a clinically suspected bleeding disorder. Establishing the diagnosis helps to avoid the use of medications which cause an acquired platelet dysfunction, and contributes to adequate prophylaxis against surgical and obstetric hemorrhage.

Presacral tumors have been traditionally approached either abdominally or via a transsacral incision. We describe a perineal approach to these tumors. A patient with a presacral benign cystic teratoma is described. The tumor was removed through a Schuchardt incision with no difficulties or complications. The vaginal approach should be considered for the removal of selected presacral tumors.

1. MPO, H2O2 and C1- form a complex that undergoes intramolecular rearrangement yielding the chlorinium ion. 2. The chlorinium ion can interact with MPO, bacteria and amino acids. 3. The reaction can occur at a wide range of pH, H2O2 concentration and C1- concentration. 4. The chlorinium ion can attack different protein molecules to cause structural changes. 5. Preincubation of MPO with bacteria results in greater bactericidal activity. 6. Diffusible bactericidal agents are also produced by the MPO-H2O2-C1- system.

Chylous is an extremely unusual cause of leukorrhea. The diagnosis is established by verification of the chylous nature of the discharge, documentation of its uterine origin, and lymphangiographic demonstration of dilated pelvic lymphatics with uterine reflux. Surgical excision of the incompetent lymphatic channels is the treatment of choice.

A retrospective analysis of the clinical data from 40 patients with amenorrhea has enabled us to reach useful generalizations applicable to the management of this problem. Chromosome studies when puberty is delayed and a thorough pelvic examination when menarche fails to appear at the proper time relative to the sequence of other pubertal events will lead to an early definitive diagnosis in most cases of primary amenorrhea. A schema for the functional categorization of patients with secondary amenorrhea is presented to obviate the necessity of obtaining a needlessly expensive battery of laboratory tests which often yield misleading or uninterpretable data.